Cortiment - Lactose, Is it an Issue?

[MrHusky]

Hey guys!

I got diagnosed with lymphocytic colitis about two weeks ago, and I've got prescribed Cortiment for it. I started taking it about 5 days ago. The first two days it was like a miracle, but ever since then, my symptoms are back (I usually had diarrhea - not watery, but loose - twice a day).

I just noticed that it has lactose in it. I can't really tolerate lactose or milk at all. I take it with Lactase Enzym just to stay on the safe side, but could the amount of lactose that is in the medication cause any issues like diarrhea or trigger my intolerance?

I'm just afraid that now it's doing more harm than good. I'll hit up my doc, but maybe you guys have some insight.

Thank you a lot!

[tex]

Hi,

Welcome to the group. If pharmaceutical products were 100% pure, I'd say that a small amount of lactose shouldn't be a problem, because it doesn't actually trigger MC (LC). Lactose causes diarrhea because anyone who is lactose intolerant can't digest it, and the undigested sugar causes diarrhea when it reaches the colon because of fermentation by gut bacteria, inflammation causes lactose intolerance for everyone, making us lactose intolerant (whenever MC is active). But it takes a significant amount of lactose to trigger diarrhea, in most cases. The amount of lactose in that product shouldn't be large enough, unless it's listed toward the top of the ingredient list.

The most likely Issue with lactose, is that the lactose is contaminated with small amounts of casein. We react to even tiny amounts of casein, because casein causes our immune system to produce antibodies (if we're sensitive to casein). And unlike food products, pharmaceutical products are not required to list inactive ingredients, although many of them voluntarily list most of the inactive ingredients. Consequently, tiny amounts of casein due to cross-contamination in the lactose, wouldn't be listed, even if the manufacturers were aware of the cross-contamination, and most manufacturers are not.

But it's also certainly possible that the reaction could be due to something else in your diet, or even something else in the Cortiment. For example, lecithin is typically derived from soy, or a legume, and If you're sensitive to soy, you could be reacting to the lecithin.

I notice that Cortimment also contains titanium dioxide, which was banned (as a suspected carcinogen) in 2021 by the European Food Safety Authority (EFSA), for use as a food ingredient, although the FDA has so far not placed any restrictions on its use as a food additive. Most likely the titanium dioxide may be your problem, because I recall seeing research published in 2017 showing that titanium dioxide is contraindicated for IBD patients. Here's a link to the original article:

https://gut.bmj.com/content/66/7/1216

I'm surprised that the manufacturer hasn't removed the titanium dioxide from that product. Obviously the manufacturers of Cortimment don't know beans about IBDs, or they don't care whether their products benefit IBD patients, or not. But the biggest question is, "Why wasn't your gastroenterologist aware of this risk?"

Sorry I couldn't be more conclusive, but I hope this is helpful. Welcome aboard, and please feel free to ask anything.

Tex

[MrHusky]

Hey Tex!

Thank you a lot for your answer, I really appreciate the effort!

I must admit that I wasn't as strict with my diet as my stomach got so much better after those two days and I got so happy! Next to that, I had an extremely stressful week unfortunately!

It's really eye-opening, I wouldn't have thought there is cross contamination like that! I always try to avoid foods that say "can contain traces of milk".

I've been gluten and dairy free since 2020 or so and I also noticed that vegetables cause issues too.

Most days I'm stuck on Chicken-Rice or Sweet Potatoes and in the morning Eggs and Gluten Free "Schar" Bread. It's interesting, but Foods with Cocoa in them for some reason make my stomach much worse.

My GI Doctor said that I might have a milder version of LC as I usually only have diarrhea 2 times a day (she said other people have it much worse, watery diarrhea and many more times a day), but it's still annoying. The Fatigue that comes with it is the worst though!

I will try to stick to my usual diet and try to rule out if Cortiment is really the issue!

Thank you very much again for taking the time for answering my question!

[tex]

If that reaction coincides with when the stress began, that may have been the problem. Chronic stress is a primary cause of MC and MC flares. We had one member who was in remission for over 10 years, and the death of their beloved family dog caused a flare that took months to resolve.

Tex

[MrHusky]

I hope that member is okay now!

Flares are never fun, I can't imagine how hard it must be combined with losing a loved one.

Thank you again for your help Tex!

[cloud9er]

I’ve just noticed this post sorry! Last year Cortiment made my flare worse! Entocort helps me though, in previous years and this one I think it was the lactose, so I avoid it in medication at all costs now.

Edit: Cortiment absorbs lower down the gastro tract I think, do maybe your inflammation is higher up. That’s what I took from this help page anyway:

https://www.ibdrelief.com/learn/treatme ... ve-colitis


Kind Regards,

Amy