Using a Milk Ladder for Babies with Dairy Allergy with Carina Venter, PhD, RD

Katie Ferraro (0s):

I have a baby Ezra update for you. So that's the little baby seven month old guy. I've been making all of his hundred first foods for baby led weaning. We're heading into week four, So I, can't believe it. He's almost 20 foods in. He's almost 20% of the way to a hundred first foods. And I've been sharing all the different foods that we're making five new foods a week following my five step feeding framework. So I'm actually following my own 100 First Foods daily meal plan making this baby five new foods a week. So I wanna tell you about week four in case you've just gotten started in the last month or so with baby-led weaning or you started and you're feeling stuck, like you just feel like you're feeding the same foods to your baby. Over and over here are the five new foods that we did in week four from the 100 First Foods daily meal plan.

Katie Ferraro (43s):

This is all part of my Baby-Led Weaning with Katie Ferraro program. I've been updating the weekly menu and the grocery list, refining the recipes to offer easier and more streamlined ways to make all of these recipes. 'cause this should not take a ton of time. And so my goal every week, I'm so proud, I've just been like getting less and less and less and less time on the food prep and making it easier for parents to be able to implement with their babies as well. So week four, new fruit of the week, we're doing banana. you can just do banana strips, the size of your adult pinky finger. Do not feed banana peel to you guys, to your baby. Like you guys, you don't eat bananas with the peel. Please don't offer it to your baby. It's a huge choking hazard. We have a really cool banana, nice cream recipe that you can do a frozen banana product if your baby's teething, they love these, you do it off of a preloaded spoon or out of an open cup.

Katie Ferraro (1m 25s):

On Tuesday we have a new vegetable. This week we're gonna be doing beets personally, not my favorite food. I was like gagging when I was cooking it. So I kinda. My kids were like, mom, the house smells like beets and I know you hate beets, but we do these balsamic beet strips for babies. They freaking love them, even though I think they smell gross. Wednesday, new starchy food of the week. We're doing corn. And so for early eaters, we don't do corn on the cob. Corn meal is a great food for your baby. I'm making these polenta strips, but polenta that you buy, the grocery store has way too much salt But. It's so easy to make it home. Then you fry 'em into these little patties and then little finger foods your babies can pick up and they try corn that way on Thursday. The new protein of the week is chicken. I'm doing my chicken adobo recipe. We've been working on this one four years babies love it. Everyone.

Katie Ferraro (2m 5s):

Everyone in my family loves this one too. And I hope that Baby Ezra likes it as well. And then the new Allergenic food of the week that we're gonna do on Friday is pasta. So that's the way that we introduce the baby to the potentially Allergenic food wheat. So if you want to follow the same 100 First Foods daily meal plan that we're doing, it's all part of my Baby-Led Weaning with Katie Ferraro program. I give you the exact sequence of foods to feeds, as well as have a weekly menu. There's daily recipes, there's a grocery list. I literally took all of the guesswork out of it for you. you can learn how to safely prepare each of the foods very quickly 'cause I want your baby to eat a hundred foods before turning one. you can follow this exact meal plan. Try all the new foods too when you sign up at babyledweaning.co/program. Again, that's babyledweaning.co/program and I hope to see you there.

Carina Venter (3m 21s):

So what a milk ladder is, we start with a small amount of milk that's been baked at a high temperature for as long as possible time. And as we go up the ladder, we decrease the heating and the cooking time accordingly.

Katie Ferraro (3m 38s):

Hey there. I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in baby led weaning here on the Baby Led Weaning Made Easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning. If your child has a cow's milk protein allergy, they may not need to avoid cow's milk protein forever. Today we're talking about using a milk ladder for reintroduction of Dairy Foods with my guest Carina Venter. Carina is a food allergy expert. She's the publisher of the original milk ladder.

Katie Ferraro (4m 19s):

So she's the right person to be talking about for this topic. And while milk ladders have traditionally been used in more mild cases, mild to moderate cases of milk allergy. Carina is explaining how the milk allergy has transformed over the years and how kids with more severe milk allergies are actually having success with milk allergies. And then also how this approach is being adopted around the world to incorporate different food cultures use of milk foods in milk allergic individuals. Carina is an assistant professor of pediatrics, Allergy and immunology at the University of Colorado. She's one of the, if not the most well-known dietitian in the pediatric food allergy space. I've had the great honor of training with and learning from Carina as a student in her advanced pediatric food allergy certification for dietitians.

