Intolerance Myths

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

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

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

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

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

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

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

Claim: The IgG blood test is 95 percent reliable.

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

Health Professional Quality Answers on Food Allergies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Allergic? Try Donkey Milk.

Each mammal's milk is different from every other mammal's milk. They vary in the amount and the composition of the fats, carbohydrates, and proteins they contain. That last is extremely important. It's not just that milk contains two main types of proteins, casein and whey, but that each are whole families of related proteins. Allergies, however, can be extremely specific. A reaction can occur to one type of casein but not another.

And that means that people who are allergic to the specific protein variations (technically known as protein fractions) in cow's milk may not be allergic to the different set of proteins in another mammal's milk.

In Italy, the researchers went to a showing of Shrek 3 and had an aha! moment. Maybe not, but they decided to investigate the allergenicity of donkey milk anyway.

And it worked.

"Adequacy and tolerance to ass's milk in an Italian cohort of children with cow's milk allergy," by Riccardina Tesse, Claudia Paglialunga, Serena Braccio and Lucio Armenio. Italian Journal of Pediatrics 2009, 35:19doi:10.1186/1824-7288-35-19

I found an article about it on Horsetalk.co.nz. (Horsetalk? Donkeys? Makes perfect sense to me.)

Thirty children with a suspected cow's milk allergy, aged six months to 11 years, were enrolled in the study.

They underwent skin-prick tests and a double-blind, placebo-controlled food challenge to confirm their cow's milk allergy.

Testing confirmed the existence of an allergic response in 25 of the children.

Each was then openly given fresh donkey's milk.

Specific biomarkers were checked to evaluate the health of the children before including donkey milk in their diet. The participants were checked again 4-6 months after going on to donkey's milk.

The researchers found that 24 out of 25 subjects (96%) tolerated donkey milk, with their blood biomarkers unchanged after incorporating it in their diet.

The children in the study had no more than moderate allergy. None of the test subjects with severe allergy agreed to take part in the study.

Where you would get donkey milk here is hard to say. I suppose you could talk to your local Democratic Party headquarters, but that's just a joke. I will hope that elephant milk will be tested next, for proper bipartisanship.

Blood Test Might Sort Out Milk Allergies

Since the NIH Lactose Intolerance conference I've been reporting on gave summaries only of previously published research, I interrupt here for some breaking news on a closely-allied front.

The HealthDay News service reported that:

A blood test may help identify children with milk allergy who can tolerate baked-milk products and those who may have a serious allergic reaction to any form of cow's milk, a new study shows.

Previous research found that up to 75 percent of children with milk allergy can tolerate heated milk.

This new study found that immunoglobulin E (IgE) antibodies from children who reacted to both baked milk and unheated milk bound to more epitopes than IgE antibodies from children who had an allergic reaction only to unheated milk. There was a direct link between the severity of the allergic reaction and the number of epitopes recognized by IgE antibodies from a child.

"IgE antibodies can travel to a type of cell that releases chemicals and causes an allergic reaction. Each type of IgE has specific 'radar' for each type of allergen, such as cow's milk. An epitope is a site on a particular molecule, such as a milk protein, that stimulates specific immune responses," according to a news release from the American Academy of Allergy, Asthma & Immunology.

The actual report will be released tomorrow, Saturday, at the Academy's annual meeting.

Food Allergy Tests You Must Avoid

The Food Allergy Initiative has a page on Unproven Diagnostic Tests that includes some familiar targets of mine, such as Nambudripad's Allergy Elimination Technique (NAET) and IgG Testing.

These tests should be avoided at all costs. Getting a false diagnosis, whether positive or negative, is bad enough. However, some of these tests involve eating the allergen itself and that can precipitate a reaction. As the page says, in bold face type:

None of these tests is recommended for the diagnosis of food allergies, and those that involve the ingestion or injection of allergens may increase the risk of a reaction.

The other tests they warn you about are:

Body Chemical Analysis
This type of test analyzes a sample of your hair, body fluids, or tissue to diagnose a mineral deficiency or confirm the presence of toxic substances. Either of these supposedly leads to food allergies or other diseases. Again, there is no scientific evidence to support these claims.

Cytotoxic Testing
In this test, the white blood cells are extracted from a sample of your blood. Then, samples of the white blood cells are applied to slides that contain dried extracts of suspect foods. A technician views the slides under a microscope and analyzes them for changes that supposedly indicate whether you are allergic to any of those foods. AAAAI has concluded that there is no scientific basis for this test.

