In most instances, people are able to manage small amounts of lactose before they experience any symptoms. Unless a person has severe lactose intolerance, eliminating dairy completely is not recommended.  Avoidance of dairy can result in an inadequate calcium intake increasing the risk of diseases such as osteoporosis.

There are a number of causes of lactose intolerance.  The two most common causes being either congenital where your genetic makeup contributes to you having less lactase than normal or gastroenteritis.  Lactose intolerance caused by gastroenteritis is usually temporary and lactase levels in the intestines improve after a few weeks.  The resident should be able to return to eating their regular diet.

To help manage a resident with lactose intolerance consider the following:

• Avoid having large amounts of dairy products in one sitting; rather spread them out over the day.
• When dairy products are consumed, it is recommended they are consumed with other foods.  Tolerance of the dairy product is normally improved as the lactose from the dairy is diluted and the stomach empties at a slower rate.
• It is recommended that those with lactose intolerance choose low lactose dairy products such as hard cheeses and yoghurts.  Hard cheeses have minimal amounts of lactose and the live bacteria in the yoghurt helps to reduce the lactose levels.  Both have good amounts of calcium therefore being beneficial in preventing diseases such as osteoporosis.
• Regular fat milk is often better tolerated than skim/low fat milks as the fat slows the digestion.  The reduced fat milks are also higher in lactose.
  Due to their high fat content and low carbohydrate content, butter and cream have low levels of lactose meaning they will be tolerated by most residents with lactose intolerance.
• In mild and moderate lactose intolerances, sauces with a small amount of milk will most likely be tolerated, particularly if this is part of a larger meal.
  If the resident wishes to avoid cow’s milk completely ensure replacement milk products have added calcium.
• A lactase enzyme supplement may be appropriate if the resident wises to continue eating dairy products.
• If a resident is having very little dairy in their diet encourage foods such as nuts and seeds, fish with edible bones (sardines and salmon), lactose free milks, cheeses and yogurts and green leafy vegetables.  These foods include calcium.

A Summary

In summary, it is important to treat each resident with a lactose intolerance individually to ensure that their diet is not overly restrictive for their particular circumstance and severity of lactose intolerance.  Your facility dietitian is available to assist any resident with a lactose intolerance develop a meal plan to meet their needs and ensure their diet is highly nutritious.

References:
Lactose intolerance - the evidence and translating science into practice, Professor Dennis Savaiano
Lactose Intolerance Fact Sheet Nestle Australia , 2010
Nutrition, Food Solutions Diet Consultants, 2015