Breastfeeding is widely recognized as the optimal way to nourish infants, providing essential nutrients for healthy growth and development. Human milk contains a unique blend of nutrients perfectly tailored to meet a baby's needs. However, new parents often worry about their baby’s fussiness after feedings, attributing it to potential allergies or sensitivities to something in their diet. This concern can be triggered by unusual diapers, gassiness, and excessive spit-up. One of the first suggestions new parents often hear is, "Did you try cutting out dairy?" This article explores the benefits and considerations of eliminating dairy from a breastfeeding mother's diet.
Is Dairy Elimination Necessary?
Being a new parent is challenging, and breastfeeding or pumping adds another layer of complexity. The last thing new parents need is an overly restrictive, potentially unnecessary diet change. Dairy can be a nutritious and convenient source of essential nutrients like protein, fat, and minerals for postpartum individuals. Removing it without a clear need can create nutritional challenges for the mother. Elimination diets can also be triggering for individuals with a history of disordered eating or restriction. It’s important to take extra gentle care of yourself and be aware that there are other interventions to try before changing the food you eat.
While dairy issues are a common concern, cow’s milk protein allergy (CMPA) actually affects only about 1% of infants. Recent research suggests that CMPA is often overdiagnosed. However, if your infant seems distressed after feedings or experiences strange gastrointestinal symptoms, it can be stressful and frightening.
Determining if Dairy Elimination is Needed
Before eliminating dairy, consider these questions:
- Is my baby’s fussiness “normal”? Some degree of fussiness without other symptoms is typical for infants and not a cause for concern. Even though babies are tiny, their needs are great!
- Are the symptoms actually related to how nursing or bottle-feeding is going? Gassiness, excess spit-up, green-colored stools, and other signs can stem from nursing or bottle-feeding challenges. For example, your baby may have gas from swallowing extra air due to a shallow latch, gulping in response to a heavy letdown, or not getting enough “breaks” while bottle-feeding. Consult an International Board Certified Lactation Consultant (IBCLC) to rule out any issues.
- Are there other troubling symptoms, too? If you’ve ruled out nursing issues and you still see fussiness coupled with colic (persistent inconsolable crying), rashes or eczema, a persistent cough, or frequent spitting up, it is worth suspecting dairy as a potential culprit.
Most infant fussiness is normal for a young baby and is not related to foods in mom’s diet. If your baby is sensitive to something you are eating, you will most likely notice other symptoms in addition to fussiness, such as lots of spitting up or vomiting, colic, rash, blood in the poop, or congestion. In this case, you should be seeing your pediatrician right away.
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Cow’s Milk Protein Allergy (CMPA) Explained
With CMPA, a breastfed infant reacts negatively to the protein in cow’s milk that the mother has consumed. This is different from “lactose intolerance,” which is a reaction to the sugar found in milk. With CMPA, your baby’s immune system sees the protein as a threat, leading to an allergic reaction. Milk proteins secreted from breast milk induce an inflammatory response in the colon that can cause pain, bloody stool, and eczema-like reactions on the skin. If your pediatrician suspects your infant may have this allergy, they may conduct a stool test to check for small amounts of blood.
The Elimination Diet: A Step-by-Step Approach
If you think your baby is reacting to a particular food, or if you suspect that your baby has a food allergy, some moms consider going on an "elimination diet." Some of the most likely suspects are cow’s milk products, soy, and eggs. If your pediatrician suspects CMPA, the best practice is to follow a dairy elimination diet for at least 3 weeks. This involves a total elimination of any dairy or dairy-containing products from your diet.
Wait 2-4 weeks to see if baby improves. If baby doesn’t improve in 4 weeks, then it may not be food related, or you may need to look at other foods. If baby doesn’t improve in 4 weeks, then try a different food category, or you may need to look at other foods.
It is important to stay healthy while on an elimination diet. It can be hard to eat enough and eat healthy. Cow’s milk and soy substitutes can also be expensive. If you don’t think you can eat enough protein or calories, or the elimination diet causes a lot of stress, then it may not be for you.
If you have found a food baby is reacting to, you will want to talk to your pediatrician and/or an allergist to talk about when it is best to reintroduce that food into your diet, if at all.
