Lactose-controlled Diet

What are low lactose and lactose-free diets?

• Lactose (LAK-tose) is the sugar that is in milk. A lactose-free or low-lactose diet is for people who do not digest (di-JEST) lactose well. Digestion (di-JES-chun) is the way your body breaks down what you eat and drink. If you eat foods and drink liquids containing lactose, you may have gas, bloating, cramping, or diarrhea (loose stools). This condition is called "lactose intolerance".
  
  
• People who cannot digest lactose do not make enough of the enzyme, lactase (LAK-tase). If your body makes some lactase, you may be able to eat small amounts of foods with lactose. By trying small amounts of the foods and drinks with lactose, you will learn how much lactose you can tolerate. This is called a low lactose diet. If you have symptoms of lactose intolerance with many foods, your body probably does not make any lactase. You will need to avoid all foods, drinks, and ingredients having lactose to avoid having lactose intolerance symptoms. This is called a lactose-free diet.

What can I do to make a low lactose, or lactose-free diet part of my lifestyle?

Changing what you eat and drink may be hard at first. Think of these changes as "lifestyle" changes not just "diet" changes. You may need to make these changes part of your daily routine. Following a low lactose or lactose-free diet may help you feel better.

• Choose a variety of items on this diet to avoid getting tired of having the same items every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet.
  
  
• Carry a list of items allowed on this diet to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can remind you about it.
  
  
• Ask your caregiver, a dietitian (di-uh-TISH-an), or a nutritionist (noo-TRI-shun-ist) any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you. Dietitians and nutritionists can also help to make your new diet a regular part of your life.
  
  
• Always read the ingredient labels on products before buying any packaged foods. Read labels on foods to learn if they have milk products in them. The ingredient section on food labels lists items found in larger amounts before those found in smaller amounts. Avoid foods that contain milk, milk solids, buttermilk, and cream. Even foods like margarine, shortening, non-dairy creamer, baked goods and salad dressings may contain lactose. Many candy bars also have added lactose. Casein, caseinates, and whey may contain lactose, but usually not enough to cause problems.

What can I eat and drink while on a low lactose or lactose-free diet?

• You may drink reduced-lactose or lactose-free milk, or use it to prepare other foods. You may need to try reduced-lactose milk to find out if it causes gas, bloating, cramping, or diarrhea. Rice milk or soymilk, and prepared drinks made with soy (such as Ensure®), may be included in your diet. You may also try cheeses, yogurt, and kefir (cultured milk drink) because they contain less lactose than regular milk. Some non-dairy creamers may also be used.
  
  
• Italian, French, pita, and some other breads are made without milk products. Pasta, potatoes, rice, and many types of crackers may be added into your diet. Cereals made without lactose, milk, or whey may also be eaten.
  
  
• You may have some margarines, shortenings, and salad dressings. Read labels on these foods to learn if they contain milk products. You may have all types of fruits and vegetables. These may be eaten raw, or cooked without adding milk products, such as cheese or cream sauces. You may also drink fruit and vegetable juices.
  
  
• On a low lactose or lactose-free diet you may eat any fresh or frozen cooked plain meats, fish and poultry (chicken). Read labels on breaded fish and meat. These may also be OK to eat. Cooked, dried, and canned peas and beans, peanut butter, nuts and seeds are good choices. You may also eat eggs that are cooked without milk. Soybean and tofu products may also be added to your diet.
  
  
• Broth, boullion and consomme soups may be included in your diet. Vegetable or meat soup, and gravy that is made with water or lactose-free milk are also good choices. Plain herbs and spices are OK to add to meals. You may use jelly, jam, and other preserves. You may also use honey, sugar, syrup, molasses, and powdered sweeteners.
  
  
• Good choices for dessert include angel food cake, frozen pure fruit bars, ices, and sorbets, and dairy-free frozen desserts. Gelatin desserts, pies, cakes, and other baked foods made without milk or whipped cream also may be eaten. Dark chocolate does not contain lactose, and may be enjoyed. Lactose-free milk or soymilk may be used to replace regular milk in recipes, such as mashed potatoes.

What should I limit or avoid eating and drinking while on a low lactose or lactose-free diet?

• Dairy foods:
  
  
  • Butter and ghee (clarified butter).
    
    
  • Cheese spreads, cheese foods, cottage and ricotta cheese.
    
