Saturday, 20 September 2014

Finding the perfect formula for the dairy free baby

Breast is best, right? 

Well, I am a big fan of breastfeeding, BUT sometimes our boobs don't work, or we have to go back to work, or we don't produce enough milk, or... well for a hundred and one reasons, there are times when for some reason or another, with the best will in the world, we need a formula to feed our little ones.

In my case, it was because I had such painfully cracked nipples, that for a while, I needed to ease up a bit on breast feeding and top up with formula.

If you've just discovered your baby is allergic to cow's milk, you might wonder what on earth you can feed your little one - after all the only alternative to breast milk is cow's milk formula, right??

Well, not quite!!

There are formulas that are suitable for a dairy free baby

There are some options out there, that might be suitable for your little one!

Before we explore them, though, let me make it quite clear that contrary to what some might say, you do NOT have to give up breast feeding if you discover your little one is allergic to milk. You may have to remove dairy from your diet whilst you're still breastfeeding - as the proteins from cow's milk can pass through your breast milk (although this is not necessarily true of everyone, as your body breaks down the proteins to some extent), but it can be done. I know, because I have done it! Check out these posts, by following this link, if that's what you wish to do. 


What's out there:

Soya Formula

There are formulas that are completely dairy free, such as SMA's Wysoy, which is made from soya. Soya has been a popular non-dairy choice for years, because the proteins are so similar. However, because they are so similar, six out of ten children with an allergy to cow's milk, might also be allergic to soya.  

The other problem with soya, is that concern has been expressed about phytoestrogens - naturally occurring oestrogen contained within soya. Because of this, soya formula is not recommended by the BDA for children under 6 months of age, particularly boys. The concerns are that the plant oestrogen could affect boys' future fertility or prolong girls' future menstruation.

Also soya milk contains glucose, which can cause tooth decay. Lactose (the sugar contained in mammalian milk) does not.


Extensively Hydrolysed Milk Formula

If your baby has been diagnosed with a cow's milk allergy they may be prescribed what is known as an 'extensively hydrolyzed milk formula,' such as Nutramigen 1 or Pepti. These milk formulas are made with cow's milk, but the proteins in the milk have been broken down into tiny pieces, to enable children with milk allergy to cope with them. They come in two kinds - either whey-based or casein-based. A dietitian or allergy specialist should be able to work out which is best for your little one. 

Most babies with cows milk protein allergy (around 90%) will be fine with formulas such as these, but sometimes babies with a milk allergy are so sensitive, that they cannot even cope with a hydrolysed formula - in which case they may be prescribed an amino acid formula.


Hypoallergenic Amino Acid Formula

An amino acid formula, such as the one prescribed our baby (Nutramigen AA) does not contain cow's milk protein at all, but amino acids - the bits (often referred to as the 'building blocks') that make up protein. Because this formula does not contain milk protein it is also lactose free. If you want to know exactly what is in a formula such as Nutramigen AA, see here. It makes for interesting reading!!

The other brand you are likely to come across in the UK is by Neocate.


Points to note:

1. The first formula that you are prescribed may not be the right one for your baby. So if it does not seem to work for your little one, keep talking to your Doctor/Dietitian, they can probably try your baby with another. However, bear in mind, also, that it may take days or even weeks for the effects of the cow's milk protein to disappear. Another thing to note is that these formulas may cause your baby's poo to be a bit loose and appear a bit green!

2. Around six months a baby's bitter taste buds develop. It can be harder to introduce a formula at this stage, as breast milk is naturally sweeter. 'Baby' went off her formula around this time. Although our dietitian tried to help by introducing another formula, she didn't take to it. Unfortunately, I wasn't aware (at that stage) of how it was possible to gradually introduce a new milk, or that it is possible to try and disguise the taste with flavouring such as vanilla (apparently breast milk tastes like vanilla - see here).

3. Plant-based milks, such as Koko, Oatly or similar, are not suitable as a main milk drink for babies. This is because milk is the means by which babies gain all (pre-weaning) or most (up to the age of one) of their nutrition. Plant-based milks do not contain enough calories, or other essential nutrients. You will need a prescribed milk formula for children under the age of one, who are not being breast fed. 

4. Goat milk formula, such as 'Nanny Care,' is not considered suitable for children with a cow's milk protein allergy, because the proteins are so similar.

5. Some other potential drawbacks with hypoallergenic formulas are outlined here.


Related post:



Further Reading: 

Suitable Milks for Children with Cow's Milk Allergy - BDA Fact Sheet

Living with cow's milk allergy - what do I feed my baby?

Suitable infant formula for babies allergic to cow's milk 

NHS Choices - Can I give my baby soya-based milk formula? 

Find a formula that's right for your baby - Baby Centre


Friday, 19 September 2014

A spoonful of medicine... and an allergic reaction!!

What a fortnight it's been!!

