Planet Lactose
The Best of The Planet Lactose Blog, volume 1
Reports from the worlds of lactose intolerance, milk allergies, and dairy-free alternatives
Steve Carper
Planet Lactose: The Best of The Planet Lactose Blog, volume 1 (2006-2008)
Copyright 2009, 2011 by Steve Carper
This book reprints edited postings from the Planet Lactose blog, 2006-2008. All rights reserved, including the right to reproduce this book, or portions thereof, in any form.
Smashwords Edition, License Notes
This e-book is licensed for your personal enjoyment only. This e-book may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
Planet Lactose Blog
blogpost.planetlactose.com
Steve Carper’s Lactose Intolerance Clearinghouse
www.stevecarper.com/li
Cover design by Ken Tryon
Cover cartoon reprinted by permission of the artist, Dan Reynolds
www.reynoldsunwrapped.com
PLANET LACTOSE Publishing
P.O. Box 10126
Rochester, NY 14610
www.planetlactosepublishing.com
First e-book edition, 2011
ISBN-13: 978-0-9798565-7-0
Chapters
3 Babies: Formulas and Feeding Issues
5 Dairy Milks and Nondairy “Milks”
6 A Hungry Person’s Collection of Cookbooks
12 Miscellany and the Just Plain Weird
E-Book Edition Note
All links in this e-book edition were active as of 2011. Dead links have been removed, and links changed to current URLs wherever necessary. Most columns have been reprinted as written, but obsolete information has been edited out and quotes that no longer can be found online have been deleted or, if possible, updated. Websites, companies, and products change constantly, and no guarantee can be made that links will remain active, or that products mentioned will remain available. Some of my favorite products have vanished over the years, but far more products for the dairy-free are available today than at any earlier time. These products cover large ranges of tastes and needs; you should sample many to see which might be right for you. Products and websites are mentioned for informational purposes only, and no endorsement is implied.
Links to the Lactose Intolerance Clearinghouse
Main Page
www.stevecarper.com/li
The Product Clearinghouse
www.stevecarper.com/li/the_product_clearinghouse.htm
The Milk-Free Bookstore
www.stevecarper.com/li/milk-free-bookstore.htm
LI Basics
www.stevecarper.com/li/LI_basics.htm
Dairy Facts
www.stevecarper.com/li/dairy_facts.htm
1. Lactose Intolerance
Lactase Drops and What to Drop Them In
Drops were the original form of lactase on the market. (Well, technically, lactase powder was the original form, but people didn’t like dealing with powder.) The idea was simple. You added lactase to milk, the lactase split (digested) the lactose into the simpler sugars glucose and galactose, and you drank the milk. Voilà. No symptoms.
Except that like most miracle cures (as seen on TV), it didn’t always seem to work quite as well in your own refrigerator as the directions made you hope. There’s always a trade-off. It takes time for the lactase to work, and the milk has to be kept cold through the process. The more lactase you used, the faster it worked, but then you used up the bottle quicker. And was that one big drop or two little ones that just squeezed out together?
With time came convenience. Companies made 100% lactose-free milk and other lactose-free dairy products available in dairy cases everywhere. Lactase pills allowed you to have dairy without waiting for it. Slowly the drops market shrank, until nobody in the U.S. sold drops at all.
For all their faults, drops still have a number of advantages that kept people fans all these dry years (often mail-ordering them from Canada, where they never left the shelves). Store-bought lactose-free milk can cost up to twice that of regular milk. Drops are a much cheaper way to get lactose-free goodness, especially now with the prices of all foods rising. Lactose-free milk is slightly sweeter than regular milk, so you can adjust the number of drops you use to regulate the taste for your personal taste buds. Drops can be used in any liquid dairy product. Those other lactose-free dairy products never sold really well either, which makes them hard to find in many places.
Nursing mothers whose babies become temporarily lactose intolerant, say from a “stomach flu” or gastrointestinal illness, can express their milk, add drops, and nurse their babies with it a day or two later without having to resort to formulas until their intestines heal.
Some limitations remain. Drops still need to be thoroughly stirred into a liquid and stored cold. And that means you can’t use drops in cooking. While you can start with a lactose-free milk, you can’t expect to mix the lactase drops into cooked pudding or cakes and get good results.
Different brands have slightly different instructions as well. If you’re trying a new brand, I’d advise you to start with what they tell you to do. However, the trade-off between more drops and faster work remains. You can decide for yourself which route you want to follow once you’re sure you have the basics down.
June 12, 2008
Lactase Drops
Even though lactase drops are once more available in the U.S., I want to pay tribute to Gelda Scientific, who did so much to keep them available to American customers for so many years.
Here’s what their Lacteeze drops page has to say [http://www.gelda.com/Gelda%20Pharmaceutical/web-content/Lacteeze.html]:
By using the Lacteeze Enzyme Drops as directed the lactose-intolerant person can drink milk or other fluid milk products without suffering from gas, bloating or diarrhea. …
May be used to reduce lactose in fresh milk, reconstituted milk, canned condensed milk, creams, chocolate milk and any other fluid milk products.
Product Shelf Life: Shelf life of the product is 12 – 15 months at room temperature from the date of manufacturing. If the product is kept refrigerated upon receipt you can extend the shelf life by [an] additional 6 months.
