Lactose Intolerance: A Normal Reason to be Dairy Free

If you aren’t lactose intolerant yourself, odds are you know someone who is. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), between 30 and 50 million people in the United States alone are lactose intolerant. Look around, that is up to 1 in every 6 people you see! And contrary to public perception, lactose intolerance isn’t typically a disorder or disease. It’s actually quite normal. We’ll explain why via FAQs in this post.

The Everyday Lactose Intolerant Guide

This post is for informational purposes only. It is not intended to diagnose or treat any medical conditions. Always consult your doctor regarding any symptoms and before undergoing a change in your diet. You can jump ahead in this article with these links:

• What Is Lactose Intolerance?
• Who Is Most Likely To Be Lactose Intolerant?
• What Are The Symptoms Of Lactose Intolerance?
• How Does Lactose Intolerance Develop?
• Can Lactose Intolerance Reverse?
• Could It Just Be Lactose Maldigestion?
• Is It Normal To Be Lactose Intolerant?
• How Is Lactose Intolerance Diagnosed?
• Is a Dairy-Free Diet Needed For Lactose Intolerance?
• Can I Consume Goat Milk Or Sheep Milk If I’m Lactose Intolerant?
• I’m On a Lactose-Free Diet, But Still Have Symptoms With Dairy. Why?
• How Do I Know it isn’t a Milk Sensitivity or Dairy Intolerance?
• How do I Know if it’s Lactose Intolerance or a Milk Allergy?
• Is it Possible to Have Lactose Intolerance and a Milk Allergy?
• More Helpful Lactose Intolerance Information

What Exactly Is Lactose Intolerance?

Otherwise known as “milk sugar,” lactose is the primary carbohydrate in milk products. During the digestion process, lactose is broken down into glucose and galactose for proper absorption. This step occurs in the small intestine with the assistance of an enzyme known as lactase. Many people have or develop a shortage of lactase, and therefore are unable to properly digest some or all of the lactose they consume. The unabsorbed lactose passes into the colon where it can cause digestive distress. This lactase deficiency and any resulting gastrointestinal symptoms, are what is typically referred to as lactose intolerance.

Who Is Most Likely To Be Lactose Intolerant?

Globally, it’s been estimated that 68% of the adult population is lactose intolerant. Men and women are affected equally. But lactose intolerance rates are much higher among adults, and are known to be significantly increased in certain nationalities. According to the NIDDK’s 1994 study, the incidence in the United States is reported as follows:

• 90% of Asian Americans adults
• 70% of African Americans adults
• 74% of Native Americans adults
• 53% of Mexican Americans adults
• 15% of Caucasian adults

What Are The Symptoms Of Lactose Intolerance?

Symptoms can vary from person to person, and they range from mild, to very uncomfortable, to embarrassing, to severe. They typically emerge about 30 minutes to 2 hours after ingesting lactose-laden foods, and can include any of they following:

• Abdominal Pain
• Abdominal Cramps
• Intestinal Bloating
• Flatulence / Gas
• Excessive Burping
• Diarrhea
• Nausea
• Vomiting

How Does Lactose Intolerance Develop?

For most people, it happens through the progression into adulthood. For some people, it’s acquired as a result of an acute illness. And for a very few, lactase deficiency is present from birth. Here are the four basic types of lactose intolerance and how they occur.

• Primary Lactose Intolerance stems from a natural and gradual decrease in lactase activity after weaning. This is the most common type. Due to the progression, symptoms may develop as early as 5 years old, and often worsen with age. Some may have a complete loss of lactase activity, but many will retain 10 to 30% of their initial level of the enzyme activity. This can be enough lactase to digest a certain level of lactose at once.
• Secondary Lactose Intolerance may occur during episodes of acute illness. This may happen at any age, and following full recovery, the intolerance might reverse. A few potential causes of this type are Irritable Bowel Syndrome (IBS), Crohn’s Disease, Acute Gastroenteritis (infections), Celiac Disease, Cancer, and Chemotherapy.
• Congenital Lactose Intolerance or congenital lactase deficiency is very rare and happens when little to no lactase is produced in an infant’s small intestine from birth. It’s genetic, and both parents have to have the gene to pass on the condition. In this case it is a disorder, since the baby cannot tolerate its mother’s milk.
• Developmental Lactose Intolerance is also present at birth, but it’s typically temporary. In some premature babies, their intestines are underdeveloped and can’t break down lactose. As their intestines mature, they usually gain lactase activity and the ability to digest lactose.

Can Lactose Intolerance Reverse?

As noted above, people with Secondary Lactose Intolerance might regain the ability to digest lactose if the underlying medical condition is able to be treated. But some pregnant women also regain the ability to digest lactose during pregnancy. For many of them, the increased tolerance is temporary, and decreases after child birth. But for some of them, it does persist for a while.

Could It Just Be Lactose Maldigestion?

According to the Oxford Dictionary, lactose intolerance is “the partial or total inability to digest lactose.” Technically, this is the definition of lactose maldigestion and lactose malabsorption, too. But in the medical industry, lactose maldigestion is the broader term. Some people with the inability to fully digest lactose do not exhibit clinical symptoms, but many others do have symptoms. Both groups could be labelled with lactose maldigestion. But according to researchers, only the group with symptoms would be described as lactose intolerant.

