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Do I Have To Cut Out Dairy in TBI?

Read to me!

(My pup was in my “recording studio” with me… you may hear her breathing as she slipped into a dream!)

It’s likely in your brain injury recovery, you’ve heard the term “inflammation” come up at least once.

Post brain injury too much inflammation can cause you problems. (If this is a new topic, no worries! I got your brain covered 😉 Check out my post on Anti-Inflammatory eating here)

There are a number of ways promoted to help lower that excess inflammation. Food & nutrition is definitely a popular and worthwhile option. However advice sometimes centres around what NOT to eat instead of what to INCLUDE in the diet.

I’ve seen many lists scandalizing foods that are considered culprits causing inflammation. And one of the most cut down “culprits” to be labeled as “bad for inflammation” in our diet culture is none other than dairy.

Photo of Glass Of milk On Table

“Dairy is my problem…”

“I’ve been trying to eat anti-inflammatory but I’m having such a hard time cutting out cheese…”

“I heard I have stop milk for migraines…”

Does this sound familiar? These phrases are often what I hear from other TBI survivors, and even other professionals who promote these messages in the brain injury community. I hear these so often they no longer surprise me. Instead, I tend to surprise others when I respond asking:

“Why do you need to cut out dairy??”

To be completely honest with you, I’m not 100% sure where all this milk gossip started and how it built momentum. Was it the result of certain research studies that were blown out of proportion? Indeed, saturated fat was previously scandalized as bad for heart health, linking it to inflammation. And milk products are a source of some saturated fats. But there are many different types of saturated fat and not all work in the same way. But it’s easier for popular diet culture to generalize and sensationalize only selective pieces of information…

Well here’s something in research that doesn’t get quite as much spotlight in pop diet culture:

DID YOU KNOW?

There are studies that show dairy can actually help LOWER inflammation.

There’s clearly more to the dairy story here…

So, if it’s right for you, grab some yogurt, slice some cheese, or pour yourself a tall glass of milk. We’re about to dig into dairy do’s and don’ts when it comes to TBI.

Sliced Red Strawberry Fruit

QUESTION #1: DOES DAIRY CAUSE INFLAMMATION?

The answer here: probably not.

If you look you will find research articles both for and against dairy & inflammation. But in 2019 a systematic review was published that looked at all the data from the previous 5 years (Ulven et al. 2019). The result?

“The consumption of milk or dairy products did not show proinflammatory effect in healthy [people] or [people] with metabolic abnormalities. The majority of the studies documented a significant anti-inflammatory effect in both healthy and metabolically abnormal [people], although not all the articles were of high quality.”

The “Too Long; Didn’t Read” (TL;DR) version is:

  • Dairy didn’t cause inflammation
  • Dairy products might decrease inflammation
  • Hard to tell because not all the research studies were great

The studies they reviewed looked at dairy in different kinds of people with different health statuses. These studies all varied in what dairy products they used and how they measured inflammation. Most showed no significant differences in inflammatory markers. Some showed lower inflammatory markers with the dairy products studied.

Cheese, Brie Cheese, Food

It’s always hard to say with studies on inflammation. Research has labeled certain markers in blood & tissue tests as “inflammatory.” However, that’s like labeling someone only based on their job title — they may be a dentist, but they may also be a parent, an artist, or bowling team member. Same goes for these inflammatory markers — it’s possible they have multiple roles.

Plus studies that just look at inflammatory markers can’t make claims on whether the presence of these markers actually causes signs & symptoms. The same goes for foods or nutrients that are considered anti-inflammatory. Just because research shows these foods or nutrients change things in the blood, this doesn’t mean they actually change your headaches, recovery, or risk of long-term problems.

There is however one way dairy might cause inflammation that’s getting better know. But this might only be in certain people who are sensitive to a specific protein in cow’s milk. This protein is known as A1 beta-casein. This is a relatively new finding, but research suggests that for those who are sensitive to this protein, it can trigger inflammation (Brooke-Taylor et al. 2017). More on this below.

