Intolerance of the Dairy Kind

Several years ago a fellow writer approached me at a party and said, "I read your column, but I don't go to any of the restaurants you recommend." I'm used to backhanded compliments, even downright insults. So I just shrugged, "Why not?"

"I'm lactose intolerant," he admitted.
When he and millions of others eat lactose, also called milk sugar, which is in cheese, ice cream, cream sauces, all that yummy stuff I frequently write about, the undigested lactose in his system ferments. This causes discomforting, even painful, symptoms most of us are too polite to discuss at the dinner table. Owing to a deficiency of the enzyme lactase in his small intestine, he can't digest lactose.

Reports vary on how widespread the disorder is. According to The American Medical Association Encyclopedia of Medicine, permanent lactase deficiency, the condition that leads to lactose intolerance, "develops in about 80 to 90 percent of blacks and Orientals and in about 5 to 15 percent of whites." The Cecil Textbook of Medicine takes a more conservative approach, allowing that "60 to 90 percent of American Indians, black Americans, and Asians" suffer from primary lactase deficiency. In short writes Sheri Updike, author of The Lactose-Free Cookbook, "approximately 80 percent of the world's population can not drink milk without experiencing some digestive problems." Lactose intolerance, she insists, "is the norm."

Then there are the legions who avoid dairy for dietary reasons. After all it's fattening and can raise cholesterol levels. Some nursing moms won't eat dairy because babies are sensitive to it, and some people have antibodies that render them allergic to the proteins in milk and related substances.

So where does that leave us? Should we react like my writer friend and simply stay home?

Yes, I do mean "us." My husband and I are both lactose intolerant. But it's probably obvious from my columns that we don't let it interfere with the physical and emotional pleasures of dining out.

The key, for me, is in sampling. While a block of four-cheese lasagna could put me in the bathroom for a week, a bite or two of fettuccine Alfredo doesn't hurt. And for those who are truly lactose intolerant as opposed to allergic or lactating, there is dairy's little helper. Called Lactaid Ultra these innocuous little pills, packaged individually like Sweet 'N Low for convenience, don't contain drugs; they simply supply the lactase enzyme, allowing you to digest diary foods comfortably. (Swallow Lactaid pills or drops right before you eat.)

But many people like my husband are extremely sensitive, and it takes more than Lactaid to help the meal go down smoothly. For these people (and maybe my colleague is one) dining out safely becomes a touch more difficult. But not impossible. First of all you can always order a dish like pizza without the cheese. A customer-oriented restaurant will honor your request, even if it means the resulting concoction will be altered in ways the chef never intended. In fact for me lactose intolerance turned out to be a hidden blessing. It's a good way to challenge just how cooperative a restaurant will be with special requests. And often you are better able to taste the food without thick blankets of cream or cheese.

At an erstwhile gourmet diner in North Miami a couple of years ago, the chef haughtily refused to prepare French onion soup without the gratin top. After tasting the dishwater brew, we could see why: The cheese was the only edible part of the dish. Sometimes it's not enough to be picky about what you eat. You have to choose the type of nosh just as wisely. Ethnicity is a factor. Mexican, Italian, French, and German restaurants, for example, go heavy on dairy; they offer meals that can funk up the digestive system and also eat away at the willpower. What fun are chips and salsa when everyone else is slurping up nachos covered with melted cheese and sour cream?

I favor Asian restaurants, particularly Japanese ones, for a quick, nondairy meal. There may be a reason why most Asians are physically averse to milk; traditionally it simply isn't part of their collective diet. Unless the tuna swallowed a pint of Häagen-Dazs ice cream right before it was filleted, chances are the raw fish and rice have no lactose. Of course some Americanized sushi rolls, like the bagel roll, are made with cream cheese, a no-no for the lactase-challenged. I find Shibui (10141 Sunset Dr., Kendall; 305-274-5578) to be very accommodating. Although about half a dozen of the restaurant's 30 rolls contain cream cheese, the sushi chefs are happy to leave it out, or to add avocado for that creamy ooze.

