Lactaid Reintroduces Lactose-Free Yogurt

Why aren't there more lactose-free dairy products available in stores? Because you don't buy them.

You can't imagine how much I hate having to write that. But I've been watching store shelves for over 30 years. I've seen dozens of products come into the market - some with huge marketing campaigns - and then quietly disappear. They go away because they don't live up to sales expectations.

Will that ever change? I'm doubtful. For most people taking lactase pills or eating small amounts of dairy is completely sufficient. Those people with real need are the ones with allergies who have to avoid all dairy. Lactose-free won't work for them. Same for vegans. And lactose-free products have another strike against them. Low-selling products are always going to be more expensive than their equivalents. Lactose-free milks are finally available pretty much everywhere but they are always much more expensive than regular milks.

Yet companies keep trying. Why? I honestly don't know. No matter. It's a great thing for those of us who are always looking for more variations.

The biggest name in lactose-free products is Lactaid. Lactaid makes a more complete line of lactose-free true dairy products than anyone else. There's the milk in whole, 2%, 1%, and fat-free varieties, calcium-enriched in all four varieties, Fit & Creamy in low fat and nonfat, and chocolate, not to mention Egg Nog and Half and Half. They also make cottage cheese and five flavors of ice cream.

And now yogurt. They've made it in the past and it went away. But here it is again. Four flavors: vanilla, blueberry, peach, and strawberry. They're marketed in the standard 6 fl. oz. cup and a multipack of four 4 fl. oz. minicups.

Lactaid has a Product Locator so you can search by your zip code to see if it's sold close to you.

Will it survive? That's up to you.

Frozen Yogurt - The More Bacteria the Better

Are germs driving us crazy? Apparently, yes. I walked into a nice diner in Greenwich, CT yesterday and the first thing I saw was a hand sanitizer set up at the doorway. I care more about the staff having clean hands. There's a tirade waiting to happen about the omnipresence of anti-bacterials creating a races of super-resistant bugs, but having caught a bug myself I'm too tired to summon up the energy.

Being the perverse sort that I am, my mind latched on to the counterexample, the times when more bacteria are better for you, not worse. That's the world of probiotics. Yogurt is the most famous and most familiar example. The "good" bacteria in yogurt are helpful in many ways. For those of us with lactose intolerance, their best feature is that they literally manufacture the enzyme lactase, and lactase is what digests lactose. That makes yogurt "auto-digesting," which means that it is better tolerated than almost any other dairy product.

The catch is a small one. The bacteria has to be in "live and active" colonies. Dead bacteria don't manufacture lactase. They don't hurt you any either. The bacteria begin to die off as soon as conditions are no longer optimal for them. By the time you eat any yogurt, there will be fewer good bacteria than in the beginning. No big deal.

One thing that leads to sub-optimal conditions is cold. That leads to an immediate and obvious question: can frozen yogurt still have live and active cultures? This question is huger than ever since the craze for frozen yogurt has moved from the trendiest portions of the coasts (see Yogurt is Hot Hot Hot from back in 2008) to every mall in America.

The answer to the big question is a qualified yes. Some cultures can survive the production process. Probably as importat, the newer, tarter frozen yogurt recipes depend on more of the lactose being converted to lactic acid. It's likely that most of what you try will be well tolerated.

Just for fun, I'm passing along an interesting chart I found on the Yogen Früz blog. I'm not showing it to endorse Yogen Früz. I've had it, and it's fine, but I have no idea how well it compares to the rest of the frozen yogurts in the world. Moreover, any chart issued by one company to tout its superiority is suspect. It may be perfectly accurate, but you shouldn't expect it to tell a full and objective story. All I want it to accomplish is to show to you that an independent testing agency, in this case Brazilian Proteste Consumers Association, can find cultures in frozen yogurt.



More is better for cultures. If you have any concerns, ask at the shop if they have the equivalent numbers available there or on their website. I'm just happy that a hot trend turns out to be something that we in the lactose community can enjoy, for a change.

Allergy Free Cook Bakes Bread

I found this tasty bit of promo from Laurie Sadowski sitting in my email, which means I have to share it with you.

