Ep.19 Should you go dairy free if you have IBS? IBS Podcast
10 Oct, 2023

Episode Intro

Would you like to start eating ice cream on holiday again? Maybe you're really missing a nice cheese board at Christmas or that stringy long cheese as you pull apart a piece of pizza. I'm talking about dairy, lactose and whether you need to remove it from your diet if you've got IBS. It could be that you're just sensitive to lactose. Or maybe you are vegan or you are allergic to dairy. I'll explain how to eat a well-rounded healthy dairy-free diet.


Podcast transcript

Hello! Welcome to episode 19 of The Inside Knowledge with me, Anna Mapson. I work with people who have IBS.

And so all the time I’m talking about diets that are good for the gut, what you can do to avoid problems like bloating, constipation, diarrhoea, excessive gas.

These are the things that my clients suffer with all the time.

Dairy is a really common thing that people will exclude, just like gluten which I covered in episode 16 about should you go gluten free if you have IBS. Today is should you go dairy free.

What is dairy?

When I’m talking about dairy, I mean anything like cow’s milk really, including cream, butter, yoghurt, cheese and other foods.

I’m just talking mostly about cow’s milk when I talk about these products, but obviously it does include other animal milk products.

What is cow’s milk made of?

Milk is mostly water, it’s like 87 percent water normally, and the solids that are in it are made up of lactose, that’s the sugar, some fats, and then also some minerals. Then there will also be protein, which is whey or casein.

The lactose digestion limit

Lactose is the sugar in dairy which most people react to. It requires us to have an enzyme called lactase to break it down. And people have a tolerance limit to lactose, depending on their ability to make this enzyme, lactase. So dairy intolerance might not mean you need to be dairy free.

But it could also mean that large portions of cheese and milk all in the same meal might be more of a trigger than if you occasionally have little bits of dairy containing foods.

Breaking down lactose with lactase

Our ability to process this sugar is dependent on our ability to create this enzyme, lactase. Genetically, some people have a harder time creating this enzyme than others.

People from Southeast Asia generally have high rates of lactose intolerance because they don’t genetically have this enzyme as freely as people from Northern Africa and Europe. Where people have grown up farming cows and having dairy as part of their diet for many thousands of years.

Temporary lactose intolerance after a bug

It’s also might be interesting to note that lactose intolerance is common and kind of temporary after a bout of food poisoning or having a stomach virus. So you might find that you, after recovering from a stomach bug, struggle to process dairy. But that doesn’t mean that it will last. It’s often children and babies particularly can really struggle with dairy containing foods after a stomach bug for a couple of days. Maybe a week, and then you should go back to normal.

What is lactose?

Lactose is a disaccharide. So if you remember the FODMAP episodes, the previous two that I’ve just done on low FODMAP diet, that means it’s a sugar.

It’s made up of glucose and galactose. And if you don’t have enough lactase to break it down, then your digestion will just be overwhelmed with this excess lactose.

Dairy protein allergy can also trigger gut symptoms

There are also proteins in dairy which can trigger issues, particularly allergic reactions, and this is mostly casein. Dairy allergy is quite rare, though, and it’s most often identified when you’re in childhood. It might be more difficult to diagnose a dairy allergy if you have a milder reaction. Especially one that is delayed.

When we talk about allergic reactions, people who have this can either get an instant reaction. Like, if you think people who get anaphylactic reaction to peanuts, for example. Or it can be delayed with dairy, so sometimes people can get a massive flare up of their eczema and other atopic conditions like asthma attacks, that kind of thing.

That can be anywhere from three hours to three days later after having a large amount of dairy.

How does dairy affect your digestion in IBS?

So, going back to lactose, let’s have a think about what dairy does for people with IBS. There are a number of ways that lactose or high dairy meals can affect you.

One of them is if you don’t have lots of lactase, then you’ve got excessive lactose in the gut. It can pull water into the small intestine, causing loose stools and gas, and that can trigger diarrhoea.

Or the undigested lactose molecules can pass through to your large intestine, which can ferment and cause gas and then also can trigger diarrhoea.

So that’s the way it can affect our digestion. But also, if you think about high fat meals. We know that they can slow down your digestion, causing slower transit of gas coming through the gut. That can really increase your pain. And just, you know, having a flare up of excessive gas can also really trigger your gut brain connection, really making you worry.

So sometimes it’s high fat and that’s if you’re eating a lot of cheese.

How much dairy can I eat if I have an intolerance?

So if it’s lactose that is your trigger, there are some things you can do to try and include dairy in your diet that avoid you getting those kind of symptoms. People who have a lactase deficiency can normally tolerate around 12 grams of lactose per meal without getting any symptoms or the symptoms will be relatively mild.

So you might be surprised to know how much lactose is actually in common foods such as cheese and ice cream, yogurt and milk.

