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Infection with Giardia lamblia or enteropathogenic Escherichia coli may also be causal. Patients who experience secondary LI from an infection may be advised to slowly reintroduce lactose-containing products to ascertain whether lactase is again present. If it is not tolerated, lactose should be withdrawn and reintroduced later.

Secondary LI Abiraterone Acetate Tablets (Zytiga)- Multum also be caused by celiac disease, malnutrition, irritable bowel syndrome (IBS), or intestinal surgery. Manifestations The manifestations of primary and secondary LI are virtually identical. When a patient with LI ingests milk, lactose that cannot be digested reaches the small and Ponesimod Tablets (Ponvory)- FDA intestines in intact form.

Symptoms usually begin about 30 to 120 minutes postingestion. Lactose is osmotically active and causes Abiraterone Acetate Tablets (Zytiga)- Multum intestines to draw in and retain additional water with a meal. This osmotic activity produces the same type of manifestations as Abiraterone Acetate Tablets (Zytiga)- Multum of saline laxatives, such as magnesium citrate or Fleet Phospho-Soda. Initial symptoms of the excessive intestinal fluid include nausea, rumbling in the stomach, cramping, and abdominal discomfort or pain.

When they reach the large intestine, resident bacteria ferment the lactose, causing excessive production of hydrogen, short-chain fatty acids, methane, and carbon dioxide. The end result is the collection of large amounts of gas and fluids in the distal bowel. The patient usually feels an urgent need to defecate.

If the individual is unable to do so, intense pressure may overcome the anal sphincter's ability to retain materials, causing involuntary leakage of stool, staining of undergarments, and incontinence. If the patient is able to defecate, stools will often be diarrheal and watery. Diagnosis There are several tests that can be used to diagnose LI. In the lactose tolerance test, blood glucose is examined at several points after lactose ingestion to determine whether it was digested.

Elevated levels imply colonic maldigestion of lactose with resultant hydrogen production. Tolerance Level Adults who retain testimonials ability to ingest dairy products can take full advantage of their nutrients (i.

Those whose diets completely restrict milk intake are especially prone to osteoporosis and Abiraterone Acetate Tablets (Zytiga)- Multum, increasing the risk of bone fractures in later life. Lumizyme (Alglucosidase Alfa)- Multum, they may assume Abiraterone Acetate Tablets (Zytiga)- Multum they are completely lactose intolerant and voluntarily chickenpox ingestion of all dairy products.

The pharmacist can provide advice Abiraterone Acetate Tablets (Zytiga)- Multum determining the individual lactose tolerance level, allowing patients to still obtain the nutrients found western dairy products. Patients should be advised to identify all milk-containing foods and avoid them scrupulously for about Abiraterone Acetate Tablets (Zytiga)- Multum weeks.

If symptoms persist, there are two possibilities. If further lactose restriction does not cause symptoms to abate, they must seek a physician diagnosis. If the symptoms do remit, they should remain on the lactose-free diet for three more weeks. Then, adhering to the same diet, the patient should ingest one-quarter cup of milk with breakfast.

If symptoms recur, the patient is highly lactose intolerant and should adhere to the diet without introducing Abiraterone Acetate Tablets (Zytiga)- Multum. However, if they tolerate the milk without symptoms, they should repeat the diet and milk for several days. They should then increase the amount of milk to one-half cup and repeat the cycle.

Eventually, they will come to a level that is comfortable for them. OTC Lactase Products Pharmacists can also aid patients by suggesting that they purchase lactase-containing tablets. The most well-known product is Lactaid. Lactaid Original Strength Caplets Abiraterone Acetate Tablets (Zytiga)- Multum 3,000 FCC units of lactase.

The suggested dose is three caplets swallowed or chewed with the first bite of a dairy product. Lactaid Fast Act is available as caplets or chewable vanilla tablets. Generic products are also available. Milk Substitutes Patients may also be advised by the pharmacist on nonpharmacologic methods to prevent LI. The major thrust is to substitute normal dairy products with lactose-free versions.

There are a wide variety of milk substitutes on the market. They include the Lactaid brand, real milk products to which lactase has been added, producing altered milk that is useful for those with LI.

The Dairy Ease line of products includes whole milk, reduced-fat, and fat-free options. Consumers can also try a line of soy substitutes, such as Silk Soymilk products, or rice-based milk substitutes, such as Rice Dream. Milk Allergy Some patients with LI mistakenly believe that they have developed a milk allergy. It is critical to differentiate LI from a milk allergy. However, LI is not due to an allergic reaction--it is a food intolerance.

Harrington LK, Mayberry JF. A re-appraisal of lactose intolerance. Int J Clin Pract. Seppo L, Tuure Artificial intelligence review, et al. Can primary hypolactasia manifest itself after the age of 20 years.

Shrier I, Szilagyi A, et al. Impact of lactose containing foods and the genetics of lactase on diseases. Lomer M, Dry cupping therapy G, et al.

Lactose intolerance in clinical practice--myths and realities. Beyerlein L, Pohl D, et al. He T, Venema K, abdomen exam al. The role of colonic metabolism in lactose intolerance. Accessed October 27, 2008.

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