Better Tasting Lactose-Free Milk Coming?

"The future's so bright, I gotta wear shades."*

More news about better products maybe possibly hopefully some day coming to a supermarket near you.

To talk about the future, you know I'm going to start with the past and work my way there slowly. Feel free to skip a few paragraphs.

Lactase supplements were invented in 1964 by a Dutch company then known as Gist-Brocades. Happy 50th lactase! I don't know what market they were aiming for, since hardly anybody outside of a tiny community of researchers knew about the existence of lactose intolerance, but with high hopes and no fanfare whatsoever the company put out a product called Maxilact. The first Maxilact was a powder that could be added to fresh milk to break down the lactose into glucose and galactose, both simple sugars that the body can easily digest. America got introduced to lactase in the 1970s, when Alan Kligerman bought the rights and started a company now known as Lactaid. Lactase pills are now so common in every supermarket, pharmacy, and discount store that they don't really need much in the way of advertising. Same with lactose-free milks, which use a liquid solution of lactase to break down the lactose before it reaches your body. They can be found everywhere, too, with most major supermarket chains having their own house brand alongside of regional and national lactose-free milk brands.

Today lactose-free worlds is super-shiny indeed compared to the world of 1978, when I learned I was lactose intolerant. I didn't even hear about Lactaid pills until 1984. Milks arrived later, and they started as 80% or 90% lactose-reduced. True 100% lactose-free milks are newer still.

So what can be greater than 100% lactose-free milk in a dozen different varieties? How does better-tasting 100% lactose-free milk sound?

Milk that's had lactase added to it apparently has a problem, a problem named arylsulfatase. Don't feel bad if you've never heard of it. I never heard of it either and I've been studying the field for 36 years. But there it is in Elsevier's Encyclopedia of Dairy Sciences (Second Edition) from 2011. I'm sure it's a steal at $1136 for the ebook edition but fortunately this particular page is available at Google Books. Here's the science:

[T]he development of off-flavor in lactase-treated UHT (Ultra High Temperature pasteurized) milk is related to the accumulation of ρ-cresol - which when present in minute quantities leads to a severe "medical" or "animal" off-flavor. It was discovered that ther accumulation of ρ-cresol in UHT milk was due to the hydrolysis of sulfanated cresol, which is naturally present in milk, by the enzyme arylsuflanase. Arylsulfanase was introduced in the milk as a side activity in the lactase enzyme preparation, and was found to be present in all commercial neutral lactases. DSM Food-Specialties has recently selected a K. lactis strain [of the yeast used to manufacture lactase] that is devoid of arylsulfanase activity.

Who is DSM Food-Specialties? None other than the current parent company of Maxilact. It's taken a while, but Maxilact just put out a press release announcing that a European patent for this new strain of lactase has been granted.

The patent relates to a lactase enzyme, which is free from arylsulfatase. Arylsulfatase is an impurity found in lactase that converts components naturally present in milk to cause off-flavor in lactose-free dairy products, resulting in a limited shelf life. Adding arylsulfatase-free Maxilact® to a dairy formulation ensures that off-flavor development is no longer an issue and the shelf life can be extended.

Only one tiny detail remains open: This new better-tasting milk doesn't appear to exist commercially right now. Certainly not in America. Maxilact is a major player in the small community of lactase so I'm confident that somebody will start using this. Maybe we'll even see a major ad campaign about lactose-free milk, something that hasn't happened in several years.

The future: you gotta love it.

*Yeah, that was supposed to be ironic but nobody had the patience for irony in the 1980s. Besides misreading Timbuk3's catchy ditty about nuclear destruction, we also managed to hear only the first line in REM's "The One I Love" (This one goes out to the one I love/This one goes out to the one I've left behind/A simple prop to occupy my time) and make a wedding song of Sting's ode to stalkers "Every Breath You Take" ("I'll be watching you"). Seriously, an entire decade in which nobody bothered to listen to all the lyrics in a rock song. What's really ironic is that the older I get the less nostalgia I have.

Lactase Powder Can Replace Lactase Drops

Hard to believe, but I started this blog seven years ago. That means I've watched entire generations of products come onto the market, leave, and come back again. It's like watching a time lapse movie of glaciers advancing and retreating.

The glaciers are back. Or let me set the scene for the new news.

Everybody who is lactose intolerant should know all about lactase. Lactase is the enzyme that digests lactose, the sugar found in dairy products. Digesting means breaking a complex chemical down to its simplest components: amino acids for proteins, fatty acids for fats, and simple sugars for carbohydrates. Lactose is a sugar, which is a carbohydrate. More importantly, it is a complex sugar, a disaccharide, composed of two simple sugars, glucose and galactose. Lactose is too big to be absorbed into the body through the small intestine, but the glucose and galactose that result when lactase splits it go through easily. Virtually every human - and every mammal - is born with the ability to manufacture enough lactase to digest the lactose int their mother's milk. And most humans - and virtually all mammals - lose that ability as they age. Result: lactose intolerance, defined here as the symptoms produced by the presence of undigested lactose in the intestines.

Until the 1970s there was absolutely nothing that could be done about this. Then Gist-Brocades, a Dutch pharmaceutical firm, discovered a way to get yeast to produce their own version of lactase, which could be harvested. This wasn't artificial lactase, but the real stuff. Or at least a variant.

Quick sidenote about enzymes. An enzyme is a catalyst, a chemical that speeds up other chemical reactions without being affected itself. Left alone lactose would still break down to its simple sugars. It might take longer than your lifetime for this to happen, but chemically it must happen. Nothing stays inside your intestines for more than a few days so waiting a lifetime is out of the question. Lactase, though, speeds up the process to near instantaneously. That ability makes enzymes vital to life. The body manufactures some 500,000 of them. Without them your chemistry would simply stall to a stop. And so would you.

All the enzymes are very complex proteins. And like all very complex proteins lactase can be put together in a multitude of ways. All the lactases work at the primary task of digesting lactose but they can be engineered to work best - i.e., split lactose fastest - under different conditions. Some lactases work best at body temperature and in high acidity. These are used to make the classic lactase pills, capsules, and tablets that you chew or swallow with food. Your stomach is notoriously acidic and always at body temperature.

That wasn't the first lactase that Gist-Brocades found. That lactase worked best in cool temperature with low acidity. Those happen to be conditions found in a container of milk sitting in a refrigerator. So they marketed the lactase as a powder to be added to fresh milk or other liquid dairy products. Once mixed in, the lactase worked over a day or so inside the milk and could be drunk the next day as lactose-reduced and symptom-free milk.

