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If you're a food service pro, then please take the next step and study this website. There's a list of
resource links near the end.
Milk: Just Say NO
A surprising number of people on this planet cannot digest milk or
milk products. An estimated 75 million Americans (about 25% of the US
population) have this condition. In the United States, as many as 25%
of the white population (with prevalence among those with southern
European roots) have some degree of lactose intolerance. Among the
Afro-American, Native-American, and Asian-American populations, the
estimated prevalence is 75-90%. Of the world population, an estimated
75% are lactose intolerant to some degree.
Click the No Milk icon
for a table showing the incidence among the world's ethnicities.
is that the small intestine makes an enzyme,
that is required to break down the lactose found in dairy products
into a form that can be absorbed into the body. If your lactase
production is deficient, the bacteria in your digestive tract ferments the
excess lactose in the food that you eat. A byproduct of fermentation
is gas and fluid secretion. Meanwhile, your GI tract has determined
that this material cannot be digested and it takes steps to expel it,
usually forcibly and rapidly, usually through the south exit, and sometimes
through the north exit. This often requires more than one visit to the
WC over the span of the next 4-6 hours.
Get the picture? If not, click
The dairy farmer's lobby (DFL) would like you to believe that We The
Afflicted can actually tolerate their ingredient in food. Is it just
psychosomatic? True, some of The Afflicted can tolerate small
quantities of dairy products, but for others, that same small quantity
is the beginning of a digestive disaster.
For many people, milk is something that our bodies tolerate during
infancy and adolescence. As we grow older, we become less and less
tolerant to milk and its byproducts. Some ethnic groups (northern
Europeans, and some Indians) have evolved genetically to being able to
tolerate milk throughout their lives, while others, like Asians and
Africans, can have trouble from birth.
Haute Cuisine means rich sauces and exotic flavors... and milk in many
cases. Cheese adds flavor complexity to food, so it's common practice
among foodies and food service professionals (and even rank amateurs)
to crank the flavor knob by adding cheese. Milk and cream add
smoothness to sauces. If you're one of The Afflicted, this is
disaster. If you're planning to travel, this will be an issue. Count
| Lactose Intolerance Around the World.
Click to enlarge
Food Service Pros
Do you operate a commercial kitchen? Consider this: one in four Americans have some sort of milk intolerance or allergy. Would you let your
waitstaff do something that alienates 25% of your customers? If your answer is no, then how about your kitchen? Within reason, there should be at least one menu item per
menu category that either excludes dairy by default, or that can be made in some way to exclude dairy products, except for butter.
If deserts are an important part of your cash flow, and if all of your desert items contain some form of milk,
you are leaving money on the table.
Here are some suggestions, not only for LI folks but also for food allergies in general.
- Dairy products are a part of our diet. More and more people are sensitive to these and other food-based allergens such as tree nuts,
certain fruits and vegetables, and some grains or grain products.
- You can't realistically eliminate these ingredients from your menu, but you can make your menu more allergen-friendly. Sure, it's a hassle,
but it's smart business too. Why? because people with food sensitivities will come back if they have a problem-free dining experience in
- All ingredient lists for all menu items need to be accessible to the staff. Any pre-prepared foods also need their ingredient lists accessible.
- An ingredient matrix for your menu might make finding suitable choices faster and easier. Menu items on the rows, allergens on the columns.
- Your staff needs to be sensitive to the needs of people with food sensitivities. They may be prickly to serve, but they're only looking
out for themselves. Nobody wants to get ill from eating. If you can avoid this by asking the right questions, you're way ahead of the curve.
- Your staff needs to take this seriously because it is serious; sometimes deadly serious. In the worst case, they could be creating work for a hungry,
- In the kitchen, collateral contamination is one of the big problems. Saute pans with milk residue from a cream sauce, tongs used to handle shellfish then used to
handle chicken served to someone with a shellfish allergy, etc. It might be a good idea to have separate tools for this.
- Pre-prep saves time, but it limits options for patrons with food allergies. Maybe prep for the masses, but keep a few plain versions around that can have secondary
ingredients added at serve time.
- When possible, serve cheese on the side. This is especially important for buffet lines.
If you're a hamburger stand, why buy buns with milk in them? Although milk extends their shelf life, if
your buns are sticking around long enough
that their shelf life is an issue, perhaps you have larger problems to deal with?
