24 hour Fermented, lactose free, a2 Dairy greek yoghurt

I don’t eat lots of dairy because I find too much does mess with hormones (it’s very individual, learn if dairy is okay for your own personal hormones here), but I do enjoy a good quality yoghurt occasionally. However, it is near on impossible to find a thick Greek yoghurt that is lactose free, organic and uses A2 type dairy, so I decided to create one. This recipe is adapted from a lactose free recipe we’re taught in my SIBO training with Dr Siebecker, so full credit to this incredible doctor!

 For those who don’t know, A2 type dairy may be better tolerated by some people and this is dairy from sheep, goats, buffalo, Jersey and Guernsey cows. A1 dairy comes from ‘regular’ cow’s dairy and can trigger quite the inflammatory reaction in some of us, and this can have a knock-on effect on pain, hormones and endo belly, but we’ll get to that…

For those who want some dairy in their lives, and feel they benefit from fermented dairy, I wanted to create a yoghurt that was as endo friendly as possible, without actually being dairy free. I am still working on a totally dairy free yoghurt, it’s a bit of a work in progress tbh, but thankfully there are a lot of good ones on the market already!

This recipe does take some effort, but once you get the hang of it, it can become quite a therapeutic ritual and you can also make a few batches at once to save you time.

This recipe is…

Lactose free to help prevent endo belly flares and inflammation.

68% of the global population is estimated to be lactose intolerant and lactose intolerance is also very common in the SIBO population, and as research suggests a possible 80% of us endo also have SIBO, there’s a fair chance that you may not tolerate lactose so well. This can result in symptoms such as gas, cramping, bloating and general IBS symptoms, worsening or even triggering your endo belly.

But all that intestinal upset can also cause gut inflammation and irritation. With repeated exposure, this intestinal inflammation can trigger the immune system on the other side of the gut lining, which can result in local (so pelvic area and abdomen a.k.a. where endo hangs out) and systemic (full body) low level inflammation.

As endo growth and pain is driven by inflammatory immune chemicals like cytokines, mast cells and prostaglandins (combined with other factors like oestrogen), we want to lower our intake of foods that cause us intestinal inflammation. To understand how all this works in detail, have a read or listen to this.

Repeated exposure to something that irritates our gut, like lactose (or A1 dairy) can irritate the gut lining and cause leaky gut, which to put simply, is when tiny holes start to appear in the gut lining. These tiny holes allow for food particles, bacteria and bacterial toxins called lipopolysaccharides (LPS) to leak through the gut lining, and into the blood stream and surrounding area. This triggers the immune system, resulting in local and systemic inflammation, furthering symptoms.

But it’s not just the inflammation that’s a problem. Leaky gut is one of the key causes of lipopolysaccharide translocation. Lipopolysaccharides are toxins that come off certain types of bacteria, and translocation is their movement from the gut to other places in the body. LPS have been found in higher levels and in the pelvic area of people with endo, and they trigger certain inflammatory pathways that further endo growth and pain. So, preventing leaky gut is an essential part of endo management.

Made with A2 dairy only to prevent endo belly flares, pain and histamine reactions.

A1 casein is a type of milk protein which research suggests some people find triggers intestinal inflammation and gut issues. The data on humans is emerging, and whilst it’s true for a number of people, not everyone will have this inflammatory reaction to A1 casein. A2 casein has been observed as typically better tolerated and this comes from sheep and goat’s dairy, as well as Guernsey and Jersey cows.

However, if you do experience inflammatory reactions to A1 casein, this can trigger a systemic full body inflammatory response with regular exposure, in a few ways.

As we discussed earlier, if we are constantly being exposed to something that triggers intestinal inflammation, like A1 casein, then the same applies here regarding inflammation spreading throughout the abdomen/pelvis and body and leaky gut.

And in people who do struggle with this A1 reaction, emerging research suggests that A1 is broken down into beta-casomorphin-7, a type of peptide. BCM-7 triggers what’s called a T-cell mediated immune response, and this type of immune response releases inflammatory cytokines. These guys then go on to make inflammatory prostaglandins, and also trigger mast cells to release histamines.

Inflammatory prostaglandins are the absolute key drivers of endometriosis pain and period pain, and people with endo and dysmenorrhea have been shown to have too high levels of these. Whereas histamines are inflammatory by nature and cause pain, as well as swelling and other symptoms. In combination with prostaglandins, they cause the uterine lining to contract during menstruation, which can (as we all know) be painful when happening in excess, they also further stimulate more prostaglandin production and can enhance their effects, and they can also sensitise nerves, making us feel more pain. Mast cells are higher in the endometriosis tissue and are implicated in the development and symptoms of the disease.

