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Managing Lactose Intolerance Naturally

Written by Institute for Natural Medicine Staff
Medically Reviewed by BreAnna M. Guan, ND
  • Last Updated August 20, 2024

In this article:

If you have lactose intolerance, you are not alone. About 68% of the world’s population and 36% of Americans are lactose intolerant.1National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for lactose intolerance. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/definition-facts Ethnicity also plays a role. For example, in Africa and Asia, most of the population is lactose intolerant, while it is far less common in Europe.2National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for lactose intolerance. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/definition-facts

But what exactly is lactose intolerance, and how is it diagnosed and treated? A discussion about treatment must begin with a thorough understanding of the symptoms.

Lactose Intolerance Symptoms

Dairy foods such as milk, cheese, yogurt, and ice cream contain a sugar known as lactose. After eating these foods, the digestive enzyme called lactase is activated in the digestive system—specifically the small intestine—to help break down the sugar into glucose and galactose.3American College of Gastroenterology. Lactose intolerance overview. Accessed August 14, 2023. https://gi.org/topics/lactose-intolerance-in-children If not processed properly in the small intestine, undigested lactose travels to the large intestine, where it causes a wide range of gastrointestinal symptoms:4American College of Gastroenterology. Lactose intolerance overview. Accessed August 14, 2023. https://gi.org/topics/lactose-intolerance-in-children,5Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019;68:2080-2091. doi.org/68/11/2080

  • Bloating
  • Cramping
  • Pain
  • Burping
  • Gas
  • Nausea
  • Diarrhea

These symptoms typically occur within an hour or two after ingesting dairy.6Silberman ES, Jin J. Lactose intolerance. JAMA. 2019;322(16):1620. doi.org/10.1001/jama.2019.9608

Lactase Deficiency

Lactase enzyme deficiency is the cause of primary lactose intolerance and can occur at any age, as the activity of this critical digestive enzyme starts to decline soon after birth. Secondary lactose intolerance occurs when injury or diseases (such as celiac disease) damage the intestines.7Deng Y, Misselwitz B, Dai N, Fox M. Lactose intolerance in adults: Biological mechanism and dietary management. Nutrients. 2015;7(9):8020-8035. doi.org/PMC4586575/?report=reader In addition, people with irritable bowel syndrome may have difficulty consuming lactose. Many individuals struggle with lactose intolerance as they get older. This is called Acquired Lactase Deficiency.

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Is It the Same as a Milk Allergy?

An inability to digest lactose is very different from having an allergy. Milk products contain proteins, like casein and whey. With a milk allergy, the immune system overreacts by trying to neutralize those proteins, which can cause digestive symptoms similar to lactose intolerance or a more severe reaction: swelling, breathing problems, and anaphylaxis.8Edwards CW, Younus MA. Cow milk allergy. StatPearls. 2023 Jan. https://www.ncbi.nlm.nih.gov/books/NBK542243/

Some children who cannot tolerate milk products may have a milk allergy. Often, children will grow out of this allergy and be able to eat dairy foods.

Diagnosis

If eating dairy causes discomfort, intolerance is likely. Tests can confirm this condition. A doctor-administered hydrogen breath test detects bacterial fermentation in the intestine, which indicates an inability to tolerate lactose.9Rana SV, Malik A. Hydrogen breath tests in gastrointestinal diseases. Indian J Clin Biochem. 2014;29(4):398-405. doi.org/PMC4175689/?report=reader

A blood test can also confirm intolerance. Because lactose produces glucose as it breaks down, low glucose levels in the bloodstream after drinking a liquid containing lactose signify intolerance.10Silberman ES, Jin J. Lactose intolerance. JAMA. 2019;322(16):1620. doi.org/10.1001/jama.2019.9608

Lactose Intolerance Treatment

Treating lactose intolerance typically entails consuming fewer dairy products to reduce or eliminate symptoms. The body often tolerates some lactose, so understanding which products contain the most lactose is essential. Milk and ice cream have high amounts of lactose, while Greek yogurt and hard cheeses contain less.11Silberman ES, Jin J. Lactose intolerance. JAMA. 2019;322(16):1620. doi.org/10.1001/jama.2019.9608 Other foods that contain lactose include buttermilk, cream cheese, sour cream, butter, and margarine. Processed foods like deli meats, powdered creamer, and breakfast cereals may also contain lactose.

For many, eliminating dairy is unnecessary, especially when dairy products are eaten with lactose-free foods.12Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019;68:2080-2091. doi.org/68/11/2080 Research indicates that most people with intolerance can digest about 12 grams of lactose—the amount in a cup of milk—experiencing only mild or no symptoms.13National Institute of Diabetes and Digestive and Kidney Diseases. Eating, diet, & nutrition for lactose intolerance. 2018;Feb. https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/eating-diet-nutrition To prevent GI discomfort, it’s best not to eat dairy on an empty stomach.

