Tuesday, March 15, 2005

Lactose intolerance in a nutshell

The piece below is simply a reprint of an OC Register article, back before my blog really got going and I didn't yet know what I wanted to do with it. But later, I added some thoughts in the famous K-blog, Marmot's Hole, which can be found here. Just do a search for "kushibo" and you can see what I wrote.

I have added a piece that explains—through semi-fictional dramatization—my own problems with lactose intolerance.


When milk bites back

The Orange County Register

Imagine munching on cookies without a tall glass of cold milk. Or passing up the scoop of ice cream on a warm piece of peach cobbler.

That was Mary Anne Foo 10 years ago.

She mostly avoided food and drink made with milk, cheese or other dairy ingredients.

The creamy clam chowder may have been heavenly, but the price she paid later was agony: gas, bloating, diarrhea and cramps so intense she sometimes fainted. These are symptoms of lactose intolerance, a condition in which the body lacks the enzyme to digest lactose, the predominant sugar in milk.

But these days, the 38-year-old executive director for the Orange County Asian and Pacific Islander Community Alliance in Garden Grove can have her cheesecake and eat it, too. More products are available to enable the lactose-intolerant to eat and drink milk products again.

There's also a greater awareness of lactose intolerance � so much that sufferers say they're less or no longer embarrassed to admit they have it.

That's welcome news to the approximately 50 million people in the United States who have this common condition. Researchers estimate that among the U.S. population, lactose intolerance affects 90 percent of Asians and 75 percent of blacks, native Americans, Jews and Hispanics. It's less prevalent among those of Northern European descent.

What's available to them that wasn't around a decade ago?

Low- or no lactose
First, there is a wider variety of milk, cheese and yogurt products with reduced or no lactose.

Milk formulations include skim, low-fat, reduced fat, plain or flavored. Organic-milk distributors such as Organic Valley and Horizon have gotten in on the act with organic lactose-free or lactose-reduced milk.

Foo and others said that these milk products tend to taste sweeter than those with lactose, but it's a matter of getting used to it.

Next, there are more supplements to help people digest lactose. These pills come in various strengths. They contain lactase, an enzyme that helps break down lactose into two simple sugars - glucose and galactose - that are more easily digested. The pills are taken with the first bite of food or sip.

Two relatively new products, DairyCare and Digestive Advantage capsules, are supposed to be an improvement. They're taken once a day. They contain live Lactobacillus acidophilus cultures — friendly bacteria that can help the body digest lactose.

Another product, Lactagen, claims to increase tolerance to lactose and stop the uncomfortable symptoms in a 38-day conditioning regimen. The program involves eating yogurt with live cultures and having meals with a special formula containing ingredients that promote growth of friendly bacteria.

"The supplements taste chalky and sweet, so I buy those that I can just swallow and not chew," said Foo, who is of Chinese and Japanese descent. The supplements have become a staple among Foo's Asian-American staff and co-workers. "When we go out for Italian and have, say, creamy fettuccine, we pass around a bottle of Lactaid that I keep in my purse," Foo said. "We keep it on the table.

"The joke whenever we eat a meal together is 'Your Lactaid or my Lactaid?' "

The downside of these products: Most lactose-reduced or lactose-free milk is 10 percent to 15 percent more expensive than regular versions. Lactaseenzyme pills cost 23 to 28 cents apiece.

Foo still limits her dairy intake to small amounts because the lactase enzyme pill can only work so far. When eating out, she'll choose a dairy-free appetizer and entree, but take one high-dose lactase pill with ice cream.

The effectiveness of these products varies, depending on the severity of lactose intolerance. Some people may be able to comfortably drink a glass of milk with one lactase pill, while others cannot. There's a lack of published studies on whether these products work, so most evidence is anecdotal.

"Lactose intolerance is permanent by the time you get to adulthood," said Dr. Maria T. Abreu of the American Gastroenterological Association. "There's no evidence that you can turn the ability to digest lactose back on."

Makers of dairy products may promote the importance of getting calcium and vitamin D, but the new lactose-reduced products are less about that and more about people being able to enjoy some of the milk products they had to give up, Abreu said.

Even people who worry about osteoporosis - a condition in which bones become weak and brittle - can get their daily calcium from other sources such as calcium-fortified orange juice or soy milk, sardines, salmon, calcium tablets, and their vitamin D from reasonable sun exposure.

Foo said she's watching for symptoms of the condition in her 5-year old son. So far, he's still able to drink milk, she said, "but it seems to 'help' him go to the bathroom, so I'm keeping an eye on it."

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