Stir-fried meat and vegetable dishes, particularly the Chinese variety, can be deliciously satisfying without being worrisome. But take care with battered foods such as lemon chicken or items made with dough, like egg rolls or dumplings. Some restaurants use milk (or eggs, which are often classified as a dairy food) in the mixes. Chinese restaurants are also notorious for preparing food with monosodium glutamate (MSG), a common flavor enhancement and preservative. Many people are aware that MSG causes headaches or dizziness, but few know that it contains a good quantity of lactose.

Sheri Updike warns about "hidden lactose," which may be present in everything from MSG to birth control pills (lactose is often used as a filler for prescription medications). Along those lines some Asian cuisines that skip on the dairy are not necessarily lactose-free. Indian food, for instance, makes use of a butter product called ghee. Some curries and many noncreamy dishes may contain it, so it's smart to question the chef. On the other hand, some dishes that look and taste creamy are ideal for the lactose-intolerant diner, and make for wonderful substitutions. At Tani Thai (12260 S. Dixie Hwy., Pinecrest; 305-253-3583), the tom ka katay soup is lightened with coconut milk. The richness complements the tangy galangal (similar to ginger root) flavor of the broth, and provides a good environment for a host of fresh seafood. Coconut milk, combined with ground peanuts, also strengthens the Penang curry, made with your choice of chicken, pork, beef, or shrimp.

Like coconuts, processed soybeans (soy milk, miso, bean curd, or tofu) can replace dairy in many dishes. You can't tell the difference between tofu and cheese at Lexie's (17850 W. Dixie Hwy., North Miami; 305-931-1113), particularly when the tofu is ground with spinach, stuffed into tortellini, and dressed with a chunky country tomato sauce. Essentially a gourmet, health-food restaurant where the emphasis is on "gourmet," Lexie's also offers a fruit tart topped with vanilla soy-based ice cream for dessert. In fact the only dairy on the premises is in the cappuccino.

Which brings up my pet peeve: coffee. I like my java the way many of us in Miami do, light and sweet. But restaurants as a rule do not stock nondairy creamer. It's easy enough to carry around packets of dried, dairy-free creamer, which you can buy at the local supermarket. But you don't have to bother hauling the extra load at Glatt kosher restaurants, which, in accordance with Jewish law, shun all dairy products. My favorite Glatt kosher eatery is the Israeli-run Pita Hut (534 41st St., Miami Beach; 305-531-6090), where fluffy falafel accented with tahini (sesame paste) and hummus have the texture of cream. As a bonus the homey mashed potatoes, served beside the shwarma and kebabs, are squashed without the aid of cream, and the coffee is served with -- you guessed it -- nondairy creamer.

If you'd rather not deal with substitutions, Porcao (801 S. Bayshore Dr., Miami; 305-373-2777) in the Four Ambassadors hotel is an excellent place to indulge. This Brazilian steak house serves rodizio, various kinds of meat and poultry cooked on skewers and sliced on your plate at the table. The one-price meal begins with trips to the salad bar, which has an endless array of prepared salads, soups, hot dishes, and luxury items like sliced prosciutto and boiled quail eggs. If the endless servings of the main-course meats (short ribs, filet mignon, sirloin, chicken thighs wrapped with bacon, and pork sausages, to name a few) don't suffice, then the side dishes of fried yuca, French fries, and black beans should fill you up, without the temptations that American steak houses offer in the way of creamed spinach and cheese-accented potatoes.

I discovered my lactose intolerance the day after I'd gorged on a big hunk of buttery Leerdammer cheese. One way to check the disorder is to drink a glass or two of milk on an empty stomach. I didn't need to take that test: Just the thought was enough to give me shudders. But if you're unsure about your own level of lactose intolerance and don't want to leave it to the try-it-and-see theory, you should know there is a safe, medical way to find out. The lactose H2 breath test measures bacterial overgrowth that results from lactose intolerance in an efficient, painless manner. Of course your HMO may not cover the cost of the test. But like the inconvenience of searching out restaurants where you can dine both affordably and assuredly, it's a small price to pay to enjoy a good meal.


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