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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.
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.
The damage that occurs with celiac disease connects it to lactose intolerance. More specifically, intestinal damage damages the microvilli and the 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.
In the case of this blog post, the damage to the small intestine can impact the release of the lactase enzyme. This disruption can cause lactose intolerance with celiac disease.
To build our understanding of the connection between celiac disease and lactose intolerance, we need to also 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.
Usually, lactose intolerance with celiac disease 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.
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.
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. This also includes things like whey protein, which can still contain lactose.
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).
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.
In some cases, people with celiac may need to avoid all dairy, not just lactose. Some research suggests that those with suspected refractory celiac where gluten definitely isn’t being added in may see recovery if milk proteins are removed.
If you’re not sure if you need to avoid dairy, lactose, etc. then meeting with a dietitian may help you figure out what is going on. I share this information not for you to self-diagnose, but to help you have an informed conversation with your provider.
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 a gluten-free calcium-rich food source. It also has a lot of vitamin D to help with vitamin D deficiency in 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.
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.
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 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: