Tag: diarrhea

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Lactose Intolerance is Usually Permenant in Some Adults

Lactose intolerance commonly develops after adolescence. It is estimated that between 30 and 50 million Americans are lactose intolerant.

Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African Americans and American Indians and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Lactose is a natural sugar found in milk and dairy products. Lactose intolerance means inability to digest lactose. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine.

Function of lactase is to break down milk sugar into simpler forms that can then be absorbed into the bloodstream. Lactose is broken down in the intestine by lactase to glucose and galactose. These simple sugars are easily absorbed through the intestinal wall and enter the blood stream to be transported to the liver. Galactose is further broken down in the liver into glucose.

At birth large amount of lactase may be present in the intestine. But as the child grows the level of lactase may fall and by adolescence the level may be low enough that the milk can no longer be digested.

Lactase deficiency may be congenital. Or the deficiency may be acquired. It may occur temporarily after a bout of gastroenteritis. Certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. But for most people, lactase deficiency is a condition that develops naturally over time.

Absence of lactase will make lactose ferment in the intestine and cause symptoms.
Common symptoms include nausea, cramps, bloating, gas, and diarrhea. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Most individuals will be diagnosed by the typical symptoms they experience. You may be asked to keep a diary for few days of what you eat and the symptoms you get. You may be advised to completely quit dairy products and see if the symptoms disappear. Then you will be asked to go back on the dairy products. If the symptoms reappear then the diagnosis is confirmed.

The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance test, the hydrogen breath test, and the stool acidity test.

Lactose intolerance is usually permanent in adults. The symptoms can be completely relieved by eliminating lactose from the diet by avoiding milk and milk products. Others can use lactase liquid or tablets to help digest the lactose. Other option would be to drink lactose-reduced milk available at supermarkets. This milk contains all the nutrients found in regular milk.

Milk is an important source of calcium in our diet. We need calcium for growth and repair of bones. If milk and milk products are avoided then consult your dietitian or physician to suggest other sources of calcium for your body.

Although lactose intolerance is widespread, it does not pose serious threat to our health.

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Traveler’s Diarrhea Can Cause Irritable Bowel Syndrome

Have you already planned a winter holiday? Besides getting your passport and appropriate currency, you need to think of getting your vaccinations updated and take actions to prevent traveler’s diarrhea (TD).

TD hits your system when you consume contaminated food and water. It occurs during or shortly after travel, most commonly affecting persons traveling from an area of more highly developed hygiene and sanitation to a less developed one. Food and water may be contaminated with bacteria, parasites or viruses. A similar but less common syndrome is toxic gastroenteritis, caused by ingestion of pre-formed toxins.

Studies have shown bacteria are responsible for approximately 85 per cent of TD, parasites about 10 per cent, and viruses five per cent. On average, 30-50 per cent of travelers to high-risk areas will develop TD during a one to two-week stay.

TD is generally self-limited and lasts 3-4 days even without treatment, but persistent symptoms may occur in a small percentage of travelers. Any diarrhea associated with fever and blood in the toilet requires medical attention.

Infectious diarrhea can have a long term effect on our system resulting in arthritis, Guillain-Barré syndrome (a reversible condition that affects the nerves in the body), and irritable bowel syndrome (IBS). IBS may occur in up to 30 per cent of persons who contracted travelers’ diarrhea or infectious diarrhea. Research is going on to determine if post-infectious IBS can lead to inflammatory bowel disease.

IBS is a complex disorder clinically characterized by abdominal pain and altered bowel habit. Its causative mechanisms are still incompletely known. It could be a person’s genes, psychosocial factors, changes in gastrointestinal motility and hypersensitivity of certain organs in the body.

TD can be self-limiting benign condition or may result in serious sequalae. So it is no rocket science to conclude that we should try and prevent TD by taking necessary preventive measures. Travelers should remember to wash their hands with soap and water prior to eating or meal preparation.

Eat foods that are freshly cooked and served piping hot and you should avoid water and beverages diluted with non-potable water. Foods like salads are washed in non-potable water. You should avoid that. Raw or undercooked meat and seafood and raw fruits and vegetables should be avoided. Safe beverages include those that are bottled and sealed or carbonated. Consumption of food or beverages from street vendors poses a particularly high risk.

What kind of medications can you use as prophylaxis against TD?

Studies from Mexico have shown Pepto-Bismol (taken on arrival at the destination as either two oz. of liquid or two chewable tablets four times per day) reduces the incidence of TD from 40 to 14 per cent, says one research paper. You should make sure that Pepto-Bismol is compatible with other medications you take. There is no conclusive evidence that use of probiotics is helpful.

E. coli is the most common type of bacteria which causes TD. Use of oral Dukoral vaccine (two weeks and one week before travel) provides protection against E. coli diarrhea for three months.

Use of prophylactic antibiotics has been demonstrated to be quite effective in the prevention of TD. Studies have shown that attacks of diarrhea are reduced from 40 per cent to 4 per cent by the use of antibiotics. But it is becoming difficult to decide which antibiotic to use as bacteria tend to develop resistance to antibiotics. For this and other reasons, prophylactic antibiotics should not be recommended for most travelers.

Three months before you travel, you should visit your family doctor and local public health nurse and discuss your travel plans. They will provide you with the most advanced information on how to have a healthy and happy holiday.

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Inflammatory Bowel Disease

Dear Dr. B: I was recently diagnosed with inflammatory bowel disease (IBD). I have been advised to stay on medication for IBD for the rest of my life. Why do I have to do that? What happens if I take it only when I have a relapse?