ELISA/ACT
A sample of your blood is drawn and cultures of the white blood cells are analyzed for their reactions to up to 300 food allergens or other substances. Studies have shown that this test is not effective in diagnosing food or other allergies. Other questionable diagnostic methods that involve white blood cell analysis are the ALCAT and NuTron tests.

Electrodermal Diagnosis
This test uses a galvanometer (an instrument that detects and measures electric currents) to gauge your body’s resistance when you come in contact with a suspect food. Increased resistance to the electric current is supposed to indicate that you are allergic to the food being tested.

Provocation and Neutralization
These tests involve injecting a solution containing a suspect food under your skin or administering it sublingually (as drops under your tongue). Increasing amounts are given in an effort to provoke a reaction. When symptoms appear, you are given increasingly weaker doses of the solution until your symptoms disappear. The last and weakest dose, which supposedly eliminates your symptoms, is called the “neutralizing dose.” This solution may then be provided as a treatment for your food allergy. Provocation tests are not only ineffective, but increase the risk of an allergic reaction. There is no scientific proof that neutralization can prevent or control a reaction.

Pulse Testing
This test is based on the notion that, if you are allergic to a particular food, your pulse (the rate of your heartbeat) will go up after you eat that food. There is no scientific evidence to support this claim.

What's really scary is that each time I've written about NAET, about as pure quackery as exists in fake medicine today, somebody always comments approvingly.

If you have questions about these or other possibly questionable allergy tests, contact the American Academy of Allergy, Asthma, and Immunology (AAAAI).

Food Allergy Tests Can Be Unreliable

There are two major types of food allergy tests. A blood test checks to see whether or not you have a particular antibody called IgE. Skin prick tests reveal reactions to the potential allergen.

Both are good in certain ways. Both also have major problems that people must understand.

Emily Sohn gave some basics in the Los Angeles Times.

IgE tests are very good at confirming the lack of an allergy -- but only when the antibody is just plain missing. In many cases, for reasons scientists don't understand, just about everybody has antibodies to foods they don't react to. ...

These skin tests are fairly reliable when they're negative. Positive reactions to foods, on the other hand, are wrong up to 50% of the time.

Someone with a milk allergy might develop bumps from beef and pork pricks, and someone with an egg allergy might react to chicken and turkey pricks, simply because the proteins in those food groups are similar enough, or because a person has sensitive skin.

Allergy tests also have the same underlying problem that plagues testing for lactose intolerance. Even when the test predicts the allergy properly, it can't predict the severity of the reaction.

The Hydrogen Breath Test

It makes my life easier when I get to quote from myself. I have a page on my website titled Tests for Lactse Intolerance and I'm going to quote an important piece of it everybody should know.

The Hydrogen Breath Test (HBT)

The HBT is the best around, simple, direct, and non-invasive (meaning no needles). It works because your breath normally never contains hydrogen gas. You find it there only when the bacteria in your colon ferment carbohydrates, exactly what happens when a load of undigested lactose hits.

Testing is typically done first thing in the morning after a 12-hour fast. You'll likely be asked to blow into a small mouthpiece connected to a laminated foil bag that resembles a pillow-shaped mylar balloon (although several variations may be found).

That first bag is set aside to be used as a baseline. You then drink a solution of lactose in water, although some doctors use milk itself. The amount of lactose may range from 10 to 50 grams: The larger amounts will identify a greater number of people as LI but will also cause more symptoms in those who are sensitive. (Be prepared. You may feel quite ill during and after.)

It takes time for the lactose to reach the colon and for the bacteria to build up a supply of hydrogen in the breath. Various labs will take further breath samples at intervals of 15-60 minutes and for up to two to six hours. Longer is usually better, and the use of milk requires a longer test.

While the test itself is so simple that it can be done almost anywhere, the collected samples are usually shipped off to a specialized laboratory that can afford the several thousand dollars needed to purchase the analyzer. Don't bother to ask for exact results. All that matters is whether you are over a certain threshold. How high doesn't matter and doesn't even relate to how bad your symptoms will be.

This test is extremely accurate. It can be even be used on very young children. But it does have a few flaws.

People on antibiotics should not take it because the antibiotics may knock out the very bacteria which would otherwise produce the hydrogen. Using aspirin before the test may create a misleading rise in hydrogen. Smoking will do the same. A certain percentage of the population don't even have the right kind of bacteria to make hydrogen.

The test is also used to discover other conditions, including bacterial overgrowth in the intestines and rapid transit. Other sugars, including glucose, fructose, sorbital and lactulose, may be used in place of the lactose. You need to talk with your doctor about these if you get a reaction that is not attributed to lactose intolerance. A good article on the test is available on MedicineNet.com.

