Eating Without Casein
A Practical Primer for People with Allergies to Milk

LAST UPDATED: June 17, 2011.

.... ALERT

McDonald's Corporation has admitted that their french fries contain milk-derived ingredients. (Gluten, too, by the way.) People with milk allergy should avoid the fries. The ingredients have included milk for several years, which explains any adverse reactions you may have had to their meals in the past.

Great news! As of late October, 2006, Duncan Hines is putting some milk-free cake mixes back on the market! They'll be marked kosher-parve, and some are already appearing in stores. According to the company, although the mixes may be processed on lines that are shared with milk-included products, the lines will be cleaned and re-koshered between runs. For most of us, this should be sufficient to be safe. For those with extremely low tolerance, take the same care as you do with any processed product. If you wish to keep Duncan Hines on the side of light and truth, call them at 1-800-562-3062 to thank them, and then go out and buy their products.

..... END OF ALERT

The text in this file is copyright by Beth Kevles 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011. Permission to copy this text, originally created in web.mit.edu/kevles/www/nomilk.html, is granted provided that 1) credit is given to Beth Kevles; 2) when the text is placed on a web site, a link back to the Eating Without Casein web page is placed on the same page as the copied text; 3) this copyright notice is placed on the same page and 4) the sense and context of the text is retained.

Casein is a protein found in the milk of all mammals. Some people (like my husband) are allergic to it, and it is to these poor souls--who will never, ever enjoy another ice cream--that this page is dedicated.

Disclaimer

Nothing on this web page should be construed as medical advice. I am not a doctor. Please check with your own physician about any information that concerns you.

You can support this site by visiting the "Eating without Casein Store at Amazon.com" or simply by using this link to the "Amazon.com home page". When you make no-milk-related or other purchases this way your cost will remain the same, but amazon.com will send a trickle of cash this way, which will help me justify the time I spend keeping this page up to date. If you decide to do this, remember that you must stay at the Amazon.com website from the time you leave my site until the time you place an your item(s) in the shopping cart, using the same browser window, for my site to get credit. Thanks for your help!

Contents

  • What is Milk Allergy?
  • Beware the Ingredients
  • Products to Seek Out
  • Cooking Tips
  • Simple Milk-Free Menus to Get You Started
  • Making a Milk-Safe Kitchen
  • Going to Restaurants
  • Kosher is Your Friend
  • Going to the Hospital
  • Disaster Preparedness, or What FEMA Can't Do
  • Is There Milk in My Medicine?
  • What About Calcium
  • What about Goat's Milk? Or Breast Milk? Or ...
  • Briefly, About the Composition of Milk
  • Infant Colic and Milk
  • Will My Children Develop Milk Allergy?
  • Keeping Costs Down
  • Medical Alert Bracelets
  • Non-Food Uses of Casein
  • References

    • What is Milk Allergy?

    Casein should not be confused with lactose. Most people who have difficulty digesting milk are lactose intolerant, meaning that they produce too little of the enzyme (lactase) that breaks down milk sugar (lactose) so bacteria flourish in their gut to finish the job. Lactose intolerance is no     laughing matter but it is not life threatening. A casein allergy can be just that-- an allergy. It may manifest as breathing difficulty, hives and rashes, or serious pain in the gut leading to inability to get nourishment from food and dangerous weight loss. If you or a loved one suffers from a casein allery, this page may be of help.

    Further information on milk allergy is presented in Nutramed's page on Milk Allergy in Children. An explanation of allergy testing and symptoms focused specifically on milk allergy can be found at the ASCIA Education Resources page on milk allergy.

    A study was published in 2011 showing that milk allergy in infants can be diagnosed via ultrasound. See The American Journal of Roentgenology for details.

    Briefly, About the Composition of Milk

    Milk has a number of components. These include lactose (milk's sugar), up to four varieties of casein and other milk proteins, and fats. The percentage of each of these contained in an ounce of milk varies according to the source of the milk (which animal), where in the milking cycle the milk comes from (lactose-rich foremilk comes out first, followed by fat-rich hindmilk), and how long the individual animal has been lactating this time around. (The milk's composition is adjusted to the needs of the individual offspring, by the infant's age.) The contents are also affected by the lactating mother's (human or cow or whale) diet, since certain dietary components can make their way from the mother's digestive tract into the milk she produces.

    For much more detailed information on the composition of milk, you should look at the course notes for Lactation Biology at the University of Illinois.

    There was an interesting discussion on the No Milk mailing list, explaining where in the milk (curds, whey, etc.) are the milk components (casein, lactose, etc)?

