Kids May Need Two EpiPens

A major study just out in the journal Pediatrics (Rudders, Susan Pediatrics, April 2010; vol 125: pp: e711-e718) has been making headlines in newspapers all over the country. Dr. Rudders' teams looked at 1255 children who were admitted to emergency rooms at two large Boston hospitals between 2001 and 2006. All the children were under 18, but the average age was closer to six. Just over half (52%) of the children had a true anaphylactic reaction. Of these 44% received epinephrine and 12% of these needed two shots. Some of these shots were given at home, some at the hospital.

That's an awful lot of anaphylactic children who received no epinephrine at all. A Reuters article summed up the study's findings of the failings.

What's troubling, the researchers say, is that half of the children with food-induced anaphylactic reactions did not get epinephrine either before getting to the hospital or while at the hospital. At the hospital, the children received antihistamines, steroids, intravenous fluids and inhaled medicines more often than epinephrine, "despite the lack of evidence" for their usefulness as a first-line treatment, the authors note.

Additionally, fewer than half of the children with food-related allergic reactions left the hospital with a prescription for self-injectable epinephrine and only 22 percent were advised to see an allergist.

Clearly, food-related anaphylaxis "continues to be under-recognized and inadequately treated," Rudders and colleagues warn. Estimates suggest that approximately 150 to 200 people die each year from food-related anaphylactic reactions, and delayed or lack of administration of epinephrine is often to blame.

UPI had a further important quote.

"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," first author Dr. Susan Rudder says in a statement.

To offset costs, Rudders suggests, school nurses carry un-assigned extra doses of injectable epinephrine for the children who need them.

Draw A Soymilk Sun, Win Your School $1000

Over at PerishableFoods.com I found a press release that turns out to be sunnier than most.

Stremicks Heritage Foods is relaunching it’s 8th continent Soymilk brand. The re-launch includes the debut of a new carton packing in the spring. To celebrate the event, the company is inviting children and their families to submit their artwork to be considered for the brand’s new packaging. All entries must be received by 11:59 pm ET June 12, 2010 to be considered in the contest. To submit your artwork for the competition, visit www.8thcontinent.com/. 100 winners will be recognized and awarded with $1,000 in art supplies. All submissions will be featured on the company’s website.

Stremicks Heritage Foods™ (Heritage), founded in 1990, manufactures, sells and distributes value-added, specialty beverage products on a regional and national scale. Headquartered in Santa Ana, Calif., the company operates in Santa Ana, Riverside and Ontario, Calif.; Cedar City, Utah; Joplin, Missouri and Mexicali, Mexico. Heritage owns, licenses and co-packs well recognized brands such as Heritage Organic Milk, Heritage Organic Milk with Omega-3 DHA, 8th Continent Soymilk, Kerns Beverages, Heritage Disney Toy Story Chocolate Milk, Lactaid Refrigerated, Rice Dream, Soy Dream, Soup Broths, Protein Drinks & Sports Nutrition Beverages.

If you visit the site, you'll have to temporarily allow pop-ups. But that takes you to a page on which your children can paint right on screen - with a mouse, of course - to create a sun logo for the new packaging. That painting can be uploaded directly from that page as well. Winning may allow a school to receive up to $1000 for its art program. Be sure to click on the Terms and Condition link at the bottom of the page for the full, long, list of rules and caveats.

Some Vegan-Friendly Foods

Geri Maria Harris wrote about the Top 5 Vegan-Friendly Foods Even Carnivores Will Love for a blog in the Houston Press.

We all know that when a blogger talks about the Top 5 anything it really means five things scraped together to fill up space rather than "Top" so I hope none of you are taking that headline literally. That's why I titled this post "Some Vegan-Friendly Foods." Wow. That's exciting, isn't it? And that's why bloggers lie to you on a regular basis. Along with everybody else who has ever written a headline. Truth doesn't jump off the screen and grab your eyeballs. Pity.

Three of the five seem to be worth your time and attention regardless. I've mentioned two of the firms before but one is new and it's nice to have them together like this. Besides, I'll give you links directly to their sites so you can explore them further.

Amy's Roasted Vegetable Pizza


Pizza without cheese? Doesn't sound too great, we know. But somehow, it is! Amy's starts this scrumptious pie off with a hearty whole-grain rice crust, then tops it off with organic olive oil, tomatoes, and a medley of other veggies that actually taste good. It sounds weird, but it works. We always have to end up sharing at least half of this single-serving entrée.

Uncle Eddie's Vegan: Oatmeal and Chocolate-Chip Cookies

We know there are many amazing vegan cookies out there, but Uncle Eddie's are our personal favorite. They have several flavors to choose from, but we like the substantive texture of the oatmeal blended seamlessly with the creaminess of the chocolate. You can actually pronounce every ingredient listed on the package, which is a plus. We brought some home yesterday and after having a few non-vegan friends over, the bag was totally empty. Not even a crumb.

Rice Dream Chocolate Frozen Pie


All right, so maybe we have a sweet tooth right now, but these things are truly decadent. A heavenly thick layer of creamy "rice cream" is sinfully sandwiched between two oatmeal cookies and covered with chocolate. We tried our first one yesterday while babysitting a niece, and let's just say we were lucky she didn't go after ours once she had finished her own. It was definitely family feud-inducing stuff. We can't wait until it gets even hotter outside and we have an actual excuse to indulge in this delightfully icy extravagance.

Substituting for Evaporated and Condensed Milk

I received this question recently:

Are there any canned lactose free evaporated or condensed milk products? If not, do you have a recipe on how to make lactose free evaporated and condensed milk?

The answer, sadly, is that there aren't any lactose-free evaporated or condensed milk products on the market. (Lactaid did a tryout of one in Puerto Rico, but has no plans to take it further.) Creative cooks will have to devise substitutes. No one-size-fits-all answer comes to mind, though. You'll definitely need to think about what you're cooking and what the role of the milk is in it.

