Though many people develop lactose intolerance as adults, all babies are born with the lactose-converting lactase enzyme in their small intestines. This enzyme decreases with age and the first symptoms of intolerance typically begin to emerge after age three.
The symptoms can range in severity, but generally present within 30 minutes to two hours of consuming food with lactose and take the form of stomach discomfort, bloating, gas, nausea, and diarrhea.
Given those issues, it’s easy to understand why folks with lactose intolerance would steer clear of milk products. But people who avoid dairy foods may not be getting the recommended amounts of calcium, vitamin D, and other nutrients, says Ugonna Iroku, MD, a gastroenterologist and assistant clinical professor at Mount Sinai Hospital in New York City. “You can find culturally appropriate foods that meet your culinary taste while providing the nutrition you need,” says Iroku.
Here are tips for figuring out if your stomach troubles are caused by a lactose intolerance—and, if so, how to make sure you’re getting the nutrition you need.
See a doctor. Start by making sure you understand the cause of any gastrointestinal symptoms. Lactose intolerance may make you uncomfortable, but it presents little medical danger, says Iroku. Milk allergies, though a lot less common, can be much more serious than lactose intolerance and even life-threatening. (These usually show up in babies, not adults.) “Our job is to help establish that it’s lactose intolerance for sure,” says Iroku. “If you’re seeing blood in your stool along with cramping that’s definitely a reason to go see your doctor.”
Keep a food journal. Either before you see a doctor, or afterward, you’re going to want to document what you’re eating and how it’s affecting you. “Start by getting some data,” says Iroku. “Carry paper and a pen, and commit to asking yourself, ‘I feel bad today. What were my last couple of meals’?” Journaling this way can help you and your doctor figure out if lactose is the culprit or something else entirely.
Make sure you’re getting your nutrients. “While you’re figuring out your relationship with dairy, you want to make sure that you’re getting calcium from a variety of sources,” says Iroku. He recommends nutrient-dense dairy-free foods like beans, leafy greens such as spinach, kale, and collard greens, and calcium-rich fish such as salmon and sardines.
Meanwhile, you probably don’t need to stop consuming dairy altogether, says Tamara Melton, a registered dietitian nutritionist and the co-founder of Diversify Dietetics, a nonprofit that empowers individuals of color in the field of nutrition and dietetics.
Lactose-free dairy products are a good place to start. The widely available Lactaid brand offers a wide range of lactose-free dairy products. But traditional dairies like Organic Valley and Fairlife also offer milk free from lactose. And private label store brands like 365 by Whole Foods Market, Walmart’s Great Value brand, and Costco’s Kirkland Signature all offer lactose-free milk.
Lactose-free options are typically processed to make them tolerable to the lactose intolerant while also delivering all of the nutritional benefits of conventional milk. “Your children can still drink it, too, so you don’t have to buy two types of milk,” Melton says.
Melton also advises reaching for kefir, hard cheese, and other dairy products that are naturally low in lactose to both provide nutrition and satisfy dairy cravings. (See “5 Dairy Products Less Likely to Cause Symptoms,” below.)
Consider experimenting with conventional dairy. Oroku and Melton both say that small doses and a little patience may make managing lactose intolerance easier. “Even if you’re lactose intolerant, you can tolerate a small amount of lactose,” says Oroku.
There is also evidence that drinking a half-glass of milk with meals slows down the movement of the dairy through the intestinal tract leading to potentially less discomfort.
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