Lactose-Free Statin Drug Lescol

Statin drugs are prescribed to reduce cholesterol, making them some of the most commonly used drugs in America. Unfortunately, nearly every one of them uses lactose as an inactive ingredient.

Several years ago I had hopes that a new statin drug that didn't cause muscle pain, a common side-effect, might also be lactose-free. No such luck. Ezetrol (ezetimibe) does contain lactose now that it's on the market.

There is one brand name that doesn't. Lescol.

Lescol doesn't work for everybody and has side-effects of its own, as a correspondent recently wrote me. I tried to find a substitute, but no luck.

The alternative is to pay an additional fee and go to a compounding pharmacy. They make up prescriptions to order with offending ingredients removed. I wrote about them in Try a Compounding Pharmacy for Lactose-Free Medications and it's time I gave you a reminder.

The links I gave then are still good.

There seem to be two major trade organizations.

The Professional Compounding Centers of America (PCCA) has more than 3500 members, many of them outside American in Canada, Australia, Europe and New Zealand. To find a compounding pharmacist close to you, call them at 1-800-331-2498 or email customerservice@pccarx.com.

The International Academy of Compounding Pharmacists (IACP) represents more than "1,800 pharmacists, physicians, technicians and patients."

Osteopenia with Lactose Intolerance

As with so many other prescription medications, Boniva, so often prescribed for people who need additional bone density, uses lactose as its primary filler. That can create a problem, as in this questioner to The People's Pharmacy in the Los Angeles Times.

Q. I am 62 years old and just had my second bone-density test. I was told I have osteopenia and should take Boniva.

I have been lactose-intolerant, so I avoid dairy products. I have tried calcium, but it makes me constipated. I took Actonel but developed leg cramps. I took one Boniva tablet the nurse gave me as a sample, but I now have unbearable indigestion. Is there anything natural I can take?

A. Osteopenia is a controversial condition. The concept of pre-osteoporosis was created somewhat arbitrarily in 1992 for research purposes rather than to guide treatment. Extra vitamin D (2,000 to 4,000 IUs daily), exercise and lots of fruits and vegetables can help. There are also other medicines.

Lactose-Free Birth Control Pills. The Definitive List.

Birth control pills are normally a series of 28 tiny pills in a case. The first 21 pills contain the active ingredient that prevents ovulation. The other seven are placebo pills, designed with no active ingredient, but included just because experience shows that it's easier for women to take a pill every single day rather than skipping a week and having to remember to restart.

All well and good, a system that has worked for 40 or more years.

The only problem, for a small set of women, was that for some reason, the vast majority of birth control pills made in America contain lactose as an inactive ingredient. Lactose, being non-reactive and slightly sweet, is an extremely common filler for many medications. Most medications have a lactose-free variety. A limited choice, therefore, but still a choice.

That limited choice used to be Demulen. Unfortunately, Demulen went off the market and was replaced by a generic named Zovia. And Zovia contained lactose.

What choices do women have today?

Thanks to the good folks at Wegmans Food and Drugs, my local supermarket chain, and one that has been in the forefront of making lactose information available, I can answer that question. Christopher Woodring, Pharmacist Intern, created a list based on information from Clinical Pharmacology. Many thanks to him for his arduous effort. Thanks also to the Wegmans East Avenue pharmacists, Katie Barbone, Natasha Dedes, and Paul Taranto.

The only pills that appears to have all its pills be completely lactose free are Nordette and Portia. [This is a correction from the original posting. Cryselle does have lactose in the active pills.] You should consult your own doctor and pharmacist to see if either of these pill are right for you.

The Alternatives listed as contractve injections, which obviously do not put lactose into your stomach. They are not pills but I am including them in this listing for your information.

You can find the full list of all contraceptive medications at this page on my site.

Women should remember that the amount of lactose in any one pill is tiny. Unless you are extremely lactose intolerant the amount of lactose in any individual pill should not cause any symptoms. The best pill for you may contain lactose. Still, I understand that many women are seeking to avoid dairy in all forms and all doses. This information should be especially helpful for you.

Drug Type			Contains Lactose in
	Drug Name	Manufacturer	Active Ingredients	Inactive Ingredients
Low Dose Monophasic
	Cryselle	Duramed/Barr	Yes	NO
	Femcon Fe chewable	Warner Chilcott	Yes	NO
	Microgestin 1.5/30	Watson	Yes	NO
	Nordette	Duramed/Barr	NO	Yes
	Portia	Barr	NO	information Not available
Extended Cycle
	Loestrin-24 FE	Warner Chilcott	Yes	NO
Alternatives
	Depo-Provera		NO	not applicable
	Depo SubQ		NO	not applicable
	Mirena		NO	not applicable
	Nuva Ring		NO	not applicable
	Ortho Evra		NO	not applicable

Tracing Lactose Back to Its Source

New Zealand. It's given us the Lord of the Rings movies, the Flight of the Conchords, and lactose. And the lactose may be more ubiquitous than either of the other two.

TVNZ reported that:

A by-product of Fonterra's waste is now being sold to some of the world's biggest pharmaceutical companies.

Inhalation grade lactose, which is not needed in the processing of cheese, is the dairy industry's second largest product in Europe and the sixth largest globally.

Around 45,000 tonnes of high grade lactose is produced each year and it all starts in Taranaki using milk produced in the North Island.

I believe that. This statement, though, seems odd, as least as written:

The ingredient has attracted Dutch pharmaceutical giant DMV, who in 2006 paired with Fonterra to develop the product into the global market worth $US800 billion.

Maybe the total global pharmaceutical market is worth $US800 billion or maybe it's the global dairy market that's worth US$800 billion, but the lactose piece of it sure isn't.

And here's another strange comment:

Now, a third of every medicine tablet made contains lactose that produced in Taranaki.

Every medicine tablet made contain lactose. No. Don't worry about that. Lactose is just plain not in every medicine tablet made. Even if you read that as lactose is in a third of tablets made, that claim is not likely to be true. Maybe a third of the total volume of tablets made with lactose is lactose, but that doesn't seem right to me either. I find that line a mystery.

