EP.320/ Dairy and the endo belly: friend or foe?
If you’ve been considering eating for endo, or you have been, you may be thinking about or may have already, cut out dairy.
But is it necessary to remove dairy entirely for people with endo?
The answer is, it’s complicated and really depends on your body and of course, your personal values, because some people may choose to lower or omit their dairy intake for ethical or environmental reasons.
So in this series, we’re going to explore all the factors to consider around dairy and endo - because there is a lot to discuss!
Now before we begin, I do want to say, that I know I have many vegan listeners who will be distressed by this topic (and I used to be vegan myself, for many years). This episode is not about being for or against dairy. I am literally trying to deliver the facts and information so people can make an informed decision, because there are many with endo who are completely confused about by the conflicting data. Also, there are so many important topics we’ll discuss today, that could shed light on people’s symptoms, so I do think it’s important to cover. If this episode causes you distress, please feel free to skip it.
Okay, so today, we’re starting with dairy and the endo belly.
Lactose:
First up let’s look at a fairly obvious consideration and that’s lactose. Lactose intolerance is pretty common amongst the general population, in fact 68% of the global population is estimated to be lactose intolerant.
Lactose intolerance can cause diarrhoea, gas, bloating, cramping, etc., which essentially worsens the endo belly bloating and GI symptoms many with endo suffer with.
But it’s not just the prevalence of lactose intolerance we should consider. Lactose intolerance is very common in the small intestine bacterial overgrowth population. SIBO is a condition where normal gut bacteria which should be in the large intestine, overgrow in the small intestine. SIBO tends to lower lactase, the enzyme required to digest lactose. Once people with SIBO clear their SIBO and improve their gut health, many find they can tolerate lactose again. As we know, many people with endo also have SIBO, with one study estimating up to 80% of people with endo may also have SIBO. So if you have SIBO, it’s worth treating that to see if you can resolve your lactose intolerance.
Lactose is also high FODMAP, which means it’s rapidly fermentable, which can increase gas and bloating in people with IBS, SIBO or gut sensitivities. The key is to resolve as much as possible, the root cause preventing your tolerance of FODMAPs, but the FODMAP diet can also help you identify which ones are most difficult for you.
Of course, if you’re eating something that triggers intestinal distress for you or you’re actually intolerant to, this can trigger intestinal inflammation. If you’re repeatedly consuming dairy and you have lactose intolerance, this can eventually cause low grade chronic inflammation in the gut, which can spread both locally (i.e. to the nearby pelvic organs) and systemically, because the reactivity triggers the immune system which is just on the other side of the gut lining, ready to attack any pathogens, infections, etc. that sneak through.
As endo growth and pain is driven by inflammatory immune chemicals like cytokines, mast cells and prostaglandins (combined with other factors like oestrogen), we want to lower our intake of foods that cause us intestinal inflammation.
The good news is not all dairy is high in lactose, in fact many hard cheeses like parmesan and cheddar are very low or so low in lactose, they’re considered lactose free. I’ve linked to a few helpful studies in the show notes to give you an idea of which foods may be better tolerated.
Another thing to consider is, providing the other points aren’t relevant to you, if lactose is your only problem, you could benefit from lactose free dairy products. For example, I make a SIBO friendly 24 hour fermented lactose free goat yoghurt. If you ferment yoghurt for 24 hours, the lactase is broken down by the bacteria, and it becomes lactose free. You can also buy droppers of lactase, not for you to take, but for you to put into dairy products, and you leave for 24 hours, and the lactase is significantly reduced to the point that most people can tolerate it.
Finally, most people with lactose intolerance can actually tolerate a small amount of lactose; 12g at any one time, and about 24g over the day.
You can actually get tested for lactose intolerance, and you could also, if doing an elimination diet or the low FODMAP diet, trial yourself on high and low lactose foods, to see which ones you tolerate better.
A1 casein:
Now let’s look at A1 casein. A1 casein is type of milk protein which research suggests some people find triggers intestinal inflammation and gut issues like slowed transit times. The data on this in animals is pretty conclusive, but the data on humans is emerging, and whilst it’s true for a number of people, not everyone will have this inflammatory reaction to A1 casein.
Now in terms of what this means for endo, as we discussed earlier, if we are constantly being exposed to something that triggers intestinal inflammation, like A1 casein, then the same applies here regarding inflammation spreading throughout the abdomen/pelvis and body. And Dr Lara Briden, who is one of the world’s leading women’s health naturopathic doctors, has observed in her work, that A1 casein can drive a lot of the inflammatory immune reactions that are linked to endo.
However, it’s not all bad news. A2 casein has been observed as typically better tolerated and this comes from sheep and goat’s dairy, as well as Guernsey and Jersey cows. So, you may find that you don’t need to go lactose free with dairy, but you do need to be careful with the type of animal dairy you consume.
