The Different Types of Dairy Allergy

Allergy. Hypersensitivity. Which one affects you or your family? How do you distinguish between them?

I took a stab at answering this in a simple way on my web site with Lactose Intolerance versus Milk Allergy.

I know that some of you want a deeper insight on the way the body works. Fortunately, a recent dissertation has addressed this question in depth.

It's MILK HYPERSENSITIVITY
Effects of Cow’s Milk and its Processing on Gastrointestinal
Symptoms and Delayed-Type Immune Responses,by Laura Paajanen.

The dissertation is a huge (83-page) .pdf file, so those with slow connections should be warned that it might be a long download.

The background information on allergies and intolerances is more important for readers than the study itself, so that should cut down on a lot of reading.

One part that I particularly want to highlight is the section on types of allergies. There are four major types, although just two are ones you normally have to worry about, true allergies and hypersensitivities. Paajanen writes:

Allergic reactions are traditionally classified under four types of hypersensitivity reaction which may lead to tissue damage, as described by Coombs and Gell (see Britton 2002, Hay & Westwood 2002, Male 2002, Platts-Mills 2002). It is not clear whether all four types of reaction are involved in the pathogenesis of food allergy, either in the gut itself or in remote organs. More than one mechanism may be involved in any allergic reaction, but the most plausible mechanisms are IgE-mediated reactions (Type I), and the non-IgE-mediated activation of T lymphocytes (Type IV): allergies may be exclusively IgE-mediated, partially IgEmediated or exclusively cell-mediated (Sampson 2001).

Type I, immediate anaphylactic hypersensitivity is characterised by the production of IgE antibodies against foreign proteins (Platts-Mills 2002). IgE antibodies bind to high-affinity Fc_RI receptors on mast cells and basophils. When an allergen binds between two IgE antibodies, it induces degranulation of a mast cell/basophil, which leads to the rapid release of histamine and the more gradual release of other mediators such as leukotrienes and cytokines. The combined effect of these agents is to constrict smooth muscle, dilate capillaries and induce cell infiltration. This mechanism underlies the common problem of atopic allergy….

Type IV, delayed cell-mediated hypersensitivity reactions take more than 12 hours to develop (Britton 2002). T cells identify antigens, and the antigen-sensitised T cells produce cytokines and other soluble factors which mediate the hypersensitivity reaction, or else they develop cytotoxicity. Th cell-activated macrophages destroy intracellular bacteria by releasing inflammatory mediators. Activated cytotoxic T cells and natural killer cells destroy virus-infected cells and transformed human cells, i.e. cancer cells and tissue transplants. Tissue damage occurs as a result of persistent antigenic stimulation, either because of continuing infection or because of autoimmunisation. Type IV hypersensitivity has been classified under three varieties: contact hypersensitivity and tuberculin-type hypersensitivity, which both occur within 3 days of a challenge; and granulomatous hypersensitivity reactions, which develop over a period of 21-28 days and are clinically the most serious of the Type IV responses. More than one type of delayed hypersensitivity may follow a single antigenic challenge, and reactions may overlap.

One other section is also a must read.

3.1 Different types of cow’s milk allergy
CMA before school age

CMA is usually the first major food allergy, since cow’s milk rpoteins are the first source of foreign antigens massively ingested in infancy. In several large clinical trials, the cumulative prevalence of allergy to cow’s milk has been approximately 2-3% during the first years of life in the general population (Jakobsson & Lindberg 1979, Hide & Guyer 1983, Bock 1987, Høst & Halken 1990, Schrander et al. 1993, Saarinen et al. 1999). In atopic infants, however, the prevalence is up to 50% (Sampson & McCaskill 1985, Isolauri & Turjanmaa 1996, Niggemann et al. 1999). CMA has been reported even in exclusively breast-fed infants (Høst et al. 1988, Isolauri et al. 1999, Järvinen et al. 1999, Österlund et al. 2004a). The majority of paediatric patients have symptoms from two or more organ systems: approximately 50-60% have cutaneous, 50-60% gastrointestinal and 20-30% respiratory symptoms (Høst 2002). In exclusively breast-fed infants with CMA, severe atopic eczema is a predominant symptom. In infants under the age of one year, CMA is reportedly IgE-mediated in 57-64% of the cases (Vanto et al. 1999, Saarinen & Savilahti 2000). The overall prognosis of CMA in infancy is good, with a remission rate of 85 or 90% by 3 years of age (Høst & Halken 1990, Høst 2002), non-IgE-mediated reactions being the quickest to recover (Vanto et
al. 2004)….

