So, here we are for the second part of our Free From diet series, and we're tackling the Dairy Free diet. Followed by more than 10% children and adults in the UK, a dairy free diet is imperative for those with Cow's Milk Allergy (CMA) and can also help those who suffer from Lactose Intolerance (1, 2). That's more than 1 in 10 of our population.
Interestingly, an imbalance of gut bacteria is associated with infants suffering from CMA (3) and those with an intolerance to lactose (4) and if you've read up on the gut microbiome in our blog about the pitfalls of the gluten free diet, you'll know just how important those microbes are to multiple aspects of health. If you haven't had a chance to read it, then our recommendation is to feed your gut microbes with foods that support the diversity of species and the production of anti-inflammatory Short Chain Fatty Acids. These include probiotic, fibre rich Vegetables, Fruit, Beans, Lentils, Chickpeas, Nuts and Oats (5, 6). You also need to give them the fuel that they need to thrive by eating prebiotic foods including Onion, Leek, Garlic, Jerusalem Artichoke, just ripe Banana, Asparagus, Mushrooms (6) and Omega 3 rich Oily Fish, Walnuts, Flax/Linseeds, Chia seeds (7).
A dairy free diet can mean an alleviation of uncomfortable symptoms for many with a lactose intolerance and can be life saving for those with a milk protein allergy. Nonetheless, if you take out a large group of foods from your diet, you're taking out an array of dietary benefits.
For a dairy free diet, the key issues are:
Energy intake: dairy is a good source of calories which are particularly important for toddlers as they move through their weaning phase.
Protein intake: pretty much every part or function within you contains an element of protein - bones, teeth, hair, skin, tissue, organs, hormones. Dairy is a great source of protein which must be replaced.
Calcium: noted for its key role in bone and tooth strength, we need to ensure that at whatever lifestage you or your family are at, they maintain this strength. It's worth noting that 125 children in the UK were recently diagnosed with rickets over a 2 year period (8), a soft bone disease associated with the Victorian era. Rickets is driven by low Calcium and Vitamin D levels.
As ever, we recommend a Food First approach.
Energy intake particularly aged over 2yo: Egg, Avocado, Olive Oil, Meat, Oily fish, Coconut yogurt with live cultures
Protein: Meat, Fish, Poultry, Egg, Tofu, Chickpeas, Beans, Lentils, Quinoa, [Hard cheese and live yogurt if tolerated/without allergy, more on this later]
Calcium: Leafy greens, Oranges, Nuts, Dried figs, Tofu, Beans, Lentils, Fortified milk substitutes, Sardines
! But did you know that to absorb and lock Calcium into bones and teeth you require adequate Vitamin D levels? Sadly, in the UK we just can't get enough of this "sunshine vitamin" because our sunlight levels are too low for much of the year; we use suncream in summer months which decreases the body's ability to convert sunlight to Vitamin D; we spend way too much time indoors; and may cover up due to social or religious norms. That's why the UK government recommends supplementing with 10mcg of Vitamin D from birth from October to May. Food sources provide poor levels of Vitamin D but these are of note:
Sardines & Tuna in oil (7mcg/100g) (9), Mushrooms left in a sunny place for 30-60 minutes (10mcg/100g) (10).
Milk substitutes
Those of you who attended the Free From Festival in Bristol this weekend will have heard me discuss these products. Whilst they can be enormously helpful, you have to remember who's drinking them and if they are advantageous to that person. Yes, they are fortified with Calcium, B vitamins and Vitamin D but check out their calorie and protein levels. We were pleased to see that one supermarket added Iodine to their milk substitutes which is crucial to a healthy metabolism. However, be aware that if you have an issue with dairy, your immune system may cross react to almond, oat or soya milk.
[Nut icon denotes possible cross reactivity]
Lactose Intolerance
The Lactobacillus strains of probiotics found in milk break down lactose, and therefore some people who are Lactose Intolerant find that they can eat small amounts of hard cheeses like Cheddar and Parmesan, live natural yogurt and milk. Research now suggests that supplementing with Lactobacillus Acidophilus probiotics (10 billion units/day) can improve Lactose Intolerant symptoms (but should not be tried in those with milk protein allergy). (11)
On a similar vein, the gut does love fermented foods as they can increase the diversity of microbes, which is beneficial to health, and can improve gut symptoms such as bloating and gas. Try Miso, Kimchi, Sauerkraut and Water (or possibly Milk) Kefir
Shopping List
As requested, the visual Shopping List is here. You'll see it's packed with dairy free whole foods and should help make life a little easier when you next visit the supermarket.
[Beware egg allergy in infants with CMA]
A full reference list for all 3 diets will be released with the Sugar Free diet blog but short citations are here, in order of use, for this Dairy Free piece:
1 Flom & Sicherer, 2019
2 McKenna, 2022
3 Sorensen et al., 2021
4 Misselwitz et al., 2019
5 Guan et al., 2021
6 Silva et al., 2020
7 Vijay et al., 2021
8 Julies et al., 2021
9 Sahar et al., 2022
10 Cardwell et al., 2018
11 Oliveira et al., 2022