Remember, you can't substitute one for the other and expect it to work very well. Don't try to mix regular lactase pills into liquid dairy. There's no harm to doing so, but you aren't going to have low-lactose milk in the end.

Powders have some disadvantages. The main one that bothered people at the time was that they sometimes didn't dissolve completely, especially if the stirring in wasn't thorough. Powders were on the market for a few years even so. The first version of what then was called "Lact-Aid" was a powder. After a few years, a liquid version was developed. A few drops of liquid dissolved much more quickly and easily than the powders.

Fast forward to 2008. (Look at that glacier melt!) Lactase drops never were a huge seller and for a time every firm in America stopped making them. Customers had to write away to Canadian firms like Lacteeze to get a supply. I called it Huge News! when a firm called Pharmax started making lactase drops available in the U.S. again, saving huge amounts on postage. As I could have told them, the market for lactase drops hadn't increased. They stopped making the drops in 2010.

Lacteeze made them available the whole time, to be sure, and other U.S. firms now also sell liquid lactase. To my surprise, Pharmax is back in business. Making lactase powder.

Product Description

Lactase Powder 1.6oz Supplement

Serving Size: 1 scoop
Servings Per Container: 75
Amount Per Serving: Lactase enzyme 12.6 mg(providing 615 LAU lactase units
Other Ingredients: Maltodextrin.
Recommended intake: Add one scoop of Lactase Powder to water or juice prior to consumption of dairy products or as professionally directed.

I'm assuming this means they've developed ways of increasing the dissolvability of the powder. The reviews on Amazon are positive. You can find Pharmax Lactase Powder on many health sites, so no need to go to Amazon. I found the image of the bottle on the PureFormulas.com site.

If you want to make low-lactose dairy products at home, probably more cheaply than the fairly expensive store brands, you should give this a try.

Ötzi the Iceman Was Lactose Intolerant

Hey all of you out there reading this who are lactose intolerant. Whenever anyone makes fun of our shared condition remind them of one big thing: We're normal, they're mutants! [Cue scary music]

As I've written over and over again - here's a post from 2005 - most adult humans in the world are genetically unable to produce the enzyme named lactase, which digests the milk sugar lactose. For most of us, our parents were lactose intolerant and their parents were and theirs and so on all the way back to our earlier ancestors.

A couple of years later, big news hit the scientific community that shouldn't have been news at all: "Just 7000 years ago, Europeans were unable to digest milk, according to a new analysis of fossilised bone samples..." Most Europeans today are lactose tolerant - they produce lactase all their lives instead of stopping at some early age - because they are heirs to a long tradition of domesticating animals that produce milk. Milk is good for you - remember than every time someone claims that milk is poison - and people who could drink milk as adults had a small but significant advantage in living long enough to produce healthy babies. That allowed the mutation that kept the lactase going for life throughout European populations and their descendents, including many in the U.S. and Canada. Being able to use DNA to check on the actual genes of individual humans who lived thousands of years ago is a scientific marvel of the first order, but it has just confirmed what earlier scientists had been saying all along in this case.

And now similar DNA testing has been performed on the most famous neolithic European, to my knowledge the only one who has a name: Ötzi.



Ötzi the Iceman is a mummified body of a man who lived about 5300 years ago. Because he was buried in ice, he's much better perserved than almost anyone else from that era and scientists have jumped at the chance to examine every aspect of his being. He's known to have died at around the age of 46 from an arrow wound and had knee problems that may have made it harder for him to escape his enemy.

To get yet more tantalizing info, scientists have been working feverishly to decode his DNA to see what it tells them. And no surprise, no surprise, one of the obvious things that pops out is that he was lactose intolerant. As this story in the New York Times, Lactose Intolerant, Before Milk Was on Menu by Sindya N. Bhanoo reports:

[R]esearchers have sequenced the complete genome of the iceman, nicknamed Ötzi, and discovered even more intriguing details. They report in the journal Nature Communications that he had brown eyes and brown hair, was lactose intolerant and had Type O blood.

The lactose intolerance makes sense, said Albert Zink, an anthropologist at the European Academy of Research in Bolzano, Italy, who was one of the study’s authors.

"In early times, there was no need to digest milk as an adult because there were no domesticated animals," Dr. Zink said. "This genetic change took hundreds of years to occur."

The original study appeared in the journal Nature.
"New insights into the Tyrolean Iceman's origin and phenotype as inferred by whole-genome sequencing," by Andreas Keller et al., Nature Communications 3, Article number: 698, doi:10.1038/ncomms1701

Abstract

The Tyrolean Iceman, a 5,300-year-old Copper age individual, was discovered in 1991 on the Tisenjoch Pass in the Italian part of the Ötztal Alps. Here we report the complete genome sequence of the Iceman and show 100% concordance between the previously reported mitochondrial genome sequence and the consensus sequence generated from our genomic data. We present indications for recent common ancestry between the Iceman and present-day inhabitants of the Tyrrhenian Sea, that the Iceman probably had brown eyes, belonged to blood group O and was lactose intolerant. His genetic predisposition shows an increased risk for coronary heart disease and may have contributed to the development of previously reported vascular calcifications. Sequences corresponding to ~60% of the genome of Borrelia burgdorferi are indicative of the earliest human case of infection with the pathogen for Lyme borreliosis.

Hmmm. I'm blood group O and I'm lactose intolerant. But I have blue eyes, the result of a different mutation. We're all mutants, just in different ways. And yes, I mean you too.

Intolerance Myths

So much misinformation out there. And so many phony tests being pushed by the Internet.

I like this article, Common intolerance myths by Julie Deardorff of the Tribune Newspapers. I've cited her articles before and I'm happy to see that she's still on the job.

As always, I'm quoting selectively from the article for fair use. Please click on the link if you want to read the whole thing.

Claim: Food intolerances are caused by eating a repetitive diet; this overloads the immune system and the body responds by rejecting those foods.

Reality: "The gut-associated immune system is well-equipped to deal with loads of antigenic material, and there is just no evidence that it may become overloaded by exposure to large amounts of the same antigen," said Stefano Guandalini, founder and medical director of the University of Chicago Celiac Disease Center. Although the amount you eat never causes food intolerances, "if you are intolerant you will clearly have more symptoms if you eat more of that food," added Robert Wood, professor of pediatrics and chief of pediatric allergy and immunology at Johns Hopkins.

Claim: Hair sampling is a safe and noninvasive method of revealing nutritional deficiencies.

