Do I have to avoid dairy products?

6
Melinda Dennis MS, RDN, LDN

Q:  If you have celiac disease do you also have to avoid dairy products?

Answer


The short answer is “Likely, no.” In untreated celiac disease, the lining of the small intestine (microvilli) is damaged by the ingestion of gluten. The enzymes (lactase) on the tips of the villi are responsible for absorbing milk sugar (lactose). Until they heal, the enzymes are temporarily unable to do their job which can lead to symptoms of lactose intolerance, such as gas, bloating, loose stool or diarrhea, and sometimes constipation.

This is a very common occurrence in patients with newly treated celiac disease. At BIDMC’s Celiac Center, if we suspect this is an issue, we will recommend a few months of a lactose-free or lactose reduced trial. In the meantime, substitutions can be lactose free milk or yogurt, hard and aged cheeses (edam, parmesan, romano, cheddar) or non -dairy beverages such as almond, coconut or rice milk (note: these typically have no protein) or soy milk. All must be labeled gluten-free. This trial period is then followed by a gradual rechallenge of the lactose-containing foods, as tolerated.

Some patients find that they cannot tolerate milk at all. They might:
A. Be highly sensitive to lactose, even in small amounts

B. Be unable to tolerate milk proteins (whey and, more often, casein)

C. Have a true food allergy to milk

D. Have chosen to avoid animal products for ethical, environmental or other health reasons.

In all cases, they can work with a dietitian to ensure they are getting adequate calcium, vitamin D, and other nutrients in their diet. Fortunately, there are many, many non-dairy sources of calcium in our food chain. If necessary, nutrient needs can be met through gluten-free supplements.

Celiac Center, Beth Israel Deaconess Medical Center. Lactose Intolerance. https://www.bidmc.org/centers-and-departments/digestive-disease-center/services-and-programs/celiac-center/celiacnow/nutrition-and-the-gluten-free-diet/lactose-intolerance/level-3. Accessed August 1, 2018.

Note: This information is provided by NCA and Melinda Dennis, NCA's Senior Consulting Dietitian. This information is meant for educational purposes and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. This information can be printed and used in consultation with your physician or dietitian. No liability is assumed by NCA, Ms. Dennis or her nutrition consulting service Delete the Wheat, LLC. by providing this information..

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About Melinda Dennis MS, RDN, LDN

Melinda Dennis, Senior Nutrition Consultant for NCA, is an expert celiac dietitian and and Nutrition Coordinator for the Celiac Center at Beth Israel Deaconess Medical Center in Boston, MA. Diagnosed with celiac disease in 1990, she specializes in the nutritional treatment of patients with celiac disease and gluten-related disorders.

Melinda lectures internationally and has written extensively on the nutritional management of celiac disease including the award-winning book Real Life with Celiac Disease. Melinda was the original founder of NCA in 1993 and so it is only fitting that she comes back to us in this capacity. We are truly honored to have her on our team.