How to make lactose intolerance more tolerable

Today, we will address once again some very interesting questions we have received from our faithful readers all over the country. The topics include lactose intolerance, and the three most commonly-used supplements for arthritis today: Glucosamine, chondroitin and MSM.

Got Milk? No Thanks!

I was recently diagnosed to be lactose intolerant. What is it? How did I get it? What can I do about it?

– F.P., Cagayan de Oro City

I am not at all surprised at your being diagnosed to have lactose intolerance. Asians, including Filipinos, have very high rates of lactose intolerance.

We are born to digest milk. Our small intestines come equipped with lactase, an enzyme that tears lactose, a big sugar molecule, into smaller ones that makes it more readily absorbed. Virtually, every mammalian milk contains lactose.

Think of lactose intolerance as a collection of symptoms produced, in part, by the way the digestive system responds and adapts to the undigested milk sugar. A person with a naturally sensitive gut – perhaps one "wired" with a lot of easily stimulated pain receptors – might feel the effects of undigested lactose more.

The symptoms include loose stools, abdominal bloating and pain, flatulence, and gurgling noises produced by gas moving through the intestine. Loose stools occur because undigested lactose pulls water into the small intestine. The extra fluid also speeds up peristalsis, the wave-like movement of the small intestine, giving the lactose even less time to be digested. Once lactose reaches the large intestine, bacteria – not lactase – break it down, producing hydrogen and other gases that may contribute to the pain and diarrhea.

Here are the things you can do to make lactose intolerance more tolerable:

• Give up dairy. Many people with lactose intolerance simply swear off milk and dairy products.

• Take lactose supplements. These products resupply the small intestine with the missing lactase enzyme. Lactaid is a popular brand.

• Limit the amount of lactose. A cup of milk contains 10-12 grams of lactose. Researchers have shown that the vast majority of people can consume up to 7 grams (and perhaps more) of lactose without any symptoms. So there is no need to fear the small amounts of lactose in, say, the milk in your coffee or in most cheeses. (Cheese is made from the part of milk that congeals into curd. It’s the liquid part, the whey, that contains most of the lactose. During the fermentation process that results in hard cheeses like cheddar, the rest of the lactose is degraded by bacterial enzyme.).

• Slow down your lactose digestion. You can give your lactase more time to work by slowing down the rate at which lactose moves from your stomach into your small intestine. Drinking milk at a meal slows down "gastric emptying." That is why pizza shouldn’t be a problem for most people, both because cheese is relatively low in lactose and the lactose in the cheese is being consumed with a mixture of food. Cold also slows down the stomach. That’s why ice cream doesn’t bother some people. But cold milk doesn’t make any difference, perhaps because milk is quickly brought up to body temperature. Fat, and, yes, chocolate, seem to slow down the stomach, which would explain the study findings that full-fat and chocolate milk produce fewer symptoms than low-fat milk.

Chocolate-loving lactose intolerants will also be happy to know that Finnish researchers published a study in the European Journal of Clinical Nutrition that the lactose in milk chocolate didn’t bother people who said they were lactose intolerant.

• Eat yogurt. Yogurt is well tolerated because it contains bacteria (the often-mentioned "live cultures") that harbor lactase, so the small intestine is temporarily replenished with the enzyme when you eat yogurt. But even when it’s been heated and therefore presumably has fewer live bacteria, yogurt doesn’t cause symptoms. Its gel-like consistency may make it easier for lactose maldigesters to digest.

• Add milk — gradually and not too much. Several studies have suggested that gradually increasing lactose intake can reduce intolerance symptoms in some people. The evidence suggests that exposing the colon to lactose can change both the amount and types of bacteria in the large intestine so it becomes better suited to processing the undigested lactose coming from the small intestine. In essence, you may be able to alter the bacterial "ecology" of your large intestine so you’ll have fewer symptoms.

Arthritis Supplements? Maybe!

