Elimination Diets

An elimination diet is one in which a person completely avoids one or more foods or food components. The most common food proteins that cause Allergic Proctocolitis in breastfed infants are milk and soy. Tips on following an elimination diet for those two foods are offered below.

Dairy

The Dairy Elimination Diet

If milk proteins bother your baby, you will need to remove all dairy foods from your diet. While some babies with Allergic Proctocolitis (AP) can tolerate the small amount of milk protein that will enter your diet from “hidden dairy” (those milk proteins added to processed foods), most mothers of babies with AP will need to cut out all sources of milk protein. The boxes below contain lists of dairy foods, names for milk proteins that may appear on labels, and tips on some surprising places to look for hidden dairy.

Dairy Foods
The following are common dairy foods that you will need to avoid on this diet:

  • Butter (and Ghee)
  • Buttermilk
  • Custard
  • Cream/Half-and-Half
  • Cheese (all kinds, including cottage cheese and cream cheese)
  • Ice Cream, Ice Milk, Sherbet, Frozen Yogurt
  • Milk (including non-fat or skim, low-fat, reduced-fat, whole, evaporated, condensed, dry, and lactose free)
  • Sour Cream
  • Pudding
  • Yogurt (and Kefir)

Removing obvious sources of dairy like the ones listed above may not be enough. Milk proteins appear in many foods in many different forms. By law, manufactured food products that contain milk as an ingredient are required to list the word “milk” clearly on or below the ingredient list. Below are some names for milk proteins that you might see in an ingredient list on a label.

Names for Milk Proteins on Labels
Below are some names for milk proteins that you might see in an ingredient list on a label.

  • Beta-lactoglobulin
  • Butter fat, butter oil, butter acid, butter ester(s)
  • Casein
  • Casein hydrolysate
  • Caseinates (in all forms)
  • Curds
  • Dry milk, milk solids
  • Lactalbumin
  • Lactalbumin phosphate
  • Lactoferrin
  • Lactoglubulin
  • Lactulose
  • Milk protein hydrolysate or hydrolyzed milk protein
  • Rennet casein
  • Whey (in all forms)

Some ingredients look like names for milk protein, but are not. Below is a list of ingredients that do NOT have milk protein.

NOT Dairy
The following ingredients do NOT have milk protein.

  • Calcium lactate
  • Calcium stearoyllactylate
  • Cocoa butter
  • Cream of tartar
  • Lactic acid
  • Lactose (may contain trace amounts of protein)
  • Oleoresin
  • Sodium lactate
  • Sodium stearoyllacylate

You would never guess that some foods have added milk proteins. Here are a few of the places milk proteins can hide:

Places Dairy May Hide
Milk proteins can show up in some unexpected places. Look carefully at foods like:

  • Artificial butter flavor
  • Baked goods (including bread)
  • Breakfast meats, like sausage and bacon
  • Broth
  • Caramel candies
  • Chocolate
  • Deli meats cut on the same slicer as cheese
  • Lactic acid starter culture and other bacterial cultures
  • High protein flour
  • Luncheon meat, hot dogs, sausages
  • Margarine, butter substitutes
  • Nisin
  • “Non-dairy” creamers or other non-dairy products
  • Nougat
  • Tuna, canned

Baking Without Dairy

There are many substitutes for milk in baking. Try replacing milk with the same amount of water, fruit juice or rice,almond, coconut, oat or hemp “milks”. Soymilk should be used only if you are sure your baby is not sensitive to soy. The vanilla and chocolate flavors of some of these milk substitutes could add to the flavor of your favorite recipe. Experiment!

Butter does contain milk proteins. Margarine and butter substitutes often do as well (whey is the most common milk protein used in these products). Butter-flavored shortening works well in some baked goods. If you are not eliminating soy, use soy-based products. If you are eliminating soy as well, try canola, grapeseed, or olive oil when baking. There are brands of dairy/soy free “butter” and shortening in the marketplace.

By law, manufactured food products that contain dairy, soy, wheat, peanuts, tree nuts, fish, or shellfish ingredients must say so on the product label. Look for bold or highlighted words in the ingredient list, the name of the allergen in parentheses after an ingredient, or a message in all capital letters at the end of the list.

Any food labeled “Vegan” will be dairy free. Be aware that these foods often contain soy. Foods that follow Jewish dietary laws must indicate if they contain dairy. Look for small markings on the front of the label: the word Parve or Pareve means the product is dairy-free. A circled “U” on a label also means dairy-free, unless it is followed by a “D” or “DE”. Again, these foods may contain soy, so look at the ingredient list.

