We hear this often in our practice, for a variety of reasons. Many clients complain of GI complaints, others complain of migraines and some even recognize swollen lymph nodes. Gas, bloating, and diarrhea are certainly among the more common reasons people choose to completely eliminate dairy from their diets. While our clinicians have full faith that diary can cause these issues, we are a bit sensitive to how often clients are told milk is the culprit, and maybe this isn’t really the offending agent or maybe after a very specific elimination, it could be reintroduced with less damaging effects.
Understanding Dairy Sensitivity
When clients have a genuine dairy allergy, their body produces immunoglobulin E which can be tested, otherwise known as IgE. This would be similar to being stung by a bee and some have a hypersensitive response. Their body’s also create IgE. Others have a sensitivity to dairy however, which does not produce an IgE response but there is evidence of hypersensitivity. Finally, there are also a group of people who are lactose intolerant who do not have an immune response, but do suffer an adverse reaction. Differentiating among these these main causes of diary-induced food reactions is vital for determining the best plan of care for the client.
Lets look more specifically at dairy allergy, a condition that causes an IgE-mediated reaction. In these unfortunate few, when they are exposed to dairy, specialized white blood cells called lymphocytes within their bodies produce and release the IgE antibodies. These circulate within the blood and attach themselves to other cells, called mast cells, which are located through the entire body. Mast cells store chemicals, including histamine, so when an allergic person consumes dairy, the IgE on the surface of the mast cell triggers the release of histamine throughout the entire body. Symptoms can therefore present within the nose, throat, lungs, skin and of course, the GI tract.
For many, these symptoms can be very quick and rather intense. Swelling of the face, lips, eyes, and tongue can be exceptionally dangerous. A runny or congested nose and sneezing are rather common, as well as hives. Some have coughing or wheezing, and may be diagnosed with asthma. Others have nausea, cramping, abdominal pain, diarrhea and even vomiting and are more inclined to be diagnosed with irritable bowel syndrome. Less common are symptoms such as decreased blood pressure, fainting, chest pain, irregular heart beat, and even more rare, death.
Similar to our previous post about managing the complexities of mental health, we prefer to really dig into the issue and assure we are truly treating the right problem, and better gain as much information about the body’s reaction so we can specialize our treatment plans. Skin testing can be offered, as well as a radioallergosorbent blood test or an enzyme-linked immunosorbent assay blood test. Sometimes these tests have already been done on a client by a previous provider, but unfortunately more than half return with false-positives. The skin test especially may demonstrate a positive response, but the client is not actually allergic to the food tested. IgE can be elevated for other reasons, other allergens or even parasites.
The gold standard for diagnosing an allergy is the double-blind, placebo-controlled food challenge which must be performed within the office in the event it creates a severe allergic response. Symptoms are monitored and are ultimately the key to diagnosis. No response is indicative of no allergy but this doesn’t mean there isn’t a clinically significant intolerance.
From a clinical perspective, those with a true dairy allergy should avoid these products, even in pancakes, waffles, pudding, and omelets. There is some evidence to suggest that baked dairy products can reduce allergic response by diminishing the intolerance, which is preferred to complete elimination. However, with severe allergies, this still maybe too much risk and in these clients, understanding how to read labels well is vital. Caramel flavoring, chocolate, whey and confectioner glaze are all offenders. Nut butters, mashed avocado, and hummus can be alternatives to cream cheese, butter or dairy-based dips. Rice milk, almond milk, oat milk, hemp milk and soy or almond yogurt are other alternatives. Those with true allergies to dairy should also be aware that the standard condom has milk proteins and so a vegan option should be sought out.
Vitamin D and calcium deficiency may be a matter of importance for these individuals so sufficient supplementation via other routes is imperative. This too can be tricky because so many nutriceuticals today just aren’t high quality. Surprisingly, this was the initial motivator for our boutique because we spent hours upon hours finding the best supplements for our clients. Our motivation is not to become a high profiting retail chain, but rather to offer our midwifery clients excellent options. The goal for supplementation is always to find a well-absorbed, high quality vitamin and mineral supplement with the appropriate calcium formulation and vitamin D3.
