The Consumer Education Project of Milk SA

What is the difference between milk allergy and lactose intolerance?

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Food allergies and food intolerances are very different conditions. An allergy is an abnormal immune response to one or more proteins, brought on by an enhanced count of the IgE-type antibody. A food intolerance is not a response of the body’s immune system. An intolerance is more likely caused by a shortage of specific enzymes or a reaction to certain ingredients that occur in a food. Don’t self-diagnose these conditions. Consult a physician or registered dietitian to confirm the diagnosis.

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Food allergies and food intolerances are very different conditions.

  • An allergy is an abnormal immune response to one or more proteins, brought on by an enhanced count of the IgE-type antibody. People often incorrectly self-diagnose milk allergy. In reality, research has shown that cow’s milk allergy affects only 2–6% of infants and 0.1–0.5% of adults worldwide. An allergic reaction may lead to undesirable or even dangerous symptoms. Symptoms for cow’s milk allergy may include hives (urticaria), vomiting, diarrhoea, colic, rhinitis and gastritis. A qualified health practitioner, such as a medical doctor or a dietitian, can diagnose an allergy through an elimination process.

If you have been clinically diagnosed as being allergic to cow’s milk, you must avoid all forms of dairy products. This includes milk and flavoured milk, cheese, yoghurt, butter, ghee, ice cream, soured milk products, milk powder, etc. You also have to study food labels carefully to determine whether a product contains milk powder, milk solids, casein or whey, as these can all lead to an allergic reaction.

  • A food intolerance is not a response of the body’s immune system. The intolerance is more likely caused by a shortage of specific enzymes or a reaction to certain ingredients that occur in the food, whether natural or artificial. Lactose intolerance occurs when the body cannot efficiently digest lactose, the sugar found naturally in milk of mammalian origin (including breast milk). Normally, the enzyme lactase aids in the digestion of lactose. If the body does not produce enough of this enzyme, it cannot digest lactose efficiently. Bacteria that occur naturally in the colon ferment undigested lactose received from the small intestine. This fermentation process may cause acid and gas to form, while the body may simultaneously attempt to dilute the concentration of the lactose by reabsorbing water from the blood. Together, these effects can lead to diarrhoea, a typical symptom associated with lactose intolerance. Intakes of more than 12 g lactose (typically one glass of milk) may lead to symptoms such as abdominal pain, discomfort, bloatness, flatulence, cramping and diarrhoea.

If you are lactose intolerant, it is best to consume small quantities of milk together with other foods (e.g. milk with cereal) and to choose naturally fermented dairy products such as yoghurt or maas. Cheese contains virtually no lactose and should not have any adverse effect. Full-cream milk is better tolerated than low-fat and fat-free milk. Alternatively, you can choose low-lactose or lactose-free milk. Taking a probiotic supplement daily can also improve the bacterial environment in the large intestine, which can help with digestion.

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