Colic and Dairy Allergy

"A baby with colic cries inconsolably for hours at a time for at least three weeks," explains Dr. Allan Stillerman of Allergy & Asthma Specialists, PA in Minneapolis, MN.

That's miserable for all concerned. Even worse is the simple truth that nobody really understands what causes colic.

But this press release from Nutricia North America, identifies a possible correlation. Colic may be related to a dairy allergy.

Babies with a milk allergy can experience a variety of symptoms, such as diarrhea, vomiting, gas, skin rash, wheezing, low or no weight gain or an overall failure to thrive.

"A milk allergy can be treated by either eliminating milk proteins from the nursing mother's diet or replacing the typical milk-based formula with an amino acid-based formula such as Neocate(R)," says Dr. Stillerman.

It should not surprise anyone at this point that Nutricia North America is the manufacturer of Neocate.

Which is probably why they throw in this line:

Babies who are allergic to milk cannot process the milk protein chains found in milk- based baby formulas and are usually allergic to soy as well.

"Usually" allergic to soy? More like "sometimes." About 25% is the figure I've seen.

An expensive specialty formula like Neocate is normally not the solution to a dairy allergy. It can certainly help in those cases in which the baby is indeed allergic to both milk and soy, although other alternatives exist as well. And there's some hope:

The good news is if your baby is not allergic to milk, she likely will outgrow the colic in about three or four months.

Is Stillerman correct when he associates colic with dairy allergies? Appears so. A check of the medical literature reveals that a connection is suspected by many pediatricians.

What is known about infant colic?, by M. L. Cirgin Ellett. Gastroenterol Nurs. 2003 Mar-Apr;26(2):60-5.

Review of the infant colic literature suggests there are at least five possible explanations-cow's milk/soy protein allergy or intolerance; immature gastrointestinal system; immature central nervous system; difficult infant temperament; and parent-infant interaction problems consisting of either the transfer of parental anxiety to the infant or the inability of the infant to give clear cues about needs to the caregiver. It is likely the cause of infant colic is multifactorial because it has proven to be so elusive.

A prospective 10-year study on children who had severe infantile colic, by F. Savino et al. Acta Paediatr Suppl. 2005 Oct;94(449):129-32.

There was an association between infantile colic and recurrent abdominal pain (p=0.001) and allergic disorders: allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy (p<0.05). ... Our findings confirm that severe infantile colic might be the early expression of some of the most common disorders in childhood.

Clinical inquiries. What is the best treatment for infants with colic?, by C.A. Crotteau, S. T. Wright, and A. Eglash. J Fam Pract. 2006 Jul;55(7):634-6.

Several small studies report some benefit from use of a hypoallergenic (protein hydrolysate) formula, maternal diet adjustment (focusing on a low-allergen diet), and reduced stimulation of the infant.

At one time, many years ago, the notion that lactose intolerance was a cause of colic was raised by some doctors. Although it is not considered a major cause, there is some evidence that treating breastmilk with lactase drops can help.

Improvement of symptoms in infant colic following reduction of lactose load with lactase, by D. Kanabar, M. Randhawa, and P. Clayton. J Hum Nutr Diet. 2001 Oct;14(5):359-63.

These findings suggest that infant colic may have a multiple aetiology, and that in a significant number of cases the immediate cause is transient lactose intolerance, in which cases pretreatment of feeds with lactase can result in considerable symptomatic benefits.

However, there are far fewer studies connecting colic with lactose intolerance than with a cow's milk protein allergy.

Lifetime Cheese Stops Mail Order

What seems like a lifetime ago, pun intended, I wrote a news item for my web site announcing that I had found a true milk lactose-free cheese.

Lifetime Specialty Cheeses says:

FLAVORS: Cheddar, Swiss, Jalapeno Jack and Mozzarella

Lactose intolerance is the inability to digest significant amounts of lactose, which is the predominant sugar of cow's milk. This condition may cause a wide range of symptoms after ingestion of foods containing lactose.

*50 Million American adults are lactose intolerant

*25% of all U.S. households include someone who is lactose intolerant.

Dairy products are a major source of calcium in the basic American diet. Calcium is needed for the growth and repair of bones throughout life. In the mid and later years, a lack of calcium may lead to osteoporosis.

The solution is to enjoy calcium rich, lactose free, fat free dairy products like Lifetime Lactose Free Fat Free Cheese!

Unfortunately, a reader just informed me that he found this also on their website:

ORDERING

Unfortunately, due to the high cost associated with shipping refrigerated cheese, Lifeline Food Company can no longer offer this service to our customers.

Our products will continue to be available in retail stores throughout the country and we will continue to expand our distribution into more areas.

We thank our customers for their loyal support of our products. Please call us if you would like to see Lifetime cheeses in your local stores.

The cheeses are still available in a wide variety of stores across the country, though.

For more info:
Lifetime Food Co. Inc.
426 Orange Ave.
Seaside, CA 93955
831-899-5040
FAX: 831-899-0285

www.lifetimefatfree.com/products/LactoseFree.html

e-mail them at info@lifetimecheese.com

You can find other real milk lactose-free cheese in my Product Clearinghouse on the
Reduced Lactose Products page.

Harvard Gets Lactose Intolerance

It's rare to find good articles on lactose intolerance. I found a column "From the the faculty of HARVARD MEDICAL SCHOOL" on the Myrtle Beach Online site that is quite readable. Check it out.

Dairy Allergy Celebrity Alert: Trace Adkins' Daughter

Trace Adkins will serve as the honorary chairman of this year's Walk for Food Allergy: Moving Toward a Cure. The event, to be held in 20 cities across the country as well as online, is sponsored by the Food Allergy & Anaphylaxis Network to increase awareness about food allergy and raise money for research and education.

Trace's daughter, Brianna, is allergic to milk, eggs, and peanuts. Now six, Brianna and her parents first learned of her allergy after a reaction to peanut butter when she was 18 months old.

Go to foodallergywalk.org for a list of the cities and dates the Walks will be held in.

Try a Compounding Pharmacy for Lactose-Free Medications

Hundreds of prescription medications and hundreds if not thousands of over-the-counter medications contain lactose as an inactive ingredient. Lactose has little taste, but some find it mildly sweet. No one is allergic to it or suffers from side effects. It is a cheap by-product of cheese production. In short, it's nearly the ideal bulk filler for a pill.

Of course, there's the tiny drawback that if you can't digest lactose, you may get symptoms ranging from gas and bloating to diarrhea. The flip side of this is that the amount of lactose in any one pill is so small that only the rarest of extremely sensitive individuals should be affected by lactose intolerance symptoms generated by a single pill.

Even that is not sufficient for those who try to avoid all milk products for whatever reason. Although you should be able to find a lactose-free alternative for most medications, this is not always possible, and often expensive or inconvenient.

What to do? Try a compounding pharmacist.

Green Dispensary Compounding Pharmacy, Australia

I was reminded of them by this article on ClickOnDetroit.com.

It's that level of dedication that brings customers facing a wide variety of medical challenges to [Kenny] Walkup's store. His is a compounding pharmacy. That means each prescription is prepared specifically for an individual patient, tailored to meet their medical needs and taste preferences.

"Today's modern drugs fit for a lot of people, but there are people that they just don't work for, whether it's a lactose intolerance, or an allergy to a drug or a color," Walkup said.

Compounding is part of medical history. In earlier days, pharmacists made their own pills in their own stores from basic ingredients. They "compounded" them, meaning literally "To produce or create by combining two or more ingredients or parts." Even a few decades ago, 60% of prescription items were compounded. Today only about 1% are.

That means compounding pharmacies are rarer than the regular pharmacies found in every drug store, supermarket, and discounter. Even so, you should be able to find one near you. I can't guarantee that every medication can be made or made lactose-free by every compounding pharmacist, but if it's important to you, seek one out to talk to.