    Finally, the book Milk: The Surprising Story of Milk Through the Ages includes a fascinating history of the use of milk in cooking along with experiments that will make clearer just what and where is in milk. The author clearly loves milk, though, so the recipes in the second part of the book are not suitable for readers of this web site.

    Beware the Ingredients!

    If it comes out of a box, a tin or any other kind of packaging, be sure to read the ingredients. You'd be amazed at the kinds of foods that conceal milk products. For someone with an allergy, even a pinch can be too much, so read carefully. Also note that there is no requirement in the U.S. to list ingredients that constitute less than 1/2 of 1% (by mass) of a product (although many companies do voluntarily.). And 1/2 of 1% may still be higher than an individual's tolerance, depending upon how much of a product you eat and how severe your allergy is. Finally, if a milk-free product is run on the same line as a milk-containing product, you may get trace amounts of milk in the milk-free product due to cross-contamination. So, when in doubt, either don't use the product or else phone up the company and ask. The following items on any ingredients list are no-nos: Be especially alert when obtaining the following, as milk products creep in:

    WARNING: Any food item may be processed on equipment which has previously processed a dairy product, and the equipment may or may not be cleaned between manufacturing runs. Therefore, even if the item itself contains no dairy ingredients, there may be a risk of cross-contamination. People with milk allergy have reported more trouble with chocolates than with other products, by the way. What does this mean? It means that if your allergy is life-threatening and your tolerance is low, you may wish to contact the manufacturer prior to sampling the product.

    Products to Seek Out

    On the other hand, many items, including cakes and brownies and mixes to make them, are completely milk free. Generally speaking, the cheaper an item is, the more likely it is to be milk-free. (Some of the products below may still pose a risk of cross-contamination. If your allergic tolerance is very low, please check kosher markings and proceed with caution.)

    The following are some brand names and product markings that I seek out because they are completely free of milk. (There is still a risk of cross-contamination, though, from other products made on the same manufacturing lines. If your tolerance for casein is very low, check with the manufacturer to determins whether a particular product is safe for you.) Do, however, always check ingredients as manufacturers do change their formulations.

    Cooking Tips

    Cooking without casein is more challenging than cooking with it, but not impossible. I've developed a number of cooking tricks for substituting ingredients and modifying recipes.

    Ingredient Substitutions

    Altered Recipes

    My favorite altered recipe is for mashed potatoes. Instead of adding milk and butter I add applesauce. It's a different flavor, but very appealing. Boil and mash the potatoes first, then add applesauce to taste. You can, of course, make your mashed potatoes with oil and a touch of water or broth for a more traditional flavor.

    I'm very fond of chowder, but chowders usually require cream. I've discovered that a creamless chowder-- that is, just add the appropriate amount of water to the soup-- is very tasty and much less fattening. It's less filling, too, so adjust your menu appropriately. Clam chowder is particularly tasty made this way. I make the roux with flour, margarine or olive oil, and fish broth and am very happy with the result.

    If you're interested in pumpkin pie recipes, here are a couple that have been sent in, just in time for Thanksgiving. You can also, of course, simply substitute soy milk for milk in your favorite recipe.

    Simple Milk-Free Menus to Get You Started

    Here are some simple meals that you can eat. Enjoy them right away, while you're learning your way around the milk-free grocery store:

    Breakfast

  • Oatmeal (not the instant kind) with raisins, cinnamon and sugar
  • Eggs (any style where you don't add milk; fry in oil, not butter) with bacon (not sausage)
  • Calcium-enriched orange juice, black tea or coffee
  • Cheerios or any other milk-free cereal, either dry or with juice added (Hey, my family likes them that way ...)

    • Lunch
  • Sliced meat (such as roast beef or turkey breast; no processed meats unless marked Kosher) on sourdough bread with real mayonnaise or mustard. Add lettuce and mango chutney for some pizzaz. NOTE: If you are dealing with an anaphylactic reaction, ask at the deli counter whether the slicing machine is also used for cheese. There may be a cross-contamination risk, in which case you should do your slicing at home AND discard the first slice.
  • Salad made with Starkist tuna packed in water. Add pickle relish and real mayonaisse. Serve plain or on sourdough bread.
  • Peanut butter and jelly on sourdough

    • Supper
  • Baked fish with honey and mustard spread over the top
  • Lambchops, broiled and served with mint jelly
  • Steamed vegetables served plain or with home-made vinagraite
  • Roasted or baked potatoes

    • Snacks and Dessert
  • Kellog's brand Pop Tarts (fruit flavors or brown-sugar flavor.
  • Sorbet (not sherbet) with fruit or Nesquick chocolate syrup
  • Fruit (fresh or canned)
  • Minute Maid calcium-enriched juice boxes
  • Challah bread is usually milk-free when made for sale. Home-made challah recipes vary.
    ...And you can add Fleischmann's unsalted (only) margerine to anything.