How would you know if A1 casein is a problem for you? The gold standard would be to do either a full elimination diet, or a partial, where you just remove all dairy for four weeks, and then introduce each type of dairy one by one, to test your tolerance. You would do this by eating a specific animal dairy (i.ie.goat’s) each week, for three days in a row, and then taking four days to calm the stomach and immune system and to look for any delayed reactions, and then you would try a different dairy. If you react badly, you do need to wait for the reaction to completely subside before trying a new diary type. It’s better to do this with a practitioner or to at least follow a course which teaches you how to do this in a systematic approach. I do teach my clients how to do this and also I teach it in my courses (they are not available for purchase at this time, because I only release them a few times a year). I am however accepting applications for one to one coaching clients, so if you’re interested in learning more about coaching with me, you can email on hello@thisendolife.com.
Histamines
Now finally, let’s look at histamines. Histamines are the immune chemicals that cause the symptoms of an allergic reaction and they are made in the body, but are also found in dairy products, especially fermented and aged dairy (though histamines are found in many foods, to be clear). We’re going to get much more into histamines in our episode on dairy and pain, so hold out for that, but in terms of histamines and gut health, some people struggle with histamine intolerance or something called mast cell activation syndrome, where the mast cells which release histamine are over active and highly sensitive.
Histamine issues are quite common within the endo population, and essentially, we can be more reactive to histamines, allergens that trigger histamine production and we may have a hard time breaking down histamines. People who have difficulty breaking down histamine from food are often low in levels of the digestive enzyme DAO, which breaks down the histamine. If we struggle with low levels of this enzyme, or our body just can’t cope with excess histamines coming in through food because we’re already making too much in our body, this can trigger gut problems like diarrhoea, intestinal pain and bloating.
Gut health problems like SIBO or gut dysbiosis can be the root cause of histamine issues, as not only can certain bacteria actually cause more histamine production, but conditions like SIBO may deplete DAO levels, so resolving your gut health problems should allow you to digest histamine rich foods (or more of them) with time. You can also try supplementing with DAO, to boost your levels and to see if it helps you to tolerate these foods.
Again, an elimination diet would likely help you here, to identify if histamines are a problem for you. The issue with a histamine diet is that it’s very restrictive. My first suggestion would be to try a standard elimination diet as I discussed above, and if you still don’t experience relief, consider working with someone or following a book or course by an expert, that teaches you how to follow a low histamine diet safely. Also, it’s worth noting that the low FOMDAP diet, which you may choose to do to see if you’re sensitive to the fodmaps, actually reduces histamine intake eight-fold.
Benefits
Now providing that lactose and A1 casein isn’t a problem for you, or if they are you go for low lactose and A2 dairy, are there any benefits for gut health?
The answer is yes, there are actually significant benefits for gut health, but the benefits are mostly based on fermented dairy, like yoghurt, kefir, cultured cream and aged cheeses. As we’ve been exploring heavily lately, people with endo may have less beneficial bacteria and short-chain fatty acids. Emerging research is showing that these gut changes play a significant role in the development of endo.
Probiotic foods can not only replenish healthy bacterial levels, but also improve short chain fatty acid production. I explain this endo and gut connection, and the specific benefits of probiotic foods, including kefir and yoghurt, in a recent episode, which I’ve linked to in the show notes (which by the way, you can read if you’d prefer).
Of course, these probiotic foods are typically high histamine, and I address that in the episode, if you’re sensitive to those.
Okay, that wraps up this first episode on dairy and endo. I hope you find it useful!
Show notes
Lactose
https://pubmed.ncbi.nlm.nih.gov/28690131/
https://pubmed.ncbi.nlm.nih.gov/20132150/
https://pubmed.ncbi.nlm.nih.gov/26138365/
https://pubmed.ncbi.nlm.nih.gov/9660426/
https://www.sciencedirect.com/science/article/pii/S0958694618300608 https://www.researchgate.net/figure/Lactose-content-of-dairy-products_tbl1_268035497
https://www.ncbi.nlm.nih.gov/books/NBK534631/
A1 casein
https://pubmed.ncbi.nlm.nih.gov/28916574/
https://pubmed.ncbi.nlm.nih.gov/24166511/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593102/
Histamines
https://pmc.ncbi.nlm.nih.gov/articles/PMC10346277/
https://www.monashfodmap.com/blog/histamines-and-ibs/
https://pubmed.ncbi.nlm.nih.gov/26976734/
https://drbeckycampbell.com/courses/
Probiotic dairy
https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2024.1373004/full
https://www.theendobellycoach.com/podcast/endo-fermented-foods
https://pmc.ncbi.nlm.nih.gov/articles/PMC8579104/
https://zoe.com/learn/best-probiotic-foods
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Produced by Chris Robson