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Potamitis Gastroenterology & Nutrition

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. While not all persons deficient in lactase have symptoms, those who do are considered to be lactose intolerant. Fortunately, lactose intolerance is relatively easy to treat by avoiding foods containing lactose. No treatment can improve the body's ability to produce lactase, but symptoms can be controlled through diet modification.

Lactose Intolerance and Balanced Diet Nutrition

Milk and other dairy products are a major source of nutrients in the diet. The most important of these nutrients is calcium. Calcium is essential for the growth and repair of bones throughout life. In the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily, a condition called osteoporosis. A concern, then, for both children and adults with lactose intolerance, is getting enough calcium in a diet that includes little or no milk.

In 1997, the Institute of Medicine released a report recommending new requirements for daily calcium intake. How much calcium a person needs to maintain good health varies by age group. Recommendations from the report are shown in the following table.

Age group

Daily Calcium (mg)

0-6 months

210 mg

7-12 months

270 mg

1-3 years

500 mg

4-8 years

800 mg

9-18 years

1,300 mg

19-50 years

1,000 mg

51-70+ years

1,200 mg

Also, pregnant and nursing women under 19 need 1,300 mg daily, while pregnant and nursing women over 19 need 1,000 mg.

In planning meals, making sure that each day's diet includes enough calcium is important, even if the diet does not contain dairy products. Many non-dairy foods are high in calcium. Green vegetables, such as broccoli and kale, and fish with soft, edible bones, such as salmon and sardines, are excellent sources of calcium. To help in planning a high-calcium and low-lactose diet, the table that follows lists some common foods that are good sources of dietary calcium and shows how much lactose they contain.

 

Calcium and Lactose in Common Foods

Vegetables

Calcium Content

Lactose Content

Calcium-fortified orange juice, 1 cup

308-344 mg

0

Sardines, with edible bones, 3 oz.

270 mg

0

Salmon, canned, with edible bones, 3 oz.

205 mg

0

Soymilk, fortified, 1 cup

200 mg

0

Broccoli (raw), 1 cup

90 mg

0

Orange, 1 medium

50 mg

0

Pinto beans, 1/2 cup

40 mg

0

Tuna, canned, 3 oz.

10 mg

0

Lettuce greens, 1/2 cup

10 mg

0

Dairy Foods

   

Yogurt, plain, low-fat, 1 cup

415 mg

5g

Milk, reduced fat, 1 cup

295 mg

11g

Swiss cheese, 1 oz.

270 mg

1g

Ice cream, 1/2 cup

85 mg

6g

Cottage cheese, 1/2 cup

75 mg

2-3g

Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives.

Hidden Lactose in Your Diet

Although milk and foods made from milk are the only natural sources, lactose is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as

- bread and other baked goods
- processed breakfast cereals
- instant potatoes, soups, and breakfast drinks
- margarine
- lunch meats (other than kosher)
- salad dressings
- candies and other snacks
- mixes for pancakes, biscuits, and cookies

- powdered meal-replacement supplements