If you asked someone five years ago what type of milk they preferred, you’d have got a pretty straightforward answer: skimmed, semi or full fat – maybe soya at a push. Fast-forward to the present day though, and the answer is likely to be very different.

Cows are no longer the only providers of this staple. These days we’re buying alternatives to dairy made from many different sources: oats, rice, hemp, nuts – even peas. These ‘milks’ in various guises and varying shades of white/cream/beige are no longer a limited choice for the few. In fact, every year more of us are saying no to cow’s milk as trendy premium nut ‘mylks’ crop up in the nation’s health-crazed capital. So what’s changed?

Changing tastes
It’s thought around one in five UK households have swapped regular milk for dairy-free alternatives. Between 2011 and 2013, our yearly consumption of free-from milks soared from 36 million litres to 92 million, while last year Waitrose reported its sales of almond milk had overtaken soya milk for the first time.

This growing appetite for alternative milks goes hand-in-hand with our increasing dietary awareness (a good thing), better allergy labelling (a great thing) and the current vogue for celebrity and online food blogger endorsement (more dubious). The feeling is, if the glowing elite is saying that cow’s milk is bad for them, the same may be true for us too, right?

A full-blown allergy to the protein in milk (which sets up an immune response) is rare. That doesn’t stop more of us than ever identifying with the symptoms of lactose intolerance, and the broad-brush solution is increasingly to self-diagnose and cut out an entire food group. So what’s really going on?

What is lactose intolerance?
From birth we produce an enzyme called lactase. This breaks down the lactose (milk sugar) in milk so that it can be absorbed into the blood. Intolerance occurs when we don’t produce enough lactase, so  lactose remains undigested and ends up in the gut, where it ferments. This causes unpleasant side effects, including flatulence, diarrhoea, bloating, stomach cramps/rumbling and nausea.

‘Lactose intolerance is a difficult one, as even people who are intolerant can actually tolerate some lactose
in their diet,’ says Dr Miranda Lomer MBE, senior consultant dietitian in gastroenterology at Guy’s and
St Thomas’ NHS Foundation Trust. ‘People who say they can’t tolerate milk find they can spread a small amount throughout the day – a dash in tea, say, as opposed to a latte.’

From birth, milk is vital to our development, either in the form of breast milk or infant formula. Once we hit our first birthday, we’re steered on to a trajectory of drinking cow’s milk for strong teeth and healthy bones. It’s a great energy source, full of protein, and packed with vitamins and minerals – the big one being calcium. It’s recommended that by the time we’re adults we get around 800mg calcium a day.

‘The reason we look to milk for calcium is that it’s very easily absorbed due to the way it’s contained within dairy,’ says Miranda. ‘Alternative milks, while fortified, don’t contain the same structures that allow calcium to be so easily absorbed in the gut. Dairy-free milks can be consumed as part of a healthy, balanced diet but we should be careful not to give regular milk a bad name – if you’re cutting it out, you need to make sure you’re getting nutritional diversity to make up for it.’

Is dairy really scary?
So is lactose intolerance increasing, or are more of us are simply following a trend?

Ethnicity plays a part. Around 90% of the population in Asian countries are lactose intolerant because milk doesn’t form a huge part of the diet after weaning, but in the UK, outside the Asian community, it’s rare for us to stop producing lactase. In fact, only about 5% of the UK population are lactose intolerant. What’s perhaps more common, explains Miranda, is secondary lactose intolerance. ‘This is related to a temporary problem, such as gastroenteritis, when the gut has become sensitised,’ she says. ‘But we can usually recover from these incidences quickly.’ Her advice? To add dairy gradually back into your diet after the problem has been resolved.

The case for A2
Lactose isn’t the only troublemaker. In recent years, we’ve heard about the digestive struggles some people seem to have with a particular protein found in milk. Naturally, the food industry has come to the rescue with a dairy-based milk that’s free from this protein.

Cow’s milk contains two types of casein (milk proteins): A1 and A2. The A1 protein is the dominant protein in the milk produced in Europe. But according to some, many of us may be struggling to digest A1. Indeed, although research is scant, Australian-founded company a2 Milk insists those who struggle to digest ordinary milk may find solace in the alternative, naturally occurring A2 protein. Some UK farmers are now rearing cows that produce milk containing only A2.

Interestingly, although A2-containing milk still contains lactose, research published earlier this year by Professor Sun Jianquin from Huadong Hospital in Shanghai found improved gastrointestinal symptoms in self-reporting lactose-intolerant subjects when they drank A2 milk – indicating perhaps that it’s not lactose that’s causing the problem but the A1 protein.

This area needs considerably more research, especially in light of a review from the European Food Safety Authority in 2009, which looked at all the available studies into the two proteins and concluded there was insufficient evidence to support the benefits of A2.

‘There’s a lot of misinformation out there and I think it goes along with current diet crazes such as gluten-free eating,’ says Miranda. ‘More of us can tolerate milk than we think, and, for the majority, it should be included in a healthy, balanced diet.’