Reality: Hair is made up of a protein, keratin, that can be analyzed to determine its mineral content. That data can be used to find out if the body is lacking in certain minerals, but it can't tell you whether you have food intolerances, allergist Lee Freund wrote in "The Complete Idiot's Guide to Food Allergies." Double-blind studies haven't shown any diagnostic value for this test.

Claim: The IgG blood test is 95 percent reliable.

Reality: The test is prone to false positives and not considered reliable by any U.S. or European allergy or immunology society.

Miley Cyrus' Lactose "Allergy"

There are days when I long for the time when nobody knew what lactose intolerance was. Sure, that era was terrible, but no information is higher on the scale than bad information. Today lactose intolerance is an all-purpose joke that the ignorant trot out when they have nothing better to say.

Miley Cyrus is now nineteen, which means she's old enough to know better and old enough to take responsibility for her words.



Images like the above have appeared on the net, which show Cyrus as being disturbingly thin. Naturally, rumors about her having an eating disorder or anorexia sprang up. That's a serious subject and worthy of a serious response. Could be we so lucky? No, of course not.

Here's her actual twitter posts:



I hope I don't need to remind anyone reading this that lactose intolerance is not an allergy - it is, in fact, totally different in almost every way from true milk protein allergies. Gluten intolerance, more properly called celiac disease, isn't a real allergy either. Both are effects of food not being digested properly rather than immune system responses.

You, and by you I mean everybody out there within reach of a normal supermarket, can thrive on a complete, healthfilled, calorie-laden, and satisfying diet even if you can't have gluten or lactose, although the earliest parts of the transition period may be rough until you learn how to adapt. Glucose and lactose intolerances should never be excuses for poor nutrition, bad food habits, or losing excess weight.

Can Ms Cyrus make things even worse? You'd think not, and you'd be wrong. Among her many tweets was one showing her holding a bag of burgers from the popular California chain Carl's Jr. Her caption: "I can’t eat it. So I’m just gonna smell the shittttt out of it! My mouth is LITERALLY watering."

That's an eating disorder. That's the definition of an eating disorder. Or else that's stupidity of a magnitude that not even spoiled pop princesses should ever be allowed to get away with.

Me, I vote both.

The Allergy Menu.com

Having trouble finding Healthy Recipes for your Multiple Food Intolerances?

Do you need 100 cookbooks because you can only find 3 appropriate recipes in each?

Stop wasting time with fruitless searching!

We’ve made it easy for you at The Allergy Menu.Com. A Global Online Community with access to:

‘The World’s First Customized Recipe Search Tool" for

‘Foodies with (Multiple) Allergies and Intolerances’.

Take a ‘Free Tour” or try it out for a week for just $5!

Let's start with the press release.

www.theallergymenu.com goes beyond the top 8 allergens (milk, eggs, peanuts, tree nuts, fish, shellfish, soy & wheat), and allows users to customize their recipe search to eliminate over 20 different items, such as fructose, corn, amines, salicylates, oxalates, fructans, polyols & glutamates. The website also caters for specific diets such as the GAPS diet & the Gluten Free, Casein Free diet which are commonly recommended for children with Autism & ADHD.

"With our site you can focus again on what you would like to eat, rather than on what you can't eat", says Pauline. Everyone's dietary needs are different, so you will find a wide variety of foods on our site (including nuts for celiacs and eggs for vegetarians). If you can't tolerate these ingredients, the search function will eliminate them from your selection in one easy search.

"There are hundreds of beautiful recipes that we have carefully adapted to be safe and taste great too", says Michelle. "And we add new ones constantly. We are so proud of what we have achieved together. It has been a labour of love, and we are confident that it will help many people."

Visit The Allergy Menu at www.theallergymenu.com

The spelling should offer a clue: the site is actually based in Australia and I assume that the fees are in Australian dollars. They talk about a global community, though, and recipes are usually easily adaptable to local products. It may be worth a look.

Does Quitting Dairy Makes You More Intolerant?

Kudos to The Toronto Globe and Mail for a solid answer to a question that I've gotten many times, If I quit dairy completely, will I become more intolerant?

Dr. Sheila Wijayasinghe breaks the bad news:

Given the large number of individuals who suffer from lactose intolerance, the possibility of developing a tolerance over time would be quite welcomed. Unfortunately, the body’s ability to produce lactase cannot be changed, so quitting dairy altogether does not increase intolerance as the amount of the enzyme remains the same.

The brainy doctor does understand the other side of the equation equally well and has some encouraging words:

Every individual is unique and has different amounts of the enzyme which is why certain people with lactose intolerance can take in larger amounts of dairy products than others. While you cannot build it up, you can test your tolerance level by gradually introducing small amounts of lactose containing products to see how much your body can handle.

Introducing small but constant amounts of lactase-producing probiotics, such as those in yogurt and other dairy products with live and active cultures or pills that contain the same, should increase tolerance as well.

A good answer, from one of the world's leading newspapers.

Lactagen No More

I usually comment on comments inside that post, but this deserves a whole new post of its own. The news is that big.

That comment was in a post called Lactagen Response - It Worked for Her.

I took this stuff about four years ago now and still can drink milk now. It seems like it worked then and is still working fine. I do like my dairy very much. I do notice that if i over do it i still am fine. I was talking to a co-worker about this stuff and she wanted to get some but it is not for sale any more????? what happened??????

What's Lactagen? I've devoted huge blocks of text to it over the years. The first was one of the earliest posts I ever made in this blog, a full six years ago, Lactagen - Questions, No Answers. That started out with some eye-popping prose:

Lactagen claims to be a cure for lactose intolerance. That's right: a cure. Take the product for 38 days and you'll never be bothered by lactose again.

Except, oops.

UPDATE: Lactagen no longer uses the word “cure” in its marketing. Its website information has also changed since this was originally posted.

The quote from the Lactagen site also caught your attention:

Lactagen's™ one-time 38-day patent-pending formula allows the gradual and painless re-introduction of dairy into the digestive system. The program painlessly trains the body to be able to digest dairy products without the usual painful reactions. The combination of taking yogurt with live cultures, having meals with the formula, taking specific dosages and with the combination of Lactose, Tricalcium Phosphate, Lactobacillus Acidophilus, FOS and Cellulose Gum and Silica, the body learns how to digest dairy products.

So many more people wrote to me about Lactagen that I did a blockbuster post in 2007, Lactagen: The Big Update, compiling many of the testimonials to its effectiveness - or lack of.

And then in 2009 a quiet press release from Lactagen that I posted under the heading Lactagen Prepares to File For New Drug.

