Could I be Lactose intolerant and not even know it?

hi angela, thank you for your comprehensive response. i'm so excited to be accessing your knowledge! last question: can one fight a sensitivity? i drink milk several times a week and i often get asked, "you drink milk? aren't you lactose intolerant?" i guess asians are more prone to lactose intolerance than other races. however, i have never felt lactose intolerant or frankly, i simply dismiss that it applies to me. if someone has lactose intolerance or any food allergy, can they trick their body out of it?

Well actually yes. You could definitely be lactose intolerant and not know it. There is a range of lactose intolerance from extreme (as in you take a couple of sips of milk and you get immediate cramping etc) to mild (you can drink a cup of milk and be OK as long as you sip and not chug). It is well known that one can essentially train themselves to tolerate small amounts of dairy even if they are lactose intolerant (i.e. officially cannot digest/break down lactose into glucose and galactose).

There are ways to be tested for lactose intolerance (breath tests), but most doctors don't bother to administer these tests. One way to find out is to eliminate dairy from your diet and see if you get an exaggerated response after you add it back in. But why would you do that to yourself? If the dairy you are having now is not bothering you there is no reason why you wouldn't just keep it up. 

Lactose intolerance is not like an allergy or sensitivity in the sense that "hidden" allergies or sensitivities could be sensitizing your immune system and causing chronic low-grade inflammation. Lactose intolerance is a simple inability to break down the lactose sugar into its constituents, which causes physical effects in your intestine and potentially affects your microbiota. But there is no evidence that a "hidden" lactose intolerance could be having negative effects other than the obvious ones. 

Other food sensitivities are a different thing. These, like gluten sensitivity for example, could definitely be having some additional effects that go beyond cramping, bloating, and diarrhea and could be leading to chronic low-grade inflammation.

Is dairy really so bad?

"hi angela, i thank you so much for your insight! i do not eat nutrition bars which i consider akin to candy. however i do eat beef as i'm addicted to the occasional cheeseburger. my burning question, though, is about dairy and why so many people go on dairy diets and say that dairy is bad for you. is it the hormones? a fertility guru i worked with said to refrain from all dairy. also, what are your thoughts on giving kids yogurt? so much sugar content."

You know, I have to start by saying that not all nutrition bars are bad. It's just that it can be hard to tell the difference between the good ones and the bad ones. But if the ingredients list is a paragraph long you can pretty much bet that it's essentially a candy bar. On the other hand, Larabars have nothing but dried fruit and nuts in them which is fine, and Clif bars actually are all pretty good. That said, they do contain a lot of sugar and you really should only be eating these for the purpose for which they were originally intended: i.e. in the context of exercise. A Clif bar is a great choice if you're going on a 2-3 hour bike ride or hike.

The occasional cheeseburger is certainly not going to hurt you health wise if you are otherwise healthy and I also don't think the environmental impact of this kind of approach is what we really need to be worrying about. Now if you're eating beef 3 or more times per week i think it's worth thinking about what you could do differently.

Now to your burning question: is dairy really so bad?

There is no question that if cows are fed hormones those hormones get into the milk. Why do they give cows hormones in the first place? Well, every extra day getting that cow ready to either sell the meat or get to the point where it's mature enough to get pregnant and start making milk is another day that cow needs to be housed and fed - costing more money and cutting into profits. And since we have allowed a corporate culture in which profits are all that matter at the expense of everything else, companies and farmers tend to adopt practices that maximize profit at the cost of quality, the environment, and even ethics. 

Even though the party line is that bovine growth hormone has not been found to cause problems in humans, it is not at all clear that this is the case. Some health effects take a long time to show up and we don't really have the resources or the attention span to fund studies that take decades. That said, the dairy industry has pretty much stopped using bovine growth hormone, even the non-organic products, because of the public outcry over this. Which again just proves how powerful the food buying choices we make really are. 

So I wouldn't say that it is likely that growth hormone is a problem, at least not any more.

However, I did and still do some research on human milk and it sure looks like the mammary gland is not genetically set up to filter out all of the various modern chemicals that we are exposed to these days. They have found all kinds of crazy stuff in human milk including pesticides, and the levels of these chemicals in milk pretty much reflect the levels in the mother's blood. So I am going to guess that cow mammary glands are pretty similar and that if a cow is fed feed and exposed to all kinds of chemicals those chemicals will end up in the milk. The same can be said for meat. That is why I definitely always choose organic for dairy products. It's not perfect, but at least there are some rules about what a cow can and cannot be fed when it's designated an organic product.

