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In populations where milk consumption has always been high, such as in Europe, most adults continue to produce lactase for their whole lives and can digest milk quite happily with only around 5% of the population being lactose intolerant.
Lactose intolerance doesn’t mean dairy free and there can often be significant differences in the amount of lactose that can be consumed before symptoms present among people diagnosed with lactose intolerance.
The Australian Dietary Guidelines say that up to 250ml of milk (about 12–15g of lactose) can be well tolerated, without symptoms, if it’s consumed with other foods or throughout the day. Most cheeses contain low or no lactose and yoghurt contains ‘good’ bacteria that help to digest lactose. Low-lactose and lactose-free milks and yoghurts are also available.
How many people are lactose intolerant?
Estimates for lactose intolerance vary by ethnicity. African American and Asian ethnicities see a 75% – 95% lactose intolerance rate, while northern Europeans have a lower rate at 18% – 26% lactose intolerance. For some people, drinking milk with their morning cereal is all the dairy they need for the day. Other people have a bowl of ice cream to end the day. If the combination of those two results in stomach cramps or churning, or a 3 a.m. emergency run to the bathroom, it’s probably safe to conclude that you don’t digest cow’s milk as well as you could. Rest assured, you’re in good company.
Is Lactose Intolerance Genetically Inherited?
Genetically, you likely inherit your lactose intolerance from your parents, and they inherited it from theirs. For most people, lactose intolerance starts developing as a toddler and gets stronger as you grow up because your body reduces or eliminates the production of lactase, the chemical that breaks down the milk sugar lactase.
It’s also important to note, that when people talk about being lactose intolerant, they’re often using a collective term used to describe a few distinctly different maladies like the maldigestion, intolerance, or allergic response to cow’s milk or dairy products. Cow’s milk gets the most attention because it seems to be the major offender, with yogurts and cheeses contributing to a far lesser extent.
How Can I Tell If I’m Lactose Intolerant?
Testing for lactose intolerance can be done a few different ways; most are performed in a physician’s office or laboratory. There’s a breath test where you drink a solution of water and lactose, then wait to have your breath tested for high levels of hydrogen. It takes a couple of hours. Another option is to have a few different blood draws to see if your blood glucose levels are elevated, but this requires a few needle sticks so most people opt for the breath test. You can have your stool (aka poop) tested for acidity, have an intestinal biopsy, or have a chromatography test done on your poop. If all of these options seem complicated, well, it’s because they are. The easiest way to see if you’re lactose intolerant is to run your own test.
Consume dairy in different amounts and see how you feel 30-90 minutes after consumption. Even with lactose intolerance, most people can digest small amounts of cow’s milk without having severe symptoms. A cup of milk (eight ounces) is a good test threshold for a day’s consumption. Then see how you feel. This will give you a level for how much dairy you can tolerate in your diet. As you remain symptom free, add dairy to your diet to find your threshold. This threshold can change over time, so be aware of how your body feels after consuming dairy.
What are the symptoms of lactose intolerance?
Because symptoms of lactose intolerance vary for individuals, you really need to understand what cow’s milk does to your body. Some people complain of minor symptoms like excessive amounts of gas or audible stomach churnings while others suffer more major symptoms like painful cramps or explosive diarrhea. In either case, it’s important to understand the dose response of dairy to your lactose intolerance level. And keep in mind, these things can change as you get older.
Does string cheese make your stomach upset? Probably not. Does eating an entire pizza send your stomach into fits? Maybe. Does drinking an oversized glass of milk to get more protein make your stomach cramp and your diarrhea explosive? Probably. So if you’re getting too much dairy and your body is reacting like a civil war in your stomach, you should reduce or eliminate your consumption of dairy to treat your body right. As the Physicians Committee for Responsible Medicine recommends, there is no reason for people with lactose intolerance to push themselves to drink milk.
How can I increase my tolerance of lactose products?
Some people crave milk and want it at every meal. If you’re lactose intolerant, but don’t want to give up your dairy products, you have a few options. A small lactose pill taken with a meal containing dairy can help you digest milk. Some people recommend trying to increase your tolerance to dairy products with a few simple tips. Drink milk with other foods instead of on an empty stomach so it digests easier. Consider smaller portions, then gradually increase the level of milk you drink. Try whole milk instead of skim milk because the fat can help the passage of dairy through your digestive system. Remember, too, that cow’s milk isn’t the only way to get calcium and other nutrients in your body.
Calcium-rich dairy options that aren’t cow’s milk
Going diary-free isn’t the only option for treating lactose intolerance. Hard cheeses, like cheddar, have low amounts of lactase so they can often be consumed without the side effects associated with milk. Yogurts, too, have probiotics that help with digestion. Consider goat’s milk, too, as goat’s milk is about as close as you can get to cow’s milk and comes with lower amounts of the milk protein responsible for milk allergies so it is generally more tolerated. As with all animal products, cholesterol is a concern, but lots of cow’s milk alternatives have been cropping up to help people consume lactose-free milk that doesn’t come from a cow.
Non-dairy alternatives to cow’s milk
Let’s talk about some alternatives to cow’s milk. If it comes from a plant, it’s largely better for you because you don’t get the cholesterol you’d normally find in animal products (like cow’s milk). Similar to milk in form and function, each plant milk option has a unique taste profile. Some people love the taste of almond milk. Some people find it too nutty. You’ll know after you’ve tried them for a few days and learned to grow accustomed to them.
- Almond milk
- is made by grinding almonds with water and straining out the pulp. It’s high in calcium and monounsaturated fat, a heart-protecting oil, and low in calories.
- Coconut milk
- is made by combining the grated meat of a mature coconut with water. It is often used in cooking recipes, and can also be used as a drink.
- Hemp milk
- is made from hemp seeds soaked in water. It resembles a cream, and is often used in coffee shops as a replacement for people intolerant or allergic to cow or soy milk.
- Oat milk
- is made from hulled oat grains and water. It has good nutrition and includes more calcium than a typical cup of milk.
- Rice milk
- is made by milling brown rice. It’s often fortified with calcium to match the levels found in cow’s milk so you get more nutrients and a similar taste.
- Soy milk
- is made by soaking dried soybeans and grinding them in water. Popular for drinking and cooking, soy milk is a popular substitute with good nutritional content.
Where can I supplement the nutrition from milk?
As with any part of your current lifestyle diet, dairy products can be removed without too much trouble. Because milk is fortified with vitamin D and is a good source of calcium, it’s important to make sure you’re getting those nutrients in your diet. The good news is that calcium is easy to get from leafy, green vegetables, protein-complete edamame or other beans or peas, nutritious fish, or other sources. If you’re meeting your nutritional needs, there isn’t a real drawback to cutting milk out of your diet. Removing cow’s milk is certainly better than suffering through the painful cramps, excessive gas, audible stomach churning, and explosive diarrhea that can accompany lactose intolerance.
So Where Do I Go From Here?
- If you’re worried about being lactose intolerant, run your own tests to see how much milk or dairy you can consume without getting symptoms.
- If milk is something you crave, consider buying lactase pills to take with dairy products, or trying to build up your tolerance to it with small doses.
- Consider a diet change to find something similar to cow’s milk you enjoy, like almond milk.
- If you have lingering questions, talk to your physician at your next appointment so they can give you personalized attention.