Q&A with dietitian Helen Bond about milk

Helen BondWe invited you to submit your questions about cows' milk and alternative options to consultant dietitian Helen Bond, as part of a sponsored webchat in July 2012.

Helen is a state-registered dietitian and operates her own practice in Derbyshire. St Helen's Farm is a goats' milk dairy and has been farming since 1986. It is based in 500 acres in East Yorkshire.
 

Pregnancy and breastfeeding | Adult health | Goats' milk | Other

 

Pregnancy and breastfeeding

Q. Susieloo: I'm 37 weeks pregnant and craving milk and yoghurt. I am drinking around three pints of milk daily and my appetite has decreased, so I can only manage very small meals. Is it OK to drink this much on a daily basis? Aside from calcium, is there any other specific nutritional benefit that my body is in need of hence the constant craving?

A. Helen Bond: There is a theory that cravings when you're pregnant are our body's way of going after nutrients that the body is short of, so perhaps your craving of milk and dairy products may simply indicate that your diet needs more calcium. But this theory isn't proven.

However, milk is one of the most complete foods in our diets as it contains many of the nutrients that we need for overall health and wellbeing, protein, fat and carbohydrate, as well as essential vitamins (such as vitamins A and D) and minerals such as calcium and phophorus. On top of helping you meet your nutrient needs, drinking milk will help to keep you well hydrated.

One thing to watch out for - as with any dairy product - is the fat content, including unhealthy saturated fat, which can vary a lot. Look at the nutrition information on the label and to make a healthier choice, go for low or reduced fat milk and dairy foods.St Helen's Farm

Whilst drinking this much milk will not do you or your baby any harm, eating too much of any food at the expense of others can become unhealthy, even if it's a food packed with as many nutrients and potential benefits as milk.

By itself, the product is highly nutritious, but it's important to eat it in conjunction with a balanced diet and keep your total calorie count in check. If you can, I would try reducing your milk intake a little, as it should help to stimulate your appetite for other foods. If you have any concerns about yours or your baby's health you should consult your GP, midwife or health visitor. Good luck!

Q. Herethereeverywhere: I'm breastfeeding at the moment, and have found that when I have dairy products, my five-month-old son suffers with bad trapped wind and stomach pains, so I cut it out of my diet and now he is a lot better. Is this reaction likely to carry on as he gets older? Will he still be having a reaction to cows' milk at 12+ months?

A. Helen Bond: If you think your baby is reacting to cows' milk, I would advise that you make an appointment to see your GP, so that they will be able to assess whether your baby's symptoms may be down to an allergy to cows' milk protein or if there may be another cause.

If a cows' milk protein allergy is confirmed, a paediatric dietitian with experience of allergy will be able to offer you tailored advice on suitable (hypoallergenic) alternatives to cows' milk formulas and cows' milk substitutes should you choose to stop breastfeeding in the future, how to avoid cows' milk in processed foods during weaning and - especially relevant to you while you are breastfeeding - advice on avoiding foods that contain cows' milk in your own diet, while ensuring that you have a healthy balanced diet, rich in calcium.

"Cows' milk protein allergy is one of the most common food allergies to occur during early infancy, affecting between 2-6% of UK children, but thankfully most children do outgrow their milk allergy by school age"

As you have experienced for yourself, some milk proteins do get through to the breast milk and this can cause some babies to react - especially those who are very sensitive to cows' milk.

Most food allergies occur during early infancy, and cows' milk protein allergy is one of the most common affecting between 2-6% of UK children, but thankfully most children do outgrow their milk allergy by school age, although some may outgrow it much earlier, and others never do.

Q. Hackster: My 22-month-old daughter has been diagnosed with an allergy to dairy, wheat and egg. I breastfed her until 11 months because of it, tried her on formula at four months to prepare for going back to work and her reaction was scary. Worryingly, I felt like a bad mum early on as her weight gain was so poor - typical symptom of a milk allergy baby. I often worry about her diet and obviously calcium is a concern.