Read also: Diet Plan: No Sugar, Carbs, Dairy
Identifying Hidden Dairy
While we tend to think of dairy being in products like cow’s milk, yogurt, butter, ice cream, and cheese, there are also a bunch of products that contain “hidden dairy.” In other words, these products sneakily contain dairy when we wouldn’t expect them. Make sure to always check the label of your salad dressings and dips, granola, chocolate, canned tuna, protein bars, and pre-made soups. Keywords to look out for on the ingredient list include “milk,” “milk protein,” “milk solids,” “casein,” or “whey.”
Foods to Avoid on a Dairy-Free Diet
The dairy-free diet excludes all dairy products: animal milk and its derivatives, such as ice cream, yogurt, cheese, and butter. Foods containing ingredients from milk (milk powder, casein, whey) should be avoided too.
- Dairy products: Animal milk, condensed, evaporated, powdered milk, buttermilk, cheese, butter, yogurt, kefir, ice cream, whipped, and sour cream.
- Foods made from milk: baked goods, salad dressings, and mayonnaise; milkshakes, hot cocoa, sherbet; candies such as caramel or chocolate; some pieces of bread and crackers; high-protein breakfast cereals, some instant coffees, vegetable spreads, creamed potatoes, and desserts such as cake or puddings, etc.
- Foods that may contain dairy: brown sugar, dark chocolate, caramel flavoring, other natural or artificial flavorings, high protein flour, luncheon meat, hot dog, sausage, and margarine.
- Ingredients to look for in a dairy-free diet and avoid: Milk byproducts, Artificial butter flavor, Butter, butter fat or oil, ghee, Derivative, malted, condensed, evaporated, or dry milk, Cheese powder, Casein, casein hydrolysates, caseinates, Curd, Whey, Nisin, Lactose, lactoglobulin, lactoferrin, lactulose, Cream, artificial cream, Custard.
Dairy-Free Substitutes
Many parents worry that without dairy, they won’t be able to meet their calcium, vitamin D, or protein needs. Fortunately, all the beneficial nutrients found in dairy products are also found in a variety of other delicious foods! Soymilk and peanut milk are rich in protein and unsaturated fats, so those are a great substitute for cow’s milk. Avocado is a creamy and delicious substitute for cheese on a sandwich or with eggs in the morning! Foods like broccoli are rich in calcium and delicious when roasted or steamed!
Vitamin D is super important for helping your body absorb calcium. Luckily eggs, fatty fish (like tuna and salmon), and some fortified cereals will help you reach your Vitamin D needs!
Dairy-Free Diet vs. Lactose-Free Diet
It's important to distinguish between a dairy-free diet and a lactose-free diet:
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- Dairy-free: Dairy-free products contain no animal milk or milk-derived products. However, this diet allows the consumption of milk alternatives from plants, nuts, and grains.
- Lactose-free: Lactose-free products contain animal milk without lactose. Milk, cheese, butter, or any dairy product labeled as lactose-free has its lactose removed or neutralized.
Reasons to Go Dairy-Free
There are various reasons to go dairy-free: allergy, intolerance, personal, or ethical reasons. Vegans and ovo-vegetarians also have dairy products excluded from their diets.
Lactose Intolerance
Lactose intolerance is a condition manifesting with digestive symptoms such as bloating, abdominal pain, flatulence, and diarrhea. Around 68% of the world's population has lactose intolerance; however, not everyone has symptoms. Lactose is a milk sugar digested by an enzyme called lactase. People with lactose intolerance have primary or secondary lactase deficiency, leading to undigested lactose. The lactose stays in the digestive system and gets fermented by bacteria causing various gases and leading to the symptoms mentioned above.
Milk Allergy
Milk allergy is an immune response caused by milk proteins, whey, and casein. In most cases, people develop allergic reactions to both proteins. The second time milk proteins enter the body, they trigger an immune response and cause many chemicals to be released, causing allergy signs and symptoms. Milk allergy symptoms may manifest as hives, wheezing, itching, swelling, vomiting, and anaphylaxis or be predominantly digestive, such as diarrhea, cramps, and bloody stools.
