The first 1000 days (~2 years) of baby's life is a critical window to ensure proper neurodevelopment and epigenetics. Epigenetics, the modification of gene expression, is influenced by the baby's diet (as well as mother's diet during pregnancy and breastfeeding), lifestyle, and environment. Nutrient deficiencies and/or poor quality food choices may cause some genes to turn off and on in unfavorable ways, increasing the risk for disease as the baby ages (1). Furthermore, during the first 4 years, but especially during the first few months and up to a year, baby starts to develop its' own unique microbiome. The microbiome of infants is influenced by the type of birth, feeding practices (such as breastfeeding vs formula feeding), antibiotic usage by mom or baby, and type of complimentary foods introduced. By the time baby reaches 3-5 years of age, the microbiome resembles that of an adult. Although the microbiome is still more adaptable to dietary changes up until the teen years, this initial period of time sets the stage for both health and disease moving forward (2).   

Having a basic understanding of infant nutrition becomes essential when you start to introduce complimentary food around 6 months of age. After reading this article, I hope you will understand why making homemade baby food provides your baby with the most nutrient dense and affordable options. But first, in order to understand where my recommendations are coming from, we have to understand the average composition of breastmilk. Fat provides the majority of energy in breastmilk, providing about 50% calories. Approximately 40% of the energy in breastmilk is derived from carbohydrates, and the remaining 10% from protein. Furthermore, energy from fat in breastmilk continues to increase as babies get older. Research found that breastmilk from moms who had breastfed for > 1 year had a greater fat percentage than those that breastfed only 2-6 months (3). 
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​Between the age of 6-12 months babies needs on average 80kcal/kg per day with at least 13g protein and at least 30g of fat per day. Generally, after about 6 months of age, the total volume of breast milk consumed by the infant becomes insufficient to meet the baby’s daily needs for energy, protein, iron, zinc, and fat soluble vitamins (4). Now look at the popular commercial baby food nutrition labels below. How is your baby going to get at least 30g of fat and 13g of protein by eating only these? The first three products make it very difficult to make a dent in either the fat or the protein recommendations. Granted babies are still drinking breast milk or formula as complimentary foods are introduced, but that doesn't mean the complimentary foods should consistently lack essential macronutrients and micronutrients. If we look at most of the choices available in grocery stores, they contain very little to no fat and protein. Although whole food based fruit/starch baby purees are not “unhealthy”, they are just lacking BALANCE, and therefore lacking some very critical nutrients that are found in protein and fat rich foods. The fourth, Serenity Kids, is the best option, but it is very expensive costing $4 per pouch (compared to $1.50-$2 for the other ones) and is only available online. Serenity Kids baby pouches are great for on-the-go or last minute options, but are not affordable if used for the majority of baby food provided.

​Fat and protein are essential macronutrients. Fat is essential to help absorb fat soluble vitamins A, E, D, and K. Foods rich in quality fat like fatty fish, egg yolks, avocados, nut butters, grass-fed butter and heavy cream, olives, and extra virgin olive oil are naturally excellent sources of one or more fat soluble vitamins. Fat soluble vitamins play a big role in growth and development, they support a healthy immune system, and reduce inflammation. Without adequate fat, we cannot digest and absorb these critical nutrients. Interestingly, mature human milk is comprised of mostly saturated (~40%) and monounsaturated (~35%) fats. Omega-6 (12-26%) and Omega-3 (0.8-3.6%) fatty acid content varies greatly depending on the mothers diet (5). Due to the high amount of fat in breast milk infants rely more heavily on both salivary and gastric lipase (enzymes that breaks down fat for absorption) compared to adults because pancreatic lipase doesn't reach maturity until 1 year of age. These enzymes preferentially break down short and medium chain fatty acids, which are abundant in milk fat and coconut oil (6,7). These enzymes allow infants to break down fatty acids found in breast milk for easier absorption. Fats in the adult diet that are rich in short and medium chain fatty acids are grass-fed butter and cream (butyric acid - short chain) and coconut milk (lauric acid - medium chain). Longer chain fats like mono and polyunsaturated fatty acids from avocados, nuts & seeds, and fish, require more complex digestion in the small intestine including pancreatic lipase and bile for absorption. Not surprisingly, research has also found that the dietary fat content of breastmilk fluctuates based on mom's dietary fat intake. If mom eats a low fat diet, her breastmilk will have a lower percentage of fat in the milk, and also a lower percentage of fat soluble vitamins. Therefore, fat intake and fat quality is VERY important for both mom and baby (8,9,10). Plus, fats increase satiety by slowing down the rate at which food empties from the stomach! This can be especially helpful to support better sleep and nap patterns.

