Overview

In a world where our favourite culinary delights revolve around creamy sauces, cheesy concoctions, and decadent desserts, abstaining from dairy may seem daunting. But for millions of people, navigating lactose intolerance isn’t a matter of preference but a dietary reality. Presenting unpleasant and annoying symptoms, lactose intolerance affects not only meal choices but also quality of life.

Let’s delve into the domain of lactose-free diets, trying to intertwine careful dietary choices with a desire for culinary satisfaction. In this changing world with constant advancements and innovations, the prospect of adhering to a lactose-free diet may not be as difficult as it initially appears.

What is lactose intolerance?

Lactose intolerance is a condition characterised by the inability to digest lactose, the sugar in milk and other dairy products. This occurs due to a deficiency in the production of the enzyme responsible for the digestion of lactose, known as lactase.¹ Lactose is composed of two different molecules of sugar.

Therefore to be absorbed by the body and used as an energy source, the lactase enzyme must break it down into two different sugar molecules during digestion. In individuals with sufficient lactase enzyme, lactose is efficiently broken down into its constituent sugars, which can be absorbed and used as energy.

However, lactose cannot be broken down in those with lactose intolerance, and undigested lactose passes through the gut without being absorbed, resulting in symptoms such as abdominal pain, bloating or diarrhoea.² Lactose intolerance can vary in severity among individuals, depending on how much lactase they can produce and the produce. Some people may experience only mild discomfort, whereas others may have a more severe lactase deficiency and, therefore more severe symptoms.

Causes of lactose intolerance

In most individuals, lactase production is at its highest during infancy, allowing for efficient breast milk or formula digestion in early childhood. However, as many of us age, lactase production can decline, leading to lactose intolerance symptoms later in life.

Lactose intolerance can also occur as a result of another illness or injury affecting the small intestine, where lactase is produced, and once the underlying condition is treated, lactase production may resume, and symptoms of lactose intolerance may diminish. Rarely, lactase production may be absent from birth due to a genetic condition, leading to lifelong intolerance to lactose, even from consuming breast milk/formula.³

Diagnosis of lactose intolerance

If you have gastrointestinal symptoms such as abdominal pain, bloating or diarrhoea that typically happen after eating, speak to a healthcare professional so you can be tested for lactose intolerance. This could include carrying out a hydrogen breath test to measure the amount of hydrogen gas in your breath, which can determine how well you digest lactose.

Lactose-free diet

If you have been diagnosed with lactose intolerance, you can prevent symptoms by reducing or avoiding foods that contain lactose. Depending on the severity of your lactose intolerance, you may be advised by your healthcare professional to follow a low-lactose diet or a completely lactose-free diet. This can improve digestion and reduce gastrointestinal discomfort, providing relief from symptoms such as abdominal pain, bloating and diarrhoea.

Foods to avoid in a lactose-free diet

Lactose is found in foods which contain dairy products, which include milk from cows, goats and sheep. Dairy products include milk, cheese, butter, cream, yoghurt and ice cream. Additionally, many processed foods have hidden sources of lactose that you may not realise, for example, cereals, sauces, salad dressings and baked goods, therefore it is crucial to read food labels carefully and identify lactose-containing ingredients. If you have been advised to follow a lactose-free diet, avoid all foods which contain any of the following in the ingredients list:

If a food contains dairy products, they will be bold, underlined, or highlighted in the ingredients list, making them easier to identify. Vegan foods are lactose-free by default since they do not contain dairy. Refer to the Allergy UK guide for further information about foods to avoid for lactose intolerance.

Lactose-free alternatives

There are various lactose-free alternatives available to replace dairy milk products, which can provide a similar taste and nutrition benefits without causing gastrointestinal discomfort:

• Plant-based milk: For example, soy milk, almond milk, coconut milk, and oat milk, are all dairy free. These milks can lack the nutrients found in dairy milk such as calcium, vitamin D, and protein, therefore opt for fortified plant-based kinds of milk which have had these nutrients added in to prevent nutritional deficiencies⁴
• Lactose-free milk: This is cow’s milk that has been treated with the lactase enzyme, so the lactose is already digested. This makes it easier to digest for those with lactose intolerance and still provides the same nutrients found in regular milk⁵

Meal planning

Planning recipes and cooking when following a lactose-free diet can seem a challenge, but with the large market of dairy alternatives and lactose-free products, careful planning and selection of ingredients can allow you to create delicious and nutritious lactose-free meals. Focusing on whole foods and building meals around minimally processed ingredients such as fruits, vegetables, whole grains and lean meats makes it easier to avoid hidden lactose in many pre-packaged products.

