Dairy-Free Diet
Rachel Dyckman, MS, RDN, CDN

Rachel Dyckman, MS, RDN, CDN

Introduction to a Dairy-Free Diet

Dairy alternatives have exploded over the past few years, with more and more dairy-free products in grocery stores each year. Milk alternatives taste great and plant-based cheeses stretch like dairy-containing cheeses. It’s easier than ever to follow a dairy-free diet. Dairy provides key nutrients like calcium, vitamin D, riboflavin and protein, but it certainly isn’t the only way to obtain these nutrients! But should you really go dairy-free?

 

What is a dairy-free diet?

A dairy-free diet excludes products made from mammal milk (like cows or goats). This includes foods that contain whey or casein (the two main proteins in milk) and foods that contain milk sugar. A lactose-free diet only excludes dairy products that contain lactose (the sugar found in milk products).

 

Who should follow a dairy-free diet?

Dairy Allergy

Anyone with a dairy allergy should exclude all dairy products from their diet. A dairy allergy is different from an intolerance, in that individuals with an allergy have an immune reaction to milk protein. These reactions can cause unpleasant and dangerous symptoms including but not limited to:

  • Wheezing
  • Coughing
  • Hives
  • Itching or tingling of the lips or mouth
  • Watery or swollen eyes
  • Difficulty swallowing
  • Skin rash
  • Shortness of breath
  • Tightness of the throat
  • Vomiting
  • Diarrhea 
  • Abdominal cramping

Dairy allergy symptoms may occur anywhere from a few minutes to a few hours after consuming dairy. Those with a severe dairy allergy may need to carry around an EpiPen in order to stop or slow down a severe reaction, called anaphylaxis, in case dairy is accidentally ingested. If you experience a severe allergic reaction and need to use your EpiPen, you should always call 911 or have someone take you to the nearest emergency room right away. This is because it is possible to have a second bout of severe symptoms that require medical attention.

 

If you suspect that you may have a dairy allergy, it is best to be evaluated by a doctor or allergist who may perform one or a combination of the following tests:

Skin Prick Test

For this test, a portion of the skin (usually on the forearm or back) is pricked and exposed to liquid that contains dairy allergens. If a raised bump develops at the site of the prick, it is likely that you have a dairy allergy. 

IgE Antibody Blood Test

A blood test can also be performed to measure the levels of dairy allergen-specific immunoglobulin E (IgE) antibodies in your blood.

 

It is important to note that it is possible to have “false positive” results from either test. Your doctor or allergist will interpret your results and determine whether or not it is appropriate to have you take part in an “oral food challenge.” 

 

Oral Food Challenge

For an oral food challenge, you are fed different quantities of dairy foods in a medical setting and observed for allergic reactions. If you develop allergic symptoms, the challenge will stop.

 

Dairy Intolerance

Those with a dairy protein intolerance may experience gastrointestinal discomfort after consuming dairy. This occurs because these individuals have difficulty digesting dairy protein properly. Many follow a dairy-free diet to reduce symptoms. These symptoms are generally less severe than allergies and are not life-threatening. They may include: 

  • Abdominal pain
  • Diarrhea
  • Bloating
  • Flatulence
  • Nausea

Onset of these symptoms generally occurs between 30 minutes and 2 hours after dairy is consumed and may last between 12 and 48 hours, depending on the individual and quantity consumed.

 

Although a number of food intolerance tests exist that claim to evaluate for dairy protein intolerance, evidence to support the efficacy of these tests is lacking. The best way to assess for a dairy protein intolerance is to temporarily eliminate dairy products from your diet for 2-4 weeks to see if your symptoms improve. Then, try gradually reintroducing dairy products back into your diet to see if symptoms return. If they do, it is likely that you have a dairy protein intolerance. You may want to consider working with a Registered Dietitian to help guide you through this process and interpret your symptoms.

 

Lactose Intolerance

Similarly to those with a dairy protein intolerance, those with lactose intolerance may experience the following symptoms after consuming dairy:

  • Abdominal pain
  • Diarrhea
  • Bloating
  • Flatulence
  • Nausea

Symptoms usually occur 30 minutes to 2 hours after consuming dairy. They will last until lactose passes through your system, which may take between 12 and 48 hours. 

 

Lactose-intolerant individuals can consume lactose-free dairy products without symptoms. Some choose to eliminate dairy products. For those that want to consume dairy, lactase pills can provide relief. Lactase is the enzyme that breaks down lactose, making it easier to digest.

 

While the most accurate way to assess for most food intolerances is trying a temporary elimination of the suspected offender for 2-4 weeks to see if your symptoms improve, there are 2 other ways to test for lactose intolerance. 