    Making a Milk-Safe Kitchen

    In some families with conflicting diets, you may need to have milk-full as well as milk-free foods in the house. Color-coding is the key to safety.. Depending upon the severity of the allergy in your family, you may wish to keep separate "milk" and "no-milk" cooking utensils, flatware and so forth. If you do, make sure that you have one style of dish, etc, for milk and a different style for milk-free items. Then just put a sticker on the drawer or cupboard where these things are stored, with one consistent color for items containing/used for milk, and another color for everything else. You can use the same sticker system for packages of processed foods and for leftovers stored in the fridge or freezer. As you unload your groceries, add a sticker to the box so that even young children will know what they can eat and what they cannot.

    It may not be necessary to separate plates and utensils in your home. However, certain items used in cooking, ones that are hard to clean thoroughly, may benefit from having milk-full and milk-free versions, kept in separate drawers. If your allergy is severe, you may also wish to have separate kitchen towels, sponges and pots&pans, and to wash them separetely.

    The preceding methods are used routinely in kosher homes to good effect. They can work for you, too.

    If you are looking at kitchen equipment, the two specialty items that we have found valuable in our kitchen are a bread machine (since it's so hard to find tasty, milk-free bread) and an ice-cream maker. When making bread in a bread machine, follow the recipe in whatever book you choose. Just omit the teaspoon of dry milk powder, or of milk) that most recipes call for. The milk makes a very slight difference to the texture of the bread and crust, but is definitely NOT necesary in the creation of a tasty loaf. Using your ice-cream maker, you can throw in just about any kind of juice or combination of juices -- fresh or frozen -- and come out with a tasty sorbet.

    What About Calcium?

    People who can eat absolutely no milk products should watch their calcium intake, especially if pregnant or nursing. Foods like broccoli, sardines and nuts contain significant quantities of calcium. We like calcium-enriched orange juice (most brands contain 30% of the_US RDA per serving) or calcium-enriched apple juice (most brands contain only 10% of the US RDA per serving but Musselmans has the whole 30%). Our favorite source of calcium these days is Rice Dream rice milk. (The calcium enriched variety is available in vanilla, chocolate and original flavors). Rice Dream is usually available at health food stores. I don't know if you can get it by mail. We also find that Tums (original flavor only, NOT fruit flavors) are a good, cheap source of calcium. Just keep a bottle in your desk drawer and nibble from time to time. Helps with neurotic bosses, too. Whole Foods carries a chewable calcium supplement that even the kids enjoy, but be careful because not all of their chewable supplements are dairy-free. However, Whole Foods stores will let you taste a sample before purchasing. Some health food stores, and now Trader Joe's, also carry a gummy bear calcium supplement which our kids adore. NOTE: According to the literature, calcium should be taken along with vitamin D in order to be properly absorbed by the human body. Plan your menus accordingly. Warning! Some calcium supplements have unacceptably high levels of lead. Tums is one which has been found to have acceptable levels.

    On the practical side, there is a new cookbook out called Calciyum!: Delicious Calcium-Rich Dairy-Free Vegetarian Recipes , by David and Rachelle Bronfman, which offers wonderful ideas and recipes for getting calcium into your diet (without dairy!), and includes information on how much calcium you'll find in different foods. If your bookstore doesn't have it, clicking on the title will get you to Amazon.com, which does.

    What About Goat Milk? Or Breast Milk? Or ...?

    Casein (in each of its variants) and lactose are found in the milk of every single mammal, although in varying ratios. Most people who have an actual allergy to any of these milk components will be unable to consume any animal's milk. However, there is only an 85% overlap in milk protein makeup across different species (I found that out doing a Medline search) so people who have an unusual milk allergy, or who are merely lactose intolerant, may find that a milk other than cow's milk is digestable. Also, remember that since each mammal has protein and sugar variants in their milk, it's possible to be allergic to the milk of only one, or one set of, mammals.

    The exception to the "all milk is dangerous milk" rule is infants. Children under the age of about five (the age at which children self-wean in non-industrialized countries) thrive on breastmilk, even when they react badly to every other kind of milk. Those who react to breastmilk are usually reacting to cow's milk protein in their mother's diet, protein which migrates from the mother's gut to her breastmilk.

