Milk Means Milk Say Milk Producers

When I write about soy "milk" or vegan "ice cream," I'm always careful to put the words into quotes. Unless I forget. Which I usually do.

Most people don't bother with the quotes. Milk is any white liquid, or else there'd be no such thing as milk of magnesia or milkweed or the lac chemicals like lactates or lactalbumin. Everybody knows that soy "milk" is just the white liquid that is pressed out of soy beans, and almond "milk" and rice "milk" are similar liquids made from those bases. None of them are the same as the milk that mammals make, whether that's from cows or sheep or goats or camels or human nursing mothers.

Everybody knows that, right?

That stops me, right there. If I've found out anything at all from writing about, well, anything and everything, is that nobody knows nothing. Nutritional information is a dark hole that people fall into and the origins of food are a mystery as impenetrable as those by Dan Brown. At worst, parents kill kids by serving them soy milk instead of infant formula.

Therefore I have some sympathy for, of all people, the National Milk Producers Federation.

According to an article by Leslie Kwoh of the Newark Star-Ledger:

Tired of competing with "phony" milk beverages made from soy, almond and rice, the group today petitioned the Food and Drug Administration to restrict the use of the word to only animal-based products.

"The FDA has allowed the meaning of 'milk' to be watered down to the point where many products that use the term have never seen the inside of a barn," said Jerry Kozak, president and CEO of the federation, in a statement. "Although some phony dairy foods may have a passing resemblance to their authentic counterparts, they are very different in nutritional value."

European countries see no problem with requiring phrases like "soy beverage" to be used instead of "soy milk." The question is whether the issue creates enough confusion to be worth the time and money that the changeover would cost. Obviously the Milk Producers think the word "milk" is sufficiently valuable that it's worth their while to fight for its exclusive use.

Next time you see people making air quotes around the word "milk," refrain from punching them. Maybe they're not being obnoxious. Just accurate and nutritionally pedantic.

Yosa Organic Dairy-Free Smoothies

Finland, the home of the giant Valio lactose-free milk empire, continues to introduce dairy-free goodies on a regular basis. Yosa organic dairy-free smoothies were brought out last year and are being extending to the Swedish and German markets as well.

Yosa smoothie is a delicious combination of high-quality organic oats and organic fruits or berries. With its high content of fruits or berries, each smoothie is an excellent source of natural fiber.

Yosa smoothies contain plenty of living lactic acid- and bifido-bacteria also known as probiotics. Probiotics have been shown to:

increase the amount of beneficial bacteria in the gut
balance the digestion
boost the immune system of gut

The probiotics in Yosa smoothies have been a subject of more than 30 scientific publications. The health-enhancing effects of these specific bifido-bacteria have also been demonstrated in long-term clinical studies.

The smoothies come in mango-vanilla and raspberry red current flavors.

Food Fight: Almond Milk vs. Soy Milk

Buried deep in the comments on one of the pages on the Starbucks vegan frappuccino was a petulant whine wondering why the company used soy milk at all when almond milk is so obviously superior.

You like what you like. Pay no attention to the man behind the curtain.

Geri Maria Harris, on the Houston Press blogs, did a somewhat more sophisticated comparison of one brand each of almond milk and soy milk, testing them to see which worked in what recipes.

Verdict?

The good news is: for people eschewing cow's milk in favor of plant sources of milk, both almond and soy milk were great alternatives. We recommend going with the Almond Milk for breakfast foods, baking sweets, and if you're really looking for a good doppelganger for cow's milk. For savory cooking and baking, go with the soy stuff.

Starbucks Vegan Frappuccinos

These days you might think you could get a frappuccino everywhere, but no. Just at Starbucks. The name's a registered trademark. So when you're drinking those Mochalattas or Coolatas, get up and look at the nameplate on the front of the store. You're someplace else and you missed your date, who's now icy. Or possibly steaming. Not that Starbucks invented frappuccinos. George Howell did, at the Coffee Connection. Guess who bought out the Coffee Connection, though? Right.

Starbucks secretly will introduce vegan frappuccinos starting on May 5th. Not secret secretly, of course. Internet secretly. With a gradual rollout so that a million sites can breathlessly announce the news. The best account seems to be at The Consumerist.

The old method to make them used a base that contained dairy, but the new way you basically add a thickening syrup to base of milk/flavour syrups/coffee depending on the drink, so as long as the drink is made with soy it’s vegan. The coffee and creme frappuccino bases are vegan, however, the light one is not— and all the other inclusions and toppings are vegan except for whip (duh) and caramel drizzle.

The whole process is fraught. Worry about the White Mocha and the Java Chips, which contain dairy, and make sure that the soy comes from the right pitcher.

Or make your own and put it in a thermos.

By the way, here's a secret that you'll only find on the Internet: that water you pay more for than gasoline to buy in bottles with a fancy brand name? It now comes from tubes that are being run into houses. Almost free. Just like the Internet itself.

Travel Time

I'm going to do something weird today. I'm going to user this blog to blog, like a normal blogger blogs. All personal and off the cuff and stuff. Don't get your hopes up! This won't last.

The endless slog through the presentations from the NIH state-of-the-science (I typoed this at stat-of-the-science, which works too) LI Conference came to an end just before I left on a vacation. Usually I predate a few posts and have them ready to appear whenever I have to go out of town. (What? Bloggers do that? Does that mean Santa isn't really real?) I realize that nobody reads this blog, but the numbers actually go negative whenever I skip my daily posts. Maybe there's a place to predate your non-clicking on links. I managed to lose a follower over the last 5 days. Come back, Shane. All is forgiven! (Early MAD magazine reference. If you get it, you're too old for the internet.)