But I doubt that it's all about the chemicals. It looks like many of us have food allergies and sensitivities that we may not even be aware of. The simplest and most obvious of these is lactose intolerance. Most of the world (75%) is lactose intolerant, meaning that we can't break down lactose into glucose and galactose, the sugars that make up lactose. So what happens is that when we ingest lactose it doesn't get broken down and instead gets to the bacteria in the colon, who then eat it up and produce gas that makes us bloated and uncomfortable. Lactose in very large amounts if it's not broken down, can also cause diarrhea because the  high lactose content increases the osmolarity in the lumen of your gut and causes water to get sucked into the gut, resulting in diarrhea. 

Is there a solution to this? Well, obviously you can avoid dairy. But you can also buy lactose-free dairy products or buy the enzyme that breaks down the lactose (lactase) and take the lactase enzyme (usually a tablet or pill) with the first bite of food so that the lactose gets broken down.

The other obvious thing is an overt dairy allergy. People can be allergic to the casein proteins in milk, the whey proteins, or a combination of both. Overt allergy is when symptoms appear rapidly and can be directly linked to the consumption of the food. So if you immediately get, say a rash or hives, or severe abdominal bloating and pain within a few minutes to an hour of consuming dairy then we are talking about an allergy. You can be assessed for food allergies by a doctor. You can either get a skin prick test or just get your blood levels of immunoglobulins to specific food antigens measured. These measurements do not always correlate with symptoms and no one really knows why.

And then there's the "food sensitivity" to dairy, which is a lot more difficult to define. In many cases, and we really don't understand very well exactly why or how this happens, people develop sensitivities to dairy. This means that if you measure blood immunoglobulins to casein or whey you may or may not see higher than normal amounts, which may or may not indicate that your immune system has been sensitized to dairy and therefore whenever you ingest it the immune system thinks it needs to attack it as if it were a foreign substance or a potential threat.

Usually, if this is going on, it's because the individual has what's called a leaky gut, or their intestinal barrier function is compromised. Again, it's hard to know why or how this happens but repeated antibiotic use is certainly bad for barrier function, as are chemicals and toxins (i.e. alcohol in high amounts), and potentially environmental exposures.

As far as fertility, I would guess that it is the possibility of an underlying dairy sensitivity that is the reason why fertility doctors may tell a woman to stop eating dairy. Which is interesting, because you can theoretically be sensitized to pretty much any food, including sesame seeds or apricots. But instead of just measuring each individual for specific food sensitivities we instead tell them to avoid the main allergens (dairy, peanuts, wheat, soy, corn) because that is what a large proportion of individuals are likely to be allergic to. But guess what, if I am trying to figure out why I am having trouble getting pregnant I don't really care what OTHER people might be sensitive to, I care about what I may be sensitive to! 

The tricky thing about trying to grow a baby is that basically you are housing another human being and your immune system is thinking hm, what is this foreign object doing in here? One of the normal physiological processes that occurs in pregnancy is a suppression of the immune system so that the fetus is not attacked. But in some people the immune system is just too "turned on" and attacks the developing fetus because it recognizes it as foreign. So there is a possibility that underlying food sensitivities which chronically trigger the immune system every time those foods are ingested, lead to an overall over-activation of immunity.

Now to yogurt. I give my kids yogurt. I think it's an excellent food. it provides protein and healthy fat (yes, dairy fat actually seems to be healthy), probiotics, and it is tasty. Yes, I avoid the really cheap yogurts that have a lot of added sugar and other unnecessary ingredients (artificial flavors and colors!!) but even if there is a little fruit or jam in there it is not the end of the world. I would much rather my kids get a little bit of sugar to make yogurt something they actually enjoy and really want to eat, than let them eat cupcakes at every single turn like it is so easy to do. Of course, if your kids will eat unflavored/plain yogurt, by all means, that's even better! The natural sugars in plain yogurt are just the lactose that is naturally in milk. No one has ever shown that lactose is bad (other than for lactose intolerance, as we already discussed). Lactose is the most abundant ingredient in human milk too. it's probably why we all love the taste of sweet so much, because it reminds us of our very first food. 

I have been a researcher for more than a decade, and a personal nutritional consultant for just as long. But I have never felt compelled to start a blog. That is, until yesterday, when two things happened:

1) I watched the documentary Before the Flood and realized I needed to be doing more to keep this planet livable for my girls and all the children of the world; and

2) I looked at the ingredients list of a Kellogg's Nutri-Grain bar for the first time.

The two don't seem to be related at first glance. But in fact, they are. The documentary is a call to action.

