Kosher Certified Lactase Drops

It was huge news when I was able to announce earlier this year that lactase drops were once again available in the U.S.

That's great, but it was insufficient news for some people who needed more information. I received a question today asking me if any lactase drops were kosher certified.

After much searching, I've found that both the Lacteeze Enzyme Drops made and sold in Canada by Gelda Pharmaceutical and the LACTAID® Lactase Enzyme Drops made and sold in Canada by McNeil specifically say that they are kosher-certified on those web pages I linked to.

Both can be ordered from a number of Canadian pharmacies and online sites.

Unfortunately, Pharmax Liquid Lactase, the brand that is sold in the U.S., does not have a kosher certification.

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.

Lactase Safe, Despite Newspaper's Mistake

I check through all the newspaper articles that contain the word lactose, just to see if there's any interesting news I can pass on to you.

Today I ran across Top trial lawyer wins big, spends big by Andrew Wolfson in the respected Louisville Courier-Journal.

The article is a big love letter to attorney Larry Franklin, a trial lawyer who gets big settlements for clients. His clients sound horribly hurt and terrifically appealing, like the little girl who got her legs severed on an amusement park ride. This isn't a rant against evil trial lawyers.

What drew my attention to the article was this eye-popping claim buried 29 paragraphs deep into the story:

And in 2004, he and Hance won a $19.2 million verdict against Sandoz Pharmaceuticals and other defendants for marketing a lactose suppressant that they showed caused 32-year-old grocery clerk Mary Gunderson to suffer a fatal seizure after childbirth.

A "lactose suppressant"? Could that mean lactase? I've never in history heard of a serious side effect from lactase. I didn't understand how I could have missed this, but this was huge news that I had to pass on.

Fortunately for you, I checked the claim first before repeating it.

The real story, as reported on the LouisvilleLaw.com site, is that Mary Gunderson had been given Parlodel, a postpartum lactation suppressant.

Mary Gunderson died suddenly in her sleep one week following the Caesarean birth of her second child. She had been given Parlodel, a postpartum lactation suppressant. The drug had a history of adverse reactions including seizures, strokes and heart attacks dating back to 1983. Plaintiffs prevailed at trial for a total judgment exceeding $19 million, including more than $11 million in punitive damages against manufacturer Sandoz. Sandoz and the prescribing physician appeal.

Parlodel is a serious drug for a serious problem. What's important for you in my audience is to remember that it has no, repeat, no connection to lactose or lactase or lactose intolerance.

Just another case of a reporter misunderstanding a fact new to him and having nobody in the chain of command above him noticing the mistake.

Happens all the time, unfortunately.

Remember. Doublecheck all facts and claims, even those made by legitimate reporters working for well-regarded news sources. They can't be expected to understand or transcribe perfectly every detail of every profession that they encounter, things that are new to them on a daily basis.

Don't let a trivial error panic you. Medications are serious, and problems do occur. Lactase, however, is not a drug. It is also about as safe as anything you can put into your mouth can possibly be.

That hasn't changed. Be happy.

I'm Back - And Not a Moment Too Soon

C'mon, world. I was only gone for a week. How could everything have gone to hell so quickly?

You know my usual rants about reporters not getting it right. Here's a world-class example from Jen Braaten of the Grand Forks Herald:

With age comes the susceptibility to anemia, or inadequate iron. Anderson also notes that the lactose enzyme gets smaller within the body, making it more difficult to digest milk or milk products.

The lactose enzyme gets smaller? Is it like The Incredible Shrinking Man? Why not just say straightforwardly - and correctly - that our bodies tend to make less of the enzyme as we grow older?

Blogs. Well, what can you say about blogs? On November 1, Jimmy Moore posted a screed against high fructose corn syrup (HFCS) in his Atkins Diet blog, Livin' La Vida Lo-Carb. Numbers are not his strong point, though.

This is a scary thought for me personally because I used to consume the equivalent of 16-20 cans of Coca-Cola on a daily basis before I started livin' la vida low-carb. That's about 45g sugar, all in the form of high fructose corn syrup, per can. So I was guzzling down--BRACE YOURSELF--upwards of 900 grams of fructose just in my soda consumption before the Atkins diet. And we won't even talk about the HFCS that was in all those snack cakes I used to eat, too! EEEEEEK!

Sigh. High fructose is not at all the same thing as all fructose. HFCS comes in several varieties, but the type normally used in soft drinks is about 55% fructose and 45% glucose. That cuts the number of fructose grams down to just under 500. Still a lot, but 400 g - nearly a pound - less than he stated.

In addition, his screed against fructose has the basic problem that all sugar has about 4 calories per gram. So Moore was consuming a whopping 3600 grams/day of calories just from colas. That's in addition to those snack cakes. And presumably everything else he ate all day long.

So why blame the fructose? He doesn't list even a single thing wrong with his body that he himself attributes to fructose.

Although lack of understanding of all processes with sugar is a severe problem in this country, I wouldn't bother with this blog if Moore didn't also mislead with a more directly relevant comment:

Many people also have fructose intolerance, similar to lactose intolerance with milk-based products...

Not too terribly similar, though. It can't be. Lactose intolerance results from the lack of an enzyme to split the complex sugar lactose into simpler sugars. Fructose is itself a simple sugar, however. No enzyme needs to be manufactured by the body. The two conditions are similar only in that undigested lactose or fructose may cause gastrointestinal symptoms. Most doctors put hereditary fructose intolerance in the category of "rare" diseases, with no more than 1 in 20,000 affected. Lactose intolerance affects more than 15,000 in 20,000 worldwide.

Avoid screeds. They're bad for your health.

One more example before my blood pressure gets too high.

