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Lactose Intolerance

Lactose intolerance is a condition that affects 30-50 million Americans.  This condition is characterized by the inability to digest lactose--the predominant sugar found in milk.  This inability is due to a lack of lactase, the enzyme produced in the small intestine, which is responsible for breaking down lactose.

Symptoms

Symptoms of lactose intolerance include:

bulletnausea
bulletcramps
bulletgas
bulletdiarrhea and bloating

These symptoms usually occur 30 mins. to 2 hours after eating or drinking substances that include lactose.  The severity of your symptoms will depend on the amount of lactose you ingest and your personal tolerance.  Each individual is different.

Lacotse intolerance can be cause by a variety of factors.  Certain digestive diseases and injuries to the small intestine can prevent the production of the enzyme lactase.  Some infants are born without the ability to produce this enzyme.  In many cases, the body naturally decreases its production of lactase after the age of 2; although, symptoms may not arise for several years afterwards.  Ethnicity is also a major factor.  Approximately, 75% of African Americans and Native Americans and 90% of Asians suffer from lactose intolerance.

Diagnosis

There are three types of procedure used to diagnose lactose intolerance:

bulletLactose Intolerance Test: after a period of fasting, the individual will drink a fluid containing lactose.  After a period of time the amount of glucose (blood sugar) present in the blood will be measured.  Lactose is broken down into glucose; therefore, a lack of glucose will confirm a lactose intolerance diagnosis.
bulletHydrogen Breath Test: normally, there is very little hydrogen present in the breath.  When ingested, undigested lactose ferments in the body cause the release of gases including hydrogen.  The hydrogen is then absorbed into the blood and exhaled by the lungs.  Therefore, an increase in hydrogen also can confirm a lactose intolerance diagnosis; although, this procedure can be inaccurate due to certain foods, medications or cigarettes.
bulletStool Acidity Test: lactose intolerance tests and hydrogen breath tests cannot be given to infants and small children because of the harmful effects high dosages of lactose can have on them.  Therefore, a stool acidity test can be used to measure the amount of lactic acid and other short-chain fatty acids that are present in the stool.  These forms of acid are produced when undigested lactose ferments in the body.  This test may also measure the presence of glucose in the stool which has not been absorbed by the colon.

Treatment

There is no treatment that can make the body produce more lactase enzyme.  Therefore, treatment is used to alleviate the symptoms associated with ingesting lactose.  Small children and infants who could be lactose intolerant should not ingest foods which contain lactose.  Mothers may choose to substitute soy formula for dairy milk.  The ingestion of dairy products by adults differs depending on the tolerance of the individual.  Through trial and error of foods and amounts, one can gain a handle on his/her ability to naturally ingest lactose.  To assist in the digestion of lactose there are several lactase enzyme supplements available without a prescription.  There are also plenty of products including lactose-reduced milk available in the supermarket.

Dairy is a major source for vitamin and minerals--especially calcium.  A lack of calcium in the diet can result in a thinning of the bones later in life--a condition called osteoporosis.  People with lactose intolerance who are avoiding dairy products should supplement their intake of calcium.  In 1997, the Institute of Medicine published new guideline for an individuals intake of calcium based on age:

Age group

Amount of calcium to consume daily, in milligrams (mg)

0-6 months

210 mg

6-12 months

270 mg

1-3 years

500 mg

4-8 years

800 mg

9-18 years

1,300 mg

19-50 years

1,000 mg

51-70+ years

1,200 mg

Pregnant or nursing women under the age of 19 should consume 1,300 mg of calcium daily.  Pregnant or nursing women over the age of 19 should consume 1,000 mg daily.

There are other types of non-dairy food that are also a great source of calcium such as broccoli and kale or fish with soft, edible bones such as salmon or sardines.

Here is a chart containing several types of food, both dairy and non-dairy along with amounts of calcium and lactose present in each:

Calcium and Lactose in Common Foods

  Calcium Content Lactose Content
Calcium-fortified orange juice,
1 cup
308-344 mg 0
Sardines, with edible bones,
3 oz.
270 mg 0
Soymilk, fortified, 1 cup 200 mg 0
Salmon, canned, with edible bones, 3 oz. 205 mg 0
Broccoli (raw), 1 cup 90 mg 0
Pinto beans, 1/2 cup 40 mg 0
Orange, 1 medium 50 mg 0
Tuna, canned, 3 oz. 10 mg 0
Lettuce greens, 1/2 cup 10 mg 0
 
Dairy Products
Yogurt, plain, low-fat, 1 cup 415 mg 5 g
Milk, reduced fat, 1 cup 295 mg 11 g
Swiss cheese, 1 oz. 270 mg 1 g
Ice cream, 1/2 cup 85 mg 6 g
Cottage cheese, 1/2 cup 75 mg 2-3 g
Adapted from Manual of Clinical Dietetics. 6th ed. American Dietetic Association, 2000; and Soy Dairy Alternatives. Available at: www.soyfoods.org. Accessed March 5, 2002.

Vitamin D is another mineral which is essential to proper nutrition.  It also aids the body in absorbing calcium.  Eggs and liver are great sources of Vitamin D; yet, sunlight causes the body the synthesize this vitamin naturally.  With enough sunlight, food and vitamin supplements for Vitamin D may not be necessary.

Finally, if you are lactose intolerant, you should read the ingredients of food products in order to find the "hidden" lactose that may be present in many non-dairy, processed foods.  Look for key words like whey, curd, milk by-products, dry milk solids and nonfat dry milk powder--products with these ingredients contain lactose.  Also, approximately 20% of prescription drugs, 6% of over-the-counter medications and some birth control pills use lactose as a base; although, this usually only affects individuals who are severely lactose intolerant.

Consult a physician or dietician before ingesting dietary supplements.  These substances, if taken incorrectly, can be very harmful to your health.  It is possible to gain all the nutrients your body needs with only minor adjustments to your diet.

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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