Wait, there's lactose intolerance so severe that people send themselves to the emergency room? Count me among the many afflicted with this ailment, and do you know what I do when I think I might encounter a rogue milk-based product during the day? I slip a couple of Lactaid pills into my jacket pocket.

Seriously, an ER? I'm not writing this guy off completely, but everyone I've ever known to be lactose intolerance just complains of gas and generally smelling like a water buffalo if they eat one spoonful too many of Ben & Jerry's.

The waitress was mad? I would have accused her of trying to kill me if she'd given me crap. I'm pretty shocked that "this much" milk was used even after being told that Jim was allergic. I certainly wouldn't have payed for any of it after treatment like that.

Of course, plenty of airlines still serve peanuts, even though people can be so allergic that being within a few feet would cause a serious reaction. I'm not sure how they justify it, but it seems like food allergies are somehow the customer's responsibility, despite the fact that they aren't the ones who know how the food is prepared.

I should also that Jim is also misinformed, at least as far as the NIH is concerned:

http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintol...

Among their rather dry facts, there's a neatly organized table near the bottom that spells out the average amount of lactose found in dairy products.

Yogurt isn't "lactose-free", as Jim claims.

(Nor is lactose really "harmful" to LI people, but I propose that he added that for dramatic effect.)

I'm all for proper product labeling and the like, but fast-food servers have no medical expertise, and if you have serious dietary restrictions, you're going to want to trust your own knowledge of the subject, not rely on theirs.

Some people are not lactose intolerant, but actually allergic to milk itself. They can have yogurt.

Lactose intolerance is difficulty in processing the sugar (lactose) in milk.

Milk allergy is a much more dramatic thing and very different. I have a close friend who occasionally is conned into eating something with milk in it (usually by people who just don't know that something had milk in it, like cookies or something). Even after a test bite, his face will get red and he will start to wheeze and his eyes tear up.

An ice cream cone would send him to the hospital, no joke.

http://en.wikipedia.org/wiki/Milk_allergy#Difference_with_...

I am also lactose intolerant, but the emergency room? I had no idea.

Perhaps the reason the milk content is not publicized is because LI actually won't put you in the ER 99% of the time. Is it possible hes allergic to something else in the milk, because this seems too extreme for simple lactose intolerance.

Menus are going to get really annoying really fast if they have to publish every single allergy warning - and not just milk, either. My mom is severely allergic to clams. Where are the clam notifications?

NM, I was wrong about the yogurt thing... so this is kinda odd (just asked him).

People with an outright milk allergy can't have yogurt.

http://www.healthsystem.virginia.edu/uvahealth/peds_allerg...

@BillyShears:

There is a varying degree of severity of lactose intolerance. It can range from a mild upset stomach, to severe irritation, all the way to where the person suffering from it can be hospitalized.

I'm just glad I'm one of the people who get a mild upset stomach. Most of the time I don't even need to take lactase supplements.

Hmmm, not to blame the victim here, but if I'm deathly allergic to milk, perhaps I wouldn't be walking into a place called STEAK AND SHAKE!!!

What next? A peanut-allergy guy complaining that the JIFF plant didn't give him adequate warning that their facility uses peanuts?

Umm...maybe I'm crazy or something but if you are actually going to a steak and shake I think the onus of making sure that they know you are allergic to milk is on you. Come on! If drinking milk can kill you and you are ordering a white beverage it might be a good idea to take some precautions. Maybe I'm just stupid or something but this seems like an obvious move to me.

There are definitely degrees of allergies to milk products. When I was a child if I so much as touched powdered milk I would break out in hives all over my body. Over the years my reaction to milk has been reduced to mild discomfort if I have too much, which is what most people think of when you mention lactose intolerance.

We should always be aware that people can have severe, life threatening allergies to all sorts of food products so I wouldn't dismiss Jim's ER claims so quickly. It is very important that a restaurant's employees be aware of ingredients and potential allergies (milk and peanuts come to mind as common ingredients that many people have problems with).

Why are comments on your previous post not enabled? Is it because the irony is not lost on you?

[You're shunning direct contact and instructing your readers to contact you via a generic tipline. However, your regular posts often encourage readers to do the complete opposite: shun generic customer service lines and contact executives directly as a more effective way to elicit a response.]

For the record, I have had a 100% (1/1) success rate in getting a response from your tipline, so by no means do I have a lack of confidence in your ability to handle the emails you get. Just thought your post was a little comical.

I noticed Dunkin Donuts had allergy information posted on its website, along with nutrition information.

You'll all be happy to know that the Coolatta is still crustacean-free.

Maybe this is nitpicky, but it struck me that the writer used the term "harmful lactose" in his letter. As much as I believe consumers should be proactive and vocal, I also think that we should not be overly dramatic (and that extends to adjectives) in telling our story. Lactose may be harmful to HIM, but it's not generally harmful. It's not like there was a razor blade in the food, which would be *generally* harmful.

