Lactose Free, Casein Free or Dairy Free? What's the Difference?

Milk, once thought to be one of the essential four food groups, is touted for "doing a body good". Milk mustaches adorn movie stars, athletes and other celebrities in full page milk ads. But milk isn't just a drink, and dairy products aren't just a food group. They are also found on the list of top 8 foods most likely to cause severe allergic reactions. The words "lactose intolerance" are often bandied about, and used interchangeably with "milk allergy" or "dairy allergy" or "casein free diet".

The trouble is, those conditions are not the same thing. Although they all refer to the act of avoiding dairy products, each condition acts differently in the body and requires a different level of caution. While lactose intolerance can be occasionally overcome with treatment, a true dairy allergy can never be ignored because the risks are too dangerous to manage with pills. Some people on a casein free diet make exceptions, some can't.

Most people are aware of lactose intolerance. Advertisements for lactose free milk and products that can be taken to replace the missing enzymes in those with lactose intolerance have made many individuals aware of the widespread condition. However, the reasons that people avoid milk products can be much more complicated than a few missing enzymes.

Lactose is the sugar that is present in dairy products. Normally, at the very tip of your intestinal villi, the body produces lactase. Lactase is the enzyme responsible for digesting lactose. If the villi are damaged, as can happen with Celiac Disease, or otherwise malfunction, not enough lactase is made and a person develops lactose intolerance.

As dairy products ferment, certain bacteria feed off the milk sugar and the resulting aged dairy products (like hard cheese or yoghurt) are low in lactose or lactose free, making them suitable for some people with lactose intolerance. Others can take supplements that simulate lactase, making small amounts of lactose digestible and eliminating the uncomfortable symptoms associated with lactose intolerance.

Symptoms of lactose intolerance include indigestion, bloating and diarrhea. The symptoms often vary in intensity. Lactose intolerance becomes more common as people age because humans are the only mammal that retain the ability to digest milk products into adulthood, and the older we get the less likely we are to maintain that ability. Lactase production can be inhibited by gastrointestinal viruses and food poisoning, as well as the aging process.

Treatment is to simply avoid dairy products or take a lactase replacement digestive enzyme before meals. People with lactose intolerance may be able to tolerate small amounts of dairy on occasion, and can use products that contain casein.

TIP: As a top 8 allergen, all FDA approved foods are now required to clearly list the word "milk" in their ingredients list if an ingredient is derived from milk.

Some people who avoid dairy are actually allergic to casein. Casein is the protein found in milk. A milk allergy is more likely to be a 'real' allergy, Which results in an immune response, than lactose intolerance.

When someone experiences a true allergy, the body sends out IgE cells to neutralize the dangerous protein. The body then sends out chemicals such as histamine to attack the perceived offender (often a humble food, like casein), which results in nasty allergic reaction symptoms. These symptoms can include digestive responses such as vomiting or diarrhea, hives and rashes, swelling, breathing problems and a dangerous drop in blood pressure. While most food intolerances are annoying and uncomfortable, a casein allergy can turn downright fatal.

Severe casein allergies affect 2.5% of children under the age of 3. While most outgrow milk allergies, many remain allergic and continue to require strict avoidance well into adulthood.

Anyone with a true allergy to milk products must avoid all traces of milk, including casein. They should also carry an epi pen with them at all times, just in case an unexpected exposure leads to a severe reaction.

Milk and dairy products managed to get an entire food group to themselves, leading people to believe that if you don't drink milk, your bones will end up shattering. The simple facts are that calcium is in a variety of foods, not just milk. In fact, human beings are the only animals that drink any milk past infancy. We are the only animals that regularly use the milk of other species. And Americans are the nation that consumes the greatest amount of dairy products. We're also the nation with the highest rate of osteoporosis, which makes one wonder if dairy products are really so great for our bones.