Yes, that's right a fortnight!! That's more or less how long 'Baby' has been ill. 

During this time, we have been attempting to clear and complete a sale on our old flat. It's not been easy with a small child who should be at school, is decidedly unwell, is in excruciating pain and is refusing to take her medicine!!

According to Mary Poppins, 

A spoonful of sugar helps the medicine go down...

Hmm! Practically perfect in every way, Mary Poppins may be, but I beg to differ!!

Our attempts to get 'Baby' to take any spoonful of medicine have been met with the kinds of shrieks and howls that might well cause any well-meaning neighbour to ring the police, in order to prevent a murder being committed. 

We needed to give her Nurofen to take her fever down (and Calpol at times too) as well as antibiotics and that's where the fun began!

That was when it became apparent that 'Baby' was reacting to her Penicillin.

When the Doctor first prescribed antibiotics, I was hoping they wouldn't be needed! After all I was still digesting the news on the BBC Horizon programme the other week - about how early use of antibiotics might contribute to developing food allergies.

However, the ear infection clearly wasn't going to go away, so reluctantly we forced (yes forced) some into our little one (some came back out again). When small red spots appeared on her cheek, an hour or so after the first dose, I wasn't too concerned. There was a red patch on her cheek that tends to appear when her body is fighting something off, so I just assumed the virus that she was also battling was entering another phase.

Her heavy eyes and doziness I just put down to her needing to catch up on the sleep she had missed due to unsettled nights, her aching limbs to the virus...

Until she had her next (hard fought) dose!!

The rash spread  quickly over her entire trunk, the heavy eyes and doziness returned, her face and lips went puffy. That's when we became alarmed and started Googling and came to the conclusion that it was either the virus or a reaction. Thing is, it couldn't be a reaction to milk - there was none in the medicine (yes, you do need to check medicines as well), our suspicion was the penicillin!

As she wasn't wheezing, we let her sleep... until the morning. 

It was a Saturday, and we were miles from home.

Despite the urgent need to shift our possessions from our old flat, The Hub had to whisk 'Baby' off to an out-of-hours appointment and the allergic reaction was confirmed. 

No more penicillin, for 'Baby!'

The good thing was that the Doctors were surprised that, given her age, this was her first experience of antibiotics. The bad thing was that the replacement medicine had it's problems too! It gave her a sore mouth and she couldn't get it down.


The second lot of antibiotics also went to waste!

The next out-of-hours Doctor was quite stern. 'Baby' HAD to have antibiotics to get well. The new medicine HAD to work. Well, I knew that, but the problem was how to get her to accept it!!

It tasted awful!

'Baby' was having none of it!

She squealed the house down, fought like crazy, clenched her teeth, covered her mouth with her hand and refused every attempt to take a spoon. NO bribe was sufficient - however much she wanted the reward, once faced with the medicine, all bets were off! There was no point injecting it with a syringe - it just came back out again! 

Reasoning, even the pain from her ear... nothing would move 'Baby' to accept the medicine.

Neither would giving it to her in lots of tiny drops washed down each time by water (which was how we persuaded her to take the Nurofen).

The Hub and I were desperate!! We felt scarred by the fight over the medicine!! No decent parent wants to cause their child such awful distress!!

Finally, we opted for mixing the medicine with something else. First her soya milk, which didn't work, then some chocolate Koko! Although it still wasn't palatable, this worked... in combination with threats of the syringe, and a fair bit of bribery (she now has quite a collection of Shopkins - don't ask) and sometimes even a spoonful of ice cream, or a bite of something sweet to follow each sip!!!


Chocolate milk works better than sugar!

But it worked!

Not a spoonful of sugar, but a CUPFUL of Koko helps the medicine go down, the medicine go down, the medicine go down...  (sing along now) 

Yes, yes, I may well have cracked, but after the fortnight I've had, who could blame me??

Now I'm after some decent dairy free probiotics - after all, we've got to look after the all important gut bacteria... I've heard Biogaia are good... and you can buy them on Amazon!


Thursday, 4 September 2014

We're going through changes - the dairy free 'Baby' starts school!!!

Well, that's it, then!

'Baby' is really definitely NOT a baby any more! 

Yesterday she started school!!!!

That might shock some of you - after all, the blog is called Dairy Free Baby and Me, isn't it? 

As she was - nearly five years ago!

BUT the eagle-eyed among you, or those who have read my Twitter bio, may have spotted references from time-to-time which have given the game away.

The thing is, I originally called this blog 'Dairy Free Baby and Me' because that's where those of us who have little ones with milk allergies begin the journey - whilst they're so small and new and we're so unprepared for it! I wanted to help others who arrived (as we did) bang, smack right in the middle of dairy free territory without a map, guide or reference point! 

Having given yourself a blog title, you then have to kind of stick with it - so people know who you are! My way around this, was to stick 'Baby' in inverted commas, to make clear it's an identity, rather than a description! But I've no idea how clear you found it!