First, what are evaporated and condensed milks? A good answer can be found at the Eating with Food Allergies site.

Evaporated Milk
Evaporated milk is just concentrated milk (with about 60% of the water removed). For an easy substitute, use Vance's Foods DariFree Original Powder Gluten-Free Beverage. Rather than mixing it as milk, mix 1/2 c. of the powder with 1 c. of hot water. I used this substitute in this Dairy Free Fudge recipe.

Sweetened Condensed Milk
Sweetened condensed milk is just evaporated milk with sugar added. To make your own dairy free version, make 1 c. of evaporated milk (recipe above) and, over medium heat, dissolve 1-1/2 c. of granulated sugar in the mixture.

Vance's Foods DariFree is a potato starch-based nondairy milk substitute that is useful is many alternative recipes.

That's just the starting point. When people look for an evaporated milk substitute, pumpkin pie is often the target. I've given a couple of different possibilities for this in previous posts. One answer is tofu, as in Use Tofu to Substitute for Evaporated Milk. Plain soy milk will work if you boil it down to about two-thirds its original liquid content. You can also try just cooking a pie five to ten minutes longer to firm it better without boiling down the soy milk.

If you're looking for a generic substitute to use in many possible recipes, GoDairyFree has a maze of links that lead you to a variety of suggestions, from coconut milk to soy or rice milks.

And another range of possibilities emerge on this page at Celiac.com with plenty of cooks sharing their personal secrets.

You will have to do some experimenting to see which substitute works best with the particular dish or recipe you want to try. No easy answers, but a wealth of advice.

Report from the LI Conference, part 17: Question 2 Summary

The Draft Report summarized the presentations that looked at Question 2 (Weaver; Heaney; and Wilt) as follows:

2. What are the health outcomes of dairy exclusion diets?

The health outcomes of dairy exclusion diets depend on whether other sources of nutrients, such as calcium and vitamin D, occur in the diet in sufficient quantities to replace dairy products as a source of these nutrients, and to what extent other components of milk are beneficial.

Calcium is necessary for normal growth and bone development as well as subsequent maintenance of bone density. The strongest argument for promotion of dairy ingestion is the beneficial effect of calcium (and fortified vitamin D in milk) on growth and development of the skeleton. Calcium is necessary for adequate bone accretion and optimal peak bone mass, which is a major determinant of risk for osteoporosis and fragility fractures later in adult life. Evidence suggests that certain age groups, such as children and teenagers, may be at increased risk for deficient bone acquisition if their diets are deficient in calcium or vitamin D. There is weak evidence that children with diets deficient in calcium have increased fracture rates. The maximal accumulation of bone mineral, and therefore the maximal calcium requirement, occurs during puberty. Although studies indicate that young children who drink milk are likely to meet or exceed the adequate intake for calcium, teenagers, as a group, tend not to take in enough calcium to meet recommended needs. This is exacerbated by dairy avoidance in individuals who consider themselves to be lactose intolerant, regardless of whether they have undergone objective testing for lactose intolerance.

Studies have demonstrated that the presence of lactose does not necessarily affect the efficiency of calcium absorption across the intestine, and that lactase nonpersisters do not have significant impairment in calcium absorption. Thus, the limiting factor in achieving optimal peak bone mass in young individuals is the intake of calcium. Similarly, in older individuals, low calcium intake rather than deficient absorption appears to be a major factor contributing to loss of bone mass. Replacement of calcium using supplements or dairy products slows the rate of bone loss in older people, possibly as a result of an overall decrease in bone turnover. Across the age spectrum, the factor limiting adequate calcium accrual in many individuals appears to be dairy avoidance.

Dairy exclusion diets may exacerbate the risk for osteoporosis for those already at greatest risk. These include women throughout the life cycle and certain racial/ethnic groups. Low intake of dairy products may place African Americans and others at risk for deficiencies of other necessary nutrients for bone health such as vitamin D, in addition to low calcium intake. Individuals with diseases that result in decreased calcium absorption due to intestinal inflammation (inflammatory bowel disease) or that require the use of corticosteroids (which in themselves directly reduce bone mass) have increased risk of osteoporosis.

Dairy exclusion diets may decrease gastrointestinal symptoms (bloating, cramps, flatus, and diarrhea) in symptomatic individuals who have lactose malabsorption or lactose intolerance. The degree of relief is likely related to the level of expression of lactase and the quantity of lactose ingested. People who remain symptomatic on a dairy exclusion diet may have other causes for their gastrointestinal symptoms, such as irritable bowel syndrome, celiac disease, inflammatory bowel disease, or small bowel bacterial overgrowth.

Dairy exclusion diets may affect other health outcomes. In several studies, individuals taking calcium supplements or increased dairy intake have decreased blood pressure. Calcium supplementation has been suggested to improve cardiac and vascular smooth muscle contractility; however, additional research is needed to clarify whether this has a significant impact on cardiovascular risk. Calcium ingestion has been associated with decreased risk of development of adenomatous colon polyps; it is not known whether this translates into decreased rates of colon cancer. One area of recent interest is the effect of lactose ingestion on colonic bacterial populations, as this may increase production of fatty acids such as butyrate, which may promote mucosal growth and reduce inflammation.

Report from the LI Conference, part 16

You want embarrassing?

Say you have a major federal agency, one that has responsibilities for a major, crucial, fraction of the nation's wellbeing. Call it, say, the National Institutes of Health. Make them responsible for the program of a major scientific get-together, say the state-of-the-science conference on Lactose Intolerance. And give that agency the very simple, basic responsibility of making the individual segments of that conference program accessible on the Internet, say, by posting links to each presentation and abstract. You do that, as everyone who has any knowledge of the Internet knows, by taking the URL and adding a # plus the name of an internal link.

So the URL for a link to, say, Evidence-based Practice Center Presentation II:
The Bone Health Outcomes of Dairy-Exclusion Diets by Timothy J. Wilt would read something like this:

http:// consensus.nih.gov/2010/lactoseabstracts.htm #Wilt

Simple enough.

