In a dairy-free diet, you are not only avoiding lactose, but casein (cay-seen). Casein is frequently confused with lactose (the natural sugar in milk) while casein is the protein. No matter the processing of cow’s milk, casein cannot be removed, unlike lactose (e.g. Lactaid).
It is common in the ASD community to try a Gluten-Free and/or Dairy-Free (Casein-Free) Diet. While many believe this is just a fad, there is clinical backing to the efficacy of this diet. In individuals with ASD, the small intestine is oftentimes compromised. This means that it is missing many “good bacteria” which are replaced with “bad bacteria”. These bad bacteria can injure the GI system and even create small perforations commonly referred to as “Leaky Gut Syndrome”.
In the gut, casein is broken down into small protein fragments called casomorphins. A distinguishing characteristic of casomorphins is that they have an opioid effect on the body and bind to the same receptors in the brain as true opioids . These particles can travel through a leaky gut and travel to the brain causing severe brain fog, autistic behaviors, increased pain tolerance, mood swings and yes, even addiction.
Alternatively, food sensitivities and intolerances can be more common in individuals with ASD. Two of the top 8 food allergens are milk and wheat. If an individual has an undiagnosed food sensitivity, this may cause bloating, abdominal discomfort, diarrhea and/or constipation, headaches, dark circles under the eyes, altered concentration, fatigue, and trouble sleeping, which can all attribute to poor behavior.
To get casein fully out of the system and to begin seeing improvements, allow a 4-6 week trial period, although trials of 3+ months often see the most improvement. You can choose to eliminate both gluten and casein simultaneously, though I suggest one at a time. Please speak to a Registered Dietitian before starting your child on a dairy-free diet.
Just as every child is different, every child with ASD is different. It is important to view each of these children as individuals. What might work for your friend’s child, or even one of your children, may not work for the other. A dairy-free diet is certainly not the answer for every child on the autism spectrum, though it is helpful for many.
Foods to Eat & Foods to Avoid
Hidden dairy ingredients:
Artificial butter flavor
Half & Half
Hydrolysates (casein, milk protein, whey, whey protein)
Milk (condensed, derivative, powder, dry, evaporated, low fat, malted, non-fat, protein, skim, solids, whole)
Sour cream solids
Sour milk solids
Whey (any form)
Favorite Dairy-Free Brands
Please note that all of these brands are completely dairy-free except Trader Joe’s. Trader Joe’s has many dairy-free products, but a majority of their products are not. Always read ingredients before purchasing any brand. Also be sure to note that some cheeses will say “lactose-free” but this does not mean it is dairy-free. As a good rule of thumb, any vegan product will certainly be dairy-free.
Trader Joe’s almond & coconut
Follow Your Heart
Trader Joe’s coconut yogurt
Follow Your Heart
Follow Your Heart
Ben & Jerry’s Dairy-Free
What about Selective Eaters?
Many kids with autism will be Problem Feeders, not just picky eaters (read more in my blog Picky Eaters vs Problem Feeders) and often times consume under 20, 10, or even 5 individual foods. There are times when a majority of the foods they will accept all contain dairy. For reference, I have had kids come to me only accepting 5 foods: cow’s milk, yogurt, Pediasure, pretzels, and bread. I would NOT recommend doing a GFCF diet right away since the child is highly reliant on these foods and typically won’t just “eat when they’re hungry”. In this case, we should either add alternative foods (see chart and brands above for ideas) and fade out the dairy. Alternatively, we could try food sensitivity testing to cut out the guesswork.
Frequently Asked Questions
By removing dairy is my child getting enough calcium?
Most milk alternatives are fortified with calcium, so your child typically gets about the same (if not more) amount of calcium as they were on dairy milk. Many other foods contain calcium such as kale, broccoli, tofu, and nuts. If your child will not drink a milk alternative and does not consume calcium-rich foods, a calcium supplement may be used (I like this mineral gummy from Smarty Pants)
What if we have a slip-up?
Whether they got into something at school, you missed an ingredient on a food label, or they snuck food from the pantry, slip-ups happen. There enzymes (my favorite is Pure Encapsulations) that can help not ruin all of your progress. I can take 4-5 days for just one slip-up of dairy to get out of the body. I recommend hiding all dairy foods at home and educating the school on the dairy-free diet.
My child loves cow’s milk, how do I make the switch to another milk?
You should first see if your child will drink any milk alternatives. (I have found that So Delicious coconut milk is thinner and whiter than many other milk alternatives). If they will not accept it, you can start by gradually adding small amounts of milk alternatives to the cows milk. For example, at first add ¼ cup milk alternative to ¾ cup dairy milk and continue for 2-3 days. Next mix it half and half for 2-3 more days. Then ¼ cup dairy milk to ¾ cup milk alternative, and finally 1 full glass milk alternative. Your child may be more or less picky, therefore the amount of time between adjusting the mixture may vary.
Are milk withdrawals real?
They are 100% real. As addressed on the first page, metabolites of casein (milk protein) can resemble opiates- called casomorphins. Some children have no symptoms of withdrawal while some are quite severe. You may notice very poor behavior, begging for milk, insomnia, or other withdrawal symptoms. Stay strong and stick to the diet. Withdrawal symptoms usually dissipate after the first week.
Will we still be able to eat out?
Yes! The key to eating out is preparation. Before you go to a restaurant, go online and check their menu for dairy-free options. Many times there will either be a separate allergen menu. Typically there is not a dairy-free menu, so you will either have to double check there is no dairy in the meal. If you don’t see options, call ahead and ask. Some restaurants are happy to assist while others will resist. Make a list of restaurants that have dairy-free options to make eating out easier and less stressful.
I am lactose intolerance but can still eat cheese and yogurt is it the same with casein?
NO. Lactose is the sugar in milk, while casein is the protein. In fermented dairy products, the live bacteria will “eat” the lactose, lowering the amount that you ingest. Casein is not this way and can not be altered. No dairy products should be consumed on a casein-free diet.
What if labels that say the food is produced in a facility that also processes milk?
This is typically fine. As long as the food doesn’t contain the ingredient itself. That being said, some children are especially sensitive - in this case I recommend avoiding any traces of contamination.
 Trivedi MS, Shah JS, Al-mughairy S, et al. Food-derived opioid peptides inhibit cysteine uptake with redox and epigenetic consequences. J Nutr Biochem. 2014;25(10):1011-8. LINK
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