Sarah Peck is a NZ registered dietitian working at Mission Nutrition. She loves showing people how to take the stress out of eating healthy and encouraging healthy everyday habits.
People cut dairy from their diet for a variety of reasons, and sometimes the whole family is included in the change. But what are the risks for dairy-free kids? Dietitian Sarah Peck investigates.
What is dairy and why do we eat it?
Dairy foods include milk and milk products such as milk powders, butter, yoghurt, cheese, cream, ice cream, sour cream, cream cheese, ricotta and custard. Dairy foods are well known for being an excellent source of calcium but they can also be an important source of protein, carbohydrate, fat for energy, minerals including zinc, iodine, phosphorus and certain vitamins including vitamin A, B12 and riboflavin. It is particularly important for pre-schoolers, children and teens to include dairy products in their diet to help build strong bones and teeth. During puberty, the rate of bone acquisition peaks. If adequate bone mass isn’t being laid down at this point, young people risk developing osteoporosis later in life.
Why do some people eliminate dairy?
People cut out dairy for a number of reasons. Some can’t have dairy because they have an allergy or intolerance. Some people cut it out for ethical or religious reasons, while others believe eating dairy is unhealthy. If you are considering removing dairy from your or your child’s diet, it is important to discuss your concerns with a qualified health professional first. The best options being your GP or a dietitian or registered nutritionist.
Cow’s milk allergy or lactose intolerance
Cow’s milk allergy (CMA) is the most common food allergy in children. There are two proteins in milk: whey and casein, and a child can be allergic to one or both proteins. Even small traces of dairy can induce symptoms in people with a milk allergy.
Reactions can vary from mild hives, vomiting, diarrhoea, eczema and respiratory problems to life-threatening anaphylaxis and can be immediate or start several hours or days after having cow’s milk. Approximately 85 per cent of children grow out of their milk allergy by the time they turn three. Unfortunately, a child diagnosed with CMA has a higher risk of suffering from asthma and eczema and developing other allergies.
Then there’s lactose intolerance. Lactose is a natural sugar found in milk. Lactose intolerance is the inability to digest significant amounts of lactose because of a shortage of the enzyme lactase. This can be temporary, for example, after a bout of gastroenteritis.
Unlike people with milk allergy, lactose intolerant people often tolerate small amounts of dairy. The good news is that yoghurt and cheese are usually well tolerated as they have less lactose than milk. Lactose-free milks and other dairy products are another option. Or chew lactase tablets before consuming milk, or add lactase drops to milk to reduce the lactose content.
Delving into dairy claims
Dairy causes acne
There is no strong evidence that dairy consumption causes acne. Some research shows weak associations but nothing strong enough to recommend eliminating dairy for this reason. Acne typically shows up in adolescence and this is an important time for optimising bone mass and strength.
Milk makes mucus or phlegm
This myth has been around for a long time. You’ve probably been told not to drink milk when you have a cold for this very reason. What really happens is milk temporarily coats your mouth, tongue and throat, giving the sensation that your body is producing more mucus or phlegm, but this is not the case. But if you suspect dairy products are causing your child’s respiratory issues, discuss it with a medical professional as this could be a sign of cow’s milk protein allergy.
Dairy free helps ASD
There are a handful of studies that suggest a gluten and casein-free diet can improve symptoms and behaviours in some children diagnosed with autism spectrum disorder (ASD), particularly in those children who have gastrointestinal disorders and associated symptoms. Gluten and casein are two types of protein found in foods, with casein the main protein found in dairy products. But more research is needed before cutting gluten and dairy is recommended for ASD generally. Before trialling this type of diet, it is important to speak with a dietitian or registered nutritionist familiar with ASD. It is possible that a well-planned gluten and casein-free diet can meet your child’s nutritional needs.
A vegan diet is unhealthy for children
Those following a vegan diet exclude all animal products including meat, chicken, fish, all other seafood, all dairy products and eggs. Common reasons for choosing a vegan diet include ethical reasons (concern for animal welfare or the environment), health considerations and religious beliefs. With a carefully planned diet it is possible for children and young people to meet their nutrient requirements, including calcium, through a wide range of plant foods and calcium fortified products, but it is challenging. In addition to calcium, the other nutrients that are at risk with a vegan diet include energy, protein, iron, zinc, vitamin B12 and omega-3 fatty acids.
What are the risks of kids not eating dairy?
Eating dairy is the most effective way to get calcium into the diet. When you exclude or limit dairy you run the risk of compromising your child’s bone health. The best evidence available tells us that getting adequate calcium and doing physical activity are the main things we can do to enhance bone health. There is also good evidence that getting enough vitamin D has a positive effect on bone mass. When vitamin D is metabolised it helps increase calcium absorption.
Approximately 99 per cent of the body’s calcium is stored in bones and teeth. The remainder is used for a number of different functions of the body. We lose calcium from our skin, nails, hair and body secretions every day and, unless we replace those calcium losses through our diet, the body will leach calcium from the bones to be used elsewhere in the body. Bone mass is acquired slowly throughout childhood but it is more rapidly acquired with the onset of puberty and the adolescent growth spurt. Our personal peak bone mass or peak bone strength is reached by early adulthood and it’s an important predictor for osteoporosis later in life. Getting enough calcium in our childhood and especially in the teens helps us achieve our highest potential for peak bone mass.
How much dairy do we need to eat to hit our daily targets?
