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USE
• Lactose-reduced milk, lactase enzyme drops or lactase enzyme tablets if you are unable to digest milk.
• Hard cheese and yogurt, which contain little lactose.

AVOID
• Foods that cause any discomfort.
• Medications containing lactose filler if you are lactose intolerant, provided substitutes are available.

METABOLIC INTOLERANCE
Lactose is found in dairy products, including milk, yogurt, and cheese. It can also be found as an ingredient or component of various food products such as cookies, breads, processed meats, hot dogs, some artificial sweeteners, and even some medications. Read labels carefully and look for milk, milk solids, cream, whey, cheese flavors, curds, and nonfat milk powder. Eat small amounts of dairy products. Most lactose-intolerant people can consume some milk without much discomfort. They can also safely eat cultured dairy products such as yogurt because the bacteria used in fermentation use up most of the lactose for fuel. For people with more severe intolerance who still want dairy products, grocery stores sell lactose-reduced dairy products, and pharmacies carry enzyme drops that can be added to milk and enzyme tablets that can be taken before eating dishes containing dairy products. Warning: Don’t confuse lactose intolerance with milk allergy, which is hypersensitivity to the proteins in dairy products. If you are allergic to milk, consuming a lactose-reduced product will not prevent a reaction.

Lactose intolerance, the inability to digest milk sugar, is very common. Lactose is the natural sugar found in milk and milk products. It has to be broken down by an enzyme called lactase into glucose and galactose before it can be absorbed and used by the body. If you don’t have enough enzyme to handle the lactose in the food you eat, you will experience a variety of unpleasant symptoms such as gas, bloating, diarrhea, and cramps after the ingestion of lactose- containing foods. This is because the unabsorbed lactose passes into the colon, where it is consumed by bacteria. The by-products of this bacterial activity are gases such as hydrogen and methane, which are responsible for the discomfort. The condition can be diagnosed by measuring the amount of hydrogen exhaled before and after ingesting lactose. An excessive amount of hydrogen confirms lactose intol ance. Except for a few inedible shrubs, the only source of lactose. Once prehisto humans were weaned, they never had lacia again; hence, they no longer needed lacta the enzyme that breaks down milk sugar in digestive tract.

With evolutionary thrift, lact: was programmed to disappear as milk phased out of a child’s diet. Adults who can digest milk are a minority in the world population; 70 percent of people of African and Asian descent are partly or entirely lactose-intolerant after 4 years of age. B contrast, 90 percent of people of Northern European descent continue to produce lactase, This genetic trait probably enabled their fore. bears to absorb extra calcium in a habitat wher there was little sunlight available to develop vitamin D in the skin. Transient or permanent lactose intolerance may follow an illness that injures the intestinal lining such as gastrointestinal illness, celiac disease, or inflammatory bowel disease. It can also follow treatment with antibiotics or and. inflammatory drugs. In some cases the intolerance is temporary and will disappear when bowel health returns to normal, In other cases, lactose intolerance is a “threshold intolerance.” This means you can handle small amounts of lactose but increasing doses cause a problem.

Kidney disease may be either a primary condition, such as kidney stones, or a consequence of other disorders, such as hypertension, atherosclerosis, or diabetes—all of which can severely damage the organs’ blood vessels. Older men are susceptible to kidney infections stemming from enlargement of the prostate. Pregnant women and diabetics are vulnerable to infections of the urinary tract. Side effects from drugs are common and preventable causes of serious kidney disorders. For example, acetaminophen, aspirin, and other nonsteroidal anti. inflammatory drugs (NSAIDs) and calcium with vitamin D supplements are among the nonprescription drugs that can damage kidneys; combining aspirin and acetaminophen is espe cially damaging. Whenever you see your doctor, he sure to mention any over-the-counter med ications or vitamin supplements you have been taking, even if occasionally.

Healthy people should not wait for problems to crop up; rather, they should try to follow a diet that will help prevent kidney disorders. Drink plenty of liquids to flush the urinary system and replace lost fluids, and consume a low-fat diet that emphasizes starchy foods, veg etables, and fruits.
Diet is crucial in treating kidney problems. If you have a serious kidney disease, your doctor will probably refer you to a clinical dietitian for advice concerning changes to your diet. The allowable types and portions of foods differ, depending upon the type and severity of the kidney disorder.

KIDNEY STONES

Approximately 1 in 10 North Americans receives treatment for kidney stones each year; men outnumber women about three to one. Some people suffer their first attack after taking up a steady exercise program, such as jogging, and failing to drink enough fluids to replace the amount lost in sweat. At least half of those who suffer one attack will have a recurrence.
Kidney stones form when crystalline miner als—normally flushed away in the urine—stick together to form clumps, ranging in size from a grain of sand to coarse gravel. The cause may be gout or another metabolic problem, or it may be a structural or metabolic abnormality within the kidney. When kidney stones block any part of the urinary system, especially the ureters or blad der, they cause intense pain. Stones may pass through the system; others must be removed surgically or by sound-wave treatment (lithotripsy).

In order to prevent recurrences, it is important to determine the cause of the kidney stones. Most are formed of calcium oxalate or calcium phosphate. Less commonly, stones may form from uric acid crystals, especially in people with gout. A fourth type, cystine stones, occurs in fairly rare metabolic diseases.

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Any modification of the diet depends on the underlying cause of the jaundice. With a nutritious, well-balanced diet and rest, viral hepati tis resolves itself—although it may take several weeks. Unfortunately, many people find it difficult to eat at the very time that they need extra calories to help the liver recuperate and regenerate its damaged cells. Many individuals report that their appetite decreases and nausea increases as the day progresses, suggesting that breakfast may be the best tolerated meal.
Eat a diet high in protein.

