Do you know someone who avoids dairy like the plague?
Recently, the anti-diary movement has grown widespread popularity, with many people fearing lactose and opting to go dairy free or switching to more expensive and potentially less nutritious almond milk or dairy free products.
But dairy isn’t all bad, especially in those without lactose intolerance or issues.
In fact, dairy can provide many benefits and be a quick, cheap and low calorie protein source.
Should you really be spending your money on almond milk or has the media blown a dietary issue out of proportion?
This article breaks down the scientific evidence to let you decide.
What does lactose intolerance really mean?
Although lactase deficiency (termed hypolactasia), lactose malabsorption, and lactose intolerance are frequently used interchangeably, these terms have different meanings.
Lactase deficiency indicates that the lactase enzyme in the small activity is reduced or non-existent [Corgneau et al., 2015]. Lactose malabsorption means a sizable fraction of ingested lactose is not absorbed in the small bowel. As lactose malabsorption usually results from lactase deficiency, the prevalence of these two entities is similar [Corgneau et al., 2015].
However, Lactose intolerance indicates that the lactose malabsorption causes the clinically recognized symptoms of diarrhea, bloating, flatulence, and abdominal pain [Corgneau et al., 2015]. Although malabsorption of moderate doses of lactose may not cause discernible symptoms, lactose malabsorbers do not necessarily suffer from lactose intolerance.
Prevalence of Lactose Intolerance
Lactose intolerance is said to affect 70% of the world adult population [Fox, 2015], although it is more likely that this is lactose malabsorption and not true lactose intolerance.
Adding to that is the “nocebo effect”, a phenomenon where people attribute a variety of abdominal complaints to lactose intake. But, irrespective of the dose, research has found that most people do not actually have any real lactose intolerance or issues [Corgneau et al., 2015].
Interestingly, the prevalence of lactose non-persistence (e.g. they stop consuming lactose based products after childhood) is strongly linked to ethnicity [Welsh et al., 1978]
In general, the vast majority of individuals originating from the traditional areas where milking animals was not popular are typically maldigesters, whereas individuals coming from a zone with an ancient milk consumption tradition present low prevalence for lactose maldigestion.
As you can see in the world map, for most people in Europe and America, lactose intolerance may only occur in 0 - 15% of the population.
Remember, our body is an incredibly adaptive machine, if you and your ancestors have consumed large amounts of lactose for years then your body will have sufficient enzymes to break it down. In contrast, if you rarely consume dairy then your body may see it as a foreign invader and this is where lactose issues often arise.
Based on this, the prevalence of lactose intolerance is low in individuals of northern European descent (15%), medium for African, Latinos, Eastern European, and south American (70 – 80%) and high in many Asian populations (near 100%) [Paige, 2005].
Sources of Lactose
As you may know, milk and milk products are the major dietary sources of lactose. Lactose is classed as a sugar molecule consisting of galactose bound to glucose by a [beta]-galactosidic linkage.
Day 1 Upper Body Mechanical Stress
|Products||Lactose Per Serving|
|3. Ice Cream||3.7g/0.5cup|
|4. Hard Cheese (cheddar/mozzerella)||0.01-0.9g/1oz|
|6. Medication Excipients||0.02-0.075g/tablet|
Taken from: Levitt, M., Wilt, T., & Shaukat, A. (2013). Clinical implications of lactose malabsorption versus lactose intolerance. Journal of clinical gastroenterology, 47(6), 471-480.
Lactose exists in the water phase of milk. Thus, butter contains virtually no lactose and hard cheeses provide less than or equal to 1 gram of lactose per 1 ounce of serving.
Thus, there is no physiological basis for the complaint that “lactose intolerance” prevents a lactose malabsorber from consuming a pizza laden with cheese (a concept used in advertisements for lactase supplements).
In addition to fluid milk, the only commonly consumed foods containing significant amounts of lactose are yogurt and ice cream. Although lactose may appear in small doses in cheese, butter, and other foods, as shown in the table, this occurs to an insignificant amount [Matthews et al., 2005].
If you are truly lactose intolerant and need to avoid even trace amounts, watch out for these terms on menus and food labels:
How Much Can Be Tolerated
As discussed, the amount that you can tolerate really depends on your symptoms and issues. Just like gluten, someone who is truly lactose intolerant can get severe side effects from even the smallest amount. However, for 99% of people who believe they are lactose intolerant, they can probably eat all kinds of dairy apart from large amounts of milk or yogurt.
In research, a pair of meta-analyses showed that almost all lactose intolerant individuals can tolerate up to 12 grams of lactose at one time, and approximately 18, but up to 24, grams of lactose spread over the day [Savaiano et al., 2006; Wilt et al., 2010].
Based on this, even individuals who are intolerant or just classed as lactose malabsorbers may be able to include some lactose in their diet without major symptoms.
As you can see, most of the time you don’t really need almond milk, unless you are truly lactose intolerant or drink large amounts of milk daily. Even someone who is sensitive to lactose could use a smaller portion (less than 8 ounces) of milk without major side effects. However, it should be noted that this was the average tolerance, and it varies between individuals.
Negatives of Cutting Out Lactose
Products containing lactose, specifically dairy, contain some valuable nutrients. By avoiding lactose for no reason, you could be losing out on these nutrients for no valid reason, while probably cutting out foods you use to enjoy, such as cheese, milk, yogurt etc.
This becomes even more important if you are vegetarian or eat smaller amounts of meat, with dairy being the easiest and best source of dietary protein for a vegetarian diet.
Regardless of whether you eat meat or not, diary, specifically whey, yogurt and milk are an extremely cheap and accessible source of protein; with the great combination of whey and casein protein, it has played a key role in the diets of bodybuilders and athletes for years.