Breastfeeding and Infant Sensitivities
Lactose intolerance or milk allergy in breastfed infants is another reason to stop eating dairy temporarily. Human breast milk contains lactose, and breastfed infants with lactose intolerance may cry and be irritated, fail to gain weight, settle at feeding times, and have abdominal swelling, diarrhea, and red and swollen skin in places. Cow's milk protein occurs in dairy-consuming humans and may lead to allergic reactions in sensitized infants. Symptoms may include skin reactions (rash, hives, eczema, redness, and swelling around the mouth), hay fever-like symptoms (runny or blocked nose, sneezing, red itchy eyes), and digestive problems (stomach pain, vomiting, diarrhea, or persisting constipation, failure to gain weight).
Health Benefits and Risks of a Dairy-Free Diet
Health Benefits
Dairy-free diet may improve digestion and mental health, aid weight loss, and clear the skin.
- Improved digestion: By eliminating dairy, lactose intolerant individuals can eliminate symptoms (such as bloating and flatulence) associated with their condition.
- Weight loss: Some dairy products are not particularly low in calories, and cutting dairy out may benefit weight loss. One serving (½ cup, 66g) of vanilla ice cream provides 137 calories; 1 tbsp (14.2) of butter provides 102 calories; one slice (1oz or 28g) of cheddar cheese provides 113 calories.
- Healthier skin: Milk (but not milkshakes, cheese, or yogurt) may be the main reason or one of the reasons for acne breakouts or worsened acne. One of the theories is milk-induced inflammation and clogged pores leading to acne. Many individuals have reported having healthier and clearer skin after going dairy-free.
- Improved mental health: Some studies suggest eliminating dairy from the diet benefits mental health; nevertheless, others either find no associations or suggest consuming dairy is beneficial for mental health.
Health Risks
The only potential risk of a daily-free diet is nutrient deficiency. It is important to ensure adequate intake of calcium, vitamin D, and other essential nutrients through alternative sources.
Additional Considerations
- Milk Soy Protein Intolerance (MSPI): Milk Soy Protein Intolerance, or MSPI, is a temporary infant intolerance to the proteins in milk and soy. Both breastfed and formula-fed babies can develop an intolerance to cow’s milk and soy proteins. This sensitivity means infants are unable to digest the proteins properly. In both allergy types, your baby is reacting to the proteins that get passed through your breast milk. As a result of the MSPI allergy, your baby will likely need more time for its gut to mature before you can introduce solid foods. Typically, your doctor may recommend that you wait until your infant is at least six months old before you introduce solids into their diet. The order of the food introductions for a baby with MSPI may be different than a baby without MSPI as well.
- Internet as a Source of Information: The most often declared source of information about lactation was Internet (85%). It's important to verify the credibility of online sources and consult with healthcare professionals for personalized advice.
- Maintaining a Healthy Diet: The majority of respondents also eliminated from diet highly processed food products, fast-food and the carbonated drinks. It's important to stay healthy while on an elimination diet. It can be hard to eat enough and eat healthy. Cow’s milk and soy substitutes can also be expensive. If you don’t think you can eat enough protein or calories, or the elimination diet causes a lot of stress, then it may not be for you.
Dairy-Free and Soy-Free Diet: Foods and Drinks to Avoid
Milk and soy products are in many foods - some of which are obvious, others are not. Eliminating dairy and soy from your diet can be a little confusing because of the way ingredients are listed on labels.
Start by looking at food label warnings. If a product contains milk or soy, it must be included in the ingredient list or state on the label as “may contain,” “processed in a facility that processes,” or “processed on equipment with.”
When reading the ingredient list, look for these ingredients when determining what to avoid in your dairy-free and/or soy-free diet.
Foods and Drinks to Avoid## Dairy and Milk Products to Avoid
Dairy/Milk Products to Avoid:
- Milk products, including milk, milk solids, milk proteins, and hydrolyzed proteins
- Yogurt
- Cheese, including cottage cheese
- Sour cream
- Cream
- Ghee
- Custard
- Pudding
- Half and half
- Nonfat dry milk
- Whey products, including whey protein and whey powder
- Casein/Caseinate
- Milk chocolate and most other chocolates
- Butter products
- Lactalbumin
Soy Products To Avoid
- Soy products, including soy protein and soy protein isolate
- Soy milk
- Soy flour
- Soy yogurt
- Soy beans
- Soy nuts
- Soy caseinate
- Soy sauce and teriyaki sauce
- Vegetable protein, broth, gum, and starch
- Tofu
- Miso
- Edamame
- Soy oil and Soy lecithin are okay
Dairy-Free and Soy-Free Options for Breastfeeding Moms
Now that you know what you Can’t eat, here are some options you can incorporate into your breastfeeding diet.
