Not All (Cow’s) Milk is the Same

an explanation by Steven Sandberg-Lewis, ND, DHANP

Does a glass of milk make you feel foggy?

Many people avoid all mammalian dairy products based on one or more of these common negative reactions:

· abdominal discomfort or pain,

· altered stool consistency

· changes in brain function.

Negative reactions to dairy products may be caused by a true milk allergy, reactions to a sugar called lactose and or reactions to alternate forms of a protein called beta-casein.

True milk allergy is not rare. The traditional medical diagnosis of milk allergy is made by the presence of high levels of cow’s milk specific IgE antibodies in the blood.

Non-IgE allergic mechanisms are also recognized although these were ardently mocked as quackery by standard practice medicine until recently. When these occur very early in life, some of the terms for these include food protein-induced allergic proctocolitis (FPIAP) and food protein-induced enterocolitis syndrome (FPIES). FPIAP can occur in healthy, full-term infants who develop rectal bleeding but are otherwise healthy. It can affect formula-fed or even exclusively breastfed infants because the offending protein can be found in maternal breast milk. Having the nursing mother avoid cow's milk in her diet is the cure for the infant’s intestinal bleeding (Burris AD, 2020). FPIES usually causes repeated vomiting and/or diarrhea, or failure to grow and gain weight. FPIES may also be diagnosed later in life. Cow’s milk is not the only offender - other foods including soy, rice, oats, fish, and egg can trigger the symptoms (Leonard SA, 2015).

Lactose intolerance or lactase enzyme deficiency causes a negative reaction to the fermentable lactose sugar in all mammalian milk. Milk from cows, goats or sheep will contain lactose, but the cheese made from those milks does not have to. As long as the cheese from these animals is fermented for at least 30 days, the lactose (sugar ) will convert to lactic acid. Yogurt fermented for 24 hours also has this benefit. Other options to avoid lactose are using lactose reduced or lactose free milk or taking a lactase enzyme capsule when consuming lactose containing foods.

Lactase enzyme is produced by humans within the microvilli of the small intestine. These are the ultramicroscopic “hairs” covering the villous infoldings of the small intestinal lining cells. Microvilli are often shed during a bout of food poisoning or gastroenteritis infections which is why lactose intolerance can sometimes come on after a gut infection. In the best case, the ability to digest lactose returns when the membrane heals.

The other form of dairy sensitivity involves a reaction to the type of casein (protein) in milk. The two main types are A1 beta casein and A2 beta casein. A1 tends to be the predominant cow’s milk in the USA, coming from northern European breeds such as Holsteins. A2 is found in cow’s milk from breeds such as Guernsey and Jersey. A2 is also found in goat’s and sheep’s milk. A1 milk is the most common, but A2 milk is available if you ask for it specifically.

A 2016 Chinese study found significantly more digestive discomfort and longer GI transit times after test subjects consumed A1 casein compared with milk containing only A2 casein. In addition, there were higher blood concentrations of inflammatory substances and beta-casomorphin. Beta-casomorphin is a narcotic-like substance which can cause confusion, mood changes and brain-fog in susceptible people. They also found lower levels of beneficial short chain fatty acids after A1 milk consumption (Jianqin S, 2016). A 2014 Australian study found similar digestive symptom effects as well as higher levels of stool calprotectin.

Calprotectin is a stool test that I commonly use to measure the level of inflammation in the GI tract (Ho S, 2014).

Burris AD, Burris J, Jarvinen KM. Cow's Milk Protein Allergy in Term and Preterm Infants: Clinical Manifestations, Immunologic Pathophysiology, and Management Strategies. Neoreviews. 2020 Dec;21(12):e795-e808.

Leonard SA, Nowak-Wegrzyn AN. Food Protein-Induced Enterocolitis Syndrome. Pediatr Clin North Am. 2015 Dec;62(6):1463-77.

Jianqin S, Leiming X, Lu X, Yelland GW. Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows' milk. Nutr J. 2016 Apr 2;15:35.

Ho S, Woodford K, Kukuloan S, Pal S. Comparative effects of A1 versus A2 beta-casein on gastrointestinal measures: a blinded randomised cross-over pilot study. Eur J Clin Nutr. 2014 Sep;68(9):994-1000.

Steven Sandberg-Lewis, ND, has been in clinical practice for 44 years, with a focus on functional gastroenterology. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine. In 2019, Dr. Sandberg-Lewis co-founded Hive Mind Medicine, continuing his specialization in gastroenterology with a focus on reflux, SIBO, inflammatory bowel disease and functional GI disorders.

He is currently working on his latest book, Let's Be Real About Reflux: Getting to the Heart of Heartburn, written to help non-medical and medical professionals alike develop a better understanding of reflux and options for its natural treatment.

Hive Mind Medicine blog posts are for educational purposes only and are not intended as medical advice. Please consult with your health care practitioner for personalized guidance. Click on the contact button below if you would like to schedule with one of our Hive Mind practitioners.