I love food! I love eating healthy, delicious meals and think of food as not only foundational to our well-being, but one of the greatest pleasures we have in life. And yet, with ingredient labels, inflated food prices, and information overwhelm, navigating the food scene has become as hard to see through as this longhaired calf’s haircut. There is plenty of space for doubt and confusion. So, no wonder patients arrive with questions about what they should be eating and how often.

Often, I feel that no one except ourselves can make the final decision about what we should put on our plate. But I do love to share information, sift and sort through the available research, and empower people to make the best decisions for their specific health challenges and preferences. So, let’s get to one of the most common questions that arises in my practice: Should I be Eating Dairy?.

How Healthy is Dairy?

There are many beautiful advantages to including this food group in your diet — it is often high in protein and can be made locally in traditional artisan contexts that connects us to our neighboring farmlands. And yet, in many other contexts, consuming dairy can be problematic for our health. Here are some of the most common ways we know that dairy contributes to symptoms for people.

• In general, dairy consumptions tends to promote sluggish digestion and constipation. If you are going to indulge in dairy and you already struggle with constipation, know that daily doses of dairy will likely make that tendency worse. You may be able to strike a balance if you temper your dairy consumption with consuming enough water and sources of soluble and insoluble fiber. But for some people with long-standing constipation, eating dairy regularly isn’t a great option.

• Dairy stimulates the production of phlegm and mucus in the respiratory tract. The immune system lining the nose, mouth, throat, postnasal cavity, and lungs produces a protein knows as Secretory IgA (sIgA) in response to dairy consumption. SIgA secretions are a way these tissues protect themselves from foreign protein (Pinnock & Blakey, 2007). Excessive sIgA is often what is happening when you experience feelings of congestion, sinus pressure, coughing, or thick mucus accumulating shortly after eating a strong dose of dairy, like an ice cream cone or macaroni and cheese. If you experience thick mucus production after eating dairy, pay attention: it is likely a sign that your body is uncomfortable with the quantity or format you just ate. This is also why it’s recommended to avoid eating dairy when recovering from a cold or virus, or when you are struggling with symptoms of a chronic respiratory condition like asthma, chronic sinusitis, or COPD.

• The proteins in dairy—caseins and whey—are among the most common instigators of IgG and IgA food sensitivities and IgE allergies (Sampson, 2004). These dairy-derived proteins can trigger different kinds of immune reactions, called agglutination reactions in the body. The immune system sees the proteins as inflammatory and mounts an immune response to them. Sometimes this inflammation can aggravate and contribute to other expressions of inflammation in the body, such as: skin reactions like eczema and psoriasis, join pain, digestive conditions, or autoimmunity. For some people, identifying the foods that are contributing to their inflammatory symptoms and avoiding them is an important part to establishing a new, healthier baseline.

• Conventional (not-organic) dairy can be hormonally activating. The chemicals used to stimulate additional milk production in conventionally-raised cows and the hormones in those cows themselves have been linked to endocrine disruption, increased incidence of childhood obesity, teenage acne, early onset of puberty, insulin resistance, and PCOS (Adebamwo, 2005).

• Milk activates and stimulates a complex known as mTORC1 that is known to contribute to aging and chronic diseases such as diabetes, cancer and neurodegenerative disorders—potentially Alzheimer's and Parkinson's (Melnik, 2015).

• Certain kinds of dairy, namely the dairy from A1 cows, have been shown to stimulate inflammation, menstrual pain, heavy bleeding, and mood symptoms associated with menstrual cycles (Afrin, 2019). For some people (not all), one of the proteins prevalent in A1-type dairy known as beta-casein is converted in the gut into an inflammatory peptide called beta-casomorphin-7 (BCM7). BCMT sets off a cascade of inflammation that increases histamine (allergies), mast cells (endometriosis flares), and inflammatory cytokines (intense period pain). Based on my clinical experience, stopping dairy can relieve heavy periods, period pain, and premenstrual mood symptoms and simply isn’t worth eating if you have endometriosis. Some people who can’t tolerate A1 dairy do well with sheep, goat, and A2 dairy from Jersey cows (He, 2017).

