You can eat
- Long-aged mature cheese, with 0.1 g of lactose per 100 g [2].
- Soft cheese such as camembert, with 0.3 g per 100 g [2].
- Butter, with 0.5 g per 100 g and just 0.1 g in the amount spread on toast [2].
- Lactose-free milk and its derivatives, below 0.1 g per 100 g [2].
- Unsweetened soy drink, which contains no lactose [2].
- Yoghurt, if it agrees with you; it keeps part of the lactose from the milk [2].
- Fresh meat, fish and eggs, which contain barely any lactose; processed versions may contain it [2].
- Vegetables, fruit, pulses, potatoes, cereals, nuts and olive oil, which contain no lactose.
What to avoid
- Whole or skimmed milk, with about 15 g of lactose in the usual serving [2].
- Large white coffee, with 8.6 g per cup [2].
- Cream and creamy ice cream, with 3.6 and 6.4 g per 100 g [2].
- Custard, flan and dairy desserts, with 3.6 g per 100 g [2].
- Cream cheese, with 3.0 g per 100 g, though the serving is usually small [2].
- Ready-made sauces, with 3.6 g per 100 g, and lasagne, with 1.1 g [2].
- Goat's milk, with 4.5 g per 100 g, almost the same as cow's milk [2].
- Cold cuts, margarines, bread, sauces and ready meals with lactose in the ingredients list [2].
Changes that help
Your morning coffee
Instead of a large white coffee, black coffee, a small white coffee or one with lactose-free milk, because that cup contains 8.6 g of lactose [2].
Your breakfast milk
Instead of ordinary milk, lactose-free milk or a soy drink with added calcium, because they keep the protein and calcium. Soy is an allergen.
Your cheese
Instead of cream cheese, long-aged mature cheese, because it drops from 3.0 to 0.1 g of lactose per 100 g [2].
Your dessert
Instead of custard, flan or creamy ice cream, fruit or the lactose-free version of the same dessert, because those desserts contain 3.6 to 6.4 g per 100 g [2].
Habits that help
- Spread dairy through the day instead of grouping it into a single serving [1].
- Have milk or yoghurt as part of a meal, with other food [2].
- Look for the word "milk" highlighted in the ingredients list, where the law requires it to stand out [3].
- During reintroduction, note the time, the amount and how it agreed with you.
- If you are worried about lactose in a medicine, ask at the pharmacy and do not stop taking it on your own.
It is the question that comes up most often in consultation on this topic. If milk disagrees with you, do you have to give it up? Almost never entirely.
Not digesting lactose well happens to most of the world’s adult population [2]. What decides whether you notice anything, and how much, is the amount you have at once. That can be measured and fitted into your day without giving up eating well.
What is lactose, and why does it stop agreeing with you as you get older?
Lactose is the sugar in milk. In the small intestine, an enzyme called lactase splits it into glucose and galactose, which are what get absorbed [2].
What changes over the years is the amount of lactase. In most of the population, this enzyme drops during childhood. It is called lactase non-persistence, and it is not considered a disease, because it is what happens to most of humanity [2].
An analysis of many studies puts lactose malabsorption at 68% of the world’s population [2]. It falls below 5% in Denmark and approaches 100% in Korea [2]. That review gives no figure for Spain.
The lactose that is not split carries on to the colon, where bacteria ferment it. That is what produces the gas, the bloating and the diarrhoea, a few hours after the glass of milk.
Which foods contain lactose, and how much?
Cow’s milk contains around 5 g of lactose per 100 ml, about 12.5 g in a 250 ml cup [2]. From there, processing takes over. Yoghurt keeps part of the lactose from the milk, and cheese contains little, especially long-aged cheese [2].