Unless, that is, said Timothy J. Wilt, M.D., M.P.H. is the author of two different presentations. In which case, a URL that reads:

http:// consensus.nih.gov/2010/lactoseabstracts.htm #Wilt

takes you to the first of the two. And never the second. So I can't give you a direct link to the abstract of Evidence-based Practice Center Presentation II:
The Bone Health Outcomes of Dairy-Exclusion Diets because the boneheads at the NIH didn't think to make the link read #Wilt2.

Programming, even HTML-markup, is all details. Mistakes and typos are all too easy to make. But somebody has to click on all the links to make sure they work!

Anyway, for all the info about Dr. Wilt and his co-authors, see the entry I posted about part I of their multi-part presentation.

This particular presentation looked again at actual consumption of nutrients among those who had dairy and those who didn't. What happens with those who don't eat or drink dairy? They don't get enough calcium.

Vegan children consumed only 47% of the RDA for calcium. Vegan women got even less, a mere 30%.

The numbers were extremely similar for LI children (45%) and LI women (37%). LI, lactose intolerance, is being defined here as anyone who claimed symptoms from dairy. Those who tested as having a lactase deficiency, technically a somewhat different group, had a somewhat but not terribly different pattern, 44% for children, 50% for women. (Why no results for men? Apparently none of the 52 studies they summarized looked specifically at males apart from other groups.)

Does this lack of calcium make any real different for bones? The evidence there was thoroughly mixed. Some studies found no differences at all, but many did show increases for bone problems of all sorts for people who avoided dairy.

Report from the LI Conference, part 15

Scientists are nothing is not methodical. After examining the consequences of dairy avoidance in children, you couldn't have found a sports book in all Las Vegas that would be willing to take money against what the next panel would be.

Consequences of Excluding Dairy or of Avoiding Milk in Adults
Robert P. Heaney, M.D., FACP, FACN
John A. Creighton University Professor
Osteoporosis Research Center
Professor of Medicine
School of Medicine
Creighton University

To no one's surprise, Dr. Heaney found that adults who think they have lactose intolerance tend to avoid dairy. And in fact, studies have found anywhere from 33% to 80% lower calcium intake in lactose intolerant populations.

Part of his talk did differ from expectations. In what should also be to no one's surprise, taking a properly close look at the nuances give a picture of reality at odds with conventional wisdom.

But it is an oversimplification to focus exclusively on single nutrients, even calcium. Nutrients are not drugs, and they do not act in a vacuum. Rather, like the instruments in a symphony orchestra, they produce their effects in concert with one another. A striking example of this mutual dependence is seen in the interaction of calcium and protein in the diet. Until recently, high protein intakes were considered to be potentially harmful for bone because of their effect on urinary calcium excretion. Increased calciuria was clearly demonstrated for protein and for pure amino acids, whether taken orally or intravenously. However, when protein was fed as a food, strangely there was no effect on calcium balance. More recently, it has become clear that calcium and protein, rather than antagonists, are actually synergistic in their skeletal effects. In postmenopausal women with low protein intakes, increasing calcium intake can slow bone loss, but not much more. By contrast, with high protein intakes, added calcium leads to actual bone gain. This is an important consideration in our context because individuals with low dairy intakes are missing not only the calcium but also a rich source of dietary protein, which is as necessary for bone rebuilding as is the calcium that is the more obvious component of bony material.

In brief, dairy supplies a broad spectrum of nutrients that work together better than gaining them individually or from foods less gifted. Even calcium-fortified orange juice isn't anywhere as good a source as dairy.

And here's a tidbit that will infuriate those who cherry-pick the medical journals for anti-milk reports.

While the focus of this session is predominantly on skeletal effects, it should be stressed that inadequate dairy intake has multiple other consequences as well, including increased risk of metabolic syndrome, hypertension, preeclampsia, obesity, and certain forms of cancer, particularly colon cancer. Thus milk avoidance is, for most adults, a risky behavior.

Reality is a harsh mistress.

Report from the LI Conference, part 14

For the next three posts, we'll be in Section 2 of NIH state-of-the-state presentations on Lactose Intolerance.

What are the health outcomes of dairy exclusion diets?

Consequences of Excluding Dairy, Milk Avoiders, Calcium Requirements in Children
Connie M. Weaver, Ph.D.
Distinct Professor and Head
College of Consumer and Family Sciences
Department of Foods and Nutrition
Purdue University

Although it is perfectly true that a totally adequate intake of nutrients can be achieved without consuming any dairy products, the reality is that Americans as a whole don't follow anything like that diet. They don't come close to getting sufficient nutrients even with dairy. The numbers are scary.

The role of milk products in meeting three nutrients for various age groups is illustrated in Table 1.

Most food guidance patterns recommend 3 cups of low-fat dairy products daily. The table contrasts the proportion of individuals meeting the dairy recommendations with those receiving less than one serving of dairy products as assessed from data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES). The best and most economical source of the limiting nutrients is dairy. Supplements typically do not fill the gap of all these nutrients for those who do not consume recommended intakes of dairy products. Using NHANES 2001–2002 data, Gao et al. determined that it is impossible to meet calcium recommendations while meeting other nutrient recommendations with a dairy-free diet within the current U.S. dietary pattern. Using the 1999–2004 NHANES data, Nicklas et al. determined that < 3% of the U.S. population met potassium recommendations and 55% did not even meet their Estimated Average Requirements for magnesium.

Bone mass growth comes during adolescence, with 95% of adult peak occurring by age 16. Getting proper nutrients in childhood in critical. Dairy drinkers have a real advantage in driving those numbers up to and past the critical requirements. Here's a table of what the bone-related nutrient requirements are for those under 18.

Planet Lactose: The Best of the Blog

Long delayed, the announcement of my book finally appeared locally.

Planet Lactose was today's selection in the Rochester Democrat & Chronicle's Spotlight on Authors: Rochester Authors column.