To see their current pricing, go to the Gelda order page. [http://www.gelda.com/Gelda%20Pharmaceutical/web-content/order_form_jan_06.pdf]
January 21, 2007
Kosher-Certified Lactase Drops
It was huge news when I was able to announce earlier this year that lactase drops were once again available in the U.S.
That’s great, but it was insufficient news for some people who needed more information. I received a question today asking me if any lactase drops were kosher certified.
After much searching, I’ve found that both the Lacteeze Enzyme Drops made and sold in Canada by Gelda Pharmaceutical and the LACTAID Lactase Enzyme Drops made and sold in Canada by McNeil specifically say that they are kosher certified on those web pages I linked to.
Both can be ordered from a number of Canadian pharmacies and online sites.
Unfortunately, Pharmax Liquid Lactase, the brand that is sold in the U.S., does not have a kosher certification.
August 14, 2008
Try a Compounding Pharmacy for Lactose-Free Medications
Hundreds of prescription medications and hundreds if not thousands of over-the-counter medications contain lactose as an inactive ingredient. Lactose has little taste, but some find it mildly sweet. No one is allergic to it or suffers from side effects. It is a cheap by-product of cheese production. In short, it’s nearly the ideal bulk filler for a pill.
Of course, there’s the tiny drawback that if you can’t digest lactose, you may get symptoms ranging from gas and bloating to diarrhea. The flip side of this is that the amount of lactose in any one pill is so small that only the rarest of extremely sensitive individuals should be affected by lactose-intolerance symptoms generated by a single pill.
Even that is not sufficient for those who try to avoid all milk products for whatever reason. Although you should be able to find a lactose-free alternative for most medications, this is not always possible, and often expensive or inconvenient.
What to do? Try a compounding pharmacist.
I was reminded of them by this article on ClickOnDetroit.com. [http://www.clickondetroit.com/health/13770929/detail.html]
It’s that level of dedication that brings customers facing a wide variety of medical challenges to [Kenny] Walkup’s store. His is a compounding pharmacy. That means each prescription is prepared specifically for an individual patient, tailored to meet their medical needs and taste preferences.
“Today’s modern drugs fit for a lot of people, but there are people that they just don’t work for, whether it’s a lactose intolerance, or an allergy to a drug or a color,” Walkup said.
Compounding is part of medical history. In earlier days, pharmacists made their own pills in their own stores from basic ingredients. They “compounded” them, meaning literally “to produce or create by combining two or more ingredients or parts.” Even a few decades ago, 60% of prescription items were compounded. Today only about 1% are.
That means compounding pharmacies are rarer than the regular pharmacies found in every drug store, supermarket, and discounter. Even so, you should be able to find one near you. I can’t guarantee that every medication can be made or made lactose-free by every compounding pharmacist, but if it’s important to you, seek one out to talk with.
There seem to be two major trade organizations.
The Professional Compounding Centers of America (PCCA) [http://www.pccarx.com/] has more than 3500 members, many of them outside America in Canada, Australia, Europe and New Zealand. To find a compounding pharmacist close to you, call them at 1-800-331-2498 or email customerservice@pccarx.com.
The International Academy of Compounding Pharmacists (IACP) represents more than “1,800 pharmacists, physicians, technicians and patients.” Go to their website [http://www.iacprx.org/] to access their Compounding Pharmacist Locator.
July 27, 2007
Medicinal Lactose: A View from the Inside
We all know about the use of lactose in medications, both prescription and over-the counter. Lactose isn’t really used in every medication, of course; it just sorta seems that way.
But why? What makes lactose so useful? One way to answer that question is to ask a manufacturer and listen to it boast.
Here’s an article [http://www.pharmaceuticalonline.com/article.mvc/Sheffield-Pharma-Ingredients-Highlights-CPhI-0002?VNETCOOKIE=NO], really a press release in disguise, that appeared on PharmaceuticalOnline.com.
The Lactose Leader
A key recent innovation has been the creation of a high-flowing ‘DTHV’ NF lactose grade, which forms harder tablets at lower compaction forces than other high-flowing directly compressible products. At the same time DTHV tablets have similar disintegration profiles as other high-flowing directly compressible lactose tablets with lower hardness values. ...
Tabletting System
Sheffield’s Tabletting System concept provides a simple way to create custom fast-dissolving tablet formulations using a free-flowing lactose-based functional powder for direct compression. Customers only need to add the desired active and a flavour (or a taste-masked active), plus lubricant, and then form into tablets using standard direct compression techniques. …
Coating Systems
Sheffield’s Film Coating Systems provide an easy-to-use yet complete solution for tablet cosmetics and functionality. The range comprises four clear coating systems, a colour coating system and two choices of enteric coating system. All are supplied as a free-flowing powder that is readily dissolved in water to yield a ready-to-spray solution for aqueous film coating. Application substrates range from pharmaceutical tablets to nutritional supplements.
It all sounds so wonderful there hardly seems to be any reason to spoil the lactose pills with those icky medicines. But they do.
And we who are lactose intolerant or dairy allergic are just going to have to live with it, because with all this wonderfulness going on you know they won’t stop using lactose for a long time to come.
