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Myth Busting: Lactose Intolerance

Sep 14, 2023Dairy Council® of Arizona

Dairy Allergy vs Lactose Intolerance

Myth:

“My stomach hurts after I eat cheese pizza…I guess I must be allergic to dairy!”

It’s the weekend.

You’re at your favorite restaurant with your gal pals or bro crew and as the waitress comes to take your order, one of your friends mentions they need to avoid pizza. They explain that their stomach hurts after eating pizza because of an allergy to the lactose in cheese. Sound familiar? Thankfully, the suspected allergy to the cheese might actually be lactose intolerance. And for those with lactose intolerance, there are ways to enjoy foods with dairy, like pizza, without discomfort.

Before You Avoid Milk …

While milk allergies do exist, there are many points to consider before taking the step of avoiding milk or dairy foods in your diet. It is important to distinguish the difference between a milk allergy and lactose intolerance. A milk allergy (often interchangeably known as a dairy allergy) usually occurs in infants and younger children and is prevalent in 2.5% of children under the age of 3 in the United States (1). Adults can also have a milk allergy, but it is not very common. Milk allergy symptoms are due to an allergy to milk’s proteins, so a sudden immune response is triggered like hives, and swelling of the face, tongue, or throat (2). 

If an individual is diagnosed by a doctor as having a milk allergy, then the individual needs to avoid all milk and all products with dairy (where the milk allergen is specified on the ingredient label). One key takeaway is for parents to continually discuss the milk allergy finding with their child’s pediatrician as your child may grow out of it (and most children do)! (1). Remember to ask your child’s doctor for consistent food allergy tests throughout their childhood so they are not avoiding nutrient-rich food groups, like dairy, altogether!

What is Lactose Intolerance?

Conversely, lactose intolerance is when the body cannot digest lactose, the sugar found in milk, and can result in various gastrointestinal issues like nausea, diarrhea, bloating, cramping, or gas (2). The inability to digest lactose is because there is not enough lactase in the body. Lactase is an enzyme that breaks down lactose, the naturally occurring sugar in milk. Unlike a milk allergy, lactose intolerance is found typically in adults. One key takeaway with lactose intolerance is that only a doctor can accurately identify lactose intolerance via a hydrogen breath test, blood test, or other methods (3). It is best to avoid self-diagnosing lactose intolerance as you may not have lactose intolerance…it might be an entirely different condition like irritable bowel syndrome or even another food allergy that you may not have been aware of.

Lactose Amounts in Foods

Myth:

“I’m lactose intolerant, so I have to avoid all dairy products and anything with dairy in it.”

Milk doesn’t always mean high lactose

You are strolling the aisles at a grocery store with your weekly list. When you pick up a bottle of salad dressing from the shelf, you scan the back label to look at the ingredients. You notice that the salad dressing you chose “contains milk” due to Greek yogurt in the ingredients. Sadly, you put back the salad dressing and feel defeated. But did you know that just because a dairy item contains milk…it doesn’t mean that it’s high in lactose? Let’s explore this a little more.

Lactose-Free Dairy = Yum!

There are a variety of dairy products that are surprisingly low in grams of lactose per serving. Individuals with lactose intolerance are still able to indulge in great flavors and enjoy the health benefits of dairy products. Items with less than two grams of lactose per serving include lactose-free milk, lactose-free ice cream, lactose-free cottage cheese, lactose-free yogurt, butter, natural cheeses, American cheese, and ricotta cheese. Lactose-free products can be created in two ways, either the lactase enzyme is added into the product to help break down the lactose, or the lactose is ultra-filtered out of the product (4). Some companies utilize both the first and second methods to ensure their products are lactose-free.

Lactose-free dairy products have the same great and familiar taste as lactose-containing dairy products with all the same key nutrients. Be sure to check the dairy product’s packaging for the words “lactose-free” on the label. There is a variety of lactose-free milk, cheeses, ice creams, and yogurts now on the market. give them a try! Fun fact: no matter the fat percentage, flavoring, or if it’s lactose-free, all real milk has the same 13 essential nutrients, including calcium, Vitamin D, and potassium, which are three nutrients of public health concern.

Naturally Aged Cheese = Low Lactose

Along with lactose-free dairy, natural cheeses are low in lactose as well. Natural cheeses are coined as those that have been naturally aged like cheddar, mozzarella, blue, Colby, Havarti, parmesan, gouda, and many others. The low level of lactose in cheese is due to the natural aging process that involves fermentation as the cheese ripens (5). Even though the lactose levels are not specifically stated on cheese, a variety of natural cheeses have less than 1 gram of lactose. Creamier and softer cheeses like ricotta and brie have more lactose in them. Furthermore, processed cheese sauces like Velveeta have higher amounts of lactose because they are not aged.

Cottage cheese has about 3 grams of lactose per serving. Due to the process of making the product, cottage cheese contains only a small amount of lactose from the milk it is made with. Traditional yogurt has almost 6 grams of lactose per serving, but it is usually easily tolerated in lactose-intolerant individuals because of the live and active cultures that aid in digestion (6). Greek yogurt has even less lactose than conventional yogurt. Greek yogurt has about 4 grams of lactose per serving. The reason there is less lactose in Greek yogurt is because the added straining process helps remove some of the lactose. As a quick visual reference, check out this infographic that displays lactose levels in several dairy foods.