You know to what lengths I go to in order to give you the illusion that I'm always blogging? No, of course you don't. That's the secret of a successful illusion. Ask Penn and Teller. Although I've been out of town several times in the past 18 months, the last "vacation" I took was a working vacation at the Worldcon, the World Science Fiction Convention, in Denver in August 2008.

Why didn't I take a vacation last year? I spent a lot of it prepping for and recovering from back surgery. Vacations aren't much fun when you can't be on your feet. And you didn't notice. Because I kept blogging. I blogged from the hospital, I blogged from recovery. I just checked. They were better - and longer - than usual posts.

Why didn't I mention it? Mostly because back surgery has nothing to do with lactose intolerance. And mostly because people are very nice (except for those who believe in quack medical treatments and like to tell me so) and I hate answering "how are you feeling?" over and over. And over. That's how you can cram two mostlys into one answer. It seems like way more than too much. Unselfishly selfish, that's me.

And my wife, who loves to travel and has had to put up with being housebound all this time. How do I get away with it? Because she can't get away from her job for more than about ten minutes at a stretch, and uses those ten minutes when she can grab them to go check on her parents, who have a variety of health problems of their own. (How elderly is elderly? They're too old to get that MAD magazine reference from the early 50s.) Which is another reason not to talk about my health issues. I don't have cancer or Alzheimer's or the stuff that any random sample of even my friends have.

So we decided to dip our toes back into the wonderful world of travel. Nothing major. A few days up in Toronto.

Rochester likes to kid itself that it is an actual city. No, really. People know that we live in the same state as Manhattan, but that's an exception. Nothing else is like New York and it doesn't really count. It's too big and too much. Might as well compare yourself to Oz. New York is Technicolor and Rochester is a Good Place to Live without all that annoying traffic and crowding and bustle and modernity. Besides, it's much, much prettier than Buffalo.

Toronto is a real city. Hip and funky and full of people of every part of the color spectrum, including a few who might have been puce. Toronto has those neighborhoods, and Rochester doesn't.

What do we do in Toronto? What you might suspect. Lots of used bookstores. Like Monster Records. I wouldn't have thought so either, and I wouldn't have stopped there if it hadn't been next store to a normal used bookstore. (Toronto is so full of record shops that you half expect four boys in leather jackets reading the Silver Beatles to be yelled at for smoking in public.) From the street, however, you can see three walls covered in books. Books on music, yes, and television and movies and popular culture, especially those paperback originals that flourished in the 1970s and you can never find any more. (Not as great as Kayo Books in San Franciscon, but nothing is.)

Lots of restaurants with interesting reviews. La Batifole, an inexpensive yet excellent place that bills itself as the best French Restaurant in Chinatown, where you can get chicken liver brûlé as an appetizer. You can't imagine writing any part of that sentence about Rochester. Or lunch at Fresh, a vegan restaurant with tons of potential ingredients that they'll let you combine in any way you like. And gluten-free cupcakes.

Or weird little museums. Rochester has a couple of world class museums, the Strong Museum of Play, perhaps the best kids museum anywhere, and the International House of Photography. Toronto has museums everywhere, with collections you never dreamed could be so interesting. My favorite this trip was the Bata Shoe Museum. Again, really.

Look at this thing. What do you think it is? I'll spot you a million guesses.



It's a chestnut crushing clog. A more efficient way to get the meat of chestnuts. Sorta like having a special shoe to tromp grapes in. And the shoes got much, much weirder than that.



Chopines started as sandals on platforms to lift womens' feet off the heated floors of bathhouses. With typical human vanity, more was better and so they got higher and higher. The ones above were used. The woman put a hand on the head of her servant to maintain her balance.

Truly, if you want to marvel at human ingenuity and remember that the species was insane long before the internet, you can do more in one room at the Bata than you can on the whole History Channel for a week.

And comedy. We've done every type of art in Toronto, from music to dance to textiles to experimental theater that moshed together all of the above and more. This time we comedized. A fine evening at Second City, followed by a night with Craig Ferguson and his manic stand-up.

Stand-up, I can't even sit-up! Wish that were a joke. Only a few days, yet my body feels like a speed bump on a road near an elementary school. I'll take a vacation again. In a few years. When I've had time to recover. In the meantime, I'll be back to information providing. Suffer.

Report from the LI Conference, part 28: Question 4 Summary

The NIH LI Conference draft report summaries the presentations from Newberg, Sanders, Keith, Gordon, Shaukat, Johnson, and Taylor to answer question 4.

What are the future research needs for understanding and managing lactose intolerance?

Reliable estimates of the U.S. prevalence of lactose intolerance and lactose malabsorption are not available in a representative population of diverse ages and races/ethnicities. Most of the available research assessed subjective symptoms in an unblinded fashion in selected groups of subjects or in individuals unable to fully absorb lactose irrespective of symptoms of lactase nonpersistence. Therefore, we recommend that a study be conducted to determine the prevalence of lactose intolerance in the U.S. population and the differences across age and racial/ethnic groups. The study should examine a representative sample of the U.S. population and determine the following:

• The prevalence of self-reported baseline symptoms
• The prevalence of lactose malabsorption with or without symptoms following a blinded lactose challenge
• The relationship between self-reported symptoms and the presence of lactose malabsorption
• The prevalence of lactose intolerance in those individuals with lactose malabsorption based on the blinded challenge.