CMA in school-aged children and adults

In most textbooks CMA is considered to be rare in adults. Only a restricted number of studies on the immunological mechanisms of adult CMA exist, supported by either double-blind, placebo controlled milk challenges or the open challenge procedure (Nørgaard & Bindslev-Jensen 1992, Nørgaard et al. 1995, Bengtsson et al. 1996b, Bengtsson et al. 1996a, Bengtsson et al. 1997, Werfel et al. 1997, Little et al. 1998, Ulanova et al. 2000, Lin et al. 2002, Magnusson et al. 2003). In recent years recovery from CMA has become a subject of controversy. Compared to the mainly IgE-mediated CMA of infants and small children, a new form of delayed-type gastrointestinal cow’s milk hypersensitivity, also known as cow’s milk sensitive enteropathy, has been described in school-aged children and adults, and it may be more common than previously thought (Bengtsson et al. 1996b, Bengtsson et al. 1996a, Bengtsson et al. 1997, Pelto et al. 1998, Pelto et al. 1999, Ulanova et al. 2000, Kokkonen et al. 2001a, Lin et al. 2002, Magnusson et al. 2003, Kokkonen et al. 2004). After childhood, reactions to milk are rarely IgE-mediated, and virtually only case reports of IgE-mediated CMA in adults exist. In one study, only 10% of the children with CMA in childhood had IgE-mediated reactions to milk protein at school age; however, half the children still reported gastrointestinal symptoms related to the ingestion of cow’s milk protein (Kokkonen et al. 2001a).

As for diagnosing allergies in infants and children:

In young infants, open controlled challenges have been shown to be reliable when performed under professional observation in a hospital (Høst & Halken 1990, Niggemann et al. 1994, Isolauri & Turjanmaa 1996). In children over 1-2 years of age and in adults, the double-blind placebo controlled food challenge is considered the gold standard for exclusion of psychological or causal reactions (Høst & Halken 1990, Niggemann et al. 1994), but is often too laborious in clinical work (Kaila et al. 2000). In patients with delayed reactions, a placebo-controlled food challenge would be the best method of diagnosis (Bindslev-Jensen et al. 2004), but this is often not practical in clinical work. In adults in particular it may be difficult to distinguish gastrointestinal allergies from other gastrointestinal symptoms such as those of lactose intolerance or irritable bowel syndrome.

In early infancy and especially in breast-fed infants who develop immediate reactions to cow’s milk, the presence of a specific elevation of IgE antibodies to cow’s milk or a skin prick test for cow’s milk may have diagnostic value. According to reports, the specificity of the skin prick test varies greatly, from 50 to 99%, and sensitivity, from 14 to 78%, when the cut-off size of the wheal diameter is set at 3 mm (Majamaa et al. 1999a, Vanto et al. 1999, Roehr et al. 2001, Saarinen et al. 2001, Strömberg 2002, Rancé 2004). In these particular studies, the atopy patch test was found to have better specificity (71 to 100%), especially in patients with skin symptoms, but its sensitivity for identifying all the disease cases was comparatively low (from 26 to 89%). When quantitatively assessed by the CAP System FEIA, cow’s milk specific IgE antibody titres of over 32 kU/l have been reported to predict IgE-mediated CMA with as high as 95% certainty in atopic patients (Sampson & Ho 1997). However, this finding was not supported by a recent study in which much higher cow’s milk-specific IgE titres (88.8 kU/l) were needed for predicting CMA with 90% probability, and the authors concluded that no meaningful predictive decision point could be calculated for predicting CMA (Celik-Bilgili et al. 2005). Skin tests are rarely useful in adults (Nørgaard & Bindslev-Jensen 1992). Increased IgA and IgG milk antibodies are not diagnostic, but merely a sign that milk has been ingested. Basophil histamine release is more frequently measured in other food allergies (Hansen et al. 2003, Østerballe et al. 2003) than in CMA (Prahl et al. 1988), and has not usually been found to be more predictive than skin prick testing or milk-specific IgE testing.

There's much more to read as well. It's a fine summary of the literature for anybody who wants more than the "allergy lite" you usually get online.

Holy Cow!

One of the silliest arguments against drinking milk is that it's somehow "unnatural," as if all the other forms of food that humans eat - and that's virtually every plant and animal in the world - are somehow designed for human consumption.

But humans have been using cows, along with all the other major domesticated milkable animals, as a food source for thousands of years.

Recently, archaeologists have found in Gohar Tepe, in the Mazandaran province in Iran, statues of cows that are at least 3000 years old, indicating that cows were being worshipped even then.


According to the Cultural Heritage News Agency, Ali Mahforouzi, head of the excavation team, said:

Some cow statues have been discovered in the archaeological excavations of Gohar Tepe, one of which is left almost intact. These sculptures which are in shape of rhytons were being used in religious ceremonies....

