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Can you tell me more about adverse reactions to cow's milk?

From a research perspective, there is no question about the greater number of adverse reactions to cow's milk—whether grass-fed or conventionally fed—than most other commonly consumed foods. Adverse reactions to cow's milk include two distinctly different types of reaction. The first type is cow's milk allergy (CMA), and the second type is cow's milk intolerance.

CMA typically involves an immune system response to certain casein proteins contained in cow's milk. Cow's milk contains some casein proteins—for example, alpha-s1-casein, alpha-s2-casein, and gamma-casein—that are simply not present in human milk as consumed by breastfeeding infants or in other foods commonly consumed by adults. In the U.S., cow's milk is included in a list of eight foods that account for over 90% of all reported allergic food reactions. These eight foods include (1) wheat, (2) cow's milk, (3) hen's eggs, (4) fish, (5) crustacean shellfish (including shrimp, prawns, lobster and crab); (6) tree nuts (including cashews, almonds, walnuts, pecans, pistachios, Brazil nuts, hazelnuts and chestnuts); (7) peanuts (which are not true nuts but rather legumes); and (8) soy foods.

The symptoms of CMA can be quite different in different individuals. These symptoms can include skin-related problems like rashes, hives, and eczema; respiratory-related problems like wheezing and coughing; or digestive tract problems like diarrhea, gas, cramping, and bloating. (These digestive tract symptoms, however, are less commonly experienced in cow's milk allergy than in cow's milk intolerance, which we will describe next.) For some adults, the symptoms of CMA are experienced in a much more generalized way—for example, as overall fatigue or as "brain fog."

An adverse reaction to cow's milk can also stem from intolerance. Intolerance does not involve an immune system reaction to casein proteins in cow's milk but rather to other cow's milk components.

By far the most common of these components is the sugar called lactose. Lactose is a sugar that is present primarily in milk of mammals, including cows. (For this reason, lactose is often referred to as "milk sugar.") Lactose is also classified as a disaccharide sugar because it's a combination of two simple sugars called glucose and galactose. An enzyme called lactase (which is present in the digestive tract of some individuals more than others) can break lactose apart into these two simple sugar components (glucose and galactose). If lactose is effectively broken down by the lactase enzyme into glucose and galactose, cow's milk tolerance is often not experienced. However, this "if" is a big one, since many people do not have enough lactase enzyme in their digestive tract to break down substantial amounts of lactose (that would be contained, for example, in a glass of cow's milk consumed as a beverage).

There are three ways for you to lower your risk of cow's milk intolerance. In all three ways, the goal is to get all of the lactose in cow's milk broken down into glucose and galactose.

The first way is to purchase lactose-free milk. Lactose-free milk has been pre-treated with the enzyme lactase to break the lactose apart into glucose and galactose. (We should note here that we have yet to see lactose-free versions of grass-fed cow's milk in stores, but we expect them to eventually become available. In the meantime, you can purchase regular grass-fed cow's milk and use the second method described below.)

A second method is to purchase lactase enzyme supplements in liquid form and add drops to the milk yourself. (About 10-15 drops per quart is often recommended.) Let the milk sit overnight in the refrigerator if you use this method to allow time for the enzymes to take effect.

A third method is to purchase lactase enzyme supplements in chewable, caplet, or tablet form. Swallow a supplement along with cow's milk whenever it is consumed.

Some individuals with lactose intolerance find these steps very effective in overcoming a cow's milk intolerance. However, the first two methods in which the milk is treated directly tend to produce better results than use of the oral enzyme supplements. It's not that the oral supplements don't work—it's that our stomach is a more complicated place containing other foods, other enzymes, and more complex chemistry. Still, oral supplements can be helpful at restaurants and when consuming foods like casseroles and baked goods where milk may have been included as an ingredient. Given all of the issues described above, some individuals with milk intolerance prefer to simply avoid milk and milk-containing foods.

Fermented milk products—like most cheeses and most yogurts—tend to trigger fewer adverse reactions than fresh liquid milk. This reduction in adverse reactions is due to the use of microorganisms in fermentation. Microorganisms change the composition of the milk, including the structure of proteins, fats, and carbohydrates. Both casein proteins and lactose may be changed during fermentation in such a way as to lower the risk of an adverse reaction. Individuals who enjoy dairy products but experience adverse reactions to fresh liquid milk may discover less problems with fermented dairy products, especially live-culture yogurts based on 100% grass-fed cow's milk or 100% grass-fed cheeses. But once again, avoidance of all milk-related foods is more effective in eliminating adverse reactions.

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