Only one-third of the population worldwide retains the ability to digest lactose into adulthood. Most adults of Asian, African, Middle Eastern, and Native American descent are lactose intolerant. In addition, half of Hispanics and about 20% of Caucasians do not produce sufficient lactase as adults.

A simple test for lactose intolerance is to drink at least two 8-ounce glasses of milk on an empty stomach and note any gastrointestinal symptoms that develop in the next four hours. The test should then be repeated using several ounces of cheese (which does not contain much lactose). If symptoms result from milk but not cheese, then the person probably has lactose intolerance. If symptoms occur with both milk and cheese, the person may be allergic to dairy products (very rarely can lactose intolerance be so severe that even eating cheese will cause symptoms). In addition to gastrointestinal problems, one study has reported a correlation in women between lactose intolerance and a higher risk of depression and PMS. However, this study is only preliminary and does not establish a cause-and-effect relationship.

In people with lactose intolerance, consuming foods containing lactose results in intestinal cramps, gas, and diarrhea.

Over the counter lactase (Lactaid®, Dairy Ease®), an enzyme that breaks down lactose, is used to either pre-treat milk or to be taken during the ingestion of dairy products.

A lactose-free diet is the most effective means of controlling the symptoms of lactose malabsorption in a person with lactase deficiency. However, some lactose-intolerant people can drink milk that has been predigested by the addition of lactase. Those individuals who must avoid dairy products should take supplemental calcium.

Although symptoms of lactose intolerance are triggered by the lactose in some dairy products, few lactose-intolerant people need to avoid all dairy. Dairy products have varying levels of lactose, which affects how much lactase is required for proper digestion. Milk, ice cream, and yogurt contain significant amounts of lactose although for complex reasons yogurt often does not trigger symptoms in lactose-intolerant people. In addition, lactose-reduced milk is available in some supermarkets and may be used by lactose-intolerant people.

Many people with lactose maldigestion tolerate more lactose in experimental studies than in everyday life, in which their symptoms may result from other carbohydrates as well. Sucrose and the indigestible carbohydrates lactulose and fructooligosaccharides (FOS) have all been shown to produce symptoms in lactose-intolerant and milk-intolerant people.

Nutritional supplements that may be helpful

Supplemental sources of the enzyme lactase may be used to prevent symptoms of lactose intolerance when consuming lactose-containing dairy products. Lactase drops may be added to regular milk 24 hours before drinking to reduce lactose levels. Lactase drops, capsules, and tablets may also be taken orally, as needed, immediately before a meal that includes lactose-containing dairy products. The degree of lactose intolerance varies by individual, so a greater or lesser amount of oral lactase may be needed to eliminate symptoms of lactose intolerance.

Researchers have yet to clearly determine whether lactose-intolerant people absorb less calcium. As lactose-containing foods are among the best dietary sources of calcium, alternative sources of calcium (from food or supplements) are important for lactose-intolerant people. A typical amount of supplemental calcium is 1,000 mg per day.

Lactobacillus acidophilus supplements do not appear to be effective in reducing the signs and symptoms of lactose intolerance. In a preliminary trial, people with lactose intolerance were given Lactobacillus acidophilus supplements twice daily for seven days, but failed to show any improvement in symptoms or laboratory measurements of lactose digestion.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

This information provided by www.healthnotes.com

Low Blood Sugar

Hypoglycemia is the medical term for low blood sugar (glucose).

Occasionally, hypoglycemia can be dangerous (for example, from injecting too much insulin). It may also indicate a serious underlying medical condition, such as a tumor of the pancreas or liver disease. More often, however, when people say they have hypoglycemia, they are describing a group of symptoms that occur when the body overreacts to the rise in blood sugar that occurs after eating, resulting in a rapid or excessive fall in the blood sugar level. This is sometimes called reactive hypoglycemia.