Following the Eatwell Guide by the NHS is a good place to start to help you plan balanced, filling and nutritious meals and ensure you are getting enough of all the essential nutrients in your diet, whilst swapping the recommended dairy products with lactose-free alternatives.

Managing nutritional needs

The removal of all dairy products from the diet can lead to nutrient deficiencies because cow's milk is a major source of calcium, vitamin B12, vitamin D, protein and other nutrients. Crucially, dairy products can contribute approximately 72% of calcium in the diet, which is needed for healthy bones, therefore eliminating dairy products could compromise bone health. Lactose-free milk is therefore recommended, to ensure the nutritional benefits of dairy products can be gained without the intake of lactose.⁶

Additionally, choose plant-based milks that have been fortified with calcium, and incorporate non-dairy sources of calcium in your diet for example leafy green vegetables such as kale, canned fish with bones such as salmon and sardines and fortified flours.⁷

Re-introduction of lactose

Under the guidance of a healthcare professional, you may wish to reintroduce lactose into your diet after finding relief from symptoms on a lactose-free diet. This can involve gradually introducing foods with a low lactose content and observing and monitoring symptoms to check that the lactose is being tolerated.

This can give the body time to adapt, and potentially begin to produce more of the lactase enzyme over time. However, this must be approached with caution and under the guidance of a healthcare professional, and if symptoms persist, lactose must be eliminated again.⁹

Low lactose diet

You may be advised to follow a low-lactose diet, rather than completely eliminating all lactose. Whilst all dairy products will have some amount of lactose, certain options will have less lactose than others. For example, ricotta is a cheese with a very high lactose content, whereas cheddar has a relatively low lactose content and, therefore may be tolerated by someone with lactose intolerance.

Refer to this guide by the NHS for more information regarding the amount of lactose in different dairy products to understand which may be tolerated in a low lactose diet, and how much of different lactose products may be consumed.

Lactase enzyme supplementation

If you are advised to follow a low lactose diet and still consume some lactose, oral lactase supplements can be taken with lactose-containing meals to reduce the symptoms experienced after eating by facilitating the breakdown of lactose in the digestive system.⁸

Difference between milk allergies and lactose intolerance

It is important to note the difference between lactose intolerance and an allergy to milk. Whilst lactose intolerance causes gastrointestinal symptoms such as abdominal pain when lactose is consumed, if an individual has a milk allergy and milk is consumed, it can be much more serious and anaphylaxis can occur, which can be life-threatening.

Additionally, individuals with lactose intolerance only need to avoid the lactose found in dairy products, therefore if this lactose is removed, they can still consume dairy products. However, in milk allergies, individuals are allergic to different proteins in the milk and cannot consume any dairy products at all.¹⁰

FAQs

What is lactose intolerance?

The inability to digest lactose, which is found in dairy products, due to a lack of the enzyme lactase. This causes gastrointestinal symptoms such as abdominal pain and diarrhoea. 

What foods contain lactose?

Dairy products such as milk, cheese, butter, cream, yoghurt and ice cream

What is a lactose-free diet?

Avoiding all foods which contain lactose to reduce symptoms of lactose intolerance. 

How can I ensure my diet is still balanced on a lactose-free diet?

Opt for dairy products that have had the lactose removed to still get the nutritional benefits of dairy, such as calcium, protein, and vitamins D and B12. Additionally, choose fortified milk and include non-dairy sources of calcium in your diet. Use the NHS Eatwell guide to plan balanced meals.

Summary

Lactose-free diets are recommended for individuals with lactose intolerance, which is the inability to digest lactose due to a deficiency in lactase production, causing symptoms such as abdominal pain, bloating and diarrhoea. Lactose is found in dairy products from cows, sheep, and goats, including milk, cheese, yoghurt, cream, butter and ice cream, as well as many processed foods, therefore it may seem challenging at first to eliminate all these foods from your diet.

However, with the rise of plant-based options, the development of lactose-free milk and careful planning and selection of ingredients, a lactose-free diet may be successfully managed to reduce the symptoms associated with lactose intolerance.