Tuesday, 31 January 2012

There are alternatives - dairy free milk substitutes

So you can't have milk, but you might still want your morning breakfast cereal or something with your cuppa. Well there's no need for complete despair, there are alternatives! 

One of the main things to consider is the age of the individual involved. Some milk substitutes aren't suitable before the age of six months, two, three or even four years, so you need to read your labels carefully. 

Baby's choice:1+ by Alpro
You might also want to bear in mind whether your milk substitute needs to be enriched with certain vitamins. If, for example, you want your milk substitute to perform the same kind of role that normal milk would previously have carried out for you (by providing a considerable amount of your daily calcium allowance) you need to check the label. Most do, but organic versions won't, because they cannot call themselves organic, if they have added anything into the mix. 

Some also have vitamin D added. It is vital for your body to get enough vitamin D, in order to absorb calcium, so it could be worthwhile to make sure your milk substitute contains vitamin D as well. Some also have B vitamins, and so it goes on...

The good news is that there are all kinds of milk substitutes these days. The problem is that the choice could be bewildering, so let's take a look at the options:

Soya Milk
Perhaps most widely known and available - often offered in coffee shops etc. no good, however, if, like me, you have an intolerance to soya milk. Many people who can't have milk also have problems with soya. There is also some question mark over the use of soya by those who are pregnant or infants - soya contains a plant form of oestrogen, which it is thought might cause some kind of hormonal effect. More worrying for boys than girls apparently, but there nonetheless.

There are other associated risks, but reading around, it's tricky sorting out the fact from (quite frankly) the fanciful. The following article, from the BDA, is quite a helpful read.

One thing that does seem to be agreed upon, is that soya is not deemed suitable for children under the age of six months. Alpro produce a junior version (suitable from one year) that we now use for 'Baby'. This is the medical profession's preferred option for young children under the age of two, unless they are intolerant/allergic to soya. This is because it has the right amount of calories and additional vitamins, that are needed by very young children.

One of the major advantages of soya, however, has to be, that (as it has been around so long, as a useful milk substitute) manufacturers have found ways of developing yoghurts, cheeses etc. made with soya. You can also get it in various flavours and in smaller cartons, which are good for carrying around. So if you can tolerate soya, and don't depend too much on it, it could be a good option.

Rice Milk
Personally I think rice milk has a nasty after taste. It is a popular alternative but not considered suitable for children below the age of four and a half (and therefore not suitable for those who are breastfeeding either). This is due to the fact that rice contains a certain level of arsenic!! The arsenic comes from the soil in which the rice is grown. Yet somehow rice is generally widely consumed and is still considered safe as a first food for babies!! Read this article by the Food Standards Agency, for official advice. And then the following article, by Foodsmatter, for a more interesting read!

For those who can have rice milk, as well as the larger cartons, it also comes in handy smaller lunchbox-sized versions, which are good for travelling. They also come in variety of flavours.

Almond Milk
One alternative that is becoming more and more popular, is almond milk. I really like almond milk. Almond is a good natural source of calcium, so it makes good sense. It's also an excellent source of vitamin E. The good news, for nut allergy sufferers, is that almonds are not nuts - they're drupes and are related to the peach!

Ecomil, Blue Diamond, Alpro, Dairy Free Dream, and Rude Health all make their own versions of almond milk, but Ecomil's, being organic will not have any extra vitamins beyond those which are naturally present in the almond itself because you can't add vitamins to an organic drink - it immediately invalidates its organic nature). Rude Health's version will not be suitable for anyone avoiding rice milk (see section below), as it contains 14% rice milk. This isn't a huge amount, so you might regard it as okay, but that's entirely up to you!

Alpro's advice (aimed at those of us who have young 'uns) is that Almond milk is not suitable as a main milk drink for children under three, but can be used in cooking etc. Additionally, they state (unless they're organic, of course), that all Alpro milks contain vitamins B2, B12, and D as well as calcium.

Hazelnut Milk
Hazelnut milk has quite a distinctive nutty flavour. I like it in porridge, as it adds a kind of creaminess, which is missing in almond milk. Alpro is the brand leader in this one. Rice Dream also make a hazelnut milk, but it's unsuitable for anyone avoiding rice milk as rice milk is blended in with the hazelnut milk. As with almond milk, Alpro state that it is not suitable as a main milk drink for children under three, but can be used in cooking etc. 

Coconut Milk
Chocolate Kara
Made by Kara, it's OK, but I thought it left a slightly powdery taste on my tongue (but maybe that's just me). Kara's coconut milk is quite good used in custard and rice pudding. It's very popular with parents whose children are unable to have rice or soya milk. Kara's coconut milk contains calcium (250ml = 375% of RDA) and now vitamin D as well (it didn't used to). It is apparently cholesterol free. 

