Ever wondered about dairy and your IBD? Here's all you need to know.
What is dairy?
Dairy refers to the group of foods that containing or made from animal milk. This includes milk, cream, butter, cheese, and yoghurt (not eggs). Many dairy products come from cows but dairy products also come from goats and sheep, like feta cheese which is made using sheep milk.
Problems with dairy
Milk allergy - an allergic reaction to foods containing dairy. If someone with a dairy allergy eats dairy a reaction usually happens within minutes. The person may experience symptoms including swelling, itching or irritation of the mouth or throat, Hives, Headache, Difficulty breathing, Cramps, nausea or vomiting and sometimes anaphylaxis. Total avoidance of dairy and dairy containing products is the only solution in milk allergy.
Lactose intolerance – lactose is the sugar found in milk. Someone who is lactose intolerant does not produce the enzyme lactase which helps to break down lactose in the small intestine so lactose passes through the digestive tract undigested and causes symptoms like diarrhoea, bloating, gas and nausea. A person’s ancestry and genetics plays a role in their risk of developing lactose intolerance; Asians and Native Americans have the highest prevalence of lactose intolerance at more than 90%. There is around a 60-70% prevalence of lactose intolerance in American blacks, Arabs, Jews, Hispanics, and South Europeans (Italians and Greeks), and the prevalence is lowest in people with Northern and Western European and Americans ancestry (10-15%). A person can also develop lactose intolerance if the lining of the small intestine (where lactase is produced) is damaged (i.e. in Crohns Disease) but this often rectifies when the damage is repaired so tolerance to dairy may change depending on whether someone with Crohns has active disease or is in remission. For most people with lactose intolerance opting for lactose free dairy products, where the enzyme lactase is added to the product during processing to break down the sugar, is enough to reduce symptoms. Another option is to take lactase enzymes with dairy containing meals. Some people with lactose intolerance can tolerate a certain amount of lactose per day. Studies have shown this to be up to 12-15g of lactose per day which is the equivalent to a 250ml glass of milk but each persons tolerance is different – some may not be able to tolerate any.
Dairy intolerance – some people report that dairy causes them digestive symptoms, even if they have tested negative for lactose intolerance, or have tried lactose free dairy products and symptoms still persist. Dairy intolerance is less well understood as it is not an allergy or a lack of enzymes. However, one explanation could be an intolerance to the proteins called casein or whey in dairy.
We can test for dairy allergy and lactose intolerance but there is no way to test for dairy intolerance.
Dairy and IBD
Some people with IBD experience symptoms like bloating, gas, pain, nausea, or diarrhoea, when they eat dairy containing foods. This could be because they have lactose intolerance, or it could be a dairy intolerance.
Lactose intolerance is more common in people with Crohn’s Disease of the small intestine which makes sense as this is where lactase is produced. One study found the prevalence of lactose intolerance changed depending on the location of Crohn’s - proximal small bowel (100%), terminal ileum (68. 1 %), terminal ileum/colon (54.9%), and colon (43.5%). On the other hand, people with ulcerative colitis seem to have the same chance of being lactose intolerance as the general population.
There is little data on dairy intolerance in IBD as this cannot be tested for so is usually self-reported by in my clinical experience dairy intolerance does exist in some patients with IBD. I have also found that peoples personal tolerance to dairy can change depending whether they have active disease or are in remission.
On the other hand, there is some research to suggest that dairy could be beneficial in IBD. In particular, dairy kefir. Kefir is a fermented dairy product that contains bacteria that can help support the microbial balance that live within our intestines and these bacteria help to keep us healthy. Researchers found that kefir consumption may change the gut microbiota, and regular consumption of kefir may improve the patient’s quality of life with IBD in the short term. More research is needed on this but kefir yoghurt is easy to include in your diet if you tolerate dairy and can be purchased at most supermarkets – Yeo Valley is a good brand.
What to do
If you think you might be intolerant to dairy there are some very important things to consider before you remove it from your diet:
Get help - you should only do this under the guidance of a qualified nutrition professional as there are risks associated with removing dairy from your diet.
Malnutrition risk - malnutrition is already a worry for people with IBD and dairy provides important nutrients in many peoples diets including protein, calcium, iodine, potassium, phosphorus and vitamins B2 and B12. These and many other nutrients are important for our health and for recovery so you need to make sure you are getting these from other foods and a nutritionist can help with this.
Additives in dairy free milks – some dairy free milks contain a thickener called carrageenan which may have an impact on relapse rates in IBD (particularly ulcerative colitis).
Dairy free products can be expensive – if you opt for lots of dairy free alternative products this can make the weekly shop more expensive so its important to get guidance on how to best follow a dairy free diet so its better for your health and your wallet!
Restricted diets can decrease quality of life – dairy is found is so many everyday foods and if you are already on a very restrictive diet it may not be the right thing for you at the moment. If done without help and guidance it may also cause stress and anxiety which we know has a negative impact on our IBD (read more about that here).
Dairy is probably only one piece of the puzzle – I’m often talking about ‘pieces of the puzzle’ because its never one thing that’s going to be the magic pill that solves your problems when it comes to IBD and nutrition. We need to look at all the pieces of the puzzle, including foods, nutrients, deficiencies, gut health, sleep, stress, movement and how all these interlink to help or hinder your progress. Its also important we are not always focused on what we need to remove from our diets but rather what we can be including that may be supportive. Ultimately my aim with all my clients is to improve their quality of life and help them achieve nutritional balance through the least restrictive diet possible.
Take away
Dairy may cause symptoms for some people with IBD but it may be beneficial for some, particularly fermented dairy yoghurt. If you think dairy is causing you problems you should speak to your GP, gastroenterologist or nutritionist. If you are advised to stop eating dairy then you need to ensure you are getting calcium, and the other nutrients that dairy provides, from other sources.
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice to work out the right way forward for you.