The statue in the picture is the only one found intact. It's about 12 inches long, 4 inches high, and 5 inches wide. It's technically known as a rhyton, which are usually used in religious places. This one shows artistic mastery.

Civilization came to this region some 5000 years ago. They understood the value of cows and their milk for those who could drink it. How have we fallen behind them?

I'm Back

Hope you didn't get worried about me because I didn't post for a while.

Nothing happened, but I did have to go out of town unexpectedly.

While I get my thoughts together for a big post, I'll put up some older stuff I had put away for a rainy day.

McDonald's Sued Over Fries Announcement

Oh, c'mon, you knew it was going to happen the second you saw the original announcement that McDonald's had hidden dairy and wheat derivatives in its fries.

And of course the lawsuits are now coming in from all over the country. The AP reports that suits have been filed in Illinois, Florida, and California.

However, only one of the lawsuits alleges that anyone got sick as a result of eating the fries, and that was a five-year-old with gluten intolerance. I have not seen any indication that anyone with a cow's milk protein allergy ever became ill.

It's early yet, though. No doubt some federal judge will put these into a class-action lawsuit somewhere down the line. At that time we'll find out a lot more info about what was in those fries and whether they ever held any danger for the milk allergic.

MTK, as they say in the news biz. More to come.

Wonder Bread Has Dairy? It Does! It Doesn't! It Will!

Whenever you think the world has gone beyond bonkers, someone in Corporate America will come along and kick it up another notch.

Take Wonder Bread. Good old-fashioned Wonder Bread, so ingrained in American lore that a spokesperson for the company issued a statement assuring folks that its new Wonder Bread with whole grains would still roll up into little balls for lunchroom food fights. Dairy-free Wonder Bread, which managed to build bodies 12 ways without using any milk for the last decade. That Wonder Bread.

The one that now complies with the new Food Labeling Law by listing a warning that it contains milk. But doesn't contain milk.

You read that right. There's a milk warning on a product that contains no milk.

Why? Because at some point in the future, Wonder Bread will change its recipe to include whey, a milk product. When? Oh, maybe later this year.

"Our customers are best served - and the spirit of the FDA regulations is best served - by changing the labeling on a schedule that ensures that consumers have the information they need," said Theresa Cogswell, vice president of research and development of parent company Interstate Bakeries Corp.

That's nice of them, and extremely civic minded.

Only one problem.

It's not currently true. They are deliberately mislabeling their product.

"The regulations state that the packaging has to be truthful and not misleading," [FDA spokeswoman Kimberly] Rawlings said. "The label should reflect the contents of the package."

So is this fraud? Probably not, but mostly because the FDA never even considered the possibility that somebody would start putting on a warning before the product was even added.

Wonder Bread. Teaching people not to trust ingredients labels since 2006.

Excuse me while I go off in a corner and babble quietly to myself.

We Hit the Quarter Million Mark

I started Steve Carper Lactose Intolerance Clearinghouse in the early days of the web, in 1997, as a way to continually update the information in my then newly published book Milk Is Not for Every Body: Living with Lactose Intolerance.

It started as no more than a few pages created in Word, before I had learned even basic HTML. I knew from the beginning, though, that I wanted to a way to get as much info from others and share it as widely as I could. That's why I named it a Clearinghouse.

Clearinghouse it's been. Dozens, if not hundreds of others have sent me info on every possible aspect of Lactose Intolerance. Today's the site's grown to over 100 pages, with information that literally can't be found anywhere else on the Net. My Product Clearinghouse lists every nationally available milk substitute product I'm aware of, along with dozens of items from countries around the world, countries which a few years ago had nothing for those who are LI. My Milk-Free Bookstore lists just about every book that might be of interest to those needing to avoid milk for any reason. I have answers to questions sent in by the thousands. And of course I have the basic information everyone needs about LI and dairy products.

I'm proud to say that my hit counter has finally gone over the magic 250,000 mark. That's probably conservative – I didn't have a counter at all in the early days – but it still means a lot. Thanks for all the support and praise you've sent me all these years.

I'm putting more time into this blog these days. It's just easier to update on a daily basis. That doesn't mean that the website is going to fall into dust. I'm still adding products, sites, books, and links to the site and I plan to continue doing so as long as there's a need.

Thanks again, everyone. I would have stopped long ago if it weren't for all of you. That's why I'm saying "We" Hit the Quarter Million Mark.

Steve Carper's Lactose Intolerance Clearinghouse.

P.S. If you forget the URL, just enter www.stevecarper.com. You'll be redirected to the site.

