No Need to Cry Over Spilt Milk
While conventional wisdom would have you believe that milk is good, especially for growing children; in this article, Dr Chan shares the latest research findings that show that cow’s milk is neither nutritionally necessary nor beneficial for your health. Even if you’re not lactose intolerant or diagnosed as having an allergy to milk, the casein in cow’s milk will elicit immune sensitivity, elevating the levels of circulating IgE and IgG antibodies in your body, which mediate Systemic inflammation and nasal congestion. The constriction in your airway due to milk sensitivity may, in fact, be the primary reason for your chronic sinusitis, pressure headaches, grinding and sleep apnoea. This is why at MyDental Care and TMJ & Sleep Therapy Centre of Sydney, we recommend a milk-free diet to help you breathe, sleep and develop better.
Dr Louis Chan is the principal dentist at MyDental Care, a leading holistic dental practice in the City of Ryde, and the Director of TMJ & Sleep Therapy Centre of Sydney. Complementing his clinical dexterity, Dr Chan has extensive knowledge, training and experience in orthopaedic orthodontics, neuromuscular full mouth reconstructions, dental sleep medicine and temporomandibular joint (TMJ) disorders. He is committed to helping people live pain free, sleep soundly, breathe better and lead healthier lives. Dr Chan believes it is important to educate his patients on what is the right diet that will minimise inflammation and maintain long-term health. In this article, he provides frank answers to some of the most common questions around the benefits of a milk-free diet.
“As passionate as I am about creating beautiful smiles,
I am equally as passionate about
breathing, sleeping and eating right.“
Q1. What’s wrong with milk?
Milk contains the sugar lactose. This is normally broken down by an enzyme in our body called lactase and ends up in the bloodstream as glucose (another term for sugar). However, many people don’t have enough lactase to properly digest lactose, resulting in lactose intolerance. People with lactose intolerance may suffer from diarrhoea, stomach cramps, bloating and excessive flatulence after consuming milk. The amount of lactose a person can tolerate varies. Lactose intolerance is more common among people from Asia, Africa, Middle East, some Mediterranean countries and Australian Aborigines. Up to five per cent of Caucasians and up to 75 per cent of non-Caucasians living in Australia are lactose intolerant.1 It is possible that you may be deficient in lactase and not be aware of it, so eliminating milk from your diet will be a good start to work out what is best for your health.
While lactose intolerance is the reduced ability to digest milk sugars, cow’s milk allergy is a separate problem involving the immune system. Milk proteins, specifically caseins, can elicit an allergic reaction with symptoms such as an itchy skin, rash, swelling of the lips or difficulty breathing. A severe reaction can result in anaphylaxis. Cow’s milk is a common cause of food allergy in Australia. Nine foods cause 90% of all food-related allergic reactions, these are: cow’s milk, egg, peanut, tree nuts, sesame, soy, fish, shellfish and wheat.2
If you suspect you have a milk allergy, an allergy specialist will ask you questions such as how often you have the reaction, the time it takes between eating a particular food and the start of the symptoms, and whether any family members have allergies or conditions like eczema and asthma. The specialist may then do a skin test on you which involves placing liquid extracts of milk protein on your forearm or back, pricking the skin a tiny bit, and waiting to see if a reddish, raised spot forms, indicating an allergic reaction. They may also take a blood sample and send it to a lab, where it will be mixed with some of the suspected allergen and checked for IgE antibodies. These types of tests are used for diagnosing what doctors call a fast-onset type of milk allergy. But for people whose allergic reactions to milk develop more slowly, skin and blood tests are not as helpful. In these cases, doctors try to diagnose the person using a food challenge. The person is told not to eat or drink anything made with milk for a period of time — usually a few weeks. Then, during the challenge, the person eats foods containing milk under close supervision. If symptoms come back after eating milk products, it’s very likely the person has a milk allergy.
