Lactose Intolerance: Facts Verses Myths

27 Feb Lactose Intolerance: Facts Verses Myths

This post was sponsored by National Dairy Council. All opinions are my own.

When it comes to lactose intolerance, there are many myths swirling around. Many of these myths lead to inappropriate changes or adjustments to the diet that can lead to increased risk of health consequences. Yes, lactose intolerance is real and affects many Americans. According to data, 36% of Americans are affected by lactose intolerance.(1,2) However, understanding this common characteristic of human genetics, managing it properly, and ensuring proper nutrition when you have lactose intolerance is key to safeguarding you and your family’s health and wellness. Below are 4 common myths about lactose intolerance—debunked.

Myth #1: Lactose intolerance is the same as having a milk protein allergy.

Fact: Lactose intolerance is a sensitivity, while a milk protein allergy is an allergy.

Lactose is a double-sugar (called a disaccharide) made of single sugar components glucose and galactose, and the main carbohydrate in milk. Lactose is found naturally in various amounts in milk and dairy foods like cottage cheese, ice cream, dry-milk powder, yogurt, kefir, cheese and butter. Lactose can also be found in baked goods, breakfast cereals, salad dressings, candies, and lunch meats. 

Lactose intolerance is a sensitivity, while a milk protein allergy is an allergy. Lactose intolerance is when you consume more lactose than your body can digest at once and can lead to uncomfortable symptoms like stomachache, bloating, gas or diarrhea. It is a gastrointestinal issue; however, there are solutions that can be customized so people diagnosed with lactose intolerance can enjoy milk and dairy foods with confidence (more on that in myth #3). It is also rare in young children.

A milk protein allergy is an immune response to protein in milk and dairy foods made from milk (typically casein) that is triggered by the immune system. Symptoms can include shortness of breath, hives, wheezing, vomiting, or swelling of the lips and throat. Those diagnosed with a milk protein and thus dairy protein allergy must avoid milk and dairy foods. Typically it occurs in young children, but most outgrow it in childhood (a physician can test for it).

Myth #2: If you suspect a milk and dairy intolerance, you shouldn’t consult a physician. 

Fact: The only way to determine if you have lactose intolerance is to get tested.

Other health issues can present with some of the same symptoms of lactose intolerance – like abdominal pain and bloating, flatulence, diarrhea, and nausea. However, these symptoms can also result from a gluten intolerance, irritable bowel syndrome or other gastrointestinal conditions. A medical doctor can help rule out conditions you don’t have and may be able to determine the health condition that you do have. Each form of management to a health condition is different. 

Specific tests your doctor can do include a BREATH HYDROGEN TEST which is the gold standard. You drink a liquid that contains high levels of lactose and measure the amount of hydrogen excreted in your breath. Breathing out too much hydrogen indicates that the lactose isn’t being fully digested and absorbed. A BLOOD GLUCOSE TEST is another test that can be taken where your blood glucose (or sugar) gets measured before and after you consume a drink of lactose. If your blood sugar doesn’t rise, it means that lactose is not being absorbed. 

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Myth #3: You must avoid milk and dairy foods when you have lactose intolerance.

Fact: You can enjoy milk and dairy foods when you have lactose intolerance by understanding the options.

There are solutions including lactose-free dairy milk and fermented foods readily available. As such, to help support a lifetime of well-being for all Americans, including those with lactose intolerance, the Dietary Guidelines for Americans (3) and the National Medical Association (NMA) – the leading organization of Black physicians – recommend including 3 daily servings of dairy foods as part of an overall healthy diet. (4) This nutrition advice was recently reinforced in an evidence-based Supplement to the Journal of the National Medical Association, entitled, “The role of dairy food intake for improving health among Black Americans across the life continuum.”(4) With a variety of lactose-free and lower-lactose dairy milk and dairy food options available, as well as customizable solutions for lactose intolerance management, there’s an option in the dairy aisle for most people.

Research shows that adults can tolerate up to 12 grams of lactose in one sitting. (5) Does that mean every person will be able to do so? Not necessarily as lactose intolerance is individual to the person. However, milk and dairy foods contain varying amounts of lactose – from zero to 12 grams per serving – so you can choose the foods that work best for you.

Below you’ll find the lactose amount of dairy foods:

• Lactose free dairy milk (1 cup) = 0 grams
• Natural cheese like Swiss, Cheddar, and mozzarella (1 ounce) = <0.1 grams
• Butter (1 tablespoon) = 0.1 grams
• American cheese, pasteurized and processed (1 ounce) = 1 gram
• Cottage cheese (1/2 cup) = 3 grams
• Greek yogurt (6 ounces) = 4 grams
• Ice cream (1/2 cup) =4 grams
• Whole, 2%, 1%, skim milk (1 cup) = 12 grams
• Yogurt (6 ounces) = 13 grams

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Myth #4: Once you are diagnosed with lactose intolerance, you will never be able to tolerate dairy again.

Fact: People diagnosed with lactose intolerance are able to tolerate varying levels of foods with lactose. In addition, there are 6 strategies listed below that help with dietary management of lactose-containing foods that make milk and dairy easier to tolerate.

• Try It: Opt for lactose-free dairy milk and dairy foods because they contain the same essential nutrients without the lactose.

1. 1. Sip It: Start with a small amount of dairy milk or other dairy food and increase it SLOWLY over several days or weeks. This can help you tolerate it better over time.
   2. Stir It: Mix milk and dairy products with other food, which helps slow digestion and allows the body more time to digest lactose.
   3. Slice It: Top sandwiches/crackers with natural cheeses like Cheddar, Colby, Monterey Jack, Swiss and mozzarella which have minimal amounts of lactose.
   4. Shred It: Shred natural cheeses onto veggies, pastas, salads and soups. Cheeses typically have lower amounts of lactose and mixing the cheese with foods helps slow digestion and allows the body more time to digest lactose.
   5. Spoon It: Dairy foods like traditional yogurt, Greek yogurt and Skyr yogurt contain live and active cultures in yogurt that make it easier to digest.

There are also lactose pills or drops that you can take before consuming a lactose-containing food. Read the instructions for the exact timing of when you should take it.

References:

1. Storhaug C, Fosse S, Fadnes L. Lancet Gastroenterol Hepatol. 2017;2(10):738-746. 
2. Bayless T, Brown E, Paige D. Curr Gastroenterol Rep. 2017;19(5):23.
3. https://www.dietaryguidelines.gov/current-dietary-guidelines.
4. Comerford K, Lawson Y, Young M, et al. Executive summary: The role of dairy food intake for improving health among Black Americans across the life continuum. J Natl Med Assoc. 2024;116(2 Pt 2):211-218. doi:10.1016/j.jnma.2024.01.026.
5. Suarez FL, Savaiano DA, Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med. July 1995;6;333(1):1-4. doi: 10.1056/NEJM199507063330101.