    
  • Cream, whipping cream, and milk (skim, fat-free, one percent, two percent, whole), and goats milk.
    
    
  • Evaporated and condensed milk, buttermilk, and kefir (cultured milk drink).
    
    
  • Ice cream, ice milk, and sherbet.
    
    
  • Malted milk and some hot chocolate mixes.
    
    
  • Processed and natural cheeses.
    
    
  • Sour cream, yogurt (fresh and frozen), and sweet acidophilus or lactobacillus milk.
  
  
• Breads and starches:
  
  
  • Certain packaged popcorn made with cream.
    
    
  • Certain prepared breads, muffins, biscuits and rolls made with milk.
    
    
  • Packaged cereals made with lactose, milk, or whey. For example, Total®, Golden Grahams®, and Honey Bunches of Oats®.
    
    
  • Pancakes, waffles, and French toast made with milk.
  
  
• Fruits and vegetables:
  
  
  • Frozen fruit bars made with milk or cream.
    
    
  • Fruit and yogurt smoothies.
    
    
  • Vegetables coated in batter, or cooked in cream sauces.
  
  
• Meat and other protein sources:
  
  
  • Egg omelets and soufflés made with milk.
    
    
  • Main dishes (pizza, burritos, tacos, casseroles) made with cheese.
    
    
  • Meat, fish and poultry that is batter-dipped, or in a cream sauce.
    
    
  • Processed meats (cold cuts, hot dogs) made with milk, whey, or lactose.
  
  
• Fats, soups, sauces and seasonings:
  
  
  • Chocolate and other spreads, such as Nutella®.
    
    
  • Chowders and cream soups.
    
    
  • Cream cheese and party dips for vegetables, bread and crackers.
    
    
  • Some brands of margarine and butter.
    
    
  • White sauce, gravy, soup mixes and meat seasonings packaged or made with milk.
  
  
• Desserts:
  
  
  • Any cookies, cakes, pies, pastries and desserts made with milk.
    
    
  • Cream and cheese-filled pastries.
    
    
  • Fudge and milk chocolate.
    
    
  • Many candy bars with added lactose, such as Snickers®, and Kit Kat® wafer bars.
    
    
  • Puddings, custards and whipped cream.
    
    
  • Toffee, butterscotch, caramels and nougat.

Checklist for the Patient:

Take this list with you when you shop. Look for products with "lactose-free" written on the label. It may not be clear what products contain lactose. This list contains items to look for when reading food and drink labels. Avoid buying products that have one or more of these ingredients:

• __Buttermilk.
  
  
• __Condensed milk.
  
  
• __Dried milk powder.
  
  
• __Lactose.
  
  
• __Milk solids, milk protein, and milk fat.
  
  
• __Sodium caseinate (made with milk).
  
  
• __Sweet and regular cream.

What other diet guidelines should I follow?

• If you have some tolerance for lactose, you may be able to drink milk in small amounts (half of a glass, for example). You may also be able to eat small amounts of lactose-containing foods. Eating other foods at the same time you eat foods with lactose may cause fewer problems with digestion.
  
  
• You may take lactase enzyme (N-zime) in a pill or liquid. This enzyme may keep you from having problems if you eat food with lactose. Read the label before using this medicine. You can buy lactase enzyme pills or liquid at a grocery or drug store. Some foods contain "lactate". Lactate is not the same as lactose. People who are lactose intolerant can safely have products that contain lactate.
  
  
• You may be worried about not getting enough calcium each day. Calcium is an element that your body needs for strong bones and teeth, as well as other important functions. Lactose-free and reduced-lactose milk contain as much calcium as regular milk.
  
  
• Calcium is also found in other foods, including vegetables, and may be taken as a supplement (pill). Many products, such as orange juice, soymilk, and rice milk are calcium-fortified. This means that calcium has been added to the product. Ask your caregiver for more information about how to get enough calcium in your diet.

Risks:

If you have lactose intolerance and do not follow these diet guidelines, you may have gas, bloating, cramping, and diarrhea. These signs and symptoms may be mild, or may be very bad. Cramping may be painful. Diarrhea may lead to dehydration (d-hi-DRA-shun). Dehydration means that the amount of fluid in your body has dropped too low. Long-term or very bad diarrhea also leads to other problems in your body. Following these diet guidelines may help you feel better.

Care Agreement

You have the right to help plan your care. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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