Do you experience headaches, fatigue, joint pain, excess mucus, congestion, hay fever, respiratory problems or skin issues? Or do your kids have frequent ear infections, eczema or colitis? In many cases, these can be related to dietary triggers, called “food sensitivities.” Dairy is a frequent culprit. But how can you find out if you are indeed dairy sensitive, and do so in a way that ensures you still remain nutritionally replete?
In our practice, we will often use an elimination diet as part of our protocol to resolve underlying health problems. One of the food groups we typically remove is dairy. If you think you may be sensitive to a particular food, including dairy, removing it from your diet for 6-8 weeks is the best way to determine if you really are. At the end of the elimination period, you can try reintroducing the food and carefully monitoring your symptoms for up to 3 days after to determine any reactivity.
Why should I consider eliminating dairy?
For many people, consuming dairy is an irritant. If you are sensitive to dairy, you may notice a variety of digestive symptoms such as gas, bloating, stomach pain, diarrhea or constipation. However, the symptoms don’t stop there. They can include headaches, fatigue, joint pain, excess mucus, congestion, hay fever, respiratory problems or skin issues, as we mentioned above. Food sensitivities, including to dairy, can also be a driving factor behind other conditions including autoimmune disorders, autism and ADHD.
Why 6-8 weeks?
The half-life of any delayed (IgG) antibodies you may have to a particular food is 21 days. That means that after 21 days, the number of antibodies you have circulating for that food will have reduced by half. After 6-8 weeks, we expect the numbers to come down to negligible, which is when you’re ready to test the food.
Dairy sensitivity, lactose intolerance or IgE reaction?
There are three main causes of dairy discomfort: dairy sensitivity, lactose intolerance and IgE reaction. Dairy sensitivity is a reaction to the protein component in dairy (casein or whey) while lactose intolerance is an inability to digest the sugar component in dairy (lactose). An IgE (Immunoglobulin E) reaction occurs when antibodies are produced by the body’s immune system in response to a perceived threat (in this case dairy); this is what most people typically think of as a food allergy and can include hives, itchy eyes and sneezing as well as difficulty breathing.
More specifically, dairy sensitivity is an IgG immune reaction to the proteins found in dairy, which can produce a delayed reaction 1-3 days (or, in some cases, longer) after consumption. Lactose intolerance, on the other hand, is an inability to break down the sugar contained in dairy (lactose).
Lactose intolerance occurs when the body does not produce enough lactase, the enzyme necessary to digest lactose. As babies, we all produce lactase in order to digest breast milk; however, many humans lose 90-95% of birth lactase levels by early childhood. In fact, it has been estimated that ~65% of the population has a diminished ability to digest lactose after infancy.
Lactose intolerance is most prevalent in people of East Asian descent; it is also common among people of West African, Arab, Jewish, Greek, and Italian descent. On the contrary, lactose intolerance is lowest in populations with a history of dependence on unfermented milk products, such as people of Northern European descent. Lactose intolerance, while commonly recognized as genetic, can also develop independently of any genetic predisposition.
Of course, dairy allergies also exist too, which occur due to an increase in another immune molecule, IgE. An IgE reaction to dairy is more immediate, and can be associated with anaphylaxis. Those who have a dairy allergy are usually already aware and working with an allergist. It isn’t safe for those with dairy allergy to do any kind of dairy food challenge unless under the approval and supervision of their allergist.
If I don’t eat dairy, where will I get calcium from?
The US recommended daily allowance for calcium is 1,000 mg for adult men and 1,200 mg for adult women. These targets are controversial, however, and higher than most others around the world. The World Health Organization, for example, targets a lower daily intake of 500 mg of calcium.
Ironically, bone diseases such as osteoporosis are highest in countries that consume the most dairy, calcium, and animal protein. Part of this may be due to the other nutrients also needed for bone health beyond calcium alone, including an array of different vitamins, minerals and phytonutrients. Exercise, and reducing inflammation also play important roles in promoting bone integrity.
Even if we relax the calcium intake levels somewhat (though this should be assessed on an individual basis with a knowledgeable practitioner), it’s still important to ensure we have good dietary sources when we cut out dairy. Luckily, there are many other sources we can incorporate (Table 1).
Table 1. Example Non-Dairy Food Sources of Calcium
Some non-dairy milks are calcium-fortified and can be a reasonable source—just be sure to check labels carefully to see that they are.
For more information about choosing the most calcium-rich dark leafy greens, see our blog here.
Boosting bioavailability
Beyond the absolute calcium content of certain foods, it is also important to understand that calcium is absorbed differently based on its source. Calcium from milk is ~33% absorbedhttps://www.ncbi.nlm.nih.gov/pubmed/12449293; for example, if you consume an 8 oz glass of milk, which contains ~300 mg of calcium, your body will be able to absorb and use ~90 mg of that calcium. Calcium from leafy greens in the kale family is similarly bioavailable as in milk. Beans, on the other hand, have a relatively high calcium content, but a lower bioavailability.
To increase the bioavailability of calcium, there are steps you can take.
Firstly, make sure you are replete in vitamin D or taking a supplement if necessary (most of us will need to if we live above the 33rd parallel, anywhere north of Louisiana, USA). Also, consume foods rich in magnesium and Vitamin K, both of which encourage the uptake and appropriate use of calcium in the body.
