Lactose intolerance: more on which foods contain lactose and lactose-free alternatives.
Lactose intolerance is not an allergy. Lactose is a disaccharide, which is naturally found in the milk of most mammals. This disaccharide consistsof one part glucose (grape sugar) and one part galactose. To allow the disaccharide contained in food, to be absorbed into the bloodstream, it must be broken downinto monosaccharides by enzymes in the intestine. This requires the enzyme lactase.
Those who suffer from lactose intolerance lack – or have insufficient levels of – the enzyme lactase. Most of the lactose consumed therefore passes undigested in to the large intestine, where it is fermented by the intestinal bacteria. This leads to symptoms such as bloating, abdominal pain or diarrhoea.
Each affected personreacts differently. The type and intensity of symptoms vary from patient to patient. The residual activity of the remaining lactase in the intestine and the quantity of lactose consumed play a key role in it’s manifestation. Many affected peoplefind relief just by reducing the amount of lactose they consume. Very few have to eliminate lactose completely. If you suffer from digestive problems and find no relief in a diet low in/free from lactose, consult your doctor.
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Test your tolerance
If you feel like you don’t tolerate lactose very well, try switching to lactose-free products for a few days. Your symptoms should subside quickly and significantly within this period. Then try to find out how much lactose you can tolerate. Gradually reintroduce certain foods. Do this until you get a feel for your individual tolerance level. If you are struggling, you can contact a qualified dietitian for help. A list of qualified experts is available from the Swiss Association of Registered Dietitians (SVDE).
Generally avoid lactose?
If no symptoms appear when you consume lactose, then you are not lactose intolerant. In this case, there is no need to avoid lactose in general. On the contrary: this will limit your diet unnecessarily and make mealplanning more complicated.
Alternatives to foods containing lactose
Lactose is naturally found exclusively in dairy products. The amount of lactose in dairy products varies according to the production process used. The following table offers an overview:
|Dairy products||Lactose level/tolerance||Alternative|
|Milk, buttermilk, whey||Contain relatively large amounts of lactose and are poorly tolerated by most affected people.||Lactose-free milk|
|Cream (whipped cream)||Although cream contains lactose, it is normally consumed in small amounts, which is therefore tolerable.||Lactose-free cream|
|Yoghurt, sour milk||The lactose has been partially broken down, making it more tolerable than milk. It’s worth testing.||Lactose-free yoghurt|
|Quark, Blanc Battu, cottage cheese, ricotta, feta, mozzarella||Contain medium amounts of lactose, test the tolerance level.||Cream cheese free from/low in lactose|
|Soft cheese (Tomme, Brie) and semi-hard cheese (Appenzeller, Tilsiter, Raclette)||Contain only traces of lactose and are well tolerated.||No alternative necessary|
|Hard cheese (Emmentaler, Gruyère) and extra hard cheese (Sbrinz, Parmesan)||Lactose-free and well tolerated.||No alternative necessary|
|Butter||Butter is almost lactose-free.||No alternative necessary|
Source: The Swiss Society for Nutrition SSN
Lactose can also be found in products such as baked goods or sausages, as products containing lactose are often used during production. Take note of the list of ingredients on the product.
Example of a list of ingredients on a packet of butter biscuits:
Ingredients: Wheat flour, sugar, butter, eggs, skimmed milk powder, salt, raising agent
The list of ingredients tells you that skimmed milk powder was used during production. However, the exact amount does not need to be listed. Only the position on the list provides an indication. Ingredients are listed in descending order of amount.
Special lactose-free products and enzyme tablets
A wide assortment of special lactose-free products is now available in stores. The lactose in these products is broken down into glucose and galactose during production, so that it can be absorbed directly by the intestine.
Enzymes are also available as pills. Those affected can take the pills shortly before a meal containing lactose. The lactase contained in the pillbreaks down the lactose contained in the meal. It is still possible to enjoy a varied and balanced nutrition if you are lactose intolerant.
Author: Stéphanie Bieler BSc, Swiss Society for Nutrition SSN
Published on: 5 June 2019
Dietitian Stéphanie Bieler
Stéphanie Bieler (BSc Dietitian, Bern University of Applied Sciences) works at the Swiss Society for Nutrition SSN in Bern. She primarily focuses on maintaining a balanced diet across various age and target groups. Stéphanie Bieler writes articles for Helsana on the topic of nutrition.