The majority of Black adults in the U.S. are lactose intolerant. But avoiding dairy can be nutritionally risky. Here’s how to manage the problem.
By Brian Vines
In my family, milk had two distinct functions: As a source of nutrition for us kids, and as a laxative for my dad.
While we were holding our noses and obediently gulping down a glass each morning, my father would be dosing himself with the goal of—how should I put this?—getting the train to leave the station.
That’s because my dad, like more than 6 in 10 Black people, is lactose intolerant.
Lactose intolerance is a condition in which the body doesn’t produce enough lactase, the intestinal enzyme that breaks down lactose, the main sugar in milk.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 36 percent of people in the U.S. have some lactose malabsorption, with the highest prevalence among people of color. In addition to between 60 and 80 percent of Black people, as many as 90 percent of those from Eastern Asia, 80 percent of Indigenous Americans, and half of Hispanics are lactose intolerant. About 80 percent of white people, on the other hand, can consume dairy without complications.
Though many people develop lactose intolerance as adults, all babies are born with the lactose-converting lactase enzyme in their small intestines. This enzyme decreases with age and the first symptoms of intolerance typically begin to emerge after age three.
The symptoms can range in severity, but generally present within 30 minutes to two hours of consuming food with lactose and take the form of stomach discomfort, bloating, gas, nausea, and diarrhea.
Given those issues, it’s easy to understand why folks with lactose intolerance would steer clear of milk products. But people who avoid dairy foods may not be getting the recommended amounts of calcium, vitamin D, and other nutrients, says Ugonna Iroku, MD, a gastroenterologist and assistant clinical professor at Mount Sinai Hospital in New York City. “You can find culturally appropriate foods that meet your culinary taste while providing the nutrition you need,” says Iroku.
Here are tips for figuring out if your stomach troubles are caused by a lactose intolerance—and, if so, how to make sure you’re getting the nutrition you need.
See a doctor. Start by making sure you understand the cause of any gastrointestinal symptoms. Lactose intolerance may make you uncomfortable, but it presents little medical danger, says Iroku. Milk allergies, though a lot less common, can be much more serious than lactose intolerance and even life-threatening. (These usually show up in babies, not adults.) “Our job is to help establish that it’s lactose intolerance for sure,” says Iroku. “If you’re seeing blood in your stool along with cramping that’s definitely a reason to go see your doctor.”
Keep a food journal. Either before you see a doctor, or afterward, you’re going to want to document what you’re eating and how it’s affecting you. “Start by getting some data,” says Iroku. “Carry paper and a pen, and commit to asking yourself, ‘I feel bad today. What were my last couple of meals’?” Journaling this way can help you and your doctor figure out if lactose is the culprit or something else entirely.
Make sure you’re getting your nutrients. “While you’re figuring out your relationship with dairy, you want to make sure that you’re getting calcium from a variety of sources,” says Iroku. He recommends nutrient-dense dairy-free foods like beans, leafy greens such as spinach, kale, and collard greens, and calcium-rich fish such as salmon and sardines.
Meanwhile, you probably don’t need to stop consuming dairy altogether, says Tamara Melton, a registered dietitian nutritionist and the co-founder of Diversify Dietetics, a nonprofit that empowers individuals of color in the field of nutrition and dietetics.
Lactose-free dairy products are a good place to start. The widely available Lactaid brand offers a wide range of lactose-free dairy products. But traditional dairies like Organic Valley and Fairlife also offer milk free from lactose. And private label store brands like 365 by Whole Foods Market, Walmart’s Great Value brand, and Costco’s Kirkland Signature all offer lactose-free milk.
Lactose-free options are typically processed to make them tolerable to the lactose intolerant while also delivering all of the nutritional benefits of conventional milk. “Your children can still drink it, too, so you don’t have to buy two types of milk,” Melton says.
Melton also advises reaching for kefir, hard cheese, and other dairy products that are naturally low in lactose to both provide nutrition and satisfy dairy cravings. (See “5 Dairy Products Less Likely to Cause Symptoms,” below.)
Consider experimenting with conventional dairy. Oroku and Melton both say that small doses and a little patience may make managing lactose intolerance easier. “Even if you’re lactose intolerant, you can tolerate a small amount of lactose,” says Oroku.
There is also evidence that drinking a half-glass of milk with meals slows down the movement of the dairy through the intestinal tract leading to potentially less discomfort.
5 Dairy Products With Less Lactose
Experts say these dairy items are less likely to trigger symptoms in lactose intolerant people.
Kefir. Kefir is a tangy drink made from milk that’s been fermented with kefir grains. Remnants of cheese created with kefir have been found in a 3,500-year-old cemetery in Xinjiang, China, where Bronze Age peoples used the technique to preserve milk without refrigeration. Kefir can usually be found near the milk and yogurt in the dairy aisle. Some people like to drink it on its own, but it can also be used in a smoothie, as a base for overnight oats, or frozen as an alternative ice-cream base.
Kefir
Photo: Getty Images
Ghee. Ghee is simply butter that has been melted and heated to the point where the water content evaporates. What’s left separates into liquid fats and milk solids, a process called clarification. When those milk solids are strained out, they take some of the lactose with them, turning butter—which is already a very low-lactose food—into a super-low-lactose ingredient. (Ghee is also usually cooked to the point where it begins to brown, giving it a subtle, nutty flavor.)
As fatty as butter, ghee should be consumed in moderation. A staple of Indian cooking for thousands of years, Ghee is shelf-stable and can be found on supermarket shelves across the country. Its burning point of 485 degrees is well above the temperature at which butter will burn (350 degrees), making it suitable for frying and sautéing. Some people also use ghee to add creaminess to coffee or hot chocolate.
Ghee
Photo: Getty Images
Aged, Hard Cheese. The longer a cheese ages, the more time there is for bacteria to break down the lactose, so hard, aged cheeses like Parmesan and cheddar generally contain less lactose than fresh soft cheeses like cream cheese and cottage cheese. There are some outliers, however: Brie and Camembert are both soft and creamy but typically have lower levels of lactose than cream cheese because of their aging processes. Feta also has relatively little lactose.
Photo: Getty Images
Yogurt. The bacterial fermentation process that turns milk into yogurt converts lactose into lactic acid. Greek yogurt—which is made by straining the liquid whey, resulting in a thicker, creamier product—contains even less lactose.
Photo: Getty Images
Heavy Cream. If whole milk upsets your stomach, you may think heavy cream would be worse—but you’d be wrong. Its high-fat, lower-lactose content may keep discomfort at bay for those sensitive to lactose.
Heavy cream
Photo: Getty Images
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