Management of lactose intolerance

Lactose intolerance is managed by reducing dietary lactose, though people with lactose intolerance do not need to avoid lactose completely. Small amounts of lactose (eg 10 g per day) are often well tolerated because of persisting residual lactase activity, which can break down a small lactose load. Symptoms may occur after consuming 4 g of lactose (eg 1/3 glass of milk), but there is considerable variation in the severity and perception of symptoms in adults. Patients should not completely eliminate milk and milk products from their diet because these are valuable sources of calcium. It is not necessary to avoid medications containing a small amount of lactose.

Options for dietary modification to manage lactose intolerance include:

choosing low-lactose and lactose-free products where possible
consuming smaller quantities of lactose-containing products more frequently over the day (rather than large quantities at a time)
using lactase enzyme drops or tablets before ingesting lactose-containing products.

For the lactose content of various milks and milk products, see Lactose content of various milks and milk products. For examples of lactose-free infant formulas, see Examples of lactose-free infant formulas.

Most oral nutritional supplements and enteral nutrition formulas have a very low lactose content (check the product label).

Table 1. Lactose content of various milks and milk products
Lactose content	Food or drink	Dietary advice
high lactose (more than 4 g/serve)	custard	make with lactose-free milk or replace with soy custard [NB1]
	milk: condensed, evaporated	limit use; if consumed in large quantities, take with lactase enzyme
	milk: fresh (cow, goat, sheep; full fat, reduced fat, skim)	replace with lactose-free milk (lactase-treated), soy milk or rice milk [NB1]
	milk: powdered	limit use; if consumed in large quantities, take with lactase enzyme
	yoghurt [NB2]	replace with lactose-free yoghurt or soy yoghurt [NB1]
moderate lactose (0.1 to 4 g/serve)	cheese: soft or unripened (eg cottage cheese, cream cheese, mascarpone, quark, ricotta)	limit use; if consumed in large quantities, take with lactase enzyme
	cream	limit use; if consumed in large quantities, take with lactase enzyme
	ice-cream	replace with lactose-free ice-cream or soy-based ice-cream [NB1]
very low lactose (less than 0.1 g/serve)	cheese: hard, formed, ripened or block (eg bocconcini, brie, camembert, cheddar, edam, feta, gouda, havarti, Jarlsberg, mozzarella, parmesan, Swiss, tasty)	suitable on a low-lactose diet
	butter, margarine
	food with milk or milk powder as a minor ingredient (eg biscuits, cake, chocolate)
Note: NB1: Ensure alternative is fortified with calcium. NB2: Many yoghurts are tolerated by people with lactose intolerance due to partial digestion of lactose by bacterial cultures in the yoghurt.

Table 2. Examples of lactose-free infant formulas[NB1]
Soy protein–based formula	Cow’s milk–based formula
Karicare Soy S-26 Soy	Aptamil Gold+ Lactose intolerance S-26 Gold LI NAN LI
Note: NB1: Trade names are provided solely to assist with identification. Their inclusion does not imply recommendation of any product.