Are Celiac Disease and Lactose Intolerance Related?

Are celiac disease and lactose intolerance related? Yes! I see this intolerance in many of my clients. The reason why lactose intolerance is associated with celiac disease lies in how damage from gluten with celiac impacts digestion.

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Are Celiac Disease and Lactose Intolerance Related - Tayler Silfverduk, celiac dietitian - Why lactose intolerance is common in celiacs

What is Celiac Disease?

Before we get into how celiac disease and lactose intolerance are related, let’s get on the same page on what celiac disease is.

Celiac disease is an autoimmune disease where the immune system launches an attack in the small intestine when gluten is consumed. This causes damage to the small intestine and launches a cascade of inflammatory reactions throughout the body.

More specifically, the damage to the gut occurs in the duodenum. In the duodenum, the reaction damages what’s known as villi. Villi are long finger-like projections that help absorb nutrients. The villi house what’s known as the microvilli and brush border.

How Does Celiac Damage Impact Digestion?

The key to celiac’s impact on digestion lie in where the damage from gluten is occurring. More specifically it lies with the microvilli and brush border found in the villi of the duodenum.

The microvilli help absorb even more nutrients, and the brush border releases digestive enzymes like lactase and sucrase to aid in the breakdown of food for absorption.

Basically, the villi of the small intestine house the brush border which releases enzymes that help with digestion and absorption of food. Because eating gluten with celiac disease causes damage to the villi, microvilli, and brush border, it can directly impact the digestion of foods other than gluten.

What is Lactose Intolerance? - Celiac Dietitian - Tayler Silfverduk

What is Lactose Intolerance

To build our understanding of the connection between celiac disease and lactose intolerance, we need to understand what lactose intolerance is.

Lactose intolerance is when the body does not digest the sugar lactose properly. Lactose is the complex sugar found in dairy products. To digest the sugar, it’s broken down into its components galactose and glucose through the use of the lactase enzyme.

So essentially, lactose intolerance is when you can’t break down the sugar lactose (from milk). Lactose intolerance can cause a variety of symptoms like diarrhea, cramping, bloating, constipation, and more. Symptoms that overlap with celiac.

How do you Know if You’re Lactose Intolerant With Celiac?

Usually, lactose intolerance is diagnosed by reported symptoms following eating dairy. There are some questionably reliable tests out there that can indicate lactose intolerance too, but the best way to know is to track your food and symptoms to see if you can find a relationship.

If you need help figuring out your food intolerances, let’s work together. I specialize in helping people with celiac identify other food triggers that might be impacting healing. And yes, I do see people virtually.

Signs and Symptoms of Lactose Intolerance - What is Lactose Intolerance and is it caused by celiac? - Tayler Silfverduk - Celiac Dietitian

Are Celiac Disease and Lactose Intolerance Related?

After breaking down the basics of celiac disease and dairy intolerance, it’s clear to see there is a connection. So, yes, there is a connection between celiac disease and lactose intolerance.

Specifically, the damage to the small intestine can impair lactase enzyme activity. This impairment of lactse activity at the brush border can play a large role in lactose intolerance in celiacs.

Do Celiacs Need to Avoid Lactose?

Just because celiac disease and lactose intolerance are related, does not mean every celiac needs to avoid lactose or dairy. Avoiding dairy requires an individualized approach. Just because the damage to the villi of the duodenum can impair lactose digestion, does not mean it will.

You only need to avoid or limit dairy if it’s triggering you. Sometimes lactose intolerance means you can’t tolerate any amount of dairy but in most cases, I find it depends on the amount and type of dairy consumed. If you need help figuring that out, again, let’s talk and figure it out together.

Additionally, lactose intolerance isn’t always forever if you are lactose intolerant because of celiac damage. That means as you heal celiac disease, your lactose intolerance can go away too as your brush border starts functioning properly again (notice I said heal not cure).

Dairy-Free vs. Lactose Free

Now that we understand the relationship between lactose intolerance and celiac, I want to make it clear: lactose-free does not mean dairy-free

Being lactose free means you are simply avoiding the sugar lactose in dairy. You can buy many lactose-free dairy products on the market.