The best approach to minimize placebo effects is to conduct blinded challenges using a standardized, taste-masked dose with and without lactose and to define symptoms using a well validated scoring system. Studies on what constitutes an optimal challenge dose of lactose also should be conducted. Dietary history regarding lactose consumption and symptoms associated with polymorphisms affecting lactase gene expression potentially could obviate the need for taste-masked, blinded oral challenges with lactose and placebo. An opportunity exists to use the infrastructure of the ongoing National Health and Nutrition Examination Survey or other ongoing nationally representative studies, which already are collecting dietary intake data and would allow additional and potentially informative evaluation of the intake of lactose-containing foods in those with rigorously determined lactose malabsorption with or without symptoms.

Despite the widespread belief that decreased vitamin D and calcium intake associated with restricted intake of dairy products will lead to poor health outcomes, particularly related to bone mineral density and risk for fractures, few data are available on bone health in individuals with lactose intolerance and dairy avoidance. Future studies should investigate the association between dietary calcium intake and outcomes in people with lactose intolerance on low-lactose diets. A diverse population should be evaluated including children, the elderly, males and females, members of ethnic/racial subgroups, and those with susceptible genetic polymorphisms. The latter genetic alterations should include potential modifying genes. Also, the efficacy of dietary calcium intake from nondairy products and from nutritional supplements should be examined in relation to bone health and as to whether other foods influence calcium absorption from these sources.

Although puberty is the period of most rapid accrual of bone mineral, studies are needed to determine whether calcium intake during this period will affect the subsequent risk to develop osteoporosis. Other health outcomes including obesity, diabetes, cardiovascular disease, and cancer also should be assessed in individuals with treated and untreated lactose intolerance and in other individuals avoiding milk products because of perceived lactose intolerance in comparison with the general population. Additional issues of importance need to be addressed in children with lactose intolerance through long-term observational studies and randomized controlled clinical trials of various treatment strategies. These issues include the incidence of infection, allergic disease, and standard measures of growth and development.

Data are lacking as to whether individuals of different races/ethnicities, ages, and genders who have lactose malabsorption have differing tolerance to lactose. Blinded, randomized controlled trials are needed to determine if the quantity of lactose that can be tolerated by lactose-intolerant individuals varies by race, ethnicity, age or gender. Symptoms should be reported in a standardized, validated format so that clinically important differences can be appreciated.

The lack of uniformity in study design and methodology hampers a rational, evidence-based approach to management of lactose intolerance. Defining the tolerable dose of lactose in those with lactose malabsorption is critical to determining the clinical importance of lactose malabsorption and the prevalence of lactose intolerance, and it may provide critical information for management. A stepwise approach should be developed to define the specific amount of dairy foods to introduce to the individual with lactose intolerance (i.e., the greatest amount of lactose that is not associated with symptoms). Studies also should be conducted to confirm whether lactose is better tolerated if distributed throughout the day or given with meals. Some individuals have reported moderate value in reducing symptoms by using lactase or lactose-hydrolyzed milk; however, sample sizes and the reporting of symptoms were so variable in reported studies that making firm recommendations is difficult. The use of prebiotics (a nondigestible food component, usually a carbohydrate, which benefits the recipient by promoting intestinal colonization by beneficial bacteria) and probiotics in dietary supplements and foods including yogurt is a popular intervention for individuals with lactose intolerance, but further studies are needed to document the efficacy of such products in reducing symptoms. Calcium intake from low-lactose dairy products, nondairy products, and nutritional supplements is an alternative management strategy in individuals with lactose intolerance, but few data are available on the effect of such interventions on individual outcomes, including bone mineral content and fractures.

It will be important to determine whether testing for lactose malabsorption will change the behavior of individuals who avoid dairy products, many of whom may not have lactose intolerance. Future research should employ standardized interventions, blinded controls, and reporting of improvement of symptoms in a consistent, validated fashion to compare the efficacy of these dietary management strategies in obtaining clinically meaningful health outcomes.

Once effective interventions have been identified, behavioral and culturally sensitive approaches to convince people to adopt recommended dietary changes should be developed and tested. Clearly, the perception of symptoms in individuals with lactose intolerance may be highly subjective and very susceptible to a number of psychological and cultural factors. Thus, various strategies may result in very different behavioral changes, and their effectiveness should be compared rigorously.

Additional work needs to be done to improve the management of patients with irritable bowel syndrome and a hypersensitive colon who also may have lactose intolerance.

Report From the LI Conference, part 27

Part 27. Hey, I sat there for a day and a half. Think how I feel.

Anyway, this was the last presentation.

Psychological Impacts: Strategies Effective in Managing Individuals Diagnosed With Lactose Intolerance
Janet E. Taylor, M.D., M.P.H.
Psychiatrist
Private Practice

Dr. Taylor wrote that "Undiagnosed individuals with gastrointestinal complaints may present with somatization preoccupation." How many of you out there know what somatization preoccupation is? If you do, you were one up on me. I had to look it up.

Somatization disorder refers to the preoccupation with multiple physical complaints suggestive of a somatic disease for which a clear physical etiology and an adequate medical explanation cannot be found.

In shorter words, you're sick with a real physical, as opposed to psychological, disease but no one can tell you what you have. Lactose intolerance should be easily diagnosed, but often isn't. And many people have a range of gastronintestinal disorders that may overlap with or be confused with or be suffered in addition to LI. I also have irritable bowel syndrome, and needed to find a treatment for that before my intestinal complaints could be brought under control.

Disorders that aren't quickly and properly identified lead to long-term distress of many kinds. More suffering, more sick days, more disruption. The psychological complaints that you didn't have in the beginning, like depression or anxiety, can result from not having the physical side go untreated.

Physicians have to become more aware of these psychological issues and look for signs of them and learn how to treat them as well as the physical illnesses.

There's more.

