Nutrition & Physical Activity

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I need an effective, short-term weight loss and toning plan

Dear Annie,

Bravo for incorporating physical activity into your schedule! Regular exercise increases energy levels, improves quality of sleep, and boosts self-esteem. In terms of the effectiveness of your routine, it's difficult to say. Losing weight and toning up is influenced by multiple factors, including height, weight, bone density, genetics, and previous exercise regimen. By "a few pounds," do you mean two or ten or more? When setting out to change your body, it's important to ask yourself if the change you are striving for is realistic. In terms of your desired outcome, first ask yourself, "is this a realistic goal for me?" If you are unsure, it is wise to consult a personal trainer, exercise physiologist, registered dietitian, or your health care provider.

Part of effectively setting and reaching a goal means establishing one, or several, measurement criteria. Are you using a scale to measure body weight? Are you measuring body/fat composition? Strength? Clothes size? Body image? It's important to keep consistent with your indicators to know if you are making progress. If you are using a scale to measure body weight (in pounds), keep a few things in mind:

  • Muscle weighs more than fat.
  • Women especially can be prone to minor weight fluctuations due to menstruation and other types of hormonal activity.
  • Water, an essential nutrient for all sorts of body functions, can tip the scale one way or another.

You can also incorporate some basic guidelines into your plan that will help you maintain an active lifestyle:

  • Start slowly and build over time. It is smart to start off with a goal of running one mile as a workout, with the intention of increasing distance over time. Many people drop out of their exercise program because they go too hard, too fast, too soon. Pacing yourself, especially at the beginning, will help you establish confidence, self-awareness, and a strong fitness base.
  • Incorporate variety into your exercise and eating routine. Including different types of food and activity into your schedule will help to maintain enjoyment and motivation. You mention running and abdominal exercises — are there other types of activities you enjoy? Decreasing body fat and increasing toning or strengthening of muscle requires a balance of cardiovascular and strength training activities. Also, a wide variety of foods will help to ensure that your body is getting the nutrients it needs. Eat plenty of fruits and vegetables and think about decorating your plate as though it were a box of Crayola crayons; that is, aim for foods that are rich in color, such as blueberries, spinach, salmon, and tomatoes.
  • Find a friend. Studies have shown social support plays an important role in exercise motivation and sticking to an activity plan. Recruit friends and/or family to join you on a run, accompany you to lunch, or offer support.
  • Get plenty of rest. Sleep deprivation often makes everything more challenging, and it is especially easy to skip exercise when you feel tired. Sleeping well may help you avoid that trap. Plus, the more you exercise, the more rest your muscles will need to repair and recover.
  • Make it fun. Listening to music, running in the sunshine, or playing a rousing game with friends are all examples of ways to maximize fun and make physical activity something you look forward to and enjoy.

Maintaining a healthy and nutritious diet is an integral part of living a healthy lifestyle and achieving your weight loss goals. Here are a few great tips that may help you achieve your nutrition goals:

  • Keep a food diary.
  • Choose a diet low in fat, saturated fat and cholesterol and moderate in sugars.
  • Eat smaller meals more often — this can help ward off hunger so that you won't overeat at your next meal. Healthy snack options include low fat yogurt, fruit, nuts, vegetables, and whole-grain crackers.
  • Prepare smaller portion sizes.
  • Eat your favorite foods in moderation to help stifle cravings and help you to stick to your diet.
  • Avoid unhealthy fad diets.
  • Eat slowly — this can help you feel more full and avoid overeating.

Above all, the most important thing to remember is that every individual is different. If you feel good about what you are doing and are making progress, keep going until you reach your realistic, healthy goal. You can do it!

Alice

Is soreness a good indicator of a good workout?

Dear Pushed too far,

The old axiom, "no pain, no gain," is just that... old and outdated. Pain and soreness aren't valid measures of the benefits of exercise. Muscle soreness can occur with anyone who exercises, from a beginning exerciser embarking on a new program to a conditioned veteran who is working at a greater intensity, frequency, and/or duration than s/he is used to. It frequently happens to well-trained people as they begin a new activity. Muscle soreness may also be a result of overuse, which may eventually lead to injury. It's important to listen to your body and seek treatment for injuries.

