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...
Discovering that you are intolerant or allergic to dairy products can seem difficult to start with. But as we found with our focus on gluten-free, 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.
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. These responses can be triggered by a very small amount of the milk protein and it will usually be immediate. If you are allergic to dairy, you may experience a rapid reaction within the digestive tract (e.g. bloating, vomiting or diarrhoea/constipation), skin (e.g. eczema), respiratory system (e.g. asthma) or other inflammatory response such as headaches or joint pain.
Intolerance - lactose
An intolerance to dairy is less severe but may also bring about digestive, skin and inflammatory symptoms. 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 - this can happen as we get older. Without lactase, the sugar ferments in the gut and causes unpleasant gastrointestinal symptoms.
The difference between intolerance and allergy...
Terms such as food allergy and food intolerance are often used interchangeably, yet they represent a disparate group of conditions. Modern classifications have divided adverse reactions to food into those that are immune mediated - food allergy and those that are NOT immune mediated - food intolerance..
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.
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.
It may be that dairy intolerance is not to do with lactose but as 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 yoghurt 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.
|Casein/caseinates||Cheese (including cream, curd and cottage)|
|Cream - all varieties||Fromage frais|
|Ghee (though vegetable ghee is fine)||Milk of all kinds|
|Lactic acid (E270)||Skimmed milk powder|
|Ice cream||Whey protein/sugar|
|Some animal fats||Artificial cream|
|Batter (for pancakes,|
waffles, fish fingers, etc.)
|Breads - many enrichedbreads will include butter and/or milk||Cakes|
|Cheese straws/biscuits||Cheese flavoured crisps|
|Creme caramel||Creme patisserie/custard|
|Custard tarts||Chocolate/chocolate products|
|Desserts - many different kinds||Ice creams|
|Ready meals - many include butter or milk||Rice pudding and most other baked puddings|
|Sauces - all white sauces and|
other ready made sauces
Milk is high in nutrients such as calcium, vitamin B2, phosphorous, magnesium and vitamin B12. Calcium is an important mineral involved in the formation and maintenance of strong bones and teeth, and also also plays a regulatory role in muscle contraction and blood clotting functions.
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.
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.
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 yoghurts can sometimes be tolerated by people with lactose intolerance. This is because the bacterial cultures used in making yoghurt produce the lactase enzyme required for digestion.
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.
- Goat, sheep and buffalo milk...
and products (such as cream, butter, yoghurt 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 products...
(cream, yoghurt and cheese) - 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 up well in sauces and soups and can be used in cappuccinos. Soya cream works as a pouring cream but you cannot whip it. Soya yoghurts both plain and fruit flavoured are now widely available. Hard soya cheese does not bear much resemblance to real cheese, soya cream cheese is more successful.
- Coconut milk...
is an excellent cooking milk to which very few people react. It 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.
- 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.
- A pancake recipe using soya milk:
Vegan tomato & mushroom pancakes
- Easy peasy dairy-free salads:
Butter bean & tomato salad
Grilled Mediterranean veg with bean mash
Watermelon, prawn & avocado salad
- Low in fat, high in calcium, great accompaniments for meat or fish:
Broccoli & peas with sesame seeds, soy & honey
Sweet & sour kale with garlic & anchovy
Stir-fried curly kale with chilli & garlic
- Try out the dairy-free milk or yogurt alternatives to accompany this yummy nutty granola:
- Coconut milk is a dairy-free substitute and makes a tasty curry:
Red Thai salmon curry
Thai green chicken curry
Vegetable curry for a crowd
- Put you feet up and indulge with a slice of delightful dairy-free cake:
Yummy scrummy carrot cake
Blueberry & coconut cake
This article was last reviewed on 27th January 2015 by nutritional therapist Kerry Torrens.
Jo Lewin holds a degree in nutritional therapy and works as a community health nutritionist and private consultant. She is an accredited member of BANT, covered by the association's code of ethics and practice.
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