DEAR DR. DONOHUE: We think my grandson, age 12, has lactose intolerance. Within a few hours after he consumes dairy food, he gets severe stomach cramps and bouts of diarrhea. Could you give us insight on what to do? Could he outgrow this condition? – E.H.

ANSWER: Lactose is milk sugar. Lactase is an enzyme in the digestive tract that breaks down milk sugar so it can be absorbed. People whose intestinal tracts have too little of the lactase enzyme run into trouble when they drink milk or consume many dairy products. They might come down with stomach cramps and pain, and have diarrhea shortly after milk sugar arrives in their small intestine. The condition is called lactose (milk sugar) intolerance or lactase (the enzyme) deficiency. You can use either name. They mean the same thing.

People don’t outgrow the deficiency. In fact, many are programmed to stop manufacturing the lactase enzyme shortly after infancy. American blacks and people with roots in Mediterranean countries, often cannot tolerate milk and some milk products when they grow older.

Your son, if he does have lactose intolerance, can take the lactase enzyme in tablet form before drinking milk or eating dairy products. Two brand names are Lactaid capsules and Dairy Ease. You can buy milk pretreated with lactase. Many cheeses have little milk sugar in them, and lactase-deficient people usually tolerate them quite well. American and Swiss cheeses and blue, cheddar and Parmesan cheeses rarely cause trouble. Yogurt is often safe to eat.

Quite often, lactase-deficient people have enough of the enzyme that they can tolerate small amounts of dairy products without having diarrhea or cramps.

The family doctor ought to test your grandson for lactose intolerance. Then you can proceed with treatment with solid evidence that you’re treating the right thing.

DEAR DR. DONOHUE: My doctor is in a snit because my triglycerides are high. He wants me to eat what looks to me like an almost vegetarian diet. Is this necessary? I really don’t have a good grasp of what triglycerides are. Will you kindly explain? – M.M.

ANSWER: Triglycerides are companions to cholesterol. They’re fats. Think of cholesterol as a wax. Cholesterol plays a greater role in clogging arteries, but triglycerides add to the blockage. A normal blood triglyceride reading should be less than 150 mg/dL (1.7 mmol/L). A value between 150 to 199 (1.7 to 2.6) is said to be borderline high.

Weight loss lowers the triglyceride level. A grain, vegetable and fruit diet promotes weight loss and limits the amount of triglycerides you get from food. In addition to decreasing the amount of fat you eat, you should lower the amount of sugar you use. It raises triglycerides. So does alcohol. Exercise brings the triglyceride reading down. Thirty minutes of brisk walking every day ought to cause a dip in your triglycerides.

Very high triglycerides levels – values of 1,000 (11.3) or more – can inflame the pancreas (pancreatitis) and must be lowered as quickly as possible.

If diet, exercise and weight loss don’t get the job done, medicines can usually do so. Omacor is a new one. Niacin, Tricor and Lopid have been around longer and have been used successfully.

As an afterthought, were you fasting when you had your blood tested? You have to fast for 12 to 14 hours to get a valid triglyceride reading.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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