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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

Lactose Intolerance or Milk Allergy?

WIC and Nutrition Services

Department of Health and Senior Services

what is lactose intolerance
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
types of lactose intolerance
Types of Lactose Intolerance
  • Congenital
    • Very rare
  • Primary
    • Develops after 2 years of age
  • Secondary
    • Usually resolves in 1-2 weeks
symptoms of lactose intolerance
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
prevalence of lactose intolerance
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
what is milk allergy
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
symptoms of milk allergy
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
review the options

Review the Options

Breastfeeding is the best option for most infants.

infants at risk for food allergy
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
bright futures in practice nutrition

Bright Futures in Practice - Nutrition

Available in every WIC agency and at

infants with milk allergy
Infants with milk allergy
  • Breastfeeding
  • Alternatives to breastfeeding
    • Soy formula
    • Hypoallergenic formula
  • Avoid milk products or foods with milk
children and women with milk allergy
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
children and women with milk allergy1
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)
infants with lactose intolerance
Infants with lactose intolerance
  • Breastfeed
  • Alternatives to breastfeeding
    • Soy formula
    • Lactose free formula
children and women with lactose intolerance
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
tips for tolerance
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
Some lactobacillus or sweet acidophilus milks are no lower in lactose and may not be tolerated any better than other forms of milk.
special food products
Special food products
  • 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
lactose free foods
Lactose-free foods
  • Broth-based soups
  • Plain meat, fish and poultry
  • Plain fruits and vegetables
  • Tofu
  • Breads, cereal and crackers made without milk, dry milk, or whey
alternative sources of calcium
Alternative Sources of Calcium
  • 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
calcium 1 cup milk
Calcium = 1 cup 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
calcium education
Calcium education
  • power point presentations,
  • calcium intake requirements,
  • functions of calcium, and
  • information regarding risks of inadequate intake of calcium are available at:

calcium related health problems
Calcium-Related Health Problems
  • Osteoporosis
  • Colon and Rectal Cancer
  • Hypertension and Stroke
  • Overweight and Obesity
wic policy

WIC Policy

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

For children and women with lactose intolerance documented by the CPA, cheese may be issued as a substitute for milk.
usda encourages programs to offer alternative types of milk for children who are lactose intolerant
USDA encourages programs to offer alternative types of milk for children who are lactose intolerant.
in schools and childcare settings
In schools and childcare settings
  • 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
child nutrition and wic reauthorization act 2004
Child Nutrition and WIC Reauthorization Act 2004
  • 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.
for more information
For More Information…
  • STTM 2
    • Calcium: pg 26-27
    • Food Allergies: pg 113
    • Calcium and Osteoporosis: pg 127-130
for more information1
For more information…
  • Rita Arni, RD, LD

WICNS Child Nutrition Team Leader


[email protected]

  • Jean Trae, PhD, RD, LD

WICNS Child Nutrition Coordinator


[email protected]