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Is lactose causing your gut symptoms?
Does your tummy feel a bit off when you eat dairy? This could be a sign of a lactose intolerance. This post will tell you everything you need to know about lactose intolerance, how to manage it, and most important how to get your ice cream fix without the symptoms.
In this post, we will cover
What is lactose intolerance?
Lactose is a sugar found in animal dairy products including cow and goat’s milk.
Lactose is digested in our small intestine by an enzyme called lactase. Lactase breaks down the lactose molecule into small sugar molecules that can be absorbed across our intestine and into our blood stream.
Some people do not make enough of lactase enzyme. So, when they consume dairy products, the lactose stays in their digestive tract where it is fermented by bacteria in our large bowel.
Poorly digested lactose can cause cramping, diarrhoea, excessive wind, urgency to go to the bathroom, and indigestion.
Lactose intolerance is different to an allergy as people can still tolerate a small amount of lactose. This is known as their threshold and the threshold can change over time and is unique to each person.
Why do I have a lactose intolerance?
Put simply, your body does not make enough lactase enzyme.
This could be due to your genetics which limit your ability to make lactase in which case, your intolerance is likely lifelong. Or, you may have a temporary lactose intolerance.
Temporary lactose intolerances can occur in people undergoing cancer treatment, surgery, or experiencing an infection such as gastroenteritis. This can cause a temporary reduction in your stores of lactase enzymes and may explain why dairy foods worsen your symptoms. Over time, your body will make more lactase enzymes and you will be able to increase your dairy consumption back to normal.
Our tolerance to lactose is not set in stone. You can always experiment with consuming different amounts of dairy to see if your tolerance has changed.
How do I get diagnosed with lactose intolerance?
There are a number of ways to get diagnosed with a lactose intolerance. An elimination diet is the most common method. This is when you remove high lactose foods from your diet for a short period (1-2 weeks). If your symptoms improve this indicates a lactose intolerance. You then need to reintroduce lactose-containing foods to determine how much you can tolerate. This is known as your threshold. Most lactose intolerant people can still manage 12-15g of lactose (around 1 cup of milk) comfortably.
Working with a dietitian will ensure you complete the elimination diet correctly and that your diet remains balanced.
Elimination diets are not appropriate for everyone. If you have a history of an eating disorder you may be better off doing a hydrogen breath test. This is when you ingest lactose and the the hydrogen content of your breath is measured. The hydrogen level is a sign of lactose malabsorption as your gut microbes are fermenting it.
Which foods contain lactose?
Dairy foods are the main source of lactose, but you don’t need to cut out all dairy as many dairy foods are low in lactose due to food processing or the removal of lactose from food.
High lactose foods | Low lactose foods |
Milk including plain and flavoured milks Ice cream Cream Sour cream Yoghurt Milk or white chocolate Soft cheeses e.g. ricotta, cottage cheese, camembert, and brie Milk powder Some milk-based protein powders
| Lactose-free milk Hard cheese such as cheddar, parmesan, feta, and Swiss Lactose-free yoghurt Lactose-free ice cream Dark chocolate
|
Nutrition considerations (what about calcium)
Dairy foods are an important part of our diet as they are a great source of calcium. Calcium is an essential mineral that we get through food. It supports the development and maintenance of bones and the proper functioning of our heart and muscles.
We store calcium in our bones and teeth. If we are not getting adequate calcium through our diet our body will break down the calcium from our bones. This can lead to low bone density, called osteoporosis, and increases our risk of fractures as we age.
If you have a lactose intolerance you can still get enough calcium through your diet without a supplement. Adults need between 1000 – 1300mg of calcium per day which is 2.5 – 4 serves of dairy or dairy-alternative foods per day.
Once serve of low-lactose calcium rich foods include:
- 20g hard cheese
- 1 cup of lactose-free milk
- 1 cup of plant-based milk with added calcium (look at the nutrition label for 100mg per 100mL)
- ¾ cup low-lactose yoghurt
- 100g tinned fish with edible bones (tuna, sardines, salmon)
- 100g firm tofu (firm tofu is set in a calcium carbonate solution)
Other sources of calcium include:
- Chia seeds
- Tahini
- Almonds
- Green leafy vegetables
- Dried figs
- Cereal with added calcium e.g. Uncle Tobys Plus
- Beans and legumes
Good news, you can still have ice cream!
Having a lactose-intolerance does not mean you can never eat ice cream or creamy soft cheese again. You are able to take lactase tablets which are sold over the counter. These tablets provide your body with the enzyme lactase so you can comfortably enjoy dairy foods without the discomfort.
You only need to take the tablet when you are consuming lactose foods. They are not a tablet you would take daily.
Getting support with your gut health
If you want to support managing uncomfortable gut symptoms or improving your nutrition, Kim is a dietitian who provides nutrition counselling through a virtual clinic. Kim takes an approach that is personalised to each individual and seeks to understand what you need to reach your health goals. Kim is a Credentialed Eating Disorder Clinician and has a special interest in digestive health and recovery from chronic dieting. Find out more here.
About
Kim Lindsay, APD
Kim Lindsay is an accredited practicing dietitian and credentialed eating disorder clinician.
She provides online dietitian appointments for people who want to improve their health while developing a positive relationship with food. Kim has a special interest in disordered eating, chronic dieting, and digestive health.
