Lactose Intolerance Doesn't Cause Bad Breath

I received a question today asking me if there's a connection between lactose intolerance (LI) and bad breath.

No. There isn't. Simple and straightforward.

As always, I forgot the internet and the legions of pseudoscience. Not to mention the anti-milk crowd which wants to demonize dairy in all its forms.

A Google search on "lactose intolerance" and "bad breath" brings up a breathtaking 75,000+ hits. Many of them are copies of (or variations of: hey, if you're peddling pseudoscience why would a little plagiarism stop you?) two basic articles.

One is by Dr. Harold Katz, founder of The California Breath Clinics.

High Protein Foods
These bacteria love those proteins, and certain foods are packed with them:

Milk and Cheese and most other dairy products. (The fat content does not matter.) If you are lactose intolerant, do not eat or drink these products! Since your system cannot digest them properly, they are available to the bacteria for an extended period of time. A recent research article from the Los Angeles Times (November 1996) on lactose intolerance showed that nearly 67% of all Americans can be classified as "Lactose Intolerant". This is due to the fact that in a diverse population such as we have here, there is a predilection for Asians, Hispanics, and African-Americans to be lactose intolerant.

Fish are high in proteins. As many people eat a high fish diet, logically they make the problem worse.

The pseudoscience here is of very high quality. Lactose intolerance is the inability to digest the lactose sugar in dairy products. Dairy proteins are digested perfectly well. No dairy proteins are available for an extended time. They are absorbed by the small intestine and don't reach the colon where the bacteria are.

Other questions should be springing to mind as you read this. Meat is high is protein as well. Shouldn't meat be a prime cause of bad breath? What about plant protein? Vegetarians always say that high protein plant products can be eaten in lieu of meat. Wouldn't they cause bad breath?

While Dr. Katz's notions about diet are bizarre and obviously wrong to anyone who knows anything about nutrition and digestion, you'd have to be more aware to catch the subtlety wrong in the other theory, which can be found in articles similar to this one by Sue Spataro.

[The bad breath] is powerfully strong and people can sense it from feet away. Others may think the person has poor oral hygiene when in reality they are lactose intolerant. The oral hygiene has nothing to do with their bad breath. The bad breath is caused by the lactose rich foods sitting in the person's intestines and fermenting. The body tries to get rid of the gases that are produced as the result of fermentation by having them reabsorbed by the bloodstream and exhaled out.

The hydrogen breath test is a common way doctors make the diagnosis of lactose intolerance. This tests measures the amount of hydrogen in the breath. Normally, very little hydrogen is in the breath. But undigested lactose in the colon (large intestine) is fermented by bacteria, and various gases including hydrogen is produced. The hydrogen is absorbed by the intestines, carried through the bloodstream to the lungs, and exhaled. In the test, the patient drinks a lactose-loaded beverage, and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can affect the test's accuracy and should be avoided before taking the test. This test is available for children and adults.

Yes, fermenting bacteria do create reactions that end in the production of extremely vile-smelling gases, mostly from volatile sulfur compounds. And it is quite true that this is the only reaction which creates hydrogen that percolates through the body and is emitted in the breath, the reason why the hydrogen breath test has become the most common test for LI.

What's not true is that the sulfur compounds do the same thing. The gases that are produced leave the body via a different exit, the process known as farting (or flatulence). Doctors would surely have noticed by now, after millions of hydrogen breath tests, if the lactose load that we drink to make the test work also caused sulfur to pour out along with the hydrogen. So would we patients. We don't, because it doesn't happen.

Notice how each theory makes use of a bit of real science to give the work a sheen of verisimilitude before venturing off into parts unknown. Katz talks about bacteria in the intestines, but ascribes to them a role unknown to other doctors. Spataro uses the hydrogen pathway to try to make a point about unnamed other gases that are not as odorless as hydrogen.

Standard medical science has nothing to say about lactose intolerance causing bad breath. A search of PubMed, the medical journal database, turns up no articles making the connection. It's a "truth" known only to the internet.

If you want real facts about bad breath - facts that nowhere mention "lactose" or "dairy" or "protein" - I recommend that American Dental Association's FAQ page on bad breath or the Mayo Clinic's Causes of Bad Breath page.

Don't get suckered by pseudoscience.

Egg Allergens Scrambled

In a breakthrough for allergy sufferers, European researchers have manipulated eggs to reduce - almost, but not quite, remove - their allergenic properties.

The press release says:

People who suffer from egg allergies may soon be able to have their quiche and eat it too. Chemists in Germany and Switzerland report development of a new process that greatly reduces allergens in eggs and may lead to safer, more specialized food products for individuals with egg allergies.

...

In the new study, Angelika Paschke and colleagues describe their process, which exposes raw eggs to a combination of high heat and enzymes to break down their main allergens. The researchers then tested their reduced-allergen egg against blood serum collected from people with egg allergies. The modified egg product was 100 times less allergenic than raw egg, the scientists say. It does not significantly affect flavor and texture when used in various products, they add.

The study "In Vitro Determination of the Allergenic Potential of Technologically Altered Hen's Egg" is scheduled for the March 12 issue of ACS' Journal of Agricultural and Food Chemistry.

Being able to do this in eggs doesn't imply that a similar technique will work against the allergens in milk, but all fundamental breakthroughs in the field are good news.

Checking the Science in the Science Fair

Mark Anderson in the St. James Plaindealer writes about a Middle School Science Fair.

Jonathan Peterson already knew about lactose intolerance because he has to watch his own diet for lactose. But his science fair project gave him a chance to go more into depth and teach others about the dietary condition.

Peterson posted a list of foods on his display, then covered up the answer key telling whether they contained lactose.

Good going, Jonathan. Simple, interactive, informative, and entertaining. High marks.

But content is as important as presentation.

Foods included chicken noodle soup, potato chips, fruit loops, crackers, roast beef, life savers, bread, jelly, processed hamburger, marshmallows and french fries.

Of those, visitors were surprised to learn only the roast beef, life savers, jelly and marshmallows are lactose free.

I'm surprised too, I'm sad to say. Let's go over these answers.

Chicken noodle soup. There must be 50 million chicken noodle soup recipes in the world. With all that variation, it would be no surprise to discover that somebody, somewhere must add a dairy product. Normally, however, there's no good reason to expect to find any lactose in chicken noodle soup. And you wouldn't expect to find any in normal commercial chicken noodle soups. Here's the ingredients list for Campbell's Condensed Chicken Noodle Soup. No lactose containing ingredients. Some restaurants may include dairy, though. The fast food chain Chick-fil-A's
Hearty Breast of Chicken Soup contains nonfat milk, whey, and butter. Chicken noodle soup is something to ask about when eating out, but can easily be found lactose-free commercially or made at home.

Potato chips. Similar situation. Your plain, standard, everyday potato chips will almost certainly be lactose-free. Plain potato chips aren't hip and cool, which is to say that brand extension ensures that potato chips comes in a huge variety of flavored varieties. You'd expect that sour cream and onion or cheddar or ranch flavored chips would have dairy in them and you'd be right.

Fruit loops. I have to assume that either Jonathan got it wrong or the reporter transcribed it weirdly. I can't find a product called "fruit loops." What any kid will be familiar with is Kellogg's Froot Loops. Slight problem. Kellogg's Froot Loops has no dairy products.

Crackers. Of the ten million different cracker products in the world, some will be lactose-free and some won't. No way of knowing unless you can read the ingredients list.

Life savers. Believe it or not, butter rum flavor Life Savers hard candy actually contains real butter. Unless you knew this, you could go through a dozen or more flavors and think they were all lactose-free, as Jonathan apparently did. I've read so many ingredients lists in my life that I happen to know of this exception.

Bread. Lots of different breads. Some, like real French or Italian breads or Jewish ryes, are bound to be lactose-free. Most commercial varieties will contain some lactose.

Jelly. Most commercial jellies will be lactose-free. I don't know of any exceptions, but I could be surprised by one tomorrow.

Processed hamburger. I honestly don't know why this is listed as having lactose. Cheeseburgers, sure. Hamburger buns, possibly. But the hamburger itself? And what does "processed" mean? I suppose some grills might use a butter-based product for frying, but oil is cheaper and more likely. Pure hamburg should be lactose free.

Marshmallows. Should be lactose-free.

French fries. Many years ago, the warning lists giving foods with lactose in them would often include french fries. I found out they did this because commercial french fries are sprayed with sugar that browns when cooked to give them that good golden appearance. That sugar is uniformly dextrose, however, a different sugar than lactose. I've never come across a real world example of lactose being used as a browning agent for french fries. That's true for all true cut-from-the-potato fries. Supermarkets and fast food restaurants are not necessarily that simple. Some flavored fries may, as with potato chips, have a dairy-based flavor added or be made of chopped, formed, processed potatoes that use some dairy as a flavoring or cooking ingredient.

