Why are more people struggling to digest dairy, and how can lactose intolerance be distinguished from a true allergy? Doctors say processed foods may play a role, while unnecessary milk avoidance in childhood can raise allergy riskAhead of Shavuot, the holiday of cheesecakes, creamy pastas and refrigerators packed with dairy products, another phrase seems to have become part of the food conversation in recent years: “I’m lactose intolerant.”More and more Israelis say that after coffee with milk, ice cream or pizza, they suffer from bloating, stomach pain, gas and diarrhea — and wonder how they could have eaten everything without a problem just a few years ago. So have more people really become lactose intolerant, or have we simply learned to identify what we once quietly endured?4 View gallery Have processed food, sterility and rising awareness changed the way our bodies respond to milk? (Photo: Shutterstock)Dr. Natalie Tamir Daghbeli, an internal medicine and gastroenterology specialist in digestive motility and function disorders at Beilinson Hospital, part of Clalit, says it is important first to understand that not every reaction to food is an allergy.Dr. Natalie Tamir Daghbeli Photo: Private“A food allergy is an immune response by the body to a specific substance,” she says. “It can cause a rash, changes in heart rate and, in extreme cases, even a real life-threatening situation.”Food intolerance, she says, is entirely different. “It is essentially a digestive problem. The body simply cannot digest a certain component, such as food sugars or fats. It manifests as stomach pain, bloating and diarrhea. There is no life-threatening danger here, but it can certainly severely affect a patient’s quality of life and comfort.”Dr. Shira Ben-Or, director of the pediatric allergy clinic at Ichilov Medical Center and a board member of the Israel Association of Allergy and Clinical Immunology, also stresses that many people confuse lactose intolerance with a true milk allergy — though they are completely different conditions.Dr. Shira Ben-Or Photo: PRLactose intolerance is caused by a deficiency of lactase, an enzyme produced in the small intestine that breaks down milk sugar. “Lactose is found in all types of milk, including breast milk, and is mainly suited to the digestive systems of young mammals,” she explains. “Over the years, enzyme levels in the intestine decline, so some teenagers and adults become less able to digest dairy products.”The condition can cause stomach pain, gas and diarrhea, but it is not dangerous. “It can be managed with lactose-free products or by taking a lactase pill close to a meal,” she says. “A breath test can also be used for diagnosis.”4 View gallery More processed food and less home cooking may affect digestive system function and the microbiome (Illustration: Shutterstock)Milk allergy, by contrast, is an immune system reaction to cow’s milk protein. “It is a rarer condition that appears mainly in babies and young children, and in most cases passes with age,” she says.When a child with a milk allergy is exposed to a dairy product, an allergic reaction can develop within minutes, involving symptoms in the skin, respiratory system, digestive system and sometimes the heart and blood vessels. “When two or more systems are involved, this is an anaphylactic reaction, which can become life-threatening without adrenaline treatment,” she emphasizes.According to Tamir Daghbeli, one of the main reasons it seems that “everyone” is suddenly lactose intolerant is tied to major changes in lifestyle and diet over recent decades.“People today consume far more processed food, sugars and industrial food, and cook less at home,” she says. “These changes have a direct effect on the digestive system and the gut.”At the same time, dairy consumption itself has also changed significantly. “Today there is a much wider variety of dairy products than in the past, and daily milk consumption has risen sharply,” she says. As a result, many people are now exposed to larger amounts of lactose — and experience more symptoms.Ben-Or says growing evidence suggests a modern diet rich in processed foods may affect not only the digestive system, but also the risk of developing allergic diseases.“The information we have today is based mainly on observational studies, but we do see a possible link,” she says. A 2024 review by the European allergy and immunology society found that childhood exposure to common components in processed foods, including fructose, monosodium glutamate and advanced glycation end products, was associated with an increased risk of food allergies and allergic diseases in children. The review also found that children with food allergies consumed an average of about 34% of their calories from ultra-processed food.But Tamir Daghbeli says it is not only eating habits that have changed — awareness has, too. “Patients are no longer willing to suffer in silence,” she says. “More people are seeking medical evaluation, and advanced medical tests to identify sensitivities, which simply did not exist in the past, are now widely available.”Conditions people once lived with for years without understanding their source can now be diagnosed more clearly and accurately. “Today we know how to identify conditions such as lactose intolerance, celiac disease or irritable bowel syndrome, which in the past people simply did not know how to name.”Alongside changes in diet and awareness, another theory has attracted researchers’ attention in recent years: the “hygiene hypothesis.”