Hard cheeses are low lactose

Around 40 grams of a hard cheese like cheddar or parmesan. That’s only one gram of lactose for 40 grams So you can actually have quite a lot if lactose is your issue. Then you probably could have quite a lot of cheese. But as I mentioned you may be tripped up by the high fat content in cheese. That can also trigger either slow digestion gas or diarrhoea, so It might be the fat content of cheese rather than the lactose. (Read more about cheese and IBS)

Butter is almost lactose free

Butter, which some people also try to avoid, has traces of lactose. Obviously, if you’re allergic to dairy, you wouldn’t ever include these kind of foods. But if you have a lactose intolerance, you’re probably going to be okay with butter. There’s very little lactose in butter.

Is ice-cream ok on a low lactose diet?

The next food that sometimes people avoid is ice cream. And actually for around 88 grams of ice cream, there’s only three grams of lactose. So if you were to have like a big bowl of ice cream, you’re probably somewhere still in the region of six to seven grams of lactose. Read more detail about ice cream on the low FODMAP diet.

As long as the rest of the meal doesn’t have any lactose like cheese, or you’re not having a really milky drink with it, you’re probably okay with a bit of ice cream on a one off occasion as well.

Is yoghurt high in lactose?

If you move on to the higher lactose containing foods like yoghurt and milk, around 200 grams of yoghurt, like a plain whole yoghurt, will have somewhere in the region of 10 to 12 grams of lactose. So that is a good portion of yoghurt, which would be around the sort of limit that you can manage for lactose.

Cow’s milk is the highest lactose dairy item

The main biggest jump comes if you’re drinking cow’s milk, and this is where a glass of milk, like a big glass, 275 millilitres, would include 16 grams of lactose. So that would easily tip you into the region of getting a lactose intolerance.

All these kind of results are going to be very individual. Some people will be fine with cheese and will be able to manage a little bit of milk in their tea. But couldn’t tolerate like a latte or a hot chocolate made of milk.

Whereas other people just wouldn’t be able to manage any of that. You do have to experiment a bit to try and find your best level. But if you enjoy eating dairy containing foods, there probably is a way that you can work it out.

So you just need to work out what your limit is for lactose.

What about lactose free milk for IBS?

Well, this is a good alternative for you if you enjoy dairy foods, but you have a problem with lactose, you can switch to lactose free milk. It’s just milk that’s added an enzyme to remove the lactose.

You can also get some yogurts where this enzyme has been added. It just helps to improve digestion for those who struggle with it. So it’s a definite advantage which means you can still enjoy some of those foods like yogurts and milk without the digestive issues.

Is A2 milk better for people with IBS?

Another question I’ve been asked about dairy is what about that A2 milk? So you might have seen this in the shops, you may, may not have, it’s not very common and it’s quite hard to find but sometimes it’s talked about online as an alternative to dairy.

Basically, it’s to do with the protein, casein, that is in milk. It’s about 30 percent of the protein content. Whey is another type of protein that’s in milk.

There are three different types of casein. There’s

  • alpha,
  • beta and
  • kappa

Beta casein has got two types, there’s A1 and A2.

In northern Europe, when farmers were farming dairy, somewhere between five and ten thousand years ago, there was just a genetic mutation in the cows. That increased the ratio of A1 to A2 beta casein. There are very small molecule differences in the chemical structure of this protein component.

A1 milk produces something called beta-casomorphine 7, which has morphine like effects. As in, it slows down the transit time. This has been shown in animal studies, but not actually in humans. One study has shown that some people who drank more A1 milk, had looser stools, and had more IBS type issues.

A2 milk may be easier for some people with IBS

There are some evidence base that A2 milk may improve your ability to digest it. That is because everybody’s so different. But the majority of cases it’s probably not going to make a difference.

If you don’t have a problem digesting dairy there is no point in trying this type of milk. That opioid like effect though, it has been shown in some people to decrease this stool mass. So like have less bulk in your stool ready to go. And it may also affect the bacterial mass and the motility. I think that is really interesting thinking about whether it’s worth a try for you.

How to eat a healthy dairy free diet

I hope that has given you some confidence that you can include some aspects of dairy. Particularly the lower lactose foods, in your diet if you so enjoy it. But if you’re vegan or maybe you do have a dairy allergy and you don’t have any dairy at all, then what nutrients must you think about in order to stay really healthy?

Calcium is important in a dairy free diet

Well, obviously calcium, that is the main thing that we often think about.

The key ways to include calcium in your diet include

  • green leafy vegetables,
  • sesame seeds,
  • almonds,
  • and tofu that is in a water based solution. So any tofu that has been sloshing around in its calcium solution will retain some of that calcium when you eat it.

Tofu is a really great way to include calcium in your diet, particularly because it has also good protein sources for vegans.

Vitamin D helps calcium absorption

Other ways to maximize your calcium intake is to make sure that you have sufficient vitamin D. That will help you to use the calcium that you do get out of your diet.

Normally people are recommended to eat two to three portions of dairy per day. I really want to stress that you should get two to three portions of vegan, calcium rich foods per day as well. Especially because the calcium that is in plant based sources isn’t as bioavailable. Which means it’s harder for your body to use them from plant based sources.

It’s not impossible, and it’s completely possible to have a great, healthy vegan diet. It’s just something you need to think about.

Iodine – the forgotten nutrient from dairy foods

Another nutrient to think about is iodine. This is not naturally really high in dairy based foods, but it is found in dairy that we consume because of the way that they clean out the dairy machinery.

