Celiac and Lactose Intolerance: It is very common for people with Celiac disease to have issues with other foods, and dairy may be the most common one. Let’s explore some of the reasons why you might have problems with both gluten and dairy, the different ways it may show up in your life and some tips on what you can do about it.
Let’s start with understanding a bit about milk. We’re talking about cow’s milk here as it’s the type that’s most consumed and the one that most frequently causes problems.
First, let’s look at milk in terms of the three macronutrients. All foods can be broken down into protein, carbohydrate and fat. Milk is the same. Milk protein is called casein. The carbohydrate or sugar part of milk is called lactose and then you have milk fat or butter fat. That’s the percentage you’ll see on most milk products. 2% milk will say 2%m.f. on the label. Cream for your coffee might be 10% m.f. and butter is about 80% m.f.
Lactose, which is the sugar in milk, is categorized as a disaccharide. This means that it consists of two sugar molecules bonded together and that makes it difficult for our bodies to digest. Therefore, Lactose intolerance is pretty common and most people know about it. So, if people notice you avoiding dairy products, they may ask you if you are lactose intolerant as most are familiar with this affliction. So why might someone be lactose intolerant?
Lactase is an enzyme that our bodies produce that allows our digestive systems to break down and digest lactose. Almost everyone produces lactase from the time they are babies in order to be able to digest their mother’s milk. For much of the world's population, humans gradually stop producing the lactase enzyme somewhere around three years of age.
If you have difficulty digesting milk products, you have no other digestive issues that could cause lactose intolerance and your background is Asian or African or Native American, this could be you. Here’s why:
For most our history in the west, it was assumed that lactose tolerance was the norm and people who could not digest lactose were a minority. Domestication of dairy animals in Europe goes back several thousand years and as a result people from those areas developed a gene for “lactase persistence” meaning that their bodies would continue to produce lactase into adulthood. This was very important as so many nutrients can be found in milk and other dairy products. Once cheese making was developed it became a central part of the European diet as it is rich in these nutrients and readily available and easy to store and transport.
It turns out however, that this assumption that most people
can tolerate lactose into adulthood was a bit of a “Eurocentric” attitude. Populations in Asia and Africa and natives to North and South America experience
rates of lactose intolerance as high as 95% where those in Northern European
regions are closer to 10%. It’s thought
that the worldwide rate of lactose intolerance is about 65%. This simply means, that at some point after
childhood when evolution has assumed, we are weaned and no longer consuming
breast milk, our bodies stop producing lactase.
If you think about food from various regions in the world this kind of makes sense. Asian cooking involves a lot of soy and coconut milk for example where European cooking incorporates lots of cream and a huge variety of cheeses.
This is where celiac and lactose intolerance come together. If you are reading this page because you have celiac disease or another digestive condition like gastroenteritis, Crohn’s disease, ulcerative colitis or if you have or have had intestinal parasites or chemotherapy and you are having difficulty digesting milk products, then this could apply to you.
Also if you are of European descent and you think you are lactose intolerant, it might be worth considering if you have one of these underlying conditions. It's not very likely that you have primary lactose intolerance and difficulty with dairy is sometimes one of the first or most prevalent ways those other conditions manifest themselves. A chat with your doctor may be in order to see if there is something like celiac disease causing your dairy problem. This is of course a generalization. People of non-European background can have issues that cause secondary lactose intolerance too, so don’t count this out if you think it may apply.
Conditions like the ones mentioned above cause damage to the small intestine. This is the place where the lactase enzyme is produced and where lactose is broken down for digestion. Secondary lactose intolerance is usually temporary. Once the underlying condition is dealt with, the gut can heal, and the body can begin to digest lactose again. If you have celiac and lactose intolerance it's because gluten has caused damage to your small intestine making it difficult for you to digest lactose. However, you may find that you only need to avoid dairy products temporarily. Once you've been gluten free for six months to one year and your gut has started to heal, then you can try reintroducing dairy products into your diet to see how well you tolerate them. You will always need to be gluten free though.
Of course, lactose will be found in dairy products like:
The good news is that the amount of lactose in these products varies and you may be able to tolerate small amounts. For example, hard cheeses like cheddar contain about 0.07% lactose and is often well tolerated. Yogurt contains the lactobacilli bacteria which can help to break down the lactose making it easier to tolerate.
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Avoiding the obvious sources of lactose may be enough, but
if you find you are still having problems you may need to pull out your label
sleuthing skills and start looking deeper.
Dairy is a common food allergen, so most jurisdictions require its
presence to be indicated on food labels.
Lactose is also used as a commercial food additive and a carrying agent
for flavourings so you may find it
Labeling laws for alcoholic beverages and medications are different than for foods so it may take a bit more digging to find lactose hiding in those places.