THE ALLERGY-FREE COOK Bakes Bread


Gluten-Free, Dairy-Free, Egg-Free

Highlights include advice on how to:
* convert your kitchen into an allergy-free zone
* interpret ingredient labels to find hidden allergens
* adapt and customize your favorite recipes
* discover the nutritional qualities of over 20 gluten-free flours
* make rich, moist breads without eggs or dairy products

ISBN # 9781570672620 • $14.95 • by Laurie Sadowski



French Bread • Focaccia • Breadsticks • Scones • Gingerbread • Crackers • Multi-Grain Breads

Savor the irresistible aroma and tantalizing flavor of freshly baked bread, straight out of the oven—even if you have food sensitivities! The Allergy-Free Cook Bakes Bread proves that you don’t have to be a magician to work magic in the kitchen. Culinary wizard Laurie Sadowski has crafted an amazing collection of gluten-free bagels, biscuits, loaves, muffins, scones, and specialty breads that rival their traditional counterparts in every imaginable way.

These wholesome, delectable, gluten-free baked goods are completely vegan—free of eggs and dairy products—and many recipes are also free of other common allergens, such as legumes, nightshades, tree nuts, peanuts, seeds, and soy. Not only can you enjoy your favorite baked goods once again, but your friends and family will also dive in with gusto. The Allergy-Free Cook Bakes Bread transforms restrictions into possibilities and makes it easy for anyone challenged by food sensitivities to eat safely, compassionately, and nutritiously—right down to the very last scrumptious morsel.

You can get the book through the usual outlets, but the URL given in the email goes to Book Publishing Company, which bills itself as a publisher of vegan, vegetarian, raw, & natural health books.

Thanks, Laurie.

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.

I'm At the Small Press Author Showcase Friday

The Barnes & Noble superstore at The Mall at Greece Ridge coordinates what it calls a Small Press Author Showcase each year. They invite local authors who have books they self-published and arrange a big meet & greet with a couple dozen or more authors and lots of readers.

This year's gathering is

Friday September 30, 2011 7:00 PM

The Mall at Greece Ridge Center
330 Greece Ridge Center Drive
Rochester, NY 14626

You can go to the B&N site and get a map and driving directions to the store.

To be honest, that tiny map isn't very good. The mall only goes up to Long Pond Rd, not Mitchell. The store is on the Long Pond Rd. side. Try this Google map instead. There's easy access from I390.


View Larger Map

The actual event will be in the mall corridor outside the store, not in the store itself. It should run two hours, from 7 to 9. I'll be there with copies of Planet Lactose: The Best of the Blog and my collection of science fiction short stories, Tyrannosaur Faire. Something for everybody.

Here's something else you ought to know. While I'm certainly pleased that B&N holds this event and it's a great experience for all the authors involved, this will be the only time you'll be able to buy my books at B&N. The corporate policy at B&N - and at Borders before it went out of business - is that they don't carry self-published books. Period. Not even from local authors. If you aren't a big enough publisher to have an account at one of the major book distributors, the big chains won't deal with you. This is a Community Relations event, something that the individual store community relations manager decides to do. It's the only one I know of in the country by that name at B&N.

If you're anywhere in the region and free on Friday, stop down at The Mall at Greece Ridge. Remember, dozens of other worthy authors will be getting their one day of public acclaim. Support us and support small presses. Plus there's a million square feet of mall around the corner. Gotta love it.

Valio Terminates Real Goodness Lactose Free Milk in U.SL

Back in 2009 I had a very exciting announcement to make. Valio, the huge Finnish manufacturer of lactose-free milk products, was entering the American market at last. They contacted me about getting the word out and I was happy to do so, in Valio's Lactose-Free Milk Is a Hit!

I just got a comment on that page complaining that the milk could no longer be found. So I did a search and came up with this undated message that is all that's left on the realgoodness.com website.

Dear Friends of Real Goodness:

Thank you for your loyalty to our brand over the past two years. In the limited time we have been in market in the United States, Real Goodness has helped thousands of people overcome the symptoms of lactose intolerance and enjoy a healthier and tastier lactose-free milk.