There seem to be two major trade organizations.

The Professional Compounding Centers of America (PCCA) has more than 3500 members, many of them outside American in Canada, Australia, Europe and New Zealand. To find a compounding pharmacist close to you, call them at 1-800-331-2498 or email customerservice@pccarx.com.

The International Academy of Compounding Pharmacists (IACP) represents more than "1,800 pharmacists, physicians, technicians and patients." Go to their website to access their Compounding Pharmacist Locator.

Flexitarian Cooking

I recommend vegan cookbooks to those with lactose intolerance or dairy allergies because they are guaranteed to have recipes that are milk free.

We do live in a meat culture, however, and vegan dishes are not always satisfactory to the majority.

But with the emphasis on increasing the amount of vegetables in our meals and lowering the meat content, a new style of cooking has emerged.

Chef Peter Berley calls it "flexitarian" and has a new cookbook out that details how to cook meals for both vegans and meat-eaters - simultaneously. It's The Flexitarian Table: Inspired, Flexible Meals for Vegetarians, Meat Lovers, and Everyone in Between.

J. M. Hirsch of the Associated Press describes it this way.

As former chef at New York's vegan Angelica Kitchen restaurant and author of the excellent "The Modern Vegetarian Kitchen," Peter Berley has serious veg street cred. And now he gives us "The Flexitarian Table."

The title is a reference to the term coined several years ago to refer to people who eat mostly vegetarian diets with a smattering of animal products. In this book, Berley demonstrates you really can have it both ways.

The book is aimed at the many families who struggle to put dinner on the table after a child announces they are vegetarian, or when the vegan friend or relative comes for dinner. The solution — cook two versions of the same dish, one with meat, one without.

It's easier than it sounds, and Berley's recipes walk readers through it so in most cases they really are cooking just one meal.

Many of the entrées call for both vegetarian and animal ingredients. The recipe explains how to prepare one dish, such as the spanakopita-style turnovers, two ways using the different ingredients. In this case, both lamb and seitan, a vegetarian "meat."

Other menus (the book is divided into seasonal menus) include both meat and vegetarian entrées, as in the spiced lamb croquettes and falafel in one of the summer menus. Each menu also includes a plan with do-ahead tips.

Hirsch also discusses Patricia Wells' Vegetable Harvest: Vegetables at the Center of the Plate.

Wells takes a refreshing approach — making the vegetables the center of the meal and treating the protein or meat as the side. It may seem backward to many Americans, but Wells' recipes are so evocative it's easy to give them centerpiece treatment.

The recipes are delightfully simple and straightforward, such as the spring onion, tomato, avocado and basil salad with basil-lemon dressing. All that in about 10 ingredients, including the dressing.

Remember that neither book is strictly vegan nor milk free. However, the emphasis on vegetables should provide numerous recipes for the whole family and promote healthier eating all around.

Serious Warning About Thyroid Medication

If you are taking high doses of the thyroid medication levothyroxine and the medication is not working properly, it may be because you are lactose intolerant.

This was the surprising news from a study in the medical journal Thyroid 2006, 16(11): 1171-1173. doi:10.1089/thy.2006.16.1171. The study, "Lactose Intolerance Revealed by Severe Resistance to Treatment with Levothyroxine," was by three Spanish researchers, Manuel Munoz-Torres, Mariela Varsavsky, and Guillermo Alonso.

Here's the abstract:

The most common cause of apparent ineffectiveness or resistance to treatment with oral levothyroxine (LT⁴) is the result of noncompliance, known as pseudomalabsorption. However, an abnormality in the bioavailability of LT⁴ should also be considered in patients requiring large doses of LT⁴ to achieve euthyroidism. The incidence of lactose intolerance in Caucasian adult patients is 7%–20%, but the association with resistance to treatment with oral LT⁴ is unusual. We report a 55-year-old woman in whom treatment LT⁴ for hypothyroidism was found related to a previously undiagnosed oligo-symptomatic lactose intolerance, an unusual association. Although rare, intolerance to lactose should be considered in the differential diagnosis of gastrointestinal diseases that can cause malabsorption of LT⁴. The possibility of correcting this disorder with simple dietary measures justifies its consideration.

Obviously, it you are taking levothyroxine, you should talk with your doctor just to be safe.

Intolerance Foods Market No Longer Niche

There's a huge potential market of foods for people with food intolerances and allergies that is being met, according to the global market research firm, Euromonitor International.

An article by Melissa Suggitt, Food intolerance products have massive growth potential in the UK, said:

Food allergies or “sensitivities” are on the rise in the UK, but the food industry is struggling to meet consumer demand for ever more specialised food intolerance products. As a result, many sufferers remain uncatered for or have to hunt around for highly priced items in specialist outlets. According to market analyst, Euromonitor International, now is the time for food manufacturers and retailers to realise that food intolerance products are no longer niche and hold massive growth potential in the UK.

...

The UK is the third-biggest market for gluten-free foods (after the US and Italy), amounting to GBP47 million in 2006. Value sales of lactose-free products (dairy products, ice cream, baby foods) have increased by 29% since 2002, reaching GBP23 million in 2006.

...

However, there is still much room for improvement. In an interview with Euromonitor International, a Food and Drinks Advisor at Coeliac UK confirmed that, although it was now much easier to get hold of specialist products, people resented having to pay such high premiums, and that most sufferers would like to see more “normal” products, such as gluten-free jaffa cakes, pitta breads, pizzas, sausage rolls or maybe even a pork pie. Such products do exist, but availability is limited to large stores.

...

Euromonitor International suggests that food manufacturers would do well to further their investment in products that can be confidently labelled as free from wheat, gluten, cows milk, lactose, egg, soya, nuts and ominous additives, such as sulphites. Now would be a good time for larger players to acquire small specialist companies, who can provide uncontaminated products from their custom-built production facilities. Such companies can blossom once provided with adequate resources, as demonstrated by organic companies such as Rachel's Dairy (acquired by Dean Foods) and Green & Blacks (acquired by Cadbury Schweppes).

Euromonitor International wants to sell its pricey marketing reports and databases, of course, but the above is accurate. The UK has always lagged behind the North American market in the easy availability of specialty foods. And the US and Canadian markets could do with more and more affordable foods as well.

I hope some manufacturers are listening.

A2 Milk Hits America

Early last year I posted A2 Milk Claims Unproven.

In it I talked about A2 milk, which is milk that contains more of the A2 beta casein protein. The milk comes from cows that naturally produce more of this particular protein because of a tiny mutation in amino acid linkage. A2 milk was sweeping Australia and New Zealand, because of the staggering health claims people were making for it. (Well, I was sure staggered that people would make these claims.)

Those claims included a significantly lower incidence of childhood diabetes and coronary heart disease.

The one claim that made sense was that A2 milk might lessen allergic reactions from people who had dairy allergies to the casein protein in standard A1 cow's milk. Goat's milk, which indeed can be safe for a number of people with cow's milk protein allergy, has more of the A2 beta casein.

I also said that "Rumors are rife that A2 milk will soon be introduced into the United States and elsewhere outside of New Zealand and Australia, especially since A2 now has a new owner."

It took a while, but that day is here. A2 milk is now being sold in Hy-Vee stores in the midwest.

The a2 Milk website says:

Working hand in hand with our licensee, The Original Foods Company, we are incredibly excited to announce that we have identified and segregated the first a2 Milk™ producing cow herd in the U.S., and The Original Foods Company a2 Milk™ will be available exclusively at Hy-Vee stores throughout the Midwest.


We are very proud to be partnering with The Original Foods Company, whose mission is to produce and distribute natural, premium food products of the highest quality that are unique to the marketplace and can be verified as coming from a specific source.


In line with this mission, The Original Foods Company sources their a2 Milk™ exclusively from the Prairieland Dairy, a family owned farm in Firth, Nebraska.


