Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Although milk and foods made from milk are the only natural sources of
lactose, lactose often is "hidden" in prepared foods to which it has
been added. People with very low tolerance for lactose should know about the
many food products that may contain lactose, even in small amounts. Food
products that may contain lactose include:
bread and other baked goods;
processed breakfast cereals;
instant potatoes, soups, and breakfast drinks;
margarine;
lunch meats (except those that are kosher);
salad dressings;
candies and other snacks; and
mixes for pancakes, biscuits, and cookies.
Some products labeled nondairy, such as powdered coffee creamer and whipped
toppings, also may include ingredients that are derived from milk and,
therefore, contain lactose.
Smart shoppers learn to read food labels with care, looking not only for milk
and lactose in the contents but also for such words as whey, curds, milk
by-products, dry milk solids, and nonfat dry milk powder. If any of these are
listed on a label, the item contains lactose.
In addition to food sources, lactose can be "hidden" in medicines.
Lactose is used as the base for more than 20% of prescription drugs and about 6%
of over-the-counter drugs. Many types of
birth control pills, for example, contain lactose, as do some tablets
used for stomach
acid and gas. However, these
products typically affect only people with severe lactose intolerance because
they contain such small amounts of lactose.
How is lactose intolerance treated?
Dietary changes
The most obvious means of treating lactose intolerance is by reducing the
amount of lactose in the diet. Fortunately, most people who are lactose
intolerant can tolerate small or even moderate amounts of lactose. It often
takes only elimination of the major milk-containing products to obtain
sufficient relief from their symptoms. Thus, it may be necessary to eliminate
only milk, yogurt, cottage cheese, and ice cream. Though yogurt contains large
amounts of lactose, it often is well-tolerated by lactose intolerant people.
This may be so because the bacteria used to make yogurt contain lactase, and the
lactase is able to split some of the lactose during storage of the yogurt as well as
after the yogurt is eaten (in the stomach and intestine). Yogurt also has been
shown to empty more slowly from the stomach than an equivalent amount of milk.
This allows more time for intestinal lactase to split the lactose in yogurt,
and, at least theoretically, would result in less lactose reaching the colon.
Most supermarkets carry milk that has had the lactose already split by the
addition of lactase. Substitutes for milk also are available, including soy and
rice milk. Acidophilus-containing milk is not beneficial since it contains as
much lactose as regular milk, and acidophilus bacteria do not split lactose.
For individuals who are intolerant to even small amounts of lactose, the
dietary restrictions become more severe. Any purchased product containing milk
must be avoided. It is especially important to eliminate prepared foods
containing milk purchased from the supermarket and dishes from restaurants that
have sauces.
Another means to reduce symptoms of lactose intolerance is to ingest any
milk-containing foods during meals. Meals (particularly meals containing fat)
reduce the rate at which the stomach empties into the small intestine. This
reduces the rate at which lactose enters the small intestine and allows more
time for the limited amount of lactase to split the lactose without being
overwhelmed by the full load of lactose at once. Studies have shown that the
absorption of lactose from whole milk, which contains fat, is greater than from
non-fat milk, perhaps for this very reason. Nevertheless, the substitution of
whole milk or yogurt for non-fat milk or yogurt does not seem to reduce the
symptoms of lactose intolerance.
Lactase enzyme
Caplets or tablets of lactase are available to take with milk-containing foods.
Adaptation
Some people find that by slowly increasing the amount of milk or
milk-containing products in their diets they are able to tolerate larger amounts
of lactose without developing symptoms. This adaptation to increasing amounts of
milk is not due to increases in lactase in the intestine. Adaptation probably
results from alterations in the bacteria in the colon. Increasing amounts of
lactose entering the colon change the colonic environment, for example, by
increasing the acidity of the colon. These changes may alter the way in which the
colonic bacteria handle lactose. For example, the bacteria may produce less gas.
There also may be a reduction in the secretion of water and, therefore, less
diarrhea.
Calcium and vitamin D supplements
Milk and milk-containing products are the best sources of dietary calcium, so
it is no wonder that calcium deficiency is common among lactose intolerant
persons. This increases the risk and severity of osteoporosis and the resulting
bone fractures. It is important, therefore, for lactose intolerant persons to
supplement their diets with calcium. A deficiency of vitamin D also causes
disease of the bones and fractures. Milk is fortified with vitamin D and is a
major source of vitamin D for many people. Although other sources of vitamin D
can substitute for milk, it is a good idea for lactose-intolerant persons to
take supplemental vitamin D to prevent vitamin D deficiency.
Lactose Intolerance - Symptoms at Onset of DiseaseQuestion: The symptoms of lactose intolerance can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Setting a good example for your children when it comes to diet and exercise will help them to make healthy decisions about nutrition and fitness. Eating calcium-rich foods and performing weight-bearing exercise will help your children prevent osteoporosis and fractures later in life.
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