How to Cure Lactose Intolerance | Chris Kresser

How to Cure Lactose Intolerance

by Chris Kresser

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Lactose intolerance is one of the most common food intolerances, affecting up to 65% of the world’s adult population. (1) Many people choose to completely cut out dairy as a way to avoid the gastrointestinal symptoms that frequently come along with eating dairy foods. But is true lactose intolerance really the cause of their digestive distress, or are many people prematurely eliminating dairy because of a perceived inability to digest milk products? And is it possible to cure lactose intolerance, even as an adult?

The major reason some people can’t digest dairy products is they lack the enzyme lactase, which is necessary to break down lactose in the small intestine. It has been determined that continued genetic expression of this enzyme, known as lactase persistence, is dependent on ancestry and racial background. (2) The ability to consume dairy probably gave early herdsmen a distinct survival advantage, allowing for the spread of the gene in certain regions of the world such as northern Europe and parts of Africa; today, only about 40% of the world’s adult population maintain full lactase function following childhood. (3, 4)  Lactase deficiency makes digesting dairy products more challenging for these individuals.

However, true lactose intolerance is rarely diagnosed by medical testing, and adults frequently mistake their gastrointestinal symptoms as a sign that they are unable to digest dairy products at all. Studies have shown that even diagnosed “lactose malabsorbers” are capable of consuming moderate amounts of dairy, tolerating an average 12 grams of lactose when administered in a single dose (the lactose content found in 1 cup of milk) with little to no symptoms. (5)

Additionally, many adults who believe they have lactose intolerance are actually suffering from other gastrointestinal disorders such as SIBO, celiac disease, or IBS, and do not see significant benefit from eliminating dairy. Ultimately, there are many people who avoid dairy products without reason for doing so.

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Why dairy is worth eating

You may be wondering why eating dairy even matters; after all, there are many examples of ancestral cultures that had no dairy in their diets and maintained superb health. However, it is believed that certain ethnicities may have had physical adaptations to their low calcium diet, and also traditionally consumed animal foods that are higher in calcium but probably not so appetizing to us Westerners, such as fish heads, bones, and skin. (6, 7) Therefore, they were able to meet their individual calcium needs without milk and dairy.

Calcium is a mineral that is difficult to get adequate amounts of in a modern Western diet without the inclusion of dairy. While the adequate levels of fat soluble vitamins A, D, and K2 reduces the amount of calcium an adult needs to maintain bone health, it can still be challenging to get enough calcium simply from leafy greens and bone-in fish. Several studies have shown that individuals with lactose intolerance have lower bone density and are at higher risk for fractures and osteoporosis, likely due to their inadequate calcium intake. (8, 9, 10) This risk is possibly exacerbated by low K2 consumption, as grass-fed dairy is one of the best sources of vitamin K2.

Pastured dairy products, in particular, are also a good source of the fat soluble vitamins A, D and K2 – which can also be difficult to obtain elsewhere in the diet. In fact, the only other significant sources of K2 are goose liver and natto, foods that aren’t typically eaten or easy to find. And, as I pointed out in a recent article, dairy is the primary source of the natural trans-fat conjugated linoleic acid (CLA), which may have anti-cancer and other beneficial properties.

So what can you do if you believe you truly have lactose intolerance but want to begin eating dairy again? It may surprise you to learn that the quality and quantity of your gut bacteria can play an important role in your ability to tolerate dairy products.

By taking certain kinds of probiotics and consuming fermented dairy on a regular basis you can improve, if not eliminate, many of the symptoms of lactose intolerance that come with eating dairy.

Using probiotics to cure lactose intolerance

Studies have shown that supplementation with probiotics, in addition to consuming yogurt that has been enhanced with certain types of bacteria, can alleviate symptoms of lactose intolerance by modifying the metabolic activity of microbiota in the colon. (11, 12, 13) These bacteria may even produce their own lactase enzyme, and consuming lactose from dairy products can promote the growth of these bacteria in the colon. Over time, these effects can lead to greater lactase content in the gut, improved lactose digestion, and eventually the elimination of intolerance symptoms.

If you plan to use yogurt and probiotics to improve your digestion of dairy products, it’s important to start slowly and build up tolerance gradually. Often, negative effects from dairy consumption come from simply eating more lactose in one sitting than one’s gut can completely metabolize. I recommend starting with probiotic supplementation first, and focusing on bifidobacterium longum, a strain that has been shown to efficiently metabolize lactose. (14)

Jarro-Dophilus, a shelf-stable probiotic that doesn’t require refrigeration, is one option. Taking prebiotics is another way of significantly increasing bifidobacterium levels; in fact, some studies suggest prebiotics are more effective than probiotics at doing this. Biotagen is the prebiotic I use in my clinic. Remember to start at a very low dose and build up slowly over time with both pre- and probiotics to avoid any unpleasant side effects.