Katie Ferraro (5m 1s):

She's my go-to on everything related to allergies and she's a huge proponent of the hundred first foods approach and baby-led weaning. Carina has been a guest on our podcast numerous times in the past. She's talked about topics like using an egg ladder, so she's got some research that supports egg ladder for the use of eggs in children who have egg Allergy. She talked also about skin reactions from food and then other topics like, you know, why we don't need to wait three to five days between foods. But in today's episode, she's gonna be teaching about milk ladders for Babies with Dairy Allergy. I hope you guys enjoy this conversation. I hope you find it educational. I think you'll also be entertained. I think Carina has just the perfect balance of expertise, but also she's just an amazing human being. So with no further ado, here is Carina Venter to talk about milk ladders for babies with dairy allergies.

Carina Venter (5m 49s):

Hey Katie, and thank you for inviting me back.

Katie Ferraro (5m 51s):

Okay, I wanna say first congratulations on your book, the Health Professionals Guide to Nutrition Management of Food Allergies. I know it came out in ebook a while back. I'm kind of old school though. I need to read books in person. I just got my print copy. It is such a wonderful reference. Just real quick, how was your experience writing the book and also like where in the heck did you find time to do this?

Carina Venter (6m 11s):

Yeah, sometimes I think I do squeeze more than 24 hours out of a day, but I know that you've previously had Marion Groetch on the podcast as well, and Marion and I, we worked very well together. So, we did really share the load of the book. Unfortunately they can always be just the one first editor or first author. We were also supported by Scott Sicherer and John James, two MDs. But really every chapter was written by a team of dietitian and an md, even the diagnosis and the prevalence chapters. And we wanted to make it very clear that the dietitian plays a crucial role in the management of food Allergy in the diagnosis of food Allergy in the treatment of food Allergy and also in the prevention of food Allergy So.

Carina Venter (6m 58s):

we did join them up with an MD because we think it's a team approach, but definitely every chapter was led by a dietitian, some fantastic dietitians and allergist across the world who acted as reviewers first line reviewers of every chapter. So it really was a team approach. It did take a lot of time. It was a dream come true and we are very proud to have this resource available now for all healthcare professionals. But I also want to say, you know, any parent following your podcast, we'll find this book extremely useful.

Katie Ferraro (7m 36s):

We've talked at length about the role of dietitians in food allergy management and there's certainly a lot in prevention and treatment, et cetera, but there's certainly a lot of work to be done. But having a good textbook reference is an important first step. And I know certainly I'm still teaching college nutrition courses and for those that are in our medical nutrition therapy track, I will definitely include this as a resource because short of, I mean I've taken your advanced training for dietitians in food allergy, but there's not a lot of educational opportunities sometimes. And so learning from you and Marion is certainly something that I think any dietitian who's interested in food allergies should, should most definitely pursue if they can. And today we're here to talk about milk ladders, right?

Katie Ferraro (8m 16s):

We've done a lot of content about introducing potentially allergenic foods. You've been a guest here in the past. You've talked about things like egg ladders for reintroduction of egg for children with egg allergy. You've talked about skin Reactions from foods that aren't true food allergy symptoms. We also did an episode on why you don't need to wait three to five days between new foods. You and I are very much on the same page that babies need to be exposed to lots more foods than we do with conventional spoon feeding. But today talking about milk ladders for babies with dairy allergy, can you explain what a milk ladder is and how it works?

Carina Venter (8m 47s):

Yes. So interestingly, you know, I've written many papers in my life that I'm proud of, but the milk leather paper has had close to a million downloads now worldwide because It is such a practical tool for, you know, allergists, dietitians, and perhaps even parents. But I will explain what the milk ladder is. So about 20 years ago we, we realized that some children develop tolerance or are able to eat baked forms of milk like in a muffin or in a cookie before they can actually drink milk from from a cup or you know, if it's an infant formula, if it's a young child. And I was working on the isle of white at the time and in England we have milk chocolate buttons, which is really just a small piece of chocolate candy.

