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Healthy Living With Lactose Intolerance


Lactose-Free Milk and Nondairy Beverages

Milk used to be simple. Your mom went to the store, bought a carton, and then plunked down a tall glass right next to your chocolate chip cookies. Nowadays, mom might find the choices downright bewildering: lactose-free milk, nondairy beverages such as soy, rice, and almond milks -- even oat, multigrain, or hemp milk.
These alternatives have hit the store shelves, but why choose them? The reasons are many.
  • People buy lactose-free milk because symptoms of lactose intolerance have soured them on regular cow’s milk.
  • People with true milk allergies, which is quite different than lactose intolerance, can’t drink cow’s milk at all, so they turn to plant-based milks to get their nutrition.
  • Vegans don't eat any dairy products from animals.
  • Soy, rice, and almond milk contain no cholesterol because they’re plant-based, so they can be a healthy choice for people trying to reduce cholesterol consumption.
But that doesn’t mean cow’s milk is bad. Cow’s milk, including lactose-free cow's milk, offers strong benefits, says Karen Ansel, MS, RD, a spokesperson for the Academy of Nutrition and Dietetics. “In addition to having a lot of calcium and vitamin D -- which are really important and we don’t get enough of -- cow’s milk is a really great source of protein.”

Milk Alternatives for Lactose Intolerance

Lactose intolerance occurs when you don’t make enough of the enzyme lactase, which breaks down the sugar in milk -- lactose, Ansel says. When the sugar stays undigested, you may have symptoms such as diarrhea, gas, and bloating.
Buying lactose-free cow's milk is just one way to help reduce symptoms. Milk companies treat these milks with lactase so that the milk sugar is completely broken down, she says. Nutritionally, lactose-free cow's milk is comparable to regular cow’s milk.

Milk Allergies

Some people believe that they’re lactose intolerant when what they really have is a true milk allergy. “There’s actually a pretty big difference,” Ansel says. “Lactose intolerance has to do with an inability to metabolize or break down lactose. That’s a metabolic issue.” 
In contrast, “An allergy to milk has to do with your immune system. When you drink milk, your body perceives one of the proteins in milk as a foreign invader. Your body responds by producing antibodies to fight that protein. When those antibodies are released, it causes the symptoms of an allergic reaction.” True milk allergies are far less common than lactose intolerance.
Milk allergy symptoms can include itching, swelling, hives, runny nose, or difficulty breathing Ansel says, “You could also have digestive symptoms. That’s why a lot of times, people confuse milk allergy with lactose intolerance. They do sometimes have overlapping symptoms.”
“Allergy can be a dangerous thing,” she adds. If you suspect that you might be allergic to milk, ask your doctor about allergy testing. “You really shouldn’t try to diagnose it yourself.”
If you learn you do have a milk allergy, buying lactose-free milk products will still cause symptoms. Talk with your doctor about the nondairy, plant milks, from almond to soy that might be right for you.

Nondairy Alternatives for Vegans

Nondairy beverages, or plant-based "milks," appeal to vegans and some vegetarians.
“There’s a lot of variety, which is great,” Ansel says.
Hemp, multigrain, oat, and potato milk are on the market. But the old standbys -- almond, rice, and soy milk -- are by far the most common for drinking and cooking, says Suzanne Havala Hobbs, DrPH, MS, RD, author of Living Dairy-Free for Dummies.
Nondairy milks vary in taste and consistency. For example, soy milk has a thicker consistency than cow’s milk, while rice milk is thinner. Rice milk is a popular choice, Hobbs says, because it “looks bright white, just like cow’s milk.” Almond and soy milk have a slightly beige color. Almond milk also has a faint almond taste.

Nutrition Comparisons

When choosing a beverage, be aware that the various types of dairy and nondairy options differ in key areas of nutrition.
Lactose-free cow’s milk is high in calcium and other nutrients and is often fortified with vitamin D like regular cow's milk.
Nondairy alternatives can vary in their nutritional values. It’s smart to compare the label to cow’s milk to make sure that you’re getting similar levels of fortification, nutrients, and protein. “If you’re not able to drink milk, these are a good way -- as long as they’re fortified -- to get calcium and vitamin D,” Ansel says. 
 option is to buy lactose-free nondairy milk options, such as almond, hemp, multigrain, oat, rice, or soy.

Nutrition Comparisons continued...

Protein amounts and qualities vary widely in nondairy milk options. Experts agree that soymilk comes closest to cow’s milk in both areas, while rice milk falls shortest.  
  • Cow’s milk, 1 cup: 8 grams of protein
  • Soy milk, 1 cup: 5-10 grams of protein
  • Almond milk, 1 cup: 1 gram of protein
  • Rice milk, 1 cup:  0.28 grams to 1 gram
Just remember:
  • Not all calcium-fortified nondairy milks have the same amount of calcium.
  • Check the type of calcium added. For example, the calcium carbonate that's typically added to soymilk is well absorbed, but tricalcium phosphate may not be.
  • Vegans, take note: Pick nondairy milk that's fortified with vitamin B12 since its richest sources are meat, cheese, and eggs.

Cooking Tips

You can use nondairy products for drinking, stirring into coffee, pouring onto cereal, and as a substitute for cow’s milk in recipes. Hobbs has used soy, almond, and rice milk in smoothies, nondairy ice cream, mashed potatoes, soups, sauces, and other dishes.
Substitute calcium-fortified lactose-free cow's milk or a nondairy alternative, cup for cup, in place of regular cow’s milk. Be aware that rice milk’s thinner consistency doesn’t lend itself as well to sauces or puddings. “Those dishes don’t come out as creamy. It’s sort of the difference between using whole milk and skim milk,” Hobbs says.
Pick the right flavor for the right dish. Nondairy beverages, such as soy and almond milk, come in plain, as well as vanilla, chocolate, and other flavors. Use plain varieties for savory recipes, such as mashed potatoes, creamy sauces, cream-based soups, scrambled eggs, or omelets. Save vanilla, chocolate, and other flavored milks for sweet foods, such as cookies, cakes, quick breads, muffins, pancakes, and waffles. If a recipe calls for buttermilk, make your own by adding 2 teaspoons of vinegar or lemon juice to one cup of any nondairy milk. Mix well and let it stand for a few minutes before using. It won't look like buttermilk, but it will act like it.
Don’t store nondairy milk in the freezer. Doing so won’t affect the product’s safety or nutrition, but freezing will harm its consistency.
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