She is currently on neonate advance, and I know that's expensive but she seems to have eczema flare-ups with soya milk, oat milk and rice milk. I feel a bit concerned and although we're finally in the system, we feel on our own to deal with it day to day.

A. Helen Bond: I'm sorry to hear of your experiences, and hope that now that you are in the system, you will get the support and advice that you need from an allergy and intolerance specialist dietitian. I understand your concerns, but rest assured you have given your daughter the best possible nutritional start by breastfeeding her for 11 months. Neocate Advance is a nutritionally complete, hypoallergenic formula, which is designed specifically for children like your daughter, with multiple food allergies. It will deliver all of the nutritional support her body needs, providing that she is consuming the recommended amount.

Your daughter can continue on Neocate Advance up until the age of 10, but from the age of two years with a nutritionally complete diet and good growth, suitable cows' milk alternatives would include calcium-enriched soya and oat milk, which you have tried, but also almond, pea, coconut, and potato milks, or the more rare alternatives such as quinoa drink and chufa milk made from tigernuts. Always check with a health professional before making the switch.

Rice milk is not actually advised before the age of four and a half, some milk-allergic children may react to soy and are also at high risk of reacting to goat/sheep milk. Always keep in mind that most children outgrow their allergy and so regular reviews are needed with your allergy consultant/health professional.

Q. mummie03: I have an eight-month-old daughter, and I've been told she's suffering from 'reflux', and have also found out she's milk intolerant. The dietitian has tried lots of different types of milk on offer, like Infasoy, and Nutramigen Lipil, but to little avail. I'm weaning her but she's still throwing up (four hours after a meal), even though I am very careful to keep milk products away from her, and I'm giving her Domperidone, Gaviscon powder, Lactulose, etc.

She's slightly above the 25th centile and looks about six months, so is there any milk product out there which is high enough in energy to help her catch up? My GP is not being very helpful.

A. Helen Bond: I am sorry to hear of your troubles. If she still has the ongoing symptoms you describe with Nutramigen Lipil, I think you need further health professional advice as to whether your baby is on the correct formula.

In general, extensively hydrolysed formulas such as Nutramigen Lipil 1 (suitable for babies from birth) and Nutramigen Lipil 2 (suitable from six months) are regarded as hypoallergenic and provide a well-balanced diet for children with allergy-induced disorders. If the underlying problem is a cows' milk allergy, then it may be that the very small amount of milk protein in Nutramigen is causing the persistent symptoms. Changing to an amino acid formula that is completely broken down and 100% free of milk proteins - Neocate LCP or Nutramigen AA, Neocate Advance and Neocate Active (suitable for one year) - may well help, so please ask for advice on this from the dietitian or doctor.

Q. Gracegrape: After suffering badly from reflux as a baby, my daughter has not had any cows' milk or other dairy product since the age of six months. The paediatrician suggested she may suffer from an eosinophilic disorder. She had Neocate formula until the age of two and currently drinks oat milk, which we also use on cereal and in cooking.

Currently, at the age of 27 months, she is not suffering from any symptoms so I am considering trying a reintroduction to dairy products. When/how should I try this? Is it better to try products such as cheese or yoghurt first?

A. Helen Bond: Fortunately, a cows' milk allergy is one of the food allergies you do tend to outgrow with most cases being resolved by school age, so there's a good chance that your daughter will be able to enjoy dairy in her diet once again in the future.

"It is very important that you discuss the idea of reintroducing dairy into your daughter's diet with a qualified health professional, as children who are sensitised to cows' milk or have a history of severe immediate type symptoms, should always be challenged in hospital, because of the risk of a reaction."

This is why regular reviews are always recommended with your child's allergy consultant or dietitian to determine your child's ongoing tolerance to cows' milk. It is very important that you discuss the idea of reintroducing dairy into your daughter's diet with a qualified health professional, as children who are sensitised to cows' milk or have a history of severe immediate type symptoms, should always be challenged in hospital, because of the risk of a reaction. Those with delayed type symptoms and no history of IgE mediated cow's milk allergy may be allowed to undergo a milk challenge at home or in the community. Again your health professional will advise you.

