How to Manage and Reverse Lactose Intolerance

Being lactose intolerant sucks. You feel like you can’t enjoy mouthwatering dairy foods like ice cream or cheese the same way your friends do. If you even think about drinking some milk, your life suddenly becomes an unpleasant series of violent farts, bloating, and explosive diarrhea.

Most people’s solution is to avoid dairy completely, but as I discussed in part 1 of this article, dairy is deeply beneficial for health and body composition. It’s also quite difficult to meet optimal nutrient levels, particularly calcium without dairy. Calorie for calorie, dairy provides more protein, calcium, potassium, phosphorus, magnesium and zinc than most foods (7).  

Furthermore, research shows dairy avoiders don’t end up getting sufficient calcium and vitamin D from other sources (6).

Fortunately, most people aren’t completely doomed to choose between discomfort and health. There are many ways to still enjoy dairy even if you’re lactose intolerant. You really can have your cake and eat it too.

Lactose Intolerance Overview

Being lactose intolerance means your body fails to produce enough of the enzyme lactase which is crucial to breaking down the sugar in milk known as lactose (1).

As you advance through adulthood, most people start to lose their ability to produce lactase. Only about a quarter of the adult population retain their lactase known as lactase persistence (2). For the rest of us, lactase activity reduces, making a majority of people to some extent, lactose intolerant.

This is commonly seen in countries with decreasing dairy and Vitamin D consumption (3,6).

So while it’s likely you don’t have as much lactase as when you were 12 years old, science shows us you have more than you think.

Research shows people who often think they’re extremely lactose intolerant usually aren’t. One meta-analysis found people who claim to be lactose intolerant generally reacted just fine to both lactose and placebo (4). A 2010 systematic review found self-reported intolerance is quite inaccurate as actual testing produced results inconsistent with self-reported diagnosis (5).

So while you might be lactose intolerant, it’s likely not that bad. Small doses of lactose are perfectly tolerable in most lactose intolerant people (2,3,8,9).

Lactose Intolerant Dairy Tips

Scientific research suggests the following tips, so you’re not destined to a life without dairy (9).

  • Start reintroducing small doses. Consumption is best with meals as this slows digestion making it easier to breakdown.
  • Eat aged or hard cheeses. These cheeses have minimal lactose in it and something about the aging helps you with digestion. White cheeses also tend to be lower in calories usually indicating lower lactose levels.
  • Consume lactose free or lactose reduced products. They have all the benefits of conventional dairy, but without the lactose (10). Sometimes, they’re lower calorie too, so that’s a plus for dieters.
  • Drink chocolate milk instead of regular milk. People with lactose issues don’t seem to have the same issues with chocolate milk even when lactose doses are raised in them (12).
  • Use Lactase tablets and/or drops before dairy consumption. These supplements essentially give you the fire power to break down lactose (11).
  • Consume fermented dairy products like yogurt and kefir. The probiotics and prebiotics helps your gut digest dairy better without discomfort (19). In fact, these might very well be the most powerful foods for lactose intolerant people (8). They also perform very well in studies looking at health outcomes.

It also doesn’t hurt to supplement or eat more calcium rich foods as that’s the biggest issue with limited dairy consumption. Foods like fortified calcium drinks, dark leafy greens, fish bones, tofu, almonds, chia seeds, and legumes are all pretty good choices.

Reversing Lactose Intolerance

Above are great tips for managing lactose intolerance, but we have various lines of evidence that reversing lactose intolerance (at least to some extent) is possible.

One study took 20 lactose intolerant adults, split them into 2 groups and put them through 2 different condition in random order (13).

  1. 10 days of progressively increased dextrose (corn sugar) ingestion followed by 10 days of progressively increased lactose ingestion followed by a large dose of lactose for testing.
  2. 10 days of progressively increased lactose ingestion followed by 10 days of progressively increased dextrose ingestion followed by a large dose of lactose for testing.

In both groups, symptoms had significantly decreased following progressive lactose ingestion.

This indicates your body is adapting and slowly tolerating lactose better especially if you slowly progress the dosage over time. Our bodies are amazing entities aren’t they?

How does this exactly happen?

The main proposed explanation is your gut bacteria. If you’re lactose intolerant, you might not have enough lactase to break down lactose, but your bacteria is able to when it’s optimized for this. Generally speaking, the healthier and more diverse your microbiota is, the less lactose intolerance hinders you (14).

This might also explain why people seem lactose intolerant. Their gut health just sucks from eating the average crappy American diet.

To improve your colonic microbiota to where symptoms are relieved, yogurt and probiotics are quite effective (15,16,17). Fiber is also critical for optimal gut health, so don’t forget to include enough in your diet as well (18).

So if you want to reverse your lactose intolerance, at least to some extent, it comes down to the following:

  • Don’t completely avoid dairy. Gradually increase doses over time to create adaptation.
  • Eat fermented dairy products like yogurt or take probiotics.

Time to Reunite With Cheese

Give some of these tips a try if you’re lactose intolerant. Even the worse of scenarios can usually be improved with lactase drops or probiotic supplements. Don’t forget to send me a thank you email when you’re finally enjoying some cheese while laughing maniacally at your previous symptoms.