Drinks
- Water, including seltzer waters
- Milk substitutes, such as rice, coconut, or almond milk
- Fruit and vegetable juice
- Soda
- Tea
- Coffee
- Milk-free hot cocoa
Breakfasts, Lunches, and Dinners
- Eggs
- Fruits and vegetables
- Non-breaded meat (Tyson’s chicken nuggets and Van De Kamp’s fish sticks are okay.)
- Grains and starches, such as potatoes, rice, quinoa, and most pastas (Make sure there are no soy fillers in pastas.)
- Beans, including hummus
- Natural peanut butter and sun butter
- Chia seeds
Snacks
- Salsa and guacamole
- Pretzels, popcorn, plain potato chips, corn chips
- Most cereals
- Gummies and hard candies
- Most sorbets
- Specific brands of snacks, such as LaraBar snack bars, HyVee wheat crackers, Nabisco’s triscuits and Wheat Thins, Eat Smart veggie chips, and Keebler and HyVee animal crackers
Condiments
- Ketchup
- Mustard
- Miracle Whip
- Buttery spreads (a plant-based product that tastes like butter)
- Hershey’s chocolate syrup
Baking ingredients
- Butter flavored Crisco
- Guittard semi-sweet chocolate chips and Enjoy Life chocolate chips
- HyVee white cake mix
Certain brands, such as Enjoy Life and Kinnikinnick, also make products for dairy- and soy-free diets. Kosher products that are labeled Parve or Pareve are certified dairy-free. This is indicated by a circled letter “U” (with no other symbols or letters) on the label.
When eating out, be sure to remind your server about your dietary restrictions.
Breastfeeding and Maternal Diet: Additional Tips
Caloric Needs
Breastfeeding mothers generally need more calories to meet their nutritional needs. An additional 330 to 400 kilocalories (kcal) per day is recommended for well-nourished, breastfeeding mothers, compared with the amount they were consuming before pregnancy. The number of additional calories needed for a breastfeeding woman is also affected by her age, body mass index, activity level, and whether she is exclusively breastfeeding or both breastfeeding and formula feeding.
Vitamins and Minerals
Continued use of a prenatal vitamin after giving birth may exceed the iron and folic acid needs of a breastfeeding mother. The recommended dietary allowances (RDAs) are the average amount of a vitamin or mineral that meets the daily nutrient needs of nearly all healthy people. Therefore, diet alone may not ensure adequate nutrition for breastfeeding women. In these cases, breastfeeding mothers may benefit from taking a multivitamin supplement.
A mother's need for iodine and choline increases during lactation. The Dietary Guidelines for Americans recommend breastfeeding women consume 290 micrograms (mcg) of iodine and 550 milligrams (mg) of choline daily throughout the first year after giving birth.
Foods to Limit or Avoid
Generally, women do not need to limit or avoid specific foods while breastfeeding. Mothers should be encouraged to eat a healthy and diverse diet. However, certain types of seafood should be consumed in a limited amount. Fish is an excellent source of protein and contains essential vitamins and minerals. Yet breastfeeding women must be careful about the amount and types of seafood they consume. Most fish contain mercury that can pass from mother to infant through breast milk.
Caffeine passes from the mother to infant in small amounts through breast milk. This usually does not adversely affect the infant when the mother consumes low to moderate amounts. Irritability, poor sleeping patterns, fussiness, and jitteriness have been reported in infants of mothers with very high intakes of caffeine. If an infant appears to be more fussy or irritable after the mother consumes high amounts of caffeine, she should consider decreasing her intake.
Vegan or Vegetarian Mothers
Breastfed infants of women who do not consume any animal products may have very limited amounts of vitamin B12. Low amounts of vitamin B12 can put infants at risk of neurological damage from vitamin B12 deficiency. Iron may also be of concern.
Other Considerations
- Alcohol consumption: One common question we often hear from new moms is whether it is safe to have alcohol if you are breastfeeding. The answer is yes, but with some important considerations. Alcohol does pass through into your breastmilk. If you’re going to have an occasional alcoholic beverage, remember that it takes your body two to three hours to eliminate the alcohol from one serving of beer or wine. The more you drink, the longer it will take to eliminate alcohol from your body and breast milk.
