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Q And A Clearinghouse
2nd Quarter, 1998

Updated July 1, 1998
This page answers the questions that arrived in the second quarter of 1998.

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

Remember, I personally answer all questions that you send me, no matter what. The ones that are of sufficiently general interest get posted here, where I hope they can do the most good.

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


    


Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

    You would think so, wouldn't you?

    But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

    In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

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Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

    That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)

    So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

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Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

    The odd answer is that you are both right.

    Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

    And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

    So?

    So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

    My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

    There. Feel better now?

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Q. Have you heard of anyone's LI symptoms being relieved by birth control pills?

    The problem is that I hear all sorts of anecdotal comments about LI, without ever being able to back them up. I have heard of women becoming LI because of pregnancy and also of women being able to drink milk for the first time while pregnant. I do not, however, know of any studies that would shed any light on the subject. But you are definitely the first to give a connection to bcp's. (However, as all but one brand of bcp's contain lactose as a filler, it's probably not surprising that few people see their symptoms disappear while on them.)
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Q. Our doctor thinks my daughter has irritable bowel syndrome, but with lactose intolerance as a trigger. I'm wondering if I am giving her enough Lactaid. Do you have any thoughts on this?

    While it couldn't hurt, it's not clear that it would do much to help unless you think you are still not detecting all milk products at those meals.

    You might want to go in a different direction. There are numerous other triggers of irritable bowel other than milk. They include: large meals, fatty or spicy foods, carbonated beverages, and caffeine. Gas-producing foods, like beans and cabbage, can also be a problem. So can sorbital, the artificial sweetener. Even some fiber sources, including lettuce, celery, and fruits, may cause gas and bloating. If you detect a pattern of symptoms in conjunction with any of these, try removing it from her diet for a few days and see if that helps.

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Q. How does heat affect lactose? Does baking alter lactose? If I see non-fat milk in a bread label, has the lactose been altered to the point that it no longer poses a problem for me?

    Unfortunately, there is no evidence that heat affects lactose in any way. Lactose in pure form, in mostly pure form (whey) and as a small percentage of other milk products, is used in hundreds of foods and people seem to respond to all of them. Of course, most people do _not_ respond to small amounts of lactose, so size does matter, as they say. But you do need to take lactose into account in any food that it is in.

    To know how much lactose is in various milk products, see the SuperGuide to Dairy or the Lactose Percentages pages in the Dairy section of my web site.

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Q. I have taken lactase several times now and gotten an upset stomach, cramping and bowel pain. I guess my question is: Is it possible to have too much of the enzyme in your system?

Q. Are the Ultra Lactaid pills constipating? Lactaid, by the way, denies any knowledge of this side effect. I called them a couple of years ago and asked.

Q. I now strongly suspect that some brands of pills can themselves cause diarrhea, especially in large doses. Do you have any information on this?

    I've been getting an increasing number of complaints that lactase pills are causing problems. As you can see, though, each person seems to have a different complaint.

    Giving advice on this issue is difficult, because except for some anecdotal complaints such as these, there is nothing in the medical literature about adverse reactions to lactase pills. Nothing. They are some of the most benign pills known to the pharmacopeia.

    So what's going on?

    One or two actual medical problems are known. There is one single case of a person being allergic, not to the lactase, but to the yeast that is used to manufacture the lactase. And a few brands of pills may contain mannitol, an artificial sugar substitute, as an ingredient. Susceptible people are known to get diarrhea from mannitol.

    Other than that, the problem is compounded because people are taking the lactase with meals. So any reaction may come from the meal rather than from the pill. And to make things more complicated, when people try to relieve symptoms or cure a supposed food-based problem, they often make many changes to their regular diet simultaneously. The reaction could come from any or all of these, alone or in combination.

    You might want to consider the possibility that if your system has been producing mild diarrhea for a long time from small quantities of lactose, you've come to think of this state as being "normal." Getting sufficient lactase into your system to eliminate the symptoms would feel much like constipation by comparison. Remember that doctors define a normal amount of bowel movements as anywhere from three times a day to three times a week.

    Or you may be having a psychological reaction to knowing you're about to eat food that contains something you shouldn't have. (Don't scoff. Many studies have shown a strong psychological reaction to milk even in people who do not test out as being LI.)

    It may even be something as simple as having a stomach flu and not realizing it.

    Not very helpful, I admit. All I can say is that you should try several different brands of lactase. Some people simply react better to some brands than to others.

    You might also look at my Lactase page in my LI Basics section. I gave lots of helpful hints as well as answers to what and when and how and how much lactase. You may find something useful there.

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Q. I know I don't get enough calcium, so I take calcium supplements. My question is, is that enough if I were pregnant?

    The answer is, probably. There are lots of other sources of calcium in a diet other than milk products and I have no idea whether you are getting a little, a lot, or none at all, or each of these at different times. It certainly will not hurt to insure that you are getting your full daily requirement, and that increases when you are pregnant in any case. I always recommend that you try to get as much calcium in your diet as possible, and supplement it with a pill to make sure you get enough.
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Q. I have read references to a lactose-tolerance test. What is that?

    There are two basic types of lactose-tolerance test. Both start with a person drinking either a solution of lactose and water or a glass of milk.