Getting enough calcium if not eating dairy

When you are not eating dairy, it is important that you and your baby get enough calcium from other sources. The good news is that studies have shown that breastfed babies get plenty of calcium, even if mom is not eating dairy products. The bad news is, the calcium comes from your bones! All lactating women lose calcium from their bones, but studies have shown that the bone strength that is lost will come back after weaning.

It is strongly recommended that mothers eliminating dairy take 1,000mg of calcium a day in supplements. 500mg of calcium twice a day works best. 1,000-2,000 units of vitamin D3 daily will help with calcium absorption.

How to Get the Most from your Calcium Supplements
  • Your body uses calcium supplements best if you take 500mg or less at a time.
  • Calcium is absorbed better with a meal. Take supplements at meal time.
  • Take calcium supplements with orange juice, an orange, or at the same time as vitamin C. Vitamin C helps with calcium absorption.
  • Do not take calcium at the same time as iron. Neither will be well absorbed.
  • Calcium citrate is absorbed best, but other (less expensive) calcium supplements are fine.
  • Magnesium helps calcium absorption. Look for a supplement with some magnesium (2 parts calcium to 1 part magnesium is best).
  • Get a little morning or late afternoon sun! When the sun hits your skin, your body makes vitamin D, which helps with calcium absorption. Try 15 minutes, three times a week without sunscreen.
  • Cut out soda. Soda contains phosphorus, which can cause your body to lose calcium.
  • Always check with a doctor before starting any supplements.

You should also eat plenty of foods like the ones listed in the chart below:

High Calcium Foods
Food Serving mg
Calcium
Tofu, calcium processed* 1/3 cup 581
Sesame seeds, whole roasted 1 oz 412
Collard Greens, boiled 1 cup 226
Sardines, canned 2 oz 210
Molasses, blackstrap 1 Tablespoon 172
Bok choy (chinese cabbage), boiled 1 cup 158
Soybeans, cooked (Edamame)* 1/2 cup 130
Calcium-added ready-to-eat breakfast cereals 1 cup 100-300
Salmon, canned, with bones 2 oz 117
Turnip greens, cooked 1/2 cup 116
Black-eyed peas, cooked 1/2 cup 115
Broccoli, boiled chopped 1 cup 94
Almonds, dry roasted 1 oz (about 22 nuts)

*DO NOT EAT if avoiding soy protein

Note: In some foods, like spinach, calcium is bound to a substance called oxalate that makes it unavailable to your body. So, while spinach contains a good amount of calcium, it is not actually a good source of calcium.

Soy Elimination Diet

By law, any manufactured food containing soy protein must say so on the label. Check labels carefully, because soy is added to an increasing number of processed foods. Snack bars and breakfast cereals are frequently soy-fortified, but soy can also be found in a wide variety of foods, including baked goods, canned tuna, crackers, sauces, and soups. NOTE: highly refined soybean oil is generally considered safe, and will not be highlighted on food labels. Soybean oils labeled cold pressed,expeller pressed or extruded may contain some soy protein.

Soy Foods and Ingredients
  • Edamame (fresh soy beans)
  • Miso
  • Natto
  • Shoyu
  • Soy
  • Soy albumin
  • Soy cheese
  • Soy fiber
  • Soy flour
  • Soy ice cream
  • Soy milk
  • Soy nuts
  • Soy protein (hydrolyzed,
    isolate, concentrate)
  • Soy sauce
  • Soy sprouts
  • Soy yogurt
  • Soya
  • Soybean (curd, granules)
  • Tamari
  • Tempeh
  • Textured Vegetable Protein (TVP)
  • Tofu
Places Soy Protein May Hide
  • Asian foods
  • Protein-enriched foods (such as high-protein cereals, breads, bars)
  • Soybean oil (cold pressed, expeller pressed, or extruded)
  • Tuna, canned (in water or oil)
  • Vegetable gum
  • Vegetable broth
  • Vegetable starch

Help! What Can I Eat?

Being told you need to eat dairy and soy free can be overwhelming. Stay calm! The truth is, there are still lots of foods you can eat! The main building blocks of healthy meals (meats, poultry, and seafood; vegetables and fruits; nuts and beans (except soybeans); rice; potatoes; and grains) are all fine. And remember: this is a short-term situation. Here are some tips, recipe ideas, and links to get you started.

Internet sites for people with food allergies have great brand information, fabulous recipes, and terrific suggestions. See the Resources section for more information.

MEAL IDEAS

Meals with a mix of protein, carbohydrate and fat are the most satisfying. Some thoughts on how to put together dairy/soy-free meals are below. Rather than give specific recipe or brand ideas here, we have provided links in our Resources section to some terrific sites. When you have some favorite meals or recipes of your own, post them on the Guestbook page for everyone to try!

