To dairy or not to dairy…

Dairy does not agree with everyone, so how do you know if you’re lactose intolerant or if you have a milk allergy? 

Some favour dairy and others oppose it vehemently…  The Prevalence towards food allergies worldwide is increasing. Studies show an early introduction to food allergens – before six months – can increase the risk of developing food allergies and why recommendations suggest only introducing those foods after six months. We speak to two experts in the field of nutrition who shed light on the topic of lactose intolerance and milk allergy; registered dietician Marijke Pienaar at Life Robinson Hospital Randfontein and gastroenterologist, Dr Hilda Smith at Life Wilgeheuwel Hospital. 

Firstly, see an expert… 

“If you suspect you have a possible dairy sensitivity, see your doctor for a food allergy test,” says dietician Marijke Pienaar. “Both allergies and intolerances can be managed, but should not be done in isolation – and it is strongly advised to see your dietician to prevent any deficiencies or to properly treat the food allergy or intolerance. Do not eliminate any foods from your diet unless it has been clinically proven that you do have a milk allergy or milk intolerance by your doctor.” 

How are food allergies diagnosed?

No single test can be fully depended on in the diagnosis of food allergies, explains dietician Marijke Pienaar. Testing food allergies usually starts off by taking a detailed history of a patient’s diet and also allowing the patient to do 7-day detailed food and symptom record. “Once a food has been positively identified to cause allergic symptoms, a skin-prick test can be performed. The choice of allergens to be tested should be guided by the food and symptom record. Skin-prick tests are preferred as the initial test as its low cost, convenient and relatively accurate. After a food or allergen has positively reacted with the skin (meaning the skin will inflame where the allergen was added to the skin), a serum (blood) specific IgE test can be performed to positively diagnose the food allergy,” she says. “One could simply try by diagnosing food allergy by eliminating the allergen from the diet for a set period of time (usually between 2-6 weeks) followed by planned and intentional re-introduction, but this process can be lengthy and often results in unclear answers or diagnosis.”

What is lactose intolerance?

Lactose intolerance, also known as lactose malabsorption is the inability to fully digest the sugar lactose in milk products due to a lactase deficiency, explains Dr Smith, and symptoms include diarrhoea, gas, bloating, nausea and cramps. “Most patients can manage without giving up all dairy products. Lactase breaks down the the sugar in milk (lactose) to glucose and galactose for absorption in the small intestine,” she explains. 

SIDE BAR: Types of Lactose Intolerance, according to Dr SmithPrimary lactose intolerancePatient starts life with a normal amount of lactase and during childhood, the enzyme decreases as the diet changes from milk to solids. Production continues to decrease into adulthood – and if production decreases significantly, the patient will become symptomatic when consuming dairy products. Secondary lactose intoleranceIn this instance, there is a decreased lactase production by the small intestine after illness, such as celiac disease and Crohn’s disease. Once the disease is treated in the small bowel, then the lactase production usually recovers. Congenital or developmental lactose intoleranceHere, the patient is born with a complete absence of lactase, which is very rare. Premature infants may also present like this due to the immaturity of their gut –  as production most often develops in the third trimester of pregnancy. 

How can lactose intolerance be treated? 

“Sadly, we are unable to boost lactase production, but encourage patients to avoid discomfort and symptoms by decreasing their dairy intake and also adding enzyme products to assist with the breakdown of dairy in the gut,” says Dr Smith. “Limit dairy products by taking smaller servings and experimenting with different dairy-containing products and choosing lactose free products can really make a difference. Lactase enzyme tablets or drops can also help.” 

What is a milk allergy?

There are two main proteins in cow’s milk that can cause an allergic reaction and they are casein (found in the solid part of milk that curdles) and whey (found in the liquid part of milk that remains after the milk curdles.) The allergic reaction happens when the immune system identifies certain milk proteins as harmful and as a result triggers the release of immunoglobulin E antibodies to neutralise the protein allergen. “Symptoms can be mild to severe and you can break out in hives or experience wheezing or vomiting. Other symptoms also include a loose stool, often containing blood, diarrhoea, cramps, coughing, runny nose, itchy skin rashes, often around the mouth,” says Dr Smith. “Avoid milk-containing products, especially from the obvious sources like milk, butter, yoghurt, ice-cream and cheese.” 

