Milk, Enzymes & Ulcers

Countless peptic-ulcer patients are put on a bland diet rich in milk and cream. If they then get cramping ab dominal pains, nausea and diarrhea, even worse than their original com plaints, their doctors usually put them on a still blander diet - meaning more milk. If such patients shirk their milk drinking and their symptoms diminish, the usual explanation is a quick, glib suggestion that they must be allergic to milk. Not so, report two University of Colorado doctors in the Journal of the A.M.A. The trouble is far more likely to be a shortage of the enzyme that the body uses to digest milk sugar (lactose).

For such patients, more milk means only more trouble.

To use lactose as fuel, the body must first break it down into two simpler sugars: glucose and galactose. The enzyme that does the cracking is lactase. Nature intended babies to live on milk, and lactase deficiency is fortunately a rarity in the newborn, but the incidence increases with advancing age. According to Georgetown University's Dr. Stuart H. Danovitch, writing in GP, as much as 10% of the adult population may suffer from lack of lactase. Colorado's Dr.

John E. Struthers Jr. says the figure may be as high as 30%, though many people have only a moderate shortage that causes them no distress.

The effects of severe lactase deficiency can be both distressing and dramatic. After drinking a glass of milk, the victim soon doubles up with cramps that may spread across his entire distended abdomen. He suffers nausea and flatulence, and then a profuse, watery diarrhea. The mechanism of these reactions has now become clear, say Dr. Struthers and his Colorado colleague, Dr. Fred Kern Jr. Lactase is supposed to do its sugar-splitting work along the lining of the small bowel; if the enzyme is missing or in short supply, the undigested sugar passes into the large bowel, where it is promptly fermented. In the process, it generates gas and draws water into the bowel.

Patients who have had part of their stomachs removed for gastric ulcer, along with victims of ulcerative colitis, diabetes, and a variety of abdominal disorders, including acute intestinal infections, are all especially liable to lac-tase-deficiency difficulties. Now that the results of research in lactase function are being drawn to doctors' attention for use in their daily practice, the A.M.A. Journal has been moved to rhapsodize editorially: "What a joy to the clinician to find the arcane skills of research scientists directed to such matters as bloating, flatulence, cramps and diarrhea!" The Journal adds: "Some patients will now acquire a new dignity, with the status of enzyme deficiency rather than neurosis."

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