Some three billion people worldwide turn their tummies into disaster zones with every intake of milk and milk-laced foodstuffs. The intestines roil and boil, gases spawn and spew, and the sufferer writhes with colic. But that's normal-lactose intolerance isn't a disease, just a terrible inconvenience.
There are others who can ingest milk with impunity though. "Since there appears to be a shortage of spare lactase-producing intestines on the black market," quips Steve Carper in his 330-pager Milk is Not for Every Body (Living with Lactose Intolerance) "the alternatives are few."
Nuke the culprit lactose to smithereens?
Better take a pill. There ought to be a pill to heal each ill, so why not turn up a lactase tablet to lick such widespread torment as lactose intolerance-and will it hurt to rake oodles from over three billion sufferers who still hanker for milk and milk-spiked goodies?
Pharmaceutical companies ought to make a killing from fixing such a huge market-three billion and growing-by making artificial lactase but, as Carper points out, synthesizing an enzyme like lactase is a "logistical nightmare."
He notes that lactase like all enzymes is a protein, a huge, complicated, and an ungainly creature compared to the typical drug. Lactose has a molecular weight of 342 moles while a molecule of lactase weighs in at about 280,000.
Pharmaceutical outfits turned to biotechnology-and sought out the perfect lactase-producing microorganism. Gist-Brocades, a Dutch firm, pioneered in this search and settled on the dairy yeast Kluyveromycis lactis, which had been used for centuries in Russia as starter culture for fermented milk products.
Gist-Brocades turned out and sold in the early 1970s the first lactase enzyme in powdered form. It is added to fresh milk to break down the lactose portion in milk into easier-to-absorb sugars glucose and galactose. The product was a solution without a problem-the 1970s was still "the dark ages of lactose intolerance." As industry leader in the race to reach a market of lactose-intolerant individuals-who never had any inkling then of their condition-Gist-Brocades also introduced milk products with reduced lactose content. By 1979, the outfit produced the enzyme in easy-to-use liquid form.
"But the all-important lactase pill, the one that would work in the body rather than only in milk, continued to elude them," Carper relates.
Here's the rub: human lactase is meant to work in the small intestine with its body heat temperature of 370 degrees Celsius and a pH value nearly neutral 7. Pills have to go through the stomach, and doused there with acids-lactase in the pill is battered dead before reaching the small intestine to do its work.
On their third try, pharmaceutical firms got to a fungus called Aspergillis oryzae. It produces lactase, which can withstand-when taken with food-the acid gauntlet in the stomach and survives to do its lactose-crunching work in the small intestine.
And with that fungus began the lactase industry. By 1985, lactose intolerance has seeped into American consciousness. The lactase industry was selling US$35 million by 1989. Sales hit US$150 million in 1993, "mostly driven by double-digit increases in sales of lactose-reduced milks," Carper recounts.
"The problem with the lactase market is that it is driven by advertising and the effectiveness of advertising on a national scale seems directly proportional to its expense," he notes.
Whatever shape or form lactase comes in, the over-the-counter relief for lactose intolerance comes with the same counsel. Take with food.
Presence of food in the stomach "buffers the enzyme, allowing it to reach the intestine and get to work on the lactose. Taking lactase long after meals-when symptoms are being felt-is far less effective than swallowing it with the first bites of lactose-containing food. Pills can be taken to good effect as much as five minutes before you start eating."
Lactase is a food supplement. That means how many tablets or pills to take before a meal or repast is all up to you. Besides, there are no known harmful effects, no allergies from taking lactase in any amount-lactase is normally present in the human body without any safety problems associated with it. Unless the pills are past their expiration date. "For some reason," Carper notes, "two pills per slice of pizza seems to be a common pattern with people who are seriously lactose intolerant."
In a way, Carper hurls a strong pitch for breast-feeding in his uptake on cow's milk protein allergy: "Babies' bodies are designed to expect nothing but mother's milk for their first vulnerable months of life. Mothers who do not exclusively breast-feed their babies will expose their children to nutrients, first in formulas and later on in solid foods, not found in mother's milk."
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He points to allergic reactions arising from infant intake of cow's milk protein (CMP) which involve the body's immune system: "Digestion normally breaks food proteins back down into individual amino acids, which the body readily accepts. If whole proteins happen to leak into the bloodstream, however, the immune system manufactures antibodies to attack those foreign proteins. These antibodies thereafter stay in the bloodstream to protect against another invasion, sensitizing it. If even a tiny amount of that protein finds its way back into the bloodstream, the body gears up and produces massive amounts of antibodies whether they're really needed or not. The result can be a variety of symptoms, most of them unpleasant, a few of them life-threatening."
He notes that babies who are immediately placed on cow's milk formulas will typically develop symptoms from CMP intolerance in the first three months of life.
Milk packs generous doses of calcium and the current recommended dietary allowance for the bone-building mineral is 800 mg a day for children ages one to 10 and 1,200 mg for those between ages 11 and 24. "These are proportionally huge amounts with a one-year old infant needing as much calcium as a full-grown adult weighing five or six times as much," asserts Carper.
Rues Carper, himself lactose intolerant: "If your reactions to lactose intolerance have made you decide to reduce the amount of milk in your diet or eliminate it altogether, whether you realize it or not, you have cut out one of the major sources of phosphorus, riboflavin, and vitamin A as well as the source of three-fourths of all the calcium eaten in America."
Rather than turning to pill supplements to supply the nutrients readily available in milk, Carper turns his attention to alternative foods-and trots out a 26-page chart of these alternatives to fill in the needs "of the low-dairy-product-consuming lactose-intolerant diet."
Carper's food list allows the consumer to compare calcium density of various foods: As sample, the yolk of a chicken egg has the same amount of calcium as a cup of mixed light and dark chicken meat-but the yolk packs greater calcium content with almost 10 times the calcium per gram.
Tops in calcium content are parmesan, Swiss, cheddar, and blue cheeses; top seafood sources of calcium are salmon, sardines, oysters, and shrimps while dates, almonds, cashew nuts, chestnuts, and pistachio nuts are top calcium providers among fruits and nuts. Salad greens dandelion and parsley are top calcium sources in vegetables.
Carper remembers that Rolling Stone magazine proclaimed lactose intolerance as 1992's "hot disorder." In that same year, sales of products aimed at the lactose intolerant-seven of every 10 people worldwide-burst through the US$100-million barrier as competition between two multinational pharmaceutical giants began to heat up.
The ongoing foofaraw isn't in the tummy-it's mostly in the raging ad war nudging a gargantuan market of some three billion to give their tummies a break.
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