Lactose: How Much Can You Take?

From the WebMD Archives

If your doctor just broke the news that you're lactose intolerant, it doesn't mean you'll never get to savor another bite of ice cream.

At first, many people fear they'll have to give up all dairy products, says Dee Sandquist, RD, a dietitian in Fairfield, Iowa. But with some trial and error, most people find they can still eat small amounts of dairy without having symptoms such as bloating, gas, stomach pain, diarrhea, or nausea.

Dairy foods are important to the health of your bones, because they're loaded with calcium and vitamin D. So the trick is to make sure you're getting enough of these nutrients, whether from dairy or other foods.

"Listen to your body and your symptoms," says Sandquist, who is also a spokeswoman for the Academy of Nutrition and Dietetics.

How Severe Are Your Symptoms?

How much dairy you can eat depends on how much lactase -- the enzyme that digests lactose -- your body makes, says Yuri A. Saito-Loftus, MD, MPH. She's an assistant professor in the Mayo Clinic's division of gastroenterology and hepatology. "That does vary a little bit from individual to individual. We don't know 100% what controls that. Presumably, it's genetically determined."

Some people with lactose intolerance can adapt. You may be able to add small amounts of foods with lactose to your diet over time and have fewer symptoms. "If you keep eating dairy, you can stimulate some lactase production," Saito-Loftus says. "That may help you better tolerate dairy products."

If your symptoms are so severe that you can't handle lactose in any foods, talk to your doctor about how to get enough calcium and vitamin D.

What Foods You Can Eat -- and How Much

"Many people know their symptoms pretty well, so they know if they can handle just a little bit or not," Sandquist says. In that case, you may be able to keep a mental tally of foods or amounts of foods to avoid. Other people get a better sense of what their body can take by jotting down notes. “A diary is extremely helpful because then you can log what symptoms you have, what you've eaten,” Sandquist says. “You can look back and see if there’s a pattern.”

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Figure out what foods you can eat. If you're not sure which foods with lactose you can handle, try one dairy food at a time, Sandquist says. You should be able to tell whether it bothers you within 30 minutes to 2 hours after eating it. Any discomfort from lactose intolerance is likely to set in by then. For example, drink a half-cup of dairy milk and see how well you tolerate it.

See how much you can eat. If you don't have symptoms from the food and the amount you try, slowly add more to see at what point you do have symptoms. For instance, maybe you don't have symptoms with a cup of milk, but you do with one and a fourth cups of milk. So your tolerance level is one cup.

If you do have symptoms, cut back on the amount to see if you can handle a smaller portion.

Once you've found how much of one food you can handle, start testing another food.

Find Substitutes

You may find you can't tolerate any amount of some foods. That's a good time to try lactose-free or reduced-lactose foods.

For instance, if milk doesn't agree with you, try lactose-free milk or a dairy-free drink, such as almond, rice, or soy milk. If you have problems digesting cheese, try one with less lactose.

  • Nonfat dry milk powder, 1 cup: 62 grams lactose
  • Sweetened condensed milk, 1 cup: 40 grams lactose
  • Evaporated milk, 1 cup: 24 grams lactose
  • Milk, 1 cup: 10-12 grams lactose
  • Ice milk, 1/2 cup: 9 grams lactose
  • Ice cream, 1/2 cup: 6 grams lactose
  • Yogurt, 1 cup: 5 grams lactose
  • Cottage cheese, 1/2 cup: 2-3 grams lactose
  • Blue cheese, 1 oz.: 2 grams lactose
  • Sherbet, orange, 1/2 cup: 2 grams lactose
  • American, Swiss, or Parmesan cheese, 1 oz.: 1 gram lactose
  • Cheddar cheese, 1 oz.: 0 grams lactose

Be Aware of Calcium Needs

People who are lactose intolerant tend to cut out dairy foods. If you do that, you can shortchange yourself on calcium. You need calcium for healthy teeth and bones, and vitamin D to help your body use calcium. "People who are lactose intolerant are at higher risk for osteoporosis," or thinning bones, Saito-Loftus says.

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If you have lactose intolerance, you don’t have to miss out on the bone-building benefits of calcium and vitamin D. Some lactose-free foods are fortified with these nutrients, such as lactose-free milk and cottage cheese. Some nondairy milks -- almond, oat, rice, and soy -- are also enriched with calcium and vitamin D.

Look at the label, and try to get at least as much calcium and vitamin D as you would get from regular cow’s milk. Calcium and vitamin D supplements can help you fill in any gaps to ensure you "bone up" on these vital nutrients.

Also, add these foods to your diet for an added boost of calcium (without the lactose):

  • Bok choy and Chinese cabbage
  • Broccoli
  • Collards
  • Greens: collard, kale, mustard, or turnip
  • Orange juice that is fortified with calcium
  • Salmon or sardines with bones, canned
  • Soybeans
  • Tofu, calcium set

Vitamin D-rich foods include:

  • Eggs
  • Orange juice that is fortified
  • Swordfish or salmon, cooked
  • Tuna fish or sardines, canned
WebMD Feature Reviewed by Brunilda Nazario, MD on April 07, 2014

Sources

SOURCES:

Yuri A. Saito-Loftus, MD, assistant professor, division of gastroenterology and hepatology, Mayo Clinic.

Dee Sandquist, MS, RD, Fairfield, Iowa; spokeswoman, Academy of Nutrition and Dietetics.

Merck Manual Online: “Lactose Intolerance.”

National Institutes of Health: “How Is Lactose Intolerance Managed?”

National Digestive Diseases Information Clearinghouse: "What I Need to Know About Lactose Intolerance." 

University of Virginia Health System.

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