It’s become an expression that I now barely notice anymore: “Is that with dairy milk?”
“What other sort of bloody milk is there?” said my aunt to me recently, as we stood in line for our coffees. At age 84, she can be forgiven for not realising how many alternatives are now available for a splash of white stuff in your americano. And for turning her nose up at the suggestion of soya milk. (“I’d rather drink puddle water.”)
Dairy gets a bad rap – sometimes justifiably so, sometimes not. Behind the rise of oat milk lattes sits a surprisingly complex question: why are so many of us choosing to avoid dairy? Because it upsets our stomachs? Because plant-based milk feels like a healthier, more ethical choice, or tastes much better? Or because of other claims – perhaps that dairy can cause excessive inflammation, clogged pores, or even cancer?
One of the biggest drivers of the dairy debate appears to be confusion – about symptoms and what causes them. But who actually needs to avoid dairy, and who might be cutting it out unnecessarily?
An adverse reaction to dairy most commonly points to one of two quite different problems: an allergic reaction to milk proteins, or an intolerance to lactose – the sugar molecule found in dairy products. Both of these are found in all (not just some) cow’s milk products, including butter, cream, yoghurt and cheeses – albeit in differing amounts.
When lactose isn’t properly broken down into smaller, absorbable sugars, it remains inside the gut – drawing in water and fermenting under the watch of gut bacteria. The result? Wind, bloating, vomiting and diarrhoea, abdominal discomfort, even pain.
Cow’s milk protein allergies are different. Since they trigger activation of the immune system, the reaction can impact more than just the gut – although symptoms like vomiting, diarrhoea and pain are common. The skin may become involved – with red, raised and itchy patches called urticaria (or hives), and flares of eczema. Respiratory symptoms can occur too, including coughing, wheezing, and nasal congestion. In children, growth and weight gain may also falter.
Symptoms can appear quickly or slowly, and be clear to spot, or extremely vague. And as with any allergy, symptoms can sometimes prove extremely severe, even life-threatening. Anaphylaxis – a severe allergic reaction – can also occur, causing symptoms like swollen tongue or throat, fast or difficult breathing, hives, floppiness, fainting and collapse. Luckily, these instances are rare – but always treat them as an emergency, and call 999 if noted.
Recognising symptoms that seem to appear after eating dairy should prompt you to speak to a doctor, rather than simply cutting foods out yourself. GPs and dietitians can provide safe guidance on monitoring food intake and symptoms, and help work out whether dairy is the true cause – many other intestinal disorders such as coeliac disease, inflammatory bowel disease and irritable bowel syndrome could be to blame instead.
And understanding a few dairy home truths can help both you and your GP – in working out the right diagnosis, and a way forward.
Myth one: those with lactose intolerance can never touch dairy
For many patients with a lactose intolerance, it’s often possible to include small amounts of dairy in their diet without troublesome reaction – and complete avoidance isn’t always necessary. Smaller portions and lower lactose foods, like cheese, can be a good starting point for experimentation. Stronger-tasting lactic goat and sheep’s milk cheeses – like feta and pecorino – often require smaller amounts to achieve a decent flavour in cooking.
The type of dairy product matters, too. Fermentation can reduce lactose levels, so foods such as yoghurt and kefir may be better tolerated than others. Goat’s and sheep’s milk are sometimes described as easier to digest, but this does not always make them reliable alternatives, since they still contain lactose. Sometimes, it’s a case of trial and error – which is often the case when giving certain dairy products a go. And it’s important to note that certain processed foods can contain dairy and therefore lactose – a good reason to read the packaging very carefully beforehand.
Myth two: dairy allergies and intolerances are lifelong
Cow’s milk allergy is most common in infancy and early childhood, affecting around two to three per cent of young children. Symptoms often become apparent when cow’s milk formulas or other dairy foods are introduced, making it more frequently observed in bottle-fed babies. However, some breastfed babies can also develop symptoms, since cow’s milk proteins from their mother’s diet can cross over into breast milk. Milk allergies can persist into adulthood too, and sometimes (though rarely) develop later in life. However, most affected children will outgrow them, as their gut and immune systems continue to evolve with age.
Lactose intolerance, however, tends to develop in later childhood, though sometimes within adolescence, or as an adult. Natural levels of lactase – the enzyme that digests lactose – may decline with time, potentially making symptoms more likely and more visible as you grow older. A dairy intolerance can also be temporary; damage to the intestinal lining following a viral infection can also impact lactose digestion in children. Dairy can often be successfully reintroduced later, after the gut has recovered.
I’ve seen reactions to dairy across the spectrum: from babies aged a few weeks old who are colicky, vomiting every feed up, or faltering with putting weight on – to patients in their sixties who’ve had mildly upset stomachs for 30-plus years, who’ve put it down to just having “bad guts”. So, it goes to show that symptoms can be easy or difficult to spot, and present at different stages of life.
Myth three: dairy is the root cause of other health problems, like acne and cancer
Dairy has been linked with several health conditions, but that doesn’t mean it is a key contributor. Some studies, for example, have found an association between milk consumption and acne – although acne is influenced by many other factors, including hormones, genetics and stress.
Other claims of generating excess mucus or hormonal imbalances don’t stand up to scrutiny. Relation to cancer is more complex – some evidence suggests dairy could increase the risk of certain types (like prostate cancer), but decrease the risk of others, like colorectal tumours.
Inflammation is another battleground. Whilst it’s clear that dairy can trigger immune responses in allergic individuals, evidence looking at the wider population suggests no clear pro-inflammatory effects. In fact, some studies have demonstrated that certain products, especially fermented ones, could have modest anti-inflammatory properties.
So, how to approach concerns about dairy?
Variability between different individuals means that symptoms can be really difficult to identify. Testing is often not as straightforward as it sounds. Blood, skin, stool and even breath tests can help, but may vary in their reliability.
Eliminating dairy in its entirety may be necessary in patients with confirmed adverse reactions – whilst for others smaller amounts of certain dairy foods can be negotiated. If you’ve noticed a recurring pattern, keeping a diary of what and how much you eat, and when symptoms occur, can be useful when discussing the problem with a healthcare professional.
And what are the alternatives? There are a wide variety of dairy-free foods available, and substitutes for common dairy ingredients, like oat, soya and nut milk – other allergies permitting. In babies, things need to be managed more carefully. Breastfeeding mothers are sometimes advised to eliminate dairy from their diet to prevent crossover in breast milk, whilst alternative preparations for bottle-fed babies are available through a GP.
Plant-milk alternatives can certainly form part of a healthy diet, but are not always nutritionally equivalent to dairy milk. They’re also not recommended as a substitute for breastmilk or infant formula in babies less than a year old.
Discussion with a doctor is vital. This is especially true for anyone with severe symptoms, and for children, where growth and development are at stake – referral to a paediatrician might be needed. If dairy needs to be excluded, appropriate substitution or supplementation may be warranted, since it can be an important source of protein, calcium, iodine, and Vitamin B12.
When it comes to dairy, the answer isn’t always simply to include or exclude – but to better understand how your body responds to it. It doesn’t have to be a hero or villain; for most of us, the real question is what we can tolerate, enjoy and need within our diet.
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