The kind of food challenge performed on your daughter will depend on the practice and procedures used at your daughter's allergy clinic and on her doctor. They may also decide to repeat skin-prick tests, blood tests (measuring the amount of IgE antibodies) or undertake a cows' milk challenge to check if your daughter is still allergic.

You daughter may also be trialed on something called a 'milk ladder' as many milk allergic children can tolerate 'cooked' versions of milk, despite still being reactive to cows' milk. There are different milk ladders but they can include a malted milk biscuit, muffins, cakes and biscuits containing milk, baked lasagna, cheese, yogurt or milk as a drink. Good luck.

Q. Bookworm15: My daughter is 10 months, and has milk, wheat and egg allergy
She is now on Neocate LCP, but how much should she be drinking a day? I can only get about 12oz into her. What milk could she move onto at 12 months instead of formula?

A. Helen Bond: Unfortunately, I am not able to offer your specific dietary advice today, I would suggest that you speak with your GP, pediatric/specialist allergy dietitian or health visitor, as approximately 50% of children with cows' milk protein allergy continue to show reactions to milk after the first 12 months of life. They will be familiar with your daughter's medical history and in a better position to advise you on follow-on milks and formula, as well as helping to ensure that through weaning your daughter's diet is balanced and varied, and appropriate to her age and development. Your child's allergy history and assessment (weight, food and fluid intake) will all be taken into consideration.

Neocate LCP formula is based on the building blocks (amino acids) that make up a protein. It is nutritionally complete and often used in the dietary management of cows' milk allergy, as well as multiple food protein intolerances. Neocate LCP is generally suitable for infants from birth to 12 months and their follow on formula Neocate Active or Neocate Advance suitable from one year. If you require further information on the use of Neocate products, it may be useful to also contact the manufacturer Nutricia directly on 01225 751098. Guidance for a 10 month old, solely on Neocate LCP is 8 fl oz, five times a day.
 

Adult health

"There is a belief that milk and dairy products increase the production of mucus, but this has no scientific basis"

Q. Beachhutbetty: I have bad sinus problems and produce lots of mucus. I've been told in the past that switching to goats' milk would help alleviate the problem. Is this true, or is animal milk in general the problem as I have also been told?

Also, I hear a lot about lactose intolerance but we have a history of milk protein allergy in the family, how common is this and how high in milk protein is goats' milk compared to cows' milk?

A. Helen Bond: I am sorry to hear of your sinus troubles. There is a belief among some people that the consumption of milk and dairy products increases the production of mucus. This has no scientific basis, and may lead to unnecessary exclusion of a food group, which can provide such a vast array of nutrients essential to good health.

Many people claim to experience real improvements in catarrh and mucus by switching to goats' milk, although most of the evidence is anecdotal and robust scientific studies are needed to back up these testimonials.You could try experimenting to work out (through a food and symptom diary) whether making the switch to goats' milk would benefit you.

Regarding the total protein content of cows' and goats' milk, they're very similar (3.3g/100ml, compared to 3.7g/100ml in goats' milk) and the protein homology of cows' and goats' milk ranges from 88%-95% depending on the protein fraction, meaning that if you have a cows' milk protein allergy, you are at high risk of reacting to goats' and other mammalian milks.

Cows' milk allergy is more common in children (2-6%) than in adults (0.1-0.5%) and it is estimated that around 5% of adults in the UK have lactose intolerance. A propensity to allergies tends to develop due to genetics.

As consultant paediatric allergist Dr Adam Fox explained in a previous Mumsnet Q&A session, if both parents have an allergic tendency then a child has an 80% chance of also having some form of allergy. However, the exact allergy or allergies that the child develops seems to also depend on environmental factors.

If you feel you want to know more about milk allergies and intolerances or get yourself tested, then seeing an allergist should be helpful - ask your GP about a referral.