Planet Lactose: The Best from the Planet Lactose Blog by Steve Carper (Planet Lactose Publishing, $16). This book distills three years of the author's blog, which focuses on avoiding dairy products for those who are lactose intolerant, have milk allergies, are vegan, or want to keep kosher. Carper, also author of Milk is not for Every Body, has spent 30 years exploring dairy-free living. Learn more at planetlactose.blogspot.com. Carper lives in Rochester.

You can purchase copies of the book by going to this page.

Report from the LI Conference, part 13a: Question 1 Summary

The Draft Report summarized the presentations that looked at Question 1 (Tishkoff; Wooten; Wood; and Wilt) as follows:

1. What Is the Prevalence of Lactose Intolerance, and How Does This Prevalence Differ by Race, Ethnicity, and Age?

The prevalence of lactose intolerance is difficult to discern because studies have varied in their interpretation of what constitutes this condition. To estimate accurately the prevalence of lactose intolerance, one first must define lactose intolerance to permit the identification of those individuals with the condition and the exclusion of those without the condition. By applying this definition to a representative population sample, one can then estimate the prevalence in the general population and assess how this prevalence differs by age and race/ethnicity. We define lactose intolerance as the onset of gastrointestinal symptoms following a blinded, single-dose challenge of ingested lactose by an individual with lactose malabsorption, which are not observed when the person ingests an indistinguishable placebo. Although lactose malabsorption and lactase nonpersistence can be easily identified, they are not equivalent to lactose intolerance.


The prevalence of lactose intolerance in the United States cannot be estimated, despite a systematic evidence review that identified 54 articles, including 15 studies in the United States with a total of 4,817 participants. None of the studies used this definition or evaluated a representative sample of the U.S. population. Seven studies that assessed self-reported lactose intolerance provide limited insight because the self-diagnoses were not confirmed by testing for lactose malabsorption, and the symptoms seen in true lactose intolerance may result from several other conditions such as irritable bowel syndrome. Nine studies evaluated only the genetic predisposition to lower than expected levels of lactase in adults (lactase nonpersistence) without assessing lactose malabsorption or intolerance directly. Five studies reported decreased intestinal tissue lactase activity, and 31 studies addressed lactose malabsorption directly (as evidenced by a positive hydrogen breath test after ingestion of lactose).


Although these studies shed some light on the epidemiology of lactose intolerance (discussed below), they cannot be used to estimate the prevalence of lactose intolerance. Many individuals who have the biologic underpinnings for lactose malabsorption (low lactase levels or a genetic profile associated with low lactase) or who have demonstrated lactose malabsorption do not experience the onset of or an increase in the severity of gastrointestinal symptoms following a blinded lactose challenge. Complicating this further, evidence demonstrates that many who self report lactose intolerance show no evidence of lactose malabsorption. Thus, the cause of their gastrointestinal symptoms is unlikely to be related to lactose.


Despite the limitations in the available studies discussed above, several trends are noteworthy across the studies regarding lactose intolerance, lactose malabsorption, lactase nonpersistence, age, and race/ethnicity. First, lactose intolerance determined by self-report or nonblinded lactose challenge is less frequent across all ethnic groups than is lactose malabsorption determined by breath hydrogen tests or lactase nonpersistence determined by biopsy or genetic testing. Second, lactose intolerance, lactose malabsorption, and lactase nonpersistence vary across racial and ethnic groups with the lowest reported occurrence in European Americans and higher although variable occurrence in African Americans, Hispanic Americans, Asian Americans, and Native Americans. The systematic evidence review notes that the racial and ethnic variability in lactose intolerance following nonblinded lactose challenge was not as extreme as that reported in lactose malabsorption and lactase nonpersistence. Third, lactose intolerance with nonblinded lactose challenge and lactose malabsorption was low in young children, but increased with age. In children younger than 6 years, lactose malabsorption was low in all the studies and peaked between ages 10 and 16 years. Little evidence suggests that lactose intolerance increases in older persons. These trends need to be verified by representative population studies using the case definition of lactose intolerance

Report from the LI Conference, part 13

Take a deep breath. You're about to be socked with the longest title and longest list of authors of the whole conference.

Evidence-based Practice Center (EPC) Presentation I: Methods of Systematic Review and the Prevalence of Lactose Intolerance and Differences by Race, Ethnicity, and Age
Timothy J. Wilt, M.D., M.P.H.
Codirector, Minnesota Evidence-based Practice Center
Core Investigator, Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research
Professor of Medicine
University of Minnesota School of Medicine

Want the full list of co-authors? Here. Timothy J. Wilt, M.D., M.P.H.; Aasma Shaukat, M.D., M.P.H.; Tatyana Shamliyan, M.D., M.S.; Brent C. Taylor, Ph.D., M.P.H.; Roderick MacDonald, M.S.; James Tacklind; Indulis Rutks; Sarah Jane Schwarzenberg, M.D.; Robert L. Kane, M.D.; Michael Levitt, M.D.

They didn't all get up on stage at once, or the auditorium would have become unbalanced and slid into the Potomac. In preparation for the conference, a team of experts combed through all the literature, hundreds, maybe thousands, of studies, to collect every one that looked at various populations. They then did a review of all the applicable studies to see what conclusions could be drawn from everything that had been written on the subject.

Some people say that only double-blinded studies (studies in which neither the testers nor the testees known what exactly what is in the test products) are suitable for drawing serious scientific conclusions. All right, me. I've said it.

Here's the problem. There aren't any. None.

Okay, so this isn't a cancer drug that will decide life or death. Maybe we can go with blinded studies, i.e., those in which just the test subject doesn't know whether there's lactose in the drink or not.

None.

What? That can't possibly be? Nobody has ever bothered to blind-test lactose versus a placebo? The Coke/Pepsi challenge was more rigorous than that.

But the disheartening results give the bad news in so many words.