Life is unfortunately not as simple as Middle School. Being aware that lactose may lurk in all sorts of products is a lesson that's a terrific one to drill into all kids with lactose intolerance or milk allergies. The complications of food processing science may take a bit longer to fully understand. Either way, reading the ingredients lists or asking waiters or serving staff are musts.

And thanks to Jonathan Peterson for coming up with such a useful teaching opportunity. Sorry to be such a tough grader.

Lebneh and Lebanese Cuisine

Low-lactose products were first made in the Middle East, where, no coincidence, herding and milking of animals began. To keep the dairy products from spoiling in the heat, they were often "soured" or acidified, by using bacterial cultures to turn the lactose into lactic acid.

Rami Zurayk of SlowFood.com tells us more about these products in the course of a fascinating article about Lebanese cuisine.

The processing of milk first started in the Middle East for the purposes of preserving it for long periods of time. Milk yields different products with increasing shelf lives: fresh milk yields yoghurt (laban) then labneh, then cheese. Milk can also be further processed into drier cheeses such as shankleesh. Labneh, since it contains less water, represents a later stage of processing than yoghurt.

Labneh is characterized by its white/cream color and its soft and smooth paste. It is easily spreadable and has a clean and slightly acidic flavor. In households throughout Lebanon, labneh is consumed on a daily basis. It is most commonly eaten fresh drizzled with olive oil and scooped with pieces of pita bread. It is also used as a filling for sandwiches.

Labneh can be made from cow, goat or sheep milk. It contains around 10% fat, 10 % protein, 5 % lactose, 15 % milk solids, and 25-35 % total solids. It has a pH ranging from 3.5-4 (Bodyfelt, 1988).Good quality labneh requires a starter culture consisting of strains of Streptococcus thermophilus and Lactobacillus bulgaricus. These bacteria are crucial to a fermentation process that transforms lactose to lactic acid and thus makes labneh more tolerable to lactose-intolerant consumers.

Shankleesh is the only mold-ripened cheese native to the Middle East. It is believed to be of Kurdish origin. Shankleesh is essentially concentrated, skimmed milk yoghurt which is hand-molded and given a smooth outer surface, then ripened and coated with thyme and other herbs. It can be consumed after ripening for a couple of days or it can be stored in containers (traditionally clay jars) at ambient temperature. It will then be colonized by yeasts including Debaryomyces hanseni and Penicillum. It is this development of this micro-flora that gives shankleesh its distinctive taste and increases its shelf life while decreasing the risk of contamination by pathogenic organisms. High salt and low moisture content also contribute to the preservative effect. This was especially important under conditions where refrigeration was not available.

Shankleesh can be made from cow, sheep or goat milk. The type of milk will affect the taste of the final product. Milk is fermented into yoghurt, which is then shaken to extract the ghee. The remaining protein rich liquid is heated until it solidifies. The coagulum is then salted and hand-molded into fist-sized balls. It is sun-dried and then fermented in a clay pot for a month. The resulting product has a moderately pungent and somewhat musty flavor with a perceptible bitter note. It is also naturally very low in fats (around 5%) and constitutes a very healthy source of proteins and calcium. Shankleesh is usually eaten as an appetizer (mezzeh) broken into small pieces, mixed with finely cut onions, tomatoes and green peppers and drenched in olive oil.

Passover By Design Cookbook Also for Gluten Intolerants

The Internet is a pleasure palace for the world's lovers of irony. How else to describe the odd thrill of finding the press release for Passover by Design, the new cookbook in the Kosher By Design series, on ChristianNewsWire.com?

Acclaimed kosher diva Susie Fishbein, author of the Kosher by Design cookbook series is releasing her fifth project – Passover by Design (ArtScroll Shaar Press, February 2008; $29.99/Hardcover, 276pp; ISBN: 1578190738). With over a quarter of a million books sold, Kosher by Design has become the most popular kosher cookbook series in print today. Passover by Design follows suit with Fishbein's signature style of combining gorgeous food and décor photos together with 172 chic recipes that shimmer with simple elegance.

...

Because 130 of the recipes are gluten-free, About.com's Guide for Celiac Disease, Nancy Lapid, has endorsed the book as a welcome year-round resource for anyone who is gluten-intolerant.

Fishbein has her own website as KosherByDesign.com, with details of the five books now in the series, the other three being Kosher By Design Entertains, Kosher By Design Short on Time, and Kosher By Design Kids in the Kitchen.

Lactose Intolerant Quadruplets

In the So You Think You Have Troubles Category...

Jill and Kyle Williams are the parents of quadruplets. They did it naturally, too, with no fertility drugs.

When Jacque Hillman of The Jackson Sun called, all four of the almost one-year-olds had a stomach virus. Jill was sick, too.

The next day a tornado hit and the Williams' power went out.

Just daily life with Ace, Hensley, Hudson and Avery is a trial. All four are teething. They have developmental problems, a consequence of all being premature. It's not clear from the article whether their lactose intolerance is also from being premature. Premature babies are often born LI because the lactase enzyme is one of the last bits to develop in the ninth month of pregnancy. Usually premature babies get their lactase very quickly after birth, however.

In the Williams' case:

Avery takes two or three bottles a night, and although she doesn't stay awake long, it means that Kyle and Jill are often up during the night. Sometimes the couple has to shop for Enfamil for lactose-intolerant babies through every Wal-Mart, Walgreens and Kroger store in Jackson to find enough.

The quads go through 24 bottles a day. And 48 diapers.

Immune System Not in Your Gut

"Probably 50% of our direct immune system resides in or around the gut."

"Fully 60 percent of your adaptive immune system resides in your small intestine."

"70% of our immune system is located around the digestive system."

"About eighty percent of the full force of your defensive immune system resides in your intestines or gut."

With these "facts" floating around the internet, it was inevitable that someone concerned about milk allergy would get the idea that "the immune system resides in the gut." Sure enough, I saw this statement earlier today.

It's not true. At best, it's a misunderstanding of the role that the digestive system plays, but even that overstates the truth. In reality, it's sheer pseudoscience perpetrated by new age quacks who want to sell you their digestive enzymes or supplements or herbs or even weirder stuff. (Yes, of course our old friend NAET peddles this nonsense. Just one of many.)

The excuse that is given on these sites is often something they call "leaky gut syndrome." The mainstream medical community doesn't recognize this syndrome, and it's tough to find any medical journal articles that even address it. That doesn't matter to the alternative medicine gurus. Leaky gut appears to be yet another of the quackeries that started in the UK, that haven of ignorance about food, nutrition, and digestion, and was snapped up here in America by those looking to make a quick buck out of other peoples' ills.

It's as perfect a scam as can be imagined. Because it has no recognized existence alternative practitioners are free to invent any set of symptoms and cures they want to sell. Since all cures will be anecdotal, and many will simply involve taking an offending food out of the diet anyway, the cures might lead to an alleviation of symptoms for some. If they do, fine, that's a testimonial. If not, the sufferer will go on to another "cure." Heads they win, tails you lose.

For information that sticks to the real world of medicine, How Stuff Works has a good, plain-language explanation of the immune system. (Seventeen pages and no mention of leaky gut!)

Another straightforward set of pages are those on Allergic Reaction at eMedicinehealth.com.

Chr. Hansen Launches Dairy Free Probiotics

Chris Hansen is the guy on Dateline who traps pederasts, right? What is he doing with probiotics?

Oh, Chr. Hansen. The Danish company Chr. Hansen. The company that proclaims right on its website that nobody knows its name.

Chr. Hansen is a very special kind of company. Virtually unknown outside our specialised field, several hundred million people around the world enjoy our products every day in the foods they eat.

Their specialty includes cultures and enzymes and all the building blocks of industrial food technology.

Their latest sounds good from the prospective of the lactose intolerant and milk allergic and vegan populations.

Probiotics and cultures guaranteed free from dairy ingredients developed for soy yoghurt and other non dairy products.

Now, in an attempt to help foodstuff producers meet a rising consumer demand for soy-based products, Chr. Hansen introduces the popular BB-12® and LA-5® probiotics in dairy free versions.

...


Free from cholesterol and lactose soy-based foodstuffs have significant health benefits. Moreover, according to Morten Boesen, Marketing Manager, Yoghurt Cultures, Chr. Hansen, adding dairy free ingredients can also improve the soy-based product. “The new dairy free fermentation cultures are optimized for soy-based production and, as a result, they can contribute to better dairy free products,” he explains.

Consumers in Europe, the UK, and possibly elsewhere should be seeing more of these products on store shelves in the near future. Maybe even here in the western hemisphere since they have two U.S. plants in addition to eight in Europe and two in South America.