We regretfully announce that our company has made the decision to terminate production at this time. Our final shipment to retailers occurred last week. This product has enjoyed widespread success in Europe. However, the product did not achieve its sales targets set out in our strategy despite the fact that the product was unparalleled in its ability to deliver great taste and superior nutrition.

On behalf of Valio USA, I want to thank each of you for supporting Real Goodness.

What can I say? While a small percentage of people with lactose intolerance cherish each and every lactose free product on the market, the greater number ignore them. They either avoid real milk products, opting for artificial substitutes or no milk-like substances at all, or just have real milk in smaller quantities. The lactose free market has always been small and chancy. I've watched dozens of products come into the market and suddenly disappear over the years.

I'm very sorry about this one, because I thought Valio had the money and marketing clout and savvy to pull it off whereas small companies can't compete nationally. It's a shame.

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.

Planet Lactose: THe Best of the Blog Now on Amazon

My enormous 86,000 word compilation of posts, Planet Lactose: The Best of the Blog, is available everywhere in every kind of format, as I announced with great relief a few days ago. On Amazon? Yes, even on Amazon. It took me those few extra days and most of the waking hours in them to reformat the book so that it looked exactly right on a Kindle and get the book properly uploaded to Amazon. Proof: there it is in all its glory. It's exactly the same edition as the one published electronically everywhere else. Remember, you can get a .mobi edition that is readable on the Kindle through Smashwords. However, you can also download directly from Amazon if you have a standard Amazon account. If there is any format you'd like to see it in that's not already covered, let me know and I'll see what I can do. I started with 5 1/4" flopy disks, proceded through 3 1/2" "floppies" (which were hard), true hard drives, and now solid-state drives so I think I can cope.

Food Intolerance vs. Food Allergy

One link in particular from the Great Page of Food Allergy Informational Links that I posted yesterday stood out for me. Of all the thousands of questions I've received over a quarter century of talking about lactose intolerance, probably the most frequent and most confusing is the difference between a food intolerance and a food allergy. Let's start with this short article on the Palo Alto Medical Foundation site, Food Allergy vs. Food Intolerance.

A food allergy is actually an immune-system response. When someone eats certain foods (such as those listed above), the body mistakenly treats an ingredient in the food (usually a protein) as if it were a harmful pathogen. The body responds by creating a defense system (antibodies) to fight it. The allergic symptoms occur as a byproduct of the action of the antibodies that battle the invading food. Food intolerance is a broad term that describes any adverse reaction to food. ... Non-allergic food intolerance is often limited to an uncomfortable digestive-system response. The most common example of food intolerance is lactose intolerance, in which one's body is unable to break down the sugar (lactose) in dairy products. Other food intolerances can be caused by irritation to the digestive system by an ingredient in the food consumed.

That's the basics. Allergies and intolerances are different conditions, produced by the body reacting in different ways, often to a different set of triggers, with different symptoms and different severity. You wouldn't think that anybody would mix them up. And yet, life is never that simple and clearcut. The big issue for most of you reading this is dairy. Dairy is the trigger - the sole trigger - for lactose intolerance. Only the milk of mammals contains lactose: it's not found anywhere else in nature. Digestion breaks down milk into its smallest and simplest components and one of these is the compound sugar known as lactose. No digestive system of any mammal can digest lactose. It must be broken down into its own components, the simple sugars glucose and galactose, before it can be absorbed by the intestines. That's pretty weird if you think about. Why would a nursing mother go through the long series of extremely complex chemical reactions necessary to produce a unique compound sugar that can't be used in that form by the offspring? Nobody really knows. It's a scientific mystery. And a useful argument against the notion that humans or mammals or any living thing was "designed." Who would design a boondoggle like this? To break down, digest, a compound chemical the body manufactures enzymes, proteins that act as catalysts to speed up the process. The enzyme that digests lactose is called lactase. (Sugars end in "ose"; enzymes end in "ase". Remember that for your next crossword puzzle.) If the small intestine doesn't manufacture lactase, or creates too little of it, then some lactose will continue through the gut and wind up in the colon. Two things can happen during that journey, both bad. One is that lactose reverses what is called the molality of the system. Normally water enters the body from the intestines, nourishing you and leaving the end product, the stool, moist but intact. Lactose creates an environment in which water is pulled from the body into the intestines, setting up conditions that usually manifest as diarrhea. In addition, many of the dozens or hundreds of species of bacteria that live in your colon will jump on the lactose as a source of food, ferment it, and produce gas as part of the fermenting process. Heavy, smelly, long-lasting, awful gas - by itself or in addition to the diarrhea - is the consequence. Put together, those are the symptoms of lactose intolerance. Any other symptoms in an adult are extremely rare. Allergic reactions make more basic, underlying sense than lactose intolerance. You obviously want your body to fight off foreign invaders in your environment or in your food. But - here's where we question the whole "designer" thing again - the body often gets it totally wrong. Sometimes perfectly good, even healthy and helpful chemicals trigger reactions. In food, these reactions are always triggered by proteins, and never by sugar of any sort. You cannot be allergic to lactose. Only the proteins in milk, which are mostly in two families, the caseins and the wheys, can set off an allergic reaction. In theory that sounds like a great dividing point. In the laboratory it is. In life, there are few times when you have a dairy product that contains only proteins or only lactose. They almost always come mixed. How do you tell which is causing the problem? The best way is by the symptoms. Lactose intolerance always and only causes intestinal distress. A dairy allergy seldom does. Another link on that great links page lead to an informational page from the Journal of the American Medical Association.

