Are dairy products making your Crohn’s symptoms worse? Foods such as milk, cheese, and butter can exacerbate inflammatory bowel disease (IBD) symptoms because they contain lactose, the naturally occurring sugar in dairy foods.

You’re more likely to have difficulty with dairy when you have Crohn’s disease that involves the small intestine. You may lack the natural enzyme lactase, which is needed to digest lactose. “This loss is in large part due to small intestinal damage from the Crohn’s disease,” explains Jeffry A. Katz, MD, a gastroenterologist at University Hospitals in Cleveland.

To avoid unpleasant Crohn’s symptoms when you want to indulge a dairy craving — and get necessary calcium — learn which dairy products you can eat in moderation and when to substitute lactose-free or lower-lactose alternatives.

Got Milk?

While people with Crohn’s disease may not tolerate milk well, Sophie Medlin, RD, a consultant dietitian at City Dietitians and chair for the British Dietetic Association for London, says it doesn’t mean everyone should completely cut milk from their diet. “Milk is such an important source of key nutrients including B12, iodine, and vitamin D, so it is essential to remember that if you don't have symptoms when you drink dairy milk, then there’s no need to cut it out if you have Crohn's disease." Just be conscious of symptoms, Medlin advises, and if you think milk is making your symptoms worse, try eliminating it for two weeks and see if symptoms improve. Medlin stresses that while plant-based alternatives are good options, they aren’t as great as dairy.

“While plant-based milk may be fortified with some of the vitamins and minerals that dairy milk has, it is unlikely that it will meet all of your needs. Plus, protein sources aren't as good quality as what we get from dairy,” Medlin says. She recommends people with Crohn’s disease consider consulting with a dietitian or physician about cutting dairy milk for the long-term before making the transition.

If you decide to opt for a milk replacement, you don’t have to look farther than the shelves of your local grocery store. The American Society for Nutrition reports that almond, pea, and flaxseed milks contain more calcium per cup than cow’s milk. Lisa Simon, RD, a registered dietitian in London, recommends going for fortified plant-based milk products, which have the bonus of extra vitamins and minerals.

Not all milk alternatives are good choices for those with Crohn's, says Patsy Catsos, RDN, a dietitian in Portland, Maine, and author of The IBS Elimination Diet and Cookbook. “Soy milk is a frequent cause of gas and bloating,” says Catsos, “and rice, almond, and other alternative milks provide only 1 or 2 grams of protein and often have added sugars.” Unsweetened versions of these milks usually don’t contain added sugars, though.

She recommends lactose-free cow’s milk as the best nutritional choice for most people with lactose intolerance: “It provides 8 grams of protein and 300 milligrams of calcium per cup.” Goat’s milk has slightly less lactose than cow’s milk and some people find they tolerate it better.

Saying Yes to Yogurt

A dairy choice with less lactose than milk is yogurt. Medlin explains that the bacteria in yogurt ferment the lactose, making it less of a carbohydrate-heavy product and better tolerated than other dairy products.

Yogurt is also a valuable source of nutrients as well as a natural source of probiotics (friendly gut bacteria), though Catsos cautions that it’s still important to choose carefully when selecting a yogurt, in order to prevent a flare-up of Crohn’s symptoms. “Yogurt is a double-edged sword for people with Crohn’s,” she says.

Catsos recommends people with Crohn’s disease choose yogurts with less lactose. “Several brands of lactose-free yogurt have recently come on the market,” she says. “If you can’t get one of them, Greek yogurt is the next best thing.” Greek yogurt contains less lactose than other commercial yogurts and, as a bonus, has more protein per serving.

Choose Your Cheese Wisely

Cheese lovers with Crohn’s disease have options. “Natural cheeses may contain some beneficial bacteria, so we don't want to demonize cheese or dairy. It can be really helpful for fighting diseases and a healthy part of the diet for someone with Crohn's disease,” Medlin says.

Low-fat cheeses such as feta and goat cheese may be a better option, according to the BWH Crohn’s & Colitis Center. A review published in January 2021 in Endocrinología, Diabetes y Nutrición reported that two weekly portions of aged cheeses that don’t contain lactose can be helpful in an IBD diet. Simon recommends nut-based cheeses such as cashew cheeses and almond-based cheeses, including almond cream cheese.

But there are certain cheeses you shouldn’t be eating. “I would only advise avoiding cheese where the main ingredient is coconut oil. Not only will they not taste very nice, but they're not going to do much good if you're eating a lot of them,” Simon says. To avoid coconut oil-based cheeses, read labels carefully. While you’re scanning the nutritional info, be sure to note the calcium content.

Stock Up on Calcium Supplements

Medlin says removing animal products from your diet increases your risk of becoming nutritionally deficient without the proper supplementation. The Crohn’s & Colitis Foundation recommends calcium supplements for all patients with IBD — especially if you’re taking corticosteroids, have low bone density, or have been diagnosed with osteoporosis (weak bones).

“It's really helpful to work with a dietitian or with your physician to understand which nutrients you are likely deficient in so that you can decide what you may need to supplement,” Medlin says. Dr. Katz suggests taking a calcium supplement with added vitamin D.