WEBVTT - Ep 46 Lactose Intolerance: Never trust a fart 0:00:01.880 --> 0:00:02.480 Hi everybody. 0:00:02.520 --> 0:00:05.920 My name is Catherine Sampson, and I met both of 0:00:05.960 --> 0:00:09.080 the Aarons and graduate school at the University of Illinois. 0:00:09.480 --> 0:00:13.399 I'm currently an ap biology teacher down in Texas, where 0:00:13.440 --> 0:00:16.680 I'm from. They asked me to share my story about 0:00:16.720 --> 0:00:20.759 my lactose intolerance throughout my life, and of course I 0:00:21.000 --> 0:00:24.200 jumped at the opportunity to be on the podcast and 0:00:24.760 --> 0:00:29.960 share my poop stories with basically the entire universe. There 0:00:30.000 --> 0:00:32.559 was one part of my life that I think was 0:00:32.560 --> 0:00:36.280 one of the most formative defication experiences I've ever had, 0:00:37.320 --> 0:00:41.920 and it goes a little something like this. My mom 0:00:41.960 --> 0:00:45.240 and I, Hi Mom. We were sitting in a restaurant 0:00:45.240 --> 0:00:48.640 eating lunch one day and I just ordered something off 0:00:48.680 --> 0:00:54.000 the menu that appealed to me. And maybe about thirty 0:00:54.040 --> 0:00:56.440 minutes later, when my mom and I were shopping at 0:00:56.480 --> 0:00:59.800 the store that is very famous for selling containers of 0:01:00.000 --> 0:01:04.240 all varieties, we were walking down the gift wrapping aisle 0:01:04.560 --> 0:01:11.440 and I felt something kind of odd in my bowels, 0:01:11.480 --> 0:01:15.080 and so I thought to myself that it's not normal, 0:01:15.360 --> 0:01:18.279 but it'll be okay. Just shake it off, just keep walking, 0:01:18.360 --> 0:01:23.280 Everything's going to be fine. And I remember thinking back 0:01:24.160 --> 0:01:27.200 about this moment, and I went, maybe that's why they 0:01:27.240 --> 0:01:30.200 called it a bowel movement, you know, because I physically 0:01:30.880 --> 0:01:35.120 felt my bowels moving inside my body. 0:01:35.280 --> 0:01:37.679 So you know, I continue walking. 0:01:39.240 --> 0:01:43.480 And I start feeling like a buildup of gas inside 0:01:43.480 --> 0:01:46.360 my body. And so for all of the people out 0:01:46.360 --> 0:01:48.520 there who ever felt that, you know what I'm talking about. 0:01:49.360 --> 0:01:51.600 And so you think, for a moment, well, maybe if 0:01:51.640 --> 0:01:55.680 I let it out and I relieve that pressure inside 0:01:55.680 --> 0:01:58.760 my body, that everything will be okay. But for me 0:01:58.800 --> 0:02:00.840 in that moment, if I can give you all, one 0:02:00.880 --> 0:02:03.680 piece of advice is to never really trust a fart. 0:02:04.960 --> 0:02:08.800 I unfortunately did trust this fart, and it ended up 0:02:08.840 --> 0:02:12.160 being very bad for both me and my pants. So 0:02:12.200 --> 0:02:15.239 I ended up defecating myself in the middle of the 0:02:15.280 --> 0:02:19.680 gift wrapping aisle in some light blue jeans, very light 0:02:19.760 --> 0:02:23.119 blue jeans, And I remember walking up to my mom 0:02:23.240 --> 0:02:26.960 going I think I just put my pants, and I 0:02:27.000 --> 0:02:29.280 remember for the rest of my life. She looked at 0:02:29.320 --> 0:02:33.399 me and laughed and went what And I said, no, Mom, really. 0:02:33.360 --> 0:02:35.480 I just I put my pants. 0:02:35.800 --> 0:02:37.960 And she looks at me and she goes, well, I'm 0:02:37.960 --> 0:02:41.120 not done shopping. Nothing's going to change it right now, 0:02:41.200 --> 0:02:46.200 right Katie, and I said, okay, yeah, And so from 0:02:46.200 --> 0:02:48.120 that moment on, I realized that, you know, I'm standing 0:02:48.160 --> 0:02:50.160 in the middle of public in Houston, Texas and I 0:02:50.240 --> 0:02:52.960 just put my pants and this was going to be 0:02:53.000 --> 0:02:55.880 my life, and so I should probably make some concerted 0:02:55.919 --> 0:03:00.880 decisions to recognize what I'm eating and telp people that 