August 25, 2008
You Are What You Eat – But You Have to Know What That Is
Suffice it to say that I’m a believer in western medicine, sometimes called allopathic medicine. Alternative medicine or complementary medicine is not my thing. I mean, I continually complain that the formal studies carried out by researchers and published in top medical journals are insufficient to give proper answers too much of the time. Imagine my feelings on types of medicines that don’t do studies at all but rely on anecdotes.
So I am disposed not to believe in ayurvedic medicine, a 5000-year-old Indian discipline. (Pronounced eye-your-VAY-dic, the word comes from the Sanskrit for “pure knowledge of life.”)
And an article by Katie Leslie, “Ayurveda: The ancient art of ‘you are what you eat’” at the Frederick News-Post website [http://www.fredericknewspost.com/sections/archives/display_detail.htm?StoryID=64675] just reinforced my unease with these practitioners.
Leslie tells the story of a woman who had ayurvedic medicine recommended to her by her massage therapist. [Insert your own sarcastic remark here.] I am removing all names except for the ayurvedic practitioners.
Both she and her son ... have a history of stomach problems, specifically lactose intolerance. They struggled to find foods that didn’t make them feel ill, she said.
They went to see [Dr. Douglas Beech, a chiropractor and ayurvedic practitioner] and his mentor, Vaidya R.K. Mishra in December. Mishra is an ayurvedic dermatologist and researcher. He said his family has practiced ayurveda for thousands of years. (Vaidya is a Sanskrit word given to ayurvedic physicians.)
“Both my son and I were very skeptical about it because it’s very foreign to us, with the Indian terms,” [she] said. “At first I thought it was very strange, but I feel so much better.”
[She] said that in a little more than a month, she’s seen dramatic improvements in her health. Her once oft-grumbling stomach is now calm. Best of all, the formerly lactose-intolerant [mother and son] can digest milk with no problem.
And how did Beech accomplish this miracle?
In addition to changing her diet to follow ayurvedic principles, Beech advised her to prepare milk by mixing it with equal parts water, then boil it with cinnamon, clove, cardamom and ginger. The resulting liquid is lighter and more readily digestible, he said.
Uh huh. And it also contains half as much lactose per ounce.
Think about it. Lactose intolerance is a continuum, not an on-or-off proposition. Most LI sufferers still manufacture some lactase, the enzyme that digests lactose. So they only feel symptoms if they go over the threshold of what the lactase can digest. If you cut the lactose you are consuming in half... Yes, you may feel as if your LI has been cured but you’re really just controlling your diet to reduce symptoms. That’s something you can do without paying an ayurvedic practitioner.
The mother summed up her experience with these words:
“It just makes sense. It can seem really complicated, but you don’t have to know it all. Just take what you need.”
The same lesson applies to allopathic medicine. You don’t have to know it all. A few basics will suffice. Amazing how much sense actual knowledge about the body can provide.
January 30, 2007
Yes, There’s Lactose in Heavy Cream
Here’s a question I received that reflects a common confusion, one actively created by the way the dairy industry constructs its labels and nutrition information.
My questioner was hoping to use heavy cream to make a lactose-free ice cream.
On your website, you note that whipping cream contains an average of 2.9% lactose. When I went to the grocery store today I grabbed some cartons of cream and read their labels. It turns out that the heaviest cream I could buy was listed as having ZERO grams of sugars per 1 tablespoon of cream. Half and Half and whipping cream both contained measures of sugars ... but the heavy cream did not. Do you think it might be safe to assume that the heavy cream really doesn’t contain any sugars/lactose?
And of course it’s not a safe assumption, or I wouldn’t be able to turn it into a explanatory post.
My response was:
You have the right answer in front of you without realizing it. The heavy cream is measured with a serving size of one tablespoon.
Well, 2.9% of a tablespoon is probably less than half a gram. By law, they can claim 0 whenever a quantity is less than 0.5 gram.
What are the serving sizes of the Half and Half and the whipping cream? I’ll bet they are 1/2 cup or a full cup. And they have lots of lactose.
But you’re not going to use a mere tablespoon, are you? You’re going to use huge amounts of heavy cream, probably more than a full cup. And that’s going to have about 3% lactose in it. Lots, in other words.
Sorry, no way out.
The problem here is that the fat content of dairy products has become a stick that the milk-haters of all stripes like to use to beat dairy with. And not in the good way that results in ice cream.
Heavy cream is heavy fat. Legally, in the U.S. anything called heavy cream must contain at least 36% milkfat. If you gave the calories and fat content in a cup of heavy cream, the size of the numbers would create palpitations in people.
However, while heavy cream has many uses, it is probably most often used a smoosh at a time to add to milk as a, well, creamer. That allows the industry to set the standard serving size at a tablespoon. Since there are 16 tablespoons in a cup, they get to shrink those awful-looking numbers down to puny size.
All perfectly legal and aboveboard. But it creates confusion, because none of the rest of the fluid dairy products use a tablespoon as a serving size.
June 10, 2008
Temporary Lactose Intolerance – It Can Happen to You
There are three types of lactose intolerance.
Congenital lactose intolerance is extremely rare. It occurs in a very few babies who can’t make lactase at all. If they aren’t put on a dairy-free formula immediately, they starve to death.
Primary lactose intolerance is also called, imprecisely, adult-onset lactose intolerance. In reality it can occur any time after the age of weaning. The ability to make lactase decreases or disappears and the symptoms of lactose intolerance strike.