Meeting goals in terms of developing strength or endurance needs to be the focus of any exercise program. Well-defined goals guide results that you are able to attain through gradual behavior change. Examples: I want to be able to do 20 push-ups; I want to be able to run a 10K by the end of the year, etc. Goals are specific and measurable and can be useful in guiding any training program. Soreness can be a consequence of working toward a training goal, but should not be a goal in and of itself.

You write: "I think it's kind of odd that he bases his progress on how sore his clients are." It's important to consider who is looking for the progress here: you the client or the trainer? Your development and achievement should be the trainer's first concern. Some trainers feel the way a client looks or how much s/he can lift is a direct reflection of her or his ability. Does it make sense for you to have a conversation with your trainer about your concerns? You may want to reference Selecting and Effectively Using a Personal Trainer, developed by The American College of Sports Medicine. If you are a Columbia student, you can contact the Dodge Fitness Center to set up an appointment with personal trainer. 

Since soreness is not a reliable indicator of a "good" workout, it sounds your trainer may need a little training. Best of luck toning up!

Alice

Cooking veggies and vitamin loss?

Dear Reader,

Vegetables can be a wonderful source of vitamins, minerals, and other nutrients that people need to stay healthy. The problem is that preparation can put a damper on the benefits that vegetables provide. In fact, according to the American Dietetic Association (ADA), improper preparation can cut the nutrient content of certain fruits and vegetables in half.

When cooking vegetables in water, some of the nutrient content, especially water-soluble vitamins including vitamins B and C, may leach into the surrounding water. But, as you suggest, using that water (or broth) in a soup or a gravy can, in fact, be a way of saving those nutrients and putting them to good use.

Still, high temperatures and long cooking times can degrade vitamins that are more sensitive to heat. While this is hard to avoid with soups, it is much less of a concern than leached and wasted vitamins. 

If you're planning on preparing vegetables to eat alone, you may want to try steaming them briefly until they are crisp and tender.  It's almost always best to keep cooking times low: microwaving, steaming, blanching, and stir-frying take the cake when it comes to speed.  Also, you may want to eat your veggies raw; salads and crudité are a great way to enjoy fresh vegetables and their full range of nutrients. Generally, the less cooked the better — overcooked vegetables don't only lose nutritional content, they also lose much of their flavor and color. This doesn't mean you should stop adding vegetables to your soup. The ADA recommends that you consume at least 3 to 5 servings of vegetables every day, so it may be a good idea to vary your preparation on a daily basis. Bon apetite!

Alice

I'm bored, so I eat

Dear Fat Frat Guy,

You write that you're sitting around the frat house bored. It sounds as though you may have more time to fit in activity than you realize. Exercise doesn't always need to be a long, intensive workout. Short, frequent bouts can be just as effective as longer ones. Why not go out for a walk? Does your frat house have weights in the basement or other area? Taking advantage of exercise equipment is a great idea, but if there isn't any available, jumping rope between sets of push-ups and sit-ups, in your room or a living room or den, can help alleviate boredom.

If these ideas aren't possible, or you still need some suggestions to resist snacking, a few questions to ask yourself may help. First of all, are you actually hungry? When was the last time you ate? Could you put off eating for 15 minutes? If you can wait 15 minutes and then see how you feel, you may decide that you really weren't hungry after all, or you may even forget all about that snack. If you don't and still want to eat — try to quantify your hunger.

Consider the Hunger and Fullness scale. On a scale from 0 - 10, with 0 being BEYOND HUNGRY as though you haven't eaten in an entire day (not recommended) and 10 representing BEYOND FULL as if you ate three Thanksgiving dinners — again not recommended, see where your hunger or fullness falls:

0 Beyond hungry
1 Extremely hungry, irritable, and cranky
2 Very hungry
3 You have a strong urge to eat, but aren't ready to fall over.
4 Just a little hungry
5 Totally neutral... neither hungry nor full
6 You are a notch past neutral — you could eat more but aren't hungry
7 You are feeling satisfied. If you stopped eating at this point, you would need to eat again in about 4 - 4½ hrs.
8 You are getting pretty full. If you stopped eating at this level, you would probably get hungry again in 5 - 6 hours.
9 You are getting really full, and uncomfortable.
10 Beyond full

One way to use this scale is to try to rate your feelings of hunger and fullness. You have to work on paying attention to your body's signals. Make an agreement with yourself that you will eat when your hunger is at 3, and stop eating when you reach 7. If you can ask yourself how you are feeling before taking a snack, you may be able to alleviate or at least cut down on boredom eating. Remember, food's for nutrition and nourishment. If another part of yourself needs nourishment, it's important to figure out what that is and create other ways of meeting that need. Excessive snacking often catches up with us in the form of excess pounds, as you have found. If you repeatedly find yourself eating when you aren't hungry, or when you are no longer hungry, you probably don't need those excess calories.