Carina Venter (9m 36s):

And I started to get all these emails and phone calls from doctors in the United Kingdom asking me what comes before a chocolate button And? What comes after a chocolate button? And so then I realized that there's a huge need to understand the sequential introduction of cow milk. So what a milk ladder is, we start with a small amount of milk that's been baked at a high temperature for as long as possible time. And as we go up the ladder, we decrease the heating and the cooking time accordingly. So, we really start with a cookie called in America or a biscuit as it's referred in the United Kingdom.

Carina Venter (10m 17s):

We go onto a muffin where we increase the amount of milk, then we go to something like, like a waffle or a pancake, we go to cheese and yogurt and then eventually we end up with, you know, just drinking a pure cow's milk that's not been heated.

Katie Ferraro (10m 35s):

Now is this for children who have a diagnosis of dairy intolerance, cow's milk, protein allergy, like who is the milk ladder for and who does it benefit?

Carina Venter (10m 45s):

Okay, this truly is the million dollar question. And so at the time when I wrote this first milk ladder in England, we really wanted it to be used in children with what we call mild to moderate cows allergy, I know you've previously talked about proctocolitis. Here we get some Babies with reflux. You know, then international guidelines say that the first line of treatment of troublesome reflux is cows milk avoidance. And then we do gradual reintroduction. But the bottom line of it was it was for children that was not going to be at risk of immediate type reactions and most definitely not for children at risk of anaphylaxis in England.

Carina Venter (11m 27s):

Getting back to the role of the dietitian, these children with the milder forms of cows milk allergy are really being looked after by dietitians. And so this was a very easy tool to say, we take milk out of the diet, they get better, we reintroduce milk. If the symptoms recur, we know they've got a milder form of cows, milk allergy, it can all be done at home. And then six to 12 months later, when we want to reintroduce milk, we do this in this sequential process working from a cookie up to having a glass of milk. Then we started to realize when we looked at all these millions of downloads worldwide and speaking to allergists across the world, that people are starting to use it for children with IgE-mediated cows milk allergy.

Carina Venter (12m 13s):

Now what IgE-mediated cows milk allergy is it's the immediate type of allergy where the child will have hives or rashes or you know, acute vomiting or anaphylaxis when they consume cow milk. And there was a concern then that perhaps by using this ladder approach where we stepped children up from the cookie to the glass of milk at home can actually predispose these children to having severe symptoms. But nevertheless, this approach has been used very successfully in the United Kingdom, also driven by dietitians, but definitely overseen and supervised by allergists.

Carina Venter (12m 55s):

A very good friend of mine, Jonathan Hourihane, who's now an allergist in Dublin in Ireland, he's recently published a study where he showed that even in children with the most severe form of IgE mediated cow's, milk allergy, so they reacted to a drop of cow's milk, to which less than 5% of cow's allergic children with reactive. So these children were highly sensitive to cow's milk and he managed to get these children by following a ladder at home up to a glass of milk at at least half of them up to a glass of milk within 12 months of diagnosis, which is huge and safely done as well. So what I would like to say to the audience is that if your child have the milder forms of cows milk allergy, where there's no immediate type symptoms, you can definitely download the many different kinds of ladders and I'm sure we'll get to that in the next question that's available online and do the ladder safely at home.

Carina Venter (13m 53s):

If you want to do a ladder approach at home and your child has got immediate type cow m allergy, it has to be done under the supervision of an allergist. And like I said, it's now really done, it's done in the uk, it's done in Ireland, it's done in Canada. There's some centers in the United States where they are beginning to use it in IgE cow's mic allergy. Some centers in the states are still very reluctant. So I would say go see your allergist and follow whatever advice they are giving you.

Katie Ferraro (14m 28s):

Hey, we're gonna take a quick break, but I'll be right back. Carina. In your esteemed opinion, do Babies who don't have any signs or symptoms of cow's milk, protein allergy, would they benefit from a sequential introduction of cow's milk protein allergy?

