Lactose intolerance and milk allergy

Lactose intolerance

Lactose intolerance

Lactose is a sugar found naturally in milk. It’s important to distinguish between lactose intolerance and milk allergy, because milk allergy can cause severe reactions.

Lactose intolerance is caused by a shortage of the enzyme lactase, which is needed to break down lactose so it can be absorbed into the bloodstream. When someone doesn’t have enough of this enzyme, lactose isn’t absorbed properly from the gut, which can cause symptoms such as bloating and diarrhoea.

Milk allergy

Allergy to cows’ milk is the most common food allergy in childhood, and affects 2-7% of babies under one year old. It’s more common in babies with atopic dermatitis. A reaction can be triggered by small amounts of milk, either passed to the baby through the mother’s breast milk from dairy products she has eaten, or from feeding cows’ milk to the baby.

Children usually grow out of milk allergy by the age of three, but about a fifth of children who have an allergy to cows’ milk will still be allergic to it as adults. The symptoms of milk allergy are often mild and can affect any part of the body. They can include rashes, diarrhoea, vomiting, stomach cramps and difficulty in breathing. In a very few cases, milk allergy can cause anaphylaxis.

Cows’ milk allergy is caused by a reaction to a number of allergens in cows’ milk, such as casein and whey. Casein is the curd that forms when milk sours, and whey is the watery part that is left when the curd is removed.

People can be allergic to either whey or casein, or both, and an allergic reaction can be triggered by very small amounts of these allergens in people who are sensitive. Heat treatment, such as pasteurisation, changes whey, so people who are sensitive to whey might not react to pasteurised milk. But heat treatment doesn’t affect casein, so someone who is allergic to casein will probably react to all types of milk and milk products.

Milk from other mammals (such as goats and sheep), and hydrolysed milk and soya formulas, are sometimes used as a substitute for babies who are at risk of developing cows’ milk allergy. However,  the allergens in milk from goats and sheep are very similar to those in cows’ milk. This means that someone with a cows’ milk allergy might react to these other types of milk as well, so goats and sheep milk aren’t suitable alternatives for people who are sensitive to cows’ milk.

Some highly hydrolysed milk formulas are suitable for babies with cows’ milk allergy, but other types of formula, such as partially hydrolysed milk and soya formulas, aren’t suitable, because many babies with cows’ milk allergy might react to them as well.

Which foods can I substitute?

Milk is rich in protein, calcium and Vitamins A and B and it is important to insure an adequate intake of these elements when on a dairy-free diet.

Soya is rich in protein, and other foods of importance in a dairy-free diet are potatoes, vegetable oil and fish. Cod liver oil or fish oils are rich in vitamin A. Calcium is found in sardines, watercress, figs, rhubarb, almonds and other nuts. Fresh fruit and vegetables are a good source and vitamins and minerals (especially important for children for the formation of strong, healthy teeth and bones).

There are a number of other milks that are available that may be substituted for cow's milk when baking or cooking. The type of substitute used will depend on the type of food it is used for. Rice milk is good for drinking and putting on cereal. It can also be used when baking or as a thickening agent. In some recipes water, broth, or juice can be substituted for the cow's milk.

Sometimes, a milk allergic person can use goat's milk or soy milk. Both of these milks, however, are also very allergenic. In fact, most people allergic to cow's milk are also allergic to goat's milk. Persons with lactose intolerance should never use goat’s milk. Lactose is present in all animal's milk.

Soya, rice, oat, nut, coconut, sheep's milk*, goat's milk*, ewe's milk*,

Soya spread (some pure oil margarines)

Soya yoghurt

Rice cheese, soya cheese (hard/flavoured/slices/spreads)

Soya cream, whip topping, coconut cream

Soya ice-cream, rice ice-cream

Carob and vegan chocolates

Whole egg

Whole egg replacer

Egg white
Egg white replacer

Egg in recipes: to replace one egg
As recommended by The Vegan Society: 1 tablespoon gram flour plus 1 tablespoon of water or 50ml
white sauce or 1/2 banana mashed

*Please be aware: Sheep, goat and ewe's milk are technically not dairy products, However they have a similar composition to cow’s Milk and may cause similar reactions and intolerances


Milk is neither the only nor the best source of calcium and has little effect on bone strength. Good sources include: green leafy veg (broccoli, cabbage, bok choy, watercress etc), pulses (eg soya – used to make tofu, soya burgers, soya milk etc, red kidney beans, chick peas, broad beans, baked beans), parsnips, swede, turnips, some nuts such as almonds, Brazils, hazelnuts, pistachio and some fruits (dried figs, currants) and olives - and exceptionally high are sesame seeds. (Hummus, that gorgeous Middle-Eastern dip, contains sesame paste.) Supermarkets and health food shops now stock a wide selection of delicious and nutritious dairy free alternatives to milk, yogurt, ice cream, margarine and cheese.

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