​Adequate protein is essential because the demand is high for tissue replacement, development of lean body mass, and growth. Infants require more protein per kilogram of body weight than do adults (1.2g/kg vs. 0.8g/kg). Furthermore, protein rich foods are excellent sources of iron and zinc, two nutrients that become important as complimentary foods start to replace breastmilk. Animal sources of protein like grass-fed beef, liver, and egg yolks, etc. contain more bioavailable sources of iron and zinc than do plant based alternatives such as beans/legumes and dark leafy greens. Pairing plant based iron sources with vitamin C rich fruit and vegetables aids in absorption. Infants between 7-12 months of age require 11mg/day of iron and 3mg/day of zinc (4). 
 
Iron Rich Animal Foods (with easily absorbed heme iron)
Chicken Liver, Beef Liver, Beef/Lamb, Dark Turkey/Chicken Meat, Eggs, Sardines, Salmon, Skipjack Light Tuna
 
Iron Rich Plant Foods (with non-heme iron)
Extra firm tofu, beans, lentils, peas, spinach
 
Pair Non-Heme Foods with Vitamin C Rich Foods 
Strawberries, Kiwi, Cantaloupe, Citrus, Papaya, Pineapple, Bell Peppers, and Broccoli
 
Research suggests that healthy full term babies have adequate iron and zinc stores that last them for at least the first 6 months. Therefore the American Academy of Pediatrics Committee on Nutrition recommends that breast-fed infants receive 1mg/kg/day of iron by 6 months, preferably from iron rich complimentary foods. Interestingly, recent research found that when compared to infants who received iron-fortified cereals vs iron and zinc rich pureed beef, the babies that consumed the beef had an increase in head circumference and had a trend towards a higher behavior index at 12 months (11). See my Baby Liver Pate recipe for a rich source of iron, zinc, and many more critical nutrients! 
 
Black Beans (1oz) vs Grass-fed Ground Beef (1oz)
Beans: 40kcal, Protein 2.3g, Fat 0.2g, Iron 0.7mg, Zinc 0.3mg
Beef: 56kcal, Protein 5.5g, Fat 3.6g, Iron 0.6mg, Zinc 1.3mg

Another important reason to make homemade baby food purees is the ability to increase the variety of foods used in the purees. Increasing variety increases both the nutrients and phytonutrients in the baby's diet. Nutrients are vitamins and minerals, while phytonutrients are plant compounds that provide a wide array of health benefits including reducing inflammation. Most interestingly, phytonutrients act as prebiotics, the food for good gut bacteria, and can modulate the gut microbiome in favorable ways. Did you know that by age 3, the gut microbiome becomes an adult like ecosystem? The adult microbiome is very resilient and difficult to change. Only 30-40% of the microbiome can be influenced by long-term dietary and lifestyle interventions (12). This is very important as the gut microbiome place a huge role in the development of health and disease.

​​One can increase the phytonutrient density of the diet by simply increasing the variety of plant foods consumed including fruit, vegetables, beans/legumes, nuts/seeds, herbs/spices, etc. Each plant food provides its' own unique array of phytonutrient compounds. Most baby food is limited to certain standard ingredients including bananas, apples, sweet potatoes, and carrots. They are also commonly peeled, even if they do not need to be peeled such as apples, potatoes, and carrots. Keep in mind, the peels of fruit and veggies contain the majority of the phytonutrients. So if you don't need to peel it, then don't. Just make sure its organic! Other foods that are rich in prebiotics that are often not included in baby food purees include garlic, leeks, and onions. Not only are they great for gut health, but they add a lot of flavor. The more flavor babies are exposed to through their diet and mother's breastmilk, the less likely they will be picky eaters later on, and more likely to have a varied diet rich in phytonutrients and prebiotics. 
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​Finally, another reason to make homemade baby food is heavy metal contamination. A recent study from Healthy Babies Bright Future, has highlighted the problem with the contamination of heavy metals in commercial baby foods. The organization looked at 168 products over 61 brands, and measured the amount of arsenic, mercury, cadmium, and lead found in the samples. They found at least one heavy metal in 95% of the products tested. Rice based foods, especially cereals where at the top of the list, with highest levels of arsenic. Fruit juice, carrots, and sweet potatoes were also found to have a higher risk for heavy metal exposure (13). If you are curious to see if your baby food products are high in heavy metal check out this website. The less stars, the more heavy metals are in the product. 