Children and adolescents’ calcium needs increase as they grow. Surveys show that the percentage of children and young people not getting their calcium requirements increases as they get older. Girls 15-18 years are at most risk of not getting enough, with a massive 88 per cent reporting an inadequate intake.
Recommended daily calcium intakes for children and young people
*Recommended daily intake
To help meet several nutrient requirements, including calcium, it’s recommended that pre-schoolers and children aged between two and 12 years old eat at least two to three servings and teens aged 13-18 years eat at least three servings of dairy foods each day.
As infants and toddlers are still growing rapidly, reduced-fat milk is not recommended before two years of age; stick to full fat milk as they need the extra energy. Reduced-fat milk can be introduced once they turn two, as long as they are eating and growing well.
What does a dairy serve look like?
- Glass of milk or calcium-fortified milk alternative (250ml)
- Pottle of yoghurt (150g)
- 2 slices of cheese (40g) or 1/3 cup grated cheese
Some ideas to help increase dairy intake
- Make smoothies with yoghurt and milk
- Prepare home-made ice blocks made with fruit and unsweetened yoghurt
- Add grated cheese to scrambled eggs, omelettes or frittatas
- Prepare oats with milk instead of water
- Bake mini cheese muffins
- Whip up a cheesy pasta bake
- Use dairy dips such as tzatziki, reduced-fat cream cheese or ricotta mixed with a small amount of melted dark chocolate to dip fruit into.
Alternatives for people who can’t eat dairy
It is possible to meet calcium requirements without eating dairy but it takes careful planning and can be difficult if you have a child who is already a picky eater.
The good news is most non-dairy milk alternatives are fortified with calcium but it is still important to check the back of the carton to make sure. Look for ones that have a minimum of 120mg calcium per 100ml. Regular soy milk contains similar levels of energy, fat and protein to standard cow’s milk, so is the best choice for under-fives. Rice milk and other cereal-based milks contain lower energy and protein levels compared with cow’s milk, so these are not recommended as a cow’s milk replacement for this age group. Not all soy milks are nutritionally equal. Some are made from the whole soy bean where others are made from the more highly processed soy protein isolate. They vary in calcium levels and some have vitamins D and B12 added, which is great for those following a vegan diet. It is also important to check and compare the added sugar content of the milks.
You can see from this table of food sources of calcium that it’ is difficult to meet the dietary targets for calcium without including a calcium-fortified milk alternative.
|FOOD SOURCE||SERVING SIZE||CALCIUM|
|Calcium-fortified non-dairy milk alternative||1 cup (250ml)||300-400mg|
|Sardines||85g (small can, drained)||220-440mg|
|Tofu||100g||Up to 200mg|
|Tahini (sesame spread)||1 tablespoon||50-75mg|
|Broccoli||1 cup cooked||60mg|
|Mixed grain bread||1 slice||30-40mg|
If dairy foods or calcium fortified milk alternatives are not included in a young person’s diet it is very difficult to meet calcium requirements. This is when you might need a calcium supplement. Talk to your doctor about this, as individual needs vary.
Article sources and references
- Auckland Allergy Clinic. www.allergyclinic.co.nz Accessed October 2016http://www.allergyclinic.co.nz/
- Bowe W et al. 2010. Diet and acne. Journal of American Academy of Dermatology 63:124-41https://www.ncbi.nlm.nih.gov/pubmed/20338665
- Burris J et al. 2013. Acne: The role of medical nutrition therapy. Journal of the Academy of Nutrition and Dietetics 113: 416-30https://www.ncbi.nlm.nih.gov/pubmed/23438493
- Dietitians Association of Australia. 2013. Eating Guidelines and Feeding Tips for Children with Autism Spectrum Disorder (ASD). www.pennutrition.com Accessed via PEN Nutrition October 2016https://www.pennutrition.com/KnowledgePathway.aspx?kpid=14219&trid=15377&trcatid=467
- Ministry of Health. 2003. New Zealand Food New Zealand Children: Key Results of the 2002 National Children’s Nutrition Survey. Wellington: Ministry of Healthhttps://www.health.govt.nz/system/files/documents/publications/nzfoodnzchildren.pdf
- Ministry of Health. 2012. Food and nutrition guidelines for healthy Children and Young People (Aged 2-18 years). A Background Paper. Wellington: Ministry of Healthhttps://www.health.govt.nz/system/files/documents/publications/food-nutrition-guidelines-healthy-children-young-people-background-paper-feb15-v2.pdf
- NZ Nutrition Foundation. www.nutritionfoundation.org.nz Accessed October 2016https://nutritionfoundation.org.nz/
- Pennesi C et al. 2012. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Journal of Nutritional Neuroscience 15:85-91https://www.ncbi.nlm.nih.gov/pubmed/22564339
- Perez-Lopez FR et al. 2010. Bone mass gain during puberty and adolescence: deconstructing gender characteristics. Current Medicinal Chemistry17:453-66https://www.researchgate.net/publication/40692420_Bone_Mass_Gain_During_Puberty_and_Adolescence_Deconstructing_Gender_Characteristics
- University of Otago and Ministry of Health. 2011. A Focus on Nutrition : Key Findings of the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Healthhttps://www.health.govt.nz/publication/focus-nutrition-key-findings-2008-09-nz-adult-nutrition-survey
- Weaver C et al. 2016. The National Osteoporosis Foundation position statement on peak bone mass developmental and lifestyle factors: A systematic review and implementation recommendations. Osteoporosis International 27:1281-1386https://www.ncbi.nlm.nih.gov/pubmed/26856587