Gak's Dairy-Free Snacks

Jill Robbins is yet another mother who took her child's allergen-free diet into her own hands. Eight years ago, after her youngest son was both with serious food allergies, she began to explore recipes that were actually edible.

This has grown into Gak's Snacks.

Jill wrote me to say:

Gak’s Snacks is a new web-based company whose mission is to make it easier for children and families with food allergies to enjoy baked goods like everyone else. We offer cookies and coffee cake, baked in our dedicated facility with no peanuts, tree nuts, eggs, wheat, or dairy. Our products are also whole grain, certified organic, and contain no cholesterol or trans fat. For those who enjoy baking, we have just published a food allergy cookbook for baked treats and we offer many of the ingredients in our web store. As a Mom of a child with multiple food allergies, I know how important it is to find resources.

Contact info:

Gak’s Snacks, LLC
P.O. Box 491
Windham, NH 03087-0491
Phone: 603-425-6613
Toll free: 800-552-7172
info@gakssnacks.com

Dairy Derivatives in McDonald's Fries

McDonald's has always claimed that it had no dairy in its fries. Good.

McDonald's has decided to disclose the presence of common allergens in its foods in response to the new labeling laws even though it doesn't legally have to. Good.

Oops. It turns out that they've slapped a milk label on those dairy-free fries. Bad.

Here's the story as it is being reported by the Associated Press.

McDonald’s director of global nutrition, Cathy Kapica, said its potato suppliers remove all wheat and dairy proteins, such as gluten, which can cause allergic reactions. But the flavoring agent in the cooking oil is a derivative of wheat and dairy ingredients, and the company decided to note their presence because of the FDA’s stipulation that potential allergens be disclosed.

“We knew there were always wheat and dairy derivatives in there, but they were not the protein component,” she said. “Technically there are no allergens in there. What this is an example of is science evolving” and McDonald’s responding as more is learned, she said.

I can't find any mention of what exact derivative of milk is used in the fries, although I'll update this report as soon as it's revealed – if ever. However, even if the flavoring agent is lactose, the amount that enters a particular batch of fries is probably way too small to create symptoms in any but the most extremely susceptible lactose intolerant individual.

For those with milk allergies, the situation is a bit more complicated. No protein component should mean that they are safe for most people with a mild allergy. Those with serious anaphylactic-potential allergies know that even a few molecules of remaining protein can trigger an attack, so they should now avoid these fries entirely.

The same holds true for those with celiac disease and other gluten intolerances.

Three cheers for the new Food Labeling Law for forcing these disclosures. More information on the law, along with a link to the bill on the FDA site, can be found at Major Change In Labeling Law Scheduled for January 1.

Blackwell's Organic Gelato

Marcia Blackwell of Blackwell's Organic, makers of vegan soy gelato and fruit sorbetto, dropped me a note about her company.

She writes:

We got in the business because my husband is lactose intolerant and I was concerned about the quality of our milk supply.

We use only the highest quality certified organic ingredients.

Their website is at http://www.blackwellsorganic.com

I found 11 flavors there: Blueberry, Chocolate, Coffee, Lemon, Mango, Orange, Peanut Butter, Peanut Butter Chocolate Swirl, Pineapple, Raspberry, and Vanilla.

Blackwell's is available in a few places in New Jersey and will soon be shipping its gelato by mail order.

Contact info:
Blackwell's Organic, LLC
9 Catherine St. Unit D
Red Bank, NJ 07701
732-229-8899 phone
732-876-0358 fax

More Great Good Dairy-Free Desserts Naturally

Fran Costigan, author of Great Good Desserts Naturally, has a sequel out called, naturally, More Great Good Dairy-Free Desserts Naturally.

Both can be found on my Milk-Free Books page in my Milk-Free Bookstore, along with links to over 200 other books for those wanting to avoid milk.

Calcium Is Not Lactose

I just received yet another question asking whether a calcium ingredient on a food label contained lactose.

The simple answer is no. No calcium additive in any food contains any lactose.

I can only assume that the confusion comes from the fact that milk is high in calcium. Some people must think that, therefore, calcium comes from milk, and so calcium must contain lactose.

Not true. Commercial calcium is rarely derived from milk. And no calcium product, not even calcium lactate, will have any lactose at all.

Just to be on the safe side, let me mention that calcium caseinate does indeed derive from the milk protein casein. And it is something that people with serious milk allergies must avoid. However, it contains no lactose. Two different problems; two different things to watch out for.

More on lactose in calcium products on my website on the page The Experts Speak.

