Spotlight on... dairy-free
What does it mean to be allergic or intolerant to dairy? What are the health implications and where can you find answers? Nutritionist Jo Lewin is on hand to help...
Discovering that you are intolerant or allergic to dairy products can seem difficult to start with. Luckily, with a little knowledge it can be a lot easier to shop and eat dairy-free than you might imagine. Let us start by separating dairy allergy and intolerance, as they’re distinctly different disorders.
What is the difference between an allergy and intolerance?
The terms 'food allergy' and 'food intolerance' are often used interchangeably, although they actually refer to very different conditions. A true food 'allergy' is a reaction which involves the immune system and can cause a range of symptoms very quickly. In some cases, an allergic reaction to a food can be severe and even life-threatening. In contrast, an 'intolerance' is generally less severe, does not involve the immune system, and symptoms are often delayed.
What is a dairy allergy?
Cow's milk allergy is an immune response to one or more of the proteins (albumin, casein or whey) in cow's milk. This means that when you consume cow's milk, your immune system identifies the protein as dangerous and mobilises your body's defences. If you are allergic to dairy, you will experience an immediate Type 1 hypersensitivity reaction. This response can be triggered by a very small amount of milk protein. Reactions range in severity from acute dermatological or digestive manifestations such as eczema, hives or diarrhoea to more severe potentially life threatening anaphylaxis or chronic malabsorption and inflammation. The only effective treatment for cow's milk allergy is to fully eliminate cow's milk and any products containing it.
What is a dairy intolerance?
Intolerance to lactose in cow's milk, is a non-immunological condition. The age of onset, previous history of milk tolerance and dose related symptoms of bloating and diarrhoea make it relatively easy to distinguish intolerance from true allergy to cow's milk. Dairy intolerance may have various causes, the most common is an inability to digest lactose. All animal milks (cow, goat and sheep) contain a sugar called lactose. We make an enzyme in our guts, called lactase, which breaks down the lactose in the milk to be absorbed. Some people do not produce enough lactase to digest the sugar. Without lactase, the sugar ferments in the gut. An intolerance to dairy is less severe but may also bring about digestive, skin and inflammatory symptoms.
It may be that dairy intolerance is not to do with lactose but as a result of an inability to break down the protein component. Those with an intolerance may find they are less sensitive and are able to consume small amounts of dairy products with no ill-effects, particularly products which have been further processed such as live yogurt or cottage cheese. Some find it easier to tolerate the milk of other animals such as goat, sheep or buffalo. Each individual is different and you will need to establish your own intolerance levels.
Individuals suffering from lactose intolerance might find it beneficial to supplement lactase enzymes to help digest dairy products. It is advised that you consult a doctor or accredited health practitioner before embarking on a supplement programme.
If you suspect you are intolerant or allergic to dairy products, you should go to your GP for diagnosis.
Foods to include and exclude
The problem for those trying to avoid foods containing dairy products is that they include the most commonly used ingredients in food manufacture. It may become harder to buy ready-made foods and you will need to become an avid reader of labels and ingredients lists.
Eating dairy-free involves omitting any product containing cow's milk, including:
- Cream – all varieties
- Milk solids
- Ghee (though vegetable ghee is fine)
- Ice cream
- Hydrolysed casein/whey
- Cheese (including cream, curd and cottage)
- Fromage frais
- Milk of all kinds
- Skimmed milk powder
- Whey protein/sugar
Dairy products are likely to be found in:
- Some animal fats
- Batter (for pancakes, waffles, fish fingers, etc.)
- Bread – many enriched breads will include butter and/or milk
- Cheese straws/biscuits
- Crème caramel
- Custard tarts
- Desserts – many different kinds
- Low-fat spreads
- Ready meals – many include butter or milk
- Sauces – all white sauces and other ready-made sauces
- Vegetable spreads
- Artificial cream
- Cheese flavoured crisps
- Crème pâtissière/custard
- Chocolate/chocolate products
- Ice creams
- Rice pudding and most other baked puddings
Milk is high in nutrients such as calcium, vitamin B2, phosphorous, magnesium, vitamin B12 and a useful source of the mineral iodine. Calcium is an important mineral involved in the formation and maintenance of strong bones and teeth, and also plays a regulatory role in muscle contraction and blood clotting functions.
