Introduction
This information leaflet is intended for children and young people who have, or are suspected to have, lactose intolerance. This information is not for those with cow's milk protein allergy.
Lactose-free diet
Lactose is found in cow’s milk; therefore any products containing milk will also contain lactose, and should be avoided. Lactose-free alternatives are available, such as lactose-free cheese, yoghurt and milk, which, although they are made from cow's milk, the lactose has been removed. These are readily available and are safe to use, although the label will still state that the food contains cow's milk.
Milk is often used as an ingredient in manufactured foods. Common foods containing milk include biscuits, bread, crisps, processed meats, desserts and sauces. The ingredients list should be checked to see whether the food is suitable to eat.
Food labelling laws require all pre-packed foods for sale within the UK and EU, containing milk, to be highlighted in the ingredients list. This may be in bold, underlined or in italics. Foods sold loose (such as from a delicatessen or bakery) must have a list of ingredients available on request. Remember that foods sold outside the UK and EU do not have to comply with these laws.
Avoid foods containing the following ingredients (unless you are buying a specially made lactose-free product):
- cow’s milk/ evaporated milk/ condensed milk
- non-fat milk solids/ milk sugar solids/ milk powder/ milk solids
- casein/ caseinates/ milk protein
- whey/ whey syrup sweetener
- lactose
- butter/ margarine/ ghee
- cream, cheese and yoghurt
- buttermilk
Some medicines, vitamin supplements, toothpastes and mouthwashes contain lactose (check the information leaflet).
Some food ingredients sound like they contain lactose but do not. These include the following:
- Lactic acid E270
- Stearoyl lactylates
- Sodium lactate E325
- Glucona-delta-lactone
- Potassium lactate E325
- Calcium lactate E327
- Cocoa butter
May contain traces of milk
Some manufactured products state that they may contain traces of milk, but do not contain milk on the ingredients list. These products do not need to be avoided on a lactose-free diet.
Non-urgent advice: Suitable foods
- Milks
-
Children under one year old: SMA LF, Aptamil lactose free
Children over one year old: Lactose free cow's milk, such as Just Milk 'Lactose Free', Arla 'Lactofree' Tesco ‘Lactose Free Dairy Milk’, Sainsbury’s ‘Everyday lactose free milk’, Aldi Cowbelle ‘Lactose free milk’
- Non-dairy milk alternatives
-
These are suitable as a main drink for children over two years. They can be used in cooking from six months of age. Choose calcium enriched types. Examples include:
- soya milk
- coconut milk
- oat milk
- nut milks, e.g. hazelnut, cashew, almond
- pea milk
- potato milk
Rice milk should not be used in children under five years.
Choose milks with added calcium, iodine, vitamin B12.
Nut milks are lower in energy and protein when compared to cow’s milk, so opt for oat and soya milk if offering as a main drink alternative.
Enriched milk alternatives have an energy and nutrient content closer to full fat cow’s milk. They are therefore suitable from 1 year of age. Examples include:
- Alpro Soya ‘Growing up milk 1-3years+’
- Oatly Barista edition
- Oatly Oat drink ‘whole’
- MOMA Oat ‘whole’
- Cheese
-
Lactose free cheese, e.g. Arla Lactofree, Philadelphia lactose free, Waitrose lactose free halloumi
Vegetable-based cheeses. Brands include Violife, Sheese, Vegusto, VBites, Koko and supermarket own brand cheeses. Choose calcium-enriched types where possible.
