Food and the gut
A guide to dairy: benefits, risks and alternatives for gut health
Dairy is neither good nor bad for everyone. Milk, curd and paneer are valuable sources of protein, calcium and vitamin B12, particularly for vegetarians. Many adults, however, digest lactose poorly and get bloating or loose stools from milk. Most of them tolerate curd, buttermilk and paneer. A two-week trial without dairy, followed by a careful return, shows where you stand.
In short
- Dairy provides protein, calcium and vitamin B12 in a form the body absorbs well.
- The usual problem with dairy is lactose, the sugar in milk, not dairy as a whole.
- Fermented and low-lactose dairy, such as curd, buttermilk, paneer and ghee, suits most people who cannot drink milk.
- If you cut dairy out, replace its calcium, protein and vitamin B12.
What does dairy provide?
- Protein of high quality, important in vegetarian diets
- Calcium, for bones and teeth
- Vitamin B12, which is otherwise found only in animal foods
- Live bacteria, in curd and buttermilk
For a vegetarian in India, dairy is often the main source of vitamin B12 and a major source of protein.
Who has trouble with dairy?
Lactose intolerance
The commonest reason. The enzyme that digests lactose declines after childhood in most of the world’s adults. Undigested lactose is fermented in the colon and causes gas, bloating and loose stools. See lactose intolerance.
Irritable bowel syndrome
Lactose is one of the fermentable carbohydrates that can trigger symptoms in a sensitive gut. See IBS.
Milk allergy
An immune reaction to milk protein, causing hives, wheezing, vomiting or blood in the stool. It is mostly seen in infants and young children and is different from intolerance.
After a gut infection
The lining temporarily loses its lactose-digesting enzyme. Tolerance usually returns within weeks.
Which dairy foods contain the least lactose?
| Food | Lactose |
|---|---|
| Milk, milkshakes, ice cream, khoya-based sweets | High |
| Curd, buttermilk, lassi | Lower; bacteria digest part of it |
| Paneer | Low |
| Hard, aged cheese | Very low |
| Ghee and butter | Negligible |
| Lactose-free milk | None |
Most people with lactose intolerance can manage about one cup of milk a day if it is taken in small amounts with meals.
Does dairy cause inflammation?
For people without a milk allergy, studies do not show that dairy increases inflammation. If you feel better without it, lactose is the likelier explanation.
What about A2 milk?
A2 milk contains a different form of one milk protein. A few small studies suggest that some people have less digestive discomfort with it. The evidence is limited, and it contains the same amount of lactose as ordinary milk.
How do I test my own tolerance?
Remove
Stop milk and milk-based foods for two weeks. Keep a note of symptoms.
Return
Bring back curd first, then paneer, then a small glass of milk with a meal, a few days apart.
Read the result
If symptoms return with milk but not with curd or paneer, lactose is the cause. If they return with all dairy, or never changed, look for another explanation.
A hydrogen breath test confirms lactose malabsorption when the answer is unclear.
What are the alternatives?
| Alternative | Points to note |
|---|---|
| Lactose-free milk | Same nutrients as milk; the simplest swap |
| Soy milk | Protein close to that of milk; choose a fortified, unsweetened one |
| Almond, oat, coconut and rice drinks | Low in protein unless fortified; check for added sugar |
Other sources of calcium include ragi, sesame seeds, leafy greens and tofu set with calcium. Vegetarians who avoid dairy need a reliable source of vitamin B12, usually a supplement.
When should I see a doctor?
See a doctor if symptoms continue after removing dairy, or if you have weight loss, blood in the stool, persistent diarrhoea or anaemia. These suggest a condition other than lactose intolerance.
Questions patients ask me
Should adults drink milk at all?
Adults who tolerate it can. It is a convenient source of protein and calcium. Those who do not tolerate it lose nothing by choosing curd, paneer or lactose-free milk.
Is curd better than milk for the gut?
For many adults, yes. It has less lactose, and it contains live bacteria.
Does milk cause acidity?
Milk gives brief relief from heartburn in some people, but a large glass, especially at night, can worsen reflux. It is not a treatment for acidity.
Is ghee suitable for people with lactose intolerance?
Yes. Ghee is almost pure fat and contains virtually no lactose.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- Review of lactose malabsorption and intolerance. Misselwitz B et al. Gut. 2019. PubMed 31427404
- American College of Gastroenterology guideline on irritable bowel syndrome. Lacy BE et al. Am J Gastroenterol. 2021. doi:10.14309/ajg.0000000000001036
- International consensus statement on fermented foods. Marco ML et al. Nat Rev Gastroenterol Hepatol. 2021. PubMed 33398112