In any case, unless something disqualifies you, in the U.S. the HBT is the one you want.

The HBT has been around literally for decades. So I was stunned when I read a press release from the University of Cincinnati's University Hospital.

A person’s breath can tell you a lot of things, like whether they are garlic lovers or regularly chew gum.

But according to doctors at the University of Cincinnati, it can also help uncover problems in the gastrointestinal (GI) tract.

Ralph Giannella, MD, and colleagues in the digestive diseases division are now offering hydrogen/methane breath testing at University Hospital to help patients discover whether they have bacterial overgrowth in their small intestines or are lactose or fructose intolerant.

He says University Hospital is the first facility to offer this test in the Cincinnati area.

The Cincinnati metropolitan area is the 24th largest in the country, more than twice the size of Rochester's. How is it possible that an area that large could have been without so simple and standard a test for so long? What other major metro areas might not give their inhabitants easy access to the HBT?

I'm glad the population of Cincinnati can now get this better test done, which may mean an increase in the number of people correctly diagnosed as LI.

If you can't get the HBT done locally wherever you live, make a fuss. Tell your doctor that the local hospitals need to offer this as a basic service. Tens of millions of Americans are Lactose Intolerant, and many may not even realize it. Stop being backward. LI is a a serious issue that is easily helped by an inexpensive pill - if you know you should be taking it. The help you need should be close at hand. Make it happen.

A Patch for Lessening Dairy Allergies

About two years ago I posted about the Diallertest Dairy Allergy Skin Test using the Viaskin patch from DBV Technologies as an easier means of allergy testing.

The company is now using Viaskin as a way of diminishing allergies, according to an abstract published in the Journal of Allergy and Clinical Immunology, by Dupont C, et al., "Epicutaneous immunotherapy in severe cow milk allergy: a double blind pilot trial" J Allergy Clin Immunol 2009; 123: S183 and reported on at the current American Academy of Allergy Asthma & Immunology Meeting in Washington. John Gever, a senior editor at MedPageToday.com wrote the article.

Children with dairy allergies were able to tolerate significant quantities of cow's milk after treatment with an investigational dermal patch-based immunotherapy (Viaskin), a researcher said here.

In eight of 13 evaluable children receiving the treatment for three months in a placebo-controlled pilot trial, the maximum amount of milk they were able to tolerate increased at least threefold, reported Christophe Dupont, M.D., Ph.D., of Hopital Saint Vincent de Paul in Paris.

None of the seven children in the placebo group showed that high an increase in tolerance, he said here at the American Academy of Allergy, Asthma, and Immunology meeting. ...

[T]he improvements seen in most participants were enough to prevent them from reacting to foods with trace quantities of milk proteins.

The patch contained 1 mg of milk protein or placebo and was applied every other day to children in the study. Participants were from three months to 15 years of age and underwent oral milk challenges at baseline and after two and three months in the trial.

The mean maximum tolerated milk dose at baseline was 2.1 mL (SD 2.6) and 4.4 mL (SD 5.9) in the active-treatment and placebo groups, respectively.

After three months, the mean tolerated dose tended to increase to 21 mL (SD 24.3) in the active-treatment group compared with 5.4 (SD 5.9) in the placebo group (P=0.37).

While these are positive results, the study group was extremely small. The full study has not been reported and peer-reviewed. The treatment is only available for clinical testing, not from any doctors. And note that the study was funded by DBV Technologies.

So, some possible good news, but good news for a distant future day.

Blood Tests Overdiagnose Allergies

Tara Parker-Pope's [corrected name] column in today's New York Times makes a point that every parent of an allergic child - or possibly allergic child - should read.

The blood tests that many parents are turning to as an easier and faster diagnostic for food allergies than the old skin prick tests aren't reliable. They identify many children as being allergic when they really aren't. These are known as false positives.

A 2007 issue of The Annals of Asthma, Allergy & Immunology reported on research at Johns Hopkins Children’s Center, finding that blood allergy tests could both under- and overestimate the body’s immune response. A 2003 report in Pediatrics said a positive result on a blood allergy test correlated with a real-world food allergy in fewer than half the cases.

“The only true test of whether you’re allergic to a food or not is whether you can eat it and not react to it,” said Dr. David Fleischer, an assistant professor of pediatrics at National Jewish Health. ...

Blood tests may be unreliable because they fail to distinguish between similar proteins in different foods. A child who is allergic to peanuts, for instance, might test positive for allergies to soy, green beans, peas and kidney beans. Children with milk allergies may test positive for beef allergy.