SYMPTOMS Allergic reactions to food can be mild to severe. They usually occur within a few minutes of eating a food, though they rarely appear a few hours after ingestion. Symptoms can include runny nose, itchy skin, rash or hives, tingling in tongue or lips, tightness in throat, hoarse voice, wheezing, cough, nausea, vomiting, stomach pain, or diarrhea.

Those symptoms are in rough order of how common they are. Notice that stomach pain or diarrhea are last on the list. They do occur in certain people. Even so, the fact that the symptoms overlap coming from food in which the triggers overlap is a recipe for confusion. Doctors can usually sort this out just from listening to you describe your symptoms. And there are tests both for lactose intolerance and for food allergies that will definitely separate them. If you don't want to wait, the easiest first step is try lactase pills, available in any supermarket or pharmacy. Those work well on most people with lactose intolerance. If they don't, then the next step really is to see a doctor. A great many gastrointestinal illnesses produce the same symptoms and some, notably irritable bowel syndrome, can also be triggered by dairy. The cures for those are seldom as easy a box of inexpensive pills. Make sure you get the treatment you need.

Great Page of Food Allergy Informational Links

Food allergies have exploded over the last two decades and nobody is quite sure why. Until scientists can tease out the true explanation from the hundreds of suggestions made, sufferers and parents of children with allergies need to learn all about them. What to avoid, what to do if symptoms arise, how to substitute for trigger foods. In that way allergies are much like lactose intolerance: the same behaviors need to become automatic. Kristen sent me a great page of useful links that appeared, of all places, on the website of LionsDeal Restaurant and Office Wholesale. Restaurants are taking allergies and intolerances with far greater seriousness and understanding than they did before the incessant publicity on them started. The people at Lion's Deal did a good amount of research and put it together on a page called Kitchen Guide: Food Allergy Information. The links all head to major academic and governmental bodies or allergy organizations, so the information is sure to be authentic. Thanks to LionsDeal.com for gathering this information for their restaurant clients and to Kristen for making me aware of it in a place I'd never think to look

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.

Lactose in Goat Cheese and Yogurt

I received an email from Jo-Ann asking me about the percentage of lactose in goat cheese and yogurt.

That's a question that looks very straightforward, but it contains traps and pitfalls.

Goat cheese is a fad food today. A few years ago you might never have seen goat cheese outside of a few specialized cheese shops or fancy restaurants. Today I went to a chain restaurant that served salads and sandwiches and paninis featuring goat cheese. They might have had goat cheese is their oatmeal, too. They called it Swiss oatmeal but it came with banana slices and goats are far more Swiss than bananas are. The irony is that practically every farm across the world makes its own specialty cheese and thousands of those cheeses with thousands of tiny distinct variations can be purchased even in ordinary supermarkets, but somehow "goat cheese" has entered the vocabulary of fast food as a single thing.

