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Lactase. A one-minute biology lesson. Iíll make it painless.

Lactose is what is known as a compound sugar, because it is made by joining two simpler sugars: glucose and galactose. Digestion is the process of splitting lactose back into glucose and galactose again. The body does this by means of an enzyme called lactase. Without lactase, lactose moves through the intestines undigested to create all the symptoms of Lactose Intolerance (LI).

There, did that hurt?

Fortunately for all of us with LI, lactase can also be made by one-celled creatures like yeasts. (A lactase plant smells a lot like a brewery on a hot day.) In pill form, this lactase works exactly like the lactase our bodies make. Lactase is almost a miracle pill: simple, effective, cheap, and safe. (One person is known to have had an allergic reaction to the yeast, however.)

Two major national brands of lactase – Lactaid and DairyEase – are found in supermarkets, pharmacies and discount stores, many of which also sell their own house brands of lactase at less cost. An additional dozen or so brands can be found in health or natural food stores. The standard dose is 3000 FCC units, although there are now double and triple strength pills on the market. As far as I can tell, all lactase pills of equal strength are equally effective for most people. If one brand doesnít work for you, simply try another. (If no brands work, consider the possibility that you donít have LI at all, but some other problem.)

As with other consumer products, the plain vanilla lactase pill has blossomed into a shelf-spanning array of varieties: chewable tablets, softgels, wafers, and capsules in addition to regular pills. Choose whichever kind you prefer; there should be no difference in effectiveness among the forms. Some of the health food store brands come with a variety of other enzymes; thereís no medical evidence that these either help or hurt. Just be sure they contain enough lactase. I wouldnít go below 1750 FCC units (or the equivalent 125 milligrams).

What does make a big difference is when you take the pills. They work best if you take them with the first bite of dairy-containing food or drink. Take them too early and your stomach acid will degrade the enzyme. Late is better than never, but some of the lactose could slip through your intestines before the lactase can catch up.

Iím always asked how many pills to take. Thatís easy: take as many as you need. Of course, the more lactose in the meal, the more pills will be needed. Seriously, how many? I hear you ask. Sorry, but thatís just not an answerable question. You have to experiment. It really does depend on a huge number of factors, including what the meal consists of, how much lactase you may be making naturally, and even how much lactose may still be in your system from a previous meal.

Fortunately, for the vast majority of people with LI, lactase pills really do work: if not perfectly and all the time, then pretty well and pretty often. As someone who remembers what life was like before they came on the market, I can assure you that Iím never without a supply of lactase on me. I keep them in a small pill case. That way I can eat what I please and not have to worry. Well, not worry about LI. All the other rules about healthy diets still apply. Thereís not a pill in the world that can change that.

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