When to Take Your Lactase

Back to lactose intolerance basics. Here's a question that I got an email about.

When should I take my lactase pills?

The best time to take your lactase is just before you start eating. The lactase is designed to go quickly through the stomach and enter the small intestine. That's where it works. If you take the pill before eating any of the dairy, the lactase will be sitting there waiting for it.

Should I take another pill if I have more dairy during the meal?

Food moves the intestines slowly. In fact, your system requires hours to break down and digest all the nutrients in food. If you take enough lactase at the beginning of a meal it will all still be there for any food eaten during the course of a meal.

If you're surprised by dairy you didn't expect, say by a big dairy-laden dessert, then go ahead and take more lactase. But otherwise it's not necessary.

What if I forget and don't take the lactase until the end of the meal or even later?

You want the lactase to be there first. If the lactase chases the lactose it may not catch up with the first part of the meal and some lactose can slip through undigested.

Even so, better to miss some lactose than to miss all of it. If you have lactase, take it. It should still do some good by reducing symptoms even if it doesn't eliminate them completely.

Take Calcium. Every Day. Forever.

Here's the short version: Take calcium. Take calcium daily. Take calcium daily forever.

Now the long version.

Two long-term major studies of calcium use by women have appeared lately. One was an Australian study of 1,460 women older than 70, reported in the journal Archives of Internal Medicine. The other was a finding from the Women's Health Initiative (WHI), that major ongoing study of 36,000 postmenopausal women that has spawned so many articles and controversy over so many of its findings.

And the superficial, quick read version of both these studies is that calcium does nothing. No statistically significant benefits found.

This is true, and yet it is dead wrong. The superficial read is the wrong read. The headlines will steer you false yet again.

Dig deeper. Take a look at "Protecting Your Bones: New Evidence Helps Clarify the Benefits of Calcium," Tara Parker-Pope's Health Journal column in the April 25, 2006 Wall Street Journal. (Available online only to WSJ subscribers. Sorry.)

The real story is buried in the data, but it's a blockbuster. The reason the Australian study found no benefits is that 43% of the women in it stopped taking their calcium during the five year study. The women who kept taking the pills had a massive 34% reduction in their overall risk of a fracture.

About the same fraction of women stopped taking the calcium in the WHI study. And many of the women in the study were under 60, making them less likely to suffer fractures in the first place. Women over 60 were 21% less likely to suffer a hip fracture. Women who took the pills regularly had a 29% lower risk. When everyone was counted in, those who weren't taking calcium supplements before the study now had a 30% lower risk.

"It was a bit of a surprise and a bit disappointing to discover that the effect was so dependent on compliance," says [Australian] study author Richard L. Prince, associate professor at the School of Medicine and Pharmacology at the University of Western Australia. Patients need to make their calcium regimen a life-long habit "to get the full treatment effect."

As with every medication, side effects occur. The WHI study found that daily calcium may increase the, low, risk of kidney stones by 17%. However, the only side effect the Australian study spotted was constipation.

So take calcium now. Take it later. Take it daily. How much? 1200 mg is what the studies recommend.

And never get medical news just from headlines.

Molecules of Lactose - the Teeny Tiny Truth

Let's take a nostalgic stroll back to high school chemistry. Yeah, I'm getting all misty eyed too. But if you ever learned the concept of gram molecular weight and Avogadro's Number, that's where it first came up. (If not, you're special and you don't need to read this but you already know the answer.)

Avogadro's number is 6.022∙10²³. That's a really really really huge number. Written out in full it reads: 602,200,000,000,000,000,000,000. The number is important because that's how many molecules exist in a mole of any substance. A "mole" is short for gram molecular weight.

The molecular weight of a molecule is the weight of N₀ such molecules. The molecular weight of a molecule is equal to the sum of the atomic weights of its constituting atoms.

So what's the molecular weight of lactose? (Aha. This suddenly gets relevant.) Lactose's chemical formula is C₁₂H₂₂O₁₁. I'll do the math for you. A mole of lactose molecules weights about 342 grams.

Now one gram is a tiny amount. There are 454 grams in a pound, 28.375 grams in an ounce. An eight ounce glass of milk has 12 grams of lactose. If you held an ounce of lactose in your hand, you couldn't even feel that it was there. Yet that one gram still contains 1,760,233,918,128,654,970,766 molecules of lactose. Rounded, that's 1.76•10²¹ molecules. (6.022∙10²³ / 342)

That's why I tell people with lactose intolerance not to get worried about a few molecules of lactose. Or even a few billion. A few molecules can't hurt you. Your system wouldn't even recognize them.

Those with dairy protein allergies need to be a bit more careful, but similar math applies. Proteins are far heavier than lactose. They can weight a million times more. And even nanograms of protein can set off a reaction. A nanogram is one billionth of a gram. Even a million billion is small next to Avogardo's number, though. If you divide 1.76•10²¹ by a million billion, you're still left with 1.76•10⁶ or 1,760,000. Almost two million protein molecules are needed at the very least to set out a reaction in the most sensitive person. The real minimum is probably larger than this.

Caution is definitely the byword for those who are anaphylactic to milk. For the rest of us, just remember a few molecules are the same as none at all.

Lactose Helps Explain Evolution

All of us with lactose intolerance should know that some of the bacteria in our colons manufacture the lactase enzyme, which helps digest any lactose that reaches them, reducing symptoms.

Few of us realize that learning how the bacteria do this was one of the breakthroughs in understanding how genes function.

The new issue of the New York Review of Books has a review by Edward Ziff and Israel Rosenfield of three new books on evolution. As usual, the review is an actual review of the subject as much as or more than a critical review of the book's involved. The authors explain the lactose collection as follows:

The number of genes in a given species, therefore, is not a measure of its complexity. Why had biologists so overestimated the number of genes in the human genome? Why is it unnecessary for complex animals such as mammals to have ten times as many genes as worms?

The answers to these questions were already hinted at more than four decades ago. At the time it was known that the bacteria E. coli, which normally live off the sugar glucose, are also capable of producing enzymes that digest other sugars, such as lactose. But biologists noticed that the bacteria only produce the enzyme when lactose is present in their immediate environment. Scientists could not explain how the E. coli somehow "knew" when the lactose-digesting enzyme would be needed.

In 1961, Jacques Monod and François Jacob discovered that E. coli bacteria actually have a mechanism that controls the production of the enzyme for digesting lactose. As unicellular organisms, E. coli bacteria have only several thousand genes, each of which is made up of a specific sequence of DNA. A single one of these genes, present in all E. coli, carries in its DNA the genetic instructions needed to assemble the enzyme that can digest lactose; the DNA is copied into RNA, which is then "translated" to produce the enzyme itself. When there is no lactose present in the bacteria's immediate environment, the gene is switched off: its DNA is not copied into RNA and the enzyme is not produced. The reason for this, the scientists discovered, is that a protein called a repressor molecule attaches itself to the DNA site where the copying into RNA begins, thus blocking off the DNA and preventing the gene from producing the RNA responsible for the synthesis of the enzyme.