0:03:01.480 --> 0:03:04.640 I'm lactose intolerant. And so I started doing that. You know, 0:03:04.880 --> 0:03:08.720 that was when I was nineteen, so nine years ago. 0:03:09.120 --> 0:03:11.840 But nowadays, when I go to restaurants, I don't really 0:03:11.840 --> 0:03:14.760 get taken seriously a lot saying that I'm lactose intolerant 0:03:15.360 --> 0:03:18.040 by the waiters or something like that. So I usually 0:03:18.040 --> 0:03:20.080 just say I'm allergic to milk, I'm allergic to cheese, 0:03:20.440 --> 0:03:23.280 or if it's a hard day, I just tell them 0:03:23.320 --> 0:03:26.200 I'm vegan and I go with it. So, yeah, that's 0:03:26.320 --> 0:03:30.160 just that's my poop story, and I hope that everybody 0:03:30.160 --> 0:03:32.200 out there can maybe relate to that a little bit 0:03:32.960 --> 0:03:36.000 and recognize that we shouldn't be ashamed of maybe pooping 0:03:36.040 --> 0:03:40.720 or pants in public. That's my story, y'all. 0:04:24.120 --> 0:04:27.880 That was amazing as always. 0:04:27.960 --> 0:04:32.279 As always, thank you so much, Katie for your always 0:04:32.400 --> 0:04:33.600 enjoyable stories. 0:04:34.200 --> 0:04:38.360 The best, the best not only poop stories, but definitely the. 0:04:38.279 --> 0:04:42.760 Best poop stories. Definitely the best poop stories without a doubt. Hi, 0:04:42.880 --> 0:04:43.520 I'm erin. 0:04:43.440 --> 0:04:45.760 Welsh and I'm erin omen Updyke. 0:04:45.600 --> 0:04:47.840 And this is this podcast will kill you. 0:04:48.480 --> 0:04:53.159 And today we're talking about wlacktose intolerance. 0:04:53.040 --> 0:04:57.000 Or lack tase persistence, because really that's the. 0:04:56.240 --> 0:04:58.159 There's so many names for this. I love it. 0:04:58.440 --> 0:05:00.520 Oh my gosh, I think we were We're gonna have 0:05:00.560 --> 0:05:02.719 to do some sort of like a primer or briefing 0:05:02.800 --> 0:05:04.479 on the names. 0:05:04.680 --> 0:05:06.839 A lot of the articles that I read had like 0:05:06.960 --> 0:05:09.919 tables of all of the acronyms that they use, because 0:05:09.920 --> 0:05:12.680 there's so many different ways to talk about. 0:05:12.400 --> 0:05:15.600 I wish that the articles I looked at had tables 0:05:15.640 --> 0:05:17.800 because that would have made my life a lot easier. 0:05:18.600 --> 0:05:20.880 I was like, oh no, does this one stand for again? 0:05:21.400 --> 0:05:25.000 So to get us through this episode, what are we drinking? 0:05:25.560 --> 0:05:29.520 Our quarantine of the day is truth or dairy. 0:05:32.960 --> 0:05:37.080 And appropriately it is essentially a milk punch, So it's 0:05:37.160 --> 0:05:43.719 got milk and ram and Brandy r Kognac and nutmeg. 0:05:44.240 --> 0:05:48.480 Listen, do you say milk or milk? I say milk 0:05:49.040 --> 0:05:53.640 because I got made fun of this morning, for saying milk, 0:05:54.960 --> 0:05:58.400 for saying what I guess, I say it weird milk. 0:05:58.920 --> 0:06:01.440 Oh great, so it's gonna be It's gonna be another 0:06:01.480 --> 0:06:04.640 one of those episodes where Aaron can't pronounce the thing 0:06:04.680 --> 0:06:08.839 we're talking about. That's fine, I'll just say dairy. 0:06:09.200 --> 0:06:16.320 There we go. We will post the recipe for the 0:06:16.600 --> 0:06:19.920 quarantine and the non alcoholic pluicy Brita on our website. 0:06:19.960 --> 0:06:22.200 This podcast will kill you dot com and all of 0:06:22.240 --> 0:06:25.000 our social media pages, so check it out. 0:06:25.480 --> 0:06:29.799 Yes, most definitely. Do we have any other business? 0:06:30.000 --> 0:06:31.760 No, I don't think. So let's just get started. 