But there is also secondary lactose intolerance, sometimes called temporary lactose intolerance. It occurs whenever there is damage to the intestines that knocks out – temporarily or permanently – the ability to manufacture lactase. Many conditions, from surgery on the intestines, to diseases, to drugs, to long-term abuse of the system can cause it. Whether the ability to manufacture lactase comes back depends entirely on the original cause of the damage and how well the intestines heal.
I mention temporary lactose intolerance now because there’s a celebrity case of it in the news.
Golfer Trevor Immelman is back to full health after losing 22 pounds in a few weeks to a parasite.
The South African lost 22 pounds after it was diagnosed he had picked up a parasite which severely affected him for three weeks, but having regained his health, Immelman found himself in fine fettle again as he posted a solid four-under-par 68 to lead the South African challenge at Quail Hollow.
The 27-year-old described how he picked up a debilitating bug a month ago, just two days before the start of the Masters.
“I started feeling really ill. I pretty much slept in the restroom. My stomach felt like it was moving around inside me,” Immelman recalled.
The cure? Antibiotics, of course. And his doctor also put him on a lactose-free diet.
Why? Two possible reasons. Without knowing more about the parasite or its effects, it might be that the bug affected the intestines and the extremely delicate and sensitive lactase-making villi, tiny projections on the insides of the intestines.
And antibiotics themselves are designed to kill bacteria. It’s hard to discriminate among bad bacteria and good bacteria, so the “good” bacteria that live in the large intestine and digest any lactose that comes their way also get killed when a person takes a course of antibiotics. That means that the symptoms of undigested lactose often occur. The last time I took a course of antibiotics, it was a horrible week of roiling intestines and spasming diarrhea.
Oddly, the answer for this can be milk. Or, much more specifically, yogurt with the live and active cultures that work to recolonize the intestines. Unfortunately, time is still the best healer for temporary lactose intolerance from most of its causes.
[Note: Time healed Immelman extremely well. He bounced back from this and other health scares to win the 2008 Masters Golf Tournament.]
May 4, 2007
Lactase Can Help. Tell Your Doctor.
It never ceases to amaze me how much misinformation doctors still have about lactose intolerance.
You say you want an example? Here’s one.
A reader wrote this letter to the Dr. Peter H. Gott medical advice column in the Monterey Herald. Except this time, the reader is the one giving the advice.
After increasingly painful bouts of intestinal cramps and diarrhea, I realized the common denominator was milk.
I discussed the issue with my general practitioner, who confirmed the diagnosis of lactose intolerance. She advised me to read labels.
When I asked what she thought of lactase enzyme tablets, she said her patients hadn’t had any luck with them. She dismissed the idea, so I asked whether they were dangerous, and she said no. I told her I was going to try them. It’s been more than a month since I started them, and I haven’t had a single incident.
I have been reading labels and am shocked at how many products contain milk, including vitamins and antibiotics that I couldn’t tolerate previously.
My doctor didn’t consider the possibility of lactose intolerance as the source of my antibiotic problems, so she just kept switching medications. I found out about the presence of lactose in my medications with one phone call to my pharmacist.
Pardon me while I boggle. Lactase tablets not helping patients? Lactase might be the single most helpful aid ever put forth as a solution to the symptoms of any problem. Out of the hundreds of people who have written me over the years about lactase, not more than a handful have ever complained that it did not help. And most of them just needed to change the brand they were taking.
I hesitate to call lactase a wonder drug, because technically it is not a drug or medication at all. It merely supplies the enzyme that those of us with lactose intolerance are missing. But since I had years of being lactose intolerant before lactase pills came on the market, I can safely say that lactase is the closest equivalent to a wonder drug ever marketed. It helps the highest percentage of people to the highest percentage of symptom relief.
Doctor, heal thyself.
August 4, 2007
Lactose Intolerance Doesn’t Cause Bad Breath
I received a question today asking me if there’s a connection between lactose intolerance (LI) and bad breath.
No. There isn’t. Simple and straightforward.
As always, I forgot the internet and the legions of pseudoscience. Not to mention the anti-milk crowd which wants to demonize dairy in all its forms.
A Google search on “lactose intolerance” and “bad breath” brings up a breathtaking 75,000+ hits. Many of them are copies of (or variations of; Hey, if you’re peddling pseudoscience why would a little plagiarism stop you?) two basic articles.
One is by Dr. Harold Katz, founder of The California Breath Clinics [http://www.therabreath.com/art_badbreath.asp].
High Protein Foods
These bacteria love those proteins, and certain foods are packed with them:
Milk and Cheese and most other dairy products. (The fat content does not matter.) If you are lactose intolerant, do not eat or drink these products! Since your system cannot digest them properly, they are available to the bacteria for an extended period of time. A recent research article from the Los Angeles Times (November 1996) on lactose intolerance showed that nearly 67% of all Americans can be classified as “Lactose Intolerant”. This is due to the fact that in a diverse population such as we have here, there is a predilection for Asians, Hispanics, and African-Americans to be lactose intolerant.
Fish are high in proteins. As many people eat a high fish diet, logically they make the problem worse.