The table shows how much each food contains. These are representative values, which vary by brand and by process [2]. Per serving, what adds up most is milk, a large white coffee and yoghurt. Mature cheese and butter barely count.
| Food | Lactose per 100 g | Per usual serving |
|---|---|---|
| Whole milk | 4.7 g | 15 g |
| Skimmed milk | 4.8 g | 15 g |
| Lactose-free milk | < 0.1 g | < 0.1 g |
| Goat’s milk | 4.5 g | 13 g |
| Buttermilk | 3.0 g | 9.0 g |
| Butter | 0.5 g | 0.1 g |
| Fresh yoghurt | 3.0 g | 9.3 g |
| “Bio” yoghurt | 4.0 g | 9.5 g |
| Cream cheese | 3.0 g | 0.9 g |
| Soft cheese (camembert) | 0.3 g | 0.1 g |
| Mature cheese (cheddar, gruyère) | 0.1 g | < 0.1 g |
| Cream | 3.6 g | 3.2 g |
| Creamy ice cream | 6.4 g | 5.7 g |
| Large white coffee | 4.3 g | 8.6 g |
| Lasagne | 1.1 g | 2.6 g |
| Cheeseburger | 0.9 g | 1.1 g |
| Ready-made sauces | 3.6 g | 4.5 g |
| Custard and flan | 3.6 g | 4.5 g |
| Rice, oat, soy or nut drinks | 0.0 g | 0.0 g |
Two dairy foods are tolerated better than milk. Yoghurt contains live bacteria that digest part of its lactose; the European Food Safety Authority recognises that they improve the digestion of the lactose in the yoghurt itself in people who digest it poorly [8]. “Yoghurt pasteurised after fermentation” no longer contains them.
Mature cheese has so little lactose because almost all of it leaves with the whey and bacteria consume the rest as it matures; the more mature, the less remains [9]. Fresh cheese and curd cheese retain more.
Do cold cuts, bread or sauces contain lactose?
They can, even though they are not dairy. Lactose powder is a common additive used to give texture and flavour to cold cuts, sauces, margarines, bread and many ready meals [2].
It depends on each manufacturer’s recipe, so the same product may contain it in one brand and not in another. The way to find out is the ingredients list, where milk and its derivatives, lactose included, are shown in a different typeface or in bold [3]. If something that does not seem to contain milk disagrees with you, start there.
Do powdered milk, condensed milk or sheep’s milk contain lactose?
Yes, all three, because all three are milk.
- Powdered, condensed and evaporated. These are milk with the water removed. Per 100 g of product they contain more lactose than the starting milk, and once reconstituted they return to the milk figure. We do not give an exact figure because our sources do not report one.
- Goat’s and sheep’s milk. Neither is a lactose-free milk. Goat’s milk contains 4.5 g per 100 g, almost the same as cow’s milk [2]. We do not have a sourced figure for sheep’s milk.
Two label terms cause confusion and are not lactose. Lactic acid (E-270) is an acid that comes from fermentation, and lactic ferments are bacteria. What the law requires to be highlighted in the ingredients is “milk and its derivatives (including lactose)” [3].
Can I drink lactose-free milk if I am intolerant?
Yes, and it is the simplest way to keep drinking milk. Lactose-free milk is ordinary milk with lactase added, the enzyme you are short of, so it splits the lactose before you drink it [2]. It stays below 0.1 g of lactose per 100 g [2].
Since only the sugar changes, it is still milk, with its protein and its calcium. As lactase splits the lactose, it leaves behind two sugars that taste sweeter, which is why it tastes a little sweeter [2]. Lactose-free yoghurts and other dairy foods work the same way, and serve for breakfast, for cooking or for a white sauce.
How much lactose can you tolerate?
There is no single figure that works for everyone. The European Food Safety Authority concluded that tolerance varies too much from person to person to set a single threshold [1]. It did set out three starting figures [1].
- Up to 12 g at once is tolerated by the large majority of people who do not digest lactose well, with mild symptoms or none [1]. That is what a 250 ml glass of milk contains [2].
- Below 6 g, some people already have symptoms [1]. They are the ones who fare worst with general advice.
- Larger amounts can be tolerated if spread through the day [1], or taken with food [2].
