Download Lactose Intolerance

Lactose Intolerance
Lactose intolerance develops when the body has difficulty digesting whole
and skim milk and other dairy products. Lactose is a milk sugar and like most
sugars, it is broken down by enzymes in the intestinal tract so it can be
absorbed as an energy source. The enzyme that breaks down lactose is called
lactase. When the intestine does not contain lactase, then lactose intolerance
can occur. It is a troublesome and annoying problem, but it is never a serious
one.
Who Has Lactose Intolerance?
As commonly expected, infants and small children have the enzyme lactase so
they can digest mothers' milk. However, during childhood, lactase begins to disappear in many people. Some
ethnic groups are more likely to develop lactose intolerance. By adolescence, it is gone in about 75% of
African-Americans, Jews, Native Americans, Hispanic persons, and in 90% of Asians. So the condition is very
common.
What Are The Symptoms?
When undigested lactose reaches the colon (large intestine), it is broken apart
by bacteria. Lactic acid and other acidic chemicals result. It is these products
that create the symptoms of lactose intolerance. These symptoms include
nausea, abdominal cramps and rumbling, bloating, rectal gas (flatus), and
diarrhea. They usually occur 30 minutes to two hours after ingesting lactosecontaining foods. The severity of symptoms usually depends on the amount of
lactose ingested and how much of the enzyme, lactase, remains in the
intestinal tract.
The Diagnosis
First, the physician reviews the patient's medical history. Sometimes that is enough to determine the problem.
However, to make a definitive diagnosis, one of several tests may be needed:
Lactose Tolerance Test - A test dose of lactose is ingested and blood sugar determinations are made over
several hours. If lactase is present to break down the lactose load, then the blood sugar level rises. If no lactase
is present, the blood sugar level does not change.
Hydrogen Breath Test - When lactose is broken down by the colon's bacteria, hydrogen is released, which
then passes out through the lungs. The amount of hydrogen released after a lactose meal can indicate a problem.
Stool Acidity Test - When lactose breaks down to lactic and other acids in the colon, the resulting acidity can
be detected by a simple measurement of stool acidity.
The Home Do-It-Yourself Test - Since lactose intolerance is not a serious disorder, some people may want to
test themselves at home. First, avoid milk and lactose-containing foods for several days. Then on a free
morning, such as a Saturday, drink two large glasses of skim or low-fat milk
(14-16 oz). If symptoms develop within four hours, the diagnosis of lactose
intolerance is fairly certain.
Treatment
Therapy depends on whether a patient is willing to tolerate the symptoms. If
the symptoms are mild, then avoiding large amounts of milk and milk
products may be enough. For those who are very sensitive to small amounts of
lactose, there are two options. First, all foods should be carefully checked for
lactose. Grocery items such as bread, baked goods, cereals, instant potatoes, soups, margarine, lunchmeat, salad
dressings, pancakes, biscuits, cookies, and candy can contain hidden lactose. Even prescription and over-thecounter drugs may contain lactose. The patient must become a label reader looking for and avoiding "milk" and
"lactose".
The second option is buying milk to which lactase, the enzyme, has been added. Lactase drops or tablets are
also available which can be placed in milk. A pharmacist or food store manager can provide advice. There are
over-the-counter lactase tablets that can be taken with meals to replace the enzyme the body no longer has.
Finally, a variety of lactose-free products are now available in the specialty section of food stores.
Calcium and Lactose
Milk is a major source of calcium and calcium is necessary for good health and strong bones. Most people need
1000 mg of calcium a day, except for pregnant and nursing females (1200 mg per day) and post-menopausal
females (1500 mg per day). The following list from the National Institutes of Health provides some information
on the calcium and lactose contents of food.
For the lactose-intolerant individual, ingesting enough calcium may be difficult. Calcium supplements, such as
calcium carbonate, are often recommended. The decision to take calcium supplements should be discussed with
the physician.