Prairieland was chosen to have the first a2 Milk™ cow herd in the United States because the a2 producing cows at Prairieland are not given rbST† or other artificial hormones to stimulate milk production and a nutritionist regularly prepares the optimum feed ration for the cows, and ample fresh water is always provided.


Whether you are satisfied with your current milk, or are a milk lover who has been disappointed by other milks, we think you’ll enjoy the unique qualities of a2 Protein Certified™ a2 Milk™.

They are soliciting comments on the milk at their website. And so am I. If you have a dairy allergy and try A2 milk, please let me know your experiences.

Answers to Questions from Readers, part 6

Q. I have taken lactase several times now and gotten an upset stomach, cramping and bowel pain. I guess my question is: Is it possible to have too much of the enzyme in your system?

Q. Are the Ultra Lactaid pills constipating? Lactaid, by the way, denies any knowledge of this side effect. I called them a couple of years ago and asked.


Q. I now strongly suspect that some brands of pills can themselves cause diarrhea, especially in large doses. Do you have any information on this?

I've been getting an increasing number of complaints that lactase pills are causing problems. As you can see, though, each person seems to have a different complaint.

Giving advice on this issue is difficult, because except for some anecdotal complaints such as these, there is nothing in the medical literature about adverse reactions to lactase pills. Nothing. They are some of the most benign pills known to the pharmacopeia.

So what's going on?

One or two actual medical problems are known. There is one single case of a person being allergic, not to the lactase, but to the yeast that is used to manufacture the lactase. And a few brands of pills may contain mannitol, an artificial sugar substitute, as an ingredient. Susceptible people are known to get diarrhea from mannitol.

Other than that, the problem is compounded because people are taking the lactase with meals. So any reaction may come from the meal rather than from the pill. And to make things more complicated, when people try to relieve symptoms or cure a supposed food-based problem, they often make many changes to their regular diet simultaneously. The reaction could come from any or all of these, alone or in combination.

You might want to consider the possibility that if your system has been producing mild diarrhea for a long time from small quantities of lactose, you've come to think of this state as being "normal." Getting sufficient lactase into your system to eliminate the symptoms would feel much like constipation by comparison. Remember that doctors define a normal amount of bowel movements as anywhere from three times a day to three times a week.

Or you may be having a psychological reaction to knowing you're about to eat food that contains something you shouldn't have. (Don't scoff. Many studies have shown a strong psychological reaction to milk even in people who do not test out as being LI.)

It may even be something as simple as having a stomach flu and not realizing it.

Not very helpful, I admit. All I can say is that you should try several different brands of lactase. Some people simply react better to some brands than to others.

You might also look at my Lactase page in my LI Basics section. I gave lots of helpful hints as well as answers to what and when and how and how much lactase. You may find something useful there.

Q. I have read references to a lactose-tolerance test. What is that?

There are two basic types of lactose-tolerance test. Both start with a person drinking either a solution of lactose and water or a glass of milk.

The most common test is called the breath hydrogen test. If you do not digest lactose then the bacteria in your colon will ferment it, producing hydrogen gas. This gas is measured in your breath. Measurements are made at intervals for several hours to see what the peak is. If the peak is higher than a certain amount, you are said to be lactose intolerant.

Because the breath hydrogen test needs special equipment to measure the hydrogen, some places still use the older blood glucose test. The idea behind this one is that if you do digest lactose, your blood sugar will go up. Therefore blood samples are taken at intervals to measure the glucose level. If it goes up, then you are not lactose intolerant. This makes it an indirect test and so not as sensitive, besides which you get stuck by a lot of needles, both of which have caused it to go out of favor.

For more info, see my LI Tests page.

Q. How should a doctor diagnose lactose intolerance?

The symptoms of LI are diarrhea, gas, cramps, flatulence, and borborygmi (the rumbling of air through the intestines) after the ingestion of milk products. Any one of a number of tests can be given to a patient to confirm LI. The major tests are the breath hydrogen test (since the bacteria in our colons produce hydrogen gas when they ferment undigested lactose) or the blood glucose test (an indirect test measuring the lack of an increase in blood glucose from the failure to digest lactose). The patient drinks a lactose solution and then either a breath sample or a blood sample is taken at intervals thereafter.

The problem for a doctor is to determine when LI is the problem and when the symptoms may be coming from any number of other, more serious, diseases and disorders with similar symptoms that the patient may have instead of or in addition to LI. You'll have to ask a real doctor how that determination is made.

Bad Vegan. Bad, Bad Vegan.

Look up at the banner across the top of this blog. It says it's for anyone who wants to reduce or avoid milk and milk products in their diets, including vegans.

I have been featuring vegan products, vegan cookbooks, and vegan restaurants on my website for 10 years. I support vegans and veganism all the way.

As long as they remember that veganism is a choice, not a superior moral stance.

When vegans forget this simple rule, they have an awful tendency to throw truth and reality out the window. Why? I can only imagine, but nothing my imagination comes up with is very flattering.

I have a current example that set me off, of course. Cow's Milk: A Substitute for Human Milk, by Colleen Patrick-Goudreau on the GreenOptions.com website.

She starts off by decrying the fact that soy "milk" and rice "milk" are considered imitation or alternative "milks," implying that they are inferior. This is a simple fact of history. Milk straight from the animal or the mother's breast has always been the standard for milk. The whitish liquid that is made from plant or other sources, even in cultures that has used them for thousands of years, is clearly the substitute for the real thing. It may have its own positive properties but it is not milk.

She then says something which has become common in vegan diatribes, even though it is utterly false and without a shred of archaeological backing:

When animals were first herded and domesticated for human consumption, about 9,000-10,000 years ago, they became the alternatives to plant foods. Plant foods were the foundation of the human diet for a long, long time - long before people started domesticating non-human animals.

Ridiculous. Human and other great apes are omnivores. Our ancestors probably started out as scavengers before they became tool-wielding hunters, but there was never a time in human history in which the apes that are in our lineage were pure plant eaters.

The amount of meat in their diets varied, to be sure. Modern aboriginal tribes vary from less than 10% of their calories being from meat to nearly 100% of their calories being from meat, as with Inuits. But all known human cultures are omnivores. No anthropologist or paleontologist worth taking seriously thinks that humans have ever been different than this.

Note that the one comment so far on her article makes also calls her on this specious argument.

As if that bit of fake science weren't enough, she makes a statement so outrageous that it's surprising the photons on the screen don't rebel.

With millions of dollars, the animal exploitation industries convinced people they need to consume the flesh and secretions of animals,

Has this women ever read a page of history? Animal flesh and "secretions" were prized in cultures all around the world throughout history. They were often reserved for the wealthy and powerful, but also were a source of rejoicing at feast days and festivals for the poor. No exploitation industries have ever been necessary to convince people to eat meat. Quite the contrary: it's those who refuse to eat meat who needed religions, cults, and secret societies to justify their oddity.

Here's another beauty:

Not only are we the only animal that drinks another animal’s milk, we are the only animal that drinks it into adulthood.

This utterly fatuous saying is a mantra among the worst vegan thinkers. It's true, but so is the fact that we are the only animal who cooks food. Heck, we are the only animal who cultivates plants, fertilizes them, alters their genetic structure by selective breeding, harvests them, transports them, and processes them into other products. Human are unique in every aspect of the way they treat food and every aspect of civilized life, for that matter. Any rational human would use this argument to support our difference and distinction from animals rather than as an argument that we should be more like them.

Colleen Patrick-Goudreau is an embarrassment. An embarrassment to vegans, an embarrassment to thinkers, an embarrassment to the human race. It is completely possible to make the choice to avoid milk or all animal foods and still have an understanding of food, history, anthropology, genetics, and culture. Patrick-Goudreau fails at every level.

