Lactose-Free Low-Lactose Diet
Location of the colon and small intestine.
Image from the National Institutes of Health
Lactose is the simple sugar found in milk and milk products. It can also be found in a variety of other foods and even as a filler in some pills and capsules. The enzyme lactase, presents in the lining of the small intestine, splits lactose into two simple sugars. These simple sugars can then be absorbed by the body and used as nourishment.
In infants, milk is the main part of the diet, so it is natural and normal for lactase production to gradually decrease as the diet changes. This tends to occur in childhood and adolescence in African Americans, Native Americans, Hispanics, Arabs, Jews, and Asians. Northern European white races seem to keep lactase production the longest.
When lactase is absent, lactose passes through the intestine to the colon (large bowel), carrying extra fluid with it. In the colon, bacteria break down lactose into lactic acid and certain gases. Lactic acid is an irritant and laxative. It can cause symptoms such as bloating, diarrhea. abdominal cramps, and gas or flatus.
Lactase activity is reduced in people with certain intestinal conditions such as Crohns disease, ulcerative colitis, and celiac disease (gluten enteropathy). Patients taking certain drugs and alcoholic patient may also be lactose intolerant. Finally, patients with surgical removal of part of the stomach or a large portion of the small intestine may need to reduce lactose in the diet.
It is important to remember that while lactose intolerance can cause uncomfortable symptoms, it does not cause damage to the intestine. The purpose of this diet is to eliminate lactose or reduce it to tolerable levels.
Nutrition Facts and Special Considerations
Dairy products are important sources of calcium, riboflavin, and vitamin D. Some lactose-intolerant people are able to tolerate certain dairy products in small amounts, and their diets may provide enough of these nutrients. However, the physician or registered dietitian may recommend certain vitamin supplements and/or a calcium supplement for some patients.
Tolerance of lactose is variable. Some people can eat small amounts of lactose without having symptoms while other need to avoid it completely.
- Low-lactose diet: Generally eliminates only milk and milk products. However, some can tolerate milk in small amounts (2 oz.) throughout the day or as part of a meal. Some can tolerate small amounts of yogurt. These patients can experiment to find the level of lactose they can tolerate. Some people can build up their level of tolerance by gradually introducing lactose-containing foods.
- Lactose-free diet: All lactose products must be eliminated, including foods that are prepared with milk, both at home and in commercially packaged foods. These people may be able to use 100% lactose free milk or soy milk. Labels should always be read carefully.
Lactase Digestive Aids and Products
Many people can drink milk in which the lactase has been partially or completely broken down. The following products may be available at a pharmacy or grocery store.
Lactaid and Dairy Ease enzyme products: check with pharmacist, registered dietitian, or a physician for individual guidance on the use of these products
- Drops: These are added to milk. Five, 10, or 15 drops per quart of milk will generally reduce lactose content by 70%, 90%, or 99% respectively over a 24-hour period.
- Caplets/capsules: A person chews or swallows 1 to 6 of these when starting to eat foods containing lactose.
Lactaid Milk
- Non-fat or 1% low-fat is 70% lactose reduced.
- Non-fat calcium-fortified is 70% lactose reduced and 500 mg of calcium per cup has been added.
- Non-fat LACTAID 100 is completely lactose free.
Dairy Ease Milk: Available in non-fat, 1%, or 2% low-fat; all are 70% lactose reduced.
For more information about these products, call the consumer information number listed on the food label. The physician, pharmacist, or registered dietitian may also have information about these products.
