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Nutrition for Older Adults: Diet and Health Guidelines For Food Intolerances

Lactose Intolerance

Lactose is a sugar in milk. Lactose is broken down by an enzyme called lactase. Lactose has to be broken down so it can be absorbed by the small intestine.

People with lactose intolerance cannot break down lactose. Intact lactose is not absorbed and moves into the large intestine. Lactose is fermented by bacteria found in the large intestine.

The body tends to make less lactase with age. In addition, some population groups are at higher risk of lactose intolerance including:

  • African Americans
  • Hispanic Americans
  • American Indians
  • Asian Americans

Symptoms of Lactose Intolerance

Symptoms of lactose intolerance include:

  • Cramps.
  • Bloating.
  • Gas.
  • Diarrhea.
  • Nausea.

Symptoms can appear within minutes to several hours after eating foods or beverages containing lactose. Symptoms vary with the amount of lactose consumed and degree of intolerance.


Is Lactose Intolerance a Milk Allergy?

A milk allergy is an allergic reaction to the protein in milk, not the lactose in milk. People with a milk allergy often must avoid all dairy foods. People with lactose intolerance often can consume small amounts of dairy foods.


How Much Lactose

The amount of lactose allowed depends on the degree of lactose tolerance. Many can tolerate the amount of lactose in 1/2 cup milk.

Many can tolerate fermented milk products like yogurt. Cheeses may be tolerated because most of the lactose is removed with the whey.

Many foods contain small amounts of lactose. Most people can handle a small amount of lactose in foods.

Many people can use milk products treated with an enzyme that breaks down lactose. People can also take enzyme tablets with meals or add enzyme drops to milk:

  • Lact-aid.
  • Dairy-ease.
  • Lactinex.

Gluten Intolerance

Gluten is a protein found in wheat, rye, and barley. Some people cannot tolerate the gliadin fraction in gluten.

Gluten intolerance is also called:

  • Celiac disease.
  • Celiac-sprue.
  • Nontropical sprue.
  • Gluten sensitive enteropathy.

Symptoms of Gluten Intolerance

With gluten intolerance the lining of the intestine is flattened. This results in reduced food absorption.


Symptoms of gluten intolerance include:

  • Diarrhea.
  • Steatorrhea (fat in the stool).
  • Bloating.
  • Appetite loss.
  • Muscle loss.
  • Weight loss.

This can lead to malnutrition.

Lactose intolerance may temporarily occur with gluten intolerance. However, lactose containing foods can be returned to the diet within a short time.


Gluten-containing grains:

  • Wheat.
  • Barley.
  • Rye.

Oats are gluten-free. However, the use of oats is controversial due to wheat contamination during processing. A limited intake of oats is currently considered acceptable.


Non-gluten grains and flours:

  • Tapioca.
  • Corn flour.
  • Rice flours.
  • Potato flour.
  • Soy flour.


Whitney, E.N. & Rolfes, S.R. (2015). Understanding Nutrition, 14th ed., Wadsworth, Cengage Learning, Belmont, CA.


Bernstein, M., & Munoz, N. (2016). Nutrition for the Older Adult, 2nd ed., Jones and Bartlett Publishers, Sudbury, MA.


Brown, J.E. (2014) Nutrition through the Life Cycle, 5th ed., Cengage Learning, Stamford, CT.


Janice Hermann, 

Extension Nutrition Specialist

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