is dairy causing your gut issues? (part 2)
Part 2 - cow’s milk intolerance, food sensitivity, and ibs
In Part 1, we looked at the different parts of cow’s milk and why it might cause gut issues in susceptible people, specifically those with a lactose intolerance. But research shows that even though people with IBS commonly report milk intolerance, there is no high-quality data to support a link between IBS and lactose intolerance.
Now, that’s not to say that individuals with IBS don’t experience lactose intolerance – simply that objective evidence does not support that it is a common causative factor for symptoms. That being said, one cannot deny the research that shows many individuals who suffer from IBS report digestive complaints after consuming milk or milk products.
This brings forth the question of: what component, other than lactose, could be contributing to the gut issues that are subjectively experienced by so many with IBS after consuming cow’s milk or dairy products? Today, I am unraveling cow’s milk intolerance and cow’s milk sensitivity to help you understand a little better. Lactose may not be an issue for some, but there are plenty of other compounds in cow’s milk that could cause one to raise an eyebrow or two…
You can review the different parts of cow’s milk here, in my first post.
Cow’s Milk Intolerance and Sensitivity
What is it?
First, let’s look at the difference between an intolerance, a sensitivity, and an allergy. These terms are often used interchangeably but they do not mean the same thing
An intolerance is an adverse reaction to a food that does not involve the immune system. It can because of an enzyme deficiency (e.g. lactose intolerance) or due to the effects of a food compound that has a drug-like effect in the body (such as histamine in oranges, or caffeine in coffee).
With an enzyme deficiency intolerance, food can go undigested. When they arrive in the colon, the gut bugs break them down by fermentation, often causing gas, bloating, cramping, and diarrhea.
Allergies and sensitivities involve the immune system. When the body is exposed to the protein component of certain foods, it can react by releasing other proteins called antibodies. Food components that cause antibodies to be released are called antigens or allergens.
There are two types of antibodies that are often produced in response to food triggers: IgE (immunoglobulin E) and IgG (immunoglobulin G).
A true allergy is an immediate reaction to a food antigen or allergen as a result of the release of IgE. Symptoms from this type of reaction appear fairly soon after exposure but may take up to two hours. Symptoms can be mild like an itchy mouth, stuffy nose, or scratchy throat, or they can be severe in the case of anaphylaxis which can cause swelling in the body tissues and breathing difficulties.
A food sensitivity is a delayed immune reaction that involves IgG. Symptoms can take hours or days to appear. Because of the delay, many people don’t even realize they have a food sensitivity, and it can be difficult to figure out which food is responsible for the problematic symptoms.
What does the science say?
While there is no solid evidence to support a link between lactose intolerance and IBS, one research study1 found that 86% of the individuals who self-reported a milk intolerance had digestive complaints following the ingestion of cow’s milk during a double-blind placebo-controlled study even though they tested negative for lactose intolerance on hydrogen breath test. This suggests that there may be a yet unidentified component of cow’s milk contributing to their symptoms of intolerance.
The same study also observed that about 20% of the participants who self-reported a milk intolerance also had complaints of constipation. While constipation cannot be a symptom associated with lactose intolerance, it is one of the common symptoms reported in children and adults with cow’s milk protein allergy. Furthermore, 98 of the participants with self-reported milk intolerance underwent a biopsy of a portion of their small intestine. Findings suggested an immune reaction in response to the ingestion of the cow’s milk as there was an increased number of immune cells found at the tight junctions of the biopsy sample.
Although more research needs to be done, the fact that many individuals with IBS report digestive symptoms following ingestion of cow’s milk warrants consideration when looking for dietary approaches to managing IBS symptoms. It’s not just about the lactose.
What are the symptoms?
Part 1 of this post already covered the symptoms of lactose intolerance. An intolerance to a different portion of cow’s milk could look similar: gas, bloating, cramping, urgency, and diarrhea.
Food sensitivity reactions also cause gastrointestinal symptoms like gas, bloating, abdominal pain or cramping. Unlike an intolerance, a sensitivity may also cause constipation. They can also affect different body systems: lungs, brain, cognition and mood, joints, and skin.
Other common symptoms associated with food sensitivities include fatigue, brain fog, migraines, anxiety, depression, joint pain, asthma, acne, and eczema. (This is not an exhaustive list.) There is also emerging evidence to support IgG food sensitivities may play a role in the development of autoimmune conditions.