QUESTION #2: CAN DAIRY CAUSE OTHER PROBLEMS IN TBI?

The answer here: it’s unlikely, but you do you.

Try as I might, I can’t find any direct research on dairy in concussion or TBI recovery.

There is some stuff out there about dairy and cognitive function in older adults, dementia, and Parkinson’s Disease (Chen et al. 2008). The data is mostly correlations, which means the studies can’t tell us for sure what the actual cause of the problems are.

Correlation studies may look at a population of people over a period of time to link certain factors with others. These types of studies can be misinterpreted to say “these people drank milk and got (insert cognitive issue here), so therefore milk must be the cause!” However, other factors might not have been considered or even discovered yet.

File:Strong--weak--no-correlation.png

Correlation studies are cool to give us an idea what to investigate further, but they can’t really be used to make firm recommendations. For example, smoking more cigarettes has been correlated to lower risk of Parkinson’s Disease! The reasons are unknown but nobody would recommend a person start smoking to lower risk of this disease, considering how horrible cigarettes are for overall health (Marques Lopez. 2018)

And just like that review on dairy and inflammation, a recent review on dairy and cognitive function in older adults found conflicting messages. They found studies that came to completely separate conclusions! Some research says dairy impairs cognitive function, others indicate that dairy improves cognitive function, and others say dairy has no effect on cognitive function… (Lee et al. 2018)

As for migraines, there also isn’t any great evidence. People may or may not notice a change in migraines with or without dairy. It may depend on genetics that prevent some people from metabolizing a food component called “tyramine.” However the jury is still out on that (Zaeem et al. 2016).

Glass, Milk, White, Cow'S Milk, Pour A, Drink

So it seems that dairy doesn’t really cause inflammation nor cognitive problems in most people. However, certain dairy products or aspects of dairy can cause you problems if you’re prone, and this in turn might hinder your recovery.

Here are 3 reasons to NOT eat regular dairy products:

1) You have an allergy to dairy

Have you ever heard me say: “there are no good foods or bad foods, just foods”? Well, there is one exception I make and that is for people who have allergies.

This should be a given. But it’s worth noting. Allergies can be life-threatening! And wouldn’t that really muck up your recovery?

One person’s favourite food could be another’s poison. If you do suspect an allergy to dairy, consider talking to your doctor about it. Don’t diagnose yourself! Because sometimes an allergy is mistaken for an intolerance. And with dairy prevalent in many foods, you’ll need to be informed and prepared.

2) You have an intolerance (lactose or A1 beta-casein?)

Like many people out there, I’m lactose intolerant. This doesn’t mean you need to nix dairy though. Lactose intolerance doesn’t trigger the immune system like an allergy does. Plus, it is so common that many dairy companies now produce lactose-free varieties. And things like cheese & yogurt are naturally low lactose anyways.

But an intolerance, whether the symptoms are felt in the gut or in the brain, may not actually be from lactose. In fact, many who suspect lactose intolerance might actually be reacting to a specific protein in cow’s milk.

This isn’t the same as an allergy to milk. One of the proteins in cow’s milk know as A2 beta-casein has naturally changed overtime in some dairy cows — a small but important transformation created a protein called A1 beta-casein. This A1 protein can be broken down in the gut to form a kind of opioid. This opioid is thought to trigger some inflammation plus upset stomach in those who are intolerant. This might also have an impact on cognitive function (Jianqin et al. 2016). Interestingly, the casein protein in goat and sheep’s milk hasn’t had this same transformation. This is why some people tolerate those better than cow’s milk. However, some dairy farmers are now selecting cows that naturally don’t produce this A1 beta-casein. The resulting product is known as A2 milk, which has just been released in the big grocers in Canada.

Goat, Pet, Farm, Horns, Livestock, Domestic Goat

So, if you feel you have an intolerance to dairy, but want to include it in your diet, then there are options out there for you.

