Milk and dairy in Ayurvedic dietetics

Milk occupies a prominent place in classical Ayurvedic dietetics. It is described as nourishing, as suitable for a range of conditions, and as a vehicle for other preparations.

The classical instructions about it are quite specific, and several of them turn out to be more interesting than they first appear.

What the texts specify

Drink it warm or boiled, not cold from storage.

Drink it on its own, not with a meal, and specifically not with certain foods including sour and salty items and fish.

Add spices — cardamom, ginger, turmeric, pepper — which are described as making it easier to digest.

Drink it at particular times, generally in the evening, and the timing recommendations vary by source and by intended purpose.

The instruction not to combine milk with certain foods is the origin of a good deal of contemporary food-combining advice.

Lactose, which the texts did not know about

Lactase persistence — retaining the ability to digest lactose into adulthood — is a genetic trait that varies enormously between populations.

It is common in populations of northern European descent and in some pastoralist populations in Africa and the Middle East, and much less common in East Asian, Southeast Asian, and many other populations.

In India the picture is intermediate and varies considerably by region, with higher rates of lactase persistence in the north-west and lower rates in the south and east.

Reduced lactase activity produces bloating, wind, cramping and loose stools after milk, with the severity depending on the amount consumed and on individual tolerance.

Where the classical advice happens to help

Several of the traditional instructions have practical effects for people with reduced lactase activity.

Small quantities. Most people with reduced lactase tolerate small amounts without symptoms. The classical framing of milk as something taken in a modest quantity on its own, rather than poured over cereal in volume, keeps the dose low.

Fermented dairy. Yoghurt and buttermilk contain less lactose than milk and contain bacteria that assist its digestion. These are prominent in traditional Indian diets, and yoghurt in particular is generally better tolerated.

Ghee. Effectively lactose-free, since the milk solids are removed.

Spicing and warming. No evidence that this affects lactose digestion. The effect on comfort, if any, is likely to be modest.

So the traditional pattern of dairy consumption — small quantities, much of it fermented, plus ghee — happens to suit populations with variable lactase activity rather better than the pattern of large volumes of fresh milk.

The classical distinctions worth noting

The texts differentiate between fresh milk and yoghurt and assign them quite different properties, with yoghurt described in more qualified terms and with specific instructions about when it should and should not be consumed.

Buttermilk is described favourably for digestive conditions.

These distinctions correspond to real differences in composition and in how the products behave, whatever one makes of the theoretical account.

The nutritional position

Dairy supplies protein, calcium, iodine, vitamin B12 and other nutrients, and it is a convenient source of them.

It is not essential — populations with low dairy consumption obtain these nutrients elsewhere, and anyone avoiding dairy should ensure calcium, iodine and B12 intake is covered from other sources.

The saturated fat content of full-fat dairy is a consideration for anyone advised to limit it, though the epidemiological picture for dairy specifically is less clear-cut than for saturated fat in general, with fermented dairy in particular associated with neutral or favourable outcomes in a number of studies.

The practical version

If you tolerate milk, the classical instructions are harmless and the warm spiced preparation is pleasant.

If you do not tolerate it, the traditional framework offers plenty of alternatives within the same tradition — yoghurt, buttermilk, ghee — which are frequently better tolerated.

If you have symptoms after dairy, the useful step is to establish whether it is lactose, since the management differs. Lactose intolerance is dose-dependent and manageable; milk protein allergy is different and more serious; and other conditions can produce similar symptoms.

Do not eliminate a food group indefinitely on the basis of a self-diagnosis, particularly for children, where dairy exclusion has nutritional implications requiring proper planning.

Persistent digestive symptoms should be assessed rather than managed by elimination. Dietary exclusion in children should be supervised by a doctor or dietitian. Suspected milk allergy, particularly with rash, swelling or breathing difficulty, requires urgent medical assessment.