A surprising number of people on this planet cannot digest milk or milk products. An estimated 75 million Americans (about 25% of the US population) have this condition. In the United States, as many as 25% of the white population (with prevalence among those with southern European roots) have some degree of lactose intolerance. Among the Afro-American, Native-American, and Asian-American populations, the estimated prevalence is 75-90%. Of the world population, an estimated 75% are lactose intolerant to some degree.[1]

Click the No Milk icon for a table showing the incidence among the world's ethnicities.

The short explanation is that the small intestine makes an enzyme, lactase, that is required to break down the lactose found in dairy products into a form that can be absorbed into the body. If your lactase production is deficient, the bacteria in your digestive tract ferments the excess lactose in the food that you eat. A byproduct of fermentation is gas and fluid secretion. Meanwhile, your GI tract has determined that this material cannot be digested and it takes steps to expel it, usually forcibly and rapidly, usually through the south exit, and sometimes through the north exit. This often requires more than one visit to the WC over the span of the next 4-6 hours.

Get the picture? If not, click here.

The dairy farmer's lobby (DFL) would like you to believe that We The Afflicted can actually tolerate their ingredient in food. Is it just psychosomatic? True, some of The Afflicted can tolerate small quantities of dairy products, but for others, that same small quantity is the beginning of a digestive disaster.

For many people, milk is something that our bodies tolerate during infancy and adolescence. As we grow older, we become less and less tolerant to milk and its byproducts. Some ethnic groups (northern Europeans, and some Indians) have evolved genetically to being able to tolerate milk throughout their lives, while others, like Asians and Africans, can have trouble from birth.

Haute Cuisine means rich sauces and exotic flavors... and milk in many cases. Cheese adds flavor complexity to food, so it's common practice among foodies and food service professionals (and even rank amateurs) to crank the flavor knob by adding cheese. Milk and cream add smoothness to sauces. If you're one of The Afflicted, this is disaster. If you're planning to travel, this will be an issue. Count on it.

Lactose Intolerance Around the World. Click to enlarge

A few Ramblings about Lactose Intolerance

Your body doesn't make enough lactase to digest all the lactose (milk sugar) that you eat. You'd think the way to go is to just take those Lactaid (lactase) pills - you can do this, but the dosage is pretty tricky --

• Is your body making ANY lactase of its own?
• Have you eaten other food or had a lot to drink?

If so, you may need more of the pills to counter the lactose in food. Try taking one pill with your first bite of lactose-containing food, and one right after and see if that fixes your symptoms. (If it does, you just lucked out!) The pills work best when you chew them, even if they taste like chalk. If that's not enough, then try one before, one during, and one after.

Rick: I take 8 ultra-strength Lactaid to eat a McDonald's hamburger. That's a hamburger, NOT a cheeseburger, although I suspect that I could actually eat a cheeseburger and get away with it. Where's the milk? It's in the bun. Milk extends the shelf life of bread.

The problem is, if I don't get away with it, then it's not worth the unpleasant surprise, especially if I'm driving!

OTOH, even though I don't particularly care for their food (mostly because there's milk in nearly all of it), McD's are handy as they are nearly always open, and they have public restrooms, and the restrooms are usually reasonably clean. So, I keep track of McD's on my routes here and there, and in an emergency, I can nearly always find one. I try to buy something from them when I have to stop and make a deposit.

Don't count on this except in the USA. In France, McDonald's does not serve breakfast. I learned this the hard way.

I treat Lactaid tablets like a morning after pill. I don't eat them so that I can have milk, I eat them so that any milk I may have been slipped doesn't poison me (word choice deliberate). The problem is that I never know for sure how many tablets are required. Take too few, and you may just delay the problem and/or you may have a BM that resembles soft serve ice cream. I try hard to not flirt with the devil when I eat.

Read The Labels!

