Lactose-Free Diet

Lactose is a carbohydrate that is found mainly in milk and milk products, as well as in foods with added milk or whey. Lactose must be digested by the enzyme lactase in order to be used by the body. Lactose intolerance occurs when there is a shortage of lactase. When your body is not able to digest lactose, you may feel sick to your stomach (nausea), bloated, and have cramps, gas, and diarrhea.

TYPES OF LACTASE DEFICIENCY

  • Primary lactase deficiency. This is the most common type. It is characterized by a slow decrease in lactase activity.

  • Secondary lactase deficiency. This occurs following injury to the small intestinal mucosa as a result of a disease or condition. It can also occur as a result of surgery or after treatment with antibiotic medicines or cancer drugs.

Tolerance to lactose varies widely. Each person must determine how much milk can be consumed without developing symptoms. Drinking smaller portions of milk throughout the day may be helpful. Some studies suggest that slowing gastric emptying may help increase tolerance of milk products. This may be done by:

  • Consuming milk or milk products with a meal rather than alone.

  • Consuming milk with a higher fat content.

There are many dairy products that may be tolerated better than milk by some people, including:

  • Cheese (especially aged cheese). The lactose content is much lower than in milk.

  • Cultured dairy products, such as yogurt, buttermilk, cottage cheese, and sweet acidophilus milk (kefir). These products are usually well tolerated by lactase-deficient people. This is because the healthy bacteria help digest lactose.

  • Lactose-hydrolyzed milk. This product contains 40% to 90% less lactose than milk and may also be well tolerated.

ADEQUACY

These diets may be deficient in calcium, riboflavin, and vitamin D, according to the Recommended Dietary Allowances of the National Research Council. Depending on individual tolerances and the use of milk substitutes, milk, or other dairy products, you may be able to meet these recommendations.

SPECIAL NOTES

  • Lactose is a carbohydrate. The main food source for lactose is dairy products. Reading food labels is important. Many products contain lactose even when they are not made from milk. Look for the following words: whey, milk solids, dry milk solids, nonfat dry milk powder. Typical sources of lactose other than dairy products include breads, candies, cold cuts, prepared and processed foods, and commercial sauces and gravies.

  • All foods must be prepared without milk, cream, or other dairy foods.

  • A vitamin or mineral supplement may be necessary. Consult your caregiver or Registered Dietitian.

  • Lactose is also found in many prescription and over-the-counter medicines.

  • Soy milk and lactose-free supplements may be used as an alternative to milk.

CHOOSING FOODS

Breads and Starches

  • Allowed: Breads and rolls made without milk. French, Vienna, or Italian bread. Soda crackers, graham crackers. Any crackers prepared without lactose. Cooked or dry cereals prepared without lactose (read labels). Any potatoes, pasta, or rice prepared without milk or lactose. Popcorn.

  • Avoid: Breads and rolls that contain milk. Prepared mixes such as muffins, biscuits, waffles, pancakes. Sweet rolls, donuts, French toast (if made with milk or lactose). Zwieback crackers, corn curls, or any crackers that contain lactose. Cooked or dry cereals prepared with lactose (read labels). Instant potatoes, frozen French fries, scalloped or au gratin potatoes.

Vegetables

  • Allowed: Fresh, frozen, and canned vegetables.

  • Avoid: Creamed or breaded vegetables. Vegetables in a cheese sauce or with lactose-containing margarines.

Fruit

  • Allowed: All fresh, canned, or frozen fruits that are not processed with lactose.

  • Avoid: Any canned or frozen fruits processed with lactose.

Meat and Meat Substitutes

  • Allowed: Plain beef, chicken, fish, turkey, lamb, veal, pork, or ham. Kosher prepared meat products. Strained or junior meats that do not contain milk. Eggs, soy meat substitutes, nuts.

  • Avoid: Scrambled eggs, omelets, and souffles that contain milk. Creamed or breaded meat, fish, or fowl. Sausage products such as wieners, liver sausage, or cold cuts that contain milk solids. Cheese, cottage cheese, or cheese spreads.

Milk

  • Allowed: None.

  • Avoid: Milk (whole, 2%, skim, or chocolate). Evaporated, powdered, or condensed milk. Malted milk.

Soups and Combination Foods

  • Allowed: Bouillon, broth, vegetable soups, clear soups, consommés. Homemade soups made with allowed ingredients. Combination or prepared foods that do not contain milk or milk products (read labels).

  • Avoid: Cream soups, chowders, commercially prepared soups containing lactose. Macaroni and cheese, pizza. Combination or prepared foods that contain milk or milk products.

Desserts and Sweets

  • Allowed: Water and fruit ices, gelatin, angel food cake. Homemade cookies, pies, or cakes made from allowed ingredients. Pudding (if made with water or a milk substitute). Lactose-free tofu desserts. Sugar, honey, corn syrup, jam, jelly, marmalade, molasses (beet sugar). Pure sugar candy, marshmallows.

  • Avoid: Ice cream, ice milk, sherbet, custard, pudding, frozen yogurt. Commercial cake and cookie mixes. Desserts that contain chocolate. Pie crust made with milk-containing margarine. Reduced calorie desserts made with a sugar substitute that contains lactose. Toffee, peppermint, butterscotch, chocolate, caramels.

Fats and Oils

  • Allowed: Butter (as tolerated, contains very small amounts of lactose). Margarines and dressings that do not contain milk. Vegetable oils, shortening, mayonnaise, nondairy cream and whipped toppings without lactose or milk solids added. Bacon.

  • Avoid: Margarines and salad dressings containing milk. Cream, cream cheese, peanut butter with added milk solids, sour cream, chip dips made with sour cream.

Beverages

  • Allowed: Carbonated drinks, tea, coffee and freeze-dried coffee, some instant coffees (check labels). Fruit drinks, fruit and vegetable juice, rice or soy milk.

  • Avoid: Hot chocolate. Some cocoas, some instant coffees, instant iced teas, powdered fruit drinks (read labels).

Condiments

  • Allowed: Soy sauce, carob powder, olives, gravy made with water, baker's cocoa, pickles, pure seasonings and spices, wine, pure monosodium glutamate, catsup, mustard.

  • Avoid: Some chewing gums, chocolate, some cocoas. Certain antibiotics and vitamin or mineral preparations. Spice blends if they contain milk products. MSG extender. Artificial sweeteners that contain lactose. Some nondairy creamers (read labels).

SAMPLE MENU

Breakfast

  • Orange juice.

  • Banana.

  • Bran cereal.

  • Nondairy creamer.

  • Vienna bread, toasted.

  • Butter or milk-free margarine.

  • Coffee or tea.

Lunch

  • Chicken breast.

  • Rice.

  • Green beans.

  • Butter or milk-free margarine.

  • Fresh melon.

  • Coffee or tea.

Dinner

  • Roast beef.

  • Baked potato.

  • Butter or milk-free margarine.

  • Broccoli.

  • Lettuce salad with vinegar and oil dressing.

  • Angel food cake.

  • Coffee or tea.