0:06:32.080 --> 0:06:56.799 Okay, we'll take a quick break first. I'm very excited 0:06:56.800 --> 0:07:02.760 about this episode. This is our first, the first non crossover, 0:07:03.080 --> 0:07:09.200 non disease episode. Wait a second, Like we've had crossover 0:07:09.240 --> 0:07:12.400 episodes where we talk about poisons or things, actually what 0:07:12.560 --> 0:07:15.000 you mean, But this is our first, just me and you, 0:07:15.160 --> 0:07:19.320 and we're talking about maybe not even a disease. Well 0:07:19.320 --> 0:07:23.920 it's not really, it's not it's really not spoilers. So 0:07:24.680 --> 0:07:28.160 I figured that because this is a wonky episode where 0:07:28.200 --> 0:07:31.240 we aren't talking about a disease, I would do the 0:07:31.240 --> 0:07:35.560 biology section in a bit of a wonky way. Okay, perfect, Okay, 0:07:35.800 --> 0:07:38.520 So we're gonna start off the biology section where we 0:07:38.640 --> 0:07:42.600 usually end up, and that is with the symptoms, because 0:07:42.600 --> 0:07:45.520 we usually kind of end with that. So if we're 0:07:45.560 --> 0:07:49.440 being honest, we pretty much already know the symptoms of 0:07:49.800 --> 0:07:58.440 lactose intolerance aka lactose malabsorption aka lactase non persistence aka hypolactasia. 0:07:58.920 --> 0:07:59.920 It's another term for it. 0:08:00.320 --> 0:08:01.920 I see, I've seen all of these. 0:08:02.160 --> 0:08:02.360 Good. 0:08:02.360 --> 0:08:03.360 It's nice refresher. 0:08:04.480 --> 0:08:06.880 So we know these symptoms. Eron, what are the kinds 0:08:06.880 --> 0:08:07.600 of symptoms? 0:08:08.320 --> 0:08:11.680 Bloating, rumbly tummy diarrhea? 0:08:12.000 --> 0:08:13.400 Do you want to know the Do you want to 0:08:13.440 --> 0:08:17.240 know the fancy word for grumbly tummy? I do? Borborygmy? 0:08:18.320 --> 0:08:20.520 Uh? Can I get the etymology of that? Please? 0:08:20.800 --> 0:08:31.880 Mmm? Let me google that for you. It's Greek. Great, 0:08:32.280 --> 0:08:37.880 it comes from the Greek bor borygmos meaning what meaning 0:08:37.920 --> 0:08:41.520 a rumbling or gurgling noise made by your tummy. 0:08:43.120 --> 0:08:48.360 Wow, So it really is specifically like that word has purpose. 0:08:49.200 --> 0:08:50.920 Amazing, I know. 0:08:51.640 --> 0:08:55.360 Ohymas. Yeah, that's a big one. That's the medical term 0:08:55.440 --> 0:09:02.760 for a gurgly tum abdominal pain. I think you said diarrhea. 0:09:03.480 --> 0:09:08.280 Diarrhea tends to be less common in adults, at least 0:09:08.280 --> 0:09:12.079 according to the literature. But we'll kind of talk about 0:09:12.120 --> 0:09:15.520 why you might see diarrhea even if you're an adult. 0:09:15.840 --> 0:09:19.160 Does that make sense? All right? Cool, So we all 0:09:19.200 --> 0:09:23.640 know what we're dealing with here. But to talk about 0:09:23.720 --> 0:09:28.079 lactose intolerance or lactose malabsorption, we have to actually take 0:09:28.120 --> 0:09:31.200 a step back and first talk about one of our 0:09:31.280 --> 0:09:39.040 favorite things, the gastrointestinal tract. Yeah, so your guts, because 0:09:39.480 --> 0:09:43.600 lactose malabsorption is a gut problem. We're going to talk 0:09:43.600 --> 0:09:46.680 about how it functions normally in order to understand what 0:09:46.800 --> 0:09:49.439 goes wonky in these situations. 0:09:49.559 --> 0:09:53.920 So hold on, okay, lactose malabsorption is the normal state. 0:09:54.520 --> 0:09:58.600 Okay, Yeah, this is going to get confusing. Yeah, yes, 0:10:00.640 --> 0:10:05.199 I mean yes and no. Right, Like, mammals can digest 0:10:05.280 --> 0:10:07.720 lactose for at least a portion of their lives. 0:10:08.280 --> 0:10:10.040 Yeah, yeah, so. 0:10:11.440 --> 0:10:17.920 As adults, some mammals, most mammals can no longer digest lactose. 0:10:18.200 --> 0:10:21.720 But let's talk about how your GI tract normally would 0:10:21.800 --> 0:10:26.160 handle lactose if it's able to digest it. Okay, okay, 0:10:26.360 --> 0:10:29.359 and just kind of how your GI tract handles sugars 0:10:29.400 --> 0:10:31.560 to begin with. Okay, well, like we're going back to 0:10:31.600 --> 0:10:35.240 the very beginning here, okay, okay, So the main function 0:10:35.440 --> 0:10:36.880 of your gi tract. 