That is why, unlike coeliac disease or a food allergy, you do not need to cut out lactose completely [2]. In practice, a glass of milk at breakfast usually fits. A large white coffee and a yoghurt at the same time already add up to almost 18 g [2], and exceed that threshold.
How to reintroduce lactose in stages
If you have gone without dairy for a while, there is no need to go straight back to it. This is the order we suggest in consultation, from what is best tolerated to what costs more effort, once you have a diagnosis and your symptoms have settled. Each step lasts a few days, except the first.
- A calm baseline. About two weeks with lactose-free milk and yoghurt, mature cheese and the rest of your usual food.
- Yoghurt or fresh cheese. A plain yoghurt or a small serving of fresh cheese, as part of a meal.
- A small amount of milk. Half a glass with breakfast, around 6 g of lactose [2], better with food than on its own on an empty stomach.
- Increase the amount. If you have been fine, a full glass, around 12 g [2]. Then, two servings at different times of day.
- Your own pattern. You settle on the highest amount you can take without discomfort and keep to it.
If a step gives you symptoms, go back to the previous one for a few days and try it again later. One bad day does not close the door on that food.
Lactose intolerance diet: a sample day
With the table to hand, a day with dairy fits without going over 12 g at any one time. Here is an example with its figures [2].
- Breakfast. White coffee with lactose-free milk and toast with butter. Practically no lactose.
- Mid-morning. A yoghurt with fruit, if it agrees with you. About 9 g, the highest amount of the day.
- Lunch. A serving of lasagne. About 2.6 g.
- Dinner. Omelette and a little mature cheese. Less than 0.1 g.
The day adds up to about 12 g, spread over four servings and always with food. If the yoghurt disagrees with you, that is the first thing to change. If you notice nothing, you can increase it following the stages above.
Eating out with lactose intolerance
In bars and restaurants you can ask for the allergen information for each dish. The law requires it to be given for unpackaged food too, and milk is one of those allergens [3].
Away from home, what usually adds up the most lactose is white coffee, creamy sauces, white sauce and dairy desserts. A grilled dish with vegetables, a salad dressed with oil, fruit for dessert and a small white coffee with lactose-free milk rarely cause problems. Mature cheese from a cheese board does not either. If you are unsure about a sauce, ask for it on the side.
Will I be short of calcium if I have less dairy?
Not necessarily. Dairy is an important source of protein, calcium and vitamin D, and these nutrients can also be obtained from other foods [2]. What is more, most people with intolerance do not have to give it up entirely. AESAN recommends up to 3 servings of dairy a day, preferably plain and unsweetened.
Lactose-free milk and yoghurt, and mature cheese, keep their usual calcium content. For adults from age 25, EFSA’s calcium reference is 950 mg a day.
Outside dairy, these foods contribute calcium:
- Tinned sardines and anchovies, eaten with the bones.
- Tofu set with calcium salts (check the label).
- Plant-based drinks and yoghurts fortified with calcium.
- Almonds and sesame seeds.
- Pulses such as white beans, chickpeas or soy.
- Broccoli, kale, spring greens and other leafy greens.
Several of these options are allergens: fish, soy, tree nuts and sesame.
Vitamin D depends mainly on sunlight; in food it is found in oily fish, eggs and fortified products. A calcium or vitamin D supplement only makes sense if ordered by whoever is treating you, after evaluating your diet and, for vitamin D, a blood test.
Are malabsorption, intolerance and milk allergy the same thing?
No, and the difference changes what you need to do. Malabsorption is when lactose is not fully absorbed and reaches the colon, and you can have it without noticing anything [4]. Intolerance is having symptoms after taking it [4]. It is the second one that is treated.
Milk protein allergy is a different thing. It is a reaction of the immune system against milk proteins, and lactose plays no part [5]. In the form mediated by immunoglobulin E, a type of antibody, symptoms appear quickly [5]. Its diagnosis and follow-up belong to allergology.
If after drinking milk you find it hard to breathe, your lips, tongue or throat swell, you feel dizzy, or you break out in hives and also vomit, call 112. That is not intolerance.