• If you see "natural flavors" or "natural sweeteners" on a label, one of those mystery ingredients could be milk! There ought to be a law! ‹‹Apparently there is, in Canada.››
• Adding milk to bread dough extends its shelf life (>80% of sliced bread has some form of milk in it. Bread with Sodium Stearol Lactylate is generally ok.).
• Milk sugar is used to coat grains of rice so they don't stick in the package (it's cheaper than cornstarch and the amount/weight is "small enough" they don't list it on the package. The clue is "no washing required.").
• Dried milk is used as a binder in sausages, hot dogs, and salami - so read the package carefully (and ask the help at the deli to let you see the package).
• Another surprise is that milk is sometimes found in pasta - as a by-product of the iron enrichment - choose those with ferrous sulfate and avoid those with ferrous lactate.
• Milk sugar is also found in items such as teriyaki sauce, soup broths, and cup-o-noodle/ramen seasoning - as replacements for the more expensive high-fructose corn syrup.
• Just say no to milk chocolate and look at dark chocolate labels carefully (sadly, Godiva Dark Chocolate has lactose in it).
• Restaurants sometimes do tricky things like soak fish in milk (or chicken in buttermilk) before breading it. And even if they don't, breadings and batters often have milk in them too.

Rick: I wanted to order razor clams at a restaurant, but before placing the order, I interrogated the waiter. Was there any milk in the "chef's special" coating? He went to the kitchen and asked, and they said "no." But upon further questioning, I found out that the coating was pancake batter made from a mix. Yes, they only added water to the mix, but I pointed out that pancake mixes contain dried milk.
KaChing! No Sale.

Don't buy expensive margarines. Butter is safe to eat because they take the white part (milk sugar) out and leave only the milk fat. My body can digest fat just fine. Nucoa brand margarine is inexpensive and has no lactose added (unlike most margarines that add whey to taste more like butter). And Nucoa tastes pretty good. But hey - just use real butter and you'll be fine.

Beware Lactose-Reduced products -- unless they claim to be lactose free, you might as well buy the better-tasting full-lactose products and take lactase pills. We did buy the Lactaid brand Eggnog this winter and were pleasantly surprised (the spices hid the off-taste of the enzyme added to the milk).

Mocha Mix makes an ice cream (sold at Issaquah Fred Meyer) that tastes close to real ice cream - they only have a few quarts on the shelf, so look carefully. Also there's a sour cream (and cream cheese) made by Tofutti called "Better than Sour Cream" It isn't really better than real sour cream or cream cheese, but comes closer in flavor and texture than most soy products. The "BTSC" is sold at our local Safeway in the organic dairy section. "BTCC" is available at most QFCs. (These are soy based, so they're out for Betty.)

Breyers makes a lactose-free Vanilla Bean Vanilla and lactose-free chocolate ice cream. It tastes very good. We can eat it WITHOUT taking any lactase pills.

There are a few cake mixes that are milk free - like Duncan Hines Golden Butter Recipe and Pillsbury French Vanilla, and some brownie mixes and dark chocolate cake mixes. Always check the ingredient list; you never know when they'll try to "improve" the mix by adding milk. Oh yeah, only a few flavors of prepared frosting are lactose free - most of them now show they contain MILK in bold letters in the ingredient list. Chicken flavored Top Ramen is "safe" while other flavors have lactose. Some things you'll just have to adapt - make mashed potatoes with Swanson's broth (no lactose), or add roasted garlic so you get better flavor. Say goodbye to lasagne unless you use soy cheese (which IMHO is not worth it).

Other things you're used to buying (like breakfast products) you'll have to make from scratch on your own - for waffles, pancakes, and muffins I often mix soy milk and fruit juice (or juice drained from canned fruit) instead of whatever milk they call for. Sometimes plain old water works just as well. For a bit more texture to water or juice, just add 1T flour and stir well.

Oh yes, and just when you thought it was only milk that had lactose ... green peas, beets, and lima beans all break down in your digestive tract to a chemical form of lactose (galactose) and can make you just as sick.

Betty: All is not lost though... Mostly I avoid ALL DAIRY/LACTOSE products, and only take lactase pills when I can't avoid milk (i.e., hamburger buns, bread in restaurants, hot dogs or sausage of unknown content, or when there's just no food alternatives and I have to eat something that might have milk in it).

However, I can drink small amounts of whole milk (2% has added whey) in a latte in the morning because I've been building up enzyme overnight. And up to 1/2 oz of certain cheeses (like swiss slices, extra sharp cheddar, and mozzarella sticks) which have less lactose than others (like havarti and parmesan) - but only in the morning. You'll have to see what works for you in combination with using lactase pills, and with your eating patterns.

