Lactose, Dairy & the Low FODMAP Diet

The low FODMAP diet is neither lactose-free nor dairy-free. Surprised? We know it can be confusing; this article will set you straight. You CAN eat dairy on the low FODMAP diet, even during the Elimination Phase.

One peek at the Monash University and FODMAP Friendly smartphone apps (which you should be using on your FODMAP journey) and you will see all kinds of dairy products listed as low FODMAP.

An overhead shot of cheese and milk on a white marble background with the words Lactose, Dairy and the Low FODMAP Diet overlaid

Table Of Contents

Lactose, Dairy & FODMAPs
Lactose-Free Doesn’t = Dairy Free!
You Can Have Cheese!
Lactose-Free Options & Non-Dairy Substitutes
Non-Dairy Alternatives
Simple Swaps
Lactase Enzyme Caplets
A Registered Dietitian Can Help
AND We Have A DIY Option
Note on Food Intolerances and Food Allergies
A Story
Lower in Lactose Recipes That Are Low FODMAP

Lactose, Dairy & FODMAPs

Lactose, represented by the “D” in FODMAP, is a disaccharide (sugar) that is naturally present in milk and foods made from milk, and it requires the enzyme lactase for digestion.

You May Want To Read: What Are Disaccharides?

Lactose intolerance is common – about 65 percent of the global population has a decreased ability to digest lactose after infancy. The amount of lactose, however, that a person can tolerate and the symptoms they experience upon ingestion can vary significantly between individuals. Additionally, lactose content varies with the type and portion size of a dairy food.

If the sugars are 1g or less per serving on a nutritional panel, that dairy product is low enough in lactose to be low FODMAP.

Lactose-Free Doesn’t = Dairy Free!

As a dietitian, I’ve worked with many patients who are lactose intolerant and assume they need to avoid dairy. Individuals on the low FODMAP diet often have the same misconception. If you have lactose intolerance and/or IBS and are following the low FODMAP diet, you need to limit lactose, but you can still consume dairy.

According to a review of the research on lactose intolerance, most individuals with lactose intolerance can tolerate 12 to 15 g of lactose: the equivalent of one cup (240 ml) of milk. Another small study showed that some lactose-intolerant individuals may be able to tolerate up to two cups of milk (480 ml) a day if it is spread out over the day and consumed with other food at a meal.

Lactose FODMAP Thresholds Compared — Graphic FODMAP Everyday.

It is important to note that the Monash and FODMAP Friendly app entries are simply guides and not absolutes. In addition, the amounts listed in the apps are based on thresholds. You might think low FODMAP items in the apps are lactose-free, but they are not; they are LOWER in lactose. The thresholds are based on the amount of lactose that most people tolerate. You can see that both Monash and FODMAP Friendly set their thresholds very conservatively.

You Can Have Cheese!

young woman pulling apart grilled cheese sandwich — Photo credit: Dédé Wilson from FODMAP Everyday®.

Believe it or not, there are many conventional cheeses that are low FODMAP: cheddar, mozzarella, Parmesan, Swiss, Monterey jack and so many more. Check out our article, Is Cheese Low FODMAP? to learn how to tell if any cheese – or really, any dairy product – is low FODMAP. It’s all about reading the nutritional panel. If the sugars are 1g or less per serving, the product is low enough in lactose to be low FODMAP.

Lactose-Free Options & Non-Dairy Substitutes

If you are following the low FODMAP diet and need to limit lactose, you have options! Lactaid is a brand of lactose-free milk, ice cream, sour cream, eggnog, creamers, and cottage cheese, and Green Valley Organics has a wide range of lactose-free dairy products, including yogurt, sour cream, kefir, and cream cheese.

Lifeway is another brand of kefir, and although they do not add lactase enzyme to their products, they state their kefir is up to 99% lactose-free and appropriate for most people with lactose intolerance. According to the company’s website, they use 12 specific kefir cultures that break down the lactose in the milk during a long fermentation process (14-18 hours).

This is similar to how some sourdough breads are lower in FODMAPs because the fermentation process breaks down the fructans (read more in How to Choose Low FODMAP Bread). Although kefir has been given a red light on the Monash University Low FODMAP Diet Smartphone App due to high levels of lactose (no brand or formula information given), Lifeway plain kefir is a product I may suggest for someone to try who is limiting lactose. There is also a lab-tested and certified low FODMAP Kefir in Australia made by Table of Plenty with servings of 250 ml.

FODMAP Friendly has also lab tested kefir (no brand or formula information given) and a max serve is 80 ml.

Although non-dairy milk and dairy substitutes are lactose-free and dairy-free, they are not always low FODMAP.

Non-Dairy Alternatives

Nowadays, there are also plenty of non-dairy milk and dairy substitutes available. You can find milk, yogurt, cheese, and kefir made from plants such as soy (soy protein), almonds, hemp, oats, quinoa, coconut, rice, and macadamia nuts.