Katie Ferraro (15m 15s):

Like I know in our 100 First Foods program, we give you a variety of different options if you have an exclusively breastfed baby, right? If we're talking about formula fed babies cow's, milk protein is the base of the formula, it's kind of moot. But for exclusively breastfed babies, they can start with yogurt or a low sodium soft cheese like ricotta. But do you think that the research is indicating that maybe they should also be moving in a phase wise approach through a ladder in order to, you know, maximize tolerance or whatever the desired outcome may be?

Carina Venter (15m 42s):

Yeah, you know, that's something that I do get asked, but we definitely haven't looked at. The one thing we know is once you put the allergenic protein in a child's diet, keep it in in whichever way and form you like. So if we are ready to go onto ricotta cheese or we ready to go onto yogurt as a first step of giving cow's milk, that's fine. If there is a reason why parents may want to go for something like a teething biscuit, make sure that their cow's milk in it, then perhaps go for something like, like a muffin that's hopefully sweetened with apple sauce opposed to a load of sugar, then perhaps you can go onto that before you get to yogurt and before you you get to cheese that's acceptable as well.

Carina Venter (16m 26s):

But just remember, once the protein is in, keep it in. And I do have families where the parents actually prefer to do the stepwise approach opposed to just going for a yogurt straight away or cheese. But then I have equally as many families that would say, you know, I have four kids, five kids, everybody in the house is eating yogurt, we are just gonna go straight for yogurt and that's fine as well.

Katie Ferraro (16m 49s):

In a clinical setting, how long would a milk ladder be used for? Do children essentially graduate back to a cup or two cups of fluid cow's milk a day?

Carina Venter (16m 57s):

That really depends. If we now have a child with diagnosed, you know, reflux or proctocolitis or other forms of, of milder forms of cow's, milk allergy, what I used to do was I would wait until the 12 months, that's what we used to do 10 years ago. And then I'd start the ladder pretty much knowing that we are gonna be tolerant to cow's milk and I would literally just work my way through the ladder stepping up every two days because I wanted that kit on cows milk. Now that we've learned much more about development of tolerance and the natural history of cows, milk allergy, we almost start with laddish right at the point of diagnosis. And so this may be a six month old that's a newly diagnosed with proctocolitis or proctocolitis diagnosis or reflux diagnosis about a month ago.

Carina Venter (17m 47s):

We may take two weeks for every step, we may take a month for every step. It also now because they're so young, brings in develop ability to tolerate different kinds of textures, which I know you as baby lead winning expert is much more of an expert than me. But you know, sometimes we may wait an extra week just before because we don't think the baby can just do a muffin yet or half a muffin yet. So it's sort of like a combination of of being developmentally ready and also being ready for the next step. But two to four weeks I would say per step, if we start them almost right at the point of diagnosis. And then if you do the 12 step, it can be 24 weeks, which is six months.

Carina Venter (18m 32s):

But I tend to use the six step Ladder nowadays, which really gets me to 12 weeks, three months maximum before I get to the top of the Ladder and it could be sometimes up to four months.

Katie Ferraro (18m 41s):

Can you talk a little bit about the different types of ladder you're mentioning a six step formula, a 12 step, I know there was an older version that you're always like, don't share this one Katie, you gotta share the new one. Give us the history and And did you design the original milk ladder? Because there's lots of people's names on it, but like it's kind of your thing, right? Yeah,

Carina Venter (18m 60s):

So I, I did design the the original milk ladder with a group of dietitians from the United Kingdom. And so the first Ladder we published in 2013 and that was the 12th step ladder. And that was really at the time when we were all new to ladders and we were a little bit, you know, anxious about introducing foods at home even in the kids where we know there wasn't anaphylaxis. And it was also really driven by the UK team where I was working with. And so there's many kind of UK foods on there, you know, things like scotch pancakes and shepherd's pie and you know, lasagna and

Katie Ferraro (19m 36s):

Tons of added sugar, which I know we've talked about this before, but some of the recipes I'm like this is a cookie, these dietitians write this. But I get the point here is about getting the protein into the Yeah

Carina Venter (19m 46s):

And hats off to the moms who contacted me on Twitter all the time to say you gotta get rid of all that sugar in the the initial Ladder. But because we became more confident, we realized that we can actually step up quicker, we can take bigger jumps between steps and So. we condense the 12 step ladder into six steps and we made it much more international and we also adapted the sugar content with that ladder. I worked very closely to adhere to the WHO standards of how much sugar can be added and the majority they were, we don't actually add any sugar to the milk ladder foods, it's all fruit purees and we also have more savory alternatives.