Me, on the other hand, I'm all too aware of how my little one is growing and developing. 'Baby' has most definitely not been a baby for some time now - walking, talking and growing in height as well as independence!!

So now I'm torn.

I'm torn between rejoicing in the fact that despite her milk allergy she's developed so well (another parent complimented me on this, just today, in fact)  and in the fact that I finally have ME back - head space, time to THINK, sort, throw out stuff, shop get a hair cut etc. etc. without the constant, 'Mummeeeee!!' in the background and sorrow at 'losing' my (usually) irrepressibly cheerful little girl companion. 

Okay, okay, I'm not losing her altogether, I know THAT, but I know we'll never have that precious pre-school time back again. AND, I'm wondering constantly how she is. 

Is she lonely, being picked on, hurt or hungry? Or is she happy, cheerfully playing with new friends? Does she understand the teacher, or the instructions given by the dinner ladies? I just hope that she's SAFE emotionally, physically and allergically (if I can put it that way)! Funnily enough, the last thing I'm actually concerned about is how well she'll learn!!

The thing is, I've done my best to prepare her for this time: I've fed, clothed and cared for her day in and day out for nearly five years - I've been every inch the 'present mum.' She can now use the toilet (that took flippin' ages); make friends (despite being an only child, we've been careful to help her socialise with others in a range of situations); all along she's been trained to know what she can/can't have to eat, as well as how to ask if something is safe. 

I haven't taught her to read or write very much at all, beyond her name - mainly because I didn't want to put pressure on her and switch off before she even started. It was also because really I (not so secretly) wish that England was more like Finland - where formal schooling doesn't begin until seven. I've heard, that come Christmas of their first term, the Finnish children can all read and write, just fine!!

I am confidant that 'Baby' is in a great school. We've chosen her school carefully - we've scoured websites, been to lots of open days, asked questions, got recommendations from friends etc. etc. 

The school where the head teacher looked at me blankly (when I asked what sort of arrangements they had in place for children with a milk allergy) and replied, 

'Well she can have packed lunches, can't she?' 

was crossed straight off our list... in catchment and rated 'Outstanding' by OFSTED or not!!

'Baby's' teacher is great. She's an experienced lady, who definitely knows her onions (me, being a 'resting' teacher, grilled her in advance). The class size isn't too big. There's soya milk and dairy free snacks available at break time. Provision is made for children with allergies in the school lunch (including dairy free ice cream, when others have their ice cream), and the school has procedures in place - a clearly displayed board on the wall, of the dining area with photos of children with allergies - listing their allergy/ies, contact numbers etc. in case of emergency...

So, even though the school is all good, that doesn't stop me, well not worrying exactly, but... concerning - if you know what I mean (I know that's not grammatically correct, but it'll have to do, for now)!! 

'Baby' hasn't cried - not yesterday when I left her in the classroom, not this morning when I left her again. Yesterday, she used the toilets, she ate her lunch, all as she should. No nasty reactions followed overnight. If she didn't exactly skip down the path, she seemed fine about going to school this morning.

Today, on arrival, she was greeted by name by another little girl. That was nice!

I haven't cried either and I'm beginning to relax...

I'm also torn in regards to the blog. Question is, now what? For me, for blogging?

These questions will have to wait for a bit, I've got certain things I need to do - one of which is a move to complete, now we've sold our old flat (the one I bought into when I was single). Then, I'm pretty sure I'll be back on these pages... maybe looking for another name or identity. After all, 'Baby' is NOT a baby any more, is she?

But she's still dairy free!

*Sigh!*

So much for growing out of it by the age of two, then! 

Tuesday, 19 August 2014

And thanks to AlproSOS... they all lived happily ever after??

I don't know about you, but I love a story with a happy ending, don't you?

The problem with a story with a happy ending is that unfortunately it has to have a miserable bit, before everything gets resolved! 


ONCE UPON A TIME...

This tale all started back in November (for those who don't know), with the announcement that Alpro had decided that in order to expand it's operations, it was going to move factories and this would result in nut milks being manufactured alongside soya milk. BUT, not only would this affect their milk, but other dairy free products such as custard, cream and yoghurt. This dealt a huge blow to families in which a family member was allergic to both dairy and nuts. Especially, when they realised that Alpro produced soya milk for many supermarket 'own' brands as well as for Provamel. 

It was a particular disaster, for families with young ones, who were relying on reliable supplies of the Alpro Plus 1 soya milk which is specially formulated for little ones - there is no other like it on the market. See why here.


Specially formulated for little ones

There was a partial resolution to this, when Alpro decided to secure the safety of this milk, back in March 2014. However, the issue of desserts and yoghurts still remained.


Many schools/nurseries use Alpro Soya products.

