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Dairy Allergy / Intolerance & Lactose Intolerance Information
For a huge selection of lactose free books gifts, recipes and information visit the Special Diets Directory Dairy and Lactose Free Book Store for great discounts on a variety of titles & products - delivered to your door. What's the difference between food allergy and intolerance? Is Dairy and Lactose Intolerance /Allergy the same thing? What is Dairy Allergy/Intolerance? What is Lactose Intolerance? Getting a lactose intolerance diagnosis My child cannot tolerate dairy – Help! How can I shop for Dairy/Lactose free food? So can you suggest alternative Dairy/Lactose Free Foods and Ingredients? How do I cook/serve Dairy/Lactose Free Meals that everyone can enjoy? How can I eat out Dairy/Lactose Free safely? How can I make Travelling Dairy/Lactose Free Hassle Free? What's the difference between food allergy and intolerance? An allergy can vary from mild to full anaphylactic shock depending on your level of sensitivity. It can be caused by eating, inhaling, with the allergen or it coming into contact with the skin or lining of the nose, throat or mouth. It can also occur if something you are sensitive to is injected. An allergic reaction will normally manifest itself very quickly and will occur every time you are exposed to the allergen so it is easier to identify as the cause than with an intolerance, which can take up to 10 days to produce symptoms. The type of reaction also differs from person to person. Symptoms can vary from mild headache, abdominal discomfort with constipation or diarrhoea and skin rashes to severe IBS type symptoms, vomiting, hives, eczema, or swelling. Swelling of the mouth, face and tongue, rash and shortness of breath and drop in blood pressure are all indicative of anaphylaxis and demands immediate emergency assistance. An intolerance is a milder reaction but is much harder to diagnose as the compound responsible can stay in the system for many days and such reactions such as IBS symptoms, headaches, fatigue, stomach ache and bloating, skin conditions and depression can be virtually impossible to associate with the source unless an accurate food diary is kept over at least a month - up to three months would be the most effective period. This requires determination. attention to detail, label reading and dogged recording of what you eat bite by bite and can make the sufferer appear (and indeed become!) quite 'OCD' when 'living' it! Although it can seem to take over your life over the time the food diary is being recorded you can eat normally, It is well worth the effort as in time a correlation will emerge to help identify the culprits. The chances are that there will be more than one food group involved. The next step should in an ideal world involve a dietitian to help ensure that any adjustments you make to avoid the foods you are intolerant to still provide you with a healthy balanced diet. The good news is that after a while many people find that if they very slowly reintroduce the foods they have had an intolerance to and maintain a regime of limiting the amount of it they eat they can tolerate it again in moderation. The danger is that complacency takes over, volume builds up again knocking the tolerance level back to intolerant again! See-saw elimination doesn't work so it is better to 'have a little of what you fancy' rather than go through the agonies of a complete ban! Self discipline rules! Is Dairy and Lactose Intolerance /Allergy the same thing? Dairy Allergy / Intolerance Dairy allergy or intolerance covers all sensitivity to Cows milk products. Cows’ milk (dairy) allergy or intolerance is caused by a reaction to a number of allergens in cows’ milk, the two main culprits being the opposites that seperate when milk goes sour - Casein (that forms the curd) and the other being Whey. Some people are allergic or intolerant to both casein and whey, some to one in particular. If pasteurized milk causes symptoms then the protein casein may be responsible as heat processing changes the molecular structure of whey rendering it tolerable to many and so is the less likely of the two to be the cause. Casein and whey should be avoided and labels studied rigourously if you are allergic to them as they lie hidden in many unlikely foods that you would not expect to be or contain dairy. Lactose Intolerance Lactose intolerance means the sufferer is unable to absorb lactose into the digestive system. Lactose is the predominant sugar in milk and when not absorbed properly, it ferments, resulting in abdominal pain and rumbling, bloating and excess gas and diarrhoea. Lactose is actually two sugars combined and to render them digestable the body needs to seperate them using the enzyme lactase in the small intestine. Some people just do not produce enough lactase to break down the lactose sugars, and so suffer the above symptoms when ingesting dairy products. For reasons unknown some people with low lactase production can still tolerate dairy foods symptom free but most cannot. Getting a lactose intolerance diagnosis You can try the elimination method by avoiding products containg lactose for five days or so and then drink two to three glasses of milk. A reaction to lactose can be quite quick so If you get