Educating Patients with Digestive Discomfort to Keep Dairy in their Diet

Digestive discomfort

An increasing number of Australians report experiencing digestive problems such as bloating, abdominal pain, diarrhoea or flatulence. These symptoms may be due to a number of factors including stress, medication, inadequate exercise and food intolerances1. Yet patients often limit or cut out dairy foods from their diet in a quest for symptom relief without consulting a health professional. 

Australians missing out on essential nutrients

With nine out of ten Australians not meeting the recommended daily intake from the milk, yoghurt, cheese and/or alternatives food group2, and over 50 per cent not getting enough calcium in their diets3, many are potentially missing out on key nutrients, including calcium, iodine, B vitamins and protein. They may also miss out on health benefits associated with consuming dairy foods such as a reduced risk of type 2 diabetes, cardiovascular disease and hypertension4

Professor Dennis Savaiano

Leading US expert, Professor Dennis Savaiano has studied lactose digestion for over 30 years and his research suggests that people who experience digestive problems should rethink limiting or cutting out dairy foods from their diet. In one particular study, lactose maldigesters who consumed dairy foods improved their tolerance to foods containing lactose5, which was most likely a result of colonic adaptation6. Professor Savaiano’s other research, including a paper in the New England Journal of Medicine has influenced dietary recommendations relating to lactose around the world, including the 2013 Australian Dietary Guidelines7.

Supporting patients with digestive problems

Health professionals can help patients with digestive problems find ways to keep dairy foods in their diet.

21-day milk-drinking intervention8 

Patients who have cut out dairy foods from their diet due to digestive problems can try a 21-day milk-drinking intervention9. This involves starting with half a cup of milk with a meal twice a day in week 1, increasing this to two-thirds of a cup in week 2 and then one cup during week 3. Patients who complete the 21-day milk-drinking intervention see an improvement in symptoms and go on to enjoy milk and other dairy foods such as cheese and yoghurt as part of their everyday meals and snacks.

Do Dairy Differently

If a patient is limiting their intake of dairy foods due to digestive problems, health professionals can help their patients find ways to ‘do dairy differently’. It may be to spread their intake of dairy over the day, by having dairy foods with meals or having smaller amounts of dairy at a time to gradually build up their tolerance.

Diagnosed lactose intolerance

Lactose intolerance is mostly a deficiency rather than an absence of the lactase enzyme, which helps break down lactose. In people with a deficiency of this enzyme, undigested lactose passes through the small intestine to the colon, where it is fermented by natural bacteria producing acids and gas. This combination of events can cause the symptoms of lactose intolerance, which may include bloating, abdominal pain or flatulence. While a diagnosis of lactose intolerance does not require the elimination of dairy foods from the diet, the amount that can be tolerated will vary from person to person.

Supporting patients with lactose intolerance

For people with lactose intolerance, the Australian Dietary Guidelines recommends:

  • Up to 250ml of milk may be well tolerated if consumed with other foods or if intake is spread throughout the day.
  • Most hard cheeses are virtually lactose-free.
  • Yoghurt contains ‘good’ bacteria that help to digest lactose.
  • Lactose-free milks are available and contain similar nutrients to regular milk10

Foods That Do Good contains other resources for health professionals to help patients experiencing digestive problems. Read more on lactose intolerance. Watch Professor Dennis Savaiano’s video interview on managing lactose intolerance. Download the Rethink Removing Dairy factsheet and infographic.

1 Bolin, TD and The Gut Foundation. Understanding Gas and Bloating. Randwick, NSW: Digestive Diseases Research, 2011.

2 Australian Bureau of Statistics. 4364.0.55.012 - Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12. 2016.Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.012~2011

3 Australian Bureau of Statistics. 4364.0.55.007 - Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12. 2015. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Calcium~714

4 National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013.Available from: https://www.eatforhealth.gov.au/

5 O’Connor L, Eaton T, Savaiano D. Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters. Journal of Nutrition Education and Behavior. 2015;47(4):325-330.e1.

6 Hertzler S & Savaiano D. Daily lactose feeding improves lactose tolerance by enhancing colonic fermentation. Gastroenterology. 1995;108(4):A289.

7 National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013

8 O’Connor L, Eaton T, Savaiano D. Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters. Journal of Nutrition Education and Behaviour. 2015;47(4):325-330.e1.

9 O’Connor L, Eaton T, Savaiano D. Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters. Journal of Nutrition Education and Behaviour. 2015;47(4):325-330.e1.

10 National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013 Available from: https://www.eatforhealth.gov.au/