    Infant Colic and Milk

    Some number of human infants get colic, which is basically an upset tummy that makes life difficult for the baby and for everyone within hearing distance. Colic may be caused by the fact that the baby's digestive tract is still immature and cannot handle certain dietary components. Of these, the casein variant that is high in cow's milk but vanishingly low in human milk is the most common culprit. (Colic may have other causes, too. And some have nothing to do with the baby's diet.) Do not, by the way, confuse loose stools with colic. Breastfed infants have very loose, runny stools, and this is perfectly normal.

    If your infant is displaying signs of colic, take heart! You may be able to relieve the problem with simple, dietary modifications.

    If you are breastfeeding, do NOT stop. (Yoour child can continue breastfeeding for about 4 years. Go for it!) Switching to formula is more likely to make the problem worse than better. Instead, try going for a week without consuming ANY casein. (Lactose will almost certainly not be the problem. An infant who cannot tolerate lactose has very severe problems, and colic will be the least of these.) At the same time, keep a diary of every bite of food you eat, beverages you drink and medicines you take. If the colic continues (even if it lessens without the milk) you can use that diary to try to figure out which foods are triggering it. Caffeine and chocolate are often implicated, but any food can be a trigger.

    For more information on colic in the breastfed baby, you may wish to look at the Bright Future Lactation Resource Center or at Dr. Greene's Page , or visit the informative newsgroup misc.kids.breastfeeding.

    If you are not breastfeeding, try switching formulas. If you're using a milk-based one, try a soy one instead. If that doesn't help, try Alimentum or Nutramigen, both hypo-allergenic. These contain casein, but in a form that's easier for babies to tolerate. Your best choice, of course, is to relactate (ie, restart breastfeeding) if at all possible. The network newsgroup misc.kids.breastfeeding is probably the best place to get information and support on relactation.

    You may also wish to consult with a pediatric gastroenterologist, particularly if your baby has reflux as well. Reflux is caused by a different varation on the immature gut, and can be alleviated with medication. Of course, if the colic or reflux are making your baby fail to thrive, RUN, do not walk, to your pediatrician for help.

    Will My Children Get a Milk Allergy?

    The single highest risk factor for developing an allergy -- any allergy -- is having an immediate family member (parent or sibling) with that allergy. The single best way to reduce the risk of developing allergies is to avoid exposure to allergens in the early months of life. For milk allergy, this means that an at-risk baby should be exclusively breastfed and the lactating mother should maintain a strictly dairy-free diet until the baby is at least six months old.

    ALERT! A recent study in the British Medical Journal suggests that solids, and particularly allergens, be introduced to infants from four months of age in order to reduce the risk of celiac disease and allergies. This is a change from the previous advice, which was to breastfeed exclusively until six months of age.

    (For a variety of healthy reasons, of which allergy is only one, you should aim to continue breastfeeding part-time until your child is 4-5 years old. Really! Although solids will, of course, be the bulk of your child's diet by around 2 years of age.) (Why is breast milk okay? It has to do with the relative ratios of lactose and the three casein variants in breast milk as compared to the milk of other mammals. Breast milk is high in lactose but low in the caseins.) Also, be aware that once a single allergy is triggered you're at greater risk of developing other allergies. (Something about how the immune system works.) For further information, you may wish to see the New York Times article on the topic of allergies, breastfeeding and infant diets by Jane Brody. It was originally published on 2/29/2000.
    According to recent research, a factor that significantly reduces the risk of allergy and asthma is exposure to animal exotoxins in the first six months of life. In other words, if you live with a goat your child will have a significantly reduced risk of any allergies. (The theory is that the exotoxins, which are shed by the animals, sort of "teach" your baby's developing immune system to react appropriately to the various things it comes across.) In this case, too much cleanliness is NOT a good thing.

    Your other challenge comes with the inevitable transition to solids. Children with a personal or family history of allergy -- any allergy, including hayfever -- are more likely than other children to develop allergies themselvies. To minimize your child's risk, you may wish to follow one of the guides for introducing solids to the allergic child.

    Keeping Down Costs

    Some milk substitutes are priced reasonably. The ones that are primarily available through health food stores, though, can be quite expensive. We experimented with purchasing some of these foods wholesale. To do this, we first called the 800 number listed on the product that we wanted. They wouldn't sell to us direct but gave us the names and numbers of their distributors. Then we phoned the distributors to find out their rules. Some will only sell to businesses, others will only deliver to commercial establishments (but not just grocers) and others will let you form a small "buyer's club". Minimum orders are typically $200-$300 -- but that may be made up of a combination of different food products.

