From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: Lactose Intolerance. How do you know?
Date: 18 Jul 1995
Newsgroups: misc.health.alternative

In <jwhitlow-1807950402440001@ft191.computek.net> jwhitlow@computek.net
(James Whitlow) writes:

>Can anyone tell me what the symptoms are to lactose intolerance? and what
>can be done about it?


The symptoms are intestinal gas, cramping, bloating, and diarrhea
starting 6-12 hours after drinking more than the equivalent of a cup of
milk.   Lactose intolerance is nearly universal in those of Asian
heretage, and is quite common in those of African heratage.  It is also
seen not infrequently in caucasions.  However, the rule that "the
blonder you are, the less likely you are to have it" holds pretty well.

   Less than a cup of milk rarely causes symptoms in anyone, even if
they have no lactase.  Yogurts don't produce as powerful an effect,
since some of their lactose is digested.  Kefirs and cheeses usually
produced much less effect also, since most of their lactose is gone.

What can be done about it is 1) quit drinking milk or eating large
amounts of dairy, or, 2) Buy some enzyme (such as Lact-Aid) in your
health food store.  The enzyme works much better added to milk than
taken with meals in tablets (which you can also do).  For optimal
results you add the enzyme to milk in your refrigerator (a one gallon
jug with one cupful removed, say), mix it well, and let it sit 2 or
even 3 days before drinking.  That will wipe out 99% of the lactose.
The milk tastes a bit sweeter, but otherwise you cannot tell the
difference.  Calorie and nutritional value is unchanged.

                                          Steve Harris, M.D.

From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: Lactose Intolerance. How do you know?
Date: 21 Jul 1995
Newsgroups: misc.health.alternative

In <3uosd0$gvq@orchard.la.locus.com> "R.R. Butte" <rrb@locus.com>
writes:


>sbharris@ix.netcom.com <...> wrote:
>>In <...> jwhitlow@computek.net <...> writes:
>>>Can anyone tell me what the symptoms are to lactose intolerance? and
>>>what can be done about it?
>>
>>The symptoms are intestinal gas, cramping, bloating, and diarrhea
>>starting 6-12 hours after drinking more than the equivalent of a cup of
>>milk.
>Not from my experience.  As little as a tablespoon will set me off. And in more
>like an hour or two.


Well, what can I say?  It's not like this problem hasn't been
extensively studied, and milk tolerance of people who really do have
total deficiency of lactase is much larger than a tablespoon (which is
why they use tens of grams of pure lactose in the challenge tests, not
a few hundred milligrams).  Talk to nearly any person of Asian
descent-- they will tell you that half a cup of milk, and surely a
tablespoon (1/2 oz) in coffee, does nothing to them.  The only
explanation I can come up for your hypersensitivity is: 1) you have an
intolerance to more than lactose, and/or 2) some of your intolerance has
a psychological component.

   To find out about the second, I would prepare some lactose free milk
and some normal milk (say a glass of each, using a lot of enzyme), add
some ovaline so you cannot tell them apart by sweetness, label them
Heads and Tails arbirarily without telling anyone which is which (but
recording it), and then have a friend or family memember flip a coin and
give you an unlabled 2 oz of one or the other based on the toss, without
telling YOU whether you got the "Heads" or "Tails" milk (but recording
it in HIS/HER log).  This is a pretty good approximation of a double
blind test, if you do it exactly as I describe.  Repeat this a couple of
times on different days (I suggest at least 6 times).  You'll have to
re-label samples each time, using the coin flip, so the same thing isn't
always Heads or Tails.  I will bet money you will either have a
significant reaction to treated milk, or have a mild or absent reaction
even to untreated milk.   In short, when you break the code using BOTH
your records and those of your partner to figure out what you got (and
you'll have to use both, of course), and then compare your reaction with
and what you really got, you won't be able to find any relationship.

If you have a junior high or high school kid, BTW, this should make a
great science fair project:  A double blind evaluation of a parent's
lactose intolerance.  It'll impress the judges no matter what you find.

                                            Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Carbohydrate content of yogurt and Lactaid?
Date: Sat, 13 Sep 1997
Newsgroups: sci.med.nutrition

In <341bcdcb.13445310@news.campus.mci.net>
djohns@peachnet.campus.mci.net (David Johns) writes:

>I was looking at a carton of Lactaid today, and it listed something like
>12 grams of carbohydrate per cup (about the same as normal skim milk) but
>said there is no lactose.  There were no other sources of carbohydrate
>listed in the ingredients.  So what's the story?  Have they changed the
>lactose to another form of sugar?


   Yes.  Lactaid treated milk has no lactose.  It has been changed to a
nearly isocaloric amount of glucose and galactose.   That's what
lactase does.   BTW, since glucose+galactose is a bit sweeter than
lactose for the same weight, lactaid-milk is a bit sweeter than
regular.