The pseudoscience here is of very high quality. Lactose intolerance is the inability to digest the lactose sugar in dairy products. Dairy proteins are digested perfectly well. No dairy proteins are available for an extended time. They are absorbed by the small intestine and don’t reach the colon where the bacteria are.
Other questions should be springing to mind as you read this. Meat is high is protein as well. Shouldn’t meat be a prime cause of bad breath? What about plant protein? Vegetarians always say that high-protein plant products can be eaten in lieu of meat. Wouldn’t they cause bad breath?
[UPDATE: Dr. Katz revised his page and removed these lines, but transferred them to another page in slightly altered form. [http://www.therabreath.com/Foods_Bad_Breath_NEW.htm]
Dairy foods are notorious for creating bad breath. An article in the Los Angeles Times once noted that over 50% of the population in Southern California was "Lactose Intolerant". This means that tens of millions of people cannot breakdown the lactose protein in dairy foods (milk, cheese, yogurt, ice cream, etc). The end result is a buildup of amino acids, which are easily converted into Volatile Sulfur Compounds by the anaerobic bacteria found within the surface of your tongue and throat.
To a lesser extent, we have seen patients who have the same problem with other dense protein foods such as: Beef, Chicken, Fish.]
While Dr. Katz’s notions about diet are bizarre and obviously wrong to anyone who knows anything about nutrition and digestion, you’d have to be more aware to catch the subtlety wrong in the other theory, which can be found in articles similar to this one by Sue Spataro. [http://www.families-first.com/hb/lactose.htm]
[The bad breath] is powerfully strong and people can sense it from feet away. Others may think the person has poor oral hygiene when in reality they are lactose intolerant. The oral hygiene has nothing to do with their bad breath. The bad breath is caused by the lactose-rich foods sitting in the person’s intestines and fermenting. The body tries to get rid of the gases that are produced as the result of fermentation by having them reabsorbed by the bloodstream and exhaled out.
The hydrogen breath test is a common way doctors make the diagnosis of lactose intolerance. This test measures the amount of hydrogen in the breath. Normally, very little hydrogen is in the breath. But undigested lactose in the colon (large intestine) is fermented by bacteria, and various gases including hydrogen [are] produced. The hydrogen is absorbed by the intestines, carried through the bloodstream to the lungs, and exhaled. In the test, the patient drinks a lactose-loaded beverage, and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can affect the test’s accuracy and should be avoided before taking the test. This test is available for children and adults.
Yes, fermenting bacteria do create reactions that end in the production of extremely vile-smelling gases, mostly from volatile sulfur compounds. And it is quite true that this is the only reaction which creates hydrogen that percolates through the body and is emitted in the breath, the reason why the hydrogen breath test has become the most common test for LI.
What’s not true is that the sulfur compounds do the same thing. The gases that are produced leave the body via a different exit, the process known as farting (or flatulence). Doctors would surely have noticed by now, after millions of hydrogen breath tests, if the lactose load that we drink to make the test work also caused sulfur to pour out along with the hydrogen. So would we patients. We don’t, because it doesn’t happen.
Notice how each theory makes use of a bit of real science to give the work a sheen of verisimilitude before venturing off into parts unknown. Katz talks about bacteria in the intestines, but ascribes to them a role unknown to other doctors. Spataro uses the hydrogen pathway to try to make a point about unnamed other gases that are not as odorless as hydrogen.
Standard medical science has nothing to say about lactose intolerance causing bad breath. A search of PubMed, the medical journal database, turns up no articles making the connection. It’s a “truth” known only to the internet.
If you want real facts about bad breath – facts that nowhere mention “lactose” or “dairy” or “protein” – I recommend the American Dental Association’s FAQ page on bad breath [http://www.ada.org/2941.aspx?currentTab=1] or the Mayo Clinic’s Causes of Bad Breath page. [http://www.mayoclinic.com/health/bad-breath/DS00025/DSECTION=symptoms]
Don’t get suckered by pseudoscience.
March 7, 2008
Milk for the Lactose Intolerant?
You should know by now that even if you’re lactose intolerant, yogurt is the dairy product that’s for you. The live and active cultures that make yogurt yogurt help to digest the lactose that’s in the milk. It’s auto-digesting, as the tech types talk. And those bacteria will reproduce in your colon, driving out the bad bacteria that ferment lactose and cause the symptoms of gas, bloating, and flatulence that make lactose intolerance a misery.
But what if milk did that? Real, drinkable milk?
That’s the theory behind Dannon’s DanActive. [http://www.danactive.com/] Known for years in Europe as Actimel [http://www.actimel.co.uk/], DanActive is currently making the big rollout into American stores.
Okay, technically, DanActive isn’t milk but a “cultured dairy drink.” (In fact, when it was first test-marketed the company labeled it a dietary supplement. I like the change because as a dairy drink it gets regulated by the FDA and has to display the full set of nutrition information mandated by law.) It contains 10 times as many bacterial cultures as the best yogurt, using Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus. These are lactic acid bacteria, similar to the ones traditionally used in yogurt and cheeses. DanActive also gets to claim all the benefits of probiotics, which are all the marketing rage.
Halfway between milk and yogurt drinks in texture, DanActive comes in blueberry, strawberry, vanilla, and plain.
So. Does it work? They say yes.
People who have difficulty digesting lactose may tolerate products that contain live and active cultures, such as DANACTIVE. The cultures begin breaking down the lactose while the product ferments and also while being digested. Because of this, dairy products with live and active cultures may be tolerated.
