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Tuesday, September 12, 2006

Weirdness from the Bottom of the Pile

Weird things happen when I clean up my office, which I do regularly every three or four years. I find stuff at the bottom of piles. Stuff that never should have been anywhere in that pile at all, let alone at the bottom.

Life offers all too many situations like that. Especially when we start talking about medications. A test of 100, 1,000, even 10,000 people can't find all the symptoms and reactions that may only occur in one person out of a million. If the reaction is deadly the results are tragic.

If the reaction is just a reaction, the results can be, well, weird.

And that leads me back to what I found at the bottom of that pile.

The good thing about lactose intolerance is that there's a pill for it. You can take, in handy pill form, the lactase your body doesn't make. Simple as that. Since I remember what life was like before the pills were available I can tell you that the pills are a scientific breakthrough of the first magnitude.

Here's another bit of great news. Lactase is about the safest thing you can put in your body. There are no known side effects from lactase, at any level ever tested on humans or animals. None. You can't overdose from it, you can't even get sick from it. All it does is digest any lactose you happen to have lying around in your intestines. If there is no lactose (and even if there is), the lactase eventually gets swept out of the body through normal digestive processes. Lactase is absolutely perfectly safe as far as anyone knows.

Here comes the but. But you don't take pure lactase. Lactase normally comes in pill form, which means that it arrives bound with fillers and sweeteners and the other inactive ingredients that are used to bulk out substances to pill size, make them palatable to swallow, and ensure that they break up at the right time in the gut. These inactive substances are about as inactive as anything you can put into your body, so they're safe as well.

Could one person in a million react to an "inactive" substance? Sure. I can't cite any studies offhand, and each and every manufacturer uses different inactive ingredients so a reaction to one brand or type doesn't guarantee a reaction to any other brand or type, but it is not impossible.

And yet, even that slim and virtually unknown reaction to an inactive ingredient would be more likely than something that actually popped up in a medical journal. In that very paper I've been looking for over these past many years, the one I found at the bottom of that pile. It's about a one in a million case. Maybe a one in a billion case.

The paper is: "Allergy to supplemental lactase enzyme," by Karen E. Binkley, from the Journal of Allergy and Clinical Immunology June 1996 (Vol. 97, Issue 6, Pages 1414-1416).

And I'm going to flag it with an immediate warning - that title is misleading.

No one has ever been found to be allergic to lactase. No one. Not even one person in a billion. As I said, lactase itself is perfectly safe.

But. But you have to get lactase from somewhere. And the easiest way to make lactase is to harvest it from a fungus that naturally makes its own lactase. One that is regularly used is called Aspergillus oryzae. Can you be allergic to a fungus? Sure you can. And Dr. Binkley reported a case – one single case, the only one in the literature – of a person who experienced burning and swelling of his throat when he took Lactaid pills because he was allergic to Aspergillus.

It's possible that weird cases like these explain some of the otherwise inexplicable symptoms that people report. If you're the only person in the world to react in a certain way, you can't expect that even the medical community will have seen it before.

On the other hand, you can't get lactose intolerance from eating chicken. Or eggs. Doesn't matter which one comes first. (Yes, I have had questions about lactose symptoms concerning both of these.)

So educate yourself to the best of your ability. You can probably eliminate most of the weirder possibilities 99% of the time. Or 99.9999% of the time. If you're one in a million, or ten million, or a billion, though, you're on your own. Good luck with the world.

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