• The sugar component of dairy products is known as lactose. Some people have a genetic defect in the enzyme that breaks down lactose (called lactase). They are lactose intolerant and experience gas, pain, bloating, and digestive upset when they consume lactose (Heaney, 2006). Other people have slightly less lactase enzyme available and their body runs out of the digestive capacity it needs to break down lactose after eating a certain amount of dairy. Lactose deficient people should limit their consumption, choose only small amounts of lower lactose sheep or goat cheeses, and supplement with lactase enzymes.

• Finally, it might be helpful to know about an addictive process that is triggered in some people by the digestion of dairy and milk proteins. The digestion of dairy creates an opiate molecule called casomorphin, which activates the the same opioid receptors in the brain that respond to prescription pain pills and heroin. The effect is compounded in ultra-processed food products. For people with high levels of these opiod receptors, going dairy-free, even if it’s best for long-term health, can cause severe withdrawal symptoms such as depression, mood swings, or worsened gut problems. For people who experience opiate responses to dairy, going dairy-free can mean a couple weeks of things feeling worse before they get better. They may also have heightened resistance to giving up dairy because their nervous systems are highly addicted to its byproducts.

• Any of the above issues may overlap or co-exist.

Solutions:

• If dairy (or any other specific food ingredient) is obviously a trigger that worsens your symptoms, eliminating or reducing your consumption within your means will be the best approach. Depending on the type of sensitivity reaction you are having, you may need to temporarily avoid it until your gut lining and immune system can heal, or you may need to eliminate it from your normal consumption more permanently.

• Consider food sensitivity testing and allergy testing if you are unsure of your body’s response to dairy.

• On balance, work towards a diet with more omega three fatty acids (flax oil, deep ocean fish, olive oil). Dairy is high in palmitic acid which is more inflammatory (omega 6 and 9).

• Whenever possible, choose organic sources of pasture-raised sheep and goat dairy.

• Use digestive enzymes including lactase if you are lactose intolerant.

Finally, it should be noted that dairy consumption is not essential for meeting daily calcium requirements. Removing dairy from the diet does not necessarily lead to a negative impact on bone density. Some research indicates that alternative sources of calcium, such as plant-based foods and fortified products, can adequately meet the body's calcium needs (Bischoff-Ferrari et al., 2011).

REFERENCES

• Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005 Feb;52(2):207-14. doi: 10.1016/j.jaad.2004.08.007. PMID: 15692464.

• Afrin LB, Dempsey TT, Rosenthal LS, Dorff SR (2019) Successful mast-cell-targeted treatment of chronic dyspareunia, vaginitis, and dysfunctional uterine bleeding, Journal of Obstetrics and Gynaecology, 39:5, 664-669, DOI: 10.1080/01443615.2018.1550475

• Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis J A, Orav E J, Staehelin, HB, & Willett WC. (2011). Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. British Medical Journal, 342, d1473.

• He M, Sun J, Jiang ZQ, Yang YX. Effects of cow's milk beta-casein variants on symptoms of milk intolerance in Chinese adults: a multicentre, randomised controlled study. Nutr J. 2017 Oct 25;16(1):72. doi: 10.1186/s12937-017-0275-0.

• Heaney RP (2006). Dairy and bone health. Journal of the American College of Nutrition, 25(2), 128S-136S.

• Melnik BC. Milk—A Nutrient System of Mammalian Evolution Promoting mTORC1-Dependent Translation. International Journal of Molecular Sciences. 2015; 16(8):17048-17087. https://doi.org/10.3390/ijms160817048

• Phy JL, Pohlmeier AM, Cooper JA, Watkins P, Spallholz J, Harris KS, Berenson AB, Boylan M. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015 Apr;5(2):259. doi: 10.4172/2165-7904.1000259.

• Pinnock, H., & Blakey, J. D. (2007). Asthma and chronic obstructive pulmonary disease: similarities and differences. Clinical and Experimental Allergy, 37(5), 575-579.. Sampson, H. A. (2004). Update on food allergy. Journal of Allergy and Clinical Immunology, 113(5), 805-819.