Food Groups
Milk and Milk Products |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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 100% lactose free milk, soy milk |
Whole, skim, 1%, 2% milk, buttermilk, sweet acidophilus milk, lactose-reduced milk, evaporated milk, acidophilus milk, sweetened condensed milk, instant hot chocolate and cocoa mixes, cheese |
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Vegetables |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Fresh, frozen, and canned vegetables without added milk tomato paste and puree, tomato and spaghetti sauce without cheese |
Reamed or breaded vegetables, packaged dried potato mixes, tomato and spaghetti sauce with cheese |
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Fruits |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Fresh, frozen, canned and dried fruits |
None |
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Bread and Grains |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Water based breads (Italian, French, Jewish rye), rice and popcorn cakes, graham crackers, rusks, Pareve-Jewish bakery products, cooked and dry cereals without added milk solids, pasta rice, oats, barley, corn meal, bulgar, and other plain grains |
The following made with milk or milk products: bread, rolls, biscuits, muffins, pancakes, sweet rolls, waffles, crackers, instant and dry cereals with added milk products, some packaged grain macaroni mixes |
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Meats and Meat Substitutes |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Plain beef, lamb, veal, pork wild game, poultry, fish, shellfish, eggs, kosher prepared meat products, peanut butter; peas, beans or lentils (dried, canned or frozen); all nuts and seeds |
Eggs, fish, meat and poultry (breaded or creamed); luncheon meats, sausage frankfurters, some brands of egg substitutes and powder eggs |
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Fats and Oils |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Bacon, butter, margarine without milk derivatives (whey), salad dressing without cheese or milk, vegetable oils, olives, most non-dairy creamers, mayonnaise, gravy made without milk or milk products |
Cream, half & half, sour cream, cream cheese, chips dips, some types of margarine, salad dressing with cheese milk, whipped toppings |
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Sweets and Desserts |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Angel food cake, gelatin, fruit ice, fruit popsicles, fruit roll ups, hard candy, gum drops, jelly beans, licorice, fruit pie filling |
Ice cream, ice milk, some brands of sherbet, souffle, mousse, pudding, custard, packaged dessert mixes, milk chocolate, toffee, caramel, butterscotch |
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Beverages |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Postum, lactose-free nutritional supplements (Sustacal, Ensure, Nutren), vegetable juices, fruit juices and drinks, tea, carbonated beverages, beer, wine, distilled spirits (gin, rum), cocoa powder, most coffees |
Instant ice tea, instant coffee, Ovaltine, chocolate drink mixes, cordials, liqueurs, milk-based nutritional supplements (Carnation Instant Breakfast) |
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Soups |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Boullion, broth, meat, or vegetable stock soups, bisque and chowders made with water, soy milk, or 100% lactose-free milk |
Cream soup, canned and dehydrated soup mixes containing milk products |
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Miscellaneous |
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LACTOSE-FREE |
LACTOSE-CONTAINING |
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Plain popcorn, pretzels, plain potato and corn chips, salsa, mustard, ketchup, pickles, uncreamed horseradish, relish, sauces made without milk or milk products, sugar, honey, jams, jellies, maple and corn syrup, molasses, herbs, spices, salt, pepper |
Cream or cheese sauces, ranch-style or cheese flavored pretzels or chips, cheese curls, sugar substitute lactose added, medications and vitamins/mineral supplements with lactose added |
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Sample Lactose-Free Menu
Breakfast |
Lunch |
Dinner |
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• orange juice, calcium fortified, 1/2 cup • oatmeal 1 cup • Italian bread 2 slices • jelly 2 tsp. • margarine 2 tsp. • coffee 1 cup • sugar 1 tsp. • non dairy creamer |
• turkey 2 oz. • Italian bread 2 slices • mayonnaise 1/2 tsp. • tossed green salad 1 cup • oil & vinegar 2 tsp. • tomato 2 slices • carrot 1 • celery 1 stalk • lactose free milk 1 cup |
• roast beef 4 oz. • noodles 1/2 cup • broccoli 1 cup • Italian bread 1 slice • margarine 2 tsp. • pear 1 • tea 1 cup • lemon 1 slice • sugar 1 tsp. |
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| The above sample diet provides the following: Calories 1,800; Protein 93 gm; Carbohydrates 261 gm; Fat 48 gm; Sodium 1,700 mg; Potassium 3,533 mg |
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