Vegans, please. Please repudiate those whose stunning ignorance make a mockery of your beliefs and customs. Please repudiate those who repeat fatuous talking points that are designed to stop all thought rather than stimulate it. Please repudiate those who feel they must attack and belittle others in order to feel better about the tenuousness of their own understanding of the world.

Colleen Patrick-Goudreau is like a puppy who has soiled the rug long after she was supposedly paper-trained. Bad vegan. Bad, bad vegan.

Answers to Questions from Readers, part 5

Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

You would think so, wouldn't you?

But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)
So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

The odd answer is that you are both right.

Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

So?

So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

There. Feel better now?

Q. Have you heard of anyone's LI symptoms being relieved by birth control pills?

The problem is that I hear all sorts of anecdotal comments about LI, without ever being able to back them up. I have heard of women becoming LI because of pregnancy and also of women being able to drink milk for the first time while pregnant. I do not, however, know of any studies that would shed any light on the subject. But you are definitely the first to give a connection to bcp's. (However, as all but one brand of bcp's contain lactose as a filler, it's probably not surprising that few people see their symptoms disappear while on them.)

Q. Our doctor thinks my daughter has irritable bowel syndrome, but with lactose intolerance as a trigger. I'm wondering if I am giving her enough Lactaid. Do you have any thoughts on this?

While it couldn't hurt, it's not clear that it would do much to help unless you think you are still not detecting all milk products at those meals.

You might want to go in a different direction. There are numerous other triggers of irritable bowel other than milk. They include: large meals, fatty or spicy foods, carbonated beverages, and caffeine. Gas-producing foods, like beans and cabbage, can also be a problem. So can sorbital, the artificial sweetener. Even some fiber sources, including lettuce, celery, and fruits, may cause gas and bloating. If you detect a pattern of symptoms in conjunction with any of these, try removing it from her diet for a few days and see if that helps.

Q. How does heat affect lactose? Does baking alter lactose? If I see non-fat milk in a bread label, has the lactose been altered to the point that it no longer poses a problem for me?

Unfortunately, there is no evidence that heat affects lactose in any way. Lactose in pure form, in mostly pure form (whey) and as a small percentage of other milk products, is used in hundreds of foods and people seem to respond to all of them. Of course, most people do _not_ respond to small amounts of lactose, so size does matter, as they say. But you do need to take lactose into account in any food that it is in.

To know how much lactose is in various milk products, see the SuperGuide to Dairy or the Lactose Percentages pages in the Dairy Facts section of my web site.

Cooking for a Healthy Lifestyle

Pam Wertz of the St. Joseph Institute Spa & Resort emailed me to let me of their book of gluten-free recipes, Cooking for a Healthy Lifestyle, by Jenny Sheetz and Lauren Matosziuk.



Jenny Sheetz says on their website that:

All of my life I have enjoyed cooking and sampling a wide variety of foods.

I developed a taste for different types of food, taking delight in each one. When I discovered that I was unable to eat wheat and other gluten-grains, my life changed dramatically.

The more I changed my life-style, the more I discovered the need for further change. Eliminating gluten-grains was not the complete answer for me. Ultimately, I had to eliminate all grains from my diet.

In a society where foods are based on grain products that was quite a challenge! Since meeting challenges is an area of specialty for me, I decided to meet this one head on. We developed a test kitchen in our home. My daughter, Lauren, and I decided to re-create the tastes we had come to know and love. This cookbook is the result of our efforts.

My hope is that this book will help you find a more convenient life-style that allows you to enjoy meals as a family without having to prepare separate dishes for those who have food allergies.

You can order the book from their order page.

Galactosemia: the Other Lactose Problem

I maintain this blog for anybody and everybody who wants to remove or reduce lactose in their lives. That covers a lot of territory.

One serious problem I rarely mention because it itself is so rare is galactosemia.

Lactose is a disaccharide, a complex sugar made up of two simple sugars, glucose and galactose. Digestion is literally the splitting of lactose into the two simpler sugars (with the addition of a water molecule, a process known as hydrolysis). The galactose and glucose then enter the bloodstream where the galactose is converted in more glucose, the basic power source of the body.

People with galactosemia digest lactose properly, but they lack the enzyme that converts the galactose. It accumulates in the bloodstream and effectively poisons the body. This otherwise completely harmless sugar can lead to brain damage, blindness and death through liver failure.

Galactosemia is a congenital disorder. It cannot be contracted, but always is present from birth. It must be diagnosed quickly, because breastfeeding or formula feeding with cow's milk-based formulas is deadly.

An English mother and daughter went through this ordeal, according to an article in This Is London.

Like every new mother, Tracey Cooper was determined to give her baby the best start in life.

When she brought her healthy 7lb 8oz daughter Dorothy home from hospital 24 hours after giving birth, she soon settled into a breast-feeding routine.

Everything seemed fine - until the ninth day, when the little girl fell into a deep sleep from which she could not be roused.

...

But it took ten doctors in three hospitals a further six days to diagnose that she had a potentially lethal allergy - to her mother's milk.

Dorothy had galactosaemia, an extremely rare condition causing a violent adverse reaction to lactose, which affects just one in 45,000 babies in Britain.

Instead of helping her grow strong, her mother's milk had been poisoning her, causing her liver to fail.

...

The infant was transferred to a surgical unit at Farnborough where she had so many blood tests taken that her veins collapsed.

After 48 hours, the family were moved to a specialist liver unit at King's College Hospital when her liver started to fail.

Finally, after being seen by a further five doctors and losing 14 per cent of her body weight, the problem was spotted and Dorothy was placed on lactose-free bottle milk.

Allergy is technically the wrong word. The immune system is in no way involved. Enzyme deficiency is better.

After all that, the cure was extremely simple and straightforward:

Now a month on, Miss Cooper and her partner have been able to take their seven-week-old daughter home after she made a full recovery. She is being fed a soya-based milk free from lactose.

Only one birth in 45,000 in Britain is galactosemic. I'm not sure that should lift the blame on the doctors who failed to make the diagnosis. Since there were 669,531 births in 2006 in England and Wales, you would expect about 15 galactosemic babies to be born that year and every year. Surely that's enough for fifteen[!] doctors to have enough experience to figure it out.

However, the rarity of galactosemia is a serious issue. As with congenital lactose intolerance the cure has to be provided quickly. Good thing milk alternative formulas are so prevalent these days.

All the best to little Dorothy. She has a milk-free life ahead of her, which is never easy. At least she'll survive to see it.

IBS - Irritated Being Single

There's no question that having digestive problems is a handicap to romance. Even the most loving spouse has to put up with a plenitude of embarrassing and exasperating situations. Now imagine trying to find a dating partner given that handicap.

Craig Jex has a solution to offer. Irritated Being Single is the first online dating service for those with digestive problems.

The site says:

The dating scene can be difficult for anyone. But if you suffer from Irritable Bowel Syndrome (IBS) or Crohn's Disease it can be cause of added anxiety and embarrassment. Irritated Being Single is here to aid IBS and Crohn's Disease sufferers who would like to date but find it difficult to build new relationships due to symptoms that can be beyond their control. There is no better feeling than being with someone who understands exactly what you are going through.

That is why Irritated Being Single hope IBS and Crohn's Disease sufferers as well as sufferers of any other bowel disorder will embrace this dating service in the wish of meeting their soul mate without being embarrassed about their conditions.

Craig was interviewed on Tim Phelan's blog. Here's an excerpt:

The site went live in April 2006 and is slowly growing with members. When I discussed the idea of having a dating site for sufferers of IBS the reaction was quite mixed. There were a few people who thought it was a bad idea. Their thoughts being that people don’t like to talk about poo and who would want to go out with someone who constantly needed to use the toilet. Some of their points I could understand but others were a little narrow minded. But I’m used to that; I can’t tell you the number of times people have said that my IBS is all in my head – I think that’s the worst thing you could say to someone who suffers from this condition. Everyone has suffered from the shits at one stage or another in their lifetime so if they can just imagine what that must be like to live with every day then they would soon realise it’s not all in our heads.