0:10:36.960 --> 0:10:40.720 Is what to digest food. 0:10:41.640 --> 0:10:46.280 Yeah, exactly, absorb nutrients, you know it all. 0:10:47.600 --> 0:10:48.000 Okay. 0:10:48.280 --> 0:10:52.000 So your gut has three main divisions, right. You have 0:10:52.280 --> 0:10:55.760 like your foe gut that's your mouth and maybe down 0:10:55.800 --> 0:10:58.760 to your stomach. Right then you have your midgut that's 0:10:58.800 --> 0:11:01.440 your small intestine, and then your hindgut, which is like 0:11:01.480 --> 0:11:07.200 your colon and your butt. Okay, okay. So digestion, which 0:11:07.360 --> 0:11:10.360 is that main function of your gut, starts at the 0:11:10.480 --> 0:11:13.200 very top in your mouth where you choose things and 0:11:13.240 --> 0:11:16.640 you physically and chemically start to break them down, and 0:11:16.720 --> 0:11:21.439 then it travels down to your stomach where that digestion 0:11:21.600 --> 0:11:26.120 process continues. Like physically, your stomach clenches in and out. 0:11:26.240 --> 0:11:29.880 Plus you've got all that acid in there. Right. Then, 0:11:30.200 --> 0:11:33.400 as your food moves into the small intestine, your small 0:11:33.440 --> 0:11:37.959 intestine has two main goals finishing up that digestive process, 0:11:38.480 --> 0:11:42.720 and this one's important absorbing all those nutrients that you 0:11:42.800 --> 0:11:45.319 unlocked during that digestion process. 0:11:45.559 --> 0:11:45.880 Okay. 0:11:46.640 --> 0:11:50.000 So to do that, your small intestine has a bunch 0:11:50.080 --> 0:11:54.880 of different enzymes which are responsible for breaking down all 0:11:54.920 --> 0:11:59.320 these nutrients into the smallest possible particles so that they 0:11:59.360 --> 0:12:02.360 can pass through the intestine wall and make it into 0:12:02.360 --> 0:12:08.840 our bloodstream. Okay. So some of these enzymes come from 0:12:08.880 --> 0:12:12.080 the pancreas and some of them come from cells in 0:12:12.160 --> 0:12:16.040 the wall of the intestines themselves. But these enzymes are 0:12:16.040 --> 0:12:21.199 all really important because your intestine basically acts as a 0:12:21.320 --> 0:12:25.280 filter and large particles can't make it through your intestine 0:12:25.280 --> 0:12:28.040 wall into your bloodstream, so everything has to be broken 0:12:28.080 --> 0:12:32.320 down into really small molecules. In the case of sugars, 0:12:32.760 --> 0:12:36.160 it has to be broken down into monosaccharides. That means 0:12:36.280 --> 0:12:37.720 one piece of sugar. 0:12:38.360 --> 0:12:39.400 Cool cool. 0:12:39.760 --> 0:12:43.840 Okay. So anything that can't be digested or can't be 0:12:43.880 --> 0:12:47.199 broken down small enough will stay in your small intestine 0:12:47.200 --> 0:12:50.559 and keep traveling down to your colon. Your colon is 0:12:50.600 --> 0:12:54.000 the last part of your gi tract, and it's basically 0:12:54.080 --> 0:12:58.760 responsible for sucking all the water out of the junk 0:12:58.800 --> 0:13:02.040 that's left in there so that you don't lose too much. 0:13:01.880 --> 0:13:05.520 Water oh aka diarrhea. 0:13:05.000 --> 0:13:07.920 Aka diarrhea, And then you have a whole bunch of 0:13:07.920 --> 0:13:11.600 bacteria in your colon which helped break down any last 0:13:11.720 --> 0:13:14.720 particles that might have nutrients in there that you want, 0:13:14.960 --> 0:13:18.920 so that you can absorb absolutely everything possible and then 0:13:18.960 --> 0:13:21.560 what's left is poop and you poop it out. 0:13:22.160 --> 0:13:22.840 Ok. Excellent. 0:13:23.280 --> 0:13:27.240 So that's your GI tract in a nutshell. So what 0:13:27.720 --> 0:13:33.880 happens in lactose malabsorption or lactose intolerance? So lactose is 0:13:33.880 --> 0:13:38.000 a sugar, it's a die saccharide. So that means two 0:13:38.040 --> 0:13:42.480 sugars bound together. It's galactose and glucose. If you care 0:13:42.520 --> 0:13:43.520 about that sort of thing. 