Frozen Yogurt's Hot, Hot, Hot

The New York Times devoted about 10,000 words to frozen yogurt today, or almost as much as that article about John McCain that has everybody so upset. And which is more important to our culture, I ask you?

The article, The Legions of Frozen Yogurt Push East by Julia Moskin, talks about New York's frenzied competition between big name frozen yogurt chains (big name in this case meaning chains that have as many stores as Starbucks does in, say, Grand Central).

Since the Korean chain Red Mango opened a store directly across from California-based Pinkberry in Greenwich Village in December, New York has become the second major battleground for the restyled, fluffed up, fruit-topped new wave of frozen yogurt.

“I’d call it a quiet face-off on Bleecker Street,” said Dan Kim, Red Mango’s president for North America. Since 2006, Pinkberry has opened nine stores in New York, Red Mango has opened four, and competitors like Flurt, Berrywild and Yolato are scrambling to stay in the game.

You remember Pinkberry from the post I did last year, Frogurt's Back with Pinkberry. The Times found an even more insane consumer comment on the treat: "God must have come down and created this place Himself."

Why the addictive behavior? Modern boutique frozen yogurts - boutique frozen yogurts? - are not your grandfather's TCBY.

The most extremely artsy — even artisanal — rendition is \eks\, appropriately located in Williamsburg, Brooklyn, where the yogurt is made from scratch. “We start with gallons of low-fat milk, we inoculate it with the live cultures, and we sweeten it with a little organic sugar,” said the owner, Neo Kim.

Even TCBY has boosted the number of live yogurt cultures in an effort to stay competitive and Pinkberry competitor - and self proclaimed originator - Red Mango boasts 400 million live cultures per gram. That's good news for those of us with lactose intolerance. The more cultures, the more likely we'll be able to tolerate the yogurt without symptoms. And these frozen yogurts are probably low lactose, because they tend to be tarter than the sweet, fruity-flavored versions of yore.

But that perfect churn of air and water, cream and tang, sweet and sour is elusive, and subjective. Some like it fluffy; others, dense. Some find the tang of Pinkberry excessive, even aggressive; others say that yogurt without tang is just low-fat ice cream. The taste of a good plain yogurt is full of lactic acid, a natural byproduct of fermentation that also gives depth to the flavors of foods like Parmesan cheese and prosciutto. Some of the newfangled yogurts also add citric acid for flavor, lending a bright lemony flavor that is very appealing on top of the sweetness, dairy and lactic tang.

Whatever, it's a good trend and I only hope that it moves out of NYC and LA sometime very soon.

Allegic Reactions from Lactose in Dry Powder Asthma Inhalers

A discussion on the No Milk List raised the perennial question of whether allergic reactions could occur when people are exposed to pharmaceutical grade lactose, the kind used in hundreds of prescription and OTC medications as a filler and binder.

Very little is in the medical literature about this. I'm grateful to Tammy Powell of the NIH, who sent me some cites on the possibility of allergic reactions to dry powder inhalers containing lactose. I've done some further searching.

In the abstracts section of J Allergy Clin Immunol (2002, 109(1); S259), Anna H Nowak-Wegrzyn et al. state that "To our knowledge, the issue of pharmaceutical grade lactose as a source of potential milk contamination has not been studied." They therefore tested "samples from two different lots of each: Serevent TM Discus ®, Advair TM Discus ~ (100/50, 250/50, 500/50), Flovent TM Rotadisc ® (GlaxoSmithCline), and Foradil TM Aeroliser ® (Novartis). Milk proteins were detected in all tested DPIs. Whey proteins were present at much higher concentrations than casein or whole milk protein, consistent with the method of lactose purification."
http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674902819248.pdf

In 2004 Nowak-Wegryzn and her team published a letter to the editor (2004; 113(3): 558-60) about an actual case, that of an eight-year-boy.
http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674903026770.pdf

"The patient continued to receive Advair for several months without any adverse reactions and with excellent asthma control. However, after inhalation of three consecutive doses from a new diskus, he immediately complained of chest tightness and feeling of distress that were treated with oral diphenhydramine and inhaled bronchodilator at home." Caseins were detected in samples from the Advair.

They further looked into whether this was an isolated incident or a general problem. The results were mixed, for a variety of reasons.

"Another factor that may contribute to lower threshold for inhaled food allergens is that allergenicity of milk proteins may be enhanced by formation of the lactose-protein complexes. Nonenzymatic glycosylation of milk proteins occurs during heat treatment (Maillard reaction), leading to significant changes in the 3-dimensional structure of these proteins. These conformational modifications might lead to large glycoprotein complex formation and enhanced allergenicity. In fact, intradermal skin test reactivity to â-lactoglobulin–lactose conjugates has been shown to be 10- to 100-fold increased compared with native â-lactoglobulin.9 Furthermore, large complexes may be randomly distributed explaining why some lots of Advair contained larger amounts of milk proteins compared with others. In addition, the purity of lactose USP may differ among the manufacturers as well as among the batches from the same source. A recent paper reported that none of the 24 children with well-characterized immediate cow’s milk allergy reacted on a blinded challenge with soy-based infant formula containing lactose and that there was no detectable milk protein in a single batch of lactose provided by an Italian manufacturer."

A second clinical case, that of an adult, was reported in the abstracts section of that journal in 2006 (117(2); S95). A dry inhaler powder was the cause, but there is too little information to be useful otherwise.
http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674905031015.pdf

A comment on the 2004 letter can be found in the Jan. 1, 2005 issue of Child Health Alert.
http://www.accessmylibrary.com/coms2/summary_0286-18598172_ITM

"COMMENT: This well-documented report indicates that parents can be legitimately concerned about milk protein contamination in lactose-containing medications. How often this might create a problem is quite another matter. In the case reported above, the child was so allergic to milk protein that he previously even had reactions to tiny amounts of milk protein that came in contact with his skin. It may be that this highly allergic child used a product that just happened to be highly contaminated with milk protein, and this coincidence might be so rare that it would be unlikely to happen to another child. However, for a child who has a severe sensitivity to milk protein, it is important to know that lactose in a medication can indeed contain small amounts of milk protein."

I'd suggest that these reports be viewed with great caution. The boy was one of those rare, extremely sensitive individuals who reacted even to skin contact with milk protein. It's hard to tell from reading the report whether contamination occurred in the batch he reacted to, whether procedures changed at the factory, or whether other factors might have led to a reaction when there normally wouldn't be one.

An allergic reaction to lactose is a concern, but few even of those who are dairy allergic have to be specifically concerned. I still haven't found any analyses of potential reactions from swallowing lactose as opposed to dry powder inhalers.

I'm always torn between dismissing odd single-source reports and considering them as tips of icebergs of under-reported problems. You'll want to decide which way to lean for yourselves.

The Two Types of Food Allergies

For some real facts, let's turn to a good summary article I found on MedicalNewsToday.com.

IgE-Mediated Food Allergies

The parts of the immune system responsible for immediate on-set reactions (the most dramatic example of which is food anaphylaxis) are IgE antibodies.

In allergic individuals (who are sometimes referred to as being "atopic") eating certain food proteins (such as whey and casein protein contained in cow's milk) results in the production of specific IgE antibody molecules directed against the protein. The second time the individual eats the food, these specific IgE molecules interact with each other, and the protein, to cause the release of harmful chemicals (such as histamine) from special mast cells. This causes the damage associated with the symptoms of food allergy. Damage may occur to the skin, respiratory system or gastrointestinal tract, where the symptoms of food allergy are almost exclusively seen.

Non-IgE-Mediated Food Allergy

"T-cells" are the components of the immune systems responsible for delayed-type food allergic reactions. In individuals with a predisposition for delayed on-set food allergy, initial ingestion of food protein leads to the production of specific types of "T-cell". When the food is subsequently ingested, the food protein is "processed" in a variety of ways and "presented" to the previously generated food-specific T-cells. These T-cells then "invade" the area of the body about to suffer damage, as the skin or the bowel. This processing, presenting and invasion can take 24-48 hours which explains the delayed response. T-cells release chemicals that, through a chain of events, lead to the damage associated with symptoms of food allergy.

IgE mediated reactions are sometimes referred to as "true" allergies, while non-IgE mediated reactions are sometimes called hypersensitivities. Unfortunately, these names are not consistently applied inside the medical profession or by the press.

You should also check out the entry on my website, Lactose Intolerance versus Milk Allergy, for a quick reference chart of the differences.

The Facts, Avoided

Mary Lee Stotler wrote that Even fake sweeteners ought to be avoided.

She asks:

As I waited in line at the drive-thru last week, I heard the woman behind me order a supersized meal with a sandwich and large fries, and then order a diet soft drink.

In what universe does that make sense?

