A dairy-free pregnancy diet excludes all sources of dairy products whilst still providing the essential nutrients needed for a healthy pregnancy. Dairy products include animal milk and milk products like butter, cheese, and yoghurt. A dairy-free diet during pregnancy is usually chosen by people who are lactose-intolerant, allergic to dairy or voluntarily abstain from dairy products due to personal reasons. Doctors also recommend that unpasteurised milk and some types of cheese be avoided during pregnancy due to possible exposure to listeria (the bacteria causing listeriosis). Whatever the reason, maintaining a balanced diet to ensure all nutritional needs are met is paramount for you and your baby.
Importance of calcium
Growing up, you most likely heard your parents tell you to finish up your glass of milk to help your bones grow big and strong. This is a true statement – dairy products are well-known sources of calcium, which is essential for bone development. In fact, most of the body’s calcium is stored in the bones. It is also stored in the blood, cells, and muscles. Of all the minerals in the body, calcium is the most abundant and for good reason.1 Apart from bone development, it is essential for teeth formation, muscle contraction, the transmission of signals between nerves, blood clotting, and proper functioning of the heart, among numerous other functions.1 Additionally, in pregnant women, calcium is needed for proper foetal development, stimulating uterine contractions during labour, preventing pre-eclampsia, and reducing the risk of pre-term birth.2
In adults aged 19-64, the recommended calcium intake is 700 mg per day. In pregnancy, WHO recommends a daily intake of 1.5-2.0 g of calcium per day in three divided doses (with meals) from the 20th week until the end of pregnancy.2 While dairy foods are good sources of calcium, there are also several non-dairy sources which provide the daily recommended intake needed for normal metabolism. In this article, we will deeply dive into what exactly calcium intake in a dairy-free diet looks like and what this means for you and your baby.
Benefits of a dairy-free diet
The purpose of this article is not to disparage dairy products because, as we know, they provide many nutritional benefits. However, as stated earlier, there are several reasons to have a dairy-free diet, which offers numerous benefits.
This occurs due to a deficiency of the enzyme lactase. This reduces the ability of affected individuals to digest and absorb lactose. Dairy products contain lactose and if not properly broken down due to a deficiency or improper functioning of lactase, this can lead to diarrhoea, bloating and discomfort.
Individuals can be allergic to certain proteins found in dairy. Exposure of these individuals to dairy foods can cause symptoms like itchy eyes and nose, sneezing, rashes, hives, stomach cramps, vomiting, diarrhoea, cough, swelling and even anaphylaxis, a life-threatening medical condition. In these cases, maintaining a dairy-free diet is essential and could well be lifesaving.
Protection of “At risk” group
Because of rapid changes occurring in both mother and baby, pregnant women can be at increased risk of getting certain diseases. Other at-risk groups include infants and young children, people older than 65 and people who are immunocompromised. Due to this increased risk of infection if exposed to listeria (which causes listeriosis), pregnant women are advised to stay away from unpasteurised milk and cheeses like goat cheese, blue-veined cheese, and mould-ripened cheese.
In some individuals suffering from skin conditions like acne, cutting out dairy foods might improve the appearance of the skin.
Lifestyle choices and sustainability
Some individuals may choose to cut out dairy for personal reasons or to be more environmentally sustainable by not relying on animal-based products.
It should, however, be noted that studies have shown that consuming dairy in recommended amounts has no adverse effect on weight, cardiovascular health, and chronic conditions like arthritis.2
Overview of increased calcium needs during pregnancy
Pregnancy is a high metabolic state,, and several physiological changes happen to maintain your body’s internal environment and promote the baby’s development in utero. Some of these changes cause an increased uptake of calcium and affect how it is utilized. Most of the body’s calcium is stored in the bones, but a small amount is stored in the blood (known as serum calcium) and can either be bound to albumin (a serum protein) or unbound. In pregnancy, bound serum calcium falls due to increased demand and unbound serum calcium remains the same as in non-pregnant women. Although the body makes several adaptations, calcium demand in pregnancy is not always met, making pregnant women prone to hypocalcemia (low blood calcium), which can cause symptoms including tetany, weakness, paralysis, tingling, depression, and increased risk of bone weakness.2
To meet this demand, the body increases the rate of calcium absorption in the intestines and the rate of bone turnover. Additionally, you can increase your dietary intake of calcium and/or take calcium supplements based on your doctor's advice.
Dairy-free calcium-rich food sources
For pregnant women on a dairy-free diet, the following foods are great sources of calcium.
Alternative plant-based sources of milk have garnered more attention in the last decade, and for good reason.3 Not only are they good for the planet, but once adequately fortified, they can provide the recommended dietary intake of calcium needed during pregnancy. Almond milk, soy milk, coconut milk and oat milk are the most common sources.4 They are versatile and can be added to smoothies, cereals, and porridge. They can also be used to make plant-based yoghurts.5
Vegetables like kale, okra, broccoli, spinach, and collard greens are good sources of antioxidants as well as vitamins and minerals, including calcium.3 These vegetables can be enjoyed in salads, lightly steamed or cooked. Additionally, leafy vegetables like kale and spinach can be added to smoothies.
