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.
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
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
Digestive Advantage pages.
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
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.
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
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.