Handily, it comes in smaller cartons now, and in three flavours: Original, Chocolate and Strawberry, although the strawberry only comes in the smaller size. The chocolate version makes a very good hot chocolate once warmed!

Hemp Milk
Called 'Good Hemp' and made by Braham and Murray. I know it has lots of fans, but I tried this one once and am not a fan - it has a very distinctive taste. I'm guessing they've successfully removed the narcotic effects of the Hemp, though, as otherwise things could get a wee bit interesting! It's main selling point seems to be that, not only does it apparently contain calcium and vitamin D, it also contains omegas 3 and 6!

Quinoa Milk
Quinoa (keen-wah) is a type of grain. It was used by the Incas to strengthen their warriors, I believe. It's quite a good source of protein and is regarded by some as a sort of 'super food'. Made by Ecomil, we've only used this in making bread, so far!

Oat Milk
Oatly, are the brand leaders with this one, although there are now more oat drinks on the market. It was my personal favourite before my intolerance problems really began. Now that I can't tolerate gluten, this one is out for me - as it's not made with gluten free oats, which is a shame. 

It's not suitable for children under the age of two, as a main milk drink (unless advised otherwise by your dietitian), but can be used in cooking. I didn't get any nasty after-taste from it, but you do need to shake the carton really well before use as the mixture can separate. You can get a chocolate version (which isn't too bad) and they also do an Oatley cream substitute which is not unpleasant either (it's fairly thick, but thins somewhat, when it comes into contact with warm food).

In case you're wondering...
Goats milk and sheep milk are two substitutes to cow's milk that we've not tried - although people often bring these up in conversation, once they realise you have a problem with cow's milk! The reason that we haven't is because both of these contain proteins that are very similar to those found in cow's milk, so we're not going there! 

I have a friend who did rear her children on goat's milk (you can get it as a powdered formula in a tin from some supermarkets and good health food shops, it's called 'Nanny Care'), but I'm not prepared to take the risk of a bad reaction. Camel's milk and mare's milk are apparently much less allergenic, but I don't know about you, I've certainly not seen them on sale in any supermarket, just yet!

If you're from the States...
For the Americans among us, a comprehensive breakdown of milk substitutes available in the US, has been produced by the American nutritionist, Heather Bauer.

At the end of the day (having considered the options) whichever milk substitutes you end up trying, I hope you find one that you can enjoy with your cuppa and/or cereal!! 

And please... let me know how you get on!

More posts about milk substitutes can be found on our blog, under the heading 'Dairy Substitutes' which also covers yoghurt, cream and cheese!

Monday, 30 January 2012

Breastfeeding a baby with cow's milk allergy means no more milk for me!

So, decision made! 

A bit daunted, I decided to breastfeed baby. 

Knowing what I do now, I sometimes wonder whether (faced with the same situation) I would do it all again, but knowing me, I probably would. I don't always make things easy for myself, but if I believe in something then I follow it through - to the extent that two years down the line, I'm still breastfeeding my rather bigger 'Baby'!* 

Excluding milk

The paediatrician, whose interest just happened to be in food allergies, was a bit sketchy about what I should do but did advise excluding absolutely ALL forms of cow's milk from my diet - which meant reading ALL labels on ALL food products and medication ( I remind my GP, each time I'm offered a prescription). He also recommended (as I was  unable to have soya milk) using Oatley as a milk substitute but warned against using rice milk - more of which another time.

Fortunately for me, my mother happens to be acquainted with a retired dietician who used to work with a Doctor who specialised in allergies. This acquaintance passed on some important information - chief of which, was was that milk is an important source of calcium in our diets, so if I was going to go dairy free, it was essential to take a good calcium supplement along with vitamin D (vitamin D helps your body absorb the calcium). 

The other key information related to the different guises that milk comes in on food labelling - milk powder, cream, yoghurt, butter, fromage frais, buttermilk and cheese are perhaps pretty obvious, whey and curds, yeah I remember learning about cheese at school, lactose also made sense, but casein? That was a new one on me! 

The practicalities

There was so much to absorb about this new dairy free existence and it hasn't been easy. Life is a lot less spontaneous! I soon became acutely aware of how much eating is a core activity in the day - my days have had to be planned around what, when and where we will eat. 

So I have had to cook a lot more - ready meals are not so easily available. This is a good thing (I tell myself) because it is a lot more healthy, BUT it is a lot more time-consuming! It has certainly meant brushing-up my cooking skills. I've also had to adjust the way I cook - so many recipes use milk and sometimes there are no easy substitutes - especially, if, like me, you can't have soya.

We have found that although it's getting better, many cafes and restaurants have no idea about how to provide for even the most common food allergies, such as dairy (and now gluten, with me, too) even if they say they do, so, going out always means taking food with you - just in case. 

