Dear all:

First, I like Karin's speculative hypothesis about sugar changing the gut flora.  We KNOW 
this to be true.  Sugar and salt are used in oral rehydration fluids for that very reason.  
They increase absorption of water.  Let alone what they do to the gut flora.

Second,

I reread the health-e learning article on lactose overload again -- and they aren't as far 
off as I thought about the diapers in my first quick read --- but I did have difficulty with 
the concept that stools are measured in handfuls.  Did they mean the baby's handful?  or 
mom's handful?  Makes a certain part of my body wince in empathetic pain for the baby 
that would have to push out a stool that big.  What happened to "quarter-sized".  Is it 
really healthy to have large gigantic infrequent stools? 

I went to Riordan and Lawrence for their references on lactose.  I think my books are as 
old as the ones referenced in the article.  Lawrence confirms my training that diet makes 
no difference to lactose content.  Riordan has an old reference to one of the many 
Prentice studies in the Gambia.  As graduate students in nutritional sciences at Cornell, 
we read these studies inside out and backwards and are familiar with their flaws.  They 
supplemented women with a nutrient rich cookie, but didn't measure home intake.  The 
supplementation may have been offset by a reduction in home intake, which is common 
in food distribution situations.  Free food enables you to spend your resources towards 
other needed endeavors because you don't have to spend your resources on buying or 
gathering food.  In every study that has measured the home intake, there is a marked 
reduction in the home diet when supplements are provided --- usually with some overall 
net increase in consumption that is lower than the amount provide by the supplements. 

In the citation of the Prentice study, Riordan says that there was higher lactose during the 
wet season when ENERGY intake was low and lower in the dry season when ENERGY 
intake was higher.  This says nothing about composition of the diet and was conducted in 
a population that had low energy consumption.  It would be a wild leap from this 
extrapolate from this study to assume that by restricting sugar (which provides energy) 
and increasing fat (which also provides energy) in a population that tends to already 
OVERconsume calories would have an impact on lactose content.

Furthermore, Cathy Genna posted a while back on a series of 4 or 5 studies that 
debunked the concept of fat content of the milk influencing growth of the infant.My 
recollection of these studies was that that the fat content of the milk was higher in infants 
with a lower volume of intake and lower in the infants with a higher volume of intake and 
that it was the total volume that influenced growth.  Cathy -- correct me if I'm wrong on 
this one.

Just to provide you with an alternative theory -- we know that infants of malnourished 
mothers are often born at a lower weight.  Most of the weight gain occurs in the last 
trimester of pregnancy.  If these infants were born at the tail end of the wet season, they 
would be born smaller and enter into the dry season eating less because of their small 
starting size.  They could then have had a higher fat, lower lactose milk due to the 
seasonal effects on their birth weights.  Mothers giving birth at the tail end of the dry 
season would be giving birth to babies with typically higher weights as they entered the 
wet season and then would have had a lower fat, higher lactose milk.

I'm not at all proposing my "theory" as particularly plausible, just as an alternative to 
what is a very sketchy leap beyond an association found in one population that has been 
extrapolated to a very different population.  I'm sure you can come up with all sorts of 
alternative explanations as well.

Having worked in a couple of labs in developing countries, I'd also want to go back to the 
methods sections of the original studies to contemplate what might happen in a lab in the 
dry season that might differ in the wet season.  Was there a problem of evaporation from 
the samples in the dry season that could have influenced the results?  Just to give you 
another challenge to the assumptions.

Bottom line,  I don't think we have any evidence yet that shows that by merely restricting 
the sugar intake of a woman with an average or more than average calorie intake or by 
increasing her fat intake that you can reduce so-called "lactose intolerance".  

The associations are far too indirect.  

Plus, here is my pet peeve with all of these studies.  Allergies to proteins, intolerances to 
lactose, overactive milk ejection reflex, and oversupply are often lumped together 
without specific investigation into whether or not all or some of these conditions are 
actually present.  Hence, I think much of the research doesn't really tell us which 
interventions are actually effective for specific situations.  Plus, most of the research on 
protein allergies are conducted with formula anyway (and unfortunately some of that 
research was conducted by Chandra who was later found to have faked at least some of 
his data).

Best regards, Susan Burger, MHS, PhD, IBCLC

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