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Lactose Intolerance or Milk Allergy?. WIC and Nutrition Services Department of Health and Senior Services . What is Lactose Intolerance?. Inability to digest significant amounts of lactose, which is the predominant sugar in milk

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Lactose intolerance or milk allergy l.jpg

Lactose Intolerance or Milk Allergy?

WIC and Nutrition Services

Department of Health and Senior Services


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What is Lactose Intolerance?

  • Inability to digest significant amounts of lactose, which is the predominant sugar in milk

  • A result of lactase insufficiency, the enzyme essential for the conversion of lactose into glucose and galactose


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Types of Lactose Intolerance

  • Congenital

    • Very rare

  • Primary

    • Develops after 2 years of age

  • Secondary

    • Usually resolves in 1-2 weeks


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Symptoms of lactose intolerance

  • Intolerance does not involve the immune system

  • Nausea, cramping, bloating, abdominal pain, gas, diarrhea

  • Symptoms may begin from 15 minutes to several hours after eating food with lactose


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Prevalence of Lactose Intolerance

  • An estimated 30 to 50 million American adults are lactose intolerant

  • 90% of Asian Americans

  • 80% of African Americans

  • 62-100% of Native Americans

  • 53% of Mexican Americans

  • 15% of Caucasians


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What is Milk Allergy?

  • An abnormal immune system reaction to proteins in the cow’s milk

  • Triggered by a combination of genetically inherited factors and early introduction of cow’s milk or soy protein into an infant’s diet

  • www.foodallergy.org


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Symptoms of Milk Allergy

  • An immune system reaction

  • Swelling, sneezing, nausea, vomiting, hives, rash, itching, runny nose, coughing, difficulty breathing, gas, diarrhea

  • Anaphylactic reaction possible

  • Symptoms may begin within seconds or up to several hours after eating the food

  • See your Doctor



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Review the Options

Breastfeeding is the best option for most infants.


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Infants at risk for food allergy

  • Exclusive breastfeeding is recommended

  • Eliminate foods that cause infant allergies from the mother’s diet while she is breastfeeding

  • Delay solid foods until 6 months of age

  • 1 year of age: Introduce cow’s milk

  • 2 years of age: Introduce eggs

  • 3 years of age: Introduce peanuts, other nuts, fish, shellfish


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Bright Futures in Practice - Nutrition

Available in every WIC agency and at www.brightfutures.org/nutrition/index.html


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Infants with milk allergy

  • Breastfeeding

  • Alternatives to breastfeeding

    • Soy formula

    • Hypoallergenic formula

  • Avoid milk products or foods with milk


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Children and Women with milk allergy

  • Eliminate milk

    • Casein or caseinate

    • Casein hydrolysate

    • Dried milk solids

    • Lactolbumin

    • Lactate solids

    • Sweetened condensed milk

    • Whey or whey solids


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Children and Womenwith milk allergy

  • Substitute other foods to provide missing nutrients

  • Cook with alternative foods

  • Alter recipes and meals

  • Avoid cross-contamination

  • Learn strategies for coping with restaurant meals and special occasions

  • Conduct food challenges (with medical support)


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Infants with lactose intolerance

  • Breastfeed

  • Alternatives to breastfeeding

    • Soy formula

    • Lactose free formula


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Children and Women with Lactose Intolerance

  • Eat or drink small servings

  • Know your personal tolerance level

  • Eliminating milk and other dairy foods may pose nutritional risks


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Tips for Tolerance

  • Experiment with gradually larger amounts

  • Drink milk with a meal rather than alone

  • Eat smaller, more frequent portions

  • Choose aged cheeses lower in lactose

  • Try dairy foods with active cultures

  • Read labels

  • Kosher foods that say “parev” or “parve” are milk-free


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Some lactobacillus or sweet acidophilus milks are no lower in lactose and may not be tolerated any better than other forms of milk.


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Special food products in lactose and may not be tolerated any better than other forms of milk.

  • Lactose-reduced or lactose-free milk and other dairy foods

  • Add lactase enzyme to fluid milk

    • LactaidTM

    • CactraseTM

    • DairyEaseTM

  • Chew or swallow a lactase supplement before eating lactose rich foods


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Lactose-free foods in lactose and may not be tolerated any better than other forms of milk.

  • Broth-based soups

  • Plain meat, fish and poultry

  • Plain fruits and vegetables

  • Tofu

  • Breads, cereal and crackers made without milk, dry milk, or whey


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Alternative Sources of Calcium in lactose and may not be tolerated any better than other forms of milk.

  • Vegetables: cooked/raw broccoli, turnip and collard greens, kale, Chinese cabbage

  • Fish/Seafood: canned sardines and salmon with edible bones, raw oysters

  • Calcium-fortified orange juice

  • Calcium-fortified soymilk

  • Tofu processed with calcium salts

  • Almonds


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Calcium = 1 cup milk in lactose and may not be tolerated any better than other forms of milk.

  • 8 cups spinach, raw

  • 1 ½ cups turnip greens, cooked

  • 2 ¼ broccoli, raw

  • 5 cups red beans, cooked

  • 3 oz. sardines, canned with edible bones

  • 1 ½ cups orange juice, calcium fortified

  • 2 ¼ cups soy beverage, calcium fortified


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Calcium education in lactose and may not be tolerated any better than other forms of milk.

  • power point presentations,

  • calcium intake requirements,

  • functions of calcium, and

  • information regarding risks of inadequate intake of calcium are available at:

    www.dhss.mo.gov/Calcium/#education


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Calcium-Related Health Problems in lactose and may not be tolerated any better than other forms of milk.

  • Osteoporosis

  • Colon and Rectal Cancer

  • Hypertension and Stroke

  • Overweight and Obesity


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WIC Policy in lactose and may not be tolerated any better than other forms of milk.

Non-contract and exempt formulas for infants or WIC-eligible medical foods for women and children require a prescription.


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For children and women with lactose intolerance documented by the CPA, cheese may be issued as a substitute for milk.


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USDA encourages programs to offer alternative types of milk for children who are lactose intolerant.


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In schools and childcare settings for children who are lactose intolerant.

  • Schools and childcare providers must make substitutions for severe food allergy.

  • Schools and childcare providers may provide substitutions for food intolerances.

  • Services funded through IDEA include

    • Purchase of special foods

    • Purchase of feeding equipment

    • Consultation with a registered dietitian

  • www.fns.usda.gov/cnd/guidance


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Child Nutrition and WIC Reauthorization Act 2004 for children who are lactose intolerant.

  • Schools and childcares must offer a variety of fluid milk with different fat contents.

  • Schools and childcares may offer flavored and unflavored milk and lactose-free milk.

  • Schools and childcares may substitute a non-dairy beverage that is nutritionally equivalent to fluid milk and fortified with calcium, protein, vitamin A and D to levels found in cow’s milk.


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For More Information… for children who are lactose intolerant.

  • STTM 2

    • Calcium: pg 26-27

    • Food Allergies: pg 113

    • Calcium and Osteoporosis: pg 127-130


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For more information… for children who are lactose intolerant.

  • Rita Arni, RD, LD

    WICNS Child Nutrition Team Leader

    573-751-6183

    arnir@dhss.mo.gov

  • Jean Trae, PhD, RD, LD

    WICNS Child Nutrition Coordinator

    573-751-6183

    traej@dhss.mo.gov