How do I know if I am lactose intolerant?

The symptoms of lactose intolerance include stomach pain, gas and even diarrhoea after eating foods containing lactose. If you notice an association between taking milk and milk products and such symptoms, see your GP, as it is easy to confuse the symptoms of lactose intolerance with other conditions such as Irritable Bowel Syndrome.

If you suspect that your baby or child is lactose intolerant, talk to your GP. While an adult can generally learn to manage the symptoms of lactose intolerance through trial and error, such symptoms in a child may reduce appetite and in turn reduce energy and nutrient intake, so always seek medical advice.

What foods contain Lactose?

The main source of lactose is milk and milk products, but for some individuals, even the smallest trace of lactose can cause symptoms. As well as milk and milk products, possible sources of lactose include:

• Breads, biscuits, cakes and cake mixes;
• Commercial breakfast cereals and baby cereals containing milk;
• Instant desserts, instant porridge;
• Instant potato mash;
• Dried and tinned soups;
• Margarines;
• Dry roasted nuts with flavouring containing lactose;
• Toffee, fudge, milk chocolate;
• Some low calorie sweeteners.

Reading the labels on food packaging will also inform you on the lactose content. Look out for terms such as milk, lactose, milk solids, whey, curds and dry milk powder. Remember also that lactose is often used as a 'filler' in tablets and medicines, so be sure to read medicine labels carefully and ask your doctor or pharmacist about alternatives if necessary.

What can I do about Lactose Intolerance?

The first thing to note is that while lactose intolerance is a bit of a nuisance, lactose will not damage your gut in the long-term. Lactose intolerance is not as serious as coeliac diseasewhere damage to the gut occurs if a person continues to eat gluten. Once lactose is reduced or removed from a lactose intolerant person's diet, the gut quickly returns to normal.

The easiest thing to do is to change your diet and there are several ways to do this:

Reduce your intake of milk and products made from milk

Many people find that reducing the amount of lactose containing foods is sufficient to get rid of their symptoms. Start by reducing the amount of milk you take by about a quarter and reduce as necessary to see how much you can tolerate. Note also that if you have milk with a meal you may be able to tolerate it. You may find that while you cannot down a pint of milk in one go, having a small glass with your dinner is fine and that the odd milk pudding causes little or no symptoms!

Choose 'lower lactose' milk products

Not all milk products contain the same amount of lactose - the harder the cheese the lower the lactose and the more 'live' a yoghurt is the lower the lactose!
Ricotta is one of the only cheeses with a significant lactose content, so it's likely that you will be able to tolerate most other types. 'Probiotic' and 'Live' yoghurts contain organisms that break down the lactose during fermentation, so by the time the yoghurt is ready to eat, there is very little lactose left.

Use 'Lactase Drops'

You can actually buy the enzyme lactase in the form of drops from your pharmacist. Lactase drops were traditionally used to treat colic in babies, but have become popular in recent years as a treatment for lactose intolerance.

In order for lactase drops to work, they must be added to milk and left for a certain amount of time until they have digested the lactose in the milk (see manufacturers details for how much lactase to use and for how long milk needs to be allowed for lactose breakdown to take place). Once the majority of lactose has been broken down, you can use milk in the same way as you normally do e.g. for drinking, using in puddings and custards. You will find that lactase-treated milk has a sweet sugary taste - this is because when lactose is broken down by lactase, it turns into a simple sugar.

Alternatives to Dairy foods

If you find that you are completely unable to take dairy foods, it is important to find an alternative source of calcium-containing foods. Meeting your calcium needs while avoiding dairy products takes a bit of extra effort.

Many common foods are now enriched with calcium. You can buy calcium-enriched versions of fruit juice, soya-milk and soy-milk products, bread and tofu (a vegetable alternative to meat).
Calcium-containing foods: Calcium contained in vegetables does not absorb as well into our body as dairy food calcium, so you will need to include the following foods in your diet on a regular basis:

• Spinach;
• Broccoli;
• Almonds.

Tinned salmon and mackerel including the fish bones are an excellent source of calcium.

It is difficult to meet your calcium needs without dairy foods, so you may need to consider calcium supplementation. It is best to have your calcium intake assessed by a dietitian before commencing calcium supplementation and to consult your doctor