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Is Lactose Intolerance A Milk Allergy

How To Find Out If You Have Lactose Intolerance

Lactose Intolerance vs. Milk Protein Allergy – Dr. Elaine Barfield & Shara Wagowski, RD

There are several ways your doctor might test you for lactose intolerance. Usually, the first step is to consume a high-lactose beverage. Then, your doctor will either measure the:

  • Glucose in your blood
  • Hydrogen levels in your breath
  • Acid in your stool .

As an alternative, your doctor may also request a blood test that does not require any ingestion of lactose, as it checks for a specific genetic trait: the presence of the gene called Lactase persistence gene. This is the gene encoding for the enzyme Lactase, and its absence implies you will lose your ability to digest lactose at some point in your life due to genetic pre-programming.

If you want to be tested for lactose intolerance, you should follow up with your primary care doctor, allergist, or gastroenterologist.

But often, people with reactions to dairy find it easier to challenge themselves to âtestâ for lactose intolerance at home â provided the symptoms they experience arenât extreme. This can be done by either taking a lactase pill before eating dairy, or consuming a dairy product where lactose has been removed by the previous addition of lactase . In either case, if you no longer have a reaction to dairy, then you can be reasonably sure that lactose intolerance is the problem, rather than a dairy allergy.

The Impact Of Knowledge About Lactose Intolerance On Dairy Avoidance

The relationship between gastrointestinal symptoms and lactose consumption has a somewhat historical basis. Such nonspecific symptoms have been recognized for a long time and have also been diagnosed under the term Irritable Bowel Syndrome . This condition, with other functional gastrointestinal symptoms, have generally been classified based on symptomatic and timeline criteria. These have gone through a number of modifications through selective meetings under the Rome Criteria . IBS represents one form of these gastrointestinal disorders. The gastrointestinal symptoms of LI can be very similar to those of IBS. In the second part of the 20th century when lactase and its relationship with lactose was described, the cause for IBS seemed to be discovered. Lactose in LNP persons caused bloating, gas, and even diarrhea without apparent pathological alterations in the gastrointestinal tract. Since LNP status could only be detected by specific tests, it was natural to consider LM to be the cause of IBS. This however is not the case.

Self-reported lactose intolerance is an unreliable diagnostic tool for lactose maldigestion. In a systematic review of 26 studies, evaluating the reliability of gastrointestinal symptoms to predict malabsorption, Jellema et al. found a highly variable outcome. When breath hydrogen outcomes were evaluated only a non-Caucasian ethnic origin was predictive of positive tests. Both lactose absorbers and maldigesters reported symptoms during testing .

Physiological Benefits Of Lactose In Human Milk

Lactose in human milk contributes significantly to the daily energy intake of breastfed infants. Due to the required hydrolysis by lactase, there is a delayed and sustained effect on blood glucose levels. Lactose in breast milk is thought to increase the absorption of calcium . As young infants do not absorb all of the lactose from breast milk, malabsorbed lactose acts as a prebiotic . This is associated with increased counts of Bifidobacteria and increased concentrations of SCFA which confer a protective effect on colonic mucosal integrity and have a beneficial effect on early immune development .

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Causes And Types Of Lactose Intolerance

Lactose is made up of the simple sugars glucose and galactose.

You need the enzyme lactase to break lactose down into glucose and galactose, which your body then absorbs into your bloodstream for energy.

Without sufficient lactase, lactose moves through your gut undigested and causes digestive symptoms. Still, there are multiple causes of lactase deficiency (

1 ):

  • Hydrogen breath test. This test measures hydrogen in your breath after lactose intake. High amounts of hydrogen suggest digestive problems that may be related to lactose intolerance but also caused by other issues.
  • Lactose tolerance test. This test measures your blood sugar after lactose ingestion. If you have lactose intolerance, your blood sugar levels wont be affected because your body cant break down lactose.
  • Genetic test. This test checks for genetic causes of lactose intolerance, but people with secondary lactose intolerance may receive a false negative.
  • Lactase activity at jejunal brush border. This invasive and expensive method requires a biopsy of the jejunal brush border, which is part of your small intestine, but is a definitive way to assess lactase activity.
  • Stool acidity test. Often used for babies and infants, this test measures stool acid levels, which have a lower pH in cases of lactose intolerance .

summary

Your doctor may choose among several tests to check for lactose intolerance. Otherwise, you can try an elimination test yourself.