Diary is also rich in micronutrients, such as vitamins and minerals. Just 2 cups (roughly 1 pint) of milk contains approximately:
- Potassium: 20% of the RDA.
- Phosphorus: 45% of the RDA.
- Calcium: 550mg (56% of the RDA).
- Vitamin D: 50% of the RDA.
- Riboflavin (B2): 50% of the RDA.
- Vitamin B12: 35% of the RDA.
- Potassium: 20% of the RDA.
- Phosphorus: 45% of the RDA.
- It also contains Vitamin A, Vitamins B1 and B6, Selenium, Zinc and Magnesium.
Along with the benefits of milk, other dairy sources such as yogurt and cottage cheese contain similar micronutrients, are high in protein and are very dynamic ingredients for baking healthy high protein recipes.
Finally, dairy products, such as cheese, taste great and are a favorite amongst many. In addition to containing some protein, cheese is full of healthy fats, including CLA and some Medium Chain Triglycerides.
Working around Lactose Intolerance
As mentioned above, individuals do not necessarily have to completely cut out dairy from their diet.
In addition to including reduced portion sizes and limiting daily lactose ingestion, there are a few options available to help people improve their ability to tolerate lactose.
- Lactase is a commercially available product that you can take with meals. It is the same enzyme that your small intestine uses to digest lactose.
- The effectiveness seems to vary between individuals [Ibba et al., 2014]
- May be effective up to certain level of lactose (~20g) [Lin et al., 1993]
- Products such as Lactaid products and supplements may offer favorite options (milk, ice cream, etc.) without lactose
- Results of published controlled studies are inconsistent, likely because of the use of specific amounts of lactose and evolving formulations of the products [Levitt et al., 2013; Suarez et al., 1995; Brand & Holt, 1991]
Probiotics and Prebiotics
- Available in supplement form, yogurts, and fermented food products
- May exert beneficial health effects through altering the intestinal microbiome [Kechagia et al., 2013]
- Positive results have been shown with inclusion, although it may vary between individuals [de Vrese et al., 2001; Levri et al., 2005].
Regular Exposure to Lactose
- Regular dairy food consumption could lead to colonic adaptation by the microbiome (similar to probiotics), and allow people to consume more lactose and dairy products [Szilagyi, 2015]
Just because you experience some bloating or abdominal discomfort after eating a dairy rich meal, it doesn’t mean you have to completely eliminate it.
More often than not, if you eat pizza or ice cream or other foods with lactose and get digestive issues/bloat, it is probably due to all the processed sugars and trans fats/hydrogenated oils contained in that meal, not the lactose. Remember, small doses of lactose can be included for individuals who are truly lactose intolerant.
- Brand, J. C., & Holt, S. (1991). Relative effectiveness of milks with reduced amounts of lactose in alleviating milk intolerance. The American journal of clinical nutrition, 54(1), 148-151.
- Corgneau, M., Scher, J., Ritié-Pertusa, L., Le, D. T. L., Petit, J., Nikolova, Y., … & Gaiani, C. (2015). Recent Advances on Lactose Intolerance: Tolerance Thresholds and Currently Available Solutions. Critical reviews in food science and nutrition, (just-accepted), 00-00.
- de Vrese, M., Stegelmann, A., Richter, B., Fenselau, S., Laue, C., & Schrezenmeir, J. (2001). Probiotics—compensation for lactase insufficiency.The American journal of clinical nutrition, 73(2), 421s-429s.
- Fox, P.F., Uniacke-Lowe, T., McSweeney, P.L.H., and O’Mahony, J.A. (2015). Lactose. In: Dairy Chemistry and Biochemistry.
- Ibba, I., Gilli, A., Boi, M. F., & Usai, P. (2014). Effects of Exogenous Lactase Administration on Hydrogen Breath Excretion and Intestinal Symptoms in Patients Presenting Lactose Malabsorption and Intolerance. BioMed research international, 2014.
- Kechagia, M., Basoulis, D., Konstantopoulou, S., Dimitriadi, D., Gyftopoulou, K., Skarmoutsou, N., & Fakiri, E. M. (2013). Health benefits of probiotics: a review. ISRN nutrition, 2013.
- Levitt, M., Wilt, T., & Shaukat, A. (2013). Clinical implications of lactose malabsorption versus lactose intolerance. Journal of clinical gastroenterology, 47(6), 471-480.
- Lin, M. Y., Dipalma, J. A., Martini, M. C., Gross, C. J., Harlander, S. K., & Savaiano, D. A. (1993). Comparative effects of exogenous lactase (β-galactosidase) preparations onin vivo lactose digestion. Digestive diseases and sciences, 38(11), 2022-2027.
- Paige, D. M., & Bayless, T. M. (2005). Lactose intolerance. Encyclopedia of Human Nutrition. 2nd ed. Oxford: Elsevier.
- Savaiano, D. A., Boushey, C. J., & McCabe, G. P. (2006). Lactose intolerance symptoms assessed by meta-analysis: a grain of truth that leads to exaggeration. The Journal of nutrition, 136(4), 1107-1113.
- Suarez, F. L., Savaiano, D. A., & Levitt, M. D. (1995). A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. New England Journal of Medicine, 333(1), 1-4.
- Szilagyi, A. (2015). Adaptation to lactose in lactase non persistent people: Effects on intolerance and the relationship between dairy food consumption and evalution of diseases. Nutrients, 7(8), 6751-6779.
- Welsh, J. D., Poley, J. R., Bhatia, M., & Stevenson, D. E. (1978). Intestinal disaccharidase activities in relation to age, race, and mucosal damage.Gastroenterology, 75(5), 847-855.
- Wilt, T. J., Shaukat, A., Shamliyan, T., Taylor, B. C., MacDonald, R., Tacklind, J., … & Levitt, M. (2010). Lactose intolerance and health.