Strategies for Discussing Lactose Intolerance

Originally published in the California Academy of Physicians Associates (CAPA) Quarterly Spring 2026 Magazine

Empowering Patients Through Nutrition: Strategies for Discussing Lactose Intolerance 
By Bessie O’Connor, RDN 

Physician assistants are trusted sources of health information and are positioned to help patients understand the role of nutrition in lifelong health. Clear, consistent and culturally sensitive communication can empower patients to navigate perceived barriers, including lactose intolerance, and meet their nutrient needs. 

Nutrient-dense foods help lay the foundation for a healthy eating pattern to support health and reduce the risk of chronic disease, yet most Americans fall short of consuming the recommended amounts of fruits, vegetables, whole grains and dairy. These shortfalls contribute to under consumed nutrients, specifically for calcium, vitamin D, potassium and fiber across all life stages.¹ 

Nutrition plays a vital role from pregnancy through older adulthood. During pregnancy, nutrients such as iodine, choline, vitamin B12 and omega-3 fatty acids support fetal brain development.² Early childhood presents an important window to introduce nutrient-dense foods like fruits, vegetables, whole grains, iron-rich proteins and dairy, helping children develop a palate for varied flavors and textures.³ For school-age children, adolescents, adults and older adults, nutrients including calcium, vitamin D, protein and vitamin B12 are essential for bone health, muscle maintenance and cognitive function. Dairy foods are an affordable, accessible and versatile source of many of these nutrients and can complement a wide range of culturally relevant foods and eating patterns. 

Nutrition gaps and barriers to healthy eating are multifaceted. Social drivers of health such as access, affordability and education play a significant role. Cultural factors also shape food choices in under-recognized ways. A model often used is the cultural iceberg, which illustrates that the visible aspects of culture such as food choices or preparation methods represent only a small portion of what drives eating behaviors. Beneath the surface lie beliefs, family traditions, religious practices, childhood food memories and economic realities that influence how and why people eat the way they do. 

Misconceptions about lactose intolerance could be a perceived barrier to reaching the recommended two to three servings of dairy each day. By recognizing the diversity of dairy options, including fermented dairy foods like yogurt, kefir, paneer, queso fresco and low-lactose or lactose-free choices, health professionals can offer practical solutions that honor patient preferences and traditions. These strategies make it easier for individuals with lactose intolerance to include dairy foods in their diet, close nutrient gaps and reduce nutrition-related health disparities. 

Practical Tips for Talking About Lactose Intolerance With Patients 

1. Normalize it. 
   Explain that lactose intolerance is common and varies by individual. There are opportunities to include low-lactose dairy foods and avoid experiencing symptoms.  
2. Focus on symptoms, not labels. 
   Ask about specific symptoms rather than whether the patient is lactose intolerant. Many people self-diagnose and may unnecessarily avoid nutrient-dense foods. 
3. Offer culturally relevant low-lactose options. 
   Highlight options like yogurt, kefir, cheddar, mozzarella, parmesan, paneer or lactose-free milk to align with cultural eating patterns. 
4. Emphasize nutrients of concern. 
   Reinforce how dairy contributes calcium, potassium, vitamin D and high-quality protein, nutrients many people do not get enough of in the diet. 
5. Validate lived experiences. 
   Acknowledge preferences or past discomfort and focus on personalized strategies that work with the patient’s cultural and dietary needs. 
6. Provide practical strategies. 
   Suggest lactose-free milk, pairing dairy with meals, starting with small portions or choosing fermented dairy like yogurt and kefir. People can often tolerate small amounts of lactose throughout the day.
7. Connect back to overall eating patterns. 
   Reinforce that dairy supports healthy dietary patterns and that three servings per day can complement other nutritious foods. For example, have yogurt with fruit in a licuado or parfait or put cheese on a salad or on rice and beans.   

Access an educational handout with tips to include dairy for patients with lactose intolerance. 


References

1. Average Intakes and HEI-2015 Scores: Analysis of What We Eat in America, NHANES 2015-2016, day 1 dietary intake data, weighted. Recommended Intake Ranges: Healthy U.S.-Style Dietary Patterns.​ 


2. Schwarzenberg SJ, Georgieff MK, Committee on Nutrition. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716. doi:10.1542/peds.2017-3716 


3. Di Prete A, Galloway AT, Farrow C, Bellagamba F, Addessi E. A systematic review of the relation between complementary feeding and children’s development. Curr Nutr Rep. 2025;14(1):104. doi:10.1007/s13668-025-00692-7 


4. U.S. Department of Agriculture; U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020–2025. 9th ed. Washington, DC: US Government Publishing Office; 2020. Available at: DietaryGuidelines.gov. Accessed December 11, 2025. 


5. Duijghuijsen LJ, Looijesteijn E, van den Belt M, et al. Changes in gut microbiota and lactose intolerance symptoms before and after daily lactose supplementation in individuals with the lactase nonpersistent genotype. Am J Clin Nutr. 2024;119(3):702-710. doi:10.1016/j.ajcnut.2023.12.016