Reporters aren't responsible for headlines, so when I saw that the headline "Soy milk may be as effective as skim in promoting weight loss" over a story by Mike Danahey at the CourierNewsOnline.com wasn't backed up well, if at all, by the actual article I could have shifted the blame upward. But then...

The study is in the Journal of the American Dietetic Association's October 2007 issue. Volume 107, Issue 10, Pages 1811-1814 (October 2007) "Preliminary Study: Soy Milk as Effective as Skim Milk in Promoting Weight Loss," by Judith M. Lukaszuk, Paul Luebbers, and Beth A. Gordon.

The 56-day study followed 14 overweight women, ages 18 to 45, from the DeKalb area. They randomly were assigned to include about three cups a day of either soy or skim milk in their calorically restricted diets.

Those on soy milk also were given a soy protein supplement so that the protein intake levels would be similar. The diet was made up of 45 percent carbohydrates, 30 percent protein and 25 percent fat.

"They then maintained the lifestyles they had when they started the study," said Lukaszuk. That included a woman who enjoys getting a latte every morning, but substituting soy milk and skipping the whipped cream.

All the women lost weight, decreased body fat percentage and went down in waist size, and the greatest losses were seen in those with high dairy intake, the study found.

However, the journal abstract said that:

There were no significant differences in weight, fat percent, abdominal circumference, and fat-free mass between groups.

One group did lost a pound more than the other, but that was not a statistically significant amount, so the greatest losses were due to dairy statement is misleading and shouldn't have been included in the article.

I have to note that the study put all the women on diets that served them 500 calories/day less than they usually ate. It's the calorie restriction that helped account for the loss in weight. However, the study, limited as it was, attempted to determine whether it was the protein in milk rather than some other property that accompanies weight loss. This very preliminary evidence indicates that any equivalent protein intake will work. Vegans and others on soymilk diets, take note.

Answers to Questions from Readers, part 8

Q.a. Some years ago a doctor told me citrus fruits contain milk sugar, which experience tells me is the case. Is this information well known? I have never seen any reference to it in the literature.

Q.b. A girlfriend who is LI claims that chicken contains lactose and causes the exact same symptoms for her as a nice big glass of milk. I think she's whacked. Is she?

a. This information is missing from the literature because there is no foundation to it. Milk sugar is found in milk and nowhere else in nature. The sugar in citrus fruits is fructose.

b. You bet she is. Lactose comes from milk. Period. But people with LI often have problems with other foods and confuse the symptoms.

Q. If I take lactose pills or lactose-reduced milk, is this depriving the baby of any needed nutrients during pregnancy or breastfeeding?

Absolutely not. All that happens is that the lactose, the sugar in milk, is broken down to its parts. This is exactly what occurs in digestion. Your body gets exactly the other nutrients it would otherwise get.

If lactase pills work for you, then take them as often as needed. If you are still bothered by symptoms, then you may want to try less milk and either increase your consumption of other foods high in calcium or take calcium supplements. But LI will be the least of your concerns.

Q. Other than cost, is there a problem with using lactase tablets at every meal (or every lunch)? Is there a limit on how many one should take?

No problems and no limits, although after the first few you're probably not going to get much additional help by taking more.

For more information on everything lactase, see the Lactase page in the LI Basics section of my web site.

Q. Is burping a symptom of LI?

Not normally. The gas almost always comes out the other end. You should have your doctor look at stomach-related problems rather than intestine-related problems like LI.

Q. I'm at the end of my first week of eating no dairy products to see if I am LI. Can I simplify this work a bit and assume that if the nutrition breakdown shows 0% calcium, that there is no lactose in the product?

Nope, sorry. Lactose is milk sugar. It has absolutely nothing to do with calcium.

The only way to tell whether a product is lactose free is to study the ingredients list and make sure that there are no milk products on it. If you aren't sure what all the names for milk products are (and many people don't know that whey is mostly lactose) you should check the Dairy Facts section of my web site and take a look at the various pages there.

Lactase Can Help. Tell Your Doctor

It never ceases to amaze me how much misinformation doctors still have about lactose intolerance.

You say you want an example? Here's one.

A reader wrote this letter to the Dr. Peter H. Gott medical advice column. Except this time, the reader is the one giving the advice.

After increasingly painful bouts of intestinal cramps and diarrhea, I realized the common denominator was milk.

I discussed the issue with my general practitioner, who confirmed the diagnosis of lactose intolerance. She advised me to read labels.

When I asked what she thought of lactase enzyme tablets, she said her patients hadn't had any luck with them. She dismissed the idea, so I asked whether they were dangerous, and she said no. I told her I was going to try them. It's been more than a month since I started them, and I haven't had a single incident.

I have been reading labels and am shocked at how many products contain milk, including vitamins and antibiotics that I couldn't tolerate previously.

My doctor didn't consider the possibility of lactose intolerance as the source of my antibiotic problems, so she just kept switching medications. I found out about the presence of lactose in my medications with one phone call to my pharmacist.

Pardon me while I boggle. Lactase tablets not helping patients? Lactase might be the single most helpful aid ever put forth as a solution to the symptoms of any problem. Out of the hundreds of people who have written me over the years about lactase, not more than a handful have ever complained that it did not help. And most of them just needed to change the brand they were taking.

I hesitate to call lactase a wonder drug, because technically it is not a drug or medication at all. It merely supplies the enzyme that those of us with lactose intolerance are missing. But since I had years of being lactose intolerant before lactase pills came on the market, I can safely say that lactase is the closest equivalent to a wonder drug ever marketed. It helps the highest percentage of people to the highest percentage of symptom relief.

Doctor, heal thyself.

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.