Helpful Hints and Ingredients to Avoid
Food Allergy article from the Culinary Institute of America
A few Ramblings about Lactose Intolerance
So they say you have lactose intolerance - you say - easy, I just
won't drink milk or eat ice cream and I'll buy those Lactaid® pills
for when I do. It's not that simple. What does it mean?
doesn't make enough lactase to digest all the lactose
(milk sugar) that you eat. You'd think the way to go is to just take those
Lactaid (lactase) pills - you can do this, but the dosage is pretty tricky --
If so, you may need more of the pills to counter the lactose in food.
Try taking one pill with your first bite of
lactose-containing food, and one right after and see if that fixes your symptoms.
(If it does, you just lucked out!) The pills work best when you chew
them, even if they taste like chalk. If that's not enough, then try one before, one during, and one after.
- Is your body making ANY lactase of its own?
- Have you eaten other food or had a lot to drink?
I take 8 ultra-strength Lactaid to eat a McDonald's hamburger. That's
a hamburger, NOT a cheeseburger, although I suspect that I could
actually eat a cheeseburger and get away with it. Where's the milk?
It's in the
Milk extends the shelf life of bread.
The problem is, if I
don't get away with it, then it's not worth the unpleasant surprise,
especially if I'm driving!
OTOH, even though I don't particularly care for their food (mostly
because there's milk in nearly
of it), McD's are handy as they are nearly always open, and they have
public restrooms, and the restrooms are usually reasonably clean. So,
I keep track of McD's on my routes here and there, and in an
emergency, I can nearly always find one. I try to buy something from
them when I have to stop and make a deposit.
Don't count on this except in the USA. In France, McDonald's does not serve breakfast. I learned this the hard way.
I treat Lactaid tablets like a morning after pill. I don't eat them so
that I can have milk, I eat them so that any milk I may have been
slipped doesn't poison me (word choice deliberate). The problem is
that I never know for sure how many tablets are required. Take too
few, and you may just delay the problem and/or you may have a BM that
resembles soft serve ice cream. I try hard to not flirt with the devil
when I eat.
Read The Labels!
Milk is hidden in lots of foods under other names: lactose, whey,
non-fat dairy solids, dried cream, and natural sweetener being a few
- If you see "natural flavors" on a label, one of those natural flavors
There ought to be a law!
‹‹Apparently there is, in Canada.››
- Adding milk to bread dough extends its shelf life (>80% of sliced
bread has some form of milk in it. Bread with Sodium Stearol
Lactylate is ok.).
- Milk sugar is used to coat grains of rice so they don't stick in the package (it's cheaper than cornstarch and the amount/weight is "small enough" they don't list it on the
package. The clue is "no washing required.").
- Dried milk is used as a binder in sausages, hot dogs, and salami - so read the package carefully (and ask the help at the deli to let you see the package).
- Another surprise is that milk is sometimes found in pasta - as a by-product of the iron enrichment - choose those with ferrous sulfate and avoid those with ferrous lactate.
- Milk sugar is also found in items such as
soup broths, and cup-o-noodle/ramen seasoning - as replacements for
the more expensive high-fructose corn syrup.
- Just say no to milk chocolate and look at dark chocolate labels carefully (sadly, Godiva Dark Chocolate has lactose in it).
- Restaurants sometimes do tricky things like soak fish in milk (or chicken in buttermilk) before breading it. And even if they don't, breadings and batters often have milk in them
I wanted to order razor clams at a restaurant, but before placing the
order, I interrogated the waiter. Was there any milk in the "chef's
special" coating? He went to the kitchen and asked, and they said
"no." But upon further questioning, I found out that the coating was
pancake batter made from a mix. Yes, they only added water to the mix,
but I pointed out that pancake mixes contain dried milk.
Should you try soy? There are lots of soy products out there, but
they don't taste anything like products made with milk and don't act
the same way in cooking either. You can try soy cheese - it has a
texture more like Velveeta and you might like the taste (even though we
don't). Start with a small package and see if you like the way it
tastes - they don't melt right either. Soy milks vary tremendously - Betty
likes Soy Dream brand, Vanilla, enriched with Vitamins A, D, E and
Calcium - it's organic, has 7g protein per glass, uses cane juice
sweetener (no HFCS), and doesn't have the strong soy taste that Silk
KaChing! No Sale.