My doctor has prescribed glucosamine, chondroitin and MSM for my arthritis. How effective and safe are these supplements?

– M.P., Marikina City

Here’s what is currently known about these arthritis supplements:

• Glucosamine. Where it comes from: Major components of joint cartilage. Supplements are derived from the shells of shellfish such as shrimps, lobster and crab. Forms and dosage: Capsules, tablets, liquid or powder (to be mixed into a drink); 1,500 mg per day for all forms. Because not as much is known about glucosamine hydrochloride and N-acetyl glucosamine, some researchers encourage people interested in trying this product to use glucosamine sulfate. What it’s supposed to do: Slow deterioration of cartilage, relieve pain of osteoarthritis (OA) and improve joint mobility. What we know: Glucosamine provides the natural building blocks for growth, repair and maintenance of cartilage. Like chondroitin, it helps cartilage absorb water and keeps the joint lubricated. Effects may be similar to non-steroidal anti-inflammatory drugs (NSAIDs) for easing OA symptoms but may take twice as long as conventional drugs to work. Studies: Studies on glucosamine are promising. A review of two studies, each of which analyzed more than a dozen glucosamine studies, found this supplement to significantly and consistently improve pain and joint function, as well as or better than conventional drug therapy (NSAIDs). One recent long-term study conducted in Belgium over three years showed patients with mild to moderate OA taking 1,500 mg of glucosamine had 20 percent to 25 percent less pain and disability than those taking placebo. Researchers also found glucosamine slowed, if not stopped, the progression of the disease and reduced cartilage loss. Glucosamine has been studied only in people with knee or hip OA. More studies are needed for long-term safety and efficacy to be established. What to watch out for: Mild stomach upset, nausea, heartburn, diarrhea, constipation and increased blood glucose, cholesterol, triglyceride, and blood pressure levels. Don’t use if you are allergic to shellfish. Extras: To determine effectiveness, the US National Institutes of Health is conducting a large long-term study on glucosamine, chondroitin and a combination of the two in people with knee OA. Results are expected in 2005.

• Chondroitin sulfate. Where it comes from: Chondroitin is a component of human cartilage, bone and tendon. In supplements, chondroitin sulfate usually comes from bovine trachea or pork byproducts. Forms and dosage: Capsules, tablets and powder; 1,200 mg daily in two doses. What it’s supposed to do: Reduce pain and inflammation, improve joint function and slow disease progression. What we know: Chondroitin is believed to enhance the shock-absorbing properties of collagen and block enzymes that break down cartilage. Currently, there is no proof that it can reverse cartilage loss. It generally takes two to four months to work completely. Studies: Many studies using chondroitin have been small and scientifically flawed. However, two large studies that evaluated data from about a dozen studies showed significant improvement in pain and inflammation and improved joint function. Some people taking chondroitin are able to decrease their NSAID dosage. What to watch out for: Diarrhea, constipation and abdominal pain. Some chondroitin tablets may contain high levels of manganese, which may be problematic with long-term use. Like NSAIDs, chondroitin taken with blood-thinning medication may increase your risk of bleeding. In the works: There is no convincing evidence that glucosamine and chondroitin together are more effective than each one individually or alone. To find out, the NIH has commissioned a large multi-centered study which will be completed next year.

• MSM (methylsulfonylmethane.) Where it comes from: Organic sulfur compound found naturally in fruits, vegetables, grains, animals and humans. Forms and dosage: Tablets or powder, topical and oral; typically 1,000 mg to 3,000 mg daily with meals. What it’s supposed to do: Reduce pain and inflammation. What we know: MSM, an organic sulfur, has been studied for arthritis. Sulfur is needed to form connective tissue. Studies: A few animal studies have shown MSM may ease inflammation. One small study on humans appeared to show relief of arthritis symptoms. No good, well-controlled human studies to date and no evidence for safety or effectiveness in treating arthritis.