Do you have lactose intolerance or dairy allergy or sensitivity? I get questions all the time about the difference between the two. Sometimes, my patients tell me that they are lactose intolerant, but after clarifying few things, we discover that it’s most likely a milk allergy or sensitivity, not lactose issues.

In the last episode and blog post, I talked about the foods that cause bloating. Bloating happens when bacteria ferments carbohydrates sugars and carbohydrates in the gut. Lactose is one of the sugars that are easily fermentable. It’s also one of the FODMAP foods that you may want to avoid if you have bloating and are looking for relief.

Today’s episode will help you identify whether what you’re dealing with is lactose intolerance or milk allergy. I’ll be reviewing their symptoms, causes, tests, and treatment.

Lactose Intolerance Symptoms and Causes

• Lactose is a sugar found naturally in milk yogurt and soft cheeses. It’s a double sugar (made of 2 pearls) made of 1 glucose and 1 galactose
• Lactase (with A) is the enzyme that your intestine cells produce to digest lactose. It breaks the bond between the 2 sugars (pearls). This is necessary because the body can only absorb the single sugars.
• Lactose intolerance happens when you don’t have enough lactase enzyme to digest the lactose and break it to the 2 individual sugars. Instead, it stays in the gut and gets fermented by the bacteria in the gut, causing bloating (we talked about last time), gas, diarrhea, stomach pain, or constipation.
• Hard cheeses typically don’t contain lactose. That’s because during the process of making cheese, bacteria eats up the lactose so there isn’t much of it left for your gut bacteria to digest. Hard cheeses are like cheddar, gouda, parmesan, provolone.
• If you tend to tolerate hard cheeses and small amount of butter but not milk, yogurt, ice cream or soft cheeses (like cottage cheese), then you may have lactose intolerance.

Lactose Intolerance Test

You can test if you have lactose intolerance through a breath test. You drink a special drink, then you can breathe into a special tube. The air collected can determine whether you digested lactase or not. You can ask your doctor to help you obtain it.

Lactose Intolerance Treatment

If you are lactose intolerant, eliminate lactose-containing foods like regular milk, yogurt, Greek yogurt, ice cream and soft cheeses. You will likely be able to tolerate hard cheeses. Choose lactose-free variations like Lactaid or Green Valley. You can also take lactase enzyme in a pill form if you want to eat ice-cream or other lactose-containing foods.

Most people think that once they stop digesting (or tolerating) lactose, that they will have to avoid it for the rest of their lives. While this may be the case for some people, it might not be the case for you. You may want to ask yourself, “why aren’t the cells that line my intestine producing lactase enzyme?” “Did something damage them?” Bacterial and parasite infections, such as rotavirus, Giardia intestinalis, Cryptosporidium and Cyclospora, damage the cells in the gut that produce lactase enzyme. Lactose-containing foods start to trigger bloating, gas, stomach pain, and diarrhea. While this is believed to be a temporary issue that should last no more than one month, if your gut is inflamed and your immune system is weakened, you may not be able to fight the infections entirely. The residual damage to your gut will affect your ability to digest foods, including lactose.

Dairy Allergy Symptoms and Causes

• While lactose intolerance is completely a digestion and fermentation problem, milk allergy and sensitivity are an immune-system problem.
• There are 2 main dairy proteins: casein and whey. You may be sensitive or allergic to one or both of them
• With a dairy allergy or sensitivity, your immune cells get activated in the presence of dairy proteins. The immune system stops recognizing these proteins and starts to attack them instead. Watch episode 20 where I talk about the difference between allergies and sensitivities.
• Symptoms of dairy allergy can be classic allergic reaction like rashes, hives, nasal and sinus issues, tingling, vomiting, and swelling of airways. Symptoms of dairy sensitivity can include bloating, constipation, diarrhea, stomach pain, as well as post nasal drip, sinus issues, acne, and eczema.
• If you can’t tolerate ANY type of dairy, including hard cheeses and butter, as well as milk, yogurt, ice-cream, and soft cheeses, then your reaction may be due to dairy proteins allergy or sensitivity, not a lactose intolerance.

Dairy Allergy Test and Dairy Sensitivity Test

I use the MRT food sensitivity program and it helps me uncover non-IgE sensitivity to milk, yogurt, and several types of cheese. If you suspect that you have a severe allergic reaction to milk or any dairy products, consult with allergist or your primary care physician. Tests for allergies are different than test for sensitivities.

Dairy Allergy Treatment and Dairy Sensitivity Treatment

First, get some relief and calm your immune system by eliminating all dairy foods, including lactose-free versions. A lactase enzyme pill will not solve the problem. Then, you must address the root cause! Ask yourself, “why is my immune system reacting to dairy?” “Do I have leaky gut or gut bacteria problems that I need to address?” You may not care so much for dairy foods and you may be ok eliminating them from your life, but a sensitivity is one of the ways your body tells you that your gut is inflamed. All food sensitivities, including those to dairy, are signs of leaky gut and dysbiosis. Both can increase your risk for developing an autoimmune condition, which is something you definitely want to prevent.

Lactose intolerance or Dairy Allergy: the Bottom Line

If you seem to be allergic to milk but not cheese, what you probably have is lactose intolerance! In this case, you typically can handle hard cheeses like cheddar and Parmesan but have a difficult time with milk, yogurt, ice cream and soft cheese like cottage or fresh mozzarella. Try using Lactaid pills when you want to eat these foods and see if it helps.

If you can’t eat any milk-based foods, including hard and soft cheeses, butter, milk, yogurt, and ice cream, it’s possible that you have a dairy allergy or sensitivity.

However, whether it is lactose intolerance or milk allergy or sensitivity, addressing the gut imbalance is an important part of healing all your body. Both conditions are related, since 80% of your immune system is in the gut. But they are not exactly the same. You may have lactose intolerance or milk allergy, or both at the same time.