Is It Normal To Be Lactose Intolerant?

Contrary to popular belief, the primary type of lactose intolerance is not a disease, but rather a natural process in human development. After weaning, lactase production typically decreases as the need for an infant to digest mother milk is no longer present.

But thousands of years ago when groups of Northern Europeans made the shift from hunting and gathering to livestock and farming, the small number in the domesticated bunch that had “lactase persistence” were able to thrive. The genetics passed on, resulting in a high rate of lactose tolerance among Northern European populations specifically. It’s believed that cross-cultural migrations are the primary reason that this genetic mutation for digesting milk has reached other ethnic populations to some degree.

How is Lactose Intolerance Diagnosed?

Many doctors will simply tell their patients to try a lactose-free diet or a stricter dairy-free diet and keep a journal to see if the symptoms subside. But some doctors will order a lactose tolerance test in order to make a clinical diagnosis of lactose intolerance. This could be a blood glucose test, hydrogen breath test, or stool acidity test. Speak with your physician to discuss the options and to decide what is best for your needs.

Is a Dairy-Free Diet Needed for Lactose Intolerance?

Many lactose intolerant people do opt to live dairy-free – some for ease and some for additional health reasons. But a strict dairy-free diet is not usually required if lactose intolerance is the only issue. Instead, a low-lactose or lactose-free diet is typically recommended by doctors. This usually involves eating many dairy-free foods, but can also include lactose-free milk products. Low lactose foods like butter and hard cheeses might also be given a green light based on the severity of your intolerance. This lactose guide offers lactose levels at a glance. Cultured dairy foods, like yogurt, are also tolerated by some people who are lactose intolerant. For those times when you plan to splurge on dairy, your doctor might recommend lactase enzyme supplements.

Can I Consume Goat Milk or Sheep Milk if I’m Lactose Intolerant?

Unlike milk proteins, which can vary in composition among different mammals, lactose is lactose. It’s a basic molecule of two simple sugars that is essentially the same, whether from cow, goat, sheep, camel, or human milk. The types of mammal milk can have different lactose levels, which is the more important aspect. For example, cow milk has a higher percentage of lactose than goat milk, but a lower percentage than sheep milk. That said, all types of mammal milk readily available on the market still have a relatively high ratio of lactose.

I’m on a Lactose-Free Diet, But Still Have Symptoms with Dairy. Why?

Even lactose-free products can still have a small amount of lactose remaining. For people with a severe intolerance, this could potentially cause symptoms. But it’s also possible that there is another component in dairy causing issues. Symptoms of milk allergies can mimic lactose intolerance, but involve an immune response to the proteins in milk (casein or whey), not the sugar (lactose). Most people think allergies only cause skin or respiratory issues, but digestive symptoms are common. If you are having symptoms, consult your physician.

How Do I Know it isn’t a Milk Sensitivity or Dairy Intolerance?

These aren’t medically recognized terms, but rather descriptive terms that are often used when a firm diagnosis hasn’t been made. There is only one type of medically recognized dairy intolerance, and that is lactose intolerance. A “sensitivity” is often stated when someone is viewed as having a mild allergy, an allergy that doesn’t require an epi-pen, lactose intolerance is ruled out, and/or they tested negative for an IgE-mediated allergy. But if there is an immune response, it is medically defined as an allergy, period. The symptoms could be immediate or delayed, mild or severe, and the reaction can be instigated by another type of immune response than IgE antibodies. The medical community only has reliable diagnostic tests for IgE-mediated milk allergies. Consequently, there is a big food allergy gray area that is often mislabeled as a dairy intolerance or sensitivity.

How do I Know if it’s Lactose Intolerance or a Milk Allergy?

If you already consume dairy, your doctor might tell you to switch to lactose-free dairy products. If your digestive symptoms abate, this points to lactose intolerance. But if you still have digestive symptoms, or also have non-digestive symptoms, then additional dietary challenges or tests might be done to determine if you have a very severe intolerance or if a milk allergy is possible. Basically, people who have lactose intolerance exclusively only get digestive symptoms from lactose consumption. So dairy products with the lactose removed or broken down do not typically cause lactose intolerant reactions. Some people with severe lactose intolerance do report reacting to trace or small amounts of lactose remaining in “lactose-free” foods. Consult your physician before any change in diet. A medical diagnosis can only be established with your physician.

Is it Possible to Have Lactose Intolerance and a Milk Allergy?

Yes, it is. They are two completely different issues, so it is possible to have just one or both. Lactose intolerance is purely digestive and relates to milk sugars, while a milk allergy is an immune system response to the protein in dairy. You can have a lack of lactase enzymes and an immune response to milk. But you can also have one and not the other.

More Helpful Information

• What is Lactase? 
• Lactose and Medications
• Should Lactose Intolerant Children Consume Dairy? Understanding the Options
• Dairy Intolerance is Real, and It’s Not About Lactose
• Galactosemia is a Dairy-Free Diagnosis, Not Just Lactose-Free
• Is Lactoferrin Dairy Free? Is it Safe for Lactose Intolerance?
• I’m Lactose Intolerant. Should I Avoid Casein and Whey Milk Proteins?
• Dairy-Free Calcium Guide

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