Q. BabyOES: My other half has high cholesterol. He loves dairy products and has been trying to cut these out of his diet but doesn't have very good willpower! We've tried a few milk substitutes (soya, rice, oat) but they taste awful! Am I right in thinking goats' milk is as high in cholesterol as cows' milk? What alternatives would you suggest for a dairy lover?

A. Helen Bond: According to the Composition of Foods, by McCance and Widdowson, goats' milk is naturally slightly lower in cholesterol than cows' milk, but when you are looking for dietary ways to improve your cholesterol levels and keep your heart healthy, it is cutting your saturated fat intake that has a much bigger impact.

Saturated fat is found in full-fat dairy products, like milk, butter cheese and cream, fatty cuts of meat, sausages and bacon also 'hidden' in pies, cakes and biscuits. Try not to eat more than the recommended amount of saturated fat - 20g per day for a woman and 30g per day for a man. Food labels are there to help you: high is more than 5g saturates per 100g, low is less than 1.5g saturates per 100g.

You don't need to give up your love of dairy, just choose low-fat and low-saturated fat varieties wherever possible - for example fresh semi-skimmed goats' milk is low in fat and saturated fat, while the skimmed goats' milk is virtually fat-free and cholesterol-free.

The plant-based milk, oat milk, contains a soluble fibre, beta-glucan that has been linked to lowering cholesterol levels.
 

Goats' milk

"Goats' milk is nutritionally closer to cows' milk than other milk alternatives, which means it naturally contains all of the milky goodness needed for good health, growth and development."

Q. Wiltshirekid: On holiday last summer my eight-year-old daughter picked up a bad tummy upset and since then cows' milk to drink seems to trigger a relapse of digestive problems. I have tried all sorts of alternative milks, and she prefers goats' milk, which doesn't upset her stomach. Is she missing out on any nutrition by not drinking cows' milk?

A. Helen Bond: Sometimes the small intestine stops making lactase (the enzyme needed to break down the milk sugar lactose) after a tummy upset but this secondary type of lactose intolerance usually resolves itself and as the lactose-free milks you tried did not ease your daughter symptoms, I don't think this was the cause.

You will be pleased to hear that goats' milk is nutritionally closer to cows' milk than other milk alternatives, which means it naturally contains all of the milky goodness needed for good health, growth and development. As it is helping to keep your daughter's tummy problems at bay, it is an ideal milk alternative for your daughter to enjoy. Goats' milk has certain physical properties that set it apart from cows' milk and are thought to be beneficial for digestion and comfort by allowing the goats' milk to form a softer curd during digestion.

You are certainly on the right track to ensure that your daughter is having enough calcium in her diet. One (250ml) serving of goats' milk will provide around half the daily calcium needs of an eight-year-old child (children aged 7-10 years need 550mg/day).

As you know a good supply of calcium is essential from early childhood to ensure the development of strong, healthy bones and teeth and help prevent osteoporosis in later life.

Q. Kitkit70: My 10 month old has been having whole goats' milk on his cereal and goats' milk yoghurt as a dessert since we started weaning him at six months, alongside follow-on formula.

I introduced regular yoghurt and he seemed to have a slight eczema reaction, which is why I switched. However, I am slightly concerned as I read that goats' milk is unsuitable for babies under a year old. I'd be grateful if you would clarify that it safe and put my mind at rest.

A. Helen Bond: Goats' milk is excellent milk for children as it is a natural source of nutrients providing a wide range of vitamins and minerals including calcium, needed to build healthy bones and teeth. Eczema is quite common, particularly in young kids as they first go to cows' milk, and by switching to goats' milk, like you, many people claim that it has helped ease their symptoms.

"Goats' milk is not suitable for children with a diagnosed allergy to cows' milk, so if you ever suspect that your baby has a cows' milk protein allergy you should seek advice from your doctor or dietitian - ask your GP to refer you."

However, goats' milk is not suitable for children with a diagnosed allergy to cows' milk, so if you ever suspect that your baby has a cows' milk protein allergy you should seek advice from your doctor or dietitian - ask your GP to refer you.

