Fortunately, lactose intolerance is relatively easy to treat. No known way exists to increase the amount of lactase enzyme the body can make, but symptoms can be controlled through diet. Small children born with lactase deficiency should not be fed any foods containing lactose. Most older children and adults need not avoid lactose completely, but individuals differ in the amounts of lactose they can handle. For example, one person may suffer symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and swiss, but not other dairy products. Dietary control of the problem depends on each person’s knowing, through trial and error, how much milk sugar and what forms of it his or her body can handle. For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain lactose, lactase additives are available from drug stores without a prescription. One form is a liquid for use with milk. A few drops are added to a quart of milk, and after 24 hours in the refrigerator, the lactose content is reduced by 70 percent. The process works faster if the milk is heated first, and adding a double amount of lactase liquid produces milk that is 90 percent lactose free. A more recent development is a lactase tablet that helps people digest solid foods that contain lactose. One to three tablets are taken just before a meal or snack. At a somewhat higher cost, shoppers can buy lactose-reduced milk at most supermarkets. The milk contains all of the other nutrients found in regular milk and remains fresh for about the same length of time.
Causes of Lactose-controlled Diet
Milk and other dairy products are a major source of nutrients in the basic American diet. The most important of these nutrients is calcium. Calcium is needed for the growth and repair of bones throughout life, and in the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily (a condition called "osteoporosis"). A concern, then, for both children and adults with lactose intolerance is how to get enough calcium in a diet that includes little or no milk. Although the RDA (recommended daily allowance) for calcium, set in 1980, is 800 mg per day, many experts in bone disease believe this is too low. The results of a 1984 conference at the National Institutes of Health (NIH), suggest that women who have not yet reached menopause and older women who are taking the hormone estrogen after menopause should consume about 1,000 mg of calcium daily (roughly the amount in a quart of milk). Pregnant women and nursing mothers need about 1,200 mg of calcium per day. Postmenopausal women not taking estrogen may need as much as 1,500 mg of calcium per day. The RDA for adult men is 1,000 mg per day and 1,500 mg per day for men in their later years. It is important, therefore, in meal planning to make sure that each day’s diet includes enough calcium, even if the diet does not contain dairy products. Quite a few foods are high in calcium and low in lactose. Many green vegetables and fish with soft, edible bones are excellent examples. To help in planning a high-calcium/low-lactose diet, the following varchart lists some common foods that are good sources of dietary calcium and shows how much lactose the foods contain. Recent research has shown that yogurt may be a very good source of calcium for many lactose intolerant people, even though it is fairly high in lactose. There is evidence that the bacterial cultures used in making yogurt produce the lactase required for proper digestion. Clearly, many foods can provide the calcium and other nutrients the body needs, even when intake of milk and dairy products is limited. Still, factors other than calcium and lactose content should be kept in mind when planning a diet. Some vegetables that are high in calcium (Swiss varchard, spinach, and rhubarb, for instance) are not listed in this varchart because the body cannot use their calcium content. They contain substances called oxalates, which stop the calcium absorption. Remember also that calcium is absorbed and used only when there is enough vitamin D in the body. A balanced diet should provide an adequate supply of vitamin D. Some people with lactose intolerance may think they are not getting enough calcium and vitamin D in their diet. A doctor is the best person to decide whether any dietary supplements are needed. Taking vitamins or minerals of the wrong kind or in the wrong amounts can be harmful. A dietitian can help in planning meals that will provide the most nutrients with the least chance of causing discomfort. Some so-called nondairy products such as powdered coffee creamer and whipped topping also may include ingredients that are derived from milk and therefore contain lactose. Smart shoppers learn to read food labels with care, looking not only for milk and lactose among the contents but also for words such as whey, curds, milk by-products, dry milk solids, and non-fat dry milk powder. If any of these are listed on a label, the item contains lactose. In addition, lactose is used as the base for more than 20 percent of prescription drugs and about six percent of over-the-counter medicines. Many types of birth control pills, for example, contain lactose, as do some tablets for stomach acid and gas. A pharmacist can answer questions about the amounts of lactose in various medicines.
Signs and Symptoms of Lactose-controlled Diet
Although milk and foods made from milk are the only noteworthy natural sources, lactose is often added to prepared foods. It is important for people with very low tolerance for lactose to know about the many foods that contain lactose, even in small amounts. Grocery items that may contain lactose include: Bread and other baked goods Processed breakfast cereals Instant potatoes, soups, and breakfast drinks Margarine Lunch meats (other than kosher) Salad dressings Candies and other snacks Mixes for pancakes, biscuits, cookies, etc.
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Medical Content Last Updated on 07/12/2008
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