Lactose Intolerance & Dairy (Milk Protein) Allergies

Lactose Free Milk: do you really need it?

True Lactose Intolerance

Lactose intolerance is caused by the inability to breakdown lactose, which is the form of sugar found in milk (including breastmilk). Typically a true lactose intolerance is due to a genetic condition where a person does not produce the lactase enzyme needed to breakdown lactose. A baby who is truly lactose intolerant would fail to thrive right off the bat, and show other signs of malabsorption and dehydration from birth. It is extremely uncommon for someone without this genetic condition to be lactose intolerant.

Secondary Lactose Intolerance

There is such thing as “secondary lactose intolerance.” This is when irritation or damage to the gut lining can impair the production of lactase. In these cases avoiding lactose acts as a band-aid, it will not solve the underlying problem. In these cases, the health of the gut must be addressed.

Other conditions that may effect the production of lactase include gastroenteritis and parasitic infections. Premature babies also may not make enough lactase for a short time after birth. 

How to Test for Lactose Intolerance

Genetic Testing - This test uses DNA from blood samples amplified and digested with restriction enzymes. The pattern of DNA fragments is then used to indicate if a person is lactose intolerant or not. 

Hydrogen Breath Test - You will drink a liquid that contains a certain amount of lactose, and every 30 minutes over the course of a few hours you breathe into a balloon-like container that measures the amount of hydrogen in your breath. If your breath hydrogen levels rise AND symptoms get worse during the test, you may be diagnosed as lactose intolerant. 

Stool Acidity Test - It is very difficult to perform a hydrogen breath test on a baby, so often times a stool acidity test will be done to measure the lactic acid, glucose, and other fatty acids.

Dairy Free Milk: do you really need it?

Milk Protein Allergy

A milk allergy is the reaction to the protein in milk. In these cases the immune system reacts as though the protein is a dangerous invader to the body. Because of the rarity of true lactose intolerance, either secondary lactose intolerance due to gut inflammation or a milk allergy is most likely going to be the cause of symptoms.

What many people don’t realize is that not all animal milk protein is formulated the same. If someone truly has an allergy to cow milk protein, they may have no problems with goat milk - which is easier on the digestive system. Goat milk contains more A2 casein protein, which is much less inflammatory. If someone is having a response to the inflammatory nature of A1 casein protein, then many times they can handle goat-milk, or even A2 grass-fed cows milk. *Protein allergies are very individualized, so this won't always be the case for everyone, but in my opinion it's worth trying before moving onto a completely dairy free alternative. However, if you do find yourself needing a dairy free option, here's some info on plant based milks.

Why Goat Milk?

Compared to cow milk, goat milk forms a smaller, softer, and looser curd in the stomach which makes digestion quicker and easier. The fats in goat milk are also easier to digest, because they are smaller than cow milk fats. 

Goat milk contains more gut-supportive prebiotic oligosaccharides, and has superior mineral bioavailability. It also contains a considerably lower amount of A1 casein protein, which is the most inflammatory casein protein. Many people who have a “dairy allergy,” actually have an A1 casein milk-protein allergy or secondary lactose intolerance due to inflammation - because of this many are able to handle goat milk just fine. Goat milk is a great option for anyone, but especially those suffering from stomach issues, eczema, recurrent ear infections, reflux, and chronic nasal congestion. 

How to Test for a Milk Allergy

Skin Test - This is when the skin is pricked and exposed to small amounts of protein found in milk. If an allergy is present, a raised bump (hive) will appear. However, this test isn’t completely accurate. 

Blood Test - This test measures the immune system’s response to milk by measuring the amount of immunoglobulin E (IgE) antibodies in the blood. This test, also, isn’t completely accurate. 

Oral Challenge - The medical professional will provide different foods that may or may not contain milk in increasing amounts. They will then observe if you react to the ones that contain milk.

Elimination Diet - This is when the provider will advise the elimination of all dairy from your diet to see if symptoms subside. However, this test can be unreliable because many times symptoms will subside because the over-processed dairy that is widely available is no longer being consumed, decreasing inflammation - giving the false sense that it was due to an allergy and not inflammation due to the junk filled milk.