Here's a real problem that is almost never talked about when health is being debated. As many as 30% of adults in this country are functionally illiterate. They read at a fourth grade level or less. They may not know basic terms like "serving" or "calcium." They're probably not reading blogs, much less books or medical journals. The nutrition information on a package is probably confounding. The list of ingredients may not be understandable. They may not go regularly to doctors and if they do they're probably more concerned about other, urgent, health care needs.

I'm addressing this blog to a literate, probably well-educated population. That turns out to be only part of what needs to be done. All of the people in the U.S - and elsewhere - need the best health and the best information to achieve it, not just 70%. If you have any ideas on how that might be possible, please let me know.

Report From the LI Conference, part 26

We're back to another round of lactose intolerance influences people to not have dairy which lowers their calcium intake which has long term effects. The difference here is that Dr. Johnson looked at people's feelings as well as their behaviors.

Behavioral Factors Related to Lactose Intolerance and Bone Consequences
Susan L. Johnson, Ph.D.
Associate Professor
Department of Pediatrics
Section of Nutrition
University of Colorado Denver
Anschutz Medical Center

Most Important Problems Encountered With Having Lactose Intolerance

1 Not able to eat certain foods that you like

2 Worry about embarrassment at social events because of lactose intolerance

3 Limit your physical activity because of lactose intolerance

4 Concern about not getting enough calcium

5 Concern about developing osteoporosis or other bone diseases

6 Limit activities that take you away from available restrooms

The perceived inability to eat certain foods goes directly to milk drinking. Some people avoid all dairy products because of LI. But realistically, people don't stop eating their favorite foods like cheese, especially on pizza, and ice cream even if they are LI. That's probably why lactose-free ice cream never breaks through in the market.

One thing that's not known and would be helpful is whether adult perceptions of foods that "can't" be eaten because of LI affects the views of their children. Some children, especially Hispanic girls, were more likely than others to think of themselves as LI and so avoid dairy. If milk can be added to breakfasts, however, it's more likely to be drunk.

Report From the LI Conference, part 25

Another member of the thundering herd from Minnesota gave one last presentation that combed through the medical literature pertaining to this question.

Evidence-based Practice Center Presentation IV: Effective Strategies for the Management of Individuals With Diagnosed Lactose Intolerance
Aasma Shaukat, M.D., M.P.H.
Investigator
Minneapolis Veterans Affairs Medical Center
Division of Gastroenterology
Department of Medicine
University of Minnesota

The literature burped up a grand total of 37 studies for managing lactose intolerance. Almost all of them showed nothing of interest or were based on such small and bad samples that they added up to nothing.

The limp conclusion: using lactose-reduced milk reduced symptoms in the lactose intolerant.

Report From the LI Conference, part 24

A lot of good stuff in the next presentation, so let's jump right in.

Treatment Recommendations in Children
Catherine M. Gordon, M.D., M.Sc.
Director
Children's Hospital Bone Health Program
Adolescent/Young Adult Medicine and Endocrinology
Children's Hospital Boston
Associate Professor of Pediatrics
Harvard Medical School

A big question that I haven't seen answered before is whether avoiding dairy - and not making the effort to replace the calcium that would be found in a dairy heavy diet - really makes a difference to health.

There are a few studies which say that not having dairy hurts your bones. And generally speaking, we can say that people who know they are lactose intolerant (LI) have less dairy - if any at all - than people who don't consider themselves to be LI. Vertebral fractures are higher in people with LI. Bone mineral density is lower, and the more severe the symptoms reported the lower the density became. This started to be true even in a population of girls aged from 10 to 13. If children aren't having dairy, they are highly unlikely to do so later in life.

How to get more dairy into your diet if you have LI? Here are several suggestions.

1. Consume small amounts of lactose-containing foods.

2. Chronic/repeated intake of lactose-containing foods allows colonic bacteria to adapt and more efficiently metabolize lactose.

3. Co-ingest lactose-containing foods with a meal.

4. Consider the form of the lactose-containing food. Hard cheeses, chocolate, higher fat milks, and ice cream are well tolerated.

5. Eat live culture yogurt.

6. Utilize commercially available lactose digestive aids.

7. Modify behaviors and perceptions from past experiences to learn that dairy/lactose-containing foods can be easily incorporated into the diet.

8. Consider the consumption of calcium-fortified foods.

The idea behind having more dairy is getting the calcium it provides. If you don't want dairy in your diet, calcium supplements are a useful source. Just be sure not to take more than 500 mg of calcium in any individual dose. Some people get constipation from calcium supplements. Before quitting them, try increasing the amount of fiber and water in your diet to see if that counteracts the constipation.

Children can take any of several varieties of supplements, including the common calcium carbonate (which is more likely to be found in chewable form), calcium citrate, and calcium glubionate.

Report From the LI Conference, part 23

The next presentation gives a useful follow-up to yesterday's post about the power of probiotics.

Treatment Recommendations in Adults With Diagnosed Lactose Intolerance
Jeanette N. Keith, M.D.
Associate Professor
Department of Nutrition Sciences
Department of Medicine
The University of Alabama at Birmingham

Probiotics can be helpful but people shouldn't expect to have them work instantly. In fact, any new dietary plan takes times to be effective.

In practice, we explain that just as it takes about 21 days to learn a new behavior, adaptation of the gut to a lactose-containing diet generally requires 3 weeks of consistent dietary change to achieve full tolerance.

As a nutritionist, rather than a research scientist, Dr. Keith had some crucial points that all practicing doctors should remember.

Patients like specifics rather than generalizations. That's the toughest thing for me to do, since I don't know you, don't know your medical history, don't know your symptoms, don't know all the little details that make up a life. Most of my advice here is generalized squared.