But I bet I know what happened. TVNZ got a press release from Fonterra and rewrote it as article, even though the writer had no idea of what the words meant. Depressing to find that as a problem everywhere in the world.

Junk Science Exposed Too Late for Some

The MMR (measles, mumps, and rubella) triple vaccine does not cause autism.

That's not a terribly original or controversial statement. The consensus of virtually all mainstream doctors was that vaccination was critical for children and that no link could be found between MMR and autism.

The American Academy of Pediatricians (AAP) said so as far back in 2001 when they published AAP panel finds no link between ASD, MMR vaccine.

The report concludes, "The available evidence does not support the hypothesis that MMR vaccine causes autism or associated disorders or IBD" (Pediatrics. 2001;107:e84). It also says pediatricians need to work with families to ensure children are protected from these preventable diseases.

"Pediatricians should feel comfortable using MMR vaccine and recommending it for their patients," said Neal A. Halsey, M.D., FAAP, co-chair of the panel that wrote the 64-page report.

With all the available medical evidence om one side, you wouldn't think this would become a major issue. Yet it's not merely major but tragic.

It all stems from an article in the prestigious British medical journal, The Lancet.

Ileal-lymphoid-nodular hyperplasia, non-specific colitis,
and pervasive developmental disorder in children
A J Wakefield, S H Murch, A Anthony, J Linnell, D M Casson, M Malik, M Berelowitz, A P Dhillon,
M A Thomson, P Harvey, A Valentine, S E Davies, J A Walker-Smith
The Lancet, Volume 351, Number 9103 28 February 1998

Summary
Background We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder.

Methods 12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.

Findings Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0·003), low haemoglobin in four children, and a low serum IgA in four children.

Interpretation We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.

Discussion
We describe a pattern of colitis and ileal-lymphoid-nodular hyperplasia in children with developmental disorders. Intestinal and behavioural pathologies may have occurred together by chance, reflecting a selection bias in a self-referred group; however, the uniformity of the intestinal pathological changes and the fact that previous studies have found intestinal dysfunction in children with autistic-spectrum disorders, suggests that the connection is real and reflects a unique disease process.

We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue.

If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988. Published evidence is inadequate to show whether there is a change in incidence or a link with measles, mumps, and rubella vaccine.

Doesn't sound like much, does it? A study of a mere dozen children. Carefully worded findings. No evidence of a connection. More study is needed.

Yet, this study by itself caused the hysteria over vaccination over the past decade. Even though no link was made between MMR and autism, use of the MMR vaccine declined sharply, especially in Britain, and even the single disease vaccines that showed no connection whatsoever dropped in popularity.

The result is predictable and inevitable. Children died.

After its publication, rates of inoculation fell from 92% to below 80%. Populations acquire "herd immunity" from measles when more than 95% of people have been vaccinated.

Last week official figures showed that 1,348 confirmed cases of measles in England and Wales were reported last year, compared with 56 in 1998. Two children have died of the disease.

That's from an article by Brian Ross of The Times of London. His actual accusations are much worse than causing hysteria. He says that the original article was fraudulent.

It claimed that the families of eight out of 12 children attending a routine clinic at the hospital had blamed MMR for their autism, and said that problems came on within days of the jab. The team also claimed to have discovered a new inflammatory bowel disease underlying the children’s conditions.

However, our investigation, confirmed by evidence presented to the General Medical Council (GMC), reveals that: In most of the 12 cases, the children’s ailments as described in The Lancet were different from their hospital and GP records. Although the research paper claimed that problems came on within days of the jab, in only one case did medical records suggest this was true, and in many of the cases medical concerns had been raised before the children were vaccinated. Hospital pathologists, looking for inflammatory bowel disease, reported in the majority of cases that the gut was normal. This was then reviewed and the Lancet paper showed them as abnormal.

To be fair, here is a .pdf of Dr. Wakefield's response.

Wakefield has been practically elevated into a god by the fringe nutgroups that regularly attack all mainstream medicine. The leader of the nut groups is Age of Autism, who awarded Wakefield their first, and I believe only, Galileo Award as a persecuted Man of Science. You won't be too surprised that autism diet-fad activist Jenny McCarthy and her husband Jim Carrey were Age of Autism's 2008 Couple of the Year.

The fact that many autism activists advocate a casein-free, gluten-free diet for their children, despite the lack of any solid medical evidence for its effectiveness, gives me the tie to write about this autism junk science. In truth, I would have written about it anyway. It displays, in unmistakable, deadly terms, the dangers of junk science, pseudoscience, and the war against mainsteam science that I have to write about all too often.

My lessons are simple. Science and medicine are consensus disciplines. One paper - especially a paper with a small number of subjects, without double-blind testing, without confirmation - is not science. Even if it makes newspaper headlines, one paper means nothing by itself. That's true for all science, all medicine, all nutrition. In a few, rare instances a huge, multi-year, carefully monitored study may reveal a danger that is so severe that you need to change your life in response. An after-the-fact study of a dozen people that states in so many words that no link was made is not one of these instances.

Wakefield was not ignored, or ridiculed, or prosecuted or persecuted by other doctors. The medical community checked out his claim and found there was nothing to it. That should have buried his work, like a thousand other preliminary articles that never get confirmation. The British government and its medical arms, along with the British press, apparently botched the response. The American press hasn't been much better. They reported the controversy rather than the science.

That's not good enough. Controversy sells, but conspiracies of the entire medical community don't exist. (The conspiracies are usually on the other side. Wakefield has been accused of taking large sums of money from lawyers who wanted to sue the vaccine manufacturers.)

The medical community is not always right. There are huge amounts we don't know yet. Those daring mavericks and loners who are opposed to the consensus? They're almost always wrong. They're almost always out to take your money. Some of them are real medical doctors. More have no expertise at all except for their ability to scare you and fool you.

This is why I do this blog. I hope that by reading it you can look at the fraudsters and tell them to go to hell at first sight, before they can do their damage.