I was also concerned about the fall-out for children who were dairy free and who were mixing with nut allergic children in schools/nurseries etc. I was worried in case that meant that they would no longer be allowed to eat Alpro dairy free desserts/yoghurts within those settings and was quite frankly dismayed at how long it apparently took some members of the dairy free online community, some allergy organisations and some health care professionals to jump on board. 

I see it this way - if one part of the allergic community suffers, some kind of discrimination/barrier/injustice then ultimately we all do... at some point. As John Donne wrote in his famous poem:


No man is an island entire of itself; every man
is a piece of the continent, a part of the main;


We all need to work together to create understanding among the many out there, who just don't 'get it' and also to bring about CHANGE!


HAPPY ENDING!!

It just goes to show what will happen if we do all work together, because yesterday, after months of uncertainty and misery for the families that were directly affected, Alpro SOS was finally able to announce that Alpro was going to make the changes for which we'd all been hoping and praying and pushing... well, some of them at least!!

See here:

Dear AlproSOS

As you know, a year ago we decided to label all our plant based products with a 'may contain traces of almonds and hazelnuts' claim. This was to give consumers advance warning of the integration of products containing almonds or hazelnuts into its production facilities.

After thorough investigation and without compromising Alpro's ethical aims of bringing delicious and safe products to the market, we are PLEASED TO CONFIRM THAT WE WILL BE GRADUALLY REMOVING THE 'MAY CONTAIN TRACES OF ALMONDS AND HAZELNUTS' CLAIM FROM OUR SOYA, RICE AND OAT DRINKS AS WELL AS OUR PLANT-BASED ALTERNATIVES TO CREAM AND DESSERTS.

As part of a major investment in our facilities, we will ARRANGE OUR CURRENT PRODUCTION LINES TO BE DEDICATED TO PRODUCING SOYA, RICE AND OAT DRINKS OR ALMOND, HAZELNUT AND COCONUT DRINKS. ANY AVOIDABLE RISK OF CROSS CONTAMINATION IS THUS EXCLUDED, WHICH MEANS THE WARNING CAN BE REMOVED from our soya, rice and oat drink products and our plant-based alternatives to cream and desserts.

We apologise for any confusion relating to the nut claim, but our intention regarding labelling has always to keep consumers fully informed of the changes as early as possible. Now that production plans have changed, the claim is no longer necessary on soya, rice and oat drinks and our plant-based alternatives to cream and desserts.

These recent decisions and measures will allow all consumers to continue to enjoy Alpro soya, rice and oat drinks and our Alpro plant-based alternatives to cream and desserts in the future.

Ann De Jaeger
Vice President, Division General Counsel & Corporate Communications

Well almost!!

However, please note, this does not include yoghurts - as of yet!! Alpro SOS are continuing to push for other information too - check out their Face Book page for more information!

Today, Alpro SOS have also been able to announce that the 'sister company' Provamel will also follow suit, and I wish to congratulate all, working behind the scenes at Alpro SOS and thank them for all their hard work. And I wish to thank Alpro too, for considering the alternatives and coming up with some solutions. I am sure that this has required a lot of logistical nightmares as well the reallocation  of some finances! I do hope that they will work to resolve the anomaly of the yoghurts very soon!


The Sequel

Meanwhile, as an allergic community, there is still plenty of work to do!

Supermarkets are still using unnecessary and useless 'may contain' labelling on their products and people with nut allergies are taking their lives in their hands should they dare to travel by airplane.  We need to continue to apply pressure, to help big companies see sense!

What can you do?

Some thing as simple as highlighting it on Twitter or Face Book, or signing a petition on Change.Org can all help. If you feel you could email/write to a company, even better!

Let's make change happen!



Related Posts:




Further Reading:



Thursday, 14 August 2014

Is A2 milk suitable for those with a cow's milk allergy?

When I had 'Baby' among all our other problems I struggled with breastfeeding - not least because huge cracks, which were incredibly painful, developed around the nipple area. What I wanted to find was a nipple cream. My problem was that the only one on the market that is recommended is made with Lanolin... and guess what?? I'm allergic to Lanolin. When I approached the matter with my (locum) GP. She wouldn't entertain any discussion as to what else I might use, because nothing else had been found to be safe and it 'wasn't ethical' to test things on babies.

How is it relevant to this post?

Because I am feeling a niggle of concern about the way that A2 milk is presenting itself to the allergic/intolerant. Recently on Twitter, someone who (as far as I'm aware) was unknown to A2 was questioning what I thought about it. A2 responded by saying, 'Why don't you try it?' (Or words to that effect!) 

'Scuse me? Apparently not knowing this person, or much about their health condition (or indeed anything else) they suggested trying it!! Well, that strikes me as being rather irresponsible at the very least and unethical at it's very worst!