Doctors should do better, but too often they don't. A probiotic, for example, isn't a magic pill. Bacteria take time to multiply and drive out competing strains. If a doctor tells you to try them but nothing more, what do you do if you don't see improvement in three days? Or even a week? Many people would toss the probiotic and curse the doctor for making them spend unnecessary money. I'd much rather come out of a doctor's office knowing that I might have to wait for three possibly agonizing weeks for that wonderful symptom relief, even if I went in wanting that bit of magic.

Lactose intolerance is not a disease, despite what far too many people - and patients - think. The symptoms are all too real, though. Doctors need to understand what to ask about how people really eat, what tips to give, and how to steer individuals in the right direction.

The most effective dietary intervention for lactose intolerance is the one personalized to meet the needs of the individual affected by symptomatic lactose ingestion.

When you see your doctor, you need the best advice for you. Personally. I hope doctors are reading this.

Report From the LI Conference, part 22

First prebiotics and then, logically, probiotics. It's like scientists were methodical or something.

Strategies for Managing Individuals With Diagnosed Lactose Intolerance: Probiotics
Mary Ellen Sanders, Ph.D.
Consultant
Dairy and Food Culture Technologies
Executive Director
International Scientific Association for Probiotics and Prebiotics
Centennial, Colorado

As I also reported yesterday, probiotics are bacteria or other organisms that produce beneficial effects. More specifically, getting bacteria that can digest lactose (by making their own lactase) into the large intestine means that they can reduced or eliminate symptoms by digesting the lactose that reaches them before it can ferment and give off gas.

The evidence, as usual, is small and mixed. You need to read the presentation summary carefully to realize that what it means to you isn't the same as what it means to scientists. Researchers may get excited by knowing that certain bacteria give better results in breath hydrogen tests, because that may point the way to better delivery mechanisms or knowledge of when and how to take them.

What's of far more importance to you here and now is that any of the probiotics will give symptom relief. Streptococcus thermophilus (ST) and Lactobacillus bulgaricus (LB) are the types found in yogurt, but you have to ensure that you get yogurt with the National Yogurt Association LAC seal that indicates that "live and active" cultures will be in the finished product. Other types are used in probiotic capsules, including Bifidobacterium and Lactobacillus acidophilus. Those should work, but the evidence is sketchier.

Report From the LI Conference, part 21

We're in the final stretch of the conference, the Tuesday morning presentations, all of which were devoted to addressing the question "What Strategies Are Effective in Managing Individuals With Diagnosed Lactose Intolerance?"

To be honest, we didn't get much of an answer from the first presenter, although he covered some issues I wasn't familiar with, issues that touch on the answer tangentially.

Prebiotics and Lactose Intolerance
David S. Newburg, Ph.D.
Associate Professor of Pediatrics
Harvard Medical School
Director
Program in Glycobiology, Pediatric Gastroenterology and Nutrition
Massachusetts General Hospital

Prebiotics are any food component that promotes beneficial bacterial growth. I've covered them before, in Prebiotics and Probiotics, where I quoted a fuller definition:

Prebiotics ("before life") are nondigestible or fiber components of foods, usually complex carbohydrates that beneficially affect the host by stimulating the growth of intestinal bacteria. Certain bacteria prefer a particular prebiotic to use as a source of energy.

Lactose itself can be considered a prebiotic, because the changes in the bacteria that live in your colon from the types that ferment lactose and produce gas to the types that digest lactose and are symptom-free is certainly a beneficial change. If you read me regularly you know that the change usually requires both time and persistence. By having dairy in your diet regularly you can promote the beneficial bacteria. Or you can try taking probiotics - foods or medications that contain the good bacteria - and have them colonize your large intestine.

Why do you need to spend so much time on this? Dr. Newburg said that just introducing a new species of bacteria doesn't make a lasting change. Unless you keep reinforcing the switchover by constant application, your bacteria, known as your intestinal flora, go back to the way they were in a few days or weeks.

Silk Makes Almond Milk

Silk and soymilk are almost synonymous. Their website even has the URL of www.SilkSoymilk.com.

But soy has its own set of enemies. And grabbing a bit more shelf space always is to a company's advantage. So Silk is extending its tendrils and doing a bit of brand extension, introducing two flavors, original and vanilla, of Silk PureAlmond, a dairy-free, lactose-free milk alternative made from almonds.

The Wegmans site has a long paragraph taken from a Silk handout on the new drink, an oddity since they aren't listed among the store locations.

All natural almondmilk (added vitamins & minerals, including vitamin E). 90 calories per serving; rich in antioxidants (added vitamins & minerals, including vitamin E), lactose-free & soy free. 90 calories per serving. What makes our almondmilk so healthy? For starters, it's the almonds. Every little nut is a perfectly packaged powerhouse of natural antioxidants and more. In fact, we like to think of almonds as Nature's Perfect Nutrition - and that's where our almondmilk begins. We make our almondmilk with all the care, quality and wholesome nutrition you expect from Silk? Along with an excellent source of natural antioxidants (fortified with natural antioxidant vitamin E), each glass provides as much calcium and vitamin D as milk, with absolutely no cholesterol, saturated fat, lactose or soy. And best of all, it's just 90 calories. Perfectly delicious nutrition, just as Nature intended. Everyday delicious. At Silk, we believe each day should include its share of pure, delicious pleasure. Smooth and creamy with rich taste of almonds, Silk Pure Almond almondmilk is guaranteed to bring a smile - at only 90 calories a cup. Over cereal, in your coffee or straight up in a glass, it's a natural, healthy way to make every day just a little yummier. Enjoy! Delicious little almonds. Great big nutrition. Silk Pure Almond Vanilla Almondmilk: 90 calories; 30% DV calcium; 25% DV vitamin D; 0 g saturated fat; 0 mg cholesterol. Data drawn from USDA, ARS 2008, Nutrient Database for Standard Reference, Release 21. This almondmilk is made from almonds that were not genetically engineered. Made in USA.