SIDE BAR: No dairy? No problem! Here are some healthy calcium-rich foodsCalcium-fortified bread and cerealsCanned salmon and sardines with the bones Fortified orange juiceBeans, legumes, chickpeasRhubarbDark green leafy vegetables like spinach, kae, broccoli and okraDried figsSoy products and tofuAlmonds
Delicious milk alternatives to try…“The most important factor to look for when purchasing milk alternatives, is to choose milk alternatives that have been fortified with calcium. In terms of what milk alternative to use from a dietetic point of view, it does not matter, it’s all about individual preferences,” explains dietician Marijke Pienaar. 
Soy Milk – Soy milk is probably the most popular and recognisable alternative to cow’s milk. Like cow’s milk, soy milk is often fortified with calcium, Vitamin A, Vitamin D, riboflavin and often has the same protein amount as cow’s milk. It is therefore the most similar milk alternative to cow’s milk in terms of nutrition profile, but often patients complain of the “nutty” taste and not a favorite in terms of flavor.
Almond Milk – Almond milk contains a much lower amount of protein than dairy and soy milk, but people prefer the Almond milk above soy due to the sweet flavor and creamy texture that is similar to dairy milk. Most almond milks are fortified with calcium, but if not, almond milk is considered low in protein, vitamins, minerals and fatty acids present in dairy milk. Other common nut milks include cashew, hazelnut and walnut milk.
Rice milk – Rice milk is the most hypoallergenic of any of the milk alternatives, free from soy, gluten and nuts. Rice milk is high in carbohydrates but low in protein compared to dairy milk. Rice milk is quite thin and watery and not suited for use in cooking and baking and unfortunately if not fortified, low in calcium.
Coconut Milk – Due to the Banting craze, coconut milk became quite popular in the last couple of years. Coconut milk is relatively high in fat and therefore does appear to resemble in terms of texture closest to that of whole milk. Despite the similarities in texture, coconut milk does not have a nutritional profile comparative to that of cow’s milk. One serving (250ml) of coconut milk contains 80 calories, 1 g protein and 100 mg calcium, while 1 cup of 1% dairy milk contains 100 calories, 8 g protein and 300mg calcium.
Hemp Milk – Hemp milk is another good alternative for those allergic to soy, nuts and gluten and is made from hulled hemp seeds, water and (in most cases) sweeteners. It contains a good amount of protein and has an excellent fatty acid profile, but is relatively low in calcium, unless fortified.
Cow’s Milk alternatives for infantsBreastfeedingHypoallergenic formulasSoy-based formulas

Read the labels! 

According to dietician Marijke Pienaar, The South African Food Labelling Regulations (under the Foodstuffs, Cosmetics and Disinfectants Act, No 54 of 1972)  requires that all packaged food products sold in South Africa that contain milk as an ingredient, must be listed in the ingredients as  ‘milk’ on the label and identified as an allergen in a separate part of the food label. “Read all product labels carefully before purchasing and consuming any item. It is part of the dietician’s education to teach patients what foods contain milk and how to read food labels properly,” she says. 

Got milk? I’ll have some goat’s milk, thank you!

Goat’s milk is believed to be more easily digestible and less allergenic than cow’s milk. The fat globules in goat’s milk are smaller than in cow’s milk resulting in an easier digestion process. Goat’s milk is also naturally homegenized, as opposed to cow’s milk, which must be homogenised in a factory. Another plus is that goat’s milk contains about 10% less lactose than cow’s milk and is easier to digest for those suffering with a lactose intolerance. Goat’s milk is high in potassium, a micronutrient lacking in cow’s milk.