Goats' milk should be introduced into a child's diet in exactly the same way as cows' milk. Both are not suitable as a main drink until after 12 months of age. However, pasteurised full-fat cows' and/or goats' milk can be used with your babies cereal/to make porridge or in cooking after six months, for example if you were going to make custard or a cheese sauce.

When you choose dairy products for your child like cheese and yogurt, always choose full fat versions. Semi-skimmed milk, from cow or goat is not suitable for babies and children under two years of age, because it has fewer calories and children need the energy from the higher fat content of whole milk and the fat-soluble vitamins that are in it.

Q. Ellasbestmum: After two years of visiting A&E very regularly, and three stays in hospital, it was suggested that my 16-year-old daughter might be lactose intolerant. From that day she was fine until she had goats' cream and she ended up with severe stomach pains. Goats' milk, cream etc has almost as much lactose as cows' milk so be aware. The Lactofree range has been a life saver for her - it is normal cows' milk with the lactose removed and tastes the same.

A. Helen Bond: Goats' milk, like cows' milk does contain the milk sugar lactose, so may provoke symptoms in anyone who is lactose intolerant. As well as Lactofree, there are several plant-based milk alternatives such as soya, rice, oat, almond, coconut, potato and even pea milk that do not contain lactose, so are ideal for anyone who is very sensitive to lactose.

Treatment for lactose intolerance very much depends on how sensitive the individual is to foods that contain lactose. For some people with a lactose intolerance even a small amount of lactose (ie milk in tea or coffee) will trigger a reaction, whereas most can tolerate small amounts of dairy products (eg a small glass of milk, some yogurt, small chunk of hard cheese, such as cheddar), particularly if these are eaten as part of a meal.

If your daughter decides to experiment (through a 'food and symptom' diary) with what she can and can't eat, to find her own personal tolerance level, make sure that she introduces new foods gradually rather than all at once.

Q. shockers:  DS got terrible stomach cramps when he drank cows' milk. I often wonder if it's because I FF him (no choice, he's adopted). I switched him to goats' milk at 11.5 months and he's been fine ever since (apart from when he's stayed at other people's houses and eaten cereal with cows' milk).  He's strong and fit, has good teeth and strong bones (plays rugby!), and the eczema and upper respiratory problems he suffered with as an infant, disappeared at the same time as we changed milk... but that could be a coincidence.

A. Helen Bond:  As cows’ milk allergies are often outgrown in early childhood, it is possible to think that switching to goats’ milk helped ease your son’s symptoms, when in fact it may just have been the natural course of the disease. Goats’ milk is not recommended as a substitute for a diagnosed cows’ milk allergy because some of the proteins in goats’ milk are similar to those found in cows’ milk and often causes similar reactions.

However, like you many people claim to experience considerable improvements in conditions such a eczema and digestive discomfort by switching to goats’ milk - although most of the evidence is anecdotal and scientific studies are needed to back up these testimonials. It is believed that it has much to do with the protein structure - goats' milk has a lower aplha-s1-casein content allowing the goats' milk to form a softer curd in the stomach. Also, goats’ milk has smaller, finer fat droplets, which may further add to ease of digestion. These properties, may go some way in helping to explain why your son’s eczema, upper respiratory problems and tummy troubles are better with goats’ milk rather than cows’ milk.

By giving your son lots of goats’ milk to drink you have certainly  "invested" in his teeth and bone health. A good calcium intake during childhood, adolescence and early adulthood, when the skeleton is still growing, is vitally important to maximise bone density and help to reduce the risk of osteoporosis and fractures later in life.

Milk and dairy products, including goats’ milk are a great way to ensure that their calcium requirements are being met. One (250ml) serving of goats’ milk will provide a quarter of the daily calcium needs of a 11-18 year old male (1000mg mg/day).
 

Other

Q. tigercametotea: I read in a book written by a dietitian that 90% (or around that) of people of East Asian descent are not able to digest milk properly because they do not have the gene for it. Do you know any more about that? What are the signs of lactose intolerance? And if the signs are mild or not very debilitating, should I cut out milk and dairy products altogether or is it okay to have some? I am of East Asian descent but my DCs are mixed race.

