How to Cure Lactose Intolerance

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Lactose intolerance is one of the most common food intolerances. A reduced ability to digest lactose is one of the major causes, and this affects 65 percent 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!

463 Comments

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  1. Look for a CLEAN dairy that will sell you raw milk. Many – not all – people who cannot tolerate pasteurized milk find that they can drink it raw. I grew up drinking raw milk, my children do as well – very few colds, flu, etc. And the taste is amazing!

  2. Chris, I added Horizon’s heavy cream into my diet when I tried to go ketogenic for 30 days and I seemed to get more deep pimples that lasted for 2 weeks or more. Loren Cordain’s most recent book suggests a link between dairy and acne, plus he mentions a bunch of other natural compounds and hormones that are found in dairy that are inflammatory. What do you say to Cordain’s research on dairy?

    • Aaron, My husband was doing the exact thing, Using Horizon organic cream while in keto. After looking @ Horizon’s label, I realized that Just because it is organic doesn’t mean it is from Grass or pasture fed cows. Harder to find organic and grass fed, but suspect it may make a difference with the acne issue.

  3. Chris wrote: “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.”

    If dairy, goose liver and natto are the only significant sources of K2, then how did our pre-agrarian ancestors get enough of it and how do today’s hunter-gatherers and traditional semi-agrarian peoples that don’t consume much dairy get enough of it (or are they deficient)?

    “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)”

    For me, raw hard cheeses (especially sheep cheeses) actually seem better digested than pasteurized full-fat yogurt (even sheep yogurt).

    The idea you raised of dairy being an alternative to the animal bones, skin, fish heads (and other connective tissues and animal body fats) that our ancestors ate but modern people tend to turn their noses up at is one of the most plausible pro-dairy points I’ve seen.

  4. Thanks so much for the great info Chris. It gives me hope. I’ve been tested as being allergic to casein. I’ve also switched to GAPS, then paleo diet. I’m hoping my food allergies are resolved someday, but for now I still react badly to dairy.

  5. Lactose intolerance is a funny thing.

    my mom is intolerant to brand A (cramps/diarrhea) but not brand B.
    my sis is intolerant to brand B (cramps/diarrhea) but not brand A.
    i’ve been lactose/casein tolerant for as far as i know.

    we’re all Han Chinese. so go figure.

    i’m also the only one who eats in paleo/WAP way.

    • SC:
      I see that no one has responded to your question. I’m not an expert though, but I understand that casein, which is a milk protein, can cause allergic reactions? Could it be a food algery then, and not an intolerence. If so, can food allergies be cured? I have a niece with a peanut allergy and it can’t be cured. How do you know it’s the casein that’s bothering you?

  6. Thanks for this info, Chris. I am always confused about “doing dairy or not”.
    Sydney (in an earlier post) asked you about goat dairy (which I consume often) and I would love if you could tell us if goat cheese , kefir and yogurt has the K2 and other properties (CLA, etc) for our health.
    I can only find raw goat cheese and goat feta that is aged in Whole Foods. I used to be able to get local raw goat yogurt and kefir, but my source dried up. For awhile I was buying Redwood Hills Goat products. Even though pasteurized, are they a good source? I’m trying to get my A1C from 5.5 to a lower point, so I cut out the yogurts and kefirs to avoid any sugar sources at all. I would love to go back to them. I’m only doing cheese now.

    I also started to purchase KerriGold cow’s milk cheeses. They have a Gouda type (Blarney Castle I think is the name). They claim their cheese is pastured as is their butter. Yes..they all are pasteurized, but grass fed.. Any thoughts on that?

  7. Chris, Going to try your cure for lactose intolerance. It has been
    years since I have been able to enjoy dairy. I had always used
    Jarrow probiobotic but became irregular in my use but for sure will
    go back and let you know how I make out. Gail

  8. I developed IBS after a bad gastro infection 20 years ago. After doing the elimination diet I found yeast and dairy were the triggers. Then, with an upcoming Europe trip coming up 5 years ago, I re-introduced dairy in very small amounts – a tablespoon in a cup of tea, and built up from there. No way was I missing out ofn French dairy products! Haven’t had a problem since, and eat all forms of dairy now. The Paleo diet has been the best thing, however. No grains or legumes certainly is the best way to go for me.

  9. Chris – this is just perfect! I am a happy lactose tolerant who enjoys fullfat dairy regularly. It does amaze me that there is such a low incidence of intolerance in northern Europe yet such a high intolerance in north America; I mean, you guys are us guys … only a couple of hundred years between us. What happened?