Unless you are using an iPad, go to SilkPureAlmond.com for some of that Apple-prohibited flash animation.

Food Bank Feeds Lactose Intolerant Toddlers

Rich Miller of WFIE reported on an innovative plan to feed needy children. And that includes the lactose intolerant ones.

The Tri State Food Bank lends a hand in feeding pre-schoolers.

It's called the piggy back backpack program. Twenty back packs will be provided for pre-schoolers to take home over the weekends. The packs contain enough food for two breakfast meals and two dinners.

The $2500 grant for the program was written by USI [University of Southern Indiana in Evansville] students and the funds came from the university. They will provide food for the toddlers for a year.

"If a child at this age doesn't receive the proper nutrition it can affect their I.Q," said USI student Mindy Prien. "It can just affect their ability to learn. It is hard to concentrate on your lessons and learning when you're hungry."

Backpacks for lactose intolerant children will also be provided as part of the program.

Allergen-Free Baker's Handbook

The Allergen-Free Baker's Handbook by Cybele Pascal. U.S. News & World Report interviewed her.

Why did you write The Allergen-Free Baker's Handbook?
In my family, we have multiple food allergies, so we eliminate many different common allergens from our diet. The recipes in the book are a way for me to make baked goods that all of us can eat safely. I also wanted to write it for other people, too, so that no one is ever deprived of sweets and baked goods. All of the recipes in the book are [also] good for people on a vegan diet. The recipes are also free of hydrogenated fats. So they're really delicious and healthy for everybody.

Tell me about some of the food substitutions you make.
I tried to find ingredients that people can usually find easily at Whole Foods or their local health-food store or online. For eggs, I often substitute applesauce. I also like to use vegan yogurt, which is a really great way to provide the structure and moisture that eggs provide. I also use vegan yogurt instead of cream. For [cow's milk], I substitute rice milk.

Here's more about the book from the publisher:

The number of people with food allergies is skyrocketing, leaving puzzled cooks and anxious parents eager to find recipes for “normal” foods that are both safe and delicious. The Allergen-Free Baker’s Handbook features 100 tried-and-true recipes that are completely free of all ingredients responsible for 90 percent of food allergies, sparing bakers the all-too-common frustration of having to make unsatisfactory substitutions or rework recipes entirely. To make things even easier, energized and empathetic mom Cybele Pascal demystifies alternative foodstuffs and offers an insider’s advice about choosing safe products and sources for buying them.

As the head baker for a food-allergic family, food writer Pascal shares her most in-demand treats and how to make them work without allergenic ingredients. Her collection includes a delightfully familiar array of sweets and savory goodies that are no longer off-limits, from Glazed Vanilla Scones, Cinnamon Rolls, and Lemon-Lime Squares to Chocolate Fudge Brownies, Red Velvet Cake, and every kid’s favorite: Pizza.

In addition to being a lifeline for people with food allergies, sensitivities, and intolerances, these entirely vegan recipes are perfect for anyone looking to avoid artificial and refined ingredients, and those interested in baking with healthful new gluten-free flours such as quinoa, sorghum, and amaranth. Best of all, Pascal has fine-tuned each recipe to please the palates of the most exacting critics: her young sons. Lennon and Monte like these tasty treats even better than their traditional counterparts, and you will too!

Random House Trade Paperback
200 pages
List price: $25.00

Allergy-Free Desserts Cookbook

Allergy-Free Desserts: Gluten-free, Dairy-free, Egg-free, Soy-free and Nut-free Delights is a newly published cookbook by Elizabeth Gordon.

Safe ways to sweeten the day for people with food allergies

Some twelve million Americans suffer serious allergic reactions to nuts, dairy, gluten, and other ingredients typically found in desserts. Finally, here’s a collection of delicious dessert recipes offering a safe option for allergy sufferers who don't want to give up their favorite treats. Even though these recipes are completely free of gluten, dairy, nuts, soy, and eggs, you'll hardly notice the difference.

Allergy-free Desserts includes recipes for all of your favorite baked treats—cakes, cupcakes, pies, quick breads, cookies, and dessert bars. Written by Elizabeth Gordon, herself allergic to eggs and wheat, this indispensable cookbook will finally let you enjoy desserts safely again.

• Featuring 82 recipes and 44 full-color photos
• Recipes that taste just like the real thing—but without the gluten, dairy, nuts, soy, or eggs
• The perfect dessert cookbook for the millions of people who suffer from food allergies or Celiac Disease

Allergies shouldn't hold you back. Allergy-free Desserts finally lets you indulge your sweet tooth.

Wiley Hardcover
192 pages
List price: $22.95

More on the Genetics on LI

If you need any more reason to understand why the medical journal coverage of how actual everyday people react to lactose is so awful, as I've been covering in more recent posts than I care to link to, all you need to do is to look at what's hot and sexy.

Genetics is. How to explain that a study called High frequency of lactose intolerance in a prehistoric hunter-gatherer population in northern Europe by Helena Malmstrom et al., BMC Evolutionary Biology 2010, 10:89doi:10.1186/1471-2148-10-89, is getting coverage all over the planet?

The reader-friendly version can be found from UPI.com.

Stone Age hunter-gatherers who lived along the southern coast of Scandinavia 4,000 years ago were unable to digest milk, researchers said.

The findings support a widely held theory that modern Scandinavians descended from people who arrived in the area after the Stone Age population.

