Lactose Intolerance Doesn't Cause Strokes. Does It?

You'll notice in the About Me column off to the right that I had a mild stroke this year, forcing me to take several months off. No, the fact that I'm lactose intolerant had nothing to do with it. Nothing, nothing, nothing. I'm saying that very, very loudly because some of you out there would be writing in tomorrow telling me that their strokes really were caused by LI. No. They weren't. Nobody can possibly be that ignorant of LI, you say. That's only because you don't read my mail. You wouldn't believe what people already think that LI can cause. Oy.

Then again, "cause" is a loose term. To my stun and amaze, this very week I stumbled across an article by Howard Reich of the Chicago Tribune, reprinted in about a million smaller papers. It concerns the medical travails of Alexei Sultanov, a concert pianist with a long history of medical problems. And the stroke he had. In the thalamus, same as mine. "Caused" by lactose intolerance. Well, in a really, really, really loose sense of the word "cause." Let me excerpt just the few relevant sentences.

On a February evening in 2001, Sultanov walked into the bathroom in the Fort Worth home he shared with his wife, leaned over the toilet and purged his dinner.

A few minutes earlier, he had eaten a crock of French onion soup that he had cooked, promising himself he would not eat the cheese because he was lactose intolerant.

But he couldn't resist its aroma and taste. After he devoured the food, his stomach began to ache, causing waves of nausea.

He decided to do what he had done since childhood - retreat to the bathroom to empty himself of his meal. But while doing so he became dizzy, lost his balance and struck the left side of his head against the porcelain sink.

…

Cranial scans showed the disaster looming inside his head. So much blood was amassing, with nowhere to go, that it began pushing his brain from left to right.

As increasing amounts of blood pummeled the organ, blood vessels to his brain stem and other areas were severed or crushed, denying vital oxygen and glucose to vulnerable tissue.

Not one but five strokes racked Sultanov's brain as he lay in the hospital.

Well. Man. Not good. Though spoilsport me does need to point out that nausea isn't a symptom of LI. Whatever.

Bathroom safety. Our resolution for the New Year.

Major Change in Labeling Law Scheduled for January 1

The Food Allergen Labeling and Consumer Protection Act (FALCPA), passed back in 2004, finally goes into effect on January 1, 2006.

The full text of the bill, formally Title II of Public Law 108-282, can be found here.

The presence of any of eight potential major allergens - milk, egg, fish (e.g., bass, flounder, or cod), Crustacean shellfish (e.g., crab, lobster, or shrimp), tree nuts (e.g., almonds, pecans, or walnuts), wheat, peanuts, and soybeans – must now be revealed in plain English and in easy-to-see and –read form on labels.

What does mean for those with milk allergies, or who want to avoid milk for other reasons? I copied the following from about.com:

• List the allergen on the ingredient list. For example: MILK, listed with other ingredients.
  
  
• Use the word "Contains" followed by the name of the major food allergen, printed at the end of the ingredient list or next to it. For example: CONTAINS MILK.
  
  
• Use a parenthetical statement to clarify technical ingredient terms. For example: CASEIN (MILK), or WHEY (MILK).

Most labels already do have this information in the U.S. Still, making sure that all labels do is an important step for the millions who must watch out for potential allergens.

And the Act also calls for follow-ups, including a study on the effectiveness of the legislation and the collecting and publishing of research pertaining to food allergies.

Santa's Kringle Kruncher

Milk and cookies. Milk and cookies. Milk and cookies. Ten million more homes to go. Milk and cookies. Milk and cookies. Milk and cookies. No wonder Santa is a tub o' lard who needs to rest up for the next 364 days.

What Santa needs is some low-fat soy milk and dairy-free cookies. Or even better, something to get around all those calories.

So a huge cheer for Shelby Macy, 12, of Beaverton, Oregon, who won first prize in the pre-teen category in The [Portland] Oregonian's Design Santa's New Sled contest with the following entry:

"Blitzn" was a careful rendering of Santa's sleigh along with detailed descriptions of its features, which propelled this entry to the front. The sleigh features a toy/coal dispenser -- to supply the needs of both good and bad children -- and a unique Kringle Kruncher, which transforms milk and cookies into energy for a lactose-intolerant Santa.

Yay, Shelby!

Lactose Intolerant? Blame Your Ancestors

I've said this before, mainly in my book - Milk Is Not for Every Body - but whether you are or aren't lactose intolerant depends mostly on whether your ancestors were.
And your ancestors' decision whether or not to domesticate milkable animals for dairy products led to the spread of the mutation that allows for lactose tolerance all through adulthood.

More confirmation of this comes from the work of evolutionary biologist Paul Sherman, a professor of neurobiology and behavior at Cornell University. His work appeared in a recent issue of Evolution and Human Behavior, but I'm going to spare you and just quote from an article about it, written by Michael Kanellos at CNET News.