Ritter's first compound, RP-G28, has been developed for the treatment of lactose intolerance. RP-G28 will effectively stand out as the first FDA-approved drug for the treatment of lactose intolerance.

For me that was the biggest news, although I realize that few thought of it that way. I never understand how Lactagen worked. It's known that probiotics that contain certain forms of "good" bacteria have the ability to manufacture lactase in the colon. This lactase can digest the lactose that your body misses. So instead of fermenting and creating gas in the colon - the cause of most peoples' problem with lactose - the lactose is eliminated. This sounds great, except that establishing what's called a colony of those good bacteria in your colon is sometimes difficult and not always permanent. They can get pushed aside by other types of bacteria that ferment lactose. They also get killed off every time you take a dose of antibiotics. Several probiotic products are marketed to people with lactose intolerance, such as Digestive Advantage, that you are supposed to take daily because of this.

How did Lactagen achieve permanence? To this day I have no idea. That's why I've always been iffy about recommending it. I'm innately suspicious of anything I can't understand.

The folks at the FDA, the Food and Drug Administration, know a thousand times more about the science than I do, though. If they gave approval to a treatment I would tell the world about it immediately.

Forward to 2011. And the comment that Lactagen can't be found anymore. So I hie over to the Lactagen site. And what I see there is very interesting.

Thank you for your interest in Lactagen® and Better Digestion™. Ritter Pharmaceuticals is no longer offering Lactagen® and its other dietary supplement products in order to focus on new products in the development pipeline. It is important to note that these products were not taken off the market due to health or efficacy concerns. We have enjoyed this opportunity to help thousands of individuals around the world find relief for their lactose intolerance symptoms.

One of these new exciting products in our pipeline is called RP-G28. RP-G28 is a second generation product geared towards treating the symptoms of lactose intolerance long-term. The product is currently being considered for FDA approval and is entering Phase 2 clinical trials. It stands to become the first prescription drug for the treatment of lactose intolerance. Ritter hopes to offer the first FDA approved treatment for the symptoms of lactose intolerance by 2014.

So Lactagen is gone - has been since January 2011, from what I gather - and Andrew Ritter is betting the whole company on that second-generation version he announced in 2009. Five years is hardly an unusual length of time to get FDA approval for a drug. (I dislike the term drug in this context, although I understand its use as shorthand. Probiotics are not drugs in the usual sense.)

Press releases on the site indicate that the treatment is getting favorable attention.

November 2, 2010

Ritter Pharmaceuticals, Inc., a biological therapeutics company with a focus on digestive diseases, announced today that it has been awarded a grant by the United States government program, the Qualifying Therapeutic Discovery Project (QTDP).The QTDP grant supports the development of Ritter Pharmaceuticals' flagship product, RP-G28, as a treatment for the symptoms of lactose intolerance.

There were over 6,500 applicants seeking $1 Billion in grant funding. Ritter Pharmaceuticals received the maximum awarded amount per project. ...

A unique mechanism of action gives RP-G28 the potential to be the only therapeutic regimen designed to impact the natural factors of the disease and alleviate the symptoms of lactose intolerance on a long-term basis. Phase 2 clinical development is underway.

CenterWatch.com reports that volunteers for clinical trials are being sought. Those announcements were made on June 1, 2011 so I assume that the trials are already under way. I found a page with complete information about the trials on ClinicalTrialFeeds.org.

But the mills of the FDA grind slowly. Even under the best of circumstances you'll have to wait three more years. And that's assuming FDA approval. What if they don't approve? That happens with fair frequency. That's also why drugs are so expensive. The approval process takes money and time, which is also money. And the product has to live up to its claims.

Anything can happen in three years. I make no predictions. Not even as whether I'll be blogging to report on it.

Where Is the Whey? Everywhere.

Holly asked me a question that is much deeper and puzzling than it looks at first. I'll try to cut through some of the confusion.

I recently had the ALCAT test done and it shows I have no reaction to casein and a severe reaction to whey. This surprized me because I have never had a noticeable reaction to dairy. I was told that it doesn't mean that I'm lactose intolerant - just whey intolerant. My question is: hasn't the whey been cooked out of evaporated milk, condensed milk, caramel, cream cheese, and most cheeses? I would think so but I can't find an answer anywhere.

Milk is like every other food we eat, a mixture of chemicals that we group into three basic families: the fats, the carbohydrates, and the proteins. That's not even including the pure minerals, notably calcium, potassium, and phosphorus, that make milk so healthy. Or the micronutrients like vitamins. All of these float in a vast sea of water. A full 88% of a glass of whole cow's milk is water. Carbohydrates - our old friend lactose - make up 4.66%, fats, 3.34%, and proteins 3.29% That tiny fraction of a percent of discrepancy is referred to as ash, and contains all the minerals and anything else that doesn't fall neatly into one of the big three categories.

The proteins, though comprising the smallest bulk of the three majors, has the most complex set of subfractions. For our purposes, all we need to concentrate on are the two main families of proteins, the caseins and the wheys. A table at an Ohio State website breaks down the families into five types each.



Having five types of casein is confusing enough. The wheys are worse. There are at least two immunoglobulins and several minor proteins.

And I'm not even going to talk about the Proteose-Peptone Fraction, which is defined as whatever is "not precipitated at pH 4.6 from skim milk previously heated to 95-100° C for 30 minutes." (I quoted that from the National Dairy Council. That Ohio State site gives slightly different numbers. Don't you love it when experts disagree on basics?) Those are at least four proteins that have some relationship to both the caseins and the wheys and I don't understand them at all. Everybody else ignores them, however, and so shall I.

In liquid milk, all the proteins, like the fats and the carbohydrates, are in a colloidal suspension. "A colloid is a substance microscopically dispersed evenly throughout another substance." You can't, therefore, go through milk and pick out the proteins very easily. It takes high-technology techniques like the membrane process of ultrafiltration, some called "very specific enzyme precipitation," or the ion-exchange processes.

Or cheesemaking. Rennet, produced in the stomachs of most mammals, is an enzyme that coagulates casein, clumping the individual molecules into larger lumps that can be much more easily separated from the rest of the liquid.

Why then do food processors and scientists need such high-tech procedures to do what villagers and nomads have done for thousands of years? Purity. Those curds of soft cheese that are formed are mostly casein protein. But they also contain some lactose and some fat and some water. And some whey. As long as there is water present, some whey will be there as well. The aging process also hardens the cheese, which is done by almost literally squeezing out the remaining water. Additional heating of cheese can harden it even further. Most of the lactose is removed with the water, which is why true milk cheeses can be sold as lactose-free. Most of the whey goes with the water as well. I can't guarantee that all of the whey goes, though. A few micrograms of remaining lactose is meaningless for anyone who is lactose intolerant. A few micrograms of remaining whey protein could trigger a reaction.

