WHY AM I REACTING TO DAIRY?
Do you react to dairy? Most people assume that are lactose intolerant- but what if it is the dairy protein you are reacting to? Both lactose and protein in cow's milk can cause symptoms if you have underlying intolerances or allergies. Find out the difference between lactose intolerance and dairy protein allergy/ intolerance.
Are you Lactose Intolerant?
Lactose intolerance does not mean that you cannot tolerate any lactose or need to go on a lactose free diet, it juts means adjusting your lactose intake to suit your unique tolerance. It is extremely rare to not produce any lactase enzymes at all.
Lactase is an enzyme that breaks down the milk sugar (lactose) in the gut. If you are lactose intolerant then you have less capacity to break lactose in your gut. Undigested lactose is a problem because it attracts extra water into the gut, speeds up transit though the gut and quickly finds its way into the large intestine where the gut microbes greedily ferment it producing extra gas. This bloats the gut and triggers the gut pain receptors.
30 minutes to 4 hours of eating or drinking a lactose rich food or drink may result in a speedy exit to the bathroom and
mushy to watery diarrhoea
excessive and often offensive wind
Lactose intolerance comes under the umbrella of FODMAPs - you can have lactose intolerance on its own or can also be sensitive to other FODMAPs such as onion, garlic and foods rich in excess fructose. A Low FODMAP elimination diet can help determine if you have other FODMAP issues in addition to lactose intolerance.
Lactose is present in all milks produced by mammals, so if you are lactose intolerant you will be sensitive also be sensitive to other animal milks such as goat, sheep, camel and buffalo, although lactose amounts can vary across these milks.
If you suspect you have lactose intolerance then you can trial a reduced lactose diet to see that clears up your symptoms.
Choosing a reduced lactose diet can be easily achieved using the diary lactose free alternatives that are now readily available:
lactose free dairy milk
lactose free yoghurt or a traditional Greek yoghurt: lactose content is reduced during fermentation and straining process. Great pre and pro biotic for the gut.
lactose free cream or sour cream or use normal cream/sour cream for when only small amounts will be consumed in a sitting (2 TBSP)
Lactose free cream cheese
Most cheeses (with the exception or ricotta, cream cheese and cottage cheese) contain very little lactose
Butter contains negligible lactose
There are dairy free alternatives such as plant milks (think almond milk) but these milks do not replace the calcium, protein, phosphorus, zinc, magnesium and vitamin A that cow's milk provides. Choosing lactose free dairy foods will provide these same nutrients, just without the lactose.
Here is a great reason to include some lactose in your diet: you can promote better lactose may improve your lactose tolerance!
Most adults with lactose intolerance can tolerate 12-15g lactose per day (roughly equal to one 250ml glass of milk), and possibly more if spread out over a day (1, 2).
Introduce gradually over 2-3 weeks to help your gut adapt. Lactose actually favours increase in gut bacteria which can break down lactose hence improve your tolerance (3, 4).
It may be useful to start with 30-60ml cow's milk and build up slowly to 1 cup (250ml).
ull fat milk may be better tolerated than lower fat milks (5).
Do you react to dairy proteins?
Do you react to lactose free milk or cheese such as tasty cheese that contains no or minimal lactose? If you do, seriously consider cow's milk protein allergy or intolerance.
There are a number of different proteins in cow's milk and they are known as the whey proteins and the casein proteins. Issues are generally linked with the casein proteins. Milk contains both, with the curds part being the casein and the watery part the whey. All dairy products contain casein and whey although cheese will usually contain mostly the casein proteins and only a little whey.
A true cow's milk allergy is not common in adults, you are more likely to encounter this with babies and children. Most will grown out of this by school age although it can persist for a small percentage. A true allergy can be defined as an immune reaction to a protein in a food that comes up on IgE testing- blood tests or skin prick tests. These type of allergies are the only allergies associated with the life threatening anaphylaxis so it is useful they can be tested for. If you feel you have an IgE allergy to cow's milk protein then see your Medical Doctor.
The delayed form of cow's milk allergies cannot be tested for and are not associated with anaphylaxis. It is impossible to determine if this type of sensitivity is an allergy or an intolerance- although it does not matter as the action taken is the same regardless.
Symptoms of cow's milk protein intolerance vary hugely:
Gut symptoms: constipation or diarrhoea
Skin issues: acne or rashes or hives or flare of eczema
Upper airway congestion/sinus
Muscle and joint pain
Loss of concentration/ brain fogginess
If you suspect cow's milk intolerance, replace diary products with dairy free substitutes of the highest nutritional quality to help replace lost nutrients such as calcium, high value protein, phosphorus, zinc, magnesium and vitamin A to promote future health and minimise risk of osteoporosis.
Soy milk is an excellent alternative which is nutritionally superior to the other plant milks- just check calcium has been added to the tune of 120mg per 100ml (see nutritional panel on the packet). If soy is not tolerated, which can happen with dairy protein allergy/intolerance due to similarities in the protein, then other alternative milks may need to be chosen. Most dairy free milks are low in nutritional quality as they are low in protein, calories, can be higher in sugar such as rice milk and do not naturally contain calcium. Other diet changes may need to be made to replace these lost nutrients.
Please note it can be dangerous to provide plant milks other than soy milk as a main milk for babies, toddlers and children. Seek a Dietitian for a baby or child following a dairy free diet.
Working out your dairy intolerance.
If going lactose free solves your issues then you are in luck! Just choose lactose free dairy alternatives but over time try and include some lactose slowly to improve your tolerance. Aim for 3 serves of dairy a day (for an adult aged 19-50 years, 4 serves for a female aged 50-70 years)) to make sure you meet your calcium needs and away you go!
If you react to lactose free dairy foods then dairy protein allergy or intolerance may be in play. Replacing a whole food group such as dairy can make a big dent in your nutrition. This is magnified if it is a child or a toddler.
It is best to seek a medical doctor is you suspect allergies or a qualified Dietitian well versed in the different food intolerance options to help safeguard your future health.
1. Shaukat, A., et al., Systematic review: effective management strategies for lactose intolerance. Ann Intern Med, 2010. 152(12): p. 797-803.
2. Suarez, F.L., et al., Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr, 1997. 65(5): p. 1502-6.
3. Heaney, R.P. Dairy intake, dietary adequacy, and lactose intolerance. Adv. Nutr. 2013, 4, 151–156.
4. Hertzler, S.R.; Savaiano, D.A. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces
lactose intolerance. Am. J. Clin. Nutr. 1996, 64, 232–236.
5. Ishayek, N, Szilagyi A.Lactose Intolerance, Dairy Avoidance, and Treatment Options Nutrients. 2018 Dec; 10(12): 1994. Published online 2018 Dec 15. doi: 10.3390/nu10121994PMCID: PMC6316316PMID: 30558337