Practical Nutrition: Ways to tolerate lactose intolerance

Does the sight of a large chocolate milkshake topped with whipped cream make you drool or want to run away in terror? If it's the latter, then you might suffer from lactose intolerance.

Lactose is the carbohydrate, or sugar, found in milk and dairy products, or foods containing them. People who don't produce enough lactase, the enzyme that breaks down lactose, can't fully digest lactose.

If they consume foods containing lactose, they might experience painful gas, bloating, diarrhea or stomach pain.

Lactose intolerance is not the same as a milk allergy. A milk allergy is the body's immune response to the protein in milk, not the lactose. When milk protein is ingested, those who are allergic might experience symptoms similar to lactose intolerance. But other allergic responses, such as itchy eyes, dry throat, rashes, hives, nausea, difficulty breathing and anaphylactic shock, also could occur, depending on the severity of the allergy.

Thanks to the Lactaid company, there's a line of lactose-free milk available as fat-free, 1 percent, 2 percent, whole or chocolate. Unfortunately, many local stores don't seem to carry the chocolate.

For a lactose-free, vegetarian option, milk made from rice, almond or soy is available locally, including chocolate flavors.

Soft cheese is high-lactose, but some brands of hard cheese, like cheddar, are lactose-free or very low-lactose. Cabot labels its hard cheeses as lactose-free. Cracker Barrel and Kraft label theirs as "0 grams lactose per serving." Check the label of your favorite cheese.

Vegetarian rice- or soy-based soft cheeses are often found in the dairy aisle, too.

Yoplait just released a lactose-free yogurt in several flavors. Although the yogurt is 99 percent fat-free, it still contains sugar and 170 calories per serving.

If you're avoiding milk or dairy products, your calcium intake could be low. Dairy foods have the highest calcium content, but you can protect your bones by getting calcium from other foods.

Select calcium-fortified soy, rice or almond milk substitutes. Other good choices include tofu, canned sardines and salmon (with the bones), dried beans, collard or turnip greens. Look for foods, such as juices, breads and cereals, labeled calcium-fortified.

Lactose intolerance varies by individual. It might be related to the amount of lactose consumed, or the degree of lactase deficiency. Some people avoid only milk and ice cream, but can eat yogurt and cheese. Others can tolerate small amounts of lactose throughout the day, but never in large amounts.

But what if you just can't resist that creamy milkshake or run out of lactose-free milk for your breakfast cereal? Lactaid makes lactase enzyme capsules and pills, which are available at local grocery and drug stores. Take one after your first bite of a lactose food, and enjoy!

Living with lactose intolerance

Lactose intolerance varies greatly with individuals, so you might be able to tolerate small amounts. Check with your registered dietitian or doctor for your specific health needs. These suggestions might give you a bit more freedom when choosing a healthy, lactose-free diet.

Recommended foods

• Lactose-free milk

• Nondairy creamers

• Almond, soy or rice milk

• Soy yogurt, cheese or sour cream

• Soy- or rice-based frozen desserts

• Fruit ices, sorbet or gelatin

• Fruits*

• Grains*

• Meat*

• Some hard cheese*

• Nuts and seeds*

• Vegetables*

• Vegetable oils

• Herbs and spices

• Foods labeled "lactose free"

• These ingredients come from milk, but do not contain lactose: casein, lactalbumin, lactate, lactic acid

* Fresh foods may be lactose-free. Read labels carefully.

Foods to avoid

• Foods made with butter, cream, milk, milk solids, yogurt or whey

• Lunch meats and hot dogs

• Baked goods

• Pancake and cake mixes

• Instant potatoes

• Instant soups

• Beverage mixes

• Salad dressings

• Candy

• Margarine

Substitutions in recipes

• Instead of 1 cup milk, use:

1 cup lactose-free milk

½ cup soy or rice milk with ½ cup water

½ cup liquid nondairy creamer and ½ cup water

OR 1 cup lactose-free milk

• Instead of ½ cup cottage cheese, use:

½ cup soft tofu

• Instead of 1 cup yogurt, use:

1 cup lactose-free yogurt

OR 1 cup soy yogurt

• Instead of 1 ounce cheese, use:

1 ounce lactose-free cheese

1 ounce soy cheese

• Instead of 1 tablespoon cream cheese, use:

1 tablespoon mayonnaise

Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association)