I have a question myself. In what universe does washing that meal down with gallons of sugared water make better sense?

Her column is called The Facts.

We've gotten beyond satire and irony, folks.

Gluten-Free, Dairy-Free Booklet

From the press release:

Up & At 'Em Publications,
a company which produces promotional booklets on a variety of subjects for companies needing give aways for trade shows, direct mailings and ad campaigns, has teamed up with HomeschoolEstore.com in order to offer one of it's titles to homeschoolers. The booklet, "Simple Tips And Recipes For Feeding The Gluten Free/Dairy Free Child," can be found at HomeschoolEstore's website under the heading "Special Needs." CEO of Up & At 'Em, Kim Hillman, said, "This is a wonderful opportunity for us to offer this booklet in a new way that can make a difference. We don't market to the homeschool community directly, but now they'll be able to obtain this title through HomeschoolEstore.com. We hope to be able to offer more titles of interest to the homeschool community on the website soon."

HomeschoolEstore.com is the only ebook and audio book website specializing in homeschool curriculum. Their dynamic and user friendly site employs the latest Adobe server technology, allowing homeschoolers to obtain ebooks and ebooklets easily, instantly, cheaply and completely free of shipping costs. Having an impressive line-up of publishers on their website who offer materials to homeschoolers, HomeschoolEbookstore.com takes books off the shelf and puts them on homeschoolers' computers or CD Roms, saving them much needed space.

Here's the booklet's page. It's currently marked down from $10.00 to $7.00

Olive Oil Baking

What made a barbarian barbaric? People in Greece and Rome in the ancient days found almost anything that the northerners did to be less than appealing, but their habit of using smelly butter instead of olive oil, the gift from the gods, was almost unbearable to the sophisticated southerners.

Go to an Italian restaurant today and the better ones - or the ones that want you to think they're better - provide a plate of olive oil, often delicately spiced, for dipping the bread in. Butter needs to be asked for.

So why not substitute olive oil for butter in baking as well? It's mostly a matter of chemistry, olive oil producing results that require some adaptation and experience in changing amounts and cooking times.

Olive Oil Baking: Healthy Recipes That Increase Good Cholesterol and Reduce Saturated Fats, by Lisa A. Sheldon, tries to be the guide you need to work your way through the change.

Product Description
Recent media attention has focused on research showing the health benefits of a Mediterranean-style diet. Olive Oil Baking is a unique addition to the growing selection of Mediterranean diet cookbooks, applying the lessons learned from this research to familiar desserts.

The focus of Olive Oil Baking is the whys and how-tos of substituting olive oil and other healthy oils and fats in favorite desserts and treats that typically use margarine and/or butter. These recipes also introduce other simple changes and options that make them healthier than traditional recipes and store-bought bakery goods. In every case, these changes preserve or improve on the familiar tastes, smells, and textures we have come to expect from a baker's kitchen.

Olive Oil Baking is not just another pretty face in the crowd of dessert cookbooks. In addition to more than 120 recipes for healthy, irresistible cookies, bars, and other desserts, it helps home bakers learn how to make healthy changes in their favorite recipes without sacrificing flavor or texture. It presents techniques and tips that show how to make healthy changes in cooking that do not require families to adopt a new diet or eat foods they won't enjoy. It is filled with recipes that are simple to prepare, using easy-to-find ingredients that are within any budget.

Olive Oil Baking is for anyone who enjoys baking, from the novice to the experienced baker. An indispensable reference for traditional home bakers who want to make healthy changes in the family diet, it can also help small-scale bakeries interested in offering fresher, healthier alternatives to their customers, in contrast to the mass-produced "low fat" cookies and treats found on supermarket shelves.

Jennifer Gish of the Albany Times-Union put the book to the recipe test.

We tested two recipes from the book -- chocolate chip cookies and apple crisp -- which we figured would best test olive oil's skill as a butter stand-in.

The apple crisp features an oatmeal crumb topping that utilizes 1/2 cup of olive oil. The texture of the apple crisp was the same, and the taste was good, although that creamy butter flavor was noticeably absent. The recipe also called for baking the dessert in a 9-by-13-inch pan, which was a little wide and kept the apple crisp from standing tall.

The chocolate chip cookies -- called "Classic Chocolate Chippers" in the book -- were similar to a traditional chocolate chip cookie in texture and thickness and pretty close in taste. Because the flavor of the cookie dough was a little weak, the chocolate chips tended to overpower.

As for appearance, Sheldon says olive oil baked goods can sometimes be a little paler than their buttery counterparts, but we realized that baking them on the oven's middle rack or higher helps them brown up nicely.

She also has some advice for those who want to go beyond the book and try some adaptations of their own.

Avoid recipes that call for more than 1/2 cup of butter. Use a combination of half butter, half olive oil for those. Any extra virgin olive oil will work, not just light olive oil. Expect that recipes will take longer to bake.

Milk-Alkali Syndrome

The medical advice column in the Hartford Courant is by Joe Graedon and Teresa Graedon and usually contains good-quality advice. So a scary-sounding problem in their February 22 column stopped me in my tracks:

Q: How much calcium is too much? I take 1,500 milligrams a day, and my doctor wants me to add another 500 milligrams for my thinning bones. I drink milk and wonder if I may be overdosing.

A: Too much calcium (2,000 milligrams a day) can lead to "milk-alkali syndrome." The extra supplement might make you vulnerable to this complication, which increases the risk of bone fractures and kidney stones.

In some ways, this answer is technically accurate. Mostly, though, it's extremely misleading, but I have to take it apart piece by piece to explain why.

First, milk-alkali syndrome.

Say that you have too much gastric acidity. You probably would want to neutralize the acid. Chemically, you neutralize an acid by adding an alkali to it. Acids and alkalis combine to produce water, which is neutral. Antacid pills - Tums, Rolaids, and the like - do this well enough that most people don't need anything more. What did people do before Tums? Back in 1915 a physician named B. W. Sippy invented the Sippy cup. No, he didn't, though that sure would make a fun fact. He invented a process that involved giving patients massive amounts of magnesium carbonate, sodium bicarbonate, and bismuth subcarbonate along with lots of milk.

Some of the more sensitive patients responded by having the acid levels in their blood go perilously low (and the alkali levels increase), called alkalosis. They developed kidney problems, renal insufficiency. And the calcium levels in the blood went too high, or hypercalcemia. The three conditions combined began to be called milk-alkali syndrome. It was never a fatal problem, but it sure wasn't something that was helpful.

The Sippy treatment got lost to medical history and by 1985 milk-alkali syndrome was seen in fewer than 1% of cases of hypercalcemia.

Then something odd happened. Doctors found milk-alkali syndrome in patients they were seeing for other problems, like renal disease or those taking calcium for osteoporosis. Suddenly as many as 12% of cases of people with these related problems had hypercalcemia.

The source of the overage in many cases was the easily available over the counter calcium that is everywhere in antacids and vitamin supplements and calcium fortified foods.

Remember that the RDA for calcium depends on age and sex, but the usual range for adults is from 1000 to 1300 mg per day. Suddenly taking 2000 mg a day, just an extra pill or two, would seem to put you in danger.

The full medical journal article on the subject available from eMedicine.com, Milk-Alkali Syndrome by R Hal Scofield, MD,Professor, Department of Medicine, Section of Endocrinology, Associate Member, University of Oklahoma Health Sciences Center, Arthritis and Immunology Program, Oklahoma Medical Research Foundation, admits that "How oral intake of more than 2 g/d [2000 mg per day] of elemental calcium with absorbable alkali results in hypercalcemia and alkalosis is not completely understood."

I can tell you right away that one thing not understood is that 2 grams (2000 mg) a day of elemental calcium is not at all the same thing as taking four 500 mg Tums pills a day. One 2000 is not like the other 2000 and that difference is a source of endless confusion.

See, you can't buy pure calcium in a store. Calcium is too reactive. You buy it in the form of calcium salts: calcium carbonate or calcium citrate or calcium lactate. Each form breaks down in the body to yield the purer calcium. A 500 mg calcium carbonate pill contains 40% calcium, and this 40% portion is referred to as elemental calcium.

Perhaps you already see the confusion. Say that your RDA is for 1500 mg of calcium. You go out and buy three 500 mg calcium carbonate. Do you have enough calcium to meet your dairy needs? Nope, sorry. RDAs are measures of elemental calcium. Your three calcium carbonate pills yielded only 600 mg of elemental calcium. You're not even to half your need. It's worse with other forms. Calcium citrate is only about 20% elemental calcium. You'd need twice as many same sized pills to equal the same calcium need.