Interestingly, a recent U.S. study conducted in four major cities, led by Johns Hopkins Children’s Center investigators, looked at food allergies among inner city children and found that more than half (55%) of children in the study were classified as sensitive to milk, eggs or peanuts. Nearly 10% of them met the criteria for a full-blown food allergy. The most common allergy was to peanuts (6%), followed by eggs (4.3%) and milk (2.7%). An additional 17% were classified as “possibly allergic,” a subgroup that had elevated immunoglobulin E (IgE) antibodies but no clear history of allergic reactions to peanuts, eggs or milk. 29% were classified as “sensitive but tolerant,” a group that included those with elevated IgE antibodies and a known history of consuming allergenic foods but who were able to tolerate the foods in question without allergic symptoms.3
IgE antibodies to food proteins are immune chemicals released by the body in response to certain foods. Sensitisation to a substance, signalled by the presence of IgE antibodies in the blood, means a person is more likely to develop allergic symptoms, but it is not sufficient to diagnose a true food allergy, which is always marked by clinical symptoms. In the study described, the investigative team deemed allergic only those children who had both clinical symptoms and elevated IgE antibodies. However, the same study found that many more children were sensitive to milk, egg and peanuts. This undiagnosed sensitivity still triggers the immune system to produce IgE antibodies and elicit an inflammatory response. The study also reported that children with food allergies were also more likely to suffer from environmental allergies, as well as wheezing and eczema, an allergic skin condition.
It is often difficult to recognise your own food allergy or sensitivity because of the often-delayed nature of the symptoms, which may show up hours or even a day later, after a food is well absorbed into your system. The difficulty is compounded by the fact that certain foods, such as milk and wheat, are so prevalent in our diet that we eat them nearly every day and therefore connecting your symptoms with your eating habits is often nearly impossible.
It is therefore quite possible that while you may not be allergic to milk you are still sensitive to it, and especially if there is a history of allergies and eczema in the family, or you have symptoms of an inflammatory response such as congestion after consumption of milk, it is highly advisable to eliminate milk from your diet.
Studies show that patients with coeliac disease on a gluten-free diet may still have gastrointestinal symptoms. On clinical grounds cow’s milk protein sensitivity may be suspected. One study showed that a mucosal inflammatory response similar to that elicited by gluten was produced by milk protein in about 50% of the patients with coeliac disease.4 Casein, in particular, was involved in this reaction. It is clear that the major problem with milk is casein.
Furthermore, in addition to lactose intolerance, casein allergy and casein sensitivity, commercial milk is a highly processed product, and farmed from large dairies where the cows are not reared in organic free-range farms. Cows may also be given antibiotics to control infections and although there is a withholding period before the milk can be collected, it is possible that antibiotics (and pesticides) may pass into the milk. Furthermore, pasteurisation of milk kills many of the beneficial bacteria we call probiotics as well as damaging vitamins, minerals and enzymes that help to digest milk. These are some other good reasons to avoid commercial milk.
Q2. How do I know if I am sensitive to milk?
Food allergies may be categorised as IgE–mediated (immediate) reactions, non–IgE-mediated (delayed) hypersensitivity reactions, and mixed reactions. IgE-mediated reactions are the ones we worry about when we hear about a “food allergy”. These reactions can occur immediately following exposure, and are the consequence of the interaction of allergens with IgE located on mast cells. Non-IgE-mediated allergic reactions can cause localised (e.g. contact dermatitis) or generalised reactions, which are usually gastrointestinal or dermatological in nature. Coeliac disease is a non-IgE related allergic reaction. Finally, some allergic disorders are both IgE and non-IgE mediated, such as atopic dermatitis (eczema).
