I've been planning this blog post for a long time because I know this is a topic many parents struggle with navigating and I want to provide some support in this area. My standpoint with any food, including dairy products, is to listen to your body, or your child's body. If you or your child are experiencing symptoms that your body is not tolerating a food currently, I believe it is best to investigate this further. Dr Maya Shetreat states that, "dairy-containing foods can trigger ailments from ear infections to migraines to seizures to ADHD, an exacerbate allergies, asthma, IBS, ulcers and Crohn's disease." If a child suffers from ear infections or has chronic cold symptoms, such as a runny, stuffy nose, congestion, or phlegm, often dairy products can be contributing.

Before I begin this novel on the milk from cows, I want to start by outlining the difference between allergies, sensitivities and intolerances. A food allergy occurs when the immune system recognises proteins of a particular food as a harmful invader and responds with an immune attack, known as an IgE response. Like an allergy, sensitivities also involve an immune response in which antibodies are created but are non-IgE reactions. Food sensitivities do not pose the threat of causing anaphylaxis, however, while reactions are not life-threatening they can still be significant and can pose considerable discomfort. Unlike a food allergy or sensitivity, the immune system is not involved in the associated physical response of a food intolerance. An intolerance does not pose the threat of causing anaphylaxis, although intolerances can pose considerable discomfort. Those who are lactose intolerant do not produce the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products.

Consuming dairy products has been commonplace for many cultures for thousands of years. In fact, it looks like humans began drinking cow's milk at least 10,000 years ago and we still do today. Particularly, it is still common for infants who are weaned from formula milk or breast milk to transition to cow's milk in a bottle instead. Interestingly, ancient baby bottles provide evidence that milk from animals was used to feed human infants at least 8,000 years ago.

So where did it all go wrong? How did we used to consume dairy products regularly without the prevalence of dairy-related sensitivities we see now?

To begin with, we need to talk about pasteurisation. In the 1800s, when rural families moved to the cities, they wanted to continue drinking the fresh milk they had been on their farms, straight from the cow. Cows were moved to the cities, but kept in abhorrent conditions so became sick which created sick milk that then led to a tremendous number of deaths in babies and children.

Instead of improving the living conditions for the cows, which most likely wasn't even an option at the time, the practice of pasteurisation was introduced instead. The theory behind this was that heating or pasteurising the milk killed any and all bacteria. Thankfully, the bacteria from the living conditions the cows were kept in was decimated, but unfortunately, so too was the beneficial bacteria found in natural raw cow's milk.

Say what? I can hear you thinking. Cow's milk naturally contains bacteria?
It sure does. Milk directly from the cow naturally contains diverse beneficial bacteria, prebiotics to feed gut bacteria, immune factors, fats and enzymes that enable fermentation. In Dr Maya Shetreat's book, The Dirt Cure (a must read for parents), she highlights a study where children who drank raw farm milk had fewer cases of asthma, allergies and hay-fever. She also references a study where mothers and infants who drank raw milk saw a 30% lower prevalence of fever, ear infections, and respiratory infections, as well as lower blood inflammatory markers. Furthermore, the raw milk's diverse microbes, fat and proteins changed these children's gene expression of innate immunity to produce protective effects that staved off the development of childhood allergies or severe infections.

When talking about raw milk, we also need to discuss the digestive enzyme lactase further. The heat used in the pasteurisation process kills pathogens in milk but also denatures proteins, damages fats and inactivates the enzymes required to absorb nutrients in milk: lipase (to digest fats); lactase (to digest lactose); and phosphatase (to absorb calcium). The phosphatase content is why raw milk contains more available calcium than pasteurised milk. Because breastmilk naturally contains lactose, babies make plenty of lactase to digest it. Lactase production tends to fall around the age of three or four, when babies were traditionally weaned. Interestingly, if you continue drinking fresh milk past weaning, your body continues making the lactase enzyme for lactose.

Fermentation also breaks down lactose, so you don't necessarily need the lactase enzyme as long as you consume fermented dairy products, such as kefir, yoghurt and cheese. In fact, prior to the 1800s when they moved the cows into the cities, babies who were weaned from breastmilk would move on to having milk fermented by bacteria, that had soured into a yoghurt-like beverage. Fermented milk products, such as kefir and yogurt, have a low lactose content because much of it gets used up during the fermentation process. Therefore, some people with a lactose intolerance have a higher level of tolerance for fermented milk products because dairy fat contains little to no lactose. This is why I recommend my clients who are starting solid foods with their babies to start by offering fermented dairy products, such as yoghurt and milk kefir, from 10 months old (more on this below).

Of course, I couldn't write a post about dairy without mentioning calcium. Children 1-3 years require 700 mg of calcium per day. The needs of babies younger than 1 year will be met through breast milk/formula, as babies should not be weaned from breast or formula milk until this age, at a minimum. Calcium is vital for our children for building strong bones and teeth, for cardiac function and proper nerve and muscle function. Dairy products do contain high amounts of calcium, however given many struggle to optimally digest dairy products, it's worth exploring alternative options of calcium. I've included here a list of calcium-rich foods that parents can work to incorporate into their family's diet (now you'll understand why I love sardines, chia seeds and tahini so much!) You'll also notice that fermented dairy (yoghurt and kefir) feature high on the list too.

