For individuals managing Irritable Bowel Syndrome (IBS) or other digestive sensitivities, the low FODMAP diet can be a helpful tool in alleviating symptoms. However, navigating the world of milk and milk alternatives can be daunting, especially when trying to determine which options are safe to consume. This article aims to clarify the role of almond milk within a low FODMAP dietary framework, providing guidance and insights for those seeking suitable alternatives.
Understanding the Low FODMAP Diet and Milk Alternatives
The low FODMAP diet focuses on reducing the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), which are short-chain carbohydrates that can be poorly absorbed in the small intestine, leading to digestive distress in susceptible individuals. Lactose, the natural sugar found in cow's milk, is a disaccharide and a common FODMAP trigger. This is why standard cow's milk, goat's milk, and many conventional dairy products are often problematic for those following a low FODMAP diet.
Fortunately, there are many low FODMAP milk alternatives available, ranging from lactose-free dairy options to plant-based milks. These alternatives can be fortified with essential nutrients, making them comparable to cow's milk in terms of nutritional content.
Almond Milk: A Popular Low FODMAP Choice
Unsweetened almond milk is a popular and generally safe choice for individuals following a low FODMAP diet. Brands like Alpro and Rude Health offer unsweetened versions that are readily available in UK stores. It has a light, slightly nutty flavor that works well in various applications, including tea, coffee, smoothies, and porridge.
Why is Almond Milk Low FODMAP?
This might seem counterintuitive considering that almonds themselves are high in FODMAPs in larger servings (more than 10 almonds). Almonds contain Galacto-oligosaccharides (GOS), which fall under the oligosaccharides category in the FODMAP acronym.
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However, commercially produced almond milk typically contains only a small percentage of almonds, often around 2%. The manufacturing process involves grinding almonds, blending them with water, and then straining out the almond solids. Since the almond content is low, the resulting milk is generally low in FODMAPs.
Important Considerations for Almond Milk Consumption
While almond milk can be a safe option, it's essential to be mindful of a few factors:
- Serving Size: According to Monash University, almond milk is low FODMAP at a serving size of 1 cup (250ml).
- Added Ingredients: Always check the label for sneaky high FODMAP ingredients like fructose, inulin, agave syrup, high fructose corn syrup, molasses, or honey.
- Homemade Almond Milk: Exercise caution when consuming homemade almond milk, as it can contain a higher concentration of almonds (10-20%), potentially exceeding the low FODMAP threshold. In a 250ml (1 cup) serving size of homemade almond milk, you might consume the approximate equivalent of 25g to 50g of almonds.
- Calcium Fortification: Look for almond milk that has been calcium fortified to ensure you're getting enough of this essential nutrient. When choosing an alternative plant-based milk, aim for one that is nutritionally similar to cow’s milk in terms of calcium and protein.
Other Low FODMAP Milk Alternatives
Besides almond milk, several other milk alternatives can be incorporated into a low FODMAP diet:
- Lactose-Free Cow's Milk: If you enjoy the taste of dairy but struggle with lactose, lactose-free cow's milk is an excellent option. It has the same nutritional benefits as regular milk, including calcium and protein, but with the lactose removed. Most supermarkets offer skimmed, semi-skimmed, and whole milk within their lactose-free range. Lactose-free milk is cow’s milk that has had an enzyme called lactase added to it. The enzyme splits the lactose sugar into two parts, glucose and galactose, which our bodies can then easily digest without causing intestinal symptoms. Because lactose-free milk does not contain lactose, it is low FODMAP and suitable to consume in large serving sizes of 250ml (or 1 cup).
- Macadamia Milk: Made from macadamia nuts, this milk is a creamy, nutty alternative that is naturally low in FODMAPs. It's gentle on digestion and works well in hot drinks, baking, and cereals. Monash has tested macadamia milk and found it to be low FODMAP at 1 cup.
- Hemp Milk: Made from hemp seeds, this plant-based milk is rich in omega-3 fatty acids and naturally low in FODMAPs. It has a slightly earthy taste and works well in smoothies and hot drinks. Brands like Good Hemp provide fortified versions available in UK supermarkets.
- Rice Milk: Rice milk is another suitable option, but should only be consumed in small servings (up to 200ml). It has a mild flavor and is often fortified with calcium and vitamins.
- Quinoa Milk: Quinoa milk is a lesser-known but nutritious option. It has a mild, nutty taste and is usually fortified with calcium and vitamin D. Quinoa milk (with and without chia) is low FODMAP at one cup per FODMAP Friendly. This milk is rather challenging to find in the US, however I did find this brand years ago and thought it was quite delish. If you are not a quinoa fan, this is not a milk for you since it definitely has a quinoa taste.
