You might remember that catchy slogan from the 1980s, “Milk, it does a body good.” Dairy products are nutritional powerhouses, full of bone-building calcium, vitamin D, magnesium and protein. While the average American drinks less milk than in the 1970s, we eat more cheese and yogurt than ever before. But what happens when dairy doesn’t agree with your body?
For many with celiac and other gluten-related disorders, dairy can be a source of discomfort. Lactose is the natural form of sugar found in dairy products. Many newly diagnosed celiac patients experience secondary lactose intolerance, a result of damaged intestinal villi. This can cause continued gastrointestinal complaints such as bloating, pain, nausea and diarrhea, even when eating gluten free. Lactose intolerance is prevalent in the general population as well; the National Institutes of Health estimates that 30 to 50 million people suffer from the condition. Those who suffer from lactose intolerance may be able to tolerate small amounts of lactose in the forms of cheese and butter or fermented foods such as yogurt and kefir. Consider taking lactase enzyme tablets or using lactose-free versions of milk and ice cream.
Allergic reactions to the protein in milk are most common in children. In fact, the incidence of milk allergies comes in second only to peanuts. Fortunately, most (but not all) will outgrow an allergy to milk. On the other hand, some adults may develop allergic reactions to dairy, including skin rash, eczema, wheezing and congestion. It can also cause life-threatening anaphylaxis. For those with milk allergies, it is necessary to avoid all forms of milk and dairy, even lactose-free items.
For Gina Passantino, a food allergy blogger, it’s been an almost lifelong struggle. “I’ve apparently had an allergy to dairy my whole life but didn’t know about it until I was an adult,” she explains. “I was very thin growing up, and I was prescribed a high-calorie, dairy-based milkshake to help me gain weight. But instead of gaining weight, I just felt worse.” Her symptoms didn’t go away with time. “As an adult, I knew I needed to get calcium, but eating dairy just made me sicker and sicker.”
Initially diagnosed with lactose intolerance, she wasn’t able to start on the right path until a visit to the ophthalmologist, after she started experiencing unexplained facial and eye swelling. “He said, ‘You have a food allergy.’ I got tested, and milk was a huge indicator,” she recalls. “It finally made sense that this is what I’d been dealing with my whole life.” Giving up dairy caused almost immediate improvements in her health that have lasted. “I don’t have a lot of the symptoms that I had as a kid. My abdominal and skin issues went away.”
Pittsburgh-based registered dietitian Jody Garlick found both professional and personal benefits after omitting dairy. “Most of my patients who have dairy issues suffer from digestive, skin and respiratory problems,” she notes. “Giving up dairy provides incredible relief from all of that. Also, I have a milk allergy and have been living dairy free for years. It sure makes it easier to guide others on this type of diet.”
Strong bones without dairy
Those with celiac are at risk for decreased bone density, so it’s vital to consume plentiful dietary calcium, vitamin D and magnesium, with or without dairy products. Garlick suggests a variety of non-dairy foods that are high in calcium. “I recommend green vegetables such as broccoli, bok choy and kale,” she advises. “While spinach and collard greens are high in calcium, the high oxalate content keeps our bodies from absorbing the calcium as well as it could.” Garlick recommends fortified and enriched products as well. “Try fortified orange juice, cereals or fortified milk such as almond, soy or rice milk. I might also encourage almond butter, sesame tahini, tofu and blackstrap molasses.”
There are fewer dietary sources of vitamin D, although it is found in fish such as salmon, sardines and cod. Our skin helps make vitamin D when exposed to sunshine, but it can be difficult for people who live in northern climates to reliably get enough sun exposure to produce adequate amounts.
Passantino has already seen consequences to her bone health because of her dairy allergy. “I do have osteopenia, and I’m still young, so I know I need to pay attention to it. I try to add non-dairy sources of calcium, like kale and broccoli, whenever I can.” In addition to diet, other ways to keep bones healthy include regular weight-bearing exercise like walking, running, weightlifting and avoiding smoking. For those with deficiencies, short- or long-term supplementation with calcium or vitamin D may be necessary.