In addition to this supplement, I suggest consuming a few spoonfuls of a high quality full-fat yogurt every day, with each meal if possible. This will introduce beneficial bacteria into your gut that are effective lactose metabolizers, and by slowly increasing the amount of yogurt you eat every day, you may be able to work up to eating two or more servings of fermented dairy every day.

If you tolerate the yogurt well, and want to try diversifying your dairy intake, my next recommendation is to start including full-fat hard cheeses (raw if possible); these cheeses are great sources of calcium and vitamin K2 and are very low in lactose. One ounce of hard cheese contains about a third of the recommended intake of calcium, and gouda is the best source of vitamin K2 of all cheeses. (15) These hard cheeses are extremely low in lactose, and make a nutrient-dense addition to a whole foods diet. As you become more tolerant of dairy products, you can try higher lactose items such as soft cheeses, cream, and even fluid milk. Just remember to stick to the full fat and grass-fed versions as often as possible.

Of course, another option to try is raw milk. Anecdotal evidence from raw milk drinkers around the country suggests that many people who cannot tolerate pasteurized milk have no trouble drinking raw milk. (16) Research conducted on this theory, however, indicates that truly lactose intolerant individuals do not experience any benefit from drinking raw milk over pasteurized milk. (17)

Some feel this result suggests that while many people believe themselves to be lactose intolerant, there is only a small percentage of people who are truly lactose intolerant from a clinical perspective.

The best way to figure out which dairy products work for you and your digestive system is simply to try them yourself. By taking the time to introduce lactose fermenting bacteria through probiotics and high quality yogurt, you may find your lactose intolerance symptoms decreasing over time. Of course, if you’d rather eat fish heads to get your calcium, feel free to skip the dairy!

Have any of you ever cured yourself of lactose intolerance? What method did you use? Let me know in the comments below!

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  1. In my 23&me results showed I’m lactose intolerant and recently took Everywell’s food sensitivity test and came as highly sensitive to milk(cow), cheese(cheddar) and egg yolk and moderately sensitive to egg white, yoghurt etc. as a child milk never sat well with me however camel milk was ok. I try to compensate it with sardines with bones but prob not enough. I can’t believe I’m sensitive to eggs! I love eggs! Especially going on paleo, eggs were my thing. I actually tried taking that Primal probiotics with prebiotics and yoghurt(full fat grassfed) but always runny stool with bloated tummy. Not sure what to do anymore. My food sensitivity test showed that basically I’m sensitive to everything to which I’ve ignored. Only taking in the highly sensitive list. So even if the genetic test and food sensitivity test showed lactose intolerant, can you still introduce it safely to your diet?

  2. This is total bullshit , i am lactose intolerant and only recently it happened to me due to aging at first i didn’t even know what was happening to me every time I’d have anything dairy I’d get explosive diarrhea and bloating within 2 hrs of consumption until i cut out all dairy especially milk and instantly ALL my symptoms vanished completely ,i have been told lactase tablets will help though i haven’t tryd them yet because even lactose free milk gives me some symptoms though i can drink small amounts of it (lactose free milk isn’t really lactose free it has lactase added to it)

  3. Rennet is added to milk in cheesemaking to separate the curds from the liquid. It is an enzyme, like in your stomach. I wonder if different styles of cheese wash the curds to remove the rennet more than others?

  4. Not sure if this was mentioned at all, since there are so many posts and a LOT to read (too much when I’m looking for relief right at this moment), but I thought I’d give you guys another suggestion to look out for. I have a friend that is actually allergic to something called RENNET which is found in many dairy products. So while he can eat some, he can’t eat anything that has rennet added to it or that occurs naturally in large amounts (it is produced naturally in mammals’). He definitely can’t eat things like parmesan cheese but can have other cheeses, like cheddar that seem to have a very low rennet content.

    He did have official allergy testing so he was able to easily confirm that rennet is the allergen for him. Just thought I’d throw that out there because I know what a struggle it can be tot figure out what you are sensitive to and it’s such a puzzle and everyone is different! Best of luck!

  5. Since my childhood, I have eaten yogurt like crazy and drink milk a lot. I moved to the USA in 2010 and my symptoms started in 2014. None of my family members had an issue but me at the age of 30. So I don’t think I have a genetic problem.

    I am not an expert but back at home milk and yogurt were fresh from the farm and homemade. Here in the USA I buy from the market. I am thinking one of the “extra” ingredients may causing these. I feel I am far from nature. even I cook at home my food is not natural or organic. It is just sad that I have to change my habbit

    • My case is similar to it. I moved to Germany in 2015 and my symptoms started from the end of 2016.
      And at present I’m not able to eat any diary products from Germany.
      Once I travelled back home for a vacation and there I didn’t experience any problem in intaking diary products, so I surely doubt that its some extra ingredients they add in these diary products. Even I think that the diary products in Germany is not organic or natural anymore. Maybe filled with chemicals.