For non-IgE mediated reactions, IgG testing may be more appropriate to detect food sensitivities, such as to cow’s milk. IgG molecules mediate interactions of cells with different cellular and humoral mechanisms. Increased IgG response to dietary antigens can be associated with gastrointestinal dysfunction and autoimmunity.5 While IgE-based testing continues to be the gold standard for suspected food allergies that elicit immediate reactions, IgG-based testing is also showing promise, with clinically meaningful results. IgG has been proven useful as a guide for elimination diets, with clinical impact for a variety of diseases.6
One study showed that 12-week specific-food exclusion diets based on eliminating foods according to food-specific IgG antibodies, resulted in significant improvements in abdominal pain (bloating level and frequency), diarrhoea frequency, abdominal distension, stool shape, general feelings of distress and total symptom score compared with baseline in patients with irritable bowel syndrome with diarrhoea.7
Interestingly, food sensitivities characterised by elevated IgG antibodies to cow’s milk caseins and wheat glutens have been reported in individuals with schizophrenia.8 Autoimmunity, gastrointestinal disorders and schizophrenia have been associated with one another for a long time. Epidemiological studies strongly link schizophrenia with autoimmune disorders including enteropathic celiac disease. Exposure to wheat gluten and bovine milk casein also contribute to non-celiac food sensitivities in susceptible individuals.9
Immune sensitivity to wheat glutens and milk caseins may also affect a subset of individuals with bipolar disorder. Digested by-products of these foods are exorphins that have the potential to impact brain physiology through action at opioid receptors. Inflammation in the gastrointestinal tract might accelerate exposure of food antigens to systemic circulation and help explain elevated gluten and casein antibody levels in individuals with bipolar disorder.10
Q3. Can milk really trigger nasal congestion and headaches?
Any food that can trigger the immune system via an allergic reaction is capable of causing inflammation. Inflammation can also be caused by a bacterial, fungal, or viral infections, or by environmental allergies. Food allergies are the most underrated cause of inflammation and congestion, and frequently exacerbate known environmental allergies.
An allergic response or sensitivity to food can be exhibited in any part of the body, because nutrients are digested, absorbed and circulated throughout the body. This is why food allergies and sensitivities can cause a wide range of problems, including chronic sinusitis and runny nose. If the food constantly triggers the immune system, the inflammation never goes away and this can result in a persistent runny nose, or recurrent sinus infections (sinusitis) due to the moist and poorly draining, inflamed environment that is maintained in the sinuses. Chronic congestion can be extremely frustrating and often patients don’t find relief even after many rounds of antibiotics or multiple surgeries, because the antibiotics and surgery is not addressing the cause of the congestion. Antibiotics are only treating the bacterial infection that is secondary to the inflammation clogging their sinuses, and surgery may scrape out the sinuses or open up a bigger hole for them to drain, but these treatments only address secondary problems resulting from the inflammation.
Sinusitis and runny nose are inflammatory conditions that result in mucous production and congestion. This can cause sinus pressure headaches or even stuffy ears. Moreover, the physical restriction due to a blocked or partially blocked nose has a profound effect on the volume of airflow through your nasal passage, which can lead to mouth breathing and suboptimal oxygen intake. The elimination of foods that you are sensitivity to, which are the primary causes of the nasal inflammation, may relieve your sinusitis and headaches, as well as facilitate easier breathing. There is little cost in eliminating milk from your diet for the benefit of your total health.
Q4. Does milk consumption affect my sleep?
The quality of your sleep is directly related to your breathing during sleep. Sensitivity to milk causes inflammation of the nasal passage and the resulting constriction in airflow makes it harder to breathe through your nose. A relatively small collapse in the diameter of your nasal passage has a profound impact on the volume of airflow, which means you may not be getting enough oxygen in through your nose. This can lead to mouth breathing, and disturb your sleep as the drop in oxygen prompts your body to awaken frequently to take deep breaths. If you’re not getting a good night’s rest, it’s worth looking at altering your diet to reduce the consumption of anything that may be inflammatory. An anti-inflammatory diet will enhance better breathing and good quality sleep, which are so important to your quality of life.
