Lactose in the IBS diet

October 12, 2021

Lactose intolerance is a common condition that can lead to unpleasant gut symptoms, especially for people who suffer from irritable bowel syndrome. Even if you’re IBS free, lactose may be something you try to avoid or limit if you experience gut issues. However, you may not need to avoid lactose completely on your IBS diet.

Keep reading to learn more about what lactose intolerance is, how lactose affects your gut, and how you can safely include lactose in your diet, without the negative symptoms of IBS.

What is lactose intolerance?

Lactose intolerance is a condition in which your body is unable to properly digest lactose, the primary type of carbohydrate and sugar found in dairy products. This is the result of the body not producing enough of the lactase enzyme, which is needed to digest lactose.

Lactose-intolerance is not the same as having a milk allergy.

Lactose intolerance is very common and can affect both children and adults. It is estimated that up to 70 percent of adults in the world have the condition, including about 30 million Americans by the age of 20.

Babies who are born prematurely and people who have had an injury or surgery that affects the small intestine are also more likely to develop lactose intolerance. In addition, developing lactose intolerance increases with age.

There are a variety of tests and procedures that can diagnose lactose intolerance. These may include a physical examination, a lactose tolerance test, a hydrogen breath test, a stool acidity test, or a procedure called an endoscopy which is done by a medical doctor.

The hydrogen breath test is the most used method because it is non-invasive, easy to perform and rather inexpensive in comparison to the other available tests.

How does lactose affect your gut?

Since people with lactose intolerance do not produce enough of the enzyme lactase, undigested lactose sits in the gut and gets broken down by bacteria.

This process can cause negative symptoms in the gut, such as:

Bloating
Diarrhea
Abdominal pain and cramping
Gas
Nausea

The type and extent of your symptoms may vary. Research shows that the composition of your microbiome, which is a collection of microorganisms in your body, contributes to what type of symptoms you may have after consuming lactose.

Thankfully, lactose intolerance is not usually life threatening. Though it may be unpleasant, most health care providers do not view it as a disease. There are many ways to manage lactose intolerance.

Do you need to avoid lactose completely?

Avoiding lactose would involve avoiding the entire dairy food group. Since dairy products provide many important nutrients like protein, iron, calcium, vitamin D, and potassium, avoiding them completely, could potentially lead to worsened health. In addition, some research shows that lactose may act as a type of prebiotic, which serves as fuel to probiotics and help nourish your gut microbiome.

Because of these health benefits, major organizations including the National Insitute of Health recommend that milk and milk products should not be avoided, even by those with lactose intolerance. Most people with lactose intolerance can tolerate up to 12–15 grams of lactose per day. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316316/)

Thankfully, most individuals with lactose intolerance are still able to consume and tolerate some types of lactose.

Tips for managing lactose intolerance

The following information can help you reap the benefits of lactose and dairy products without causing negative symptoms of lactose intolerance:

Consume small amounts of lactose at one time. This means smaller servings of foods like milk, yogurt, cheese, ice cream, or any other food made from milk. The amount you tolerate will vary, so experiment with what works for you.

Pair dairy products with other foods containing fiber. Rather than drinking milk or eating yogurt on its own, for example, try pairing it with a high fiber food such as nuts, fruit, vegetables, or seeds. Fiber helps slow down the speed that food moves through your intestines. This gives more time for digestion of lactose to occur and may help reduce negative symptoms.

Choose hard cheeses. Hard cheeses like parmesan, swiss and cheddar contain less lactose. They are generally better tolerated in people with lactose intolerance, compared to soft cheeses like mozzarella, brie, and feta.

Stick to fermented dairy products. This includes yogurt and kefir. These provide live and active bacteria (probiotics) that help with breaking down lactose in your digestive tract. In addition, supplementing with high quality and multi-strain probiotics has been shown by research to help improve symptoms of lactose intolerance.

Choose lactose-free or non-dairy milk products. While non-dairy milk products give the benefit of providing substitutes for common dairy products, they do not provide the same nutritional profile. If you do end up avoiding all or most dairy products, be sure to make extra effort to get enough calcium, vitamin D, and other nutrients from milk into your diet by eating a wide variety of foods, and taking a multivitamin supplement if necessary.

Consider taking a lactase enzyme supplement. These can typically be purchased over the counter without a prescription and can help with lactose digestion. They should be taken at the start of a meal or snack containing lactose, or as directed by your healthcare provider.

You should follow up with your healthcare provider if you continue to experience symptoms despite following the above guidelines.

If you choose to use vitamins and supplements keep in mind, not all supplements are created equally. Talk to your healthcare provider about what supplement may be best for you.

In Summary

Lactose intolerance is a common, but usually not a life-threatening health condition. Since dairy products provide many important health benefits, they should not be avoided unless absolutely necessary.

You can experiment with including lactose in your IBS diet by following the information outlined above.