“According to this theory, in the modern world we live in excessive sterility and protect ourselves too much from the environment,” Tamir Daghbeli explains. “As a result of insufficient exposure to diverse foods in the early years of life, the body does not learn to recognize triggers and may develop allergies and sensitivities.”Ben-Or says that while it is difficult to prove a direct link, more studies suggest that the modern lifestyle may affect the development of the immune system.“In general, it can be said that a modern lifestyle, distant from nature, does not support the proper development of the immune system,” she says. “We are seeing more allergic and autoimmune diseases, but it is still difficult to prove a direct causal link.”She notes that one study found families that disinfected pacifiers with antiseptic substances instead of washing them with water had a higher incidence of food allergy. The increased use of disinfectants and wipes during the COVID pandemic has also been linked to worsening atopic dermatitis — sometimes called “skin asthma” — a condition that is itself considered a risk factor for developing food allergies, especially in areas of skin around the mouth.4 View gallery Cow’s milk and cream contain more lactose, while hard cheeses and goat milk are considered easier to digest (Photo: Shutterstock)Even people who consumed dairy for years without any problem may eventually find their bodies reacting differently. One of the most common questions among patients is how someone who has eaten dairy all their life can suddenly begin suffering from bloating, stomach pain or diarrhea.According to Tamir Daghbeli, “the human digestive system was not really designed to digest lactose optimally throughout life.”The decline in enzyme levels can appear later in life, even in people who previously consumed dairy without difficulty. “There is still no clear answer as to why enzyme levels change over the years, but it may be linked to dietary changes, changes in gut bacteria — the microbiome — use of supplements or medications, as well as smoking and alcohol consumption,” she explains.She emphasizes that lactose intolerance is not considered a digestive system disease, but a condition that can be managed through dietary and lifestyle adjustments. “The goal is not only to reduce symptoms, but to preserve patients’ quality of life,” she says.Not all dairy products contain the same amount of lactose, so their effect on the digestive system varies from person to person. Tamir Daghbeli says cow’s milk and cream are considered relatively high in lactose — especially drinking milk, which many people find more problematic. Hard cheeses, by contrast, contain less lactose, partly because the production process reduces some of the milk sugar. Goat milk also naturally contains less lactose.Before rushing to remove dairy products entirely from the diet, she says, it is important to undergo proper medical evaluation and rule out other infectious, inflammatory or immune-related conditions that can cause similar symptoms.4 View gallery In children, unjustified avoidance of dairy products may actually increase the risk of allergy (Photo: Shutterstock)After diagnosis, dietary and medical solutions can be tailored to reduce symptoms and allow continued consumption of dairy products. Options include switching to lactose-free products or taking a supplement containing the lactase enzyme before meals to help break down milk sugar and improve digestion.Ben-Or stresses that not every rash or stomachache after eating a dairy product requires complete avoidance of dairy foods, especially in babies and children.“Babies tend to develop rashes easily while eating, and sometimes it is simply skin irritation from contact with food — not an allergy,” she explains. “It is worth consulting a pediatrician and not rushing to remove foods from the diet because of a mild rash.”Prolonged and unjustified avoidance of dairy products in infancy, she says, may actually increase the risk of developing a milk allergy. “This is also true for other allergenic foods, such as eggs, peanuts and tahini. Once they are introduced into the diet, it is important to maintain regular exposure.”Finally, she says it is important to pay attention to new products marketed as “vegan” or kosher “pareve.” “Some of these products are made in a lab and still contain cow’s milk protein, so they are not suitable for children with milk allergy.”