Researchers at Cornell University have shown in a recent study that lactose intolerance is largely a factor of cultural evolution. That is, members of ethnic groups that emerged in regions where raising cattle was common often are more genetically predisposed to digest milk products. Meanwhile, people whose ancestors came from regions where extreme temperatures, short growing seasons and dangerous animal-borne diseases made animal husbandry expensive and difficult often feel cramped and nauseous after eating dairy products.

In cheese-happy Denmark, for instance, only 2 percent of the population studied was lactose intolerant. In Zambia, near the equator, 100 percent of the individuals studied were lactose intolerant.

"The implication is that harsh climates and dangerous diseases negatively impact dairy herding and geographically restrict the availability of milk, and that humans have physiologically adapted to that," Sherman said.

The key to lactose intolerance is the enzyme lactase, which is required to digest milk. Although infants around the world produce the enzyme, more than half the people in the world, particularly those of Asian and African descent, stop producing it as they mature. People of northern European descent tend to continue to produce the enzyme because of a genetic mutation, according to Sherman. Thus, they can drink milk throughout life.

The full journal article can be found at Bloom, G. and P.W. Sherman. 2005. Dairying barriers and the distribution of lactose malabsorption. Evolution and Human Behavior 26:301-312.

Goat's Milk for Lactose Intolerants? No.

Due to the pernicious influence of the Internet, which spreads misinformation worldwide in seconds, I've been getting a lot of people asking whether they can switch to goat's milk if they are lactose intolerant.

The simple, direct, and correct answer is no.

Almost all of the animal milks that humans have used over the centuries are very close to one another in lactose content. They tend to have 4% - 5% lactose, allowing for the inevitable variations due to breeds and feeds. (See my Lactose Zoo page for detailed percentages.)

Why the confusion, then? Goat's milk – along with all the other animal milks – has a markedly different set of proteins, especially casein proteins, than cow's milk does. Those with Cow's Milk Protein Allergy (CMPA) may find that they can tolerate goat's milk without symptoms. Emphasis on the may. I would not suggest goat's milk to those severely anaphylactic to cow's milk. The rest of you with milk allergy, however, and that's the majority, may be in luck.

An article, "Cow or goat: which milk is better?", by Jane Clarke, in The Times of London adds some other advantages and warnings:

Some young children with eczema and other allergies may do better with goat’s milk formula than cow’s milk or soya milk products, as goat’s milk is much closer in molecular structure to mother’s milk. These formulas are also higher in essential fatty acids than cow’s milk formulas.

The mineral content of both milks is generally similar, although goat’s contains slightly less calcium and slightly more vitamin A, potassium and selenium, which is an antioxidant.

Finally, a warning to pregnant women. Listeria is found in unpasteurised goat’s milk, yoghurt and cheese, so you need to avoid all of these and drink only pasteurised goat’s milk. The FSA advises avoiding soft goat’s cheeses such as chèvre.

Lactose intolerance remains a problem with the lactose, so if you do try goat's milk, remember to take your lactase pills, just as you would when having cow's milk.

No Need to Avoid Milk Even If You Have Symptoms Says New Study

According to medpagetoday.com, a new study by a leading Finnish research team denies that cow's milk is the cause of their gastrointestinal symptoms.

HELSINKI, Finland, Dec. 16 - Milk and other lactose-rich products may be getting a bum rap for food-related gastrointestinal symptoms, researchers here say.

The real culprit could well be an as-yet uncharacterized intestinal immune-mediated disorder, reported Laura Paajanen, M.D., of the Foundation for Nutrition Research here in the December issue of the American Journal of Clinical Nutrition.
…

"We conclude that food-related gastrointestinal symptoms in young adults are caused by unspecific and unknown traits of altered mucosal immune response rather than by cow milk, as is often suspected by the patient," the study authors wrote.

"We suggest that this new entity, i.e., intestinal immune-mediated disorder, may be a self-perpetuating disease with fluctuations in symptoms, they wrote. "An autoimmune characteristic of the syndrome, at least in a subgroup of the affected subjects, cannot be ruled out."

Individuals who avoid milk and diary products in the mistaken belief that these are the source of their GI symptoms may not be getting important nutrients, they added.

Primary source: American Journal of Clinical Nutrition
Source reference: Paajanen L et al. Cow milk not responsible for most gastrointestinal immune-like syndromes-evidence from a population-based study. American Journal of Clinical Nutrition. 2005; 82:1327-1235.

As I've often argued, never assume that all your symptoms are coming from one food unless you have done a lengthy and exhaustive food diary to carefully study every food that you are eating. Symptoms from food are often hard to pin down. Milk is not always to blame, and there is no need to take it out of your diet unless you are forced to.