When we combine all the data highlighting the needs for 50% of the calories to come from fat, increased need for fat soluble vitamins, as well as iron and zinc, and the importance of adequate protein, then the simple fruit and veggie blends just do not meet the infant’s needs. Plus, commercial baby foods, especially rice based products, could be a source of heavy metals in your baby’s diet. Therefore, making simple BALANCED baby purees rich in a variety of plant foods at home is the best choice for your baby. Offering two to three different purees at each meal ensures adequate variety and nutrient density. 

​Making baby food at home doesn't need to be complicated. Simply steam or bake a veggie that you have at home and mix it with a protein and/or fat item. Use a little bit and mash it up as needed or prepare a whole batch with a food processor and freeze into individual servings. The VERY SIMPLE combinations below only require a fork for mashing…no processor needed. Depending on your baby you may need to adjust the texture, adding more liquid for a smoother texture. As the baby gets older and swallow/chew function improves, you can increase the texture, leaving more chunks.

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​Baby FORK MASHABLES
Zesty Avocado Chickpea (makes 4 servings)
INGREDIENTS
1/3 cup canned chickpeas (rinsed) + ½ avocado + squeeze lemon/lime juice + pinch salt/pepper
 
DIRECTIONS: Place rinsed and drained chickpeas in a bowl and heat in microwave for 30 seconds. Mash with a fork until desired texture. Stir in a small squeeze lemon/lime juice and a pinch salt and pepper. Add the avocado and mash together until desired texture. 
 
Garlicky Cauliflower Yolk (makes 4 servings)
INGREDIENTS
1/3 steamed medium cauliflower (florets only) + 1 steamed garlic clove + 1 egg yolk + 2 teaspoons grass fed butter + pinch salt/pepper + sprinkle dulse granules
 
DIRECTIONS: Steam cauliflower head in steamer basket along with garlic clove, ~ 20 minutes. Meanwhile medium boil and egg for ~ 8 minutes. Rinse under cold water. Peel and remove white and keep the yolk. Once the cauliflower is fork tender remove 1/3 of the cauliflower (florets only) and place into a bowl along with egg yolk and steamed garlic clove. Mash until desired texture. Season with pinch salt, pepper, and sprinkle dulse granules. 
 
Spiced Banana Chia (makes 4 servings)
INGREDIENTS
1 medium banana + ¼ cup whole milk yogurt + 1 teaspoon chia seeds + ¼ teaspoon cinnamon 
 
DIRECTIONS: Mash the banana to desired texture. Stir in the yogurt, chia seeds, and cinnamon until combined. Allow to sit at least 1 hour to allow chia seeds to plump up. 

Sweet Potato & Chèvre (makse 4 servings)
INGREDIENTS
1 small steamed and cooled sweet potato/yam + 1oz plain chèvre (fresh goat cheese) + salt and pepper + 2 teaspoons extra virgin olive oil

DIRECTIONS: Remove the peel from the sweet potato and place into a bowl/glass food storage container. Top with chèvre and sprinkle salt and pepper. Microwave for 90 seconds or until the sweet potato and chèvre are warm. Drizzle with olive oil and mash with fork.

You can also make puree blends (adjust texture per baby’s development) to increase the variety of flavors and spices baby gets exposed to. Babies love flavor just like adults! Keep in mind that it may take 10-15 tries before baby likes a new food item. Allow them to explore a new flavor or texture multiple times before giving up on the food itself. Some babies even like the food served cold or room temperature. See some of my recipes below for inspiration! They have all been approved by baby Toren :)
 
Berry Prune FRUIT BLEND
Apple Butternut VEGGIE BLEND
Potato & Fennel with Greens VEGGIE BLEND
​Baby Liver Pate PROTEIN BLEND
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​Although initially it can be overwhelming to make your own baby food (amongst everything else you have to do as a parent), it is good to know HOW & WHY. Not only is it the more budget friendly choice, but it can be the more nutrient dense choice if done right. During the first 2 years of life (and beyond), it is so important to provide high quality, nutrient dense food options, that do not omit certain critical nutrients. Although fruits and vegetables are essential to health, don't forget to add some quality FAT and provide some quality PROTEIN. There are many other nutrients of concern regarding infant and early toddler nutrition not highlighted in this general overview. Consider working with your dietitian for more personalized recommendations, especially if food allergies or food intolerances are an issue. 

FRUITPHOBIA 
Fresh seasonal fruit is so delicious! There is nothing that compares to a bright red strawberry picked in the middle of June or a fresh papaya drizzled with lime juice when traveling in Hawaii. Especially in the hotter months, cooler water-rich foods like fruit are more often desired than a hot meal. 
 