For those who don't know, A2 is a milk that in it's modern incarnation hails from Australia, where a special breed of cows has been bred. These cows produce milk that doesn't contain A1 milk proteins, but instead produces milk containing A2 proteins. The idea is that some people might be better off drinking A2 milk, rather than milk containing A1. The way it's explained all sounds very beguiling - to those who are having problems with 'normal' cows' milk. After all, we're desperate aren't we??  To find a solution to our problems??



A2 Milk is still Cow's milk

Up to now, I have restrained myself from blogging about A2 milk. My main worry being that if I draw attention to this product, that people will inevitably (out of curiosity, which is a powerful thing) want to try it - to see if they are the 'lucky' ones for whom it might work - especially if 'helpful' friends or relatives suggest they should 'give it a go'. BUT because the subject of A2 milk keeps cropping up, I've come to decide that some words of caution might well be required.

Following a recent exchange with A2 on Twitter, I discovered that A2 say that their milk is NOT suitable for those with a cows' milk allergy*. Good! I'd agree with them about that! 

So what's my problem? You may well ask!

Well, the thing is, it appears that A2 like to use the term dairy/milk intolerance or cmpi - which, by the way, doesn't feature in up-to-date NHS terminology. They referred me to their Nutritionist*, who tried to point me to a line in the NICE document which refers to 'food intolerance' but the bit to which she referred was talking about food intolerance as a whole - NOT specifically milk allergy. 

According to the NHS (see here near the bottom of the article): 

'There are three conditions that cause a reaction to milk.'

The article goes on to explain that there is lactose intolerance and there is milk allergy - of which there are two kinds - Ige and Non-Ige.***

That's it. 

What used to be called cow's milk protein intolerance or cmpi is now referred to as a Non-Ige Mediated Cow's Milk Allergy. 

Following this one through, it would seem either that A2 mean that their milk is suitable for a medical condition that doesn't exist, or they mean that they think their milk is suitable for those who once upon a time would have been described as cow's milk protein intolerant, but who are now described as having a Non-Ige Mediated Cow's Milk Allergy. But as A2 say their milk is NOT suitable for those with milk allergy, it can't be the latter, can it?

Part of my worry about the use of the term cmpi/cow's milk protein intolerance, is that, confusingly, it still seems to be in use, by some individuals. Perhaps some medical professionals (hopefully not allergy professionals) are still using out-dated terminology, because people often seem refer to themselves, or their little ones, in this way

Or, it's quite possible that if you/your child were diagnosed around the time 'Baby' was diagnosed (she was originally diagnosed as cow's milk protein intolerant) or any earlier, you/your child may have been diagnosed as cow's milk protein intolerant. Unless your knowledge has since been updated you might still be referring to your diagnosis using the old terminology. If you describe your condition as cmpi/cow's milk protein intolerance, when it is in fact a milk allergy, you might wrongly assume that A2 milk might work for you. 

Now, even supposing that A2 milk might work for you/your child, the first problem you face is how to test/challenge you/your child to see if they're okay with it - without the risk of causing a significant reaction - remember the unethical bit? So I imagine the sensible way to do it would not be with a drink of A2 milk, but to follow the so-called Milk Ladder. Of course, you could only safely take this approach with a Non-Ige  Mediated Cow's Milk Allergy. Milk challenges of children with an Ige Mediated Cow's milk Allergy are usually carried out within a hospital setting - just in case (Heaven forbid) the worst happens!

The Milk Ladder (in case you've never heard of it before) is a 'safe' way of reintroducing milk to those with a Non-Ige Mediated Cow's Milk Allergy, by exposing them first to the tiniest trace. It is meant to be followed under the guidance of a dietitian - who can advise on specific amounts (even of biscuit, as this can make a difference) and for how long to stay on each stage, before moving on to the next. This will vary from person to person - which is why there is the need for a dietitian to be involved.

The Milk Ladder begins with trialling milk in the form of margarine or butter - which has been baked in a biscuit that has been heated long enough, at a high enough temperature, in order to 'denature' the milk protein, somewhat. It has been discovered that most children with a milk allergy can tolerate milk in this form (my little one couldn't, until quite recently, see here) so this is a fairly safe starting point to use.

Of course the first problem is that A2 milk is (currently anyway) a standalone product - there is no A2 margarine or butter to bake in a biscuit. There is no A2 cheese (much further up the Milk Ladder) to be baked in a dish like Lasagna. So how, therefore, can you introduce A2 milk in a controlled way?

Even supposing you discover that A2 milk is suitable for you (without the use of the Milk Ladder), you will still only have one stand-alone product - another expensive replacement for 'normal' milk. You will still have to use dairy free/vegan margarine, butter, cream and yoghurt etc. When you eat out, you will still have to check every packet, every item on the menu for cow's milk - 'cos no one else will be using A2 milk.

