I remember the anecdotes associated with these words of wisdom, after a period of enjoyment comes a bout of payback. Valentine’s Day was just some weeks ago and I know that some of my readers had ice cream, or at least bought ice cream. How many of those who swallowed the creamy stuff, luxuriating in the coolness, the ease with which it went down the throat, the taste of cow’s milk percolated into fatty cream, and then frozen, ended up in the toilet within hours? If you were one of them, you have Lactose Intolerance.
Lactose intolerance is a condition—completely misnamed, since contrary to what the title suggests, it is actually the normal state for adult mammals—in which the ability to digest the sugar, lactose, is impaired because of a lack of the enzyme lactase. The etymology of the words lactose and lactase are self-explanatory. Lactose is the predominant sugar found in milk. And in adults, the frequency of absence of the enzyme lactase in populations ranges from 5% in Northern Europe, and some pastoral communities in Africa, to 71% in Sicily and up to 90% in Africa and Asia.
What happens is this: lactose is a disaccharide, a sugar made of two smaller units. Disaccharides cannot be absorbed directly through the intestine’s walls. So when a lactase-deficient individual ingests milk, the sugar remains in the lumen of the gut where it is immediately acted upon by bacteria. This fermentation produces by-products, gas: hydrogen, carbon dioxide and methane. These in turn produce the intestinal symptoms some of you remember from the 15th of February: cramps, bloating, heartburn, and flatulence, and of course, diarrhoea. Although to be pedantic, the way Lactose Intolerance produces diarrhoea is through the direct action of the undigested sugar itself, not through the action of bacteria. The sugar draws water into the lumen of the gut leading to the watery stools.
But what is the real-world relevance of Lactose Intolerance, you ask. You see, in the northern-hemisphere-dominated world we live in, assumptions can lead to, and have led to, death. During the Nigerian Civil War, Caritas, the Catholic aid agency, and others pushed large shipments of aid to help the protein-energy-malnourished children in the Biafran enclave. They came with egg yolk, with dried fish, with milk. And doctors, including the pair who would go on to found Médecins san Frontières, noticed that older children were dying from consuming milk. From consuming milk? Yes. The Red Cross initially ascribed these deaths to spoilage, to contamination, to even outright poisoning by the opposing forces. They said Biafrans were preparing the milk wrongly. But it was Lactose Intolerance. Even the brilliant can be slow to latch onto the obvious.
Lactase is an enzyme that every child is born with, an important trait because the infant’s entire diet consists of mother’s milk. The mammalian production of lactase drops off as infants approach the weaning period but some populations—because of a mutation in the genes that code for this trait—have retained the ability to process lactose into adulthood. Unsurprisingly this recent agriculturally associated trait confers an advantage in pastoral communities, so lactose intolerance is rare in societies where dairy products have a long, almost prehistoric, history of being consumed, i.e., the Fulani, the Tutsis, and Northern Europeans. However, most other humans lose this ability. And it is not modifiable, although new research seems to suggest that retaining Lactase activity into adulthood is on the rise worldwide, a sign, some say, of evolution in action.
So those who stole to mommy’s kitchen cupboard to binge on powered milk; those who add coffee to their milk instead of vice versa; those who quaffed Valentine’s Day ice cream as if there was no tomorrow, now you know why you ended up in the loo hours later.
You will recall that in my last piece, I shared with you a story from when I was a “Baby Doc’ in medical school. My Professor had told me that in clinical practice I would find all kinds of human reactions to the idea of sex and sexual performance.
And so I return again to the sad story of the young undergraduate who, allegedly and inadvertently poisoned a friend with a “sex enhancing” drug presumably with the intent of not just having sex with her, but with plans to make the experience a much more pleasurable one for both of them.
As was alleged in news reports, the story ended tragically with an allergic reaction to the drug, and is still a pending investigation.
That story brings to mind how many people, (and I am restricting my comments to Nigeria where I practice,) dabble with sex enhancing drugs for entertainment without proper knowledge of what they really contain and the possible side effects.
Various potions and drugs from the benign to the ridiculous are advertised to enhance sexual desire and performance. When you run through the list from the harmless ones like malt stout and “suya” pepper, garlic marinated in alcohol, to “honey moon snacks” like exotic dates and nuts which are popular in the north, and the Yohimbe tree (Corynanthe yohimbe) bark steeped in alcohol to the dangerous ones like caffeine stimulants, herbal concoctions, and narcotic drugs, it becomes quite clear that bedroom anxiety is a real enough medical issue for many.
Let’s take the “Spanish fly,” which is the stuff of legends.
As a teenager in secondary school looking to head to University, one of the earliest stories I was told about the university was that girls who were too friendly with boys on campus would have “Spanish fly” slipped into their drink when they weren’t looking, and subsequently be robbed of their virtue.
I made a solemn vow there and then that when I got into the university, I would always have enough money to pay for my own soft drink and to never let it out of my sight.
It was a fortunate thing, even though disappointing for my curiosity that I never saw or heard about “Spanish fly” in all my years in the university.
But then I eventually got to see this drug in clinical practice when a patient who had been having sexual difficulty at home brought it to me, early one morning, to ask whether it was safe to use with his wife.
It was quite an unremarkable powdery substance in a small, brown bottle. He bought it at a very expensive price; he said and wanted to have a medical opinion on its safety, especially since his wife had asked him to.
Now you see, “Spanish fly” is a specific type of drug that is gotten from a beetle called Cantharis vesicatoria or Lytta vesicatoria.
The truth about it is this; when taken in moderate doses Spanish fly produces irritation of the genitals which results in an increase in blood flow to the area thus mimicking the engorgement and erection that occurs with sexual excitement.
However, this drug can be extremely toxic when ingested and may cause priapism; a very painful and dangerous condition in which the male has an erection for an extended period of time—hours or even days.
In spite of my lengthy explanation, my patient, holding on to the bottle with all the hope a person could have, still asked me;
“Ok Doctor, but… does it work”?
“Well, yes. And no,” I told him.
I had to break his heart that day, and to make sure he didn’t do anything stupid, I took the bottle from him before sending him home. The small brown bottle remains in my work drawer to this day. (And it is still unopened, I swear!)
Now, there are some people for whom sexual dysfunction is a real problem, and I do empathize, having seen first hand at work, how distressing a condition it can be.
Most problems of sexual dysfunction are not solvable by drugs, but instead through lifestyle modification and counseling.
But a great number of people continue to try quick and usually dangerous fixes to the problem of sexual dysfunction. And many others who have no real illness, just for the sake of increased performance and excitement.
Like many sex therapists preach, good sex actually happens in the head, and not quite solely in the genitals.
P.S: My patient and his wife saw a sex therapist, spent more time together as a couple and have come in to see me many times since then, and not once, has he ever asked to have his bottle back.