Just like the gluten-free diet, reading food labels for dairy free takes practice. “One of the biggest challenges I’ve had is getting to know the other names for milk on food labels,” Passantino says. “I also never thought there could be milk in certain foods, like mustard. It can be in so many foods that you would never think of.” Learn other names for milk found on food labels in the sidebar below.
Fortunately, there are a multitude of dairy-free options now available, even for traditionally milk-based foods like cheese and ice cream. “When I’m baking, I typically like to use coconut or olive oil to replace butter,” notes Garlick. “Sometimes I will use a combination of pureed fruit or applesauce along with oil as a butter replacement. I also like dairy-free margarine.” Both Passantino and Garlick recommend milk alternatives. “I love nut-based milk,” says Passantino. “I can bake with both coconut and almond milk, and even hemp and flaxseed milk are great alternatives.” Garlick agrees, “Milk is by far the easiest to replace. My favorites are unsweetened coconut or almond milk.”
Not all dairy substitutions are easy, though, as Garlick notes. “Cheese is the most difficult to replace. My usual go-to for this is nutritional yeast, but I only use it when a recipe calls for a small amount of cheese.” Passantino recommends some of the alternative cheese products now commonly available. “There are so many great products around now that weren’t before.”
Dining out without dairy
Eating away from home presents significant challenges for those on the gluten-free diet, and eliminating dairy can further complicate things. Garlick advises that particular styles of restaurants may be more able to accommodate. “Chinese, Thai and Japanese restaurants use virtually no dairy in most dishes,” she notes. “For more traditional places, it’s best to stay away from cream-based sauces, soups and salad dressings. Try to stick to the basics, such as ordering foods that are baked, grilled or broiled with oil rather than butter.” Garlick also recommends caution when ordering breakfast foods and desserts because they are often made with dairy ingredients. “Just like you have to with gluten free, when in doubt, always ask.”
Passantino finds that preparation helps in many restaurant situations. “I recently also became a vegan, so I often carry my own food to make sure I have something safe to eat. One thing I’ve learned, though, is to bring a separate serving spoon.” She also recommends planning ahead. “I do a lot of research to see who can accommodate my meals before I go. I’m a big fan of Disney for this reason, because I know I can get safe food.”
Tips for getting started
If you’re thinking of giving up dairy, it may be best to start slow. “I encourage my patients to look at the main sources of dairy to get a sense of what needs to be replaced,” advises Garlick. “I suggest baby steps to replace one item at a time with something they really enjoy. There are so many great products available now, so I encourage them to try lots of different options before deciding what they like best.”
Even so, she admits it’s not easy. “The biggest challenge for many people is living without cheese. It’s such a big part of the Western diet and is used so often to add flavor,” she says. “It’s much more challenging to replace cheese than it is milk, butter or even yogurt.” Passantino also advises a gradual transition, if possible. “Pick two nights out of the week to make those your dairy-free nights,” she recommends. “Start slow.”
Coping with even more restriction
Eating gluten and dairy free can feel overwhelming, but Passantino offers words of encouragement. “Try not to think of it as a burden, like, ‘I’ll never have pizza or ice cream again.’ Don’t be afraid to try new products, and try to keep an open mind,” she says. “My husband grew up in a milk- and cheese-eating family, and he now finds that vegan cheeses are good.”
Passantino notes she has found eating dairy free rewarding in many ways. “I think I am healthier now and am more aware of what’s in food. On top of that, I’ve developed great relationships with the food allergy community,” she says. “I started the blog with the thought that I had a story to share. I also wanted to reach out to other adults to let them know that your life isn’t over when you’re diagnosed with a food allergy.”
Amy Keller, MS, RDN, LD, is a dietitian and celiac support group leader from Bellefontaine, Ohio.
Want more information on adhering to other dietary restrictions in addition to gluten free? Check out our Not Just Gluten Free section!