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  1. Deng, Yanyong, et al. “Lactose Intolerance in Adults: Biological Mechanism and Dietary Management.” Nutrients, MDPI, 18 Sept. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4586575/.
  2. Mattar, Rejane, et al. “Lactose Intolerance: Diagnosis, Genetic, and Clinical Factors.” Clinical and Experimental Gastroenterology, Dove Medical Press, 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3401057/.
  3. Bayless, Theodore M, et al. “Lactase Non-Persistence and Lactose Intolerance.” Current Gastroenterology Reports, U.S. National Library of Medicine, May 2017, www.ncbi.nlm.nih.gov/pubmed/28421381.
  4. Savaiano, Dennis A, et al. “Lactose Intolerance Symptoms Assessed by Meta-Analysis: a Grain of Truth That Leads to Exaggeration.” The Journal of Nutrition, U.S. National Library of Medicine, Apr. 2006, www.ncbi.nlm.nih.gov/pubmed/16549489.
  5. Jellema, P, et al. “Lactose Malabsorption and Intolerance: a Systematic Review on the Diagnostic Value of Gastrointestinal Symptoms and Self-Reported Milk Intolerance.” QJM : Monthly Journal of the Association of Physicians, Centre for Reviews and Dissemination (UK), Aug. 2010, www.ncbi.nlm.nih.gov/pubmed/20522486.
  6. Alharbi, Ohood, and Ahmed El-Sohemy. “Lactose Intolerance (LCT-13910C>T) Genotype Is Associated with Plasma 25-Hydroxyvitamin D Concentrations in Caucasians: A Mendelian Randomization Study.” The Journal of Nutrition, U.S. National Library of Medicine, June 2017, www.ncbi.nlm.nih.gov/pubmed/28446633.
  7. Rozenberg, Serge, et al. “Effects of Dairy Products Consumption on Health: Benefits and Beliefs–A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.” Calcified Tissue International, Springer US, Jan. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4703621/.
  8. Shaukat, Aasma, et al. “Systematic Review: Effective Management Strategies for Lactose Intolerance.” Annals of Internal Medicine, Centre for Reviews and Dissemination (UK), 15 June 2010, www.ncbi.nlm.nih.gov/pubmed/20404262/.
  9. Szilagyi, Andrew, and Norma Ishayek. “Lactose Intolerance, Dairy Avoidance, and Treatment Options.” Nutrients, MDPI, 15 Dec. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6316316/.
  10. Silanikove, Nissim, et al. “The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds.” Nutrients, MDPI, 31 Aug. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4586535/.
  11. Gingold-Belfer, Rachel, et al. “Use of a Novel Probiotic Formulation to Alleviate Lactose Intolerance Symptoms-a Pilot Study.” SpringerLink, Springer US, 7 Jan. 2019, link.springer.com/article/10.1007%2Fs12602-018-9507-7.
  12. Järvinen, R M K, et al. “Tolerance of Symptomatic Lactose Malabsorbers to Lactose in Milk Chocolate.” European Journal of Clinical Nutrition, U.S. National Library of Medicine, May 2003, www.ncbi.nlm.nih.gov/pubmed/12771971.
  13. Hertzler, S R, and D A Savaiano. “Colonic Adaptation to Daily Lactose Feeding in Lactose Maldigesters Reduces Lactose Intolerance.” The American Journal of Clinical Nutrition, U.S. National Library of Medicine, Aug. 1996, www.ncbi.nlm.nih.gov/pubmed/8694025.
  14. Zhong, Yan, et al. “The Role of Colonic Microbiota in Lactose Intolerance.” Digestive Diseases and Sciences, U.S. National Library of Medicine, Jan. 2004, www.ncbi.nlm.nih.gov/pubmed/14992439.
  15. He, T, et al. “Effects of Yogurt and Bifidobacteria Supplementation on the Colonic Microbiota in Lactose-Intolerant Subjects.” Journal of Applied Microbiology, U.S. National Library of Medicine, Feb. 2008, www.ncbi.nlm.nih.gov/pubmed/17927751.
  16. de Vrese, M, et al. “Probiotics–Compensation for Lactase Insufficiency.” The American Journal of Clinical Nutrition, U.S. National Library of Medicine, Feb. 2001, www.ncbi.nlm.nih.gov/pubmed/11157352.
  17. Oak, Sophia J, and Rajesh Jha. “The Effects of Probiotics in Lactose Intolerance: A Systematic Review.” Critical Reviews in Food Science and Nutrition, U.S. National Library of Medicine, 2019, www.ncbi.nlm.nih.gov/pubmed/29425071.
  18. F;, Makki K;Deehan EC;Walter J;Bäckhed. “The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease.” Cell Host & Microbe, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/29902436-the-impact-of-dietary-fiber-on-gut-microbiota-in-host-health-and-disease/.
  19. Chey . “Galacto-Oligosaccharide RP-G28 Improves Multiple Clinical Outcomes in Lactose-Intolerant Patients.” Nutrients, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32290344/.

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