So what is goat cheese? There are two main varieties, the Mediterranean style of brined curd known as feta and the French style known as chevre. Feta is crumblier and chevre is creamier. As Wikipedia handily points out, though, goat cheeses come in many varieties from many nations under many forms. The cheese used in salads is probably feta, because the crumbles are visually attractive and give good mouthfeel.

Cheese is the slipperiest dairy product. Pinning an exact number on a product you can't even identify by name is an exercise in futility. Those thousands of variations mean thousands of variations in the percentage of lactose they contain. I doubt if anybody's ever bothered to do a lactose comparison between Mató and Pantysgawn and Kunik and Rubing, just to pull a few fun-sounding names out of that Wikipedia article. It gets worse when big corporations buy from many sources that produce an individualistic product that varies season to season and probably cow to cow.

Don't give up just yet, because it turns out there are a few things that I can say. Your intestines aren't research scientists and they aren't grading you to three significant figures. Approximations and generalities will do.

We know one big fact about cheese. The more aging that goes into cheese, the lower the lactose percentage. The aging process literally squeezes the liquid out of the cheese and the liquid takes the lactose with it. Broadly speaking, therefore, the harder a cheese is, the lower the lactose percentage. And that also implies that the softer a cheese, the higher the lactose percentage. And feta and chevre both are soft cheeses.

I put together collections of lactose percentages from several sources into a table on my website called The Really BIG List of Lactose Percentages. Yep, feta is there. At 4.1% lactose it's definitely at the high end of lactose in cheese.

Still, it's part of a continuum of percentages, not an outlier. And that brings up an important point that I try to hammer home whenever I can because so many other people avoid saying it. Goat cheese, like goat milk, like every other goat dairy product, has essentially the identical lactose content to the similar product made from cow's milk. I've ranted about this before so I won't go down that road today. When it comes to lactose all the milks that people use to make dairy products from are essentially interchangeable.

Which takes care of the answer to the question about goat yogurt. If it is made in traditional tart style, it's probably low in lactose, just as cow's milk yogurt is. But manufacturers often make yogurt sweeter for the North American market, and that usually means adding in no merely sugar and fruit but also additional dairy products than can drive up the lactose percentage. All I can tell you, as good consumers, is to check the ingredients lists and see if they contain milk products other than the milk at the top of the list. If you see them, assume that lactose will follow.

Planet Lactose: The Best of the Blog! Now on Smashwords!

86,000 words. Hundreds of articles. The cream of the crop. The most informative, penetrating, useful, controversial, opinionated, wild, and absurd posts I've done over the first several years of this blog. That was Planet Lactose: The Best of the Blog. The book is still available. From me, in fact. Just go over to Planet Lactose Publishing to order it.

Paper is out, I know. Electrons are in. But the formatting of the book, with many quotes, large numbers of pictures, and lots of sections, meant that it was a nightmare to convert into digital form and not make it an unholy mess that would offend the eyeballs.

Finally, though, after many, many hours of reformatting, the digital edition is ready to go.

I've posted it on Smashwords.com, a writer-friendly multi-platform site that converts your manuscript in almost every major format that anyone could want to download.

eBook Formats


epub
This is the format Smashwords distributes to the Apple iBookstore, Sony, Kobo, B&N, Stanza, Aldiko and others. Also very popular with Smashwords.com customers. EPUB is an open industry format.

Sony Reader (LRF)
LRF is the format used on older Sony Reader ebook devices. The newer Sony Readers use EPUB.

Kindle (.mobi)
This is one of the most popular formats for Smashwords.com customers. Mobipocket is an eBook format supported on the Kindle, as well as Windows PCs and many handheld devices.

Palm Doc (PDB)
PalmDoc is a format primarily used on Palm Pilot devices, but readers are available for PalmOS, Symbian OS, Windows Mobile Pocket PC/Smartphone, desktop Windows, and Macintosh.

PDF
Portable Document Format, or PDF, is a file format readable by most devices, including handheld e-readers, PDAs, and computers.

