Download ALTERNATIVES - Beth Israel Deaconess Medical Center

Lactose-restricted diet
Your doctor has prescribed a lactose-restricted
diet. Please follow these guidelines as you
plan your diet. If you have any questions,
please call our nutrition clinic for help.
 If you have questions….
Please call our nutrition clinic at:
617- 667- 2565
What is lactose?
Lactose is a natural sugar found in milk and in foods made from milk such as ice cream,
yogurt, cheese, and butter. Many baked products and processed foods also contain
lactose. Lactose is a so-called “complex sugar.” In order for it to be used by the body, it
must be split into two “simple” sugars – glucose and galactose. An enzyme called
lactase is needed for this breakdown. The lactase enzyme splits the lactose so that its
sugars can be used by the body.
What is lactose intolerance?
Lactose intolerance is a condition in which there is problem digesting lactose in the diet.
It occurs when there is not enough of the lactase enzyme to split all the lactose a person
takes in. This leaves some of the lactose undigested. Undigested lactose draws fluid into
the digestive tract. This extra fluid can cause diarrhea. In addition, bacteria that are
normally present in the colon begin to use the undigested lactose as food, producing
hydrogen gas as a by-product. This causes bloating and gas.
A person is said to be lactose intolerant if nausea, abdominal cramping, bloating, gas,
and/or diarrhea occur 30 minutes to two hours after consuming milk, milk products, or
foods prepared with milk.
What causes lactose intolerance?
Lactose intolerance is caused by a deficiency of the lactase enzyme. There are three
types of lactase deficiency that can cause lactose intolerance.
Primary lactase deficiency
The most common type is primary lactase deficiency. It is caused by a gradual decrease
in lactase production after the age of two years. Members of certain ethnic groups are
prone to this type of lactose intolerance. People who have primary lactase deficiency
often have enough lactase during infancy and early childhood. But by adolescence,
symptoms of lactose intolerance appear.
By adulthood, at least ½ to ¾ of African and American blacks, as well as Arabs,
Israelis, and Asians are lactase deficient. Among Caucasians of northern European
ancestry, lactase deficiency is less frequent, occurring in only 5 to 20 % of young
adults.
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Secondary lactase deficiency
Some diseases can cause damage to the lactase-producing cells in the intestines, causing
a lactase deficiency. This is known as secondary lactase deficiency. Examples include
celiac sprue and inflammatory bowel disease. In some cases, treating the underlying
disease will result in an improvement of lactase production and normal lactose
digestion. In other cases, symptoms of lactose intolerance remain indefinitely.
Secondary lactase deficiency can also occur when the digestive tract has not been used
for a long time. This sometimes occurs during prolonged or critical illness, when
patients are given nutrition by vein instead of into the digestive tract. In most cases, this
type of condition is temporary. Normal lactose digestion slowly returns after the person
begins eating and drinking again.
Congenital lactase deficiency
A rare condition known as congenital lactase deficiency can cause lactose intolerance
from birth. Babies born with this disorder have little or no ability to produce lactase. All
lactose-containing foods must be eliminated from the diet.
How is lactase deficiency diagnosed?
Currently, two methods of diagnosing lactase deficiency are used: the hydrogen breath
test and the lactose tolerance test.
Hydrogen breath test
The hydrogen breath test is the most common way to identify people who are lactase
deficient. A person drinks a lactose solution, then breathes into a balloon. A special
apparatus called a gas chromatograph measures the amount of hydrogen in the expired
breath. A high level indicates lactase deficiency.
Lactose tolerance test
Another method of diagnosing lactase deficiency is the lactose tolerance test. A person
drinks a lactose solution, and blood samples are taken at various intervals. If the
digestion of lactose is normal, the lactase enzyme will begin to split the lactose into
glucose and galactose shortly after it is consumed. The blood tests will show a rise in
blood glucose. In lactase deficient individuals, the lactose is not digested, so the blood
glucose does not increase.
What is the treatment for lactose intolerance?
Although lactose intolerance cannot be cured, most patients can learn to control their
symptoms and maintain good nutrition. There are three aspects to most lactose
intolerance treatment plans:
1. Control the amount of lactose in the diet. Not everyone with lactose
intolerance is the same. You may be able to tolerate a certain amount of
lactose in the diet, or to tolerate certain foods better than others. For a while,
you will need to pay attention to what you are eating and how you feel. That
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Sources of lactose: Remember,
check food labels see if any of these
ingredients appear.
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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 or other
medications, prescription and nonprescription – ask your pharmacist
for further information
will help you decide how much lactose
your system can tolerate. As you are
learning, remember:
 The main sources of lactose are
listed in the box to the left. Be aware
that prepared foods can also contain
lactose. Read food labels carefully to
see if milk, cheese, or other lactosecontaining ingredients have been
added.
 In the most severe cases of lactose
intolerance, such as during acute
phases of Crohn's or celiac disease,
patients usually cannot take in any
lactose at all. In many cases, lactose
foods may be slowly introduced
later, when the acute phase of illness
has passed.
 To find out what lactose foods your
body can tolerate, start with small
amounts of low-lactose foods. Aged
cheeses, such as cheddar and Swiss,
are very low in lactose. If you can
eat these foods without feeling sick,
try a small amount of a cultured milk product, such as yogurt.
Eventually, you will learn what foods you can consume in small
amounts, and what foods are best to leave out of your diet completely.
