Allergy: Avoiding Milk and Lactose
Avoiding Milk and Lactose
Fruit lassi
There are two quite distinct reasons for avoiding milk: either to avoid milk proteins or to avoid
lactose, the sugar found in milk. It is important not to confuse these two because the details of the
avoidance diet required are different. Only a few people need to avoid both milk proteins and lactose.
Diarrhoea and wind in response to drinking milk, but few other symptoms, usually indicates a reaction
to lactose — but a reaction to milk proteins could be an alternative explanation. If it is a reaction
to lactose, this may be due to either primary lactase deficiency or secondary lactase deficiency — your
doctor can order tests to make an exact diagnosis (see p. 79). Note that a bout of diarrhoea, however
caused, often produces a temporary lactose intolerance (secondary lactase deficiency).
Any symptoms other than (or in addition to) diarrhoea and wind strongly suggest a reaction to milk
proteins. This might be a true allergy, another type of immune reaction to milk (see pp. 72-3), or an
idiopathic intolerance reaction (see pp. 76-7). In theory, skin tests should identify true allergic
reactions to milk proteins. Unfortunately, skin tests are not infallible, and it is possible to have a
genuine allergy or other immune reaction to milk proteins, but give negative skin tests. This is
especially common with babies (see p. 65 and p. 69). There are no accurate tests that can confirm
intolerance reactions to milk proteins.
It is possible to have sensitivity to both milk proteins and lactose.
If tests do not give you a definitive answer, you may have to try both types of diet and see which one
works. Remember that lactose intolerance may be only temporary.
Avoiding milk proteins
If you have a sensitivity reaction to cow’s milk proteins, then you need to avoid:
• milk and all milk-based drinks, including lactose-reduced milk (if you need to avoid lactose as
well, drops and tablets to reduce lactose — see Using lactase replacers, p. 183 — are safe and could be
used with a tolerated milk, e.g. goat’s milk)
• cream, yoghurt, creme fraiche
• all kinds of cheese, cottage cheese and cream cheese (some people may be able to tolerate
Norwegian brown cheese, called Gjetost, which is made with milk whey)
• white sauce, bechamel sauce and other creamy sauces
• custard, rice pudding and other milk-based puddings
• almost all home-made cakes, biscuits, cookies, pancakes and pastry
• some bread, rolls, waffles
• almost all chocolate
• casein, casemate, and lactalbumin in packaged foods (see p. 173); you may be able to tolerate
whey but experiment cautiously.
Unless your sensitivity is fairly mild, you will also need to avoid:
• butter, except clarified butter (ghee)
• most kinds of margarine (they generally contain milk derivatives, but
some are milk-free — health-food shops are a good source of these).
As long as you do not have a severe allergy to milk, you should be able to tolerate clarified butter.
Make this by melting butter over a low heat, pouring it into a glass jar, and leaving it to cool in the
refrigerator. The milk proteins will settle to the bottom, and be visible as whitish granules — only
eat the clear butter above this level.
Alternatively, put olive oil into a wide-necked container and place in the freezer. It will solidify,
and can be used as a spread in place of butter.
A few of those with cow’s-milk allergy can tolerate sheep’s milk, and possibly (but less commonly)
goat’s milk. However, most people must avoid these as well. (There are also rare individuals who are
allergic to goat’s and sheep’s milk but not to cow’s milk.) Ass’s milk, if you can get it, is tolerated
by most with cow’s-milk allergy. There are many substitutes for cow’s milk now available, such as soya
milk, almond milk, rice milk and hazelnut milk. Try a health-food shop for these. All can be used in
place of ordinary milk when cooking.
Margarine or clarified butter can be used in recipes that call for butter. Soya yoghurt and cream make
reasonable substitutes for ordinary yoghurt and cream.
Avoiding lactose
If you have lactose intolerance, you must avoid:
• milk and all milk-based drinks, unless lactose-reduced
• cream, creme fraiche
• most kinds of yoghurt, especially mild yoghurt. A very strong, acidic yoghurt may contain
little lactose. The bacteria that make yoghurt turn lactose into lactic acid, so the more acidic it is,
the less lactose it contains.
• cottage cheese and Norwegian brown cheese, or Gjetost. Other kinds of cheese are usually so low
in lactose that they are tolerated. Only those people with extreme lactose intolerance need to avoid
all cheeses.
• white and bechamel sauce, custard, rice and other milk-based puddings
• almost all home-made cakes, since milk is generally used for baking. Items cooked with butter
but not milk, such as biscuits, cookies and pastry, are usually tolerated, as is butter itself, and all
margarine.
• lactose in medicines. Lactose powder is used in many tablets and capsules, just to bulk out the
drugs. The amount used can be sufficient to evoke symptoms in some people with lactase deficiency.
Certain asthma inhalers also contain lactose (see p. 162), and a small amount may be swallowed. The
lactose from inhalers will affect you only if you have severe lactase deficiency.