Getting Enough Calcium In Your Diet

Are You Really Lactose Intolerant?

Once you learn you are allergic to milk, you may wonder how to replace that 240 mg of calcium per glass back in your diet. The obvious answer is to take calcium supplements on a daily basis. But there are foods that supply a good amount of calcium that you should be aware of:

leafy green vegetables

enriched soy milk, rice milk, or tofu

baked beans

molasses

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When To Seek Medical Advice

The symptoms of lactose intolerance can be similar to several other conditions, so it’s important to see your GP for a diagnosis before removing milk and dairy products from your diet.

For example, the symptoms above can also be caused by:

  • irritable bowel syndrome a long-term disorder that affects the digestive system
  • milk protein intolerance an adverse reaction to the protein in milk from cows

If your GP thinks you have lactose intolerance, they may suggest avoiding foods and drinks containing lactose for 2 weeks to see if your symptoms improve.

What About Dairy Allergies

Milk allergy is an abnormal reaction to one or more of the proteins in cows milk. It can cause anything from mild to severe symptoms and always involves the immune system. It affects about 3-6% of infants and young children, although most grow out of it by five years of age. Milk allergy in older children and adults is rare, but if you do suspect an allergy, its really important to speak to your G.P. who can refer you to an allergy specialist if necessary.

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Is This A Milk Allergy Or Lactose Intolerance

Milk makes you sick, but you dont know why. In this article, well take a closer look at what could be causing your discomfort as we explore the difference between milk allergy and the more prevalent lactose intolerance.

What is happening in my body?

  • Milk allergy is a result of your immune system reacting to proteins found in milk. There is nothing wrong with these proteins, but your body gets confused and perceives them as harmful invaders in the same class as germs. In order to protect your body from this perceived threat, your immune system triggers the release of chemicals into your body. The irony is that these chemicals do nothing to the milk proteins. Rather, they make you feel crummy.
  • Lactose intolerance has nothing to do with your immune system. Rather, it has to do with an enzyme called lactase. Lactase is an enzyme that breaks down the sugar found in milk. That sugar is called lactose. Your body should produce enough lactase all on its own to break down the lactose contained in milk. However, if you cannot produce enough of this enzyme, you will find yourself feeling miserable every time you ingest dairy products.

What are the symptoms of these two conditions?

  • Lactose intolerance:
  • Gastrointestinal problems

As you can see, both of these conditions cause gastrointestinal problems, but the similarities generally stop there.

How common are these conditions?

Can I get a diagnosis?

Are there treatment options?

About The Author

How To Find Out If Youre Allergic To Milk

Food for Thought | Milk Allergy vs. Lactose Intolerance

To find out if youâre truly allergic to milk, the gold standard test is an IgE food allergy blood test. This test will tell you if you have an IgE-mediated milk allergy. During or after testing, itâs a good idea to work with a certified allergist for management. This is important regardless of whether your test results are positive or negative for milk allergy.

If your test is positive, an allergist can help you come up with an appropriate treatment plan, so you know what to do if you have a reaction. If your test is negative, they can help figure out whether a different food is causing your symptoms, you have a non-IgE mediated allergy, or you have an intolerance, which canât be diagnosed by IgE blood testing. An allergist might also have you try an elimination diet and/or run an oral food challenge to confirm the results of your blood test.

