Nachos, chocolate, frozen yogurt, smoothies and many more delicious foods have one thing in common: they traditionally contain milk. The trouble is, not everyone can absorb and tolerate milk in the same way because many people are affected by lactose malabsorption, which in turn can lead to lactose intolerance.

As reported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in “Definition & Facts for Lactose Intolerance,” it estimates that about 68% of the world’s population has lactose malabsorption, a reduced ability to digest lactose. Lactose intolerance simply means that a person actually presents digestive symptoms based on this inability to break down Lactose, a sugar naturally derived in milk and milk products. Most lactose intolerant people can stomach some lactose without experiencing symptoms. It is not a milk allergy, however, as a milk allergy is an entirely different disorder related to the immune system.

In certain parts of world, lactose malabsorption and lactose intolerance are more common than in other places. In the U.S., specific ethnic and racial groups have been observed to have higher rates of lactose malabsorption; these groups are those of African American, American Indian, Asian American or Hispanic/Latino descent. 

Symptoms and diagnosis of Lactose Intolerance

As outlined by the Cleveland Clinic on its “Lactose Intolerance” page, common symptoms of lactose intolerance include nausea, cramps, gas, bloating or diarrhea roughly 30 minutes to two hours after consuming milk or other dairy products. These symptoms occur because the body does not have enough lactase, an enzyme produced by the small intestine needed to digest lactose. The severity of the lactose intolerance and how much lactose is needed before symptoms develop varies from person to person.

For an official confirmation of a lactose intolerance diagnosis, a hydrogen breath test is often conducted in an outpatient clinic or doctor’s office. Patients who suspect that they may be experiencing lactose intolerance will avoid milk and dairy products for one to two weeks to monitor if their symptoms subside, and then the hydrogen breath test is conducted to confirm or disprove the diagnosis. The test measures the amount of hydrogen in a patient’s breath after drinking a lactose-heavy beverage.

How to Manage and Treat Lactose Intolerance

Typically, lactose intolerance is managed by dietary changes that restrict or eliminate drinks and food containing lactose. The degree to which a lactose intolerant person needs to limit or remove lactose from their diet depends on the severity of their symptoms. Lactase products have proved helpful as well for some people in managing their intolerance.

Typically in pill or drop form, lactase products contain the necessary lactase enzyme to help consumers break down lactose. Tablets can be taken prior to eating or drinking milk products. Lactase drops can also be added to milk prior to drinking. These products can help the chances of reducing lactose intolerance symptoms materializing. As with the introduction of any new medication or supplement, consult with a primary care professional before using lactase products. Young children, as well as pregnant and breastfeeding women, may not be advised to use them.

Individuals with lactose intolerance need to take care to get enough calcium and vitamin D from other sources besides milk to keep their bones strong. NIDDK recommends several alternative calcium sources to incorporate in a healthy diet, like broccoli, leafy greens, oranges, tofu, brazil nuts, almonds, dried beans and fish with soft bones such as salmon or sardines. Vitamin D is found in salmon, eggs and supplements, as well as good old-fashioned sun absorption by spending time outdoors.

Sneaky Lactose Sources

It’s not always easy to tell what products contain lactose and which don’t, as milk and milk products can be used in a wide variety of boxed, canned, frozen, packaged and prepared food. NIDDK lists potential sources of lactose that might go under the radar, which are:

  • Bread and other baked goods like pancakes, biscuits, cookies and cakes
  • Processed foods like cereals, instant potatoes, soups, margarine, salad dressings, flavored chips and other snack foods
  • Processed meats like bacon, sausage, hot dogs and lunch meats
  • Milk-based meal replacement liquids and powders, smoothies, protein powders and bars
  • Nondairy liquid and powdered coffee creamers, as well as nondairy whipped toppings

The ingredients list can be your best friend when trying to limit lactose intake. It may make sense to put a product back if it says it contains milk, lactose, whey, curds, milk byproducts, dry milk solids or nonfat dry milk powder. Even some prescription and over-the-counter medicines can contain a small amount of lactose. If you cannot tolerate even small lactose portions, discuss with your doctor about the medicines you take and their potential for an upset stomach.


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