- Creams/ Whiteners
-
Lactose free cream, e.g. Arla ‘Lactofree Cream’
Non dairy alternatives to cream e.g. Oatly ‘Creamy Oat Fraiche’, Oatly ‘Creamy Oat Single Cream’, Food Heaven ‘Whipped Spray Cream Vegan’, Provamel ‘Organic soya alternative to single cream’, Alpro Single Soya, Elmlea Plant
- Fats/ oils
-
Lactose free margarines e.g. Arla ‘Lactofree Spreadable’
Dairy free margarines e.g. Pure, Koko, Vitalite, Flora Plant, Lurpak Plant Based
Lard, suet, dripping, vegetable oils
- Yoghurts and desserts
-
Lactose free yoghurts e.g. Arla ‘Lacto-free’, Rachel’s Organic ‘Lactosefree’, Muller Corner ‘Lactose Free’, ASDA ‘Lactose Free’, Tesco ‘Lactose Free’
Soya yoghurt, soya desserts, soya rice pudding e.g. Alpro, Provamel Yofu, supermarket own brand
Dairy and soya free yoghurts and desserts. Brands include Co-Yo, Koko, Oatly , Supermarket own brands, The Coconut Collab. Choose calcium-enriched types where possible
Sorbet
Dairy-free ice cream. Brands who produce such foods include Swedish Glace, Breyers Delights non dairy, Booja-Booja, Alpro, Magnum (vegan), Whole Creations, Yorica, The Coconut Collab, Ben and Jerry’s (non-dairy ice cream), Halo Top dairy free, Supermarket own brands
Jelly, homemade jellies made with water or a suitable milk
Some custard powders (check ingredients list) made with a suitable milk or soya custard
Homemade tapioca, sago, semolina or rice pudding made with a suitable milk
- Breakfast cereals
-
Cornflakes, Crunchy Nut Corn Flakes, Frosties, Coco Pops, Rice Krispies, Weetabix, Shredded Wheat, Honey Loops, Ready Brek (original and honey), porridge oats
- Cereals, flour and cereal products
-
All varieties of flour, cornflour, arrowroot, baking powder, pasta, rice, sago, semolina, tapioca, spaghetti, rice noodles, egg noodles
Some breads (white, brown and wholemeal), rice cakes, crackerbreads, crackers and rye crispbreads (check ingredients labels)
Homemade biscuits, cakes and puddings using lactose free ingredients or manufactured dairy free versions
Ginger nuts, rich tea, jammie dodgers, party rings (check ingredients label)
- Meat, fish, chicken and alternatives
-
All varieties prepared and cooked without milk
Quorn, tofu
Soya products e.g. mince, burgers, sausages, nuggets (check ingredients labels)
Pulses e.g. red kidney beans, chickpeas, butter beans, cannelloni beans
Lentils
- Eggs
-
All forms of egg (made without added milk, e.g. boiled, poached, fried).
- Vegetables
-
All fresh, frozen or tinned without butter.
Oven chips (check labels).
Baked beans (check labels).
- Fruit
-
All fruits (fresh/ frozen/ dried/tinned in juice or syrup).
Fruit in jelly
Fruit juice
- Nuts
-
Fresh and plain salted nuts (whole nuts are not suitable for children under five years). Peanut and tree nut butters
- Snacks
-
Some plain potato crisps, puffed wheat and corn snacks, prawn crackers, oatcakes (check ingredients labels)
Plain sweet and salted popcorn
Plain pretzels and Twiglets
Homemade guacamole
Pepperami
Olives
Hummus
Some cereal bars e.g. Jordan’s Frusli bars; Fruitus organic fruit and cereal bars, specific Nature Valley bars (e.g. oat & honey crunchy granola bar), Nākd bars
- Preserves and confectionery
-
Sugar, glucose, jam, honey, syrup treacle, marmalade
Some brands of plain (dark) chocolate
Some brands of carob or soya bars, vegan and ‘free from’ chocolate (check labels).
Boiled sweets, lollipops, pastilles, gums, jelly tots, peppermints, softmints, chewy fruit sweets e.g. Fruitella, marshmallows
- Drinks
-
Plain tea and coffee
Nesquik powder, Crusha syrup, some cocoa powders (made up with suitable milk) (check ingredients labels)
Squashes, fizzy drinks, fresh fruit juices, fruit smoothies (check ingredients labels)
- Soups, sauces and gravies
-
Home-made soups, sauces and gravies made using milk-free ingredients
Certain brands of soups, sauces, gravies (check ingredients labels)
Some tomato ketchups, brown sauces, mustards, pickles, chutneys, mayonnaise, salad cream (check ingredients labels)
- Miscellaneous
-
Salt, pepper, herbs, spices, vinegar, mustard, mustard powder, bicarbonate of soda, cream of tartar, baking powder, yeast, colourings, essences, gelatine, monosodium glutamate
Bovril, Marmite, Vegemite
Dairy free chocolate spread e.g. Nutella plant based, Sweet Freedom, JimJams, Valsoia plant based, Plamil
Non-urgent advice: Unsuitable foods
Milks and dairy foods
Standard infant formula, cow's, goat’s and sheep’s milk. Fresh, dried, condensed, evaporated, and skimmed cow’s milk.
