Cow’s Milk Free Diet for Breast Feeding Mum’s This dietary advice sheet gives some general information to help you make the recommended changes to your diet while you are breast feeding and while your child requires a cow’s milk free diet. If you need more detailed advice, please ask your GP to refer you to a registered dietitian. Your baby has been diagnosed as being allergic to the protein found in cow’s milk. Breastfeeding is the best milk for your baby. However the proteins in foods you eat can travel through your breast milk to your baby. This means that your baby can be exposed to cow’s milk protein through your breast milk. To prevent this from happening it is important that all cow’s milk-based products are removed from your own diet. Sources of milk Cow’s milk is found in many foods. Some are obvious sources, however many foods contain hidden sources. When you go shopping it is important to check the labels of foods to make sure that they do not contain milk. As from December 2014 any milk in foods has to be highlighted in the ingredient panel on the label. Remember manufacturers may change the ingredients without warning. Check labels for the following ingredients and AVOID Obvious Sources Hidden Sources cow’s milk (fresh, UHT)*, buttermilk, casein (curds), caseinates, calcium or sodium cheese, condensed milk, cream/artificial caseinate, hydrolysed casein, hydrolysed whey cream, evaporated milk, butter, butter oil, protein, lactoglobulin, lactoalbumin, lactose, milk ghee, margarine, fromage frais, ice-cream, powder, lactofree products, skimmed milk powder, yoghurt. milk protein, milk sugar, milk solids, non -fat milk *Please note Sheep and goats milk are not solids, modified milk whey, whey solids, hydrolysed suitable alternatives to cow’s milk whey, whey protein, whey syrup sweetener Dairy free alternatives to milk Milks*1 oat, soya, flaxseed, sesame, rice, pea, coconut, quinoa, hemp, potato and nut (e.g. almond*2 or hazelnut*2) Spreads milk free and vegan spreads Cheese hard, soft, melting and parmesan varieties of milk free cheeses based on coconut, soya, pea, cashew*2, almond*2 or rice protein Yoghurts and desserts soya, pea, coconut, almond*2 Ice creams and frozen desserts soya, rice, coconut, almond*2 and cashew*2 Creams soya, oat, rice, coconut and almond*2 *1Ensure you choose a calcium enriched/ fortified product *2 Avoid nut-based milk alternatives if you have/are at risk of a nut allergy Manufacturers and supermarkets produce lists of own brand products that are free from cow’s milk or other allergens. These can be requested from customer services or downloaded from their websites. These lists can help you to identify which foods are safe to eat and make your diet more interesting and nutritious. A useful app which enables you to scan the barcode of products to help you to identify suitable cow’s milk free foods can be found at http://www.foodmaestro.me. Calcium When breast feeding, your body requires approximately 1300mg of calcium a day. This can be difficult to obtain from your diet when you are avoiding cow’s milk. It is important that you replace milk with a calcium enriched milk substitute, such as those listed on page 1. Other mammalian milks such as goats and sheep milk and their products contain proteins very similar to cow’s milk and should therefore be avoided. Do not use rice milk for children under 5 years of age due to its arsenic content. Other non-dairy sources of calcium are listed below. Produced by Lara Ellison; Prescribing Support Dietitian WECCG, September 2017. Review November 2020 . Approved by West Essex Clinical Commissioning Group Medicines Optimisation Programme Board October 2017 Calcium content of Dairy Free Alternatives Glass of calcium enriched soya milk 370mg 1 slice calcium fortified bread e.g. Hovis 191mg (280ml, ½ pint) Best of Both Glass of calcium enriched coconut or 336mg Pot of soya yogurt 150mg almond milk (280ml, ½ pint) Glass of calcium enriched rice or oat milk 335mg Soya custard (120g) 145mg (280ml, ½ pint) Fruit juice with added calcium (250ml) 300mg Pot of soya dessert 135mg 2 tinned pilchards/2 tinned sardines with 270mg 2 large slices wholemeal bread 130mg bones If you are unable to eat 1300mg of calcium a day, discuss whether you require a calcium supplement with your doctor or dietitian. Calcium supplements are widely available to purchase. Vitamin D Vitamin D is needed by the body to absorb calcium. The Department of Health recommend that all breast feeding mums have a daily 10ug supplement of Vitamin D, these are widely available to purchase. Ensure you do not exceed this dose as excess Vitamin D can build up in the body. Helpful hints 1. Milk free products can be substituted in recipes. 2. Many dairy free varieties of milk can separate in hot drinks- try placing the milk in first, and then add water. 3. Use plain, soya or coconut based yoghurts, coconut milk or oat cream or oat crème fraiche when making curries, raita, stroganoffs, creamy sauces and dips. 4. Egg white replacer (available from chemists) can be used to make a dairy free and soya free whipping cream. 5. Grate milk-free hard cheeses on the fine part of the grater. Use a milk-free melting cheese on pizza, cheese on toast and on lasagne. Use a non-melting hard cheese to make cheese sauces. Using a microwave will stop it sticking to the bottom of the saucepan (which also works for milk free custard and porridge). Use milk-free soft or spreading cheese or dairy-free sour cream in dips, cheesecakes and other savoury and sweet sauces. How long will my baby stay on a cow’s milk protein free diet? The majority children will grow out of milk allergy by 3-5yrs of age, however, many will be able to tolerate some forms of milk earlier and you may be encouraged to start gradually reintroducing milk from 9-12 months depending on your child's symptoms. However, if your baby’s allergy is severe it may be necessary to have a supervised challenge in hospital. Your baby should be referred to a paediatric dietitian who can provide advice on how to wean your child onto a milk free diet that continues to meet your baby’s nutritional requirements- initial advice can be downloaded at https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/469-cows-milk- allergy. Further information British Dietetic Association Food Facts Milk allergy: https://www.bda.uk.com/foodfacts/Milkallergy.pdf NHS Choices Food Allergy information: nhs.uk/conditions/food-allergy Produced by Lara Ellison; Prescribing Support Dietitian WECCG, September 2017. Review November 2020 . Approved by West Essex Clinical Commissioning Group Medicines Optimisation Programme Board October 2017 .