Planet Lactose: The Best of the Planet Lactose Blog, volume 1

By Steve Carper

Steve Carper is the Internet’s leading expert on lactose intolerance. He learned he was lactose intolerant back in 1978 when the condition was virtually unknown. With no books or resources readily available, he plunged into the necessary research and wrote No Milk Today: How to Live with Lactose Intolerance in 1986. There was still more to be learned, so he followed that in 1995 with the larger and definitive book on the subject, Milk Is Not for Every Body: Living with Lactose Intolerance. A pioneer on the web, he started Steve Carper’s Lactose Intolerance Clearinghouse in 1997. He’s answered thousands of questions from readers in more than 30 countries.

Today his Planet Lactose Blog (planetlactose.blogspot.com) is similarly acclaimed for solid medical information and carefully researched facts. Carper covers the varied but overlapping worlds of the milk allergic, vegans, those keeping kosher, and parents whose children require dairy-free nutrition, as well as the lactose intolerant. This collection of the Best from the Planet Lactose Blog is a compact source of knowledge about living dairy free, from the basics to the totally unexpected.

"His wit shines though with amusing notes of sarcasm and blunt fact-telling that will not only leave you feeling better educated, but also entertained" – Alisa Fleming

"Scientifically solid, timely, and comprehensive" -- Edward Miron, M.D.

• Language: English
• Publisher: Steve Carper
• Release date: Aug 2, 2011
• ISBN: 9780979856570

Steve Carper

Steve Carper is the Internet’s leading expert on lactose intolerance. He learned he was lactose intolerant back in 1978 when the condition was virtually unknown. With no books or resources readily available, he plunged into the necessary research and wrote No Milk Today: How to Live with Lactose Intolerance in 1986. There was still more to be learned, so he followed that in 1995 with the larger and definitive book on the subject, Milk Is Not for Every Body: Living with Lactose Intolerance. A pioneer on the web, he started Steve Carper’s Lactose Intolerance Clearinghouse (http://www.stevecarper.com/li) in 1997 and moved the active commentary over to the Planet Lactose Blog (http://planetlactose.blogspot.com) in 2005. He’s answered thousands of questions from readers in more than 30 countries.

Book preview

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

Table of Contents

Chapters

1 Lactose Intolerance

2 Dairy and Other Allergies

3 Babies: Formulas and Feeding Issues

4 Food and Nutrition

5 Dairy Milks and Nondairy Milks

6 A Hungry Person’s Collection of Cookbooks

7 Genetics

8 Product Reports

9 Probiotics

10 For the Vegans

11 Animal Planet

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 [e-mail].

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