LACTOSE INTOLERANCE

Mount Sinai School of Medicine

Department of Gastroenterology

What is lactose intolerance?

• Lactose, the sugar found in milk, needs an enzyme called lactase in order to be digested and absorbed.
• Those with lactose intolerance are lacking in this enzyme and are unable to properly digest certain
amounts of lactose, which may result in symptoms such as diarrhea, gas, and bloating after consuming
dairy products1.

Why dairy is an important part of our diet:

• According to the 2020 Dietary Guidelines for Americans, it is recommended that adults and children
consume 3 servings of low-fat or fat free dairy products daily as part of a healthy diet.
• Dairy products are a good source of calcium and vitamin D, which are important for maintaining bone
health. Many Americans are not getting enough calcium and vitamin D in their diet3.
• Having lactose intolerance does not require the avoidance of all dairy products. Many dairy foods are
actually very low in lactose and may be easily digested by those with lactose intolerance4,6.

Dietary management tips for lactose intolerance:

• Low-lactose dairy foods may be tolerated by those
with lactose intolerance4,6 (see “Calcium Content of Low-Lactose Foods” handout for suggestions).
• Lactase enzyme pills sold at pharmacies can be taken before eating dairy foods high in lactose1.
• Try lactose-free cow’s milk products like Lactaid®1.
• If dairy must be avoided, be sure to incorporate other food sources of calcium into your diet, such as
nondairy replacements that are fortified with calcium and vitamin D2.
How to reintroduce dairy back into your diet:
• Start with one dairy food at a time, in small amounts, and without other foods. For example: 1/2 cup
milk, 1-2 oz. cheese, 2 tbsp cream cheese, 1/3 cup cottage cheese.
• A food journal may be helpful in keeping track of which foods trigger symptoms.
• Once small amounts are tolerated, gradually increase serving size and enjoy with other food groups.

Resources:
1. Dai, N., Deng, Y., Fox, M., & Misselwitz, B. (2015). Lactose intolerance in adults: Biological mechanism and dietary
management. Nutrients,7(9), 8020-8035. doi:10.3390/nu7095380
2. Duchateau, A. L., Hilten, P. H., Scheppingen, W. B., & Vijverberg, M. P. (2017). Selective and sensitive determination of lactose in low-
lactose dairy products with HPAEC-PAD. Journal of Chromatography B,1060, 395-399. doi:10.1016/j.jchromb.2017.06.024
3. Heaney, R. P. (2013). Dairy intake, dietary adequacy, and lactose intolerance. Advances in Nutrition,4(2), 151-156.
doi:10.3945/an.112.003368
4. Kimball, M. (2012, July 13). Some dairy products may be OK for the lactose intolerant. Retrieved from
https://www.nola.com/health/index.ssf/2012/07/some_dairy_products_may_be_ok.html
5. Mishkin, S. (1997). Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. The American Journal
of Clinical Nutrition,65(2), 564-567. doi:10.1093/ajcn/65.2.564
6. Mattar R, Ferraz de Campos Mazo D, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and Experimental
Gastroenterology. 2012;5:113-121. doi:10.2147/ceg.s32368.
7. Images from: https://www.thrillist.com/eat/nation/lactose-intolerance-diet-the-best-cheeses-to-eat-if-youre-lactose-intolerant#
 CALCIUM CONTENT OF LOW-LACTOSE FOODS
Mount Sinai School of Medicine
Department of Gastroenterology

The recommended daily value of calcium for adults is 1,000-1,200mg per day.

Food Group Food Item Serving Size Calcium Content

Low-Lactose Dairy Yogurt 8 oz 275-450 mg
Kefir 12 oz 300 mg
Butter 1 Tbsp 3 mg
Cheddar 1 oz 200 mg
Swiss 1 oz 220 mg
Brie 1 oz 52 mg
Camembert 1 oz 110 mg
Feta 1 oz 145 mg
Parmesan 2 Tbsp 110 mg
Goat cheese 1 oz 84 mg
Mozzarella 1 oz 205 mg
Lactose-free Milk Lactose-free cow’s milk (i.e. 1 cup 500 mg
Products & Nondairy Lactaid® Calcium Enriched)
Alternatives Lactose-free yogurt (i.e. ¾ cup 250 mg
Green Valley Organics®)
Dairy-free creamer 1 Tbsp 25 mg
Calcium & vitamin D 1 cup 250 mg
fortified almond, hemp, rice,
coconut or soy milks
Calcium fortified vegan 1 slice 250 mg
cheeses (i.e. Go Veggie®)
Nondairy Foods High Sardines 3 oz 325 mg
in Calcium Canned salmon 3 oz 180 mg
Calcium-fortified tofu ½ cup 430 mg
Beans & peas ½ cup 50-100 mg
Dried figs 5 each 135 mg
Collard greens ½ cup 135 mg
Turnip & bok choy greens ½ cup 100 mg
Calcium fortified instant 1 packet 110 mg
oatmeal
Resources:

1. Kimball, M. (2012, July 13). Some dairy products may be OK for the lactose intolerant. Retrieved from
https://www.nola.com/health/index.ssf/2012/07/some_dairy_products_may_be_ok.html
2. Mattar R, Ferraz de Campos Mazo D, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clinical and Experimental
Gastroenterology. 2012;5:113-121. doi:10.2147/ceg.s32368.
3. Calcium Content of Foods. eat right. Nutrition Care Manual. www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=139.