 Remember, whatever your own pattern turns out to be, keep servings of
milk or milk products small. Many people are able to take in a small
portion of a milk product, such as 1 oz. or ½ cup, with each meal and
snack. This is one way to make sure you get the important nutritional
benefits of dairy products without feeling sick.
2. Make sure you get enough calcium in your diet. Milk and milk products
are a main source of calcium – an important nutrient in your diet. If you are
taking in less milk, you will want to make sure to get enough calcium in
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other ways. Foods high in calcium are listed in the box below. In some
cases, your doctor or dietitian will recommend that you take a calcium
supplement to make sure you are
Lactose-free sources of calcium
getting the calcium you need.
3. Use special products. A number
of products are available that can
help people with lactose
intolerance. For example,
Lactaid® milks and cheeses
contain reduced lactose. Lactaid®
100 milk is 100% lactose free.
Other varieties may have some
lactose.
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broccoli
collard greens
kale
turnip greens
Chinese cabbage
sardines with bones
salmon with bones
shrimp
oysters
blackstrap molasses
tofu, processed with calcium salts
Additional products, such as
lactase enzyme tablets, can be taken with lactose-containing foods to help
with digestion. Lactaid Ultra® is a convenient choice for many people. Have
one to three tablets with your first bit of dairy food. The tablets work
naturally to help your body digest the food.
Soy and almond milk products, such as yogurt and cheese, are another
option to explore. Sorbet is a delicious alternative to ice cream and does not
contain lactose. In addition, Kosher foods that are labeled “pareve” do not
contain milk or milk products.
This material was prepared by clinicians from the department of nutrition services at Beth Israel Deaconess Medical Center.
It is produced and distributed by The Beth Israel Deaconess Learning Center. ©2008 Beth Israel Deaconess Medical Center.
All rights reserved.
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Food choice guidelines for lactose intolerance
Remember, no two people with lactose intolerance are the same. Experiment with small portions to
find the food choices that are best for you.
Milk and milk
products
Breads and cereals
Potato and potato
substitutes
Foods allowed (low lactose or
lactose-free)
Foods to avoid, or to take in
moderation (high lactose)
Soybean and other lactose-free
dietary supplements or formulas such
as Boost; soy milk; non-dairy
creamers made without lactose, such
as Coffee Rich and Poly Rich;
imitation cream cheese and other
non-dairy imitation cheeses
Milk and milk drinks in excess of the
amount that you can tolerate,
including whole, skim, dried and
evaporated (except those treated with
Lactaid); yogurt; cheeses; cottage
cheese; ice cream; puddings; custards;
junket; sherbet; supplements and
formulas containing milk or lactose
Breads made without milk, such as
French or Italian bread; water bagels;
pareve breads; matzohs; graham
crackers; saltines; soda crackers;
Syrian bread; most cooked and dry
cereals made without lactose or milk
solids
Bread products made with milk or
milk solids; prepared mixes; crackers
made with butter; any baked product
made with milk; muffins; biscuits;
pancakes; waffles; donuts; sweet
rolls; zweiback; cereal products made
with milk solids or lactose, such as
instant cream of wheat
Potatoes; all enriched grain products,
such as noodles, rice, spaghetti,
macaroni, pasta or others prepared
without milk or cheese
Potato or potato substitutes prepared
with milk or milk products (i.e.
mashed potatoes)
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Foods allowed (low lactose or
lactose-free)
Foods to avoid, or to take in
moderation (high lactose)
All cooked, canned, frozen, or fresh
vegetables; all vegetable juices
Vegetables prepared with milk, milk
products, or cream sauces
All fruits and fruit juices
None! You may enjoy all the fruits
and fruit juices you like.
Meats and meat
substitutes
All meats, poultry, fish; kosher cold
cuts; eggs; legumes; peanut butter;
kosher frankfurters
Meats, poultry, fish or meat
substitutes prepared with cheese or
cream sauces; breaded meat, fish, or
poultry; cold cuts that are not kosher
Fats/0ils
Kosher pareve margarine (for
example, Mother's Margarine);
vegetable oils and shortening; salad
dressings not containing lactose;
pure mayonnaise; lard; bacon; nuts;
olives; gravies prepared without milk
or milk products
Broth-based soups; any soup
prepared without milk or milk
products
Cream; salad dressings made with
milk or milk products; sour cream;
butter; margarine made with milk
solids; milk-based gravies
Beverages (nondairy)
Coffee, tea; decaffeinated coffee,
soft drinks and carbonated beverages
Cocoa and hot drink mixes; powdered
fruit drink containing lactose
Desserts/sweets
Any made without milk or milk
products, such as gelatin desserts,
water ices, fruit pies, angel cake,
fruit crisp; pudding and custard made
with Lactaid milk
All spices, herbs, and other
condiments; sugar; honey; molasses;
maple syrup; corn syrup; jelly; jam;
hard candy; gum; gum drops;
marshmallows; artificial extracts and
flavorings
Commercial desserts and baking
mixes; desserts prepared with milk,
milk products, or milk chocolate, such
as ice cream, custard, puddings,
junket, sherbet, or ice milk
Chocolates or other candies that
contain milk or lactose
Vegetables and
vegetable juices
Fruits and fruit
Juices
Soups
Miscellaneous
All creamed soups; chowders; cheese
soups
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