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Q And A Clearinghouse Archives

Updated through 1997

Send your questions to me, Steve Carper, at SteveCarper@CS.com.

I personally answer all questions that you send me, and I post the ones that are of sufficiently general interest here, so don't hesitate to ask me anything.

If you don't spot your question here, be sure to check my Q and A Quick Finder Index.


Q. I am so lactose intolerant my pharmacist had to buy a machine so he could make capsules for me without lactose. He informed me that there were other things that could be used in medication instead of lactose, but lactose was the cheapest. Until now I have felt safe with capsules, but my newest medication, a capsule also brand new on the market, has lactose. I called the company, Wythe, and screamed. They made note and according to them they will listen. One voice in the wilderness will achieve nothing. With your following can't we start a movement to have lactose removed from medication PLEASE!!!!

    You are not alone and you are doing exactly the right thing. Companies do listen to the people who use their products.

    Unfortunately, the number of people as sensitive to tiny amounts of lactose as you are is quite small. That means that manufacturers have little incentive to reformulate their products.

    So the more of you who take the time to write to manufacturers and scream, the better. You can get the address from your pharmacist. Or go to a library and find the Physician's Desk Reference, which has the names of all major manufacturers and the ingredients of all major prescription drugs.

    Don't forget that my book, Milk Is Not for Every Body, has a listing of over 300 lactose-containing medications, and gives non-lactose-containing forms of them where available.

    Good luck, and go get them!

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Q. I sometimes get LI symptoms 6 to 8 hours after eating a meal, and sometimes even the next day. Is this possible?

    Sure is. You get LI problems in two ways: from the water pulled into the intestines by the excess lactose and from the gases produced by the bacteria in your colon that eat the undigested lactose.

    Each person and each meal creates different intestinal transit times, as they are called. Food can take ten hours to reach the colon, and then more time for the bacteria to work and to finish up the lactose. You might need two or three days to completely rid your system of the lactose.

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Q. I always wanted to know the role of glucose & galactose (digested lactose) in the body and how important they are. Does the absence of these sugars affect the body in any way? Is it completely OK to be without them?

    Glucose is only the single most important substance in the body, because it is the basic energy source for all the internal chemistry of the body. Not to worry, though. All carbohydrates (including galactose) eventually get converted to glucose so that the body has a constant supply. As long as you eat a basic healthy diet, you'll always have plenty of glucose.

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Q. Have you ever heard of a baby reacting to the lactose in human milk? And does the effect of eating lactose-containing food pass through breast milk the way eating broccoli or cabbage does?

    Babies are designed to be able to drink milk for their first couple of years of life. Even mothers in societies in which virtually every adult is lactose intolerant naturally breastfeed infants without any problems.

    A very, very tiny minority of babies are born without the ability to drink milk, but I would doubt if this happens once in a hundred million births. By all means try breastfeeding your next child. In the unlikely event that your child has a problem, you will know about it almost immediately and you can make the switch to a non-milk formula without any further harm.

    As for lactose passing through milk, you're thinking of allergic reactions, which are very different from lactose intolerance.

    Lactose doesn't work that way, and even if it did, breast milk naturally will contain hundreds of times as much lactose as could possibly leak through from foods that you eat.

    Don't give it a second thought. Have as much milk as you desire and can safely tolerate.

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Q. Are non-dairy creamers really non-dairy?

    Yes, non-dairy creamers are lactose-free. Most of them do contain casein in some form, however. Casein is derived from milk protein, which is why some people don't consider them truly non-dairy. People with just LI and not milk allergy should not be affected by any minuscule residue of lactose that may remain after some manufacturing processes.

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Q. I've noticed that most major brands of canned tuna have "hydrolyzed casein" as an ingredient. What is it and is it safe for lactose intolerant people?

    Casein itself is one of the milk proteins. It may have a tiny amount of lactose left in it after processing, too tiny to have any effect on the normal person with LI.

    Hydrolyzed casein is protein that has been broken down to its component amino acids. It should have even less effect. However, some people with milk allergies may react even to hydrolyzed casein. But the rest of you don't have to worry about it at all.

