What’s the difference between lactose intolerance and a milk allergy? I’m discussing the key differences and what you need to know about lactose intolerance and a milk allergy.
Lactose intolerance seems like a pretty common thing these days. I can think of at least four friends off the top of my head who are self-diagnosed lactose intolerant. It’s important to recognize that lactose intolerance and a milk allergy are not the same thing and what you should know about each. I’m also answering whether or not you can have any dairy if you are lactose intolerant.
Disclosures: None. This post was not created in partnership with any product or brand.
What’s the difference between lactose intolerance and a milk allergy?
Sometimes the terms are used interchangeably, but a milk allergy and lactose intolerance are not the same thing. A milk allergy is characterized by an immune reaction to cow’s milk proteins (1).On the other hand, someone with lactose intolerance doesn’t produce enough of the enzyme lactase which breaks down the naturally occurring sugar in milk called lactose (1).Lactose intolerance is not an #allergic reaction. Learn more about the difference between a #milk #allergy and lactose intolerance here! Click To Tweet
Across the board, food allergies and food intolerances (sometimes called food sensitivities) are not the same. Allergies cause immune reactions that could be life-threatening. Sensitivities or intolerances generally cause discomfort (like gas, bloating, diarrhea, etc.) but are not life-threatening.
Cow’s milk allergy is one of the top 8 food allergens, along with peanuts, tree nuts, wheat, soy, fish, eggs and shellfish. Between 2% and 7.5% of kids have a milk allergy. When a milk allergy is present, it usually develops within the first year of life, though it resolves in 85% of kids by the time they are 3 to 5 years old (1). In adults, the prevalence of milk allergy is much lower, between 0.1% and 0.5% (1).
In a cow’s milk allergy, all dairy must be completely avoided. That said, a challenge reintroducing baked milk can be done under clinical supervision and may accelerate the resolution of an allergy (2).
Lactose is naturally-occurring milk sugar. It’s found in the milk of all mammals, including breastmilk (6% weight in volume) and cow’s milk (4% weight in volume) (1). Lactose is a disaccharide made up of two monosaccharides: glucose and galactose. Lactase is the digestive enzyme that splits lactose into glucose and galactose. Basically, lactase makes it so you can digest lactose. Lactose intolerance most often means your body doesn’t produce enough of the lactase enzyme.
Lactose intolerance in infants is extremely rare. Our bodies naturally produce less lactase in adulthood, but in some populations lactase production starts to decline in childhood after weaning. Lactose intolerance is common in up to 80% of Asians, Africans, Native Americans and people of Middle Eastern, Arctic or Mediterranean descent. Only about 20% of people of European descent have lactose intolerance. Lactose intolerance doesn’t involve the immune system at all and isn’t an allergic reaction.
Both milk allergy and lactose intolerance can have digestive symptoms like abdominal pain, diarrhea, nausea, vomiting and bloating. Any other symptoms the like a runny nose or skin reaction would only occur with an allergic reaction to milk, not in lactose intolerance.
So Can You Have Dairy with Lactose Intolerance or Not?
Yup! Most people with lactose intolerance can tolerate between 12 and 15 g of lactose, about the amount of lactose in 1 cup of milk (1). The important thing to remember is to consume at or below your tolerance level.
Here’s How People with Lactose-Intolerance Can Still Manage Dairy
- Introduce dairy slowly, if you’ve been avoiding it completely
- Try it in small amounts – many are able to tolerate small amounts of dairy
- Have dairy with other foods, which can slow down the digestive process
- Choose lactose-free dairy (Fairlife, Lactaid and Mootopia are a few brands)
- Try yogurt, which is more easily digestible because of the live and active cultures
- Try hard cheeses, which are virtually devoid of lactose (like cheddar, Colby, Swiss, provolone or brie) (1,2)
Why even try to eat dairy if you are lactose intolerant?
Dairy is a nutrient powerhouse, and it can be hard to get the same nutrients from other foods. You can read this blog post about when I dropped almond milk for cow’s milk a few years ago, but just as an example: it would take 10 cups of spinach to equal the same amount of calcium as in one glass of cow’s milk. Dairy is also a source of 3 of the 4 nutrients of concern which Americans are not getting enough of. Including small, tolerable amounts of dairy can help meet your body’s needs without relying on a cocktail of supplements. Food is always the preferred form of any nutrient.
(1) Joneja JV. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and Dietetics, 2013.
(2) Carillo M. Lecture presented: Got Milk? Milk Allergy vs. Lactose Intolerance: Understanding the Difference. June 4, 2018; Frisco, TX.