RTF
Rich Text Format, or RTF, is a cross-platform document format supported by many word processors and devices. Usually pretty good at preserving original formatting from Word documents.

Plain Text
Plain text is the most widely supported file format, working on nearly all readers and devices. It lacks formatting, but will work anywhere.

That's great. Here's something even better. Smashwords sells the book to you directly. Just go to my page.

You can view it online or download to an astounding number of formats.



Anyway you want it, the ebook price is a low, low $4.95. That's less than a penny for each hour of work that went into it! Seriously.

It gets better. Smashwords would like you to buy directly from them. But you don't have to. They make the book available at all the major online sellers, so you can get it along with any other of the million books available electronically.

For example, if you happen to be at Barnes & Noble just add it to your shopping bag.

Only one tiny problem remains, and I'm working to take care of that. Although you can get the book in .mobi format and you can read that on a Kindle, you can NOT buy it directly from Amazon. Soon, though, I hope.

UPDATE: As of September 15, 2011, you can so too buy it directly from Amazon. Go to this page to download it.

In the meantime, however, I can't think of many needs that Smashwords isn't already covering. You can even read a large sample of the book for free.

And the book has been completely updated to ensure that all the URLs given are live, that the products listed are still available, that unavailable products or sites have been eliminated, and comments or updates added wherever necessary.

It's finally ready to go. And that means I can return to posting on this blog. You'll see new posts starting September 5. And then everything is back to normal.

Planet Lactose Emerges from Hibernation

Hi everybody. As I was saying...

As you can see from the dates, I took some time off. A daily blog about a specialized subject is a tough thing to pull off. I found that I was thinking about content all the time while finding less and less that new and original and worthwhile to post. I needed to break away and clear my head.

Many people have continued to write me with product information or questions or comments. Thank you for thinking of me. I've answered everyone who sent emails, but I fell behind on authorizing comments here on the blog. Unfortunately, the level of spam made me flip the virtual switch so that no comments appeared without my personal OK. I've gone though and adding those for the past few months. I'll try to get in and add comments or answers where appropriate.

You'll see a string of posts over the next couple of weeks that have been accumulating from all that email. I'm going to try to find time to get over to my website, Steve Carper's Lactose Intolerance Clearinghouse, and update the pages on books and products. That's immensely time-consuming so please bear with me.

There was one other project that ate up huge amounts of my time, one so big I'm going to separate it out into a post of its own. You'll understand why once you see it.

So, What Can I Eat Now?! Cookbook

Remember the interrobang?! A combination of a exclamation point and question mark, it was the missing piece of punctuation that all keyboards leave off. There's a whole Facebook page devoted to Bringing Back The Interrobang. And they're right. We need the interrobang and we need it now. Proof? Rhonda Peters just wrote the So, What Can I Eat Now?! cookbook and badly, sadly misses the useful interrobang.

So, What Can I Eat Now?! is subtitled Living Without Dairy, Soy, Eggs, and Wheat, which makes it just right for me to feature here.



Guess what? There's a press release.

Ms. Peters' decision to write a cookbook which focused on low sodium, gluten free, soy free, egg free and dairy free ingredients stems from her own battle with thyroid disease and rheumatoid arthritis and her inability to consume foods with gluten, soy, dairy and eggs due to multiple food allergies. Ms. Peters' 15 year struggle with these chronic health issues and her desire to continue to enjoy the Southern style of cooking which she had enjoyed as a child propelled her to study and dissect traditional Southern and holiday recipes in search of healthy, flavorful alternatives. The result of Ms. Peters' laborious efforts is an exciting new approach to holiday cooking. So if you’re searching for the perfect holiday brunch menu or if you’re trying to prepare a full spread for your family’s holiday gathering, order your copy of So, What Can I Eat Now?!, as it is destined to become the premier holiday cookbook for people with dietary restrictions.

Instead of the links in that press release, try this one: http://rhondascooking.wordpress.com/so-what-can-i-eat-now-cookbook/.

Review of The Kosher Baker

Rabbi Rebecca Joseph is founder and owner of 12 Tribes Kosher Foods in San Francisco and creator of the Parve Baker, a dairy-free baking blog.