Children are dying of measles in the U.K. They are dying because of ignorance and fear. While cases of measles have shown a slight rise in the U.S. because of parents not vaccinating their children, deaths are still rare. Worldwide, however, measles is still deadly, killing an estimated 197,000 children in 2007. Massive as that number is, it's still a 74% decline from 2000. Why? More vaccinations. Measles vaccinations worldwide pushed over 80% in 2007. That's right. There are now more parents vaccinations their children in the third world than in Britain.

The junk science brigade is trying to turn Britain into a third world country. Maybe now they have less chance to succeed. Let's hope more children don't have to die to prove them wrong.

UPDATE: News broke today that U.S. courts will deny accusations that the MMR vaccine caused autism.

A special U.S. court ruled against three families on Thursday who claimed vaccines caused their children's autism.

The Vaccine Court Omnibus Autism Proceeding ruled against the parents of Michelle Cedillo, Colten Snyder and William Yates Hazlehurst, who had claimed that a measles, mumps and rubella vaccines had combined with other vaccine ingredients to damage the three children.

"I conclude that the petitioners have not demonstrated that they are entitled to an award on Michelle's behalf," Special Master George Hastings, a former tax claims expert at the Department of Justice, wrote in the Cedillo ruling.

They also declared that the vaccines with the mercury-containing preservative called thimerosal did not cause autism symptms.

Medicinal Lactose: A View from the Inside

We all know about the use of lactose in medications, both prescription and over-the counter. Lactose isn't really used in every medication, of course; it just sorta seems that way.

But why? What makes lactose so useful? One way to answer that question is to ask a manufacturer and listen to it boast.

Here's an article, really a press release in disguise, that appeared on PharmaceuticalOnline.com.

The Lactose Leader
Sheffield has been manufacturing pharma-grade Lactose products since 1940. It has the longest reputation for anhydrous direct tableting excipients, and holds the original patent for NF Anhydrous Direct Tableting (DT) lactose. Today it produces both monohydrate and anhydrous forms of lactose at a fully cGMP compliant FDA registered drug establishment in the US. It uses a certified rennet-free whey source to eliminate any possible TSE contamination concerns.

A key recent innovation has been the creation of a high-flowing ‘DTHV' NF lactose grade, which forms harder tablets at lower compaction forces than other high-flowing directly compressible products. At the same time DTHV tablets have similar disintegration profiles as other high flowing directly compressible lactose tablets with lower hardness values. ...

Tabletting System
Sheffield's Tabletting System concept provides a simple way to create custom fast-dissolving tablet formulations using a free-flowing lactose-based functional powder for direct compression. Customers only need to add the desired active and a flavour (or a taste-masked active), plus lubricant, and then form into tablets using standard direct compression techniques.

Pharma Flavours
Sheffield's recently launched range of Kerry Pharma Flavours, which now enjoys pharma levels of quality control, can improve the taste of pharmaceuticals by masking the unpleasant taste associated with many active pharmaceutical ingredients. Kerry's understanding of flavour perception, regional consumer preferences and extensive product knowledge permit the optimal choice of flavour profiles for every pharma application. 14 standard flavours are available, but in-house development capabilities permit the creation of custom flavours as required.

Coating Systems
Sheffield's Film Coating Systems provide an easy-to-use yet complete solution for tablet cosmetics and functionality. The range comprises four clear coating systems, a colour coating system and two choices of enteric coating system. All are supplied as a free-flowing powder that is readily dissolved in water to yield a ready-to-spray solution for aqueous film coating. Application substrates range from pharmaceutical tablets to nutritional supplements.

It all sounds so wonderful there hardly seems to be any reason to spoil the lactose pills with those icky medicines. But they do.

And we who are lactose intolerant or dairy allergic are just going to have to live with it, because with all this wonderfulness going on you know they won't stop using lactose for a long time to come.

Seriously Now, Is Lactose a Problem in Medications?

Yesterday I mentioned that seemingly every pill you can put in your mouth, even karaoke pills (no, not pills to cure karaoke, but pills to make you sing better for karaoke) contains lactose as a filler.

A frivolous frippery, to be sure, but a fun way to approach a serious subject. Just how much of a risk does someone with lactose intolerance face when taking pills containing lactose?

A bunch of serious-sounding doctors, Joseph P. Nathan, M.S., Pharm.D.; Sara Schilit, Pharm.D.; and Jack M. Rosenberg, Pharm.D., Ph.D. Drug Topics, of the International Drug Information Center of the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, N.Y., took a look at the medical literature on this subject.

They reported back to a physician audience on Drug Topics.

Case reports describing lactose-intolerant patients experiencing adverse reactions to the lactose content of medications have been published over the past 30 years. The symptoms experienced were ameliorated to some degree with supplemental lactase enzymes and resolved when the patients discontinued the offending medications. Notably, the majority of patients in these cases were extremely sensitive to lactose-containing products.

While it has been reported that the amount of ingested lactose necessary to produce adverse effects varies, it generally ranges between 12 and 18 gm of lactose (approximately 8 to 12 oz of milk). Considering the fact that most oral medications contain quantities of lactose that are far less than 12 to 18 gm, one would theoretically not expect such small quantities to result in gastrointestinal symptoms. Nonetheless, the cases reported in the literature suggest that certain individuals may react to very small quantities of lactose.

In summary, it appears that most patients who are lactose intolerant can probably tolerate the quantities of lactose that are incorporated into oral drug products. However, one must keep in mind that certain highly sensitive patients may present with gastrointestinal complaints even after ingesting the small quantities of lactose found in oral medications. Furthermore, patients ingesting multiple lactose-containing medications may experience symptoms of lactose intolerance due to the cumulative lactose intake from these medications. Patients who experience adverse gastrointestinal effects after ingesting lactose-containing drug products may opt to use lactase enzyme supplementation.

I feel good in that this is exactly what I've been saying on the subject.

If taking lactase with the pills doesn't alleviate the symptoms, then the choices are fewer. You can try requesting an alternate medication or form of the original medication that does not contain lactose. This isn't always possible, though. Some medications don't have good alternatives, or the alternatives might be considerably more expensive.

Or you could try finding a Compounding Pharmacy that will make up personalized versions of the medications just for you. That link will give you contact information to help you find a compounding pharmacist in a location near you.

