Lactose and casein are two components of dairy that are often blamed for causing inflammation in some people. Lactose is the sugar found in milk, while casein refers to the family of milk proteins. Both have been extensively studied for their potential to trigger inflammatory responses in the body. This article reviews the evidence on whether lactose or casein is more likely to cause inflammation when consumed, and who may be impacted.
Lactose
Lactose is the main carbohydrate found in dairy products. It is a disaccharide sugar composed of galactose and glucose. In order for lactose to be properly digested and absorbed, the body must produce an enzyme called lactase. This enzyme breaks lactose down into simple sugars that can then be absorbed into the bloodstream.
Many people do not produce enough lactase naturally. This condition is called lactose intolerance, and it impacts 65-70% of the global population. Those with lactose intolerance lack the ability to fully digest lactose. As a result, undigested lactose travels through the digestive tract where it can draw fluid into the intestines through osmosis and gets rapidly fermented by gut bacteria. This leads to symptoms like bloating, gas, abdominal pain, and diarrhea when lactose is consumed.
The passage of undigested lactose into the colon provides a large substrate for gas-producing bacteria. Bloating and flatulence occur due to the production of hydrogen, carbon dioxide and methane gas during fermentation. The increased amounts of fermentation products like organic acids can also irritate the intestinal lining and alter stool consistency, causing diarrhea.
Additionally, the fermentation process results in increased production of short-chain fatty acids and gas. This combination can trigger intestinal distension and muscular contraction, contributing to cramping and discomfort.
Therefore, for those with lactose intolerance, lactose is generally the main culprit behind gastrointestinal symptoms and inflammation after dairy consumption. Those who are lactose intolerant experience a dose-dependent inflammatory response when ingesting lactose. The higher the amount of lactose consumed, the more severe their symptoms may be.
Casein
Casein refers to the family of phosphoproteins that account for about 80% of proteins in cow’s milk. Unlike lactose, most people do not have difficulty digesting casein. However, casein has still been implicated as a potentially inflammatory trigger for some.
The mechanisms behind casein causing inflammation are not fully understood, but a few theories exist:
Allergy/intolerance
Some people may be allergic to or intolerant of casein. Casein allergy appears most common in infants, while casein intolerance (difficulty digesting casein) is more often seen in adults.
In those with a casein allergy or intolerance, casein can trigger immune reactions involving immunoglobulin E (IgE) antibodies. The immune system responds as if casein is a threat, releasing chemicals like histamine that promote inflammation. Gastrointestinal, skin, and respiratory symptoms can result.
Casomorphins
During digestion, casein breaks down into smaller peptide fragments called casomorphins. Casomorphins have an opioid-like activity and are thought to bind to opioid receptors in the brain and gastrointestinal tract.
This interaction may promote inflammation in some individuals. By mimicking opioids, casomorphins may alter gastrointestinal motility, increase intestinal permeability, and change gut immunity – all effects that influence inflammation.
Lectins
The casein in dairy contains lectins, which are proteins that can bind to cell membranes. Some research indicates certain lectins may be hard to digest, making them pro-inflammatory. The potential inflammatory effects of casein-derived lectins are not fully proven, but it remains a theory linking casein to inflammation.
Histamine production
Certain probiotic bacteria like Lactobacillus casei and Bifidobacterium longum can metabolize casein, releasing histamine in the gut. Higher histamine levels stimulate immune responses involved in inflammation. However, the extent to which bacterial casein metabolism contributes to inflammation is uncertain.
Exorphins
Beta-casomorphins are one type of exorphin derived from casein. Exorphins are peptides with opioid-like activity. By interacting with opioid receptors, beta-casomorphins may increase intestinal permeability and initiate inflammatory responses, according to some research in rodent models and cells.
Major differences
The major differences between lactose and casein in relation to inflammation appear to be:
Prevalence
Lactose intolerance is very common, impacting 65-70% percent of people globally. Comparatively, casein allergy or sensitivity is rarer.