Don't buy expensive margarines. Butter is safe to eat because they
take the white part (milk sugar) out and leave only the milk fat. My
body can digest fat just fine. Nucoa brand margarine is inexpensive
and has no lactose added (unlike most margarines that add whey to
taste more like butter). And Nucoa tastes pretty good. But hey - just
use real butter and you'll be fine.
Beware Lactose-Reduced products -- unless they claim to be lactose
free, you might as well buy the better-tasting full-lactose products
and take lactase pills. We did buy the Lactaid brand Eggnog this winter
and were pleasantly surprised (the spices hid the off-taste of the
enzyme added to the milk).
Mocha Mix makes an ice cream (sold at Issaquah Fred Meyer) that tastes
close to real ice cream - they only have a few quarts on the shelf, so
look carefully. Also there's a sour cream (and cream cheese) made by
Tofutti called "Better than Sour Cream" It isn't really better than
real sour cream or cream cheese, but comes closer in flavor and
texture than most soy products. The "BTSC" is sold at our local
Safeway in the organic dairy section. "BTCC" is available at most
Breyers makes a lactose-free Vanilla Bean Vanilla and lactose-free chocolate
ice cream. It tastes
We can eat it WITHOUT taking any lactase pills.
There are a few cake mixes that are milk free - like Duncan Hines
Golden Butter Recipe and Pillsbury French Vanilla, and some brownie
mixes and dark chocolate cake mixes. Always check the ingredient list;
you never know when they'll try to "improve" the mix by adding milk.
Oh yeah, only a few flavors of
prepared frosting are lactose free - most of them now show they
contain MILK in bold letters in the ingredient list. Chicken flavored
Top Ramen is "safe" while other flavors have lactose. Some things
you'll just have to adapt - make mashed potatoes with Swanson's broth
(no lactose), or add roasted garlic so you get better flavor. Say
goodbye to lasagne unless you use soy cheese (which IMHO is not worth
Other things you're used to buying (like breakfast products) you'll
have to make from scratch on your own - for waffles, pancakes, and
muffins I often mix soy milk and fruit juice (or juice drained from
canned fruit) instead of whatever milk they call for. Sometimes plain
old water works just as well.
Oh yes, and just when you thought it was only milk that had lactose
... green peas, beets, and lima beans all break down in your digestive
tract to a chemical form of lactose (galactose) and can make you just as sick.
All is not lost though... Mostly I avoid ALL DAIRY/LACTOSE products,
and only take lactase pills when I can't avoid milk (i.e., hamburger
buns, bread in restaurants, hot dogs or sausage of unknown content, or
when there's just no food alternatives and I have to eat something
that might have milk in it).
However, I can drink small amounts of whole milk (2% has added whey)
in a latte in the morning because I've been building up enzyme
overnight. And up to 1/2 oz of certain cheeses (like swiss slices,
extra sharp cheddar, and mozzarella sticks) which have less lactose
than others (like havarti and parmesan) - but only in the morning.
You'll have to see what works for you in combination with using
lactase pills, and with your eating patterns.
Once a year, when I'm at home and not traveling anywhere (just in
case), I'll eat 8 lactaids and have a dish of ice cream. Yes, that's
sleeping with the devil. A man has to take chances once in awhile.
see note above about Breyer's Lactose Free Ice Cream.
Many medicines are compounded with lactose as an ingredient. I take
Allopurinol once a day, and I have to take a lactase tablet before
consuming the pill or it comes squirting out an hour later. Ask your
pharmacist to look at the medicine's formulary the next time you fill
a prescription. If you're up to it, complain to the manufacturer about it.
Note: Formularies are not standardized across all manufacturers of generic or branded medicines.
I have to be careful when I consume milk products for days at a time.
Sometimes, a pizza two days in a row will be ok, but then on the third
day some unwashed rice will push me past my enzyme supply and I'll get
sick. I have to be careful to limit unnecessary intake (since I don't
avoid milk-heavy products outright) after I know I've had a high
exposure, even if it's been a day or two. (Janis is our daughter, who
is now somewhat LI.)
Collateral milk contamination.
You go to a restaurant and order sauteed shrimp, which should be safe.