Tofu and tempeh
Calcium set tofu and tempeh, both soya-based products, are commonly used as meat replacements in vegan meals because of their firm and chewy textures. Tofu is made from processed coagulated soya milk and compressed into solid blocks. Tempeh, on the other hand, is made from fermented soya beans compressed into a dense cake-like structure.5 Some varieties can contain brown rice, quinoa, or flaxseed. Tofu and tempeh offer 15% and 6% of the daily recommended calcium intake, respectively.5 However, when purchasing tofu or tempeh, be sure to check the ingredient list, as not all brands contain calcium.
Nuts and seeds
Consumption of nuts in moderate amounts proffers several benefits, including lowering blood cholesterol levels and reducing the risk of metabolic syndrome. They are also good sources of calcium, but care needs to be taken as they contain oxalate (which can hinder calcium absorption and cause kidney stones). Compared to other nuts, almond nuts have the highest levels of calcium at 28 grams per serving, providing up to 6% of the daily recommended intake.3 Chia seeds, sesame seeds and poppy seeds are also high in calcium and can be easily incorporated into a non-dairy pregnancy diet. One serving of sesame seeds and poppy seeds provides approximately 7% and 10%, respectively, of the daily recommended intake. They can be eaten on their own as snacks or as part of meals.5
Calcium can be added to various foods to improve their nutritional quality. This is especially helpful in increased metabolic states like pregnancy, where calcium utilisation is increased and calcium obtained from a standard diet might be inadequate. In addition to tofu/tempeh and plant-based milk, cereals, juices, and grains like wheat can be fortified with calcium. For example, two medium waffles made with fortified wheat flour contain about 200 mg of calcium.5
In addition to omega-3 and minerals like selenium, seafood like salmon, pilchards, sardines (especially if eaten with their bones), and shrimp contain high levels of calcium. A 92 g serving of sardines contains about 27% of the daily recommended intake, and 85 g of salmon contains about 19%. Fish and shrimp can be boiled, fried, grilled, or cooked in a myriad of ways and served as part of dishes.5
Consulting a healthcare professional
While there are numerous non-dairy sources of calcium, it is important to discuss your diet with your healthcare provider to ensure you’re meeting the recommended calcium intake. This is essential to ensure you and your baby remain healthy throughout your pregnancy journey. It is important to discuss this with your doctor as they might also recommend calcium supplements in addition to your non-dairy diet and regular serum calcium monitoring during scheduled antenatal appointments.
Potential pitfalls and considerations
The following points need to be considered.
Absorption and bioavailability
The rate of absorption and bioavailability of calcium in non-dairy sources (28-26%) is lower than in dairy sources (about 30-40%), partly due to the absence of lactose. Larger amounts of non-dairy calcium sources may need to be consumed to get the same amount as from dairy sources.1
Non-dairy sources of calcium are usually more expensive than dairy sources.
Adopting a dairy-free diet generally involves more planning. It is important to note that some non-dairy foods may be more difficult to source and may not be available in some restaurants and grocery stores.
Compared to a diet incorporating dairy, there is a higher risk of not meeting the required daily recommended calcium intake with a non-dairy diet.
Calcium plays a pivotal role in a dairy-free pregnancy diet, supporting both the expectant mother's health and the developing baby's needs. While dairy products might be excluded, it's crucial to ensure sufficient calcium intake through alternative sources to prevent deficiencies and promote strong bones and healthy development.
A well-rounded, nutrient-rich diet remains paramount during pregnancy. Embrace a diverse array of plant-based foods, including leafy greens, nuts, seeds, and fortified non-dairy milk. By maintaining a balanced approach to nutrition with the help of your doctor, you’re providing the best foundation for a healthy pregnancy journey.
- Siggaard-Andersen O, Thode J, Fogh-Andersen N. What is “ionized calcium”? Scandinavian Journal of Clinical and Laboratory Investigation [Internet]. 1983 Jan [cited 2023 Nov 1];43(sup165):11–6. Available from: http://www.tandfonline.com/doi/full/10.1080/00365518309169073
- Kumar A, Kaur S. Calcium: a nutrient in pregnancy. J Obstet Gynecol India [Internet]. 2017 Oct 1 [cited 2023 Nov 1];67(5):313–8. Available from: https://doi.org/10.1007/s13224-017-1007-2
- Suri S, Kumar V, Prasad R, Tanwar B, Goyal A, Kaur S, et al. Considerations for development of lactose-free food. Journal of Nutrition & Intermediary Metabolism [Internet]. 2019 Mar 1 [cited 2023 Nov 1];15:27–34. Available from: https://www.sciencedirect.com/science/article/pii/S2352385918300069
- Mefleh M, Pasqualone A, Caponio F, Faccia M. Legumes as basic ingredients in the production of dairy‐free cheese alternatives: a review. J Sci Food Agric [Internet]. 2022 Jan 15 [cited 2023 Nov 1];102(1):8–18. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jsfa.11502
- Tangyu M, Muller J, Bolten CJ, Wittmann C. Fermentation of plant-based milk alternatives for improved flavour and nutritional value. Appl Microbiol Biotechnol [Internet]. 2019 Dec 1 [cited 2023 Nov 1];103(23):9263–75. Available from: https://doi.org/10.1007/s00253-019-10175-9