So, once you realize that you aren't hungry, there are probably a ton of things you can do to pass the time. Getting off your duff and moving your body — somewhere further away from the kitchen — would be a good start!

Alice

Dizzy after exercise

Dear Reader,

And thanks to you and everyone else for asking the questions.

Feeling lightheaded and/or dizzy, as if you are about to pass out, are not normal reactions to exercise. After an aerobic exercise session, you should feel invigorated, not totally wiped out. Your description sounds as though you are working extraordinarily hard. Do you eat anything before your physical activity? Are you drinking during your run or bike ride? How is your overall fluid intake? Although an exact diagnosis based on your description can't be given here, these few suggestions may help avoid these feelings:

  • Eat a snack prior to exercise. If you have less than one hour before your session, fewer than 200 calories is recommended. A piece of fruit and a couple of crackers work well for many people. Your snack can be a bit larger if you have two hours or so until your workout begins: one small plain bagel with jam, a piece of fruit and a yogurt, or handful of nuts and some crackers are a few suggestions.
  • Drink 16 oz. of fluid two hours before an event. This promotes hydration and allows enough time to excrete any excess liquid.
  • Drink fluids during exercise. Weighing yourself before and after exercise can help determine your sweat rate, and how much you'll need to drink.
    • If you lose 1 lb. per hour: drink 4 oz. every 15 min
    • If you lose 2 lbs. per hour: drink 8 oz. every 15 min
    • If you lose 3 lbs. per hour: drink 8 oz. every 10 min.
    • If you lose 4 lbs. per hour: drink 10 oz. every 10 min.
  • If you are exercising for longer than 60 minutes, add some fuel to your water with a sports drink. These fluid replacement drinks include glucose and electrolytes (sodium and potassium) to help with fluid intake and absorption.

Talking with your health care provider is a good idea if these strategies don't help. Being properly fed and hydrated, as well as getting enough rest and watching your breathing as your exercise, should help make your workouts more productive.

Alice

Track versus treadmill

Dear Reader,

First off, it's not clear if you are running on an indoor or outdoor track. For the sake of this answer, let's assume you run outdoors when you do your track runs. There may be some slight physical differences between how your body expends energy running on a track versus a treadmill.

  • The treadmill belt offers some help by pulling your feet back underneath your body, so you are potentially exerting less energy to move your feet and legs than if you were not on a treadmill. However, running stride may change depending on jogging geography. Studies have shown that many runners shift their stride when running on a treadmill. There is a chance that these changes may contribute to your slumping stamina. Subconscious attempts to correct balance on the revolving surface of the treadmill may also cause a runner to increase the amount of time his or her support leg is in contact with the belt, which, in turn, may decrease his or her forward lean. This may result in a runner spending more energy on moving up and down rather than forward, potentially leading to a quicker sap on energy.
  • When you run indoors on a treadmill, you do not have to overcome wind resistance. The lack of wind means you'll spend less energy running four miles on a treadmill than you will when you run four miles outdoors. However, it may depend on how fast you are running. For the average person, running five to nine miles per hour (mph) will result in little difference. Some studies say outdoor running expends up to five percent more calories; if you run faster than nine mph, running outdoors could utilize up to ten percent more calories because you are working harder against wind resistance. Other studies say there's no difference. One study demonstrated the way to balance energy use between indoor and outdoor running is to set the treadmill at an incline (or grade) of one percent.
  • Running indoors maintains or offers stable elements. Runners not only avoid wind, but also other potential natural elements, such as cold air, rain, or sand (if you run on a beach), which demand extra energy. The stability offered by a treadmill, however, does not necessarily mimic reality. On a treadmill you consistently run at the same pace. When outside, you may subconsciously slow down as your body tires, allowing you to run farther since you're exerting less energy. If you haven't already done so, use a stopwatch to measure your outdoor running speed to see if this is the case.
  • Running on a treadmill versus pavement (the composition of the track surface you run on is unclear) provides a softer surface, making it a little easier for your joints. People with knee pain or soreness might opt for a treadmill versus the road outside for this reason.
  • Though running on a treadmill may offer these benefits plus others, the psychological benefits of running au naturel may be contributing to your feelings of fatigue. Psychological cues from running outdoors, such as feeling wind against your face or gaining motivation from running with or around other people may make runners feel like they're making progress. On a treadmill, there is also the option to track the distance, speed, and other characteristics of your workout which may subconsciously cause you to feel tired ("wow, I'm running really fast/far!").