Answer: First, we need to clarify what is IBD. IBD covers two forms of intestinal inflammation: ulcerative colitis and Crohn’s disease. It has nothing to do with irritable bowel syndrome (IBS).

Ulcerative colitis is inflammation of the colon and rectum only. It does not affect other parts of the gastro-intestinal tract. Crohn’s disease can occur anywhere in the gastro-intestinal tract, from mouth to anus. The most common sites being the terminal ileum and the colon.

Exact cause of IBD is not known. IBD is associated with wide variety of complications which may affect the bowel or other parts of the body. There is no medical treatment to cure IBD. Therefore bringing the disease under control and maintaining remission is very important to prevent complications. But attaining and maintaining remission is a big challenge.

After appropriate investigations, in 80 to 90 per cent of the cases of IBD your doctor should be able to tell you whether you have ulcerative colitis or Crohn’s disease. Sometimes it is hard to differentiate between the two.

Most common medications used in the management of ulcerative colitis are: 5-ASA (aminosalicylates) and corticosteroids. Patients who do not respond to these medications are then managed by azathioprine, 6-mercapturine, methotrexate, cyclosporine or infliximab.

5-ASA is the first line of treatment. Episodes of remission and relapse are very common in ulcerative colitis. Studies have shown that those who take their medications on regular basis are fivefold more likely to remain in remission than those who are not compliant.

There are many advantages to maintaining remission in ulcerative colitis. Abdominal cramps, diarrhea and blood loss are not pleasant symptoms to have every few weeks or months. It may also reduce the risk of colon cancer by half in compliant patients. It is important to remember ulcerative colitis is a pre-malignant condition. Corticosteroids are good for short term use but should not be used for long term remission because it has many side-effects.

Ulcerative colitis can be cured by surgically removing the whole colon and rectum and having an ileostomy for faecal passage. Surgical option is entertained only if there is a risk of cancer, if cancer is found in the colon, if the disease is not responding to medical treatment or patients develop complications. Overall, in ulcerative colitis, very few patients need surgery.

Drugs used to induce remission in Crohn’s disease are the same ones as used in ulcerative colitis. First line of treatment is 5-ASA but it is not as effective in Crohn’s as it is in ulcerative colitis. Most patients end up getting corticosteroids. But corticosteroids have many side-effects so it should be used only for short term purposes.

If the patient has recurrent episodes of flare-ups then azathioprine or methotrexate is effective in maintaining remission. There is no consensus as to how long these medications should be continued as they can be associated with side-effects. The next line of treatment to maintain remission is infusion of infliximab every eight weeks.

There is no simple way to keep Crohn’s in remission. Eighty per cent of the patients with Crohn’s will eventually require surgery as they become resistant to medical therapy or develop complications. Surgery does not cure the disease. It only removes the diseased segment of the bowel. There is high rate of recurrence of the disease after surgery. Within 15 years, more than 70 per cent of patients will require a second operation.

Unfortunately, in IBD, taking pills is a life long commitment without any guarantee of cure or episodes of relapse.

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Lactose Intolerance

Dear Dr. B: I have chronic diarrhea. Is it possible that I may have lactose intolerance?

Answer: Many conditions can cause diarrhea. It can be acute or chronic in nature.

Acute diarrhea is more likely to be the result of a viral illness such as infection with rotavirus, adenovirus, or astrovirus. Bacterial or parasitic infection can also cause acute diarrhea. These may be contracted from exposure to contaminated water and food.

Chronic diarrhea can result from malabsorption, food allergy, celiac disease, bacterial overgrowth, lactose intolerance, chronic Giardia infection, short-bowel syndrome, inflammatory bowel disease, malignancy and irritable bowel syndrome.

Lactose intolerance is a condition where a person has inability to digest lactose, the natural sugar found in milk. Normally, the enzyme lactase breaks down lactose in the intestines to form the sugars glucose and galactose, which are easily absorbed through the intestinal wall.

Persons with lactose intolerance are unable to digest significant amounts of lactose because of a genetically inadequate amount of the enzyme lactase. As a result, the lactose remains undigested in the intestines and causes abdominal pain, diarrhea, bloating and excessive flatus.

The condition most commonly develops in adolescence and adulthood. It is more common in non-Caucasians than in Caucasians. It is present in up to 15 percent of persons of northern European descent, up to 80 percent of blacks and Latinos, and up to 100 percent of American Indians and Asians.

A diagnosis of lactose intolerance is usually not too difficult. It can usually be made with a careful history supported by dietary changes. If necessary, diagnosis can be confirmed by using a breath hydrogen or lactose tolerance test.

Individuals with chronic diarrhea believe they are lactose intolerant but do not actually have impaired lactose digestion, and some persons with lactase deficiency can tolerate moderate amounts of lactose, up to 250 mls. of milk daily without symptoms.

Lactose intolerance is usually a permanent condition. Treatment consists primarily of avoiding lactose-containing foods. Lactase enzyme supplements can be helpful. If one has to go off milk and milk products completely then one must maintain adequate body calcium balance by taking oral calcium supplements.

Question of the week:
What is the difference between a nice guy and a good guy?

According to 83 years-old Jack Fleck (1955 U.S. Open golf champion), nice guys are pleasant outwardly, but they’re looking for how situations can benefit them. Good guys give of themselves, no questions asked.

A thought for the week for the new graduates:
“Having an education is no excuse for not using your head”.
-from Musings by Dennis van Westerborg, a local artist and writer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!