Unlike modern Scandinavians, the DNA of the hunter-gathers shows they were lactose intolerant, said researchers at Stockholm University and Uppsala University. ...

"The findings are indicative of what we call 'gene flow,' in other words, migration to the region at some later time of some new group of people, with whom we are genetically similar," Gotherstrom said.

A more technical account can be found on Razib Khan's science blog at Discover Magazine.

Exactly how, when, and by whom the genes for lactase persistence arrived in northern Europe, where they would in historical terms be almost instantly spread around the world by colonists, is a fascinating question. Just not our personal number one question. As long as that is where the funding goes and the newspapers hunt for hot articles, our personal problems will stay as ignored as they have been for the past couple of decades.

Life's not fair. And there's nobody to rant at.

More Desensitization Therapies for Allergies

The Boston Children's Hospital did a major and apparently successful test of desensitization treatments. I reported on them and a series of videos on the progress of the treatments in "Desensitization: the Hot New Word In Allergies and Desensitization Injections Cured Boy's Milk Allergy.

Today a report emerged from Dallas of another desensitization treatment, a different one of a different type. Take a look at Controversial Treatment Ends Food Allergies by Deborah Ferguson of the Dallas NBC affiliate.

Both treatments do have the same basic idea. Start with tiny quantities of the allergen, so tiny that the immune system can handle them with antibodies, and then so gradually increase the dosage that the body can keep up. It's based on well-tried cures for other allergy types.

"We fool the body's allergy and immune system by kind of sneaking up on it. We give very, very teeny doses of the food that causes the problem and gradually increase over time," is how Dr. Richard Wasserman described his food desensitization program. "This is an approach that has been done for one thing or another for a hundred years. It just hasn't been done for foods very often, and developing the protocol we use has allowed us to make a difference and take care of a lot more children."

Even in the small, 50 person trial, however, it's not all successes and champagne.

"Sometimes people do have problems and can't tolerate the food even with this procedure," Wasserman said. "This is a demanding thing for a patient and family."

The increasing number of successes is certainly promising and the fact that some insurance plans will pay for it is a cause for that champagne, especially for a $5000 program.

What's also great is that these programs are treating children who have had allergies for years. One 10-year-old who had to avoid dairy since infancy can now have milk.

Small clinical trials don't always translate into mass programs that everyone can use. The fact that several different programs are reporting good results is a good sign. Parents should talk to their pediatricians and keep informed.

Report from the LI Conference, part 20: Question 3 Summary

The NIH LI Conference draft report summaries the presentations from Szilagyi and Savaiano and Levitt to answer question 3.

What amount of daily lactose intake is tolerable in subjects with diagnosed lactose intolerance?

Among individuals appropriately diagnosed with lactose intolerance, differences in a variety of factors—including lactase activity, gastric emptying rates, fecal bacterial metabolites, colonic mucosal absorptive capacity, and intestinal transit time—can greatly influence their susceptibility to develop intolerance symptoms following the ingestion of foods and beverages containing lactose. Individuals differ in the intensity of symptoms of lactose intolerance due to differences in abdominal pain perception and psychological impact of pain and social discomfort. Determining the amounts of lactose that can be tolerated is an important step in developing evidenced-based dietary recommendations that meet the needs of the individual.

High-quality evidence to address the question is limited as documented by the 28 studies summarized in the systematic evidence review. Studies were variable in terms of the definitions of lactose intolerance, study population selection criteria, how lactose was administered, and the type of assessment methods. The lack of validated measures made quantifying the severity of symptoms difficult to interpret. The majority of studies used a single dose of lactose without food and evaluated short-term responses. Efforts often were not made to mask the taste difference between lactose-free milk and milk containing lactose.

To assess tolerability, only a handful of studies tested the subjects in a double-blinded fashion with increasing amounts of lactose administered throughout the day to determine the daily tolerable load of lactose. Furthermore, the majority of studies examined small numbers of subjects, and no data were reported on the relationships of age, sex, or race/ethnicity. No studies focused exclusively on children; two studies examined adolescents exclusively; and two others included both children and adolescents. Only two studies were conducted on pregnant women; none focused on lactating women.

In the majority of available studies, subjects were classified as malabsorbers or absorbers based on breath hydrogen measurements or a blood glucose test, and symptoms of lactose intolerance were not always required for study entry. A blinded control was rarely employed to define lactose intolerance at study entry; thus it is probable that some individuals would have reported symptoms following ingestion of lactose-free solutions. The majority of studies investigated individuals with proven lactose malabsorption, not diagnosed lactose intolerance. As a result, only recommendations for individuals with proven lactose malabsorption and perceived lactose intolerance can be made with reasonable assurance.

The available evidence suggests that adults and adolescents who have been diagnosed with lactose malabsorption could ingest at least 12 grams of lactose when administered in a single dose (equivalent to the lactose content found in 1 cup of milk) with no or minor symptoms. Individuals with lactose malabsorption can tolerate larger amounts of lactose if ingested with meals and distributed throughout the day. However, 50 grams of lactose (equivalent to the lactose content found in 1 quart of milk) usually induces symptoms in those adults with lactose malabsorption when administered as a single dose without meals. For women with lactose malabsorption, tolerance to dietary lactose may improve during pregnancy but then worsen after delivery. Some data suggest that the routine ingestion of lactose increases the amount of lactose that is tolerable in both adults and adolescents. There is no scientific evidence to identify the tolerable dose of lactose for children with lactose malabsorption.

We stress the importance of additional scientific investigations to provide evidence-based and culturally sensitive recommendations about the amount of daily lactose intake that can be tolerated by lactose-intolerant individuals, with special emphasis on pediatric and adolescent populations and pregnant and lactating women.