3) If you don’t like dairy or don’t like how the products accessible to you are produced

I don’t believe people necessarily need to force feed themselves foods that don’t jive with them. Not all of our meals are going to be stellar, and maybe loving food just isn’t a priority for you. But we should make attempts to make food less stressful for you. And if there’s something about dairy that feeds into something stressful for you, then hey, maybe you don’t have to have it.

I have a client who’s main priority is ethical food choices. When people hear that, they may immediately think “vegan.” But this person will eat pretty much any food so long as it’s produced ethically. Just recently this client came across a new local producer of dairy that fits their criteria. So my client is now happy to be able to add milk back into their diet. I thought this was an important lesson in not labeling a whole food category as unethical just because popular opinion, or elsewhere in the world, it’s produced in ways that are harmful.

Cow, Head, Cow Head, Animal, Livestock, Nature

QUESTION #3: CAN DAIRY HELP ME IN MY TBI RECOVERY?

The answer here: depending on your situation it’s possible.

Like any foods, even if they provide a lot nutrients and/or benefits, they still shouldn’t be your entire diet. But here 3 reasons why dairy might be a great accompaniment to your TBI recovery nutrition:

1) Dairy might help with inflammation and DHA

As mentioned above, dairy might in some cases help lower inflammation. It’s not yet clear how. It might be related to how certain types of fat found in dairy work in the body. It might also be related to bacteria found in fermented dairy products. One study showed that dairy helped increase DHA and neuroplasticity in the brain of baby mice (Dinel et al. 2016) — this is far from human TBI recovery, but an interesting discovery!

2) Fermented dairy products might help with memory and cognitive function

Fermented dairy products are things like yogourts, kefir, and some cheeses. A number of studies are suggesting these can help with memory and prevent cognitive decline in aging (Ano et al. 2018). But how? Some suggest it could be from certain parts of the whey protein that is broken down during fermentation. But fermented products are also known to support that gut microbiota for better gut health 🙂

3) Dairy has high quality protein and easy-to-get nutrients

Many people I meet dealing with a brain injury have low appetite. When you have no desire to eat, it can be hard to get in all the nutrients your brain & body need! General advice for low appetite is smaller more frequent meals, plus trying liquids (like milk or smoothies) to more easily get some food in.

Berry Breakfast, Cereal, Milk, Cream, Delicious, Diet

Dairy offers a nice balance of fat, protein, and sometimes even carb, with a number of other vitamins & minerals (Giles-Smith. 2013).

If you’re concerned about the fat in milk, you might not have to be. Before carbs, fats had a a bad reputation and many recommended switching to low-fat dairy options. But one review article completely contests this, citing research that showed full-fat dairy was more likely to help lower inflammation than low-fat dairy (Lordan et al. 2019).

And when it comes to the protein, milk protein is considered high quality. In fact, whey protein is considered the highest quality protein out there because of how much is absorbed and stays in the body for growth & maintenance (Giles-Smith. 2013).

TO SUM UP: WHAT YOU NEED TO KNOW

There’s a lot of info here, I know. Dairy is a really grey area in nutrition. But it’s likely gotten much worse press than it deserves.

So let me wrap up the key points for you here:

  1. Dairy products likely do not cause inflammation in most people.
  2. Dairy products might even lower inflammation, including full-fat dairy products.
  3. Don’t have dairy products if you’re allergic to milk protein.
  4. If you are intolerant to cow’s milk, this doesn’t trigger inflammation, but is still unpleasant and makes getting good nutrition challenging. You can likely still have dairy products that remove the thing you are intolerant to. The most common things that cause an intolerance are lactose and now, A1-beta casein. You can try lactose-free dairy products, goat/sheep milk products, or A2 milk if accessible to you.
  5. There is no concrete evidence that dairy affects memory, cognitive function, or migraines.
  6. Fermented dairy products may have extra benefits, so be sure to include these!
  7. The best thing you can do is to tune into your own body and choose foods that don’t add more stress. I have no doubt that there are people out there who have limited or removed dairy, and feel better. I also don’t doubt that there are people out there who feel better when including dairy in their diet! If dairy doesn’t work for you, then you don’t need it. If you can eat dairy and you have low appetite or other things limiting your food choices, then it’s a conveniently nutritious option 🙂

In my experience, restricting foods unnecessarily often leads to more difficult challenges.

