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Are you lactose intolerant, or do you have a milk allergy?

They both involve a reaction to dairy products but they’re not the same.

23 August 2019
by Meg de Jong

Much confusion reigns when it comes to figuring out the difference between lactose intolerance and a milk allergy, which are actually two different digestive problems. One of the key differences is that a milk allergy (a true food allergy) ensures a much more severe physical reaction than lactose intolerance does. Another one is that a milk allergy generally shows up early in life, while a lactose intolerance can occur at any time of your life, is more common and takes longer to develop. 

We break them down further for you so you know how to differentiate between them and deal with them effectively. 

What is lactose intolerance?

Lactose intolerance is the body's inability to produce enough of the enzyme lactase needed to break down lactose, a sugar found in milk and dairy products such as butter, cheese, cream and yoghurt. 

“Lactose is digested with the aid of the enzyme, lactase, that is produced in the small intestine,” explains Mayuri Bhawan, a dietician. “Inadequate production of this enzyme causes lactose not to be digested, and undigested lactose that passes through the gastro-intestinal tract can cause great discomfort.” 

This intolerance can be genetic or it can be caused when your small intestine is damaged by a viral or bacterial infection. It can be temporary or permanent, and it generally increases with age and is quite common amongst the elderly. 

Symptoms of lactose intolerance are limited to the stomach and intestines, and include stomach ache, nausea, cramps, bloating and diarrhea.

What is a milk allergy?

“With a milk allergy, the immune system reacts inappropriately to the protein in milk,” explains Bhawan, adding that an allergy to cow’s milk is the most common food allergy in infants and young children. Fortunately many children outgrow this allergy by age five. 

Symptoms involve the immune system and can range from quite mild to very severe. They include rashes, hives, itching, swelling, trouble breathing, wheezing and loss of consciousness. 

What to avoid when you are lactose intolerant or have a milk allergy

Even doctors have trouble differentiating the two from each other and may ask you to keep a food diary, avoid dairy for a while and then reintroduce it (lab tests can also help diagnose the condition). 

The first step in managing a milk allergy or intolerance is to avoid most dairy products, including:

  • Milk and milk products
  • Evaporated milk
  • Condensed milk
  • Ice cream
  • Yoghurt
  • Custard 
  • Egg custard
  • Cheese

It’s also very important to read the labels on food products, as lactose may be included in unexpected places, such as in processed meat, packet and tinned soups, bread and cakes, soy sauce, fruit juice, omelettes and scrambled eggs, and desserts.

Fortunately for some who suffer from a lactose intolerance, you may be able to tolerate small amounts of dairy, such as hard cheeses and yoghurt products, which tend to be lower in lactose than milk. 

If you have a milk allergy, you also need to avoid ingredients such as casein, whey, lactulose, lactalbumin and ghee.

Alternative food and practical cooking advice 

Bhawan recommends several non-dairy products as alternatives to products that include lactose. These include:

  • Products marked “Kosher”, “Parve” and “Parevo”
  • Cardin or Ole, non-dairy margarines
  • Orley whip, an example of a non-dairy instant cream
  • Non-dairy coffee creamers in place of milk in hot beverages
  • Water, soya milk (although some people with an allergy are allergic to soy too), rice milk, almond milk, coconut milk, fruit juice, or meat/ chicken stocks may be used in recipes in place of milk
  • Tofu instead of cheese 

Get enough calcium

Milk is the greatest source of calcium, the mineral that builds bones and keeps them strong. If you have to cut out milk products completely, ensure you are taking in enough calcium. “This can be difficult as you’d have to take in impractically large amounts of other food groups (such as dark leafy green vegetables like spinach, as well as almonds) in order to get the same supply of calcium as from milk,” explains Bhawan. “Supplementation is, in fact, the best course of action. 

Talk to your dietitian or Clicks pharmacist about finding the right supplement for you.

IMAGE CREDIT: 123rf.com