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Lactose-free or dairy-free?

We’ve noticed that some of our patients and friends aren’t clear on the differences between dairy-free and lactose-free. If you have a friend who has dietary restrictions, it may be helpful to clarify this, so that you can invite them to dinner, or bake them a birthday cake that they can enjoy. For such folk that’s a huge treat: a gift in and of itself!

Lactose is the main sugar in milk. It is made up of 2 small sugar molecules bound together, and it is broken into those two molecules in our digestive tracts, by an enzyme called lactase. We can absorb those small sugar molecules, whereas the larger lactose molecule is too big to be absorbed.


Most of us make lactase, so we absorb those sugars nicely. Some people can’t make it after childhood, so the lactose they consume remains intact. Lactase was most important in infancy, because milk is food for baby mammals. 


If we don’t break lactose down in our small intestines, it passes intact into our large intestine, where it feeds the good bacteria that live there. An unfortunate by-product of this consumption is gas, which can be uncomfortable and embarrassing!

This genetically-based intolerance to lactose has been noted for a long time. There is a test for it in the western medical system, so it has become relatively well known in our general population. Those who test positive for lactose intolerance can get lactose-free dairy products in many shops. 


However, this shouldn’t be confused with dairy-free. This is a common misunderstanding we see in practice. Lactose-free milk contains all of the other ingredients of milk, and many of these components trigger intolerance reactions in some people.  For those folk, using lactose-free dairy products isn’t going to be enough of a change to deal with their discomfort. But if they don’t realise that lactose isn’t the only problematic part of dairy, they may never try being completely dairy-free to experience the benefits of that. 


Dairy sensitivity may manifest as more than just gut cramps and gas. It can trigger headaches, affect skin, mood and mental clarity, and has been implicated in auto-immune conditions.


The main milk proteins are casein and whey. Whey protein became a popular supplement in powder form. Whey is separated from curds in making cheese from milk. Cheese is made from the curds, and the whey is a by-product. Dr. Penny’s aunt was a cheese-maker and pig farmer, and she fed the whey to her pigs, to increase their protein intake.


The caseins in goat’s and sheep’s milks are slightly different from the caseins in cow’s milk. Some people find they tolerate those better.

Also, the casein in milk from Holstein cows differs from the casein in milk from Devonshire cows. Holstein breeds are more common on the North American continent, Devonshire breeds are seen more in Europe. Some people find they can tolerate milk from Devonshire cows better than milk from Holstein cows, presumably for this reason. Some cheese-lovers have been delighted to find they could enjoy French cheeses on their European holidays, although cheeses from the North American continent always cause them problems.


Some people find they react more to pasteurised milk, as the heat that is used to control bacterial growth and help the milk last longer, also alters the proteins. Proteins are complex molecules, so it is easy to imagine that some of those changes may alter how they work in some people’s systems.


Ghee is purified butter: the proteins have been removed. Those with a mild intolerance may find that they can tolerate ghee better than butter. People with strong intolerances should probably stay away from ghee too, and those with overt allergic reactions should definitely avoid it. It is “cleaner” but not guaranteed 100% free of all potentially aggravating molecules.


Most margarines contain whey or other milk ingredients. Don’t be fooled by names such as “olive margarine”: it may contain olive oil, but that does not mean it is free from milk ingredients. And margarines are mostly ultra-processed foods, so are best avoided anyway.

If you are avoiding dairy, the constituents to look out for on lists of ingredients are:


Butter🔷Casein or Caseinate🔷Cheese 🔷 Lactose 🔷 Milk 🔷 Whey

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