@kevinhall: If his reaction is life threatening - or seems like it is during the onset of symptoms, it no longer qualifies as "lactose intolerance" and graduates to straight on allergies to milk-based products, in which case he'd know to stay far, far away from yogurt as well.

He sent himself to the ER for bad cramps and possibly the runs. Nothing a granola bar and a shot of Pepto couldn't fix.

Lactose intolerance is different from a milk allergy. LI is caused by a deficiency in the enzyme lactase, which is needed to digest lactose (milk sugar). With out lactase, lactose stays in the intestine and ferments, causing all those lovely intestinal symptoms.

Lactose does exist in yogurt, but the live cultures also produce lactase. It's nature's Lactaid.

Milk allergy is different. It's an inappropriate immune system response to milk protein, not milk sugar. It can cause anaphylactic shock, among other things. Yogurt isn't safe; it still has the proteins.

So, either Jim doesn't understand the nature of his malady, or his LI symptoms are so bad, he'd wind up in the ER seeking painkillers. There are varying degrees of intolerance. Either way, restaurants often disregard people's genuine, life-threatening food allergies.

Jim sounds like he needs to educate himself before he goes out. Geez, he has a severe food allergy, and he expects other people to take care of him.

I've got a severe milk allergy (not a lactose intollerance) and let me tell you, there is some wild stuff out there that has made me sick. Examples: Oreos from a grocery store are fine but Oreos from a vending machine have milk (seriously). McDonalds fries have milk. Is this info out there? Yeah but I sure wished it was more prominant before I had to reach for my epi-pen.

For those too lazy to look at the links on lactose intolerance, here's my summary of it.

Lactose Intolerance is just the body's inability to produce an enzyme (lactase) that breaks down lactose into simpler sugars. Not being broken down by that enzyme, the lactose travels further down the digestive tract where it is eaten by all the lovely bacteria that live in there and they spit out lots of gas, causing discomfort, flatulence, possibly even irritating the bowels to the point of causing diarrhea.
This is a completely unique condition separate from any lactose or other milk related allergies that may exist, and only allergies would have enough effect to send someone to the hospital. Still, at lesser severities, digestive discomfort caused by lactose allergies could seem quite similar, so confusion by Jim and perhaps some posters is understandable.
This doesn't change the fact that staff should be well informed about the contents of food and how they need to treat people's inquiries about "does this have so and so in it?". It seems to me as if every question by a customer about the contents of a food item should be treated as an allergy related inquiry, just to be on the safe side.

Complaining about the service at Steak n Shake is like complaining about the service at Waffle House, you're just spinning your wheels. Notwithstanding, if (heaven forbid) I were allergic to any sort of milk product I don't think I would tempt fate and rely upon the advice of a waitress when my health swings in the balance.

Jim should have asked a second time before ordering the shake. Making the comment in passing that you have an allergy may not be enough for it to register, especially if it really was busy in there that day. The waitress may not have been paying attention when you mentioned it.

That said, this is exactly why restaurants should have nutritional information available. Jim shouldn't have to rely on a distracted server who isn't even preparing the food.

If you are so lactose intolerant (though I find the story hard to believe), that you wind up in the emergency room, you shouldn't be ordering something that could possibly have something like milk it. Seriously, this is their fault? When does Jim get to be responsible for his own health.

Many employees at restaurants don't know exactly what is in things like shakes. I think it's pretty stupid to put your life in the hands of someone hoping they have the right information.

"Being lactose intolerant ( and as all lactose intolerant people know) frozen yogurt and yogurt is a good alternative to ice cream"

I am lactose intolerant and never been able to eat yogurt or frozen yogurt without a reaction.

@msthe8r: Well put. This is what I was thinking, glad I wasn't off the mark. I wish the letter writer would have been more careful in his use of terminology, so does he have an allergy or lactose intolerance?

Why would you trust a waiter/ress regarding the ingredients? do they make the food? Do you think this girl knows what is in the mix they put in the shakes? i seriously doubt it. just because they aren't workaraunt doesn't mean the staff knows everything.
food allergies: don't trust anyone about the food other than the chef (not the cook) or a manager. even then its iffy.

One time this family went out to my mom's favorite Italian restaurant and asked if the pesto had nuts in it. The waiter assured them it didn't, and the kid died. Now then, pesto IS pine nuts, and if you work at an upscale Italian restaurant, shouldn't you know that?

Confused as the man's claims are about his intolerance/allergy/milk-hatred, stuff like this would always be in the back of my mind.

The customer didn't ASK... Jim simply made a comment when ordering, which probably went in one ear and out the other. I'm not letting the waitress off completely, but maybe if Jim had posed the same question a little more plainly BEFORE ordering, he could have saved himself the trouble.