Dating is always a nerve wracking experience and having IBS makes it that little bit worse so having a dating site where sufferers wouldn’t have to worry about their condition had people thinking it was a good idea.

Although, the majority of people probably thought it was a good idea especially when you take into account the figures you mentioned due to the fact that if half of the world’s IBS sufferers signed up I would be a millionaire. Those figures really are amazing especially when you consider those who haven’t been diagnosed yet as they’re too afraid to bring their bowel habits up with a doctor.

The signups are growing very slowly. On This is Local London (yes, Craig's site is a UK site) Kerry McQueeney wrote:

He has 70 people registered on the website but hopes more will come forward when they hear of it.

They should. Channel 4 is due to screen a documentary about Craig and the website at the end of August.

LI Celebrity Alert: Michael Rasmussen

The Danish cycler Michael Rasmussen is leading the Tour de France after the eighth stage on Sunday in France.

In the The Guardian, Julien Pretot wrote:

Rasmussen had thought for a long time he could do well in the mountains if he lost weight. He is allergic to lactose and often refuses to drink during a climb in order to keep his weight down.

Allergic to lactose? Those UK writers never get that right, do they?

The Lactose-Intolerant Ice Cream Man

It's almost like a Greek tragedy. He brings happiness to thousands of children, happiness that he can never partake of himself, even though he has The Sweetest Job.

He is Ben Shelton. The Ice Cream Man. Wrote Mary Lancaster:

[He] makes the rounds of [Nantucket] island neighborhoods in an old, spiffed up truck decorated with surfboards and announces his presence with '60s surfer music and a ship's bell mounted on the inside of the passenger door.

...

"I've always wanted to do one so I decided why the hell not, to get it out of my system," he said, as the truck was waved down on Norquarta Drive by several smiling children. "The idea is to break even. If I make money that's even better, but it's so much fun. There's nothing for kids on Nantucket - I had no idea they would go bonkers when they see it. It is the funnest job I've ever had."

The only problem? Shelton is lactose intolerant. Never mind. All he cares about is hearing a forlorn customer say:

"Ice Cream Man, can you come tomorrow?" asks a child as we prepare to move along.

Friday the 13th!

All hail Walt Kelly!

Cold Stone Creamery Buys Cereality

Kahala•Cold Stone, the parent company of Cold Stone Creamery*, just announced the purchase of the now small but planning to grow Cereality^® Cereal Bar & Café chain.

The article in QSRMagazine.com describes Cereality as:

a new concept in the QSR [Quick-Service Restaurant] space, specializing in creating a unique and entertaining experience around the American ritual of eating cereal. Customers choose a base from Cereality’s menu of more than 30 cereal varieties and signature cereal blends, and select from 40 toppings and mix-in combinations to create their ultimate bowl topped with their favorite assorted milk and hot and cold beverage. The offerings extend to parfaits, smoothies, cereal bars and other bakery items. The Cereality customer experience is enhanced by a home kitchen atmosphere and the preparation of orders by pajama-clad Cereologists™.

Cereality has seven cafés in operation, with an eighth location scheduled to open at JFK International Airport later this month. Cereality currently holds franchise commitments for the opening of an additional 24 cafés over the next six years.

...

Cereality is the first restaurant business to ever break the mold of traditional foodservice to bring a unique, highly personal, healthy eating experience to the consumer, entirely focused around brand-name cereals. Customers can choose from more than 30 different cereal varieties, over 40 different toppings, a variety of milks (including soy and lactose-free) and choices of hot and cold beverages.

Like the smoothies mentioned below, Cold Stone offers a variety of "healthy" alternatives, many of them non-dairy.

Cold Stone Creamery’s Healthy Indulgences are:

• Sinless Sans Fat™ - Non-fat No Sugar Added Ice Cream
• A variety of non-dairy Sorbet flavors
• Reduced Fat Light Ice Cream
• Non-dairy Sorbet Smoothies
• Smoothies made with Soymilk
• A variety of mix-ins that fit your health and diet needs

*And also BLIMPIE, Frullati Café & Bakery, Great Steak & Potato Co., Johnnie’s New York Pizzeria, NRgize Lifestyle Café, Ranch1, Rollerz, Samurai Sam’s Teriyaki Grill, Surf City Squeeze, TacoTime, V’s Barbershop, and WafflÔ.

Did Lactose Intolerance Beget Smoothies?

Ah, smoothies. Thick, rich shakes of juice and fruit, sometimes yogurt and fruit, heck, sometimes vegetables. (Raw fooders, for example.)

Was lactose intolerance responsible for this delicious treat?

Could be. An article by Rachael Bowerman in the RocktownWeekly says that Stephen Kuhnau, the founder of the Smoothie King franchise, began mixing them in the 1960s for people who, like him, were lactose intolerant.

Smoothies now have lots of potential add-ons, and claims - unproven as far as I can tell - of nutritional benefit from supplements, herbal extracts, and soy.

But the base smoothies are, um, good enough to eat.

Even without the milk or ice cream, a smoothie can be as rich and creamy, or as thin and slushy, as one wants, [Donah] Sandridge said. All smoothies begin with a base, such as ice, nonfat plain yogurt, cottage cheese, tofu, fruit or vegetable juices or, if a milky consistency is preferred, nut or seed milks. Chopped fruits, frozen or fresh, are added next; some folks also like smoothies made with tomatoes, celery, carrots and other vegetables. Although she prefers the flavor of the fruits and juices to stand alone, she said honey, vanilla extract, cinnamon and other spices may be added for people with a sweet tooth. But keep in mind that the type of ingredients you add can boost the caloric content.

"Some fruits are more sweet than others; you just have to taste and experiment," Sandridge advised.

Remember, the sweeter you make your smoothie, the more sugar you're having. If you're looking to smoothies for health you need to balance the sweet tastes with less sweet bases.

However you make them, the ninety degree weather outside encourages smoothie consumption. Enjoy.

Answers to Questions from Readers, part 4

Q. I'm planning on going to Samoa soon, and I need to know if there is lactose in coconut milk, as it is used in most Samoan dishes.

Coconut "milk" is just the white liquid found in a coconut. None of the nut "milks" or nut "butters" have any real dairy content.

(A warning for non-travelers. In this country coconut milk is often processed with cow's milk. I doubt this is much of a problem in Samoa, but here it wouldn't hurt to doublecheck that you are getting pure coconut milk, not some canned processed variety.)

For a big fun list of such similar sounding foods, none of which contain the slightest amount of lactose, go to my The Better Look Twice List of Supermarket Products That Appear To Contain Milk -- But Don't! page.

Q. I have SLI (Secondary Lactose Intolerance) that I got from a really bad undiagnosed intestinal infection that left me severely intolerant two years ago. Yes, there are people like me out there who really can't tolerate anything more than one teaspoon of butter a day. We want to be acknowledged too!

And here's your acknowledgment!

It's true that I have my doubts that there are very many people out there with normal LI due to aging who cannot have even a speck of lactose. But here's a big BUT. But I've always made an exception for people with damage to their intestines; I know that their intolerance can be much worse than what happens with normal aging.

Avoiding all dairy projects is a project. I know, I did it for years before lactase pills came along. It can be done, and there are many more products around now to help you. Check out my Product Clearinghouse for info on dozens of them.

Q. Can you tell me what percentage of the population is Lactose Intolerant and if it is more prevalent in different ethnic groups?

My book, Milk Is Not for Every Body, has a listing that runs a full 15 pages, summarizing the results of dozens of such studies from around the world.

