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
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.
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.
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, 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?
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.)
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.
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
section of my web site.
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
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.
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.
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.
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.
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.
Fortunately, you are wrong. If lactose is an ingredient it
must be listed. "Sugar" as an ingredient means sucrose and
sucrose only. Every other sugar must be listed by name. So
Coke and Pepsi do not contain any 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.
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
Q. How should a doctor diagnose
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.
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
screening could test which version of the gene a person has;
I don't know if anyone has ever done so.
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.
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