Because eating out in restaurants can be tricky, it has affected days out, social occasions, family get-togethers and even where we go on holiday. 

Shopping is not so easy these days, either. Most supermarkets have 'Free From' sections, but you can't buy all your food there, so all food labels need to be examined very carefully. Particularly as with our baby we've discovered we need to check for the slightest traces of milk. 

This is a particularly good Free From aisle. Unfortunately many stores don't stock this much choice.

One thing I have discovered is that 'may contain traces of milk' can depend on how the product is manufactured and even what batch. Others with cow's milk allergy might not be so sensitive, BUT following the occasions where this has caused problems, we no longer like to take the chance. As baby has a delayed reaction, it's not life-threatening, but it causes her a great deal of pain - not something we like to inflict on our little one, unnecessarily!

And, as I'm now milk and soya free, I find myself going on shopping expeditions in all kinds of different places, just to track down milk and soya free substitutes that can't commonly be found in supermarkets. These are often more expensive!! And tracking these products down can be very time-consuming!! Thank goodness for the Internet and online shopping is all I can say!!

If you can have soya, lucky you!! Soya substitutes are pretty good - most forms of dairy can be substituted pretty well, with soya and soya substitutes can be found everywhere - including many restaurants and cafes!

Soya substitutes, like these, are quite common

The sacrifices

It hasn't been easy having to sacrifice things that I loved. I've missed my lattes, cheese, cakes, puddings etc. etc. especially in the early days. There are times when I have felt quite jealous of everyone else eating 'normally' and even a little bit... well... angry? But then I remind myself that it was my decision to carry on breastfeeding my baby, no-one made me, and there is still so much more food that, thankfully, I can still enjoy or could - until I had a tummy bug and became intolerant to wheat (among other things) but that's a whole different story.

The joys

Along with the sacrifice there are some joys that should be mentioned. No claims that I feel healthier or have lost weight on a dairy free diet, however, my baby is healthier and thriving. That to me, is priceless, and on a more practical note although we initially had problems with breastfeeding and it has meant an awful lot of sitting down, it's quite handy and convenient! No more washing and sterilising etc. etc. (anything for less work, me) and it's with you wherever you go and isn't another thing to shove in your already overburdened change bag!!

Summing up

Time on, I must admit, I still miss those leisurely lattes I envisaged myself having once baby was born, but not so much these days - I now enjoy my black coffee and I can still have chocolate - there's a lot more dairy free chocolate out there, these days! All I know is that I did what I felt I had to do, and my baby is a healthy, happy and thriving little girl - which makes it all worthwhile.

*This is by no means what I originally intended - it came about partly because she still can't tolerate cow's milk protein but still needs calcium in her diet. The other reason is that I have an intolerance to soya milk - a common cow's milk substitute. Some people with cow's milk protein allergy have been known to also be unable to tolerate soya, so I have hung back a bit from introducing her to soya, until fairly recently. 

After the diagnosis... breast or bottle?

Choices, choices...

Following the diagnosis, it became clear that I had two choices: continue breastfeeding and completely exclude dairy from my diet or switch to bottle feeding my baby, using a special formula. 


The definite advantage of using formula is that as the cow's milk protein passes through the mother's milk, the baby's mother doesn't have to give up dairy herself. The formula which we were prescribed, Nutramigen, comes in small tubs and needs to be prescribed by a doctor. At roughly £25 a tub, it's just as well that it comes on prescription as it's not a cheap option by any means! I had one (locum) doctor ask me roughly how many tubs I needed, as it was so expensive!! 

One disadvantage of Nutramigen is the nasty smell, which emanates both from the formula and baby. Another disadvantage is the rather distinctive taste. I haven't tried it myself but it apparently doesn't taste that nice. I used it to make baby rice and baby cereal (having used it as a top-up when my baby was tiny) however, after a short while, my baby refused to eat it any more. When I discussed this with the dietician, she said it was because babies are predisposed to like sweet things (it's a survival instinct, because poisonous things tend to taste bitter) and the formula was a bit bitter. This tends to kick in around six months and might explain why one mother I spoke to said that she had quite a battle to get her child accustomed to the formula, when she tried weaning her onto it.


The advantages of breastfeeding are spelled out everywhere these days, but the obvious disadvantage of breastfeeding a cow's milk protein allergic infant is that the baby's mother has to exclude milk completely from her diet - not an easy option, if like me you love lattes, cheese and cakes. Although actually when you look really carefully at food labels, there's an awful lot more ordinary everyday things that you used to take for granted that you can't eat, like chicken gravy.

My Personal Choice...

Let me stress that this bit of my blog is completely biased - it's about my choice.  It's not something I would push on another person - each to his/her own. I think I would have found this option a lot more tricky, if I had a bigger family to consider or if I had gone back to work. Fortunately for me, there are just the three of us and my husband was happy to go with whichever path I chose.