    In our area it turned out that our local health food store sold most products at a better price than the wholesaler who would deal with us would give us. Therefore, we are not purchasing wholesale. Nonetheless, you should investigate as your area may be different.

    Your best bet is simply to make your own foods from scratch. You may find it cost-effective, therefore, to invest in a bread machine and an electric ice-cream maker. Then you can make your own breads, sorbets and tofuttis, avoiding the expensive ones in the stores. And depending upon your personal background, a basic cooking class may be in order. Personally, I'm trying to find time to take a class in serious cake decorating so that all those birthday cakes I keep making can look spiffier.

    References

    There are new and excellent web sites for people with milk allergy every day. You can get excellent results by searching for "milk allergy" with your favorite search engine. (Each search engine yields different results, so try more than one.) Using search engines I've discovered that many paints and glues, especially professional-quality ones, contain casein. I've also found entirely reputable medical advice, including the NIH's general information on food allergy. I cannot keep up with the excellent links, so the following is a very small subset of ones that I have found particularly useful or interesting.

    Don Wiss' No Milk Page is an excellent set of web links to pages that deal with milk problems: casein intolerance, lactose intolerance, and milk-free products, from both the pragmatic view of living with an intolerance and the scientific view of understanding what's going on. His links are well-organized and lead to a surprising variety of informative sites.

    Steve Carper's Lactose Intolerance Clearinghouse is a large, rich site for people with any form of milk allergy or intolerance. It includes detailed information on those food additives which are derived from milk, and a set of web links sorted by country of origin. His on-line bookstore is also well worth the visit.

    The Food Allergy Network has a lot of useful information including a cookbook section and product alerts (since manufacturers do, alas, do change their procedures and ingredients from time to time.) The FAN also can provide you with an excellent set of materials to inform your child's school or daycare about allergies.

    You may also find the YAHOO discussion group Parents of Food Allergic Kids (POFAK) to be helpful.

    About.Com has a nice discussion of the different caseins that you may encounter, both in foods and in other products. This site is well worth a look. About.Com is an excellent resource, in general, for allergy and other information.

    If you're planning to travel abroad, you may find the Select Wisely web site of interest. It's got plenty of practical information and translation cards for people with food allergies.

    A promising site that debuted in late March of 2001 is AllergySupport.Org . The site has the framework to cover everything you could possibly want to know about allergies. Right now (April 2001) it is looking for its members to fill in information. In a few months, it should become very useful to newcomers to the world of allergy, too. Membership, by the way, is free.

    A new book (as of November 2008) is Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance, and Casein-Free Living. This book includes not only yummy recipes, but a guide for those with multiple allergies, information on calcium, and other useful tidbits.

    Several people with life-hreatening food allergies have recommended the book Caring for Your Child With Severe Food Allergies : Emotional Support and Practical Advice from a Parent Who's Been There by Lisa Cipriano Collins. One review says, "Parents will learn how to reduce risks while promoting their child's normal emotional development."

    I love the recent book The Parent's Guide to Food Allergies. In addition to a chapter devoted to milk, there are sections on elimination diets, dealing with epi-pens, reading ingredient labels, other food and environmental allergies, asthma and eczema .. and it's co-authored by the parent of a food-allergic child, an allergist, a psychotherapist, and a leading researcher on food allergies. Did I mention the recipes?

    There is a wonderful book out by Dr. Doris Rapp called Is This Your Child? :Discovering and Treating Unrecognized Allergies in Children and Adults. It contains an excellent discussion (with plentiful anecdotes) about allergies in general, food allergies in particular, and how to diagnose food allergies with food diaries, elimination diets, and multiple elimination diets. If you have multiple allergies, she also covers how to live with them using a rotation diet. I would even go so far as to recommend that you read her book before selecting an allergist of your own, and discuss it with the allergist before deciding who should treat you and your family.

    Jonathan Brostoff and Linda Gamlin have a highly recommended pair of books, Food Allergies and Food Intolerance: The Complete Guide to Their Identification and Treatment and Food Allergies: The Complete Guide to Understanding and Relieving Your Food Allergies.

    The Allergy and Asthma Web Page was designed as a FAQ for readers of misc.kids. It has some excellent references for cookbooks and food sources that contain no milk products, as well as information for people restricted by other food allergies.