Despite it being common to offer cow's milk as a follow-on milk after weaning from breast or formula milk, provided baby has a well-rounded, nutritious diet, a follow-on milk is actually not necessary from the age of one year old. Not only is pasteurised cow’s milk is very hard for little tummies to digest, it's also worth mentioning here that too much cow’s milk can actually cause iron deficiency in babies and toddlers. However, if a formula milk is being offered to fill any nutritional gaps, then parents can choose to continue with one they thrive on. If parents choose not to offer a follow-on milk, it is important to offer foods high in the critical nutrients young children need at this age, such as calcium, DHA and probiotics. The idea actually isn’t to ‘replace’ breastmilk or formula milk with any other liquids, because no other liquid is as nourishing. Parents can still offer the occasional bottle when needed for comfort with any milk substitute, like coconut milk, knowing that this substitute does not replace the nutrients in formula, breast or cow's milk. To add my personal experience with this, we didn't offer my son any follow-on milks once he weaned from breastmilk.

For children who experience difficulties with cow's milk, it is possible for a baby with a cow’s milk sensitivity to develop a tolerance to goat, sheep, and/or buffalo milk. Compared to cow's milk, goat's milk is lower in allergenic casein and more of the less allergenic whey. However, many dairy-allergic or sensitive children still unfortunately don't tolerate it. Similarly, there is A2 milk which some may tolerate more than A1 milk. Nutritionally, A2 milk is similar to regular milk in terms of how much protein, fat and calcium it contains. The difference is in their types of beta-casein protein. Beta-casein makes up 30% of the protein in milk and comes in two main forms – A1 and A2. Most cows produce a mix of A1 and A2 beta-casein but some cows produce only A2 beta-casein, which is where A2 milk comes from. It's important to see what works for your child as an individual. I work closely with parents to eliminate all dairy products when necessary, focusing on alternative foods that still meet nutrient needs.

I also want to make specific mention about butter too. Butter, and especially ghee (clarified butter) are often well-tolerated because they’re higher in fat, lower in lactose, and contain only trace amounts of milk proteins. Ghee is made by slowly heating butter until the small amounts of milk protein separate from the fat and you're left with glorious golden butterfat which is delicious as a butter alternative. Children's bodies and brains need a constant supply of fat, with their nervous systems being composed of more than 60% fats (another blog post coming on this soon). Although historically we've been told that fat, particularly saturated fat is bad, what we now know is that industrial seed oils, such as canola, corn, grapeseed, soybean, safflower, sunflower, and vegetable oils are the ones we want to minimise (I'll dive into this in detail in my blog on fats). Butter from grass-fed cows is an excellent source of vitamins A, D, E and K2 and rich in many trace minerals too. I also recently learned that when you eat butter, it gathers on your skin and turns into vitamin D when stimulated by the sunlight?! How clever is that! Interestingly, many of the vitamins in food are fat-soluble, meaning they can't be absorbed without the presence of adequate fat. By serving butter with meals (such as on broccoli, for example), you are ensuring the nutrients in the broccoli are well-absorbed.

So, if you are going to include dairy in your family's diet, where do you start?

I want to start by saying that if you suspect that your child has a sensitivity to dairy products, it's important to work through any elimination diet with the support of a practitioner. I work closely with parents in my consultations to identify and remove the trigger food, before mindfully reintroducing, after a period of strengthening the gut lining and diversifying the gut microbiome. If your child is allergic to cow's milk, you should avoid all forms of dairy unless advised otherwise by your health care provider.

When starting with dairy products, around 10 months I recommend beginning with ghee (butter with the milk protein removed) and butter as they have the lowest amounts of lactose. If your child tolerates ghee and butter, you can then introduce milk kefir which is a fermented milk beverage. After milk kefir is tolerated, you can move on to greek yoghurt which is also fermented. At 12 months, if all other forms of dairy are being tolerated, you can introduce cow's milk. Cheese can also be introduced now, being mindful that it is high in sodium.

When choosing your dairy products, I encourage you to purchase:
- Grass-fed: Thankfully here in NZ, most of our cow's are pasture-raised, meaning that they eat only grass. The grass and sunshine contribute to the vitamin A and D you find in milk.
- Full Fat: Did you know that consuming calcium with a source of fat is required for optimal absorption? Nature knows best as all dairy products are naturally full fat, it's only when humans intervene that they become low fat. As I mentioned above, fat is incredibly important for growing children's bodies and brains.
- Unpasteurised: This decision is a personal one to make, ultimately, you have to feel confident with the decision and weigh up the benefits of raw milk vs the potential bacteria concerns. If you choose to try some raw milk, it's important to find a credible certified retailer who tests their milk regularly for pathogens. If you are in the South Island of NZ, there is a supplier I prefer, email me for details.
- Fermented: As I've covered in great detail, fermented dairy products can be easier for some to digest.
- Organic: In NZ, organic dairy means 365-days pasture grazed (yay), non-GMO and antibiotic, pesticide and herbicide free (yay again!)

References:
Shetreat, M. 2016. The Dirt Cure: Healthy Food, Healthy Gut, Happy Child.
Planck, N. 2009. Real Food For Mother and Baby.
Shanahan, C. 2008. Deep Nutrition: Why Your Genes Need Traditional Food.
Lipski, E. 2006. Digestive Wellness For Children.