Unfortunately, with the popularity of low carbohydrate diets many individuals are fearful of fruit. Many paleo and low carb diet advocates recommend sticking to only small amounts of low sugar fruits like berries stating that other fruit provide too much unnecessary sugar. I have had multiple patients in practice that are too afraid to eat more than a ½ cup of berries per day! 
 
I agree that it is important to reduce your intake of added refined sugars like high fructose corn syrup, maple syrup, honey, sugar, and other processed foods. However, this does not immediately place fruit into the same category. Although fruit does contain sugar (glucose and fructose), it is not found in the same concentration as high fructose corn syrup in sodas, pastries, pancake syrups, etc. For example, soda contains a sugar ratio of 60% fructose to 40% glucose. One 20 oz bottle of Coke contains roughly 36 grams of fructose. Now compare that to a banana, which contains 7 grams of fructose, or a medium sized apple with 13 grams fructose. When do you sit down and eat 7 bananas in one sitting? Never! Plus, that banana comes in a completely different package, rich in fiber, and made by nature.
 
However, this way of thinking can cause harm. You are not addicted to sugar if you enjoy fruit. Fruit is rich in easy to digest carbohydrates, antioxidant rich vitamins and minerals, gut healing fiber, and anti-inflammatory polyphenols. Plus, they are easy to throw into a bag and hit the road. Rather, if fruit is lacking in your diet you may be missing out on a lot of health benefits. 
 
REASONS WHY FRUIT ARE GOOD TO EAT

Fruit are Rich in Polyphenols: Polyphenols are plant compounds that are found most concentrated in the outer parts of plants. These chemical compounds have been studied in relation to their potent anti-inflammatory and antioxidant capacities. Each type of polyphenol has different health benefits. Therefore, it is important to consume a variety of unpeeled fruit (unless it's a melon or banana of course). Polyphenols have been shown to help:

• Reduce inflammation
• Prevent cancer, cardiovascular disease, and neurological disorders. 
• Fight infections
• Promote the growth of good gut bacteria. 

Fruit Are Rich in Soluble Fibers and Prebiotics:
Soluble fibers and prebiotic fibers help support the growth of good gut bacteria. When these fibers reach the large intestine, they are fermented by bacteria and produce short chain fatty acids which help fuel colon cells and prevent colon cancer. 

• Apples, oranges, and bananas are rich in soluble fiber. 

Fruit Are Rich in Vitamin C: Vitamin C is a nutrient that is very sensitive to heat, light, and air. Therefore, whole fruit become an excellent source of vitamin C. It is suggested that the current RDA for vitamin C is too low (75-90mg) and that we should be shooting for at least twice as much from whole foods. Especially if you are under a lot of stress, exercise a lot, or have an inflammatory condition, getting plenty of vitamin C is essential. 

• Excellent sources of vitamin C include: kiwis, oranges, papayas, strawberries, and pineapples.

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Fruit Are Easy to Digest Whole Food Carbohydrates for Active People:If you are on the go and active, especially in the summer months, then fruit can be a great way to fuel your activity. Generally, your carbohydrate intake increases with your amount of activity. If you are unsure what to pack to fuel a mountain bike ride, trail run, or hike, pack some fruit! It comes in its own protective barrier, and is easy to eat!

• Easy Fruit to Pack: Apple, Banana, Orange, Grapefruit,

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Fruit Can Help You Digest Protein: Some fruit contain unique enzymes that aid in digesting proteins and help reduce inflammation, support wound healing and relive constipation. You can even buy digestive enzymes in supplement stores made with these fruit enzymes. 

• Protein Digesting Fruit: papaya, pineapple, and kiwi.

 
SOME CONSIDERATIONS
Daily fruit consumption depends on the individual. Some can tolerate more than others due to activity levels and certain health conditions. For example, individuals with a fructose intolerance or severe gut imbalances may not do well with apples, pears, cherries, figs, and mangos. On the other hand, those that have metabolic disorders like diabetes and PCOS (polycystic ovarian syndrome) may have to stick to lower sugar fruits like kiwi and berries or pair their fruit with protein for better blood sugar balance. If you have any of these issues it may be best to work with a dietitian to help you find out what fruit and what portion is right for you. 
 
TAKEWAY
Don't fear fruit!! If you are a healthy individual, eating seasonal organic fruit to your liking can provide many health benefits and should not be avoided. I generally recommend 2 servings of fruit per day and adjust the types of fruit based on the individual needs of the patient.  