And that's where we come back to Holly's question. Processed dairy products may be low in whey, even negligible in whey for practical purposes. Allergies are impractical. They can affect people in doses too tiny to be otherwise noticed. That's exactly why those with severe dairy protein allergies are advised never to eat any dairy product. Removing every last molecule of protein is a task for a scientific lab, not a food processor. This difference is the main reason for the vast gulf between lactose intolerance and a milk allergy. You can take chances with lactose. Allergies require extreme caution and care. Some people, like Holly apparently, have mild symptoms to no symptoms at all. For others, the symptoms are frequent and severe. For those people allergies are serious and must be treated that way. And the more you know about food, its composition, and its processing, the better off you are.

A Quick History of Lactose Intolerance

Winnie wrote me to ask "if you can give me an idea of what are the best places to talk to a lactose intolerant community online. In addition, what are the typical questions you get on lactose intolerant."

Here's what I wrote back to her.

LI is a strange problem. It's not medically serious so it doesn't attract communities in the way that life-threatening or -altering problems do. People have tried but they never grow or last. Probably the closest approximation today is Alisa Fleming's GoDairyFree.org. She's focused on sharing recipes and foods that don't contain milk rather than specifically lactose, although in many cases that's the same thing.

I gave the history of LI in my book Milk Is Not for Every Body. Nobody realized that such a condition existed until about the 1960s. That's when doctors and anthropologists went around the world testing native groups. They kept finding LI everywhere. But most of them didn't really notice because dairying was not part of their heritage so they didn't have large amounts of lactose in their cultures. Only northern Europeans and their descendants and colonies did.

There's a long history of not wanting to talk about intestinal problems in those societies. Since large amounts of lactose produce both diarrhea and particularly smelly flatulence, it was socially embarrassing to talk about. And doctors knew practically nothing about it, so all they did was recommend removing all milk from the diet. Full labeling regulations by the FDA were still in the future so it was often hard to tell whether a processed or baked food contained any milk in the first place. Lists of foods to avoid included such things as french fries and peas. (Presumably because sometime somewhere lactose was involved in the processing, though I've never tracked down exactly where.)

The food labeling requirements helped a lot. But the breakthrough was when a Dutch pharmaceutical company, Gist-Brocades, invented a method for producing commercial lactase, first a powder to add to liquid milk and remove the lactose and then a pill that could be taken with food. The American company Lactaid bought the rights to make it here. Their first pills were marketed in 1984. It was in the early 1990s, though, that they entered into a product war with a competitor, Dairy-Ease. Spending tens of millions on television commercials, they made the American public aware of LI. It became a regular joke for late-night comics and the regular ailment for the comic sidekick in movies and television. Making a joke of an ailment was oddly helpful. It's hard to be afraid of something that's a mere joke.

Since then all the attention has turned to food allergies (and celiac disease, which used to be called gluten intolerance). These are much more serious. Allergies primarily appear in babies unlike LI, which primarily appears in adults (except as a temporary condition after an intestinal ailment in babies), and is both much more difficult to deal with and, in a very few cases, life-threatening. There are hundreds of communities for these problems. The milk allergy community will provide some info about milk products that is useful for LI. But all the great majority of people with LI really need to know is to limit the quantity of lactose taken in at any one time and use lactase. Avoiding milk products really isn't necessary. There isn't much need for a community under these circumstances.

Many people still insist that isn't sufficient. It's difficult to know what to say to them. You can look at the results I posted in my blog about a year ago about the NIH State of the Science Conference on LI. Paper after paper was presented that said essentially that it was next to impossible to induce any symptoms at all in a laboratory setting, no matter how much lactose is given, making it impossible to study. If people insist than any trace of lactose triggers symptoms I'm sympathetic, but I have no medical information to present. Is it possible that much of the reaction for many people is psychological rather than physiological? Apparently. But LI is not life-threatening, so there is zero money for research. The medical studies are on tiny and often unrepresentative groups. We still don't know the answers to many basic questions.

If and when some of these answers emerge, you can be sure that I'll post them here.

Chocolates Truffles. Have One. Just One. Ok, Two.

Email from Jennifer, about a problem almost too good to be true.

My question concerns gourmet chocolates, like truffles and other filled chocolates. I have always loved those, and do try to steer clear of cream-filled chocolates, but sometimes I'm too tempted, and have one or two. I don't seem to have a problem digesting them, even though just about everything else with dairy (muffins, ice cream, milk, etc.) causes problems. I've joked that I've somehow been lucky to get a chocolate exception to LI. Is there something to that (more than a joke)? Is there something about cream-filled chocolates that would cause less of a reaction than other dairy items?

What a wonderful question to get to answer the very same week that the headline "Chocoholics may have an edge in heart health" appeared in the Washington Post.

I normally have the dismal job of reminding people that most headlines they see in newspapers about the latest miraculous report about foods or medicines are literally not worth the paper they're printed on. The studies are too small, or too short, or too conflicted to rely on. This study rises to a much higher standard. It's what's known as a meta-study, one that analyzes the medical literature and tries to form a conclusion based on all the best and largest studies. This one looked at 114,009 adults from seven studies, with different methodologies. Here come the science.

Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. Adriana Buitrago-Lopez et al. BMJ 2011; 343:d4488 doi: 10.1136/bmj.d4488 (Published 29 August 2011)

Abstract

Objective
To evaluate the association of chocolate consumption with the risk of developing cardiometabolic disorders.

Design
Systematic review and meta-analysis of randomised controlled trials and observational studies.

Data sources
Medline, Embase, Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, reference lists of relevant studies to October 2010, and email contact with authors.

Study selection
Randomised trials and cohort, case-control, and cross sectional studies carried out in human adults, in which the association between chocolate consumption and the risk of outcomes related to cardiometabolic disorders were reported.

Data extraction
Data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The primary outcome was cardiometabolic disorders, including cardiovascular disease (coronary heart disease and stroke), diabetes, and metabolic syndrome. A meta-analysis assessed the risk of developing cardiometabolic disorders by comparing the highest and lowest level of chocolate consumption.

