Author: Marnie Nitschke, is an experienced Accredited Practising Dietitian specialising in gut health and food intolerances.
As an experienced food intolerance dietitian, I can confirm that lactose intolerance is one of the most misunderstood dietary intolerances out there. Many people are over-restricting their diet in order to avoid lactose. Here’s my 5 minute explainer of how to best manage this common intolerance!
What is lactose Intolerance?
Lactose is the disaccharide (double sugar) naturally present in the milk of mammals, including cow, goat, sheep and human milk. In our digestive system, we produce an enzyme called lactase, which separates the disaccharide lactose in to two easily digestible sugars – glucose and galactose.
The term lactose intolerant refers to a person with reduced ability to digest and absorb lactose – caused simply by low lactase enzyme production.
When lactose in food or drinks isn’t able to be broken down and absorbed, it moves through the digestive system and can commonly cause symptoms of gas, bloating and loose / urgent stools. Importantly, lactose does not cause damage to the digestive system, and does not cause non-digestive systems like headaches, rashes or fatigue.
How common is lactose intolerance?
As babies and children, we produce high amounts of lactase, making us well equipped to digest lactose in milk. However as we age, lactase production decreases significantly in a large proportion of people. According to our heritage and genetics, some of us will tolerate lactose better than others. For example, adults of northern European descent tend to digest lactose well throughout their lives, whereas many of Asian and west African descent will be lactose intolerant.
We can also become temporarily lactose intolerant (ie. for a few weeks) after an insult to the GI system like the dreaded gastroenteritis or an episode of acute food poisoning. In this case, lactase production and lactose tolerance returns once the gut is healed. Phew!
How much lactose is too much?
Great question!
Your sensitivity to lactose will depend on a variety of factors, including:
- The dose of lactose in the food or drink you consume
- How much lactase enzyme your gut still produces
- The speed of your digestive system (quicker transit time = less opportunity for absorption of lactose)
- How sensitive or ‘irritable’ your gut nervous system is.
According to Monash University researchers, most people with lactose intolerance will tolerate up to 4g of lactose in one sitting, and up to 12g if it is spread through the day in food and drinks.
Essentially, what this means is that a splash of milk in a cup of tea, a spoonful of white sauce on your cauliflower, a dollop of cream on your cake or a spoon of yoghurt in your smoothie are unlikely to cause any symptoms at all. Low lactose dairy foods like cheese, butter and dairy spreads can be consumed freely.
Where does lactose fit into the FODMAP equation?
Lactose is only a FODMAP for those who are intolerant. On the first phase of the low FODMAP diet, lactose is limited, but after challenges are conducted, many people are able to bring lactose containing foods back into their regular diet.
How much lactose is in different foods?
As you can see from the table below, the lactose content of dairy products vary enormously, and will depend on the serve you have in a sitting.
The lactose content of products containing ingredients like milk, evaporated milk, milk solids and milk powder will really depend on how much has been added (realistically, these are unlikely to be a problem unless they are in the first 5 ingredients listed).
And when it comes to yoghurt, lactose levels are lower because of the fermentation process the yoghurt goes through, with traditional Greek yoghurt being naturally moderate-low compared to regular commercial varieties. The lactose content of yoghurt can even depend on how close it is to the best before date!
Table: Lactose content of common foods, Monash University FODMAP Blog, 2016
| Dairy product | Lactose content /serve | Serving size | Lactose classification/serve |
| Full cream milk | 15.75g | 250ml | High |
| Low-fat milk | 15.25g | 250ml | High |
| Skim milk | 12.5g | 250ml | High |
| Natural yoghurt | 8.5g* | 170g | High |
| Regular flavoured yoghurt | 5.8g* | 170g | High |
| Thickened cream | 3.75g | 125ml | Moderate |
| Sour cream | 3.13g | 125ml | Moderate |
| Cream cheese | 2.0g | 80g | Moderate |
| Ricotta cheese | 1.6g | 80g | Moderate |
| Cottage cheese | 0.7g | 36g | Low |
| Feta cheese | 0.13g | 125g | Low |
| Cheddar (tasty) cheese | 0.04g | 40g or 2 slices | Low |
| Camembert cheese | 0.04g | 40g | Low |
| Brie cheese | 0.04g | 40g | Low |
We Feed You meals and lactose intolerance
For your enjoyment and peace of mind, We Feed You have developed a large range of delicious meals that are strictly lactose free. You can find these using the ‘shop special diets’ tab and selecting ‘lactose free’ or click here > https://www.wefeedyou.com.au/collections/lactose-free-meals
Those requiring a low lactose diet will also be pleased to know that meals marked Low FODMAP are very low in lactose (less than 1g per serve) and suitable for the vast majority of people following a lactose free diet. Products containing dairy ingredients like yoghurt and cheese are not labelled lactose free, but will be minimal in lactose.
When browsing the We Feed You range and selecting your meals, we suggest you consider your own tolerance to lactose.
We Feed You has a wide range of lactose free ready meals
What are lactose free dairy products?
Lactose free dairy products are either naturally lactose free due to processing (ie. cheese, butter), or have had the lactase enzyme added to break down lactose.
If you are lactose intolerant, lactose free milk, yoghurt and ice cream are a convenient and nutritious alternative to regular dairy products. But items like set cheeses (anything you can slice or grate) and butter/spreads do not contain any significant lactose, so buying ‘lactose free’ versions of these is really just a drain on your hip pocket!
Are lactase enzyme supplements helpful?
Lactase enzymes supplements are available in tablet and chewable forms, to help you digest foods containing higher amounts of lactose. They can be a really helpful tool for the lactose intolerant diner who wants to enjoy an ice cream, cappuccino or slice of cheesecake!
5 COMMON MYTHS ABOUT LACTOSE INTOLERANCE:
1. Lactose intolerance causes mucous, nasal congestion and skin breakouts
Nope! As lactose is poorly absorbed by those with lactose intolerance, it can’t create any symptoms except the digestive ones discussed.
2. Lactose causes damage to the gut
Untrue. Although lactose can cause discomfort and diarrhoea in large doses, this is simply due to the effects of fermentation, distension and osmotic movement of water into the gut. Lactose intolerance does not affect your gut health.
3. Lactose intolerance requires a dairy free diet
This is an incredibly common misconception! Be assured that low lactose and ‘lactose free’ dairy products are well tolerated and safe for those with lactose intolerance.
4. Creamy and cheesy dishes are high in lactose
Another frequent assumption that doesn’t hold true. If a pizza made with lots of cheese upsets you – it wasn’t because of the lactose. If a pasta dish made with cream upsets you, it’s more likely the fat and FODMAP content of the meal than the lactose.
5. Breath testing is necessary to diagnose lactose intolerance
Absolutely not! Breath testing is expensive and unreliable. You will find out much more about your tolerance to lactose by experimenting with various doses of lactose in foods, to find your tolerance threshold. Milk is a very easy food to use to gauge your tolerance – starting with 1⁄4 cup, and moving up to 1 cup.
And there you have it. Everything you ever wondered about lactose, and hopefully a little less restricted diet moving forward. If you still have questions and confusion around lactose, dairy foods and food intolerance, contact an Accredited Practising Dietitian for more specialised dietary advice.