Many people have heard of vitamin D and understand its relationship to the sun. I often hear people say “soaking up my vitamin D”, when a nice, sunny day arrives. But is it really as simple as that? Of course not. Today I will clarify what vitamin D is, why you need to make sure you are getting enough, and how to make sure you are getting what you need. 
 
Vitamin D is a fat soluble vitamin with hormone like properties that is found naturally only in a few foods and can be synthesized in the skin from the sun’s UVB rays. It is commonly known for its facilitative role in bone health by increasing calcium absorption and for its role in improving seasonal affective disorder. However, many people do not know that it also is required for proper immune function, hormone health, cellular growth and development, and blood sugar and blood pressure regulation. That's a lot! Many studies have found an inverse relationship between vitamin D status and autoimmune disorders, diabetes, eczema, cancer, depression, and more. The current recommended dietary allowance (RDA) is set at 400IU per day for infants, 600IU per day for children and adults alike, and 800IU for the elderly. 
 
SOURCES OF VITAMIN D
 
Vitamin D from the Sun
The sun doesn’t give you vitamin D3, it merely starts a process. Upon the skin’s exposure to the sun’s UVB rays, pre-vitamin D3 is converted to inactive vitamin D3 (cholecalciferol). After conversion in the skin, cholecalciferol is quickly transported to the liver and then to the kidneys to be metabolized to active vitamin D3, also known as calcitriol. Therefore, if the liver or kidneys are not functioning properly, vitamin D status can be impaired. 
 
However, the darkness of your skin, the fat deposition underneath your skin, and the coverage on your skin (including sunscreen and clothing) all play a role into if and how much pre-vitamin D3 is converted to cholecalciferol. If you have darker skin tone, are elderly (less fat under skin), wear a protective clothing layer, or apply a sunscreen greater than 10 SPF you will have reduced or no vitamin D3 conversion. Furthermore, the time of year and time of day also play an important factor. In latitudes above 42 degrees North (or below 42 degrees South), there is inadequate UVB radiation to support vitamin D synthesis from mid-October to mid-March. Keep in mind Bellingham is at 48 degrees North. Plus, the best time for good UVB exposure is between 10am – 2pm. Therefore, if you are working an indoor job from 9am to 5pm, are fully clothed, and wear sunscreen on your face, then you will not synthesize any vitamin D. And if you think you will get some vitamin D when sitting in a sunny spot inside, think again. It doesn’t matter what time of year it is, or time of day, if you are sitting in front of a window, all UVB rays will be blocked and you will not synthesize any vitamin D.   
 
Nutritionist Tip: Get outside around noon for 15 minutes and expose your hands, arms, and face (without sunscreen) in the late Spring, Summer, and early Fall months to synthesize about 1000IU. Then you can layer on the sunscreen or seek shade. 
 
Vitamin D from Food
Vitamin D is only found naturally in very few foods including fatty fish like salmon and sardines (340IU per 3oz), eggs (40IU per egg), and liver (40IU per 3oz). Mushrooms, although advertised as a source of vitamin D, often do not provide much useable vitamin D unless the grower purposefully has exposed the mushrooms to UV light. One cup of sliced “unexposed” crimini mushrooms only provides 5IU, whereas the “exposed” provides around 400IU. Ask your grocer what kind they offer. However, there are other foods on the market that are fortified with vitamin D such as dairy and plant milks, orange juice, and some cereals, usually providing anywhere between 50-100IU per serving. 
 
Nutritionist Tip: Enjoy fatty seafood like salmon, UV “exposed” mushrooms, and fortified milk or non-dairy milks multiple times per week for substantial food sources of vitamin D. 
 
Vitamin D from Supplements
Vitamin D supplements can be found as vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). Vitamin D2 is synthesized via UV irradiation of yeast, whereas D3 is synthesized via UV irradiation of lanolin. However, research studies have found that vitamin D2 may not be as effective in increasing active (calcitriol) vitamin D3 serum levels. Taking supplements is essential when adequate dietary intake and proper sun exposure are lacking. 
 
How Much to Supplement?
The optimal intake of vitamin D to support general health and wellbeing remains controversial. Researchers have found a U shaped curve regarding vitamin D status, indicating that both low and high vitamin D serum levels are correlated with disease development and progression. The Linus Pauling Institute recommends that generally healthy adults supplement with 2000IU of vitamin D3 daily. Some may need more or less depending on all the factors discussed previously. However, more is not always better! High dose vitamin D supplementation that is not monitored can lead to abnormally high serum calcium concentrations which can damage the kidneys and heart. Research suggests that daily intakes of less than 10,000IU per day in healthy individuals is very unlikely to result in toxicity.  
 
