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Lactose Intolerance: The Dairy Dilemma

Lactose intolerance is a rather common food intolerance that occurs when the body can’t digest lactose properly. Lactose is a type of sugar that is naturally found in milk, yoghurt, cheese, ice cream and even chocolate. With symptoms that can be very unpleasant and uncomfortable, it's a dairy dilemma. But before excluding all dairy, it is important to consult with the dietitian. So with that in mind, let’s take a look at what a lactose intolerance is, your diet and how to manage it. With dietary management, it doesn’t have to impact your quality of life.


Dietary management with Lactose Intolerance

What is Lactose?

Lactose is a type of naturally occurring sugar found in dairy foods. The sugar is usually digested by an enzyme found in the gut, called lactase. If a person doesn’t have enough of the lactase enzyme, then they are unable to effectively breakdown all the lactose that enters their system when they eat dairy foods.


What is Lactose Intolerance?

A food intolerance is categorised as an adverse reaction to a food or foods that, unlike a food allergy, does not involve the immune system and is not life threatening, though can still be severe.


When the body is unable to effectively digest lactose due to insufficient amounts of the lactase enzyme, the undigested lactose ends up in the large intestine. Here it attracts water and begins to ferment which can cause some pretty uncomfortable side effects such as gas, bloating, stomach cramping, and diarrhea.


Causes of Lactose intolerance

Lactose intolerance is most often related to genetic factors, with some population groups being at an increased risk for the condition. Those of an East Asian, West African, Middle Eastern, Greek, Italian, or Aboriginal and Torres Strait Islander background have an approximately 70-95% chance of being lactose intolerant. Compare this to Caucasian populations where on average 1 in 20 people have the condition.


Inflammatory intestinal conditions, such as coeliac disease, which can cause inflammation and damage to the intentional lining, can impede the lactase's ability to do its job effectively and therefore cause lactose intolerance.


Temporary lactose intolerance can also occur from conditions such as gastroenteritis or parasitic infection, which can temporarily reduce the amount of lactase your body produces.


Your Diet and Lactose Intolerance

There are a few dietary aspects to consider when dealing with lactose intolerance.

 

Your level of lactose tolerance

People have varying degrees of lactose intolerance and are therefore able to tolerate varying amounts of dairy products. For example, one person may experience symptoms after eating just one slice of cheese, but someone else may be able to drink a cup of milk before they notice any symptoms. A Dietitian can work with you to determine where your tolerance sits and develop dietary strategies to manage the symptoms.


Calcium levels

A common response to being diagnosed with lactose intolerance is to avoid dairy foods all together. This is usually not necessary and can end up having other negative effects on your health. Dairy foods contain many important nutrients, specifically, they are our main source of dietary calcium. By removing dairy products all together the risk of calcium deficiency is increased, and as a result there is a higher risk of conditions such as osteoporosis.


Calcium can also be found in fortified soy products, as well as some nuts, seeds, and green leafy vegetables, though the amounts are often much lower than in dairy foods. Calcium is an essential nutrient, so it is important if you are reducing the amount of dairy in your diet to work with a Dietitian to develop individualised strategies to meet your calcium requirements.


Protein

Dairy foods are also an excellent source of protein, and so reducing dairy will often also mean a need to find alternative ways to reach your individual protein requirements. This could be through meat, eggs, nuts, beans, or legumes. Again, it is best to seek individualised advice from a Dietitian as we all have different protein requirements.


Diarrhea and Dehydration

Some of the side effects of lactose intolerance can also cause complications. The main one being diarrhea which can cause dehydration and electrolyte imbalances.  It is important to speak to your doctor if you are experiencing diarrhea as dehydration has many potentially dangerous consequences.


Managing Lactose Intolerance

Managing Lactose Intolerance

Lactose can be found as an ingredient in many processed foods that contain dairy, always check the food labels and the ingredients list for things such as milk solids, non-fat milk solids, whey and milk sugar to identify hidden lactose. However, if the ingredients are only in a very small amount, then often it is still safe to consume. A good way to identify this is to see where in the ingredient list the dairy ingredient is named, if it’s not in the first three ingredients it is likely only a small amount.


Some key tips from our Dietitians for managing lactose intolerance include…

  • Consume dairy products in smaller quantities based on your own tolerance levels

  • Spread lactose containing foods out throughout the day and try to eat/drink them with other non-lactose containing foods

  • Some dairy foods are naturally low in lactose such as yoghurt and hard cheeses like cheddar, and are usually well tolerated by people with lactose intolerance 

  • Medications such as Lacteeze contain the lactase enzyme and so taking a dose of the medication prior to eating lactose containing foods can assist in the digestion of the lactose

  • Lactose free products are available and will usually contain the same nutrients, such as calcium, as their lactose containing counterparts 

  • Soy milk, and other plant-based milks can be a suitable alternative for dairy milk provided they are fortified with added calcium, check the ingredients list for added calcium


Check out our 17 Dairy myths busted by a Dietitian article for answers to common lactose questions too. And if doubt, speak to one of our OSCAR Care Group Accredited Practising Dietitians for individualised, evidenced-based advice on managing lactose intolerance.


We’re here to support you.


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