Eat to beat lactose intolerance

Can't drink milk? Get tummy pains and bloating when you eat dairy? Around one in every 10 Australians suffers from lactose intolerance, a condition where they are unable to digest dairy foods, mainly milk. If they drink too much milk, they end up with pain, bloating, wind and even diarrhoea. Here are ways to help sufferers. 

What is lactose intolerance?

Lactose is a sugar naturally occurring in milk. Lactose intolerance occurs when the body is unable to digest this sugar because of an insufficiency of an enzyme in the small intestine that breaks down the sugar allowing it to be absorbed.

It is most common among Asian, Aboriginal, Mediterranean, Middle Eastern and Maori adult populations and tends to be less common in those of northern European descent.

However it can also occur short term whenever the digestive tract is affected, say after a bout of gastroenteritis or in certain illnesses like coeliac disease or HIV infections.

Don't confuse it with milk allergy which occurs via a different biological mechanism involving the body's immune system. 

What is lactose?

Lactose is a sugar and is made up of two simple sugars glucose and galactose. It is a natural component of the milk of all mammals including cows, goats, sheep and also of humans (breast milk). 

Good news for sufferers

One of the most common misconceptions about intolerance to lactose is that it means no more dairy. The good news is that milk and other dairy foods - important sources of protein, calcium and B vitamins - don't need to be completely eliminated. Research shows that most people with low enzyme levels can have up to two glasses of milk, with meals every day, without symptoms of lactose intolerance.

Start small. Work out your own tolerance by trying one quarter of a glass of milk and gradually increasing your intake.

7 tips to manage lactose intolerance

1. Initially cut out those foods which are high in lactose like milk, custard, yoghurt, white sauce and desserts made from milk (see download below). They can be gradually re-introduced once your system has settled down. The tiny traces of lactose in margarine, bread, cracker biscuits and milk chocolate are usually not a problem.
2. Eat lactose-containing foods as part of a meal rather than on an empty stomach. Milk with your cereal and fruit may pose no problem but a strawberry milkshake on its own can give you bloating and upset tummy.
3. Reduce the amount of lactose-containing foods you eat at any one time. Eating ‘a little often' is likely to be better tolerated that a large quantity from time to time.
4. If you are really sensitive, stick to low and moderate lactose foods like cheeses and ice cream (see download). Avoid milk.
5. Look for ‘lactose-free' or ‘lactose-reduced' milks at your supermarket.
6. Try regular milk instead of skim - it has a slightly lower lactose level (see download).
7. Yoghurt may be better tolerated than milk as it's ‘pre-digested'. Around 30% of its lactose has been broken down to lactic acid and the friendly bacteria present actually produce the enzyme that splits lactose. 

What about calcium?

If you eliminate ALL milk, yoghurt and cheese from your diet, you're eliminating the major source of calcium. So a calcium supplement is a good idea, particularly for children or pregnant women. Adults require 1000mg a day, while children range from 700 to 1200mg.

Look for a supplement that will give you at least 600mg of ‘elemental' or pure calcium per day. Check the label - the quantity of pure calcium should be listed, not just the amount of calcium carbonate or calcium gluconate. Take them at night as calcium uptake by bones peaks during the night.

Easy lactose self test

Try this simple test at home to see whether you are lactose intolerant. It has been devised by Professor Terry Bolin of the Gut Foundation.

1. Drink 2 cups or 500ml of regular milk (which is equivalent to 25g of lactose) first thing in the morning on an empty stomach.
2. If you experience bloating, indigestion, wind or diarrhoea in the following 1 to 4 hours, chances are you could be lactose intolerant.

Your chances are increased if you also:

• are of Asian, Mediterranean, Middle Eastern or Aboriginal heritage.
• have one or both parents who suffer from lactose intolerance.
• have recently suffered any gastro-intestinal illness.

If you answered Yes to one or more of the above factors, you are probably lactose intolerant. See your doctor for a full diagnosis.

Shopping tips

The presence of milk must be declared on the label of all food products as milk is one of the major allergens. If in doubt, you can scan the list of ingredients for:

• Milk solids
• Non-fat milk solids
• Whey
• Casein

More help

• Zymil Longlife and fresh, chilled lactose-free milks in 1L cartons or 2L bottles from Pauls Milks. Call 1800 676 961 to find your nearest supermarket for stocks. You can find out more on the Zymil section of the Pauls website.
• Consult a dietitian for help planning balanced meals and an adequate calcium intake. Visit http://www.dietitiansaustralia.org.au and click on ‘Find a dietitian' or call 1800 812 942 Mon-Fri 9-5.
• www.lactose.com.au
  A site with everything you need to know about lactose intolerance including recipes, desserts, fact sheets and newsletter
• www.lacteeze.com.au
  On this site,  you'll be able to purchase liquid enzyme drops or tablets. With the drops, you simply add a number to your regular milk and leave it for 24 hours in the refrigerator. This breaks down the lactose before drinking.  The tablets are designed to be taken with a meal that you know contains some lactose - say if you're dining out.