But unbeknownst to you, the last dish the pan was used for was
‹‹cardiac on a plate ››
and most restaurants simply scrub the pan under hot water, so the milk
in the alfredo sauce is still clinging to the pan... If you're fairly
sensitive, you'll get sick. So, take lactaid as a preventative
measure. It's unreasonable to ask them to scrub the pans better; it
ruins the seasoning. Teflon pans are better... but you have to wipe
the pan out after washing, to make sure you get all of the residue.
This can also occur with fry fat that is shared across menu items.
The major calcium source for many people is milk and other dairy
products. Milk is good nutrition; no bones about it. But if you're
lactose intolerant, milk spells misery unless you have a way to help
your body accomodate it (i.e. lactase pills).
Since we practice avoidance, we have to do something to try to replace
the calcium that we would have gotten via dairy products. Calcium
fortified OJ, calcium tablets, broccoli and soft-boned fish are the
major sources of calcium in our house. But if you look at
you'll see that you need to eat a whole lot of broccoli to equal a glass of
milk. In fact, you have to eat a lot of other things to equal the
calcium content in a glass of milk.
Some things we've found to help:
Although eggs are usually found in the dairy aisle at the store, they
come from Chickens or other birds.
Eggs do NOT contain lactose.
Now this does nothing to overcome adding milk to eggs, but whole eggs,
however served, are safe to a lactose intolerant person... unless some
bozo has added milk. Don't overlook collateral contamination.
When you order eggs in a restaurant, either order them in such a way that they
must be broken from the shell (i.e fried), or if you like yours scrambled, ask the
restaurant to break them from the shell instead of using the mix that many kitchens use.
The Big Print
Here's the things to be aware of either as a sufferer or if you're
preparing food where a sufferer may attend. Consider the following:
Read the labels.
Be aware of where milk can be hidden. The DFL is insidious and sneaky. You wouldn't expect to find lactose as an ingredient in Asian foods. Maruchan Cup-o-Noodles has it, so do some of the Nissin flavors. Some Teriyaki sauces have it.
Remember that a mix with nonfat dry milk that you just add water to amounts to containing milk.
It doesn't matter what animal it comes from, lactose is still lactose.
Lactose reduced products work for some people and not for others.
Peas and Lima Beans convert to a form of lactose during digestion. They cause trouble, just like a glass of milk does.
Wash rice before cooking, especially if it is labelled
Remember that butter is usually OK for most of The Afflicted (ask).
Margarine, unless it is Nuccoa brand, has whey added to it.
Many breads contain milk.
Dessert ices can hide milk because of collateral contamination.
Crutons usually harbor milk because of the bread. Sometimes there may be embedded cheese flavorings.
Food coatings (like fry mixes) often contain milk.
Soaking things in milk leaves milk on them.
Cooking milk makes no difference.
- Some foods just can't be made without milk. Identify them.
- If cheese is just a garnish, such as on spaghetti or in a salad, serve it on the side.
These are the terms that we know of that indicate milk.
- Milk, Cream, Yogurt
- Whey, whey powder, milk sugar
- non-fat dairy solids, non-fat dry milk
- Natural Flavors (could indicate one of the above)
- Cheese, cheese solids, cheese food
- Margarine (because of added whey)
These items are safe:
- Sodium Stearol Lactylate
- lactic acid
- eggs, chicken, fish, or other.
When we went to France, Rick made up a laminated, wallet-sized card
that told them what was cool and what wasn't,
(with thanks to my French teacher)
Je ne supporte pas les produits laitiers.
Je ne supporte pas le lait, le crême, le sucre de lait, le lait
sec, le fromage, le whey, tous les laits.
Le beurre est trés bien.
La margarine n'est pas bien.
(with thanks for the translation to my friend Julian)
Sufro de HIPERSENSIBILIDAD AGUDA A LA LACTOSA:
No puedo comer ningun alimento que contenga leche o sus derivados:
leche, crema de leche, leche condensada, leche en polvo (o productos
que la contengan), queso, yogurt, helados con base lactea, salsa
bechamel, chocolate con leche, azucar de leche, arequipe, etc.
Si como alguna cosa que contenga peque as cantidades de lactosa
(excepto mantequilla) me enfermo gravemente.
SI PUEDO comer mantequilla
(no contiene lactosa) pero soy igualmente
alergico a la MARGARINA.
(with thanks to Adriana)
Sono intollerante al lattosio.