(You can learn more about food sensitivities and allergies here.)
How is it diagnosed?
Current testing for cow’s milk intolerance and sensitivity is quite limited. For that reason, there are no commonly accepted methods for diagnosing these conditions. Some practitioners offer food sensitivity testing which measures the number of immune complexes your body has against cow’s milk (and other foods) to determine the likelihood of a sensitivity. This type of testing remains controversial in the conventional medicine world, but new evidence is constantly emerging to support its use.
(You can learn more about Food Sensitivity Testing and the mini-lab packages I offer here.)
How to tell if I have a cow’s milk intolerance or sensitivity:
If your doctor has ruled out lactose intolerance via hydrogen breath testing but you still suspect a milk intolerance, food and symptom journaling may be helpful. There are many apps you can download to your smart phone to make this quick and easy. (My favourite app for food and symptom journaling is mySymptoms.) Alternatively, you can kick it old school and use an actual journal or notebook.
Here are a few tips to help you succeed with food journaling:
Eat typically and record honestly. Many people tend to be on their “best behaviour” when keeping a food diary. Food journaling will not be helpful if you are not eating your typical foods that may be causing your typical symptoms.
Have columns for: time, food, drink, activity, mood, energy, and bowel movements.
Record for 3-4 days and then look for patterns of common allergens contributing to gut symptoms, and mood or energy crashes after meals or specific foods. (In this case, you would be looking for patterns associated with cow’s milk and dairy products, but this method can be used to illuminate other food triggers as well.)
If you identify that cow’s milk and dairy may be a problematic food, you can attempt an elimination diet for 4 weeks. During this time, you should remove all sources of dairy from the diet. Be wary of hidden sources that may be in sauces, dressings, processed foods, baked goods, and when eating out at restaurants. Make sure you read labels. Continue to keep your food and symptom journal during this time.
After removing dairy from the diet for 4 weeks, most people can tell if it was causing problems or not.
(For those experiencing skin or joint problems, an elimination of more than 4 weeks may be necessary to note improvements as these conditions take longer to resolve.)
After your trial elimination diet, you can try reintroducing the food to see how you feel. Consume cow’s milk or dairy products 2-3 times a day for 2-3 days. If you are intolerant or have a sensitivity, it may feel like you got hit by a truck, so time your reintroduction when you have space in your schedule to rest if needed. If you become symptomatic with your reintroduction by the end of Day 1 or 2, there is no need to continue with the challenge as this will give you your answer.
Living with Cow’s Milk Intolerance or Sensitivity
If it turns out you like have a cow’s milk intolerance or sensitivity, the best approach for optimal health is to avoid these foods completely.
Fortunately, there are many excellent dairy-free alternatives available. Going dairy-free doesn’t have to be difficult. See the table below for common dairy products and their dairy-free alternatives.
TABLE 1:
*** I have a more comprehensive one-page guide that lists foods to avoid, ingredients to watch out, and dairy alternatives. You can download that here.
Some people can’t imagine a life without dairy. I often hear, “But, what about cheese!?” Honestly??? That’s a choice that you have to make for yourself.
What I can tell you is that if you have an intolerance or a sensitivity to cow’s milk, and you continue to consume it, there will be some level of low-grade inflammation in your body. Inflammation is at the root of many, many ailments, illnesses, and disease. Emerging evidence even suggests that it may be a contributory factor for IBS. The amount of inflammation will be dependent on your genetics, how often you are consuming dairy, the amount of dairy you consume, and the type of dairy you choose (i.e., organic, commercial, pasteurized, unpasteurized).
The choice is yours.
Hippocrates, the ancient Greek physician regarded as the father of medicine said it best, “Before you heal someone, ask if they are willing to give up the things that make them sick.”
Resources:
Whole Cow’s Milk but Not Lactose Can Induce Symptoms in Patients with Self-Reported Milk Intolerance: Evidence of Cow’s Milk Sensitivity in Adults - https://pubmed.ncbi.nlm.nih.gov/34836089/
“One Food Is Another’s Poison” by David W. Rowland
Is There a Correlation Between Irritable Bowel Syndrome and Lactose Intolerance? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032600/
Lactose Maldigestion, Malabsorption, and Intolerance: A Comprehensive Review with a Focus on Current Management and Future Perspectives – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265758/
Cow's milk proteins in human milk – https://pubmed.ncbi.nlm.nih.gov/23158513/