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What Is The Government Of Canada Doing About Priority Food Allergens Gluten Sources And Added Sulphites

The Government of Canada is committed to providing Canadians with the information they need to make safe and healthy food choices. The Canadian Food Inspection Agency and Health Canada work closely with municipal, provincial and territorial partners and industry to meet this goal.

The CFIA enforces Canada’s labelling laws and works with associations, distributors, food manufacturers and importers to ensure complete and appropriate labelling of all foods. The CFIA recommends that food companies establish effective allergen controls to prevent the occurrence of undeclared allergens and cross-contamination. The CFIA has developed guidelines and tools to aid food companies in developing these controls. When the CFIA becomes aware of a potential hazard associated with a food, such as undeclared allergens, Health Canada is asked to assess the situation. When a serious risk is identified, the food product is recalled from the marketplace and a public warning is issued. The CFIA has also published several advisories to industry and consumers regarding allergens in food.

More information on the regulations that enhance the labelling of food allergens, gluten sources and added sulphites can be found on the Health Canada website:

If you come across a food that you think is improperly labelled, contact the CFIA and provide information about the product.

Report a food safety or labelling concern.

Colorectal Cancer And Inflammatory Bowel Diseases

Epidemiological studies evaluating the correlation between colorectal cancer or IBD and lactase distributions appear to be inversely related with LNP . As such, countries with high dairy consumption appear to have higher rates of these bowel diseases, with colorectal cancer and ulcerative colitis showing a statistically significant relationship. These calculations were centered around the year 2000, and since then rates have increased even more in developing countries with progressive industrialization. However, despite the geographic observations colon cancer rates actually were consistently shown to be inversely associated with dairy intake in observational studies . Although no formal Mendelian randomization studies exist evaluating dairy products and colorectal cancer a geographic regional evaluation of observational studies from three regions of the world based on predominant phenotypes of lactase distributions in the world showed that dairy modestly protects in both high LP and high LNP regions .

More recently, other nutrients than calcium and vitamin D, in dairy products, have also been attributed to possess antineoplastic properties (milk fat globule , medium chain triglycerides , conjugated linoleic acid , whey protein , and lactose .

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When Should You Contact A Doctor About A Milk Allergy

If you suspect that you or your child has a milk allergy, you should contact a healthcare professional either your own care provider or an allergist to be evaluated. If you have been diagnosed with a milk allergy, you should follow up with your allergist annually as new treatments are coming available.

If you have a milk allergy, epinephrine should be carried with you at all times. Also, you should always call 9-1-1 and go to an emergency room when you have used epinephrine, not because the medication is dangerous but because the reaction you are having is dangerous.

Milk Allergy Or Lactose Intolerance

Are you Intolerant or Allergic to Milk?

There are many individuals who have to avoid milk, but why do they have to? Is it because of an allergy or intolerance? Many people dont realize that there are different causes to some of the similar symptoms, like stomach upset, that can occur after consuming milk. There is a difference between cows milk allergy and lactose intolerance.

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What Causes Lactose Intolerance

The body digests lactose using a substance called lactase. This breaks down lactose into 2 sugars called glucose and galactose, which can be easily absorbed into the bloodstream.

People with lactose intolerance do not produce enough lactase, so lactose stays in the digestive system, where it’s fermented by bacteria.

This leads to the production of various gases, which cause the symptoms associated with lactose intolerance.

Depending on the underlying reason why the body’s not producing enough lactase, lactose intolerance may be temporary or permanent.

Most cases that develop in adults are inherited and tend to be lifelong, but cases in young children are often caused by an infection in the digestive system and may only last for a few weeks.

What Can I Do

Be informed

Consult your allergist or physician in order to obtain the advice and support needed to help manage your condition. Contact your allergy association for further information.

If you or anyone you know has food allergies and would like to receive information about food being recalled due to improper allergen labelling, sign up for the Canadian Food Inspection Agency’s e-mail Food Recalls and Allergy Alerts notification service. When you sign up you will automatically receive timely food recall notifications.

