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Why should I try going "dairy-free"?

Dr Alan Desmond, MB, BcH, BAO, MRCPI, FRCP

I often recommend a dairy-free diet to my patients with significant digestive symptoms, either as a long-term treatment or as a temporary change whilst they are awaiting the results of various important tests.

Dairy foods are rich in a simple sugar called lactose. Our bodies need an enzyme called “lactase” to break this sugar down and allow our body to digest it. New-born babies consume a lot of milk and usually have high levels of this enzyme; however our lactase levels decrease as we age and some adults are quite deficient in this enzyme. If all of the lactose in your diet is not broken down, you will experience a degree of bloating, abdominal discomfort, excess gas and loose stools soon after you have consumed dairy products. This is referred to as “lactose intolerance”.

Lactose intolerance can develop at any age. Many cases first develop in people aged 20 to 40, and it can become more prominent as we get older. Lactose intolerance is very common, affecting up to 65% of people in Asia and Africa, and up to 10% of people in Northern Europe. The symptoms of lactose intolerance (bloating, excess gas and loose urgent stools) can also be seen in patients with Irritable Bowel Syndrome (IBS).

Many patients with IBS identify that dairy foods make their symptoms worse (1-3). One Spanish study showed that about 40% of patients with IBS identified dairy foods as a trigger for their symptoms and more than half had an underlying degree of lactose intolerance (3). Several studies have shown improvements in symptoms in response to a lactose-free diet in a significant proportion of IBS patients (4, 5). Beyond lactose, other components of milk and dairy foods such as casein may also trigger IBS symptoms (6, 7).

Studies have shown that a significant proportion of patients with Ulcerative Colitis or Crohn's disease may also have lactose intolerance (8). Therefore a 6-week trial of going dairy-free is also worthwhile if you have been diagnosed with one of these conditions. 


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What foods do I need to avoid to become “dairy-free”?

Becoming dairy-free  means completely avoiding any foods made from cow’s milk or any other animal milk (goat’s milk and sheep’s milk etc.).  The following foods are not allowed: Butter, butter-milk, dairy yogurt, cheese (all types), cream (all types), milk and milk solids, ice-cream, cottage cheese, fromage frais, skimmed milk, milk powder and all products containing casein or whey.

There are other foods that are likely to contain added dairy, so always check the label! These foods include: pre-prepared batter (for pancakes, waffles etc.), some breads, cheesy biscuits or straws, crème caramel, custard tarts and other puddings, ready meals, sauces especially white or creamy sauces, artificial cream, some vegetable spreads, cakes and biscuits, cheese-flavoured crisps, margarine, rice pudding and scones.

Dairy chocolate contains milk and is off the menu! However, lots of darker chocolates are made without milk, casein or whey. So you can still enjoy chocolate, just check the label.


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Can I use dairy-free substitutes?

There are many dairy-free alternatives to milk and yogurt on offer at supermarkets. Instead of using cow’s milk on your breakfast cereal or in your coffee, you can use almond milk, oat milk, rice milk or soya milk. You may have to experiment to find the type you like. These non-animal milks are usually sold in “sweetened” and “unsweetened” varieties, so choose whichever suits your taste. Supermarkets and health shops also sell a wide range of non-dairy yogurts and custards (such as Alpro), dairy-free vegetable spreads (such as Vitalite Dairy Free, Pure Dairy Free and Sainsbury’s Deliciously Freefrom Spread) and even dairy-free ice-cream. Always double check that the dairy-free product you are buying is free from milk, butter, whey and casein.

There are thousands of excellent dairy-free recipes available on-line, why not start with BBC Goodfood’s top 30 dairy-free recipes?

 https://www.bbcgoodfood.com/recipes/collection/dairy-free


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How long should I remain “dairy-free”?

If you are making this change to try and reduce IBS-type symptoms then a 6 week period of strict-dairy free eating is required to decide if things are improving. After this period, if your symptoms have not improved you may wish to reintroduce dairy foods. However, if you plan your diet and are eating a wide variety of non-dairy foods, there is no reason that you can’t remain dairy-free and healthy for the long-term.