symptoms such as a stomachache or diarrhoea within half an hour it's a pretty good (or rather bad!) sign you are lactose intolerant. You will then need to get your self diagnosis confirmed ny your GP who should offer you the three most common tests. One involves your doctore measuring your blood sugar levels before and after you drink some milk. If the blood sugar level rises, then you are not lactose intolerant as your body is metabolising it. Another is a breath test whereby you drink some milk and then your breath is tested for the presence of hydrogen gas. This will only be detectable if the lactose has fermented indicating intolerance to lactose. A more invasive and conclusive test is done by an endoscopy (which involves inserting a small tube into the stomach) to take a sample from the lining of the small intestine. Dealing with Lactose Intolerance Tolerance levels and the severity of the symptoms can range from very mild to severe. Some people merely need to reduce the amount of dairy products they eat or drink whereas others can react to very small amounts and so need to go on a compeletly lactose free diet.If this is the case a consultation with a dietitian would be wise and make life a lot easier, and your GP will help you arrange this. Yoghurt and ewes and goats milk may be tolerated by some. Unlike coeliac disease, lactose intolerance is a harmless condition unless you are actually allergic but an actual dairy allergy is not anywhere near so common. What is lactose found in? Milk, cheese,butter, margarine, fermented milk products, and cheese, milk powder, bread,cakes, biscuits, pre-packaged foods chocolate, and beware of many pills and medecines (so always read the labels!) Yoghurt,ewes and goats milk do contain lactose but only low levels. My baby / child cannot tolerate dairy – Help! Childhood Dairy/Lactose Hypersensitivity is common - to the extent that an estimated 8% of babies under a year old may suffer from hypersensitivity to cow’s milk. Symptoms are often relatively mild and include diarrhoea, vomiting, stomach cramps and rashes. However these can be still cause huge anxiety when the cause is unknown and if the baby isn’t thriving as expected. If there is any difficulty in breathing obviously emergency medical help should be sought as in few cases, milk allergy can cause anaphylaxis though thankfully this is pretty rare. A reaction will be caused by ingesting cow’s milk or formula containing it, but even more worrying, it can also be passed through the mother’s breast milk after she has consumed dairy products and even this can provoke a reaction in her baby. The good news is that in this instance the old saying ‘ They’ll grow out of it!’ is often true as many children do become tolerant of dairy by the time they are about three years old - however around 20% will remain intolerant/allergic into adulthood. The severity of the reaction/symptoms will vary from baby to baby and will be dependent on whether it is due to a milk allergy or an intolerance. The pros of diagnosing babies are that milk is often all they consuming apart from water so it can be easier to identify as the cause, the cons on the other hand are that babies cannot communicate, and abdominal pain and vomiting and diarrhea occur for any number of reasons, pinpointing milk allergy requires close monitoring to be absolutely certain. The help of your doctor in referring you to a paediatric dietitian should be sought to find a solution as emotion and conflicting advice on the internet or from others etc often makes it difficult for a distraught parent to deal with on their own. However, you know your baby better than anyone so stick to your guns and make your point clearly if you are sure of any particular fact that is being contested or overlooked. Finding substitutes for cows milk can be difficult too as identifying whether it is lactose, casein or whey that is causing the reaction can be tricky especially when babies tummies are often sensitive to many things as their digestive systems mature and colic can complicate the process of elimination... Annoyingly, the same allergens occur in sheep’s and goat’s milk (though in some cases to a lesser degree) so may also cause similar symptoms but is certainly worth a try with professional guidance. Soya milk is often tried as an alternative but unfortunately often people who are sensitive to cow’s milk can be similarly affected by a Soya so this should be considered and monitored with babies also. If whey is the culprit the baby may be OK on formula or pasteurized milk as the heating process renders the whey tolerable to many who are sensitive. Some special formulas for dairy ntolerant babies are available which break the proteins down into smaller parts so the body doesn't recognize them as milk proteins and these ‘highly hydrolysed’ milk formulas can be the answer for babies with cows’ milk allergy, but some other varieties of formula, like partially hydrolysed milk and Soya milk aren’t, and many babies with cows’ milk allergy/intolerance could be sensitive to them also. Specialist formulas can sometimes cause constipation but some mothers find that also giving the baby plenty of water or breast milk, diluted prune juice and chamomile tea are successful remedies for this together with Vaseline applied externally