Katie Ferraro (20m 30s):

And, what year was that? The six-step one.

Carina Venter (20m 32s):

2017.

Katie Ferraro (20m 32s):

Okay.

Carina Venter (20m 32s):

We did the six step one about four years later.

Katie Ferraro (20m 38s):

So What's the next version? Is there another one coming?

Carina Venter (20m 43s):

Yeah. Yes, So I. I was contacted by colleagues from India and they said, Carina, we'll use your ladder but our families want to eat, you know, Indian foods and is there any way that we can make it more culturally appropriate for Indian patients and families? So we are, I've just submitted it, we've gone through the first round of review, so I'm hoping to share with you shortly that we've got an Indian milk ladder published and then I was also contacted by a colleague of mine from Greece that said we really need a Mediterranean milk ladder. So the Mediterranean milk ladder, I have published with Emilia Vassilopoulou and I'm happy to share the link with you for that because it's also free to download.

Carina Venter (21m 30s):

But what we've done with the Mediterranean milk ladder, we actually got funding to look at whether the milk protein, when you test it in a laboratory matches the calculated milk protein. Now why would the milk protein that we test in the laboratory not be similar to what we calculated? Because we have milk protein in a matrix So, we bake it in wheat and we, there's fat added and there may be eggs added. There may be six gram of calculated milk protein in this cookie, but the immune system can only really detect four grams because the other bits is sort of like hidden.

Carina Venter (22m 10s):

So it's not disappeared, but it's sort of like hidden by the matrix and So, we really wanted to know whether the calculated proteins matches what the immune system can recognize and then we can also break milk into two proteins. The one is the casein protein. Casein looks like a flat line. And we also always believe that when you cook this flat line, it's already a flat line, you can't change it. But we have now with the testing realized that you can slightly change this flat line and you can change the amount of cain the immune system can recognize. And there's another protein in milk called beta-lactoglobulin, which looks like a ball of wool.

Carina Venter (22m 51s):

And if you cook foods with, with milk in the beta-lactoglobulin unravel like a cat playing with a ball of wool. And now you can imagine if you don't cook it, the immune system sees a beautiful ball of wool and thinks don don't like that, I'm gonna launch a reaction to this. But when you cook it and you unravel it, all the immune system sees there's a heck of a lot of wool lying on the floor and it doesn't recognize it as a ball of wool and it doesn't actually launch an allergic reaction. But we weren't really able to ever calculate how much cain and how much beta lactoglobulin is in each of these foods and we really didn't know exactly how the heating would affect it, even though we assumed that the more you heat it, the longer and the higher the temperature the more unraveling will happen.

Carina Venter (23m 41s):

And so in this Mediterranean milk ladder we have now actually also detected how much craziness in the food and how much beta-lactoglobulin. I'm happy to say that for the most of it, what we thought would happen happened, but there were some outliers and So we did have to move the Mediterranean ladder a little bit around. And now as a mom you may think, what's the point of listening to all of this? The point of listening to all of this is that I wanna say to you is when we publish ladders, we do the best we possibly can to get it standardized and academically correct. But there's a lot we still need to learn about how much protein the immune system can see and react to in each step of the ladder.

Carina Venter (24m 30s):

And this is why it's so important if you use the ladder in a child with immediate type food allergies, where there may be a risk of anaphylaxis that you follow the steps as well as you can and you always do it under the supervision of an allergist because it's not a hundred percent exact science as of today But it will be because I'm doing as much research as I can to improve the Ladder out there.

Katie Ferraro (25m 3s):

Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (25m 50s):

I love this because I was gonna ask you, this sounds like something parents get ahold of, especially, you know, there's so much gray areas as we know in food allergies. Like maybe your baby did have some practical colitis, maybe they outgrew it, you know, maybe they had a skin reaction and you never know you're, you know, either pregnant or you're not pregnant, right? But you've been, we always say like you're not kind of pregnant but you've, you're talking about like a kind of food allergy and parent's like, well I'm just gonna do this at home. But I just want you to reiterate that again, that this is not something if your child does have cow's milk, protein allergy of any degree, you shouldn't be trialing this at home on your own, right?

