No more milking it

When eating cheesecake shifts from guilty pleasure to religious custom, many grab a free pass to indulge. Yet for some, being lactose intolerant means that whether it’s Shavuot, a special occasion, or an ordinary day, consuming dairy is never a simple prospect. 

“On Shavuot, I always worry, ‘Am I going to be able to eat things?’” says Natalia Levin. Now 23, Levin was diagnosed with lactose intolerance when she was 16, and later also with an intolerance to gluten, a protein found in wheat, barley, rye, and their derivatives. “I try prepare before I go out by taking my own food as I don’t expect people to cater according to me.” 

For Levin, ensuring there’s appropriate food available, whether she’s going to a restaurant, friends, or family, has almost become second nature. That’s not to say that this doesn’t still come with a degree of anxiety. 

“It’s around whether I’m going to be the one left out at a meal or that I won’t be able to eat, which is awkward,” she explains. Her anxiety also manifests in other ways, for example when ordering coffee and asking for alternative milk. “I always ask about 500 times if the person serving me is sure it’s correct as I’ve had an experience where I got sick because I was served dairy. So, it’s led to almost not trusting people and having to constantly triple check.” 

Levin is not alone in the challenges she faces. It has long been acknowledged that Ashkenazi Jews have a higher chance of being lactose intolerant. 

“Lactose intolerance affects around 25% of people in Europe, but rises to 50%-80% among Ashkenazi Jews, people of Hispanic origin, South Indians, and black populations,” says registered dietitian Leigh-Ann Silber. This risk approaches 100% in Asian and American Indian populations, she says. “The reason comes down to evolution and understanding genetic adaptation. Lactase persistence, the ability to digest lactose comfortably into adulthood, developed in populations that depended heavily on dairy farming, particularly Northern Europeans.” 

Lactose intolerance is rooted in what is essentially a digestive mismatch, Silber explains. “Lactose is the natural sugar found in milk and most dairy products, and to absorb it properly, your small intestine needs to produce an enzyme called lactase. When lactase production is insufficient, lactose passes undigested into the large intestine, where gut bacteria ferment it ‒ and that’s where the trouble starts. 

“The resulting gas and short-chain fatty acids cause the classic cluster of symptoms: abdominal cramps, bloating, diarrhoea, nausea, and flatulence.” These symptoms usually occur between 30 minutes and two hours after eating dairy, she says. “The severity depends on how much lactase someone produces, how much dairy they’ve consumed, and what else they ate at the same time. It’s a spectrum, not a switch.” 

Silber says lactose intolerance is different from a dairy allergy, which is an immune response and an entirely different condition. “Lactose intolerance is a digestive enzyme issue, uncomfortable, but not dangerous in the way an allergy can be.” 

With lactose intolerance, cutting out all dairy is rarely necessary. “The goal is finding your personal threshold, the point at which your digestive system starts complaining. The key is portion size and context. Dividing daily intake into smaller portions and taking dairy with other foods helps significantly. Gradually increasing milk intake over time also can encourage intestinal adaptation, allowing higher amounts to be tolerated in the long run.” Lactose-free dairy products, which are readily available at many retailers, are also worth investigating, Silber says. They’re nutritionally identical to regular dairy but pre-treated with lactase. 

Those with the condition can also take lactase enzyme supplements before a meal, which compensate for what the gut isn’t producing adequately. 

Levin says she’s sometimes annoyed by fellow sufferers who advocate eating dairy anyway because of the “Yolo (“You only live once”) philosophy. “I can’t, because I know I’ll be in pain and that could be in a day lost in the bathroom,” she says. Indeed, not modifying diet can reduce quality of life for those with lactose intolerance, Silber says. 

“Continuing to consume dairy well beyond your threshold keeps the gut in a state of ongoing fermentation-driven inflammation. Over time, this disrupts the microbiome, keeps the gut inflamed, and can compound other digestive vulnerabilities.” Yet, she cautions those who need to reduce dairy significantly to intentionally replace calcium with foods including sesame seeds, almonds, and fortified plant milks and supplements. 

For those facing challenges beyond lactose, full dairy avoidance can be necessary. At 11 months old, Talya Brodkin was diagnosed with dairy intolerance. “My body couldn’t properly break down both the sugar element (lactose) and the protein element (casein) found in milk,” she says. “I still have this condition today, but I control the symptoms by cutting out dairy.” 

Brodkin also suffers from celiac disease, an autoimmune disorder in which eating gluten triggers an immune response that damages the small intestine. “Today the only treatment is a lifelong, 100% gluten-free diet,” she explains. 

“There are certainly emotional aspects of being forced to give up gluten and dairy products,” Brodkin says. “One feels overwhelmed at first but it gets easier when you get the hang of the diet. It’s a steep learning curve as to what you can or cannot eat.” 

She says she’s grateful that these days there are so many wonderful dairy- and gluten-free products available that it’s easy to find substitutes or alternatives for foods. “But, at night I do dream of Shavuot cheesecake, Purim hamantaschen, and Chanukah doughnuts,” she admits. 

Brodkin’s challenges have, however, been instrumental in shaping her professional journey. “I studied to become a nutritionist, and I specialise in the gluten-free diet.” She runs celiac and gluten-free support groups on Facebook and WhatsApp and consults with those newly diagnosed with celiac disease. “Fellow sufferers have lived it and can offer invaluable tips and emotional support,” Brodkin says. “They understand these conditions in a way textbooks often cannot. There’s comfort in that.”