I got very excited when I read that, because it sounded like a great thing to share with you. I'm somewhat less excited when I saw that no new posts have been made in over a year. Still, check out what's there.

Rabbi Rebecca is still writing, though. I found her via a review of The Kosher Baker: Over 160 Dairy-free Recipes from Traditional to Trendy by Paula Shoyer. You may remember that I posted about it two months ago. Yes, I'm that far ahead of the curve.

Anyway, here's an excerpt from her review.

The real test was the whole wheat challah. I regularly make challah in several varieties, but have never found a whole wheat recipe that I wanted to use again. That is, until now. This one balances white and whole flours, honey, sugar, yeast and eggs perfectly in a bread that looks beautiful as a crown or braid, tastes good, and has a substantial, but delicate texture. The dough rises three times so this is a not project that can be rushed. When you can plan ahead, the time is worth it.

There is so much to like about “The Kosher Baker,” including the many practical tips and attention given to special diets. With her sensitivity to dietary restrictions and commitment to expansion of the parve baker’s repertoire, the only disappointment is that Shoyer does not offer much advice to people who are generally concerned about making desserts and other baked goods more nutritious or are soy-sensitive.

The Gluten-Free Mall

The Gluten-Free Mall has been around since 1998. It's been on my list of LI Links since forever, but I've never devoted a blog post to it.

The Gluten-Free Mall has the best prices and selection of gluten-free, wheat-free, casein-free and other allergy-related health foods and special dietary products on the Internet! All of our gluten-free products are specifically designed for people who need to eat gluten-free foods due to celiac disease, autism, Attention Deficit Hyperactivity Disorder (ADD, ADHD) or other health reasons. The Gluten-Free Mall offers you low product and shipping costs, and the convenience of being able to choose from hundreds of gluten-free products and have them shipped to your door. Unlike other companies, 98% of our orders of gluten free food are shipped on the next business day.

Our state-of-the-art Gluten-Free Mall warehouse is centrally located and contains hundreds of hand-selected gluten-free foods from dozens of special dietary food manufacturers so that you can, in only minutes, browse through our products and place a single, secure order. To make it into our warehouse, each gluten-free food manufacturing company must demonstrate its total commitment to high quality and excellent tasting gluten-free products. We are truly a "one-stop shop" for your gluten-free and other special dietary needs!

The Gluten-Free Mall was created by Scott Adams, who is better known in the celiac/gluten-free community for founding Celiac.com.

You can also search for lactose-free products on their site.

Shabtai Bakery Wins Again

Shabtai Gourmet is a "dedicated gluten free, dairy free, peanut free, soy free, lactose free, casein free, corn free, and kosher bakery." If that isn't amazing enough, it manages to make its desserts tasty with whatever ingredients are left. It just won the Kosherfest Best New Passover Product Competition for the fourth time, for their Gluten-Free Yidels Mini Swiss Chocolate Rolls.

I alerted you to Shabtai last year. But their new press release has even more info.

In past Years Shabtai Gourmet has won best new product with some of their other items, such as their Gluten Free Devils Food Ring Ting Cupcakes, Gluten Free Bell Ring Cakes, & their unforgettable Marzipan Sushi.

Some other delectable allergen friendly desserts baked by Shabtai are his: Gluten Free Honey Cakes, Gluten Free Rainbow Cookies, Gluten Free Flourless Chocolate Cakes, Gluten Free Jelly Rolls, Gluten Free Brownie Bites, Sponge Loaf Cakes & so much more.

Many of Shabtai's baked goods contain no-hydrogenated oils, no trans fats, no artificial colors, no artificial flavors, no preservatives, are all natural, and baked with organic ingredients.

Shabtai Gourmet Gluten-Free baked goods are available at fine health food stores and supermarkets all year round and for Passover as well. Shop for Shabtai Gluten-Free items @ www.shabtai-gourmet.com or @ www.glutenfreemall.com.

Use their store locator to find the nearest retail location to you.

Look for Shabtai products at Wegmans, Shoprite, ACME, King Kullen, DAG NYC, Price Chopper, Hy-Vee, Woodmans, Mrs. Greens, Key Food, & Best Yet Markets.

