Lactose Intolerance & Chocolate Milk...the Conundrum

Does your child tell you they CAN drink chocolate milk, but their stomach hurts after drinking "regular" milk? I'll share that when I told MY parents this, they laughed and thought I was simply asking for more sweets. As an adult, I was often puzzled that certain milk products did not agree with me, while others did. People asked if I was allergic to milk, or whether or not I had lactose intolerance...and I simply said that I do not like milk, because I didn't know the answer.

So, here it is. That kid that can down chocolate ice cream but not skim milk may indeed be lactose intolerant, and she is telling the truth! Lactose intolerance refers to the inability to digest lactose (the main milk sugar). Lactase lives on the inside surface of our intestines. Symptoms typically appear 30 minutes to 2 hours after consuming a product that contains lactose. The degree of symptoms produced (abdominal bloating, cramping, gas and/or diarrhea) depend on several variables:
1. The amount of lactose consumed
2. The level of lactase enzyme present
3. The SPEED of gastric emptying- the faster the gut transit, the worse the symptoms

Higher fat content will SLOW gastric emptying, which reduces the symptoms, so voila! There is your explanation for the chocolate milk. Of course, adding lactase in the form of a powder or capsule will also reduce the symptoms.

Who gets lactose intolerance? 80% of Blacks and Hispanics, nearly 100% of Native Americans and Asians, and roughly 15% of Caucasians develop it. Symptoms usually appear later in childhood or even as an adult. Also, anyone can transiently develop lactose intolerance after a serious bout of diarrhea, because that temporarily strips off the lining of the gut (which houses the lactase). Avoiding dairy products for a few days typically takes care of this type of intolerance.

The easiest way to tell if you have lactose intolerance is to eliminate it from your diet, and see if your abdominal complaints disappear. Remember, though, to read labels carefully, looking for "milk sugar, whey, or curd" as well as plain "milk". Note, too, that many prescription and OTC medications also use lactose as a base. Typically, however, even a lactose intolerant person is fine with SOME lactose (roughly 12 g) so it is not necessary to eliminate lactose 100% to see results.

If you are lactose intolerant, remember you will still need calcium to protect your bones, so talk with a registered dietician to be sure you are getting all you need.

BOTTOM LINE: Lactose intolerance is all about degrees, not simply "yes, you have it" or "no, you don't". Try a simple lactose elimination diet for a few days if you are concerned about abdominal complaints and think you may have lactose intolerance.

Medicine Cabinet Staple #7: TUMS

What else is in the front of my medicine cabinet? This season's favorite flavor of TUMS. Over the counter antacids are still the fastest way to speed relief for indigestion, and a quick fix for an extra blast of calcium (especially in rapidly growing pre-teens and teens.) Yes, there are fancier and more expensive acid blockers out there (see my "Q&A about GERD"), but I only keep TUMS in my cabinet because it works fast and it is inexpensive and easy to take: no water required! Our family prefers the rapid, smooth-dissolve texture and flavor of the name brand product versus the generic equivalents, but the other brands work as well.

Calcium supplements were recently in the news with a link to heart disease, but the take-home message is that it is better to get extra calcium from your diet than to rely on a pill. Additionally, if you are going to take calcium supplements chronically (whether it's via an antacid or other supplement product), Vitamin D should also be supplemented.

Another use of antacids/calcium supplements beyond indigestion is for nighttime leg cramps. Occasionally "growing pains" (leg pain, typically worse at night during growth spurts) often respond to an extra helping of calcium in the evening.

Antacids can potentially block absorption of other medications, so it's best to take them alone. If you find you are needing the antacids more than once or twice per week, it's time for a visit to your doctor to determine the cause and a more lasting solution.
BOTTOM LINE: Keep a bottle of antacid tablets in your cabinet to have on hand for occasional indigestion or leg cramps.

When Does High Cholesterol Start "Counting"?

Calcium and heart disease are staying together in the news. Yesterday, I talked about calcium supplements. Today, I want to tell you about another study- the "CARDIA" study (Coronary Artery Risk Development in Young Adults). Basically, this study looked at young people who began the trial at age 18-30 in the early 1980's. Their blood cholesterol levels were measured at baseline, and then followed periodically for twenty years. At the endpoint, coronary calcium scores were evaluated. (These scores are from a CT scan that looks at calcium deposits in the coronary arteries- the ones that if clogged, cause a heart attack.) The question was whether or not high lipid (cholesterol) levels in your youth led to these deposits in your middle age. The answer: a resounding YES.

As always, there is a catch. This time, the tricky part is that although high calcium deposit scores are definitely associated with heart disease, it is not the same objective evidence as whether or not people with early high cholesterol levels will actually have more heart attacks. I believe, however, that the take-home message is this: we do indeed pay for "the sins of our youth"- high cholesterol levels that are UNTREATED in young people are going to lead to problems down the road.

What should we do? The jury is still out on whether or not we should be starting younger patients on lipid-lowering medications, despite numerous studies trying to evaluate this issue. We DO know that improving diets and increasing aerobic activity reduces heart disease, with NO negative side effects.

BOTTOM LINE: Don't wait till you are 40 to check your cholesterol levels- find out EARLY and make lifestyle and dietary changes to improve your numbers NOW so you can decrease your heart disease risk LATER!

Now CALCIUM is Dangerous??

Have you heard about the latest study that showed CALCIUM supplements may increase your risk of heart attacks? What's next, finding out Vitamin C makes you sick? Okay, I'm being facetious here, but let's talk about this news from a couple different angles.
First of all, here is what the study from the BMJ (British Medical Journal) says. They looked at a bunch of studies with a total of roughly 12,000 patients and assessed whether those people who took calcium supplements of 500mg or more (without Vitamin D) had more or less heart attacks compared with those who took placebo pills. There were a total of 296 people who suffered heart attacks- 166 on calcium supplements, and 130 on placebo pills. Does this mean placebos CAUSED 140 heart attacks? NO. Does it mean that calcium supplementation by itself CAUSED heart attacks? No- but it does show "an association" with heart attacks, one that may or may not be present if you add Vitamin D, which plays a role in calcium absorption, bone health, and cardiac protection.
There is NO association of heart attacks with increased purely dietary calcium intake (meaning high calcium intake through eating dairy and other calcium-containing foods). What does this tell me? Once again, we are spending a zillion dollars to PROVE THAT GETTING OUR NUTRITION FROM WHOLE FOODS, RATHER THAN SUPPLEMENTAL PILLS, IS BETTER FOR OUR HEALTH.
We've got to stop looking for a quick fix, and start improving our diets (MORE fruits and veggies, less of everything else) and increasing our exercise. Common sense AND scientific studies have proven this over and over.
In the meanwhile, realize that medicine is constantly evolving. What we preach as doctrine today may be heresy tomorrow. Look at what we have recommended for positioning of newborn babies in the last couple decades as an example- first we said on their stomachs (so they don't choke if they spit up), then their sides, and now their backs. Each time, we are SURE we have the answer. Remember that doctors used to recommend smoking to relax- how crazy is THAT?
BOTTOM LINE: Calcium supplements are unlikely to be your greatest risk factor for heart disease- talk with your doctor about your total health picture before you decide whether or not to take ANY supplement!