University of Virginia Health System

Lactose is a sugar found in dairy products.  Many adults have trouble digesting lactose and dairy products; this is often due to low levels of the enzyme (lactase) needed to break down lactose in the intestine.  Patients with intestinal disease or injury may also experience lactose intolerance.  Symptoms of lactose intolerance include nausea, bloating, gas, diarrhea or abdominal pain / cramping.  These symptoms generally occur 30 minutes to 2 hours after eating a food containing lactose.

The amount of lactose an individual can tolerate varies from person to person.  Many people with lactose intolerance can tolerate some dairy products in the diet by adjusting the type, amount and timing of these foods.  Some patients may need to (or may chose to) limit or eliminate dairy products completely. If you wish to include dairy products in your diet, the following suggestions may help.  Add new foods one at a time; decrease the amount or eliminate the food if symptoms occur.  Always talk with your doctor before making changes in your prescribed diet.

• Cultured yogurt contains a natural enzyme that helps digest lactose.  Many people with lactose intolerance tolerate cultured yogurt well.
• Hard cheese has a low lactose content and is often well tolerated.
• If you wish to drink milk, try taking small amounts (1/2 cup at a time) throughout the day.  Many people can tolerate up to 2 cups of milk per day when taken in smaller servings spread out over the course of the day.
• Dairy products may be better tolerated if they are eaten with a meal.

If you are not able to tolerate dairy products using the above suggestions, special products are available for patients with lactose intolerance.   These include lactase supplements that can be taken with dairy products (available in caplet and chewable form) and ready-to-drink 100% lactose reduced milk (available in the dairy section).  See the reverse side of this handout for more details.

Studies have shown that individuals with lactose intolerance often do not take in enough calcium and vitamin D.  Inadequate calcium and vitamin D intake increases the risk of osteoporosis in later life.  A nutritionist can help you determine whether you are getting enough of these nutrients in your diet.

Specialty Products

A variety of specialty products are available for individuals with lactose intolerance.  Keep in mind, not everyone with lactose intolerance needs special products; many can tolerate regular dairy products by adjusting the type and amount.  You may want to try the tips given on the reverse side of this handout before adding the cost of specialty products. 

Lactase Enzyme Supplements

These products contain the enzyme lactase, which is needed for the digestion of dairy products, but often lacking in the intestine of those with lactose intolerance.

• Available in caplet or chewable form.   
• Lactase enzyme supplements may not be needed with some dairy products, such as cultured yogurt and cheese.
• Most products recommend a dose of 9000 lactase units be taken with each dairy product.  This amount may not always be needed; you may want to start with a smaller dose and increase only if symptoms persisit.

100% Lactose Reduced Milk

• 100% lactose reduced milk is available in the dairy section of most grocery stores. 
• Available in nonfat, 1%, 2%, and whole milk varieties. 
• Lactose reduced milk contains the same nutrition, including calcium and vitamin D as regular milk.
• The cost of lactose reduced milk is approximately 39 cents per cup compared to 17-29 cents per cup of regular milk.

Vitamite 100 is a non-dairy, lactose free milk alternative also available in the dairy section of grocery stores.  It contains calcium and vitamin D in levels similar to milk, but is lower in protein (3 grams per serving compared to 9 g per serving in regular milk).

Soy milk and rice milk are lactose free.  If you plan to use soy or rice milk as an alternative calcium and/or vitamin D source, read labels carefully and choose a brand which specifically states it contains these nutrients (and in what amount).