Cow’s milk alternatives

Not everyone tolerates cow’s milk. Two main problems are intolerance and allergies. First, intolerance is when the gut cannot digest something and when you eat it you get symptoms such as gas, bloating, and diarrhea or constipation. Many teens and adults have lactose (a milk sugar) intolerance. Infants with intolerance are unlikely to have lactose intolerance and more likely to be intolerant to milk proteins. Some infants with milk protein intolerance have blood in their stool. FPIES is a separate issue which is not addressed here. In contrast an allergy is due to having antibodies (IgE) or an immune response to a component of the food and symptoms include hives, vomiting, and anaphylaxis. Strategies and milk alternatives differ depending on whether you have allergies or intolerance.

If an infant is allergic to milk and on a formula without cow’s milk you have a couple options as they approach their first birthday. Many infants outgrow milk protein allergies around 1 year and with the help of you doctor you can try re-introducing cow’s milk gradually in a controlled and monitored way. Another option is you can continue to give infant formula or transition to a toddler formula that is free of cow’s milk. If insurance was paying for your specialty formula that may end at the first year. Many infants who are allergic to cow’s milk are allergic to soy. Even to the point of having anaphylaxis when soy is introduced. Therefore it is not recommended to use soy products. Many parents ask about the alternative milks: coconut, rice, or almond. As seen in the follow chart from Toddler 411

From Toddler 411
From Toddler 411

none of vegetarian milks have anywhere near the protein of animal’s milk. New to the market is pea milk. Both Ripple and Bolthouse Farms sell milks made from pea protein.  Bolthouse’s product has 10 grams of protein per serving versus 1 gram in almond milk. Ripple has 8 grams. Ripple is found at stores like Whole Foods and Bolthouse has said it will distribute its milk to regular stores. Both are great options free of major allergens and with a nutrient content similar to animal milk.

Now if your child has lactose intolerance (more likely in older children) not protein intolerance than Lactaid is a great option. Other options are soy milk or pea milk. For those on a FODMAP diet lactose and soy are issues so almond milk is an option. Pea milk hasn’t been tested for FODMAPers but I suspect it is not tolerated since pea is a legume and the milk has pea protein. Depending on the reason for the FODMAP diet a trial for tolerance can be done.

As with all information from the Internet – before major a major change in your child’s diet consult with your pediatrician.


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