    This is such a useful article and one very close to my heart. Thank you.

    • “You guys are us guys”… Not really.

      Yes, I have a lot of European blood, and I’m so white I practically glow in the dark, but a lot of North Americans are “mutts.” I’m 1/16 native American, though you wouldn’t know it to look at me (most “white” people I know have a bit of native american blood… Or claim to). There are also a LOT of people in North America who aren’t of European origin viz half of our president’s parent-couple.

      So we’re not exactly a carbon copy of Europe over here in The New World…

  10. I forgot to add. You can get fish heads at any Chinese market for about $2.00 a lb, even wild caught salmon. I can’t verify that it’s actually wild caught, since I’ve found the label wild caught on some frozen oysters counters that were stated farm raised on the package. Then on the other hand, there are both labels of wild caught and farm raised items on the fish counter, so maybe it was just a mixed up.

    I also inquired at the fish department at Whole Foods and they have frozen wild caught salmon heads, for $4.99 a lb.

  11. DAIRY = ACID pH?
    Chris, there is a wide school of thought and science behind the notion relating to dairy being a great source of calcium and the mis-guided directive of this notion. The premise being; as dairy is highly acidic, as a consequence and to compensate, the body will leach the existing calcium from our bones to make up for the acidic nature of the milk, cheese and other highly acidic foods we may consume causing the depletion of even more calcium in the bones and subsequent osteoporosis. The irony! What are your thoughts, as this is a very contentious issue relating to pH balance in our body, which of course has credence when it comes to health. PS: I love dairy, meat etc but have read many books relating to pH balance and having a diet balanced in alkaline/acidic foods. I’d really appreciate your thoughts on this confusing and contradictory topic. Thanks. Katrin (Australia)

    • Pasteurized/homogenized milk is slightly acidic. Raw milk is neutral to slightly alkaline. There are significantly more acidic foods out there. I think as long as you’re not regularly consuming strongly acidic stuff like soda, sugar, flour like everyone else then you should be fine. I wouldn’t worry about milk, and you can always eat alkaline foods anyway. I eat beef, pork, and chocolate quite a bit, and they’re strongly acidic but then again eat quite a few alkaline foods.

  12. Energetic work such as BioSET, Neuromodulation Technique, Yuen Method, EFT and TFT can correct just about any allergy. It’s also very helpful to take digestive enzymes with every meal.

  13. I come from a culture of fish head eaters and though I never ate one while growing up myself, I use to watch my step father attack them with gusto. In fact he liked them so much that out of respect and the learned repugnant attitude of eating fish heads from my mother, who didn’t like fish to begin with, and the American society which we grew up in, we all left it to him to consume. But since I grew up mainly on the food my mother prepared, Chinese food. I also didn’t have much dairy, though I was always pushed to drink milk, which I also gave up as soon as I left home, including all the traditionally healthy nourishing dishes, my mother made, such as home made soup with every meal. When I reached the age of 50 or so, my teeth started to disintegrate and recently discovered from CURE TOOTH DECAY the foods that rebuild teeth and started integrating them all in my diet, including eating the entire fish. That’s when I discovered why my step father coveted all those fish heads. Though the skin of the some of the fish, I must admit, is a bit more fishy, but can easily be masked with a bit of ginger, soy sauce lemon juice, garlic, pepper, or other spices, depending on your recipe. The meat that is encased inside that skin is absolutely moist and delicious. More moist than any that you’ll ever have and the gelatin around it is chocked with nutrients that may not be found anywhere else. I’ll just eat it along with the meat. Fish skin eaten with the meat usually makes the meat more moist. Just make sure the skin is scaled before cooking. If you prefer not to eat the skin, at least cook the fish with the skin attached. You can also save the bones in the freezer for the next time you make bone broth. Though I also learned to drink, eat and love grass fed dairy, I try to eat at least two meals of fish heads a week. It’s delicious even with no seasoning, just baked in the oven until the meat flakes off the bone, about 5 minutes. There are all kinds of recipes for fish head soup all over the Internet. Here’s one of my favorites http://voices.yahoo.com/how-fish-head-soup-2974509.html

  14. Great article. I have mild osteoporosis despite being pre-menopausal, a combination of years of eating disorders, a genetic link (my mother has osteoporosis too), times of my life without periods, including two bouts of long-term breastfeeding without menstruation along with long-term vitamin D deficiency, now under control thankfully (oh, I also have raised parathyroid hormone levels though my endocrinologist still seems to think it is as a result of vitamin D deficiency and will resolve). Anyway, as a result of all this I’m super-keen to get enough calcium but reluctant to take supplements. I don’t eat grains, drink raw milk in tea and the occasional glass of it, eat raw cheese and green vegetables daily and sardines with bones in a couple of times a week – oh, and bone broth daily too. I can’t think I can do more but at almost 40 years old have probably only got 10 years or so to build any kind of bone density back before I hit the menopause. Do you have any other advice, Chris? Thanks

  15. Chris, what about the huge insulin response to milk? Can you speak to that please? That’s the one thing that concerns me regarding milk. Thanks!