Soya-based products, and all other nut- or grain-based milk substitutes, are lactose-free. Sheep’s
milk, goat’s milk and other animal milks (including human breast milk) all contain lactose.
Using lactase replacers
Many people with lactose intolerance are able to eat a more varied diet by using lactase replacers.
These provide a temporary supply of the missing enzyme, lactase (see p. 79), which helps out by
digesting the lactose in milky foods. Lactase replacers must be taken at the same time as the milky
food, and are only effective for that one meal. The more lactose there is in the meal or snack, the
more of the lactase replacer you need – trial and error is the only way of working out how much you
need for a particular food. There are a number of different brands of lactase replacer now available,
and it is worth trying out several. Some people find that they are sensitive to an added ingredient in
some brands. Sources of lactase replacers include health-food shops and specialist suppliers – these
can be located through the Internet (see p. 255).
Savoury white sauce
Savoury white sauce is the base of many dishes. Here the flavour of the wine and stock goes well with
chicken, vegetables or fish.
PREPARATION TIME: 7-8 minutes MAKES: approx. 600ml (1 pint)
50g (13/4oz) milk-free baking margarine 50g (1314oz) plain flour
200ml (7fl oz) dry cider or dry white wine 400ml (14f1 oz) vegetable or chicken stock 1 bay leaf, salt
and pepper
Melt the margarine in a small saucepan and stir in the flour. Cook, stirring, over a low heat for
1 minute then stir in the cider or wine, followed by the stock. Add the bay leaf and simmer, stirring
occasionally, for 5 minutes until thickened. Season to taste.
Variations. add approx. 6 tbsp finely chopped herbs, e.g. parsley, chives, tarragon or chervil; or add
English or French mustard; or add lemon juice.
Sweet white sauce
PREPARATION TIME: 5 minutes MAKES: approx. 300ml (’/?pint)
2 tbsp cornflour
25g (1 oz) caster sugar
300ml (V2 pint) apple or white grape juice 4 tbsp soya cream
25g (1oz) milk-free margarine
In a saucepan, mix the cornflour and sugar with a little of the juice to give a smooth paste then
gradually stir in the rest of the juice and bring to a simmer over a low heat. Simmer for 1-2 minutes
until thickened, stirring all the time. Finally, add the soya cream and margarine.
Variations: melt in 1008 (3-/2oz) or more of milk-free chocolate; or add rum or brandy to taste; or add
4-6 pieces finely chopped stem ginger together with 1-2 tbsp of their syrup.
Pancakes
Soya milk has a slightly thicker consistency than cow’s milk and therefore more is used in this pancake
recipe than would be needed in a traditional one.
PREPARATION TIME: 25 minutes MAKES: approx. 16 small pancakes
150g (5V2oz) plain flour, sieved 2 large eggs
pinch salt
450ml (16f1 oz) soya milk
oil or milk-free margarine for frying To serve:
lemon juice and caster sugar or golden syrup
Combine the flour, eggs, salt and soya milk in a liquidiser until smooth. Alternatively place the
flour, eggs and salt in a bowl and slowly whisk in the soya milk to form a thin batter.
Heat approx.1 tsp oil or margarine in an 18cm (7in) non-stick frying pan and swirl until hot. Pour in
sufficient batter to just cover the base of the pan and cook until golden. Turn and cook on the other
side until golden.
Serve with lemon juice and caster sugar or with golden syrup.
Apple and frangipane tart
An alternative to a milk-based custard tart. The combination of apple and almond is delicious. Serve
freshly baked. It can also be eaten cold, but if possible, warm it a
little before serving.
PREPARATION TIME: 30 minutes COOKING TIME: 1-11/4 hours MAKES: 8 servings
Pastry:
175g (6oz) plain flour, sieved
1008 (3 V2oz) milk-free baking margarine, softened
25g (1 oz) caster sugar
Filling:
50g (13/4oz) milk-free sunflower margarine 1008 (3112oz) ground almonds
100g (3112oz) plus 1 tbsp caster sugar 2 egg yolks
2 tbsp dark rum, brandy or orange juice 2 large dessert apples
4 tbsp apricot jam
Work the flour, margarine and sugar together with 1 tbsp cold water to make a soft dough. Roll out and
use to line a deep 20cm (8in) fluted flan tin. Chill this while you prepare the filling.
Preheat the oven to 190′C/375′F/gas mark 5. Beat together the margarine, ground almonds, 100g (3Y2oz)
caster sugar, egg yolks and rum. Peel, core and roughly chop one apple and stir into the mixture.
Spread this in the pastry case. Core and thinly slice the remaining apple and arrange the slices on
top. Sprinkle with the remaining sugar and bake for 1-1′/’4 hours until risen and golden. Cool slightly
then brush the surface with the apricot jam (warm this gently in a saucepan first).
Coconut rice pudding with mango
This pudding is based on a Thai recipe. The rice pudding will become thicker the longer it cooks and
also as it cools. Make sure the mango is ripe.