 

You Can Enjoy Milk!

Even though milk has the highest amount of lactose per serving at 12.6 grams, small amounts of milk may be tolerated by individuals who have lactose intolerance (7). Enjoying milk with other foods like cereal helps slow down digestion so milk can be better tolerated. Try small amounts of milk (less than one serving) to establish a tolerance level that you are comfortable with and are not impacted by. Since lactose intolerance is not the same for everyone, it is important to find out how much lactose can be ingested without causing gastrointestinal stress. Try keeping a food diary to track the dairy foods you eat, how much dairy you are consuming, as well as any subsequent symptoms.  Another option is to include a lactase enzyme supplement such as Lactaid when ingesting milk or dairy products, to aid in the digestion process.

Alternative Plant Beverages for Lactose Intolerance

Myth:

“I love to drink almond milk…it’s lactose-free and it’s basically the same nutrition as real milk”

Plant-Based will Leaf You Hangin’

You are scrolling social media when you pause on a video by an influencer speaking about how almond milk is better for those who are lactose intolerant because there’s no lactose. You also read the text in the caption stating that nutrition-wise it fits the bill and can replace real milk. Sadly, this claim that the influencer is making is not true. Alternative plant-based beverages are not equal to the nutrition found in real milk.

Real Dairy Really is Better

Once you have been diagnosed by a doctor with lactose intolerance, there are options for enjoying lower lactose products. However, another common misconception is to choose to replace dairy milk with that of plant-based beverages to obtain the same nutrition. The only plant-based beverage that equals the protein content in dairy milk are those that have had nutrients added, and even then, it may not always equal 8 grams of protein per serving like real milk (8). Substituting plant beverages may lead to deficiencies in calcium, zinc, iodine, Vitamin A, Vitamin B2, Vitamin B12, Vitamin D, and essential amino acids, especially in infants aged 1 or older, children, teens, and the elderly. Plant-based alternative beverages may also have extra added ingredients, compared to milk which only has added vitamin D3. Real milk’s nutritional content and ingredient list (milk and vitamin D3) make it a powerhouse beverage that cannot be replicated by alternative plant-based beverages.

Key Takeaways:

  • Remember to ask your child’s doctor for consistent food allergy tests (including dairy allergies) throughout their childhood so they are not avoiding nutrient-rich food groups, like dairy, altogether!
  • Only a doctor can accurately diagnose lactose intolerance in their patients via a hydrogen breath test, blood test, or other methods. Refrain from diagnosing yourself as lactose intolerant without the consultation of a licensed healthcare professional.
  • Lactose-free dairy products have the same great and familiar taste as lactose-containing dairy products with all the same key nutrients!
  • Natural cheeses, conventional and Greek yogurt, and cottage cheese are all lower in lactose and are usually better tolerated in individuals with lactose intolerance.
  • Find out what your lactose tolerance level is by keeping a food diary.
  • Plant-based alternative beverages are not nutritionally equivalent to milk other than fortified ones having similar protein content.
  • Only real milk has 13 essential nutrients with virtually no added ingredients

Lauren Peña is a Registered Dietitian Nutritionist (RDN) and a team member of the Dairy Council of Arizona.

References

  1. FoodAllergy.org. (n.d.). https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/milk
  2. Milk allergy vs. lactose intolerance.org. (n.d.). https://www.foodallergy.org/resources/milk-allergy-vs-lactose-intolerance
  3. Misselwitz, B., Butter, M., Verbeke, K., & Fox, M. R. (2019). Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut, 68(11), 2080–2091. https://doi.org/10.1136/gutjnl-2019-318404
  4. Sharp, E., D’Cunha, N. M., Chaminda S. R, Vasiljevic, T., Panagiotakos, D. B., & Naumovski, N. Effects of lactose-free and low-lactose dairy on symptoms of gastrointestinal health: A systematic review. International Dairy Journal, 114(1), 1. https://doi.org/10.1016/j.idairyj.2020.104936
  5. Gille, D., Walther, B., Badertscher, R., Bosshart, A., Brügger, C., Brühlhart, M., Gauch, R., Noth, R., Vergères, G., & Egger, L. (2018). Detection of lactose in products with low lactose content. International Dairy Journal, 83(1), 17-19.

https://doi.org/10.1016/j.idairyj.2018.03.003.

  1. Vitellio, P., Celano, G., Bonfrate, L., Gobbetti, M., Portincasa, P., & De Angelis, M. Effects of Bifidobacterium longum and Lactobacillus rhamnosus on gut microbiota in patients with lactose Intolerance and persisting functional gastrointestinal symptoms: A randomized, double-blind, cross-over study. (2019). Nutrients, 11(4), 886. https://doi.org/10.3390/nu11040886
  2. Scholz-Ahrens, K.E., Ahrens, F. & Barth, C.A. Nutritional and health attributes of milk and milk imitations. (2020). European Journal Nutrition, 59(1),19–34. https://doi.org/10.1007/s00394-019-01936-3

 

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