Nobody is saying that the blood test shouldn't be used. Instead, it should be used as a first method of screening for allergies. A quick, easy test that shows up negative means that your child is spared longer or more invasive tests.

However, further testing is necessary if a number of allergies are detected. Usually this testing involves food challenges. Foods that have been removed from the child's diet because of a positive result are put back into the diet, carefully and in small quantities, to see if a reaction occurs. Reactions to actual food are the best evidence of an actual allergy. Remember that very young allergic children often outgrow allergies to milk as well as to eggs, soy and wheat.

Reintroducing food should only be done under the supervision of a doctor. If the child remains allergic a severe reaction could occur and doctors can control this.

The risks of a serious allergic reaction are real. However, so are the risks of taking children off of common foods unnecessarily. Cases of malnutrition have been reported from overly restricted diets. And the chances of a reaction when the food is reintroduced - deliberately or accidentally - are increased.

Allergies are increasingly widespread. That also means that some parents are assuming allergies where they don't exist, creating a vicious cycle. Doublecheck all positive results from testing, especially from blood tests. And make sure they are real tests from the best trained doctors. There are too many quacks preying on peoples' fears to take any chances with your child's health.

Only Half of Suspected Food Allergies Real

A fascinating and unusually readable article on food allergies was recently published in the German journal Deutsches Ärzteblatt International. "Food Allergy in Adults: An Over- or Underrated Problem?" by C. S. Seitz, P. Pfeuffer, P. Raith, E. Bröcker, and A. Trautmann, Dtsch Arztebl Int 2008; 105(42): 715-23
DOI: 10.3238/arztebl.2008.0715.

An English translation of the article can be found on the journal's website.

They tested 419 patients sent to a clinic because their symptoms indicated a food allergy. However, after extensive testing, only 214 tested positive for an IgE-mediated true allergy.

Background:
10% to 20% of the population sees itself as suffering from food allergy, yet genuine, immune-mediated food allergy is suspected by patients and their physicians far more often than it is actually shown to be present. The unfounded suspicion of an IgE-mediated food allergy can substantially impair a patient's quality of life through needless dietary restriction and the accompanying anxiety. On the other hand, an IgE-mediated food allergy that has gone undiagnosed or that has not been taken seriously can manifest suddenly with anaphylaxis, which may be life-threatening. The present study, carried out on a large cohort of patients, underscores the importance of differentiating IgE-mediated food allergy from other, non-allergic types of food reaction.

Methods:
419 patients that had been referred to our outpatient allergy clinic for suspected food allergies underwent a standardized allergologic diagnostic evaluation, including thorough allergologic history-taking, IgE serology, and challenge tests when indicated.

Results:
214 patients (51.1%) were found to have an IgE-mediated food allergy. Almost half of these patients (24.3% of the overall group) had previously experienced food-induced anaphylaxis. In 205 patients (48.9%), however, an IgE-mediated food allergy was ruled out as far as possible.

Conclusion:
Only a comprehensive allergologic evaluation performed by an experienced allergologist in accordance with current guidelines can protect patients from the negative consequences of excessive concern about a non-existent food allergy (e.g., needless dietary restriction) or, on the other hand, the negative consequences of inadequate attention to a genuine food allergy (anaphylaxis). A proper evaluation consists of detailed allergologic history-taking, skin tests, and challenge tests when indicated.

Other interesting findings not included in the abstract were that a full 97.6% of symptoms manifested within four (4) hours and that positive skin-prick tests had little predictive ability, but negative ones did.

Answers to Questions from Readers, part 12

Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

You would think so, wouldn't you?

But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)

So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

The odd answer is that you are both right.

Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

So?

So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

There. Feel better now?

Answers to Questions from Readers, part 6

Q. I have taken lactase several times now and gotten an upset stomach, cramping and bowel pain. I guess my question is: Is it possible to have too much of the enzyme in your system?

Q. Are the Ultra Lactaid pills constipating? Lactaid, by the way, denies any knowledge of this side effect. I called them a couple of years ago and asked.


Q. I now strongly suspect that some brands of pills can themselves cause diarrhea, especially in large doses. Do you have any information on this?

I've been getting an increasing number of complaints that lactase pills are causing problems. As you can see, though, each person seems to have a different complaint.

Giving advice on this issue is difficult, because except for some anecdotal complaints such as these, there is nothing in the medical literature about adverse reactions to lactase pills. Nothing. They are some of the most benign pills known to the pharmacopeia.

So what's going on?