There is also a wealth of milk substitutes and non-dairy cheese, yogurt, and ice cream.14Dekker PJT, Koenders D, Bruins MJ. Lactose-Free Dairy Products: Market Developments, Production, Nutrition and Health Benefits. Nutrients. 2019;11(3):551. doi.org/PMC6471712/?report=reader Plant-based options such as cashew cheese, coconut yogurt, soy ice cream, and almond milk, pistachio milk, cashew milk, oat milk, soy milk, rice milk, and coconut milk contain no lactose.

Natural Remedies

When it comes to natural remedies for lactose intolerance, the most popular and effective strategy is taking lactase enzyme supplements with meals. Lactase enzymes help break down lactose in the digestive tract.

Preliminary research shows probiotics and prebiotics may also alleviate or reduce symptoms of lactose intolerance.15Leis R, de Castro MJ, de Lamas C, Picáns R, Couce ML. Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials. Nutrients. 2020;12(5):1487. doi.org/PMC7284493/?report=reader A 2022 review of five studies found prebiotic and probiotic supplements improved GI symptoms.16Scalcon de Oliveira L, Wendt G, Crestana A, Casaril K. The use of probiotics and prebiotics can enable the ingestion of dairy products by lactose intolerant individuals. Clinical Nutrition. 2022;41(12):2644-2650. doi.org/S0261-5614(22)00354-5/fulltext

Studies also show that active cultures in probiotic-rich foods like yogurt, sauerkraut, miso, kimchi, and sourdough bread may help break down lactose and further diminish lactose intolerance symptoms.17Ibrahim SA, Gyawali R, Awaisheh SS, et al. Fermented foods and probiotics: An approach to lactose intolerance. Journal of Dairy Research. 2021;88(3):357-365. doi:10.1017/S0022029921000625

Reversing Lactose Intolerance

In addition to natural remedies such as lactase digestive enzymes, prebiotics, and probiotics, research shows some people with lactose intolerance can enjoy dairy again symptom-free.18Szilagyi A, Ishayek N. Lactose Intolerance, Dairy Avoidance, and Treatment Options. Nutrients. 2018;10(12):1994. doi.org/PMC6316316/?report=reader Through a process called adaptation, a person regularly consumes small amounts of dairy, helping the body gradually adapt and eventually tolerate lactose. Preliminary studies suggest that combining prebiotics and probiotics with the adaptation strategy could positively influence the gut microbiome, potentially reversing lactose intolerance entirely.19United States Department of Agriculture. MyPlate: Dairy. Accessed 2023, Aug. https://www.myplate.gov/eat-healthy/dairy More research is needed in this area.

Managing Lactose Intolerance

On a low- or no-dairy diet, you could be missing nutrients your body needs, such as vitamins A, D, B12, calcium, magnesium, and phosphorus.20United States Department of Agriculture. MyPlate: Dairy. Accessed 2023, Aug. https://www.myplate.gov/eat-healthy/dairy It’s important to eat calcium-rich foods (dark, leafy green vegetables; canned salmon). To avoid deficiencies and further ease lactose intolerance symptoms, consider consulting a naturopathic doctor. Naturopathic doctors optimize diet and incorporate dietary supplements to enhance health.

Although there is no “cure” for lactose intolerance, there are ways to reduce symptoms and occasionally enjoy dairy products. Relief is possible through a combination of diet, supplements, and adaptation.

Footnotes

This article is provided by

The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform health care in the United States by increasing public awareness of natural medicine and access to naturopathic doctors. Naturopathic medicine, with its person-centered principles and practices, has the potential to reverse the tide of chronic illness overwhelming healthcare systems and to empower people to achieve and maintain optimal lifelong health. INM strives to fulfil this mission through the following initiatives:

  • Education – Reveal the unique benefits and outcomes of evidence-based natural medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research on this complex and comprehensive system of medicine

About The Author(s)

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Institute for Natural Medicine Staff

Our dedicated content team of professional staff writers represents decades of experience covering essential natural health topics in an accessible, evidence-based, and engaging way. Guided by a shared passion for holistic well-being, each and every one of our writers strives to empower our readers to take charge of their health.

Supported by a rigorous fact-checking and medical editing process from licensed naturopathic doctors that examines the latest in peer-reviewed research, our team brings their in-depth knowledge of natural health practices into every piece of content we produce. We strive to be the gold standard for evidence-based natural medicine, providing trustworthy information and inspiring narratives to help you live your best health, naturally.

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