Keep in mind, however, that although non-dairy milk and dairy substitutes are lactose-free and dairy-free, they are not always low FODMAP. The same is true for flavored lactose-free dairy products – choose the plain option or check the ingredients list for high FODMAP ingredients like apple, banana, or pear.

Lactose, Dairy and the Low FODMAP Diet-a birds eye view of a frothy glass of milk — *Photo by Frank Luca- Unsplash*

Simple Swaps

Here are some simple swaps to go lactose-free:

Pour lactose-free cow’s milk or almond milk on your breakfast cereal.
Try lactose-free yogurt with low FODMAP granola.
Make smoothies with lactose-free kefir or almond milk kefir.
Top tacos with shredded cheddar or crumbled feta cheese.
Use canned or UHT coconut milk in creamy soups and curries.

Lactase Enzyme Caplets

woman in hat eating ice cream cone. zoomteam via 123rf.

Lactase enzyme caplets are another option that may help people with lactose intolerance, although they may not be as effective as lactose-free foods. I recommend not using lactase enzymes during the Elimination Phase, and only use them after you have determined you are sensitive to lactose in the reintroduction Challenge Phase.

Also, if you are sensitive to Polyols, look for a lactase enzyme that does not contain mannitol, such as Lactaid Fast Acting Caplets. (Note that there are two different kinds of Lactaid tablets and only one kind is mannitol-free).

Save this article

Enter your email address and we'll send it straight to your inbox.

Intoleran brand has several ways to help you with lactose intolerance. They have different strength tablets, plus drops. Read more here: Reclaiming Food Freedom: Expert Insights on Digestive Enzymes from Intoleran.

A Registered Dietitian Can Help

If you are avoiding dairy for any reason – including lactose intolerance, IBS, dairy allergy, or dietary preference – talk to a Registered Dietitian to make sure that your diet is meeting your needs and helping you feel your best.

AND We Have A DIY Option

DIY Lactose-Free Dairy. Lacteeze lactase enzyme next to a glucose test strip — Image FODMAP Everyday.

Check out our article, DIY Lactose-Free Dairy to learn how to CREATE your own lactose-free milk, cream, half-and-half and more.

Note on Food Intolerances and Food Allergies

A food intolerance is not the same thing as a food allergy, although both can cause gastrointestinal symptoms.

Food intolerances often manifest as excessive gas, indigestion, diarrhea, and bloating, and are typically caused by digestive enzyme deficiencies (such as lactase deficiency in lactose intolerance) or sensitivity to various food components (such as food additives and gluten).
A food allergy occurs when your body’s immune system reacts to a component in food — typically a protein — causing symptoms that can range from mild (itchy mouth, indigestion) to severe and potentially life-threatening (anaphylaxis).

Individuals with a milk allergy must avoid all milk and dairy, regardless of lactose content. If you have a food allergy, it is imperative that you check labels since milk and dairy products are used in a variety of packaged foods, including breakfast items, soups, and baked goods.

Please read: Food Allergy vs. Food Intolerance: Navigating a Complicated Path.

A Story

When I attended one of the Food and Nutrition Conference and Expos (FNCE), I was surprised to see “lactose-free butter” at one of the exhibitor booths. Why was I surprised? Because even though butter is made from milk, it is primarily composed of fat and naturally very low in lactose. It is low enough for the parameters of the low FODMAP diet.

I asked one of the company’s reps about it, and their response was: “It’s what customers want.” The takeaway is that you do not always need to spend more money buying “lactose-free” products when following the low FODMAP diet. Some of it is marketing.

Lower in Lactose Recipes That Are Low FODMAP

For some low FODMAP recipes featuring lactose-free dairy, check out our:

Sources

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Definition & Facts for Lactose Intolerance.
https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/definition-facts

National Institutes of Health, U.S. National Library of Medicine. Lactose Intolerance. 2017.
https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics

Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis.
https://pubmed.ncbi.nlm.nih.gov/28690131/

Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut (BMJ).
https://gut.bmj.com/content/68/11/2080

Suchy FJ, Brannon PM, Carpenter TO, et al. Lactose Intolerance: Pathogenesis, Diagnosis, and Treatment.
https://pubmed.ncbi.nlm.nih.gov/33887513/

Vesa TH, Marteau P, Korpela R. Lactose intolerance.
https://pubmed.ncbi.nlm.nih.gov/28421381/

Shaukat A, Levitt MD, Taylor BC, et al. Systematic review: effective management strategies for lactose intolerance.Annals of Internal Medicine. 2010.
https://www.ncbi.nlm.nih.gov/pubmed/20404262

Suarez FL, Savaiano DA, Levitt MD. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. American Journal of Clinical Nutrition. 1997.
https://www.ncbi.nlm.nih.gov/pubmed/9129483

Cleveland Clinic. Lactose Intolerance.
https://my.clevelandclinic.org/health/diseases/7317-lactose-intolerance

StatPearls Publishing. Lactose Intolerance. NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK532285/

Lifeway Foods. Why Our Kefir is Up to 99% Lactose Free. 2015.
https://lifewaykefir.com/why-our-kefir-is-up-to-99-percent-lactose-free/