Cheese
All types of dairy cheese and cheese spreads
Creams/ Whiteners
Single cream, double cream, vegetable fat ‘creams’ such as Elmlea.
Coffee whiteners, for exapmle ‘Coffeemate’, ‘Coffee Compliment’.
Fats/ oils
Butter, margarine and spreads containing milk.
Hydrogenated vegetable oils may contain milk – please check ingredients.
Yoghurts and desserts
Yoghurt, fromage frais, crème fraiche, dairy ice cream, milk chocolate desserts
Dairy desserts e.g. custard, mousse, instant whips, trifle, Angel Delight, rice pudding, tapioca
Instant custard powder
Custard tarts
Breakfast cereals
Some brands of breakfast cereals, muesli and chocolate-flavoured cereals (check ingredient labels).
Yoghurt coated cereals, instant porridge.
Cereals, flour and cereal products
Pasta dishes with sauces containing milk e.g. lasagne, some bolognese and moussaka sauces, macaroni cheese
Milk loaf, croissants, brioche, buns
Biscuits, cakes, cake mixes and puddings made with milk or milk-containing ingredients (check ingredients labels)
Pastry (check ingredients labels), quiche
Crackers containing cheese, e.g. cheddars, rice cakes containing chocolate or cheese
Meat, fish, chicken and alternatives
Meat, fish or poultry products which contain milk derivatives e.g. pre-packed ham, chicken
Some meat, fish or poultry in batter, crumbs or sauce (check ingredients labels)
Certain brands of sausages, tinned meat (check ingredients labels)
Eggs
Eggs made with milk, for example scrambled or omelette.
Eggnog.
Vegetables
Vegetables canned in sauce containing milk or pre-packed in butter.
Instant potato, waffles, potato shapes, some flavoured potato crisps which often contain milk powder.
Potato salad, vegetable salad, coleslaw (check labels).
Fruit
Fruit yoghurt, fruit tarts or flans.
Yoghurt-coated dried fruit.
Nuts
Some dry-roasted and flavoured nuts (check ingredient labels).
Yoghurt-coated nuts.
Snacks
Most flavoured potato crisps, pretzels, puffed wheat and corn snacks containing milk (check ingredients labels)
Toffee popcorn
Cheese flavoured snacks e.g. ‘Cheddars’,
‘Wotsits’, cheese straws, pretzels, crackers
Manufactured dips e.g. guacamole, cheese and chive, sour cream
Yoghurt coated cereal bars/snack bars
Preserves and confectionery
Lemon curd (check label).
Toffee, fudge, caramels, butterscotch, some sweets (check labels).
Milk and white chocolate.
Most brands of plain/ dark chocolate.
Most confectionery bars.
Drinks
Coffee and coffee mixes, with added milk e.g. cappuccino, lattes
Babychino
Malted drinks e.g. Horlicks, Bournvita, Ovaltine, Milo
Drinking chocolate, hot chocolate (check ingredients labels)
Milkshakes, milkshake powders, yoghurt drinks
Soups, sauces and gravies
Soups, sauces, mayonnaise, gravies made with milk derivatives such as pesto, cook in sauces, curry sauces, marinades, cream sauces, gravy granules (check labels).
Miscellaneous
Medications or vitamin and mineral supplements containing lactose (check labels).