Your boredom theory may certainly be contributing to feeling like you're running on empty. Without the need to worry about navigating different paths, terrains, or natural elements, treadmill runners may have more of an opportunity to think about how tired they are. Some people find that being distracted may help them fight this and run for a longer duration. Sports and exercise psychologists often refer to the "distraction hypothesis" as an explanation for the stress/anxiety reducing effects of exercise. Running, in this case, gives someone a time-out from daily stressors or worries by diverting attention. Some people enjoy running on a treadmill because they can watch television, listen to music, or just zone out and run. Others prefer running outdoors because they are distracted by the scenery, other people, the weather, varying terrain, and/or avoiding traffic.

The next time you run on a treadmill, if possible, position yourself in front of a television or listen to your favorite music to test this "distraction hypothesis." See if you can run for a longer period of time. Other factors that contribute to how a person feels when s/he runs include the food(s) s/he has eaten, how well s/he has slept, and/or whether or not s/he is properly hydrated. Every day is a different day for our bodies, but if someone is a consistent runner and has fairly consistent lifestyle behaviors, it may be that their enjoyment of the outdoors is what fuels their running. Though track and treadmill running both offer many of the same benefits, finding out what works best in your workout routine will lead to a more satisfying experience.

Alice

What does body fat percentage mean?

Dear Reader,

Your choices for increasing fat are not as limited as you may think. First off, know that body fat is essential to normal body functioning. What is referred to as essential fat is the type of fat needed to do just that — help the body function well. Essential fat is found in the bone marrow and spinal cord; it also surrounds the liver, spleen, heart, kidneys, and other organs. We also have fat in our breasts, genitals, and muscle tissue. External layers of body fat offer insulation and protect us from the cold. In addition to this, most of us have some storage fat.

Body fat percentage indicates how much of your total body composition is fat. How much is healthy or unhealthy is determined by your body and its needs. Too low a body fat percentage results in disrupted metabolism, fatigue, and lowered cognitive function, among other things. Women with "too low" body fat will develop amenorrhea (absence of menstrual periods), because the body senses inadequate energy reserves or high physical stress — and won't sustain a pregnancy, for example. Some experts believe that 17 percent body fat is needed for the onset of menses and that 22 percent body fat is needed to maintain normal menstrual cycles. Of course, some people are healthy outside of these parameters. A gynecologist or endocrinologist can better evaluate your specific situation; you can start with your primary care provider.

Body fat is measured in terms of percentage, and you can get your body fat measured at your gym, for example, but what are you going to do with the number? Getting a body fat measurement can be anxiety-provoking. Make sure you go for an assessment with a qualified health professional. Most of the measurement techniques for assessing body fat percentage fall short in terms of accuracy. A good rule of thumb is to expect a standard error of 3 percent; meaning, whatever percentage you are measured at, consider that you could, in reality, have 3 percent less or 3 percent more than that measurement. Body fat percentage is more useful as a measure to track how your body changes over time.

In terms of ways to increase body fat, you can do so by taking in more calories than you expend. One food specifically won't increase your body fat. If your eating plan is low in fats, though, you will have difficulty absorbing vitamins A, D, E, and K and a variety of valuable plant chemicals, known as phytochemicals. Your friend and/or fitness instructor may suggest high fat foods because they are denser in calories than low fat foods. This means they will provide you with more calories for a smaller amount of food. Calories supply energy, and fat has a higher number of calories per gram than other nutrients:

 

Nutrient Calories per gram
Fat 9
Carbohydrate 4
Protein 4

 

This table gives you an idea of why calories from fat may be a smart choice for you. Good choices for a vegetarian are avocados, olive and canola oil, nuts, peanut butter, and olives. If you're willing to relax your vegetarianism a bit, fatty fish are also a good option, but aren't as calorie dense as the first group of foods mentioned. If you're avoiding dairy foods, include other rich sources of calcium, such as collard greens, turnip greens, kale, or calcium-fortified juices, to strengthen bones, among other functions.