    • What’s the concern? Insulin goes up, it comes back down again. I’ve never seen convincing evidence that dairy has a harmful effect on metabolic health in real people. In fact, some studies suggest that full-fat dairy is protective against diabetes. I linked to a few articles about this above in the comments section.

      • Huh? then just tell everyone to eat lots of sugar that has the same effect. Hi insulin levels have major harmful metabolic effects. I do not understand where you are coming from with that statement?? Anything causing major spikes in insulin is of concern.

        I have seen several convincing studies showing dairy’s harmful metabolic effects, studies that go back 100 years. Pasteurized, homogenized, grain fed, non organic dairy is not a health food and can be highly inflammatory and highly toxic. For example, non organic butter can have 20 times the pesticides as non organic produce.

        Here is a study showing dairy consumption causes a 3 fold increase in childhood type 1 diabetes: http://diabetes.diabetesjournals.org/content/49/6/912.full.pdf. BTW, vitamin D sufficiency during pregnancy and early childhood majorly reduces the risk of type 1 diabetes. In fact, I have heard a couple of diabetes experts say that vitamin D sufficiency during pregnancy and early childhood would essentially wipe type 1 diabetes off the planet.

        Just to name a few problems with pasteurized, homogenized, non organic, grain fed dairy:
        1. Homogenization allows xanthine oxidase in the blood – highly inflammatory and cardio harmful.
        2. Homogenization can cause auto immune problems because it pulls foods into the blood that should not be there causing an immune response. One reason why dairy and gluten are so harmful when eaten together. You get atrophy of the villi – i.e. leaky gut – plus homogenization pulling in broken down “things” into the blood.
        3. Pasteurization, especially ultra pasteurization, makes casein more intolerable, destroys all of the enzymes, all of the beneficial bacteria, and converts the lactose into beta lactose, which can cause blood sugar and thus insulin spikes. Pasteurization also renders the calcium more unabsorbable because it converts some the calcium into calcium carbonate and calcium phosphate.
        4. Non organic dairy is a chemical soup. Typical non organic cow dairy sold in the grocery store contains 59 active hormones (including rBGH), up to 52 powerful antibiotics, pesticides, herbicides, PCBs, dioxins (up to 200 times the safe level), blood, puss, feces, solvents, viruses, excessive bacteria, and radioactive compounds. For example most of the milk used to make commercial ice cream comes from rBGH treated cows and one serving of such ice cream has twelve times the amount of IGF-1 as does a glass of milk because of the concentration in the cream.
        5. The omega 3 to omega 6 ratios can be way off in favor of omega 6, which is highly inflammatory. I know that grain fed beef for example can have a ratio of 20:1 for O6 to O3 ratio – very bad – where as grass fed has a closer to 1:1 ratio.

        I have a personal friend who had severe asthma her whole life (from about age five) and she used an inhaler every day and went to the emergency room twice. When she was 18 she removed diary from her diet completely and nothing else. The asthma went completely way and she has had no asthma and has been inhaler free for about 5 years now. This alone from removing dairy.

        In my opinion, the only type of cow milk that is truly healthy is from type A2 grass fed cows, raw and organic. And this type of milk fermented is even better and more tolerable. If you can get this type of dairy you are lucky! This type of dairy is not for everyone, I realize, but for some people it is a superfood!

        All other types should be avoided/limited. You can get plenty of sufficient calcium from plants and and plant based supplements. The best foods are black sesame seeds, kelp, kale, seaweeds, algae, carob, and moringa. Other good non cow dairy sources: Raw goats milk, Raw goat milk kefir, Raw goat milk cheese, sardines (with bones), dark green leafy vegetables (e.g. Broccoli and Broccoli Sprouts), pearl powder, the pith of citrus fruits, and wheatgrass. The herbs horsetail and oat straw are also excellent natural whole food calcium sources and best consumed as a tea. Note that spinach is NOT a good source. Good supplemental forms are calcium malate, calcium orotate, calcium AEP (amino ethyl phosphate), and calcium taurate. As usual, it is best to get calcium from a whole food source if possible.