Very briefly, LI is most prevalent (up to near 100% levels) in East Asians, Native Americans and most Africans. It runs around 50% in people who live around the Mediterranean -- from Arabs and Jews to Romanians and Italians. The farther north one goes in Europe, the less likely you are to be LI. Scandinavians run no more than 5% LI.

The same holds true for this country. If your ancestors come from northern Europe, you are unlikely to be LI. If your ancestors come from places where LI is universal, you are likely to become LI yourself.

Nobody has ever done an LI survey of the entire U.S. population. (That 50,000,000 LI figure you see tossed around a lot is sheer meaningless extrapolation off of insufficient data.) But generally, the LI percentages for groups are similar to those of their ethnic ancestors.

This is already changing, however. Intermixing of the population is rapidly blurring these distinctions in this country. In another few generations LI will be mostly a thing of the past in the U.S.

Q. I have been reading that LI is mostly seen in certain regional areas and ethnic groups. Why this is so? Is it perhaps those individuals' diets do not consist of dairy products?

I cover this in detail in my book, Milk Is Not for Every Body, but here is as brief as explanation as possible.

In most places in the world, humans were able to get enough of certain important nutrients, especially calcium, without using dairy products. As people moved toward less hospitable climates, like northern Europe, those alternate sources were hard to come by. People who could have dairy products after the age of weaning had a reproductive advantage. Lactase persistence (LP), the ability to produce lactase as an adult, is a known dominant genetic mutation, so it would easily spread through a population.

Those who had the mutation in places where it was not necessary to eat dairy products to survive had no reproductive advantage and LP remained rare.

The oddest case is in Africa, where many tribes who live on the edges of the Sahara and other deserts survive for many months almost entirely on milk and nothing else. The almost total lack of other food generates as severe genetic pressure as one can imagine. These tribes are the only ones in Africa who are LP.

Q. I am Chinese and in my family, we eat a lot of vegetables, fish, and rice--non-dairy products. And in the last few years I have developed Lactose Intolerance. Did I develop LI because I stopped eating foods with lactose thus, my lactase enzyme was depleted?

Nope. The loss of lactase is genetically regulated only. Nothing that an individual does or doesn't do is known to change the rate of loss in any way.

There is some evidence that a person can reduce the symptoms produced by LI, however. LI symptoms are produced by the gases created when the bacteria in your colon ferment the undigested lactose. Some bacteria do this more than others and it would seem to be possible to encourage more of the ones that don't by regularly eating certain dairy products, yogurt in particular. Your lactase levels remain as low as ever, even so.

Gluten-Free Essentials, Plus A Prize

Alisa Fleming, of GoDairyFree.org, sent out a press release about her latest contest.

A new specialty food manufacturer has burst onto the scene, proclaiming, "Gluten-Free is not a luxury… We just make it taste like one." They have arrived not a moment too soon, as gluten-free and other “free-from” diets are no longer considered a passing fad; they are a lifelong necessity for millions of people.

With three generations of Celiacs to serve, the founders of Gluten-Free Essentials are dedicated to helping those on a gluten-free diet live a healthy, happy and normal life. Of course, they are all too aware of autistic (GF/CF), food allergy, and food intolerance needs also. Every product in the extensive Gluten-Free Essentials line-up is all natural, vegan, dairy-free, egg-free, nut-free, and of course gluten-free.

Leaving virtually no stone unturned, the Gluten-Free Essentials product line includes 16 baking mixes, 5 quick-cooking rice mixes, and their newest line of 6 Speedy-Bake mixes for kids. Each Speedy-Bake package sports colorful pictures and directions for preparing in an easy-bake oven, along with the full-size oven directions. Though the fun graphics and kid-friendly directions suit the primary target audience, less populous households without kids will enjoy the smaller sizing of these mixes (making a more convenient amount for one or two people) and the correspondingly lower price.

While each of the 27 mixes is available to purchase directly from www.GFEssentials.com, you can enter to win your own gluten-free “starter kit” at www.GoDairyFree.org.

Register for the free Go Dairy Free e-newsletter and receive your chance to win a Smart-Starts gift box from Gluten-Free Essentials. The package, which retails on their website for $50.00, will include their five Assorted Rice Side Dishes, Chocolate Chip Cookie Mix, Decadent Fudge Brownie Mix, Yellow Velvet Cake Mix, Spice Cake & Muffin Mix, Meatloaf Starter Mix, Seasoned Breading Mix, All Purpose Baking Mix, and Pancake & Waffle Mix.

www.GoDairyFree.org offers a different prize each month to newsletter subscribers. The winner of the Gluten-Free Essentials July giveaway will be selected during the week of July 22nd. Go Dairy Free is an informational website for dairy-free consumers, vegans, special dieters, and anyone interested in a healthy, natural food lifestyle.

About the Company:

Gluten-Free Essentials mixes are made in a dedicated gluten-free, dairy-free, nut-free facility. Their products are also egg-free (suitable for egg replacers in preparation) and for the most part soy-free, with just a few mixes containing soy lecithin. Beyond the directions on each package, the staff members at Gluten-Free Essentials are continuously trialing inventive recipes and uses for their products, which offer outstanding versatility.

Product reviews for most of the Gluten-Free Essentials products are available to read at www.GoDairyFree.org.

Visit the Gluten-Free Essentials website to purchase and learn more about their products:

Website: www.gfessentials.com
Phone: 785-446-3639
Email: gfessentials@yahoo.com

Lactose Free Cheese Recipes

Last week I talked about finding real milk cheese that's lactose free, in Zeroing in on Lactose in Cheese. One of the brands I mentioned was Cabot Cheese.

By coincidence, I found this press release on EarthTimes.org that reminds us that Cabot features recipes on its website. Imagine. Real lactose free recipes using real milk cheese.

Not all Cabot's cheeses are lactose-free, remember. Aged cheddar cheese like Cabot's 50 Percent Reduced Fat Cheddar is lactose-free; Colby, Jack, Swiss and Parmesan are low-lactose options.

But if you do use one of the lactose-free varieties you can have the following, a recipe not at the Cabot site:

Harvest Stuffed Turkey Burgers with Cranberry Mayo

▪ 1 pound ground turkey (breast meat)
▪ 1/4 cup cranberry sauce
▪ 4 ounces Cabot 50% Reduced Fat Cheddar, cut into 4 (1-ounce) slices
▪ Vegetable cooking spray
▪ Salt and ground black pepper to taste
▪ 4 mixed-grain hamburger buns
▪ 8 large leaves arugula, rinsed and patted dry

1. Shape ground turkey into 8 thin patties. Spread 1 tablespoon of cranberry sauce in center of each of four of patties and top with 1 slice cheese; place remaining 4 patties on top, pinching edges together to seal.

2. Lightly coat large nonstick pan with cooking spray and place over medium heat. Cook burgers for 4 minutes per side, or until well done. (Alternatively, cook on grill.)

3. Season with salt and pepper. Place on buns and top with Cranberry Mayo and arugula.

Cranberry Mayo

▪ 1 tablespoon cranberry sauce
▪ 3 tablespoons light mayonnaise

In small bowl, stir together cranberry sauce and mayonnaise; cover and refrigerate until serving time.

Contact:
Julie Dennehy Dennehy
Public Relations
1-508-533-8311
julie@dennehypr.com
Cabot Cooperative

Low Vitamin D Levels Put Healthy Children at Risk

Humans can make vitamin D just by exposing their skin to sunlight. The first humans, living in sunny Africa, had no problems with this. Their skins became as dark as possible to prevent the overabundance of sun from doing them harm. But what happened when humans started living in the cold north, and needed to cover their skin much of the year?