Nonetheless, it is best to test not guess! Work with a health care practitioner to check your vitamin D status 1-2x per year to get a feel for what your unique needs are. Research studies suggest that a serum vitamin D concentration between 40 ng/mL and 60 ng/mL is ideal. 
 
Nutritionist Tip: Supplement with 1000 - 2000IU per day and check your vitamin D levels annually to ensure a serum vitamin D between 40-60ng/mL. Make sure to check your multivitamin, as they often already contain some vitamin D.
 
RESOURCES FOR THE INSPIRED INDIVIDUAL
 Overall, low vitamin D status can impact your health in many ways. Unfortunately, testing vitamin D status is not as routine as it should be, especially here in the Pacific Northwest. Ensuring optimal vitamin D levels year round can help keep you feeling your best. Be an advocate for yourself and request vitamin D labs at your annual doctors visit or see the resources below for more helpful research, testing, guidelines, and applications. 

• Check out GrassRoots Health for more vitamin D information and research. They also provide vitamin D testing for $65. 
• Check out the free DMinder App to monitor your vitamin D status and local sun exposure. 
• Check out the Environmental Working Group “Guide to Sunscreen” for safe sunscreen products. 

 
Article References:
Krause’s Food & The Nutrition Care Process, 14thEdition. Pages: 1071-1072.
Linus Pauling Institute. Vitamin D. https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#RDA
GrassrootsHealth. Resources. https://grassrootshealth.net/documentation/

If you suffer from seasonal (or chronic) allergies, the Spring and Summer months may be your least enjoyable time of the year. As the flowers bloom and the grasses grow, your ears, nose and eyes keep you inside. However, there are a few things you can do via diet that may help you enjoy the summer months once again and maybe even save some money on over-the counter anti-histamines down the road.
 
Eat a Whole Foods Diet:
By eliminating processed foods and eating a diet rich in quality grass-fed meats and wild caught seafood, fruits & vegetables, whole grains, beans and legumes, nuts and seeds your diet will help reduce inflammation and histamine production. The benefits don't stop there! Many people are sensitive to food additives such as sulfites, MSG, food coloring, and added sugars all of which may contribute to allergic symptoms. By switching to a whole foods diet like the Mediterranean Diet, Anti-Inflammatory Diet, Whole 30, or Paleo you will naturally reduce the consumption of these additives.
 
Dietitian Tip: No matter what whole foods based diet you choose aim for at least 6 servings of veggies per day and 2 servings of fruit. One serving is equal to: 1 cup of leafy greens, ½ cup hardy veggies, 1 cup diced melon or berries, and 1 medium piece of fruit. 
 
Increase Foods Rich in Magnesium & Calcium:
Did you know that more than two thirds of Americans consume less than recommended magnesium daily? Magnesium is a mineral that is required in over 300 enzymatic reactions including histamine metabolism. It is found in whole grains, beans and legumes, nuts and seeds, and leafy greens. Pumpkin seeds are one of the richest sources of magnesium. Other big super stars include quinoa, chia, flax, almonds, dark chocolate, oatmeal, and spinach. Aim to eat 3 servings of magnesium rich food daily to ensure adequate intakes. Furthermore, calcium has been found to have a regulatory role in histamine release as well. 
 
Dietitian Tip: Monitor your intake of calcium rich foods such as grass-fed dairy, sardines with bones, or calcium fortified nut milks to make sure you are getting close to 1000mg daily. You may also consider an additional magnesium supplement of 200mg of magnesium glycinate per day and note for improvement in symptoms. Discuss this with your health care provider.  
 
Increase Foods Rich in Vitamin C:  
Vitamin C helps prevent the release of histamine from mast cells. As with magnesium, many Americans are not getting adequate vitamin C via their diet. Foods rich in vitamin C include papaya, raw bell pepper and broccoli, strawberries, citrus fruit, and cantaloupe. Aim for at least 2 servings of vitamin C rich fruit or veggies per day. 
 
Dietitian Tip: Camu Camu is a supplemental powder and can be a great adjunct to a whole foods diet rich in fruits and vegetables. One teaspoon of Camu Camu powder provides ~680mg vitamin C (760%). I suggest mixing Camu Camu powder in smoothies or juices for best tolerance. 
 
Eat Fermented Foods:
Many research studies have looked at the effect of various probiotic strains in patients with chronic or seasonal allergies. In most studies, probiotics have been found to significantly reduce symptoms. This is not surprising as gut dysbiosis (imbalance of good and bad bacteria) can contribute to both environmental allergies (pollen, grass, dander, etc) and food sensitivities. Nancy’s yogurts and kefirs, Good Belly Shots and Drinks, and Kevita Probiotic Beverages all provide therapeutic probiotic strains via food. 
 