Lactose-Free Low-Lactose Diet
Purpose
Lactose is the simple sugar found in milk and milk products. It can also be found in a variety of other foods and
even as a filler in some pills and capsules. The enzyme lactase, present in the lining of the small intestine, splits
lactose into two simple sugars. These simple sugars can then be absorbed by the body and used as nourishment.
In infants, milk is the main part of the diet, so it is natural and normal for lactase production to gradually
decrease as the diet becomes more varied. This tends to occur in childhood and adolescence in African
Americans, Native American Indians, Hispanics, Arabs, Jews, and Asians. Northern European white races seem
to keep lactase production the longest.
When lactase is absent, lactose passes through the intestine to the colon (large bowel), carrying extra fluid with
it. In the colon, bacteria break down lactose into lactic acid and certain gases. Lactic acid is an irritant and
laxative. It can cause symptoms such as bloating, diarrhea, abdominal cramps, and gas or flatus.
Lactase activity is reduced in people with certain intestinal conditions such as Crohn's disease and celiac disease
(gluten enteropathy). Patients taking certain drugs and alcoholic patients may also be lactose intolerant. Finally,
patients with surgical removal of part of the stomach or a large portion of the small intestine may need to reduce
lactose in the diet.
It is important to remember that while lactose intolerance can cause quite uncomfortable symptoms, it does not
cause damage to the intestine. The purpose of this diet is to eliminate lactose or reduce it to tolerable levels.
Nutrition Facts
Dairy products are important sources of calcium, riboflavin, and vitamin D. Some lactose-intolerant people are
able to tolerate certain dairy products in small amounts, and their diets may provide enough of these nutrients.
However, the physician or registered dietitian may recommend certain vitamin supplements and/or a calcium
supplement for some patients.
Special Considerations
Tolerance of lactose is variable. Some people can eat small amounts of lactose without having symptoms
while others need to avoid it completely.
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Low-lactose diet: generally eliminates only milk and milk products. However, some can tolerate milk
in small amounts (2 oz) throughout the day or as part of a meal. Some can tolerate small amounts of
yogurt. These patients can experiment to find a level of lactose they can tolerate. Some people can
build up their level of tolerance by gradually introducing the lactose-containing foods.
Lactose-free diet: all lactose producst must be eliminated, including foods that are prepared with milk,
both at home and in commercially packaged foods. These people may be able to use 100% lactose free
milk or soy milk. Labels should always be read carefully.
Lactase Digestive Aids and Products: Many people can drink milk in which the lactase has been partially or
completely broken down. The following products may be available at a pharmacy or grocery store.
LACTAID and Dairy Ease enzyme products - check with a pharmacist, registered dietitian, or a physician
for individual guidance on the use of these products.
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Drops: These are added to milk. Five, 10, or 15 drops per quart of milk will generally reduces lactose
content by 70%, 90%, or 99% respectively over a 24-hour period
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Caplets/Capsules: A person chews or swallows 1 to 6 of these when starting to eat foods containing
lactose
LACTAID Milk
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Non-fat or 1% low-fat is 70% lactose reduced
Non-fat calcium-fortified is 70% lactose reduced and 500 mg of calcium per cup has been added
Non-fat LACTAID 100 is completely lactose free
DAIRY Ease Milk
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Available in non-fat, 1%, or 2% low-fat - all are 70% lactose reduced
SOY Milk
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Calcium-fortified soy milk has no lactose, is low in fat and is a good source of Vitamin D.
For more information about these products, call the consumer information number listed on the food label. The
physician, pharmacist, or registered dietitian may also have information about these products or any newer
products now available.
