By our in-house experts

If you’re living a gluten-free lifestyle, but still experience symptoms such as stomach bloating,
you could be lactose intolerant. Lactose intolerance is a common condition that means
people are unable to fully digest lactose - the natural sugar in milk and other dairy products.
Although there is no cure, there are many ways in which the condition can be managed
without drastically changing the way you like to eat.

 

What is lactose intolerance?

Lactose intolerance is one of the most common forms of food intolerance. Symptoms of
lactose intolerance are caused by an inability to produce enough enzymes called lactase.
Most people are born with the ability to digest lactose until weaning; then, for some, the
supply of lactase reduces to a point where symptoms appear with the consumption of dairy,
particularly milk.
The absence of the enzyme lactase causes gas to form from the fermentation of undigested
sugars found in lactose, creating bloating and diarrhoea. Symptoms intensify with the level of
lactose consumed (3) and vary considerably.
Lactose intolerance is uncomfortable to live with. Milk allergy is more serious and shares
some symptoms with lactose intolerance, and tends to affect younger children. It is important
to get symptoms checked out with your GP, in both adults and children.

 

How common is lactose intolerance?

According to The Lancet (2) the prevalence of lactose intolerance is estimated to be 28% of
the European population, whereas the global prevalence is estimated to be more than 55%.

 

What are the symptoms of lactose intolerance?

The top four symptoms of lactose intolerance that appear after lactose consumption include:
● Abdominal pain
● Gas and bloating
● Diarrhoea
● Abdominal cramping

Additionally, the following symptoms are seen less frequently (1) :

● Gurgling noises
● Nausea
● Vomiting

 

Which foods contain lactose?

Highest amounts of lactose are found in dairy products including milk (from any animal),
butter, buttermilk, yogurt, cream cheese, soft and hard cheeses, and ice cream.
Other foods that may include lactose are those prepared with milk or milk products such as
some processed meats, breaded or battered meat or fish and egg substitutes.
Lactose is also a common additive in many processed foods, such as frozen meals, sweets,
cakes, and sauces. This "hidden lactose" is used for its texture and flavour-enhancing
properties.
However, some lactose-intolerant individuals can tolerate up to five grams of lactose per
single meal and manage well with aged hard cheeses (10).

 

Are lactose free dairy products available?

Many new lactose-free products are available, made using processes that remove lactose
from lactose-rich dairy products. Lactose-free milk and cheese can now be found at most
supermarkets.
Alternatively, you could try naturally lactose-free foods such as soy products (tofu,
edamame) and plant-based drinks (soy, almond and rice milk) which are good alternatives to
high-lactose foods.

 

How do I make up for lost calcium if I’m lactose intolerant?

Calcium is one of the main minerals found in milk and is important for bone development.

Taking calcium from vegetable sources is beneficial as they provide the added benefit of

containing magnesium, a mineral that helps the body absorb calcium.

Try to build at least six portions of the following foods daily, including fortified milk

alternatives and good quality bread with added calcium. If you can include sardines regularly

into your diet, you will get a large portion of your daily requirement at 382mg of calcium for

every 100mg of sardines.

Foods providing around 50mg of calcium per average portion include:

● Green or French beans - 1 serving (90g)

● Green cabbage - 1 serving (95g)

● Raw, white cabbage - 1 serving (90g)

● Steamed broccoli - 1 large portion (110g)

● Watercress - 1 small bag (40g)

● Fried onion - 1 medium-sized (150g)

● Tinned tomatoes - 1 tin (400g)

● Red kidney beans - 2 tbsp (70g)

● Vegetable casserole - 1 serving (260g)

● Veggie burger - 1 (56g)

● Boiled basmati rice - 2 portions (1 portion = 5 heaped tbsp)

● Dried apricots 8 (64g)

● Orange - 1 large orange (50g)

● Easy peel citrus, e.g. tangerines/satsumas - 3 easy peelers (210g)

● Almonds 10 - whole nuts (22g)

● Brazil nuts - 9 whole nuts (30g)

This information is not designed to replace the advice from your Doctor. If you suspect you

are lactose intolerant, please speak to a medical professional.

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References:

(1) Misselwitz, B. et.al (2019) Update on lactose malabsorption and intolerance:

pathogenesis, diagnosis and clinical management. Gut.

(2) Storhaug, C. Fosse, S. Fadnes, L. (2017) Country, regional and global estimates for

lactose malabsorption in adults: a systematic review and meta-analysis. The Lancet

(3) (2018) Microbiota stability in healthy individuals after single-dose lactulose challenge—A

randomised controlled study

(4) Fassio, F. et.al (2018) Lactose Maldigestion, Malabsorption, and Intolerance: A

Comprehensive Review with a Focus on Current Management and Future Perspectives.

Nutrients.

(5) Ojetti. V. et. al (2008) Regression of lactose malabsorption in coeliac patients after

receiving a gluten free diet.

(6) Tirpitz, C. et al. (2002) Lactose intolerance in active Crohn's disease: clinical value of

duodenal lactase analysis J Clin Gastroenterol

(7) Hu, Y. et al. (2016) The incidence of infants with rotavirus enteritis combined with lactose

intolerance

(8) Varju, P. (2020) The role of small intestinal bacterial overgrowth and false-positive

diagnosis of lactose intolerance in southwest Hungary—A retrospective observational study

(9) Jianqi, S. et al. (2016) Effects of milk containing only A2 beta casein versus milk

containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of

discomfort, and cognitive behaviour of people with self-reported intolerance to traditional

cows' milk

(10) Shaukat, A. (2010) Systematic review: Effective management strategies for lactose

intolerance

(11) USDA Food Composition Databases. Available online:

https://ndb.nal.usda.gov/ndb/search/list?home=true

(12) Lesi, R. et al. (2020) Effects of Prebiotic and Probiotic Supplementation on Lactase

Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trial

(13) https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/

(14) Schnedl, W. (2022) Helicobacter pylori infection and lactose intolerance increase

explained