Once an IgE response is ruled out in those who do experience symptoms after consuming dairy, then the goal is to determine if the response is inflammatory. In reality, true IgE-mediated hypersensitivity is likely very rare. Other cells, especially T-lymphocytes, are now being recognized as players in clinical responses that are seen later, or in a more delayed fashion. White blood cells and inflammatory mediators are plentiful, creating a complex reaction that could range from eczema and constipation to migraines and joint pain. Sinus congestion and postnasal drip is a very commonly overlooked response as well. Have you ever recognized that person that sort of snorts in effort to scratch their nose or throat, and maybe wipes their nose in an upward fashion with their hand, again itching it, but frequent enough that they cause a line across their nose? Think diary.
Since different mediators are involved in the inflammatory response than simply IgE as found in allergic responses, other tests must be utilized. One test, and the one we currently prefer, is the Mediator Release Test (MRT). More on this test later, but the challenge for those who suffer food sensitivities is that because symptoms can be delayed for days, or because some foods can be tolerated in small doses or prepared in certain ways, it makes for challenging identification. Those with true allergies can not tolerate milk products in any forms or in any quantities, but when the response is not IgE-mediated, there can be tolerance to milk in one form, but not in another. For example, there may be a sensitivity to milk but not cheddar cheese.
Now if we take this a step further, sometimes the issue isn’t the milk itself, but an antigen within the milk. This makes sense especially for breastfed babies. It isn’t the milk itself often, but something mom has consumed that is within her milk. The flavor, color and aroma of human milk changes depending on what mom has consumed. It may be deceiving to a person with a corn or soy allergy, because milk may not be the issue but rather the cow’s diet. Grass-fed milk may be tolerated with complete ease.
The Elimination Diet
Many are familiar with the elimination diet, and in my opinion, these are too frequently recommended, not easily applied, and not well understood. In our experience as well, when we are working with a client who has allergies or even sensitivities, it generally isn’t to just one item. Many are also sensitive to artificial and natural chemicals which are pervasive in our food supply, and even our pharmaceuticals. These allergies often create the inflammatory responses which clients are all too familiar and what brings them into our office is the cascading effect, ultimately they realize they are having difficult conceiving, or have uncontrolled anxiety, acne, irregular cycles, thyroid disease, or blood sugar issues.
This is when we typically implement MRT testing. Our goal is to identify with as much certainty as possible, what the actual triggers are and then create a precise diet plan. The MRT test can evaluate 150 foods and chemicals which can then be eliminated for a period of time, ultimately allowing their body time for healing, and finally reentry into their diet.
We haven’t talked about food intolerance, so let’s dive into that now. The sugar within milk is called lactose. Many people are familiar with this because they say they are “lactose intolerant,” which means their small intestines does not create sufficient enzyme to break down the lactose. They will experience gas, bloating, diarrhea, and sometimes vomiting. This may be a genetic issue, related to parasites, or even a bacterial overgrowth. Some have celiac or Crohn’s disease, and others experience lactose intolerance following chemotherapy or small bowel surgery.
These individuals can be diagnosed with a breath test, blood test, or a stool test. There are many who have lactose intolerance, but can tolerate aged cheeses and yogurt, but not milk and ice cream because they have a higher content of lactose. They can tolerate lactose-free cow’s milk and other lactose-free cow products in which the lactose is already broken down. Enzymes are also available to help these people digest lactose and subsequently eat a wider variety of dairy products with fewer symptoms. Again, because of a life-long struggle with dairy, some avoid it religiously and may need evaluated for calcium and vitamin D deficiency.
A few final points that you may find helpful include understanding that as children grow, their enzymes change. This is why foods that were once really horrible to you as a child, taste significantly better as an adult. It still amazes me that I enjoy beans so much today because I would rather sit at the dinner table all evening than even put one on my lips as a child. Adults with lactose intolerance however, are likely going to struggle their entire life. Keep in mind if the issue isn’t an allergy, and not related to an enzyme issue such as with lactose intolerance, an elimination diet can heal the gut and eliminate the intolerance. Finally, while gluten and dairy allergies and subsequently elimination diets are the current rave, there are many other sensitive that can invite havoc on one’s life. We’ve had clients suffer significantly from paprika, coffee, various dyes, avocado, asparagus, and pork. Who knew? We certainly didn’t. Too often we learned we had clients on restrictive diets that were far too broad and understanding their specific issue helped us better dial into a healing diet and ultimately, heal their body.