Management of Stomach Pain from Lactose Intolerance
The most effective approach is to reduce or eliminate lactose from your diet until symptoms resolve, focusing on avoiding fresh milk while continuing to eat yogurt and hard cheeses, which are generally well-tolerated even by lactose-intolerant individuals. 1, 2
Immediate Dietary Management
Avoid fresh milk and most dairy products during symptomatic periods. 2 However, you do not need to eliminate all dairy:
- Yogurt and firm/hard cheeses contain negligible lactose and should NOT be eliminated 2, 3
- Hard and semi-hard cheeses are lactose-free or contain only trace amounts 3
- Yogurt is well-tolerated despite containing some lactose because the live bacteria help digest it 3
Determining Your Lactose Threshold
Only patients consuming more than 280 ml (approximately 0.5 pint or 1 cup) of milk daily typically need intervention. 1, 2 If you consume less than this amount, you may not need strict restriction since most lactose-intolerant people can tolerate moderate amounts (up to 12 oz of milk daily) without symptoms. 4
Start with a 2-week dietary restriction trial by removing lactose-containing foods and observing if symptoms resolve—this is a simple, economical diagnostic and therapeutic approach. 1, 2
Additional Treatment Options
Lactase Enzyme Supplements
- Over-the-counter lactase supplements can be taken before consuming dairy products 4
- These provide the enzyme your body lacks to digest lactose 4
Probiotics
- Consider taking probiotics for 4-12 weeks to help your colon bacteria adapt 1, 2
- Lactobacillus acidophilus and Lactobacillus casei strains may be particularly helpful 1
- Discontinue if no improvement after 12 weeks 1
Important Considerations
Rule Out Secondary Causes
Before accepting primary lactose intolerance, consider reversible causes: 1, 2
- Celiac disease
- Gastroenteritis
- NSAID use
- Small bowel disease
- Chemotherapy (causes reversible lactose intolerance in up to 35% of patients) 1
Consider Broader Food Intolerances
At least 50% of patients with presumed lactose intolerance actually have broader intolerance to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). 1, 2, 5 If lactose restriction alone doesn't resolve your symptoms after 2 weeks, you may need a low FODMAP diet supervised by a trained dietitian. 6
Watch for Hidden Lactose
Many processed foods contain "hidden lactose" including baked goods, breakfast cereals, drinks, and processed meats. 7 Check food labels carefully, though most lactose-containing medications have amounts <12g and rarely cause symptoms. 1, 2
Nutritional Safety
Ensure adequate calcium intake since eliminating dairy products can lead to osteopenia and osteoporosis. 7, 4 Focus on calcium-rich alternatives or supplements if you must avoid most dairy products.