When recovering from hepatitis, a person should consume a healthy diet with sufficient protein daily, from both animal and vegetable sources. The best sources are lean meat, poultry, fish, eggs, dairy products, and a combination of legumes and grain products. If the appetite is poor, intersperse several small meals a day with a nutri tious snack (such as a milk shake or an enriched liquid drink). Fried and very fatty foods, which are difficult to digest, should be avoided; a small amount of fat is acceptable, however, to provide needed calories and add flavor. In general, the fats in dairy products and eggs are easier to digest than those in fatty meats and fried foods.

Avoid sweets and alcohol. Because they may squelch the appetite for more nutritious foods, it is best to avoid sweets. Alcohol should not be consumed, because it places added stress on an already sick liver. It may be tolerated after recovery, but some liver disorders mandate total abstinence from alcohol for life. There is some evidence that herbal preparations based on milk thistle may help treat liver dysfunction.

It is not uncommon for a baby to develop jaundice during the first few days after birth, especially if the infant is premature. This is known as physiological jaundice, and is usually caused by a liver that is not fully functional. There are usually no other symptoms, and the condition typically clears up within a week, as the liver matures. Exposing the baby to ultraviolet light hastens the process, as the light changes biliru. bin to a form that is more readily excreted.

Feeding the infant soon after birth and con tinuing with frequent feedings helps to reduce the risk of jaundice by stimulating the intestinal tract to produce frequent stools, which increases the excretion of bilirubin. In a few cases the newborn may be reacting to the mother’s milk, and breast-feeding must be discontinued for a day or two in favor of a formula. After this resolves the problem, the mother may resume breast-feeding safely.

A yellowing of the skin and the whites of the eyes is the symptom of jaundice. This condition typically occurs when bilirubin, a pigmented component of bile, builds up in the blood. Bilirubin is a by-product produced by the liver as it breaks down red blood cells to recycle their iron. It is mixed with bile, a digestive juice that is made by the liver, and is eventually excreted from the body in the urine or stool. Jaundice develops if the bilirubin is allowed to accumulate in the body.

There are three general types of jaundice: the most common is due to hepatitis or some other liver disorder; another, known as obstructive jaundice, usually results from gallstones or another gallbladder disease; and the least com mon involves some Sort of abnormality in bilirubin metabolism.

Each year more than 27 million North Americans are afflicted with liver and gallbladder disorders, but not all of these people develop jaundice. Among those who do, hepatitis—an inflammation of the liver—is the likely cause. Five major forms of viral hepatitis have been identified to date; the liver inflammation may also be due to alcohol or drug abuse, adverse reaction to a medication, as well as bacterial, parasitic, or fungal infections of the liver. Some strains of viral hepatitis are highly contagious and can enter the human body through water or food (especially shellfish) that has been contaminated by human waste. Hepatitis can also be spread through blood transfusions from an infected person or by direct contact with infected body fluids or the use of contaminated syringes.

In addition to jaundice, the symptoms of hepatitis include fever, fatigue, nausea, vomiting, diarrhea, and loss of appetite. The urine may be dark in color due to increased bilirubin content, and the stools may be light, clay- colored, or whitish, an indication that bilirubin is not being excreted from the intestinal tract. In a few cases, hepatitis may be serious enough to result in liver failure, coma, and death.

Jaundice may also be due to Gilbert’s syndrome (a disorder of biliruhin metabolism), which affects 3 to 5 percent of the population and may be misdiagnosed as hepatitis. In Gilbert’s syndrome, chronic jaundice is the only abn and does not signify liver disease. Several other rare forms ofjaundice are inherit ed disorders.

The first step in learning to control IBS symptoms is recognizing the factors that may trigger symptoms. A diary that records IBS symptoms along with all foods and beverages ingested and stressful events can help pinpoint possible culprits. A woman should determine whether symptoms flare up during certain times of her menstrual cycle. When tracking lBS symptoms, jot down the nature and location of any pain, as w as the frequency and consistency of stools and any related problems, such as headaches. Your diary should also note all medications taken, including supplements. A doctor should review this diary to help identify specific con tributing factors.

DIETARY MODIFICATION
Because IBS differs from person to person, it’s essential to develop an individualized regimen to treat your symptoms. To begin, avoid foods that your diary suggests are causing problems. Eat several small meals a day instead of large ones. This can reduce the meal-stimulat ed increase in bowel contractions and diarrhea. Eat slowly. Eating too quickly may increase swallowed air, which promotes irritating intes tinal gas. Also, poorly chewed foods can be more difficult to digest. Drink lots of water. To maintain adequate fluid, drink at least eight glasses of water or other beverages daily, hut avoid such potential bowel irritants as alcohol and caffeine. Avoid fatty foods. Most doctors advise against eating fried and other fatty foods because fat is the most difficult nutrient to digest. Many people find that it helps to avoid beans and other gas-producing foods.

Watch your fiber intake. Whole-grain products and other high-fiber foods can pose problems for some lBS sufferers who have chronic diarrhea. On the other hand, if constipation is the predominant symptom, a diet that includes ample fresh fruits and vegetables, whole-grain breads and cereals, nuts and seeds, and other high-fiber foods is usually recommended. Insoluble fiber (see Fiber) helps to bulk up stools and ease elimination, relieving lBS-associated constipation. Foods high in soluble fiber absorb water and are helpful for bouts of diarrhea. If constipation is pe ask your doctor about ãking seeds or another high- fiber laxative. Avoid chronic laxative use, which can lead to problems with vitamin and nutritional deficiencies. Avoid sugar alcohols. The sugar substitutes sorbitol, lactitol, mannitol, and maltitol are used in a variety of foods and can trigger lBS symptoms in some people. For others, the lac tose in dairy pr and possibly fructose can exacerbate sym