One or two actual medical problems are known. There is one single case of a person being allergic, not to the lactase, but to the yeast that is used to manufacture the lactase. And a few brands of pills may contain mannitol, an artificial sugar substitute, as an ingredient. Susceptible people are known to get diarrhea from mannitol.

Other than that, the problem is compounded because people are taking the lactase with meals. So any reaction may come from the meal rather than from the pill. And to make things more complicated, when people try to relieve symptoms or cure a supposed food-based problem, they often make many changes to their regular diet simultaneously. The reaction could come from any or all of these, alone or in combination.

You might want to consider the possibility that if your system has been producing mild diarrhea for a long time from small quantities of lactose, you've come to think of this state as being "normal." Getting sufficient lactase into your system to eliminate the symptoms would feel much like constipation by comparison. Remember that doctors define a normal amount of bowel movements as anywhere from three times a day to three times a week.

Or you may be having a psychological reaction to knowing you're about to eat food that contains something you shouldn't have. (Don't scoff. Many studies have shown a strong psychological reaction to milk even in people who do not test out as being LI.)

It may even be something as simple as having a stomach flu and not realizing it.

Not very helpful, I admit. All I can say is that you should try several different brands of lactase. Some people simply react better to some brands than to others.

You might also look at my Lactase page in my LI Basics section. I gave lots of helpful hints as well as answers to what and when and how and how much lactase. You may find something useful there.

Q. I have read references to a lactose-tolerance test. What is that?

There are two basic types of lactose-tolerance test. Both start with a person drinking either a solution of lactose and water or a glass of milk.

The most common test is called the breath hydrogen test. If you do not digest lactose then the bacteria in your colon will ferment it, producing hydrogen gas. This gas is measured in your breath. Measurements are made at intervals for several hours to see what the peak is. If the peak is higher than a certain amount, you are said to be lactose intolerant.

Because the breath hydrogen test needs special equipment to measure the hydrogen, some places still use the older blood glucose test. The idea behind this one is that if you do digest lactose, your blood sugar will go up. Therefore blood samples are taken at intervals to measure the glucose level. If it goes up, then you are not lactose intolerant. This makes it an indirect test and so not as sensitive, besides which you get stuck by a lot of needles, both of which have caused it to go out of favor.

For more info, see my LI Tests page.

Q. How should a doctor diagnose lactose intolerance?

The symptoms of LI are diarrhea, gas, cramps, flatulence, and borborygmi (the rumbling of air through the intestines) after the ingestion of milk products. Any one of a number of tests can be given to a patient to confirm LI. The major tests are the breath hydrogen test (since the bacteria in our colons produce hydrogen gas when they ferment undigested lactose) or the blood glucose test (an indirect test measuring the lack of an increase in blood glucose from the failure to digest lactose). The patient drinks a lactose solution and then either a breath sample or a blood sample is taken at intervals thereafter.

The problem for a doctor is to determine when LI is the problem and when the symptoms may be coming from any number of other, more serious, diseases and disorders with similar symptoms that the patient may have instead of or in addition to LI. You'll have to ask a real doctor how that determination is made.

Answers to Questions from Readers, part 5

Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

You would think so, wouldn't you?

But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)
So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

The odd answer is that you are both right.

Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

So?

So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

There. Feel better now?

Q. Have you heard of anyone's LI symptoms being relieved by birth control pills?

The problem is that I hear all sorts of anecdotal comments about LI, without ever being able to back them up. I have heard of women becoming LI because of pregnancy and also of women being able to drink milk for the first time while pregnant. I do not, however, know of any studies that would shed any light on the subject. But you are definitely the first to give a connection to bcp's. (However, as all but one brand of bcp's contain lactose as a filler, it's probably not surprising that few people see their symptoms disappear while on them.)

Q. Our doctor thinks my daughter has irritable bowel syndrome, but with lactose intolerance as a trigger. I'm wondering if I am giving her enough Lactaid. Do you have any thoughts on this?

While it couldn't hurt, it's not clear that it would do much to help unless you think you are still not detecting all milk products at those meals.

You might want to go in a different direction. There are numerous other triggers of irritable bowel other than milk. They include: large meals, fatty or spicy foods, carbonated beverages, and caffeine. Gas-producing foods, like beans and cabbage, can also be a problem. So can sorbital, the artificial sweetener. Even some fiber sources, including lettuce, celery, and fruits, may cause gas and bloating. If you detect a pattern of symptoms in conjunction with any of these, try removing it from her diet for a few days and see if that helps.

Q. How does heat affect lactose? Does baking alter lactose? If I see non-fat milk in a bread label, has the lactose been altered to the point that it no longer poses a problem for me?

