Is milk healthy? Define lactose intolerance. Plant-based milk

Today in her author ‘ s column #DietitologistReviews cardiologist, candidate of medical sciences, member of the National Society of Nutritionists, the Russian Society of Cardiology, WORLD CLASS Romanov doctor Oksana Lishchenko will tell you whether you should be so wary of milk of animal origin and in which cases it is really necessary to replace it with vegetable milk.

“Let’s start with the fact that milk and dairy products – belong to one of the main groups of foods, it is a source of complete protein and easily digestible fat. Without dairy products it is difficult to imagine a complete diet of modern man – milk (including vegetable origin), cheese (non-sharp and unsalted varieties), sour milk products (with reduced fat content), cottage cheese, yogurt, dairy desserts and so on.

Milk consists of whey (20%) and casein (80%) – they are also called “a source of fast and slow proteins” – whey contains many branched-chain amino acids (leucine, isoleucine, valine), while casein is a more “long-lasting” source of amino acids and is more often recommended to be taken before bedtime. Protein for our body is the main building material, it is especially important for muscles and for creating a beautiful, healthy and athletic body.

What is in a glass of milk?

With a glass of milk we get not only proteins, fats, carbohydrates, but also calcium, phosphorus, potassium, magnesium, iron, vitamins A, B1, B2, PP, C, D. Tofu (soy curd), soy milk and other soy products can also be a great addition to the diet and a source of high quality proteins. Cream cheeses, cream, sour cream – these products should not be abused because of their high fat content and low calcium content.

It is recommended to watch the amount of saturated fat in dairy products for a proper healthy diet, but it is wrong to completely refuse or significantly limit them in your diet. Basically, I and my fellow nutritionists recommend getting protein from animal and plant sources (50%/50%) – so milk in your diet can be either regular cow’s milk or any vegetable milk.

But you should take into account that drinking a glass of different milk, you get a different amount of protein and it is also digested by the body in different ways.

Rice milk and almond milk, for example, contain much less protein than cow’s milk and soy milk. Cow’s milk contains lactose (milk sugar) and casein (the main protein of milk), which is the reason for most problems with cow’s milk: lactose intolerance or protein allergies. Mare’s milk has less protein and fat, but more lactose, essential fatty acids and vitamins than cow’s milk. Goat’s milk also has more essential fatty acids and is easier to digest due to its smaller fat particle size.

The main advantages of plant-based milk are:

Lower calorie content;
unusual flavor;
plant milk is a source of essential polyunsaturated fatty acids;
rich composition of minerals and vitamins;
suitable for people with lactase deficiency and allergy to cow’s milk protein.

This is important: it is necessary to realize that plant milk can also be contraindicated, for example, in case of gluten intolerance you can not use oat milk, and in case of allergy to almonds – almond milk.

How can I determine if I have a milk intolerance?

If milk is well tolerated, it can be a daily product in a person’s diet – up to 300-400 ml per day! But with age, some people do not tolerate fresh cow’s milk well, and some people are already allergic to milk in childhood. What milk intolerance can be, how to recognize it and what to do – let’s understand in detail.

1st variant: true food allergy to cow’s milk (caused by IgE).

Allergy to cow’s milk protein is the most common of all food allergies. Milk contains about 20 proteins with varying degrees of antigenicity: casein, alpha-lactalbumin, betta-lactoglobulin, bovine serum albumin, bovine gamma-globulin, and others. Casein has the lowest antigenic activity and betta-lactoglobulin has the highest. For people allergic to a particular protein, it is important to know that, for example, milk proteins such as bovine serum albumin and alpha-lactalbumin are destroyed after 15-20 minutes of boiling.

Manifestations may range from gastrointestinal symptoms (abdominal pain, vomiting, constipation, diarrhea) and skin rashes (urticaria, atopic dermatitis) to respiratory disorders and general anaphylaxis (allergic shock, Quincke’s edema). In typical cases, clinical symptoms appear 5-10 minutes or 3-4 hours after ingestion. Duration of allergic reaction varies from 2-3 hours to 7-10 days.
Occurs more often in childhood, accompanied by allergies to other foods, dust, blooming plants, etc., as well. It is detected with the help of allergy tests and blood tests – at an allergist. Treatment in such cases is also prescribed by an allergist.

2nd variant: milk intolerance associated with a deficiency of digestive enzymes.

Most often it is an absolute or relative deficiency of lactase – an enzyme that breaks down milk sugar (lactose) into 2 monomers: glucose and galactose. Such people do not tolerate milk well, complain of such non-specific (unfortunately) signs of lactase deficiency as bloating and heaviness in the stomach (flatulence), rumbling and increased gas in the intestines, nausea, belching, vomiting, diarrhea, abdominal pain.

Absolute lactase deficiency can be detected by genetic test. Different tolerance of milk and dairy products depends on the polymorphism of MCM6 gene: for example, genotype CC or GG indicates lactose intolerance, and genotype TT, AA, CT, GA – that a person can safely drink and digest milk. Relative deficiency of lactase occurs in old age or in the presence of problems with the gastrointestinal tract, in such cases it is recommended to use biologic supplements with lactase – a person takes a capsule with lactase during a meal containing dairy products.

Please note: lactose can be found not only in cow’s milk, but also in such products as sausages, sauces, hamburgers, mayonnaise, chocolate bars, puree soups, in ready-made packaged foods and so on. Read labels more carefully!

3rd option: the cause of intolerance – metabolic disorders or diseases of the gastrointestinal tract.

Poor tolerance to milk and dairy products can be associated with intestinal dysbiosis, intestinal infections, occurs after abdominal surgery, after antibiotic therapy, in various problems of the digestive system (Crohn’s disease, nonspecific ulcerative colitis, etc.).

In this case, it is recommended to consult a gastroenterologist and after a comprehensive examination and diagnosis to change the diet and select a treatment.

To drink or not to drink?

The importance of dairy products as sources of protein in the diet is determined not only by their amino acid composition (animal proteins contain essential amino acids in contrast to vegetable proteins), but also by the digestibility of protein and its biological value (how much protein is of high quality and is used for the needs of the body). Dairy proteins have the highest rate of digestion and assimilation, while vegetable proteins have the lowest. The general physiological need in protein for the adult population in Russia is as follows: for men – 65-117 g of protein per day, for women – 58-87 g of protein per day (based on an average man weighing 70 kg and a woman weighing 60 kg). With increased physical activity, in old age, in some diseases-conditions – this need may be greater.

How to calculate the daily allowance?

For a long time, the food pyramid was used to assess the balance of the diet. According to this rule, it was recommended to get at least 3 servings of dairy products daily: for example, 1 glass of milk (or fermented milk products, or yogurt) + 45 g of cheese + 100-150 g of cottage cheese. Currently, we consider it important to have at least one meal per day consisting of dairy products.

In addition, there is a standard for the quality of protein obtained with food, which determines which protein is the most qualitative, necessary and important for the body. Casein and egg protein have the highest PDCAAS (1.0), followed by beef (0.92), beans and peas (0.68), oats (0.57), lentils (0.52), peanuts (0.52), wheat (0.40), and so on.

Thus, the presence of dairy products is mandatory in the diet of a healthy person – after all, it is one of the main sources of protein, if you have a normal tolerance, you can choose milk of both animal and vegetable origin, in any case – try to maintain the variety and balance of your food”.