Questo è simile (ma da un punto di vista medico, differente) a essere
allergico al latte e ai suoi derivati. Non posso digerire né ingerire latte, panna,
siero del latte, zucchero del latte, latticini, formaggio, o qualsiasi cosa
fatta con e dal latte,
ad eccezione del burro.
Queste cose mi fanno molto ammalare.
Burro è OK, margarina non è ok.
I am lactose intolerant. This is similar (but medically different) to being allergic to milk and other dairy products.
I can not digest milk, cream, whey, milk sugar, cheese, or anything made with milk
EXCEPT butter. These things make me very ill.
Butter is OK.
Margarine is NOT OK.
Thank you very much.
(with thanks to Google Translate)
There is hope on the horizon. The state of Massachusetts just signed
into law, an act relating to food allergy awareness in restaurants.
Sponsored by Senator Cynthia Stone Creem (D-MA), and lobbied for by
chef/restauranteur Ming Tsai, the bill was signed into law on January
15, 2009. It takes effect 90-days later. This
landmark legislation, the first of its kind in the US,
calls for simple, inexpensive measures all restaurants can take to
make dining safe for those with food allergies.
The new law calls for restaurants to take a few straightforward
precautions, all of which Blue Ginger (Chef Tsai's restaurant) already
The full Bill S. 2701 can be viewed here:
- Requires the placement in restaurant kitchens of an approved poster providing general information on food allergies as they relate to food preparation. (Tsai worked with FAAN
to create these posters.)
- Requires menus to include a statement that the customer should inform the wait staff of any food allergy issue.
- Requires standard food service courses to include the viewing of an approved food allergy video.
- Requires Department of Public Health (DPH) to develop a program for restaurants to be designated as “Food Allergy Friendly” and to maintain a listing of restaurants receiving such designation on
its website. Participation in the program is voluntary, and, in
addition to any other DPH requirements, in order to receive such
designation restaurants would be required to make available to the
public a master list of all the ingredients used in the preparation of
each food item available for consumption. (This section of the law was
inspired by the "Food Bible" Tsai has kept since day one at Blue
Ginger that includes a list of all ingredients used in each menu
This sort of law needs to be enacted in the remaining 49 states.
Furthermore, a similar law needs to be enacted for food labeling, so
that allergens can not be hidden under the guise of "natural flavors."
Your physician can administer a test that proves conclusively that you
are LI or not. You can also conduct an empirical test by simply
eliminating dairy products from your diet for a few days and see if
your symptoms diminish or disappear. If so, then try eating something
containing dairy and see if the symptoms recur.
It could be that your system is not producing enough lactase to meet
your present level of dairy product consumption. Thus, (as the DFL
would have us believe) you may be able to consume small amounts of
dairy without problem. It is worth experimenting to determine the
threshold of your tolerance.
Further, after a severe attack, it may take some amount of time for
your lactase level to return. It might be worth trying to determine
how long this takes. All of this empirical testing can help you manage
your condition and live a better life with it. This is probably better
than switching your underwear to Depends®.
Remember, for the definitive test, consult your physician.
Some other gastrointestinal conditions can mimic LI symptoms,
which is why your physician needs to be part of the solution.
Resources and Links
on the condition.
A great website
Digestive Diseases site
has their own site (Español tambien)
calcium/lactose content page
for restaurant and food service operators from the Culinary Institute of America (the
CIA). If you own a restarurant or other hospitality venue (or even if you don't), this is a
Watch this video
about having food sensitivities and dining out in restaurants.
from the CIA about food sensitivities.
A fairly comprehensive list of troublemakers from the above CIA website.
a Canadian magazine about living with allergies and food sensitivities.
Sloane Miller, aka
has a great Blog
about food allergies and sensitivities.
Lactaid: Don't leave home without it!
The information in this site is generally believed to be accurate and
is presented in the spirit of information sharing. If you think that
you are lactose intolerant, by all means try any of the suggestions in
this website. You should also discuss this with your physician.
This website's content is based on our personal experiences and
intended solely for entertainment purposes only. We are not medical
professionals and the content on this site is not to be considered
Lactaid® is the trademark of McNeil Nutritionals LLC and our use of
their tradename in no way indicates any sort of ownership on our part
of their trademark. The trademark remains the property of McNeil
Copyright ©2009 by Betty and Rick Chinn. All rights reserved.
 US population data from cia.gov (about 300 million). Percentages
of population data from:
Last modified 06/16/2013.