Rick: Once a year, when I'm at home and not traveling anywhere (just in case), I'll eat 8 lactaids and have a dish of ice cream. Yes, that's sleeping with the devil. A man has to take chances once in awhile. see note above about Breyer's Lactose Free Ice Cream.

Many medicines are compounded with lactose as an ingredient. I take Allopurinol once a day, and I have to take a lactase tablet before consuming the pill or it comes squirting out an hour later. Ask your pharmacist to look at the medicine's formulary the next time you fill a prescription. If you're up to it, complain to the manufacturer about it.
Note: Formularies are not standardized across all manufacturers of generic or branded medicines.

Janis: I have to be careful when I consume milk products for days at a time. Sometimes, a pizza two days in a row will be ok, but then on the third day some unwashed rice will push me past my enzyme supply and I'll get sick. I have to be careful to limit unnecessary intake (since I don't avoid milk-heavy products outright) after I know I've had a high exposure, even if it's been a day or two. (Janis is our daughter, who is now somewhat LI.)

Collateral milk contamination.

Nutrition Concerns

Since we practice avoidance, we have to do something to try to replace the calcium that we would have gotten via dairy products. Calcium fortified OJ, calcium tablets, broccoli and soft-boned fish are the major sources of calcium in our house. But if you look at nutrition tables, you'll see that you need to eat a whole lot of broccoli to equal a glass of milk. In fact, you have to eat a lot of other things to equal the calcium content in a glass of milk. Sigh. You can also try taking calcium citrate supplements.

Defensive Measures

• If someone wants to confuse LI with an allergy, let them. The difference in terms of their attitude isn't important, in fact it might be to our advantage. People know about allergies and know that they aren't to be trifled with (like peanut allergies). Let their paranoia run rampant. Agree with them. "Yes, I'm allergic to milk."
• Buy the lactase pills at Costco, and buy their Kirkland brand instead of the almost twice as expensive Lactaid-Ultra pills. They come in individual packets that are easy to carry around in a pocket, wallet, etc. Just try to keep them in a cool-ish place because they don't seem to be as effective if they have been left in a hot car.
• Eating out? If you can, call ahead and discuss your problem with the manager. We are finding that more and more restaurants are taking food allergy issues very seriously.
• Restaurant help: the good ones will go ask in the kitchen. The bad ones don't care or don't understand, and they guess. The good ones let you know if they find out that something has milk in it. The bad ones let you find out the hard way, and then they say, "Sorry 'bout that!"
• If you survive the meal and they've done something to help, reflect it in the tip and make a point of letting them know just how much you appreciate their effort. Tell your friends too!
• Kosher practice, in addition to the Rabbi blessing the preparation area and standards for the treatment of food animals, also bans the consumption of meat and dairy products together. A cheeseburger washed down with a milkshake may be all-American, but it is NOT Kosher. Specifying a Kosher meal can be a good defense on airline flights, although as of late, with the Airlines making everything ala carte, you're probably going to end up bringing your own food onboard anyhow.

  Note: Kosher does not mean no dairy. It means no consumption of meat and diary together. That Kosher meal could well be swiss cheese on rye bread.

Eggs

When you order eggs in a restaurant, either order them in such a way that they must be broken from the shell (i.e fried), or if you like yours scrambled, ask the restaurant to break them from the shell instead of using the mix that many kitchens use. Note: it is really hard for restaurants to put milk into a hard boiled egg!

The Big Print

• Some foods just can't be made without milk. Identify them.
• If cheese is just a garnish, such as on spaghetti or in a salad, serve it on the side.
• Read the labels.
• Be aware of where milk can be hidden. The DFL is insidious and sneaky. You wouldn't expect to find lactose as an ingredient in Asian foods. Maruchan Cup-o-Noodles has it, so do the Nissin flavors. Some Teriyaki sauces have it. (it is a recent development (2016) that Cup-o-Noodles contains lactosse in the chicken flavor)
• Remember that a mix with nonfat dry milk that you just add water to amounts to it containing milk.
• It doesn't matter what animal it comes from, lactose is still lactose.
• Lactose reduced products work for some people and not for others.
• Peas and Lima Beans convert to a form of lactose during digestion. They can cause trouble, just like a glass of milk does, about 1-2 hours later.
• Wash rice before cooking, especially if it is labelled no wash rice.
• Remember that butter is usually OK for most of The Afflicted (ask).
• Margarine, unless it is Nucoa brand, has whey added to it.
• Many breads contain milk.
• Dessert ices can hide milk because of collateral contamination.
• Croutons usually harbor milk because of the bread. Sometimes there may be embedded cheese flavorings.
• Food coatings (like fry mixes) often contain milk, or foods may be dipped in milk before breading or flouring.
• Soaking things in milk leaves milk on them. DOH!
• Cooking milk makes no difference.