Lactose in Karaoke Pills. Karaoke Pills?

Lactose is a slightly sweet sugar. It's imparts just a hint of pleasant taste to counteract the bitterness of most medications. And it's cheap because it's a waste product of cheesemaking. It's inert in most ways as well. It can be packed down and retain a shape or heated to form a smooth outer coating. All in all, lactose is close to the best and most versatile filler that can be used for pills.

It's not even that big a deal for the vast majority of us who are lactose intolerant, because there's just too little lactose in any one pill to create symptoms. Medical grade lactose should be completely free of contamination by whey or casein proteins, so it would have very low reactivity for those with dairy allergies who are not anaphylactic to dairy. Those of you who are should avoid any lactose, in pill form or in foods.

So I wasn't terribly surprised to see lactose as an "inactive" ingredient in a pill. I was terribly surprised to see the pill.

The karaoke pill.

Serkan Toto, on Crunchgear.com, found The Fushigi na Karaoke Taburetto (Mysterious Karaoke Pills) at the Japanese site Rakuten.

According to the manufacturer, they treat bad breath, expand your singing range by softening the vocal cords and relieve stress. As a result, you are supposed to sing better. They promise your next performance at Karaoke will be brilliant if you take 3 pills 10 minutes before.

Take them just before you sing. Isn't that the equivalent of taking lactase pills just before you eat?

They come in packs of five pills. Since you need three at a time, one pack doesn't get you two karaokes. You only come out even if you buy three packs. Devious marketing indeed. Of course, any mind that could dream up karaoke pills has as high a level of deviousness as Donald Trump on Deal or No Deal. Why expect the ordinary?

More on the Use of Lactose in Medications

I've posted numerous times about the frequent presence of lactose as a filler, binder, or coating for pills, whether prescription or over-the-counter (OTC). The fullest discussion was probably in Lactose in Medications.

Whether a pill's formulation uses lactose or not is just one of the possible variations that might affect your response to a drug, an issue that Melissa Healy, a staff writer for the Los Angeles Times, reports is not as well regulated by the Food and Drug Administration (FDA) as it should be.

In fact, a brand-name drug's generic counterpart is rarely an exact replica. Though the two share equal amounts of the same active ingredient, they generally look different. And those differences, say some pharmacologists, can result in small variations in how they work in patients.

A brand-name drug and its generic in most cases are formulated with different colorants, fillers and binding materials. Though all of those must come from an FDA-approved list of pharmaceutical ingredients, they are, in most cases, assembled differently in each manufacturer's product. One version of a drug might use lactose or sugar as an inactive ingredient; another might not. But incidental ingredients like these can affect the way patients dissolve and metabolize a drug's active ingredient -- faster or slower. And that, in turn, can result in variations in the two formulations' effects.

In almost all cases, the FDA permits a generic drug to release 80% to 125% of an active ingredient into the bloodstream, compared to that released in a single dose of the original medication. That range would make little practical difference in the effect that most drugs have. And the FDA and generics manufacturers defend the allowable range of variance as the same that is permitted among "batches" of brand-name drugs.

But medical and pharmacology specialists warn that the FDA's range may be too broad for some drugs, especially in cases where a drug has a "narrow therapeutic index" -- the fine line between an ineffective dose and a dangerous one.

Both doctors and pharmacists have guides that spell out the inactive ingredients for every prescription medication. As I mentioned in the linked post, they've been able to do a quick lookup of prescriptions drugs containing lactose for a long time.

But as I also mention there, a simple lookup of drug names that contain lactose fails to answer all the needed questions. The situation is much worse when generic drugs are involved and worse yet for over-the-counter medications. Discovering the use of lactose for a specific type, size, strength, and variety of pill is normally simple. Discovering whether any variation of the needed medication, in any guise from any manufacturer, contains lactose is sometimes next to impossible.

You need to start with your doctors and make sure they are aware of any concerns you have. You also need to be aware that you probably need to have few concerns. Few if any sufferers of lactose intolerance are so sensitive that they will react to the lactose in any one pill. I have found no medical journal articles that reported any allergic reaction caused by taking a pill containing lactose. (However, there are at least two known Allergic Reactions from Lactose in Dry Powder Asthma Inhalers.)

The use of lactose in so common that avoiding it may limit your choices - and your doctors' choices - unacceptably. If you feel you must do so, do so wisely and knowingly and be sure to thoroughly examine all the alternatives.

Nightmare Advice on Allergies

I write fantasy and science fiction professionally. Even so I swear I could never make anything up as wild as homeopathy.

Homeopathy is based on the ancient folklore of "like cures like." Practitioners take herbs that create symptoms superficially similar to those produced by a disease or ailment and then dilute them until nothing but water and a "memory" of the herb is left. This magically creates a cure.

You can therefore use homeopathy to cure just about anything that creates symptoms. Ricky Hussey in The American Chronicle want to cure eczema this way.

Treatment

Homeopathy Apis, Graphites, Pulsatilla, Rhus tox., and Sulfur may be helpful. Herbal Medicine Marigold tea, calendula ointment, or aloe vera gel are all helpful. Aromatherapy Add 12 drops of fennel, geranium, or sandalwood to 2fl oz/60ml of carrier oil.

Pulsatilla? It's "the weather cock among remedies." What? Huh? Even after reading this site I can't figure out what that's supposed to mean.

The disposition and mental state are the chief guiding symptoms to the selection of Pulsatilla. It is pre-eminently a female remedy, especially for mild, gentle, yielding disposition. Sad, crying readily; weeps when talking; Changeable, contradictory. The patient seeks the open air; always feels better there, even though he is chilly. Mucous membranes are all affected. Discharges thick, bland, and yellowish-green. Often indicated after abuse of Iron tonics, and after badly-managed measles. Symptoms ever changing. thirstless, peevish, and chilly. When first serious impairment of health is referred to age of puberty. Great sensitiveness. Wants the head high. Feels uncomfortable with only one pillow. Lies with hands above head.[bolding and punctuation as in original]

Wow. If this were the 60s, everybody would know what this guy was on, and they wouldn't think homeopathy.

