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“I often have the feeling I have to go but when I get to the bathroom nothing happens. I am irregular and my stools tend to be thin and there is mucous. I am full of gas—I wake up with it in the morning and have to control it all the time. I feel fat because even if I lose weight my abdomen looks too big. After several medical examinations they find nothing wrong!”

The foregoing gives a patient’s view of the misery of spastic colon. Usually the doctors do find nothing demonstrably wrong with the bowel. It is simply the diet that doesn’t fit the individual. And the most frequent troublemaker is MILK! No, this is not allergy to casein, the milk protein. This is lactose intolerance, inability to digest the milk sugar. Lactose is the same, whether it is obtained from humans, cows, goats, sheep, horses, or camels. One cup of animal milk contains between two and three teaspoonfuls (10 to 15 grams) of lactose. As a rule, lactose intolerant people get bowel symptoms if they ingest more than 5 to 10 grams per day, i.e. less than a 8 ounces of milk.

This applies to 9 out of 10 people on Earth. Most of the human race has not evolved biologically so as to be able to digest milk! We lack an enzyme required to split lactose into its component parts, namely glucose and galactose. This enzyme, lactase, is present in infants up to about age 3 but then diminishes gradually so that by late adolescence most people must resort to cultured milk products or else just avoid milk altogether—or else be miserable and sick much of the time.

Luckily our intelligence is more advanced than our digestion and so cultured milk products are widely available. I am referring to yogurt, buttermilk, cottage cheese and the large variety of aged cheeses that have been among our traditional foods for thousands of years, ever since our ancestors noticed that when milk spoils it is still good to eat. Marco Polo1 described how the Mongols produced dried milk 700 years ago:

“First they bring the milk to the boil. At the appropriate moment they skim off the cream that floats on the surface and put it in another vessel to be made into butter, because so long as it remained the milk could not be dried. Then they stand the milk in the sun and leave it to dry. When they are going on an expedition, they take about ten pounds of this milk; and every morning they take out about half a pound of it and put it in a small leather flask, shaped like a gourd, with as much water as they please. Then, while they ride, the milk in the flask dissolves into a fluid, which they drink. And this is their breakfast.”

This product fits the description of defatted dry milk, still in use today. Half a pound, the amount used by a Mongol warrior, provides 3700 calories, 86 grams of protein and 125 grams of lactose, sustenance for most of the day, not just breakfast. That is about ten times the amount that causes bowel irritation, gas, cramps and diarrhea so it is likely that the re-constituted milk fermented in the flask after water was added. This would have removed lactose and added enzymes to break down any residual lactose even after the liquid was swallowed.

This is identical to what we find with yogurt in common use today. The bacterial enzymes continue to digest the lactose, doing the work that our own digestive tract cannot. This works so long as the milk is pasteurized before it is cultured and not afterward. One way to know that the culture is still active is to let the yogurt stand at room temperature for an hour or so. If water accumulates it is digesting and has active enzymes.

I am writing this article because I am convinced that the health hazard of lactose intolerance is under-estimated. Many people with irregularity, gas bloat, hemorrhoids and fatigue actually are unaware of lactose intolerant, are ingesting more lactose than they can handle, and may never find out about it. This is so because we live in a dairy-based society that makes milk so convenient and we are told: “everybody needs milk.” And there it is in the refrigerator, on the table and in so many of our staple foods: baked goods, canned goods, processed foods, and even in processed meats and sausages.

If you are going to look into this for yourself, you must learn to read labels in search of the key words: lactose, whey and non-fat dry milk. Often the label does not mention lactose, but only the word “carbohydrate.” You must figure out the source. If it is a vegetable carbohydrate, then it is not lactose. Lactose is an animal product and therefore found only from animal sources, such as milk, non-fat dry milk and whey.


WHEAT INTOLERANCE

Wheat intolerance is also called gluten enteropathy, referring to the specific wheat protein, gluten. It is about equally common as lactose intolerance, but the results are even worse, because a fraction of the gluten, called gliadin, causes real damage, atrophy of the absorptive lining of the small bowel. This knocks out many of the enzyme secreting cells of the intestine and thereby induces lactose intolerance as a complication. Gliadin antibodies are now detected in about 20 percent of Americans, which is to say that there are millions of people with gluten intolerance and many of them have combined food intolerance for both wheat and milk. This poses a diagnostic challenge for the doctor; and it is a treatment challenge as well because in many cases BOTH milk and wheat intolerance must be treated in order for patients to get better.


IRRITABLE BOWEL

In many cases these disorders cause symptoms that make the patient’s life miserable; but the X-ray studies, stool examinations and various other diagnostic tests are often indefinite. All too often the patient is left with a diagnosis of “irritable bowel.” This is actually an accurate description but the implications are not favorable. In the first place, health insurance policies often reject claims with this diagnosis. Perhaps this excerpt from a leading medical text2 will explain why:

“The irritable bowel syndrome (also referred to as spastic colon and mucous colitis) is one of the most frequent gastrointestinal disorders. ... (characterized by) ... periodic or chronic bowel symptoms which include diarrhea, constipation, and abdominal pain. These symptoms are often associated with psychiatric illness, but the anxiety produced by the bowel disturbance is sometimes regarded by the patient as the fundamental cause of the emotional upset ... If the patient’s life goals can be shifted away from the quixotic search for the perfect stool, much can be accomplished.”

