Lactose Intolerance

Lactose is the major sugar found in milk and milk products. Lactose intolerance is the inability of a person to digest significant amounts of lactose (e.g. 250 ml of milk).
Lactose intolerance is caused due to lack of enzyme lactase produced by the cells of the small intestine. Lactase converts lactose into the simple forms of sugar, glucose and galactose, which can be absorbed and used by the body.

Infants have the highest levels of lactase to digest their mother's milk but in about 75% of people by adolescence lactase levels irreversibly decrease after weaning, due to a genetic trait. By adulthood, lactase activity is almost lost still not everyone has symptoms of lactose intolerance after consuming normal amounts of lactose.

Whether or not people develop symptoms appears to be linked to the ability of a certain type of beneficial intestinal bacteria, called lactic acid bacteria, to break down lactose. Some people may have more lactic acid bacteria in their intestines than others, so they don’t develop symptoms.

People who develop symptoms are said to have lactose intolerance.

Symptoms –
• Gas
• Cramping
• Abdominal pain
• Nausea
• Bloating
• Diarrhea
The undigested Lactose in the intestines causes diarrhea, because of the excessive amount of water that is drawn into the intestines by lactose. The undigested lactose in the colon (the large intestine) is broken down by bacteria into Lactic acid and other acidic chemicals. It is these products that create the symptoms of lactose intolerance. Hydrogen is produced, causing gas and bloating. These symptoms may occur 30 minutes to two hours after ingesting lactose-containing foods or late as it takes more than four hours for any food to reach colon. The severity of symptoms usually depends on the amount of lactose ingested and how much of the enzyme, lactase, remains in the intestinal tract.

Diagnosis – Do-It-Yourself Test - Since lactose intolerance is not a serious disorder, people test themselves at home. First, avoid milk and lactose-containing foods for several days. Then on a holiday morning drink two large glasses of skim or low-fat milk (400 – 500 ml) and take nothing else. If symptoms develop within four hours, the diagnosis of lactose intolerance is fairly certain.
In most cases the physician diagnoses simply by reviewing the patient's medical history. 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, then the blood sugar level rises. If the blood sugar level does not change means no lactase is present.

Hydrogen Breath Test - When lactose is broken down by the colonic bacteria, hydrogen is released, which then passes out through the lungs. The amount of hydrogen released after a lactose meal can indicate the 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.
In cases of recently developed lactose intolerance it is important to consult with physician. Lactose intolerance can also be caused by medications or by an underlying condition that damages cells lining the intestines, such as:
• Crohn's disease
• Celiac disease
• Giardiasis
• HIV enteropathy
• Carcinoid Syndrome
• Diabetic gastropathy
• Zollinger-Ellison syndrome
• Alcoholism
• Iron Deficiency

Treatment –
Homoeopathic Medicines – There are many homoeopathic medicines indicated in milk and dairy product intolerance and symptoms arise as a result of it. For successful prescribing a particular medicine in a particular situation Law of similia is to follow. However, some of the symptomatically indicated medicines are listed here –
Acid nitricum, Aethusa cyn., Angustra vera, Belladona, Bryonia, Bufo, Calcarea carb., Carbo veg., China, Conium, Cuprum met., Iris ver., Lac – defloratum., Lycopodium, Magnesium carb., Magnesium mur., Magnesium sulph., Natrum carb., Raphanus, Silicea, Sulphuric acid, Sulphur are a few but other medicine may be found indicated.
If diarrhea, flatulence and distention is prominent Carbo veg. or Conium should tried.
Crampy pain indicates Sulphur, Lac defloratum, Bufo, magnesium sulph. and Nitric acid.

Diet – As digestion of lactose depends mostly on the bio-environment of intestines, some of the dietary measures very effectively keep the condition under control. For mild symptoms avoiding large amounts of milk and milk products may be enough. Those who are very sensitive to small amounts of lactose should check all foods carefully for lactose. Items such as bread, baked goods, cereals, instant potatoes (packed and ready to cook), soups, margarine, lunchmeat, salad dressings, pancakes, biscuits, cookies, and candy can contain certain amount lactose. Even certain drugs and Homoeopathic medicine may contain lactose.
Milk is a major source of calcium and calcium is necessary for good health and strong bones. Normal requirement is 1000 mg of calcium a day but pregnant and nursing females require 1200 mg per day and post-menopausal females 1500 mg per day. So, sometimes calcium supplement is required.

Some dietary strategies for people with lactose intolerance include:
• Drink one cup or less of milk at a time
• Eat milk and milk products with meals rather than alone
• Try reduced-lactose milk
• Try yogurt (known as curd in India) instead of milk
• And the most important is to add sufficient green vegetables in daily diet. Green turnip and leaves, broccoli (fresh phool gobhi and its leaves), cabbage and other green leafy vegetable can fulfill about 50% of daily requirement.


Acidophilus and Probiotics
(Probiotics are defined as ‘mono- or mixed cultures of live micro-organisms which, when applied to animal or man, beneficially affect the host by improving the properties of the indigenous microflora.)

Acidophilus is one of the lactic acid bacteria in the intestines which break lactose down into short-chain fatty acids and other substances that can be absorbed by the colon.

Lactic acid bacteria are available as dietary supplements in the form of capsules, tablets, or powders.
The bacteria commonly used for lactose intolerance include:
• Lactobacillus acidophilus
• Lactobacillus bulgaricus
• Streptococcus salivarius
• Lactobacillus reuteri
• Lactobacillus plantarum
• Streptococcus thermophilus

Studies have found that probiotics reduced breath hydrogen levels but not in all cases. Same is the case with the symptoms studies show both positive as well as negative results. A significant reduction in symptoms may be possible if the right type of bacteria in the right amount is used.

Yogurt (Dahi or popularly called Curd in India) -
Although yogurt is a milk product, many people with lactose intolerance do not experience symptoms after eating yogurt, even the kind that doesn't contain live active bacteria. Bile acids disrupt the bacterial cell wall thus release the enzyme beta-galactosidase (related to lactase) which enhances lactose digestion in the intestines.

Acidophilus Milk
Acidophilus milks are made by adding Lactobacillus acidophilus to cold milk. Though many studies have found no improvement in lactose digestion with it, may be due to insufficient amount of bacteria.

Lactase Supplements – Lactase supplements are only needed for larger quantities of lactose. Tablets containing lactase can be taken with lactose-containing foods.

Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H.Research Officer
Sewa Mandir
Mobile" 09829157926
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in