A total of 54 articles met inclusion criteria, including 15 articles from the United States. Studies did not directly assess LI in a blinded lactose challenge but instead assessed unblinded subjective LI symptoms, an inability to fully absorb lactose (LM), or lactase nonpersistence. The data available tended to be from highly selected populations and were likely not representative of the overall U.S. population. We report results according to the following conditions: LI, LM, or lactase nonpersistence. Within these conditions, we further describe findings according to assessment method and populations studied.

Man, that's ugly.

The truth is that scientists got all hot and bothered about LI when they first started looking around the world and finding it everywhere. Most of those studies took place back in the 1970s. Once they found that lactose malabsorption was common and traced the route that lactase persistence took that made most people in northern Europe milk drinkers, they stopped caring. LI isn't really a medical problem, so the medical community has never been terribly interested in studying all the effects. We just don't get sick enough to make us worth their attention.

Is that good news or bad news?

Report from the LI Conference, part 12

Back from a short lunch we plunged directly into more presentations.

Aging: Lactose Intolerance and Calcium Absorption in the Elderly
Richard J. Wood, Ph.D.
Associate Professor
Department of Nutrition
School of Public Health & Health Sciences
University of Massachusetts

We're a nation of just over 300,000,000 people. We're also an aging nation. People are living longer than ever before, and the demographic bulge caused by the vastly increased birthrates that represent the baby boomer generation is moving to the older segment of the population. The first boomers are turning 64 this year. By the year 2030 there will be an estimated increase of 33 million people in the 65 and over age bracket, making a total of 25% of Americans. You can't blame the boomers entirely. The oldest will be only 84 that year but a full 5% of the population will be 85 or over then.

What happens to humans as they become older, an older population than ever before? Specifically, what do we know about the elderly and LI? As will be a woefully recurring theme, the answer is "next to nothing."

Although many studies have characterized the prevalence of lactose maldigestion and symptoms of lactose intolerance in various adult populations, there is surprisingly little information concerning this condition in the elderly, especially in the very old (>80 years). What little evidence is available indicates that the prevalence of lactose maldigestion may increase with age in adults, but that symptoms of lactose intolerance do not increase with age.

Little evidence means little evidence. Apparently fewer than a hundred elderly in total have ever been investigated in LI studies.

And those meager results are big time compared to the number of elderly patients tested to see whether lactose malabsorption affects calcium absorption. We just don't know. The possible good news is that tests on younger patients don't show any difference. Keep on having calcium in whatever form you like.

Lactose-Free Cheese

The Since Your Asked column in the Medford, OR, MailTribune got a softball question and hit, well, a weak single.

I was recently diagnosed as lactose-intolerant. It's very easy to find lactose-free milk, but is there such a thing as lactose-free cheese or any other food items? If so, are there any local stores that sell them?

The first part of the answer is completely correct, which is I give them credit for a hit.

The good news about a lactose-free diet is that it can still include cheese, but the type of cheese makes all the difference.

"The fresher a cheese, the more lactose will be present," says Gianaclis Caldwell, co-owner and cheesemaker of Pholia Farm near Rogue River. "Hard, aged cheese — it's virtually gone."

The reason is a chemical reaction that occurs in cheesemaking or other types of fermentation. Lactose is a sugar found in all milk. Bacteria, often added as a culture, eats sugar. The longer dairy products are aged, the more sugar is converted into lactic acid. All-natural yogurt is another fermented food that may be digestible for some people with lactose intolerance.

A general rule of thumb is the harder the cheese, the longer it's been aged. Think Parmesan, Swiss and sharp cheddar. To be sure, stick with the highest-quality cheeses, more likely produced with natural methods, rather than additives to alter texture.

The problem with the column as a whole is twofold.

First, as I keep telling people and my NIH LI Conference series should make abundantly clear, you don't need to go onto a lactose-free diet even if you have LI.

Second, the column claims that their shoppers couldn't find any true cheeses marked "lactose-free" in local stores. I can't dispute that, but such cheese definitely exist. My Steve Carper's Lactose Intolerance Clearinghouse website has a page of Reduced Lactose Milk Products that include the names and contact information several brands of true cow's milk lactose-free cheeses.

FAAN College Network

The always-busy, coming-up-with-new-sites, allergy organization FAAN (the Food Allergy & Anaphylaxis Network) has yet another one, the Food College Network.

And that is? The Food Safety News said:

The FAAN College Network is a website that provides college-related food allergy resources for college students and parents. The network provides a searchable database of over 40 colleges and universities with the contact information for food allergy representatives on each campus as well as what steps the schools have taken to accommodate students.

FAAN also provides a list of guidelines for schools to follow in accommodating students with food allergies.

In addition to joining the FAAN College Network, some Colleges and Universities have begun posting more detailed labels near food in the dining halls. Signage in these dining halls can include anything from pointing out common allergens to full ingredient lists. Some schools even offer convenient frozen meals and special items such as gluten-free bread to make things easier for students.

Their FAQ Page is a good place for college-bound students to start.