Now I suppose it could be possible that the the Doctors, Dietitian's etc. just haven't yet identified the condition for which A2 milk is suitable - after all medical science is constantly evolving and discovering new things. However, one thing is for certain, until the Allergy Specialists say otherwise, I won't be touching it with a barge pole! Neither will my little one, with her confirmed diagnosis of Non-Ige Mediated Cow's Milk Protein Allergy

Anyone with a milk allergy, who is interested in the merits of A2 (or any other kind of milk, for that matter), should first discuss any new course of action with their own HCP's - that's Health Care Professionals - Doctors and Dietitians, who are best placed to advise you appropriately. 

Update:

I was most interested to read an article shared by Dr George Du Toit (@GoAllergy on Twitter) regarding A2 Milk. See here:


* I was therefore most surprised to see that despite this, they have published a testimony about their milk (on their website) by someone who describes themselves as having a milk allergy, but who is OK, apparently, with their milk. 

** I feel the need to point out that although some nutritionists are qualified in some way, not all are - in fact anyone can call themsleves a nutritionist. I could, if I so wished, without a qualification to my name (see here for more about this)! Melanie Bibby, according to her profile on the A2 website has an MSc in Food Science from the University of Reading, but even so, the advice of a nutritionist should not supersede that of your Allergy Doctor or Specialist Allergy Dietitian.

***  For a more detailed description of Ige and Non-Ige Mediated Cow's Milk Allergysee here.


Related Posts: 

Which Dairy Free Milk Is Best?

Challenging 'Baby'!


Further Reading:


A2 milk is Allergenic - The Medical Journal of Australia (subscription required)

Cow's Milk (Dairy) Allergy - Australasian Society of Clinical Immunology and Allergy

More A2 Milk Nonsense - Planet Lactose (NZ blog)

Warning: A2 Milk - Allergy UK


Wednesday, 13 August 2014

Baking with 'Baby' 14 - Silvana's Super Shortbread

Shortbread. 

Once upon a time it seemed such a simple pleasure. I used to love the shortbread that came in tartan tins at Christmas! The pictures on the front were always a tad twee, but the contents were what truly mattered to me!

Shortbread that is dairy free and gluten free and tastes convincing - well that's a bit more tricky to come by!

This shortbread does it for me!

I've tried a number of substitutes, but that buttery flavour is pretty hard to replicate and most gluten free shortbreads are very fine and crumbly - due to all that rice flour! My favourite susbstitutes for shortbread, until now, have been Asda's Free From Shortbread and Sunstart's Supreme Golden Crunch (the latter not claiming to be shortbread at all, but tastes more like it to me than the shortbread by the same firm)!


Anyone for Asda's?

I've tried making straight substitutions with Dove's gluten free flour and Pure sunflower margarine, but that just didn't cut it for me!

However, I finally hit on a recipe that does it for me when I came across this recipe from Silvana's Kitchen. Apologies for those who can't have almonds, or eggs, because this recipe requires them!

Silvana's recipe also uses 'cups' for measurement. This is fine by me, as I love using these to cook too! I love the fact that it's a simple measure and being more visual, I think it makes it easier for 'Baby' to understand - rather than loads of digits on a scale.

Lovely visual way of measuring, especially with these!

If you're not used to cooking with cups, the thing to remember is these aren't your average teacup or mug, they are an actual specific unit of measure, that you need to buy from a shop, OR you can use this simple conversion chart instead, and carry on using your kitchen scales!! If you do use cups, then make sure you level them off properly, for accuracy (see why here, if you don't believe me)!!

The next thing you need to know is that the margarine I used was Pure sunflower margarine and the flour was Dove's gluten free flour. 'Confectioner's sugar' (just in case you're wondering) is good old icing sugar.

The only other translation you may need, is that Silvana cooks her shortbread at 325 degrees Fahrenheit, my oven works in degrees Celsius, which roughly works out at 160 - 165 degrees. Gas would be mark 3.

Now when your shortbread comes out of the oven, it will hopefully look somewhat like this (mine are a bit thicker than Silvana's):


Not quite perfect, but near enough!

You can of course eat them as they are... and we do!

But sometimes, it's fun just to bling them up a bit, like this (all 'Baby's' own work):


Fun for 'Baby'


OR, if you want a more grown-up finish, you could always melt some dairy free chocolate, dip your shortbread and leave it to harden... or you could just dip it in the chocolate and eat it anyway! 

Well, why not?

I would! 



If you enjoyed this post, you may also like:

Baking Dairy Free




Further baking adventures with 'Baby' can be found by following this link.



Wednesday, 6 August 2014

Which Dairy Free Milk Is Best?

Some Background

The other day someone on Face Book asked whether there was any information available comparison the nutritional values of different types of dairy free milks. 

'Good question!' I thought... After all, there is a very wide range of dairy free milks available now. How DO we know which one is best? 

So I decided to do a little digging!   