- Dieting: Women, however, should not “diet” while breastfeeding. During your first three months of breastfeeding, it’s completely normal to see minimal weight loss; every individual and every pregnancy is different. Just know that over time, many women report that breastfeeding actually helps them lose pregnancy pounds!
- Balanced diet: As you breastfeed, it’s important to keep a healthy, balanced diet so you can get the nutrients you need. If you don’t have the nutrients needed for your baby within your diet, your body will draw on its reserves, which can eventually become depleted. As you decide what to eat, make sure you choose a variety of foods to create a fully balanced diet. You can have longer-lasting energy by eating complex carbs such as whole grains, cereals, fresh fruit, and vegetables. A healthy breastfeeding diet should be filled with nutritious, balanced foods.
- Foods that cause discomfort: Foods like broccoli, cabbage, Brussel sprouts, certain dairy products, garlic, chili pepper, or chocolate, have been known to cause babies to be irritable or gassy. What might cause your baby discomfort, however, is much different than eating something that your baby has an allergic reaction to. If you were to eat a food that caused your little one to have a reaction, the symptoms might include a rash or hives, congestion or hard time breathing, or green and mucousy stools.
- Celiac disease: Celiac disease is an autoimmune disorder that results in the inability to digest gluten. Celiac disease is hereditary - people with a first-degree relative with the disease have a 1 in 10 risk of developing it as well. Just because you don’t have it, doesn’t mean your baby can’t develop the disease. Luckily, a balanced, nutrient-based diet for breastfeeding doesn’t have very many wheat, rye, or barley staples. You should still stick to the food guidelines above to maintain a healthy diet - with the exception of pasta, and other foods that may have traces of gluten in the seasonings or ingredients of prepackaged food. Despite its name, buckwheat does not contain wheat in it or the gluten protein. If you already have celiac disease, it is very important for you to stick to a gluten-free diet during your pregnancy and as you breastfeed. If you consume gluten, the disease will become active and lead to a lack of absorption of nutrients that are crucial for both you and your baby. You shouldn’t feel the need to keep your baby on a gluten-free diet just because you are on one.
- Dairy-free journey: As a little treat (and a way to keep you motivated to stay on this difficult dairy-free journey), keep in mind that Oreos are dairy-free!
Benefits of Breastfeeding
Although there are many benefits to breastfeeding your baby, it’s important to note that not all women and babies are able to breastfeed and that’s okay! Breastfeeding is a natural way to provide your baby with nourishment and allows for bonding time with mom.
- Antibodies are passed to your child through your breast milk, which can protect them against infections, including respiratory and ear infections.
- You can use breastfeeding as a way to gauge overfeeding and prevent your baby from consuming too many calories.
- Your baby will be on the most effective path to optimal brain development.
- Breastfeeding helps your uterus get back to its normal size and shape.
- Producing breast milk for your baby burns a lot of calories! In fact, breastfeeding can eat up to 500 calories per day.
- Breastfeeding is convenient. You can often do it anytime, anywhere, on demand.
- Breastfeeding is cheap!
- Breastfeeding your baby will often delay ovulation, which means your body will not menstruate.
- Breastfeeding causes the release of prolactin, which keeps estrogen and progesterone levels low.
- Your body will naturally begin to change as it prepares for breastfeeding.
- The early days of breastfeeding can be tough on you, baby, and surprisingly, your partner! Just be prepared for ups and downs and know that with time, you’ll all get the hang of it!
- One of the first considerations is to be cognizant of what you eat -- and eat more! As you are preparing your meal plans, it is important to eat a balanced diet.
- If you’re looking to learn more about breastfeeding, we would strongly advise you to attend breastfeeding classes. Interested in learning more breastfeeding tips? Department of Health & Human Services Office on Women's Health 'Your Guide to Breastfeeding' offers tips and advice to help you on your breastfeeding journey.
- It’s normal to be thirsty when you’re breastfeeding. This is because of the increased amount of the hormone oxytocin. Oxytocin levels increase when your baby latches onto your breast, which causes your milk to flow. Breast milk is made up of almost 87% water, which is why it’s so important to stay hydrated. When your baby is drinking, so should you! Staying hydrated is really important for you and baby, but it can be challenging to remember to drink water as you navigate life with a newborn!
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