Dairy-free Vs Lactose-free: do you need to avoid dairy if it upsets your tummy?

By Jaime Rose Chambers, Accredited Practicing Dietitian (B. Nutrition & Dietetics)

Do you have a latte or a smoothie and feel sick in the tummy or perhaps it sends you running to the loo shortly afterwards. It’s common to blame dairy for this reaction, however it may not necessarily be dairy that is the problem, but the naturally occurring sugars in dairy called lactose that many people find difficult to digest [1]. It’s important to distinguish this because cutting out all dairy from your diet can have health consequences in the long term [1] [2].

Dairy allergy

Dairy foods are those which come from cow’s milk and the products made from it, such as yoghurt, cheese, butter and ice cream. Dairy foods contain proteins which some people are allergic to, known as a cow’s milk allergy, where their immune system overreacts to it causing symptoms such as hives, respiratory symptoms, itching, vomiting, diarrhoea and in severe cases, anaphylaxis [2]. It is one of the most common food allergies in children, mostly presenting in kids under 16, but most outgrow it by the age of five [3]. 

Lactose-intolerance

Dairy foods contain a naturally occurring sugar called lactose. Lactose needs to be broken down in our gut by an enzyme called lactase so that we can digest it properly [1]. Some people have a deficiency in this enzyme, meaning that lactose is not digested properly and moves through to the large bowel undigested causing symptoms such as abdominal pain and cramps, bloating and wind, nausea, loose stools or diarrhoea, often with urgency [1]. A lactose-intolerance can develop at any age and may present after a gut infection such as gastroenteritis (gastro), with inflammatory bowel diseases, or after surgery to the bowel [1].

How to test for a dairy allergy vs lactose-intolerance?

A dairy allergy can be tested with a blood test through your GP. A lactose-intolerance is most commonly tested with a lactose challenge, where you would have a large serving of a food high in lactose, such as a glass of regular milk, and monitor for symptoms [1]. A lactose-intolerance can also be diagnosed with a small bowel biopsy as part of an endoscopy procedure, or less commonly with a hydrogen breath test [1].

How to manage your diet if you have a dairy allergy or lactose-intolerance?

Dairy foods provide precious nutrients such as calcium that are difficult to get elsewhere in our diet. Cutting them out can lead to brittle bones known as osteoporosis and an increased risk of bone fractures [4]. 

For people with a cow’s milk allergy, a reaction is triggered by any food that contains the cow’s milk protein, which include all dairy foods – milk, yoghurt and cheeses, ice cream, custard, cream and butter, and any foods that contain those ingredients, such as cakes and pastries [2]. It’s a difficult allergy to navigate as these ingredients are common in our food source, so it’s essential to work with a Dietitian for support.

A lactose-intolerance however is much easier to navigate because most people can tolerate a small amount, plus lactose is only found in two foods in significant amounts: milk and yoghurt [1]. This simply means switching to the lactose-free varieties, which are readily available in all major supermarkets, including lactose-free Vaalia yoghurt. 

Ice cream, custard and fresh cheese like ricotta contain small amounts of lactose and butter, cream and mature cheese like parmesan contain almost none, so can be enjoyed relatively freely [5].

 #AD

Bibliography