Galactosemia
Galactosemia is a genetic condition where a person does not produce the lactase enzyme needed to breakdown lactose. A baby who truly cannot breakdown lactose would fail to thrive right off the bat, and show other signs of malabsorption and dehydration from birth. Testing for galactosemia is part of the routine newborn screening.
It is extremely uncommon for someone without this genetic condition to not be able to breakdown lactose without another underlying cause.
Secondary Lactose Intolerance
If someone does not have galactosemia or a protein allergy, and is still irritated by dairy, it could be due to a secondary lactose intolerance.
This is when irritation or damage to the gut lining impairs the production of lactase. In these cases avoiding lactose may ease symptoms, but it will not solve the underlying problem of the gut.
Milk Protein Allergy
A milk allergy is the reaction to the protein in milk. In these cases the immune system reacts as though the protein is a dangerous invader to the body. Because of the rarity of a true inability to breakdown lactose, if not a secondary lactose intolerance due to gut inflammation/irritation, a milk allergy is most likely going to be the cause of symptoms.
Many people will switch to dairy-free or plant based formula and milks thinking they have a lactose intolerance, when it may very well be a protein allergy. The problem with these formulas and milks is that they are often filled with different forms of sugar like sucrose, corn syrup, brown rice syrup, maltodextrin; gums, and emulsifiers - all of which can cause inflammation in the gut.
The good news is, not all animal milk protein is the same. If someone truly has an allergy to cow milk protein, they typically have no problems with goat milk - which is easier on the digestive system as a whole, and a much better option than anything lactose free. If there is truly a protein allergy to both, thankfully there are better plant based milks out there. You just have to know what to look for.
The other issue is that conventional milk (especially cow milk in the US) is commonly full of steroids, antibiotics, & pesticides, and depleted of beneficial enzymes and vitamins. This can cause inflammation in the gut, ear/respiratory infections, asthma, allergies, eczema, and more.
Often times someone will cut dairy from their diet (or a mom will cut dairy out for a breastfed baby) and symptoms improve, therefore being diagnosed with a “dairy allergy” or “lactose intolerance” when it may not even be the case, but actually an inflammatory response to the over-processed and junk filled dairy that’s wildly available.
Don’t get me wrong. True milk protein allergies do exist. They may just not be as common as we think.
How to Test for a Lactose Intolerance
Genetic Testing - This test uses DNA from blood samples amplified and digested with restriction enzymes. The pattern of DNA fragments is then used to indicate if a person is lactose intolerant or not.
Hydrogen Breath Test - You will drink a liquid that contains a certain amount of lactose, and every 30 minutes over the course of a few hours you breathe into a balloon-like container that measures the amount of hydrogen in your breath. If your breath hydrogen levels rise AND symptoms get worse during the test, you may be diagnosed as lactose intolerant.
Stool Acidity Test - It is very difficult to perform a hydrogen breath test on a baby, so often times a stool acidity test will be done to measure the lactic acid, glucose, and other fatty acids.
How to Test for a Milk Protein Allergy
Skin Test - This is when the skin is pricked and exposed to small amounts of protein found in milk. If an allergy is present, a raised bump (hive) will appear. However, this test isn’t completely accurate.
Blood Test - This test measures the immune system’s response to milk by measuring the amount of immunoglobulin E (IgE) antibodies in the blood. This test, also, isn’t completely accurate.
Oral Challenge - The medical professional will provide different foods that may or may not contain milk in increasing amounts. They will then observe if you react to the ones that contain milk.
Elimination Diet - This is when the provider will advise the elimination of all dairy from your diet to see if symptoms subside. See the “Milk Allergy pt. 2” slide for the possible issue with this test, as well as all of the milk allergy tests.
Safer Milk: Cow
Raw Cow Milk
Raw milk has the highest nutritional value, and is the least inflammatory. Many people who believed they had a dairy or cow milk protein allergy were actually having an inflammatory reaction to “conventional” milk, and found relief once switching to raw.
100% Grass-Fed Cow Milk
There are many misconceptions about raw milk. However, many are still uncomfortable with raw milk or don’t have access. The next best option is 100% grass-fed milk. These dairy cows never eat any grain, and their milk has the next highest nutritional value - especially Omega-3 fatty acids and conjugated linoleic acids. .
Safer Milk: Goat
Compared to cow milk, goat milk forms a smaller, softer, and looser curd in the stomach which makes digestion quicker and easier. The fats in goat milk are also easier to digest, because they are smaller than cow milk fats.
Goat milk also contains more gut-supportive prebiotic oligosaccharides, and has superior mineral bioavailability. And the steroid and antibiotic use in cows is not as widespread in the goat industry.
If someone has a cow protein allergy, often times they can handle goat milk since the protein properties are not the same.
Safer Milk: Plant Based
See my post on plant based milk for more in depth info and brand options.
What to avoid in plant based milk:
Gums (i.e guar, gellan, xanthan, locust bean gum
Oils (i.e rapeseed oil aka canola oil)
Emulsifiers (sunflower lecithin)
Natural Flavors
Sweetened
“Original” (you want to look for “unsweetened,” as it’s not the same)
Look for as simple and plain ingredients as possible.
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