Lactose and lactose intolerance

If you wish, take a look at  lactose intolerance on wikipedia

To sum up, it tells you that lactose is a sugar that is found in all animal milks. In babies there is the production of an enzyme called lactase which breaks down the lactose.  Most people lose the ability to make lactase as they mature and thus the majority of people are lactose intolerant to an extent.  They can no longer break down the lactose they consume and so it ferments in the gut, causing bloating, diarrhea, constipation, cramps - all very similar to the symptoms of Irritable Bowel Syndrome.

Different people have different levels of tolerance and in some groups where a gene mutation has prevented the shutdown of lactase production, there is no intolerance at all.  According to research done in the 70's, Swedish people have the lowest lactose intolerance levels in the world.

Apparently many Western Europeans can safely consume milk all their lives but East Asians, and sub-saharan Africans cannot (important to bear in mind when providing food aid during disasters).  However, globally about 70% of the population cannot digest lactose in adulthood. Some of this can be due to individual circumstances such as having a faulty gene that means the individual never produced lactase, even as a child - as in my case.

This Wikipedia article is incomplete since it does not refer to very recent British research on lactose intolerance which revealed a far wider set of symptoms than previous research.

Dr's Tony Campbell and Stephanie Matthews are a Cardiff based husband and wife team who have done a great deal of research into lactose intolerance and published a number of papers and a comprehensive cookbook for people with lactose intolerance.

Are you being `poisoned' by something in your diet? Do you suffer from unexplained irritable bowel, severe headaches, fatigue, nausea, allergies, or heart palpitations? Have you been told to sort yourself out, or perhaps even see a psychiatrist? If so then you are just like the 500 patients Tony and Stephanie have cured over the past 6 years who were at their wits end because no doctor could explain what was wrong with them. It just wasn't in the text books. They were intolerant to the sugar in milk - lactose.

The book is a tad self-congratulatory but nonetheless very informative.  But note here the extended list of symptoms.  I developed ME/Chronic Fatigue when I was 14, was vomiting every day, suffered from migraines, muscle cramps, joint pain, nosebleeds, palpitations and so on.  A totally systemic wrecking of my life and we didn't know why.  Social services got involved and threatened to take me into care if I didn't go back to school since they believed I was making it all up.  

Everything changed when I started uni and was living on a diet of baked beans and pasta and not much else - all the dairy was suddenly taken out of my diet and those symptoms disappeared. I could be active again, think clearly without feeling like my head was full of cotton wool etc.  Then whenever I did have milk, I realised that it was having a bad effect on me and so asked for allergy testing.

3 years later (yes, that's how long the waiting list was) I was diagnosed as having a complete intolerance to lactose. It became clear that other members of my family were also lactose intolerant but a lifetime of non diagnosis had caused considerable and irreversible illness; including early arthritis, osteoporosis and long term chronic illness such as ME/Chronic Fatigue Syndrome.

I then went about the rather arduous task of trying to cut lactose out of my diet and this is where all of my gripes over food labelling come in.

Food labelling

Cutting lactose out of the diet is not as simple as avoiding milk or products that label milk, whey, butter and so on.  Lactose has found itself quite a niche as an additive, preservative and sweetener.

It is used as a browning agent on bread, a filler in many medications, a preservative in meat, especially chicken (injected into the carcass), a sweetener for 'low fat' foods, an extra additive in already overloaded sweets and crisps and drinks.  Basically, anything processed, even if it seems really unlikely, cannot be trusted.

I've realised by trial and error that anything that has 'sugar' on the food label could contain lactose, since lactose is a sugar.  It is extremely rare for lactose to be specified.  I don't know why but crisps seems to be very good at labelling lactose. Other than that, it is hit and miss.

The only times you get properly labelled food is when there is a clear market demand for it.

There are 'free from' ranges that cater for people with milk, nut, lactose and dairy intolerances/allergies but they cost twice as much as regular food and are very limited in range.  

Organic food has strict labelling requirements so I can safely eat anything organic that doesn't have milk or lactose labelled.  But again, this is expensive and I shouldn't have to be forced into buying 'special' and overpriced food produce because food suppliers are allowed to pump their products full of crap and not tell us what we are eating.

And here is what really gets my goat... whatever faddy weight control diet is all the rage at a particular point in time, be it Atkins or the GI index thing or whatever else; within weeks, you start to see food being labelled as 'Atkins friendly' or 'low GI index'.  All for a bunch of vain and lazy people following the latest trend instead of just eating healthily and cutting out processed crap and MacDonalds, and getting themselves a bit more exercise.  