                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Increase in allergies, asthma, lactose intolerance
Date: Sat, 20 Sep 1997
Newsgroups: alt.support.menopause

In <342402A9.D2E@sirius.com> Coad & Scott <coad@sirius.com> writes:

>If you don't want to supplement, aside from using the proces-
>sed (fermented) milk products above, there's Lactaid.  I've
>only seen whole pre-treated milk, but the tablets work.
>
>Stacy Scott



   Yep.  Probably the most effective option (in terms of fraction of
lactose pre-digested) is to pretreat your own milk with Lactaid drops.
Just mix it into your milk and let it "marinate" in the refrigerator a
day (or better, two days).  The only difference you'll notice is that
the milk will be a tad sweeter.
                                     Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Lactase
Date: 30 Jan 1999 03:50:14 GMT

In
<32F7A28E5F97552B.D067DD7FC05031D8.228925B16026DC4C@library-proxy.airne
s.net> jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:

>On Fri, 29 Jan 1999 09:29:16 -0500, Andrew Chung <achung@emory.edu>
>wrote:
>
>>> For people who have
>>> lactase produced naturally in their GIT, where is lactase produced?
>>
>>pancreas
>
>Actually, lactase, along with all the other monosaccharidases, is
>produced by the small intestine.
>
>--
>Jonathan R. Fox, M.D.



   Disaccharidases, you mean, of course.  They are produced by the
small intestine, but not released by it, interestingly.  The enzymes
are struck in the walls of intestinal villus cells.  They cleave the
sugars as they are caught, and monosaccharides are released again.  A
second transporter then grabs the monosaccarides and carries them
through into the cells.  This process is slower than the hydrolysis for
all sugars but lactose (so oligosaccharides are absorbed as fast as
simple sugars, in general-- part of why starch and maltodextrin have
the same glycemic index and action as simple glucose).

   With lactose, hydrolysis is slower and rate limiting, even in
creatures that have it.  In part, the problem is competition with
absorbtion of glucose and galactose (which use the same transporter)
which are the fastest of all of the monosaccaride uptake systems.  If
you don't have disaccharidase, you don't absorb the intact
disaccharide.   Commercial enzyme preparations (Lactaid, etc) cleave
the sugar in the lumen of the gut to monosaccharides, which are
absorbed by the monosaccharide transporters.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: lactose intolerance
Date: 16 Feb 1999 09:13:47 GMT

In <36c7f7e7.1716805@news.carnet.hr> me@usa.net writes:
>
>I've read that in lactose-intolerant people lactose gets fermented to
>fatty acids and gas. Now I wonder: do these acids get absorbed into
>blood or not? Thanks.



   No, probably not.  It all happens in the colon (bacteria do it), and
the colon is pretty much impermiable to everything but water.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: 14 Mar 1999 08:31:03 GMT

>enCycLoPedic wrote:
>
>> I am a 52 year old, lactose intolerant male.  I am too fond of milk to
>> eliminate it from my diet--I drink almost a gallon a week.
>> 
>> Too much lactase enzyme causes its own set of problems, so I take just
>> enough to ameliorate my symptoms.  I am left with chronic mild symptoms
>> from my lactose intolerance.


    I know of no "problems" from too much lactase enzyme.
Nevertheless, the difference between enzyme-tretaed milk with a little
lactose and milk with none, is just time.  I suggest you either buy 99%
lactose-free milk off the shelf (it's available), or else follow the
directions on your Lactaid drops, and let the milk sit in the
refrigerator an extra two days before drinking.  It comes to the same
thing.

                                      Steve

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: 15 Mar 1999 09:31:30 GMT

In <slrn7ep6jg.v3.boojum@hp.localdomain.us> boojum@ibm.net
(enCycLoPedic) writes:

>On 14 Mar 1999 08:31:03 GMT, Steven B. Harris <sbharris@ix.netcom.com> wrote:
>
>>    I know of no "problems" from too much lactase enzyme.
>
>I develop painful cramps, gas and constipation when I take an "adequate"
>amount of lactase.  Symptomatically, too much is worse than too little.


    Well, what can I say?  You're an anomally, and I can't think of any
medical reason why this should happen.  Have you tried the tablets
alone with no milk to see what they do to you?




>>Nevertheless, the difference between enzyme-tretaed milk with a little
>>lactose and milk with none, is just time.  I suggest you either buy 99%
>>lactose-free milk off the shelf (it's available), or else follow the
>>directions on your Lactaid drops, and let the milk sit in the
>>refrigerator an extra two days before drinking.  It comes to the same
>>thing.
>
>I am not sure I follow.  Are you saying that not totally surpressing the
>symptoms with adequate lactase *is* harmful, even in a mild case of
>lactose intolerance?  By mild, I mean that even with no lactase, I get
>only mild to moderate symptoms from a glass of milk with a meal.