  16. I was diagnosed with lactose intolerance at the age of 16. They did not use any fancy tests just a trial diet of avoidance. Mine was really really bad. I would be curled up in the fetal position on my bed for about 3 hours in severe pain and periodically go to the bathroom to try to relieve myself. It took time however for what I just ate to work it’s way through me. I would get terrible waves of severe pain followed by a lessening & then back to severe pain. I would also get very HOT. I’ve even fainted before trying to get back to my bed from the bathroom. After months of this I went to my mom and told her I needed to go to the doctor becasue I thought I was dying. I avoided dairy for a number of years (3-5) until I found out about lactose pills and started using them & they helped alot. I tried vaious things as I found out about them such as soy milk & when lactaid milk came on the market I used that. Eventaully (about 15 yrs ago) I read a small 1/2 pg article in Prevention Magazine that said to eat 1/2 cup of ice cream immediately following a full meal and that since the dairy was with food that it would not run right through you, and that it would help you to produce more of the enzymes that break down dairy. Well I did it and it really did help alot. I did not get sick that night. At that point I hadn’t had ice cream for about 10 years. I personally considered this to have cured my lactose intolerance. I do fluctuate and still can’t drink milk, not even raw without digestive upset but I can for example eat pizza or cheesecake. Unfortunately I now have malabsorption issues of a different nature, fat malabsorption as well as other nutrients. None of it is as horribly painful as what I desribed above.

  17. I used to think I was lactose intolerant, so I didn’t eat dairy for years (I also was vegan for a bit.) Then I went on a gut healing diet and started eating paleo-ish foods. After a little while I started *craving* dairy, so I tried cow’s milk, and it made me sick (I have a massive gluten sensitivity, so this makes sense) but then I tried goat and sheep’s milk, and I digested it just fine. Now I eat goat yogurt and raw sheep/goat cheese as part of my regular diet.
    Another good thing to note too was that eating cheap industrialized goat cheese, especially the harder kinds, makes me ill, similar to how cow’s milk makes me feel. I have to buy the nice imported cheeses from the cheese counter.
    So I totally think there are other people out there who think they’re “lactose intolerant” but might actually be cow casin sensitive instead.

  18. Hey Chris,
    Great article. After enjoying dairy for more than 40 years with no problems, I began having symptoms of lactose intolerance. My Dr.’s solution was to have me avoid dairy or use a lactase supplement. That approach conflicted with my instincts, but I didn’t know what else to do. Even though I avoided dairy, my digestive problems got worse. I finally started doing my own research and discovered information about GMO’s, Ultra-High Temp Pasteurization, probiotics, Leaky Gut, and so much more. My self diagnosis was that my gut had been destroyed by GMO’s and antibiotics, and that our food industry was supplying us with inferior, nutrient deficient, dead food. I switched to organic food and I started consuming Amasai and cultured whey. After suffering for almost 10 years with digestive discomfort I began feeling great in just a few weeks. I began adding more probiotic rich, raw, live, foods to my diet; including fermented veggies that I made myself, and I feel terrific. I now drink raw milk and eat other high quality dairy products with no problem.
    Your article was the first thing I ever read that mentioned “lactase persistence”. If a person doesn’t have the genetics to continue producing lactase after childhood, during what age range does that typically occur? If a person who lacked the genetics had a healthy gut and consumed probiotic rich foods, do you think they would have a problem eating raw or low temperature pasteurized dairy products?

    • They would stop being able to digest lactose right sometime in childhood, at about the age most kids are weaned in hunter-gatherer cultures (somewhere around 3-4 years old). The studies I discussed in this article do suggest that even someone without the lactase persistence mutation may be able to tolerate lactose after probiotic or fermented dairy consumption.

  19. Hi Chris
    Dairy products seem to be a migraine trigger for me so I avoid them. For my sons who are prone to eczema, especially when they eat too much dairy (their dad also gets eczema when he eats dairy and caffeine) so I also limit their intake. I would, however, like to treat them and myself on occasion to small amounts of dairy. I would like to use a lactase supplement for these occasions. Are there serious draw-backs to doing so? BTW, I am trying to build-up a healthy bacteria population in all of us using probiotics. For calcium supplementation, we all take New Chapter’s Bone Strength.
    -NK

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