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Celiac Disease and Lactose Intolerance: Can enzymes help?

Frank L. Anderson

Frank L. Anderson, M.D.

Surgery Center Division

Sutter Pacific Medical Foundation

Sutter Santa Rosa Regional Hospital

Question:

I just purchased a gluten lactase enzyme medication that claims to let me eat anything safely. I have recently been diagnosed with celiac disease, and also feel lactose intolerant. Will this product work, or did I just waste my money?

Answer:

That sounds like a product too good to be true and I would imagine persons suffering from celiac disease and lactose intolerance would be very receptive. Unfortunately these are two very different problems which need to be discussed separately.

Celiac disease is an autoimmune disease which is active when gluten contacts the small intestine, particularly the upper small intestine. There is no enzyme deficiency, it is an allergic reaction that can be reversed only by avoiding intestinal lumen contact with gluten-containing foods.

Sometimes corticosteroids are necessary to control the symptoms. When celiac disease results in damage to the small intestine, lactose and sometimes fructose cannot be digested since the enzyme which breaks these carbohydrates down is the first to be destroyed and the last to recover from the damage. So it can easily be said celiac and lactose intolerance coexist but treatment of celiac can treat both problems in most persons. Lactase is an enzyme or facilitator of a chemical reaction, in this case dividing lactose sugar for absorption. It can always help digest dairy lactose whether is occurs alone or with celiac.

I found this product on the web and could find no details of what it contains or what they are promoting as a celiac enzyme. I would imagine a valid pill which could block the immune reaction of celiac would be widely disseminated in the reviewed medical literature. This is not to date.

I would also want to consider how the diagnosis of celiac disease was made in this case - by empiric diet withdrawal, a blood test or intestinal biopsy? There clearly are many persons who feel better avoiding gluten. This is a substance which thickens food, and you may feel better avoiding it.

I would recommend saving your money spent for this product - which you will need for the foods which are gluten free. However if this product works for you, it is always hard to argue against using it as long as the manufacturer can provide details about what is in this product and what evidence they offer for effectiveness.

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