Results
From 4576 references seven studies met the inclusion criteria (including 114 009 participants). None of the studies was a randomised trial, six were cohort studies, and one a cross sectional study. Large variation was observed between these seven studies for measurement of chocolate consumption, methods, and outcomes evaluated. Five of the seven studies reported a beneficial association between higher levels of chocolate consumption and the risk of cardiometabolic disorders. The highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease (relative risk 0.63 (95% confidence interval 0.44 to 0.90)) and a 29% reduction in stroke compared with the lowest levels.

Conclusions
Based on observational evidence, levels of chocolate consumption seem to be associated with a substantial reduction in the risk of cardiometabolic disorders. Further experimental studies are required to confirm a potentially beneficial effect of chocolate consumption.

Or as the Washington Post boiled it down:

People who ate the most chocolate — dark or light and in such forms as bars, drinks, desserts, snacks and nutritional supplements — were 37 percent less likely to have developed cardiovascular disease and 29 percent less likely to have had a stroke than were those who ate the least amount of chocolate.

More chocolate for everyone!

Yes, that includes you, readers who are lactose intolerant. There are two parts to this answer, and both of them are good news.

Personally, I'm a dark chocolate fanatic. That doesn't mean that the higher the cocoa content the better. Truthfully, those 85% cocoa super-intense bars go over the edge into bitterness. I'll stick with 70-72% cocoa for the best experience. Adding fruit doesn't hurt, either for flavor or health. I found a supplier of dark chocolate-coated black currents, an intense rush that satisfies even when I have just one or two raisin-sized pieces. I substitute that for dessert, part of an overall purge of excess sugar from my diet. I've gone down a pants size in the past few months, losing about one pound a week, a good recommended amount.

And all that dark chocolate? It's milk free. So the lactose content is zero.

That's not what Jennifer asked about, though. Chocolate truffles may be dark chocolate or milk chocolate. Either way, they're likely to have some sort of cream-filled interiors that kiss each taste bud and send them flying. And cream means milk. Which means lactose.

The secret? A truffle is tiny. All that intense flavor is packed into a tiny volume, a neutron star for calories. I checked a number of brands and found that truffles seem to run from 10 to 20 grams, much less than an ounce, which is 28.375 grams. An ounce of pure milk contains less than a gram and a half of lactose. Truffles are half that size and are mostly not milk. Therefore the fraction of a gram of lactose in any given truffle is probably too small to matter.

As long as you don't gobble down (or it is gobble up) the whole carton of truffles at a sitting, the vast majority of us with lactose intolerance don't have to worry about symptoms. Think of it as the indulgence it's supposed to be, and have one, just as some better restaurants offer at the end of a meal. Just remember that a truffle is an indulgence and stop at one. I'll allow two. I mean, we're talking truffles here.

If you want to up your chocolate content to get some of that heart-healthy goodness, though, I'd recommend sticking to a good dark chocolate with less fat and fewer calories. In place of dessert, not in addition to it. Then you can go shopping for new jeans. Three pair, including tax, $36 at the VF outlet store. Talk about indulgence.

Yogurt Good for Lactose Intolerance

I know that headline has a bit of "sun rises in the east" obviousness. I've been telling you for 20 years that yogurt is the best tolerated dairy product even for people with lactose intolerance.

The news is who is saying it. The European Food Safety Authority. And they're backing it up with science. Science!

Scientific Opinion on the substantiation of health claims related to live yoghurt cultures and improved lactose digestion (ID 1143, 2976) pursuant to Article 13(1) of Regulation (EC) No 1924/2006

Summary
Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies was asked to provide a scientific opinion on a list of health claims pursuant to Article 13 of Regulation (EC) No 1924/2006. This opinion addresses the scientific substantiation of health claims in relation to live yoghurt cultures and improved lactose digestion. The scientific substantiation is based on the information provided by the Member States in the consolidated list of Article 13 health claims and references that EFSA has received from Member States or directly from stakeholders.

The food constituent that is the subject of the health claim is “yoghurt cultures (live)”, which contain the starter micro-organisms “Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus” as specified by Codex Alimentarius Standard No. 243/2003. The Panel considers that live yoghurt cultures which are the subject of the health claim are sufficiently characterised in relation to the claimed effect.

The claimed effect is “lactose digestion”. The target population is individuals with lactose maldigestion. The Panel considers that improved lactose digestion is a beneficial physiological effect for individuals with lactose maldigestion.

In weighing the evidence, the Panel took into consideration that thirteen of fourteen human studies showed enhanced lactose digestion in lactose maldigesters, when live yoghurt starter cultures were ingested in yoghurt, that the one study which did not show such effect reported reduced symptoms and that there was strong evidence for the biological plausibility of the effect.

The Panel concludes that a cause and effect relationship has been established between the consumption of live yoghurt cultures in yoghurt and improved lactose digestion in individuals with lactose maldigestion.

In order to bear the claim, the yoghurt should contain at least 108 CFU per serving live starter microorganisms (i.e. Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus). The target population is individuals with lactose maldigestion.

Before you lift that spoon to your mouth, remember one small caveat. Many American yogurts aren't really yogurt, but sweet candy concoctions that have lots of extra milk powder added. They're about as healthy as french fries. Real yogurt is slightly sour, and doesn't have much added to it. A bit of flavoring or fruit, maybe. Food companies love to take healthy products and "adapt" them to American tastes by bypassing or even wiping out all the stuff that makes them healthy. A bit of candy is okay, but don't think that candied yogurt is a health food. It's just candy.

LI and Pregnancy

Megan sent me the following email and said I could share it with you.

I am 27 and pregnant. And I recently discovered something I think is amazing and not very well known. I wanted to share in hopes of informing other pregnant women. Nearly half of women who are LI prior to pregnancy do not suffer from symptoms during pregnancy. I have done a little research on the topic and can't seem to find too much of a scientific explanation other than the slowed digestion that takes place. It seems as though the body recognizes the need for calcium in order to grow a healthy fetus and acts accordingly. I have been severely LI for 10 years and during this pregnancy I have been able to eat and drink ALL kinds of dairy with only slight discomfort a handful of times (and it's entirely possible I over did it those times due to my new found freedom. Lol)

I've written about this before over at my website. Many women have written to me. Some, like Megan, found that their LI symptoms went away during pregnancy. Others became LI during pregnancy but saw their symptoms go away later.

What gives? Well, Megan also sent a very good link to a pregnancy advice page featuring a response by Joanne Saab, RD. Saab "is a registered dietitian who practices in pediatrics at McMaster Children's Hospital in Hamilton, Ontario." And she writes:

This is actually a very common phenomenon during pregnancy. Many women find they experience an improvement in lactose tolerance when they get pregnant and, for some, this ability to digest lactose remains after they deliver, but for others their lactose intolerance returns or even becomes worse.

