Allergy diet - lactose low

Aim

To provide a diet with a significantly reduced level of lactose (the sugar in mammalian milks).

Characteristics

Eliminates foods with > 2g lactose per 100g.

Indications

Lactase deficiency. Well-controlled double-blind studies show that people who have difficulty digesting lactose can usually tolerate small quantities of milk when consumed with other foods, therefore a completely lactose-free diet or very low-lactose diet (< 3g per day) is unnecessary. A milk-free diet is outlined separately.

Nutritional adequacy

Nutritionally adequate, if calcium-fortified dairy alternative beverages (e.g. soy beverage) or lactose-reduced milk is included.

Precautions

It is not possible to provide a full list of all permitted commercial products; the following are general guidelines only. Care should be taken to read all product ingredient lists to look for ingredients with lactose, eg buttermilk, milk or dairy solids, non-fat dairy solids, whey and curds.

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All plain cooked meat, poultry, fish, eggs and legumes Other dishes made with allowed ingredients	Any dishes containing > 2g lactose/100g e.g. mornays, macaroni cheese, lasagne
Sauces, gravies	Sauces or gravies made without milk, e.g. tomato sauce	White sauces made with milk
Starchy vegetables / pasta / rice	All vegetables made without milk, soft or processed cheese Mashed or pureed potato with < 2g lactose/100g Rice and pasta dishes made without milk	Any dishes made with milk, or soft or processed cheese e.g. potato bake
Vegetables	All others	Any vegetables made with milk, soft or processed cheese, butter or regular margarine (e.g. cauliflower au gratin)
Soups	All other soups	Any soups made with milk or large amounts of cream
Sandwiches	Sandwiches made with allowed fillings	Soft or processed cheese
Salads, dressings	All others	Soft or processed cheese Mayonnaise with > 2g lactose/100g
Breads, cereals	Regular bread, including rolls Rice cakes Rolled oats prepared with water Most regular breakfast cereals – check label	Hot breakfast cereals prepared with milk Cereals or muesli containing > 2g lactose per100g
Spreads	Butter and regular margarine Jam, marmalade, honey, Vegemite™, peanut butter	Cheese spreads
Hot breakfast choices	All others	Omelettes made with milk
Fruit	All fruit	-
Yoghurt	Soy yoghurt or low lactose yoghurt may be used Milk-based yoghurt is usually tolerated in small serves (up to 150g/day)	-
Desserts	Jelly Some sorbets – check label Tapioca and sago made without milk, eg lemon or orange sago Meringues, cakes, pastries and crumble desserts which are not milk based	Milk-based desserts, (e.g. custards, ice-cream, mousses, cheesecake) Creamy rice
Milk and cheese	Dairy alternative beverages (e.g. soy beverage) Lactose-reduced milks (e.g. Zymil®, Liddells®) Matured and semi-matured cheese (e.g. cheddar	All cow’s milk (full and low fat) Processed and soft cheeses (e.g. cottage cheese, ricotta)
Beverages	Tea, coffee, cordial, soft drinks, fruit juices	Milk, flavoured milk Milo®, Aktavite®, Ovaltine®
Biscuits	Most plain biscuits	Biscuits with > 2g lactose per 100g (e.g. those made with a large amount of milk or added milk solids such as chocolate-coated cream-filled biscuits)
Miscellaneous	Plain nuts Dark chocolate Plain cream with <2g lactose/100g Salt, pepper, sugar, sweetener	Some nutritional supplements - check label

References

1. Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
2. National Digestive Diseases Information Clearinghouse. Lactose intolerance.
3. McBean LD, Miller GD. Allaying fears and fallacies about lactose intolerance. J Am Diet Assoc 1998;98:671-6.
4. Maher AK, editor; Iowa Dietetic Association. Simplified diet manual. 10th ed. Ames: Blackwell; 2007.
5. Food Standards Australia New Zealand. NUTTAB Online searchable database: foods that contain lactose.
6. Food Standards Australia New Zealand Standard 1.2.7 Nutrition, Health and related claims.