Valio Moves Lactose Free Milk Across Europe and into Asia

Valio Ltd. has marketed a lactose free milk in Finland, it's home country, since 2001. It's a milk unlike most lactose free milks in the United States. Those have a sweet taste, because they use the lactase enzyme to break down the lactose into simpler sugars that are much sweeter than lactose. Valio uses a chromatographic separation process that physically removes the lactose. Lactose itself is so mildly sweet that removing it makes less of a difference. The process works so well that less than 0.01% of the lactose is left, allowing the milk to be considered lactose free.

Valio has since introduced its milk to lactose intolerant customers in Belgium (Valio brand), Sweden (Valio), Switzerland (Emmi) and Spain (Kaiku sin lactosa) in Europe and has now moved into the potentially huge Asian market with its Maeil brand milk in South Korea. Check out this chart of countries, brands, and types of milk. ESL (extended shelf life) means shelf stable brick packs; UHT (ultra high temperature pasteurization) means longer shelf life fresh milk.

Valio is also the parent company of Finlandia Cheese which sells lactose-free cheeses in the U.S.

Contact info for Valio in Finland is:
Valio Ltd, Head Office
Meijeritie 6, PO Box 10
00039 VALIO, Helsinki
Finland


Tel. +358 1038 1121
Fax +358 9 562 5068


You can also use their web site to send a message directly from their contact us page.

Vaalia Introduces Lactose Free Yoghurt in Australia

Vaalia, a Parlamat brand, has added lactose free yoghurt in Australia to its Zymil line of lactose free milk. Both use the lactase enzyme to break down the lactose into simpler sugars.

According to their press release, "the new offering comes in 2x175g packs in four flavours - French Vanilla, Creamy Lemon, Apricot Mango and Strawberry." It's a low-fat yogurt with 1.4% milkfat content.

Free e-book: ‘Grocery Shopping For Your Food-Allergic Child’

Plumtree Press has announced the publication of a free downloadable e-book, “Grocery Shopping For Your Food-Allergic Child.” The book is written by food allergy expert Linda Coss.

You can download it from www.FoodAllergyBooks.com/shopping.html.

Accordig to its press release, the book teaches parents:

• How to determine if a product is safe for their child;
  
  
• Why they should always read the ingredient statement of each item they purchase;
  
  
• What they need to know about the dangers of cross-contamination;
  
  
• How and when to call the product’s manufacturer;
  
  
• How kosher labeling can be helpful for the dairy-allergic
  
  
• And other important information they need to keep their food-allergic child safe.

Coss is the author of two books on food allergy: How To Manage Your Child’s Life-Threatening Food Allergies: Practical Tips For Everyday Life and What’s to Eat? The Milk-Free, Egg-Free, Nut-Free Food Allergy Cookbook. Both books are available at www.FoodAllergyBooks.com, Amazon.com, and various booksellers nationwide.

Trans Fat in Lactose-Free Margarines

The Food Allergen Labeling and Consumer Protection Act that went into effect on January 1 does more than just require the prominent labeling of allergens in the ingredients list.

(See Major Change in Labeling Law Scheduled for January 1.)

Another change is the requirement that the amount of trans fats be listed along with the amount of saturated fats. Trans fats are now thought to be the worst type of fats in foods, as this FDA QandA reveals:

Q: What ARE trans fatty acids?
A: Trans fatty acids (or “trans fat”) are fats found in foods such as vegetable shortening, some margarines, crackers, candies, baked goods, cookies, snack foods, fried foods, salad dressings, and many processed foods.

Q: Why Should I Care About Trans fat?
A: It’s important to know about trans fat because there is a direct, proven relationship between diets high in trans fat content and LDL (“bad”) cholesterol levels and, therefore, an increased risk of coronary heart disease – a leading cause of death in the US.

Q: Aren’t ALL Fats Bad?
A: No. There are “good” fats and “bad” ones, just like there’s good and bad blood cholesterol. Saturated fats and trans fat have bad effects on cholesterol levels. Polyunsaturated fats and monounsaturated fats (such as olive oil, canola oil, soybean oil, and corn oil) have good effects.

Q: How much trans fat is too much?
A: There is research currently underway to determine this. However, it is true and accurate to say that the less saturated fat, trans fat and cholesterol consumed the better. Trans fat while pervasive in many of the foods we eat is not “essential” to any healthy diet.

Trans fats are a special problem in foods made almost entirely of fats, like margarines. In my Product Clearinghouse I have a page listing Nondairy Margarines. All of them are lactose-free and I believe that all of them are casein-free as well. The usual disclaimer: Ingredients change without warning. Always check the package to be sure.

What's the trans fat contents of these margarines? A good question that was fortuitously answered in the January/February 2006 issue of Nutrition Action Healthletter, the publication of the Center for Science in the Public Interest.