Dietitian Tip: Try a probiotic for 2-3 months to see if you note further improvement. Choose one with one or more of the following researched strains: Bifidobacterium longum BB536, L. salivarius PM A0006, Lactobacillus johnsonii EM1, or L. paracasei HF A00232. Discuss this with your health care provider for product suggestions. 
 
Enjoy Local Honey:
Most people have heard that raw local honey can help reduce seasonal allergies. Although there is not much research in this area, I have heard testimonials from patients and friends that they have found an improvement in their symptoms with the daily addition of raw local honey. The only study I was able to find did see a significant improvement in participants who consumed 1g/kg of honey daily for 4 weeks in addition to 10mg of loratadine (anti-histamine). To put this in perspective a 150lb individual would need to eat ~ 3 tablespoons of honey per day to get close to the study recommendations. So, if you like honey, adding a little to your tea, homemade salad dressings, or drizzled over plain yogurt,  will not hurt, and perhaps it will help!

Check Your Vitamin D Status: 
The prevalence of vitamin D deficiency is significantly higher in individuals with allergic rhinitis. In latitudes above 40 degrees North or South, vitamin D production via the sun is insufficient between the months of November through March. Also sunblock with an SPF factor of 10 reduces vitamin D production by 90%. Therefore, many individuals here in Bellingham are at an increased risk of vitamin D deficiency. 
 
Dietitian Tip: Ask your health care provider to test your vitamin D level annually and replace as needed. Aim for levels between 40-60 ng/mL. Linus Pauling Institute recommends that general healthy adults supplement with 2000IU daily.
 
Consider Food Elimination:
If you have done all of the above without good effect on symptoms, I suggest looking into possible food sensitivities as these are often related. Work with a trained dietitian or certified nutritionist to help guide you through a 4-6 week elimination diet excluding the most common symptom evoking foods including dairy and wheat/gluten. A more comprehensive elimination diet may be utilized if the elimination of gluten and dairy do no provide relief. 

When you look at the dairy shelves today there are many vegan options available. Usually, they are made from a nut or seed base. Lately, oat milk has been getting a lot of marketing press. But do these products really make the cut nutritionally speaking?? That is a great question! Making a smart choice can be really difficult if you do not know what to look for.  
 
Although plant based non-dairy products can be a helpful alternative if someone struggles with a lactose or milk protein intolerance, they are often not as nutrient dense as you may think they are. Plant based yogurts and milks are commonly low in protein and calcium and high in added sugars, thickeners, and gums. You have to be very careful when selecting a product to make sure you are not missing out on certain nutrients that you would otherwise get from dairy milk products.  
 
PROTEIN CONTENT vs SUGAR CONTENT
When comparing protein content most plant based milks and yogurts contain very little, usually about 1-3g per serving (unless it’s soy milk). On the other hand, 1 cup of regular milk or yogurt contains 8g of protein, while the Greek yogurt varieties contain up to 25g per cup! That is very significant when compared to their plant based counter parts. 
 
Unfortunately, both the plant and dairy based products are often sweetened with added sugars to increase palatability. This is more often true with plant based products because milk is naturally sweet from lactose. Even plain varieties of plant based yogurts often contain added sugar. If you combine this with their low protein content it is a recipe for increased blood sugar spikes and increased hunger shortly after consumption. 
 
Dietitian Tip: Choose a plant based product that contains more protein and less added sugar to help maintain satiety for a longer period of time and reduce blood sugar spikes. Plus, instead of adding more honey or maple syrup to plain yogurts or milks, pair them with fresh berries for a little high fiber sweetness and add a handful of nuts (or tablespoon nut butter)  to increase the protein, fat, and fiber for more blood sugar support and increased satiety. 
 
Plant Based Yogurts with HIGH protein and LOW Sugar:

1. Kite Hill Plain Greek Style Almond Yogurt: 13g protein, 0g added sugars, 0% calcium, 0% vitamin D
2. Nancy’s Plain Oatmilk Non Dairy Yogurt: 6g protein, 0g added sugars, 2% calcium, 0% vitamin D

 
Plant Based Milks with HIGH Protein and LOW Sugar:

1. Orgain  Organic Protein Almond Milk: 10g protein, 0g added sugars, 25% calcium, 25% vitamin D
2. Silk Protein Almond & Cashew: 10g protein, 2g added sugars, 30% calcium, 10% vitamin D
3. Westsoy Organic Unsweetened Soymilk: 9g protein, 0g added sugars, 0% calcium, 0% vitamin D

 
PROBIOTIC POTENTIAL
As with dairy products the probiotic action of most plant based yogurts is very minimal. By the time yogurts reach your plate the number of live cultures is limited. Tanginess or tingling is often the characteristic of live, active fermentation which indicates higher probiotic potential. If you make your own 24 hour yogurt at home, whether dairy or plant-based, it will yield a much higher probiotic count than store bought. 
 