BREAKFAST

Add a glass of calcium-fortified orange juice to:

  • Oatmeal made with water or a dairy/soy-free “milk” such as almond milk (try vanilla flavor!). If you are short on time, some flavors of instant oatmeal are dairy/soy free. Mix in some almonds for added protein, calcium, and healthy fats. Use a little dried fruit for sweetness.
  • Eggs. Any style. Use cooking spray or a little oil to grease the pan instead of butter. Mix in chopped veggies for added nutrition. Add milk/soy free cheese shreds (like Daiya brand). Or top with salsa! Homefries, anyone?
  • Dairy/soy-free breakfast cereal with dairy/soy-free “milk”. To make this meal more nutritious and satisfying, throw in some fruit and grab a hard-boiled egg.
  • Here is a great breakfast sandwich that takes about 2 minutes to make: Toast a bagel or dairy/soy-free bread (frozen Lenders and bagged Pepperidge Farm are good bets. Check labels). Beat an egg in a microwave-safe small bowl or cup. Microwave 1 minute. It comes out fluffy and round! Put the egg on the bagel and enjoy! If you want, add some Daiya brand or other dairy/soy-free cheese.
  • Rice or coconut milk “yogurt” and fruit parfait. On the side, have peanut butter or hummus on half a small dairy/soy-free bagel, or a hard-boiled egg for protein.
  • Smoothie: Put half a banana and some dairy/soy free milk or yogurt in a blender. Add frozen fruit, even a little dark chocolate. Blend and enjoy! (Adding nut butter will add fat and protein, which will help hold you until lunch.)
  • Nutty Banana Wrap: Spread peanut or other nut butter on a dairy/soy free wrap. Put a whole banana in the center of the wrap. Sprinkle with chopped nuts, drizzle with honey, agave, or maple syrup. Roll and enjoy. (Also great warm!)
  • Nut-Free Banana Wrap: Spread a small amount of dairy/soy-free vanilla “yogurt” on a dairy/soy free wrap. Put a whole banana in the center of the wrap. Add berries, peaches, or other soft fruit. Sprinkle with dairy/soy free granola. Drizzle with honey, agave, or maple syrup if you want a treat. Roll and enjoy. (Also great warm!)
  • Who says breakfast has to be “breakfast foods”? Leftovers from lunch or dinner make a fine and healthy breakfast. (Eating a good-sized, balanced breakfast may actually help you lose weight!)

LUNCH

Finding or baking some dairy/soy free bread will make sandwiches and wraps an option, but there are plenty of other choices:

  • Salads: Start with lettuce or other greens and throw in any veggies you like. Look for dairy/soy free salad dressings, or shake up your own vinaigrettes. Top with cold sliced chicken, turkey, ham or beef, shrimp, fish, hard-boiled eggs, or beans for protein. Nuts, seeds, dried fruits, or mandarin oranges are great in salads. Get creative! For example: top lettuce with black beans, salsa, and diced avocado, and crumble some soy-free corn chips on top for a quick, delicious Taco Salad. Use last night’s chicken breast, canned mandarin orange slices, diced red bell pepper and chopped scallions for an Asian Salad. Rice crackers are great on the side.
  • Leftovers: Reheat last night’s dinner, or re-mix it creatively. For example: Chicken breast with rice and broccoli last night becomes chicken fried rice or a cold rice salad today. Taco fixings can become a taco salad or a Mexican-style stuffed baked potato. Meatloaf with green beans and boiled potatoes becomes a meatloaf sandwich with a side of potato/bean salad with vinaigrette. Last night’s pasta is today’s pasta salad!
  • Don’t forget about soups!
  • Look for dairy/soy-free frozen entrees.
  • GoDairy.com and other sites listed in our Recipes section have lots of good ideas!

DINNER

Mix and match from the columns below to put together a nutritious dairy- and soy-free meal:

Protein Starch Vegetables Fat
  • Poultry (chicken, turkey, duck)
  • Beef
  • Pork
  • Lamb
  • Fish/Shellfish
  • Beans
  • Eggs
  • Peanut or Nut butters
  • Pasta
  • Rice
  • Potatoes
  • Grains (barley, buckwheat, quinoa, etc.)
  • Any you like!
  • Eat them raw, or steam, sauté, boil, bake, roast, fry…anything without butter, cream sauce or cheese sauce should work!
  • Dairy/soy free spread
  • Dairy/soy free salad dressing
  • Avocado
  • Nuts
  • Dairy/soy free cheese substitute

SNACKS

Nutritionist’s Tip: Try to get some protein and fiber with your snacks to keep you feeling satisfied.

