|
|
Intolerance to lactose-containing foods (primarily dairy products) is a common problem in the United States. The prevalence is 7 to 20 percent in Caucasians and as high as 80 to 95 percent among Native Americans, 60 to 75 among Africans and African-Americans, and 50 percent in Hispanics. The prevalence exceeds 90 percent in some populations in Eastern Asia.
Most clinical symptoms of lactose intolerance includes diarrhea, abdominal pain, flatulence or gas after ingestion of milk or milk-containing products. These symptoms have been attributed to low intestinal lactase levels which are enzymes that break down milk and milk products in the small intestine. This enzyme decreases as we get older so it is not surprising that patients tolerate milk and milk products at younger ages but only later in life they have trouble with milk and dairy products. Most patients are often attributed to having irritable bowel syndrome.
To determine whether you have lactose intolerance you could undergo a lactose breath hydrogen test which measures lactose malabsorption. It is a simple to perform, noninvasive test. However, the most cost effective way to determine if you have lactose intolerance is to follow a 10 to 14 day dietary lactose restriction diet (see below)
Commercially available lactase preparations are actually bacterial or yeast enzymes and may reduce the symptoms of lactose intolerance. There are different preparations of lactase supplements – Lactaid, Lactrase, and DairyEase – for people concerned that milk products are a good source of calcium. They may not get enough calcium. Live cultured yogurt is an alternative source of calories and calcium. It may be well-tolerated by many lactose intolerant patients. However, yogurts that contain milk or milk products added back after fermentation (such as many of the commercially available yogurt products in the United States) may produce symptoms. In other patients I usually recommend calcium carbonate for calcium supplementation because it is the cheapest form available, TUMS is popular and effective. Standard preparations containing 500 mg of calcium carbonate equivalent to 200 mg of elemental calcium, which is 20 percent of the USRDA for adults. In infants and young children, liquid calcium gluconate is readily tolerated and available. When complete lactose restriction is recommended, the USRDA for calcium should be provided as a supplement. I would recommend calcium supplementation in excess of 500 mg per day to be given in divided doses.
The absorption of calcium carbonate but not calcium citrate is poor in patients with poor acid production in their stomach. That disease is known as achlorhydria. Although it might seem prudent to take calcium carbonate with meals, since it is often difficult to know who has a lack of acid production, there is some evidence suggesting that taking calcium supplements with meals reduces iron absorption from food by about 50 percent. As a result, I usually recommend that patients take calcium carbonate with a low-iron meal (such as breakfast) to avoid possible iron deficiency. An alternative is calcium citrate (Citracal). Below you will find what I feel is a simple lactose-free diet that you can try for 10 to 14 days to see if your symptoms improve. If your symptoms do improve on this diet, you likely have lactose intolerance and you might wish to consider lactase enzyme supplements and calcium supplements as described above.
[Top]
You Should Know :Dr. Bhandari specializes in digestive disease disorders. He is triple board certified in Internal Medicine, Medical Nutrition & Gastroenterology. He is a highly trained and skilled Endoscopist. |
Download Brochure
|
|
This website has been selected
|
