Lactose Intolerance in India: Getting Calcium Without Dairy

The Dairy Paradox in India

India is one of the world's largest producers and consumers of milk. Chai, curd, paneer, ghee and lassi are part of everyday life. So it can feel odd to hear that a large share of Indian adults cannot digest milk sugar well.

Studies suggest that lactose malabsorption is common in South Asia, and many Indian adults have some degree of it. Plenty of people live with it without a name for it. They put the bloating, gas and loose stools down to "weak digestion", spicy food or stress. If these symptoms follow milk, kheer or milk-heavy sweets, lactose intolerance is worth thinking about.

What Lactose Intolerance Is

Lactase is an enzyme in the small intestine that breaks lactose (milk sugar) into simpler sugars the body can absorb. In most people, lactase falls after childhood. When undigested lactose reaches the colon, gut bacteria ferment it. That causes:

• Bloating and a swollen belly
• Gas
• Cramps and abdominal pain
• Loose stools, usually within a couple of hours of dairy
• Nausea in some people

How strongly you react depends on how much lactose you eat and how much lactase you still make. Some people handle curd or a little milk but react to a big glass of milk or a bowl of kheer.

Similar symptoms come from other conditions too, such as irritable bowel syndrome and coeliac disease. If symptoms are frequent or severe, or there is blood in the stool or weight loss, see your doctor rather than guessing.

The Calcium Problem

For most Indians, dairy is the main source of calcium. If you cut it down, the gap needs to be filled, because calcium matters for bones, muscles and nerves. The ICMR-NIN recommended intake for adults is in the range of 1,000 mg a day, and your needs may be higher at certain life stages. Bone loss is common in India, particularly among older women, so for anyone avoiding dairy, finding other calcium sources is a real priority.

High-Calcium Indian Foods Without Dairy

Figures differ between food tables and between varieties, so treat the comparisons below as rough guides.

Ragi (finger millet)

Ragi is one of the best plant sources of calcium in the Indian diet. Ragi dosa, porridge, mudde, roti and laddoo are all traditional ways to eat it, and it is standard in Karnataka, Andhra Pradesh and Tamil Nadu kitchens.

Sesame seeds (til)

Sesame is very calcium-dense, so even a spoon or two counts. Til laddoo, til chikki with jaggery, chutneys and sprinkled garnishes all work. Hulled and unhulled seeds differ, and whole unhulled seeds tend to give more.

Amaranth (rajgira) and its leaves

Amaranth leaves (chaulai saag) and rajgira grain are both good calcium sources, and rajgira laddoo and chikki are old favourites.

Drumstick leaves (moringa)

Moringa leaves are rich in calcium, iron and vitamin C. Drumstick leaf dal, sambar and chutney are traditional ways to eat them, and they are underused outside South India.

Colocasia (arbi) leaves

Arbi leaves, used in Gujarati and Maharashtrian patra and alu vadi, are another useful source. They are steamed or cooked well, which is important because raw arbi leaves irritate the throat.

Almonds, chia and tofu

Almonds, chia seeds and calcium-set tofu add smaller amounts. Chia and tofu are not traditional, but are easy to find in cities. Tofu set with calcium salts is a handy paneer substitute in sabzi and stir-fries.

What About Fermented Dairy?

Many people with lactose intolerance can tolerate some dairy better than others. It is highly individual, so test gently.

• Curd (dahi): Fermentation breaks down part of the lactose, and many people tolerate it.
• Buttermilk (chaas): A diluted form of curd, often easier than milk.
• Ghee: Almost pure fat with very little lactose, usually fine.
• Hard, aged cheese: Contains little lactose.
• Paneer: Lower in lactose than milk, but not lactose-free.

Lactase Supplements

Lactase enzyme tablets or drops, taken just before a dairy meal, help some people. They are handy for weddings and eating out. Ask your doctor or pharmacist which product suits you and how to use it.

A Calcium-Rich Day Without Much Dairy

• Breakfast: Ragi dosa or ragi porridge
• Lunch: Drumstick leaf dal with rice or roti, plus a bowl of tolerated curd or chaas
• Snack: Til laddoo or a few almonds
• Dinner: Tofu sabzi or patra with roti

If you cannot reach your calcium needs through food, or if you are postmenopausal or at risk of osteoporosis, talk to your doctor about a calcium supplement. The type and dose depend on your health and any medicines you take, so please do not choose them yourself. A nutritionist can add up your actual calcium intake and adjust your meals.

Sources: ICMR-NIN Recommended Dietary Allowances 2020, Indian Food Composition Tables 2017 (ICMR-NIN), NIDDK (US National Institute of Diabetes and Digestive and Kidney Diseases) on lactose intolerance. This article is general information and not medical advice.

FAQ

How do I know if I am lactose intolerant?

Bloating, gas, cramps or loose stools within a couple of hours of milk or milk-heavy dishes are the usual signs. Other conditions cause similar symptoms, so speak to your doctor about testing if it keeps happening.

Can I still eat curd and paneer?

Many people can, in moderate amounts. Curd and chaas are often easier than milk, and paneer has less lactose than milk. Try small portions and see how you feel.

Where can I get calcium without milk?

Ragi, sesame, amaranth, drumstick leaves, arbi leaves, almonds and calcium-set tofu are the main Indian options. Use several of them across the day.

Do I need a calcium supplement?

Only if food falls short or your doctor advises it. The right type and dose depend on your health and medicines, so ask your doctor.