Many people who believe they have reactive hypoglycemia do not, in fact, have low blood sugar levels, and many people who do have low blood sugar levels do not have any symptoms of reactive hypoglycemia. Some evidence suggests that reactive hypoglycemia may be partly a psychological condition. Consequently, some doctors believe that reactive hypoglycemia does not exist. Most doctors, on the other hand, have found reactive hypoglycemia to be a common cause of the symptoms listed below.

Common symptoms of hypoglycemia are fatigue, anxiety, headaches, difficulty concentrating, sweaty palms, shakiness, excessive hunger, drowsiness, abdominal pain, and depression.

A diet of frequent, small, high-protein, low-carbohydrate meals is often recommended. If illness prevents eating, hospitalization for intravenous glucose injections is typically required. In cases of pituitary or adrenal insufficiency, hormone replacement may be prescribed. For hypoglycemia due to an insulin-producing tumor, surgical removal of the tumor is usually recommended.

Dietary changes that may be helpful

Doctors find that people with hypoglycemia usually improve when they eliminate refined sugars and alcohol from their diet, eat foods high in fiber (such as whole grains, fruits, vegetables, legumes, and nuts), and eat small, frequent meals. Few studies have investigated the effects of these changes, but the research that is available generally supports the observations of doctors. Some symptoms of low blood sugar may be related to, or made worse by, food allergies.

Some people report an improvement in hypoglycemia episodes when eating a high-protein, low-carbohydrate diet. That observation appears to conflict with research showing that increasing protein intake can impair the body's ability to process sugar, possibly because protein increases insulin levels (insulin reduces blood sugar levels). However, some doctors have seen good results with high-protein, low-carbohydrate diets, particularly among people who do not improve with a high-fiber, high-complex-carbohydrate diet.

Nutritional supplements that may be helpful

Research has shown that supplementing with chromium (200 mcg per day) or magnesium (340 mg per day) can prevent blood sugar levels from falling excessively in people with hypoglycemia. Niacinamide (vitamin B3) has also been found to be helpful for hypoglycemic people. Other nutrients, including vitamin C, vitamin E, zinc, copper, manganese, and vitamin B6, may help control blood sugar levels in diabetics. Since there are similarities in the way the body regulates high and low blood sugar levels, these nutrients might be helpful for hypoglycemia as well, although the amounts needed for that purpose are not known.

Glucomannan is a water-soluble dietary fiber that is derived from konjac root (Amorphophallus konjac). In a preliminary trial, addition of either 2.6 or 5.2 grams of glucomannan to a meal prevented hypoglycemia in adults with previous stomach surgery. A trial of glucomannan in children with hypoglycemia due to a condition known as dumping syndrome produced inconsistent results.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Salt (sodium chloride) is omnipresent in the modern American diet because many packaged and prepared foods contain high levels of salt. Moreover, salting food at the table has become second nature to many people. Dietary intake of high levels of salt is thought to contribute to the progression of a number of chronic diseases. Strange as it seems to scientists, however, non-chloride sources of sodium (e.g., monosodium glutamate [MSG], sodium bicarbonate [baking soda], sodium ascorbate [a form of vitamin C]) do not increase blood pressure. Studies that have looked sodium consumption and other diseases have only looked at salt. Therefore, the problem of high sodium intake as it relates to disease may really be a problem of high salt intake.

The American Heart Association and other organizations advise people to limit their salt intake to the equivalent of no more than 3 teaspoons [6 grams] each day. Additionally, health experts advise people with certain health conditions, such as Ménière's disease, to further limit their salt intake to levels even lower, sometimes as low as 1 teaspoon [2 grams] per day.

A low-salt diet is beneficial for certain people with cardiovascular disease. Preliminary evidence has linked salt consumption with increased cardiovascular disease incidence and death among overweight people. Low-salt diets seem to be especially important for people with hypertension (high blood pressure). Salt intake has been definitively linked to hypertension in Western societies, and eliminating salt from the diet lowers blood pressure in most people.