That analysis is a holdover from the days when if there was no obvious medical diagnosis, then it must be psychological. I tend to agree with the patient’s complaints rather than with knee-jerk psychoanalysis for reasons that I hope to make clear in this article. In fairness to the text-book, a different consultant had this to say 1500 pages later in the text:3

“The irritable bowel syndrome is the most common gastrointestinal disease in clinical practice, and although not a life-threatening illness, it causes great distress to those afflicted and a feeling of helplessness and frustration for the physician attempting to treat it.” ... “Lactase deficiency may masquerade as irritable colon syndrome and should be excluded by a trial of milk restriction, a lactose tolerance test, or a lactose breath hydrogen test.”

Which leads us back to our main topic: the milk and health relationship. We all know that milk is rich in protein, vitamins B2 and D, calcium and zinc. All that is well and good; it is the milk sugar that we are concerned about here. Millions of people are just unable to digest it and so it acts like a toxic waste product, an irritant, in the digestive tract.


HERE IS HOW IT WORKS

In healthy conditions, there are specific enzymes to break down lactose, sucrose and maltose. These enzymes are produced at the site of the action, in the intestinal wall, where they convert lactose into glucose and galactose; sucrose into glucose and fructose; and maltose into two molecules of glucose. Not surprisingly, if there is damage to the intestine, the function of these enzymes can fall off drastically. It can take months or years to recover from seemingly modest episodes of diarrhea if one fails to take this into account. If the intestine is over-loaded with indigestible foods too soon after damage, the ongoing inflammation can create a vicious circle of mal-function and damage.

After recovery from acute illness, food poisoning or parasite infestation, one resumes a normal diet, expecting to be good as new. If intestinal symptoms persist, it may look like a case of yeast over-growth, especially if there has been antibiotic treatment, which often leaves an imbalance of the intestinal organisms in its wake. The antibiotic may help kill off infection, but it also kills other organisms. How to restore the balance: No doubt that live yogurt culture and capsules of probiotic Lactobacilli are helpful; but the real culprit is often a too-early return to full diet, especially the all-too-popular carbohydrates. The most important therapy is simple avoidance: know your lactose and learn to avoid foods that otherwise will keep you sick.


LACTOSE-CONTAINING FOODS

FOOD

PORTION

LACTOSE grams

Cow Milk

8 ounces

11.0 grams

Skim milk

8 ounces

12.0 grams

Human milk

8 ounces

17.0 grams

Goat milk

8 ounces

11.0 grams

Buttermilk

8 ounces

12.0 grams

Yogurt low-fat

8 ounces

16.0 grams

Yogurt whole plain

8 ounces

11.0 grams

Non-fat dry milk

1 Tbsp (1/2 ounce)

2.5 grams

Evaporated milk

1 Tbsp (1/2 ounce)

2.0 grams

Malted milk powder

1 Tbsp (1/2 ounce)

10.0 grams

Sweet whey powder

1 Tbsp (1/2/ ounce)

5.5 grams

Half and Half

2 Tbsp (1 ounce)

1.3 grams

Half and Half

8 ounces

10.4 grams

Cream-table

8 ounces

8.8 grams

Cream-heavy

8 ounces

0.0 grams

Cream cheese

2 Tbsp (1 ounce)

0.7 grams

Cottage cheese

4 ounces

2.0 grams

Cottage cheese (1% fat)

4 ounces

3.0 grams

Ricotta cheese

4 ounces

4.0 grams

Cheddar (aged) cheese

1 ounce

0.4 grams

Feta or Swiss cheese

1 ounce

1.0 grams

Mozzarella cheese

1 ounce

0.7 grams

American processed

1 ounce

0.5 grams

Ice cream

8 ounce cup

9.0 grams

Sherbet

8 ounce cup

4.0 grams

Bakers/milk chocolate

1 ounce

4.0 grams


LESSER FOOD SOURCES OF LACTOSE

(Average serving of any one contains about a gram of lactose)

  • Pastries, bread, cookies, cakes
  • Pancakes, waffles, dry cereals
  • Processed meats, sausage, wieners
  • Processed potatoes, i.e. instant type
  • Prepared soups
  • Prepared salad dressings


WHAT TO DO

Study the quantities of lactose in the food list above; then refer to your diet. Add up your typical lactose intake and see if you exceed 10 grams per day. You can test yourself for lactose sensitivity by avoiding milk, yogurt and wheat and taking lactase supplements in pill form with meals for at least two weeks. If there is even a suspicion that you may be deficient in lactose, it is a good idea to take a 125 mg lactase capsule supplement with every meal. If you have excess flatus, diarrhea, constipation, cramps, bloat, or chronic fatigue give it a month before judging the results. Even if you don’t now have obvious symptoms of bowel irritation, you may notice improved energy, mental clarity and mood. These general symptoms, not specific to the bowel, are generally undiagnosed because there is no specific test for sub-clinical lactose overload. The only way is to test yourself for a few weeks. If you respond favorably it confirms both the diagnosis and cure.


1. Tannahill, Reay: Food in History. Stein and Day, NY, 1973. p. 132.
2. Petersdorf RG et all: :Harrison’s Principles of Internal Medicine, 10th Ed. McGraw Hill, 1983. p199.
3. Ibid, p 1757.

©2007 Richard A. Kunin, M.D.

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