How do you know if you are lactose intolerant?
With a hydrogen breath test ordered by a doctor. You drink lactose dissolved in water and blow into a device at set intervals over a few hours. If the lactose reaches the colon, bacteria produce hydrogen and it rises in your breath [4].
The European consensus on these tests sets the dose, from 25 to 50 g of lactose to detect malabsorption and 25 g to document intolerance [4]. Something else comes before the test. If there are warning signs, that same consensus calls for investigating them first with blood tests, endoscopy and imaging [4]. You will find them at the end, under “When to see a doctor”.
IgG tests, hair tests or bioresonance tests do not diagnose any intolerance. Many of the endless lists we see in consultation come from these. The opposite trap is also common: assuming it without a test. An elimination diet is kept for when the link between taking lactose and having symptoms has already been documented [4].
Can lactose intolerance go away?
It depends on why it appeared [2]. Primary intolerance is due to the drop in lactase that begins in childhood; it is the baseline situation for most of the world’s population and is not described as reversible.
Secondary intolerance appears when the lining of the small intestine is damaged, by gastroenteritis, inflammatory bowel disease or undiagnosed coeliac disease. Because lactase sits at the tip of the villi, this kind can reverse, and is often temporary [2].
Many people newly diagnosed with coeliac disease test positive for lactose intolerance and digest it again after six to twelve months without gluten [2]. If this is your case, talk to your doctor or your dietitian before writing milk off for good. And if milk starts to disagree with you when it did not before, it is worth having someone look at what has changed.
Do lactase tablets work?
They help, though only a little. Lactase tablets supply the enzyme you are missing and improve both lactose digestion and symptoms, but the effect is modest [2]. As an example, symptoms fell overall by 18% [2].
Probiotics that produce lactase in the gut work in a similar way. Their overall effect is positive, but it does not clearly beat that of the tablets, and the studies are of low quality [2]. That is why they are not our first tool. Knowing your threshold and spreading out lactose usually help more, and lactose-free milk already has the enzyme built in.
If you cut out lactose and do not improve
Then lactose was not the problem, or not the only one. When small or moderate amounts cause trouble, there is often irritable bowel syndrome behind it [2]. These people react to a whole group of sugars that ferment in the colon, called FODMAPs, and what helps them is a low-FODMAP diet [2].
Lactose is one of those sugars. Fructose and sorbitol are two more [6]. The low-FODMAP diet is temporary, with two to six weeks of restriction followed by a gradual reintroduction of foods [6].
There are two more causes worth ruling out with your doctor. Undiagnosed coeliac disease, which causes similar symptoms and can cause secondary lactose intolerance. Do not cut out gluten before having the tests, because they can come back normal even if you have it. And small intestinal bacterial overgrowth (SIBO), in which bacteria ferment sugars prematurely and cause very similar symptoms.
What mistakes do we see in consultation?
These situations come up almost every week in consultation.
- Cutting out mature cheese too. It is one of the lowest-lactose dairy foods in the table, and cutting it out reduces calcium for no reason.
- Swapping milk for any plant-based drink. Many contain little protein and not all have added calcium. If you swap it, choose a soy drink or another with at least 3 g of protein per 100 ml, and with calcium. Check the label, and bear in mind that soy and nuts are allergens.
- Trusting the “lactose-free” label on dairy and not checking cold cuts, sauces or bread, where lactose turns up as an additive.
- Checking every label for “traces of milk”. Traces matter for milk protein allergy. In an already diagnosed intolerance, such a small amount does not usually cause symptoms.
- Taking all of the day’s lactose at once, almost always in the morning white coffee, and concluding that none is tolerated.
- Carrying on cutting foods when the list keeps growing. If there is almost nothing left that agrees with you, it is time to review the diagnosis before cutting out anything else.
If milk disagrees with you, you almost never need to give up dairy. Knowing how much lactose is in what you have and spreading it through the day is usually enough to eat a varied diet with peace of mind.