As you can see, if you’re sensitive to A1 dairy, swapping to A2 may really help you to manage your endo symptoms. If you want to learn how to test if you’re sensitive to A1 dairy, have a read or listen to this podcast episode.

Low FODMAP to help reduce endo belly flares and IBS reactions.

Lactose is a type of carbohydrate/sugar which is rapidly fermentable, this means that our good gut bacteria have a real munch on it, and then produce gas as a result. In some people, this process, called fermentation, triggers abdominal upset, like gas, cramping, bloating, constipation and/or diarrhoea.

To prevent these reactions to lactose, I have made this yoghurt lactose free. Unlike most yoghurts, this yoghurt is fermented for 24 hours. During this process, good bacteria eat the lactose in the milk (just like they would in our gut, as explained above), and this allows for the bacteria to multiply which is what makes yoghurt so good for you and also creates lactic acid, which gives the yoghurt that sour taste. Because of the long fermentation time, the majority of the lactose is removed by the bacteria, resulting in extremely low lactose/lactose free yoghurt that many with lactose intolerance can tolerate. In fact, this 24 hour yoghurt recipe is a classic go-to recipe in gut specific diets like the SCD and certain SIBO friendly diets.

Packed with probiotics to healing with endo belly dysbiosis.

In some research, fermented dairy has been associated with lower inflammatory markers and inflammatory disease risk, and a recent meta-analysis confirmed these benefits. Research has shown that people with endo have higher levels of inflammatory markers, and we know that inflammation impacts our pain levels and disease progression, so lowering these markers is a step towards managing the disease.

People with endo may also have less beneficial bacteria and short-chain fatty acids, both of these factors can have an influence on endo pain and progression, which you can learn more about here. Probiotic foods not only replenish healthy bacteria levels, but also improve short chain fatty acid production, and research has demonstrated that fermented dairy products like kefir and yoghurt improve the gut microbiome, as well as the SCFAs we’re often low in too, like butyrate. You can learn more about this here.

Finally, fermented dairy may play a role in helping us to heal leaky gut - providing we tolerate it of course, as if we don’t, that can irritate the gut lining and actually cause leaky gut. We know that microbiome dysbiosis, which is common in endo, is a driver of intestinal inflammation and intestinal permeability, so improving the microbiome could have an indirect beneficial effect on the gut lining. Additionally, whilst we don’t have specific studies on dairy for the gut lining (that I can find), research does show that probiotics foods help to support gut barrier integrity.

Important notes to help you tailor this toast recipe to your own body and needs (and tastebuds!)

Histamine

Fermented foods are naturally high histamine. Does this mean that you should be avoiding yoghurt and fermented foods due to the histamine and endo link? No, not necessarily.

The difference with A1 dairy is that it triggers a mast cell reaction in your body which releases histamines and this can be a problem for endo, as we explored before. But when you eat histamine foods, it’s not exactly working the same way. If you have low levels of DAO, the enzyme that breaks down histamine, this could be an issue for you, because it may mean that you can’t digest all that histamine, resulting in histamine reactions like gut upset, allergy like symptoms, etc. because you have too much for your body to process.

However, not everyone with endo has low levels of DAO, so you may well be fine digesting this amount of histamine.

For some of you who are sensitive to histamines, you may find that you can tolerate fermented foods at certain points of your cycle, but other times when histamine is naturally higher, like pre-period and ovulation, it’s too much for you.

So in short, monitor how you feel when consuming this yoghurt and find out if it works for you personally.

Which A2 milk to use?

Goat's milk is probably the easiest to get hold of, but it also has the funkiest tasting flavour! Buffalo, Guernsey and Jersey milks are all creamier and more neutral tasting, and they typically have a higher protein content, which is helpful for blood sugar and supporting our protein needs, and creates a better yoghurt consistency. Finally, I’ve never tried sheep’s milk, but I’ve heard it’s thick and more neutral tasting than goat’s. If you  can get hold of it, I’d love to hear how your recipe turned out!

Does it matter if I can’t find organic?

Some farms can’t be classified as organic for various reasons, but that doesn’t mean that they are using hormones or antibiotics on their animals, or using feed covered in pesticides. If you’re using an online farm shop and having these milks delivered, email the farm and ask them what they use and what they feed their animals with, or read the ‘About’ page. Most will tell you if they avoid pesticides, hormones, etc. and if there animals are grass-fed or also are fed feed, but if you’re not sure, reach out.

If they are a farm that aren’t strictly organic but they don’t use routine hormones and antibiotics on their animals, and their animals are largely grass-fed, I say go for it, because it’s normally quite hard  to find the perfect organic A2 milk.