EU Directives
I tried taking a look at the EU directives that look at food labelling - there's dozens of them.

The Food Standards Agency tells me;

Since 25 November 2005, food labelling rules require pre-packed food sold in the UK, and the rest of the European Union, to show clearly on the label if it contains milk (or if one of its ingredients contains it).

But what about lactose itself?  Being milk free does not equate to being lactose free. In order to prevent labels becoming too complex, some ingredients do not need to be listed if they make up less than 5% of the final product.  But it only takes a very small amount of lactose to make me ill.

Europa website tells me

The new Directive also establishes a list of ingredients liable to cause allergies or intolerances; alcoholic beverages will also have the obligation to mention allergens on their labels.

(...)

However, since it is possible that some ingredients or substances, derived from allergens, are not likely to be a risk for allergic peoples, the Directive establishes, during a transitional period, a procedure which allows the industry to provide scientific justification for that, and to obtain a provisional labelling exemption for these ingredients or substances.

I found a lecture on EU food labelling

4.2.1.4 The following foods and ingredients are known to cause hypersensitivity and shall always be declared:

• Cereals containing gluten; i.e., wheat, rye, barley, oats, spelt or their hybridized strains and products of these;
  
• Crustacea and products of these;
  
• Eggs and egg products;
  
• Fish and fish products;
  
• Peanuts, soybeans and products of these;
  
• Milk and milk products (lactose included);
  
• Tree nuts and nut products; and
  
• Sulphite in concentrations of 10 mg/kg or more.
  

But lactose isn't being labelled - I do sometimes eat food that labels 'sugar' and find myself getting ill afterwards.  

There is a call in the UK for clearer labelling of lactose but it just isn't making much impact so far. The research and evidence to support it is there. I'm wondering if lactose falls under this derogation;

Ingredients which belong to well defined categories may be designated under their category name, as stated in paragraph 6 of Article 6.

In this case, milk doesn't have to be labelled on cheese because it is widely known that cheese contains milk. Perhaps lactose isn't labelled because it comes under the category of sugar?

I actually am not complaining about the forced changes in my diet because it has changed my life and I am far more healthy for it. I won't touch processed food if I can help it and I tend to make most things from scratch for myself.  It's just those times when I need to pop out and get a quick snack or lunch or I go out to a restaurant and I cannot trust what I eat.  There's so little awareness in the UK around lactose. If I ask in a baguette shop or a restaurant whether or not they have lactose in their food, they often can't tell me because they have never heard of it.  They run away to ask the chef and come back to say "can you have butter?"

However, I am well informed and I know what foods are unsafe and how to avoid them, this isn't the case for many others.  

Health service

There is only one lactose clinic in the UK as far as I am aware.  There are not enough allergy clinics in the UK (the massive increase in allergies is a whole diary post by itself).  Dieticians on the NHS won't deal with lactose intolerance (in Wales at least), so it leaves people without the support and information they need to change their diets and improve their quality of life.

And here is another big gripe of mine regarding the NHS in the UK - the complete lack of preventative healthcare. Again and again in just about every area from mental health to heart disease, people have to be in a critical situation to receive treatment.  So much money would be saved with earlier interventions that prevented illness in the first place.  The healthcare system is only dealing with acute cases and leaving it up to local authorities to do the preventative side - generally rather badly. It is just unsustainable.

There are implications on other policy area such as free milk in schools (we have this in Wales). Should schools be forcing milk on children with evidence of the negative health impacts arising from drinking milk?

I think out of all this what concerns me isn't the labelling itself but more the ethics of letting all sorts of stuff into our diet.  This extends to the argument over GM foods, the use of all sorts of additives that we just haven't evolved to be able to deal with, hidden health problems that arise from eating processed food instead of seasonal, locally grown and freshly prepared food.

The environmental problems that arise from transporting food all over the world because people want to eat cherry tomatoes and satsumas all through the year; environmental problems that arise from wiping out huge areas of forests to make way for cattle that become Big Macs.

There is a healthy eating trend going on in the UK in some ways - lots of smoothie bars are opening up so people can get their 5 a day with less effort.  But it is just a trend, and the levels of obesity in the UK are shocking.  

How on earth can we expect to instill a long term improvement to people's lifestyles and diets and health, when so much can make its way into the food we eat with no clear scientific measurement of long term impact?