Healthcare professionals often talk about a "rule of thirds" during pregnancy. The "rule of thirds" means that approximately one third of pregnant women will see an improvement in their symptoms, one third will remain the same, and one third will see their symptoms worsen. This rule of thirds can occur with many conditions, including: migraine headaches, eczema, asthma and lactose intolerance. Researchers still don't completely understand why this happens, although some attribute it to hormonal changes during pregnancy.

Yep, yet another thing about lactose intolerance that doctors don't understand. (Remember my million-part series on the State of the Science Lactose Intolerance Conference at the National Institutes of Health? Here's a summary to start with.)

All I can suggest is that you experiment with small amounts of easily digestible dairy products like yogurt and hard cheeses first and then progress onto to other types of dairy if you can tolerate those. You may be part of the lucky third.

Milk's Not the Worst Thing Your Teenager Can Do

How bad has the anti-milk and milk is poison campaigns gotten? Parents are now going to doctors worried sick because their healthy children are *gasp* drinking milk.

You're going to think I'm making this up, so I have to quote this letter to the doctor column of the major UK newspaper, The Guardian.

Since my 15-year-old son was born, he has been a great milk drinker. Now, at 6ft tall, healthy, active and without an ounce of fat on him, he drinks between 12 and 16 pints of milk a week, and we're a little worried about the possible long-term effects. He is of mixed Indian/English background – I say this because I know that lactose intolerance can be a problem for Asians, having experienced it first hand. What can we advise him?

What a horrible tragedy! He's fit, fat-free, 6ft tall. He's practically superhuman. Let's stop this madness!

Fortunately, Dr. Tom Clark doesn't see the need to panic. In fact, he says, calmly, "There are a whole lot worse teenage habits to have than drinking a lot of milk."


I can't help but be reminded of PETA's horrifying - and failed - "Got Beer" campaign. Back in 2000, they seriously tried to make the claim. "The campaign compares the nutritional and moral benefits of beer vs. milk, and says beer comes out on top."

Honestly, milk is better for your 15-year-old child than beer. As long as he's fit and doesn't start showing lactose intolerance symptoms, then he's just fine. Maybe he'll become a doctor, even, giving more good medical advice.

History of the Food Pyramid

I started my website, Steve Carper's Lactose Intolerance Clearinghouse, back in 1997. (And don't say that it looks it. It doesn't. It looks like the 1998 version. So there.)

That was several generations ago in internet terms. I was on Compuserve even earlier. Compared to the hordes that crowd the net now, I'm an oldbie.

Yet there are still many things that I never understand. Like why a history of the U.S. Food Pyramid would appear on an Australian blog site. (Which means it's dated tomorrow as I write this. How's that for breaking news!)

It's a pretty good history, though. Worth the read. Lots of pictures to help it go down.

And some relevance to those who are lactose intolerant.

In theory, we digest and process food in the same ways, but a lot of us have allergies and dietary restrictions. Whether your restrictions are voluntary or not, you probably have to substitute a normal item you find on the food group pyramid for something else. It's important to remember that substitutes can have a major difference in nutritional value and to know what those differences are. Let's take lactose intolerance and milk as an example. If you're replacing milk, your most obvious choices are soy milk and rice milk. Rice milk has significantly higher levels of carbohydrates than regular milk, and soy milk often has a lot of sugar added (not always the case, but it's always worth checking first). If you don't eat meat and are looking at substitutes, many of them have a very high sodium content that you wouldn't find in actual meat. This isn't necessarily worse; it's just different. It's important to be aware of the differences in substitutions and not assume you're getting the exact same nutrients you'll find in the item it was designed to replace.

Lactose Intolerants a Possible Market for Dairy

Lactose-free milk is the one dairy product that sells well. Lactose-free ice creams exist, and so do lactose-free cottage cheeses and sour creams, but they are the tiniest of niche products.

Even so, the amount of lactose-free milk isn't anywhere near proportional to the percentage of lactose intolerant people in the U.S. And the dairy industry thinks that this is an opportunity.

The Innovation Center for US Dairy issued a white paper saying that this is "an opportunity to achieve 273 million gallons of incremental growth by targeting the lactose intolerant consumer segment."

"Our extensive consumer research and analysis found that 81 percent of lactose intolerant consumers would be willing to include dairy in their diets if they could do so while minimizing symptoms," said Jim Layne, vice president of strategic initiatives with Dairy Management Inc.™ "This shows that a solid opportunity exists to meet the health and enjoyment needs of this market segment with nutrient-rich dairy foods. ...

"There is a solution to lactose intolerance that is not avoidance or restriction,” Layne said. "Increasing consumption of dairy in the lactose intolerant consumer segment could help grow long-term loyalty, generation after generation, totaling 2.35 billion pounds of incremental growth."

Like any good research marketing firm, the Innovation Center folks broke down the market and into target segments.

The four segments below offer the most significant growth opportunities for lactose-free milk and dairy.

Healthy Wealthy consumers make up 20 percent of the lactose intolerant segment. People in this group tend to be college-educated, employed and health-conscious. They are considered milk-friendly, but don’t drink a lot — preferring 1 percent to whole milk — and only 44 percent consider milk to be a healthy choice. Reinforcing the benefits of dairy would be a strong approach for this group. Lactose-free milk and dairy recipes may appeal to them.

Family Milk Lovers constitute 20 percent of the lactose intolerant segment. Two-thirds female, and generally married, this group includes family milk consumption “gatekeepers.” They associate milk with health, enjoyment and taste, and shy away from lactose-free due to cost and its different taste. Messages showing lactose-free milk as a whole-family solution may resonate with this group.

Avoiders represent 20 percent of lactose intolerant consumers. More likely to suffer from gastrointestinal disorders, obesity and high cholesterol, this group is the least likely to have tried lactose-free foods. They are open to dairy solutions, and good-tasting lactose-free milk and milk products may succeed with these consumers.

Aware and Managing consumers represent just 14 percent of the lactose intolerant segment. As the oldest market segment, nearly one-fourth is retired. They are the most likely to have their lactose intolerance diagnosed by a physician and to drink lactose-free milk. Their awareness and symptom management allows them to enjoy dairy, but they also are experimenting with alternatives such as soy. There is room to increase loyalty with this group.

Enjoy dairy yourself... if your only issue is lactose intolerance.