What's even worse is that many, if not most, homeopathic pills are made out of lactose. The Organic Pharmacy dips its toe into the world of science.

Homeopathic products are very clean-meaning they have no binders, fillers or coatings. The soft molded lactose tablets are made to dissolve almost instantly when placed in the mouth. Because the remedies dissolve in the mouth, they are absorbed by the mucous membranes in the mouth and carried directly into your system. For this reason, the remedies work faster than conventional medicines because conventional medicines are usually coated and don't get absorbed into the system until the coating is dissolved by the stomach acid, and that generally takes about twenty minutes.

In standard, or allopathic, medicine, this is called sublingual administration. It can be very effective, but doctors and pharmacists will note that not every chemical works well this way, with some not mixing well with saliva or containing chemicals too large to be absorbed.

Besides, if lactose isn't a binder or filler, then what conceivable role does it play?

For even more evidence that homeopathists understand nothing of chemistry, here is another mind-busting statement from the pulsatilla site:

[Q.]Does anyone know if there can be a problem using the homeopathic tablets which are lactose tablets when a person is lactose intolerant?

[A.]Probably no problem. But if you wish you can disolve them in water further diluting any lactose content.

Dilution solves everything! Yay!

Lactose is lactose. The amount you take in counts. It doesn't matter if the amount is concentrated in a pill or spread through a glass of water. That same amount will enter your intestines.

This is absolutely the most basic chemistry of digestion. If the homeopaths don't know this, you shouldn't allow them or any of their products within a thousand feet of your intestines.

And I shouldn't have to tell you that people with serious dairy allergies will avoid any product that contains lactose in the first place.

Homeopathy is a nightmare of pseudoscience and its most ignorant peddlers are dangerous.

More Uses for Whey and Lactose May Be Coming

Whey is a cheap by-product, effectively what the cheese industry used to throw away. Naturally, food scientists saw whey as an opportunity. Sure enough, whey started to be added to a million packaged food products.

Since lactose is most easily refined from whey, whey is the source of the lactose used in food products and also in medications.

Good for the food industry, bad for us.

Now the food scientists, who can't seem to let anything alone, are interested in finding a new use for whey and lactose. Microencapsulating aerogels.

Stephen Daniells pays that into English for us at FoodNavigator.com, discussing an article, "Use of whey proteins for encapsulation and controlled delivery applications," by S. Gunasekaran, S. Koa and L. Xiao in Journal of Food Engineering (Elsevier), Volume 83, Issue 1, Pages 31-40.

Whey proteins hydrogels - 3D networks with the ability retain water in its structure when dissolved - have the potential to encapsulate sensitive ingredients, suggests a new study.

"The advantages of using whey protein-based gels as potential devices for controlled release of bioactives is that they are entirely biodegradable and there is no need for any chemical cross-linking agents in their preparation," wrote the authors.

...

They also report that the swelling and release behaviour could be easily slowed by coating the gels with alginate, a result that could lead to targeted release of bioactives at specific points in the gastrointestinal tract.

So the idea is that a drug, a vitamin, a nutrient, or whatever is needed could be encapsulated like time-release capsules, only much, much smaller, and delivered to the exact point in the intestines where it is needed. Actually, that sounds pretty good. Much better than just swallowing a pill, hoping the medication survives the acid bath of the stomach, and assuming that the right dosage will be absorbed before the whole mess is pushed out of the system.

The question for us, as yet unanswered, is whether the whey protein - or possibly lactose - would create symptoms in those who are susceptible to the proteins or milk sugar.

Too soon to tell, I suppose. As Daniells wrote:

More research is needed to further explore the potential of whey protein hydrogels, and whether other bioactives, both lipid and water soluble, could be encapsulated in this way.

Answers to Questions from Readers, part 9

Q. Do you think taking lactase artificially in tablet form would induce the body's natural mechanism to decrease its natural production. In other words do I become dependent on this tablet forever?

There is no evidence that using (or not using) lactase tablets has any effect whatsoever on the body's natural supply of lactase. For most people, the lactase-making ability declines with age. Nothing is known that will slow it down; nothing (other than actual damage to the intestines) is known that will speed it up.

You may need to use lactase tablets forever, but that is only because your natural amount of lactase will be forever insufficient.

Q. What mutations if any cause lactose intolerance and what chromosome are they on?

Sorry, you have it the wrong way around. No mutations cause LI. LI is the normal state of humanity. It is the ability to continue to produce the enzyme lactase all one's life that is the mutation. The gene is on chromosome 2.

Q. I may need to soon begin taking a medicine that contains lactose. Would this be a problem for my son since it is dairy? Or maybe not because breast milk already has lactose?

If your son can tolerate your breast milk, he should be able to tolerate anything you eat containing lactose. Lactose does not travel to breast milk in any case; it's only the milk proteins (which are not found in pills) that you have to worry about.

And the amount of lactose in any given pill is so small that only a tiny few exceptionally sensitive people ever react. However, a lactase tablet will help even those.

Q. Does being allergic to mother's milk necessarily mean being allergic to cow milk? What's the best way to tell if a 5 month old is allergic?

As far as I know, no infants are ever allergic to mother's milk itself. The allergy is to something in the milk. It is possible, if the mother is drinking cow's milk, for some of the proteins to filter through into the milk. The cow's milk itself is the true culprit. Of course, some other contaminant may be to blame, anything from corn to onions or about a zillion others.

The way to tell if an infant is allergic depends very much on the specifics of the allergy. However, in many cases an allergic infant will react with a rash or welt if you simply put a few drops of milk on an arm. In other cases, you will have to notice a pattern of reactions to drinking the milk itself. If you're really concerned, a formal allergy test can be done.

Q. Do lactose intolerant people get their reactions with an hour of eating the food that they are intolerant to or are the cramping and diarrhea a much longer-delayed reaction?

I wish I could give you a better answer, but I'm stuck with "it depends." Some people seem to feel the effects right away. At other times, and in other people, it can be delayed several hours.