Hope this helps you understand your body a little better.

Alice

Vegan eating

Dear Reader,

Veganism: easy as 123 and ABC? Let's discuss. Before we start though, it will be helpful to determine what kind of "vegan lifestyle" you want to lead. The Vegan Outreach group and The American Vegan Society define vegan practice as not eating, buying, or using animal products (including honey and silk) or products tested on animals. Vegan groups give some attention to the health benefits of vegan style eating, but their main focus is on maintaining a lifestyle that minimizes the mistreatment of animals. By exploring your feelings about ethical issues related to consuming animal products and food, you will find your niche in the wide range of interpretations of what a vegan lifestyle entails.

Though some people may be able to completely overhaul their lifestyle all at once, it may be easier to make the change to veganism by breaking it down into three steps:

  1. Start with a small objective, such as cutting one thing out of your eating plan, like red meat, for example. Explore the nearest health food store and start sampling alternative non-meat protein sources. A registered dietitian may be able to offer extra guidance. Columbia students considering a vegan lifestyle may want to make an appointment by contacting  Medical Services (Morningside) or the Student Health Service (CUMC).   
  2. When you are comfortable with this small change, try cutting more if not all animal products from your diet. Sample vegan egg replacements, soy cheeses, and soy, rice, or almond milks. Also consider phasing out other products you use that contain animal byproducts (i.e., gelatin, leather, or soaps made with animal fat). Now would also be a great time to start researching and experimenting with one new vegan dish each week and checking out recipe sources such as Vegetarian Times or the vegan cookbook section at your local library. One low-carb breakfast recipe you may want to consider is a veggie omelet. Use vegan egg substitute, red or green peppers, soy cheese, salt and pepper to taste, and one slice of whole-wheat toast on the side.  Throw in an 8 oz low-fat soy latte and you have yourself a high-protein, relatively low-carb breakfast! 
  3. Once you've experimented with some recipes and are more familiar with new ingredients and household items, take the final step of cutting out all animal products from your diet and everyday usage. By doing your research and taking time to reach the ultimate goal of a vegan lifestyle, you will have eased into new approaches to shopping not only for food but other products as well.

Whether you have a strict or liberal definition of a vegan lifestyle, it is a given that you will cut animal products from your eating plan, but it is crucial to keep up on the ABCs of nutrition as well. Most of your replacement protein sources and vegan staples such as grains, fruits, and vegetables will contain carbohydrates, so a low carbohydrate/vegan meal will be hard to achieve — though not impossible. Without paying careful attention to the nutrients you are consuming, you may be at risk for not meeting your nutrient needs. If you're just looking to minimize carbs on the whole, cutting down on junk food (i.e., chips, crackers, sugary cereals, breakfast bars, and cookies) is the ideal way to do this.

As for maintaining appropriate protein levels in your vegan diet, experts at the Institute of Medicine recommend that 15 to 20 percent of daily calories come from protein. This amounts to about 65 grams of protein per day for men and approximately 55 grams for women. Although you will be cutting out commonly recognized protein sources — meat, fish, poultry, and dairy — from your eating plan, have no worries. Plant foods such as soy, legumes, nuts, and seeds also contain a good amount of protein. Check out the Vegetarianism section in the Alice! archives for more information on specific foods that will help you meatlessly "beef up" your pantry and fridge.

By cutting animal products out of your eating plan, you will also cut out the most common sources of a number of high priority nutrients like vitamin B12, vitamin D, calcium, and omega-3 fatty acids. For tips to help you make sure you're consuming enough of them in your vegan diet, check out the Related Q&As below. Being conscious to include fortified soy products, cereals, and non-dairy milk, plus a variety of dark green veggies, legumes, seed, nuts, and beans in your diet is imperative in ensuring you're getting the nutrients your body needs. Many of these foods will also provide good sources of iron, riboflavin, and zinc which are also harder to come by in a vegan diet.

When making changes to your lifestyle and eating habits such as those dictated by veganism, it is best to have a clear understanding of the challenges that lie ahead. The concern you show for doing so in a healthy way is great. Keep it up and remember, although it may not be as easy as 1-2-3, by staying on top of your nutrition ABCs you can successfully convert to a vegan lifestyle healthfully!