Traveling

Je ne supporte pas les produits laitiers.
Je ne supporte pas le lait, le crême, le sucre de lait, le lait sec, le fromage, le whey, tous les laits.
Le beurre est trés bien. La margarine n'est pas bien.
Merci!

Sufro de HIPERSENSIBILIDAD AGUDA A LA LACTOSA:
No puedo comer ningun alimento que contenga leche o sus derivados: leche, crema de leche, leche condensada, leche en polvo (o productos que la contengan), queso, yogurt, helados con base lactea, salsa bechamel, chocolate con leche, azucar de leche, arequipe, etc.

Si como alguna cosa que contenga peque as cantidades de lactosa (excepto mantequilla) me enfermo gravemente.

SI PUEDO comer mantequilla (no contiene lactosa) pero soy igualmente alergico a la MARGARINA.

¡Gracias!

Sono intollerante al lattosio.
Questo è simile (ma da un punto di vista medico, differente) a essere allergico al latte e ai suoi derivati. Non posso digerire né ingerire latte, panna, siero del latte, zucchero del latte, latticini, formaggio, o qualsiasi cosa fatta con e dal latte, ad eccezione del burro.

Queste cose mi fanno molto ammalare.

Burro è OK, margarina non è ok.

Grazie mille.

I am lactose intolerant. This is similar (but medically different) to being allergic to milk and other dairy products.
I can not digest milk, cream, whey, milk sugar, cheese, or anything made with milk EXCEPT butter. These things make me very ill.
Butter is OK. Margarine is NOT OK.
Thank you very much.

Hope

The new law calls for restaurants to take a few straightforward precautions, all of which Blue Ginger (Chef Tsai's restaurant) already does:

• Requires the placement in restaurant kitchens of an approved poster providing general information on food allergies as they relate to food preparation. (Tsai worked with FAAN to create these posters.)
• Requires menus to include a statement that the customer should inform the wait staff of any food allergy issue.
• Requires standard food service courses to include the viewing of an approved food allergy video.
• Requires Department of Public Health (DPH) to develop a program for restaurants to be designated as “Food Allergy Friendly” and to maintain a listing of restaurants receiving such designation on its website. Participation in the program is voluntary, and, in addition to any other DPH requirements, in order to receive such designation restaurants would be required to make available to the public a master list of all the ingredients used in the preparation of each food item available for consumption. (This section of the law was inspired by the "Food Bible" Tsai has kept since day one at Blue Ginger that includes a list of all ingredients used in each menu item.)

This sort of law needs to be enacted in the remaining 49 states. Furthermore, a similar law needs to be enacted for food labeling, so that allergens can not be hidden under the guise of "natural flavors."

Testing

It could be that your system is not producing enough lactase to meet your present level of dairy product consumption. Thus, (as the DFL would have us believe) you may be able to consume small amounts of dairy without problem. It is worth experimenting to determine the threshold of your tolerance.

Further, after a severe attack, it may take some amount of time for your lactase level to return. It might be worth trying to determine how long this takes. All of this empirical testing can help you manage your condition and live a better life with it. This is probably better than switching your underwear to Depends®.

Remember, for the definitive test, consult your physician. Some other gastrointestinal conditions can mimic LI symptoms, which is why your physician needs to be part of the solution.

Resources and Links

Disclaimer

This website's content is based on our personal experiences and intended solely for entertainment purposes only. We are not medical professionals and the content on this site is not to be considered medical advice.

Furthermore Lactaid® is the trademark of McNeil Nutritionals LLC and our use of their tradename in no way indicates any sort of ownership on our part of their trademark. The trademark remains the property of McNeil Nutritionals LLC.

Copyright ©2016 by Betty and Rick Chinn. All rights reserved.

Last modified 06/16/2013.