One thing they did was evolve lighter colored skins that allowed the UV rays of the sun to more easily penetrate. But there was more going on that led to the spread of this mutation. A post on ScienceBlogs.com talks about the science:

Frank W. Sweet published an essay in 2002* which offered that the feasibility of a farming lifestyle at very high latitudes in Europe due to peculiar climatological conditions served to drive Europeans to develop light skins over the last 10,000 years. In short, Sweet argues that the diets of pre-farming peoples were richer in meats and fish which provided sufficient Vitamin D so that skin color was likely light brown as opposed to pink. But with the spread of agriculture Vitamin D disappeared from the diets of northern European peoples and so only by reducing their melanin levels could they produce sufficient amounts of this nutrient to keep at bay the deleterious consequences of deficiencies.

In part 2 of his post, the pseudonymous Razib makes the lactose connection clear.

Adult lactose digestion, blonde hair, very light skin and blue eyes are all extant at very high frequencies around the Baltic sea. The last three characters are diagnostic for northern European populations.1 We know that lactose tolerance is a recent adaptation, within the last 10,000 years. We know that one of the major skin color genes in humans, SLC24A5, has swept to near fixation in Europeans relatively recently, on the order of 10,000 years. We also know that OCA2 has been subject to a recent bout of selection. Agriculture arose in the Middle East about 10,000 years ago and finally "conquered" southern Scandinavia as late as 5,000 years ago. I am beginning to suspect that the cultural revolution prompted by the transition from hunting & gathering to farming was followed by a genetic revolution due to co-evolutionary dynamics. In exchange for scalable caloric resources in the form of grains human populations were faced with a narrowed diet so that their nutrient streams became depauperate. Where it was feasible these agricultural populations naturally turned to animal husbandry to supplement their diet and round out their nutritional balance. Like grain farming dairying is a relatively scalable enterprise, especially if the cattle are fed upon unpalatable leavings or fallow land which would otherwise be underutilized. In the specific context of Vitamin D, though pre-fortified cow milk is a poor source of this nutrient in comparison with fish, it would have provided a non-trivial supplement (also, there is some reason to assume that modern cattle might produce somewhat deficient milk in terms of Vitamin D load because of factors of diet and sun exposure).

It therefore shouldn't come as a shock to anyone that those living in colder climates of the United States are also at risk for Vitamin D deficiency.

A press release on Eurekalert.com highlighted the findings of a new study just published in the American Journal of Clinical Nutrition, Vol. 86, No. 1, 150-158, July 2007. "Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents," by Francis L Weng, Justine Shults, Mary B Leonard, Virginia A Stallings and Babette S Zemel.

Many otherwise healthy children and adolescents have low vitamin D levels, which may put them at risk for bone diseases such as rickets. African American children, children above age nine and with low dietary vitamin D intake were the most likely to have low levels of vitamin D in their blood, according to researchers from The Children’s Hospital of Philadelphia.

A study in the current issue of the American Journal of Clinical Nutrition measured blood levels of vitamin D in 382 healthy children between six years and 21 years of age living in the northeastern U.S. Researchers assessed dietary and supplemental vitamin D intake, as well as body mass, and found that more than half of the children had low blood levels of vitamin D. Of the subjects, 55 percent of the children had inadequate vitamin D blood levels and 68 percent overall had low blood levels of the vitamin in the wintertime.

...

Vitamin D is crucial for musculoskeletal health. The primary dietary source of the vitamin is fortified milk, but the best way to increase vitamin D levels is from exposure to sunshine. Severe deficits in vitamin D may lead to muscle weakness, defective bone mineralization and rickets. In addition to musculoskeletal effects, vitamin D is important for immune function, and low blood levels of the vitamin may contribute to diseases such as hypertension, cancer, multiple sclerosis and type 1 diabetes. Decreased blood levels of vitamin D have also been linked to obesity.

Milk needs to be fortified with Vitamin D because it does not have any naturally. But milk is a good source of calcium, and the new agricultural diet of the northern Europeans lacked sufficient calcium. That's one of the reasons that the lactose tolerance mutation and the white skin mutation appear to have evolved in close harmony. Milk still has an important role to play for those who want it.

An article on the study by Joi Preciphs of Bloomberg News makes the point forcefully:

Vitamin D-deficient diets are also associated with milk allergy; intolerance to lactose, a sugar found in dairy products; and strict vegetarianism.

You can get Vitamin D from other sources than milk, and calcium pills with Vitamin D are widely available. But milk-free diets all too easily can lead to this problem for those who are not aware.

Dairy-free is a choice, and can be a perfectly healthy one. But you have to understand all of its ramifications and make the adjustments needed to stay healthy when you remove a good source of many bioavailable nutrients. Eat smart.

*Essays on the Color Line and the One-Drop Rule.

Answers to Questions from Readers, part 3

Q. I am interested in calcium supplementation and read labels. Many of these labels list a calcium lactate. Should someone with LI be concerned about lactates or just lactose.

Just lactose.

None of the sound-like-milks (lactates, lactylates, lactic acid, etc.) should be a problem to anyone who is LI.

One word of warning: Occasionally, these products are made from other products that originate from milk. That still shouldn't be any problem at all for the LI, but people with severe milk allergies should avoid such products. It can be extremely difficult to tell the origins of any additives, however. You have to call the manufacturer and ask about each product individually.

I have an extended discussion of this issue in my Dairy or Nondairy? The Experts Speak page.

Q. If there is lactose-free milk, then why isn't there lactose-free ice cream?

Because it doesn't sell, is my guess. Various companies have put out lactose-reduced ice creams in the past and most people, and I mean most LI people as well, never buy them.

I have a list of all the ones I know of in my Product Clearinghouse. Look on the Reduced-Lactose Products page.

But what you should be doing is checking out the Frozen Desserts page in the Product Clearinghouse for listings of lots of completely milk-free alternatives.

And don't forget that many people with LI can still eat frozen yogurt and that most true sorbets and ices are also milk-free.

Q. I recently read in a nutrition book that soy products can cause gas, bloating, diarrhea etc. if eaten too often. Is this true?

I don't think so. There is no reason to believe that any food that is not intrinsically harmful causes problems just from regular consumption. What the book might have been trying to say is that many people who are allergic to milk and turn to soy products as a substitute find that they are also allergic to soy protein. In that case, more is definitely less. And soybeans are a legume, like peas and beans, and legumes can produce gas in some people. Otherwise, if soy doesn't bother you now, eating more of it later shouldn't be any different. (Of course, if you eat too much of anything at one meal, you'll pay for it, but that's another issue.)

Q. If one is lactose-intolerant, what effect, if any, does the presence of lactose in an injected medication have? How is it absorbed and metabolized? Is there an effect on delivery of the accompanying drug?

Bearing in mind that I'm not a doctor or a biochemist, here goes.

Lactose symptoms are caused solely by the presence of undigested lactose in the small and large intestines. I can think of no reason why lactose in the bloodstream should create any problems for anyone. I have read of only one, single, isolated case of an allergic reaction to lactose itself. Lactose is used in so many medications because it is basically as neutral an agent as possible, and it also has the nice property of not caking, another reason for its use. It's an interesting question, but I have never run across any reason to think that injected lactose would be a problem.

Q. My intestinal distress increases with the fat content of the lactose carrier, particularly butter and cream. Yet your tables show that the lactose content actually decreases with fat content. Could something else be going on here?

There is some slight evidence that a small number of people have milk fat intolerance. Unfortunately, the studies were never redone, so it's hard to know whether such a thing really exists.

A somewhat different study found no difference in symptoms between people drinking high-fat milk and those drinking fat-free milk.

But fat alone can create problems in some people. All I can give is the common sense advice to lay off high milkfat items for a while and see if your symptoms decrease.

Getting Into Supermarkets the Tough Part for Allergen-Free Foods

A perhaps not-so-surprising number of small firms making products that are free of allergens started when a family member needed the food for a loved one. Martin Hopkins was one, who started making peanut-free foods for his long-term girlfriend.