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Q. The softgel is my product of choice since I have difficulty swallowing pills and dislike the taste of the chewables. Can you give me any help regarding Digest-It softgels?

    Digest-It softgels are from Park Taft Laboratories. And that's all I know. That name on the side of the one package of Digest-It that I found was the only evidence of Park Taft's existence I ever had -- and the store where I bought them no longer even carries the brand.

    But there are a couple of other suggestions I can make.

    KAL Lactase Enzyme comes in 125 mg softgel capsules. Their address is KAL Inc., Woodland Hill, CA 91365 and their phone number is 800-755-4525.

    There's also Milk Digest-Aid 1750 FCC unit softgels, from Schiff Natural. That address is Schiff Products Inc., Moonachie, NJ 07074. Their phone is 800-436-4333.

    This information is from my book, Milk Is Not For Every Body, so it's a couple of years old and I can't guarantee that either one is still around. But they're worth following up

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Q. Has anyone done any research on how much lactase is needed to balance out 1 gram of lactose?

    Trial and error. That's all there is. Just trial and error.

    Seriously, the problem is that each individual is different. Most people still manufacture some lactase, even if they are LI, so they only need sufficient additional lactase to balance out what they're missing. And the type of food eaten, how and when it is eaten, and even when the lactase is taken all have effects on what the symptoms might be. There are -- and probably can't be -- even rough approximations given out.

    Still and all, I find that one of the new Lactaid Ultra pills, with 9000 FCC units (three times the normal strength), is all I need for ordinary occasions. I haven't tried them with an actual glass of milk, yet... But I would certainly be interested to know what happens if you try it!

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Q. Will taking acidophilus pills help my LI symptoms at all?

    The most I can say is, maybe. Here's why.

    The symptoms that people associate with lactose intolerance -- gas, bloating, diarrhea -- are actually caused by the bacteria and other microscopic organisms (the flora) in your colon taking the undigested lactose that makes its way past the small intestine (where it should get absorbed) and fermenting it, releasing a lot of gas in the process. Different bacteria like lactose to different extents. Some gobble it up, releasing huge amounts of gas; some ignore it, creating few problems.

    Lactobacillus is a genus of bacteria. There are many species of Lactobacillus, some of which are used in the manufacture of yogurt, including (aha) Lactobacillus acidophilus. They have the property of making their own lactase, the enzyme that digests lactose. (That's why yogurt is usually better tolerated by those who are LI than other forms of milk products.) So there is some logic in thinking that increasing the concentration of lactobacillus in one's colon would lessen LI symptoms. The big question is whether taking the pills would actually do that. And I just don't know if that's true.

    There has been much more attention paid to the role of colonic bacteria in LI over the past few years, but I don't know of any solid research that has anything to say about whether lactobacillus or acidophilus actually helps, whether it's acting as a placebo, or whether other factors are involved. But it's an area I'm going to watch closely in the future.

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Q. Is whey protein a problem for people with lactose intolerance?

    Whey itself is the liquid portion of milk that is left over when the casein protein (curds) is removed. This liquid also contains almost all the lactose that is in milk. So when whey protein is manufactured, it depends on the purity of the manufacturing process whether all the lactose is removed.

    I have seen on the shelves of natural foods stores several brands of whey protein that label themselves as lactose-free. If you are concerned, you should look for one of these. Brand names include The Ultimate Whey Designer Protein, from Naturade Products; Biochem Ultimate Protein, from Country Life; Unipro's Perfect Protein, from Unipro Performance Nutrition.

    I am not recommending any of these, by the way, just passing along word that they exist. And you should double-check even those brands I mentioned above to ensure that they still say lactose-free.

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Q. What's "New" about "New" Imodium A-D Anti-Diarrheal Caplets?

    As far as I can tell, the difference is that the "new" Imodium A-D Caplets is that they no longer contain lactose. Yes, that's right, there was actually an anti-diarrheal medication that contained lactose as the second non-active ingredient. (The liquid version never did, however.) Normally this would not merit a big announcement, because I have been telling people NOT to take anti-diarrheals for lactose-induced diarrhea, on theory that getting the stuff out of your system as fast as possible was the best course of action. I may have to modify that in the future. Or maybe not.