  6. Probably lactose intolerant for years, but recognized in the last 15 or so. Many family members have it but we all have different symptoms and different coping. I have only had severe intestinal distress… cramping and pain… twice, early on and I just avoid the common denominator (milk solids) like the plague. I noticed early on that days when I had oatmeal for breakfast, I had little or no symptoms and started testing that… I figure it’s the absorbency of the oats. My symptoms are almost immediate… eat dairy, tummy says bye bye! No discomfort, just don’t find yourself far from a bathroom. I guess the oats absorb what my body won’t digest and carry it away quietly without disturbance. Other fiber does help, but nothing like the oats (quick or regular, but not instant)

    I missed cheese so much! Try Swiss if it’s produced traditionally, the process burns of the lactose (sugar). And other ways that “cooking” milk or butter to use up the sugar also work. A scratch vanilla or banana pudding where the milk is slowly heated and cooked to thicken the pudding also removes the lactose, or enough so I’m ok with it. Some ice cream is produced in a way that cooks off the milk sugar, I just trial and error to find them. Butter was what I dreaded most, ghee or clarified butter give the same taste and cooking value with all the lactose cooked away.

    Just some tips!

  7. I did this twice and it worked immediately. I dropped my carbs to under 20 per day, and up my proteins unlimitedly, eating cheese all day long without lactose symptoms. BUT when I up my carbs it all comes back.

    • My bet is you actually have SIBO (small intestinal bacterial overgrowth) -any carbohydrate entering the small bowel -whether lactose, sucrose, fructose, etc., will be chomped on by the additional bacteria. Symptoms include diarrhea, gas, abdominal pain, bloating.
      It could easily explain why you do well on a low carb diet, but have problems when you have more carbs.

  8. I was told 30 years ago that I was lactose intolerant by my OB/GYN after the birth of my second child. It started with just gas…lots of little silent toots (the non-odiferous kind , thank goodness). Over the years it developed on in to what I assumed was lactose intolerance. I never had the diarrhea issue but cramping and bloating appeared within 30 minutes of a sip of milk or bite of hubby’s ice cream. Thank goodness I could still eat cheese in moderation. I switched to lactose free milk and all but gave up ice cream. About 3 weeks ago I bought a huge bottle of fiber gummies from Sams Club. They are delish and I have to remember not to eat more than 2/day. I have become very regular which I have never been. These gummies do have some kind of probiotic. Well, since starting the gummies, I consumed an ice cream sandwich at DQ and then waited for the pain and bloating. IT NEVER CAME! About a week later, I tested it again with another ice cream sandwich, this one was even larger. Again, I had no symptoms. I forgot to mention that caffeine has also given me issues over the years, causing excessive, painful gas. I drank two glasses of iced tea and had a cup of ice cream a few nights ago. I did have a little tummy discomfort, but think it was the food that accompanied my indulgences. (We were at a large gathering where 750 people were catered.). My question is, do you think I was ever lactose/caffeine intolerant or did I just need more fiber in my diet? I am now 62 so have been fighting this for 30 years now.

  9. Nice to meet everyone. As hard as this may be to believe, I’ve been lactose intolerant for YEARS and didn’t know it. I blamed it on leaky gut and anything else I could research. I went to a physician about it and described symptoms but was never tested for lactose. It was so bad that within minutes of eating, I’d have diarrhea and unless I took something to stop it, it would go on for hours along with bloating, nausea, stomach pain, and I even developed an anal fissure so I was often bleeding during these bouts of diarrhea. It wasn’t until about a month ago when I decided to go gluten free that I discovered it. I bought a choc milk, ate some carrots and ranch dressing, a piece of cheese, and a cup of yogurt all in one sitting and had a DRASTIC response that left me in misery for a solid 24 hours. I haven’t been diagnosed, but I know it’s lactose intolerance. Any time I accidentally eat dairy (even in small amounts) I get an immediate reaction. The diarrhea almost feels like acid. My intolerance is extremely high. Drinking a cup of milk would do me in completely.

    I’ve been buying yogurt, etc. with coconut/almond milk but the thing I miss the most is candy bars (milk/white choc). If I take a Lactaid, I can sort of tolerate it although I still get a low-grade nausea for several hours.

    I’d love to know more about what has worked for others in alleviating this, great dairy substitutes you’ve found, or foods to watch out for that has hidden lactose. Thank you and sorry for the long post.

    • p.s. I also wanted to know if anyone else has this severe a reaction? I get a reaction within 10 minutes of eating dairy. Lactaid taken after the fact helps some, but I still feel nauseated. One symptom I didn’t mention is fatigue. Once it starts, I am exhausted within an hour and feel like I need a nap (i’m sure this is my body trying to get rid of the lactose).

    • I also get an immediate reaction of diarrhea. It’s horrible. I don’t get the nausea, but bloating and gas, also. Taking more than 1 lactaid before eating dairy does seem to help, but not consistently. Unfortunately, everything I love involves dairy. Lasagna, milkshakes, ice cream, cheeseburgers and any kind of cream soup. I also find that at times I have no reaction at all. I can’t explain why. Does this ever happen to you?

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