On the other hand, when the E. coli bacteria encounter lactose, the lactose binds itself to this repressor molecule, causing the repressor to be detached from the DNA site. This unblocks the DNA, allowing the gene to be copied into RNA, and produce the enzyme that can digest lactose. In other words, the repressor molecule acts as a switch that controls the gene's production of the enzyme. Since only a fraction of the total number of genes present in an organism are expressed, or turned on, at any given time, Monod and Jacob conjectured that other genes must be similarly turned on and off.

Although they had not yet found systematic evidence to support these ideas, the discovery of the repressor molecule allowed the two scientists to form a powerful new hypothesis about how genes function. As Jacob recently wrote, in a brief description of the new hypothesis:

It proposed a model to explain one of the oldest problems in biology: in organisms made up of millions, even billions of cells, every cell possesses a complete set of genes; how, then, is it that all the genes do not function in the same way in all tissues? That the nerve cells do not use the same genes as the muscle cells or the liver cells? In short, [we] presented a new view of the genetic landscape.

The deeper significance of the Monod-Jacob model of gene function, and its implications for the nature of evolution, became apparent with the new field of embryo research that arose almost twenty years later.

There's much more to the article. Read it for a better understanding of the evolution of evolution.

Go GoDairyFree.com

Alisa Fleming of GoDairyFree.com - "The Complete Resource for Dairy Free Living" – sent me an email alerting me to her site.

I got these on a regular basis, and most fail on almost all counts. Too limited, poor information, bad design, not up-to-date.

None of these apply to GoDairyFree.com. It takes a lot to impress me, but I'm impressed.

GoDairyFree.com is divided into a number of sections,

What's New?

• Monthly Newsletter
  
• Online Retailers for Hard to Find Products
  
• The Recipe & Discussion Forum
  
• Dairy Free Product Lists

Dairy Free . . .


• . . . At the Grocery Store
  
• . . . In the Kitchen
  
• . . . When Dining Out
  
• . . . In the News

Topics of Interest


• All About Milk
  
• Calcium
  
• Key Issues
  
• Medical Conditions Linked to Milk
  
• FAQs

Additional Resources
The 10-day Dairy Free Challenge

Each section has several long articles inside of it.

Most impressive is the Dairy Free Foods & Products page. This lists 2500 dairy-free products with information and a link for each. It's similar to my Priduct Clearinghouse except that I limit my info to direct substitutes for dairy products, while GoDairyFree.com includes hundreds of the various foods that are dairy-free. The additional information should be valuable. I just hope they have a staff of a thousand to be it updated!

There's also a forum to share tips and ask questions.

A newsletter is coming in May. So are many other tempting items.

Real work went into this site. I feel better about not having the time or energy to keep my website going at top speed. The field of products for those with lactose intolerance or dairy allergies or vegans or all the others who want to avoid dairy has gotten just too huge for any one person to cover it as a part-timer. I really do hope that they have the staff to keep this going. I know just how hard that is.

Best of luck!

More UK Free-From Foods Honoured

Good to hear that the UK is finally catching up with the States in foods that are milk and wheat-free.

Checkout Magazine reported on the latest to win honours for their foods.

Two companies in the food sector have been awarded Queen’s Awards for Enterprise.

Cumbrian family bakery, Bells of Lazonby, has won the Queen’s Award in the Innovation category for its gluten, wheat and dairy-free products produced under the Ok and Village bakery brands.

Bells’ innovation has centred on the production of its allergy-friendly bakery products. The company’s aim was to provide great tasting rather than clinical products, which would have a wide appeal in the growing health and diets food markets. The products were launched at IFE in 2003 and are now listed by Asda, Booths, Boots, Morrisons, Sainsbury’s and Tesco. Bells’ sales have grown to £2.5m and its workforce has expanded to 30 from nothing two and half years ago.

I remember when just finding a single lactose-free milk product was an issue.

For more on UK products for those with lactose intolerance or milk allergies, also check my UK News page.

Non-Dairy "Milks"

Here's another interesting site I link to on my LI Links page.

The Cook's Thesaurus site has a Non-dairy Milks & Creams page that defines a variety of liquid milk substitutes from almond "milk" to soy "milk".

Both those who have lactose intolerance or a dairy allergy need these substitutes, at least at times. Here's info that can help you decide what to buy. And there are also recipes for making these "milks" yourself to your own taste.

Sheep's Milk - Less Lactose?

Slim Ewe is not a user id on MySpace, a curseword on the Sopranos, or the winner of Nashville Idol. It's the latest fad form of dairy, ice cream made from whole sheep's milk.

Nutraingredients.com featured Jess Halliday's article, The healthy potential of sheep’s milk, on David Baker, owner of Styles Farm in the sourthwest of England, who's been making ice cream from sheep's milk for the past 18 years.

So why is this of interest to us? Because of the usual nutty claim.

According to market analyst Mintel, non-cow milks (sheep and goat) currently have a 0.8 per cent share of the white milk market value. The market is growing – but not so much because of the healthy profile (indeed the higher fat content of the milk is a drawback) but because of lower lactose content than cow's milk, making it more suitable for people with a perceived intolerance.

Of course, the article provides nothing to back up the claim that non-cow milks have a lower lactose content than cow's milk. If you want facts about milk, the first place to look is, that's right, my web site. My Lactose Zoo page gives average lactose content for over 30 animal milks.

Cow 3.7-5.1%



Goat 4.1-4.7%



Sheep 4.6-5.4%

Even if you assume – correctly – that most cow's milk is at the higher end of the scale and sheep's milk is at the lower end, the difference is a few tenths of a percentage point at most. Not enough to make any noticeable difference in anyone's symptoms.

Your ability to have Slim Ewe will be almost exactly that of your ability to have cow's milk ice cream. You shouldn't feel any difference in lactose content.

But the claims just keep on comin'.

Allergy Warning - Don't Chew Your Clothing!

From the life gets weirder every day department:

According to an article on the online version of the Canadian magazine Macleans, clothing is now being made from "100 per cent dehydrated spun cows' milk fibre."

That means that people who chew or drool on their clothing, like infants or your Uncle Fred, can release the milk proteins involved.

Researchers in the Food Allergy Research and Resource Program at the University of Nebraska in Lincoln found that milk allergens can easily be extracted from clothes made from the fibre, and in concentrations sufficient to pose a hazard to people with milk allergies….

Dry milk fibres may also pose a risk to people with a milk allergy if the fibres are inhaled or come into contact with the skin.

How do you know if you have clothing made from dehydrated milk? Beats me. I always tell people to read the ingredients list on every product they buy, but I didn't know that also meant their pants.