Also, if you can’t find online stores, get on Google maps and search your area for diary farms. I travel full time and it’s actually incredible how many A2 dairy farms I have found (many of which emphasise free range, grass fed, etc) by Google maps, but who don’t have an online presence.

It’s more the bigger commercial, supermarket brands that I would be cautious of. Some of these bigger companies do use things like added hormones and antibiotics (though there are restrictions on these in certain countries), and there is some research suggesting that these could influence our own hormones. If this is all you can get hold of, it’s absolutely up to you what you do, but I’d be perhaps mindful of consuming this dairy daily, and maybe consider keeping it to a few times a week, to avoid high exposure that may impact hormonal health. Feel free to experiment and see how you feel best.

Further resources

If you’re struggling with your gut health, you might find my courses and one to one coaching helpful. You can find out more here. I’ve also got endless podcast episodes on gut health and blood sugar.

To understand more about the low FODMAP diet, start here.

Method:

Note: All equipment inc. storage jars, yoghurt maker, etc. must be scrupulously clean. Any dirt/bacteria could spoil the yoghurt and cause unhealthy bacterial growth, rather than the good kind we want!

• Add all the milk into a large saucepan and heat gently until it reaches 90 degrees celsius, stirring or whisking frequently to prevent a skin forming (don’t worry if it does, just remove it or whisk it back in).

• Once the milk has reached 90 °C, lower the heat slightly and keep at this temperature for 10 minutes. This denatures the protein structures and allows for a thicker yoghurt. Don’t worry if it goes higher than 90°C or even boils a little, all it’ll do is make for a thicker yoghurt – just don’t allow the milk to burn at the bottom of the pan, because your yoghurt will taste burnt! The best way to prevent this is to monitor your milk closely for the 10 minutes, whisking frequently. Keep it as close to 90°C as possible, but don’t stress about it.

• After the 10 minutes, you need to let your yoghurt cool to 37°C before you can add your yoghurt starter, otherwise it’ll kill the good bacteria. This can actually take quite a long time, so I recommend either placing your saucepan into the sink with super cold water around it (don’t let the water get into the saucepan) or place it into a larger bowl with ice and water. You can also transfer your milk out of the saucepan (because the saucepan is hot) and into a cold bowl, and then place that bowl into the sink or into another bowl filled with cold water.

• Once the milk has reached the right temp, empty your yoghurt starter into a medium sized bowl or a large cup/glass. Add around 100-200ml of the cooled milk (don’t worry, it doesn’t need to be precise, it’s just to get the yoghurt smooth and liquid so it blends in nicely) and whisk until smooth. Then pour the yoghurt mixture back into the remaining milk and whisk well to incorporate.

• Transfer this yoghurt blend into your container which you’ll be using for fermentation. If you have a yoghurt maker, follow your instructions for this (typically this will involve leaving the container in the heating device) but you can also make yoghurt without a maker. There are a few ways to do this, which I have listed below, however, I have only used a yoghurt maker for this method.

• Leave the yoghurt to ferment for 24 hours, the long fermentation time is what makes this recipe lactose free. The bacteria eat up all the lactose during the process, resulting in a very low lactose/lactose free yoghurt.

• After 24 hours, don’t disturb the yoghurt, as it now needs to set and if you stir or remove some now, it often results in separation and you’ll have a lot of liquid whey to deal with. So, now you can either transfer to the fridge for a few hours or overnight to firm up, or you can turn it into Greek yogurt. If you want to skip the Greek yoghurt part, once you’ve left your yoghurt to set, give it a good stir before serving - this creates a smooth and creamy consistency vs. a set yoghurt consistency (which you might like!).

• For Greek yoghurt, many yoghurt makers will have a sort of ‘basket’ that you put inside another container. If you have this, fit the basket into the container and transfer your yoghurt into the basket, and place in the fridge, the whey will drain off leaving a thick yoghurt behind. Leave for at least four hours to strain, the longer you strain it, the thicker the yoghurt will become, so you can adjust to your preference.

• If you don’t have one of these baskets, you can use a cheese cloth. Line a fine-mesh colander or a regular sieve with a few layers of cheesecloth, place the colander over a large bowl to catch the whey. Pour in the yogurt, cover it with a lid or wrap, and let it strain for at least 4 hours in the fridge (or overnight for thicker yogurt).

• Once your Greek yoghurt is ready to go, transfer it to an airtight container and give it a good stir. Keep the jar sealed, and only use clean utensils when serving. This should keep in the fridge for at least a week.