Carina Venter (26m 23s):

Definitely not, especially not in the immediate type allergy. I also don't wanna come across as criticizing allergists who use this approach at home. These are highly skilled people, they've got a lot of training, they know what they're doing. So if your allergist advise you to do it at home under his guidance, please follow the allergist advice. But never ever do this at home. It would be like starting to do oral immunotherapy, you know, to Peanut at home without having an allergist involved. We, we don't wanna do any risky behavior at home. There are some, if I can just be slightly critical, there are some ladders now out there that puts lots of different food in one step.

Carina Venter (27m 5s):

So they would say a cookie is equivalent to a muffin is equivalent to a waffle. I'm very concerned about ladders that puts the same foods in the same step when we, we know that the allergenicity differ quite a lot. So my preference is really still for ladders where we have one single food per step So, we know what we are feeding the child opposed to just saying we are putting all these foods in one step and, and I think that is slightly less scientific even than the current ladders, which we are trying to make as scientific as we can.

Katie Ferraro (27m 37s):

When you're mentioning all these different ladders, it's making me think of like flashbacks, like remember the 1992 pyramid and then old ways got ahold of the pyramid and then there was a, you know, there was a soul food pyramid and a Mediterranean. I think they were most known for the Mediterranean period. But I think it'd be helpful if there was like one central place where it's like, where are Karina's ladders? Because like you said, sometimes, first of all you've worked in like every country around the world. So I'm like, this is the ladder that she did when she was in the UK. This is what she did when she was in Colorado. But like, just to know again that if you have cow's, milk protein foods as part of your food culture, we should be making these tools for clinicians that do have culturally appropriate foods. I love that idea. Is there a plan to put them all in one place or because you publish them with different groups and entities and funding sources, I would assume that's not really feasible.

Katie Ferraro (28m 21s):

Well

Carina Venter (28m 21s):

I think eventually we will put them all in one place, you know, because I, and I think I, I've just now mentioned the ladders that where I can understand the language it's written in, there has been many other versions of the ladders around the world where the ladder has been translated into different languages and different foods has been used. I've worked with a Brazilian group, they've got like a a, a Portuguese version of the ladder with more, you know, Portuguese or Brazilian type foods. So that is one of my projects on my list is to get all of these ladders onto one platform in all these different languages with all these different foods.

Carina Venter (29m 3s):

And the Indian Ladder is currently written in English, but we will most definitely translate it into Indian language as well.

Katie Ferraro (29m 8s):

Well you've literally trained like every pediatric dietitian who specializes in food, allergy, So, I feel like at this point. I know when I took your pediatric food allergy course for dietitian, it was so fascinating the dietitians from different countries. I got in a breakout group with some of the gals from Mexico City. I still stay in touch with them and, and just to learn the different ways that we're, you know, Babies are learning how to eat foods all around the world and there are a lot of commonalities. But like with our own 100 First Foods program, like, and those a hundred foods are in North America, some of them are available elsewhere. We'd love to see when other families take it and they're like, you know, I did persimmon instead of papaya or whatever the case may be, that we're offering a variety of these foods in a safe manner at the end of the day, that's the goal. Which kind of leads me to my final question.

Katie Ferraro (29m 49s):

Like I know for me personally, our goal with baby-led weaning and the work I do, I wanna make force feeding infants by spoon a thing of the past because babies can eat so many more foods than we give them credit for. What do you hope for as the outcome of your life's work in food allergy? I mean you have your hands in so many pots, like I can't, I can't even keep it straight some days.

Carina Venter (30m 10s):

So bigger picture than just the ladder, but the ladder sort of like fits within that as well. I think we focused in food allergen so much on eating the food allergen for so many years and we've forgotten that food allergens It is just a protein with inner food. And for me, and I do a lot of work with the European Academy of Allergen Clinical Immunology on this whole concept of immuno-nutrition and It is just, you know, we feed allergens with, with inner healthy diet. And that's the beauty of baby led weaning. You, you may not know that, but you're famous as well because I quote you at every conference where I speak right from Australia through Asia, Europe and back to the United States, you know, there's 100 foods in 100 days.