Sources of calcium besides milk include: fortified cereals, fortified orange juice, spinach, kale, blackstrap molasses, sesame seeds and/or tahini, almonds, and a variety of beans. A varied diet, including plenty of leafy greens and plant sources of protein, is more important to overall health than a glass of milk. Especially if there's a good medical reason to avoid that milk.

A casein free diet is a diet plan that avoid dairy products. People often pair a casein free diet with a gluten free diet to treat Autism Spectrum Disorders and difficult to treat digestive disorders like Crohn's Disease or IBS.

People who are on a Casein Free diet for medical reasons will usually avoid all dairy products, but don't need to carry an epi pen with them. Sitting next to another child with a glass of milk is not considered nearly as dangerous for the child avoiding casein to treat another condition as it is when the child is actually allergic to milk. Many people avoiding casein may tolerate small amounts of dairy through cross contamination or derivatives like caseinate in dairy free cheese. Others are as strict as they would be with a true dairy allergy.

Not all medical professionals believe that a casein free diet is useful in the treatment of Autism Spectrum Disorders, but as long as an individual is following an otherwise balanced diet there is no harm in avoiding dairy products. If it hurts to ingest something, then you are much better off without it.

There are lactose intolerance, casein free diets, and milk allergies. And then there's veganism. People who follow a vegan diet are usually doing so out of a desire to avoid ingesting products that come from animals. A true vegan diet avoids all sources of food that come from animals, including honey, gelatin and dairy products. A savvy vegan will read labels to avoid even small sources of dairy such as sodium caseinate, which is used in dairy free cheese to improve the melting texture.

Vegans are much stricter than those with lactose intolerance. They're also much louder advocates than those with dairy allergies. The vegan movement has produced a variety of delicious dairy free alternatives to products that once were dairy based, such as pudding, cheese and ice cream. Vegan cookbooks make it easy to find tasty dairy free recipes for just about anything imagineable.

Although people following a vegan diet do not suffer intense physical symptoms when they ingest dairy products, their desire to stay dairy free still needs to be respected.

Products labeled vegan are suitable for anyone following a dairy free, casein free or lactose free diet for any reason.

While most of these diets boil down to the same exact 'avoiding milk' conundrum, not all food labels are created equal. Lactose free foods were developed with lactose intolerant individuals in mind. Those specialty items will need to be double checked for milk derivatives such as caseinate and butter fat or butter oil. Ghee, whey and yoghurt also need to be avoided by people with a dairy allergy.

Casein free foods are usually marked dairy free and suitable for vegans. While not all vegan products are fully dairy free, if the V symbol is on there, they are free of all animal products including casein.

You should always read the ingredients of anything you intend to ingest. Milk can be hiding in the unlikeliest of places, from hard candies to salad dressing. Federal law requires that the 8 allergens responsible for 90% of hospitalizations due to food allergy (known as the "top 8 allergens") be clearly labeled with their source ingredient, which means that if a milk product is in a food, the ingredient will be clearly listed in the ingredient list or there will be a disclaimer at the end of the list stating "This product contains milk".

As a special note for caregivers, dietary issues can be confusing and complicated. No one knows the hassle of following a medically restricted diet more than the parents of a child who was recently diagnosed. There are a myriad of reasons someone might need to avoid milk, although the easiest thing to claim is a milk allergy. The term allergy is short, to the point and self descriptive.

Unfortunately, caregivers see a lot of 'allergies' that range from lactose intolerance to 'my kid hates milk and it's easier to just humor him most days' to full blown anaphylaxis. The former two are much more common than the latter, but it's the ones who risk anaphylactic shock that make it imperative that caregivers understand the potential severity of an allergy.

In the end, it's the parent's decision what a child will eat. Understanding why the milk free diet is in place (lactose intolerance, autism spectrum, personal beliefs or allergy) may help you to better manage the diet, but it doesn't give you the freedom to choose whether or not to respect the parent's wishes. Unless a specific parent tells you differently, always assume the worst and avoid all forms of milk. It's better to have a hungry kid who feels left out than one in an ambulance; or even one who spends the following night vomiting.