“Should I avoid Dairy if I have IBD?”
The short answer is no, if you do not experience symptoms, then you do not need to avoid dairy.
If you do experience symptoms when eating dairy and you have IBD, the following article will help to answer why that might be and what to do.
What is dairy?
Dairy refers to foods that contain or are made from animal milk. This includes milk, cream, butter, cheese and yoghurt (but not eggs). Most dairy products are made from cow’s milk, but they can also come from goats and sheep – for example, feta cheese is made using sheep’s milk.
Problems people can have with dairy
Many people tolerate dairy well and can enjoy it as part of a healthy, balanced diet. However, some people with IBD may experience problems with dairy, including:
Lactose intolerance
Lactose is the naturally occurring sugar found in milk. Someone who is lactose intolerant does not produce enough of the enzyme lactase, which helps break down lactose in the small intestine. This means lactose can pass through the digestive tract undigested, causing symptoms such as diarrhoea, bloating, gas and nausea.
A person’s ancestry and genetics play a role in their risk of developing lactose intolerance. Asians and Native Americans have the highest prevalence, at more than 90%. Prevalence is around 60–70% in American blacks, Arabs, Jews, Hispanics and Southern Europeans (Italians and Greeks), and lowest in people with Northern and Western European and American ancestry (10–15%).
Lactose intolerance can also develop in people with IBD, particularly Crohn’s Disease (more on this below).
For most people with lactose intolerance, choosing lactose-free dairy product - where the enzyme lactase is added during processing to break down the lactose - is enough to reduce symptoms. Another option is to take lactase enzymes with meals containing dairy.
Some people can tolerate a certain amount of lactose each day. Studies have shown this may be up to 12–15g of lactose, equivalent to around a 250ml glass of milk, but everyone’s tolerance is different and some people may not tolerate any.
Milk allergy (IgE mediated)
This is an allergic reaction to foods containing dairy that usually happens within minutes or up to two hours after eating them. Symptoms can include swelling, itching or irritation of the mouth or throat, hives, headache, difficulty breathing, cramps, nausea or vomiting and, sometimes, anaphylaxis.
Milk allergy (non-IgE mediated)
This reaction is slower to appear, usually 2–72 hours after eating dairy, and can cause gastrointestinal symptoms such as bloating, pain and nausea, as well as eczema.
It is possible to test for IgE-mediated dairy allergy and lactose intolerance, but there is no test for non-IgE-mediated dairy allergy. This requires an exclusion and reintroduction diet.
Dairy and IBD
Some people with IBD experience symptoms such as bloating, gas, pain, nausea or diarrhoea when they eat foods containing dairy. This could be because they have lactose intolerance, or there could be another issue.
Lactose intolerance is more common in people with Crohn’s Disease affecting the small intestine, which makes sense as this is where lactase is produced. One study found that the prevalence of lactose intolerance varied depending on the location of Crohn’s Disease: proximal small bowel (100%), terminal ileum (68.1%), terminal ileum/colon (54.9%) and colon (43.5%).
People with Crohn’s may also find that lactose intolerance is transient – present during a flare but resolving when they are in remission. In contrast, people with ulcerative colitis seem to have the same chance of being lactose intolerant as the general population.
There is also some research suggesting that dairy could be beneficial in IBD, particularly dairy kefir. Kefir is a fermented dairy product containing bacteria that can help support the microbial balance within our intestines.
Researchers found that kefir consumption may change the gut microbiota and that regular consumption may improve quality of life in people with IBD in the short term. More research is needed in this area.
What to consider before removing dairy
If you think you might be intolerant to dairy, there are some important things to consider before removing 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.
Consider malnutrition risk. Malnutrition is already a concern for people with IBD, and dairy provides important nutrients in many people’s diets, including protein, calcium, iodine, potassium, phosphorus and vitamins B2 and B12. These nutrients are important for our health and recovery, so you need to make sure you are getting them from other foods. A nutritionist can help with this.
Check additives in dairy-free milks. Some dairy-free milks contain a thickener called carrageenan, which may have a negative impact on IBD, particularly Crohn’s Disease.
Dairy-free products can be expensive. Relying on lots of dairy-free alternatives can make the weekly shop more expensive, so getting guidance on how best to follow a dairy-free diet can be better for both your health and your wallet.
Restricted diets can reduce quality of life. Dairy is found in many everyday foods and, if you are already following a very restrictive diet, removing it may not be the right thing for you at the moment. Without appropriate help and guidance, further restriction may also cause stress and anxiety, which we know can negatively affect our IBD (read more about that here).
Dairy is probably only one piece of the puzzle. I often talk about ‘pieces of the puzzle’ because it is rarely one thing that acts as a magic pill when it comes to IBD and nutrition. We need to consider foods, nutrients, deficiencies, gut health, sleep, stress and movement, and how these interlink to help or hinder our progress.
It is also important that we are not always focused on what we need to remove from our diets, but on what we can include that may be supportive. Ultimately, my aim with all my patients 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 can also form part of a healthy, balanced diet.
If you think dairy is causing you problems, speak to your GP, gastroenterologist or an IBD specialist Dietitian or Nutritionist (like me!). If you are advised to stop eating dairy, it is important to make sure you are getting enough calcium and the other nutrients dairy provides from other sources.
Want to feel more confident about what to eat & improve your symptoms?
Living with Crohn’s, Colitis, a J-pouch or stoma can make knowing what to eat feel confusing, particularly when you are experiencing symptoms or worrying that certain foods might make things worse.
Ready to feel better and enjoy food again?
Through my 1:1 clinic, we can work together to help reduce your symptoms, expand the foods you feel comfortable eating and take away some of the worry around food, so you can get back to enjoying meals, eating out and living your life with more confidence.
Want to feel more confident about what to eat during a flare?
My What to Eat in a Crohn’s Disease Flare and What to Eat in an Ulcerative Colitis Flare courses help you understand how to adapt your diet to manage symptoms, take the guesswork out of mealtimes and feel more confident about what you can eat, without unnecessarily restricting foods.