However, if you regularly have cramping and diarrhea an hour after every meal with lactose and not after meals that have none, then I'd have to say lactose intolerance is a good bet. In any case, I'm glad you're seeing your doctor. There is a very accurate test for lactose intolerance that your doctor can arrange. Of course, most doctors will try to rule out the more serious diseases with similar symptoms first, so don't be surprised if you're asked to take other tests in the beginning.

Try a Compounding Pharmacy for Lactose-Free Medications

Hundreds of prescription medications and hundreds if not thousands of over-the-counter medications contain lactose as an inactive ingredient. Lactose has little taste, but some find it mildly sweet. No one is allergic to it or suffers from side effects. It is a cheap by-product of cheese production. In short, it's nearly the ideal bulk filler for a pill.

Of course, there's the tiny drawback that if you can't digest lactose, you may get symptoms ranging from gas and bloating to diarrhea. The flip side of this is that the amount of lactose in any one pill is so small that only the rarest of extremely sensitive individuals should be affected by lactose intolerance symptoms generated by a single pill.

Even that is not sufficient for those who try to avoid all milk products for whatever reason. Although you should be able to find a lactose-free alternative for most medications, this is not always possible, and often expensive or inconvenient.

What to do? Try a compounding pharmacist.

Green Dispensary Compounding Pharmacy, Australia

I was reminded of them by this article on ClickOnDetroit.com.

It's that level of dedication that brings customers facing a wide variety of medical challenges to [Kenny] Walkup's store. His is a compounding pharmacy. That means each prescription is prepared specifically for an individual patient, tailored to meet their medical needs and taste preferences.

"Today's modern drugs fit for a lot of people, but there are people that they just don't work for, whether it's a lactose intolerance, or an allergy to a drug or a color," Walkup said.

Compounding is part of medical history. In earlier days, pharmacists made their own pills in their own stores from basic ingredients. They "compounded" them, meaning literally "To produce or create by combining two or more ingredients or parts." Even a few decades ago, 60% of prescription items were compounded. Today only about 1% are.

That means compounding pharmacies are rarer than the regular pharmacies found in every drug store, supermarket, and discounter. Even so, you should be able to find one near you. I can't guarantee that every medication can be made or made lactose-free by every compounding pharmacist, but if it's important to you, seek one out to talk to.

There seem to be two major trade organizations.

The Professional Compounding Centers of America (PCCA) has more than 3500 members, many of them outside American in Canada, Australia, Europe and New Zealand. To find a compounding pharmacist close to you, call them at 1-800-331-2498 or email customerservice@pccarx.com.

The International Academy of Compounding Pharmacists (IACP) represents more than "1,800 pharmacists, physicians, technicians and patients." Go to their website to access their Compounding Pharmacist Locator.

Serious Warning About Thyroid Medication

If you are taking high doses of the thyroid medication levothyroxine and the medication is not working properly, it may be because you are lactose intolerant.

This was the surprising news from a study in the medical journal Thyroid 2006, 16(11): 1171-1173. doi:10.1089/thy.2006.16.1171. The study, "Lactose Intolerance Revealed by Severe Resistance to Treatment with Levothyroxine," was by three Spanish researchers, Manuel Munoz-Torres, Mariela Varsavsky, and Guillermo Alonso.

Here's the abstract:

The most common cause of apparent ineffectiveness or resistance to treatment with oral levothyroxine (LT⁴) is the result of noncompliance, known as pseudomalabsorption. However, an abnormality in the bioavailability of LT⁴ should also be considered in patients requiring large doses of LT⁴ to achieve euthyroidism. The incidence of lactose intolerance in Caucasian adult patients is 7%–20%, but the association with resistance to treatment with oral LT⁴ is unusual. We report a 55-year-old woman in whom treatment LT⁴ for hypothyroidism was found related to a previously undiagnosed oligo-symptomatic lactose intolerance, an unusual association. Although rare, intolerance to lactose should be considered in the differential diagnosis of gastrointestinal diseases that can cause malabsorption of LT⁴. The possibility of correcting this disorder with simple dietary measures justifies its consideration.

Obviously, it you are taking levothyroxine, you should talk with your doctor just to be safe.

Answers to Questions from Readers, part 5

Q. Doesn't there have to be some type of LI measurement degree scale so that I know just how intolerant I am?

You would think so, wouldn't you?

But, as far as I can tell, you would be wrong. This bothers me too, but in all my research I have never come across any discussion of a scale of degrees of LI. In all the medical journal articles I have read, a simple threshold is used. Anybody who goes over that threshold is considered to be LI. The amount over the threshold is never considered. In fact, I have seen it stated that there is no correlation, although I do not know what the justification for this statement is.

In reality, symptoms are based on so many other factors than just the amount of lactase one produces that it would indeed be very difficult to make more definitive statements, but I would like to see some research done to clarify this point. You might also want to take a look at my Lactase page in the LI Basics section of my web site for more on why symptoms may vary so greatly.

Q. I think that I might be lactose intolerant. What type of doctor should I see to confirm if I am or not?

That really depends on your situation. Most family doctors can send you to a clinic for a test. However, some will prefer to send you to a specialist gastroenterologist. That's because many of the symptoms of LI are also symptoms of some much more serious problems and they want to eliminate them as possibilities first. Then you'll get sent to a clinic for a test. (Or to a hospital or whoever does it in your area.)
So you probably should just start at your regular doctor. However, if you just want to see one doctor and don't need to get a referral for insurance or HMO reasons, see a gastroenterologist.

Q. I have two vegan friends who eat no milk products, and they both have VERY strong feelings that the American Dairy Association is spitting out propaganda by telling us that we need to drink so much milk. I have been brought up drinking skim milk at every meal, and feeling healthy and happy about it - so my gut reaction is that milk IS good for you. What do you think?

The odd answer is that you are both right.

Yes, the milk industry has always been a propagandist for milk. Why should this surprise anyone? That's its job.

And vegans can live perfectly healthy lives without ever touching a milk product. That's their job.

So?

So, everybody is missing the real issue. Is milk good for you, personally? Of course it is. It has large amounts of lots of nutrients, and in a form that most people find preferable to the alternatives. Whole milk does have a large amount of fat, true, but since you drink skim milk, that's not a problem. There are people who believe that milk does awful things to you, but I see no widespread evidence of any of these ills in the general public.

