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The Doctors Book of Home Remedies: Lactose Intolerance

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Lactose Intolerance

15 Soothing Ideas

When you drink a glass of milk, do you bloat up with enough gas to float yourself and Phineas T. Fogg around the world in 80 days? When you eat ice cream, could your subsequent intestinal rumblings substitute for the timpani in the 1812 Overture? Does a cheese pizza in your belly produce diarrhea in quantities worthy of a laxative study?

If so, you probably have lactose intolerance. That is, your small intestine doesn't produce enough lactase, the enzyme you need to digest lactose, the natural sugar found in dairy products. Never fear, it's not dangerous.

Nor are you alone in your intolerance. The majority of humans get some degree of lactose intolerance by the time they're 20, according to gastroenterologist Seymour Sabesin, M.D., director of the Section of Digestive Diseases at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois. As many as 30 million adult Americans may have some degree of lactose intolerance. But there's good news. You can have your ice cream and eat it, too. Here's how.

Take the tolerance test. Since most everyone's degree of tolerance is different, you'll want to find out how much of a good thing you can have before you stop enjoying it, says Theodore Bayless, M.D., the director of clinical gastroenterology at Johns Hopkins University Hospital in Baltimore, Maryland.

The obvious thing to do is decrease the amount of milk and dairy products you eat until your symptoms go away.

"Some people are bothered by as little as one-fourth of a glass of milk," he says. "About 30 percent of lactose-intolerant people will get symptoms only after a quart, maybe 30 to 40 percent from a glass."

Don't forget your calcium. "Milk products are a major source of calcium," Dr. Bayless cautions. "Most people should get the calcium equivalent of two glasses of milk daily." If milk is your main source of calcium and you cut back on milk, then you should supplement your diet with substitutes "like Tums, or sardines with bones, or spinach or broccoli," he says. Calcium supplements are another option, as are lactase enzymes, pills, or lactase-treated milk.

Never drink milk alone. "Some people find their symptoms disappear if they take their dairy products with meals," Dr. Bayless says.

Inoculate yourself. It may be worth trying to take just a small amount of milk products each day, gradually increasing the dose to build up your tolerance, Dr. Bayless suggests. Back off if your symptoms reappear.

Eat yogurt. The organisms that make yogurt what it is, also produce lactase to digest the lactose contained in yogurt, says Naresh Jain, M.D., a gastroenterologist in private practice in Niagara Falls, New York. "Secondly, the bacteria themselves also probably break down the lactose in the milk. Most people with lactose intolerance don't have it very severely," Dr. Jain says. "Maybe 70 to 80 percent of all otherwise healthy lactose-intolerant people should be able to tolerate yogurt quite well."

Dr. Sabesin notes that "yogurt has only about 75 percent of the lactose content of an equal amount of milk." That difference, Dr. Sabesin says, may be all you need to be able to tolerate lactose. About 4 to 6 ounces a day is about all you need to keep gas away.

Here are some other tips on yogurt.

Choose regular over frozen. The only problem with frozen yogurt would be if it has been repasteurized, Dr. Jain says. Yogurt is made from pasteurized milk. But sometimes manufacturers repasteurize the yogurt before they freeze it. "This would kill the beneficial organisms that produce lactose," he says. So try to find yogurt that has not been repasteurized.

Choose nonfat. "Fat slows gastric emptying," Dr. Jain says, "Yogurt with fat in it sits in the stomach for a longer time. This means stomach acid may have more of a chance to kill the organisms."

And since lactose digestion takes place in the small intestine, you want your organisms to get there as soon as possible, even if your stomach acid doesn't kill them. Although this is still only a theory, Dr. Jain says, it's probably best to stick with nonfat yogurt.

Eat it every day. "We gave study subjects yogurt on a regular basis every day," Dr. Jain says, "and we demonstrated improvements in their digestion."

Eat yogurt before ice cream. "If you eat yogurt 5 to 15 minutes before you eat ice cream [or other milk products], probably any symptoms of lactose-intolerance would be less," Dr. Jain says.

Add your own lactase. Several companies make lactase enzyme and add it to milk. Or you can buy it in liquid form and add it yourself. Lactaid, using research done by Dr. Bayless and David Paige, M.D., at Johns Hopkins University Hospital in Baltimore, Maryland, makes tablets you can take at the same time as you eat lactose-containing foods. A few drops of lactase liquid in a quart of milk renders the milk flatulence-free with a slightly sweeter taste.

"The only problem is whether you add enough lactase," Dr. Sabesin says. "Each person has a different degree of lactose intolerance, so it's a matter of trial and error." The tablets and drops are available OTC in pharmacies, while supermarkets nationwide carry tummy-ready Lactaid milk. Lactase-treated cheese and cottage cheese are available in some areas.

Try buttermilk. "Buttermilk should be pretty much tolerable," Dr. Jain says. (Despite its name, buttermilk also has less fat and less cholesterol than even 2 percent milk.)

And cheese, too. "Cheese has less lactose in it than milk," Dr. Jain says. Hard cheeses are the best, Dr. Bayless says, because they're fermented the most. Adds Dr. Sabesin, "Swiss cheese or extra sharp cheddar cheese contain only a trace amount of lactose and are thus less likely to produce digestive upset."

Know that acidophilus milk doesn't help. Although acidophilus organisms are highly beneficial for digestion, they colonize the large intestine, notes Jeffrey Biller, M.D., a gastroenterologist at the Center for Pediatric Gastroenterology and Nutrition in Boston, Massachusetts. Lactose digestion occurs in the small intestine, so acidophilus whizzes right on by the lactose.

Beware the fillers. Lactose is a very common filler in many kinds of medication and nutritional supplements. "In some pills and for some people," Dr. Jain warns, there's enough lactose to cause lactose-intolerance symptoms. Read labels carefully. Ask your pharmacist if your medication has a lactose filler.

Call a hotline. Lactaid has a toll-free phone line for questions about lactose intolerance. Phone 1-800-LACTAID.

PANEL OF ADVISERS

Theodore Bayless, M.D., is the director of clinical gastroenterology at the Johns Hopkins University Hospital in Baltimore, Maryland.

Jeffrey Biller, M.D., is a gastroenterologist at the Center for Pediatric Gastroenterology and Nutrition in Boston, Massachusetts.

Naresh Jain, M.D., is a gastroenterologist in private practice in Niagara Falls, New York.

Seymour Sabesin, M.D., is a gastroenterologist and director of the Section of Digestive Diseases at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois.

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