Before eating

Allergists recommend that if you do not have your auto-injector device with you that you do not eat. If the label indicates that a product contains or may contain milk, do not eat it. If you do not recognize an ingredient, if there is no ingredient list available or if you don’t understand the language written on the packaging, avoid the product.

Watch out for allergen cross-contamination!

Cross-contamination is the accidental transfer of an ingredient to a product that does not normally have that ingredient in it. Through cross-contamination, a food that should not contain the allergen could become dangerous to eat for those who are allergic.

Cross-contamination can happen:

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Milk Allergy Vs Lactose Intolerance: Whats The Difference

Milk allergy and lactose intolerance are often mixed up and confused for the same thing, even though the conditions are both very different and have different causes behind them. Although they may sound similar to each other, they have different causal agents that need to be understood properly.

When you speak of lactose intolerance, you are talking about a condition that takes place in the digestive tract. You see, every time you consume milk, your body releases an enzyme called lactase that helps break the lactose in the milk down and helps you digest it.

Those who suffer from lactose intolerance cannot make this enzyme or make enough of it to be able to properly digest milk all the way. This causes a lot of digestive problems and discomfort. The non-digested lactose, which is the sugar in the milk, moves away from the stomach and small intestine.

The lactose ends up in the colon where all kinds of gut bacteria feed on it and break it down, releasing gas as a byproduct. This process causes you to feel very bloated and gassy and causes digestive irritation and might even cause you to have watery bowel movements.

A dairy allergy, on the other hand, treats milk in your body like a foreign invader, attacking it ferociously. Your body starts releasing a chock full of histamines into your systems in order to attack the milk proteins, and these histamines are what cause allergic symptoms to appear in your body.

Other Treatments Which Encompass A More General Food Intolerance Symptoms

Cow’s milk protein allergy (CMPA) and lactose intolerance

When patients present in a clinic complaining of symptoms lactose does come up in the differential diagnosis, but its role is unclear even after appropriate tests for maldigestion of lactose. Most patients have heard of lactose intolerance and often they have restricted their intake without clear benefit. These patients may have other food intolerances or react to nutrients different from lactose in dairy.

As outlined above symptoms of lactose intolerance can merge with several other causes. Milk intolerance due to fats, A1 casein, or actual milk protein allergy, which is not IgE mediated, can overlap. In children Cows Milk Protein allergy is more significant, while in adults this condition is rare and may overlap more with symptoms of LI. The role of genetically-determined casein in cows causing symptoms requires further evaluation. In others several diseases, particularly celiac and Crohns disease, are conditions to consider in younger patients, while several other diseases, like microscopic colitis and others, need to be considered in older populations.

When symptoms persist , irritable bowel syndrome or other food intolerances need to be considered, although pharmaceutical treatments or other probiotics may be available several diets have been introduced that may help.

Where these diets will ultimately fit into treatment of gastrointestinal symptoms with dairy, therefore, is not yet clear, but do serve as other possible therapeutic options.

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Living With A Dairy Intolerance Or Allergy

So, you or someone you love is dairy free. Now what? Some individuals who are lactose intolerant may still be able to consume dairy by using a product such as lactaid. This product is said to help break down the lactose found in dairy products such as milk and cheese to allow digestion without stomach discomfort. But for those with a dairy allergy or for whom this type of product is not effective, eliminating dairy may be the only option. That was the case for my husband who, in addition to being gluten free like I mentioned in my last post, is also dairy free. He has personally chosen to simply eliminate dairy from his diet and add very few dairy alternatives in its place. The number one dairy free item we use is almond milk. I have found it to be a great replacement in pancakes, waffles and baking, as well as for smoothies. I always recommend using the plain, unsweetened variety. Or, better yet, you can make it yourself as I have recently started doing after reading several articles about some questionable ingredients used in the name brand products. I have included the recipe below if youd like to give it a try.

We also use rice milk , but, much less often. I find rice milk to be better for cooking as opposed to baking, such as for making dairy free mashed potatoes.

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