Could You Be Lactose Intolerant?

More than 50% of the world's population is lactose intolerant, which is what happens when the small intestine doesn't make enough of the enzyme lactase, leading to difficulties digesting the milk sugar lactose. Lactose intolerance can develop anytime from infancy to adulthood and it can be tricky to diagnose because the symptoms may mimic other conditions, especially irritable bowel syndrome (IBS) which can also cause diarrhea, gas, bloating, nausea and abdominal cramping.

More than 50% of the world's population is lactose intolerant, which is what happens when the small intestine doesn't make enough of the enzyme lactase, leading to difficulties digesting the milk sugar lactose. Lactose intolerance can develop anytime from infancy to adulthood and it can be tricky to diagnose because the symptoms may mimic other conditions, especially irritable bowel syndrome (IBS) which can also cause diarrhea, gas, bloating, nausea and abdominal cramping.

When I see someone in my office with symptoms suggestive of lactose intolerance, I'll usually ask them to avoid any and all dairy for a period of two weeks to see if their symptoms improve. A lactose hydrogen breath test is a more formal way of diagnosing lactose intolerance but more cumbersome than empirical avoidance. In the setting of lactase deficiency, a test dose of lactose will pass undigested from the small intestine to the colon where it undergoes fermentation by bacteria into hydrogen and other gases. A rise in the level of these gases during the test is considered evidence of lactase deficiency.


Once the diagnosis is made, either empirically or with formal testing, some people choose to continue to eliminate dairy products from their diet as a way of controlling their symptoms. For those with milder symptoms or who consider the dietary change a hardship, I recommend reintroducing small amounts of yogurt and hard cheeses, which contain less lactose than things like ice cream and mozzarella. Most people with low lactase levels can tolerate small amounts of dairy but will have symptoms with larger doses.

One of the important things to keep in mind when treating people with lactose intolerance is that although it is exceedingly common, it can also be a sign of other problems in the gastrointestinal tract. Celiac disease, an allergy to gluten-containing foods such as wheat, rye and barley may result in accompanying lactose intolerance because of the damage to the villi of the small intestine. Likewise for Crohn's disease where inflammation to the lining of the small intestine may result in a loss of the lactase enzyme. Gastrointestinal infections such as Giardia and Rotavirus are a common cause of secondary lactose intolerance which can be temporary or permanent. In the setting of gastroenteritis I'll often counsel people to temporarily avoid dairy and then cautiously reintroduce it once the acute illness is over.

If you think you might be lactose intolerantm there is no problem with doing an avoidance trial, but if your symptoms don't resolve after eliminating dairy, then by all means seek medical advice to make sure you don't have an underlying gastrointestinal condition such as IBS, celiac disease, Crohn's or an infection.

High Blood Pressure: Why You Shouldn't Ignore This Silent Killer

About one in five people have high blood pressure and they don't even know it

For those of you who love murder mysteries, there just may be a silent killer wreaking havoc inside of you. Untreated hypertension, or high blood pressure, can go undetected for a long period of time, mainly because most people with elevated blood pressure do not experience any symptoms. In fact, about one in five people with high blood pressure are walking around unaware that they even have high blood pressure. Left untreated, hypertension can place you at a significantly increased risk for heart attacks, strokes, aneurysms tearing open, heart failure, kidney failure, blockages in your legs, dementia, vision problems including blindness, and sexual dysfunction (I bet that last one got some of your attention).

How to Read Your Blood Pressure Numbers

Your blood pressure is made up of two numbers. The top number, called the systolic blood pressure, is the pressure inside your arteries when your heart contracts. The bottom number, the diastolic blood pressure, is the pressure inside your arteries when your heart relaxes. Both numbers are important and should be monitored. As people age, both numbers tend to increase, mainly due to increased stiffness in large vessels. Frighteningly, many studies have demonstrated that just a 20 mm Hg (units used for blood pressure) increase in the systolic number, or a 10 mm Hg increase in the diastolic number, doubles one's risk of death from heart disease or stroke.

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