Reach out if you have any questions, or if you want to better understand if dairy is a do or don’t for you!

Krystal Merrells

Survivor of multiple concussions

Registered Dietitian

And I love cheese <3

Close-Up Photo Of Assorted Cheese

References

Ano, Y., Ayabe, T., Kutsukake, T., Ohya, R., Takaichi, Y., Uchida, S., Yamada, K., Uchida, K., Takashima, A., & Nakayama, H. (2018). Novel lactopeptides in fermented dairy products improve memory function and cognitive decline. Neurobiology of aging, 72, 23–31. https://doi.org/10.1016/j.neurobiolaging.2018.07.016

Brooke-Taylor, S., Dwyer, K., Woodford, K., & Kost, N. (2017). Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein. Advances in nutrition (Bethesda, Md.), 8(5), 739–748. https://doi.org/10.3945/an.116.013953

Chen, H., O’Reilly, E., McCullough, M. L., Rodriguez, C., Schwarzschild, M. A., Calle, E. E., Thun, M. J., & Ascherio, A. (2007). Consumption of dairy products and risk of Parkinson’s disease. American journal of epidemiology, 165(9), 998–1006. https://doi.org/10.1093/aje/kwk089

Dinel, A. L., Rey, C., Bonhomme, C., Le Ruyet, P., Joffre, C., & Layé, S. (2016). Dairy fat blend improves brain DHA and neuroplasticity and regulates corticosterone in mice. Prostaglandins, leukotrienes, and essential fatty acids, 109, 29–38. https://doi.org/10.1016/j.plefa.2016.03.013

Giles-Smith, Karen. (March 2013). Milk Proteins: Packing a Powerful Nutritional Punch. Today’s Dietitian, Vol 13, No 3, P 26. Accessed online Nov 2 2020 at https://www.todaysdietitian.com/newarchives/030413p26.shtml

Jianqin, S., Leiming, X., Lu, X., Yelland, G. W., Ni, J., & Clarke, A. J. (2016). Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk. Nutrition journal, 15, 35. https://doi.org/10.1186/s12937-016-0147-z

Lee, J., Fu, Z., Chung, M., Jang, D. J., & Lee, H. J. (2018). Role of milk and dairy intake in cognitive function in older adults: a systematic review and meta-analysis. Nutrition journal, 17(1), 82. https://doi.org/10.1186/s12937-018-0387-1

Lordan, R., Tsoupras, A., Mitra, B., & Zabetakis, I. (2018). Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned?. Foods (Basel, Switzerland), 7(3), 29. https://doi.org/10.3390/foods7030029

Marques Lopez, José. (Nov 28 2018). Study Llinks Smoking, Reduced Parkinson’s Risk, But Comes with Caveat. Parkinson’s News Today. Accessed online Nov 3 2020 at: https://parkinsonsnewstoday.com/2018/11/28/smoking-linked-reduced-parkinsons-risk-but-carries-caveat/

Ulven, S. M., Holven, K. B., Gil, A., & Rangel-Huerta, O. D. (2019). Milk and Dairy Product Consumption and Inflammatory Biomarkers: An Updated Systematic Review of Randomized Clinical Trials. Advances in nutrition (Bethesda, Md.), 10(suppl_2), S239–S250. https://doi.org/10.1093/advances/nmy072

Zaeem, Z., Zhou, L., & Dilli, E. (2016). Headaches: a Review of the Role of Dietary Factors. Current neurology and neuroscience reports, 16(11), 101. https://doi.org/10.1007/s11910-016-0702-1

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