Patients with IBS or IBD often have a dairy intolerance, sensitivity or combination of both. The prevalence of lactose intolerance in the general population worldwide is about 68 percent by some estimates.1 In the United States, that ratio drops to around 38 percent, which still means a significant number of Americans–up to 125 million–suffer from lactose intolerance. Overall, certain ethnic and racial groups are more likely to experience lactose malabsorption. These include:
- African Americans
- Native Americans
- Asian Americans
Of note, northern Europeans are the least likely to suffer from lactose malabsorption.1
Dairy Intolerance in IBD
Patients with IBD are often told to avoid dairy altogether. But is this the right choice for all of them? According to one journal article, “The prevalence of lactose malabsorption is significantly greater in patients with Crohn disease involving the small bowel than it is in patients with Crohn disease involving the colon or ulcerative colitis.”2 Other factors, such as bacterial overgrowth in the small bowel or rapid transit time, can contribute to lactose malabsorption in patients with IBD.
Another meta-analysis from a pulled database of over 71 million patients, including almost 600,000 patients with IBD, concluded that IBD patients have a 2.7 times higher risk of lactose intolerance.3
Dairy Sensitivity vs. Intolerance
Unlike an intolerance, which is solely dependent on a deficiency of the lactase enzyme, dairy sensitivity involves an IgG immune reaction to dairy proteins–either casein, whey or both. This happens when protein digestion is incomplete in the presence of increased intestinal permeability. Short peptides, which are long enough to activate white blood cells, can then be absorbed and stimulate an immune response.
The factors that can lead to poor protein breakdown include:
- Hypochlorhydria (physiologic or medication-induced)
- Inadequate production of proteases
- Vagal nerve malfunction
- Pancreatic insufficiency
The rates of dairy sensitivity are less clear because most studies only focus on IgE-mediated allergic responses to dairy products from cows. However, we as clinicians likely will encounter patients in our daily practice that have an intolerance or immune reaction to dairy, based on the prevalence of increased intestinal permeability in the population.
The Right Digestive Enzymes for Dairy Sensitive Individuals
Digestive enzymes offer your patients the ability to consume foods they otherwise would not be able to digest properly, saving them from stomach discomfort and allowing them to enjoy a less restrictive diet.
When evaluating digestive enzyme options, make sure to choose one that will break down the three main components of dairy:
- Lactose: a disaccharide sugar found most notably in milk and formed from galactose and glucose
- Casein: an insoluble, essential, amino acid-rich protein which, if processed incorrectly or incompletely, can result in peptides that cause discomfort
- Whey: a soluble, essential, amino acid-rich protein which, if processed incorrectly or incompletely, can result in peptides that cause discomfort
The problem is many enzyme blends seemingly contain the right enzymes, but they don’t completely break down the sugar and proteins to the ease digestive discomfort associated with lactose malabsorption and dairy sensitivities. For this reason, you want to choose one that is dual functioning, containing 1) lactase enzymes to break down the lactose and 2) protease enzymes to break down the proteins.
Dairylytic® – A Dual-Functioning Dairy Enzyme Blend
One enzyme blend called Dairylytic® is formulated to support digesting lactose, whey and casein with effects in as little as 15 to 30 minutes under physiologic conditions. It can break down the amount of lactose found in one 8 oz. glass of milk quickly and efficiently over a 90-minute period. In addition, this enzyme blend can break down whey into very small peptides within 15 minutes and achieves complete hydrolysis within 90 minutes, and it can break down casein into very small peptides that are easily absorbed within 30 minutes, with complete hydrolysis within 90 minutes.
By breaking down lactose into its component sugars, lactose fermentation and malabsorption are prevented. In addition, breaking down casein and whey into smaller peptides reduces the likelihood they will bind to antibodies and activate the immune response. Thus, an enzyme blend like Dairylytic® is a great choice for patients with dairy intolerance or sensitivities who enjoy dining out or want to experience more freedom with their food choices.
The Bottom Line
Dairy intolerance and sensitivity are issues that will inevitably be encountered among our patient populations. Dairy elimination diet adherence varies widely among patients, so it is important to offer a convenient option that allows these patients to function in the real world without feeling overly deprived. A dual-functioning, effective dairy enzyme blend is a great adjunct to the care of these patients to help them manage uncomfortable GI symptoms associated with dairy intolerance and sensitivity.
Dr. Vincent M. Pedre is the medical director of Pedre Integrative Health, founder of Dr. Pedre Wellness, and a functional medicine-certified practitioner in private practice in New York City since 2004. He is also certified in yoga and medical acupuncture, as well as the Chief Medical Officer of United Naturals. As Spanish-speaking faculty for The Institute for Functional Medicine, Dr. Pedre has taught the AFMCP in Spanish in Lima, Peru, as well as an introduction to functional medicine in Mexico City. He has been a part of the team at the Lifestyle Matrix Resource Center as a Clinical Expert, serving the Pillars of GI Health Program since 2017. He believes the gut is the gateway to excellent health. As the bestselling author of Happy Gut—The Cleansing Program To Help You Lose Weight, Gain Energy and Eliminate Pain, he has helped thousands of people worldwide resolve digestive and gut-related health issues to regain their well-being.
- Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. The Lancet. Gastroenterology & Hepatology. 2017;2(10):738–746.
- Mishkin S. Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease. Am J Clin Nutr. 1997 Feb;65(2):564-7. doi: 10.1093/ajcn/65.2.564. PMID: 9022546.
- Asfari MM, Sarmini MT, Kendrick K, Hudgi A, Uy P, Sridhar S, Sifuentes H. Association between Inflammatory Bowel Disease and Lactose Intolerance: Fact or Fiction. Korean J Gastroenterol. 2020 Oct 25;76(4):185-190. doi: 10.4166/kjg.2020.76.4.185. PMID: 33100313.