More Lactase, Please

Press releases lie. That's not really a condemnation of them. It's their job description. No matter what the product is or what it does, the press release will make it sound far more wonderful, perfect, effective, and useful than it can possibly be. Smart consumers have learned to go beyond the press release and dig up the real facts.

You want an example? Naturally, I have one handy. It's from National Enzyme Company announcing their new BioCor^e™ line of digestive enzymes. Yes, the whole product line really has that crazy, er, nifty raised, italicized ^e as part of its name.

And naturally, there's a dairy supplement that's part of the line:

BioCor^e Dairy™ is a potent formula comprised of lactase and protease designed to alleviate symptoms associated with dairy intolerance. BioCor^e Dairy Ultra™ is an enhanced dairy formulation targeting milk fat in addition to dairy intolerance.

I have a page in my Product Clearinghouse for Lactase Pills. That page has all the name brand lactase pills available in the U.S. that I know of that meet my standards. The biggest and pretty much only standard that you need to worry about is whether a pill has enough lactase in it to do the job of relieving symptoms due to lactose intolerance. Since you can take more than one pill at a time, I set that standard fairly low at 1500 FCC units. (That can also be expressed as 1500 Lac U. or 1500 ALU or 100 mg.)

What you don't see on that page are many pills that contain other digestive enzymes. That's because there is not the slightest scientific evidence that other digestive enzymes make any difference at all in controlling symptoms from lactose. Only lactase counts. If you have enough lactase, then the digestive enzymes added are meaningless, although probably harmless. If you don't have enough lactase, then all the other digestive enzymes won't do a thing.

So what about BioCor^e Dairy™ and BioCor^e Dairy Ultra™? Some digging at the National Enzyme website shows that they contain 1000 ALU. Not enough to make them effective, and not enough to make them cost effective since you would need to take several at a time to feel any relief. I won't be adding those pills to my website.

Sorry, National Enzyme. But I know not to believe the wonders promised by press releases. I hope you readers now do as well.

The Lactase Gene: A Precursor to Cultural Evolution?

All mammals produce milk to feed their young, and virtually all mammals use the sugar lactose, found nowhere else on earth, as an energy source for that milk. The young manufacture the enzyme called lactase, which split the lactose into simpler sugars, which can be absorbed by the intestines and used by the body. And all mammals lose their lactase-making ability at about the normal age of weaning, when it presumably would never be needed again.

Humans are mammals, and for most of our existence we functioned just like all the others. Humans naturally stop making lactase at about three years of age, and are lactose intolerant after that.

Except that a few had a mutation to a single gene. This mutation never sent out the signal to stop making the lactase. It was what is called a "neutral" mutation. For most of human history nobody ever saw the effects of this mutation, because no adult human ever drank milk.

But sometime around 10,000 years ago or so, humans started domesticating animals that were milkable. And at some point after that, they started regularly collecting the milk and using it, either to feed motherless children, or to process it into yogurt, kumiss, kefir, and other milk products.

The people who could manufacture lactase as adults suffered from fewer symptoms when they had these dairy products, and were also better able to use the nutrients in the milk. They prospered and spread their mutated genes through the local population. Since these people happened to be the ancestors of today's Europeans, these genes also got spread throughout the entire world, making adult milk-drinking common almost everywhere.

That's the standard story of lactose tolerance. What's new is that some scientists are postulating that the story of this one mutated gene may be something that's been duplicated with other genes without our being aware of it.

A story online from Wired magazine, "Getting Evolution Up to Speed," by Annalee Newitz talks about these notions, especially a study that demonstrates that two key genes connected to brain size are currently under rapid selection in populations throughout the globe. Newitz cites University of Chicago geneticist Bruce Lahn when she writes:

Chicago geneticist Lahn is most intrigued by the possibility that cultural factors are involved in brain evolution. "We think some of these new gene variants may be as young as a few thousand years, a period when human culture was changing dramatically," he said. "Maybe these genes are selected not for hunting but because of organized society." He cautioned that this is just a hypothesis, but "recent cultural evolution and biological evolution may be linked."

Jonathan Pritchard, an evolutionary biologist also at the University of Chicago, has also been looking at the lactase gene in these terms:

"The time scale for a strongly favored mutation to sweep through a population is about 5,000 years," [Pritchard said]. "It's hard to get an exact estimate for rates of change, but we know that the lactase gene is evolving the fastest in humans. It was new 5,000 years ago and now it's in virtually everybody in Europe."

The lactase gene is what allows humans to metabolize dairy products as adults. It's widely believed to have evolved in response to humans' domestication of dairy animals -- individuals who could enhance their diet with dairy products had such a strong survival advantage that the gene spread at the speed of, well, several thousand generations.

A storm of publicity greeted Pritchard's recent paper on signals of selection across the human genome. The response came in large part because Pritchard and his colleagues had found such overwhelming evidence that many human genes are evolving: not just ones that govern the brain, but also ones associated with reproduction, disease resistance and the ability to process certain kinds of foods.

"I think my work is changing people's ideas about evolution, because now natural selection seems to have continued all the way up to the present day," said Pritchard. "There's no reason to think it stops now."

Many other scientists are arguing that human changes to health, medicine, and the environment are overwhelming these natural evolutionary changes, which is why Pritchard and Lahn's notions are so controversial.

Both pathways might come into play in the future.

Lahn is comfortable with this idea. "If there's an evolutionary advantage to be had by using technology, then people will do it," he said. "People are going to start changing the game in evolution in ways Darwin never anticipated."

"Free From" Foods Grow in Sales

Sales of so-called "free from" foods are soaring in Britain and elsewhere in the world, matching the huge rise in sales of these products in the U.S. They've gone up an estimated 329% over the past five years creating a market worth £90 million in 2005. Meanwhile, dairy-free products are valued at £32 million, with sales of products such as soya milk and yoghurts growing by 28% over the same 3 year period.

Why? Blame (or credit) celebritites. Orlando Bloom and ex-Spice Girl Victoria Beckham have to stay away from dairy products, say sources close to them (or tabloids or somebody equally respectable). Another ex-Spice, Geri Halliwell, and actress Rachel Weisz can't have wheat. (see http://www.nutritionpoint.co.uk/ for a UK-based gluten-free site.

There's an ongoing argument over whether these stars have raised awareness about a real problem ignored in the past or are merely creating false self-diagnoses by celebrity followers. Lactose intolerance is easy to misdiagnose, since so many foods create the same intestinal symptoms.

Life Style Extra quotes a Dairy Mail article concerning a report by the market research group Mintel:

One of the interesting characteristics of the market is the high level of "misdiagnosis", which stems from the public's willingness to self-diagnose at best or simply avoid a particular product based on little more than one bad experience, a news article or peer and family advice, says the report.