Unfortunately, there is no evidence that heat affects lactose in any way. Lactose in pure form, in mostly pure form (whey) and as a small percentage of other milk products, is used in hundreds of foods and people seem to respond to all of them. Of course, most people do _not_ respond to small amounts of lactose, so size does matter, as they say. But you do need to take lactose into account in any food that it is in.

To know how much lactose is in various milk products, see the SuperGuide to Dairy or the Lactose Percentages pages in the Dairy Facts section of my web site.

More Info on Diallertest Dairy Allergy Skin Test

More details are emerging about the major new skin testing system for dairy allergies that I posted about last week in Skin Patch Dairy Allergy Test Announced.

The German site InnovationsReport.de has a article on the Diallertest system. One thing it emphasizes is that the system helps to identify "hypersensitivities." These are reactions mediated by other antibodies than the IgE antibodies that cause true allergy and are the source of anaphylactic reactions. Many people have them but don't realize they are allergies, or confuse them with lactose intolerance because gastrointestinal symptoms are the result.

In the past decade, food allergies have become a major point of concern for paediatricians, especially those treating very young children. The number of cases has almost doubled over the last ten years. EUREKA project E! 3292 MULTI-PATCH has helped to develop a full range of ‘DIALLERTEST’ products, aimed at detecting the most frequently observed children’s allergies, including milk, corn, soy and house dust mites. Already being marketed internationally, the results represent a major success for European medical research and development.

The scientific approach to allergies has evolved explains Pierre-Henri Benhamou of France’s DBV technologies. Aside from the well-known ‘immediate’ forms of allergy, which involve rapid acute symptoms upon allergen ingestion, ‘delayed’ types have also been described since the 1990s. Here, clinical symptoms, usually digestive or cutaneous reactions, occur several hours, days or even weeks after. “These allergies are caused by foods that form the base of the day-to-day diet,” says Benhamou, “and to which the patient becomes only gradually sensitised. Unlike the more traditional forms of allergy, the delayed forms pose important problems in terms of diagnosis.”

“What’s different about the ‘DIALLERTEST’ system is that it uses DBV’s new E-patch technology,” explains Benhamou. “This allows us to set dry powdered milk onto the patch by means of electrostatic forces. Thus, no additive or wet substance is needed to hold the suspected allergen in place. This represents an important simplification of the patch test.” It means that a much tighter control over the quantity of allergen is delivered, a more measurable and reproducible reaction, and, ultimately, more reliable and standardised screening for cow’s milk protein allergy. It will also allow doctors to keep allergens in their best reactive state, the powdered form. The materials used in ‘DIALLERTEST’ patch tests are all bio-compatible, specially conceived for the pharmaceutical industry.

When will you see this test? Soon, one hopes.

Today, our products are being distributed in Mexico, Australia and the countries of the ex-USSR, and the necessary paperwork is also being completed for distribution in the US and with the European drug agency (EMEA).

LI Celebrity Alert: Jessica Simpson

A syndicated article from Bang Showbiz reveals the single fact about Jessica Simpson's life that hasn't already been beaten to death by the celebrity mags.

Jessica Simpson has revealed dairy products give her terrible wind.

The 'Dukes of Hazzard' star - who is getting in shape for her new movie in which her character joins the Marines - has to watch her diet because her lactose intolerance causes her to omit gas from "all ends."

Jessica told US TV show 'Extra,' "I am going to be all ripped. But it's tough, I'm not good on sugar. Or dairy - you'll hear it come out of all ends!"

That may be why she's in that "Who? Me?" pose.

Skin Patch Dairy Allergy Test Announced

How would you like a test to see if your child is allergic to dairy that is "Practical, simple to use, and painless as it is completely non-invasive, and it can be applied directly by the parents to the child's back at home."

Sure sounds good. The product, under the name Viaskin, has been announced by DBV Technologies.

According to an investment information site:

DBV Technologies was formed by two paediatricians in March 2002, for the purposes of developing food allergy diagnostic tests. The company won the Altran Foundation Innovation Award in 2003, and receives backing from the French Innovation Agency (Oséo-ANVAR).

DBV Technologies has developed and patented a non-invasive, painless, affordable, and highly-reliable patch system based on an original electrostatic technique.

In 2004, DBV Technologies launched the first test patch that can be used to diagnose cow's milk allergy, a condition afflicting approximately one out of every 12 newborns. Within only 18 months, over 20,000 of these diagnostic tests were sold in pharmacies.