to help pass stools. The longer a mother can breast feed whilst avoiding eating dairy products herself the better as long as she finds other sources of essential nutrients such as calcium etc. Again a dietitian will be able to help provide advice for a balanced diet. How can I shop for Dairy/Lactose free food? Labelling and ingredents: In November 2005, food labelling rules were implemented (2003/89EC) requiring pre-packed food sold in the UK and the EU to be clearly labelled to show any allergenic ingredients it contains. However some still slip throught the loop, (european gourmet ingredients for some reason seem to be consitent offenders so if in doubt leave them on the shelf!). Unpacked foods are a bit more of a lottery but The Food Standards Agency introduced new guidelines to the Food Industry regarding Food Allergies (see the News And Info section of the Resouces area of this site for more info) The more allergy friendly producers have an 'Allergy Advice' section on the packaging, so look out for dairy and lactose free varieties. It is so easy to eat something containing dairy derivatives by mistake - dairy ingredents are thoughtlessly dolloped into the majority of processed food as it is cheap and easy. To avoid this trap it is important to read the labels carefully as dairy products are hidden in the most obscure places! Assuming guilty until proved innocent is, in this case, the best approach. OK it's bore initially, but once you identify the products that are safe you can stick to them (however still check from time to time as sometimes when the manufacturers bring out 'improved' versions the ingredients can change....) Ingredients to avoid: Apart from the obvious (such as milk, butter cheese etc) the following ingredients are dairy related so walk away!: "milk derivative",curds,whey,(any kind), demineralized, delactosed, buttermilk,artificial butter flavor, casein,caseinate, actalbumin, lactalbumin,caramel color, caramel flavoring,ghee, custard, hydrolysates, hydrolyzed milk protein,high protein flour, lactoferrin, lactoglobulin, lactose,l actulose, margarine, rennet, protein, Simplesse, nougat. Many margarines contain casein or whey to give the buttery taste so avoid if you are intolerant or allegic to dairy Confusingly indictions are that lactic acid an anything with lactate or lactylate in the name should be OK as it is considered a natually occuring substance in vegetables and most mammals and not a cow derivative. So can you suggest alternative Dairy/Lactose Free Foods and Ingredients? Try to buy fresh food from local or specialist/ethical sources and get to know the producers for peace of mind and convenience Obviously standard milk, cheese, butter, margarine, fermented milk products and milk powder need to be avoided. Yoghurt, ewes and goats milk do contain lactose but in lower levels so can be tolerated by some as can low lactose cows milk which is now sold in most supermarkets. Milk substitutes / alternatives : At last rice, soy, oat and hemp & coconut milks are becoming mainstream. Soya milk curdles in coffee but tastes pretty good. Rice milk is also a good substitute in hot drinks but as it is so runny you may need to use more. These alternatives are useful in cooking too - coconut milk is lovely in desserts, cakes and curries. Butter substitutes in the form of dairy free spreads & margarines are now pretty accessible in larger supermarkets and health shops. Dairy Free Creams and Yoghurts etc: Soya and tofu yoghurts, creams and custards (single, double and thick) are now fairly accessible and not bad at all! Dairy free ice cream is becoming more available and sorbets are a healthy alternative. Dairy Free Cheese: This is a tough one! There are alternatives out there which are very tasty but they are not cheese! If you can get your head around this you'll move on to enjoy them as something else for their own merits! Ewes and goats cheese have lower levels of lactose so these are tolerable in moderation in many cases. Bread,cakes, biscuits and sauces are a hotbed when it comes to dairy free and if you think about it anything that would normally include dairy ingredients need to be eliminated HOWEVER BE HAPPY -some of the delicious free from versions that abound can be substituted and are sometimes better than the real thing especially those hand made by smaller bakeries! Pre-packaged foods and all confectionery and chocolate should be viewed with suspicion. Again read the labels and source some of the yummy dairy free equivelents. When Good is Bad... Beware many pills and medicines contain lactose so make sure your doctor is aware and check again with the pharmacist (and always read that tiny writing detailing the instructions and ingredients!) This applies to vitamin pills and supplements too. Items to watch out for and avoid are the processed foods in which dairy ingredients are hidden so take care when buying anythng in a white sauce, soups, gravy/sauces/cooking sauces (ready made and mixes), ready meals, sweets and confectionery, spreads, desserts, flavoured crisps and savoury snacks. Don't be lulled into a false sense of security by 'lactose free' labelling as this doesn't necessariy mean dairy free - if you have a sensitivity or allergy to casein or whey these might not be safe. Adjustments may be needed to