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What? Where? How Many?
How Much? Which? When? Why?


    First, the two-minute chemistry lesson. I'll make it painless.

    Lactose is what is known as a compound sugar, because it is made by joining two simpler sugars: glucose and galactose. Glucose is the body's most important chemical, the energy source for every molecular activity. Most of what we eat is turned into glucose. That's the whole function of digestion. (Even the galactose is swiftly converted into more glucose.)

    If you can join two simple sugars into a compound one, then it should be possible to split them back up again. This is the process we call digestion. The body uses proteins called enzymes to do this. The enzyme that splits lactose is called lactase. There, did that hurt?

    (For you more technical types, here's a fun fact. The bond that joins glucose and galactose is a beta-type bond. Since lactase works by attacking that bond, it is more formally known as a beta-galactosidase. Are there are alpha bonds? Sure are. And are there also alpha-galactosidases? You bet. They're the enzymes that are used in Beano, pills that reduce the flatulence caused by the oligosaccharides in beans in exactly the same way that lactase pills work in the body. Not at all surprisingly, Beano is made by the people who make Lactaid. Similar pills by other manufacturers are also now on the market.)



    What with the shortage of spare lactase-producing intestines on the black market, manufacturers had to come up with a different way of making commercial lactase.

    Fortunately, a whole menagerie of bacteria, fungi, and other little critters have learned to live on lactose by making their own lactase. Some of these are the ones in our intestines that help ease the problems of undigested lactose. Others are known as dairy yeasts, and have been used for centuries to make yogurt and other fermented dairy products.

    If scientists could grow these in the lab, they'd have a perpetual lactase factory with really, really cheap labor. There's a problem, though. (There always is.) Few people understand that each critter that makes lactase (not just bacteria but mammals as well) makes it in a slightly different form. All the lactases will split lactose, but they work their best under different conditions of temperature and acidity.

    The lactase from one dairy yeast called Kluyveromyces lactis would get destroyed by the acidity in our stomachs if we took it in pill form, but it proved to be perfect to add to milk. This is the lactase that is used in lactase drops. A fungus known as Aspergillis oryzae, though, creates a lactase that works best under high acidity, so manufacturers seized it for use in lactase pills. (How important is this? Very, as you'll see below when I talk about when to take these pills.)

    The differences between the two lactases mean that you can't easily substitute one for the other. In an emergency that finds you stuck completely pill-less, you can try putting a few drops in milk just before you drink. Don't expect much, but it might be a smidge better than nothing at all.


How Many?

    The question that I am most asked is, "How much lactase should I take?" And the answer is, "I don't know." This, of course, tends to disappoint people.

    I can't help it. The question sounds simple and easy, hardly something more complicated than questions scientists answer every day. After all, your doctor will tell you exactly how much to take of any other drug. That's part of the problem. Lactase is not a drug. It's a natural bodily substance that's geared to work on the insides of your particular body.

    The amount of lactase you need is governed by the following items:

    • How much lactase you still are manufacturing in your body
    • How much lactose you are ingesting
    • What particular foods the lactose is in
    • Whether the foods are solids or liquids
    • Whether the food contains any lactase itself
    • Whether the lactose is part of a meal
    • How quickly you move that food out of your stomach
    • How quickly you move the food through your intestines
    • Whether your intestines are in good shape
    • Whether there is food still remaining from an earlier meal, snack, or drink in your system
    • The amount of the lactase in the pill you are taking
    • How long that particular pill has been sitting on the shelf
    • The purity of the lactase in the pill
    • When you take the lactase pill in relationship to the lactose in the food you are eating
    • What television program you are watching at the time

    OK, maybe not that last item. But who can be sure? The point is that there is no possible way anybody can compute all the factors that go into this particular equation. And that's why the amount of lactase that seemed to work before in a seemingly identical situation doesn't work now: no two situations actually are identical.

    Admittedly, for most people the answer is easy. They just need to take a pill or two and their problems are over. They're not the ones asking the question. For those of you who are, all I can say, sadly, is: trial and error, mostly error.

    If the lactase doesn't work for you, here are some tips:

    • Try more lactase (How much more? See below.)
    • Get a new bottle
    • Try a different brand
    • Consider the possibility that you don't have LI, or that you have some other problem in addition to LI. Lactase works on most people. If it doesn't work for you, think of it as a clue.

    There's also an alternative - probiotic capsules with lactase. Two kinds of bacteria naturally live in everybody's colon: the type that digests lactose and the type that ferments it, creating gas, cramps, bloating, and flatulence. Naturally you want to have the first type. You can try cultivating it by eating yogurt or other dairy products with live cultures. Or you can get it in a pill.

    Several companies now market these pills. For more information, look at my DairyCare and Digestive Advantage pages.


How Much?

    Telling people how much lactase is safe to take is a touchy issue. You'll sometimes find packaging that gives a maximum amount, usually 6 regular strength (3000 FCC unit) tablets. I have been told, by the proverbial highly placed inside source, that the only reason for this is that their testing did not involve having people take more than 6 tablets at a time, so that the lawyers told them not to make any claims for higher amounts.

    Are higher amounts harmful? According to Dr. Pol Vandenbroucke, who was then Director of Medical Affairs for the people who made Dairy Ease (and may still very well be: I just haven't checked lately), there are no known harmful effects from ingesting lactase in any amount. Lactase in pill form is not even absorbed into the body but stays in your intestines until being broken down into harmless protein fragments.