  • Dip pretzels, carrots, celery, or apple in 2 Tablespoons of peanut butter or other nut butter. Or sprinkle nut butter with 1 Tablespoon of raisins and eat with a spoon (yum!)
  • Scoop up hummus with rice crackers, baby carrots, or other veggies.
  • Smoothies (see breakfast ideas)
  • Trail mix: Mix nuts and dried fruit. You can add dairy-free chocolate chips for a treat!
  • The fiber in an apple makes it a very satisfying snack.
  • Popcorn. “Butter flavor” usually doesn’t mean dairy. Check labels. (3 cups is a serving!)
  • Munch on (calcium-fortified!)dry breakfast cereals.
  • Fill up with fiber-rich fruits and vegetables. Don’t forget about applesauce

DESSERTS

  • Sorbet (not sherbet)
  • Banana whip “ice cream” (puree frozen banana chunks with other fruits until smooth)
  • Rice dream or other dairy/soy free ice cream
  • Core an apple, drizzle with maple syrup or put brown sugar in the core hole, and bake.
  • Halve a grapefruit, spread with apricot preserves or marshmallow fluff, and broil until warm.
  • Dark chocolate (try dipping strawberries, bananas, or pineapple!)
  • Home baked dairy/soy free cakes and cookies. See Recipe Links for ideas.
  • Store-bought dairy/soy free desserts. See Resources section for links to sites with brand information.

Shopping Tips/Meal Planning

You are a tired and busy new mom with a family to feed! Meals and snacks may take a bit more planning than they used to, especially at first. Planning may seem like a luxury, but it will actually save you time in the end. Here are some planning strategies:

  • Set aside one hour a week to plan a week’s worth of meals. Use these recipes and meal ideas to make a shopping list.
  • Using a “cycle menu” can help: Come up with 7-14 days of meals and the shopping lists that go with them. Put the recipes and lists in a notebook. When you reach the end of the notebook, start over!
  • Stock up on non-perishable items you like.
  • Try shopping the same day every week. Scheduling time for this chore makes it less stressful.

Shopping Tips:

  • There is a lot of information on the Internet about dairy- and soy-free brands. Do some research before hitting the supermarket. You can even see ingredients and allergen lists in your favorite brands without leaving home! Take a list of possible brands/foods to the market with you.
  • Schedule one or two baby-free trips to local markets to track down the items on your list and read labels.
  • Look for local health food stores and specialty markets in your area.
  • Be prepared to try new things.
  • Don’t worry…it won’t take long to come up with your favorite new go-to foods and meals!
  • Foods with labels (processed or manufactured foods) have added ingredients that often include forms of dairy or soy.
  • At the bottom of the Nutrition Facts label on every box or can is an ingredient list. After this list, in bold print, will be a statement of allergen content. Soy and milk must be listed if they are in the product.
  • Shop the perimeter of the market — this is where the whole foods (without labels) are found.
  • Almost all snack bars have dairy or soy ingredients. Most breads do too.

Eating Out Allergen-Free

Eating out should be a pleasurable, relaxing experience. Eating out when you are trying to avoid common food proteins can seem anything but. Here are a few things you can do to make eating out easier:

  • Many restaurants have their menus on their websites. Take a look before you go so that you have some dishes in mind that might work for you.
  • Call ahead. If you call between prime meal times, you can often speak to someone in the kitchen about your needs and find out what they can do for you.
  • Chain restaurants should have nutrition information on their websites. It is even possible to read ingredient lists. Be sure to mention your needs to your server or call ahead anyway, in case there have been any changes.
  • Be aware of cross-contamination. Most babies with Allergic Proctocolitis will be fine if you ingest trace amounts of a protein that bothers them. Do be aware, however, that seemingly allergen-free foods can contain trace amounts of allergens if they are cooked with or stored with other foods. This is called “cross-contamination”. An example would be french fries deep-fried in the same oil as mozzarella sticks, or a deli meat slicer also used to slice cheese. In recent years, many restaurants have actively tried to decrease cross-contamination to protect their allergic patrons, but it never hurts to ask.
  • When you get to the restaurant, ask your server to let the kitchen know of your special needs. If you like, you can carry an allergy card (see the AP/Allergy Links in the Resources section)listing the ingredients you need to avoid. Hand a card to your server and ask them to give it to the chef with your order.
  • Be aware of some restaurant secrets: chefs usually pour butter over steaks and seafood before serving. They will leave it off if you ask!
  • Think about other hidden sources of dairy, such as cream or butter in mashed potatoes, buttered vegetables, or cheese in spaghetti or pizza sauce.
  • Become a regular! Frequenting a restaurant will help you know what to order, and help them know how to meet your needs, making the whole evening more relaxed.

The internet is a great source of information on allergen-free dining. Please see the Resources section for some references. There are many sites that offer advice on which restaurants and dishes will work for you. There is even an “app” to help you choose dairy-free fast food!