Lactose intolerance takes planning, but alternatives to dairy abound

Lactose intolerance doesn't have to mean giving up the stuff you love, just tweaking it. Above, chocolate almond milk with coconut whipped cream.

Lactose intolerance doesn’t have to mean giving up the stuff you love, just tweaking it. Above, chocolate almond milk with coconut whipped cream.

Earlier this year, I found out I’m lactose intolerant. So what’s an English-Irish-Scottish-Welsh fifth-generation Californian import-to-Hawaii to do?

Lactose intolerance means your body doesn’t produce enough of the lactase enzyme to digest the amount of lactose sugar you consume in dairy products. My body produces little or no lactase.

When I figured out that drinking milk gave me the condition’s classic symptoms – bloating, flatulence, diarrhea, cramps – I mentioned it to my mom. She said, “That could be why you were a colicky baby.” (Thanks, mom!) My sister was born lactose intolerant; she grew up drinking soy milk.

Lactose intolerance can be hereditary or it can be caused by disease, injury or surgery affecting the small intestine. Or simply by aging: About 75% of adults worldwide develop it (to an extent) 18-20 years after weaning. (I’ll let you guess how many years past weaning I am!).

It affects many in Hawaii, given our diverse population. As much as 90 percent of Asian-Americans are lactose intolerant.

And while lactose intolerance can definitely be managed, there are some things to be worried about. For one, lactose intolerance can take a hit on your calcium intake, since you’re avoiding dairy and because your body doesn’t digest milk very well. That combination doesn’t help maintain strong bones.

The basic goal of managing lactose intolerance is to maintain a healthy calcium intake while avoiding digestive problems. Here are some easy ways to help you deal with lactose intolerance:

Read the ingredients list first

Do you like Krispy Kreme doughnuts? One time, I had three. (Yes, still working on that “eat healthy” thing!) Then I read the ingredient list and saw “nonfat dry milk” on it … sigh. Non-fat dry milk is 51% lactose! As if doughnuts don’t already have way too much sugar in them.

My favorite Zippy’s bean soup contains milk, too. In the Portuguese sausage.

One brand of locally-baked whole wheat bread uses non-fat dry milk. Some other brands use whey, the liquid part of milk left over from making cheese. Whey is loaded with lactose. Fortunately, there are other locally-baked breads that don’t have it.

When eating out, ASK

I found out the hard way that the hot chocolate mix used by Coffee, Bean and Tea Leaf contains milk. What’s the point of getting a hot chocolate with almond milk and no whipped cream when they’re just going to put milk in it?

On a more positive note, my wife and I had lunch at Macaroni Grill. We asked what they had that was milk-free, or could be made that way. Turns out a number of their meals are or can be made milk-free (just ask them to leave out the cheese). I settled on grilled chicken spiedini – skewers of grilled chicken, with roasted vegetables in a lemon-infused olive oil. Very tasty!

Know your dairy limit and stick to it

If you consume something with milk, don’t overdo it. Figure out how much you can tolerate and stick to your limit. No matter how much you like the taste of double dark chocolate ice cream.


A little planning goes a long way in creating dairy-free dishes. Above, wheat waffles with coconut whipped cream.

If you really like foods that normally contain milk, look for replacement recipes. Vegetarian or vegan recipes are a good place to start, since many of them are also milk-free.

Recipes from southern Italy and eastern Asia are also good bets, since lactose intolerance is common in these regions.

Some replacements are easy. Instead of ice cream, have a nice fruit sorbet (not sherbet) such as strawberry, mango, raspberry or lychee. Ono without the fat and cholesterol! Your body will thank you.

Replacing milk

My uncle grew almonds in northern California, so I reconnected with my roots and use almond milk for drinking and cooking. Almond milk also has 50% more calcium than dairy milk and no cholesterol.

Other milk replacements include soy milk, coconut milk and rice milk.

Replacing cheese

Replacing cheese is hard. The replacements generally don’t melt well (or at all) and definitely can’t match the subtlety of cheese flavors.

Fortunately, some cheeses have less lactose than others. The key to this is finding out how much whey is removed from the curdled milk and how long the cheese is cultured and aged.

Whey is the liquid left behind when milk is curdled for cheese. Remember the nursery rhyme about Little Miss Muffet and the spider? She was eating her “curds and whey.” Whey contains most of the original milk’s lactose. The more whey that’s removed, the less lactose the cheese starts out with.

The remaining lactose in cheese breaks down as the cheese is cultured and aged. Dry, hard cheeses are generally aged longer, but some soft cheeses like Brie and Camembert are also aged.

Here are some no- or low-lactose cheeses:

  • Gruyère (undetectable)
  • Liederkranz (near 0%)
  • Muenster (0-1.1%)
  • Camembert (0-1.8%)
  • Brie (0-2%)
  • Provolone (0-2.1%)
  • Aged sharp cheddar (trace to 2.1%)

Note: 2% lactose can cause tolerance problems for some people. So watch your dairy limit!

Lucky me, I like provolone. And Gruyère, particularly in my part-French wife’s marvelous French onion soup gratineé.

Side note: Pasteurized, processed cheese foods contain as much as 51% lactose. If you’re going to eat cheese, at least eat real cheese!

Replacing milk chocolate

I’m a chocoholic. I admit it. I’ve been a fan ever since I met unsweetened, dark, non-milk chocolate in Europe. Lactose tolerance just encourages me to avoid milk chocolate. Looking at you, Hershey’s milk-plus-extra lactose “chocolate”!

Chocolate dairy milk has even more lactose than regular milk. But you can make really tasty milk-free hot chocolate using almond or soy milk and some unsweetened powdered baking chocolate! (Sweeten with honey or agave if you must).


Think whipped cream can only be made with dairy? Think again. Above, lactose-free coconut whipped cream.

The holidays are coming. My favorite holiday desert is pumpkin pie with a mound of whipped cream. This year, I’ll try out some dairy-free pie recipes. It’s not as simple as substituting almond- or soy milk, since non-dairy milk alternatives have different cooking characteristics.

But here’s a coconut whipped cream that’s very easy to make:

  1. Refrigerate a can of full-fat coconut milk overnight.
  2. Punch a hole in the bottom of the can and drain the coconut water. Keep it to use in other things.
  3. Open the can and scoop the white coconut into a bowl.
  4. Add a little cinnamon and vanilla to the bowl.
  5. Whip the coconut until it begins to thicken.

It’s great if you like coconut (I do). If you don’t like coconut, there are many non-dairy whipped cream replacements made of almonds, cashews, or tofu. Note: these are not artificial whipped toppings like Cool Whip. When Cool Whip was invented, it was completely milk-free. But now it contains milk and cream.

A final way to deal with lactose

If you find that you can’t avoid lactose in your diet, you might consider taking a lactase tablet, which will help your body digest the milk sugar. My sister does this when she has ice cream. But be sure to talk to your doctor before taking lactase tablets, and know that they might not take away all your symptoms.

jonesDavid Jones is a communications consultant/content coordinator at HMSA. He is also a writer, artist, photographer and musician who blogs (not as often as he would like!) at Jones is a member of the West Oahu Writers Group, helping writers write better since 2000. And while he once was a disc jockey, he is neither as handsome nor as talented as Fernando Pacheco. You can follow him on Twitter.

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