Protect Against Osteoporosis When You’re Lactose Intolerant

Medically Reviewed by Louise Chang, MD on June 08, 2010

For millions of Americans suffering from lactose intolerance, dealing with painful bloating, gas, nausea, and diarrhea is a part of daily life.

Lactose intolerance occurs when your body has problems digesting lactose, a sugar found in milk and other dairy products. The small intestine produces an enzyme called lactase that breaks down lactose.

If you don’t produce enough lactase, you may experience the symptoms of lactose intolerance. These symptoms include:

To prevent the discomfort and pain of lactose intolerance, many people avoid dairy completely. This can make it difficult to get enough calcium and vitamin D, which are important nutrients for healthy bones. Dairy does not have to be avoided by people who have lactose intolerance, however.

In February 2010, the National Institutes of Health (NIH) held a national conference on lactose intolerance. The NIH expressed concerns that a diet that completely excludes dairy creates risks to bone health. Removing all dairy from your diet may put you at an increased risk for osteoporosis, a serious medical condition where bones are weakened.

“Of the three main components of a healthy diet: fruits, vegetables, and sources of calcium, calcium is always lacking,” says Ruth Frechman, registered dietitian and spokeswoman for the American Dietetic Association (ADA). “People who avoid dairy don’t usually get enough of the key nutrients for bone health.”

Without enough calcium and vitamin D, bones may become porous and weak and may be more prone to fracture -- a condition known as osteoporosis. Many people have no idea that they have osteoporosis until they fracture a bone.

According to the Surgeon General’s report on bone health and osteoporosis, as many as 48 million Americans are affected by reduced bone density. The majority of them (68%) are women. According to the report, by 2020 those numbers could rise to more than 60 million Americans.

Osteoporosis typically has no symptoms. As the disease progresses, it can lead to painful and far more serious conditions. Symptoms of osteoporosis include:

  • Bone, spine, and neck pain
  • Frequent fractures that occur with little or no trauma
  • Loss of height
  • Stooped or humped posture

NIH warns that people such as those with lactose intolerance, who totally eliminate dairy from their diet, are at a substantial risk of developing osteoporosis. Limiting dairy consumption can greatly reduce your intake of calcium, an important nutrient for developing and maintaining bones.

Other known risk factors for osteoporosis include:

  • Thinness or small frame
  • Family history of osteoporosis
  • Postmenopausal or early menopause
  • Abnormal absence of menstrual periods (amenorrhea)
  • Prolonged use of certain medications, such as those used to treat lupus, asthma, thyroid deficiencies, and seizures
  • Lack of physical activity
  • Smoking
  • Excessive alcohol intake

An important part of preventing osteoporosis is making sure you receive enough calcium and vitamin D during your lifetime. If you have lactose intolerance, that may be a more challenging task.

“People with lactose intolerance need an even stronger focus on calcium and vitamin D intake, and they need to maximize other measures to promote bone health such as weight bearing exercise,” says Mary O’Connor, MD, chair of the Orthopaedic Surgery Department of the Mayo Clinic Florida and spokeswoman for the American Academy of Orthopaedic Surgeons (AAOS).

Most people with lactose intolerance can tolerate a small amount of dairy without getting symptoms.

Other options that don’t exclude dairy to help prevent lactose intolerance include:

  • Lactose-free or reduced-lactose milk and dairy products. Many manufacturers now offer dairy products that have had the lactose removed.
  • Lactase tablets or drops. Taking these tablets or drops with the first bite or drink of dairy helps prevent lactose intolerance symptoms.

There are many non-dairy sources of calcium that offer these nutrients. “Consider almonds,” Frechman says. One ounce of almonds contains about 80 milligrams of calcium. She also recommends eating fish with bones like sardines and salmon. Before canning, the fish is slightly cooked, and this softens the bones.

Non-dairy source of calcium include:

  • Vegetables (lettuce, kale, broccoli, okra, bok choy, and many others)
  • Non-dairy milk products (soy, rice, and almond milk)
  • Canned Fish (salmon and sardines with edible bones included)
  • Nuts (almonds, hazel nuts, pecans, walnuts)
  • Seafood (shrimp, raw oysters, mackerel)
  • Calcium fortified products (fruit juices, breakfast cereals, tofu)
  • Dried fruit
  • Molasses

Adequate calcium intake should begin early. “The really scary thing is the young girls who aren’t consuming enough calcium. These are the bone-growing years. Over 80% of teenage girls are not getting enough calcium,” Frechman says. According to the USDA, that number may be even higher, and boys aren’t faring much better. Nearly 90% of all American teenagers do not consume enough calcium.

O’Connor stresses the importance of teaching kids about bone health. Teaching them good habits now can protect against problems as they get older. “The best option in kids is to develop good awareness of bone health early. They are in the time of peak bone development and peak bone health,” she says. “It’s all about calcium, vitamin D, and weight bearing exercise.”

You need calcium and vitamin D to have healthy bones. Vitamin D allows calcium to be absorbed by your body. High-calcium foods like dairy, including lactose-free dairy, are the best source of calcium. Supplements may be needed if you don't get enough calcium through foods..

“It is a challenge. It’s hard to remember to take supplements even once a day, so I keep a bottle of wafers on my desk that contain calcium and vitamin D. I take one at lunch and another with my dinner. I get the rest through my diet,” O’Connor says.

She encourages her patients to find a way that personally works for them. In addition to dairy, options include pills, wafers, chewable tablets, and even chocolate with added calcium. Because your body can only absorb 500mg of calcium at a time, O’Connor says it is important to take your calcium supplements throughout the day.

Getting enough vitamin D can be a challenge for everyone, even those who are not lactose intolerant. Very few foods contain vitamin D, but our bodies can make vitamin D when exposed to the sun. However, like with regular dairy, lactose-free dairy is fortified with vitamin D. Non-dairy beverages, such as soy and almond milk, as well as orange are also often fortified with vitamin D.

You can also get vitamin D through small amounts of sun exposure. “We wear sunscreen every day and stay out of the sun, but you need at least 15 minutes of sun a day to get enough vitamin D,” says O’Connor. Other researchers suggest between five and 30 minutes of sun exposure at least twice a week. Because it is so hard to be sure you have adequate vitamin D, O’Conner and Frechman recommend a calcium supplement that contains vitamin D as well.

Frechman says she is living proof that caring for bone health with diet and exercise pays off. “At 57, I have not shrunk in height and have zero evidence of osteoporosis,” she says. “I drank lots of milk when I was young and my bones were growing. I exercise like crazy -- weight bearing, hiking, etc. My bone density test is excellent.”

O’Connor says she believes it is never too late to get the message out. “We can’t just focus on the osteoporosis patient. When a patient comes in with the first fracture, the visit is a teachable moment. We must recognize at this moment that this is important for the patient and the rest of the family. We need to tell them, ‘Pay attention now so this doesn’t happen to you.’”