I think I may be intolerant of milk; what should I do? Numerous symptoms are blamed on cow’s milk, from an overly snotty nose to bloating, constipation, eczema, migraine and diarrhoea. Thousands of people name cow’s milk as their demon, and this trend seems to keep growing.There are usually two reasons why someone might feel better avoiding cow’s milk: they may have a problem with cow’s milk protein, and should opt for other sorts of dairy milk, such as sheep’s or goat’s milk (the latter has proteins slightly similar to cow’s milk, so keep an eye on your symptoms). Or they may have a problem with lactose, the sugar in milk; which indicates a lack of lactase, the enzyme that breaks down the lactose. In which case they will need to go for cereal-based milks — soya, oat and rice.

I’m unsure whether milk intolerance, detected by the presence of IgG antibodies has enough scientific evidence behind it to make it a convincing reason to give up dairy.

Could it be something else? Often the symptoms people put down to dairy intolerance can be due to an unbalanced diet. Removing a suspected offending itemcould mean you become more aware of your diet and start eating more healthily, and this cures your symptoms rather than any avoidance of a specific substance. So before you start excluding lactose or cow’s milk protein, check that your diet is well balanced — lots of water, fresh fruits and vegetables.

How do I check if dairy is the problem? Keep a food diary for a couple of weeks, record everything you eat/drink, plus your symptoms alongside. If when you look at your diary you still think dairy might be an issue, cut it out completely for a couple of weeks, avoiding all dairy milk; ie, animal milks and their products — cheese, yoghurt, butter, cream and foods made with milk, which in the case of packaged foods will be described as lactose, milk, skimmed-milk powder, cow’s milk protein, casein, caseinate salts and whey powder (the latter two are derivatives of milk). If you suspect that your child may be intolerant of dairy, it is important to consult a a paediatric dietitian or your doctor before excluding anything from his or her diet because it is crucial that you don’t inadvertently deprive them of essential nutrients.

Do I need to take any supplements? You need to make sure that you include a non-dairy source of calcium in your diet; this means lots of green leafy vegetables such as kale and collard, pulses, seeds such as sesame seeds, small-boned fish such as sardines. You shouldn’t need to take a calcium supplement (if you already take one, check that it doesn’t contain lactose or milk derivatives). A couple of weeks without dairy shouldn’ t cause your bones any harm. In the longer term, if you find that you feel really well when you’re not consuming dairy, and plan to cut it out permanently, you may need a daily 1,000mg calcium supplement.

If I seem to be intolerant only of cow’s milk, what other dairy foods can I eat? If you think it’s cow’s milk protein that triggers your symptoms — bloating, constipation, diarrhoea, migraine — you could try sheep’s or goat’s products (keep an eye on your symptoms); as well as the milks, there are delicious cheeses and yoghurts in most supermarkets. You can also buy butters from some delis, or use one of the dairy-free margarines to cook with. Olive oil spreads can sometimes be dairy-free (check the labels, and watch out for hydrogenated fats or trans fatty acids, as these are bad for your heart).

If I think my body can’t tolerate any dairy, what can I use instead? You may want to try soya, rice or oat milk, either to glean some calcium or as an alternative to add to drinks, cereals, etc. These have a different taste from cow’s milk and may not be to your liking, but try disguising them by adding honey. Try to be inventive with your cooking (see my recipes, above right, for ideas to get you started) — and if you can’t stand the taste of the cow’s milk substitutes in coffee and tea, try herbal teas.

Scientific research has linked soya milk and yoghurt to male fertility problems, changes in the menstrual cycle, certain cancers, brain disease and developmental abnormalities. One study advises that babies should not be given infant formula milk made from soya. However, the Soya Protein Association, which represents food makers, says: “We have seen no convincing evidence that soya causes any harm.” Intolerance and allergy to soya are also becoming increasingly common. I sometimes use oat milk (which strangely enough seems to help my daughter sleep at night) and rice milk as substitutes for cow’s milk.

If after a few weeks off dairy you find that you feel much better, you could explore whether it’s possible to take in a little lactose or cow’s milk products, every couple of days without triggering your symptoms. It may be that you were just eating too much dairy before.

Sometimes I seem able to tolerate dairy and at other times I don’t. Am I just imagining it? There are times when people can be more intolerant than usual: if they’re very stressed or over-tired, or at different points in the menstrual cycle. If this is the case, it may be that you can enjoy small amounts of dairy, rather than missing out on it all the time. Note that people can also have a problem with dairy after an illness such as flu or a stomach bug; they can be temporarily lactose intolerant, but then after a few weeks they can digest it again with no ill-effects.

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