Food Groups
Group
Lactose-Free
Lactose-Containing
Milk & milk products
100% lactose-free milk, soy milk
milk: whole, skim, 1%. 2%;
buttermilk; sweet acidophilus milk;
lactose-reduced milk; evaporated
milk; acidophilus milk; sweetened
condensed milk; instant hot chocolate
and cocoa mixes; cheese
Vegetables
fresh, frozen, and canned vegetables
without added milk or milk products;
tomato paste and purée; tomato and
spaghetti sauces without cheese
creamed or breaded vegetables,
packaged dried potato mixes, tomato
and spaghetti sauce with cheese
Fruits
fresh, frozen, canned, and dried fruits
none
Breads & grains
water-based breads (Italian, French, Jewish
rye), rice and popcorn cakes, graham
crackers, rusks, Pareve-Jewish bakery
products, cooked and dry cereals without
added milk solids, pasta, rice, oats, barley,
cornmeal, bulgar, and other plain grains
the following made with milk or milk
products, breads, rolls, biscuits,
muffins, pancakes, sweet rolls,
waffles, crackers, instant and dry
cereals with added milk products,
some packaged grain mixes,
packaged macaroni mixes
Meat and meat substitutes plain beef; lamb; veal; pork; wild game;
poultry; fish; shellfish; eggs; kosher
prepared meat products; peanut butter;
peas, beans, or lentils (dried, canned or
frozen); all nuts and seeds; tofu
Fats & oils
bacon, butter, margarine without milk
derivatives (whey), salad dressing without
cheese or milk, vegetable oils, olives, most
non-dairy creamers, mayonnaise, gravy
eggs, fish, meat, or poultry (breaded
or creamed); luncheon meats;
sausage; frankfurters; some brands of
egg substitutes and powdered eggs
cream, half & half, sour cream, cream
cheese, chip dips, some types of
margarine, salad dressing with cheese
or milk, whipped toppings
made without milk or milk products
Sweets & desserts
angel food cake, gelatin, fruit ice, fruit
ice cream, ice milk, some brands of
popsicles, fruit roll ups, hard candy, gum
sherbet, soufflé, mousse, pudding,
drops, jelly beans, licorice, fruit pie fillings custard, packaged dessert mixes, milk
chocolate, toffee, caramel,
butterscotch
Beverages
Postum, lactose-free nutritional
supplements (Sustacal, Ensure, Nutren),
vegetable juice, fruit juices and drinks, tea,
carbonated beverages, beer, wine, distilled
spirits (gin, rum, etc.), cocoa powder, most
coffee
Soups
bouillon, broth, meat, or vegetable stock
cream soup, canned and dehydrated
soups; bisques and chowders made with
soup mixes containing milk products
water, soy milk, or 100% lactose-free milk
Miscellaneous
popcorn, plain pretzels, plain potato and
corn tortilla chips, salsa, mustard, ketchup,
pickles, uncreamed horseradish, relish,
sauces made without milk or milk products,
sugar, honey, jams and jellies, maple and
corn syrup, molasses, herbs, spices, salt,
pepper
instant iced tea, instant coffee,
Ovaltine, chocolate drink mixes,
cordials, liqueurs, milk-based
nutritional supplements (Carnation
Instant Breakfast)
cream or cheese sauces, ranch-style
or cheese-flavored snack pretzels or
chips, cheese curls, sugar substitutes
with lactose added, medications and
vitamin/mineral supplements with
lactose added
Sample Menu-Lactose Free
Breakfast
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Lunch
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orange juice, calcium fortified 1/2 cup
oatmeal 1 cup
Italian bread 2 slices
jelly 2 tsp
margarine 2 tsp
coffee 1 cup
sugar 1 tsp
nondairy creamer
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turkey 2 oz
Italian bread 2
slices
mayonnaise 1/2
Tbsp
tossed green salad
1 cup
oil & vinegar 2 tsp
tomato 2 slices
carrot 1
celery 1 stalk
banana 1
lactose-free milk
1 cup
Dinner
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roast beef 4 oz
noodles 1/2 cup
broccoli 1 cup
Italian bread 1
slice
margarine 2 tsp
pear 1
tea 1 cup
lemon 1 slice
sugar 1 tsp
Calories
This Sample Diet Provides the Following
1800
Fat
48 gm
Protein
93 gm
Sodium
1700 mg
Carbohydrates
261 gm
Potassium
3533 mg
This packet was prepared for you by Dr. Aaron J. Burrows
(303) 320-1111