This is one of my pet peeves -- if you have a question about something, ASK. Don't disguise it as a comment or observation and await confirmation or rebuttal. This sort of exchange requires far to much attention by indifferent people who aren't really apt to pay it (wait staff being a prime example).

On the menu it is listed as a "Fruit 'n Frozen Yogurt Milk Shake" (emphasis added). Regardless if that should have clued in Jim or not, they are probably made on the same equipment on which they make the "real" milk shakes.

In a perfect world the waitstaff would know accurate allergy information, but in the real world (speaking as someone with food allergies), if you have a food allergy and you are not sure, don't order it.

Maybe the server should know what's in the product, but come on -- it's the Fruit and Frozen Yogurt MILKShake, fer cryin' out loud. It has the word "milk" in its name! At least according to the Steak and Shake press release back in December, it does.

i'm not condoning what the waitress did, but i agree with the other commenters who say that if you have a serious allergy, you pretty much have to take on the onus of being very careful about what you eat, and not putting your safety in other (untrained) people's hands.

i have some pretty strict self-imposed dietary restrictions, and if i'm in a situation where i have to ask about something, i don't order it. i just get something else. for instance, let's say you're allergic to eggs but you like italian food. you really can't go to a place that has homemade pasta, because even if the waiter doesn't know, they are using eggs to make most of the pasta you can get. solution: go somewhere else or don't order the pasta. it's never made sense to me to go through a bunch of items with the waiter and say, "does that have eggs in it? does this have eggs in it?" they really don't know, and you're inconveniencing them and the rest of the staff (if they have to ask), so i think it's better for everybody if you suck it up and don't eat things that may have something in it you don't like.

ps. i had heard spiderjerusalem's pesto story before and figured it was an urban legend. it was a bertucci's when i heard it.

My girlfriend isn't allowed to have gluten, or cheddar cheese, and it really bothers me the way she orders food at a restaurant. She says "I can't have gluten or cheddar", and things happen where she gets gluten or cheddar in her food.

Whenever I interject with "She can't have either of those because she has a serious food allergy that could kill her" we've never had a problem. Not to victim blame or anything, but if your food allergy is that serious play it safe and say something.

"Does the fruit and yogurt milkshake have milk in it?" is a very different question from "Does the fruit and yogurt milkshake have milk in it, it could put me in the hospital."

Here's an idea...if you're lactose intolerant, don't be out ordering any sort of "shakes". Better yet, why don't you avoid any restaurant with the word "shake" in it because you know what? I can guarantee you that no matter what a restaurant *says* is in their completely-100%-non-milk-only-yogurt-milkshake, it's got milk in it.

I'm not trying to rag on this guy or anything here because I'm a big proponent of full disclosure, both nutritionally and allergenically speaking, but am I being really snitty here when I say this guy needs to be his own advocate? I disagree with the way the waitress acted and the service he was given, but man...if you've got a food allergy it is NOT a restaurant's responsibility to take care of YOU.

Don't be trusting some $3.35/hr earning waitress to understand the intricacies of your Steak 'n Shake order's ingredients. That's all I'm saying.

I don't know about the whole hospital thing... my fiancee has wicked lactose intolerance and though he may get really, really sick, he has never gone to the hospital, even after I made him scrambled eggs and pancakes with milk in both (before he told me of his ailment, of course).

Me thinks Jim may be using some hyperbole. If he's not, he's not lactose intolerant, he's allergic to milk (which would eliminate yogurt as well).

Consider me in the camp of those who think Jim's a bit misinformed. He uses "milk allergy" and "lactose intolerance" so interchangeably that I'm not sure he knows there's a difference.

If the issue had indeed been a milk allergy, the individual should really be avoiding a place so heavily centered around milkshakes. Lactose intolerance, which a person suffering from milk allergy would never call their affliction, merely causes discomfort -- and in the small amount apparently specified, would probably not even be noticed.

I agree the restaurant didn't exactly handle this situation very well, but that's not an excuse to have all your facts wrong.

I'm lactose intolerant and have IBS, and yes, eating something that sets either of these off has caused pain bad enough to send me to the hospital. (Granted, it's happened maybe twice, but...)

I'm on both sides of the fence about this. I'm very careful about what I eat, and when a fast-food place (or even a fancy restaurant) tells me something isn't made with milk, I take it with a grain of salt. However, I've had enough sandwiches made with cheese that I said "no cheese, please" on to make me really angry.

@BillyShears: Yes. It's not BS. And besides, that was rude to question someone's statement about their medical health. You never, EVER assume someone's exaggerating with something like this. Quite the opposite.

Thumbs down.

Allergies alone might not be the whole reason for a trip to the ER. Maybe the guy is already on the edge, and the combo of allergy and other illness sends him to the hospital.