The problem was that a lot of the nutritional analysis of dairy free milk, that I came across on the Internet, such as this article, came from the United States. It was interesting, there were similarities but the brands were different. 

Then Specialist Peadiatric Allergy Dietitian Lisa Waddell pointed me in the direction of Itch, Swell, Ooze and Wheeze blog. There was an interesting post - closer to home, for sure. 

However, some of the major players were missing, so I decided to compile my own table - including some of the big dairy free branded products that I know a lot of us are using regularly.

Et Voila!


Table comparing well-known brands of dairy free milk (UK)


Per 200ml serving
Calories

(Kcal)
Protein

(g)
Carbs

(g)
Sugar

(g)
Fat

(g)
Sat.
Fat
(g)
Fibre

(g)
Sodium

(g)
Calcium

(mg)
Vit. B12
(µg)
Vit.
B2
(mg)
Iron

(mg)
Vit. C

(mg)
Vit. D

(µg)
Tesco Organic Whole Cow’s Milk
137
6.8g
9.4
9.4
8
5.2
0
0.04
244
1.8
-
-

-
Trace
Oatly
(Oat)
90
2.0
13
8
3
0.4
1.6
0.08
240
0.76
0.42
-
-
1.5
Almond Breeze

48
1
5.8
5.6
2.2
0.2
0.6
0.1
240
-
-
-
-
-
Alpro Almond

48
1
-
6
2.2
0.2
0.4
0.1
240
0.76
0.42
-
-
1.5
Almond Breeze (unsweetened)
28
1
0.8
0.2
2.4
<0.1?
0.6
0.1
240
-
-
-
-
-
Alpro Almond
(unsweetened)
26
0.8
-
0.2
2.2
0.2
0.8
1
240
0.76
0.42
-
-
1.5
Good Hemp

78
<0.1?
6.8
3.2
5
0.4
<0.1?
0.04
240
-
-
-
-
1.5
Rice Dream

94
0.2
18.8
8
2
0.2
0.2
0.08
240
-
-
-
-
ü

Koko
(Coconut)
54
0.4
3.8
3.2
4
3.8
0.2
0.08
240
0.76
-
-
-
1.5
Alpro Soya
80
6
5.6
5.4
3.6
0.6
1
0.04
240
0.76
4.2
-
-
1.5
Alpro Plus 1
(Soya)
124
5.2
15.4
5.8
4.6
0.8
0.8
0.02
200
0.38
4.2
2.2
15.6
1.5
Alpro Hazelnut

58
0.6
6.2
6.2
3.2
0.4
0.6
1
240
0.76
0.42
-
-
1.5

Note:
1. Nutritional Values sourced from Websites/Cartons of Brands, except Oatly (Holland and Barrett website).
2. -  indicates that I couldn't source a value
3. a tick indicates present but value unknown
4. ? indicates value unknown due to < therefore it couldn't be doubled.
5. Organic dairy free organic milks were not included in this table, as they are not fortified with essential vitamins, such as calcium, vitamin D2 and B vitamins. B12 is a vitamin that needs to be particularly considered by those on a plant-based diet (see here)
6. Two types of Almond Milk and two brands - just to see (out of interest) how they compared.


Method in my Madness

The table I compiled includes cow's milk - since that has been excluded from the dairy free diet - in order to provide some kind of reference point. 

For the purposes of the table, I've taken the nutritional information provided by the brands in regards to their products (which is calculated per 100ml) and then translated that into what one might refer to as a 'serving' (i.e 200 ml) - simply because that helps me to better understand what it is that we're putting into our bodies and where the shortfall lies.

Some cells in the table have been left blank - merely because the brand has not provided that particular information in regard to their product - it doesn't mean it's not there, it's just not mentioned, if it is!

The table is by no means exhaustive - other vitamins etc. have been omitted partly because most brands didn't list them - so there was nothing to compare against, but also because the table was getting rather large and unwieldy! 

Compiling the table, although laborious, was a useful exercise for me - usually when I look at a table full of numbers, my eyes glaze over and the numbers all go flying over my head! It made me really take note of the statistics and apply that information to my own situation.

One of the things I noted was that, as far as dairy free milk is concerned, calcium, and vitamin D2 came pretty much as standard, so shouldn't come into consideration when choosing a dairy free milk (as long as it's not organic). But there are clear differences in other areas, such as protein and sugar.

It made me wonder whether the lack of protein in almond milk may be the reason why I don't feel so satisfied when I've eaten my cereal with dairy free milk - since protein makes us feel fuller for longer. Therefore, something made with egg would probably better for me to eat, for breakfast, as it would make me feel fuller for longer! 