DanActive should be available in stores across the country.
July 20, 2005
Lactic Acid Is Not Lactose
Here’s one of the all-time most common questions on lactose intolerance, from the British newspaper The Independent. [http://www.independent.co.uk/life-style/health-and-wellbeing/health-az/lactose-intolerance-is-sourdough-bread-the-cause-of-my-lactose-intolerance-853017.html]
I do not eat dairy products, but I have heard that sourdough bread contains lactic acid. Could this be the cause?
The doctor writing the column writes a technically correct response, except for one tiny little detail. He doesn’t actually answer the question.
The proper answer is that lactic acid is not lactose. It can be made from lactose, but that’s not the issue. No byproduct of lactose will cause any distress to those who are lactose intolerant.
In fact, no ingredient in food that starts with “lac” will ever be a problem to those with lactose intolerance. Not lactates, or lactones, or lactylates, or any of the dozen other chemical names that might be encountered. The only “lac” to worry about, ever, is lactose.
June 24, 2008
Remember, Cheese Is Low Lactose
Let me put in a kind word for low-lactose sources of dairy for those who still want milk in their diets.
Like cheese. An article in the New Zealand Herald [http://www.nzherald.co.nz/section/6/story.cfm?c_id=6&objectid=10409767] tells the good folk of Auckland that Jones the Grocer, a famed Australian gourmet food store, is coming to Newmarket.
Kelvin Bartholomeusz, the former fromagier for Jones, is one of us. When asked, “How would you cope if you became lactose intolerant?” he responded:
I am. Cheese contains much lower levels of lactose than milk, and hard cheese has virtually none, as the lactose is held in the water (whey) which, in hard cheese, has wept out of the curds. I eat small amounts of very good cheese. If I couldn’t eat cheese or dairy, I’d find life difficult as I base all my travel plans on food shows and where good food is, such as my annual pilgrimage to France.
November 8, 2006
Allergic Reactions from Lactose in Dry Powder Asthma Inhalers
A discussion on the No Milk List (see “No-Milk List’s Tenth Anniversary”) raised the perennial question of whether allergic reactions could occur when people are exposed to pharmaceutical grade lactose, the kind used in hundreds of prescription and OTC medications as a filler and binder.
Very little is in the medical literature about this. I’m grateful to Tammy Powell of the NIH, who sent me some medical journal citations on the possibility of allergic reactions to dry powder inhalers containing lactose. I’ve done some further searching.
In the abstracts section of J Allergy Clin Immunol (2002, 109(1); S259), Anna H Nowak-Wegrzyn et al. [http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674902819248.pdf] state that “To our knowledge, the issue of pharmaceutical grade lactose as a source of potential milk contamination has not been studied.” They therefore tested:
… samples from two different lots of each: Serevent™ Discus®, Advair™ Discus® (100/50, 250/50, 500/50), Flovent™ Rotadisc® (GlaxoSmithCline), and Foradil™ Aeroliser® (Novartis). Milk proteins were detected in all tested DPIs. Whey proteins were present at much higher concentrations than casein or whole milk protein, consistent with the method of lactose purification.
In 2004 Nowak-Wegryzn and her team published a letter to the editor (2004; 113(3): 558-60) about an actual case, that of an eight-year-old boy. [http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674903026770.pdf]
The patient continued to receive Advair for several months without any adverse reactions and with excellent asthma control. However, after inhalation of three consecutive doses from a new diskus, he immediately complained of chest tightness and feeling of distress that were treated with oral diphenhydramine and inhaled bronchodilator at home.
Caseins were detected in samples from the Advair.
They further looked into whether this was an isolated incident or a general problem. The results were mixed, for a variety of reasons.
Another factor that may contribute to lower threshold for inhaled food allergens is that allergenicity of milk proteins may be enhanced by formation of the lactose-protein complexes. Nonenzymatic glycosylation of milk proteins occurs during heat treatment (Maillard reaction), leading to significant changes in the 3-dimensional structure of these proteins. These conformational modifications might lead to large glycoprotein complex formation and enhanced allergenicity. In fact, intradermal skin test reactivity to [beta]-lactoglobulin–lactose conjugates has been shown to be 10- to 100-fold increased compared with native [beta]-lactoglobulin. Furthermore, large complexes may be randomly distributed, explaining why some lots of Advair contained larger amounts of milk proteins compared with others. In addition, the purity of lactose USP may differ among the manufacturers as well as among the batches from the same source. A recent paper reported that none of the 24 children with well-characterized immediate cow’s milk allergy reacted on a blinded challenge with soy-based infant formula containing lactose, and that there was no detectable milk protein in a single batch of lactose provided by an Italian manufacturer.
A second clinical case, that of an adult, was reported in the abstracts section of that journal in 2006 (117(2); S95). A dry inhaler powder was the cause, but there is too little information to be useful otherwise.
A comment on the 2004 letter can be found in the Jan. 1, 2005, issue of Child Health Alert.