Research studies consistently find that increased dietary salt aggravates asthma symptoms, especially in men. In a small, preliminary trial, men with asthma who doubled their salt intake for one month experienced a worsening of their lung function. Although not all of the observed effects were conclusive, several double-blind trials have provided evidence of clinical improvement following a period of salt restriction.

Other conditions that may benefit from a low-salt diet include Ménière's disease, migraine headaches, kidney stones, gastritis, and ulcers caused by H. pylori infection. Preliminary evidence also suggests that restricting dietary salt may play a role in the prevention of certain types of cancer, including stomach, colorectal, and head and neck cancers.

Restricted levels of salt may help to preserve bone density. Short-term increases in dietary salt result in increased urinary calcium loss, which suggests that over time, salt intake may cause bone loss. Increasing dietary salt has increased markers of bone loss in post- (though not pre-) menopausal women.

Lower salt intake may also help to protect against the development of reduced insulin sensitivity, a physiological process that can lead to blood sugar regulation problems in certain people. Preliminary studies suggest that high salt intake decreases insulin sensitivity in young, healthy people, but not in older people with hypertension. Moderate restriction of salt, however, also decreased insulin sensitivity in one preliminary study of healthy people, but had no effect in other studies of people either with or without hypertension.

Salt restriction also may be helpful in reducing edema in some people. High salt intake tends to lead to water retention that may promote the further accumulation of fluid beneath the skin.

Pregnant women who are experiencing hypertension of pregnancy should not follow a low-salt diet. As a low salt diet has not been shown to have a significant effect in reducing blood pressure during pregnancy, salt restriction is not recommended to women with gestational hypertension and preeclampsia. Additionally, unlike other conditions that cause high blood pressure, salt restriction (and use of diuretics) can worsen preeclampsia by reducing blood flow to the kidneys and placenta. In preeclampsia, unrestricted use of salt and an increased consumption of water are needed to maintain normal blood volume and circulation to the placenta.

People with certain conditions have been found to benefit from salt intake and should not follow a low-salt diet. Children with cystic fibrosis lose a large amount of salt in their sweat and thus should be encouraged to salt their food liberally. Chronic fatigue syndrome sufferers who have a form of low blood pressure triggered by changes in position (called orthostatic hypotension) have been reported to be helped by additional salt intake. Additionally, people with goiter or hypothyroid condition should not restrict intake of iodized salt if it is their only major source of iodine.

To avoid salt ask about ingredients at restaurants and others' homes, and read food labels. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet.

• Canned soups, juices, and vegetables
• Cereals: cornflakes, bran flakes
• Cheese
• Cottage cheese
• Hydrolyzed vegetable protein
• Ketchup
• Lite soy sauce
• Microwave popcorn
• Miso
• Olives
• Pickles
• Processed meats: bologna, cured ham, frankfurters, etc.
• Salad dressings (prepared)
• Salted butter and margarine
• Salted nuts
• Seaweeds
• Smoked or cured fish
• Snack foods: potato chips, pretzels, tortilla chips
• Soy sauce
• Table salt
• Worcestershire sauce

Best bets

• Fresh foods such fruits, meats, vegetables
• Oats
• Packaged or prepared foods: look for labels stating low-sodium, salt-free, or unslated
• Pasta
• Rice
• Seasonings and marinades such as dried herbs, garlic, lemon juice, and/or vinegar (in place of salt)

Are there any groups or books associated with this diet?

American Heart Association
1615 Stemmons Freeway
Dallas, TX 75207 8806
www.americanheart.org

The No Salt, Lowest-Sodium Cookbook: Hundreds of Favorite Recipes Created to Combat Congestive Heart Failure and Dangerous Hypertension by Donald A. Gazzaniga, New York: St. Martins Press, 2001

Get the Salt Out: 501 Simple Ways to Cut the Salt Out of Any Diet by Ann Louise Gittleman, New York: Crown Trade Paperbacks, 1996.

Cooking Without a Grain of Salt by Elma W. Bagg, New York: Bantam Books, 1998.

USDA Nutrient Database for Standard Reference (on-line search for sodium content)