My bottom line has always been that if you want to drink milk -- or use milk products -- you should go ahead and do so. As long as you do so moderately and in the proverbial balanced diet, you'll be just fine. And if you don't ever want to use milk, then there is absolutely no need to. You can get every nutrient from other sources, and as long as you do so moderately and in the proverbial balanced diet, you'll be just fine.

There. Feel better now?

Q. Have you heard of anyone's LI symptoms being relieved by birth control pills?

The problem is that I hear all sorts of anecdotal comments about LI, without ever being able to back them up. I have heard of women becoming LI because of pregnancy and also of women being able to drink milk for the first time while pregnant. I do not, however, know of any studies that would shed any light on the subject. But you are definitely the first to give a connection to bcp's. (However, as all but one brand of bcp's contain lactose as a filler, it's probably not surprising that few people see their symptoms disappear while on them.)

Q. Our doctor thinks my daughter has irritable bowel syndrome, but with lactose intolerance as a trigger. I'm wondering if I am giving her enough Lactaid. Do you have any thoughts on this?

While it couldn't hurt, it's not clear that it would do much to help unless you think you are still not detecting all milk products at those meals.

You might want to go in a different direction. There are numerous other triggers of irritable bowel other than milk. They include: large meals, fatty or spicy foods, carbonated beverages, and caffeine. Gas-producing foods, like beans and cabbage, can also be a problem. So can sorbital, the artificial sweetener. Even some fiber sources, including lettuce, celery, and fruits, may cause gas and bloating. If you detect a pattern of symptoms in conjunction with any of these, try removing it from her diet for a few days and see if that helps.

Q. How does heat affect lactose? Does baking alter lactose? If I see non-fat milk in a bread label, has the lactose been altered to the point that it no longer poses a problem for me?

Unfortunately, there is no evidence that heat affects lactose in any way. Lactose in pure form, in mostly pure form (whey) and as a small percentage of other milk products, is used in hundreds of foods and people seem to respond to all of them. Of course, most people do _not_ respond to small amounts of lactose, so size does matter, as they say. But you do need to take lactose into account in any food that it is in.

To know how much lactose is in various milk products, see the SuperGuide to Dairy or the Lactose Percentages pages in the Dairy Facts section of my web site.

Answers to Questions from Readers, part 3

Q. I am interested in calcium supplementation and read labels. Many of these labels list a calcium lactate. Should someone with LI be concerned about lactates or just lactose.

Just lactose.

None of the sound-like-milks (lactates, lactylates, lactic acid, etc.) should be a problem to anyone who is LI.

One word of warning: Occasionally, these products are made from other products that originate from milk. That still shouldn't be any problem at all for the LI, but people with severe milk allergies should avoid such products. It can be extremely difficult to tell the origins of any additives, however. You have to call the manufacturer and ask about each product individually.

I have an extended discussion of this issue in my Dairy or Nondairy? The Experts Speak page.

Q. If there is lactose-free milk, then why isn't there lactose-free ice cream?

Because it doesn't sell, is my guess. Various companies have put out lactose-reduced ice creams in the past and most people, and I mean most LI people as well, never buy them.

I have a list of all the ones I know of in my Product Clearinghouse. Look on the Reduced-Lactose Products page.

But what you should be doing is checking out the Frozen Desserts page in the Product Clearinghouse for listings of lots of completely milk-free alternatives.

And don't forget that many people with LI can still eat frozen yogurt and that most true sorbets and ices are also milk-free.

Q. I recently read in a nutrition book that soy products can cause gas, bloating, diarrhea etc. if eaten too often. Is this true?

I don't think so. There is no reason to believe that any food that is not intrinsically harmful causes problems just from regular consumption. What the book might have been trying to say is that many people who are allergic to milk and turn to soy products as a substitute find that they are also allergic to soy protein. In that case, more is definitely less. And soybeans are a legume, like peas and beans, and legumes can produce gas in some people. Otherwise, if soy doesn't bother you now, eating more of it later shouldn't be any different. (Of course, if you eat too much of anything at one meal, you'll pay for it, but that's another issue.)

Q. If one is lactose-intolerant, what effect, if any, does the presence of lactose in an injected medication have? How is it absorbed and metabolized? Is there an effect on delivery of the accompanying drug?

Bearing in mind that I'm not a doctor or a biochemist, here goes.

Lactose symptoms are caused solely by the presence of undigested lactose in the small and large intestines. I can think of no reason why lactose in the bloodstream should create any problems for anyone. I have read of only one, single, isolated case of an allergic reaction to lactose itself. Lactose is used in so many medications because it is basically as neutral an agent as possible, and it also has the nice property of not caking, another reason for its use. It's an interesting question, but I have never run across any reason to think that injected lactose would be a problem.

Q. My intestinal distress increases with the fat content of the lactose carrier, particularly butter and cream. Yet your tables show that the lactose content actually decreases with fat content. Could something else be going on here?

There is some slight evidence that a small number of people have milk fat intolerance. Unfortunately, the studies were never redone, so it's hard to know whether such a thing really exists.

A somewhat different study found no difference in symptoms between people drinking high-fat milk and those drinking fat-free milk.

But fat alone can create problems in some people. All I can give is the common sense advice to lay off high milkfat items for a while and see if your symptoms decrease.

Answers to Questions from Readers, part 1

I started my Steve Carper's Lactose Intolerance Clearinghouse in 1997. Almost immediately people began writing to me with questions about lactose and lactose intolerance and dairy allergy and milk. I put up the answers to some of the more interesting questions on my web site.

With my 10th anniversary rapidly approaching, I'm taking a look back at my site and its history. I find that most of the questions I was asked 10 years ago are still being asked today.

So I'm gradually going to copy some of those questions over here, updating those few whose answers have changed over the decade. If they spark new questions or comments from you, all the better.