I've tried to match their data to the brands and varieties listed on my site. Remember, the lower the Bad Fat the better. Here's the results:

Total Fat – ToF; Saturated Fat – SF; Trans Fat – TrF; Saturated + Trans Fat=Bad Fat – BF; all are measured in grams

Benecol

• 55% Vegetable Oil (tub) ToF – 8; SF – 1; TrF – 0; BF – 1
  
• Light – 37% Vegetable Oil (tub) ToF – 5; SF – 0.5; TrF – 0; BF – 0.5
  

Canoleo

• 100% Canola Margarine (tub) ToF – 11; SF – 2; TrF – 2; BF – 4

Earth Balance

• Natural Buttery Spread (tub) ToF – 11; SF – 3.5; TrF – 0; BF – 3.5
  
• Soy Garden Natural Buttery Spread (tub) ToF – 11; SF – 3.5; TrF – 0; BF – 3.5
  
• Natural Buttery Sticks ToF – 11; SF – 4.5; TrF – 0; BF – 4.5
  

Fleischmann's

• Sweet Unsalted Margarine (tub) ToF – 8; SF – 1.5; TrF – 0; BF – 1.5
  
• Sweet Unsalted Margarine (stick) ToF – 11; SF – 2; TrF – n/a; BF – n/a
  
• Light Margarine (tub) ToF – 5; SF – 0; TrF – 0; BF – 0
  
• Light Margarine (stick) ToF – 5; SF – 1; TrF – n/a; BF – n/a
  

Mother's – not listed

Smart

• Smart Balance Light Buttery Spread (tub) ToF – 5; SF – 1.5; TrF – 0; BF – 1.5
  
• Smart Beat Super Light Margarine (tub) ToF – 2; SF – 0; TrF – 0; BF – 0
  
• Smart Squeeze Fat-Free Margarine ToF – 0; SF – 0; TrF – 0; BF – 0
  

Spectrum

• Natural Spread (tub) ToF – 10; SF – 0.5; TrF – 0; BF – 0.5
  
• Natural Spread Essential Omerga-3 (tub) ToF – 10; SF – 1; TrF – 0; BF – 1
  
• Organic (tub) – not listed

Willow Run

• Soybean Margarine (tub) ToF – 11; SF – 2; TrF – 0; BF – 2

The Healthletter rates any margarine with Bad Fat of 1 or less a Best Bite. Those with 1.5 rate Honorable Mention.

Dairy-Free Valentine's Chocolate

The people at Chocolate Decadence never fail to send me reminders about upcoming holidays and all the specialty chocolates they have available.

With Valentine's Day coming up fast, you should know that even last minute orders made on February 12 will be shipped to be received on time. I expect you pay for that privilege, of course. Order sooner for cheaper.

All their chocolates are:
"Dairy-Free ~ Lactose Free ~ Casein Free ~ Gluten Free ~ Vegan"

Specialty valentine's hearts and much more can be found at:
www.chocolatedecadence.com/product.htm#valentines

Here's the contact info:
Chocolate Decadence
1050-D Bethel Drive
Eugene, OR 97402
Tel: (541) 607-9073 or (800) 324-5018
FAX: (541) 607-6373
www.chocolatedecadence.com/

Reduced Lactose Milk Hits the U.K.

I can't believe it hasn't happened before this - and please correct me if I'm wrong - but lactose intolerant consumers had no equivalent to the reduced-lactose milk pioneered by Lactaid (and copied by many others) here in the U.S. and in Canada.

But Arla Foods has announced Lactofree, which it calls "a UK first."

Lactofree is produced by:

putting semi-skimmed cows milk through a filtration process and adding a lactase enzyme to ensure 99.95% of the lactose is removed.

Lactofree is already in stores, including Sainsbury's and possibly Tesco.

Medicine and Alternative Medicine

In my last post I mentioned the No-Milk List. We're having a dust-up now as people argue about their anti-milk beliefs in particular and their larger view of the worlds of medicine and alternative medicine in general.

I just put up there a post so long that I had to split it into two parts. I'm repreating it here to get it all up in one place, and also before I think it's generally applicable to anyone who has an interest in this blog.

-----

People here are correct when they say that anecdotal information can't be applied generally to a group of people. I'd go even farther: Most of the time it can't properly be applied to the person with the anecdote. The reason is simple. Change.

Any scientific or medical study depends on changing as few variables as possible. The more things that change, the harder it is to separate out what difference any one change is making. When we take dairy out of our diets, we think we're making just one change, but the truth is that we making all sorts of changes simultaneously. We eat different foods, we substitute for dairy in familiar foods, we alter the amount of food and the ratio of nutrients, lots of changes we seldom stop to think about.