Report from the LI Conference, part 19

This presentation and the next one are going to infuriate everyone. They're so connected that I'm going to vary from the way I've been handling these posts and put the two of them together.

Dosing, Symptoms, and Tolerable Doses of Lactose
Dennis A. Savaiano, Ph.D.
Professor and Dean
College of Consumer and Family Sciences
Department of Foods and Nutrition
Purdue University

Evidence-based Practice Center Presentation III: The Tolerable Amount of Lactose Intake in Subjects With Lactose Intolerance
Michael Levitt, M.D.
Professor
Minneapolis Veterans Affairs Medical Center
Division of Gastroenterology
Department of Medicine
University of Minnesota

The titles sound innocuous enough. If you click over and read the summaries of the presentations, you'll see that in broad generalities they say very little that I haven't said before and haven't repeated what feels like a dozen times just in my reports on the NIH Conference.

Believe me, the talks that they gave weren't so bland. I'll put it into a sentence.

Nobody gets symptoms from lactose.

Ridiculous, right? Ludicrous even. This whole blog is about lactose intolerance. My books are about LI. The conference was the state-of-the-science on LI. I've received thousand of letters and emails and posts from people telling me about their LI symptoms. Both presenters are researchers who've spent entire careers writing about LI.

Something's totally nuts here. I wish I knew what.

Figures 1 and 2 from Levitt's presentation won't reproduce well here so you have to click over and look at them. They represent the findings from a series of major studies on lactose. A minus sign means that a certain dose of lactose - with other foods in Figure 1, by itself in Figure 2 - produced "no or trivial symptoms" in the test subjects. "Severe symptoms" - the kind I think I get and the kind you tell me you get - are represented by a double plus sign. Remember that an eight-ounce glass of milk has about 12 grams of lactose in it.

When you look at the charts you'll see minus signs for all doses up to and including 12 grams. Virtually no one in the entire set of experiments got symptoms from the lactose in a glass of milk. If you used milk itself or some equivalent, a dose closer to what happens in the real world when you have dairy, no one, not a soul, got symptoms from two full glasses of milk.

Their breath hydrogen goes up, the certain signal that they are lactase maldigesters. But no symptoms.

Savaiano talked about experiments in which subjects received 50 grams of lactose over the course of a day without a single one of them having any symptoms.

Look, as I've reported earlier, the testing in the medical literature is bad. The groups are small, the experiments are not blinded, the doses are not physiologic, meaning that they don't correspond to the foods or eating experiences you get in everyday life. Still. Nothing? No symptoms? Sure, forcing a test subject to drink a full 50 grams of lactose in water - at one time the standard amount of lactose used in testing - will make people sick. But that's like testing for drunkenness by forcing a jug of moonshine down your craw in a single gulp. Anybody would be affected by that. It's so bad a test that doctors stopped recommending its use decades ago.

I didn't get it then, and I don't get it today. I'm reporting what the medical journal evidence says. In the next part I'll give the summary from the draft report. But I'll put the concluding paragraph here.

We stress the importance of additional scientific investigations to provide evidence-based and culturally sensitive recommendations about the amount of daily lactose intake that can be tolerated by lactose-intolerant individuals, with special emphasis on pediatric and adolescent populations and pregnant and lactating women.

That's the biggest "we don't understand what the hell's going on, give us some funding money" you'll ever see in scientific language.

Report from the LI Conference, part 18

Back at the NIH LI Conference, the presenters were ready to tackle question 3.

What Amount of Daily Lactose Intake Is Tolerable in Subjects With Diagnosed Lactose Intolerance?

Adaptation to Lactose Intolerance
Andrew Szilagyi, M.D., FACN, FRCPC
Assistant Professor of Medicine
McGill University School of Medicine
Department of Medicine
Division of Gastroenterology
The Sir Mortimer B. Davis Jewish General Hospital

Szilagyi is pronounced something like Siz-lah-ee.

What does it mean to be adapted to LI? It all relates to the big gap between people who have undergone testing to show that they don't digest lactose and the people who report symptoms of lactose intolerance. Some people who do digest lactose report symptoms in any case. But most people with lactase malabsorption - the technical term - aren't really all that bothered by milk.

I've covered some of these already, but we went over the list again. Having certain types of bacteria in the colon mean that less lactose is fermented and less gas created. Slowing the transit time through the intestines means that whatever small amounts of lactase remain have more chance to work on the lactose.

He also cited some studies that said that pregnant women have fewer symptoms, but worse symptoms after delivery. I've received email from women who are on both sides: some say their symptoms lessen, some say that pregnancy made it worse. But the evidence from these studies is interesting.


Improved lactose digestion during pregnancy: a case of physiologic adaptation?

Obstet Gynecol. 1988 May;71(5):697-700.
Villar J, Kestler E, Castillo P, Juarez A, Menendez R, Solomons NW.

Loss of intestinal lactase activity among adults could theoretically limit milk consumption and hence dietary availability of calcium during pregnancy. The present study sought to define, using breath hydrogen (H2) production as an index of incomplete carbohydrate absorption, the prevalence during pregnancy of lactose maldigestion of 360 mL of milk (18 g of lactose), and to determine whether lactose digestion improved as pregnancy advanced. The prevalence of lactose maldigestion among 114 pregnant women tested before the 15th week of gestation was 54%. By term, 44% of those originally classified as maldigesters had become digesters. There was a significant reduction in the four-hour sum of the changes in breath H2 concentration from the period before 15 weeks (116.6 +/- 9.6 ppm) to the time after 36 weeks (54.4 +/- 7.3 ppm; P less than .01). This apparent adaptive improvement in intestinal handling of milk lactose during gestation has implications for calcium intake and absorption.