COMMENT: This well-documented report indicates that parents can be legitimately concerned about milk protein contamination in lactose-containing medications. How often this might create a problem is quite another matter. In the case reported above, the child was so allergic to milk protein that he previously even had reactions to tiny amounts of milk protein that came in contact with his skin. It may be that this highly allergic child used a product that just happened to be highly contaminated with milk protein, and this coincidence might be so rare that it would be unlikely to happen to another child. However, for a child who has a severe sensitivity to milk protein, it is important to know that lactose in a medication can indeed contain small amounts of milk protein.
I’d suggest that these reports be viewed with great caution. The boy was one of those rare, extremely sensitive individuals who reacted even to skin contact with milk protein. It’s hard to tell from reading the report whether contamination occurred in the batch he reacted to, whether procedures changed at the factory, or whether other factors might have led to a reaction when there normally wouldn’t be one.
An allergic reaction to lactose is a concern, but few even of those who are dairy allergic have to be specifically concerned. I still haven’t found any analyses of potential reactions from swallowing lactose as opposed to dry powder inhalers.
I’m always torn between dismissing odd single-source reports and considering them as tips of icebergs of under-reported problems. You’ll want to decide which way to lean for yourselves.
February 26, 2008
Lactose in Karaoke Pills. Karaoke Pills?
Lactose is a slightly sweet sugar. It’s imparts just a hint of pleasant taste to counteract the bitterness of most medications. And it’s cheap because it’s a waste product of cheesemaking. It’s inert in most ways as well. It can be packed down and retain a shape or heated to form a smooth outer coating. All in all, lactose is close to the best and most versatile filler that can be used for pills.
It’s not even that big a deal for the vast majority of us who are lactose intolerant, because there’s just too little lactose in any one pill to create symptoms. Medical grade lactose should be completely free of contamination by whey or casein proteins, so it would have very low reactivity for those with dairy allergies who are not anaphylactic to dairy. Those of you who are should avoid any lactose, in pill form or in foods.
So I wasn’t terribly surprised to see lactose as an “inactive” ingredient in a pill. I was terribly surprised to see the pill.
The karaoke pill.
Serkan Toto, on Crunchgear.com [http://www.crunchgear.com/2008/07/17/try-these-karaoke-pills-in-case-you-suck-at-singing/], found The Fushigi na Karaoke Taburetto (Mysterious Karaoke Pills) at the Japanese site Rakuten. [http://item.rakuten.co.jp/marionet24/provoice/]
According to the manufacturer, they treat bad breath, expand your singing range by softening the vocal cords and relieve stress. As a result, you are supposed to sing better. They promise your next performance at Karaoke will be brilliant if you take 3 pills 10 minutes before.
Take them just before you sing. Isn’t that the equivalent of taking lactase pills just before you eat?
They come in packs of five pills. Since you need three at a time, one pack doesn’t get you two karaokes. You only come out even if you buy three packs. Devious marketing indeed. Of course, any mind that could dream up karaoke pills has as high a level of deviousness as Donald Trump on “Deal or No Deal.” Why expect the ordinary?
July 17, 2008
Seriously Now, Is Lactose a Problem in Medications?
Yesterday I mentioned that seemingly every pill you can put in your mouth, even karaoke pills (no, not pills to cure karaoke, but pills to make you sing better for karaoke) contains lactose as a filler.
A frivolous frippery, to be sure, but a fun way to approach a serious subject. Just how much of a risk does someone with lactose intolerance face when taking pills containing lactose?
A bunch of serious-sounding doctors, Joseph P. Nathan, MS, PharmD; Sara Schilit, PharmD; and Jack M. Rosenberg, PharmD, PhD Drug Topics, of the International Drug Information Center of the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N.Y., took a look at the medical literature on this subject.
They reported back to a physician audience on Drug Topics. [http://drugtopics.modernmedicine.com/drugtopics/Pharmacy/Clinical-Q-amp-A-Can-lactose-intolerant-patients-u/ArticleStandard/Article/detail/484449]
Case reports describing lactose-intolerant patients experiencing adverse reactions to the lactose content of medications have been published over the past 30 years. The symptoms experienced were ameliorated to some degree with supplemental lactase enzymes and resolved when the patients discontinued the offending medications. Notably, the majority of patients in these cases were extremely sensitive to lactose-containing products.
While it has been reported that the amount of ingested lactose necessary to produce adverse effects varies, it generally ranges between 12 and 18 gm of lactose (approximately 8 to 12 oz of milk). Considering the fact that most oral medications contain quantities of lactose that are far less than 12 to 18 gm, one would theoretically not expect such small quantities to result in gastrointestinal symptoms. Nonetheless, the cases reported in the literature suggest that certain individuals may react to very small quantities of lactose.
In summary, it appears that most patients who are lactose intolerant can probably tolerate the quantities of lactose that are incorporated into oral drug products. However, one must keep in mind that certain highly sensitive patients may present with gastrointestinal complaints even after ingesting the small quantities of lactose found in oral medications. Furthermore, patients ingesting multiple lactose-containing medications may experience symptoms of lactose intolerance due to the cumulative lactose intake from these medications. Patients who experience adverse gastrointestinal effects after ingesting lactose-containing drug products may opt to use lactase enzyme supplementation.
I feel good in that this is exactly what I’ve been saying on the subject.
If taking lactase with the pills doesn’t alleviate the symptoms, then the choices are fewer. You can try requesting an alternate medication or form of the original medication that does not contain lactose. This isn’t always possible, though. Some medications don’t have good alternatives, or the alternatives might be considerably more expensive.