0:13:43.520 --> 0:13:46.120 Oh, I mean, I didn't think I did, and I 0:13:46.120 --> 0:13:49.120 don't think that I do. But still interesting. 0:13:49.240 --> 0:13:53.400 You're good to know. Yeah, okay, And lactose is found 0:13:53.520 --> 0:13:58.400 in milk, of course, milk dairy products. I don't hear. 0:13:58.840 --> 0:14:00.880 I don't hear milk and milk, but thank you. 0:14:01.000 --> 0:14:03.240 I appreciate that because I really got made fun of. 0:14:05.160 --> 0:14:08.360 And so, since lactose is a die saccharide, we know 0:14:08.400 --> 0:14:11.680 that it has to be broken down into monosaccharides, the 0:14:11.720 --> 0:14:14.560 two that it's made up of, galactose and glucose, in 0:14:14.679 --> 0:14:18.319 order to be absorbed by the small intestine. It turns 0:14:18.360 --> 0:14:22.400 out that this happens in our small intestine by a 0:14:22.400 --> 0:14:27.720 specific enzyme called lactase. So what happens right off the 0:14:27.760 --> 0:14:33.040 bat is that if lactase isn't able to break down 0:14:33.240 --> 0:14:37.200 lactose into its two component parts, then you will have 0:14:37.480 --> 0:14:41.920 undigested lactose, a die saccharide that's left in your small 0:14:41.960 --> 0:14:47.680 intestines to travel down to the colon. Okay, that's the 0:14:48.240 --> 0:14:53.479 main thing that happens in lactose intolerance or lactose malabsorption. 0:14:54.160 --> 0:14:57.440 So the function of the colon is to absorb the 0:14:57.480 --> 0:15:01.680 water that's left and leave your behind. When you have 0:15:01.920 --> 0:15:07.280 undigested sugars like lactose, they serve as a really great 0:15:07.400 --> 0:15:12.720 food source for bacteria. So the bacteria in your colon 0:15:12.840 --> 0:15:18.600 gets super stoked and they will go nuts eating this sugar, 0:15:18.760 --> 0:15:23.080 this lactose, and they convert this sugar via biokin We're 0:15:23.080 --> 0:15:28.800 not going to get into into fatty acids and hydrogen gas. 0:15:28.920 --> 0:15:29.360 Uhah. 0:15:30.080 --> 0:15:32.920 So guess what it feels like when you're intestinal bacteria 0:15:32.960 --> 0:15:34.560 start producing a bunch of gas. 0:15:35.160 --> 0:15:45.160 I mean, whatever the Greek word you said, borberygmy, barberigmy. 0:15:43.240 --> 0:15:46.520 Exactly, You're literally going to have a bunch of gas 0:15:46.600 --> 0:15:50.520 in your colon. Okay, And that is why you have 0:15:50.640 --> 0:15:53.560 these symptoms. If you have a bunch of lactose, that 0:15:53.880 --> 0:15:56.280 makes it all the way from your small intestine down 0:15:56.360 --> 0:15:59.360 into your colon. Now, the other thing that can happen 0:15:59.440 --> 0:16:03.640 if you have undigested disachrides like lactose in your colon 0:16:04.240 --> 0:16:09.160 is that it turns out that this sugar, this disacharide, 0:16:09.240 --> 0:16:12.480 it's what we call osmodically active, which means that it's 0:16:12.480 --> 0:16:15.520 going to draw water towards it. So if you have 0:16:15.600 --> 0:16:19.080 sugar left in the lumin of your gut, you're not 0:16:19.200 --> 0:16:22.600 going to be able to absorb water through the walls 0:16:22.640 --> 0:16:24.960 of your colon. Rather, water is going to stay in 0:16:25.000 --> 0:16:28.040 your colon because in your body there has to be 0:16:28.080 --> 0:16:33.840 a balance between the solutes and water. Right, Okay, so 0:16:34.160 --> 0:16:37.600 what does that mean arin If you've got a bunch 0:16:37.600 --> 0:16:39.400 of water left in your colon. 0:16:39.440 --> 0:16:42.520 I think we both know where this is going. It's 0:16:42.640 --> 0:16:45.480 rather bashroom for some loose stool. 