I know this topic confuses a lot of you because I get asked so often from clients with Hashimoto’s about dairy. Unfortunately there is no black and white answer, you’ve got to experiment and discover for yourself what your body tolerates. I know we all love some cheese but no food is worth damaging your health or exacerbating your autoimmunity for. So in today’s blog I’m going to outline the best way to do this and demystify dairy intolerance because it ain’t just about the lactose.

I don’t believe that dairy is an unhealthy food. Indeed, it has formed part of many traditional diets for thousands of years. But if you have a disordered immune response (autoimmunity), inflammation and a breakdown in the integrity of your gut lining and function then it’s going to be very high on the list of foods that your body will not tolerate. Anything that stimulates the inflammatory cascade in the gut is going to be problematic and regular supermarket cows dairy products DO seem to do that for most of my Hashimoto’s clients.  

Let’s look at the red flags for dairy intolerance and the difference between casein & lactose. Plus practical tips with understanding the difference between A1 & A2, dosing of dairy & what steps to take to see if you tolerate dairy.

Dairy Intolerance Red Flags

Common symptoms include:

– Gastrointestinal distress such as bloating, gas, nausea, bowel urgency, diarrhea, and stomach cramps that occur within a few hours of consuming dairy. Reflux, burping & upper gastrointestinal symptoms are all common.

– Some individuals might experience more subtle symptoms, such as persistent fatigue or headaches. Even worsening of autoimmune inflammatory symptoms like joint pain.

– Dairy intolerance can really affect your skin too. Acne, particularly hormonal acne, eczema and dermatitis can be caused by dairy intolerance.

Lactose Intolerance

Lactose is the sugar in dairy. When we can’t break down lactose it causes a lot of gas and brings a lot of water into the bowel. Generally if you have lactose intolerance you’ll know because within a short period of consuming dairy (think 30 mins or so) you’ll get gassy, gurgly in the abdomen and may have urgent diarrhea. If you are an individual of Asian and African descent you are highly likely to be lactose intolerant. These populations tend to have lower levels of lactase, the enzyme needed to break down lactose. Lactose is VERY dose dependant and you need to find your own personal limit. You might be ok with a dash of milk in a cup of tea but a latte will likely be too much.

Low lactose dairy products include: aged cheeses, yogurt, butter, ghee, kefir. Fermented dairy is usually tolerated as the bacteria consume the sugars.

High lactose products: milk, ice cream, cream, custard, cream cheese & ricotta.

Casein Intolerance

This is by far the most common issue I witness with Hashimoto’s clients and dairy. And this is because casein as the protein in milk is more likely to trigger an inflammatory response in the gut. I’ve talked about this before but intestinal permeability (AKA leaky gut) means larger protein molecules have direct access to immune cells which would normally be guarded by a healthy gut lining. The result is that the immune system mistakenly identifies casein as a threat. 

If you are casein intolerant you will find your symptoms are harder to pinpoint as it causes a slower burn of inflammation rather than the obvious digestive disfunction that lactose causes. Yes, it can present as gut aches and gas too but Hashi’s sufferers might also find it contributes to an unhealthy gut which leads to a disordered immune response and can consequently drive up antibodies, exacerbating autoimmunity. So general autoimmune symptoms like body pain, brain fog and fatigue may worsen. So, for those navigating autoimmune disorders, while lactose is often blamed, casein may well be the culprit. It is possible to have both too. It’s important to note that lactose intolerance won’t damage your gut, it’s just really uncomfortable. On the other hand, if you continue to consume casein despite being intolerant it will be causing inflammation and damage to your gut. 

The only low casein dairy product is ghee.

What’s the difference between A1 and A2?

No, it’s not just clever marketing. A1 and A2 are the two predominant proteins found in cows milk. Beta-casein is a major protein in cow’s milk, its structure can vary slightly due to genetic differences among cows.

Let’s look at the difference:

A1: this type contains A1 beta-casein. It comes mainly from cows. For some people A1 beta-casein might be harder to digest and may cause gastrointestinal symptoms.

A2:  contain A2 beta-casein which is structurally different from A1 beta-casein by one amino acid. It comes from goat, sheep, Jersey & Guernsey cows. Interestingly, historically cows produced A2 in higher quantities but now many dairy breeds have reversed this and mostly produce A1 proteins. There is a growing number of farmers making the switch to A2 producing breeds again. Often those who cannot tolerate A1 find A2 easier to digest and less likely to cause issues and I definitely count myself as one of them. 