    I'm assuming that if you have lactase deficiency, any residual
lactose you eat has the chance to cause symptoms.  Getting rid of it is
not necessarily a matter of using more enzyme, so much as letting the
same amount work longer.


>(Incidentally, I normally use lactase tablets because I need
>portability.)


    Well, can't help you there.  If you drink your gallon of milk a day
at lunch time and don't use much from the refrigerator at home, then I
guess you're stuck.  Likewise if you travel and must drink milk on the
road, and can't find any larger stores with 99% lactose free product in
stores.

   Look-- there are three different solutions to this problem, and you
reject two of them, and have a problem with the third that nobody else
I've ever seen or read about, has.  You may be one of those people who
is just chronically unhelpable.

                                      SBH

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: Mon, 15 Mar 1999 17:46:42 GMT

On 15 Mar 1999 09:31:30 GMT, sbharris@ix.netcom.com(Steven B. Harris)
wrote:

>In <slrn7ep6jg.v3.boojum@hp.localdomain.us> boojum@ibm.net
>(enCycLoPedic) writes:
>>
>>On 14 Mar 1999 08:31:03 GMT, Steven B. Harris <sbharris@ix.netcom.com>
>wrote:
>>
>>>    I know of no "problems" from too much lactase enzyme.
>>
>>I develop painful cramps, gas and constipation when I take an "adequate"
>>amount of lactase.  Symptomatically, too much is worse than too little.
>
>
>    Well, what can I say?  You're an anomally, and I can't think of any
>medical reason why this should happen.  Have you tried the tablets
>alone with no milk to see what they do to you?

One question that comes to mind is:  Have you really been diagnosed
with lactose intolerance, or is this a presumptive diagnosis?  Most
cases of self-diagnosed lactose intolerance aren't really lactose
intolerance.

--
Jonathan R. Fox, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: Tue, 16 Mar 1999 05:17:27 GMT

On 15 Mar 1999 18:45:36 GMT, boojum@ibm.net (enCycLoPedic) wrote:

>On Mon, 15 Mar 1999 17:46:42 GMT, Jonathan R. Fox
><jrfox@no.spam.fastlane.net.no.spam> wrote:
>
>>One question that comes to mind is: Have you really been diagnosed
>>with lactose intolerance, or is this a presumptive diagnosis?  Most
>>cases of self-diagnosed lactose intolerance aren't really lactose
>>intolerance.
>
>Good question.  By the time I started seeing a physician regularly, in
>the early 1970's (I was in my 20's then), I had a long history of
>chronic recurring diarrhea sometimes alternating with constipation.
>Tests (upper and lower GI, perhaps others) were done at that time to
>rule out organic disease.  None was found so the problem was
>attributed to "spastic colon" a term which I don't think is used much
>anymore, having been replaced by IBS.
>
>I noticed a worsening of symptoms perhaps 15 years ago.  My physician
>at the time did not seem interested or alarmed by that.  It took about
>five years for me to notice that eliminating milk or taking lactase
>tablets reduced my symptoms significantly.  I mentioned that to my
>physician and he replied, "oh, you're probably lactose intolerant".
>Nothing further has ever been done.

This is exactly why so many people believe they are lactose
intolerant, and spend lots of money on lactase pills when they may not
be doing them any good.  Bowel irregularities are so incredibly common
and variable in severity in the same person that a chance improvement
of symptoms on a trial off milk may make the person conclude he is
lactose intolerant.  I personally believe, and a study in the New
England Journal of Medicine some years ago concurs with me, that
trying to do trials on and off of milk and watching symptoms in most
people will not give a reliable answer about their tolerance for
lactose.

You may very well be lactose intolerant, or you may have discovered
the simple fact that the gastrointestinal tract is one of the most
finicky systems in the body, the most sensitive to your psyche, and
the most vulnerable to placebo.  (Which isn't necessarily a bad
thing!)

>If there is a more definitive way to determine whether one is really
>lactose intolerant, I'd like to know about it.  One person in this
>thread suggested my problem could actually be celiac disease and I
>plan to investigate that possibility further.

There is a more definitive way -- a hydrogen breath test after a
lactose challenge.  Metabolism of unabsorbed lactose by colonic
bacteria produces hydrogen gas as a by-product, some of which is
absorbed in the bloodstream, and exhaled.  A more invasive diagnostic
method is to biopsy the small intestine by endoscopy and assay for
lactase.  A biopsy of the small intestine could also rule out celiac
disease.

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: 16 Mar 1999 05:34:02 GMT

In
<3BDF02C8EAC54C3C.0601CC862737B2C0.7690AADEA6FD0F80@library-proxy.airne
s.net> jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:

>One question that comes to mind is:  Have you really been diagnosed
>with lactose intolerance, or is this a presumptive diagnosis?  Most
>cases of self-diagnosed lactose intolerance aren't really lactose
>intolerance.
>
>--
>Jonathan R. Fox, M.D.