    In addition, animals have been tested with dosages up to 50% of their entire food supply (a standard procedure) with no ill effects. There has never been, to my knowledge, a single medical journal report or even anecdotal evidence of any dosage, however high, causing any problem whatsoever. I have had a correspondent who told me that he regularly took 90,000 FCC units worth every time he had lactose. (That's right, 10 triple strength Lactaid Ultra tablets at a time.) There is one reported instance of a person having an allergic reaction to the Aspergillis fungus in the pill, however.

    Before the lawyers climb down my own throat, let me jump right in and say that I do not advise anybody to take this much lactase. There's no real evidence that more is better. In fact, there are proprietary tests cited by that same inside source that appear to indicate that you reach a point of diminishing returns. After all, you're only taking in so much lactose with any meal. You only need so much lactase to deal with it. Are ten pills twice as effective as five? Almost certainly not. Are ten pills even any better than five? That's not a question I can answer. But I wouldn't place any large bets on it. Here's the important point. If you think you feel better taking ten pills than when you only take five, take ten. So you're spending an extra fifty cents on your piece of mind. Cheap at twice the price.



    Now for a slightly different question. Which tablet should I take? (And the corollary, Are pills (chewable tablets, softgels, capsules) better than the other forms?) This is easy. Take whatever you feel like. The formal studies of individual brand name pills are next to useless, having been done on too few people to generalize off of. However, the good and important news is that every brand that has been tested, to my knowledge, has worked on most of the people who tried it. Of course, like everything else in life, no brand works on every single person.

    So it's up to you. Take what you find convenient. Lactaid and Dairy Ease are the only two true national brands, at least one of which is available in every supermarket and pharmacy I've ever checked. Either make your decision by whether you want swallowable or chewable tablets or buy whatever is cheapest in your area.

    Most discounters (Wal-Mart, Target), supermarket chains and drugstore chains have house brands. Just by looking at the pill you can easily see who they are imitating. (And who may really be manufacturing it: The chewable knockoffs tend to look exactly like Dairy-Ease. The tablet lookalikes are dead ringers for Lactaid.) They are certainly cheaper. They have never, to my knowledge, been formally tested in a public medical study, but anecdotal evidence indicates that they work.

    Every natural food store and vitamin emporium carries a number of brands that you won't find marketed in mainstream supermarkets. My only advice there is to watch the dosage carefully. Many of these pills come in dosages too small to be of any real use or mixed in with other dietary enzymes that may or may not have value to you. I would stick with pills that contain at least 1750 FCC units. Some pills have their strengths measured in milligrams. As raw lactase comes in both a pharmaceutical strength and a food grade strength, it is harder to determine FCC unit equivalents in those cases, but 125 mg should be effective, as several manufacturers give that number as the equivalent to 1750 FCC units.



    The other big question that I rarely get asked but is even more important is, When exactly should I be taking the lactase? Remember my comments above about stomach acidity? Here's where they pay off.

    The A. oryzae lactase is designed to work at a certain level of acidity. This makes sense because the stomach is awash in acids that are used to break down food for digestion. But here's the kicker. The stomach is too acidic even for this lactase! (It's way too acidic for the K. lactis, which is why you need to give it a day to do its work in the milk first before you put it in your stomach.) If you take a lactase pill on an empty stomach, the acidity will destroy the enzyme before it can pass on to the intestines where it can do some good.

    But putting food in your stomach buffers the acidity so that the enzyme can survive. So here's what you do. Take the pill right with the first bite of food. You can take it as much as five minutes before the meal and it will still be okay. Too much earlier and you run the risk of its not being effective.

    You're probably thinking, in that case, why not take the pill after I've eaten so that there's lots of food in my tummy? Because lactase doesn't work in the stomach, it works in the intestines. And you want the lactase there before the lactose arrives or it doesn't do any good. Mixing it with the full contents of your stomach will just slow its arrival. It may still do some good, but not as much as it would otherwise.

    Same thing about taking the pill after you start feeling symptoms. Taking some lactase with a small amount of food at that point may allow it to catch up with whatever lactose is still remaining. But the stuff that's causing the symptoms is already long gone and beyond its powers.



    Why? Because it works!

    The big market in lactase is in lactose-reduced milks, which are made by adding lactase, just as you would at home. (They are mostly then Ultra High Temperature (UHT) pasteurized to give them a much longer shelf life.) These milks work for the vast majority of people with LI.

    If you're still reading, then you're probably in the minority of those who need to take the lactase pills for small amounts of lactose in your food. For you, the pills really are the miracle drug that those of us who remember the days before them spent half our lives wishing for. With lactase pills, you can eat most anything, most anywhere. You can slip a few into a pill case in your pocket, as I do every day of my life, and have them on you always. You can eat out, you can travel, you can go to friends and relatives and not have to fuss about special meals. You can go through life with greatly reduced symptoms or none at all.

    No, the pills don't work perfectly. Yes, sometimes they don't seem to work at all. Yes, you have to remember to have them with you and to take them at the right time. Yes, they can be expensive if you use them all the time in large numbers.

    So what? Imagine trying to avoid all milk all the time. I did it for years. I know. And now nobody comes between me and my lactase.


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