Living with lactose intolerance
People who are lactose intolerant are still able to eat and drink small amounts of dairy products – preferably together with other foods. So far there is no scientific proof that lactase products and probiotic dietary supplements help to digest lactose better.
Most people who are lactose intolerant have no or almost no symptoms when they eat or drink small amounts of lactose. Symptoms can also be milder if the dairy products are consumed together with other foods. That's because solid or fatty foods slow down the digestion process in the stomach. A smaller amount of lactose then enters the intestine in one go, and the intestine reacts less sensitively.
Research suggests that some people can tolerate lactose better if they carefully and gradually increase the amount of lactose in their diet. But more research is needed to be sure if this is true.
How much lactose can lactose-intolerant people have?
Researchers have found that lactose-intolerant people can usually tolerate the following amounts:
- Up to 12 g of lactose at once (about 250 ml of milk)
- Up to 24 g of lactose spread out across the day (about 500 ml of milk)
This means that most lactose-intolerant people can eat a certain amount of dairy products without having any symptoms. But it's important to spread this amount out throughout the day rather than eating it in one go, and eat lactose-containing foods together with other foods.
How can I adapt my diet?
The symptoms can usually be relieved by eating fewer high-lactose dairy products. This isn't a problem for people who don't like milk, cream cheese, or cream very much anyway. But others will find it difficult at first to eat less dairy or none at all – even if tastes sometimes change over time. It can be particularly hard to adjust to a special diet if the rest of your family and friends continue to eat as normal.
But replacing high-lactose dairy products with some that contain less lactose is usually enough to make a difference. Fermented dairy products such as cheese, quark, or yogurt contain less lactose than fresh milk, for example. Many hard cheeses contain no lactose or almost no lactose. And a lot of lactose-intolerant people tolerate certain kinds of yogurt better than others.
Worries about your own nutrition or concerns about whether particular meals will cause problems can make things worse. But over time it will get easier to tell what you are able to eat. Learning to understand ingredient lists on food labels can help make you feel more confident – if the list has the information you need, such as lactose in grams per serving.
Dealing with lactose intolerance eventually becomes a normal part of daily life for most people who have it. More vegan – and therefore also lactose-free – foods are becoming available because the demand is increasing. The same is true of milk substitutes like soy, almond, and rice milk. These purely plant-based drinks taste similar to milk, but are completely lactose-free. Some of these products also contain added calcium. The number of available dairy-free recipes is increasing too.
Are there any other options besides cutting out dairy products?
Some cow's milk products are available with reduced lactose content or have been hydrolyzed. Reduced-lactose milk is made by filtering out the lactose, or by using a device called a chromatograph to separate the lactose from the rest of the milk. In hydrolyzation, the enzyme lactase is added to the milk.
These kinds of milk are more expensive than cow's milk and usually still contain some lactose, so it's important to read the information on the packaging very carefully.
One systematic review found that people who drank lactose-reduced milk (less than 2 g of lactose per glass) did not have fewer symptoms than people who drank normal milk (up to 12 g of lactose per glass). This is probably because most lactose-intolerant people can tolerate up to 12 g of lactose anyway, or only have mild symptoms after consuming this amount.
Other products like lactase tablets or capsules aim to help the bowel break down lactose. Even though many claims are made about the effectiveness of these products, research hasn't shown that lactase tablets or capsules help.
There has also been research on prebiotics and probiotics (bacteria in the bowel that help digest food). Some dietary supplements contain these bacteria too. It is not yet clear whether any of these help in lactose intolerance.
Overall, the research results show that trying to reduce the amount of lactose in your diet as described above – and only eating and drinking dairy products together with other foods – is still the best known way to reduce the symptoms of lactose intolerance.
Can cutting out dairy lead to a calcium deficiency?
Dairy products are not an essential part of a balanced diet. But they do contain a lot of calcium. This mineral is an important nutrient and is needed for things like strong bones, teeth, and nails. Young people, pregnant women and older people need higher amounts of calcium. People who eat and drink less dairy, or none at all, get less calcium in their diet too. But calcium isn't only found in dairy products. Other foods and drinks are also rich in calcium, such as spinach or calcium-enriched soy milk.
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Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL et al. Systematic review: effective management strategies for lactose intolerance. Ann Intern Med 2010; 152(12): 797-803.
Wilt TJ, Shaukat A, Shamliyan T, Taylor BC, MacDonald R, Tacklind J et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep) 2010; (192): 1-410.
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