I wanted to talk a little bit about milk alternatives today. We’ve already talked about diet and how it’s necessary to cut out things that may cause an inflammatory response and one of those is dairy. It’s a real struggle for a lot of people, myself included. I thought I would be okay with it but I actually really miss cheese and I’ve yet to find a commercially available cheese alternative that really hits the spot. Milk or cream are hidden in absolutely everything, from crisp flavourings, to soup thickeners, to patisserie. One of the mistakes I made early on was to order dairy free chai lattes from various high street cafe chains thinking that was okay, only to later discover that the ones who make it with powder instead of syrup aren’t dairy free because the powder has powdered milk in it. Same with most commercially available hot chocolates.
So how can you avoid it? A lot of specialist items are labelled dairy free but the other label to look for is vegan. Most vegan products aren’t made with any kind of dairy (or egg) because obviously those are animal products. You may find that including vegan in your search for items will give you a much wider range than just searching for dairy free. If you are in a cafe and looking at the menu and you see something that would ordinarily be made with regular milk, ask the waiter/barista if there’s any kind of milk powder in it before ordering a dairy free alternative. You don’t have to be ashamed or embarrassed or in any way guilty. It’s their job to know the allergens in their products and if they can’t give you an answer then the safest thing is to avoid it.
The good news is that there are a lot of milk alternatives on the market right now, from soy to various nut milks, to rice and oat milks. The first thing to avoid is the sweetened versions, because you can’t forget that you also need to lower sugar consumption. There are a couple of other considerations to take into account as well.
Soy has long been argued about as it contains phytoestrogens and flavonoids. There’s very little scientific research out there about its direct effect on women with PCOS and what research there is is very mixed. One of the bigger studies concluded that its use is favourable because it lowers, amongst other things, LH, low density lipoprotein cholesterol and also testosterone in the blood. These are all good things. However, the fact that soy contains phytoestrogens which mimic regular oestrogen in the body have caused a lot of controversy over the actual impact on the menstrual cycle. For example, a small study from 1994 concluded that soy’s interference with hormone levels that would normally regulate the follicular phase of the menstrual cycle can actually lengthen that phase and therefore lengthen the cycle. With all of the arguments for and against soy, probably the most comprehensive review I’ve found of the whole issue concludes that soy is okay to ingest in low levels. So it’s okay to have it in your tea and coffee and cereal, but if you’re going to have several soy based lattes a day then it’s not a good idea to also start including tofu and soy proteins into your meals as well.
The other milk that I would advise caution with is oat milk because it will often contain gluten. While oats themselves don’t have gluten in, they do contain a protein called avenin which has a similar structure to gluten. The other issue is that oats are often processed in the same places as wheat, barley and other gluten containing grains. This makes them liable to contamination. While you can by certified gluten free oats, it’s a little harder to find certified gluten free oat milk. There’s a great page on the Coeliac UK website (which you can read here) that tells you pretty much all you need to know about oats and whether or not you should consider eating/drinking them.
So what do you do if you’ve tried all the available milk alternatives and just can’t find one that’s right for you? It’s not good in your coffee or it’s not working in your recipes? Well all is not lost. There is some evidence that it’s not the lactose in milk that we really need to be concerned with, but that it’s the A1 type B-casein that causes the majority of people’s intolerance to milk and there are certain dairy products, such as butter and cream, that only contain traces of casein per serving. Depending on how strict you want to be and how much you’re prepared to compromise the management of your PCOS, you may be willing to take that risk. The second dairy alternative is milk from sources that produce A2 milks, meaning milks that contain A2 B-casein instead of A1, or at best contain only traces of A1 B-casein. Examples of these milks are from Channel Islands or southern French cows, Asian cattle and some things like sheep, goat, buffalo or donkey milk. Unfortunately with cows, unless they are heritage herds with a really long history and have been tested as homozygous for the A2 protein gene only, there’s a lot of potential for there to be a blend of A1 and A2 B-casein in them. Basically, if you decide you want to try milk from specific breeds or other animals, such as sheep or goats, do your research first and read the labels carefully. A label stating “naturally contains A2 B-casein” means that it still contains A1 B-casein. You are either looking for “A1 casein free” or “A2 only certified milk”. I also found this interesting article from a cheese stockist and while it doesn’t appear to be scientifically linked to any actual research, and should therefore be taken with a LARGE pinch of salt, it does have an interesting theory that matured and aged cheeses should be okay, even when made from A1 milk. The reason they provide for this is that the milk used to make the cheese undergoes a process called proteolysis (breaking down of proteins) as it ages. The more aged it is, the more protein has been broken down and that includes the casein proteins. Again, it’s up to you how much you are prepared to compromise and take risks. In any event, do your research before you try.