Numerous medical studies have suggested that a balanced dairy-free diet can have multiple long-term benefits beyond improved digestive health. Most notably, reducing your consumption of dairy products may significantly reduce your risk for prostate cancer (9-11) and breast cancer (12).


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Will I get enough calcium and other nutrients on a dairy-free diet?

The short answer to this important question is: Yes.

If you are using dairy-free milks and yogurts, you will notice that most of these products are supplemented with calcium and vitamin D. A small glass of almond milk (250mls) typically provides half of an adult’s recommended daily allowance of calcium. You can also get more than enough calcium from other sources. For example, one cup of cooked kale contains about 100mg of absorbable calcium. Leafy green vegetables and beans are also rich sources of calcium and other nutrients that are important for bone health. This is not surprising, given that cows get all the calcium they need from eating grass!

Contrary to popular belief, milk consumption does not help to reduce your risk of osteoporosis or fractures in later life. The Harvard Nurses’ Health Study, which followed more than 72,000 women for 18 years, showed no protective effect of increased milk consumption on fracture risk (13).

Milk and dairy products are not necessary in the diet. If you are living “dairy-free” you will meet your dietary requirements for bone health by consuming a healthy diet of grains, fruits, vegetables, legumes, and fortified foods including cereals and juices. These nutrient-dense foods will help you to meet your calcium, potassium, riboflavin, and vitamin D requirements with ease.


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References

Here are all the research studies and review articles used to produce this page, if you click on the [PubMed] link you can read the original paper or abstract on-line for free

1.       Vernia P, Marinaro V, Argnani F, Di Camillo M, Caprilli R. Self-reported milk intolerance in irritable bowel syndrome: what should we believe? Clin Nutr. 2004;23:996–1000. [PubMed]

2.       Yang J, Deng Y, Chu H, Cong Y, Zhao J, Pohl D, Misselwitz B, Fried M, Dai N, Fox M. Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2013;11:262–268.e1. [PubMed]

3.       Dainese R, Casellas F, Mariné-Barjoan E, Vivinus-Nébot M, Schneider SM, Hébuterne X, Piche T. Perception of lactose intolerance in irritable bowel syndrome patients. Eur J Gastroenterol Hepatol. 2014;26:1167–1175. [PubMed]

4.       Böhmer CJ, Tuynman HA. The effect of a lactose-restricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5-year follow-up study. Eur J Gastroenterol Hepatol. 2001;13:941–944. [PubMed]

5.       Lisker R, Solomons NW, Pérez Briceño R, Ramírez Mata M. Lactase and placebo in the management of the irritable bowel syndrome: a double-blind, cross-over study. Am J Gastroenterol. 1989;84:756–762. [PubMed]

6.        Jianqin S, Leiming X, Lu X, Yelland GW, Ni J, Clarke AJ. Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk. Nutr J. 2016;15:35. [PubMed]

7.       MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis. 2007;13:91–96. [PubMed]

8.       Szilagyi A, Galiatsatos P, Xue X. Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases. Nutr J. 2016;15:67. [PMC free article] [PubMed]

9.       Qin L, Xu J, Wang P, Tong J, Hoshi K. Milk consumption is a risk factor for prostate cancer in Western countries: evidence from cohort studies. Asia Pac J Clin Nutr. 2007;16:467–476.

10.     Song Y, Chavarro JE, Cao Y, et al. Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians. J Nutr. 2013;143:189-196.

11.     Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Am J Clin Nutr. 2001;74:549-554.

12.      Kroenke CH, Kwan ML, Sweeney C, Castillo A, Caan Bette J. High-and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. J Natl Cancer Inst. 2013;105:616-623.

13.       Feskanich D., Willett W.C., Colditz G.A. Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Am. J. Clin. Nutr. 2003;77(2):504–511. [PubMed]