    There is a Milk Substitute FAQ that is stored on the gluten-free mailing list. It is mostly a compilation of various people's opinions of the different ones available in the marketplace. As of May, 1996 it was some 21K in length. You can retrieve it by sending GET CELIAC MILKALT in a message body to LISTSERV@MAELSTROM.STJOHNS.EDU

    An excellent listserv exists for those interested in issues related to milk allergies. To subscribe, send in the body of an email to: LISTSERV@icors.org the line
    SUB NO-MILK YourFirstName YourLastName
    If you wish, you may look at the no-milk archives, which contains all the messages posted to the no-milk list. The same website contains a link to the list of Frequently Asked Questions which may be of interest, and even lets you subscribe to the list, unsubscribe, and change your listserv settings. Thanks, ICORS!

    The National Institutes of Health has put out some information on lactose intolerance that includes general information on avoiding milk in food and medicine. Lactose crops up all over the place, it seems. There's also information on the calcium and lactose content of some common foods.

    You can read a set of very informative course notes from the Lactation Biology course at the University of Illinois. They explain why infants with trouble digesting milk can still breastfeed, what the different components of milk are, and how the milk of different animals differs from each other. This is a must-see site for the scientifically curious.

    There are several cookbooks out that cater specifically to those with milk allergies. I have The Milk Free Kitchen: Living Well without Dairy Products by Beth Kidder, which I have found useful. (Her book includes information for people who also have egg allergy.) There are others as well. See the Allergy and Asthma web page for detailed reviews. Any of these books, for as long as they stay in print, can be ordered through your local bookstore as well as though Amazon.com Just go up to the information desk and ask.

    Another cookbook, one that will tickle your sweet-tooth, is 101 Fabulous Dairy-Free Desserts Everyone Will Love. Many recipes depend upon eggs. so this may not be suitable for the vegan sweet-tooth, but it sure is for the dairy-allergic one!

    Calciyum!: Delicious Calcium-Rich Dairy-Free Vegetarian Recipes by David and Rachelle Bronfman is an excellent resource, with completely dairy-free, vegetarian recipes that are high in calcium, and information on the calcium content of common ingredients. Many recipes depend heavily upon soy, so this will not be sueful for those with a soy allergy complicating their cooking, but for the rest of us it's worth checking out.

    The new cookbook Recipes for Dairy-Free Living sounds terrific. It's aimed at those of us with no dietary restrictions beyond milk products, so it includes recipes that include meats and desserts. I'm hoping to purchase it myself, soon. (If you get it, let me know what you think.) It's not for vegans, cholesterol-lowerers, or those with multiple allergies, though.

    Since kosher food requires that milk and meat be kept completely separate, kosher cookbooks usually have excellent cooking suggestions, complete with tried and true substitutions. I saw a recipe for pudding based on tofu in one, for example. The best one I've found for recipe substitutions (and it will let you make all kinds of dairy-free foods that are usually dairy-full) is Spice and Spirit : The Complete Kosher Jewish Cookbook. My favorite kosher cookbooks for recipe variety are by Joan Nathan. Try Jewish Cooking in America for the widest variety of recipes.

    Vegetarian cookbooks, on the other hand, are not especially helpful. Most vegetarian cookbooks depend upon milk and yogurt. If you can find a vegan (no milk, no eggs) cookbook, though, you should find some very useful recipes (and should email the reference to me). A vegan cookbook that was recently recommended to me is Eco-Cuisine: An Ecological Approach to Gourmet Vegetarian Cooking, by Ron Pickarski (whose name is confusingly sometimes spelled Pickarsky).

    Another interesting resource is the magazine Living Without . It's got a variety of articles and recipes that are completely dairy-free. It's designed for people with allergies and food sensitivies, including people with celiac disease or multiple allergies, so if you have one of these conditions, you may find the magazine exteremely helpful. You can get a sample on-line, or get the actual magazine at your local bookseller/newstand or by subscription.

    Going to Restaurants

    Restaurants are a tricky business. Waiters try to be helpful, but some would much rather lie than help. And there's always the sous-chef who poisons the chef's milk-free masterpiece by heaving some buttered vegetables on the plate as it goes out the door. So the short answer is, never trust a restaurant more than you trust your own instincts.

    The cuisines of several countries, including Japan, Korea and China, are typically milk-free. On the other hand, European cuisines tend to be very milk-based, and the cuisines of India and Vietnam are particularly dangerous because the milk is often hidden inside of perfectly safe-looking dishes. Kosher meat and pareve restaurants, however, are as safe as you can get. That's because the laws of kashrut absolutely forbid mixing milk with meat. So if you're in an area with a strong Jewish community, you may be in luck.