And consumer analyst Julie Sloan has much more to say:

The popularity of soya milk under high profile brands has certainly played its part in catapulting the free-from food sector into the mainstream away from the specialist dietary food field.

"The explosion of new product launches in the free-from market as a whole, as well as greater dedicated shelf space, have also had a significant role in the market's growth.

"High-profile cases of life-threatening allergies to products such as nuts have undoubtedly brought the problem of allergies and food intolerance into the limelight as well.

The "free from" market is expected to double in the UK between 2005 and 2010.

And elsewhere. An article by Lindsey Ord in the South African newspaper The Daily News has the following quote:

And South African dietetics experts predict that we're heading for a boom in "free from" foods here, too.

Dudu Mthuli, chairwoman of the KZN branch of Adsa, the Association for Dietetics in South Africa, says that "free from" foods are not as readily available in South Africa as in most first world countries, but she foresees an increase in their sales because of increased awareness and self-diagnosis.

But she adds a word of caution: "Omitting foods without proper supervision is not recommended and can compromise your health.

"It is important to consult your doctor who can determine if you are indeed suffering a food allergy, or whether it might be some other cause of your symptoms.

"Only after proper diagnosis should there be long-term dietary changes - and this should be under the supervision of a registered dietitian, who will be able to advise on a balanced diet by ensuring proper nutrient intake to maintain your health, while taking your diagnosis into consideration.

"Free from foods are usually much more expensive and sometimes not so well suited to our tastebuds and therefore should not be encouraged unless a proper diagnosis has been made."

If you truly have an intolerance or food allergy, this is all great news. If you just think you do, make sure you get checked by a reputable medical doctor (not a homeopath or chiropractor) before making this drastic a change in your diet.

Calcium

Everybody needs calcium.

From here on all is murky.

How much calcium anyone needs and where best to get the calcium are highly contentious subjects. The National Osteoporosis Foundation recommends 1,000 mg a day of calcium for Americans ages 19 to 50; 1,200 mg for people older than 50; 1,300 mg for ages 9 to 18 and lesser amounts for younger children. But in an article, Got Controversy?, in the Rochester Democrat & Chronicle, Dr. Walter Willett, nutritionist and epidemiologist at Harvard School of Public Health contends that "500 to 700 milligrams of calcium daily is probably plenty."

And he says that dairy isn't necessarily the best source for calcium. Most cultures around the world get their calcium from plant sources.

Willett, who works closely with three of the biggest and longest-running health studies in the country including the Nurses' Health Studies, found that women getting the most calcium from dairy products had more fractures than women who had less dairy — the opposite of conventional wisdom.

The other side of the case is argued by J. Edward Puzas, a research scientist and director of the Osteoporosis Center at the University of Rochester.

It's fine to get calcium from dairy or nondairy sources, including supplements, he says, but the reality is that most Americans don't get enough.

The body needs a certain level of calcium concentration in the blood in order to work properly. When calcium levels run low, the body removes calcium from its bones. If that calcium is not replaced regularly, people end up with weak bones and fractures, he explains.

Here's what most everybody does agree on:

Vitamin D is key because it allows the body to use calcium. "You can have all the calcium you want, but if you don't have enough vitamin D, you just poop it out," says [Dr. Stephanie Siegrist, orthopedic surgeon at Westfall Orthopaedic and Sports Medicine Center in Brighton]. Current research suggests 800 to 1,000 international units a day of vitamin D for a healthy adult, Siegrist says, although the National Osteoporosis Foundation calls for 400 to 800 IU. Both amounts are well above the 200 IU in a typical calcium-plus-D supplement. One cup of fortified cow milk or soy milk provides 100 IU of vitamin D. Your body can make vitamin D when you get 15 to 30 minutes a day of sun on your face and arms (the amount depends on the angle of the sun). Vitamin D levels can be checked with a blood test.

Weight-bearing exercise strengthens your bones.

Smoking and excessive alcohol consumption hurts your bones.

And what if you're lactose intolerant?

Dr. Stephen Cook, a pediatrician/internist and instructor at Golisano Children's Hospital at [the University of Rochester's Strong Memorial Hospital], finds that many people who say they are lactose-intolerant actually can tolerate a glass of milk with a meal. At the Rochester clinic where he works, he sees children too often drinking soft drinks and sugary juice drinks that lack calcium and add excess calories. Worse, the phosphates in soft drinks hinder calcium absorption. Cook, who studies obesity, endorses the three-a-day guideline for dairy. More isn't better because of the extra calories. Chocolate milk — even if low-fat — has excess sugar, he adds.

If you're looking for good information about non-dairy sources of calcium, my LI Links page has a number of links to good pages on the Net that talk about calcium, from dairy, from non-dairy, and from supplements.

Choosing an Infant Formula

Lactose intolerance is something that happens as we age. In some cultures, where virtually every adult is lactose intolerant, the ability to manufacture the lactase enzyme starts to diminish at about the time of weaning. Before the age of about three, therefore, hardly any babies have lactose intolerance.

Except.

Except if they have something go wrong with their intestines. It doesn't take much. A bout of the so-called "Stomach flu" (really a gastrointestinal problem) can knock out the lactase making machinery for a few weeks until the intestines heal.

Dairy allergies are totally different. Babies can have them. In fact, most babies who are allergic to dairy when they're young grow out of it by, yep, about the time of weaning, ages two or three.

In both cases parents will want a lactose-free infant formula. Breast milk can contain dairy proteins from the mother's diet, so unless she goes onto an absolutely strict and rigid no-milk diet, the baby is still at risk.

I'm no expert on infant formulas. The matter is best taken up with you and your doctor. Some basic information, though, can be found on a site I just added to my LI Links page, Choosing an Infant Formula.

One part is particularly important:

Soy formulas are made with soy protein and are lactose free. Brands include Enfamil ProSobee, Similac Isomil, and Nestle Good Start Supreme Soy. They are good for children who don't tolerate lactose or milk proteins.

Elemental formulas are also lactose free and are made with hydrolysate proteins, which are easy to digest for infants with protein allergies. Types of elemental formulas include Nutramigen, Pregestamil and Alimentum.

If you have a family history of food allergies or formula intolerances, you might choose to start your baby off with a soy or elemental formula if you do not want to breastfeed.

Lactose free formulas, such as Lactofree and Similac Lactose free are made without lactose, but do have cow's milk proteins in them. Infants are not usually thought to be born with a lactose intolerance, so these formulas are usually not needed.

There's much more on that page, so read it all.

Phony Numbers - Phonier Science

Here's a link that I was going to include in my World Links section of my LI Links page, but had to throw out because the numbers turned out to be pure junk.

It's Statistics by Country for Lactose Intolerance, by CureResearch, a wacky attempt to estimate how many people in each major country actually would show symptoms from drinking milk.

