Updated: Feb 23
Confused about what you can and can't eat? Want to make sure you're getting enough calcium? What is casein? Plus, what's the difference between coeliac disease and a gluten allergy or sensitivity? There some important things to know when going gluten and/or dairy free and some common mistakes to avoid if after results.
Lactose Free Versus Casein Free
The first thing to realize is that going lactose-free is NOT the same as going dairy-free. Dairy-free means avoiding the casein protein that is found in all dairy products, and is sometimes clarified as casein-free (CF). This includes cows, goats and sheep's milk, cheeses, butter, dairy ice cream, yoghurts and many chocolate products. It also includes lactose-free milk and cheeses which are now readily available in supermarkets.
Lactose is the milk sugar found in dairy and can come in varying quantities. Harder cheeses, for example, are lower in lactose than softer cheeses. Lactose-free products can have the lactase enzyme added to remove the lactose, but the casein is still present.
Sensitivities and allergies to casein protein are common, but so is lactose intolerance. You can react to both casein and excess lactose, or just one. It may be challenging to work out as both sensitivities and intolerances can have a delayed reaction of up to 3 or 4 days.
The protein casein in dairy can resemble gluten to the body, which is why these two often go hand-in-hand.
What about Goat's milk and cheese?
There are two main types of casein protein: Alpha S1 casein and Alpha S2 casein. Most dairy products derived from cows contain the Alpha S1 (A1) protein, and this appears to be more allergic than Alpha S2 (A2). Some, can tolerate goat milk because it is very low in Alpha S1 casein and primarily contains Alpha S2 casein. A2 cow's milk is also available in the supermarket.
If you are still consuming goat milk and cheese, you are not strictly casein-free.
Sheep's and buffalo milk & cheese also contain casein.
What about whey?
Whey is the liquid remaining after milk has been curdled and strained. It is a byproduct of the manufacture of cheese or casein and has several commercial uses. Whey protein is popular in exercise nutritional supplements.
Whey technically does not contain casein but is often contaminated with it. It is very difficult to find a whey that has been separated 100 percent from the casein. Reactions to whey are also possible, though are much less likely than to casein.
How will I get my calcium if dairy-free?
If you're concerned about getting enough calcium, please make sure you include some of the following foods in your meals daily. Absorption of calcium is thought to be better from plant based sources anyway. (50% compared to 32%).
Calcium is also not the only nutrient important for bone health. Magnesium, vitamin D, and vitamin K, in some ways are more so.
What can I drink instead of cow's milk?
Non-dairy milk alternatives can include coconut, oat, almond, macadamia, cashew, rice, soy, hemp and more. It's recommended to choose unsweetened options and those with the least ingredients and no gums. Organic or homemade is also preferred, particularly for oat and rice milk.
Activated nut milks are also encouraged. But, please be wary of nut milks if you have oxalate toxicity or sensitivity.
Avoid oat milk if needing to go low FODMAP, if wanting to lose weight or if insulin sensitive or resistant. Please also be aware that soy milk is typically highly processed.
What is a good butter substitute?
A high-quality olive oil, frozen, and then place in the fridge can be a great replacement for butter on toast. Coconut oil can also work. Add a little salt if necessary. Olivani, and other processed, inflammatory margarines are not recommended.
The vegan society has some recommendations for dairy-free cheeses and the like.
What is gluten and why is it a common sensitivity?
Gluten is a mixture of proteins found in all grains. There are thousands of different forms of gluten with 400 new ones discovered as recently as 2010. The most studied gluten protein is alpha-gliadin because of its relationship to Coeliac disease. Gliadin is found naturally in wheat, barley and rye. Combined with the glutenin protein the two together make dough sticky and flexible. When we use the term gluten-free, we typically mean gliadin free. Some can react not just to gliadin though, but other similar looking gluten proteins in other grains like oats, millet, quinoa, buckwheat, and occasionally even rice.