Q. I am so lactose intolerant my pharmacist had to buy a machine so he could make capsules for me without lactose. He informed me that there were other things that could be used in medication instead of lactose, but lactose was the cheapest. Until now I have felt safe with capsules, but my newest medication, a capsule also brand new on the market, has lactose. I called the company, Wythe, and screamed. They made note and according to them they will listen. One voice in the wilderness will achieve nothing. With your following can't we start a movement to have lactose removed from medication PLEASE!!!!

You are not alone and you are doing exactly the right thing. Companies do listen to the people who use their products.
Unfortunately, the number of people as sensitive to tiny amounts of lactose as you are is quite small. That means that manufacturers have little incentive to reformulate their products.

So the more of you who take the time to write to manufacturers and scream, the better. You can get the address from your pharmacist. Or go to a library and find the Physician's Desk Reference, which has the names of all major manufacturers and the ingredients of all major prescription drugs.

Q. I sometimes get LI symptoms 6 to 8 hours after eating a meal, and sometimes even the next day. Is this possible?

Sure is. You get LI problems in two ways: from the water pulled into the intestines by the excess lactose and from the gases produced by the bacteria in your colon that eat the undigested lactose.

Each person and each meal creates different intestinal transit times, as they are called. Food can take ten hours to reach the colon, and then more time for the bacteria to work and to finish up the lactose. You might need two or three days to completely rid your system of the lactose.

Q. I always wanted to know the role of glucose & galactose (digested lactose) in the body and how important they are. Does the absence of these sugars affect the body in any way? Is it completely OK to be without them?

Glucose is only the single most important substance in the body, because it is the basic energy source for all the internal chemistry of the body. Not to worry, though. All carbohydrates (including galactose) eventually get converted to glucose so that the body has a constant supply. As long as you eat a basic healthy diet, you'll always have plenty of glucose.

Q. Have you ever heard of a baby reacting to the lactose in human milk? And does the effect of eating lactose-containing food pass through breast milk the way eating broccoli or cabbage does?

Babies are designed to be able to drink milk for their first couple of years of life. Even mothers in societies in which virtually every adult is lactose intolerant naturally breastfeed infants without any problems.

A very, very tiny minority of babies are born without the ability to drink milk, but I would doubt if this happens once in a hundred million births. By all means try breastfeeding your next child. In the unlikely event that your child has a problem, you will know about it almost immediately and you can make the switch to a non-milk formula without any further harm.

As for lactose passing through milk, you're thinking of allergic reactions, which are very different from lactose intolerance.

Lactose doesn't work that way, and even if it did, breast milk naturally will contain hundreds of times as much lactose as could possibly leak through from foods that you eat.

Don't give it a second thought. Have as much milk as you desire and can safely tolerate.

Q. Are non-dairy creamers really non-dairy?

Yes, non-dairy creamers are lactose-free. Most of them do contain casein in some form, however. Casein is derived from milk protein, which is why some people don't consider them truly non-dairy. People with just LI and not milk allergy should not be affected by any minuscule residue of lactose that may remain after some manufacturing processes.

Lactose and Medications

Lactose is a sugar, a slightly-sweet sugar. It is only about one-seventh as sweet as sucrose, ordinary table sugar. Oddly enough, this is a good thing to many in industry. Lactose allows a bit of pleasant sweetness to be added to products, without overwhelming them with an overly-sweet taste. Commercial bakers can sprinkle lactose on the tops of bread and let it caramelize to a beautiful golden-brown. Food processors can add lactose (or whey, which is mostly lactose) to add taste and texture to foods without affecting the primary taste of the food. Best of all, lactose is made from whey, and whey is a waste product in the cheese-making process, so it's really cheap.

That's why lactose is used so often in pill-making. The extremely tiny amount of actual working ingredient in a medication needs to be surrounded with fillers that bulk it out to be large enough to handle. A substance that is mostly tasteless but with just enough sweetness to balance out the bitter taste of many medications is great. That lactose can be formulated to break down in the stomach to release the medication makes it nearly ideal.

Literally hundreds of branded prescription medications use lactose as a part of their formulations. If you add in generics and over-the-counter drugs, you probably have thousands of medications that include lactose.

And there will soon be more rather than fewer pills that use lactose.

Phil Taylor on DrugResearcher.com wrote Roquette wins US patent for Starlac in novel dosage form about a new and improved way to dispense medications.

French company Roquette has been awarded a US patent for a dissolve-in-the-mouth drug delivery technology that makes use of its novel Starlac excipient.

Use of the excipient could allow the creation of tablets that are hard and resistant to damage during handling, yet still disintegrate quickly in saliva after dosing.

The US patent, awarded to Roquette earlier this month, covers a solid dose form based on lactose and starch, the constituents of Starlac excipient, alongside one or more active pharmaceutical ingredients (APIs).

...

Xavier Duriez, senior project manager at Roquette, told in-PharmaTechnologist.com that almost all ODT products on the market use mannitol as a diluent, but that in some cases Starlac could be used as a good alternative.

"Starlac is preferred for ODT and chewable formulas where palatability is a 'must'," he said, adding that the excipient provides a creamy mouthfeel that mannitol doesn't provide.

...

Starlac, a mixture of 85 per cent lactose and 15 per cent natural corn starch, was first introduced in 2002.

Of course, the mere granting of a patent doesn't mean that any products using Starlac will hit the market any time soon. But unless there is a serious bug with the project, it's too good an idea not to come to pass.

What does this mean for those who are lactose intolerant? Not as much as you might think. Only a tiny amount of lactose is present in any one pill. One study I read estimated that the average pill had 25 mg of lactose. You'd need to take 480 such pills to equal the lactose in an eight-ounce glass of milk at that rate.

A very few people might still be bothered by this tiny amount, especially if they have to take many such pills each day, as the elderly or those with serious illnesses must do. All I can suggest is to take a lactase pill along with the medication to see if that helps.

Those with a dairy allergy also need to be somewhat concerned, but with the same caution. Medical-grade lactose is extremely pure and not likely to be contaminated with the dairy protein that causes problems. Extremely anaphylactic people should certainly talk with their doctor before taking any pills with lactose. Those with lesser allergies and symptoms probably can take pills that contain lactose with no problems. But certainly check to see what alternatives there are.