According to their numbers, 32,388,462 or about 11% of the U.S. population is lactose intolerant. The same percentage holds for Canada. And for the U.K. And for Nigeria. And Korea. And, well, every other country in the world.

This is ridiculous, of course. The percentage of people with LI vary tremendously from country to country. Those whose ethnic heritage is not western-European white, are far more likely to be LI. I put a summary of the medical community's decades of findings on this issue into my book Milk Is Not For Every Body: Living with Lactose Intolerance. The percentages of LI individuals vary by country from less than 5% to more than 90%.

No self-respecting fifth grade science class would put these numbers onto construction paper for a science fair. So why would anyone take the time to do a whole (badly proofread) worldwide table? I can't imagine. It's of no conceivable use to anyone, anywhere. They don't even bother to explain or justify where they got the 11.03% figure for the U.S. from.

It's the worst use of numbers to make a pretend case for science that I've ever seen. Just another example of why you have to be so careful to find sites you can trust on the Internet. Don't believe everything you read.

Vegetarian Travel and Restaurants

When I updated my Li Links page, I added a new section called World Links. These are links to sites that aren't concentrated on just one country, but either apply to many countries or are aimed at travelers.

Traveling with a food problem, like lactose intolerance or milk allergy, is a pain and a constant irritation. You can't take all your food with you, and you have to eat several times a day. Besides, one of the pleasures of travel is trying the local delicacies and specialties. Anything that can be done to make the experience more pleasurable deserves a highlight.

One such page is Questions About Vegetarian Travel and Restaurants from the Vegetarian Resource Group. That page contains questions and answers in an FAQ format, along with links to many other pages that give additional information.

One problem with the page is that it indiscriminately mixes up info for vegetarians and for vegans. While all vegan information is automatically good for those of us with dairy issues, not all the vegetarian info is. You have to be cautious when reading.

The page also hasn't been updated in a very long time, but remarkably most if not all the links are still live, so feel free to click around for more current info.

My LI Links Page Updated

Told ya I wasn't abandoning my Lactose Intolerance Clearinghouse. I just put some time and effort into updating my LI Links page.

That page has dozens of links about matters I don't cover directly on my site. That includes subjects like calcium, multiple food allergies, celiac disease, osteoporosis, and veganism. There are also some sites on lactose intolerance itself that have information worth pursuing.

In addition, I've been trying to gather links to all the important sites based in other countries that talk about these issues. I have links to sites in Canada, the UK, Australia, New Zealand, and Germany. Most of these sites are relatively new. Lactose intolerance became an issue in the U.S. long before it did elsewhere, but the rest of the world is fast catching up.

What surprised me is how few links had gone bad over the two years since my last update. In the early days of the Net, links would go missing all the time as people stopped maintaining sites. Today sites have much more permanency. The Net is maturing, and the information it provides gets better all the times. What it lacks most, though, is context, and that's one of the things I aim to provide.

I did some Googling and found a dozen new links to enter onto that page, bringing the total to 67. Or 69. Somewhere around there. I'll be talking about some of them here on the blog over the next few days.

As always, the disclaimer. These are just sites I've found on the Net. They appear to have useful information, but I can't vouch for everything they say or contain. If you have a site you think I missed, let me know about it.

ShopDairyFree.com

You don't have a real issue until somebody opens a store to cater to your needs, and for the longest time no stores in the real world or online were set aside for those who were lactose intolerant or had milk allergies. A few years ago, no-dairy.com tried to make it work on the Net but it seems to have disappeared.

The good news is that a new contender is trying to give it a go.

ShopDairyFree.com is the name of the store, and you can get there by typing www.shopdairyfree.com into your browser. But you'll get redirected to http://www.shopbydiet.com/store/dairyfree/ or the even more ungainly http://www.shopbydiet.com/store/dairyfree/index.php?diet_info=0,3. Doesn't matter. They all work equally well.

ShopByDiet.com is the parent site that provides online access to numerous special diet items. Besides lactose-free foods, you can also select casein-free, dairy-free, kosher, egg-free, soy-free, and many more.

That main page, however, just brings up an unsorted list of foods many pages long and is difficult to sort through. The ShopDairyFree page breaks the main list down into alphabetical categories from baby needs to vitamins & supplements. Some of the categories are far better stocked than others. Beverages was a real disappointment with only four selections offered.

However, if you are searching for a particular brand or don't have local access to a store that sells these products, even a limited supply can be more than welcome.

They take credit cards and offer limited free shipping for orders under ten pounds but costing over $99 and discounted shipping for heavier offers. They say, "UPS ground shipping is calculated for the contiguous United States and most of Canada. UPS 2-day air service is calculated for Alaska, Hawaii, the Virgin Islands and Puerto Rico."

If you're in Chicago, their store is located at:

ShopDairyFree.com
Natural Health Foods, Inc.
411 E Ogden
Naperville, IL 60563

Other Contact info:

No email address is given, but their contact page is: http://www.shopbydiet.com/store/dairyfree/contact.php?diet_info=0,3

Phone: 630-355-4840

Instant Message (when available) on AIM username: ShopByDiet

Or write:
ShopDairyFree.com
c/o Natural Health Foods, Inc.
411 E Ogden
Naperville, IL 60563

I have not used this site and I have no personal knowledge of its goods or its effectiveness. Let me know what you think.

Use Tofu to Substitute for Evaporated Milk

How do I substitute for evaporated milk when making a nondairy pie? I get this question a lot, and I have no good answer. There's just no direct nondairy milk substitute for evaporated milk.

Here's a possible workaround, though. Bev Shaffer in the Cleveland Plain Dealer uses tofu as a replacement for milk in a pumpkin pie recipe. The tofu recommended is the boxed, silken variety, not the refrigerated tofu.

Ingredients:

18 oz silken extra firm tofu (Shaffer mentions the Mori-Nu brand, but other brands should work)
2 cups canned pumpkin
2/3 cup honey
1 teaspoon pure vanilla
1 tablespoon pumpkin pie spice*

*If you don't have pumpkin pie spice, you can make your own by combining 1½ teaspoons ground cinnamon, ¾ teaspoon ground ginger, ¼ teaspoon ground nutmeg and ¼ teaspoon ground cloves.

Unbaked 9 in pie crust


Directions:

Heat oven to 350º.

Drain the tofu and then blend it, using a food processor, until it is smooth.

Move the smooth tofu to a mixing bowl and add the pumpkin, honey, vanilla, and spice. Stir until well mixed.

Spoon the mixture into the pie crust.

Bake about 1 hour. The filling will still be soft at the end of that time, but it will firm as it cools.

Let stand for 15 minutes on wire cooking rack, then put into refrigerator to chill.


Let me know how it works out!