Remember, though, I've always advocated that if it works for you and doesn't cause any damage, fine. Go with it. I have no objection to those who want to remove dairy from their diets. I've spent over 20 years supplying people with all the possible information they might need if they make this decision for themselves.

At the same time I've always warned people that getting tested is always a good idea. You never know where your symptoms are coming from: and the symptoms you're likely to get from either lactose intolerance or dairy allergy can have a thousand causes, some of them quite serious. Just assuming that you have a food allergy can mask another unrelated illness. Trying to determine if a particular food is causing your problems can be a nightmare.

That's what makes medical studies on foods so incredibly difficult. People could be brought into a clinical setting where every particle of food is monitored – but that hardly compares with the realities of everyday life. Much more often, people just keep food diaries and try to make as few other changes as possible. Even so, food studies are expensive, hard to run, and harder to evaluate. Worse, you can't do a double blind study for food. You know if you're taking dairy out of your diet or not, and that will affect the results.

This explains why medical studies about food, nutrients, or medications so often come out with big announcements that seem to vanish or be contradicted by the next study. Most of these studies are of tiny groups for short periods of time, often using protocols that just don't have much relationship to the real world. Even so, they're real studies that get printed in real medical journals and reporters look at the conclusions and write articles that make headlines. That's why I always say that you should never get your medical news from a newspaper. Or the internet, these days.

Most reporters – most people – have no idea of how to read a medical or scientific paper. This is one of the greatest failings of our school system. You can't just read the conclusions section and use that as guidance. You have to go through the entire methodology and procedure to see if the experiment as a whole works to give you real and new information. This isn't all that hard, and doesn't usually require any advance medical training. A few basic questions are all that's needed. Is the group studied random and representative? Is the group healthy or do they have medical problems? How large is the group? How many dropped out before the study was over and why? Is the study something that corresponds to real eating patterns or is it totally artificial? Are the results a true difference or just a slight tendency?

If you read closely, you'll soon notice that the studies that change the way medicine is practiced tend to be huge, long-term studies in which data from many papers are put together to make a larger and more comprehensive whole. This averages out or entirely deletes the exceptions, the poorly done studies, the natural variations in human physiology. Doing this takes medicine as far away from anecdotal information as it can safely get.

So if medicine tries to stay away from anecdotal information, who uses it? The answer is everybody else. All of alternative medicine is based on anecdotal information. All those people out there selling herbs and vitamins and enzymes and proteins and nutrients and nostrums. The ones selling raw milk or soy milk or rice milk or seaweed or spelt or sorghum. All the naturopaths and homeopaths and holistic practitioners. Every person whose religion gives them a special road to healing. They're all faith healers really, every last one, no matter whether a formal religion is mentioned or not. All of them absolutely depend on anecdotal information. They have to. Not one of them has ever done an actual study to back up their claims.

Let me repeat that. Not one of them has ever done an actual study to back up their claims.

Why should they? First, studies are difficult and expensive and time-consuming. Nor do they have the expertise to conduct a study. But most importantly, studies have one major obstacle to faith healing: they sometimes show that what you believe in is wrong. And the common element of all these alternative sites is that they're never wrong. They never allow people to come onto their pages and tell them that they cure is quackery, or that the money spent on their product was wasted, or that it had dangerous side effects, or that it prevented someone from getting medical help until it was too late. Instead, they give you anecdotes about how wonderful their product or their religion or their way of life is.

It may sound like I'm condemning all anecdotal information. Not at all. We use it all the time. If I need some work done on my car, I'll ask my friends for recommendations for mechanics. That's anecdotal information. Usually this works out fine. But there are no guarantees. Maybe all the mechanic's work was really done by a helper who just quit. Maybe my problems are completely different from those of my friends, more complicated, or on a foreign rather than a U.S. car.

It would really help if I knew something about how a car worked and it would be even better if there were a source of objective outside information about the procedures.

Most of us know a little something about cars, even if we can't fix them ourselves. If the mechanic were to tell me that the reason my engine won't start was that the gyroscopes in the tire weren't aligned with the phase of the moon, I'd laugh in the person's face. I sure wouldn't listen to anything else said about cars.

But people on this very list have posted information about the way our bodies work that is just as much moonshine. What's totally frightening is that people didn't laugh or stop listening. Why? Because just as nobody is taught how properly to evaluate a study, nobody is taught even basic knowledge about the way our bodies work.

Those of us with medical problems or conditions of any kind have an absolute need to learn as much as possible about human physiology. You don't have to become an anatomist, you don't need advanced medical training. You just need to know enough to understand when people are talking moonshine to you.

Where can you get this knowledge? Well, not from any of the alternative sites. They don't even want to know how you body works. How could they sell you magnetic bracelets or magic crystals if you knew anything about the body?