There are a few factors thought to have had an impact on our ability to tolerate gluten.
Changed milling techniques - roller milling vs stone milling and bleaching. (Also whole wheat is not necessarily better as the outer wheat component is put back in often days later, leaving it rancid and less nutritious).
Changed eating habits - gluten was introduced only 10,000 years ago with the advent of agriculture.
Hybridization of wheat - changed the structure of wheat.
Bread is baked differently now - the shorter time frame means more gluten is present in the bread (was 2%, now more like 20%).
Poor gut health or an unhealthy microbiome - destroyed by antibiotic use, medications, environmental toxins, poor food choices and more.
Chemical and pesticide exposure - such as glyphosate or roundup use on our wheat and most agricultural products. A graph plotting the rising incidence of coeliac disease over a 10 year period, also showed an almost identical rise in glyphosate use on wheat.
How can gluten trigger a reaction?
The gliadin protein of gluten has been found to activate a hormone called zonulin. Zonulin opens the tight junctions of the gut, increasing the permeability of the gut wall, making it "leaky". Gluten can then enter the bloodstream resulting in an immune & inflammatory response. The immune system views gluten like a virus, attacking it.
What's the difference between coeliac disease and a gluten allergy, sensitivity, or intolerance?
Coeliac disease (CD), is a serious chronic autoimmune disorder that, in those genetically susceptible, results in inflammation and damage to the gut (small intestine) when they are exposed to even a tiny amount of gluten. In autoimmune conditions, the immune system mistakenly attacks the body. In this case, the small intestine.
With an allergy, the immune system is also involved (an acute IgE immune response) but the body is not attacking itself but the viewed threat. In this case gluten. The effects are the result of the immune reaction and the inflammatory chemicals released. Even the tiniest amount of gluten can be a trigger.
A sensitivity involves a different part of the immune system (IgG typically) and unlike an allergy is often not immediate in its effects. The reaction may not be noticed until days later, and can be dose-dependent. A sensitivity can be acquired and occur due to a break down in gut function. A "leaky" gut, and damage to the gut wall from infection (e.g. candida), other sensitivities, nutrient deficiencies, poor diet, and an imbalanced gut microbiome (dysbiosis) can be the cause.
An intolerance is an inability to tolerate and digest gluten and is due to a break down in digestive function. This may be due to low levels of digestive enzymes, or gut damage.
The effects are not immediate and can be delayed by days. An intolerance is most certainly dose-dependent and does not have an obvious immune reaction.
Please note: the symptoms can vary in severity for all, and may not even involve the gut. Mouth ulcers, fatigue, depression, poor coordination, frequent dental cavities, small stature or osteoporosis may be the only signs of coeliac disease, particularly initially. Some with Non-Coeliac Gluten Sensitivity have fatigue, brain fog, muscle aches and pains as primary symptoms.
How do I avoid gluten? Where can gluten be hidden?
The following diagrams can be helpful when avoiding gluten. Many processed foods may appear gluten-free but can be either contaminated or have hidden gluten ingredients. For many, even the tiniest amount can trigger a reaction, that might not be noticed until days later. The effects can be serious, especially if exposure is ongoing, even in the smallest amounts. To truly see if gluten is an issue, avoiding it strictly is a must.
Can I just switch to gluten-free labeled products?
Simply replacing gluten-containing foods with gluten-free packaged foods is not ideal. Gluten-free products often contain more sugar and other questionable ingredients. Choosing a whole foods diet, rich in real fruit and vegetables and good quality protein is the better way to go. You are less likely to miss vital nutrients essential to good health.
Having said that, there are some great less processed gluten-free products available now.
Going gluten and/or dairy-free may seem overwhelming at first. You may even feel like you're missing out or it's just going to be a massive hassle but it really doesn't need to be that way.
If you're wondering how to navigate barbeques and eating out, and if you'd like a list of favourite recipes and products, along with some additional tips when going gluten-free and/or dairy-free then head here.