0:16:45.800 --> 0:16:51.000 Exactly dirhea. As a fun side note, this is how 0:16:51.120 --> 0:16:54.360 osmotic laxatives work. So if you've ever taken merr lax 0:16:55.000 --> 0:16:58.680 or lactulose, lots of kids take it because kids are 0:16:58.720 --> 0:17:02.880 always constipated. That's exactly how they work. It's basically just 0:17:03.280 --> 0:17:07.879 big molecules that can't be broken down by our enzymes 0:17:08.040 --> 0:17:10.800 or our gut bacteria. So then it draws a bunch 0:17:10.840 --> 0:17:11.919 of water into your colon. 0:17:12.200 --> 0:17:14.200 Wow, that sounds uncomfortable. 0:17:14.800 --> 0:17:17.080 Yeah, I mean it just cleans you out. It's what 0:17:17.200 --> 0:17:25.360 you use if you're having a colony. Yeah. Okay, So 0:17:25.440 --> 0:17:31.800 that is how lactose intolerance or lactose malabsorption happens, why 0:17:31.840 --> 0:17:34.119 it causes the symptoms that it causes. So now we 0:17:34.240 --> 0:17:38.360 have to get back to the beginning where we mentioned 0:17:39.200 --> 0:17:43.040 this isn't really a disease state. So why is it 0:17:43.080 --> 0:17:48.760 that some people have this and some people don't. Wow, 0:17:49.920 --> 0:17:53.600 turns out there's a few different ways. Let's talk about 0:17:53.600 --> 0:17:58.840 the least common first. Okay, First, you could be born 0:17:59.359 --> 0:18:04.280 with very low levels of this lactase enzyme function that 0:18:04.520 --> 0:18:09.840 is called congenital lactase deficiency. You can imagine that because 0:18:10.560 --> 0:18:14.919 mammal's main food source is breast milk, which has lactose, 0:18:15.520 --> 0:18:16.919 that would be pretty bad. 0:18:17.119 --> 0:18:19.680 So this is pretty rare, okay. 0:18:19.760 --> 0:18:24.320 And those good question. Actually I never did find I 0:18:24.359 --> 0:18:27.200 have starstar EPI numbers, and I never found good EPI 0:18:27.280 --> 0:18:32.240 numbers on this it's most common in the Finish population. 0:18:33.080 --> 0:18:38.639 Really yeah, I know, you know, Okay, this is jumping 0:18:38.680 --> 0:18:42.840 the gun a little bit. But in Northern European countries 0:18:42.880 --> 0:18:48.240 and Northern European populations, lactase persistence, so the ability to 0:18:48.320 --> 0:18:52.879 digest lactose is pretty high across the board. Yes, but 0:18:53.040 --> 0:18:55.959 when I was living in Finland, I saw so many 0:18:56.680 --> 0:19:00.399 like lactose free or low lactose milks and yogurt and 0:19:00.400 --> 0:19:04.600 blah blah blah blah blah, we'll talk about it. Okay, great, Yeah, 0:19:04.720 --> 0:19:07.640 I was like, wait a second, but I thought, yeah, okay. 0:19:07.440 --> 0:19:11.680 M mmm. So yeah, this congenital lactase deficiency. You can 0:19:11.720 --> 0:19:15.919 imagine you would recognize this pretty early on when a 0:19:15.960 --> 0:19:18.600 baby is an infant, because they would have some pretty 0:19:18.600 --> 0:19:23.960 severe symptoms from breast milk. This is an autosomal recessive disorder. 0:19:24.000 --> 0:19:27.840 So this is a genetic disorder. Okay, uh, but again 0:19:27.920 --> 0:19:30.800 it's pretty rare. I don't have exact numbers, but that's 0:19:30.840 --> 0:19:33.800 one way that you could end up with lactose malabsorption. 0:19:34.320 --> 0:19:39.000 Another way is if you are a very premature baby. 0:19:39.200 --> 0:19:44.959 Sometimes premature babies have what's called developmental lactase deficiency because 0:19:45.000 --> 0:19:48.480 their GI tract just isn't quite developed enough, and it 0:19:48.800 --> 0:19:51.119 for some reason turns out that lactase is one of 0:19:51.160 --> 0:19:54.720 the last genes to get properly turned on during development. 0:19:55.840 --> 0:19:58.200 But this is something that would be rather transient. 0:19:59.240 --> 0:20:02.160 Okay, it's interesting that it's one of the last genes. 0:20:02.720 --> 0:20:04.679 I know, you'd think it'd be an important one. But 0:20:04.720 --> 0:20:08.080 also like so is surfactant production, and that's like essential 0:20:08.119 --> 0:20:11.760 for life. That's what allows your lungs to stay open. 0:20:13.000 --> 0:20:13.800 That's pretty crue. 0:20:14.720 --> 0:20:17.879 Yeah, it doesn't happen till like after thirty five weeks 0:20:17.920 --> 0:20:19.520 of gestation anyways. 