Free-From Foods to be Less Fickle in UK

The U.S. and, more recently, Canada offer hundreds of alternative foods to choose from if you’re lactose intolerant. Other countries have lagged behind. But perhaps they’ll be something for those of you who are Fickle coming soon.

The Yorkshire Post reported that "Emma Killilea, a food marketing management student from Sheffield Hallam University, won £7,000 of business support for her Fickle Foods business, which produces luxury cocoa cake bars with a difference – they are free from both gluten and lactose."

Killilea herself has a wheat intolerance. After garnering the Winner of Winners Award, she said:

Around 10 per cent of the UK's population avoid food containing wheat and dairy, because they are either allergic to them or find they upset their stomachs. Many others avoid foods like nuts, sesame seeds and soya for the same reason, but 'free-from' products are difficult to find. About the same number of people in the UK are vegetarians, yet most restaurants and cafés offer customers a meat-free option. I believe Fickle Foods can really help readdress the balance."

"Emma made the Winner of Winners' grand final after triumphing in Sheffield Hallam University's 2005 Enterprise Challenge, an annual business start-up competition for students and recent graduates. She has already used the 5,000 Challenge prize money to develop the Fickle Foods range to include ginger syrup, lemon, and pecan and carrot cake bars, all of which are free from additives, preservatives and genetically modified ingredients and use innovative packaging to keep them fresh," the paper reported.

She plans an August launch for her brand, along with a website that will allow people to buy "free-from" foods online. Fickle Foods will become part of the Deliciouslyorkshire bransd.

For information about Fickle Foods, contact ekillilea@ficklefoods.co.uk.

Schools Should Provide Nondairy Drinks

I'm normally suspicious of press releases claiming that people should be doing something, since that "something" is always whatever the people paying for the press release will make money from.

Even self-interest can be in the public interest at times, though, and a stopped watch is right twice a day, and politics make strange bedfellows, and all those good clichés. I mean, when I agree with a group as nutty as the Physicians Committee for Responsible Medicine (PCRM) the cause has to be good, right? (The PCRM is a fanatical anti-meat group somewhere to the right of PETA, for those who don't know.)

Anyway, The Cancer Project, which is an affiliate of the PCRM, sent out the following press release:

New study suggests schools should add nondairy beverages to the lunch menu

Soymilk proves a popular option for lactose intolerant students

WASHINGTON -- Offering soymilk to elementary school students boosts the number of children who select a calcium-rich beverage in the lunch line and reduces the amount of saturated fat consumed from calcium-rich beverages, according to a study in April's Journal of the American Dietetic Association.

Almost a quarter of students were choosing soymilk over cow's milk by the end of the four-week study, which was conducted at three ethnically diverse elementary schools in Florida. Total calcium-rich beverage selection increased more than 4 percent, and calcium consumption per gram of saturated fat consumed from calcium-rich beverages rose from 194 milligrams to 237 milligrams. The findings suggest that schools across the country should add soymilk to the lunch menu.

"Soymilk has major health advantages over cow's milk," said Jennifer Reilly, R.D., a Cancer Project dietitian and the study's lead author. "It avoids the problem of lactose intolerance and skips the 'bad' fats--and kids seem to like it."

The majority of African-Americans, Asian-Americans, and Hispanic-Americans are lactose intolerant. Enriched soymilk has no lactose and little or no saturated fat, but it has as much calcium, vitamin A, and vitamin D as dairy milk. Dairy milk is the single largest source of saturated fat in children's diets, according to a National Cancer Institute study. Studies have linked ovarian cancer and prostate cancer to the consumption of dairy products.

###

Most U.S. schools do not offer soymilk, in part because the National School Lunch Program doesn't offer a reimbursable alternative to dairy milk without a note from a doctor. Introducing children to soymilk may help them reduce their risk of cancer and heart disease. For a copy of the new study or an interview with Ms. Reilly, please contact Susanne Forte at 202-244-5038, ext. 339, or sforte@cancerproject.org.

The Cancer Project is a collaborative effort of physicians, researchers, and nutritionists who have joined together to educate the public about the benefits of a healthy diet for cancer prevention and survival. Based in Washington, D.C., The Cancer Project is an affiliate of the Physicians Committee for Responsible Medicine.

While I don't advocate the removal of lowfat milk from the diet across the board, providing a soymilk alternative for the many Americans who have lactose intolerance is a good idea and should be reimbursable by the government the way milk is subsidized.

A good idea is a good idea, no matter who it comes from. When it comes from all sides of an issue, take time to listen. And parents, please act.

Follow Your Heart Vegan Gourmet™ Cheese Alternative

My Product Clearinghouse attempts to list and give addresses for every single national and most regional milk alternative products available in the United States. It's a big job, and it's unique. That's somewhat redundant. Nobody else would be dumb enough to try to compile something this big and keep it updated.

And while I try to doublecheck everything, some mistakes do slip through. I have to rely on readers and viewers to catch me if I don't get it right.

So a thank you, an apology, and a plug for Bob Goldberg of Follow Your Heart/Earth Island, makers of Vegan Gourmet™ Cheese Alternative for letting me know that I got the URL of his website wrong. It's already corrected on my Cheeses page, and here it is again: www.followyourheart.com.

If you go to that site, you:

can visit our Online Store, where you can purchase Vegenaise, our eggless, dairy-free mayonnaise, (Original, Grapeseed Oil, Expeller Pressed or Organic), Vegan Gourmet™ Cheese Alternative (Mozzarella, Nacho, Monterey Jack, and Cheddar), as well as our Chicken Free Chicken™ vegetarian meat substitute.

What's more, Bob tells me that they'll soon be adding a vegan sour cream and cream cheese to their Vegan Gourmet line.

If there are any other corrections that need to be made on any product, send me an email at stevecarper@cs.com.

Lactose and Sugars

All lactose is sugar, but not all sugar is lactose. And that's just the start of the confusion.

When most people talk about "sugar" they're referring to sucrose, the sugar found in sugar cane and sugar beets, among other sources. Sucrose is so common that if you see just plain "sugar" in an ingredients list on a food package, it means sucrose and nothing else. Any other type of sugar has to be mentioned specifically by name, either chemical name or common name. Honey is a type of sugar, and so is high fructose corn syrup, and molasses, and a host of other sweeteners.

Lactose is a special case, because it's the one sugar that so many people have trouble digesting. Those of us who are lactose intolerant lack the enzyme called lactase which breaks the lactose down into the simpler sugars called glucose and galactose.

And that leads to an interesting question, answered by Robert L. Wolke, professor emeritus of chemistry at the University of Pittsburgh whose latest book is "What Einstein Told His Cook 2, the Sequel: Further Adventures in Kitchen Science" (W.W. Norton, 2005), in a column in the Washington Post online.