Let's cut through the confusion. and go back to the question from the lady who wants to add another 500 mg calcium pills to the three she already takes that provide 1500 mg of calcium. She's buying 2000 mg of calcium, but only 800 mg of elemental calcium. A women over the age of 50 requires 1200 mg of elemental calcium. So she's not in danger of overdosing; she not even getting her full RDA from supplements, so she better hope that she is getting some extra calcium from milk or other foods.

Is she at risk for milk-acidity syndrome from that 2000 mg of calcium pills? Again, no. She would have to consume regularly 2000 mg of elemental calcium. That's 5000 mg of calcium carbonate pills. That's too much. Put a warning flag on taking ten pills a day.

The RDA is expressed in elemental calcium. The warning dose for milk-alkali syndrome is expressed in elemental calcium. But the package amount on a calcium supplement is a higher total amount, only 20-40% of which is elemental calcium. Confusion in a bottle.

The only good part of the confusion is that the way it's arranged, you're not likely to wind up taking too much calcium at any time. And unless you happen to have existing problems that can be made worse by excess calcium, hypercalcemia or milk-alkali syndrome are not high priority worries.

Get enough calcium. Watch your doses. And don't worry about exotic syndromes.

10 Tips on Lactose Intolerance

A good short summary of tips on LI from the British publication Pulse, written by gastroenterologists John Leeds and David Sanders. What follows is not the entire article, of course, but just the first sentences of each of the ten sections.

1. Lactose intolerance comes in many forms and each responds to different degrees of therapy.

2. Symptoms depend upon age and may mimic other conditions.

3. Secondary lactose intolerance is common.

4. Involvement of a dietitian may be helpful in preventing dietary imbalance.

5. Medications often contain lactose but not usually enough to cause symptoms.

6. Complete lactose withdrawal is not always needed.

7. Lactose intolerance is genetic and recessive.

8. A number of laboratory tests exist but none is 100% sensitive.

9. Treatment of primary lactose intolerance depends upon clinical symptoms.

10. Most patients can be diagnosed and treated in primary care.

Snakes Have Milk Allergies?!?

File this one under snake oil.

West Bengal's snake charmers close to starvation.

According to the World Wildlife Fund survey on the occasion of Nagpanchmi, some 70,000 snakes die of pneumonia, lung infection, sepsis and milk allergy.

Can this possibly be true? A CNN article has a longer explanation.

As a crowd pleaser, some snakes [because of a myth that they can drink milk] are fed milk and butter during festivals, which often makes the snakes ill.

The World Wildlife Fund says some 70,000 snakes annually die from milk allergy, pneumonia, lung infection and sepsis.

In August, hundreds of snakes, their mouths sewn shut and venom glands punctured, were confiscated by wildlife officials before a Bombay Hindu festival in which starving cobras and rock pythons are forced to drink milk.

Puncture wounds in their mouths can turn septic and kill snakes, and milk causes them to suffer digestive problems and possibly choke them when it fills their lungs.

The mechanism by which snakes suffer digestive problems from milk is not at all clear from even this article. What is obvious is that what they suffer from, given this ignorant and cruel treatment, is in no way a milk allergy. Why the World Wildlife Fund, which should know better, uses this term is beyond me.

Applying a human term that is of concern to parents to barbarous behavior that is not connected to that term does a disservice to everyone. I wonder if someone more knowledgeable about the animal world can help clear this up.

LäraBar, Gluten and Dairy-Free Energy Bars

Sarah Musgrave burbles ecstatically in the Montreal Gazette about an energy bar called the LäraBar, an dairy-free, gluten-free, vegan, kosher, energy bar with crunchy umlaut goodness.

The taste: I've avoided health bars ever since realizing the sesame snaps I was given as a child weren't really candy bars. But Larabar's lemon bar won me over; it's sweet, lively with citrus and there's a lot more chew than crunch.

The story: I first tried this snack in 2004, in Colorado, where the brand was founded, and instantly appreciated the flavour. Upon reading the ingredients, I was even more impressed: dates, cashews, almonds, lemon concentrate, and that's about it. It's uncooked, it's unsweetened, it's gluten-free, it's dairy-free, it's soy-free, it's vegan, it's kosher - sum it up as sinless.

LäraBars come in umpteen flavors and also have a chocolate bar counterpart, Jŏcalat.




Both bars are available in the U.S. as well as Canada and in many other countries, as a store locator on their website will reveal if you have the patience to go through it.

The website has one of the most evil Flash animation interfaces I've had the misfortune to encounter. Designers who perpetrate these atrocities should be strapped down in front an old Atari and forced to watch Frogger until their eyes bleed.

I found information for LäraBar and Jŏcalat on the Delicious Organics shopping site, where the have the old-fashioned idea of allowing you to see the product and read the text simultaneously.

Our Greatest Weapon is Fear...

Parents, do you like being scared out of your shoes for no good reason at all? What about guilt trips? Do you prefer to make your purchasing decisions based on how horrible you'd feel if something happened to your child, no matter than the product has nothing useful to offer? Do the latest buzzwords slide down your brainstem to lubricate the pathway to your wallet?

If so, then you are the target audience for the BabyBam Collection.

The rest of us may be forgiven if we take a pass.

I'll just quote the one relevant section here, although the entire press release has a rising gorge factor of ten.

As the number of infants with gluten, soy, and lactose intolerance rises each year - so do severe skin allergies. Our exceptionally soft onesies, pants, pajamas, and towels are naturally hypoallergenic, anti-microbial, moisture wicking and anti-bacterial thus preventing odor and skin irritations," added [BabyBam Collection CEO Jody Graziano] Jonas.

No indication exists that the number of infants with lactose intolerance is rising. Probably the opposite is true. Lactose tolerance is a dominant mutation. If you receive the gene from either one of your parents you will become lactose tolerant. The number of adults with lactose tolerance increases every year.

Very few babies are naturally lactose intolerant. Only the tiniest handful are born lactose intolerant. Most of humanity - that's the four billion or so of us who are lactose intolerant - do not lose the ability to digest lactose until after the age of weaning. Some babies do become temporarily lactose intolerant because their intestines are affected by common "stomach flus" - really gastrointestinal ailments - and a much smaller number are affected by more serious problems that damage the delicate lining in their intestines. Even if you add them all up, the vast majority of infants - more than 99% - are not and never will be lactose intolerant.

But let's say that all the lies are truth. Say that lactose intolerance is a scourge that is ravaging our precious children. Say that lactose intolerance is, despite all medical evidence, increasing rather than decreasing.

Even in that upside-down, Bizarro world, where day is night and sweet is sour, nothing - repeat, nothing - that you could put onto your infant would make one particle of difference. Lactose intolerance is not an allergy. It comes solely because of the lack of an intestinal enzyme, lactose. Contact with milk, milk products, or milk byproducts has never produced a single case of lactose intolerance in the history of humanity.

Using lactose intolerance to sell onesies is pure pig ignorant fear-mongering.

The only thing we have to fear is fear itself. True. Still true. Always true.

Do not let your fear, your guilt, your hopes or dreams or nightmares, start you down the path to acting irrationally, to blindly blunder down the pathway to darkness, to imagine feverishly that you can avert the doom peddled by the ignorant or the cynical or the heartless, by swallowing their snake oil.

Beer Not Better Than Milk and other obvious news.

PETA went more insane than usual for them back in 2000, when they tried to launch a "Got Beer?" campaign. Modern Brewery Age didn't find the endorsement helpful.

PETA argues that drinking beer is healthier than milk and that the daily industry is cruel to cows and calves.

Mothers Against Drunk Driving sent a letter last week asking PETA to pull the campaign for fear it will encourage underage drinking. Many college students are under the legal drinking age of 21.

"We're very concerned and appalled with it for the simple fact that underage drinking is the number one drug problem among American youths," said Teresa Hardt, a spokes-woman for the Irving, Texas-based group, whose mission includes the prevention of underage drinking.

The campaign also comes at a time when increased attention is being focused on binge drinking on college campuses.

"If PETA's misguided purpose is to denounce the dairy industry, they certainly aren't advancing their ball by advocating alcohol consumption by college students," said David Botkins, spokesman for Virginia Attorney General Mark L. Earley.

A spokesman said PETA will proceed with the campaign and that it does not promote underage or drunken driving.

PETA did not proceed with the campaign. The howls of outrage got it shut down almost instantly.

Never one to learn or apply common sense or good taste, PETA tried reviving the campaign in 2002. Jennifer Small at the Boston University newspaper had the sense to check the claim.

Regardless of what People for the Ethical Treatment of Animals (PETA) claims, beer does not "Do a body good," according to Boston University Clinical Assistant Professor Joan Salge-Blake.

Salge-Blake said low-fat milk or skim milk provides an excellent source of calcium and vitamin D, which are especially important for college students to consume as their bones continue to grow. She said while milk is a good source of protein and rich in nutrients, the same cannot be said about beer.

