lactose intoleranceMilk.  Does a body good, right?   An ample source of protein and calcium, dairy products have always been a central part of diets – particularly for children.  But as it turns out, cow’s milk is the most common food allergy in American children, which some outgrow but many don’t.  In fact, adults can develop an allergy or intolerance when they never previously had one.  When you think about it, dairy has only been a part of the human diet for a short period of time, relatively speaking.  We are the only species that intentionally consumes another species milk, so it should come as no surprise that the immune system doesn’t always recognize it as a friendly food.  However, for those who do tolerate dairy well, organic and locally raised dairy products can provide a wonderful source of protein, vitamins and minerals to your diet. (If the presence of antibiotics, hormones and pesticides hasn’t already made you make the switch to organic, I implore you to do so now). There may be some confusion about lactose intolerance and dairy / casein allergies; the information below should clear that up.

Lactose Intolerance

Lactose intolerance is a perfect example of a food intolerance – it is not an allergic immune response, but a digestive response.  Lactose intolerance means that your small intestines are not producing the enzyme lactase, which is necessary to digest the sugar in milk: lactose.  We are born with high levels of lactase in our small intestines, enabling us to digest mother’s milk.  Most of the world population loses the enzyme lactase after weaning off mother’s milk, which results in the inability to digest milk of any kind.  It’s thought that the rise of cattle domestication, about 10,000 years ago, resulted in larger portions of the world’s population retaining lactase enzymes.  This allowed many people to utilize dairy in their daily diets, unfortunately this was a very different product than what is commonly consumed today.

Lactose intolerance symptoms can occur at any age.  Premature babies sometimes have lactose intolerance, while those born at full term are generally okay with lactose.  Generally speaking, lactose intolerance in children will happen anytime after weaning, between 2-5 years old.  As people get older, it is very common to lose the ability to digest lactose.  Many people often say, “I used be able to eat cheese with no problem.”  This somewhat sudden inability to absorp lactose is not uncommon in adults.  They simply stopped producing the enzyme to properly digest lactose.  Lactose intolerance is more common in Mediterranean, Asian, African-American and Native American descent than it is in Western or Northern European descent.  Lactose intolerance is relatively easy to pinpoint, as symptoms occur anywhere from 15 minutes to 2 hours after you eat or drink milk products.


  • Bloating
  • Cramping
  • Gas (often foul smelling)
  • Diarrhea

The most approrpriate test to use when determining lactose intolerance is the  lactose-hydrogen breath test.  Consider though that this may be an unnecessary action to take – as it’s quite simple to determine if you can’t tolerate dairy.  If you have symptoms after consuming it, then avoid it and see if those symptoms subside.  There are some people who may have successful results utilizing digestive enzymes (that include lactase) when they consume dairy.  Others may be okay consuming certain types of dairy in small portions, which may include

  • Hard, aged cheeses (Lactose is primarily in the whey, not the curds. When cheese is made – with the exception of some soft cheeses – the whey is discarded and the lactose goes with it. As cheese matures and becomes hard, there is even less lactose left in the curds)
  • Fermented and unsweetened milk products, such as yogurt (Naturally present bacteria help with the digestive process)
  • Goat’s or sheep’s millk (Goat’s milk is naturally homogenized and easier to digest)
  • Raw milk (Weston A. Price website is a great resource for those interested in raw dairy products and health)

The only real cure for lactose intolerance is avoiding all milk products.  Be mindful that lactose is added to many processed foods as a flavor additive.  Learn to read your labels!

Dairy / Casein Allergy

A dairy allergy is an example of a true food allergy – the body creating an immune response to a protein within the food.  Usually the immune reaction is to the protein known as casein, but reactions can be from any of the dozens of proteins that are in dairy.  Being a true IgE allergy, dairy allergies can potentially be life threatening due to the risk of anaphylaxis.  In most cases they provoke gastrointesinal, skin and respiratory conditions.  The troubling part is that dairy / casein allergies may occur within a few minutes of exposure (immediate reactions) within a few hours, or sometimes even days (delayed reactions).  This of course can make it difficult to diagnose.

Milk protein intolerance is similar to a milk allergy, but it produces a non-IgE antibody and is not detected by allergy blood tests. Milk protein intolerance produces a range of symptoms very similar to milk allergy symptoms, but potentially milder.

Something important for those with severe milk allergies (especially children) is that milk derivatives, like casamino acid, are sometimes present in vaccines. It is also important to note that many foods that do not contain milk may be produced in a facility contaminated with dairy foods, which can potentially cause an allergic reaction in some sensitive individuals.

In some cases, heating the dairy product can denature the proteins, so some who are sensitive or allergic report not having reactions to dairy in items such as baked goods.


  • Bloating
  • Cramping/Pain
  • Gas (often foul smelling)
  • Diarrhea or constipation
  • Gastroesophageal reflux (GERD)
  • Acne
  • Behavioral disorders (ADD, ADHD etc.)
  • Iron deficient anemia
  • Colitis
  • Headache
  • Hives
  • Vomiting
  • Skin rash, eczema and atopic dermatitis
  • Wheezing
  • Baby colic
  • Anaphylaxis


You can determine if you have a dairy / casein allergy by administering one of the tests mentioned on the food allergies, sensitivities and intolerances page (scroll down to bottom).  Keep in mind, if you have a milk protein intolerance (different than a true allergy or lactose intolerance), you will not have positive test results even though you are reacting to dairy.  If you have any or many of the symptoms listed above, you can simply remove dairy from your life and see if your symptoms subside (you should eliminate for a minimum of two weeks to let symptoms clear, but two months is ideal).

What to Eat

To the right is a link that will help you cook and bake without dairy.  You’ll see after a while it’s not as bad as you think.  Yes, you will miss pizza.  But let’s get real, pizza isn’t good for you anyway.

Those with lactose intolerance should simply follow a dairy / casein-free diet as well, with the exception of whey protein (no lactose in whey).  Lactose-free milk is not safe for those with dairy / casein allergies, it is only acceptable for those with lactose intolerance.  When removing dairy from the diet, it is vital that adquate calcium and vitamin D be a part of your whole foods diet or whole foods supplement.

There are two very handy lists I keep on hand for myself and clients.  Go Dairy Free’s “Dairy Ingredient List” and  Living Without’s Casein-Free Diet Quick Start Guide.  Both lists are fantastic resources that cover hidden culprits of dairy, how to read ingredient labels, foods that contain casein, foods that may contain casein, and casein-free alternatives.  Some of the most common hiding places for dairy are in processed foods (bread, crackers, cookies, cakes, deli meat, soy products, gravy, and even products that are specifically labeled as “non-dairy,” such as creamer (non-dairy, by food labeling standards, simply means less than 0.5% milk by weight).  Those with dairy / casein allergies will not tolerate goat’s or sheep’s milk.

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