A. Helen Bond: The amount of lactase (the enzyme needed to break down the milk sugar lactose) a person produces is mainly down to genetics but it may also be the result of other conditions. Lactase, has been described as a 'use-it-or-lose-it enzyme' and this goes a long way to explaining why levels of lactose intolerance differs greatly between different ethnic groups. 

In cultures where there is ready access to milk and dairy products, such as Europe, being able to digest lactose is important, so people usually retain their ability to produce lactase throughout their life, but in other cultures where milk isn't traditionally a part of an adult's diet, such as China, once a child is weaned, there is no significant benefit in being able to digest lactose, so lactase production is reduced.

The symptoms of lactose intolerance usually occur between half an hour to two hours after consuming lactose and include wind, diarrhoea, bloated stomach, stomach rumbling and cramps.

If you suspect that you may be lactose intolerant, make an appointment to get a diagnosis confirmed (or ruled out) by a doctor. Lactose intolerance can be diagnosed with a breath or blood test that can assess how the body reacts to lactose.

If you are diagnosed as lactose intolerant, you will be advised to follow a reduced-lactose diet. Plant-based milks like rice, oat or soya that do not contain lactose are a perfect solution for anyone suffering from lactose intolerance.

However, lactose tolerance levels varies from person to person. Some people can manage a glass of milk, still enjoy chunks of hard cheeses (such as cheddar) and/or yogurt without triggering any symptoms, particularly if they are consumed as part of a meal, while others may not even be able to have milk in their tea. You should try experimenting to work out (through a food and symptom diary) how much lactose you can eat and your own personal tolerance level.

Q. Sunflowerseeds: My household doesn't drink milk.All that oestrogen can't be good. Why do you think milk is necessary?

A. Helen Bond: Milk and milk products, like other food products, do naturally contain hormones such as oestrogens, but the levels are tiny in comparison to what the body naturally produces itself. Likewise, many plants including soy beans and soy products contain phytoestrogens, which have oestrogenic properties.

While there have been concerns reported in the press that eating foods naturally containing oestrogen could potentially increase the risk of cancer, scientific studies have found that due to the very small amounts of natural hormones present, it is unlikely.

A healthy and varied diet is essential in optimising health and reducing the risk of disease. As illustrated with the 'eatwell plate', a balanced diet is made up of five main food groups, and milk and dairy foods are one of these.

Milk plays an important role in the diet, not just for growing toddlers and children, but for all age groups including the elderly. This is because it contains a wide range of the nutrients needed to maintain good health and wellbeing. It provides protein, fat and carbohydrate, as well as essential vitamins (like B vitamins and vitamins A and D) and minerals like calcium. On top of helping you meet your nutrient needs, a glass or two of milk keeps you hydrated all day long.

Three servings (750ml) of cows' or goats' milk provide around 100% of an adult's recommended daily amount of calcium needed for development and maintenance of healthy bones.

"Goats' milk is actually drunk by more people around the world than cows' milk."

Q. Silbury: I think that drinking another mammal's milk is repulsive and nutritionally unnecessary. Why do we do it?

A. Helen Bond: I am sorry that you feel that way. Milk is one of the most nutritionally complete foods in our diets and together with dairy foods, plays an important part of a healthy and balanced diet for all age groups. This is because it contains many of the key nutrients that we need for overall health and wellbeing eg protein for our bodies to work properly and to grow or repair themselves. Calcium helps to keep our bones strong. The calcium in dairy foods is particularly good for us because our bodies absorb it easily. On top of helping us meet our nutrient needs, drinking milk also helps us to keep well hydrated.

While most of us who have grown up in the UK think cows' milk is the only 'normal' milk to drink, what is less known is that goats' milk is actually drunk by more people around the world than cows' milk. More than any other mammalian farm animal, the goat is the main supplier of dairy and meat products for rural people and has been an integral part of the developing world's diet for centuries. The UK consumer has only recently begun to appreciate goats' milk for its nutritional qualities and purported health benefits.

