¶ … lactose intolerance, and a description of its' relevance to nutrition; consumers, health care professionals, and patients. Lactose intolerance is a disease aggravated by milk sugars. It can be controlled by diet, but often other measures must also be used to control the disease, such as the use of dietary aids such as "Lactaid." Health care professionals must understand the treatment and problems associated with the disease to help their patients combat the disease, and a major portion of understanding lies in the principles and understanding of proper nutrition. Lactose intolerance affects millions of Americans. In fact, the American Gastroenterological Association (AGA) estimates that 50 million Americans suffer from the disease, and it can make their lives miserable if it is not treated. The symptoms of lactose intolerance include stomach cramps, diarrhea, nausea, gas, painful bloating, and flatulence ("Living" 66). These symptoms can begin as soon as 30 minutes after consuming milk products, and can last for several hours. While the disease can exist from birth, it often occurs in older women, and many ethnic populations, including African-Americans, Jews, Mexican-Americans, Native Americans, and Asian-Americans. The AGA estimates that almost 75% of blacks and 90% of Asian-Americans exhibit lactose intolerance (Editors). Thus, the disease can be considered an ethnic disease that affects the general population as well. Medically, the definition of the disease is the inability of the small intestine to break down and adsorb milk sugar (lactose). Normally, the small intestine creates an enzyme, lactase, that breaks down milk sugars, and allows them to be adsorbed by the blood stream (Editors). However, when lactase is not present, milk sugars do not digest properly, and cause distress to the digestive system. The disease is still not fully understood, and scientists do not know why the body stops producing lactase, or what can be done to fully cure the disease. They do know that in many cases the body begins to slow down or stop producing lactase after two years of age, and that some people are simply born with the inability to digest lactose. Certain injuries can cause the disease, such as some types of injuries of diseases affecting the small intestine. There are also varying degrees of the disease, and many patients test their tolerance by eating small amounts of milk products, until they find the amount that causes distress. In other cases, the digestive system simply will not tolerate any form of lactose. The AGA notes, "The severity of symptoms varies depending on the amount of lactose each individual can tolerate" (Editors). For example, some sufferers may be able to eat small amounts of ice cream, milk, or cheese, especially if they combine them with other foods. Some studies have also shown that many sufferers can still eat yogurt, perhaps because of the bacterial cultures present in the yogurt (Editors).

If lactose intolerance is suspected, the patient's physician can perform three tests that indicate the disease and its' severity. These tests, the lactose intolerance test, the hydrogen breath test, and the stool acidity test, are usually performed at a clinic or hospital on an outpatient basis, and are available in almost every community. Before treating the disease nutritionally, these tests should be performed to verify that lactose intolerance is really the patient's problem. The lactose intolerance test is the most common form of testing, and it can be given to both adults and most children. The other two tests are more specialized, and are not appropriate for babies and young children (Editors). Once the diagnosis is confirmed, treatment can begin, and treatment includes modifying the diet.

The nutritional concerns of lactose intolerance are many and quite obvious. Dairy products form a significant part of a healthy diet, especially for their calcium and protein content. Many milk products play a critical role in the popular high-protein diets such as Atkins and South Beach. While the benefits of these diets are still being studied, the benefits of calcium, especially to growing children, are well-known. Calcium is also important later in life, when bones can become brittle. The AGA continues, "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')" (Editors). Because of this, lactose intolerance can cause a calcium deficiency, and can skew the diet to other forms of protein. In addition, another concern is the "hidden" sources of lactose. Most patients...

For example, forms of lactose may be found in many prepared foods, such as "bread, cereal, lunch meats, salad dressings, mixes for cakes, cookies, pancakes, and biscuits, and frozen dinners" ("Why"). Many consumers and patients may not be aware of these hidden milk products, and so, may continue to suffer symptoms even after they remove most milk products from their diet. Thus, the nutritionist must be able to advise patients on hidden lactose, as well as devise a diet that is rich in calcium and protein, while avoiding milk products. The patient should be advised to avoid milk and cheeses, but also look for other ingredients such as "whey, milk solids, powdered milk, lactose, and dried milk" when they shop for food. Other foods, such as "non-dairy creamer, margarine, whipped topping, instant potatoes, soups, and breakfast drinks, and even breakfast cereals" may also contain milk derivatives that can cause problems in the diet (Editors). The most important concern, however, may be the effects calcium has on other areas of the body. One report notes, "The nutrient also plays an important role in regulating other body functions such as blood clotting, blood pressure, nerve transmission, and contraction and relaxation of muscles (including normal heartbeats)" ("Living" 66). Thus, the patient must be always aware of what they are eating and drinking, and the nutritionist can aid the patient in many ways by also understanding the complexities of the disease and the appropriate dietary controls.
Since the only way to control the disease is through diet, it is imperative that the patient and the nutritionist understand the implications of the disease, and devise a diet that is appropriate for the disease and the individual. There are many foods that are rich in calcium and/or protein, but do not contain lactose. For example, "canned salmon with bones, sardines, collard greens, turnip greens, broccoli, and tofu" ("Why") are all excellent sources of calcium and/or protein that do not contain lactose. Adding items such as these to the diet can ensure a balanced diet that meets the needs of the patient while removing some of the concerns of a lactose free diet. However, there are other concerns that must be addressed when planning a lactose free diet. Some food items, such as Swiss chard, spinach, and rhubarb, contain fair amounts of calcium, but the calcium is not usable by the body. In addition, vitamin D is necessary for the successful adsorption of calcium; therefore, the diet must contain enough vitamin D to ensure the calcium consumed is actually used by the body (Editors).

A sample diet for treating the disease might include many leafy and green vegetables, such as kale, turnip and collard greens, bok choy, broccoli, canned oysters, shrimp, salmon with bones, and sardines, small amounts of processed cheese or cheddar cheese, which contain far less lactose than milk, meats, vegetables, and even molasses for sweetening, which does not contain lactose. Consumers should also be very aware of packaged foods they purchase, and add them to the diet only if they do not contain hidden forms of lactose. Many nutritionists and physicians also recommend the patient try the many products that are available to combat lactose intolerance, such as "Lactaid," which is taken before a meal containing lactose products. These dietary supplements are sold over-the-counter and they can help many people digest lactose more effectively. There are also a growing number of lactose-free or low-lactose dairy products in the marketplace that patients may be able to substitute for milk products in their diets and in recipes.

This diet helps in the treatment of the disease because it removes lactose in the diet, thus removing the problem with lactose digestion by the small intestine. In addition, the successful diet will contain a balance of the right vitamins and minerals to ensure the proper adsorption of calcium and protein, while effectively blocking lactose. The disease can be distressing and uncomfortable, but with the proper attention to food and nutrition, patients can lead healthy and comfortable lives even if they suffer from lactose intolerance.

In conclusion, researching this topic has given me considerable knowledge and insight into the problems people face that suffer from this disease. I thought I understood what this disease entailed, but I discovered there was much more to it than simply the inability to drink milk or…