"There are no ways in which beer is healthier than milk," Salge-Blake said. ... "[Milk and beer] shouldn't even be compared," said Salge-Blake, who is also the Dietetic Internship Director. "They have nothing in common except that they are both liquids."

...

Salge-Blake responded to the statement, saying PETA was only comparing it using facts that were beneficial to their claim.

"PETA seems to be saying that because milk has some fat and beer has none means beer is better than milk," Salge-Blake said. "But beer is full of calories, and all calories in excess will make you gain weight; any time you consume more calories than you burn off, you will gain weight."

PETA was lying through its vegan teeth, as always.

That campaign was equally short-lived. No matter how much college students might want the support of an argument that beer is good them them, or, minimally, better than milk for them, nobody can take such nonsense seriously.

They don't stop trying, though. Mike Simeone, of the Anchor, Rhode Island College's Student Run Newspaper, trots out many of the same flawed arguments in Beer Good for You?

According to Lisa Dorfman, MS, RD, CSSD, LMHC, a certified Sports Nutrition Expert and Sports Nutritionist at the University of Miami (FLA) , "Beer is sort of like a food drink because it's so filling. It's like bread because it's starchy and high in carbohydrates. Drinking 12 ounces of beer is the equivalent of eating two slices of bread, and the carbohydrates in beer, like those in bread, are used as an energy source for the brain, the blood and the muscles."

Beer can be considered a "food drink" because of the ingredients in it. Water makes up around 90 percent of beer. Barley is another component. It is a basic cereal grain which is malted. Malted means that a grain is brought to its highest point of possible soluble starch content by allowing it to germinate. Hops are an important ingredient. Hops come from the flowering hop vine and are used as a preservative. They are also used for their essential oils that add flavor (bittering hops) and aroma (aroma hops) to balance the sweetness of the malt. Finally, there is the yeast. This is the most essential part of beer because the yeast turns the sugars into alcohol.

These grains in beer can help protect you against osteoporosis and heart disease. Drinking a pint of beer can be substituted for a glass of milk. This is a boon for those who are lactose intolerant as they've found an alternative source of their milk vitamins as the ingredients in beer can help strengthen bones.

Simeone backs off from this argument later in the article when he notes that the only real science that exists makes the far more mild claim that non-drinkers have less chance to develop heart failure. This almost certainly comes from other life-style factors than the alcohol in beer, however.

And that's the bottom line. No matter how it's phrased that beer drinking in moderation is a pleasant activity that is associated with moderation in other forms of activity, beer contains alcohol and it it consumed primarily to feel the effects of that alcohol. Beer can never be confused with a healthy drink, nor does it ever come out on top of milk when the full run of nutrients are compared.

Never listen to PETA, never believe PETA, never support PETA. They are an embarrassment to vegans.

Arico Gluten-Free, Casein-Free Cookies

I found another vendor of gluten-free, dairy-free, everything natural, even Kosher-certified snacks, Arico Foods. (Not vegan, though, because they contain eggs.) They use brown rice quinoa flour in place of wheat.

Arico says about itself:

Arico Products are free of: gluten, wheat, casein, dairy, trans fat, refined sugars, preservatives and colorings.

They have three lines.

Arico gluten-free casein-free healthy bars are available in four flavors: Almond Cranberry, Chocolate Chunk, Double Chocolate, and Peanut Butter. Each sleeve of Arico Bars contains twelve individually wrapped 1.4 oz cookie bars, made for the grab-and-go convenience. Arico: ingredients for mindful snacking.

Each of Arico gluten-free casein-free family-pack of cookies weighs 4.8 oz. Order is per case, and each case contains six family-packs. The re-closable pack ensures freshness and highest quality before and after opening. Arico: ingredients for mindful snacking.

Arico gluten-free casein-free cassava chips are available in four flavors: Original, Sea Salt Mist, Barbeque, and Ginger on Fire. Each case of Arico Cassava Chips contains twelve 5 Oz. bags. Originally consumed in ancient South American civilizations, cassava is a root plant that grows like potato. From the Amazon basin, its cultivation spread to greater Latin America, Asia, and Africa thousands of years ago. Today, cassava is a staple food consumed by more than 500 million around the world. With twice the fiber and 40% less fat than the leading potato chips, Arico Cassava Chips offer a light, crispy addictive crunch that will delight your senses.

UK's National Health Service's New Food Allergy Symptom Checker

Over the last year, the UK has been to me what President Bush is to late-night comics: a continuing source of fodder for jokes and head-slapping. At any given time, it seems that half the population thinks it wrongly suffers from food allergies, is guzzling goat milk to prevent the symptoms of lactose intolerance, is getting bad advice from doctors, or is censoring those who are reporting on the quackery.

Now the government is finally stepping in, trying to put an end to some of this nonsense. I'll take the hit in material if it will do some good.

NHS Choices (www.nhs.uk), the online 'front door' to the NHS, launches a new interactive tool aimed to help people better understand the difference between food allergies and intolerances.

Based on NHS accredited information, the food allergy symptom checker (www.nhs.uk/Tools/Pages/FoodTool.aspx) enables users to find out in seconds whether they have either a food allergy or intolerance, and provides them with clinically approved guidance to help them improve their health. This interactive tool is the latest addition to the NHS Choices' extensive tool library.

"This interactive tool has been created with users in mind and is a valuable addition to the health resources being made available to the public by the NHS Choices," said a spokesman. "It puts patients in the driving seat by giving them exactly the sort of reliable and dependable information they need to take control of their health at the click of a mouse."

NHS Choices is the online information service of the NHS that gives ordinary people the tools to make better, more informed choices about their treatments, health and wellbeing. It includes more than 80,000 pages of content, including video, interactive tools, a daily news service and lifestyle features. Users can also check and compare hospital and doctor's profiles and performance on-line.

New Kids' Allergies DVDs from FAAN

First parents had no tools to help their children learn how to cope with food allergies, then we progressed to books. This, in a world in which Sesame Street is so old that it's earliest programs can't be shown to kids today (because they contain material that's considered too dangerous! And just in case you think I'm kidding, Sesame Street... For Adults Only?).

Why not animation and DVDs?

Apparently, that's what FAAN, the Food Allergy & Anaphylaxis Network, thought. Well, to be fair, the first Alexander the Elephant Who Couldn't Eat Peanuts video came out a full ten years ago, and spawned (can elephants spawn?) an empire of 13 books which now are leading back to more videos. On DVDs. Of course there's a press release.

The Food Allergy & Anaphylaxis Network (FAAN) is proud to announce the release of two animated DVDs that both entertain and educate children about food allergies. Alexander, the Elephant Who Couldn't Eat Peanuts ... Goes to School and Alexander, the Elephant Who Couldn't Eat Peanuts ... Gets a Babysitter help children cope with their own allergies and teach other children about tolerance. Both videos combine colorful animation with interviews of real-life children with food allergies who talk about their experiences. ...

Alexander the Elephant Who Couldn't Eat Peanuts ... Goes to School is designed to make it easier for them. Alexander faces his first day of kindergarten with trepidation, but thanks to his bus driver, Mariel, who also has an allergy, he is encouraged to tell his new classmates about his peanut allergy. As he makes his presentation to the class, he discovers that his new friends not only accept his condition, but also are eager to learn about it and help him stay safe.

Alexander, the Elephant Who Couldn't Eat Peanuts ... Gets a Babysitter deals with a common worry that children with food allergies face: being left in the care of someone other than their parents. They are anxious about whether someone else can keep them safe from harmful foods and will know what to do in an emergency. Alex discovers just how much fun having a babysitter can be after his parents teach her all about his food allergies.

...

The original and current Alexander DVDs are produced by Susan Leavitt of Time Frame Productions, Inc., who has produced all of FAAN's educational videos. The animators are Bill and Colleen Davis of Artbear Pigmation, who have worked on projects for Sesame Street, Reading Rainbow, and Nickelodeon, among many other clients. The newly released DVDs were funded by an educational grant from Triad Foundation. Alexander DVDs can be ordered at www.foodallergy.org or (800) 929-4040.

Tricked-Out Nog

This is so weird I had to share it.

Erin Hartigan wrote about hot winter drinks in the USA Weekend magazine supplement.

The first sentence ought to be enough to warn you:

"Hot booze hits you quicker and gets into every nerve," says David Wondrich, author of Imbibe!

So I really shouldn't have been surprised when I got down to "Milky drinks are warming but heavy." Heavy? Heavier than what? Heavier than... almond milk? Really? And heavier than cognac mixed with... Well, I'll let you read it for yourself. You wouldn't believe me.