If you have celiac disease, you are no stranger to researching unfamiliar products, so you definitely have a transferable skill. Keep in mind though that celiac and lactose intolerance are different. Lactose causes discomfort but does not cause additional damage. It’s probably not necessary to ferret out every last molecule of lactose. Just take it to the degree that your system can tolerate.
You can talk to your doctor. He or she can recommend an approach for you and may also recommend tests to confirm that you are in fact lactose intolerant. Or, you can go ahead and deal with it your self. There are really two options, so let's look at both:
As I mentioned above, celiac and lactose intolerance are different. With gluten, “cutting down” doesn’t cut it. When it comes to lactose, take it to the degree that you feel comfortable and your digestion improves. You may even decide that the occasional cheat is worth it. When my hubby and I are out for dinner I totally sneak bites of his crème brulé. Sometimes I get away with it and sometimes not, but it’s sooo worth it. I would never cheat like that with gluten!
For example, milk, especially low-fat milk, is quite high. You may want to avoid or severely limit fluid milk or only have it with meals when food is slowing digestion and you may tolerate it better. Many people find they can tolerate a bit of milk or cream in their coffee or tea.
Hard cheeses and butter have almost no lactose. Most people tolerate these quite well.
The table below shows the amount of lactose in common dairy products.
*Although yogurt is quite high in lactose, it has the Lactobacillus acidophilus bacteria which aids with lactose digestion.
If you have secondary lactose intolerance, meaning that it’s caused by some other condition like celiac disease you may be able to start adding dairy back into your diet after six months to a year, once your gut has healed.
Can’t you take a pill for that? Well yes, as a matter of fact you can.
This is another way that celiac and lactose intolerance are different. Depending on how severe your lactose intolerance is, there may be some help in the form of pro-biotics and enzyme supplements. For gluten there is currently no supplement or medication that can help. The only treatment is a gluten free diet.
Lactase enzyme supplements come in capsule or liquid form and are available in most health food stores. Some are added directly to your milk product to break down the lactose in advance. If you use these, you will notice that the milk tastes sweeter as the enzyme turns the lactose into simple sugars which have a sweeter taste.
Another form of the lactase enzyme is taken orally about 15 minutes before ingesting lactose. There is some variability in results. Some people find taking enzymes works very well and others report that it doesn’t help.
Lactobacillus acidophilus is a bacterium that occurs naturally in our digestive systems and in fermented foods such a sauerkraut, miso and some yogurts. These little microscopic residents of your gut break down lactose and help with overall digestion. It is also available in capsule form. Probiotics function a little differently than enzymes. You’ll want to take them with food, but it’s not as targeted to the food you are eating now. The idea is to inoculate your gut with healthy bacteria to aid with overall digestion and to crowd out harmful bacteria. You should take them regularly according to the directions on the bottle, not just with dairy products. The folks at your health-food store are usually quite knowledgeable and can recommend a good full spectrum probiotic for you.
This kind of goes hand in hand with the avoidance option, but gives you some ways to keep the creamy taste and texture of dairy in your diet without the pain.
These are quite easy to find in your grocer’s dairy case. Regular cows milk products are treated with the lactase enzyme. This breaks down the lactose into simple sugars to make it easier to digest. You may find these products taste sweeter than untreated dairy products.
If lactose free milk causes you problems, or if dairy products with minimal lactose like hard cheese or butter cause you problems, then the issue may be casein instead of lactose.
There are lots of plant based "milks" on the market that work fine in your coffee, on your cereal, in baking and sauces.
Some examples of non-dairy substitutes include:
Experiment to find what you like. You may choose different options for different applications. For example, I like oat milk on my cereal and I use canned coconut milk in baking and creamy sauces.
If you’re eliminating dairy products from your diet, you’ll be looking for some substitutions. Here are a few ideas.
Milk and milk products are an excellent source of several
important nutrients and a recommended part of a healthy diet. Of course, you can have a healthy diet
without dairy products, you just need to be aware of what you are missing and
make it up elsewhere. The key nutrients
in milk are calcium, vitamin D, protein, phosphorus, magnesium, potassium,
vitamin B12 and zinc. Here is a
separate article that breaks down the key nutrients in milk and offers
alternatives and resources for further reading.
To summarize, a healthy diet that includes dark leafy greens, meat,
fatty fish like salmon, and poultry will fill in the gaps nicely. If you are vegan or vegetarian then meat
substitutes like grains, nuts, seeds, beans, peas and legumes will serve you
So there you have it. You found out you had celiac and would have to give up gluten, but that wasn’t the end of it. Lactose intolerance snuck up and grabbed you from behind and now you have to avoid both gluten and dairy. But you’re tough, I know you are, and you’ve got this! And the good news is, it’s probably temporary.
But what if it doesn’t work? What if you thought you had narrowed your problem down to dairy, but your tummy still rebels when you eliminate lactose? What if after 6 months to a year on a gluten free diet you still can't handle dairy products. Maybe your problem is casein.
Go here to read about Gluten and Casein.