Dietitian Tip: GT’s CocoYo provides a live probiotic punch. Be aware it is VERY tangy and tingly which is not everyone’s cup of tea. Lavva Yogurts also promote that they have 50 billion units per cup, but what strains is not indicated. Nancy’s Oatmilk yogurts is another great option because it contains researched probiotic strains that have been shown to provide health benefits. 
 
MICRONUTRIENTS OF CONCERN
Finally, if one must replace dairy products with their plant based alternatives due to intolerance or personal preference, one must consider what nutrients are being missed. Those of biggest concern are calcium, vitamin D, and iodine. 
 
Calcium:
With an average daily recommended intake of 1000-1200mg, calcium is one of the biggest concerns. As many people know, calcium is essential for bone health. It also plays a role in cell signaling including regulating blood pressure, insulin secretion, nerve impulse transmission, and muscle contraction to name a few. Some plant milks and yogurts are fortified with calcium. However, if you are not careful, you can easily select one that is not fortified or contains very little thereby increasing your risk of calcium deficiency. For example, 1 cup of dairy milk or yogurt contains between 300-400mg of calcium. If you replace your 1-2 cups of dairy milk or yogurt with a non-fortified plant based product you are missing out on a lot of your daily needs!
 
Dietitian Tip: Choose a plant based milk or yogurt that contains at least 20-25% of your daily value of calcium. Make sure to shake the milk container well prior to each use because the added calcium carbonate can settle at the bottom. 
 
Vitamin D: 
Vitamin D plays an important role in calcium absorption. Without adequate vitamin D individuals will not be able to obtain as much calcium from their diet. Since dairy is often fortified with vitamin D, it can be easy to lose out on this source of vitamin D if you switch to a plant based alternative. Unfortunately, in the Pacific Northwest you can only rely on the sun to provide vitamin D during the months of May through September. 
 
Dietitian Tip: Choose a plant based milk that is fortified with vitamin D and/or make sure your daily multivitamin provides 800IU of vitamin D3. 
 
Iodine: 
Finally, iodine is an essential nutrient for proper thyroid function and therefore directly effects metabolism. Dairy products are a main source of iodine in the American diet. Plant based milks and yogurts do not contain iodine. Keeping this in mind it is very important to replace iodine from other food sources including fish, seaweed, or iodized salt. 
 
Dietitian Tip: Sea Seasonings Dulse Granules or Eden’s Gomasio are fun ways to add a great source of iodine to your diet. If you don't like the flavor of seaweed, simply use iodized salt in cooking. 
 
CONCLUSION
It is really hard to find a non-dairy milk or yogurt that has it all; protein, low sugar content, and 20% or more of your calcium or vitamin D, and not to mention a flavor profile that you like. Even the new oat milk craze doesn’t match up with only 3g of protein per cup. The items below are close to meeting most specifications, but are not perfect. Therefore, it is important to be aware of what you are getting out of your non-dairy product. Is it protein, micronutrients, or live probiotics? Or is it simply because it tastes delicious? Just make sure to be smart to avoid missing out critical nutrients in the long run. 
 
Best All Around Choices:

1. Orgain Organic Protein Almond Milk: 10g protein, 0g added sugars, 25% calcium, 25% vitamin D
2. Silk Protein Almond & Cashew Milk: 10g protein, 2g added sugars, 30% calcium, 10% vitamin D
3. Oatly Oat Milk: 3g protein, 0g added sugars, 25% calcium, 20% vitamin D.
4. Nancy’s Oatmilk Yogurt: 6g protein, 0g added sugars, 2% calcium, 0% vitamin D
5. So Delicious Plain Cultured Coconut Milk: 0g protein, 7g added sugars, 40% calcium, 40% vitamin D
6. GT’s CocoYo Living Yogurt: 1g protein, 0g added sugars, 0% calcium, 0% vitamin D 

 
Dietitian Tip: If you have a favorite brand of non-dairy milk or yogurt and it is low in calcium consider stirring in 1/8th or ¼ teaspoon of KAL Bone Meal Powder per serving to increase the calcium content. 
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