"We create a guilt-free noggish drink, the Chai Almond Zoom," [cocktail caterer and bar consultant Christy] Pope says. It has cognac or rum plus chai tea and almond milk. "It's dairy-free but incorporates wintry spices, like cardamom and cinnamon, to really warm you." Faux-nogs also can be made with other flavors. "Any flavor you like to eat can become [or infuse] a liquid form," [Eben Freeman of New York City's Tailor restaurant and bar] says. "Add [a chunk of] fruitcake to cognac. Find your most unusual, personal food memory or preference and infuse it."

A step back to the planet of reality for a moment. Alcohol is not warming, it is faux-warming. It dilates the blood vessels, which makes you feel temporarily warmer but also has the effect of causing you to lose heat more quickly.

Cognac and rum are intoxicants. Adding almond milk to them instead of cow's milk doesn't lessen any guilt for any aftereffects.

I'm not a teetotaler, and I won't guilt-trip you for drinking alcohol. As long as it's done in moderation. And without ridiculous anti-scientific rationales for its consumption. And free of fruitcake.

Soluble Calcium Supplement

Steve Ford writes in the UK Nursing Times that a soluble calcium supplement, a calcium supplement that comes in dissolving tablet form rather than as a hard pill, is now available in the British market.

A widely prescribed calcium and vitamin D supplement has been made available in a new dissolvable formulation.

Adcal-D3 Dissolve is indicated as an adjunct to specific therapy for osteoporosis and in situations requiring therapeutic supplementation of malnutrition.

It is available in handy tubes containing 14 effervescent tablets. Four tubes will be packaged together at a basic NHS price of £4.99.

Calcium tablets were known in the past to have poor dissolving abilities. They also passed into the bloodstream from the intestines in lower than optimal dosages. Many articles have been written over whether calcium citrate absorbed better than calcium lactate or calcium carbonate, for example.

Most tablets are better today and standard calcium carbonate tablets are so cheap and come in such large doses that they should be effective for most. Many pills are also chewable, including pills such as Tums, which is mostly calcium.

However, getting the calcium into liquid before it hits the stomach would help those, especially the elderly, who have more difficulty getting calcium to absorb properly. That's why the effervescing pills (i.e., pills like Alka Seltzer tablets) would be helpful.

I've also found some liquid calcium solutions in the U.S., although I don't know anything about them or their usefulness.

One potential warning. A New Zealand study of elderly women (Bolland MJ, Barber PA, Doughty RN, et al. "Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial." BMJ 2008; DOI:10.1136/bmj.39440.525752.BE. www.bmj.com) found - to the utter shock and consternation of the doctors involved - that "cardiovascular events over five years: death, sudden death, MI, angina, other chest pain, stroke, transient ischemic attack, and a composite end point of MI, stroke, or sudden death" appeared to increase in the group given calcium supplements. When other factors were added in, however, the differences were less pronounced. The study included only 61 women given the calcium supplements, which were given in a higher dose and for a longer time. In addition, at an average age of 74 the women were much older than the usual group studied. For all these reasons, none of the doctors is considering this a definitive study. However, if you are elderly and at a risk for a cardiovascular event, talk to your doctor before starting on a soluble calcium supplement.

PetsHotel and the Dairy-Free Breakfast

The hundredth PetsHotel is about to open. It needs more fanfare than that. The 100th PetSmart PetsHotel with Doggy Day Camp will open in late February or early March.

Does your pet cuddle up with you at bedtime? Do you sign your pet's name on holiday cards? Or do you just love your pet like a family member? At PetSmart, we understand your special bond because we're pet parents, too. That's why we created PetSmart PetsHotel - a revolutionary alternative in day and overnight care.

Growing by 35 hotels a year, to go with the 1000 PetSmart stores, the company is a billion dollar business. A billion dollars every quarter. The New York Times reporter Juston Jones interviewed Philip L. Francis, the chairman and chief executive of PetSmart, to see what special care the doggies get.

We have a morning snack, which is dairy-free frozen yogurt. An afternoon Yappy Hour. We’re testing what we refer to as Pawsidential services, which can include bedtime stories, belly rubs and other services that allow pet guests added one-on-one time with our associates.

An Unanswered Question May Be Answered

Tucked away in a far back corner of my website, Steve Carper's Lactose Intolerance Clearinghouse is a page that I forgot I had. Well, we don't like to forget our failures, do we? It was called Questions Even I Couldn't Answer.

I'm not alone. Columnists from Dear Abby to Dan Savage pile up questions that are so off the wall that no good answer is possible. A fun column can always be had on a slow day by simply reprinting them.

Like I said, I had almost forgotten about the page until I came across a newspaper article that triggered an inch in my head. Wasn't I asked a question something like this once? Turns out I had. Here was the original question.

Q. I have noticed over the years that the severity of my LI waxes and wanes with the amount of physical activity I do. I recently started working out 4-5 days a week and noticed about a week or so afterward that the LI was "gone". I also noticed this several years ago when I was cycling about 20-25 miles a day for 4-5 days a week. Have there been any studies linking physical activity to a significant reduction in LI?

My original answer had to be, no. Nobody's ever done a study to see if anything outside normal digestion is implicated in LI.

Allergies may be a different story. An unsigned article in the Tamil Star, What is exercise-induced food allergy? starts with this tantalizing paragraph.

Exercise can induce an allergic reaction to food. The usual scenario is that of a person eating a specific food, and then exercising. As he exercises and his body temperature increases, he begins to itch, gets lightheaded, and soon develops the characteristic allergic reactions of hives, asthma, abdominal symptoms, and even anaphylaxis. The cure, actually a preventive measure, for exercise-induced food allergy is simple-not eating for at least two hours before exercising.

No cites, no studies, no doctors quoted.

Tantalizing, though. And unproven.

Answers to Questions from Readers, part 14

Q. Can lactose intolerance in children cause behavioral problems in children if left undetected?

Only two small possible problems. Truly undetected LI may result in your child's having what is politely called "anal leakage." Once you know about LI, however, you should be able to avoid this by either keeping your child away from large amounts of milk or by making sure you keep lactase pills available at all times. If children do stay away from milk, there is always the "different child" syndrome, in which they dislike not being like everybody else. This is usually not a major problem; children with milk allergies, who must be many times more cautious about milk than anyone with LI, soon learn how to cope.

Q. It seems that I can't digest anything high in carbohydrates without extreme LI symptoms. Is there lactose in spaghetti? potatoes? biscuits? bread? cake?

There can be - and most likely is - lactose in biscuits, breads, and cake, (although definitely not in spaghetti and potatoes unless it's added in cooking) but that's probably totally besides the point. Lactose and most other carbohydrates share one trait in common: they must be broken down into simpler sugars by digestive enzymes. Usually the lactase enzyme that digests lactose is the only one missing, but that does not have to be the case. And in fact the inability to digest carbohydrates may be an indication of a more serious underlying problem. I would advise you to talk to your doctor about this and see if testing needs to be done.

Q. Is "Lecithin" a lactose milk product? It seems as if it is derived from a Latin root word for milk, and therefore I am afraid to eat anything containing it without taking a lactase tablet.

My dictionary shows it as coming from the Greek for egg yolk, which is quite correct. It has nothing to do with milk.

Q. I keep seeing ingredients like malted barley, malted this and malted that. I used to drink malts and malted milk when I was young. Is there any kind of milk in "malt"?

The only milk in malted milk is in the milk. Any malt by itself should be milk-free. And "malted" barley or any grain merely means sprouted grain.

I Like Food, Food Tastes Good

If there's a candidate for the group with the worst eating habits in existence, touring rock bands would seem to be right up there with the guy who eats whole bicycles.

Guess I'm wrong, though. Modern indie bands talk the talk and eat the eats, making mostly vegetarian or vegan delicacies even while on the road.


Who knew? Kara Zuaro. She started collecting recipes for the awesomely titled I Like Food, Food Tastes Good: In the Kitchen with Your Favorite Bands after interviewing Death Cab for Cutie and discovering their vegan sausage and peanut butter sandwich. Some were upscale (Patrick Phelan's Swanky Mac N Cheese, featuring lobster and white truffles); some were weird (a combination of onions, peppers, cheese, eggs and refried beans that Silkworm calls a Cheesy Sleazy); some are indescribable (because they don't make sense even when described: NOFX's El Hefe says "make some mac and cheese, then mix in a can of nelly chilly ... word). Zuaro wrote the recipes in the musicians' voices, so your tolerance may be limited if you're like, you know, an adult.

Maybe this is a book to offer to your college-aged kid, to get them to cook something healthier than take-out and ramen (although Strung Out's Rock 'N' Ramen secret is using two Ramen flavors). As you would expect, the recipes are mostly pretty simple and straightforward (there's one for a bologna sandwich).