0:20:20.040 --> 0:20:20.840 Huh. 0:20:20.920 --> 0:20:24.959 Another way that you could end up with being not 0:20:25.080 --> 0:20:30.080 able to absorb lactose very well is if you get 0:20:30.080 --> 0:20:33.520 a GI tract infection, for example, giardia. 0:20:34.720 --> 0:20:35.400 Wow. 0:20:35.560 --> 0:20:40.320 Okay, that kind of GI tract infection can cause damage 0:20:40.320 --> 0:20:44.640 to your small intestine where this enzyme is located, so 0:20:44.720 --> 0:20:49.359 that even after clearance of that infection, you don't have 0:20:49.480 --> 0:20:53.080 proper function of that lactase enzyme. So it basically just 0:20:53.119 --> 0:20:56.320 causes damage to the cells of your small intestine. 0:20:56.320 --> 0:21:01.160 Okay, So in theory, you could still produce lactase, but 0:21:01.200 --> 0:21:04.240 the cells are so damaged exactly, there's no way to 0:21:04.359 --> 0:21:06.439 write blackchase, okay, precisely. 0:21:07.400 --> 0:21:10.919 But finally, number four, the most common way that you 0:21:11.000 --> 0:21:14.119 can have lack toast malabsorption. 0:21:14.400 --> 0:21:17.080 I feel like people are gonna get angry with us 0:21:17.160 --> 0:21:21.080 because we're describing the normal state of things. 0:21:21.240 --> 0:21:24.320 Well, then let me say this, Aaron. The fourth option 0:21:24.480 --> 0:21:27.719 is you can be a normal human adult Okay, okay, 0:21:29.040 --> 0:21:33.199 in most humans, in fact, in most adult mammals, it 0:21:33.280 --> 0:21:37.760 is totally normal for the activity of the lactase enzyme 0:21:38.119 --> 0:21:41.800 to downregulate as we age. What does that mean. It 0:21:41.880 --> 0:21:45.160 means that this enzyme works really well when we're babies 0:21:45.200 --> 0:21:48.040 in infants, and literally by the time we're like six 0:21:48.160 --> 0:21:52.480 years old, the action of this enzyme is substantially less 0:21:52.520 --> 0:21:53.880 than it was when we were babies. 0:21:54.200 --> 0:21:54.400 Right. 0:21:55.280 --> 0:22:00.720 So, lactase persistence, which means that your lactase enzyme is 0:22:00.880 --> 0:22:04.760 on at high levels throughout your life, is actually the 0:22:04.880 --> 0:22:09.280 mutant state, and that is what is present in some 0:22:09.480 --> 0:22:13.160 populations and erin I'm pretty sure you're going to talk 0:22:13.200 --> 0:22:17.240 about why and where this mutation came from. Definitely awesome, 0:22:18.400 --> 0:22:20.840 But yeah, the bottom line is if you can drink 0:22:20.920 --> 0:22:25.639 milk as an adult human and not have borborygmy and 0:22:25.840 --> 0:22:30.920 tons of gas and abdominal cramping and possibly diarrhea. You're 0:22:31.040 --> 0:22:36.440 the mutant, we're the mutants. So I think that's really fun. 0:22:36.960 --> 0:22:40.560 So I don't know this episode is lactose intolerance, but 0:22:40.640 --> 0:22:45.320 it's really like weird lactase persistence. Yeah mutants. 0:22:45.560 --> 0:22:52.520 Maybe we'll just milk mutants, milk milk mutants. 0:22:52.400 --> 0:22:58.960 Milk mutants. But arin what you mentioned about in Finland 0:22:59.040 --> 0:23:04.399 having really high levels of seeing a lot of like 0:23:04.560 --> 0:23:07.720 lactaid type. 0:23:06.840 --> 0:23:09.520 Yeah LA products, low lactose products. 0:23:09.840 --> 0:23:13.720 It turns out that people are actually really bad at 0:23:14.080 --> 0:23:18.960 knowing if their symptoms are associated with lactose intolerance or not. Right, 0:23:19.440 --> 0:23:21.880 So when they've done studies to look at, like what 0:23:22.000 --> 0:23:25.520 your tolerance levels actually are, it turns out that even 0:23:25.560 --> 0:23:31.280 people with lactose intolerance or lactase non persistence can actually 0:23:31.359 --> 0:23:35.320 tolerate about a cup or a little more than a cup, 0:23:35.359 --> 0:23:37.400 like twelve ounces of milk a day. 0:23:37.960 --> 0:23:40.320 I was gonna make that point or like bring bring 0:23:40.400 --> 0:23:45.840 that up, that lactose intolerance and lactase non persistence are 0:23:46.200 --> 0:23:49.840 different things, Like you can also have different levels of 0:23:49.920 --> 0:23:56.840 lactose intolerance exactly even if you don't produce lactase into adulthood. 