Milk suits many people, but not quite everyone. The same dairy products can cause different symptoms in different people. Milk contains, among other things, sugar and different proteins. Different people’s bodies process these substances in different ways. One common cause of symptoms is lactose intolerance, meaning poor tolerance of milk sugar. Another possible cause is an allergy to certain proteins in milk. These two things do not mean the same problem at all.
Lactose is a sugar that occurs naturally in milk and dairy products. In the small intestine, an enzyme called lactase breaks lactose into two smaller sugars. Only the broken-down sugars can then be absorbed from the small intestine into the bloodstream. If there is little lactase, not all lactose is broken down. Then some of the lactose travels onward through the intestine as far as the colon. Bacteria in the colon break down lactose and form gas and fluid. The gas and fluid can then cause abdominal symptoms.
Common symptoms are bloating, gas, diarrhea, and abdominal pain. For some people, the stomach also rumbles or they may feel nauseous. Symptoms often begin within a few hours of food containing lactose. The severity of symptoms often also depends on the amount of lactose eaten. Lactose can also be poorly absorbed without clear abdominal symptoms. Many people tolerate a little lactose without clear symptoms. A larger amount can cause them clearer abdominal symptoms. Therefore, two people can react differently to the same amount of milk.
Most babies can initially digest lactose quite well. In many people, the amount of lactase later decreases with age. Symptoms may begin later in childhood or as a young adult. Genes affect how much lactase the body makes. In Northern Europe, many people can digest lactose well even as adults. In Africa and Asia, poor absorption of lactose is more common. Sometimes an intestinal illness or injury also reduces the amount of lactase.
Lactose intolerance does not usually mean completely avoiding all milk. Many people tolerate a small amount of lactose without clear symptoms. However, a suitable amount is slightly different for each person. Lactose-free and low-lactose products can make symptom management easier. A small amount of milk with food may suit some people better. Yogurt and hard cheeses may also suit some people. Lactase products can help the body break down lactose during digestion.
In milk allergy, the problem is not lactose but milk protein. Then the immune system reacts to one or more milk proteins. Symptoms can also appear on the skin, in the abdomen, or in the airways. Swelling of the lips or throat can be part of an allergic reaction. A severe allergic reaction can sometimes also be life-threatening. Therefore, with milk allergy, food is chosen differently than with lactose intolerance.
A lactose-free dairy product can still contain ordinary milk proteins. Therefore, it may suit a person with lactose intolerance, but not a person with milk allergy. With milk allergy, milk and milk proteins usually have to be avoided completely. Milk allergy is clearly more common in small children than in adults. Milk allergy often gradually disappears as a child grows older. Lactose intolerance, in turn, often begins only at school age or in adulthood. Thus, the same word milk is connected with two very different problems.
So milk does not suit all people in the same way. The body can process milk sugar and proteins in different ways. In lactose intolerance, the problem is related to too little lactase in the small intestine. In milk allergy, the decisive issue is the immune system’s reaction to milk proteins. Therefore, it is always important to identify the correct cause of the symptoms. A lactose-free product does not help with an allergy related to milk proteins. When the cause is known, suitable foods are easier to choose. Avoiding dairy products can reduce intake of calcium and vitamin D.
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