I started out married life depending on a cooking for college kids cookbook and it helped almost every day. I Like Food, Food Tastes Good may not be the only cookbook to rely on but if it gets read all the way through, that's got to be a good thing.

Don't Neglect Calcium on GFCF Diet

Many parents of autistic children have tried removing the wheat protein gluten and the dairy protein casein from their food, known as the GFCF (gluten-free, casein-free) Diet. Whether the positive results are anecdotal, real, or false hopes are not yet known, as I wrote about in Gluten-Free, Casein-Free Diet for Autistic Children Still Controversial. The results of a major five-year study on the GFCF Diet should be out later this year.

In the meantime, the National Institutes of Health (NIH) has also been conducting a major study, along with the Cincinnati Children's Hospital Medical Center. A preliminary finding is so serious that the NIH announced early results even before the full study is released. Thin Bones Seen In Boys with Autism and Autism Spectrum Disorder.

The researchers believe that boys with autism and ASD are at risk for poor bone development for a number of reasons. These factors are lack of exercise, a reluctance to eat a varied diet, lack of vitamin D, digestive problems, and diets that exclude casein, a protein found in milk and milk products. Dairy products provide a significant source of calcium and vitamin D. Casein-free diets are a controversial treatment thought by some to lessen the symptoms of autism. ...

"Our results suggest that children with autism and autism spectrum disorder may be at risk for calcium and vitamin D deficiencies," Dr. Hediger said. "Parents of these children may wish to include a dietitian in their children's health care team, to ensure that they receive a balanced diet."

It's important to note that only nine boys were part of this study. Too few girls have autism to provide any good candidates for it.

Parents of children with autism know that their children are often picky eaters at the best of times, so getting them to eat calcium-rich foods that don't contain dairy may be a continuing issue. Digestive problems also are common in autistic children and that may play a role in the non-absorption of calcium.

The researchers do not know for certain why the boys had thinner than normal bones. A possible explanation is lack of calcium and vitamin D in their diets. Dr. Hediger explained that a deficiency of these important nutrients in the boys' diets could result from a variety of causes. Many children with autism, she said, have aversions to certain foods. Some will insist on eating the same foods nearly every day, to the exclusion of other foods. So while they may consume enough calories to meet their needs — or even more calories than they need — they may lack certain nutrients, like calcium and vitamin D.

Other children with autism may have digestive problems which interfere with the absorption of nutrients. Moreover, many children with autism remain indoors because they require supervision during outdoor activity. Lack of exercise hinders proper bone development, she said. Similarly, if children remain indoors and are not exposed to sunlight, they may not make enough vitamin D, which is needed to process calcium into bones.

Parents should not simply remove foods from a child's diet without working with a physician, nutritionist, or dietitian to ensure that the remaining foods give a full spectrum of all essential nutrients.

General information about autism may be found on the site of the National Institute of Child Health and Human Development.

Vegan Super Bowl Treats

C'mon. I know you really watch the Super Bowl just for the ads. That leaves oodles of time for eating while watching grown men fall down a lot.

I've scouted out a range of vegan treats (some that call for optional cheese for the vegetarians) that are less filling, but taste great. Or something like that.

Gail's Sugar Cookies must be good because they're reprinted all over the internet.

VegCooking.com has a full menu of goodies, including Flaming Firehouse Chili, 'Chili-Cheese' Fries, Greektown Pizza, Seven-Layer Mexican Dip, Kickoff Chick’n, Halftime Hero Sandwiches, and Fireballs.

Another full slate comes from Alison Tyler at Suite101.com. Red, Gold, Black and Green Chili, Honolulu Skillet Beans, Crispy Black Bean Corn Cakes, Giant Chocolate-Toffee Cookies, and a variety of dips and spreads.

Need some romance after a long day of being tube-glued? Try the vegan Amaretto-spiked chocolate mousse at MyVegetarianRecipeoftheDay.com.

Or just save all these for those huge blow-out Pro Bowl bash that will be blitzing you before you realize it.

LI Celebrity Alert: Bubble Buddy

OK, I'm doing my homework by reading all the stories that roll across the newspapers of the world that contain the word "lactose." I do this because you have better things to do with your time.

And I run across this essay by Lori Holcomb in the Wilmington News-Journal.

Then there is the “black-toast incident,” as it has become known our family. Conner loves Sponge Bob, much to the dismay of pretty much all the adults in his life. However, certain events occasionally make the nuisance worthwhile. One day, he apparently heard Sponge Bob tell how he was lactose intolerant. He related that fact the best way he could to what he knew in his little world, filed it away and went on.

Hold the presses! SpongeBob SquarePants is lactose intolerant? That's great news! Most characters in television or movies or cartoons who are lactose intolerant are secondary characters who are there just to be made fun of. Giving the lead character our little affliction, and not just any lead character, but a lead character that is an international superstar, would be wonderful.

But if it's so wonderful, how come I never heard this before?

The essence of Holcomb's essay is that her kids are weird alien creatures whose world that she doesn't truly understand. The giveaway is that she can't even spell SpongeBob correctly.

You guessed it. The lactose intolerant character on the show isn't SpongeBob, but Bubble Buddy, a comic sidekick.

To glean the backstory, I went to the font of all things SpongeBob, SpongeBob Wiki, in which adults can plumb the depths of our cheese-avoiding pal. (Yes, really. A SpongeBob Wiki. And there's also a Spongepedia. And a Spongywiki. Think about that. And Lori Holcomb is a newspaper columnist who can't spell the name correctly. That about that, too.)

Bubble Buddy - is a sentient soap bubble created by SpongeBob when he felt alone in the episode, "Bubble Buddy." He comes to life at the end of the episode when Squidward and other Bikini Bottomites threaten to pop him with a needle. A taxi picks him up and he leaves with a suitcase and disappears in the sky. He also appears in the video game Battle for Bikini Bottom, teaching SpongeBob new bubble moves. Bubble Buddy likes bendy straws, funny jokes, and shampoo. He is very picky about his Krabby Patties. He likes no cheese, no crust, pickles to the left, four squirts of ketchup, wheat buns, non-deli lettuce, and farm raised tomatoes; carnival style. He is lactose intolerant, and is naturally nervous around pointy objects. His birthday is October 9. Bubble Buddy is also known for taking a long time to use the bathroom.

He's noted for taking a long time to use the bathroom. How humiliating. For all of us.

Restaurants Get "How-To" Food Allergy Manual

Back when I first discovered I had lactose intolerance, restaurants became a nightmare. Remember that this was before lactase pills existed, and also before I really understood how much lactose was in various foods. I treated lactose-containing dairy products the way people with dairy allergies today treat them: I avoided them entirely.

Since nobody who worked in a restaurant had ever heard of lactose intolerance or dairy allergies back them, the idea that someone might ask if milk or butter or cheese might be in a dish threw them entirely. Bread? You want to know if there's milk in the bread? How many kinds of weirdo are you?

Today life's much easier. Everybody's heard of lactose intolerance and dairy allergies - and those pesky vegans - but it's still almost impossible to find out if there's dairy in the bread. (Uh, it comes in frozen from headquarters and we're not allowed to ask for the secret recipe.)

What restaurants need is a simple, basic, easy-to-understand set of instructions for What To Do About Allergy Ingredients. Maybe in booklet form. Call it a manual.

Apparently, the AQAA, the Quebec Food Allergy Association (isn't that QFAA?; no, you think Quebeckers would use English initials instead of French?), has come up with exactly that.

The Quebec Food Allergy Association introduces: The "Food Allergy Management Manual for Restaurants and Food Services"!

MONTREAL, Feb. 1 /CNW Telbec/ - It is with pride that Lyne Gosselin, co-Chair of the Board of the AQAA, invites members of the media to the official launch of the "Food Allergy Management Manual for Restaurants and Food Services", to be held during a press conference scheduled for 11 a.m., Monday, February 4 in Room 8 (exhibition area) of Montreal's Place Bonaventure. Finally, a manual that covers every aspect of this issue and provides concrete, practical tools for the management of food allergies by restaurants and food services.

This event will be attended by Chantal de Montigny, dietician/nutritionist and author of the manual; Michelle-Jamali Paquette, Political Consultant of the Minister Philippe Couillard; Joanne Twigg, Regional Director, Food Directorate, Bureau of the Minister Laurent Lessard; Paul-Guy Duhamel, General Manager of the AQAA; Samuel Benrejeb Godefroy, Ph.D., Director, Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada; Richard Mainville, General Manager of the HRSA, as well as the Executive Chef of the Fairmont Montebello, Serge Jost, and Pierre Moreau, Vice-President, Sales and Restaurants at Rôtisseries
St-Hubert, who will share their experience with regards to the application of the 2004 edition.

Let's hope that this version of the manual turns out to be such a good idea that restaurant associations everywhere decide to copy their example.