Today’s post seems perfectly timed; since many of you I’m sure spent most of the bank holiday contentedly consuming chocolate for breakfast, lunch and dinner. Easter Eggs are a huge part of Easter Sunday but interestingly, a recent guardian article noted that searches for dairy-free and vegan eggs were at an all time high. Many of us, it seems, are ditching dairy- especially those with gut health problems. Lots of these people don’t have a true allergy or diagnosed lactose intolerance, but can trace an increase in their digestive symptoms back to milk products. Today’s blog aims to explore the link between dairy and crohn’s and other gut issues- to consider why just why so many of us seem to find dairy so tricky to stomach.
First up, it’s important to distinguish the different levels of intolerance we might suffer from:
- Lactose Intolerance is an inability to digest milk sugars. This can be diagnosed by your GP but many people find they seem to be intolerant despite a negative test. If you are intolerant to lactose, your body may not produce enough lactase enzyme to digest lactose properly. This can be something you are born with, something that develops over time or something that happens for a short period of time (e.g. after a bout of gastroenteritis). If you have lactose intolerance, you should find that you can tolerate things like yoghurt and some types of cheese (e.g. cheddar) since they have low to no levels of lactose. You might also find a lactacse supplement helpful; since this replaces the enzyme your body needs to digest the proteins in milk.
- Milk intolerance. People who find it difficult to digest milk, may find symptoms do not improve even if they replace their usual dairy with lactose-free alternatives. They could therefore find the milk protein and fats difficult to digest (such as whey and casein) as well as the lactose. In this case, they will need to avoid all forms of dairy and experiment with other forms (e.g. goat’s, sheep, almond and soy sources). A2 milk has recently been launched; which offers an alternative to those who may be intolerant with A1 milk protein. There’s no real way of knowing this if this you; other than experimenting with the product.
- Those who have an’ on/off’ allergy. It seems some people can digest milk fine some days but not others. There are many factors at play here: sensitivity to fat could be part of this (if people find that ice cream and cheese are an issue), it may also be that people are more susceptible to a reaction during ‘flares’ or recovering from a bug -this is because of a change in gut bacteria.
Why can’t those with gut health issues digest milk?
Let’s start with Inflammatory Bowel Disease. I recently blogged about the best diets for IBD and one thing that many of these diets had in common featured the exclusion of dairy. This isn’t just random but instead many studies are finding a link between dairy and crohn’s disease/Ulcerative Colitis. For example this study in 2014 suggested a significant relationship between Ulcerative Colitis and casein.
But what’s the link between the inflammation caused by the immune system and milk? Well, depending on which studies you believe- lots! First of all is the theory that links MAP bacteria to the cause of IBD (you can read my info guide on MAP vaccine in this post); which is supported by the fact that many countries that are rapidly increasing their milk intake (such as China) are now being more increasingly diagnosed with IBD.
Another possibility is that inflammed guts find it harder to break down milk proteins; perhaps due to lower enzyme levels or altered gut bacteria. Indeed, this study found that Milk Fats increased the inflammatory process in rats by changing the bacteria level. If your gut is inflammed or has a poor bacteria balance, it may find dairy (alongside gluten) difficult to digest.
What about IBS and Coeliacs?
I often focus on IBD- but this is one thing that IBD patients that share with IBS sufferers and even coeliacs. This is likely because all these conditions can be linked by a shift in gut bacteria balance. Although IBS does not involve inflammation, if the gut bacteria is poor- this could lead to a leaky gut. Leaky gut means that the gut is more permeable and allows larger particles to slip through indigested- dairy particles are quite large and therefore can be difficult to fully breakdown; this can lead to an ‘allergic’ type response from the body as the food particles enter the bloodstream.
Leaky gut is complicated and controversial since many deny it’s existence. Yet it does explain why some may experience the inability to digest milk when the gut is under strain from things like antibiotics. This is often the case of newly diagnosed coeliacs; who find that even after eliminating gluten they do not feel better. This is because the gut needs time to repair and the previous gluten intolerance may have weakened the gut. Some coeliacs find they need to temporarily eliminate milk from their diet.
What to do next?
If you are finding dairy difficult to digest, it’s time to do some digestive work and keep a food diary. It’s important to recognise if it’s lactose, milk proteins or even fat (for example, if pizza is tricky to digest- it could be the fat or gluten too!). Patients can find that relief isn’t instant- since the gut needs time to repair. I would also discourage replacing the dairy with a whole host of new things; such as soy yoghurts, goats cheese as it might be they contain a potential trigger. It’s best therefore to gradually introduce alternatives one-by-one as removing dairy isn’t a magic cure: for example I still can’t tolerate coconut yoghurt (possibly due to the fat) or any goat’s type product (life is cruel!). Therefore, if I ate those I’d think my symptoms hadn’t improved! Of course, this kind of thing is often best done with a trained Nutritional Therapist or dietican to ensure it’s done properly (since milk is in everything) and your diet is balanced. If you have any questions about trying to eliminate dairy in your diet, I’m happy to help.
I hope you’ve enjoyed this post- diet and digestion is a minefield but I hope I can provide informative posts that help people make sense of food; then they can make an informed decision about what is right for them! Let me know your experiences with dairy below!