Join our Mailing List! No International Coffeehouse or Famous Stories this Friday or Next During Spring Break we will not be having our International Coffeehouse. We also will not be having our Friday or Sunday Famous Bible Stories studies. Regular activities will resume March 29th. No Study this week or next because of Spring Break. See below for schedule! Famous Bible Stories Studies Fri 2:30-4:00 or Sun 12:30 - 2:00 Each week we will be looking at a new story in its historical context and modern issues that it may raise. This class will be offered at two different times each week. Choose which works best for you. Each weeks classes are independent so come when you can. Classes are free and we have bibles you can borrow. Fridays from 2:30 - 4:00 pm and again Sundays from 12:30 - 2:00 pm (This class will be include a "lite lunch") Friday April 2nd & Sunday April 4th - Jesus' Betrayal and Death Friday April 9th & Sunday April 11th Resurrection Friday April 16th & Sunday April 28th - Pentecost Friday April 23th & Sunday April 25th - Stories from the Book of Acts Friday April 30th & Sunday May 2nd - To be determined Classes will be held in the Etc. Coffeehouse at Wesley and the Student Lounge across the hall. 1203 W. Green Street Urbana Food Pantry Volunteers Needed Wed and Thurs PLEASE SIGN UP THIS MONTH WE ARE REALLY ENCOURAGING OUR INTERNATIONALS TO HELP Each month our Wesley Foundation serves over 1000 persons in need a week's worth of groceries. This is a huge undertaking as we convert our foundation into a food pantry (grocery store) each third Thursday of the month. We need to unload a semi's worth of food, set up tables open boxes and direct traffic. At the end of the evening we need to tear it all down and clean up. You do not need to speak English to help as much of it is "manual labor." This is a great way to see another side of America. Food Pantry volunteers are needed for many jobs throughout the month, but especially the days and hours leading up to, and through, distribution on the evening of the 3rd Thursday of the month. Training for persons who have not yet be trained will be Wed at 7:00pm and on March 17th also at 8:30pm. Training lasts a little over an hour and is required for all persons volunteering for all Thursday shifts (except clean up). You do not need to be trained to help at other set up or cleanup times. Some of the times you can volunteer include (you do not need to work the full time slot): Wed. Mar 17th 12:30-2:00 pm Truck Unloading, 18 persons each hour Wed. Mar 17th 6:30 - 8:30 pm Food Setup Wed. Mar 17th 7:00 pm Training for volunteering on Thursdays Wed. Mar 17th 8:30 pm Training for volunteering on Thursdays Thurs. Mar 18th 2:00 - 4:30 pm Final Set-Up (Training Required) Thurs. Mar 18th 3:00 - 5:30 pm Registration and Number Handout (Training Required) Thurs. Mar 18th 4:30 - 7:30 pm Food Distribution (Training Required) Thurs. Mar 18th 8:30 - 10:00 pm Cleanup 18 persons each hour PLEASE sign up ahead of time online so we know who will be helping or going through training. http://wesleypantry.org/volunteering/ Spring Break Mission Trip to Louisiana needs cars & drivers If you have a car and haven't nailed down your spring break plans, we could use you. We have a group of 14 students going to Lake Charles Louisiana to help do small home repairs. This area of Louisiana struggles with chronic poverty and then was hit very hard by hurricane Rita. We will leave early on March 20th and return late on March 27th. The cost of the trip is only $250 but expect to work while we are down there. We will also have one tour day in New Orleans. If you are interested please email Pastor Rob As Soon As Possible (ASAP). Events Coming Later This Semester To Be Announced Come learn about the Organ and even practice playing on it. Spring Break Mission Trip to Lousiana

Join our Mailing List! No International Coffeehouse or Famous Stories this Friday or Next During Spring Break we will not be having our International Coffeehouse. We also will not be having our Friday or Sunday Famous Bible Stories studies. Regular activities will resume March 29th. No Study this week or next because of Spring Break. See below for schedule! Famous Bible Stories Studies Fri 2:30-4:00 or Sun 12:30 - 2:00 Each week we will be looking at a new story in its historical context and modern issues that it may raise. This class will be offered at two different times each week. Choose which works best for you. Each weeks classes are independent so come when you can. Classes are free and we have bibles you can borrow. Fridays from 2:30 - 4:00 pm and again Sundays from 12:30 - 2:00 pm (This class will be include a "lite lunch") Friday April 2nd & Sunday April 4th - Jesus' Betrayal and Death Friday April 9th & Sunday April 11th Resurrection Friday April 16th & Sunday April 28th - Pentecost Friday April 23th & Sunday April 25th - Stories from the Book of Acts Friday April 30th & Sunday May 2nd - To be determined Classes will be held in the Etc. Coffeehouse at Wesley and the Student Lounge across the hall. 1203 W. Green Street Urbana Food Pantry Volunteers Needed Wed and Thurs PLEASE SIGN UP THIS MONTH WE ARE REALLY ENCOURAGING OUR INTERNATIONALS TO HELP Each month our Wesley Foundation serves over 1000 persons in need a week's worth of groceries. This is a huge undertaking as we convert our foundation into a food pantry (grocery store) each third Thursday of the month. We need to unload a semi's worth of food, set up tables open boxes and direct traffic. At the end of the evening we need to tear it all down and clean up. You do not need to speak English to help as much of it is "manual labor." This is a great way to see another side of America. Food Pantry volunteers are needed for many jobs throughout the month, but especially the days and hours leading up to, and through, distribution on the evening of the 3rd Thursday of the month. Training for persons who have not yet be trained will be Wed at 7:00pm and on March 17th also at 8:30pm. Training lasts a little over an hour and is required for all persons volunteering for all Thursday shifts (except clean up). You do not need to be trained to help at other set up or cleanup times. Some of the times you can volunteer include (you do not need to work the full time slot): Wed. Mar 17th 12:30-2:00 pm Truck Unloading, 18 persons each hour Wed. Mar 17th 6:30 - 8:30 pm Food Setup Wed. Mar 17th 7:00 pm Training for volunteering on Thursdays Wed. Mar 17th 8:30 pm Training for volunteering on Thursdays Thurs. Mar 18th 2:00 - 4:30 pm Final Set-Up (Training Required) Thurs. Mar 18th 3:00 - 5:30 pm Registration and Number Handout (Training Required) Thurs. Mar 18th 4:30 - 7:30 pm Food Distribution (Training Required) Thurs. Mar 18th 8:30 - 10:00 pm Cleanup 18 persons each hour PLEASE sign up ahead of time online so we know who will be helping or going through training. http://wesleypantry.org/volunteering/ Spring Break Mission Trip to Louisiana needs cars & drivers If you have a car and haven't nailed down your spring break plans, we could use you. We have a group of 14 students going to Lake Charles Louisiana to help do small home repairs. This area of Louisiana struggles with chronic poverty and then was hit very hard by hurricane Rita. We will leave early on March 20th and return late on March 27th. The cost of the trip is only $250 but expect to work while we are down there. We will also have one tour day in New Orleans. If you are interested please email Pastor Rob As Soon As Possible (ASAP). Events Coming Later This Semester To Be Announced Come learn about the Organ and even practice playing on it. Spring Break Mission Trip to Lousiana