Calcium – not just from dairy
Adults need 700-1000mg of calcium in our diets, per day. Pregnant, post-menopausal women and older adults may need more. In general, we are led to believe that we do not obtain sufficient calcium if we do not consume milk and dairy produce. However, calcium is readily available in foods such as canned fish (those that include the edible bones), green leafy vegetables such as watercress, kale and broccoli, nuts, seeds, dried fruit, pulses and whole grains, and is increasingly fortified in a variety of foods. If you are following a dairy-free diet, try to ensure it is nutrient dense and full of whole foods. Speak to your GP if you suspect you may be at risk of nutritional deficiency including calcium deficiency.
In the UK, milk and dairy products are one of the main sources of iodine. Studies from the University of Surrey suggest that plant-based milk alternatives such as soya, almond, oat and rice supply only 2% of the iodine found in the equivalent glass of cow's milk. A low intake of iodine over an extended period may make your thyroid, which governs your metabolism, work harder. Those most at risk of milk iodine deficiency are school-age girls and pregnant women. Alternative food sources of iodine include fish, especially white fish, and seafood. Seaweed is a concentrated source, but it can provide excessive amounts so restrict it to no more than once a week, especially during pregnancy.
The importance of vitamin D
Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. Alongside calcium, vitamin D plays a central role in the condition and strength of bones. The two nutrients work together; we need vitamin D to absorb calcium. Vitamin D helps the body transport calcium to the bones making them strong. Sunlight helps the body naturally synthesise vitamin D. It is recommended that we aim for 10-15 minutes of exposure to sunlight to support vitamin D production, thereafter, be sure to apply sun protection. When sunlight is scarce, opt for sources of dietary vitamin D found in oily fish, eggs, liver and fortified cereals. In the UK, cows' milk is generally not a good source of vitamin D because it isn't fortified, as it is in some other countries. Speak to your GP if you suspect you may be at risk of nutritional deficiency.
There are many myths surrounding milk and the consumption of dairy products. Some believe that semi-skimmed/skimmed milk has a lower calcium content than the full-fat variety. This is false. Lowering the fat content does not affect the calcium level. It is also a common myth that eggs fall into the dairy category. This is also untrue; eggs are not a dairy product. Live yogurts can sometimes be tolerated by people with lactose intolerance. This is because the bacterial cultures used in making yogurt start to break down and reduce the amount of lactose present.
Things to watch out for
- It is advisable to read the labels on everything you plan to eat and create a 'safe' foods list.
- Other animal milks: some people with dairy allergy and intolerance can tolerate sheep, goat's and/or buffalo milk.
- Labelling: 'dairy free' food labels only applies to cow's milk, not to other animal milks.
Alternatives to cow's milk and dairy products:
- Goat, sheep and buffalo milk
As well as other products (such as cream, butter, yogurt and cheese) – it is worth checking if you are able to tolerate small quantities of other animal milks as they are now quite easy to obtain and available both fresh and UHT.
- Soya milk alternative products
These include soya-based cream, yogurt and cheese alternatives – soya milk has been a staple vegetarian ingredient for many years so there are different varieties. It comes sweetened and unsweetened, flavoured and plain, fortified and unfortified. Most cook well in sauces and soups and can be used in cappuccinos. Soya cream alternative works as a pouring cream but you cannot whip it. Soya yogurt alternatives both plain and fruit flavoured are now widely available. Hard soya cheese alternatives do not bear much resemblance to real cheese, soya soft cheese alternatives are more successful.
- Coconut milk
Coconut milk is an excellent cooking milk to which very few people react. Coconut milk is extensively used in Southeast Asian cooking. Coconut yogurt and coconut cream are also available. The cream is available both in tins and as a solid block, which needs to be broken down with hot water. Coconut oil is an excellent butter substitute.
- Plant-based milk substitutes
These include rice, oat, almond and soya milk. Learn how to make dairy-free milk at home.
- Alternative spreads and margarines
Check the labels carefully as some contain whey or casein. Most can be used in sauces and baking (pastry, cakes etc.). They are less good for frying.
This article was last reviewed on 30 September 2018 by Kerry Torrens.
A qualified nutritionist (MBANT), Kerry Torrens is a contributing author to a number of nutritional and cookery publications including BBC Good Food magazine. Kerry is a member of the The Royal Society of Medicine, Complementary and Natural Healthcare Council (CNHC), British Association for Applied Nutrition and Nutritional Therapy (BANT).
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