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CHEESE IN GALACTOSAEMIA: A PRACTICAL GUIDE It is now 15 years since some types of mature hard cheese were first allowed for patients with galactosaemia in the UK. Fifteen years ago we found it hard to accept that some types of cheese could be sufficiently low in galactose to be suitable for galactosaemia, but we have made great progress since those early days. Anita MacDonald Consultant Dietitian in IMD, Birmingham Children’s Hospital
Pat Portnoi, Dietitian, Register Coordinator, Galactosaemia Support Group (GSG)
One of the UK’s top paediatric dietitians, Anita’s specialism lies with inherited metabolic disorders. She spends 50 percent of her professional time in clinical work with children and 50 percent researching and teaching.
Pat worked as a dietitian in the NHS before joining SHS in 1981, becoming a director of the company in 1990. She is now retired, but continues to work with the galactosaemia support group and with PKU, attending NSPKU conferences.
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In fact, since 2000, the UK Galactosaemia Support Group (GSG) has sponsored the testing of over 173 samples of cheese on 12 different occasions (1, 2). Even the USA dietitians are following the UK lead (3). Which criteria are used to decide if a cheese is suitable in galactosaemia? To ensure a cheese is suitable, at least five samples of a UK or European cheese (with knowledge of origin and processing) are analysed to check its lactose and galactose content. If they have a lactose and galactose content that is consistently below 10mg/100g when analysed, they are permitted in the diet. This is less than the amount of galactose in 0.5ml cows’ milk which is minimal. It is difficult to detect lactose/galactose below this amount. How is lactose and galactose removed in cheese production?
The lactose and galactose in cheese is removed through different processes. 1 Cheese is made by coagulating milk. This transfers milk into a semi-solid mass and separates milk into solid curds (casein) and liquid whey. Most cheese types contain high levels of casein (containing no more than 1.0% lactose), but low levels of whey (which contains 70 percent lactose). Therefore, removing whey by drainage is important in reducing the lactose content of cheese, and during this stage, most of the lactose will be removed (approximately 98 percent).
NHDmag.com April 2015 - Issue 103
2 The temperature of coagulum, starter culture, coagulating enzyme, and the acid produced, influences the properties of the curd and degree of whey expulsion and hence the final lactose content. 3 As the cheese ages or matures it dries out and as it dries out, it loses lactose and galactose in the whey. CHEESE ALLOWED IN GALACTOSAEMIA
Cheddar cheese Unfortunately, we have had to change the advice we give on cheddar cheese, primarily due to the poor availability of the cheddar cheese that we first analysed. The GSG recommended mature or very mature cheddar cheese from the West Country Farmhouse Cheese makers group, which was consistently very low in lactose/galactose. The number of farms producing this cheese has fallen; it is no longer available to purchase online and very few supermarkets now stock it. To add to the difficulty, it became clear through the work of the GSG that some caregivers/parents were mistakenly using the wrong type of cheddar cheese. Therefore, we have reanalysed new types of mature cheddar cheese. We now only recommend cheddar cheese by brand name to avoid confusion for both caregivers and dietitians. Only five types of cheddar cheese are now allowed and are all suitably low in lactose and galactose (Figure 1). Other hard cheese allowed in galactosaemia are Emmental, Gruyere, Jarlsberg, French Comté, Italian Parmesan and Grana Padano (Figure 2).
