Dairy
What is Dairy?
Cow’s milk, while it contains a wide variety of nutrients, is one of the most common food sensitivities in children with autism, and the protein casein may be to blame. Many (but not all) children with ASD benefit from a dairy-free diet. The growing number of dairy-free alternatives makes this change easier than ever, though certain nutrients may need to be supplemented for picky eaters.
Cow’s milk is a great source of nutrients like calcium, potassium, vitamin D, and protein. If your child is sensitive to dairy, they can still consume adequate levels of these nutrients from other dietary sources (see each note for sources).
Calcium-fortified soy milk is considered part of the Dairy Group and can be an alternative to cow’s milk [1]. However, many children who are sensitive to milk also end up being sensitive to soy. See the note on Milk Alternatives for more ideas.
Pea Milk (i.e. Ripple) is dairy-free and contains 450 mg calcium per 8 fl oz, compared to 2% milk, which contains 300mg calcium. Both contain 8 grams of protein/serving, making it the closest milk alternative to meeting the nutrient contents of cow’s milk
When dairy is processed into products like cheese, the protein Casein can be found in the solid product (the curdles), while the protein Whey can be found in the liquid part left over [2]. Lactose is the natural sugar in milk.
Milk allergy is one of the most common allergies in children. The allergy can be outgrown with time, but this is not always the case. [2]
Evidence is conflicting on whether diets that contain milk are linked to autism. Some research mentions that milk may be linked with causing autism, and others say that excluding milk from the diet of an individual with autism is not conclusively a treatment. [3-4] Each person with autism should be individually evaluated to decide if milk avoidance is an appropriate approach.
Some research states that reduction of casein in the diet can improve behavior for individuals with autism. [8]
See the note on the Casein-Free Diet for more guidance on avoiding dairy.
A1 VS A2 milk
Milk contains two major proteins: casein and whey. Approximately ⅓ of the proteins found in milk consist of a specific casein called β-casein (pronounced: beta cay-seen).
Depending on the type of cow, the form of β-casein can be A1 and/or A2. Goat and Sheep’s milk are naturally an A2 β-casein milk. [14]
Most African and Asian cattle produce only A2 β-casein, while cattle from Australia, New Zealand, and Europe produce both A1 and A2 β-casein.
Conventional milk contains both A1 and A2 β-casein, while A2 milk contains solely A2 β-casein.
A2 milk has gained popularity in recent years as A1 β-casein has been associated with negative cognitive, gastrointestinal, and inflammatory effects. Refer to the research section at the bottom of the page for more information about these effects.
This difference seen between A1 and A2 β-casein is due to a molecule that is only released during the digestion of the A1 β-casein. This molecule is called BCM-7. It belongs to a class of chemicals that are known to have addictive properties. This may explain the “addiction” that can be seen in some people who drink conventional milk. [15]
Dairy Sensitivity and A2 Milk
See more above about the difference between A1 and A2 Milk. For more on the difference between an intolerance, sensitivity, and allergy, see the Food Reactions note.
An individual can be lactose intolerant and not allergic to the protein in milk or the lactose in milk. If an individual is intolerant, their body will not have an immune response, rather lacking the enzyme lactase that breaks down lactose. Milk intolerance requires different treatment from true milk allergy. In the case of an intolerance, the individual may tolerate A2 milk better than A1.
If an individual is has a dairy sensitivity, A2 milk may be better tolerated.
NOTE: For those that have a true dairy allergy, A2 milk would not be an appropriate beverage to consume as they will still have an immune response, and possibly dangerous allergic reaction. See ideas for better alternatives in the “A2 Milk Alternatives” section.
Although A2 milk may be a better option than conventional milk for those without a dairy allergy, this still may not be appropriate for kids with autism. For more on the dairy-free diet, click here.
Nutrient Breakdown
Dairy is a great source of a variety of nutrients, including:
When dairy is processed into products like cheese, the protein Casein can be found in the solid product (the curdles), while the protein Whey can be found in the liquid part left over. [2] Casein is the milk protein that gives cheese the ability to melt and stretch. [6] Whey is one of the prominent proteins within dairy products. [7]
Lactose is a sugar within dairy products that remains with the liquid during processing. For example, soft cheese has more moisture which means it will contain more lactose. Harder cheeses will contain less lactose.
Enrichment in Dairy Products
Some individuals with ASD are sensitive to some of the added vitamins, especially B vitamins, since they are often unmethylated. If this is a concern, unenriched dairy products are available (just read the labels).
Common vitamins enriched in dairy products include:
Foods Containing Dairy
Milk
Yogurt
Ice cream
Butter
Cream cheese
Kefir
Cheese
Cream
Ghee (though this is made from butter, it is typically tolerated by those on a dairy-free diet as it does not contain casein or lactose!)
Dairy Alternatives
Butter Alternatives
Miyokos (our personal favorite!)
Ghee (though this is made from butter, it is typically tolerated by those on a dairy-free diet as it does not contain casein or lactose!)
Earth Balance
Melt
Cheese
Miyokos
Kite Hill
Follow Your Heart
Daiya
[See more alternatives in the Casein-Free Diet note]
Food Reactions
Dairy Allergy
Milk allergy is when the body’s immune system reacts to milk and products containing milk via an IgE antibody reaction. Cow's milk is the usual cause of milk allergy, but milk from sheep, goats, buffalo and other mammals also can cause a reaction. There are two main proteins in cow's milk that can cause an allergic reaction: Casein and Whey. You or your child may be allergic to only one milk protein or to both.
An allergic reaction usually happens immediately after dairy is consumed. Signs and symptoms include wheezing, vomiting, hives, digestive problems and anaphylaxis. A severe allergy can be fatal if not addressed.