He had a vision, though, of marketing foods that were free of all 12 major allergens identified by the European Union.

His story is told in an article by Andrew Cave on the Telegraph.co.uk.

He decided to make soups and cook-in sauces that were not only free of all nuts but also wheat, gluten, eggs, dairy products, sesame seeds, milk and fish, as well as free of more minor allergens such as celery and mustard seeds.

The first problem he encountered was finding a manufacturer with the dedicated facilities to be able to guarantee no contamination from any of these allergens.

After no luck with 13 different contracting companies, he set up his own factory near Buxton in the Peak District.

An even bigger challenge, however, was securing national distribution through one of Britain's big supermarkets.

"We were selling through wholefoods shops and delicatessens," says Hopkins, "but 70% of all Britain's food retailing goes through the major supermarkets.

To do that Hopkins had to study how supermarkets find new products.

"They buy new products only at certain times, when they have product reviews. We found out they were having one in our sector last summer so we approached them but we spent a lot of time trying to find out who was the buyer for our products, because they have hundreds.

"We eventually found the right person and undertook a trade show just so we could show our products to him. It was a big risk and it cost us a couple of thousand pounds but big chains are used to dealing with large companies.

"We had a very small budget but we had to try to make ourselves look as big as we could. The buyer came to the show and we showed him our products' benefits.

"From their point of view, we could offer efficiencies because they had a range of products that were free of particular allergens. We were able to offer something suitable for people with all the major food allergies.

"We were lucky in that the buyer turned out to have a minor nut allergy himself. He loves the product."

Luck like that is almost always preceded by hard work and research, though.

Britain's "free-from" market is predicted to double in the three years. Now is the time for you other potential entrepreneurs to get cracking.

Food Allergy Wordlists

Over at News-Medical.net (what, all the MedicalNews domains were taken?) is an article featuring wordlists with 200 terms needed for international travelers.

Researchers and students at Wageningen University in the Netherlands have translated the names of allergenic food ingredients into most European languages and a number of international languages such as Japanese, Chinese, Indonesian, Arabic and Swahili. The list is available at www.food-info.net/allergy.htm.

The initiators of Food-info.net and EFFoST (European Federation of Food Science and Technology) provide these wordlists for people with an allergy or intolerance for certain foods. The list includes more than 200 ingredients such as lactose, hazelnuts, shellfish, soya and gluten, sorted into categories (dairy, nuts, spices, additives etc). The wordlists can be downloaded as PDF files and offers translations from almost any language into thirty other languages, so that nearly 700 language combinations are currently available. Travellers planning to pass through Denmark, Sweden and Finland, for example, can get translations from German into all three languages, as well as between the three languages (e.g. from Finnish to Danish) and from these languages into Dutch, English or any other language in the database.

The process at Food-info.net took me a minute to figure out.

If you want to translate another language into English, you click on the link for that language and it takes you down the page to a drop-down menu under the flag for that nation. (You can scroll down directly to the flag if you want.) You find the English listing in the menu and highlight it. You will automatically be taken to another screen with a two-page .pdf of the wordlist.

To translate from English, go to the first flag (which is Britain's) and bring up the language of choice. It will then take you to the new screen with the new wordlist.

Answers to Questions from Readers, part 2

Q. Has anyone done any research on how much lactase is needed to balance out 1 gram of lactose?

Trial and error. That's all there is. Just trial and error.
Seriously, the problem is that each individual is different. Most people still manufacture some lactase, even if they are LI, so they only need sufficient additional lactase to balance out what they're missing. And the type of food eaten, how and when it is eaten, and even when the lactase is taken all have effects on what the symptoms might be. There are -- and probably can't be -- even rough approximations given out.

Q. Will taking acidophilus pills help my LI symptoms at all?

The most I can say is, maybe. Here's why:

The symptoms that people associate with lactose intolerance -- gas, bloating, diarrhea -- are actually caused by the bacteria and other microscopic organisms (the flora) in your colon taking the undigested lactose that makes its way past the small intestine (where it should get absorbed) and fermenting it, releasing a lot of gas in the process. Different bacteria like lactose to different extents. Some gobble it up, releasing huge amounts of gas; some ignore it, creating few problems.

Lactobacillus is a genus of bacteria. There are many species of Lactobacillus, some of which are used in the manufacture of yogurt, including (aha) Lactobacillus acidophilus. They have the property of making their own lactase, the enzyme that digests lactose. (That's why yogurt is usually better tolerated by those who are LI than other forms of milk products.) So there is some logic in thinking that increasing the concentration of lactobacillus in one's colon would lessen LI symptoms. The big question is whether taking the pills would actually do that. And I just don't know if that's true.

There has been much more attention paid to the role of colonic bacteria in LI over the past few years, but I don't know of any solid research that has anything to say about whether lactobacillus or acidophilus actually helps, whether it's acting as a placebo, or whether other factors are involved. But it's an area I'm going to watch closely in the future.

Q. Is whey protein a problem for people with lactose intolerance?

Whey itself is the liquid portion of milk that is left over when the casein protein (curds) is removed. This liquid also contains almost all the lactose that is in milk. So when whey protein is manufactured, it depends on the purity of the manufacturing process whether all the lactose is removed.

I have seen on the shelves of natural foods stores several brands of whey protein that label themselves as lactose-free. If you are concerned, you should look for one of these.

Q. What, if any, are the differences between the terms lactose intolerance, lactose maldigester, and lactase deficiency?

You've touched on a sore point. Technically, the three terms mean slightly different things. You are a lactose maldigester if a clinical test indicates that you do not digest all of the lactose you eat or drink, regardless of whether you get any noticeable symptoms or not. You have a lactase deficiency if you do not produce your full potential amount of lactase, no matter what the cause of this might be, and no matter whether you drink milk or not. Since neither of these terms mention symptoms, we should reserve lactose intolerance for those times when having lactose actually causes symptoms.

In practice, of course, everybody outside of a medical journal just talks about lactose intolerance, and uses it to embrace all three definitions. Even in medical journals, doctors tend not to make fine distinctions. They use one term and stick to it. (In European, especially Scandinavian, medical journals, doctors will use hypolactasia in place of any of these three terms. The opposite condition is known as normolactasia.) Don't worry about terminology. Use lactose intolerance. Everybody will know what you mean.

Q. I'm lactose intolerant, but neither of my parents are. If lactose intolerance is inherited, how is this possible?

Some people produce lactase all of their lives. Others find that their lactase production gradually slows or even stops as they grow older. This is controlled by a gene on the second of the 46 pairs of chromosomes that humans have. There are two forms of the gene, one for lactose intolerance, which we can think of as "stop," and one for continued milk drinking, which I'll call "go."

One set of each pair of genes comes from our fathers and one set from our mothers. Therefore, a person's individual pair can be one of only four possibilities: Mother stop with Father stop; Mother go with Father stop; Mother stop with Father go; Mother go with Father go.

The go gene is dominant and the stop gene is recessive. That means that if you have a stop and a go, go always wins. Lactose tolerance is genetically dominant. When you stop to think about it, this has to be true. A mere 10,000 years ago, virtually everybody in the world was lactose intolerant. Today over a billion people are not. For a trait to spread across the world that quickly, it must obviously be dominant, so that it will be transmitted to children even if only one of the parents has it. (Originally the go gene must have appeared through random mutation. If nobody drinks milk as adults, the trait sits there quietly and does nothing. But if adult milk drinking provides even a slight reproductive advantage, as it probably did by providing better nutrition, the trait is likely to spread through that population.)

With this as background, let's go back to your case. Your mother must have had a stop gene paired with a go gene, making her lactose tolerant. The same with your father. You just inherited the one in four chance of getting the stop half from both your parents, giving you a stop paired with a stop, and making you lactose intolerant.