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December 28, 2016

Infrequently Asked Questions: Does milk really alleviate a stomach ache?

Popular knowledge goes that a coating of milk in the stomach can bring relief from aches and pains in your gut. 

Whether that's truth or household gospel, however, is the question. 

Curious to understand the interactions between milk and the stomach, we reached out to Colin Smith, a gastroenterologist at Jefferson Health.

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There's an old wives' tale that milk coats the stomach and alleviates its aches. Any real truth to that? And if there is, does it matter what kind of milk?

Before we discuss treatments for stomach pain, I think it is important to understand its causes. Pain in your stomach, which we call dyspepsia, can be from many different things, including problems outside the stomach such as gallstones, inflammation of the pancreas, or even a rupturing blood vessel in your abdomen. Pain actually coming from the stomach can be from irritation in the lining of the stomach -- gastritis -- due to infection, medications or food, an ulcer in your stomach or the first part of your small intestine called the duodenum, or may actually be a component of acid reflux. (Gastroesophageal Reflux Disease, aka GERD.)

If pain is coming from gastritis, an ulcer, or GERD, stomach acid may make the pain worse. The thought behind drinking milk is that it can decrease the acid content and thus soothe the stomach. Interestingly, milk is actually slightly acidic! However, it is less acidic than your stomach and acts as a "buffer" to decrease the total acidity. Unfortunately, this effect is short-lived, so drinking milk is definitely not a good, long-term approach to treating stomach pain. I certainly don't include it in my treatment recommendations for patients. As far as what type of milk to drink, fatty foods tend to worsen reflux, so perhaps skim is the best choice. 

Are you actually doing more harm than good beyond that short-term relief?

An occasional stomach ache is not concerning, but frequent or persistent pain may be a sign of something more serious going on. The pain may be a symptom of a common stomach infection called H. pylori, which can lead to stomach ulcers or even stomach cancer, if left untreated. Ulcers can cause life-threatening bleeding or perforation in the stomach. Untreated, severe GERD can result in a narrowing of the esophagus or even esophageal cancer. Milk is not going to prevent any of these complications from happening. If you need to take milk or some other medication frequently or on a recurring basis, you should see your primary care physician or a gastroenterologist. Weight loss, trouble swallowing, or bloody or black stool are other signs that you should see your doctor right away. 

I think the thing is, it sounds counter-intuitive that a dairy product would help an upset stomach. What are some general realities about dairy products and how they interact with our stomachs and digestion – useful tidbits people can have on hand for their diets?

The sugar in cow's milk – lactose – is what gives most people GI issues. Lactose is broken down by the lactase enzyme, which is a protein produced by the cells in small intestine. Without lactase, your body can't absorb the sugar, and it ends up being broken down by intestinal bacteria into gas that causes abdominal pain, diarrhea, bloating and sometimes even vomiting. Some people, particularly those of Asian or African background, make less lactase enzyme as they get older and are more prone to have issues with dairy products. If you think you might have lactose intolerance, you can try to avoid milk products for a week to see if you have less symptoms.

Allergies to milk proteins are more common in infants and children but rare in adults. There are a host of different syndromes and symptoms that go along with this, from diarrhea, to chest pain, and even skin irritation. If you are worried about a milk allergy, you should talk to your doctor about a referral to an allergist. 

How recently have we started to better understand how dairy impacts our digestive systems? It seems like we're all starting to adjust our diets accordingly, only within the past few years. 

Soy and nut milks are definitely more popular these days, which is great for people with lactose intolerance or milk allergy. It's important to note that cow's milk still has the most amount of protein, vitamins, and minerals compared to these plant-based milks. Make sure to read the labels!  

Any strong recommendations for how to treat a stomach ache that doesn't include milk?

The easiest thing to do is change your lifestyle. Fatty foods tend to sit in the stomach longer, and may cause discomfort. Overeating obviously can cause discomfort, and contribute to acid reflux. Alcohol and caffeine can also cause irritation. Antacids like Tums or Maalox are fine to use for occasional stomach pains, but are not good for frequent issues. Your doctor may do a test for the bacteria H. pylori, which can be treated with a course of antibiotics. We often also prescribe medications that decrease stomach acid, especially if there is a component of heartburn with the stomach pain. The first step is a class of medications called Histamine Receptor Antagonists, like Pepcid or Zantac. We then move on to Proton Pump Inhibitors, like Nexium or Prilosec, if those don't work. Many people only need a short course of medications for a month or two to get rid of their symptoms. 

Anything to add?

I would recommend that anyone dealing with significant or chronic stomach pain see their doctor. We can quickly rule out serious issues, and there are a variety of effective treatment options -- other than milk -- that we can offer.