As an undergrad at Cal I took Dr. Edwards' intro to social studies class in which I was deeply offended as a young idealist when he stated with such surety that the world was not going to rise up and do anything about the environmental situation until there was a crisis. I went to his office hours and waited in line to tell him I had more faith in humans to act when we could see so clearly that we should. And he literally laughed and said "there there little girl" or something to that effect and repeated very clearly that there would be no major action until disaster was imminent.

And years later I realize it turns out that he was absolutely right.

We have known for decades that our consumption of fossil fuels, burning of rainforests, pollution, wastefulness and general disregard for our planet's health has been setting in motion processes that would eventually be irreversible. Only in the last several years has the evidence become more and more difficult to ignore with melting glaciers, droughts, disappearing coral reefs, and flooding.

We are finally here, where Edwards and others knew we would be: facing imminent environmental disaster.

And at this point, if we haven't yet or if we've forgotten to think about it lately because life has gotten so busy, we have to ask ourselves: am I part of the problem, or am I part of the solution?

Being a nutritionist, I think about things from the lens of food and nourishment. Even if I can't drop everything and go live in a yurt in order to minimize my carbon foot print right now, is there something that I CAN do to make a positive and meaningful change?

There are a number of things, from teaching my girls about what's going on and inspiring them to pursue science or engineering or something where they might be able to contribute directly to coming up with the solutions we will need to fix the damage that has already been done; to driving less or getting a hybrid.

But the two things that the documentary brought up that really struck me were beef and palm oil. I won't belabor the reasons why these two foods/ingredients are bad for the environment since the documentary and many others have explained it so well already.

But hopefully I can offer some additional insight. Back to my reading the ingredients label on the Kellogg's Nutri-grain bar. Let me just say that this "food product" is an abomination and the epitome of everything that is wrong with our food system.

From the high total amount of sugar, partly from high fructose corn syrup, and partly from a number of other sugar sources, to the red #4, to the artificial flavoring, there is nothing about this "food product" that is "food" in the classic sense of something that we eat that is nourishing and worth eating. This bar is the result of countless hours of testing of mixing different chemicals together to come up with something that is dirt cheap, shelf stable, and yet supposedly fulfills the criteria for healthy eating that are laid out in the dietary guidelines. And yet, when you put all these things together what you get is something that is edible and yet is not really food.

The scientists and nutritionists who reviewed pages and pages of published research to come up with the recommendations set out by the dietary guidelines certainly never envisioned that bar when they wrote those guidelines. Yet somehow that bar is the frankenstein result of them. It is "low in fat." "low in saturated fat," and "includes whole grains" just like it's supposed to. Although this particular product doesn't contain palm oil, many others like it do.

Palm oil is the solution for the tricky problem that the dietary guidelines recommended we eat less saturated fat. That meant butter, lard, and other fat sources that were typically used in baked goods before were now no longer on the table. Whole fat dairy has long been vilified as a culprit for our cardiovascular disease problem, it turns out wrongfully so (we'll have to tackle that one in a separate post).

So the food industry switched to hydrogenated vegetable oils. Oops. It turns out trans fat is even worse for you than saturated fat!

So now we are stuck between a rock and a hard place, what on earth do we use when we need a solid fat for stability and other properties that baked goods need but we can't use butter or hydrogenated vegetable oil. Well, how about a natural plant based source of saturated fat?

Sounds good right? You can even eat it if you're vegan. Plant source, must be better right? Well not really, there is no evidence that dairy fat is any worse than saturated fat from palm oil. But more importantly, because we want to be able to buy a "breakfast bar" for 40 cents we have artificially created this need for cheap sources of shelf-stable fat and thus inspired places like Indonesia to burn down all their rainforests so they can plant palm plantations.

What we choose to eat matters. Every $ we spend on food products that contain things like palm oil is a $ that contributes to the burning of rainforests.

And this is even more obvious in the case of beef. There is no larger influence on the burning of the Amazon rainforest than the clearing of land for cattle grazing to feed our ever growing appetite for cheap burgers and steaks. Everyone is now on the "corn-fed beef is bad"bandwagon so even fast food joints are selling "grass-fed beef," so is the problem solved? Is that grass-fed beef better for you? Is it less harmful to the environment?

SO. I have started this blog to offer my opinion and knowledge on all things nutritional. Ask me questions and I will do my best to find time between playing with my girls and writing grants to keep my research program going, and trying to squeeze in that 15-minute run to keep me sane, to answer your burning nutrition, food, and health related questions.

I do this in the hope that I can help sort through the morass of information and misinformation out there about nutrition because frankly, the question of what we should eat and what we shouldn't eat can be really complicated once you actually try to make it work in the real world.

...and because I want to help make it easier for people to make choices that are healthy for them AND for the environment, because what we choose to buy and eat DOES MATTER.