Low A1 products include: products made from the milk of goat, sheep, Jersey & Guernsey cows. In fact goat and sheep contain only A2 beta-casein and you can get some lovely cheeses like feta, chevre, hard cheese as well as yogurt, kefir and milk. And these products are pretty widely available in major cities at the big two supermarkets, Aldi, Ritchies and local delis & greengrocers.

The Dose Counts

If dairy tends to cause you trouble, experimenting with smaller servings/doses could be worth a shot. You might find that a spread of butter or a dash of milk is fine while a bowl of ice cream has pushed you over the limit of what your body will tolerate. Generally, properly fermented dairy like yogurt & kefir is better tolerated because its probiotic content exerts an anti-inflammatory effect on the gut. What I really recommend though is doing an elimination challenge because it will give you clarity.

Dairy Elimination Challenge

A dietary elimination is pretty simple but not always easy, I think any endeavor that might bring cheese into your life is well worth pursuing! Essentially, you remove a food or food group for a period of time and then introduce it back into your daily eating to observe any effects. It’s the gold standard for identifying food intolerances and is more accurate than any food intolerance testing on the market. It’s also, freeeee! Check above for the symptoms you’ll be looking for when you challenge dairy back into your diet. This is a bit like a choose your own adventure but if you stick with the process you’ll get a very good idea of what you can tolerate. Keep a journal throughout the journey.

• Start by eliminating all dairy for three weeks. You are going to need to read packets and be very thorough to test this accurately. 
• Next is the reintroduction or challenging phase. Start with goat products, try one serve of goats cheese per day for three days. This might look like 50-100gm of goats cheese. How do you feel? Take note in your journal. Symptoms may take 30mins to 48 hours to develop. If you feel good then great, you can give goats products the green tick. If you experience any adverse reactions, note them down and eliminate all dairy for two weeks or until you have been symptom free for five days.
• Next you’ll trial sheep products in the same way. You might try sheep yogurt or feta to test your response. If your body says yes then it gets the green tick, if not start the process again. Remember, you need to eliminate dairy for three weeks after a response or be symptom free for five days before you can trial the next food.
• Next try 1-2tbs of ghee and butter following the same principles. 
• Next try A2 containing products, 1 cup milk or 1 cup of yogurt from Jersey or Guernsey cows. 
• Repeat with 50-100gm of cheeses, you may respond differently to hard versus aged versus soft cheeses. It’s harder to find A2 cows cheeses which is why I have left this until last. Everything up to this point contains all or mostly A2 proteins. You might be lucky enough to have a cheese producing farmer who uses Jersey cows locally. 
• Lastly you could also challenge A1 supermarket milk but only if you passed the A2 milk challenge. I wouldn’t recommend anyone with Hashimoto’s to consume A1 products regularly or at all. I’ve rarely seen anyone with Hashimoto’s get on with A1 dairy products.

By the end of the process you’ll have a good idea of what you tolerate all laid out in your symptom journal.

You might also like to test your antibodies to see if eliminating dairy makes a difference to your autoimmunity. 

The Good News – Healing can help!

The good news is that with some attention to gut health, many people find they can reintroduce dairy into their diets. By addressing issues like leaky gut or imbalances in gut bacteria which are very common in autoimmunity some individuals experience improvements in their tolerance to dairy products. I used to be dairy intolerant and now I can tolerate small amounts without incident but that was after walking the walk of an anti-inflammatory, whole foods, gut healing & blood sugar regulating diet for a few years. And yeah, I did other things like microbiome testing and personalised prebiotic protocols too.  

I hope the dairy puzzle makes a lot more sense to you now. Remember, what works for one person might not for another. If you have Hashimoto’s then you’re more likely to be intolerant to dairy, particularly casein. There is a good chance that goat, sheep or even Jersey or Guernsey cow products may be tolerated in varying doses. It’s worth trialing with the elimination diet outlined above as you don’t want to cut out food groups unnecessarily. 

Also, cheese! (Wallace & Gromit style)

Get in touch if you try it, I would love to hear from you.