For children, who often have enlarged tonsils, nasal congestion exacerbates mouth breathing, and the sleep disordered breathing can mean poor concentration due to disrupted sleep, and may also lead to poor facial development.
Q5. Can milk consumption be the reason I’m grinding my teeth?
During the night, the brain cycles through lighter and deeper stages of sleep. As the brain approaches deep sleep, all the muscles in the body fully let go and relax. This can cause trouble for the airway – the jaw is heavy and when fully relaxed it greatly expands and can block the airway and the tongue.
Researcher studied brain scans of people with partial blockage in their airways while they slept and they noticed that it was grinding (also called bruxism) that reopened the airway and got the study participants breathing again. While grinding may be what saves us from suffocating at night, you’re not sleeping well if you grind your teeth. Even with mild sleep apnoea, the disruption to good quality sleep means you’re waking up in a damaged state. Tensing up the muscles to grind bounces the body out of deep sleep, and all the associated health benefits. Untreated sleep apnoea can have serious and life-shortening consequences like high blood pressure, heart disease, stroke, automobile accidents, diabetes, depression, anxiety, and weight gain.
Grinding is therefore an indicator for obstructive sleep apnoea. If you grind your teeth, the new standard of care is that you get a sleep study done because you’re likely having episodes of interrupted breathing during the night and missing out on all the health benefits of deep stage sleep. And of course, grinding will also damage your teeth and jaw joint. Years of grinding and clenching will damage your teeth due to excessive wear and tear, cause tooth decay and tooth sensitivity, periodontal tissue damage, and lead to permanent jaw pain, headaches and damage to the jaw joint.
Most importantly, it is critical to treat the sources, not just the symptoms, of grinding and sleep apnoea – and that is a restricted airway. Treating the airway cures teeth grinding. This is where eliminating milk (and other inflammatory foods like gluten and refined sugar) will help. Milk consumption causes inflammation of the nasal airways. This nasal obstruction leads to mouth breathing and sleep apnoea. Once you remove the need to grind, teeth grinding stops.
Q6. Is there a link between asthma and milk?
Many medical experts now believe that undiagnosed milk allergies may be the underlying problem behind the link between milk and asthma. An Australian study, involving a prospective birth cohort (n=2860) in Perth, which followed up 2195 children up to age 6 years, found that less exclusive breastfeeding was associated with increased asthma and atopy.11
What is interesting is that even if the symptoms are not the same, the underlying allergy may be. A child who has suffered milk-associated asthma, for instance, may have severe acne as a teenager. The milk allergy is still there, but its symptoms have moved to a different organ system, often misleading the patient and physician into thinking that the original allergy has been outgrown. Many eczematoid children became asthmatics later on unless their eczema is cleared early by dietary manipulation. If you have a family history of allergies, asthma, eczema or sinusitis it is worth experimenting with total elimination of cow’s milk in all of its forms.
Q7. Would I still be able to meet my recommended calcium intake if I cut out milk?
Many people worry that a milk-free diet will result in calcium deficiency, especially in growing children. However, after weaning, humans do not need to drink milk as we can readily get all the calcium we need from other food sources such as leafy green vegetables, seafood, legumes and fruit. So if you are sensitive to milk, you can happily adjust to life without it and you won’t really be missing anything.
Below is a table comparing the calcium content of selected foods. The recommended intake of calcium for adults is 1,000 mg/day.
Based on source: NUTTAB 2010 – Australian Food Composition Tables: Food Standards Australia New Zealand, Canberra.
Contrary to what many people might believe about milk being important for your bones, a population-based case-control study which identified risk factors for hip fracture among elderly women and men, found that consumption of milk products, particularly at age 20 years, was actually associated with an increased risk of hip fracture in old age, along with smoking, underweight in old age, overweight at age 20 years, and weight loss.12
Q8. What would you recommend in place of cow’s milk?