It soon became clear that breastfeeding was not going to be an easy option, but it was the right one for me, because although I loved milk and would have to cut it out, I saw this as having a short term impact on my life - according to the paediatrician most children grow out of the intolerance by the age of two and I wasn't intending to breast feed my baby that long! Meanwhile, I would be feeding my baby all the nutrients she needed through my milk and providing her with vital immunity. Also, breastfeeding is meant to help prevent food allergies and I certainly didn't want any more to deal with! 

In the end I actually chose a third way - I  combined breastfeeding and formula for a while, as although I wanted to breast feed I was very sore, so I opted to breastfeed from the least sore side, express from the other and top up with formula, until I had healed up enough (my aim was to drop bottle feeding and drive my milk supply back up, once I was better). Thankfully this didn't take too long and I was glad to drop the formula, at least until weaning time, as it was manufactured and therefore (in my humble opinion) second best! 

Actually, knowing what I do now, maybe if I had my time again I might choose differently and be less hard on myself, but who knows?

An article that might be helpful, if you choose to use formula, is this one by Nutramigen:
From diagnosis to weaning

In the beginning...

The problems

It began all in the midst of that big muddle when you have your first baby and you're trying to adjust and get to grips with it all - everything is new and a bit worrying. Crying, sleepless nights and lots of poo was to be expected wasn't it? Certainly the midwives thought so, and just advised me to keep changing the nappies and give her plenty of 'air time' to keep the 'nappy rash' at bay. I was struggling with feeding her and we'd just been through the whole drama of being readmitted to hospital with a very jaundiced baby. Constantly feeding her, to overcome the jaundice, became painful and eventually we concluded that her tongue-tie could perhaps be the cause. The local doctor agreed to refer us to a private pediatrician, which is where it all got interesting!

The diagnosis

The paediatrician discounted the tongue-tie, but obviously wanting to make the most of the session, asked us if anything else was worrying me. When I mentioned the way she screwed herself up in pain before a nappy, expelled small amounts in explosive spurts and had a very sore botty, he became excited. He examined her, upon which she performed just as I had described. The paediatrician quickly reached his conclusion and dropped the bombshell that my little baby, only a month old, had an intolerance to cow's milk protein*. Cow's milk protein was apparently passing through my milk into my baby's intestines. Her intestines, unable to digest the protein properly, became uncomfortable and caused her to pass acidic poo. It was this poo which was burning the skin on her botty. The solution was simple - to go dairy free.  

The solution

I was skeptical and reluctant to believe the diagnosis - I love milk and had been ill. I certainly didn't want to drop it, just like that! However the evidence that followed, as I excluded milk from my diet, spoke for itself - within about three days the cramps in her tummy had subsided. What's more I was getting more sleep and what seemed most miraculous to me, her botty which had been raw (and which no amount of clean nappies and air time would solve) was now clear! She was a different baby! 

*I have recently discovered that the pediatrician was using a term that is currently not recognised - she would now be described as having an non-Ige allergy to cow's milk. See here to see the difference between  an Ige and a non-Ige cow's milk allergy.

What am I doing here?

My raison d'etre is simple: I'm not a vegan and I don't believe (as some people do) that milk is bad for you. In fact I love milk - in all it's many forms (so much so, that my family used to refer to me as a 'pussy cat') it's just that, for now anyway, my baby and I can't have it. 

Baby and Me!

When she was diagnosed with a cow's milk protein intolerance*, without being too melodramatic, it was a huge shock to my system - it felt like my whole world view had changed and there was a steep learning curve to follow. There was a lot of information that I felt we needed, and it was out there, but most of it we had to find for ourselves. 

Since then, I have come across others, embarking on the same journey, who are wondering quite how to go about going 'dairy free'. The idea of this blog is to try and make things easier by sharing ideas and combining all sorts of information. 

I am not by any means an expert, nor am I endorsed by any manufacturers, so if I mention a product, it's simply for the purposes of making life easier! If I can make anyone else's life simpler, easier, happier, and ease them through the same process, then it will make the whole thing seem more worthwhile. 

I am simply buzzing with ideas for this blog - it'll be fairly personal at times, as I share some of the things we've been through, but I also want to include: reviews, recipes, and useful information. If you can't see something you need or want, then please be patient with me... hopefully I'll get there. Alternatively, drop me a line and I'll see what I can do to point you in the right direction. 

Meanwhile, if anyone else has any thing else to add, I'd be more than happy to hear from them. Let's do this together, after all (as a well-known UK clothing retailer says) 'Life is out there!'

*I have since discovered that cow's milk protein intolerance is actually more correctly described as a Non-Ige mediated allergy to cow's milk protein - we have had a lot of learning to do!!