Or you could try finding a compounding pharmacy (see “Try a Compounding Pharmacy for Lactose-Free Medications”).
July 18, 2008
Kids and Lactose Intolerance
I’ve been writing a lot about kids and dairy allergies because that can be a scary topic for parents in a new school year.
But what about those children with lactose intolerance?
That’s actually a harder subject in some ways, because the vast majority of kids who are lactose intolerant do not have to give up dairy entirely. Yes, despite all the scare stories you may have read, a small amount of lactose, especially in cookies or cake or other desserts, probably won’t result in any symptoms at all. Most kids just need to be careful not to have too much at once. The problem is that sensitivity is totally individual. Allergic kids can simply be told not to touch dairy. Ever. Once lactose-intolerant kids get old enough to understand the problem, though, there is no one-size-fits-all solution for them. Trial and error is the only approach.
One thing you as parents can do is make sure that your children always have a supply of lactase pills with them just in case. A number of companies make chewable, flavored pills that are easier for kids to use. You can see them on the Lactase Pills page on my website.
Digestive Advantage also makes a version of its probiotic plus lactase pills for children. They say that the advantage is that the pills need only be taken once a day so children don’t have to remember taking them with food or even bothering to question what’s in food. That would be enormously helpful, since most kids won’t want to interrupt the process of getting something tasty for questions or pills.
I can’t say if the pills work, although many people have sent me emails that they have had good experience with other Digestive Advantage products. If you do have your children try them, please let me know how they work, one way or the other.
September 2, 2006
Pediatricians Agree That LI Kids Can Have Milk
Hey, it looks like pediatricians are finally catching up with our reality.
Just three days ago, I posted an item, “Kids and Lactose Intolerance,” in which I said that kids who are lactose intolerant don’t need to avoid dairy entirely.
And guess what: the American Academy of Pediatrics (AAP) just put out guidelines in its journal Pediatrics concerning Lactose Intolerance in Infants, Children, and Adolescents, written by Melvin B. Heyman, MD, MPH for the AAP Committee on Nutrition. [http://pediatrics.aappublications.org/cgi/content/abstract/118/3/1279] And it does not recommend eliminating dairy products to treat lactose intolerance.
An article on Forbes.com summarizes the new guidelines. [http://www.forbes.com/forbeslife/health/feeds/hscout/2006/09/05/hscout534721.html]
New guidelines say the academy “supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents.” Specifically, it does not recommend eliminating dairy products to treat lactose intolerance.
In practical terms, said Dr. Melvin B. Heyman, a member of the committee that wrote the guidelines, the new advice is for parents of children with lactose intolerance, in collaboration with pediatricians, to “test the system and see how much milk, cheese and ice cream they can tolerate.”
One reason for the new advice, said Heyman, who is a professor of pediatrics at the University of California, San Francisco, is that “we have more information about what people will tolerate. We know that children who have lactose intolerance have a tendency to tolerate some dairy products.”
At least an equally important factor is the need for the calcium in dairy products, he said. “Young people have to get as much calcium as they can to lower the risk of problems with bones as they get older,” Heyman said.
There’s hope for doctors yet. Maybe eventually they’ll even learn the difference between dairy allergies and LI.
September 5, 2006
Lactase Tablets for Children
I recently received a question often asked, so I thought I would repeat the answer here.
What is the recommended dose of lactase for children given their age and weight?
I answered:
Lactase is not a medication. It works only on the lactose that is in dairy products.
Therefore, there is no children’s dose of lactase. Your child can safely take whatever amount is needed to reduce the symptoms.
If your child doesn’t like taking pills, try a chewable lactase tablet or crush the pill and put it into a food.
There are no side effects to lactase. Any unneeded lactase will simply be eliminated along with other waste.
March 8, 2007
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.
February 9, 2006
The “Sugar” in Ingredients Lists Is Not Lactose
Here’s a recent question emailed to me that been asked often enough to warrant a feature here:
I have had the typical symptoms of L.I. after consuming canned peas that were labeled “peas, salt and sugar”. I am wondering if the sugar in these peas is milk sugar. Do the labeling directives require that it be indicated if the disaccharide is lactose? I am a label reader and I often wonder if the list of ingredients has been changed to indicate any recent changes in the contents?
The answer to this is simple. The only ingredient that can be called just plain “sugar” on a food label in the United States is sucrose, ordinary table sugar.
Lactose must be referred to as lactose. Any other sweetener, from glucose to honey to corn syrup to aspartame to any and all of the hundreds of others, must be called by its proper name. Never just “sugar.”
Lactose can be hidden in other milk products, of course. Whey is mostly lactose, to take the most important example.
But sugar is always sugar and lactose is always lactose and never the twain shall meet.
November 18, 2006
Lactose and Dextrose
A more unusual question that I received:
After I got very ill I again looked at the ingredients and spotted dextrose. Are they similar and do you get others who have to also avoid too much dextrose?
Both lactose and dextrose are sugars but the resemblance stops there. Dextrose is in fact another name for glucose. Glucose is not only one of the sugars you get if you properly digest lactose, but it is the body’s basic energy source. All sugars and carbohydrates break down to glucose, or to another sugar that gets converted to glucose. You need it to keep your body going.