Low calorie sweeteners containing lactose, e.g. Sweet ‘n’ Low, Canderel tablets
Monosodium glutamate with lactose filler bought as a powder for Chinese cooking
Please note: All branded products are lactose free at the time of printing, however ingredients do change over time, therefore please continue to check the labels.
This is also not an exhaustive list and products can change frequently so please do look in your local supermarkets for additional suitable products. Detailed information on manufactured products can be obtained from the customer services department of most supermarkets.
Milk substitutes
Breast milk contains lactose. If your child is breastfeeding and your child has been advised to follow a lactose fee diet, you should seek advice from your health professional.
Formula-fed infants, under one year, should be given a lactose-free formula, such as SMA LF and Aptamil Lactose Free. These can be bought in pharmacies and supermarkets and do not require a prescription.
Lactose-free cow's milk is suitable for children over one year of age and young people. It is the preferred alternative as it contains the same level of energy, vitamins and calcium as standard cow's milk.
Other milk substitutes can be used, such as soya milk and oat milk, in those over two years of age if preferred (enriched versions from 1 year – see milks section in table above). Rice milk is a suitable substitute for children over the age of five years. It is recommended that you choose one which is calcium and vitamin enriched.
Guidance on the reintroduction of lactose
You may be advised to reintroduce lactose as part of the process of diagnosing the condition. If you or your child has secondary lactose intolerance, you may be advised to reintroduce lactose after six to eight weeks. The chart below describes how to do this.
Trial each step for a few days if you or your child remain well. If symptoms develop, return to the last step tolerated.
- Begin with using butter, rather than dairy free spread.
- Try a slice of hard cheese with a low lactose content e.g. mature cheddar, double gloucester, emmental, gruyere or parmesan. If tolerated, increase up to your desired portion size
- Try a slice of semi-soft cheese such as brie, camembert or mozzarella. If tolerated, increase up to your desired portion size.
- Try a teaspoon of soft cheese such as Quark, Philadelphia, cottage cheese, fromage frais or ricotta. If tolerated, increase up to your desired portion size.
- Try a tablespoon of yoghurt or ice cream. Try 'live' versions first, if available. If tolerated, increase up to your desired portion size.
- Try cow’s milk (use a standard formula if your child is under 1)
- begin with ¼ volume of cow’s milk + ¾ current milk substitute or formula
- then give ½ volume of cow’s milk + ½ current milk substitute or formula
- then give ¾ volume of cow’s milk + ¼ current milk substitute or formula
Individual tolerance
Once a diagnosis of lactose intolerance has been confirmed, those with a primary intolerance can begin to reintroduce small amounts of lactose. Each person can tolerate different amounts of lactose, and it is useful to experiment. For example, a person may develop symptoms after drinking a glass of milk but have no symptoms with a cup of tea containing milk.
As medicines contain only a small amount of lactose, they often do not cause symptoms unless you/your child is particularly sensitive. Likewise, foods suggesting they 'may contain traces of milk' are often tolerated well.
Hard cheeses, which have been aged for over 12 months, such as mature west country farmhouse cheddar, emmental and gruyere, contain only traces of lactose. Yoghurts containing live bacteria (probiotics) also have very low lactose content. You may find you/your child have/has no symptoms with these products.
Some people find consuming lactose-containing foods with a meal, rather than on their own, are better tolerated.
Calcium and vitamin supplements
While a child or young person is growing, it is important that they are getting enough energy, protein, vitamins and minerals. Dairy is an important source of these nutrients, particularly calcium, and it is important to include other sources of calcium while following a lactose free diet. Lactose free products contain the same amount of calcium as the standard versions.
If a calcium and/or vitamin supplement is required, your dietitian will advise you on an appropriate product and dose for you or your child.
The Department of Health recommends that all children under the age of five take a supplement containing vitamin D. Many suitable preparations are available over the counter at pharmacies and supermarkets. If your child is taking 500ml or more of an infant formula per day then they will not require a supplement, as the formula milk provides enough vitamin D. Please ask your dietitian or local pharmacist if you have any questions.
Who can I contact for further information?
Dietitian: ….............................................................................................
Contact number: 01223 216655
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