COOKING TIME: 30-40 minutes MAKES: 6 servings
175g (6oz) pudding rice, rinsed 50-75g (131-2314oz) sugar
1 litre (13/4 pints) carton rice milk 400ml (14f1 oz) coconut milk To serve:
1 extra-large ripe mango, peeled and diced
toasted coconut shreds
Place the rice in a large saucepan with 50g (13/4oz) of the sugar and the rice milk and coconut milk.
Bring to a simmer, stirring. Simmer gently for 30-40 minutes, stirring occasionally, until the rice is
cooked and the milk absorbed. Add the extra sugar if wished. Serve warm or cold, topped with mango and
toasted coconut.
Baked strawberry creams with strawberry sauce
The riper the strawberries the better, to give intensity to both the creams and the sauce.
PREPARATION TIME: 30 minutes COOKING TIME: 20-25 minutes MAKES: 6
1008 (3112oz) caster sugar
4 tbsp Muscat wine
1 tsp lemon juice
350g (12oz) strawberries, hulled and sliced
4 large eggs, beaten Sauce:
225g (Boz) strawberries, hulled and chopped
2 tbsp icing sugar 2 tbsp Muscat wine To serve:
a few whole strawberries
Preheat the oven to 1 70′C/325′F/gas mark 3. Set six 1 50ml (Y4 pint) ramekins in a small roasting tin.
If you plan to unmould the creams, oil the ramekins lightly.
Place the sugar, wine, lemon juice and strawberries in a saucepan and heat gently to dissolve the
sugar. Bring to the boil and cook, uncovered, for 5 minutes. Cool slightly then puree in a liquidiser
and whisk into the beaten eggs. Pass through a sieve then pour into the ramekin dishes.
Pour hot water from a kettle around the ramekins and cook in the centre of the oven for 20-25 minutes
until lightly set.
Remove the dishes from the tin and allow to cool. Chill, if wished.
Combine all the sauce ingredients and liquidise until smooth. Pass through a fine sieve.
Serve the creams in the ramekins with a little sauce poured on top and decorated with a whole
strawberry, or carefully unmould, pour a little sauce over, then decorate with a whole strawberry.
Variation: oil the ramekins. Dissolve 100g (31/2oz) caster sugar in 4 tbsp water in a small saucepan
over gentle heat, then cook to a rich caramel without stirring. Pour a little caramel into each oiled
ramekin then continue as above. Pour the wine for the sauce into the pan used to make the caramel and
warm gently to dissolve any leftover caramel, then continue with the sauce as above.
Frozen vanilla dessert
This is a cross between a sorbet and an ice cream.
PREPARATION TIME: 30 minutes, plus freezing MAKES: 4-6 servings
1 vanilla pod, split
150g (51/2oz) caster sugar 500g carton soya yoghurt
Place the vanilla pod and sugar in a saucepan with 300ml (1/2 pint) water. Dissolve over gentle heat
then bring to a simmer and simmer for 20 minutes. Leave to cool then remove the pod, scraping all the
seeds from it and returning them to the syrup. Beat in the soya yoghurt and freeze.
You will get the best texture by using an ice-cream machine. Alternatively, freeze in a plastic
container then remove from the freezer and beat the mixture well until smooth (you can do this in a
food processor). Return to the freezer. Repeat this process once or twice.
Baked strawberry cream with strawberry sauce
Variations: add 100g (31/2oz) melted plain chocolate; or add 2 tbsp instant espresso coffee dissolved
in 2 tbsp hot water. Alternatively, dissolve 100g (3/2oz) caster sugar over a gentle heat in a small
saucepan until it turns to a rich caramel; then add 100g (31/2oz) unblanched almonds and stir with a
metal spoon until they start to pop. Transfer to an oiled tray and leave to set. Crush roughly and add
to the basic mixture.
Fruit lassi
This refreshing Indian drink can also be made with frozen fruit, in which case don’t use iced water –
cold will do.
PREPARATION TIME: 10 minutes
MAKES: approx. 1.35 litres (21/4 pints)
500g carton soya yoghurt
50-75g (1314-231aoz) sugar
225g (8oz) berries such as raspberries, strawberries, blackberries or blueberries or the equivalent
weight of chopped fruit such as mango, peach or papaya
600ml (1 pint) iced water
Place all the ingredients in a liquidiser and blend until smooth.
Frozen vanilla desert
Banana and strawberry shake
A special treat for a child who cannot have milk.
PREPARATION TIME: 5 minutes MAKES: 600ml (I pint)
2 large, very ripe bananas
150g (5112oz) strawberries
1112 tbsp olive oil
a little nutmeg or other spice, if liked 200ml (7fl oz) water
Peel the bananas and roughly chop the fruit. Combine all the ingredients in a blender until very
smooth. Serve immediately, or cover tightly and store in the refrigerator.
Variations: use a nectarine or a skinned peach instead of strawberries; use coconut milk (available in
tins) instead of olive oil, and the flesh of a small mango, or half a large mango, instead of
strawberries.