And you can't get it from pure anti-milk sites. That's like getting your information about the Democrats from the Republican National Committee website. You might think you were getting at least half the truth, but it doesn't work that way. All you get are the negatives. It's not just that the positives are never mentioned, but that the negatives are manipulated. The conclusions are quoted without any evaluation of studies as a whole. Comments are ripped out of context, and put together in creative new ways. Sometimes the remarks have no relationship to anything the original might have said. Instead of gaining information, you actually lose overall knowledge.

Medical studies have many faults. Many of them are just resume padding. Some of them are funded by firms who have a stake in the outcome. (Although who else is going to put up the money? I often wonder.) Most cannot be taken on their own but have to be evaluated as part of a much larger whole, and this is again, difficult and time-consuming.

But the alternative is no alternative. Even the people who most loudly decry the medical establishment are perfectly willing to quote them whenever a result is on their side. Because real medicine doesn't take sides. It publishes the positives and negatives, the cures and the dangers, the successes and the failures. Medicine changes with the times.

This upsets many people, I know. We all want certainty. But that's the basic difference between faith and medicine. The faith healers of all kinds and types and sorts will sell you certainty. They have a product, whether it's in a bottle or in a belief, and this product will help you, no ifs, ands, or buts. And this never changes. That's the guarantee that it's wrong.

Medicine is uncertain. It changes, updates, revises and contradicts itself. It's difficult and expensive and time-consuming. And it's the only thing we have. Accept no alternatives.

The No-Milk List

I belong to the No-Milk List, a listserv for people interesting in avoiding milk, fior whatever reason. For the most part, they aren't people with lactose intoilerance but sufferers of dairy allergies or parents of children with dairy and other allergies.

Messages can be posted to everyone on the list to ask for help or supply answers to others. Archived resources, on parve foods or nondairy recipes, for example, are also available at http://listserv.icors.org/archives/no-milk.html.

To subscribe, send an email to: LISTSERV@LISTSERV.ICORS.ORG
with these words in the body of the e-mail: SUB NO-MILK YourFirstName YourLastName

When you subscribe you will get all the instructions for the list so you can configure it to your own interests. However, I find it easier to receive each day's posting in a single e-mail. To do this, include SET NO-MILK DIGEST in your e-mail to the list. If you want individual e-mails use SET NO-MILK MAIL instead.

Note: This is a new e-mail address as of 2006.

FDA Announces New Prescription Drug Information Format

Those pages full of tiny type that come along with prescription medication will have to be revised to make them more understandable starting June 30, 2006.

The US Food and Drug Administration (FDA) announced this week that pharmaceutical companies will have to make changes to the "package insert" that has all the legally required information about the drug for physicians, pharmacists, and consumers. It's the first revision in more than 25 years.

The major changes, according to the FDA's press release include:

A new section called Highlights to provide immediate access to the most important prescribing information about benefits and risks.

Table of Contents for easy reference to detailed safety and efficacy information.

The date of initial product approval, making it easier to determine how long a product has been on the market.

A toll-free number and Internet reporting information for suspected adverse events to encourage more widespread reporting of suspected side effects.

The press release also said:

The most notable change is the addition of a summary outlining the most important information about a product, prominently displayed at the top of the page. Designed to help healthcare professionals find the information they need quickly, Highlights will typically be half a page in length and will provide a concise summary of information about specific areas including: Boxed Warning, Indications and Usage, and Dosage and Administration; and will refer the healthcare professional to the appropriate section of the Full Prescribing Information. In addition, drug makers will be required to include a list of all substantive recent changes made within the year, to ensure healthcare professionals have immediate access to the most up-to-date information about the product before prescribing it.

The addition of a new Patient Counseling Information section places greater emphasis on the importance of communication between professionals and patients. This new section is designed to help doctors advise their patients about important uses and limitations of medications. It will also serve as a guide for discussions about the potential risks involved in taking a specific treatment and steps for managing those risks. If FDA has approved patient information for a prescription drug, it will be printed at the end of the label immediately following the Patient Counseling Information section or will accompany the label so it can be easily shared.

More detailed information about the changes can be found at: http://www.fda.gov/cder/regulatory/physLabel/default.htm

Unfortunately, for those of us looking for lactose on the label nothing will change. As far as I can determine, the list of inactive ingredients will not be part of the new Highlights section. You'll still have to search down into the fine print to the section called DESCRIPTION to see the fillers and additives.

Overall, the new format is being hailed as a great improvement in ease of understanding. Other aspects of the reform, especially those limiting patients' ability to sue in state courts, are being widely attacked by consumer groups, though. I'll be monitoring the status of the new rules over the next six months to see if this pressure results in any changes before the revisions go into effect.