your drinking habits too - some alcoholic drinks such as liquers contain dairy products. On the non alcoholic front, avoid milk shakes, smoothies, yoghurt drinks, ready mixed hot chocolate and coffee sachets and substitute coffee creamers. Other weird (and not so wonderful) ways of ingesting dairy ingredients: Makeup & cosmetics Sun creams Cross contamination from cooking utensils, serving spoons, pots and appliances (eg sandwich makers etc) and re-used cooking oils How do I cook/serve Dairy/Lactose Free Meals that everyone can enjoy? Dairy Free Milk substitutes / alternatives: Rice, soy, oat and hemp & coconut milks can be used in many dishes. Coconut milk is delicious in desserts, cakes and curries. Indulge in some dairy free condensed milk with a 3 parts milk to 1 part sugar/honey mix, boiled until reduced my two thirds. When making a savoury sauce try using cornflour to thicken or for savoury dishes potato flakes or mashed potato. A kind of buttermilk can even be created using lemon juice or vinegar Some milk alternatives can contain comparatively high levels of sugar so check the labels and keep a stock of some unsweetened ones for savoury recipes. Dairy Free Butter substitutes / alternatives: Dairy free spreads & margarines are now pretty accessible in larger supermarkets but interesting alternatives are extra light virgin olive, canola, vegetable oils, coconut oil and nut oils. Making your own chilli, peppercorn and other flavoured oils is really simple and the results are healthier, more slimming, individual and cleaner tasting. Dairy Free Creams and Yoghurts etc: Soya and tofu yoghurts, creams and custards (single, double and thick) are now fairly accessible and very nice! Dairy Free Cheese alternatives in cooking: This is a little trickier. Making up a dairy free white sauce using herbs and spices and stronger flavours will make a chef of you! Some of the cheese alternatives are much more convincing when used in cooking. If you can tolerate goats and sheeps cheese then the world of cookery becomes your oyster! How can I eat out Dairy/Lactose Free safely? Invest some time in talking to eateries before you go especially if you think you may want to use regularly, and sound them out. Make sure you speak to the owner or chef as your initial conversation will speak volumes about their knowledge and interest in meeting your needs. This is essential as even if they are not up to speed if they are keen to learn - you can help them to help you. Just pitching up and demanding dairy or lactose free food is not only running the risk of putting your health at risk, but it is just not fair to put a busy establishment on the spot. (OK in an ideal world it wouldn't be an issue but until we have done our bit to change things we have todo the ground work!) Handled in a friendly manner many can be nurtured and encouraged into providing just what you need - if you just give them some guidance and patience.... They may not have a clue about how dairy free and lactose free differ so help them out and offer to provide and information sheet for them to keep in the kitchen. Ask if they cook their sauces and meals themselves or if they buy in. If they cook from scratch they are more likely to be serious about what they do and be open to an informed discussion and substituting key ingredients. Avoid the creamy sauces if you are in any doubt and go for the tomato based ones or more simple sauce free options. Canteens and pubs etc are more likely to buy in ready made componants which is not a problem as long as they are happy to check the ingredients list for you or allow you to look yourself. Yep it's a faff and takes away the spontaneity somewhat but better that than being ill or having an embarrassing public debate at the table or being ill afterwards. If in doubt play safe and go for something you know is safe. It's worth going through the menu in advance and putting in your order a day or so before you go. To avoid constant repetition it may be worth building up a fact sheet and standard email to send to eateries in advance telling them you will call them in a couple of days to chat about it. Suggest they keep it on the wall as a reference for your future visits and to help them with the many other customers who will be asking for dairy free options. Tell them how much custom they are missing out on by not offering and advertising dairy free on the menu! Give a huge thank you and encouragement to any restaurants, hotels, b&bs, canteen, pubs, takeaways, cafe's, sandwich bars, chippies etc who make an effort and listen.... and post them on to Rave and Praise (But if they are rude or unhelpful or cheat and make you ill - snitch on them and post on Name and Shame! Takeaways These can present a challenge as the nature of beast often means that the frontline staff are casuals who are not necessarily food experts or worldly wise! Sandwich Bars - most don't seem offer many dairy free sandwiches or salads - so make a point of asking them.....repeatedly! You could make your point by plonking your own bread and dairy free spread on the counter and asking to buy a safe filling only at a discount. Write names of dairy free butter alternatives or safe margarines and some ideas for dairy free fillings and salads especially if you are a potential regular customer. Going