How to Deal With Lactose Intolerance
A dietitian shares tips, tricks, and food swaps.
Raise your hand if you’re one of the many celiacs who’s also lactose intolerant. (I’ve sadly joined the club in recent years, although I have a pretty mild case.) According to the National Celiac Association (NCA), lactose intolerance is especially common early on in a celiac diagnosis when your intestines have yet to fully heal.
February is National Lactose Intolerance Awareness Month, so I interviewed Lauren O’Connor, MS, RDN, owner of Nutri Savvy Health and author of 28-Day Mediterranean Diet Heart-Healthy Solution, for her best tips and tricks for managing lactose intolerance.
What is lactose intolerance?
“Lactose intolerance occurs when the body doesn't produce enough lactase, the enzyme needed to break down lactose, a sugar found in milk and dairy products,” explains O’Connor. “Without sufficient lactase, undigested lactose reaches the colon, where it ferments and produces gases, which can lead to bloating, gas, and other digestive discomforts.”
Per the Mayo Clinic, one of the risk factors for developing lactose intolerance is diseases that affect the small intestine, such as (you guessed it) celiac disease and Chron’s disease.
The NCA states that if you have celiac disease, once your intestines heal after going on a gluten-free diet, you may produce the lactase enzyme again and be able to tolerate dairy foods—but this isn’t true in every case.
Other risk factors include age (we tend to produce less lactase enzyme as we get older) and ethnicity (people of African, Asian, Hispanic, and American Indian descent are more likely to be lactose intolerant).
What are the most common symptoms of lactose intolerance?
According to O’Connor, some of the most common symptoms of lactose intolerance include bloating, diarrhea, gas, and abdominal pain. “Some people may also experience nausea or vomiting after consuming dairy products,” she adds.
How is lactose intolerance diagnosed?
How can you tell if you’re lactose intolerant? Your doctor may do a breath test to determine if you have this, says O’Connor. If your breath contains high levels of hydrogen, it suggests you’re not fully digesting lactose, she explains.
You can also be diagnosed through bloodwork. “Lactose intolerance can also be determined via a blood test following the consumption of a high-lactose beverage,” says O’Connor. “If your blood glucose (sugar) levels don’t increase, it may mean you aren’t fully digesting lactose.”
I found out I had mild lactose intolerance, meanwhile, during my last upper endoscopy.
What are the best ways to manage lactose intolerance?
There are some easy things you can do to keep your lactose intolerance in check. “Eating dairy-free is one way to manage,” she says. Here are good guidelines from Johns Hopkins Medicine on starting a dairy-free diet.
O’Connor suggests swapping out cow’s milk for plant-based milk, such as soy, oat, hemp, or almond. “To get comparable protein, soy milk can be a good option,” says O’Connor. “Look for plant milks fortified with calcium and vitamin D.”
You don’t necessarily have to go entirely dairy-free, however. “You can also find lactose-free dairy products,” notes O’Connor. These products typically range from 0.01-0.1 grams of lactose per 100 grams. “Low-lactose products are also available (these generally contain less than 1 gram lactose per 100 grams),” she says.
What are some easy food swaps to make if you’re lactose intolerant?
Here are a few food swaps to consider if you’re lactose intolerant:
Butter: “Though butter is already low in lactose, some individuals are highly sensitive,” says O’Connor. “Challenge Lactose-Free Butter is a spreadable option that the whole family can enjoy. Its simple ingredients include clarified butter for that buttery appeal.” (Note: I received a sample of Challenge Lactose-Free Butter for editorial consideration in this newsletter—and I can attest to the fact that it’s a great alternative to regular butter. I used it on gluten-free toast, for cooking scrambled eggs, and in baking recipes.)
Ricotta cheese: “Kite Hill Ricotta Alternative is made with almonds, so its dairy-free—and a perfect swap texture-wise to dairy ricotta,” says O’Connor.
Shredded cheese: O’Connor is a fan of Daiya’s plant-based, dairy-free shredded cheeses. They have a few different options, including mozzarella, cheddar, Mexican blend, spicy Monterey Jack, and Parmesan.
Cream cheese: O’Connor also likes Daiya’s cream cheese alternatives, such as the chive and onion blend.
Milk and ice cream: “Like Challenge Lactose-Free Butter, Lactaid milk and Lactaid ice creams contain actual dairy and are considered lactose-free, which means you get that desirable dairy appeal without the gas or bloat,” says O’Connor. There are also many non-dairy frozen treats you can eat in place of ice cream.
Yogurt: If you’re not highly sensitive, you may be able to tolerate Greek yogurt since much of the lactose is strained out to produce a thicker, denser product, says O’Connor. Otherwise, opt for plant-based yogurt, like Forager’s cashew yogurt, she suggests.
Whipped cream: Use coconut or cashew cream instead of whipped cream, says O’Connor.
Sour cream: Choose vegan sour cream or plant-based cream cheese instead of regular sour cream, says O’Connor.
Dips and salad dressings: “Replace dairy with avocado or unsweetened cashew cream to make creamy dips or salad dressings,” suggests O’Connor.
How do you deal with celiac disease and lactose intolerance?
What if have both celiac disease and lactose intolerance? How do you deal with being gluten-free and dairy- or lactose-free? Here are a few tips from O’Connor to get you started:
“Focus on whole foods that are both gluten-free and lactose-free or low-lactose,” says O’Connor. “Prioritize a variety of fruits and vegetables, lean proteins, fish, and gluten-free grains such as corn, rice, and quinoa.”
“Consider using vegan probiotics to support digestion,” says O’Connor.
“Opt for plant-based milks (like almond, soy, or gluten-free oat milk) and gluten-free cereals that are fortified with calcium and vitamin D,” says O’Connor.
“To ensure adequate calcium intake, enjoy leafy greens (such as kale), tofu, and a variety of beans and legumes (like chickpeas and lentils),” suggests O’Connor. “These foods will help provide the calcium and other nutrients you need while avoiding dairy and gluten.” It’s best to start with smaller portions of beans and legumes—while they’re gluten-free, they do contain raffinose sugars, which can be harder on the digestive system for some people, notes O’Connor.
Do you have celiac disease and lactose intolerance? Are you gluten-free and dairy- or lactose-free? Share any tips you have for managing two dietary restrictions in the comments!
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Amazing resource - thanks for sharing. I have 2 friends that are lactose intolerant. I like to be able to accommodate them, and your knowledge and posts help so much.
Great article! There are several in my family that are lactose intolerant and now I understand why they don’t have any issues with butter or Greek yogurt! Funnily enough, they do have problems with Daiya cheese and some DF vegan substitutes. Thanks for sharing this info!