   They are in Asians <g>.  Bayes' theorum.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Lactose intolerance harmful?
Date: 16 Mar 1999 05:38:36 GMT

In <36ed4e07@news3.us.ibm.net> boojum@ibm.net (enCycLoPedic) writes:

>I am sorry that it is coming across that way.  Your tips seem sound
>and I will put them into practice for the milk I consume at home.  But
>my question was not "how do I eliminate the symptoms of lactose
>intolerance?" but rather "what harm, if any, results from not
>eliminating the symptoms of lactose intolerance?"
>
>I find gobs of information on how disaccharidase deficiency develops
>and the mechanism by which symptoms develop.  I find gobs of
>information on treatment.  What I don't find is whether untreated or
>undertreated lactose intolerance is harmful.  Unpleasant?  Yes!
>But harmful?  That I (still) do not know.
>
>CLP


   Mild intolerance is not thought to be harmful, since the effects
happen in the bowel, long after all digestion and absorption is
finished.  Indeed, a non-absorbed sugar called lactulose, which does
much same thing in the gut as unabsorbed lactose, is used clinically to
treat constipation (for example, in renal patients who cannot take milk
of magnesia).

    If you get the best results from this kind of thing (ie, you enjoy
the gas...) you might consider eliminating the lactose from your diet
and using lactulose, which you can precisely titrate.   Otherwise, milk
of magnesia is a lot cheaper.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med
Subject: Re: lactose intolerance
Date: Tue, 14 Sep 1999 15:04:45 GMT

On Tue, 14 Sep 1999 09:09:51 -0400, "Lori Houghton"
<houghton@mcmail.cis.mcmaster.ca> wrote:

>What are the symptoms and treatments of lactose intolerance?  I have a
>terrible time after eating cheese but only cheese (cramps, bloating,
>diarhhea) .  Can you be lactose intolerant to only one dairy product?

You do describe the symptoms of lactose intolerance.  Unfortunately
those are also the symptoms of dozens of other conditions, and can
also be seen in completely normal people.

Because of the frequency with which people get these symptoms for a
variety of reasons, and the relative popularity of the diagnosis of
lactose intolerance, it is often self-diagnosed.  However, a study a
few years ago in the New England Journal of Medicine showed that most
self-diagnosed lactose intolerance actually isn't!  This is because
the symptoms are so common that once someone starts looking at lactose
intolerance it's easy to convince himself that it's the cause.

It happened to me when I was in college.  I diagnosed myself with
lactose intolerance because I thought my symptoms were from milk, when
I drank an 8 oz. glass and developed cramping, bloating, and diarrhea
a few hours later.  Eliminating milk from my diet seemed to help.  For
years I avoided milk and recently re-introduced it to my diet with no
problem.  (In retrospect, my symptoms were probably due to my overall
lousy diet, rather than milk!)

It's important to remember that in addition to being prone to many
kinds of direct insults, the gastrointestinal system is also one of
the most finicky in response to any other disturbance.  Everything
from systemic poisoning to viral infections to mental stress can cause
GI symptoms.  This is why it's often very difficult to pinpoint the
cause of an individual's symptoms.

Lactose intolerance is a deficiency of an enzyme called lactase that
lives on the intestinal wall.  This enzyme breaks down lactose so that
it can be absorbed.  If it is not broken down, it makes its way to the
colon where it exerts an osmotic effect, causing diarrhea and
cramping, and it can be fermented by bacteria that lives in the colon,
producing gas.  While not directly harmful to your intestines, the
symptoms themselves can be very disruptive.

Let me also remind everyone that lactose intolerance is NOT an
allergy.  It is an enzyme deficiency.  Allergy involves abnormal
immune responses to an antigen.

Diagnosis is best established by the hydrogen breath test, assuming
you have an appropriate clinical history.  When your colonic bacteria
ferment lactose, they produce hydrogen gas, some of which is absorbed
in the bloodstream and exhaled from your lungs.  After a lactose
challenge, the hydrogen content of your breath is measured to detect
this.

Treatment is simple -- eliminate lactose from your diet or predigest
your lactose.  There are pills that contain lactase that you can take
with lactose-containing foods that will digest the lactose for you.
There are also predigested milk products where the lactose is already
broken down before you drink it.  However, these enzyme supplements
and special foods are expensive.  This is why proper diagnosis is
important.  Spending money on expensive treatments that are not
effective is not the way to go.

I would guess that you do not have lactose intolerance if you don't
have symptoms from milk.  Moreover, cheese generally has relatively
low lactose content compared to milk.  If you really do get symptoms
that really are directly related to your consumption of cheese, you
may have some other form of intolerance for that cheese.

--
Jonathan R. Fox, M.D.