Ask Shelley Case: Does Celiac Disease & Lactose Intolerance Go Hand-in-Hand?

Q. I have just been diagnosed with celiac disease. In addition to avoiding gluten do I need to avoid dairy products too? I hear that celiac disease and lactose intolerance can sometimes go hand-in-hand.

Celiac disease is an autoimmune disorder triggered by the consumption of gluten found in the grains wheat, rye and barley. The small intestinal villi (tiny finger-like projections) become inflamed and flattened (known as villous atrophy) due to the reaction to gluten. Malabsorption of various nutrients such as iron, folic acid, calcium and vitamin D can result. Fortunately, removing gluten from the diet will allow the villi to regenerate fairly quickly- often weeks to a few months. In some people with long-standing, undiagnosed celiac disease or in older individuals, it may take months to several years until the villi are completely healed. The most important factor is to follow a strict gluten-free diet for life.

The tips of the villi also contain enzymes such as lactase which is responsible for the digestion of lactose- a natural sugar found in milk and milk products. In some individuals with newly diagnosed celiac disease, especially those with major villous atrophy, the level of lactase is significantly reduced. This temporary lactose intolerance causes undigested lactose to pass through the intestinal tract, drawing fluid with it. It is then fermented by bacteria in the large intestine producing short-chain fatty acids and gases. Symptoms of lactose intolerance may include abdominal cramping, bloating, gas, nausea, headache and diarrhea. These symptoms can occur 15-30 minutes or as long as several hours after consuming foods with lactose.

The good news is that this temporary lactose intolerance often improves on the gluten-free diet alone. However, some people may also need to restrict or reduce lactose until the villi are completely healed and the lactase enzyme levels are restored to normal. This may take weeks to months depending on individual response. It should be noted that most individuals with lactose intolerance can digest small amounts of lactose.

Here are some options for those with lactose intolerance:

 Lactose-reduced milk contains added lactase enzymes and about 99% of the naturally occurring lactose has been converted to simple, easily digested sugars. Some brands such as Lactaid and Dairy-Ease are available in refrigerated forms and Lacteeze is in shelf-stable and refrigerated forms. Lactose-reduced milk is slightly sweeter than regular milk but it has the same nutritional value and can be used in cooking and baking as well.

 Lactase supplements can be taken just before meals or snacks that contain lactose. Lactaid makes caplets that can be swallowed or chewable tablets. Lacteeze brand has ultra-strength tablets.

 Lactase enzyme drops can be added to liquid dairy products. You need to pre-treat the milk at least 24 hours in advance to ensure the lactase breaks down the lactose. Lactaid and Lacteeze make these drops that are available in drug stores.

 Non-dairy beverages made from nuts, potatoes, rice or soy do not contain any lactose. Look for brands that are gluten-free (do not contain any barley malt flavoring) and are enriched with calcium, vitamin D and other nutrients.

 Yogurt is often tolerated by those with lactose intolerance. Although yogurt contains lactose, the lactase enzymes in the active cultures digest this lactose. Choose brands that contain “active” or “live” cultures.

 Cheese  especially aged, natural cheese such as Cheddar, Swiss, Parmesan and Mozzarella are low in lactose. In these cheeses most of the lactose is removed with the whey and the small amount remaining is broken down during the aging process, therefore, most aged cheese are well tolerated.  However, processed cheese food and processed cheese spreads often contain added modified milk solids, therefore their lactose content may be higher than plain processed cheese. Light cheese products also contain modified milk solids that replace milk fat. They tend to be high in lactose.

 Milk  taken in small amounts (1/4-1/2 cup) at a time may be tolerated. Avoid drinking large amounts at once. Consume milk with meals or snacks but avoid drinking on an empty stomach. The higher the fat content in the milk, the slower it is digested and more easily tolerated. Whole milk may be better tolerated than low-fat or non-fat milk.


The above information was excerpted from Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD. See

Tags: ,

9 Responses to “Ask Shelley Case: Does Celiac Disease & Lactose Intolerance Go Hand-in-Hand?”

  1. Tammie Alves Says:

    Hi there…thank you very much for explaining the Celiac and Lactose in more detail. I learned a few more items I didn’t know, especially in the cheese area.
    As you know I was diagnosed in June and I’m still learning. I do understand this healing process does need patience and understanding.
    Again, thank you and I hope to see you soon.
    Have a GREAT week and enjoy your week. Tammie 🙂

  2. gfe--gluten free easily Says:

    This is an excellent post. As a support group leader, I often share the lactose intolerance connection with new members, but this post explains it so well. I’ll be sharing this one with my group. Thanks, Shelley and Kathy.


  3. Karina O'Malley Says:

    Dear Shelley,

    Do sprouted wheat, barley and rye contain gluten? Is Ezekial bread considered gluten free?

  4. Shelley Case, RD Says:

    Health Canada recently tested Ezekiel Sprouted Grains Bread (contains sprouted wheat, barley, spelt, millet, lentils and soy) using the Tepnel and R5 Biopharm tests and found the bread contained very high levels of gluten. Sprouted breads from gluten-containing grains must be avoided on a gluten-free diet.

  5. Mommy of Celiac/lactose newbie Says:

    Thank you for posting this. I just spoke with my sons’ dr. and his allergy/celiac panel showed that he has an allergy to cow’s milk/lactose but the Celiac test came back negative. However, we had had our son on a gluten free diet while waiting for the test results and he has done extremely well. Leaps and bounds better than before in fact. Also while waiting for results we learned that there is a large number of aunts, uncles and a nephew with Celiac that we were unaware of. All of these things together the Dr. was willing to diagnose him with the milk allergy and keep him on a GF diet for a month to see any more improvement. His imporvement and the family history has led his dr. to say that we are on the right track regardless of the test results. Anyone with similar experiences?

  6. Shelley Case, RD Says:

    Celiac antibody blood tests can be falsely negative. If you have a strong family history of celiac disease along with symptoms (see, medical experts recommend a small intestinal biopsy to confirm or rule out celiac disease. It should also be noted that if you have been on a gluten-free diet for an extended period of time the celiac antibody and biopsy tests can be falsely negative. That is why it is not recommended to try the gluten-free diet before the testing has been completed.

    For those who have already been on the GF diet and want to confirm a diagnosis of celiac disease there are only 2 options. One is a gluten challenge which can be very difficult to complete if you have been gluten-free for awhile. The other option is doing the genetic testing for DQ2 and DQ8. If the genetic tests come back negative it is highly unlikely you have celiac disease. On the other hand if it comes back positive you may or may not have celiac disease. About 30% of the general population will also be positive for these genetic markers and do not have celiac disease. Therefore it is back to square one- needing the biopsy to confirm the disease. For more information about genetic testing see

    It is essential to work with a physician knowledgeable about celiac disease and the testing procedures. Here are links to celiac specialty centers for more information

  7. Jeannette Says:

    I have had Celiac disease for more than 50 years. I was recently diagnosed with lactose intollerance and now Fructose intollerance. How common is it that all 3 travel together?

  8. Debbie Says:

    I ate lactose-free for over 10 years until I figured out ( with the help of a friend who is an RN) that I am at least gluten intolerant ( blood test for Celiac showed negative) and after eating gluten-free for over 5 years I can now enjoy all the lactose I want. I am so glad to see it is(was) short-lived after going off gluten

  9. Jamie Stern Says:

    Thanks for this post. I learned at least one new fact – I will have to pass the yogurt tolerance item on to a friend. Nice blog site. Thank you.

Leave a Reply

Be Free For Me Blog is proudly powered by WordPress
Entries (RSS) and Comments (RSS).