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? Nutritional therapist Jo Lewin is on hand to help...

A bottle of milk with a 'stop' sign on the front

Dairy-free diet

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 first imagine. Let us start by separating dairy allergy and intolerance as they are two 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 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 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's goat's and sheep's) 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.

Woman holding her stomach in pain

Everybody's different...

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.

For more information on lactose intolerance see:
Information from The Dairy Council
NHS advice about lactose intolerance

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:

Butter                                           Buttermilk
YogurtHydrolysed casein/whey
Casein/caseinatesCheese (including cream, curd and cottage)
WheyLactalbumin
Cream - all varietiesFromage frais
Milk solidsLactose
Ghee (though vegetable ghee is fine)Milk of all kinds
Ice creamSkimmed milk powder
 Whey protein/sugar

 

Dairy products are likely to be found in:
Some animal fats                  Artificial cream
Batter (for pancakes,
waffles, fish fingers, etc.)
Biscuits
Breads - many enriched breads will include butter and/or milkCakes
Cheese straws/biscuitsCheese flavoured crisps
Creme caramelCreme patisserie/custard
Custard tartsChocolate/chocolate products
Desserts - many different kindsIce creams
Low-fat spreadsMargarine
Ready meals - many include butter or milkRice pudding and most other baked puddings
Sauces - all white sauces and
other ready made sauces
Scones
Vegetable spreadsSweeteners

Health implications

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.

Read more about the best sources of calcium and how to build strong bones.

A selection of calcium rich foods including almonds, greens, cheese, milk and canned fish

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.

Iodine

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.

Myths

There are many myths surrounding milk and the consumption of dairy products. Some believe that semi-skimmed/skimmed milk has a lower calcium content that 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, goats and/or buffalo milk.
  • Labelling: 'Dairy Free' food labels only applies to cow's milk, not to other animal milks.

A glass of coconut milk in front of half a fresh coconut

Alternatives to cow's milk and dairy products:

  • Goat, sheep and buffalo milk...
    and 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...
    (such as soya-based cream, yogurt and cheese alternatives) - soya milk alternative 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 up 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 alternative does not bear much resemblance to real cheese, soya cream cheese alternative is more successful.
  • 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...
    include rice, oat, almond and soya milk. Learn how to make dairy-free milk alternative 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.

Dairy-free recipes

Dairy-free breakfast recipes
Dairy-free lunch recipes
Dairy-free dinner recipes
Dairy-free snack recipes
More dairy-free inspiration


This article was last reviewed on 27th September 2017 by nutritional therapist Kerry Torrens.

A registered Nutritional Therapist, Kerry Torrens is a contributing author to a number of nutritional and cookery publications including BBC Good Food. 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).

Jo Lewin works as a Community Nutritionist and private consultant. She is a Registered Nutritionist (Public Health) registered with the UKVRN. Visit her website at www.nutrijo.co.uk or follow her on Twitter @nutri_jo.

All health content on bbcgoodfood.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. If you have any concerns about your general health, you should contact  your local health care provider. See our website terms and conditions for more information.

Comments, questions and tips

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Jacqueline Bel
10th Nov, 2016
Correction: Lactic Acid is mentioned in the list of foods and substances to be omitted when one has a milk allergy, but this is not correct. Lactic acid is a bacteria, it is not made from milk. See text below from the website of food-info.net: "LACTIC ACID: Dietary restrictions : None, lactic acid and lactates can be consumed by all religious groups, vegans and vegetarians. Although the name refers to milk, it is not made from milk and thus suitable for people with milk allergy or lactose intolerance."
Felicity Smith
13th Jun, 2014
Mortimer Chocolate Company does a range of chocolate powders for cooking that are free-from dairy, gluten and soya. You would not guess their White Chocolate Ice Cream recipe is dairy -free http://chocolatefriends.wordpress.com/2012/11/09/dairy-free-white-chocolate-ice-cream/
TotalDietFood's picture
TotalDietFood
14th Apr, 2014
A very interesting and insightful article. We have written a blog post on lactose intolerance that may be of interest for people wanting more information :) http://www.totaldietfood.com/news/316/27/Could-you-be-lactose-intolerant/#.U0uuMlVdWSo
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