So they slosh it on to make sure that it is sterile and that can then lead to some iodine getting into our milk. This is why organic milk tends to have slightly lower levels of iodine than non organic dairy milk.

Plant based iodine sources

Iodine can be found in other things that are from the sea. So for vegans, seaweed is a great option and I would sprinkle that on your food and add it a couple of times a week to make sure that you’re getting some sources of iodine.

If you’re dairy free, but not vegan, you could also eat some white fish, so things like cod, haddock, or include Prawns and other seafood. They will have levels of iodine in them that would add to your diet. And iodine is one of the nutrients that is routinely missed when people completely give up dairy and are following a vegan diet with no seafood.

This is because it’s not something you automatically think about, but people can get very low in it.

Importance of iodine

And some of the issues with not having enough iodine may be to reduce your ability of your thyroid to work properly, and that maintains your metabolism. and controls your weight and all kinds of things.

The thyroid is really essential for keeping us going. Like our little clock inside our body. So iodine is helpful for that, but also for a range of other things. But it’s such a micronutrient, like we don’t need a lot of it. So I’m not suggesting anyone should rush out and start taking loads of supplements.

But what you can do is just think about where else to get it from your food. It’s not routinely added to alternative milks in the same way that calcium is. So you’ll often find calcium carbonate added to almond milk, soya milk, those kind of things. But iodine just isn’t added as much.

What’s the best dairy free alternative milk

So if we move on to choosing alternative milks. There are obviously tons out there nowadays of almond milk, soya milk, oat milk. All different brands, different tastes and different types of nut milks that you can get.

They’re actually not really allowed to be called milks. I think they’re called almond drink most of the time because milk is a protected characteristic of the dairy trade.

And I get it, it’s not an actual milk, but, you know, it’s a milk drink, so it’s semantics, isn’t it? Um, anyway, a question I get sometimes is, What should I actually drink if I am dairy free? What is the best alternative? My main advice for you is to think about what you like drinking and just choose that.

There is no dairy alternative with the same nutrients as milk

So, there is no way you’re going to replace the nutritional content of dairy with a plant based alternative. There just isn’t anything that is a good match in terms of the protein content, the calcium content, vitamin D, iodine. But you don’t have to get those nutrients from a milk. You can have all of those nutrients in your very healthy diet, it doesn’t need to come from milk.

The best thing to do when looking for an alternative to dairy, if you’re switching out to a different source, is to think about something that you like. If you want to have coconut milk on your cereal and then soya milk in your tea, as an example, that is completely fine.

It’s just whatever you will enjoy the most.

Dairy free children’s diets

For smaller children who are in a dairy free household, or kids who can’t drink a lot of milk, I would try to make an exception to that. There is certain milks which are aimed at children. I don’t want to like, brand drop or anything, but there’s Alpro milk, soya one. That’s called Growing Up, or something that’s made for children.

It does try to match some of the nutrients. And try to like, be a bit more of a overall good nutritious milk. Rather than something like oat milk, which is just basically oats and water. Which is not going to give you the amount of nutrients that a dairy milk would.

So that’s one of the reasons where, especially when we’ve got children. With growing bones, teeth, everything like that. They’re really energetic. You want to make sure that they’re hitting all of those key nutrients.

Once you stop worrying about what is the best milk for you on a nutrition basis. And you just think about how to get those nutrients in another way, then it just comes down to taste. And personal preference, and there’s no real drama.

Additives in dairy free foods may irritate your digestion

The only thing I would say is that some milks may contain things that can set off your IBS. So if you’re someone who’s very sensitive, be aware of ingredients like carrageenan. Or other thickeners and gums that try to emulate some of the fatty content.

Where you’re using plant based milks, they’re often very thin. They try to add thickeners to make them a bit more palatable.

These in some people with IBS can make your stomach a little bit sensitive. The same goes for things like natural flavours or sweeteners. Just check that it is suitable for you. And if other products containing those things also have the same effect, before you rule them out completely.

In summary of this episode

I hope with this episode that you’ve been able to see there are some nuances in dairy consumption that need to be tailored to you and your experience of eating and drinking these kind of foods.

In my experience of working with lots of people with IBS, there is a very big difference to somebody who has cereal in the morning with loads of cow’s milk on it. Maybe two or three lattes throughout the day. And then something like a cheesy pasta sauce with a sauce made of milk and loads of cheese for their main meal.

Compared to somebody who might have a little bit of feta in a salad. Maybe you have a tiny bit of milk in a tea a couple of times a day.

That consumption of dairy is very, very different, but can still give you some of the benefits of getting your correct calcium intake and making sure you’re getting some of that iodine that I mentioned.

And also just a good source of protein, so we mustn’t forget that dairy is also a good source of protein as well.

Get in touch for more help

If you found all of this helpful, but you still don’t know how to apply it to your own life, then get in touch. Because I take on one to one clients in my gut reset, where I work with people individually over three months.

If you want to work with me, just come to my website and sign up for a free discovery call. We can talk about the issues that you’re experiencing and how I may be able to help.

That’s it for this week. I’m going to be back next week, so bye for now.

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