What should I do if I can’t consume dairy?
Dairy may have to be excluded owing to cow’s milk allergy (CMA) or limited in the case of lactose intolerance. These conditions should be diagnosed and managed by a medical doctor or registered dietitian to prevent patients from developing protein, calcium and vitamin B12 deficiencies. CMA is rare and requires total exclusion of dairy from the diet. Lactose intolerance can occur more commonly, but does not require patients to exclude dairy completely.
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Dairy may be excluded from the diet because of cow’s milk allergy (CMA) or lactose intolerance. These conditions should be diagnosed and managed by a medical doctor or registered dietitian to ensure that a patient’s nutritional intake is not compromised.
- CMA affects only a small percentage of the world’s population. The allergy is more prevalent in infants (2-6%) than in adults (0.1–0.5%), as the dominant immunological factors driving allergic reactions change with age. It is difficult to ascertain the true prevalence of CMA in South Africa, but it is estimated that 2% of children under the age of two years are truly allergic to cow’s milk; CMA in adults is rare.
Once an allergy has been diagnosed by a qualified health professional, the offending food(s) should be eliminated from the diet. Even trace amounts can cause severe symptoms. So, if cow’s milk protein is the problem, avoid all milk and dairy products, including milk, cheese, yoghurt, butter, ghee, ice cream, buttermilk, cultured milk, milkshakes and flavoured milk or milk from any other mammals (e.g. goat milk). However, it is advised to challenge the allergy regularly (every 6–12 months) to monitor tolerance.
- Lactose intolerance is due to the reduced ability to digest lactose, the sugar that is found naturally in milk. Consuming more than 12 g lactose in a single dose (the amount typically found in 250 ml milk) may lead to abdominal pain, bloating, flatulence, cramps and diarrhoea.
Complete avoidance of milk and dairy products is unnecessary in most cases of lactose intolerance. People who are lactose intolerant should use milk along with other foods, such as having milk with cereal. If you are lactose intolerant, gradually increase your milk consumption from small quantities. Full-cream milk is also better tolerated than low-fat or fat-free milk, as are fermented dairy products such as yoghurt or amasi. Hard cheeses such as Gouda and Cheddar contain almost no lactose and so are generally tolerated well. Alternatively, you can choose low-lactose or lactose-free milk and take a probiotic supplement daily to aid digestion.