However, if you’re lactose free you can also enjoy dairy-free substitutes as they’d also not have lactose.

But the same does not go for you if you are dairy-free. If you’re dairy-free, it’s likely due to an allergy to proteins found in dairy or intolerances to other parts of dairy.  You can not enjoy lactose-free dairy products because you’re reacting to other parts of dairy.

Risks of Being Gluten-Free and Dairy-Free

It is ideal that celiacs continue to eat dairy if they do not have an allergy, or are not vegan. That’s because milk is an excellent source of vitamin D and calcium, two common nutrient deficiencies with celiac disease.

However, if you are gluten-free and vegan, or you’re gluten-free and dairy-free, that doesn’t mean you can’t still get these nutrients. It just requires more planning. Check out my post on How to Follow a Gluten-Free Vegan Diet to learn more.

If you have a lactose intolerance than it’s up to you to decide to avoid dairy completely, take a lactase enzyme, or buy lactose-free dairy products. A dietitian can help you determine the right option for you.

Do people with celiac disease need to avoid milk? Celiac disease and lactose intolerance, lactose free and celiac, Are Celiac Disease and Lactose Intolerance Related - Tayler Silfverduk, celiac dietitian

Dairy-Free, Lactose-Free, and Gluten-Free Alternatives:

So you’re lactose intolerance and you understand the connection between lactose intolerance celiac, now what? Now, you have a choice: avoid lactose, avoid all dairy, or consider taking a lactose digestive enzyme.

That being said whether your lactose or dairy-free, below are some gluten-free alternatives to consider.

Gluten-Free Lactose-Free Foods

Lactose-free or low-lactose foods are a great way to keep dairy in your life without all of the lactose intolerant symptoms.

Some gluten-free foods that are naturally lower in lactose include probiotic yogurt, hard/aged cheese, butter, heavy cream, most flavored coffee creamers, and kefir.

You can also buy lactose-free milk and ice cream (an example would be those from the brand Lactaid) where the lactose is predigested for you. Bryer’s also makes a lactose-free ice cream too.

Gluten-Free Dairy-Free Foods

Gluten-free and dairy-free alternatives will be your best friend should you need to cut out all dairy. Your best bet is to start trying to find delicious substitutes as soon as possible. Some of my gluten-free dairy-free alternatives are below:

  • Yogurt: Silk has soy-based and almond-based yogurts. Though my favorite gluten-free and dairy-free yogurt is the Oui by Yoplait Coconut Yogurt line – so decadent and yummy.
  • Cheese: Daiya has some good gluten-free and dairy-free cheeses but the trick I find is that you need to melt them to be good. Kite Hill and Violife have some gluten-free plant-based cheeses to try too. 
  • Ice Cream: You can not beat So Delicious’s dairy-free and gluten-free ice creams. They are delicious and are made with a variety of different milk alternatives depending on your preference.
  • Milk: The best way to find a dairy-free milk alternative is to reflect on what you like about real milk. Is it the flavor? Fattyness? Mouthfeel? Sweetness? Or is it just an easy way to get in calcium? Once you’ve determined that, trying the different dairy-free kinds of milk will help you find your favorite. I personally love almond milk. A word of caution: if you are leaning towards oat-milk or oat-milk alternatives, make sure the products are using certified gluten-free or purity protocol oat. Learn more about when oats are celiac-safe here.
  • Butter: use oil, coconut oil, etc. instead.
  • Cream: when baking, use coconut cream (you get it by storing canned coconut milk in the fridge, and the cream rises to the top of the can). If you need a coffee creamer, you can use coconut cream or I personally love Califia farms dairy-free creamers. It doesn’t taste fake like some of the other coffee creamer lines.
  • Buttermilk: combine 1 tbsp apple cider vinegar or lemon juice for every 1 cup of dairy-free milk of choice. Let it “curdle” for 5-10 minutes and then use as you would regular buttermilk.