The company is currently developing other therapeutic applications for its patch, including vaccinations, cutaneous drug administration, and the diagnosis of and desensitisation to other allergies (wheat, dust mites, etc.).

The latest news about the Viaskin patch is being announced at the 2007 BIO International Convention, the Global Event for Biotechnology, now ongoing at the Boston Convention & Exhibition Center.

DBV Technologies' press release, found at LaboratoryTalk.com, says:

Viaskin is a dry, disc-shaped cutaneous device system that holds an active ingredient in powder form on an electrically charged plastic film that only delivers it when Viaskin is placed on the skin.

...

Application of the disc creates a occlusive chamber between the disc and the skin, making the chamber's conditions humid enough to hydrate and release the active ingredient, and to open the skin's pores to better absorb the active ingredient.

Diallertest Milk uses this technology to diagnose cow's milk protein allergy and is suitable for everyday medical practice.

Practical, simple to use, and painless as it is completely non-invasive, and it can be applied directly by the parents to the child's back at home.

It significantly improves the effectiveness in the diagnosis of cow's milk protein allergy.

The faster the diagnosis and treatment, the lower the risk of developing allergosis.

DVB is also developing Diallertest to diagnose dust mite, soy, and wheat allergies.

The milk allergy test will soon be available to the United States.

DBV Technologies and Numico, a Dutch company specialising in the production and sale of nutritional foodstuffs, have announced a distribution agreement for Diallertest Milk that will extend its original network to include the entire world.

Since February 2006, Nutricia, Numico's French subsidiary, has distributed Diallertest Milk in France.

Today, about 70,000 tests have already been prescribed.

The test is available in Australia, France, the Middle East, and New Zealand.

Founded in 2002, DBV Technologies was created by Pierre-Henri Benhamou, a pediatrician specialising in gastro-enterology, allergosis, and nutrition, and Bertrand Dupont, a qualified engineer from the Arts et Metiers institute.

Today it is chaired by Jean-Francois Biry, CEO.

The company has perfected and globally patented the Viaskin technology.

Let's hope we hear more about Viaskin becoming commercially available in the U.S. soon.

Lactose Does What?

I despair about getting accurate information about milk in general and lactose specifically out to the general public when members of the medical profession profess versions of reality I am not familiar with.

The National Website of Wales featured an article about a debate to be held on the value of milk by "Two eminent Welsh professors - both from Cardiff University's School of Medicine."

One of them, Peter Elwood, talks about studies that have been done on long-term effects of drinking milk, something one would think was within his specialty of epidemiology.

There have been 13 major studies throughout the world which provide evidence about milk drinking, heart disease and stroke – these state that there is a 15% to 20% reduction in the incidence of heart disease and stroke in people who drink milk.

...

Drinking milk raises cholesterol by a very small amount, far smaller than most people seem to imagine, but it also lowers blood pressure. Those who focus on milk and cholesterol only are ignoring the effect it can have on blood pressure and possibly other factors that we don’t yet know about.

...

Another condition, which has become a very hot topic, is the metabolic syndrome. It is important because it predicts heart disease quite strongly and diabetes very strongly.


There are four studies throughout the world to look at this and milk drinking and again they show a substantial reduction in metabolic syndrome in people who drink the most milk – that’s quite convincing.


Unfortunately there are only two studies to look at diabetes and milk consumption but both show a reduction in diabetes in people who drink the most milk.


The conditions which are responsible for more than half of deaths show a beneficial effect from drinking milk.


There is also very, very good evidence that milk drinking is associated with a reduction in colon cancer – the second most common form of cancer.

Against this evidence is the report from Tony Campbell, a medical biochemist:

It’s commonly believed that lactose intolerance causes problems like gas, constipation and diarrhoea, but it can also bring about a whole range of problems like migraines, chronic fatigue, eczema, hay fever, and muscle and joint pains.

We have hundreds of patients who didn’t know these troubles until they came to us and they changed the way they managed their conditions.

We now have a genetic test that judges how sensitive people are.

If you are sensitive to lactose, what happens is that when it reaches the bacteria in your intestine, it breaks down, generating gases, which are what causes the distension.

But they also create toxins, which are absorbed into the body, causing a whole range of problems.

This is the really revolutionary part of our research.

Anthony K. "Tony" Campbell is a legitimate researcher and has published articles on lactose intolerance in legitimate medical journals. You find his name familiar. I did a post on Tony's Lactose Free Cookbook last year. He and co-author Stephanie B Matthews have a little self-publishing empire on LI, including a pamphlet called "The hundred commonly asked questions in the lactose intolerance clinic," which I would love to get my hands on.