    Here's the scoop. I found a report of an article in Alimentary Pharmacology & Therapeutics ["Influence of Loperamide in Lactose Handling and Oral-Caecal Transit Time," by A. Szilagyi, R. Solomon, & E. Seidman, Oct. 1996, 10 (5):765-70] that, while very preliminary, is worth noting. The authors tested loperamide on 16 volunteers and found that the loperamide slowed down transit time (the time it take food to move through the digestive tract) so much that the lactase still remaining in people's bodies had more time to work, thereby reducing symptoms. The big catch: the subjects got the loperamide BEFORE getting the lactose. No wonder it worked. I wouldn't actually want to bet that it would still be so useful once the diarrhea has actually. started.

    There's also this report from the Scandinavian Journal of Gastroenterology ["A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome," by P.S. Efskind, T. Bernklev, & M. H. Vatn, May 1996, 31 (5):463-8]. They found that loperamide "improved stool consistency," "reduced defecation frequency," and "reduced intensity of pain," although nightly pain actually increased.

    Loperamide may do some good in some cases. And Imodium A-D is the only anti-diarrheal on my local drugstore's shelves with loperamide, so their new formulation couldn't come at a better time. I wouldn't count on any magic effects. If anyone does try loperamide out, please e-mail me and let me know your results.

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Q. What, if any, are the differences between the terms lactose intolerance, lactose maldigester, and lactase deficiency?

    You've touched on a sore point. Technically, the three terms mean slightly different things. You are a lactose maldigester if a clinical test indicates that you do not digest all of the lactose you eat or drink, regardless of whether you get any noticeable symptoms or not. You have a lactase deficiency if you do not produce your full potential amount of lactase, no matter what the cause of this might be, and no matter whether you drink milk or not. Since neither of these terms mention symptoms, we should reserve lactose intolerance for those times when having lactose actually causes symptoms.

    In practice, of course, everybody outside of a medical journal just talks about lactose intolerance, and uses it to embrace all three definitions. Even in medical journals, doctors tend not to make fine distinctions. They use one term and stick to it. (In European, especially Scandinavian, medical journals, doctors will use hypolactasia in place of any of these three terms. The opposite condition is known as normolactasia.) Don't worry about terminology. Use lactose intolerance. Everybody will know what you mean.

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Q. I'm lactose intolerant, but neither of my parents are. If lactose intolerance is inherited, how is this possible?

    Some people produce lactase all of their lives. Others find that their lactase production gradually slows or even stops as they grow older. This is controlled by a gene on the second of the 46 pairs of chromosomes that humans have. There are two forms of the gene, one for lactose intolerance, which we can think of as "stop," and one for continued milk drinking, which I'll call "go."

    One set of each pair of genes comes from our fathers and one set from our mothers. Therefore, a person's individual pair can be one of only four possibilities: Mother stop with Father stop; Mother go with Father stop; Mother stop with Father go; Mother go with Father go.

    The go gene is dominant and the stop gene is recessive. That means that if you have a stop and a go, go always wins. Lactose tolerance is genetically dominant. When you stop to think about it, this has to be true. A mere 10,000 years ago, virtually everybody in the world was lactose intolerant. Today over a billion people are not. For a trait to spread across the world that quickly, it must obviously be dominant, so that it will be transmitted to children even if only one of the parents has it. (Originally the go gene must have appeared through random mutation. If nobody drinks milk as adults, the trait sits there quietly and does nothing. But if adult milk drinking provides even a slight reproductive advantage, as it probably did by providing better nutrition, the trait is likely to spread through that population.)

    With this as background, let's go back to your case. Your mother must have had a stop gene paired with a go gene, making her lactose tolerant. The same with your father. You just inherited the one in four chance of getting the stop half from both your parents, giving you a stop paired with a stop, and making you lactose intolerant.

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