0:23:56.480 --> 0:24:01.320 Exactly, because lactose intolerance is essentially you having symptoms from 0:24:02.119 --> 0:24:06.600 after you drink milk, but most because your colon bacteria 0:24:06.840 --> 0:24:11.560 can actually digest lactose. As long as you're not drinking 0:24:11.720 --> 0:24:16.160 or eating so much lactose that you become symptomatic, then 0:24:16.240 --> 0:24:19.520 it's no problem, right, So the only problem is if 0:24:19.520 --> 0:24:22.800 you have so much that basically your whatever whatever your 0:24:22.840 --> 0:24:28.199 individual colon bacteria can handle, after that point is when 0:24:28.240 --> 0:24:30.399 you're going to become symptomatic. So for some people that 0:24:30.520 --> 0:24:33.359 might be like one piece of cheese, and for other people, 0:24:33.520 --> 0:24:37.919 even if their lactase enzyme is very low activity or 0:24:38.000 --> 0:24:40.399 no activity, they might still be able to drink like 0:24:40.440 --> 0:24:43.480 a full glass of milk and not have any problems. 0:24:44.680 --> 0:24:51.159 So the microbiome, the gut microbiome, and lactose, yes, the 0:24:51.560 --> 0:24:56.680 bacterial species that feed on the lactose. Like, is there 0:24:57.119 --> 0:24:59.560 have there been any studies that look at maybe like 0:24:59.600 --> 0:25:03.520 different amounts of that type of bacteria or anything like 0:25:03.600 --> 0:25:07.040 that in association with symptoms or tolerance or whatever else. 0:25:07.200 --> 0:25:11.960 Like whether you could give somebody probiotics and lessen their symptoms. Yeah, yeah, 0:25:12.000 --> 0:25:14.359 there have been studies of it to my knowledge, they're 0:25:14.400 --> 0:25:18.359 not like, we don't have a pill, a probiotic pill 0:25:18.359 --> 0:25:20.640 that you can take to be able to digest lactose 0:25:20.640 --> 0:25:22.760 with no problem at this point, but there are definitely 0:25:22.760 --> 0:25:27.680 people looking into it because for sure, differences in colon 0:25:27.800 --> 0:25:31.639 bacteria would lead to differences in symptoms. And there have 0:25:31.680 --> 0:25:34.920 been a number of studies that have shown that if 0:25:34.960 --> 0:25:39.120 you kind of train your colon bacteria over time, then 0:25:39.160 --> 0:25:43.480 you might actually be able to tolerate greater levels of lactose, 0:25:43.560 --> 0:25:46.920 although other studies have said maybe that's just a placebo effect. 0:25:47.080 --> 0:25:51.800 So in any case, if you don't have the allele 0:25:52.000 --> 0:25:55.720 that allows you to produce lactase, you're not digesting. 0:25:55.960 --> 0:25:57.679 On your own. You're not digesting it. 0:25:57.840 --> 0:26:01.640 Yeah, so tell me about lactase and the little pills, 0:26:01.800 --> 0:26:03.919 the little helper pills. What do those do? 0:26:04.600 --> 0:26:08.679 So the lactase pills that you take are lactase enzyme. 0:26:09.200 --> 0:26:10.080 Oh okay, So. 0:26:10.000 --> 0:26:12.440 That's literally just going to break down the lactose before 0:26:12.480 --> 0:26:14.920 it makes it to your colon. Okay. There are other 0:26:15.000 --> 0:26:18.560 things that you can put, like in your milk, like droppers. 0:26:18.760 --> 0:26:20.639 I don't know if it's a liquid or not, but 0:26:20.720 --> 0:26:23.880 that is yeast or bacteria that you can let sit 0:26:23.960 --> 0:26:26.879 in your milk and it'll digest the lactose for you. 0:26:28.040 --> 0:26:28.840 I think, wasn't it? 0:26:29.000 --> 0:26:30.119 I am hearing milk? 0:26:31.000 --> 0:26:31.840