However, if you choose to remove milk and dairy foods from your diet, you should replace it with suitable plant-based alternatives, such as soya, almond, rice potato, coconut or oat milk, to ensure your diet remains nutritionally adequate.

Q. Sunnymogsy: I want to try veganism for a bit - what calcium sources are best instead of cows' milk? I've heard a lot about synthetic vitamins/minerals being of no use to the body as they are not absorbed. How can you tell if a calcium supplement is a good one? Are there any particular vegetables that provide lots of calcium?

A. Helen Bond: If you are thinking of becoming vegan, don't worry - there are lots of non-dairy sources of calcium you can include in your daily diet to help meet your dietary needs, but before throwing away the milk and yogurt in your fridge, it is important to realise that significantly greater quantities of these foods may need to be eaten in order to provide the same amount of calcium as in dairy foods. This is because the calcium in dairy foods is often more easily absorbed by the body than from other foods.

Non-dairy sources of calcium:

  • Dark green leafy vegetables, such as broccoli, watercress, cabbage and kale
  • Soya beans, baked beans, chick peas
  • Tofu
  • Nuts, such as almonds, hazelnuts, walnuts
  • Seeds, such as sunflower and sesame seeds
  • Bread and anything made with fortified flour 
  • Soya, oat, rice and almond drinks with added calcium
  • Oranges
  • Dried fruits - apricots, dates and figs

In theory you should be able to get all of the calcium that your body needs (adults aged 19 to 50 need 700mg of calcium a day) by eating a healthy balanced diet. While dietary calcium supplements in recommended amounts offer a proven means to boost intakes of this essential mineral, popping a pill will never be as good as eating a healthy diet as there's far more in food than just vitamins and minerals including energy, protein, fibre and other plant chemicals.

Standard multivitamins and calcium supplements are inexpensive and will do the job of topping up your dietary intake if you are concerned. I would chat to your doctor or pharmacist about this and the correct dose, as sometimes, if you take too much it can cause stomach pain and diarrhoea. Taking 1,500mg or less a day of calcium supplements is unlikely to cause any harm.

One other thing to remember is that if you skip all animal foods, it can be difficult to get all of the vitamin B12 needed for a healthy nervous system, so you may want to discuss supplementation of this B vitamin with the pharmacist as well.

Q. Itsallgoingtobefine: Are there any genuine benefits to drinking 'raw' milk over pasteurised and homogenised milk. And is there really pus and blood in milk? If so, what other 'extras' are allowed?

A. Helen Bond: Raw milk advocates claim that the pasteurisation (heat treatment) process destroys the nutritional value of milk and that pasteurised milk is less nutritious, more allergenic and more liable to cause lactose intolerance and that raw milk contains antibacterial components that make pasteurisation unnecessary.

Unfortunately, however, there is no scientific support for such claims. Studies have found only minor nutritional differences between raw and pasteurised milk (slight reductions in B vitamins and vitamin C), which are unimportant in the context of a balanced diet.

Raw and pasteurised milk are equally allergenic (they contain the same proteins), both contain the same amount of lactose and raw milk may contain harmful bacteria that can cause food poisoning. Children, people who are unwell, pregnant women and older people are particularly vulnerable to food poisoning and so should not have unpasteurised milk or cream or dairy products made with unpasteurised milk. All milk sold via the supermarkets and milkmen in the UK has to be heat-treated (pasteurised) to kill harmful bacteria.

Homogenisation of milk involves forcing the milk at high pressure through small holes. This breaks up the fat globules in order to spread them evenly throughout the milk and prevent separation of a cream layer. Goats' milk is naturally more homogenous than cows' milk ie it has a higher percentage of smaller fat globules, so a much lower pressure is used than for cows' milk. Most milk available on the market is homogenised. Although some people praise the virtues of non-homogenised milk, there is no proven benefit.

With regards to added extras in milk, although this is not my area of specialty, there are strict hygiene regulations governing the quality of milk and which prohibit the sale of milk from infected animals.

Last updated: almost 2 years ago