I am a public health nutritionist and often need to recommend dairy alternatives or lactose-reduced products for clients who do not digest lactose well.
Here is my question: Why are the sugar levels of milk, yogurt and lactose-free milk all the same? It seems like the yogurt should have lower levels due to the consumption of milk sugar by the culture bacteria. And lactose-free milk should certainly have lower levels because of whatever they do to take the lactose out. However, the labels of all three products read about the same in terms of sugar.

It's puzzling, but true.

According to the U.S. Department of Agriculture's National Nutrient Database for Standard Reference, whole milk contains an average of 5.25 percent lactose by weight, while unflavored whole-milk yogurt contains 4.66 percent. Presumably, then, the culture bacteria have been allowed to consume only 0.59 percent of the milk's lactose before being forcibly restrained by cooling or killed by heat. By that time, the fermentation bacteria will have converted enough lactose into lactic acid to curdle the milk to the desired consistency.

The real head-scratcher, though, is lactose-free milk. If they've taken the lactose out of it, how come it still contains about 5 percent sugar -- the same as in whole milk?
The answer is that lactose-free milk is made not by removing the lactose but by adding the enzyme lactase. Just as sucrose is made of two simple sugars bound together, lactose is made of the two simple sugars glucose and galactose, bound together. The lactase enzyme splits the lactose into its two components, which are digestible by lactose- intolerant people.

But glucose and galactose are still sugars, and the FDA requires the aggregate amount of all sugars to be listed in the Nutrition Facts chart.

Good question, good answer, and a good rest of column as well. Take time to read it all.

Dairy Symptoms May Be Neither Intolerance Nor Allergy

Ah, science. It never stops changing, never stops learning. While you have to work to keep up with it, the glory of science is that it has something new to say every single day. (For the same reason, Intelligent Design aka Creationism will always be a fraud designed to keep you stupid – it can never say anything new: all it can do is say "no" to whatever stuff science comes up with.)

Anyway, remember Dr. Laura Paajanen, author of the dissertation I summarized in A Serious Look at Lactose Intolerance and The Different Types of Dairy Allergy?

You can take a look at a summary of another piece of her research at medpagetoday.com. The original article was published in the American Journal of Clinical Nutrition. (Paajanen L et al. Cow milk not responsible for most gastrointestinal immune-like syndromes-evidence from a population-based study. American Journal of Clinical Nutrition. 2005; 82:1327-1235.)

By giving laboratory and genetic tests to people who claimed to have symptoms when eating or drinking dairy products, Paajanen found that only a tiny minority of them tested positive for either lactose intolerance or milk allergy. What's the problem, then? Possibly something that we haven't recognized before and don't fully understand:

"We conclude that food-related gastrointestinal symptoms in young adults are caused by unspecific and unknown traits of altered mucosal immune response rather than by cow milk, as is often suspected by the patient," the study authors wrote.

"We suggest that this new entity, i.e., intestinal immune-mediated disorder, may be a self-perpetuating disease with fluctuations in symptoms, they wrote. "An autoimmune characteristic of the syndrome, at least in a subgroup of the affected subjects, cannot be ruled out."

This "as-yet uncharacterized intestinal immune-mediated disorder" as Jeff Minerd, the medpagetoday writer, put it, could explain why so many of the people who write me complaining about milk have symptoms and effects that don't correspond to anything we know about intolerance or allergy.

Unfortunately, there's no advice yet about what to do if your suffer from this, or even how to test for it. But in science identifying a problem is always the crucial first step toward a solution. Keep tuned.

Yogurt One of World's Healthiest Foods

Health magazine named the five healthiest foods in the world in its current issue.

Yogurt was one of them. "Among yogurt's benefits: enhanced immunity, improved lactose intolerance, and stronger bones," the magazine said.

That's real yogurt, as made in Greece: the slightly sour natural variety, not the sugar-laden dessert that is usually found in American supermarkets. That still has some of the same health benefits, but the extra sugar can be a problem.

The other top four:

Spain: Olive Oil
Antioxidant-rich olive oil protects against heart disease.

Japan: Soy
Protein-packed soy is linked to the prevention of cancer and osteoporosis.

India: Lentils
Lentils give you protein, cholesterol-lowering soluble fiber, and lots of iron.

Korea: Kimchi
Loaded with key vitamins, kimchi contains healthy bacteria that aids digestion.

Lactose in Beer?

I'm often asked about lactose in the oddest places. And then when I do the research it turns out the places aren't so odd.

Take beer. Once upon a time brewers used to make "milk stout," by adding whey (the lactose-containing portion of milk) to the barley. The yeast used in beer doesn't ferment the lactose (unlike some of the beasties that live in your colon) so instead of sour lactic acid, you keep a sugary taste. Milk stout was a milder form of beer and also thought to be more nutritious than the regular ales, so good that it was given to nursing mothers to fortify them.

Some people say that you can't call a beer milk stout in the United States these days, but the beers are still being made - using pure lactose rather than whey - both here and in other countries. A list of American milk stouts and other types of sweet stouts can be found at the Beer Advocate site.

Now the answer you've all been waiting for. How much lactose is left in the beer? You won't be surprised to learn that it varies too much with the recipe for a definitive answer. I did a calculation from one recipe and found that it resulted in about half as much lactose as a glass of milk. Other sources say, however, that the lactose content is small for some milk stouts. If you drink for flavor and not a buzz the lactose shouldn't be a problem.

Indian Alternatives to Milk

An article in the online Hindustan Times, Dislike cow's milk? Try alternatives, gives a great summary of the varieties of non-dairy products available in India.

In addition to commercial products, such as Oatly oat milk, the article also lists various milk alternatives that people can make for themselves including their own oat milk, rice milk, Kokkoh (a rice milk of Thai origin), almond milk, and lupin milk.

One warning: the article also lists goat milk as an alternative. As I've written before (see Goat's Milk for Lactose Intolerants? No.), goat's milk has the same lactose content as cow's milk. It's the different protein composition that allows some people with dairy allergies to drink it.

Gluten-Free Store Opens

It took years for vegetarian cafés to appear in more than a couple of cities. Vegan stores are even rarer. Allergy-free shops? Almost invisible.

So it's news that an all-gluten-free store is not only operating but thriving in Clawson, MI, in the suburban Detroit region.

The Bel Cibo Marketplace was opened by Al Doyle, who nearly died before his celiac disease was diagnosed around seven years ago.

His deli, cafe and grocery

sells only gluten-free foods, from packaged breakfast cereal, soy sauce and salad dressing to glazed doughnuts, chicken potpies, salads and side dishes, and fresh-baked pizzas.

Yes, the pizzas are available with cheese and in dairy-free style with a soy substitute. So is the lasagna. Doyle is a former restaurant chef.

Most people with celiac disease do wind up lactose intolerant, because the disease damages the part of the intestine where the lactase enzyme is made.

We can only hope for the success of this store. The better it works, the more likely it'll be that others copy it and start stores and delis of their own all over the country.