    If you're up for a fancy restaurant and can phone ahead a day or two, explain that a member of your party has a severe allergy to all milk products and ask if you can be accommodated. We've had excellent luck with our holiday meals that way. The Tabard Inn in Washington, D.C. offered us our choice of any item on the menu in milk-free format, which particularly impressed.

    Is There Milk in My Medicine?

    Sometimes the medicine that is supposed to make you better can make you sicker, instead. Many medicines and vitamins use lactose as a filler. Casein in medicines is not unknown, although it is relatively rare. Depending upon the severity of your allergy, either of these may cause you problems. So what can you do?

    First, check with your physician, your pharmacist, the Physician's Desk Reference (which lists ALL ingredients in medicines) or the manufacturer. Be SURE that there is no milk hiding in what you plan to take!

    If the prescription you require is not formulated without milk, you may be able to get your drugs "compounded". A compounded drug is, basically, hand-mixed. (It's what ALL pharmacists used to do in the old days.) You can specify no lactose, or whatever you are avoiding, in the compound. There are a few thousand compounding druggists in the US. One that is close to the celiac community is Stokes Pharmacy in Medford NJ.

    If you're looking into vitamins, assume that lactose is used as a filler unless the product specifally says "milk free" on the bottle. Several store brands refrain from lactose use. So do most vitamins at GNC. Centrum, on the other hand, has lactose and has caused difficulty for people on the no-milk mailing list.

    It has recently come to my attention that several of the DPT vaccines (Boostrix and Certiva) use the Stainer's Culture Medium which contains casein hydrolysate. The Adacel doesn't. For the vast majority of babies, this will not be an issue. For the few who are at risk, make sure you check, and also check that the culturing medium hasn't changed since this was written.

    Going to the Hospital

    Hospitals can be dangerous places for people with food allergies. Hospital kitchens just aren't set up, as a rule, to keep allergenic foods away from allergic people.

    If you need to go to the hospital you should arrange a visit with the staff nutritionist in advance, if possible, and explain your allergy and the possible repercussions if you are exposed to the allergen. Depending upon the severity of your allergy you may be able to select carefully from the menu, or you may have to arrange to bring food in from the outside.

    If you have the luxury of choosing a hospital then your best bet with a milk allergy is to select a Jewish one. Since observant Jews keep milk and meat strictly separate, you should be able to eat safely of all meat meals. But you should still have a chat with the staff nutritionist if at all possible.

    Preparing for Disasters, or What FEMA Can't Do

    No matter where you live, you are at risk for some kind of disaster. It could be a hurricane, a tornado, a blizzard, an earthquake, or even a terrorist attack. FEMA may come within a few days to help you, but FEMA won't be ready to manage severe food allergies. Your disaster plan needs to take your food allergy into account.

    The likeliest disruption will be to electricity. Be sure you have a supply of non-perishable foods that you can eat. Canned goods, beef jerky and dried fruit can keep you alive a long time as long as you also have access to water. (The rule for water is 1 gallon per person per day. Store it in a closet in sealed bottles.)

    Medication may also be an issue. If you use an epi-pen, be sure you have an in-date supply available. EMS may not be able to get to you. If you are prone to asthma, be sure you have a battery-operated nebulizer and fresh batteries. Do you have medications that require refridgeration? Dry ice can tide you over for a few days, a generator can provide electicity if you can get gasoline to power it, or you can put a tiny fridge in your car that will run off of your car battery.

    The Food Allergy and Asthma Network's Guidelines for Sheltering in Place offer some good advice. So does the Allergic Kid blogspot on hurricane preparedness.

    Kosher is Your Friend

    The Jewish laws of kashrut (koshering) demand a number of dietary restrictions. For our purposes, the wonderful thing about kashrut is that milk and meat may not commingle. Therefore, kosher foods fall into three categories:
  • MILK: products which contain dairy or dairy derivatives or are processed on equipment which has processed dairy-containing products,
  • MEAT: products which contain meat or meat derivatives or are processed on equipment which has processed meat-containing products,
  • PAREVE: products which contain neither meat nor dairy, nor their derivatives, nor are produced on equipment which has processed meat or dairy products.