    The most common test is called the breath hydrogen test. If you do not digest lactose then the bacteria in your colon will ferment it, producing hydrogen gas. This gas is measured in your breath. Measurements are made at intervals for several hours to see what the peak is. If the peak is higher than a certain amount, you are said to be lactose intolerant.

    Because the breath hydrogen test needs special equipment to measure the hydrogen, some places still use the older blood glucose test. The idea behind this one is that if you do digest lactose, your blood sugar will go up. Therefore blood samples are taken at intervals to measure the glucose level. If it goes up, then you are not lactose intolerant. This makes it an indirect test and so not as sensitive, besides which you get stuck by a lot of needles, both of which have caused it to go out of favor.

    For more info, see my LI Tests page.

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Q. Is vomiting sometimes a symptom of lactose intolerance?

    Normally, no. Vomiting is only associated with LI in extremely young children. Unfortunately, it's impossible to say anything about a single instance of vomiting. It could be caused by almost anything.
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Q. I was wondering if it is typical that symptoms get worse over time and foods that didn't cause a problem before start to be a problem as one ages. Do I need to go to the MD or can I give up dairy on my own and if this works just live without milk?

    Yes, this is very typical. It does not mean that your symptoms will necessarily grow worse year after year, however. The amount of lactose I can eat has stayed the same for many years now.

    I always recommend getting tested by a doctor. There are too many other problems with very similar symptoms that it would be nice to have a doctor eliminate. Having LI is the least serious thing that can go wrong with you.

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Q. Am I wrong but isn't lactose not listed as an ingredient on food packages? Do soft drinks such as Coke, Pepsi etc contain lactose?


    


Q. Spring Valley Prenatal Vitamins have LACTOSE in them! Just shows how important it is to read labels when you have an allergy concern.

Q. Did you know many medicines contain lactose?

    Absolutely. Lactose is an excellent filler to bulk out vitamins and it also makes those nice smooth coatings that make pills easier to swallow, so it gets used a lot in all sorts of medications. Most good companies today list inactive ingredients on the box for over-the-counter products, but of course you don't get to see the packaging on prescription medication, so if you have an allergy, be sure to ask your pharmacist each and every time for the inactive ingredients. You might also take a look at my Lactose in Medications page.

    And my book, Milk Is Not for Every Body: Living with Lactose Intolerance, includes the only complete list of all lactose-containing medications contained in the PDR (Physicians Desk Reference). If you want to order the book go to the The Milk-Free Bookstore section in my web site. There's lots of other crucial stuff in the book as well.

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Q. How does Imodium A-D work inside your body?

    According to the Physician's Desk Reference, Imodium (whose active ingredient is loperamide hydrochloride) acts by slowing intestinal motility and by affecting water and electrolyte movement through the bowel. It inhibits peristaltic activity by a direct effect on the circular and longitudinal muscles in the intestinal wall, prolonging the transit time of the intestinal contents. It reduces the daily fecal content, increases the viscosity and bulk density, and diminishes the loss of fluid and electrolytes.

    Translated, Imodium calms the muscles so that they stop spasming. So instead of your feeling a slurry of water and fecal material straining to get out, your insides have a chance to do their jobs properly. The result is that the material has time to bulk up into a single proper bowel movement instead of lots of little watery ones.

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Q. How should a doctor diagnose lactose intolerance?

    The symptoms of LI are diarrhea, gas, cramps, flatulence, and borborygmi (the rumbling of air through the intestines) after the ingestion of milk products. Any one of a number of tests can be given to a patient to confirm LI. The major tests are the breath hydrogen test (since the bacteria in our colons produce hydrogen gas when they ferment undigested lactose) or the blood glucose test (an indirect test measuring the lack of an increase in blood glucose from the failure to digest lactose). The patient drinks a lactose solution and then either a breath sample or a blood sample is taken at intervals thereafter.

    The problem for a doctor is to determine when LI is the problem and when the symptoms may be coming from any number of other, more serious, diseases and disorders with similar symptoms that the patient may have instead of or in addition to LI. You'll have to ask a real doctor how that determination is made.

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Q. Is lactose intolerance caused by a gene or chromosome? If so, which one? Is lactose intolerance dominant or recessive? Can this be diagnosed through genetic screening or other mechanism?

    Production of Lactase (the enzyme that digests lactose) appears to be controlled by a single gene on chromosome 2. It either stops lactase production with aging or it doesn't, depending upon which version of the gene a person has. The gene that allows a person to continue producing lactase forever is dominant. I would assume that genetic screening could test which version of the gene a person has; I don't know if anyone has ever done so.
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Q. Are bananas considered dairy? I have some of the same symptoms as with milk with them.

    No, nothing that doesn't come from a cow should be considered dairy. But you can have a reaction to almost anything; being LI doesn't make you immune from any of that.
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Q. I was told that molasses is made through a process that contains lactose. Could you tell me if this is true?

    As far as I know, molasses is made from pure cane sugar. Its constituents are glucose and invert sugar, which is a mixture of glucose and fructose. (Honey is also mostly invert sugar.) None of these sugars are related in any way to lactose, except that they are all sugars. Making molasses is about as straightforward as making maple syrup, and I have never heard of any process involving lactose. That doesn't mean that none exists, but I have my doubts.
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