Unfortunately, that book still reads available 2006 with no other information. And also unfortunately, I can find no evidence of a working genetic test for sensitivity in any of Prof. Campbell's articles. The closest lies in "Systemic lactose intolerance: a new perspective on an old problem," by S B Matthews, J P Waud, A G Roberts and A K Campbell, Postgraduate Medical Journal 2005;81:167-173.

Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. This, with a 48 hour record of gut and systemic symptoms and a six hour breath hydrogen test, provides a new approach to the clinical management of lactose intolerance.

I don't know who is doing this test or what kind of sensitivity it talks about.

And even weirder, I don't understand where the research comes from that blames lactose for a range of symptoms always associated with cow's milk protein allergy, a totally different ailment.

I'm confused, and as always when I'm confused, I'll try to dig deeper and give you a better idea of the real situation.

Doctors: Learn to Diagnose Celiac Disease!

Once a rare and virtually unknown disease in the U.S. celiac disease, or gluten intolerance, has become fairly well known and understood. Even better, there are many resources available for dealing with it, including many foods that are gluten-free as well as lactose-free. The lactose-free foods part is necessary because celiac disease destroys the villi, the tiny projections on the insides of the intestines where the lactase enzyme is made.

I've covered this topic in several recent posts, including Gluten-Free, Casein-Free (GFCF) Diet Helps Autistic Children, The Gluten-Free Restaurant Awareness Program (GFRAP), and New Gluten-Free, Casein-Free Diet Cookbook.

Apparently, celiac disease, or as they spell it coeliac disease, is not as well known in the U.K.

It's absolutely chilling to read Family's battle to have disease diagnosed by Lucia Clifford on the Warwick Today website.

To see her now, Summer Wareing is like any other active five-year-old.

She began to suffer with the symptoms of coeliac disease, but doctors put her ill health down to a reaction to her recent MMR booster.

Summer continued to suffer with severe diarrhoea and her condition was so bad, her mum Ruth took her to the doctor every couple of weeks. She was told to stop being 'neurotic' and that children pick up all manor of bugs.

As the weeks passed, the three-year old was losing more and more weight and had her tummy had become extremely bloated.

Ruth, of Burton Green, said: "After one particularly bad night, I took Summer to our local A and E department where the doctor just laughed and said: "It's the weekend, what do you want me to do about it?"

...

Out of sheer desperation, they turned to private medical care. However, even this was not straightforward and the family had to persist before Summer finally had a blood test for coeliac disease.

When the results came back positive, her family were just relieved to finally have an answer, a diagnosis. However, unfortunately they couldn't begin to help their daughter by starting her on a gluten-free diet until she had had a biopsy to confirm the diagnosis. By the time biopsy was performed, Summer had no villi left in her intestines, which had led to an intolerance to lactose and she weighed less than when she was 18 months old.

Ruth added: "Trying to feed her on a gluten-free diet was a nightmare, she had become so afraid of food, all she knew was that when she ate her tummy hurt. Her doctors told me she was becoming a fussy eater and that we were making her worse because we were being sympathetic to her."

Eventually Summer did begin to trust again and did begin to eat but it wasn't easy trying to find gluten-free foods, while also omitting milk (due to her lactose intolerance), that would entice a three-year old.

Now five years old, Summer is thriving and according to her mum 'has way too much energy'.

It's hard to know whether this is an indictment of Britain's National Health Service (NHS), or just a general lack of knowledge among U.K. doctors.

Either way, the government doesn't come out very well.

People diagnosed with coeliac disease can be prescribed an NHS prescription for basic food including bread, pasta and flour.

Due to current funding considerations within the NHS, some PCTs have sought to restrict or stop prescriptions for gluten-free foods. Due to the comparatively high cost of gluten-free food for many people on lower incomes the prescriptions are essential to ensure they maintain a healthy diet. Coeliac UK has opposed measures to restrict prescriptions where it effects staple foods.

Coeliac UK is "the charity for people with coeliac disease and dermatitis herpetiformis*." Looks to be lots of good information and lists of gluten-free food on the site.

And try to make doctors aware of the problem so that no future Summers are so dark and stormy.


*"Dermatitis Herpetiformis (DH) is an important associated disorder or complication of celiac disease which is manifested in the form of a skin rash. There is strong evidence that the changes in the intestinal mucosa and the immunologic findings in the majority of patients diagnosed with DH are identical with those found in celiac disease. Gluten has been found to have a close relationship with this skin rash. DH is often referred to as "celiac disease of the skin" while CD is referred to as "celiac disease of the gut."
from the Celiac Sprue Association.