If you have been cutting things out for months and the list of what disagrees with you keeps growing, it is worth having someone look at it with you. Our team of dietitians specialising in allergies and intolerances works with your diagnosis in front of them and a plan to bring foods back in, in Barcelona and online.
We explain it on video
More videos
Your first step this week
Three breakfasts with very little lactose or none, using foods from the lower part of the table. You only need to check the label on the bread.
Toast with avocado and egg
Bread with avocado, a fried egg and sliced tomato. Not a trace of dairy, and it keeps you going until mid-morning. If the bread is sliced loaf, check the label: it sometimes contains lactose as an additive.
Black coffee and a mature cheese sandwich
A small sandwich of long-aged mature cheese, at 0.1 g of lactose per 100 g, with black coffee or a small white coffee with oat drink.
Oats with plant-based drink and fruit
Rolled oats with unsweetened soy or oat drink, which contain no lactose, chopped fruit and a handful of nuts.
Your gluten-free week, with the food you already love
- 7-day menu with the shopping list
- 10 gluten-free recipes with everyday food
- How to read the label and keep gluten out
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When to see a doctor
When to see a doctor
Lactose intolerance is confirmed with a breath test ordered by a doctor, and it is almost always a matter of quantity. Our job is to find your threshold and stop you ending up eating only four foods, which is the real risk here.
See a doctor without waiting to change your diet if you notice any of these signs:
- You are losing weight, see blood in your stools, have a fever or anaemia: intolerance does not explain that [4] [7].
- Symptoms began suddenly in adulthood and do not change at all when you cut out lactose.
- You have cut out whole food groups and there is hardly anything left that you can eat.
- You have been “diagnosed” with an intolerance using an IgG, hair or bioresonance test.
With weight loss, blood or fever, see your GP this week. If the list of foods that disagree with you keeps growing, see a dietitian to rebuild your diet rather than keep cutting it back. If after drinking milk you find it hard to breathe, your lips, tongue or throat swell, or you feel dizzy, call 112.
Almost everyone with lactose intolerance ends up tolerating more than they thought. What matters is knowing how much.
Tell us which foods don't agree with you
In the first appointment we talk about your symptoms, what you eat and what you have already cut out. A week later you have your plan. If you have a diagnosis or a report, bring it with you.
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Sources
- EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on lactose thresholds in lactose intolerance and galactosaemia. EFSA Journal. 2010;8(9):1777. doi:10.2903/j.efsa.2010.1777
- Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019;68(11):2080-2091. doi:10.1136/gutjnl-2019-318404
- Reglamento (UE) n.º 1169/2011 del Parlamento Europeo y del Consejo, de 25 de octubre de 2011, sobre la información alimentaria facilitada al consumidor. Anexo II, punto 7, y artículo 21. Texto consolidado. Disponible en: https://eur-lex.europa.eu/legal-content/ES/TXT/?uri=CELEX:02011R1169-20180101
- Hammer HF, Fox MR, Keller J, et al. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus. United European Gastroenterol J. 2022;10(1):15-40. doi:10.1002/ueg2.12133
- Fiocchi A, Bognanni A, Brożek J, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines update — I — Plan and definitions. World Allergy Organ J. 2022;15(1):100609. doi:10.1016/j.waojou.2021.100609
- Monash University, Department of Gastroenterology. About FODMAPs and IBS [consultado el 22/09/2026]. Disponible en: https://www.monashfodmap.com/about-fodmap-and-ibs/
- National Institute for Health and Care Excellence. Irritable bowel syndrome in adults: diagnosis and management. NICE guideline CG61. London: NICE; 2008 (actualizada en 2017). Disponible en: https://www.nice.org.uk/guidance/cg61
- EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the substantiation of health claims related to live yoghurt cultures and improved lactose digestion (ID 1143, 2976) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2010;8(10):1763. doi:10.2903/j.efsa.2010.1763
- Facioni MS, Raspini B, Pivari F, et al. Nutritional management of lactose intolerance: the importance of diet and food labelling. J Transl Med. 2020;18:260. doi:10.1186/s12967-020-02429-2
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