to a Fish and Chip shop can be a minefield so be on your toes - ensure your food is not cooked in the same oil as battered items this can be enough to cause symptoms. If you fancey a burger or sausage ask if you can check ingredients are dairy free. You could try asking if they have dairy free batter a....Good Luck! These same principle apply everywhere and ensure anything else you order has not been cross contaminated by the same oil/pans/utensils In general pizza takeaways still haven't considered, let alone mastered dairy free pizza - so join theSpecialDD crusade and nag them!!!! Chinese - ask ask ask! There are lots of dairy free stirfry choices so there is no excuse for dairy in most of them, but ask just to be sure. Indian/Curry - As many dishes are cooked to order ask for no ghee (clarified butter) and request oil instead. Due to the high level of coronary problems possibly associated with Ithe Asian diet many domestic kitchens are changing over to healthier ingredients and banning the butter. Commercial kitchens are still sticking to the more traditional methods though so you will need to talk it through with them. Thai - The best bet as they are normally really helpfull and are well used to cooking from fresh ingredients and always seem to be friendly and flexible when it comes to special dietary requirements. Coconut milk features prominently avoiding the need for dairy. Restaurants Apply the same consideration as for takeaways above. Pizza and Pasta Bars - again why they are so slow on the uptake who knows?! Unless you like the salad bar the pizza option will probably be too cruel to tempting to deal with! If eating Italian go for the tomato based sauces or the meat and fish with vegetable options to paly safe. Most proud chefs will cook from scratch and know exactly what is going in to each meal - if they use bought in sauces either check the labels or take your custom to estblishments who are professional enough to cater for you properly. Fine Dining - Unfortunately and although you have every right to expect it, expensive is not always the most allergy friendly. In fact having the audacity to ask for a deviation from the 'artist's' creation can occassionally provoke a less than friendly response! Health comes before ego so in these cases leave! It is not safe nor reasonable to assume that reputation brings automatic knowledge of all special dietary requirements so call ahead and speak to the chef . See how your request is recieved and talk through the options to ensure that a special occassion isn't ruined or to avoid paying for an expensive meal you can't eat. Again Thai restaurants come high in the league tables for intolerant foodies. Mexica offers some great choice but tell them to leave out the cheese and make sure you check they have dairy free tortillas and nachos etc Japanese restaurants seem to cater well for dairy free too but again give them some notice, French restaurants - best to avoid the buttery roux based sauces and definitely check out the menu and talk to the chef in advance. Dinner Parties These can be tricky. Major embarrassment potential if not handled positively! It is important that you communicate with the cook well in advance - even offer to help if you feel your host is worried or nervous. Be resolute and explain that this is not a food fad but a potentially serious illness and give some suggestions. If you cover this beforehand you can avoid the subject completely later (and those uncomfortable discussions which can spoil the atsmosphere and the appetite!) Check out the menu - it may only need slight fine tuning and you are the best qualified to suggest how to adapt it to your needs. How can I make Travelling Dairy/Lactose Free - Hassle Free? Flying In flight food is rarely a joy but with a special dietary requirement it takes on a whole new dimension! Firstly check your airline offers dairy or lactose free meals, if so they normally need at least 24 - 96 hours advance notifaction so bear this in mind if it is a last minute booking. Ensure your requirements are recorded at the time of booking and that it is shown on the details of your eticket under your PNR (booking reference) if you have one. It is always a good move to reconfirm within 96 hours of departure. Even with these precautions what you end up with is often not right or just plain awful! Steamed fish with steamed vegetables and maybe some rice, followed by a piece of dry cardboard, and some tinned fruit seems to be a favourite with airline caterers! So whatever you do - make sure you take some lactose or dairy free snacks just in case! Useful 'Props' It could ease the hassle factor considerable to devise a translation card to carry with you with details of what dairy free foods you can safely eat in the language of the country or countries you are visiting. Also cobble together some stock dairy free/lactose free phrases in the local language to reel out when needed. (Impress your travel companions by practicing them to word perfection before you go!) The brilliant news is that there are some absolutlely gorgeous dairy free alternatives for just about everything that even people who can eat dairy adore! To take a look at some Lactose Free click here or Dairy Free click here! |
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