You can email them at InnovationCenter@USDairy.com for a copy of the white paper, "Lactose Intolerance: Opportunity to Grow Volume for Dairy through Dispelling Myths and Meeting Consumer Needs."

Another False Milk Claim

Another unique characteristic of Ronnybrook milk is that it's unhomogenized. Instead, the cream that naturally rises to the top of a glass jug of milk remains there, unless you decide to shake it up. The result, Osofsky explained, is milk that the body can more easily digest, especially for people who typically have trouble digesting lactose.

"We have a lot of families that drink our milk because they're lactose intolerant," he said.

The quote comes from an article by Jaclyn Bruntfield in the Harrison Patch.

The article is terrible for our purposes because Bruntfield never bothers to say whether the milk is "raw," i.e. unpasteurized, a claim that is often made - totally wrongly, in my estimation - for milk drinkable by those with lactose intolerance.

If possible, a claim that unhomogenized milk is safer for those with LI is even wronger.

Ignore it at your peril.

UK Overrun By Lactose-Intolerant Hedgehogs

Hedgehogs are not native to North America, but they're so common in England that Monty Python included them in a skit. Dinsdale Piranha, the crime boss, had an imaginary hedgehog enemy named Spiny Norman that grew bigger and bigger the more depressed Dinsdale got. At worst, Norman could be up to 800 feet long.

I don't know what an 800-foot hedgehog would eat (first person to say "anything it wants" gets bounced from the internet) but I know what not to feed him: milk. Yes, adult hedgehogs, just like the adults of every other mammalian species, are lactose intolerant. Which makes them like the majority of adult humans.



It's also true that a majority of adult humans try to rescue distressed animals and apparently feed them the first thing that comes into their heads, which is - you guessed it - milk. So every year I have to run a story about Brits being warned not to serve their hedgehogs milk. Last year it was Yes, Hedgehogs Are Lactose Intolerant Too. Two years ago Lactose Intolerant Hedgehogs with greenish diarrhea. Ew.

And this year it's a twofer. Lorena Higgins of The Irish Times found an Irish family who adopted five abandoned baby hedgehogs but had sense enough to talk to a veterinarian before they started feeding them:

Mr Thomas is using a heat lamp to provide warmth, and the animals are being fed lamb’s colostrum, which is normally given to young lambs in springtime.

Mr Thomas said that this was on the advice of a vet and pharmacist, as the hedgehogs cannot tolerate lactose found in milk. He has also been using a syringe to feed vitamin supplements.

Somewhat less sensible was the writer and/or editor of The Malvern Gazette, who couldn't be bothered to proofread their article.

Wildlife lover Viv Smith, who runs Malvern Hedgehog Rescue, has seen a marked increase in the number of distressed animals being reported and brought in this summer.

"It is a red alert situation really," she explained. "Hedgehogs and other wildlife are so emaciated and dehydrated at the moment because they cannot find their natural sources of food and water.

"The ground is so hard that they are not able to dig for food."

Mrs Smith is calling on members of the public to help out by putting out food and water for hedgehogs.

Mrs Smith also spelled out what not to put out:

Bread and water should not be put down for hedgehogs as they are lactose intolerant and gain no nutritional value from the bread.

Uh, no. That makes no sense. What that was supposed to read was:

Bread and milk should not be put down for hedgehogs as they are lactose intolerant and gain no nutritional value from the bread.

Still. Two article about lactose-intolerant hedgehogs. No wonder England got bounced out of the World Cup.

Your Symptoms Aren't Always Coming from Lactose

One point made frequently in the NIH state-of-the-science conference on Lactose Intolerance (LI) was that people often misinterpreted the symptoms they got from food. Having symptoms, even when having dairy products, didn't necessarily mean that lactose was the cause.

Another larger and better test of this notion just appeared in the medical journal Clinical Gastroenterology and Hepatology. "Subjective Perception of Lactose Intolerance Does Not Always Indicate Lactose Malabsorption," by Francesc Casellas et al., Volume 8, Issue 7 , Pages 581-586, July 2010.

Abstract.

Background & Aims
Symptomatic lactose intolerance is common; however, abdominal symptoms that patients experience after ingestion of lactose-containing foods can have causes beyond lactose malabsorption. We aimed to determine whether symptoms that patients usually attribute to lactose intolerance are comparable to symptoms provoked by a controlled lactose challenge and whether these symptoms are related to lactose absorption capacity.

Methods
We performed an observational, prospective, transverse study of 353 patients referred for a lactose hydrogen breath test (HBT). Patients completed a validated questionnaire about symptoms associated with consumption of dairy products at home (home symptoms). After a 50-g lactose breath test, they completed the same questionnaire again (lactose challenge symptoms). Patients were assigned to groups of absorbers or malabsorbers according to HBT results and tolerants or intolerants according to the results of the questionnaire.

Results
The total symptom score was significantly higher for home symptoms than for the lactose challenge (16 vs 8, P < .01). Symptoms perceived at home were reported to be more intense than those that followed the lactose challenge for lactose absorbers compared with malabsorbers (16 vs 4, P < .01) and lactose tolerants compared with intolerants (12 vs 2, P < .05). Overperception of lactose intolerance at home was similar in men and women.

Conclusions
Daily life symptoms that patients associate with lactose intolerance are often unrelated to lactose malabsorption. Even among true lactose malabsorbers, symptom recall tends to be amplified by the patient. Thus, conventional anamnesis is a highly unreliable tool to establish symptomatic lactose malabsorption.

A 50 gram lactose challenge is enormous. That's the amount of lactose in four 8-ounce glasses of milk, more than almost anybody normally gets from food. So much lactose should create enormous and violent symptoms in anyone who is truly LI.

Yet the symptoms reported at home from normal food intake were more numerous and more severe than the symptoms reported from the lactose challenge. That's impossible to explain except subjectively. People either are getting their symptoms at home from foods other than lactose (or non-food reasons entirely) or else they simply report symptoms worse than they really are.

LI is real and people do get symptoms from it. But it's not the fault of the most or the worst symptoms for most people. Hard as that may be to believe, here's another test - and of a large number of patients - that replicates that claim.

NIH Conference Report on Lactose Intolerance and Health

Yeah, I know that I already did a 28-part series on this. However, I wanted to get the official journal citation onto the record.

The summary statement from the National Institutes of Health Consensus Development Conference: Lactose Intolerance and Health by Frederick J. Suchy et al. was published in Annals of Internal Medicine, June 15, 2010, vol. 152 no. 12 792-796. Full text at: http://www.annals.org/content/152/12/792.full.pdf+html.