That'll be more pancakes and waffles, for breakfast, for me then!  ;)


The table I created has since been eclipsed by this one, kindly supplied by Dr Carina Venter, which specifically addresses the nutritional needs of children:



Note:
1. I am extremely grateful to Dr Carina Venter, Allergy Specialist Dietitian, for granting permission to share this table.
2. Please note the values in this table are given per 100ml, not as per 200ml in my table.
3. Vitamin B2 is expressed here as Riboflavin
4. Chufa Milk is otherwise known as Tiger Nut MilkIsola Bio make an organic version of Tiger Nut Milk - it is unfortified as it is organic. Tiger Nut Milk seems to be more common in Spain (see here). 
5. I've not seen either chufa or potato milk commercially available in the UK. 


What should we be getting?

Just in case you're wondering how this information stacks up against what we should be getting, I've compiled some information here:

Reference Nutrient Intakes 


AGE
Calories

(Kcal)
Protein

(g)
Sodium

(g)
Calcium

(mg)
Vit. B12
(µg)
Vit.
B2
(mg)
Iron

(mg)
Vit. C

(mg)

AGE
Vit D

(µg)
Under 1 Year
721
13.5
0.3
525
0.3
0.4
5.4
25

0 – 6 months
8.5

1 - 3
1197
14.5
0.5
350
0.5
0.6
6.9
30

7 months – 3 years
7.0
4 - 6
1630
19.7
0.7
450
0.8
0.8
6.1
30

4 - 6
-
7 - 10
1855
28.3
1.2
550
1.0
1.0
8.7
30

7 - 10
-
11 – 14 (male)
2220
42.1
1.6
1000
1.2
1.2
11.3
35

11 – 14 (male)
-
15 - 18
2755
55.2
1.6
1000
1.5
1.3
11.3
40

15 - 18
-
19 - 50
2550
55.5
1.6
700
1.5
1.3
8.7
40

19 - 50
-
50 +
2340
53.3
1.6
700
1.5
1.3
8.7
40

50+
-
11 – 14 (female)
1845
41.2
1.6
800
1.2
1.1
14.8
35

11 – 14 (female)
-
15 – 18
2110
45.0
1.6
800
1.5
1.1
14.8
40

15 - 18
-
19 - 50
1940
45.0
1.6
700
1.5
1.1
14.8
40

19 - 50
-
50+
1877
46.5
1.6
700
1.5
1.1
8.7
40

65 +
10.0
Pregnant 16 - 50
2140
51.0
1.6
700
1.5
1.4
14.8
50

Pregnant
10.0



Note: 
1. Vitamin B2 may otherwise be called Riboflavin
2. - indicates that I couldn't source a value
3. Source RNI
4. Source Vit D 


SO, back to the original question - which dairy free milk is best? 

Well, this I will have to leave up to you to decide. This will all depend on you and what you need - I'm aware that not all dairy free folks are babies, toddlers or even allergic!

If you're the parent of a little one, you'll probably be aware that calories and protein are especially important, alongside calcium and vitamin D. But most adults are probably getting a more than adequate supply of calories elsewhere  ;) 

If you want to lose weight, then something like rice milk would probably be best for you - as it's extremely low in calories, but if you're sporty or athletic, you'll definitely be burning more calories and need protein to build muscle, but of course, you're not going to get them from milk alone!

When it comes to choosing the milk that's right for you, you might want to consider the following points

Further points to consider when choosing a dairy free milk

1. Soya milk might need to be avoided by those with an under active Thyroid. Consult your HCP for further advice.

2. If you're coeliac/very sensitive to gluten check all cartons to make sure they're gluten free. Oat milk should be avoided by anyone with gluten problems - unless it's Rude Health, which is organic (and therefore not fortified).


Further points to consider when choosing dairy free milk for young children

1. Under the age of one, non of the dairy free milks are suitable as a main milk drink, unless otherwise specifically recommended by your HCP (Health Care Professional). This is because milk is a major source of nutrition for babies and none of the plant-based milks contain all the necessary nutrients. At this stage, either breast milk or alternative safe/prescribed formula would be required. 

2. Well, if you're not continuing with a dairy free or hydrolysed formula, Alpro Plus 1 seems to be the choice of most HCP's when recommending a dairy free main milk drink for children between the ages of 1 and 2. It has been specifically created to mimic 'follow-on' milk - carefully balanced calories and vitamins etc. 

Obviously if your little one is allergic to soya,  or, if you have concerns about the level of oestrogen in soya, your HCP can advise you otherwise and suggest how you might supplement your little one's diet, accordingly.

3. Rice milk is not advised as a main milk drink for under 5's due to the level of naturally occurring arsenic in rice. Recent research suggests that this age limit may even need to be revised upwards. Regarding rice milk, you need to be careful, as some companies are blending other milks with rice (Alpro Coconut and Coconut Dream are the two that immediately spring to mind).

4. Nut milks should be avoided by those at risk of a nut allergy. A coconut is not a nut but a 'drupe'. Those potentially allergic to nut need not avoid coconut unless this has been identified as a problem.