Managing Dairy Free Diets
Elderly people can be particularly susceptible to malnutrition for a number of reasons, so Tess Warnes, our Registered Dietitian, focuses attention on managing dairy free diets in a care home setting.
An increasing number of people are now excluding dairy from their diet, for a multiple of reasons such as environmental, dairy allergy or lactose intolerance. Managing dairy free diets in a care home setting can have its challenges, because dairy products are often nutrient rich and therefore an important way for residents to meet nutritional requirements. However, with careful management and consideration these issues can be well managed.
Why might someone exclude dairy from their diet?
- As part of a vegan diet or reducing animal product consumption
- Milk allergy
- Lactose intolerance
Vegan diet – Someone following a vegan diet will exclude all animal products from their diet. Many people are now trying to reduce their meat/milk consumption to lessen the impact on the environment.
Milk allergy – a cow’s milk protein allergy is where the body’s immune system reacts to the protein found in milk. Signs and symptoms of cow’s milk allergy usually occur within minutes of contact with cow’s milk but can also occur up to one hour later. Most allergic reactions are mild but they can also be moderate or severe, including causing an anaphylaxis reaction. Goat or sheep milk will not be suitable for someone with a milk allergy as the protein is very similar.
Lactose intolerance – is when the sugar in milk (called lactose) cannot be digested. Some cheeses are naturally low in lactose so are often suitable e.g. Edam, Cheddar, cream cheese. For those with lactose intolerance, lactose free milk, cheese, ice cream and yoghurt products are available. These have all the nutritional benefits of cow’s milk, but just without the lactose. These products however are not suitable for cow’s milk allergy because the protein content is unchanged.
There are a number of challenges associated with a dairy free diet
- Meeting nutritional requirements
- Sourcing alternative milk free foods
- Cooking with milk free foods
Older adults are at higher risk of malnutrition. Malnutrition is a major public health issue costing the NHS over £19 billion per year in England alone. There are approximately 3 million people in the UK who are malnourished or at risk of malnutrition; 93% are living in their own home, 5% are living in care homes and just 2% are in hospital (Elia M, Russell C. 2009. Combating Malnutrition: Recommendations for Action. Report from advisory group on malnutrition led by BAPEN). Consequences of malnutrition include:
- increased risk of illness and infection
- slower wound healing
- increased risk of falls
- low mood
- reduced energy levels
- reduced muscle strength
- reduced quality of life
- reduced independence and ability to carry out daily activities
Many older people in residential care accommodation are undernourished, either through previous poverty, social isolation, or personal or psychological problems, or due to the effects on appetite of illness or medication. Although total energy requirements decrease as we get older, often older adults’ intake can be less than the body needs, which then means the level of nutrients in the diet can become dangerously low, leading to a vicious circle of muscle loss, even less activity and even lower appetite.
Dairy and dairy products are considered a nutritious and easy way to increase calories in individuals’ diets, as well as increasing the nutritional intake. Dairy is high in calcium, phosphorus, vitamin A, vitamin D (in products fortified with vitamin D), riboflavin, vitamin B12, protein, and magnesium. Excluding diary from the diet could leave someone at high risk of malnutrition.
Choosing alternatives to milk, yoghurt and custard that are fortified with calcium is essential. Many now contain as much calcium as you would find in cow’s milk (120mg per 100mls). Ensure that for every dairy dish on the menu there is an equivalent dairy free dish, which has fortified milk/dairy free cream added to boost the calories if needed. Below are some ideas to boost the calories/nutrients for those struggling:
- Use soya alternatives to meat, yoghurt, milk and custard
- Add soya/oat cream alternatives to porridge
- Add peanut butter to smoothies
- Add cashew nuts or silken tofu to soups and blend
- Use crumbled tofu and vegan mayonnaise as a sandwich filling
- Add olive oil to vegetables
- Add vegan spread to potato
There is a large range of milk alternatives now on the market which makes creating a dairy free menu much easier. Below are a few examples:
- Milks – oat, soya, flaxseed, sesame, rice, pea, coconut, quinoa, hemp, potato and nut* (e.g. almond, hazelnut, cashew)
- Spreads – milk free and vegan spreads
- Cheese – hard, soft, melting and parmesan varieties of milk free cheeses based on soya, pea, cashew, almond, rice or coconut
- Yoghurts and desserts – soya, pea, coconut, oat, almond* ice creams and frozen desserts – soya, rice, coconut, almond* and cashew*
- Creams/ crème fraiche – soya, oat, rice, coconut and almond*
- Lactose free milk, yoghurt, cheese – NOTE these are only suitable for these with lactose deficiency, they are NOT suitable for milk allergy sufferers or those following a vegan diet
* Avoid nut-based milk alternatives if you have/are at risk of a nut allergy
Cooking with milk alternatives
Often the same recipes can be used with substituted meat free products. However, some milks are suited to different things, so here are some helpful hints:
- Don’t add soya milk to coffee as it tends to curdle (go lumpy) but it is fine in tea. Oat milk works well in coffee.
- Use plain soya or coconut-based yoghurts, coconut milk or oat cream/ crème fraiche when making curries, raita, stroganoffs, creamy sauces and dips.
- Egg white replacer can be used to make a dairy free and soya free whipping cream.
- Grate hard cheeses on the fine part of the grater.
- Use a milk free melting cheese on pizza, cheese on toast and on lasagne.
- Use a non-melting hard cheese to make cheese sauces. Using a microwave will stop it sticking to the bottom of the saucepan (which also works for milk free custard and porridge).
- Use milk free soft or cheese or dairy free sour cream in dips, cheesecakes and other savoury and sweet spreading sauces.
A dairy free diet in summary
With the large growth in veganism over the last few years, catering for an individual on a dairy free diet is considerably easier now, with such an extensive range of products. The key is to ensure that there is always a nutritious dairy free alternative for those needing it on the menu, and to give careful consideration to the nutritional profile of these dishes aiming to match them to the dairy equivalent as much as possible.
Working with Tess and her team at allmanhall will enable care home catering teams to ensure that their residents are being provided with quality ingredients which are both nutritionally balanced and meet dietary requirements. Do contact Tess at email@example.com for more guidance and expert dietetic advice.