Mechanism
The underlying cause of inflammation is simpler with lactose. Inflammation results from lactose fermentation by gut bacteria when it is not properly digested due to lactase deficiency. With casein, the mechanisms by which it triggers inflammation are thought to be more complex, multifactorial, and not fully characterized yet.
Dose-dependence
Lactose intake displays a clear dose-response relationship – the more lactose consumed, the worse symptoms are in those with lactose intolerance. With casein, individual sensitivity appears highly variable and dose-dependence is less straightforward.
Speed of response
Symptoms of lactose intolerance typically occur rapidly after lactose consumption within 30 minutes to 2 hours. Casein sensitivities may induce more delayed reactions.
Types of symptoms
Lactose primarily causes gastrointestinal upset like diarrhea, bloating and cramping. Casein has been tied to a wider range of inflammatory reactions affecting skin, respiration, the brain, and gut.
Who is most impacted?
Lactose
Those with lactose intolerance are most prone to inflammation from lactose intake. This includes:
– Individuals who naturally lose lactase expression after weaning in childhood, including about 75% of the global population.
– People with lactase deficiency or congenital lactose intolerance, rare genetic disorders preventing lactase production.
– Those with secondary lactose intolerance due to gastrointestinal disorders like celiac disease or viral infections that damage gut lining cells that make lactase.
Casein
People who may react to casein with inflammation include:
– Infants/young children with casein allergy. Most outgrow this allergy.
– Individuals with casein intolerance. This is uncommon and poorly understood.
– Those with conditions causing increased gut permeability like leaky gut syndrome. More casein may reach immune receptors and trigger inflammatory cascades.
– People with gastrointestinal disorders, particularly irritable bowel syndrome (IBS), Crohn’s disease, and ulcerative colitis.
– Autistic individuals. Some research finds those with autism may have abnormal casein metabolism or sensitivity.
However, inflammation from casein is quite variable even among these groups. Response likely depends on individual differences in sensitivity as well as casein digestion and metabolism.
Replacing casein or lactose
Eliminating lactose or casein may help those who react to these milk compounds. However, both provide nutritional benefits that should be considered before fully eliminating them long-term.
Lactose
Most lactose intolerant individuals can tolerate small amounts of lactose. The quantity that triggers symptoms varies greatly among individuals.
Strategies to limit lactose intake include:
– Consuming dairy in limited amounts spread throughout the day.
– Choosing lower-lactose dairy like aged cheeses and yogurt with live cultures.
– Using lactase enzyme supplements to aid digestion of lactose.
– Substituting lactose-free or plant-based dairy like soy milk or almond milk.
Casein
Those sensitive to casein should avoid casein-containing dairy products like milk, cheese, yogurt, butter, cream and ice cream. Casein-free alternatives include:
– Plant-based milks like soy, almond, oat, rice and coconut milk.
– Dairy products labeled casein-free. These are produced using casein removal processes.
– Milk protein isolates like whey protein, which is low in casein.
However, unless medically required, avoiding all casein long-term is not necessary for most and can risk inadequate intake of nutrients like calcium. Monitoring symptoms while limiting casein sources may be advantageous for some adults and children.
Other dairy components
While lactose and casein are the most suspected inflammatory culprits, other compounds like whey proteins, milk fat globule membrane proteins, and bovine serum albumin have also been proposed to trigger inflammation in some. However, evidence is limited and effects are likely very individualized. Limiting lactose and casein is typically adequate for managing most dairy-related inflammation.
Conclusion
In summary, both lactose and casein have been associated with inflammatory responses in certain individuals. However, the prevalence of lactose intolerance makes lactose a more problematic compound for the general population. The mechanisms also appear more complex and variable for casein sensitivities. Still, some people clearly react to casein with inflammation as well.
Limiting lactose intake via strategies like using lactase supplements or low-lactose dairy can help those with lactose intolerance minimize inflammatory symptoms. People sensitive to casein likely need to more strictly avoid casein-containing dairy. For the majority, moderate dairy consumption spread throughout the day is unlikely to cause inflammation issues. But all individuals should monitor and tailor their intake based on their personal tolerance and symptoms.
