All dairy products contain milk sugar, called lactose. In order to digest lactose, one requires a digestive enzyme called lactase. People with lactose intolerance have no, or inadequate levels of lactase, and lactose it therefore poorly digested. The undigested lactose passes through the intestines, drawing water because of its high concentration (osmotic potential). Bacteria feed off this abundant food source, and during the process produce lactic acid, carbon dioxide and hydrogen gas as by-products. This causes bloating, diarrhoea, flatulence and cramps.

Lactose intolerance can be primary, where a patient is born with a lactase deficiency, or secondary, where a patient develops a lactase deficiency over time. The level of tolerance differs from one person to the next, and some people can tolerate more lactose than others.

Mildly intolerant individuals may be able to consume small amounts without symptoms, and we suggest the following:

• Drink milk in servings of not more than one cup.

• Consume hard cheeses, like cheddar, which are low in lactose content.

• Drink milk with a meal and never on its own.

• Consume yoghurt made with live cultures.

Severely intolerant individuals may try consuming artificial lactase enzymes, which can be prescribed by your doctor. These should be taken before your meal, and we advise that you adhere to the above-mentioned principles as well.

This is a true allergy, and we suggest that you avoid the following products:

• Milk & dairy products: all forms of cow’s milk (fresh, evaporated, condensed, sour milk, milk blends, butter milk, cow’s milk based baby formula, cheeses and milk based ice cream).

• Breads & cereals: many breakfast cereals / porridges contain milk based products, especially the ready-to-serve varieties. Most commercial cake and biscuit mixes contain milk products.

• Desserts: some desserts are made with milk, cream, butter or ice cream.

• Fats: butter, cream, certain types of margarine, mayonnaise and some salad dressings.

• Meat, fish & chicken: certain processed meats and crumbed / creamed dishes.

• Eggs: scrambled eggs sometimes contain milk, and egg dishes like quiche.

• Vegetables: creamed vegetables and some forms of mashed potato.

• Beverages: some fruit juices, and many powdered hot or cold drink mixes.

• Medicines & artificial sweetening tablets: sometimes use lactose as a filler or binding agent.

• Sweets: chocolate, fudge, toffee, and caramel.

It is always important to read the labels of food items. Avoid foods with the following terms: milk solids, whey, skim milk powder / solids, milk sugar, buttermilk, casein, caseinate, sodium caseinate, curds, cream, lactalbumin and lactoglobulin. Kosher food marked “milchick” contain milk product, and those marked “parev” are free of milk products.

Individuals who avoid all dairy products may develop certain nutritional deficiencies and should supplement their diet with the following nutrients:

• Calcium

• Vitamin B2

• Vitamin B12 if you are a vegetarian.