Carina Venter (30m 57s):

You know that this amazing. So perhaps we are feeding peanuts and cashews and egg and milk within those 100 foods. But we are not just feeding these kids milk protein and egg protein. We are feeding them foods. They learn to love a variety of foods, they learn to eat foods in different textures. And when we talk about food avoidance and now we talk about food in reintroduction and I've learned my lesson with that very sugary ladder, whatever we do in allergy, we have to think about the food. And I think that's the one thing I would like to leave the world with is that we are not just feeding or avoiding allergens, but we really need to see the bigger picture.

Carina Venter (31m 37s):

And on that note, and not so much relevant to Today, I have just published a diet diversity menu with Asian foods as well as typical American American foods. So not am I just trying to diverge my ladders, but I'm also really trying tort the whole concept of di diversity, which you so beautifully do with your 100 foods in 100 days. But definitely thinking how different cultures and also different socioeconomic, you know, classes can incorporate this into the baby's life.

Katie Ferraro (32m 12s):

Hey, we're gonna take a quick break, but I'll be right back.

Katie Ferraro (33m 18s):

Carina, thank you so much as always for sharing your time. I'm gonna link up all of the references I always have. First of all, you are, you not only do so many different things, but you're one of the few researchers who like responds to emails super quickly and you always are very thorough. Like we have some people like you can't ask two questions in one email 'cause they can't write back, but I always write to you after the interviews, I'm like, can you please send me the Diet Diversity manual? I wanna make sure I have the right Indian Food Guide Ladder So. I'm gonna follow up, get all of this from you. I'll put it on the Shownotes page for this episode. But tell us if our audience wants to get the most current version of the milk ladder, the six step one that you did, where do they go to get that?

Carina Venter (33m 55s):

So that is actually published in Clinical and Translational Allergy. And the reason we published it in that journal is because it's free to download to anybody. So I will definitely give you the link. The Ladder is there as well as the recipes that you know goes with the ladder. So happy to share that with you.

Katie Ferraro (34m 10s):

Well, thank you so much Carina.

Carina Venter (34m 12s):

Thank you for having me.

Katie Ferraro (34m 13s):

Well, I hope you guys enjoyed that interview with Carina. I could talk to her all day long. She just starts opening up other areas where I'm like, oh, we need to talk about that. We need to cover that. In True to Form, she responded to my email right away with all the links, with some of the kinda missing pieces of the research and the different documents that I didn't have that she did mention in this episode. I will link that all for you on the Shownotes, which you can find at BLWpodcast.com/368. Thank you to our partners at AirWave Media. If you guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave Media.

Katie Ferraro (34m 55s):

We're online at BLWpodcast.com. Thanks so much for listening guys. I'll see you next time. If you're interested in doing baby led weaning, but you're not exactly sure, like what does that mean? What does it look like? Where do I start? My online program called Baby-Led Weaning with Katie ferraro has everything you need to give your baby a safe start to solid foods and get them to eat over a hundred foods before they turn one, whether you're terrified of choking or maybe you've started but you feel like you're feeding your baby the same foods over and over 'cause you don't know what to feed next or you're looking for guidance on how to prepare foods safely for your baby's age and stage. My program has exactly what you need. There's five hours of concise self-paced video training. you can knock this thing out during nap time this week. You also get access to my 100 First Foods content library so you can see and learn exactly how to prep all of the hundred foods as well as my original a hundred days meal plan.

Katie Ferraro (35m 41s):

I've been refining this program for the last seven years. Just today, a mom wrote to me and told me that the a hundred days meal plan has been a quote game changer for her busy lifestyle. When you join the program, you also get access to over a hundred phase two combination food recipes. So you're gonna try out the trickier textures, push your baby's palate. And what's cool about these recipes is your whole family will enjoy them. So everything you need to give your baby a safe start to Solid Foods is inside of the program. It's created by me, a registered dietitian who specializes in infant feeding. If you're tired of hunting and pecking around the internet trying to piece this stuff together on your own, I put it all in one convenient place for you. I invite you to check out the baby led weaning with Katie Ferraro program that's at babyledweaning.co. Again, that website is babyledweaning.co and click on program to learn more.