The best way to treat a true milk allergy is to avoid dairy products in the diet. [2]
Dairy Sensitivity
Dairy sensitivity is when the body’s immune system reacts to milk and milk products via a non-IgE antibody reaction such as IgE, IgA, IgM, or other immune-mediated reaction. The best way to treat a dairy sensitivity is to avoid dairy products.
Dairy Intolerance
An individual can be intolerant to the protein in milk or the lactose in milk, but their body will not have an immune response which means they are not allergic to dairy, but rather lacking the enzyme lactase that breaks down lactose. Milk intolerance requires different treatment from true milk allergy.
Signs or a milk protein or lactose intolerance mostly include digestive issues such as bloating, gas or diarrhea after milk products are consumed. [2]
DISCLAIMER: Always consult with your pediatrician and/or your Registered Dietitian to help you test for a food reaction or to aid you in making individualized dietary changes.
A Note on Food Reactions
The body can respond to foods in many different ways including food allergies, food sensitivities, or food intolerances. If you suspect a food reaction, you can either choose to avoid the food or seek food reaction testing. Click here more information on the difference in types of food reactions and testing options.
Supplements
Certain digestive enzymes can help break down lactose and/or casein and whey. This should not be used as a bandaid to following a dairy-containing diet, but can be helpful after accidental exposure.
Examples:
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Dairy & Autism in the Research
Milk, Good or Bad for Autism?
Evidence is conflicting on whether diets that contain milk are linked to autism. Some research mentions that milk may be linked with causing autism, and others say that excluding milk from the diet of an individual with autism is not conclusively a treatment. [3-4]
Milk and Behavior
Research is conflicting between dietary milk and behavioral changes in individuals with ASD. [7-11]
Some research states that reduction of casein in the diet can improve behavior for individuals with autism. [8]
Deficiencies
Individuals with autism have been found to have lower intake of dairy products. Dairy provides important nutrients like calcium that support bone health. Dietary approaches to help with autism include a casein free diet. Low calcium levels can be a concern for this population. [12]
Carnitine can be made in the human body or can be found in dairy products in the diet. Carnitine deficiency has been found within the autism population. Research is being done to find a connection between carnitine and critical periods of brain development linked with autism. [13]
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[1] Choosemyplate.gov. 2020. All About The Dairy Group | Choosemyplate. [online] Available at: <https://www.choosemyplate.gov/eathealthy/dairy> [Accessed 10 August 2020].
[2] Mayo Clinic. 2020. Milk Allergy - Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/milk-allergy/symptoms-causes/syc-20375101> [Accessed 10 August 2020].
[3] Turck D. Cow's milk and goat's milk. World Rev Nutr Diet. 2013;108:56-62.
[4] Jarmołowska B, Bukało M, Fiedorowicz E, et al. Role of Milk-Derived Opioid Peptides and Proline Dipeptidyl Peptidase-4 in Autism Spectrum Disorders. Nutrients. 2019;11(1)
[5] 2020. [online] Available at: <https://fdc.nal.usda.gov/fdc-app.html#/food-details/781089/nutrients> [Accessed 10 August 2020].
[6] Healthline. 2020. Nondairy Substitutes For 7 Common Dairy Products. [online] Available at: <https://www.healthline.com/nutrition/dairy-substitutes#section4> [Accessed 10 August 2020].
[6] Mayo Clinic. 2020. Whey Protein. [online] Available at: <https://www.mayoclinic.org/drugs-supplements-whey-protein/art-20363344> [Accessed 10 August 2020].
[7] Navarro F, Pearson DA, Fatheree N, Mansour R, Hashmi SS, Rhoads JM. Are 'leaky gut' and behavior associated with gluten and dairy containing diet in children with autism spectrum disorders?. Nutr Neurosci. 2015;18(4):177-85.
[8] Knivsberg AM, Reichelt KL, Høien T, Nødland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5(4):251-61.
[9] Lange KW, Hauser J, Reissmann A. Gluten-free and casein-free diets in the therapy of autism. Curr Opin Clin Nutr Metab Care. 2015;18(6):572-5.
[10] González-domenech PJ, Díaz atienza F, García pablos C, Fernández soto ML, Martínez-ortega JM, Gutiérrez-rojas L. Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial. J Autism Dev Disord. 2020;50(3):935-948.
[11] Monteiro MA, Santos AAAD, Gomes LMM, Rito RVVF. AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW ABOUT NUTRITIONAL INTERVENTIONS. Rev Paul Pediatr. 2020;38:e2018262.
[12] Panossian C, Lyons-wall P, Whitehouse A, et al. Young Adults with High Autistic-Like Traits Displayed Lower Food Variety and Diet Quality in Childhood. J Autism Dev Disord. 2020;
[13] Longo N, Frigeni M, Pasquali M. Carnitine transport and fatty acid oxidation. Biochim Biophys Acta. 2016;1863(10):2422-35.
[14] Küllenberg de Gaudry, D., Lohner, S., Schmucker, C., Kapp, P., Motschall, E., Hörrlein, S., Röger, C., & Meerpohl, J. J. (2019). Milk A1 β-casein and health-related outcomes in humans: a systematic review. Nutrition reviews, 77(5), 278–306. https://doi.org/10.1093/nutrit/nuy063
[15] Kurek, M., Przybilla, B., Hermann, K., & Ring, J. (1992). A naturally occurring opioid peptide from cow's milk, beta-casomorphine-7, is a direct histamine releaser in man. International archives of allergy and immunology, 97(2), 115–120. https://doi.org/10.1159/000236106