My husband has food allergies, but not bad enough to send him to the ER on their own. His other immune-related condition (UC) combined with it will. (just imagine diarrhea and vomiting for 3 - 7 days straight)

Another gripe: trying to ferret out MSG or disodium guanylate in food at any restaurant. Any prepackaged sauce or dressing or marinade sends my in-laws into a migraine at best, coma and blindness at worst. The servers never know, so we stick to places we research ahead of time or just order everything plain, just in case the spice shaker has a little MSG in it.

Organic labels at the grocery store is about the only way to get safe broth or soups.

"You'll all be happy to know that the Coolatta is still crustacean-free."

Hey, don't laugh. A vegan's gotta know this. =P

As stated ad nauseum, milk allergies and lactose intolerance are two different things, and both have differences in severity that range from mild discomfort to death if not treated at an emergency room or with an epi-pen.

My grandmother is severely allergic to milk, I am lactose intolerant. I'm also a vegetarian, and thought that I had come up with a clever way to keep meat off my food when I order it by saying, "Pretend I'm allergic, and CAN'T HAVE it". It amazed me the amount of times that my food came out with bacon bits anyway, or had clearly had a meat patty dropped on it and then taken off (gross!). Because my food restrictions are self-imposed, I have no problem being super extra careful to ask clearly whether something has meat (including fish) in it and that it be left off. I have no problem sending something back to the kitchen if it has meat on it. I think it's unfair to tell people with medical needs or personal preferences to go eat somewhere else because their situation might warrant some modification to the standard way a menu item is prepared.

In this situation, I think the guy should have made the waitress understand the nature of his allergy a little more clearly and asked twice BEFORE ordering, but she should also have stopped to consider that thinning yogurt with milk is the same thing as putting milk in his shake--she clearly didn't listen to the customer, and shouldn't have argued with him about taking something off his bill that he didn't consume.

@Buran:
I'm not sure if you're too familiar with the menu at Steak 'n' Shake, but someone with a full-blown milk allergy walking into one is tantamount to a vegan expecting a decent selection at McDonald's.

Lactose Intolerance won't kill you; milk allergies will. I stand by my claim that this guy is at best a drama queen, and at worst fishing for a nice, fat lawsuit. Especially since he's had past "encounters" at Dairy Queen.

@BillyShears: Uhm, the OP already explained why yogurt is OK but milk is not. And I'm familiar with the menu. I know they make yogurt shakes that are described as containing yogurt.

And by the way, anything that puts you in the ER is quite possibly serious enough to kill you if not treated.

Why is that so hard to understand?

@spiderjerusalem: That sounds like an urban legend, but I can't fault someone too much who reads Transmetropolitan and has the Crass symbol as his icon.

Haha.

@Buran: You can check yourself into the ER for a papercut, it doesn't mean you're going to die from it.

The guy's lactose intolerant, while uncomfortable it's by no means life threatening. "Even though lactose intolerance is common, it is not a threat to good health."

NIH's words, not mine. If he's got a milk allergy, then the best that can be said about him is that he's being grossly wreckless with his health; if he's lactose intolerant, he needs to spend $15 and buy some OTC pills at Wal-Mart.

@BillyShears: So you're taking the word of a site that has to generalize over someone who knows his medical condition as it applies to HIM?

Most people can get stung by a bee and nothing happens beyond some pain and minor irritation. Some people go into shock and die.

You need to realize that there are exceptions to the generalization. You're wrong if you think otherwise.

Hmm... this is funny to me. Allergens and restriction are personal responsibility. My grandmother can not just go into a resturant and order anything be cause she knows she is diabetic, and she can't pass that responsibility to the server, my sister is LI, she takes pills for that. This guy sounds like he was fishing for an excuse to be Emo.

@BillyShears: Oh, so Omnipotent Billy knows the OP's medical history, condition, and exact symptoms? Wow, how'd you manage that?

@Buran: I'm taking the word of the National Institute of Health over someone who's about two trips to DQ away from accusing some poor 16-year-old of trying to kill him, yes.

Read his letter.

Now read it again.

The guy can't distinguish between "allergic to milk" and "lactose intolerance," both drastically different conditions. One can potentially cause anaphylactic shock; the other causes, in the worst circumstances, a bathroom run of Biblical proportions, not unlike what happens when you go nuts with hot sauce at Taco Bell.

Yeah, this is stupid.

If you can't eat chicken, don't go to Roscoe's House of Chicken and Waffles.

If you can't drink milk, guess you're gonna have to keep your oreos company with some orange juice.

Effing deal with it. It is NOT the responsibility of a minimum-wage burger jockey to make sure you don't order something YOU KNOW can do you serious harm.

If something related to dairy is harmful to you, don't effing order anything that has anything to do with dairy. That's your own medical condition, and it's your responsibility not to put yourself in harm's way.