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    What is ?
    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.

    Lactose intolerance can be caused by a number of things. In humans, the body produces less lactase after the age of two. However, in white Western Europeans, lactase can be produced into adult life, which allows lactose to be broken down properly.

    Because of this, lactose intolerance is more common in certain ethnic and racial populations than in others. In the UK, we think about 5% of the general population have lactose intolerance. In communities where milk is not traditionally part of the typical adult diet, a much bigger proportion of people are affected. For example, up to 75% of the black African community and more than 90% of the Asian community are intolerant to lactose.

    Digestive diseases, or injuries to the small intestine can sometimes cause lactose intolerance, because they reduce the amount of lactase produced. In rare cases, the condition can be inherited.

    Milk from mammals including cows, goats, sheep and humans contain lactose. This means that goats’ milk and sheep milk aren’t suitable alternatives to cows’ milk for people who are intolerant to lactose. There is no medical treatment for lactose intolerance, but symptoms can be avoided by controlling the amount of lactose in the diet. Adults with lactose intolerance can often have a small amount of milk without getting any symptoms.
    (See last table for info on egg products). Intolerance should not be confused with allergy. See Symptoms of below.

    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 goat’s 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.
     


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    Symptoms of

    Unlike a food allergy (which is triggered by small amounts of food and causes immediate symptoms), food intolerance symptoms appear hours, or even days, after consuming your problem food.

  • Common symptoms include:
  • Irritable bowel syndrome
  • Joint problems
  • Migraines
  • Muscle and joint pain
  • Depression and anxiety
  • Fatigue
  • Nausea and vomiting
  • Ulcers and hyperactivity in children

    Most people are intolerant to more than one food. The commonest culprits are wheat, dairy products and yeast, eggs, beans, nuts, tea and coffee.

    Food intolerance can be caused by enzyme deficiencies, viral infections, allergic reactions and disturbances of the body's normal gut bacteria.

    Eating large amounts of a certain food, spicy or processed foods, drinking too much alcohol and exposure to toxic chemicals may increase the risk of developing food intolerance.

    The standard way of diagnosing food intolerance is eliminating suspect foods from the diet for several weeks. If the symptoms ease, foods are reintroduced individually and the effects assessed - a qualified dietician should supervise this. This process is called an elimination diet and can be hard going, but the results are well worth it.

    Many alternative therapists offer treatment for food intolerance. Although they may be helpful, none of these methods have been clinically validated - if in doubt ask for evidence of clinical trials.
     
     

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    Risk Indicator

    An intolerance to a foodstuff, such as dairy, is not life threatening. NB It is important to distinguish between an intolerance and an allergy, the latter will cause an almost immediate reaction and can be dangerous or life threatening.

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    Triggers
    Unless the sufferer of milk allergies/intolerances is aware of all the names that milk (or milk derivatives) can be disguised as on a label then it is difficult to totally avoid.

    Please note that product ingredients with a * do not necessarily contain milk products. This depends on the manufacturer or type of product.

    • ammonium caseinate
    • artificial butter flavour
    • butter solids/fat
    • calcium caseinate
    • caramel colour*
    • caramel flavouring*
    • casein
    • caseinate
    • delactosed whey
    • demineralised whey
    • dried milk
    • dry milk solids
    • flavouring*
    • high protein flour*
    • hydrolysed casein
    • hydrolysed milk protein
    • lactalbumin
    • lactalbumin phosphate
    • lactate
    • lactoferrin
    • lactoglobulin
    • lactose
    • magnesium caseinate
    • milk derivative
    • milk fat
    • milk protein
    • milk solids
    • natural flavouring*
    • Opta (fat replacement)
    • potassium caseinate
    • rennet casein
    • Simplesse (fat replacement)
    • sodium caseinate
    • solids
    • sour cream solids
    • sour milk solids
    • whey
    • whey protein concentrate

    Flavourings with Lactic Acid may sometimes contain derivatives of milk. So if someone is severely allergic to milk, what happens if it touches their skin?

    If a certain product touches a sufferers skin, the reaction caused is likely to be an itchy rash, urticaria (nettle rash), sneezing, wheezing or shortness of breath. Occasionally, anaphylaxis has been reported as a result of skin contact with an allergen.

    So what happens if the milk or it's derivatives are an ingredient of a cosmetic, toiletry or perfume that comes into contact with the skin? Depending on how allergic the sufferer is, they may get any of the reactions described above. This is true for all food allergens, not just milk.

    Milk derivatives may be found in hair conditioners, body creams, soaps and face foundation creams. Casein, one of the main proteins in milk, is often present in the lubricant coating of condoms. Casein-Free "Condomi" condoms are available from the Vegan Society.


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    What 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 an 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.

    Try Meals.com for a great range of calcium rich, dairy free recipes

    Milk
    Soya, Rice, Oat, Nut, Coconut, Sheep's Milk*, Goats Milk*, Ewes Milk*,

    Butter/Margarine
    Soya Spread (some pure oil margarines)

    Yoghurt
    Soya Yoghurt, Oat Yoghurt

    Cheese
    Rice Cheese, Soya Cheese (Hard/flavoured/slices/spreads) 

    Cream
    Soya Cream, Whip Topping, Coconut Cream

    Ice-cream
    Soya Ice-cream, Rice Ice-cream 

    Chocolate
    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 NOTE:
    Sheep's, Goats And Ewes Milk Are Technically Not Dairy Products, However They Have A Similar Composition To Cows Milk And May Cause Similar Reactions/Intolerances


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    Medication

    No medication exists for Lactose intolerance. Avoidance of dairy and products containing Lactose is essential fro effective management of the condition. If you must have dairy products you may consider taking lactase enzyme . These come in the form of drops to add to milk and in capsules to have before a meal. Prolactazyme is also beneficial, containing not only Lactase but a range of other digestive enzymes.


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    Egg Products
    Egg derivatives can be identified on a food label as follows:

    • Albumin
    • Egg Powder
    • Egg Protein
    • Egg White
    • Egg Yolk
    • Dried Egg
    • Frozen Egg
    • Globulin
    • Livetin
    • Ovalbumin
    • Ovaglobulin
    • Ovomucin
    • Ovovitellin
    • Pasteurised Egg
    • Vitellin
    • Lecithin (also known as E322, this may be an egg derivative, but it is usually derived from soya. Still, it is important to be aware that E322 is a possible allergen, if you suffer from egg allergy.)

    The cosmetic and beauty products most likely to contain egg derivatives are hair shampoos and conditioners.


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