Join our Mailing List! No International Coffeehouse or Famous Stories this Friday or Next During Spring Break we will not be having our International Coffeehouse. We also will not be having our Friday or Sunday Famous Bible Stories studies. Regular activities will resume March 29th. No Study this week or next because of Spring Break. See below for schedule! Famous Bible Stories Studies Fri 2:30-4:00 or Sun 12:30 - 2:00 Each week we will be looking at a new story in its historical context and modern issues that it may raise. This class will be offered at two different times each week. Choose which works best for you. Each weeks classes are independent so come when you can. Classes are free and we have bibles you can borrow. Fridays from 2:30 - 4:00 pm and again Sundays from 12:30 - 2:00 pm (This class will be include a "lite lunch") Friday April 2nd & Sunday April 4th - Jesus' Betrayal and Death Friday April 9th & Sunday April 11th Resurrection Friday April 16th & Sunday April 28th - Pentecost Friday April 23th & Sunday April 25th - Stories from the Book of Acts Friday April 30th & Sunday May 2nd - To be determined Classes will be held in the Etc. Coffeehouse at Wesley and the Student Lounge across the hall. 1203 W. Green Street Urbana Food Pantry Volunteers Needed Wed and Thurs PLEASE SIGN UP THIS MONTH WE ARE REALLY ENCOURAGING OUR INTERNATIONALS TO HELP Each month our Wesley Foundation serves over 1000 persons in need a week's worth of groceries. This is a huge undertaking as we convert our foundation into a food pantry (grocery store) each third Thursday of the month. We need to unload a semi's worth of food, set up tables open boxes and direct traffic. At the end of the evening we need to tear it all down and clean up. You do not need to speak English to help as much of it is "manual labor." This is a great way to see another side of America. Food Pantry volunteers are needed for many jobs throughout the month, but especially the days and hours leading up to, and through, distribution on the evening of the 3rd Thursday of the month. Training for persons who have not yet be trained will be Wed at 7:00pm and on March 17th also at 8:30pm. Training lasts a little over an hour and is required for all persons volunteering for all Thursday shifts (except clean up). You do not need to be trained to help at other set up or cleanup times. Some of the times you can volunteer include (you do not need to work the full time slot): Wed. Mar 17th 12:30-2:00 pm Truck Unloading, 18 persons each hour Wed. Mar 17th 6:30 - 8:30 pm Food Setup Wed. Mar 17th 7:00 pm Training for volunteering on Thursdays Wed. Mar 17th 8:30 pm Training for volunteering on Thursdays Thurs. Mar 18th 2:00 - 4:30 pm Final Set-Up (Training Required) Thurs. Mar 18th 3:00 - 5:30 pm Registration and Number Handout (Training Required) Thurs. Mar 18th 4:30 - 7:30 pm Food Distribution (Training Required) Thurs. Mar 18th 8:30 - 10:00 pm Cleanup 18 persons each hour PLEASE sign up ahead of time online so we know who will be helping or going through training. http://wesleypantry.org/volunteering/ Spring Break Mission Trip to Louisiana needs cars & drivers If you have a car and haven't nailed down your spring break plans, we could use you. We have a group of 14 students going to Lake Charles Louisiana to help do small home repairs. This area of Louisiana struggles with chronic poverty and then was hit very hard by hurricane Rita. We will leave early on March 20th and return late on March 27th. The cost of the trip is only $250 but expect to work while we are down there. We will also have one tour day in New Orleans. If you are interested please email Pastor Rob As Soon As Possible (ASAP). Events Coming Later This Semester To Be Announced Come learn about the Organ and even practice playing on it. Spring Break Mission Trip to Lousiana

Pennymint Patties Wins Allergy Free Recipe Contest

Allergiesandme.com, an online store offering selections of allergen free foods, held a recipe contest last month. The Grand Prize winning submission was "Pennymint Patties" by Lori Zook of Pennsylvania.

"My daughter, Jazlyn, is anaphylactic to egg, dairy, peanuts and tree nuts. I have always tried to come up with recipes for the foods she saw and wanted to eat. One day Jazlyn asked my mom what her favorite candy was and she said York Peppermint Patties. Jazlyn adores my mom and wanted to try the candy. Since the store bought version was unsafe, I came up with this amazingly easy recipe that tastes just like the original. I've called them Pennymint Patties because my mom's name is Penny. Since I have developed this recipe, my mom no longer eats the original candy, she just asks me to make another batch of these for her".

You can find links to Pennymint Patties and the other prize-winning recipes on the Allergy and Me recipe contest page.

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Please consider subscribing to our weekly online Student E-Newsletters.

Rescue Chocolate's Vegan Egg

With Easter and Passover approaching (don't look at me: the only holidays whose dates I know are the Fourth of July and Cinco de Mayo), a company that brags about vegan Easter eggs and Passover Bark has to get my attention. Mostly because I don't know what Passover Bark is. (If you don't either, the picture is below.)



The news comes from a handy press release telling us the story behind Rescue Chocolate.

The newest do-good gourmet chocolate company, Rescue Chocolate, recently launched two boundary-breaking sweets for the spring holidays.

Candy Easter eggs are a dime a dozen, sometimes literally. The Good Egg from Rescue Chocolate changes that notion. This is a dairy-free "cream"- filled chocolate egg perfect for the Easter basket or Passover table. It breaks bounds in the dairy-free confection world in that it's the country's only vegan chocolate egg actually made with a creamy filling. Those who no longer eat a diet with milk or egg products can now relive that traditional holiday treat from Easters past. This writer was able to try a taste, and the egg did not disappoint. The chocolate cream filling tasted sweet, airy and light; while the chocolate egg shell was dark and smooth as can be.

