Got Milk But Can’t Stomach It? [الأرشيف]

Houssam

10-07-05, 01:22 AM

<H2 style="MARGIN: 0in 0in 0pt">Got milk but can't stomach it?<O:P></O:P></H2>
What you need to know about lactose intolerance<O:P></O:P>
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<H4 style="MARGIN: auto 0in"> By S. Jhoanna Robledo<O:P></O:P></H4>
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For as long as she can remember, Sheeba Cook, a financial analyst who lives in suburban Detroit, had to find other ways to indulge her sweet tooth besides digging into a bowl of ice cream. She liked the tasty treat, but felt uncomfortable after eating it. "My stomach churns, I have diarrhea and I feel kind of sick," she says. She experienced the same symptoms when she ate too much cheese or other dairy products; only skim milk in small doses didn't have that effect. <O:P></O:P>
Cook finally put two and two together: "I realized I was lactose intolerant," she says. <O:P></O:P>
She's not alone: About 90 percent of Asians (Cook is of Indian descent) are lactose intolerant, as are about 70 percent of African-Americans and Native Americans. Caucasians fare better, with only up to 20 percent exhibiting symptoms. <O:P></O:P>
According to Dr. Sheila Crowe, associate professor of internal medicine at the University of Virginia and spokesperson for the American Gastroenterological Association, a person develops lactose intolerance when the body doesn't produce enough lactase, an enzyme found in the small intestine that helps digest lactose — milk sugars made up of galactose and glucose — for absorption into the bloodstream. Without sufficient lactase, the milk sugar passes through the stomach undigested and reaches the large intestine where it ferments, causing some people to experience abdominal pain, bloating, gas and diarrhea. Contrary to popular belief, says Crowe, lactose intolerance isn't technically an allergic reaction to milk; rather, it’s the body's inability to break down certain ingredients. <O:P></O:P>
People with lactose intolerance experience symptoms as early as 30 minutes or up to several hours after consuming foods or drinks that contain lactose. Like Cook, they usually develop diarrhea but may also feel crampy, gassy or bloated. Severity varies, depending on how intolerant a person is: You may react to just a few sips of milk, while others may be able to handle multiple servings. The condition isn’t considered serious, but it can be distressing. "[I make] too many trips to the bathroom and [spend] too much time dealing with it," says Carrie Wheadon, an editor in Berkeley, Calif., who has the condition. <O:P></O:P>
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Roots of intolerance
At birth, says Dr. Douglas Seidner, a gastroenterologist at the Cleveland Clinic, most everyone is able to digest milk sugars. At age five, though, those who go on to develop lactose intolerance begin to produce smaller amounts of lactase in their body; eventually, there isn't enough of the enzyme to be found on the intestinal surface. No one knows for certain why some people become intolerant and others don't, although there's a strong genetic component to the condition. Some researchers believe that all humans were once lactose intolerant, and that "lactase persistence" may have evolved only after people domesticated animals and began drinking their milk.<O:P></O:P>
While anecdotes proliferate linking lactose intolerance to gastroesophageal reflux disease, a malady often characterized by severe heartburn, experts say there's no causal link between the two. "I've never heard about people with lactose intolerance being more predisposed to GERD," says Dr. Philip Jaffe, associate professor of medicine at the University of Connecticut Health Center. Sometimes, he says, patients mistake the bloating they feel after consuming milk products for heartburn, but it's a bloating that's localized in the intestinal area, not the upper stomach and chest where GERD usually manifests itself. <O:P></O:P>
However, lactose intolerance is commonly confused with irritable bowel syndrome (IBS), a painful disorder in which the large intestines malfunction. "Lactose intolerance is one of the great imitators of IBS," says Jaffe. The symptoms are similar, and some patients mistake one disorder for the other. <O:P></O:P>
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Diagnosing a problem
The simplest and most common way to diagnose is by exclusion, says Seidner. "We tell patients to avoid dairy products for a period and then reintroduce it slowly to see what they experience."<O:P></O:P>
While some sufferers self-diagnose, Seidner says it's best to consult with your physician as there may be other food ingredients that could be causing you problems. <O:P></O:P>
Digestive-disease experts also frequently employ the hydrogen breath test. In this outpatient procedure, patients curb their intake of dairy foods and then drink a beverage loaded with lactose. Afterward, they blow into a balloon-like contraption; the exhaled air is evaluated for increased levels of hydrogen, which usually exist if the patients are intolerant. <O:P></O:P>
In rare instances, doctors use a stool test to measure acidity. But, says Seidner, "this test isn't very specific." Consequently, it's now rarely relied on to arrive at a definitive diagnosis. <O:P></O:P>
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Prevention and management
While people newly diagnosed with lactose intolerance may be tempted to forgo dairy entirely, doctors say there's no reason to do so. For one, the food group is high in calcium, a nutrient that's essential for maintaining bone health — especially in women who are at a higher risk for developing osteoporosis. Also, most people who are intolerant can handle a certain amount of lactose in their systems; determining just how much — or how little — can be achieved by simple trial and error. "Most people can get away with eating smaller portions," says Dr. Christine Gerbstadt, a spokesperson for the American Dietetic Association. <O:P></O:P>
Rather than skip dairy products altogether, pay attention to what Gerbstadt calls "lactose load." Milk is a frequently cited culprit, but ice cream may be the hardest to process, as it's high not only in lactose but also in fat, which can irritate the digestive system. If you must indulge, you can try adding lactase, an additive available at most drugstores and health-food stores, in your meals. Lactose-reduced products, such as Lactaid milk, are also readily accessible at local supermarkets. Yogurt and cheese, especially hard cheese such as Parmesan and Romano, are easiest on the gastrointestinal system because they contain only small amounts of lactose. Be sure to read labels, which will tell you how much, if any, lactose is present; ask the staff at restaurants about the ingredients in the dishes they serve. "Most people don't realize restaurants add butter" — which is rich in lactose — "to everything," says Wheadon. <O:P></O:P>

If you're severely lactose intolerant (which is quite rare) and must avoid dairy products altogether, be sure to incorporate calcium-rich foods in your diet, such as calcium-fortified orange juice or milk, tofu, almonds and green vegetables. "It's not easy for the body to absorb calcium from these sources, however," cautions Gerbstadt, so eat as much of them as you can. <O:P></O:P>
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S. Jhoanna Robledo Wade is a health writer based in New York.<O:P></O:P>
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