Lactose Tolerance Test

One way is through a lactose tolerance test. For this test, an individual drinks a lactose-containing solution and then has their blood sugar levels checked. If the individual is lactose intolerant, their blood sugar levels may either rise very slowly, or stay the same. This occurs because they are not able to break down lactose sugar into glucose. 

Hydrogen Breath Test

Alternatively, a hydrogen breath test can be used to diagnose lactose intolerance. For this test, an individual fasts overnight and then blows into a device that measures the hydrogen content of their breath. They are then given a lactose-containing solution to drink and have their breath re-tested for hydrogen gas in 15-minute increments over a 2-hour period. If an individual produces a large amount of hydrogen gas, this suggests that lactose sugar was not adequately broken down and made its way into the large intestine. Here, bacteria start to ferment the lactose sugar and produce hydrogen gas as a byproduct, indicating lactose intolerance.

 

Skin Conditions

Individuals with skin conditions that may be linked to food allergies, such as atopic dermatitis (a type of eczema), may also benefit from a dairy-free diet. Furthermore, some people blame dairy for worsening their acne, but evidence for this claim is largely anecdotal. 

 

Personal, Ethical or Cultural Reasons

Some choose to follow a dairy-free diet due to personal preference or for ethical or cultural reasons.

 

How to follow a dairy-free diet

A dairy-free diet excludes any foods made with dairy products (such as milk, yogurt, cheese, butter, buttermilk, sour cream, ice cream and some baked goods). Dairy can also show up unexpectedly in salad dressings, dips, protein powders, chips, and even in some chewing gums (look out for Recaldent—a dairy-derived compound used to help remineralize tooth surfaces)! If you have a dairy allergy, it is crucial to always check ingredient lists for dairy-containing ingredients. The Fig browser extension and aisle can help you identify dairy-free foods!

 

Helpful tips when starting a dairy-free diet

There are several surprising dairy-containing ingredients to watch out for. This includes (but is not limited to): 

  • casein
  • caseinates 
  • casein hydrolysate  
  • curds  
  • diacetyl 
  • dry milk powder  
  • dry milk solids 
  • ghee  
  • lactalbumin  
  • lactoferrin 
  • lactoglobulin  
  • lactose  
  • lactulose 
  • milk byproducts   
  • non-fat dry milk  
  • Recaldent 
  • rennet casein 
  • and whey 

 

Watch out for the phrase “contains milk” on food labels because this indicates dairy. Milk is considered to be one of the 8 major allergens by the FDA (soon to be 9). The Food Allergies Labeling and Consumer Protection Act of 2004 requires all milk-containing foods to be clearly labeled. 

 

When dining out, it’s important to inform your server that you cannot consume any dairy products. Don’t be afraid to inquire about the ingredients in dishes. With food allergies on the rise, most restaurants will accommodate dietary restrictions. Asian cuisines provide a wide array of dairy-free options (but it is always important to double check!).

 

Things to look out for on a dairy-free diet

A dairy-free diet can be healthy and nutrient-dense, but you should make sure you still get enough calcium, vitamin D, protein and riboflavin.

 

Calcium

Calcium is required for bone health and muscle contraction, and plays an integral role in blood clotting. Luckily, calcium can be found outside of dairy products. Dark green leafy vegetables, especially those in the cruciferous family (like broccoli, kale, bok choy and mustard greens), are excellent sources of calcium. Just 2 cups of cooked kale contains more calcium than a glass of milk! Other dietary sources of calcium include canned fish (such as sardines, salmon and anchovies), tofu, and calcium-fortified milk alternatives.

 

Vitamin D

Vitamin D plays many roles in the body, and is important for immune function, calcium absorption, and overall bone health. In the US, most milk is fortified with vitamin D, helping milk drinkers maintain adequate vitamin D levels. The sun’s rays are our most significant source of vitamin D, but foods such as eggs, fatty fish and cod liver oil also contain this important vitamin.

 

Riboflavin

Riboflavin is essential for carbohydrate metabolism, which helps our bodies produce energy. Dairy products contain riboflavin, but eggs, whole grains, meat, poultry, seafood and green vegetables also do.

 

Protein

You can get protein in a lot of ways. One option is animal sources, like meat, poultry, seafood and eggs. Plant-based sources, like beans, legumes, nuts, seeds, tofu, tempeh, and seitan, and even whole grains can also be good sources of protein. You don’t need to eat dairy to get enough protein. Many dairy alternatives contain less protein than their dairy-containing counterparts, which is important to keep in mind when planning your meals.

 

Who is a dairy-free diet not for?

Following a dairy-free diet is generally safe and poses few risks. If you follow a dairy-free diet, make sure you are obtaining sufficient calcium, vitamin D, riboflavin, and protein from other sources. Additionally, seek out medical care to better evaluate for a potential allergy or health concern before testing out a dairy-free diet by yourself!

 

Photo by Alexander Mills on Unsplash.com

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