The Un-Constipated Gourmet: Secrets to a Moveable Feast

Stacey Palevsky, on JWeekly.com (J as in Jewish):

was thrilled when the book "The Un-Constipated Gourmet: Secrets to a Moveable Feast" arrived in our newsroom last month.

My editor was appalled by the title. I was unfazed. And excited. Finally, a cookbook for people with troubled intestines.

I'd be thrilled, too. What a great concept.

The book's author is Danielle Svetkov, a Jewish native of Larkspur now living in San Francisco. She writes out of a Jewish tradition, for Jews...

Studies indicate both Jewish men and women suffer digestive maladies in disproportionate numbers.

Jews are two to four times more likely than non-Jews to have a spectrum of digestive ailments, such as Crohn’s disease, Irritable Bowel Syndrome, food allergies or lactose intolerance.

...and not for Jews:

But her recipes are not exclusively for the Jewish dinner table, because “there’s a broad audience for this cookbook,” she said. Pregnant women, couch potatoes, travelers and seniors also are often plagued with digestive ailments.

The recipes seem to be high-fiber dishes, using a variety of fibrous ingredients to give it taste.

Product Description

Now, millions of Americans can beat constipation, without giving up gourmet food.

Millions of Americans have to pass up good food because of their bad problem - constipation. In 2004 alone, there were 41.3 million visits to physicians for digestive system symptoms.

[The Un-Constipated Gourmet: Secrets to a Moveable Feast – 125 Recipes for the Regularity Challenged] is the kind of cookbook home chefs can count on every day to deliver regular meals with exotic variety and homey comforts. For the family cook, it has the main courses, sides, and deserts that will keep everyone moving: pasta puttanesca on Monday, pizza with shrimp on Tuesday, and pork chops on Thursday. [The Un-Constipated Gourmet: Secrets to a Moveable Feast – 125 Recipes for the Regularity Challenged] is the go-to cookbook for anyone who wants the pleasure of a great meal without worrying about the side effects.

(Puttanesca, pizza with shrimp, and pork chops? Can Jews eat any of the recipes?)

Constipation isn't normally an issue that those with lactose intolerance ever have to deal with, but other with dairy issues definitely do. And fiber is yet another of those things Americans don't get enough of in their diets.

Constipation Not Linked to Dairy Allergy in Children

The Doctor NDTV site reported on a new study on chronic constipation.

The prevalence of allergies among children with chronic constipation is not significantly different from that of the general population and an allergy to cow's milk does not seem to be involved.

In several studies, chronic constipation in children has been reported as a clinical manifestation of cow's milk allergy. Allergic proctitis - an allergic reaction causing inflammation of the rectum, which can be accompanied by a frequent urge to defecate, bloody stools and other symptoms - has been suspected, but the response to eliminating cow's milk protein from the diet has been variable.

They took this from an article in the December 2008 issue of Archives of Disease in Childhood. D. Simone et al. 93(12):1044-1047, December 2008.

Prevalence of atopy in children with chronic constipation.

Abstract
Objectives: To evaluate the prevalence of chronic constipation (CC) in unselected children, its association with atopy and the efficacy of a cow's milk protein (CMP) elimination diet on refractory constipation.

Study design: The study was conducted by six primary care paediatricians, serving a population of 5113 children aged from birth through to 12 years; only 2068 children were 6 months to 6 years. During a 3-month period, prevalence of CC was determined for the entire study population, ages 0-12 years. In the second part of the study, all patients aged 6 months to 6 years with CC, and age- and sex-matched controls, were evaluated for atopy and its association with CC. A questionnaire was completed including personal and family history of atopy and bowel-movement characteristics. Patients were tested for atopy by specific serum IgE and/or skin-prick tests. Constipated patients, refractory to osmotic laxatives, underwent a 4-week CMP elimination diet.

Results: 91 (1.8%) children had CC, and 69 (3.3%) of the 6 months to 6 years age group fell into the atopy study age range. All 69 constipated children (mean age 34.9 (18.0) months) and 69 controls completed the questionnaire. Twelve of the 69 constipated children (17.3%) and 13 out of the 69 control children (18.8%) had a diagnosis of atopy. Eleven out of 69 (15.9%) constipated children were refractory to constipation treatment, and three (27.3%) of these had atopy. The 4-week trial of dietary elimination did not result in improvement in any of these 11 children.

Conclusions: In our study group, prevalence of atopy among children with CC is similar to that in the general population. The level of refraction of CC does not seem to be related to cow's milk allergy.

Answers to Questions from Readers, part 15

Q. What exactly is the ingredient in dairy products that causes the binding? I read that you feel it is not the lactose.

You're right about that. It's the protein.

Take a look at this Constipation and Milk Allergy page on my web site. It's a discussion of a seminal journal article that makes a connection between a dairy protein allergy and constipation in young children, the first such report to my knowledge. You should then talk to your doctor about it.

Q. What is the lactose content of yogurts containing active cultures?

This sounds like a straightforward question, but it isn't. Two problems.

One is that many manufacturers add additional milk solids to the yogurt during the manufacturing process, because true natural yogurt tends to be too thin and sour for American audiences. This makes it impossible to judge lactose content.

The other problem isn't really a problem, but a boon. The active cultures work to manufacture their own lactase, both during the manufacturing process and even in your intestines. This neutralizes, pretty much, any lactose in the yogurt, even from added milk solids.

So the amount of actual lactose is more or less irrelevant to the end result, which is that yogurts with live and active cultures are well tolerated by most people with lactose intolerance.

Q. a) How is lactose made - I assume it is a protein in the cows stomach or something? Or is it part of the grass?
b) And is Lactaid a protein or an enzyme?

a) Neither. Lactose is made in the mammary gland. (It's a part of milk and found only in milk.) It's a tremendously complicated chemical process that starts with the simple sugar, glucose. Some other glucose is converted to another simple sugar, galactose. Then the whey protein called alpha-lactalbumin bonds them together to make the complex sugar we know as lactose.

b) Lactaid is a brand name for the enzyme known as lactase. (But all enzymes are proteins, except for a couple of weird exceptions.)

Q. I have heard that some meats can contain lactose (unless they are Kosher) is this true? If so which ones?

No meat of any kind contains lactose in and of itself. However, some processed meat products (including cold cuts and hot dogs) can have a dairy product as an ingredient.

The only way to tell is to be sure you always read ingredients lists for anything you buy. And you're right about Kosher meats being dairy-free. They have to be that way. If you can, try to find Kosher cold cuts and hot dogs. Not only are they great tasting, but you can be assured that they don't contain milk.

Q. Does cocoa butter contain lactose like I think it probably does?

Nope, butter here refers only to consistency. Peanut butter, apple butter, and cocoa butter are all lactose free.

You might want to check out my Foolers page on my web site.

Q. If LI is the result of not being able to breaking down the compound sugar found in milk and milk products, then would it also be true that anything made with a compound sugar would also be a problem?

This is a very good question. However, the answer is no, except is a very few people.

The lactase enzyme that digests lactose is an unusual one. Even in people who can drink milk as adults, it is manufactured in smaller quantities than the enzymes that digest other compound sugars. The reasons probably go back well into human evolution, since lactase only needed to be manufactured early in life when milk was the sole food, while all the others were needed for a wide range of foods all one's life.

There are some people who have a wide range of sugar intolerances, but overall it is seldom a problem.