- Coconut Milk (UHT): UHT coconut milk (long-life coconut milk that comes in a carton) is low FODMAP at 125ml (½ cup) servings. However, be aware that these UHT milks often contain moderate FODMAPs at 150ml and are high FODMAP at 250ml (1 cup) serving sizes. Canned coconut milk used in cooking is low FODMAP in ¼ cup servings and contains moderate FODMAPs in ½ cup servings.
- Soy Milk (from Soy Protein): Soy milk made from soy protein is low FODMAP. In terms of nutrient content, soy milk made from soy protein has equivalent levels of protein and calcium when compared to lactose-free cow’s milk. However, be aware that whole soybean milk is high FODMAP, so you will need to check the ingredients list to see if the milk is made from just soy protein. According to Monash University soy milk made from soy protein is safe to have in 250ml (or 1 cup) serves FODMAP. Soy beans are high in GOS, a type of water-soluble FODMAP. In soy milk made from whole soy beans, GOS leaches into the milk, resulting in a high FODMAP product. In contrast, soy protein milk is made by first extracting protein from soy beans, leaving all the GOS behind, resulting in a low FODMAP product. Don’t worry, the ingredients list should tell you whether the product was made from whole soy beans or soy protein.
- Cashew Milk: Monash now has a few certified low-FODMAP cashew milks that are safe at one cup. FODMAP Friendly also tested cashew milk using activated cashews that made the cut at one cup. Based on these results, this dietitian would deduce that the majority of cashew milks are low FODMAP at one cup.
Milk Alternatives to Approach with Caution
- Oat Milk: While oat milk is widely available and has a creamy texture, it needs to be restricted to no more than 40ml on the low FODMAP diet. Larger portions are high in fructans, making it high FODMAP. In the UK, oat milk is low FODMAP in 125ml serves and then contains moderate amounts of GOS and fructans at 165ml serves.
- Soy Milk (from Whole Soybeans): As mentioned earlier, soy milk made from whole soybeans is high FODMAP and should be avoided.
- Goat Milk: Goat milk contains moderate levels of lactose, even in small ⅓ cup servings.
Incorporating Low FODMAP Milk Alternatives into Your Diet
There are many ways to use low FODMAP milk products in your diet during the elimination phase and beyond. Start with just substituting a low FODMAP friendly alternative if needed (i.e. Please do not add oat milk to oats.
Low FODMAP Dairy Products
If you are intolerant to lactose but would like to continue consuming dairy, consider lactose-free milk (and yoghurt). In these dairy products, the enzyme that breaks down the milk sugar, lactose, is added to the product before it hits the shelves, saving your gut from having to do all the breakdown work. Lactose-free milk is slightly sweeter than normal milk as lactose is broken down.
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Supermarket shelves have a plethora of lactose free alternatives currently. From custard to ice cream, yoghurt and cheese. Many stores sell their own brand lactose free yoghurt and lactose free Greek Yoghurt seems widely available. Regarding cheese and the low FODMAP diet: a small amount of Cheddar, Brie or Feta is allowed as part of the low FODMAP diet. However, if you want to indulge a bit more, go for the lactose free cheese option.
General Tips for Choosing Low FODMAP Milk Alternatives
- Read Labels Carefully: Always scrutinize ingredient lists to identify potential high FODMAP additives like inulin, honey, agave, high fructose corn syrup, and certain gums (e.g., guar gum, carrageenan).
- Choose Calcium-Fortified Options: Plant-based milks do not naturally contain the same nutritional benefits as lactose-free dairy products, including calcium, vitamin B12, and phosphorus. Ensure that the product you choose is calcium fortified (≥120mg/100ml).
- Consider Vitamin B12 Fortification: If you're following a vegan, low FODMAP diet, look for vitamin B12 fortified products, as vegans are often at risk of being deficient in this vitamin.
- Be Mindful of Serving Sizes: Always adhere to the recommended low FODMAP serving sizes as indicated in the Monash University FODMAP Diet App. For example, unsweetened UHT coconut milk has a low FODMAP rating in a serving size of ¾ cup, but it becomes moderate FODMAP at a larger serving size of 1 cup (250ml).
- Experiment and Listen to Your Body: Even within the low FODMAP framework, individual tolerance levels vary. Experiment with different milk alternatives to find what works best for your digestive system.
The Importance of Professional Guidance
If you're struggling to manage your IBS symptoms or navigate the low FODMAP diet effectively, consider seeking professional support from a registered dietitian or healthcare provider. They can provide personalized guidance, help you identify trigger foods, and ensure you're meeting your nutritional needs.
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