Shabtai Gluten Free Baked goods are now available at select Bloomingdale's stores on the East Coast.

In the weeks prior & during the passover holidays you can find Shabtai Gourmet baked goods at over 35 Supermarket Chains throughout the country. Look for the Kosher for passover symbols listed on their packaging.

Shabtai Gourmet supports various celiac & autism support groups all over the country. Contact them to get involved in your local gluten free event - www.shabtai-gourmet.com
(516) 374-7976.

Health Professional Quality Answers on Food Allergies

Pulse is a UK site intended for health professionals only. That's code for saying that they use medical terms and expect their readers to understand them.

That's okay. The answers are pretty straightforward, and most people with food allergies have already encountered these terms over the years.

The current topic is Key questions on food allergies. "Allergy GPSI Dr Adrian Morris answers GP Dr Mandy Fry’s questions on diagnosing cow’s milk allergy, prescribing Epipens and the value of allergen avoidance in pregnancy."

Here are some excerpts that are of concern to those with dairy allergies.

2. How can you confirm a diagnosis of cow’s milk allergy?

Cow’s milk allergy is relatively common in infants (1:50) and rarely develops after one year of age. Symptom improvement on a cow’s milk-free diet and recurrence of symptoms with reintroduction of cow’s milk formula is the most accurate diagnostic method.

Skin prick tests using fresh cow’s milk and RAST blood tests for cow’s milk protein IgE antibodies are the only reliable tests and have 60-90% accuracy. The higher the milk-specific IgE, the more likely there is to be a clinically relevant milk allergy. On the other hand, IgG antibody testing for cow’s milk proteins (casein and b-lactoglobulin) is of no diagnostic use.

The clinical history and observation of the infant feeding are very helpful, and a family history of atopy increases the likelihood of a food allergy. Cow’s milk allergy can manifest with immediate urticaria and facial angioedema and respiratory, oral and laryngeal symptoms, as well as deteriorating eczema in addition to typical symptoms such as vomiting, diarrhoea, persistent reflux, food refusal and even anaphylaxis in severe cases.

Mildly milk-allergic infants will tolerate small amounts of processed dairy produce such as yoghurt and cheese. Infants with severe cow’s milk allergy will react to traces of milk protein in partially hydrolysed formula, and even breast milk, as well as any skin contact.

3. What are the best formula alternatives and what role do other milks play?

Cow’s milk-free formulas are expensive - £8 to £20 per 400g. Amino acid-based formulas such as Neocate and Pepdite are best because they are completely free of cow’s milk protein, but are more expensive than extensively hydrolysed formulas such as Nutramigen and Pregestimil, which are the current preferred cow’s milk-free formulas. Exquisitely sensitive infants may react to traces of cow’s milk protein even in extensively hydrolysed formulae.

An amino acid-based formula provides a good therapeutic trial for initial diagnosis of cow’s milk allergy, after which it would be cheaper to switch to an extensively hydrolysed formula – if it can be tolerated.

Although soy milk is the cheapest alternative formula available at around £4 per 400g, 20% of cow’s milk allergic infants will develop a concomitant soy allergy. The fear that soy milk phyto-oestrogens can feminise male infants is without scientific foundation.

Goat’s milk is inappropriate as it contains many of the allergenic proteins found in cow’s milk, so should not be recommended. Comminuted chicken meat suspensions are another alternative, particularly if there is associated carbohydrate intolerance.

4. How many affected infants will grow out of a cow’s milk allergy?

Half will outgrow their cow’s milk allergy within one year, 75% by two years and 90% within three years. Cow’s milk protein intolerant infants with problematic gastro-oesophageal reflux and colic usually spontaneously recover by the end of the first year. This represents a delayed hypersensitivity to the cow’s milk protein resulting in oesophageal inflammation and eosinophilic infultrates. Depending on severity it makes sense to rechallenge cow’s milk allergic children after one year and then every six months thereafter. In severe cow’s milk allergy challenge testing should not be contemplated outside a hospital setting.

The rest of the article is way too long to repost, but contains a lot of good general information for parents of kids with food allergies. Please take the time to read it.