KEY POINTS:

  • Lactose is the natural sugar present in milk (dairy) and in foods made from milk, such as yogurt, ice cream, cheese and butter. In patients with newly diagnosed celiac disease, lactose intolerance is very common because the enzymes (lactase) that digest milk sugar (lactose) are found along the lining of the small intestine where the damage in celiac disease occurs. 1 Since the damage is caused by gluten, a gluten-free diet heals the intestines. In many people, lactose may be slowly added back into the diet.
  • Lactose intolerance is also common in the general population, especially in older individuals and people from certain non-European ethnicities .
  • Symptoms of lactose intolerance range from mild to severe depending on the amount of lactose consumed and the amount a person can tolerate. Generally, these symptoms occur between 30 minutes to 2 hours after consuming milk and milk products.
  • Common symptoms include: 2,3,4
    • abdominal pain
    • abdominal bloating
    • gas
    • diarrhea or loose stools
    • nausea
    • Some people may experience constipation.
  • Trialing a low-lactose diet at home for a short time with improved symptoms can indicate lactose intolerance. To clinically diagnose the condition, your doctor may suggest a Lactose-Hydrogen Breath Test. 2
  • No two people with lactose intolerance are the same. Some people may need to eliminate lactose entirely while their gut is healing. Sometimes lactose needs to be temporarily restricted after a stomach illness or virus.

    Most people produce at least a small amount of lactase which means that they may be able to control their symptoms on a low-lactose diet rather than avoid lactose-containing products completely.

If you are able to tolerate a small amount of lactose, consider the following:

Examples_Low_Lactose

    • Pay attention to how much lactose you are eating and how you feel. It may help to keep a log of food/ beverage intake and symptoms. Click here to download a blank log to track your intake.
    • Educate yourself on the main sources of lactose. See the Ingredient Sources of Lactose chart below.
    • Many prepared foods, such as soups, flavored snacks and deli meats, can contain lactose. Read ingredient lists carefully.
    • Learn how much your body can tolerate by starting with small amounts of low-lactose foods. See the Low Lactose Foods chart below.
    • Notice which foods you can consume in small amounts and which you need to avoid completely.
    • Consider using special products, like Lactaid® milks and cheeses, which are lactose free. Some people also benefit from lactase enzyme tablets which are designed to be taken with lactose-containing foods and help with digestion.4 Be sure to purchase gluten-free lactase enzyme tablets.
  • If you are limiting or avoiding milk products, your body could be lacking certain nutrients (such as calcium and vitamin D).5 Therefore, non-dairy foods high in calcium should be added to your diet. There are very few vitamin D-rich food sources in the American diet. Lactose-free, gluten-free food sources of calcium and vitamin D are listed in Level 2.
Vit_D_and_Calcium
  • Ask your doctor or dietitian to give you an estimate of your daily recommended intake of calcium and vitamin D and use supplements, when necessary, to meet your needs.
  • Sometimes people with lactose intolerance notice that other carbohydrate-based foods or ingredients also bother them. Some examples include corn syrup, high fructose corn syrup, soda, candy, apples, pears, grapes, honey, asparagus, onions, garlic, and soybeans, to name a few.

TAKE HOME MESSAGES:

  • Lactose intolerance is very common in the celiac population.
  • If you have removed all the gluten from your diet and you are still having symptoms, you may have lactose intolerance.
  • While you may need to temporarily limit your intake of lactose while your intestinal villi are healing, you usually do not have to avoid it completely.
  • Talk to your doctor or dietitian about calcium and vitamin D supplementation if you are on low-dairy diet.
dairy

INGREDIENT SOURCES OF LACTOSE:

CHECK FOOD LABELS TO SEE IF ANY OF THESE INGREDIENTS APPEAR
Milk
Cheese
Yogurt
Ice cream
Butter
Margarine
Buttermilk (may cause fewer symptoms in some people)
Sweet acidophilus milk
Milk chocolate
Cold cuts
Hot dogs
Cream
Some sweeteners
Dried or powdered milk
Milk solids
Lactose
Whey
Curds
Caseinate
Lactoglobulin
Some vitamins, supplements or other medications contain lactose (prescription and non-prescription): read ingredients and ask your pharmacist for further information

Reference: Lactose-restricted diet. Nutrition Services, Beth Israel Deaconess Medical Center, ©2008.

LOW-LACTOSE FOODS
Lactaid® milk
Kefir
Low-lactose cheeses: Parmesan, Swiss, hard Cheddar, Romano
Yogurt with live, active cultures
Sheep's milk*
Goat's milk*
*These milks contain less lactose than cow's milk and may be better tolerated by a person with lactose intolerance.
 

References:

  1. Dennis M, Barrett J. Malabsorption of Fructose, Lactose, and Related Carbohydrates. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler, D. AGA Press. Bethesda, MD, 2010.
  2. Lactose Intolerance. National Digestive Diseases Information Clearinghouse.http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/ . Accessed May 2, 2011.
  3. Crowe S. Food Allergies and Intolerances. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press. Bethesda, MD, 2010.
  4. National Institutes of Health Consensus Development Conference: Lactose Intolerance and Health. Ann Int Med. 2010;152(12):792-798.
  5. Lactose-restricted diet. Nutrition Services, Beth Israel Deaconess Medical Center, ©2008.
  6. Lactose Intolerance- Topic Overview. WebMD. http://www.webmd.com/digestive-disorders/tc/lactose-intolerance-topic-overview . Accessed May 2, 2011.

Revision Date: 8-23-12 
Author: Melinda Dennis, MS, RD, LDN and Annie Peer 
Editors: Suzanne Simpson, RD and Daniel Leffler, MD, MS

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