Amy Keller, MS, RDN, LD, is a dietitian and celiac support group leader from Bellefontaine, Ohio.
I was recently diagnosed with celiac. I am doing pretty well eating gluten free, but it also appears I’m now lactose intolerant. I miss ice cream! Is this a forever thing, or do you think it will get better?
The good news is that it will (most likely) get better, and you’ll be able to enjoy ice cream again. A new celiac diagnosis indicates that there is damage to your small intestinal villi. These villi have many functions related to the absorption of nutrients, and they also house our lactase enzyme. Lactase enzyme is necessary to break down lactose found in foods such as ice cream and milk. Continuing on your gluten-free diet will help heal these villi, and the lactase enzyme should become more readily available over time.
What can you do until then? Keep in mind that there can be varying degrees of lactose intolerance. Some people with lactose intolerance can enjoy small amounts of dairy products without issues while others are more sensitive. Let your symptoms guide your choices. If tolerated, lower-lactose dairy products, such as aged cheeses (cheddar, Swiss, Parmesan), cream cheese, half-and-half and sour cream, can be enjoyed. Dairy products with added lactase enzyme are also good choices, including milk, cottage cheese, yogurt and, yes, even ice cream! Some fermented forms of dairy may also be tolerated, such as kefir or yogurt.
You might also consider taking an over-the-counter lactase enzyme when you plan to eat dairy products, which may help reduce symptoms. Furthermore, plant-based milk such as almond or soy milk can be a good alternative. Of course, check the label of all products to make sure they don’t also contain gluten.
Dairy is also a great source of calcium, which prevents loss of bone mineral density. People with celiac are at risk for osteopenia (reduced bone mass), which can lead to the more severe condition osteoporosis. Osteoporosis can result in fractures, which can significantly affect your quality of life. If you continue to struggle with dairy products long term, consider non-dairy sources of calcium, including leafy green vegetables such as kale, collard greens and bok choy, calcium-fortified orange juice or plant-based milk, almonds, white beans, teff flour and almond flour. You might also discuss with your physician whether a calcium supplement might be appropriate.