As with all of the Rescue Chocolate products, this egg has its own mission. The company emphasizes that an unruly pet is not a "bad egg," and instead of giving up said animal, a person needs only to seek out no-cost or low-cost solutions from a vet or animal shelter professional. The egg's presentation, nestled in a cozy wood nest, makes The Good Egg a shoo-in gift for the spring holidays.

As Passover approaches, many observant Jews find themselves dreading the bland food which they annually resign themselves to in the name of tradition. "It's only eight days," they tell themselves, "you can go without the good stuff for eight days." No longer. Rescue Chocolate is offering a limited edition Kosher for Passover-certified chocolate bark. Called Don't Passover Me Bark, it features a matzoh-textured slab of Belgian chocolate with a sprinkling of whole almonds. It's the perfect finish for any Seder meal, and it would make quite a welcome Passover hostess gift.

Both products are cruelty-free, vegan, and certified as Kosher Pareve (with the bark only certified for Passover). And, as with all of their products, consumers feel good shopping because 100% of the net proceeds are donated to non-profit organizations working on animal rescue issues. For the month of March, the United Animal Nations is the beneficiary group for their international animal welfare programs.

Contact information:

Rescue Chocolate
Sarah Gross
917-767-7283
info@rescuechocolate.com
www.rescuechocolate.com

Eatright.org

While we're taking a lunch break from the series of LI Conference posts, I'm going to catch up with some of the news about nutrition and products that I've been missing the past couple of weeks.

The American Dietetic Association (ADA) is an important source of good, solid information about dietary issues. They've updated their website, which can be found at www.eatright.org/Public/.

They put out a press release that touted the new features.

1. Diet reviews» This section looks at popular diets (South Beach, the 4-Day Diet, the Flat-Belly Diet, among others) and reviews them from a medical standpoint. A member of the ADA summarizes the diet's claims and strategies, lays out its nutritional pros and cons, and offers a bottom-line critique on whether it's a sound dietetic choice.

2. Question of the day» What is the shelf life of canned vegetables? Is lactose-intolerance the same as a milk allergy? Can pizza be healthy? A new query is posed and answered every one to two days, often with a link to other resources if you're looking for even more information.

3. Find a dietitian» Enter your ZIP code and specialty needs (e.g., celiac disease, weight control), and the site will provide a list of qualified dietitians and their contact information.

4. "Weigh In" blog» Registered dietitians blog about tackling a loved one's eating habits, helping kids navigate snack time, the earthquake in Haiti and other timely topics. The comment section - often the most fun part of blog reading - is sparse at this point, but that might improve as the site attracts more readers.

5. Disease management and prevention» It can be hard to get your general practitioner to discuss diet's role in various diseases, so this section - with information on autism, cancers, kidney disease and others - is a great place to turn for answers.

Report from the LI Conference, part 11 [Lunch]

Bethesda, MD, was still recovering from the giant snowstorms of the previous weeks, with sidestreets lined with cars that nobody had bothered digging out from the packed snow thrown up by the plows. That Monday of the conference was chill and rainy and thoroughly miserable (as I found later that day, when I missed a shuttle bus back to my hotel by moments and waited 25 minutes for the next one to arrive, having only a sport coat to break the cold). The good news is that the NI thoughtfully held the conference in a building containing a major cafeteria. The bad news - or at least the comical news - occurred just as the entire conference descended on the cafeteria only to find that the last tray had been scarfed by the NIH's normal inhabitants. The distinguished group balancing plates, soup bowls, bottles, and silverware on top of briefcases, purses, and coats looked more like extras from a Laurel and Hardy movie.

I managed to snag the last seat at a crowded table of the large Lactaid contingent plus Alan Kligerman. We had a mutual admirefest (I have fans, who knew?) and the conversation was lively, if heavy on shoptalk.

Since none of the questions I asked in any of the discussion periods had been answered (nobody has any idea of the duration, rate, or variation of the time it takes to lose lactase production, e.g.) I thought I'd try a more practical question given the expertise I had on hand.

I've been asked multiple times why no lactose-free powdered milk is available to consumers. Alan said that it simply doesn't work. When lactose-free milk is dried, the result is brown, smelly, and bad-tasting.

What likes heat? Chocolate. All the Lactaid people agreed that the chocolate milk Alan had created was one of their best-tasting products, because chocolate loves heat.

So next time you each for a lactose-free carton of milk, try the chocolate. It has approval from on high.

Report from the LI Conference, part 10

The pattern of lactose tolerance varies widely around the globe. People from northern Europe and their descendents have the highest percentages of tolerance, or ability to drink milk. East Asians have among the lowest. Though I reported yesterday that some African tribes developed lactose tolerance, the majority of tribes did not. These were predominantly the tribes whose populations were enslaved and many of their descendents now live in the United States. Forced matings during the era of slavery ensure that many slave descendents have white, usually northern European, ancestors as well.

This all implies that African-Americans will have an intermediate level of lactose tolerance. That doesn't imply that African-Americans typically consume large quantities of dairy products.

Lactose Intolerance and Ethnic Prevalence
Wilma J. Wooten, M.D., M.P.H.
President
San Diego Chapter
National Medical Association
San Diego County Health Officer
San Diego, California

Wooten's talk spelled out some of the implications of this lack of dairy in African-Americans.

• Less than 75% of African Americans meet the 2005 Dietary Guidelines for Americans, which recommends three servings of dairy foods per day (Beydoun 2008; NHANES data).

• African American children consume only 0.8 to 1.0 servings of milk per day.

• By consuming the recommended three servings of low-fat dairy products (milk, yogurt, or cheese), a number of health benefits can be achieved.

• An estimated 75% of African Americans fail to meet daily calcium requirements because of lactose intolerance.

Much of the problem goes to self-selected attitudes towards dairy. Although only a minority of African-Americans consider themselves lactose intolerant, there is a pattern of excluding dairy.

We'll hear a lot more about dairy later on. But first it's time for lunch.