Understanding lactose intolerance and dairy allergies

Dairy foods are recommended as part of a healthy, balanced diet. They are known for their calcium, iodine, zinc and protein content and also provide a source of vitamins A, B, D, B12 and B2. While dairy products like milk, cheese and yoghurt can taste amazing, not everyone can digest them.

In fact, according to the Australasian Society of Clinical Immunology and Allergy, around 2% of infants in Australia and New Zealand have a cow’s milk allergy. Cow’s milk allergy is much less common in school age children,  with most growing out of  the allergy by the time they’re three to five years old.

If you have an allergy to cow’s milk, it usually means you’re unable to digest the sugar in dairy (lactose) or have an allergy to the protein casein.

Lactose intolerance is most common in people of East Asian, West African, Arab, Jewish, Greek or Italian descent.

Lactose intolerance

Lactose is the main sugar found in milk and dairy products made from milk. If you have lactose intolerance, it usually means that you have a low level of lactose, the enzyme that helps your body break down lactose.

Symptoms of lactose intolerance can include:

• bloating
• gas
• nausea
• diarrhoea
• abdominal pain and discomfort.

While this condition is uncomfortable, it’s not usually dangerous or life-threatening. If you think you or someone in your care might have lactose intolerance, it’s important to see your doctor for a diagnosis and appropriate treatment.

You can also read some tips for managing lactose intolerance in adults from the Dietitians Association of Australia.

Casein allergies

Casein is the protein found in dairy milk and products made from dairy milk. Casein allergies are far less common than lactose intolerance.

If you’re allergic to casein, your body will mistakenly identify casein as a harmful substance and create antibodies to fight it. You’ll produce histamines when these antibodies react with casein, which can cause the following symptoms:

• Swollen lips, mouth, tongue, and face
• Skin rashes, hives, itchy skin
• Nasal congestion, sneezing, runny nose, itchy eyes.

Symptoms can vary depending on the sensitivity of the individual.

Extreme allergic reactions and anaphylaxis

Anaphylaxis is a very serious reaction to a milk allergy and can even result in death. It happens very quickly and requires emergency medical attention.

Symptoms of anaphylaxis include:

• swelling of the tongue and throat
• chest pain
• difficulty breathing
• difficulty talking or a hoarse voice
• wheezing or persistent cough
• persistent dizziness or collapse

If you suspect you or someone in your care is experiencing an anaphylactic reaction, you should immediately call emergency medical services on 000.

To find out more, read about first aid for anaphylaxis.

Five alternatives to dairy milk

If you or someone you care for has lactose intolerance or a dairy milk allergy, there are alternatives on the market that you could try.

1. Soy milk

   Soy milk is a popular alternative to dairy. It’s contains soybeans or soy protein isolate. It often also contains vegetable oils and thickeners. It’s readily available in most supermarkets in Australia. It works well in coffee, smoothies or on cereal. It contains a similar amount of protein to dairy milk, but around half the calories and calcium. It’s important to remember that some people have allergies to soy products as well as dairy products. Make sure you select a soy milk that has had calcium added to it if you need to replace all your dairy with soy to ensure you get enough.

2. Almond milk

   If you’re not allergic to almonds, almond milk is another alternative to try. It’s made with whole almonds or almond butter and water. It usually has a light and nutty taste and can have added sugar. It’s not as nutritious as dairy or soy milk however, and contains less protein, calcium and calories. It also contains phytic acid, a substance that may restrict the absorption of iron, zinc and calcium. Make sure if you choose almond milk that it contains no added sugar and has had calcium added to it. 

3. Coconut milk

   Coconut milk is another alternative to dairy that has been growing in popularity. It’s quite low in protein, calcium and carbohydrates. It contains one-third of the calories of cow’s milk. If you’re looking for an alternative to dairy milk that’s low in carbohydrates, coconut milk could be your alternative.

   Keep in mind that it does contain a type of saturated fat known as medium chain triglycerides. Some research suggests that medium chain triglycerides can help us to reduce our appetites and improve cholesterol. However, other research suggests it may raise our level of bad cholesterol (low-density- lipoproteins). The National Heart Foundation recommends we limit our saturated fat intake and avoid too many foods and drinks (including coconut milks) high in saturated fat. If choosing a coconut milk as your alternative, be sure it contains added calcium. 

4. Oat milk

   Oat milk is available in some supermarkets in Australia, but it’s also fairy easy to make at home with oats and water. The supermarket variety may have other added ingredients. Oat milk has a sweet taste, but people on a low-carbohydrate diet might like to avoid it, as it has up to double the amount of carbohydrates as dairy milk with a lot less calcium. It’s low in protein and fat and is a great choice if you’re on a high-fibre diet because it’s high in soluble fibre but be sure to choose one with added calcium 

5. Rice milk

   Rice milk is a good option if you have allergies or intolerances to dairy, gluten, soy and nuts. It usually has a watery consistency and you can have it on its own or in smoothies. It’s not so good if you’re on a low-carbohydrate diet, as it’s very high in carbohydrates and can have added sugars. It’s also low in protein, so isn’t the best option for children, the elderly or those in need of higher protein requirements. It contains very little calcium too so when selecting rice milk, be sure you select one with added calcium

More information

• Cow’s milk (dairy) allergy at the Australian Society of Clinical Immunology and Allergy
• Dairy foods at healthdirect Australia
• Lactose intolerance at healthdirect Australia
• Lactose intolerance and the breastfed baby at the Australian Breastfeeding Association
• Milk intolerance in babies and children at Pregnancy, Birth and Baby

Sources

https://allergy.org.au/hp/anaphylaxis/first-aid-for-anaphylaxis/

https://www.healthline.com/nutrition/best-milk-substitutes#section4

https://www.healthdirect.gov.au/lactose-intolerance

https://healthywa.wa.gov.au/Articles/J_M/Lactose-intolerance-in-babies

https://www.breastfeeding.asn.au/bf-info/lactose

https://www.pregnancybirthbaby.org.au/milk-intolerance-in-babies-and-children

https://www.healthdirect.gov.au/dairy-foods

https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/understanding-lactose-intolerance/

https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics

All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified healthcare professional.