    • Note that kashrut says nothing about eggs, which are not considered "dairy" for religious purposes. Also note that while MEAT always refers to red meat, it may or may not refer to poultry or fish. Finally, bear in mind that the rules for meat are far more complicated than I have explained here. For example, the meat of scavengers (such as shellfish) and cloven-hoofed animals (such as pigs) are strictly forbidden. For further information on the laws of kashrut, you may wish to visit the Kosher page of the Orthodox Union, or Kashrut.Com. The Orthodox Union is one of the more widely used kosher supervisors. Kashrut.Com is an umbrella organization for many, many kosher supervisors worldwide.

    Another important point: Kosher equipment CAN be ritually washed and then used to make a different kind of product. Bakers, for example, can use the same mixing bowl to make ice-cream and then parve donuts. Ritual cleaning is very (but not 100%) thorough. It involves first a standard, thorough cleaning of the equipment, followed by the recitation of special prayers. Sometimes a blowtorch is involved. To re-kosher a microwave oven, all you need to do is boil a glass of water in it for 10 minutes! As you can see, the rules vary. Usually re-koshered equipment is safe for dairy-allergic diners, but your results may vary, especially with smaller hechsers and smaller businesses. I, for example, would be confident eating a product make by Kellogs, which is large and supervised by the Orthodox Union. I would be less confident of a local kosher bakery whcih makes both dairy and parve products, and is supervised by a strictly local hecsher.

    Now, how does this help you when you go shopping? Worldwide, there are about 300 kosher certifying organizations. Each has slightly different rules about what constitutes a kosher item and how frequently the manufacturers of food products must be observed for compliance. This is important, since some manufacturers may be sloppy, and some certifiers may permit dairy derivatives in meat or pareve products, provided the dairy has gone through sufficient processing and refining (so as to make it, according to the certifier, no longer dairy).

    The laws of kosher permit 1/60th part of a food to contain accidental dairy and still be considered meat or pareve. However, the major hechshers, such as OU, are aware that their certification is used by people with milk allergy and therefore have a zero-tolerance policy.

    When you're shopping, look for a hechsher (kosher certification symbol, pronounced "heck sure") on the product you wish to buy. There are a number of kosher certifications. "OU" is one of them. An item with the OU designation by itself is pareve. Otherwise it will be followed by the word "meat" or "dairy". Most hechshers, however, don't specify the type of kosher (meat, dairy or pareve) unless it isn't obvious from context. That is, a gallon of milk may bear simply the hechsher and not the word "dairy".

    Note that the letter "K" means nothing with respect to kosher certification, since a single letter cannot be trademarked. Also notice that the letter "P" after a hechsher does NOT mean "pareve". Rather, it means "kosher for Passover". During the festival of Passover, the rules of kosher become more restricted. No leavening is permitted. (Check with manufacturers if you're allergic to corn, wheat, beans, rice or yeast. Yeast is leavening, and is strictly prohibited during Passover. Many manufacturers reformulate their products to omit grains during Passover, too, since the rules around kosher for Passover grains are difficult to comply with. Coca Cola, for example, is made with cane sugar rather than with corn syrup during Passover.) Finally, the simple word KOSHER doesn't necessarily mean that an item adheres to strict kosher standards. Make sure that any kosher product you purchase bears that symbol of a certifying organization that you trust. If it does not, or only bears the word "kosher", then it may not, in fact, be truly kosher. And if it bears the words "kosher style" (as many excellent dill pickles do) be doubly certain to check for that all-important symbol!

    There are many, many hechshers. A partial list can be found in the Kashrut.Com List of Agencies. Some further details about hechshers can be found in the no-milk Pareve FAQ.

    Thank-you to Arlene Mathes-Scharf of Kashrut.Com for checking over this section for accuracy. Any errors that may have wandered in are mine, not hers.

    Medic Alert Bracelets

    If your allergy is life-threatening you should definitely consider wearing a medic alert bracelet or other such identifying tag. MedicAlert can be reached at 1-800-432-5378.

    Non Food Uses of Casein

    Casein is used in some adhesives, paints and beauty products. If you are sensitive to casein when you touch or inhale it, you may wish to investigate further. One instructive web site is the American Casein Company , You may find more interesting sites by doing a search for the word casein on your favorite search engine. You may also, of course, contact the manufacturer of any particular product that concerns you to determine whether it's formulated with casein.

    In Conclusion

    If you have any suggestions to improve this page, or questions that you'd like answered, I can be reached by email as bethkevles@gmail.com. If you'd like to find out what other books I recommend -- books that have nothing to do with milk -- visit my Bookshelf. And thanks for visiting!

    My According to the Web Counter you are visitor number since counting began on June 11, 1996. As of 2004 this site is getting a over 100 hits/day ... and rising!