Alice

Airborne — does it cure/prevent colds?

Dear To sneeze or not to sneeze,

People in the United States spend billions of dollars a year trying to escape the misery of the common cold. Though some swear by remedies ranging from vitamin C to garlic to exercise, scientists have not conclusively found anything that will prevent, cure, or shorten the course of the common cold. The manufacturers of Airborne claim that the unique combination of herbs, amino acids, antioxidants, and electrolytes "offers vitamin and mineral support for hours," and imply that it helps the body fight bacteria and viruses by boosting the immune system. They have withdrawn their original claims that their product cures or prevents colds.

In addition to vitamins, Airborne contains Echinacea, an herbal supplement some people take on its own for colds or the flu. Similar to research on vitamin C, studies draw a mix of conclusions about whether Echinacea works in preventing or treating colds. There are many products on the market, as well as natural remedies, that successfully treat the symptoms of the cold: body aches, sore throat, stuffy nose. However, as of yet, there is no proven cure.

Some people may feel that Airborne works for them, but it's tough to say conclusively. Colds can last anywhere from one to ten days and a person's immune system will eventually fight it off, even without vitamins or supplements. There has been one study on the effectiveness of Airborne. The clinical trial was a double-blind, placebo study, meaning that neither the researchers nor the participants knew who took the real supplement and who took the placebo until after the trial ended. The study found that Airborne out-performed the placebo, however many people question the potential bias of this study because the research was conducted by the manufacturer.

Additionally, some people have expressed concern about the amount of vitamins A and C contained in Airborne. According to the Food and Drug Administration, the average adult should have 5000 units of vitamin A each day, and 60mg of vitamin C. One dose of Airborne contains 5000 units of A and 1000mg of C, and the package recommends taking a dose every three hours. That means taking significantly more than the recommended daily allowance of both. Overdosing on vitamin A may cause nausea, vomiting, headache and dizziness. Too much C can cause diarrhea and excess gas.

Subways and other enclosed spaces with many people can be germy, especially in cold season. Medical professionals say your best defense against the common cold is maintaining a healthy lifestyle. That includes: eating a balanced diet, being physically active, and getting plenty of sleep. On top of that, thorough hand washing with soap and water, especially before you eat, can keep the subway germs at bay. So, before you go out and buy the new very berry flavor of Airborne or a similar supplement, it might be wise to take its claims with a grain of salt (mix with 8 ounces of water and gargle!).

Alice

Milk allergy or lactose intolerance?

Dear Kathy,

Your question does not seem dumb. Many people confuse allergies with intolerances, or mistakenly use the terms interchangeably. So, what's the difference?

Intolerance is a physical reaction to a substance that usually does not involve the immune system. For example, lactose intolerance occurs when a person has a deficiency in lactase — the enzyme that breaks down lactose, the carbohydrate found in cow's milk. So, this milk sugar is not digested adequately, producing abdominal discomfort, gas, and diarrhea. Lactase enzyme supplements and reduced lactose dairy products can help people tolerate foods containing lactose.

An allergy is an immune response — when the body senses that a harmful substance has entered it, and releases specific chemicals to combat the perceived threat. For example, when you are having an allergic reaction, your body releases chemicals called histamines. These cause allergic symptoms that may affect your gastrointestinal tract, skin, respiratory system, and/or cardiovascular system. The effects on one's respiratory system could include a runny nose, cough, swelling of the larynx, and asthma. In the case of foods, studies show that food allergies rarely cause nasal symptoms or wheezing without also causing skin or gastrointestinal symptoms.

Since you are experiencing this set of symptoms, it seems possible that you have a milk allergy. It's important to get the diagnosis from an allergist, so that the appropriate treatment can be identified. If you're a Columbia Student, you can make an appointment with a health care provider by contacting Medical Services (Morningside) or the Student Health Service (CUMC)

Other substances found in milk also can trigger allergic reactions in some people, including antibiotics given to cows, or the proteins of ragweed, linseed, peanut, or wheat that make their way into milk. People with a milk allergy may need to cut milk out of their diet entirely.

Diagnosing food allergies is complex. And having symptoms that seem like a milk allergy doesn’t necessarily rule out the possibility of also having an intolerance to lactose. You have found that cutting milk products out of your diet works well for you, which is a great step. It may make sense to see an allergist to learn more about your own specific situation.

Good luck!

Alice

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