Vitamite Might Not Be Around Any Longer

I've had several people ask me where their Vitamite went.

Vitamite 100 was a non-dairy milk substitute distributed by Diehl Specialties, not to be confused with various vitamin supplements that also used the Vitamite name.

The Vitamite 100 web site is no longer functioning.

I'm taking the product off of my web site unless and until I hear that it's still officially available.

The sad truth probably is that small niche products like this have an extremely difficult time competing for shelf space and simply don't create enough sales to keep them going.

You can check for other similar products on my Nondairy Milk Substitutes page in my Product Clearinghouse.

A Serious Look at Lactose Intolerance

The dissertation, MILK HYPERSENSITIVITY
Effects of Cow’s Milk and its Processing on Gastrointestinal
Symptoms and Delayed-Type Immune Responses, by Laura Paajanen, that I just wrote about in The Different Types of Dairy Allergy also has some good technical information on lactose intolerance (also called hypolactasia in some of the medical literature.

Paajanen writes:

In lactase deficiency the activity or concentration of the lactose cleaving enzyme β-galactosidase, also called lactase, in the brush border of the small intestinal mucosa is insufficient. This hypolactasia causes insufficient digestion of lactose, the major carbohydrate of milk, a phenomenon called lactose malabsorption or lactose maldigestion. As reviewed by Sahi (1994), lactose maldigestion affects approximately 60% of the world’s adult population, the prevalence varying in Europe from 2% in Scandinavia to 70% in Italy, 70-90% in South America, Africa and Asia, and reaching 100% in some Asian countries.

The forms of lactose maldigestion are 1) lactase non-persistence, 2) secondary lactose maldigestion, and 3) rare congenital lactase deficiency. In lactase non-persistence, also called adult type lactose maldigestion, lactase activity is high at birth, decreases in a genetically programmed way in childhood and adolescence, and remains low in adulthood, which is the normal physiological situation for humans and other mammals. In populations where lactase non-persistence is predominant, the loss of lactase begins soon after weaning, and vice versa – in populations with low prevalence of lactose maldigestion, it develops later in adolescence or even in early adulthood (Sahi et al. 1983, Sahi 1994). Lactase is found at the tip of the intestinal villi, and is therefore vulnerable to intestinal diseases, inflammation and chemotherapy, leading to a secondary form of lactose maldigestion. Typically, lactase activity returns after recovery from the original disease (e.g. celiac disease, Crohn’s disease, enteritis) and after the discontinuation of chemotherapy (Bode & Gudmand-Hoyer 1988, Murphy et al. 2002, Österlund et al. 2004b). A small intestinal resection may cause irreversible secondary lactose maldigestion. Congenital lactase deficiency is an extremely rare inheritable genetic defect, which is apparent immediately after birth (Savilahti et al. 1983).

Hypolactasia accompanied by clinical symptoms such as bloating, flatulence, nausea, diarrhoea, and abdominal pain is called lactose intolerance. The symptoms occur when undigested lactose passes to the large intestine, where it serves as a fermentable substrate for the microbiota and osmotically increases the flow of water into the lumen. The intensity of the symptoms depends on the amount of lactose ingested, on individual sensitivity, the rate of gastric emptying, gastrointestinal transit time, and the pattern of microbiota in the large intestine. Ingestion of 50 g lactose, the amount commonly used in clinical tolerance tests, causes symptoms in 80-100% of lactose maldigesters, whereas the ingestion of a glass of milk (200-250 ml) causes symptoms to only 30- 50% (Vesa et al. 2000). For some unknown reason, a small percentage of maldigesters remain symptom-free even after the ingestion of large amounts of lactose. Symptoms of lactose intolerance can be reduced by food and meal pattern choices and by the consumption of low-lactose and lactose-free dairy products. Total avoidance of dairy products often results in poor calcium intake and an increased risk of fractures; so lactose intolerance is associated with reduced bone mineral density and may predispose to bone fractures (Jackson & Savaiano 2001, Kudlacek et al. 2002, Obermayer-Pietsch et al. 2004). Self-described "lactose-intolerant" individuals may restrict their dairy and calcium intake without real clinical need, and are at risk of osteoporosis and bone fractures (Savaiano 2003).

Lactose digestion can be measured by direct or indirect methods (Arola 1994). The direct methods – the measurement of mucosal disaccharidases, and an intestinal perfusion technique for the exact measurement of lactose digestion – are laborious. The most widely-used indirect tests are the traditional lactose tolerance test (measurement of serum glucose), the lactose tolerance test with ethanol (measurement of serum galactose), the hydrogen breath test and the urinary galactose test. Genotyping for the C/C-13910 variant of lactase persistence/nonpersistence is a new way of determining susceptibility to adult-type hypolactasia; however, it cannot be used as a diagnostic tool to determine lactose intolerance, as the age of reduction of lactase varies (Enattah et al. 2002, Kuokkanen et al. 2003, Rasinperä et al. 2004).

(One important point: the lactose intolerance test with ethanol is not used in the United States.)

Technical, to be sure, but a strong grounding in the technical side will help you to sort out sense from nonsense when reading articles in newspapers, magazines, or online that often are so simplified by people who dion't understand the subject that they can lead to confusion.

The Different Types of Dairy Allergy

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

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

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

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

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

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

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

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

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

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

One other section is also a must read.

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

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

CMA in school-aged children and adults

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

As for diagnosing allergies in infants and children:

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

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

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

Holy Cow!

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

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

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


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

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

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

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

I'm Back

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

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

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

McDonald's Sued Over Fries Announcement

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

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

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

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

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

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

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

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

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

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

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

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

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

Only one problem.

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

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

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

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

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

We Hit the Quarter Million Mark

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

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

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

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

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

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

Steve Carper's Lactose Intolerance Clearinghouse.

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

Gak's Dairy-Free Snacks

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

This has grown into Gak's Snacks.

Jill wrote me to say:

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

Contact info:

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

Dairy Derivatives in McDonald's Fries

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

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

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

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

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

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

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

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

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

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

Blackwell's Organic Gelato

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

She writes:

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

We use only the highest quality certified organic ingredients.

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

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

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

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

More Great Good Dairy-Free Desserts Naturally

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

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

Calcium Is Not Lactose

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

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

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

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

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

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

Valio Moves Lactose Free Milk Across Europe and into Asia

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

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

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

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


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


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

Vaalia Introduces Lactose Free Yoghurt in Australia

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

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

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

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

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

Accordig to its press release, the book teaches parents:

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

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

Trans Fat in Lactose-Free Margarines

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

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

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

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

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

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

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

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

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

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

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

Benecol

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

Canoleo

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

Earth Balance

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

Fleischmann's

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

Mother's – not listed

Smart

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

Spectrum

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

Willow Run

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

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