Avoid excessive consumption of foods with oxalates (e.g., raw spinach, collard greens, sweet potatoes, rhubarb, beans) and phytates (fiber-containing whole-grain products, beans, seeds and nuts), which bind to calcium and inhibit its absorption. You can reduce the phytate content of beans and whole grains by soaking and sprouting them, and diminish oxalate content with gentle cooking.
And finally, to minimize calcium loss, you can also avoid excessive sodium consumption and minimize intake of alcohol and caffeine, all of which contribute to calcium excretion.
What does this look like on my plate?
Taking all of this into account, pairing a nice sautéed bok choy sprinkled with sesame seeds with some roasted tempeh makes for a calcium-rich dinner. Or, you might try a kale salad topped with white beans and tahini dressing. Yum!
But what can I have instead of [fill in your favorite dairy-laden food here]?
If you are choosing to live a dairy-free or dairy-light lifestyle, either short-term or long-term, finding swaps for traditional dairy items is a key survival technique:
Instead of cow’s milk, try unsweetened almond milk, coconut milk, rice milk or hemp milk
Instead of cow’s milk yogurt, try unsweetened coconut yogurt
Instead of cow’s milk cheese, try nut-based cheese or nutritional yeast (to add a cheesy flavor to dishes)
Instead of butter, try coconut oil or ghee (butter without the reactive milk proteins). Nut and seed butters are also super tasty and nutritious.
Instead of ice cream, try coconut milk ice cream, almond milk ice cream, hemp milk ice cream or avocado / coconut milk / banana as an ice cream base.
To add “creaminess” to dishes (e.g., baked goods, smoothies), try avocado, canned coconut milk or tofu / tempeh. Cashews can also be soaked and then blended to a smooth cream in their soaking liquid, or added directly to a smoothie.
Many of these products can be made at home yourself with simple ingredients. If you are purchasing these items from the store, it’s best to avoid added sugars, unnecessary fillers (e.g., carrageenan) and artificial flavors.
Once I have eliminated dairy completely, how do I find out whether I am sensitive to it?
After you have eliminated dairy from your diet for 6-8 weeks, you can then “challenge” it to see if you experience symptoms. You can choose from the following dairy categories to conduct your challenge: plain yogurt, cheese, milk or cream. If there are other foods you avoid, it is also important that you don’t test multiple food sensitivities at once. For example, a grilled cheese sandwich may not be a good challenge food because it includes gluten and dairy, both of which are common allergens; instead, test the cheese alone or with foods that you know that you don’t react to.
Our preferred food challenge process takes 4 days: You ingest the food for 2 days with three servings each day, gradually increasing the amount of the food over the first day to a full serving size. Use full serving sizes on day 2. After you have tested the food for 2 days, you then continue to observe for another 2 days to see if you have any reactions (e.g., digestion, bowel function, energy levels). If you notice a clear reaction, you should discontinue eating the food.
I think I have a mild sensitivity—what next?
You may be able to tolerate some kinds of dairy, such as ghee, lactose-free dairy, or fermented dairy. Fermented dairy is generally considered to be easier to digest than non-fermented dairy. Both the protein and lactose content are lower in fermented milk than those in the original milk, making them more easily digestible. Yogurt, kefir and buttermilk are all fermented cow’s milk options to consider here.
Both goat’s milk and sheep’s milk dairy are also considered to be easier for the body to digest than their cow’s milk counterparts. There are several reasons for this. Both goat’s milk and sheep’s milk have smaller fat molecules than cow’s milk, which may make them easier to digest and assimilate; both goat’s milk and sheep’s milk also have a lower alpha S1 casein protein content (which is associated with allergies). In addition, the lactose content of goat’s milk is lower than that of cow’s milk. Together, these characteristics may make goat’s milk and sheep’s milk more digestion friendly options than cow’s milk for many. Keep in mind, though, that around 90% of people who react to cow’s dairy, will also react to sheep and goat dairy.
What should I do if I notice a definite sensitivity, even when choosing more easily-digestible dairy?
The best thing to do is avoid dairy. You can work with a functional medicine practitioner to support a more balanced immune system and restore gut integrity. This can sometimes reduce the effects of food sensitivities, and help correct the underlying imbalances that may otherwise continue to provoke other negative health effects. A nutritionist can also help you create a healthy and balanced dairy-free diet.
The dairy elimination didn’t help—I still have symptoms
You may have other underlying food sensitivities such as to gluten, soy, egg, or other foods. You can follow similar elimination protocols with those foods, or others that you eat frequently, to uncover potential connections. There can also be many other contributing factors to your situation which require evaluation by a functional medicine practitioner.
This article was written with Alexandria DeVito. Alexandria is a functional nutritionist, Eating Psychology Coach, yoga teacher and personal trainer. With a background in nutrition and fitness, she brings the best of both disciplines to help clients address any areas they may want to optimize in their lives (e.g., increasing energy levels, relieving digestive distress, losing or maintaining weight). Alexandria is dedicated to helping clients unlock their best selves in order to give and receive the most out of their relationships, work and life. Prior to becoming a nutritionist, she was a consultant to the pharmaceutical and medical device industry. Alexandria holds a Bachelor’s of Science in Business Administration from Georgetown University, a Master’s of Science in Nutrition from University of Bridgeport and a Master’s in Business Administration from Harvard Business School.
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My best,
DrKF
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