Since the nutrients we obtain from milk are available from many other food sources, finding a replacement for milk is not necessary from a nutritional point of view. However, if you do want to substitute cow’s milk with another type of ‘milk’ beverage, I would recommend unsweetened almond milk or coconut milk, as they’re easy to source and generally not inflammatory.
Q9. What about other dairy products like cheese, cream, butter and yogurt?
When it comes to milk sensitivity and resulting inflammation, casein is the big problem. Cheese making involves curdling and souring of milk, and adding rennet. One of the enzymes in rennet is a proteolytic enzyme, which breaks down the casein. These enzymes continue to work long after the initial curdling and are what gives aged cheeses their distinctive tastes and appearance. For this reason, we recommend aged, soft cheeses such as camembert and bree over younger, harder cheeses.
When milk is left to stand it naturally separates into a high fat, somewhat thicker layer, known as curds and a clearer, liquid, layer known as whey. Cream is made from the higher fat, curd layer of milk. The much higher fat to protein ratio, and the smaller quantity in which cream is used means that only small amounts of casein are ingested.
Made largely by churning of cream, butter falls into much the same category as cream. While casein is still present in butter there is typically less than 1g of protein per 100g of butter making side effects from the consumption of butter very rare indeed. We recommend preferably organic butter from grass-fed cows.
Yoghurt is a fantastic, healthy, snack. If made properly, yoghurt also contains many beneficial microorganisms that help maintain the correct balance of intestinal flora. Much like cheese, making yoghurt involves the introduction of microorganisms. While the bacteria lactobacillus and bifidobacteria primarily operate on the milk sugar lactose, the resulting lactic acid breaks down the proteins in the yoghurt and that is what provides the characteristic taste. It is the breakdown of casein by lactic acid that makes yoghurt safe to consume.
- Better Health Channel. Lactose intolerance. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lactose-intolerance Accessed February 5, 2016.
- Australasian Society of Clinical Immunology and Allergy (ASCIA). Food allergy. http://www.allergy.org.au/images/pcc/ASCIA_PCC_Food_Allergy_2015.pdf Accessed February 6, 2016.
- McGowan EC, Bloomberg GR, Gergen PJ, et al. Influence of early-life exposures on food sensitization and food allergy in an inner-city birth cohort. J Allergy Clin Immunol. 2015;135(1):171-178.
- Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow’s milk protein in coeliac disease. Clinical and Experimental Immunology. 2007;147(3):449-455.
- Rubicz R, Yolken R, Alaedini A, et al. Genome-wide genetic and transcriptomic investigation of variation in antibody response to dietary antigens. Genetic epidemiology. 2014;38(5):439-446.
- Mullin GE, Swift KM, Lipski L, Turnbull LK, Rampertab SD. Testing for food reactions: the good, the bad, and the ugly. Nutr Clin Pract. 2010;25:192–198.
- Guo H, Jiang T, Wang J, Chang Y, Guo H, Zhang W. The value of eliminating foods according to food-specific immunoglobulin G antibodies in irritable bowel syndrome with diarrhoea. J Int Med Res. 2012;40:204-210.
- Severance EG, Gressitt K, Halling M, et al. Complement C1q formation of immune complexes with milk caseins and wheat glutens in schizophrenia. Neurobiology of disease. 2012;48(3):447-453.
- Severance EG, Yolken RH, Eaton WW. Autoimmune diseases, gastrointestinal disorders and the microbiome in schizophrenia: More than a gut feeling. Schizophrenia research. 2014;14:319-313.
- Severance EG, Gressitt KL, Yang S, et al. Seroreactive marker for inflammatory bowel disease and associations with antibodies to dietary proteins in bipolar disorder. Bipolar disorders. 2014;16(3):230-240.
- Wendy H, Sherriff JL, de Klerk NH, et al. The relation of breastfeeding and body mass index to asthma and atopy in children: a prospective cohort study to age 6 years. Am J Public Health 2004;94(9):1531–1537.
- Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. J. Epidemiol. 1994; 139(5):493-503.