Dear Dr. Roach: When I was diagnosed with hemochromatosis, my doctor explained that a ferritin level of 380 ng/mL was too high. I am a male and would like to know if I need to continue getting phlebotomies. After several phlebotomies in three to four months, my level was 122 ng/mL.

Currently, I have a score of 97 ng/mL. I prefer to accept this lower score and monitor it every two to three months. Please let me know if this sounds reasonable.

— J.D.

Answer: Hereditary hemochromatosis (HH) is caused by excess absorption of iron. The body can normally regulate how much iron to absorb, but in people with HH, the body absorbs as much as possible all the time. This leads to iron overload, which can damage many organs, especially the bone marrow, heart and liver.

This is one of the few diseases that is treated by phlebotomy, aka bloodletting. Red blood cells contain iron, and frequent bloodletting can take away the excess iron so that it does not damage these critical organs.

The blood ferritin level is an excellent reflection of the overall body iron stores, so keeping ferritin levels in the normal range is the goal. In fact, most experts prefer them to be at the lower end of the normal range. One commonly used guideline is 50-150 ng/mL, so you are right where you should be. Since your body will continue to absorb iron excessively, you will need periodic phlebotomy to maintain the ferritin level in the normal range.

Dear Dr. Roach: I am lactose intolerant and have recently learned that lactose is used in many prescriptions, but there is no warning on the information sheet. I only became aware of this after starting a new prescription and seeing that my morning sugar levels increased. Knowing there is lactose in a medication or supplement is critical.

I have two questions: Why is lactose added? Why is the user not informed?

— A.C.

Answer: Lactose (literally “milk sugar”) is a sugar composed of two saccharides: glucose and galactose. Many adults do not make large amounts of the enzyme lactase that breaks down lactose into simpler components, which the body then uses for energy. Undigested lactose will pass into the colon, where colonic bacteria will convert lactose into hydrogen gas and short-chain fatty acids.

The amount of lactose that people make is variable, and a few people make very little enzymes. If the person’s lactase deficiency is severe enough, and they take in enough lactose, they can develop symptoms of abdominal pain, bloating, gas, nausea and diarrhea within a few hours of ingesting the lactose.

People who have irritable bowel syndrome and lactose deficiency are particularly prone to developing symptoms. Symptoms can be prevented by avoiding large amounts of lactose or by taking lactase before eating a meal that contains lactose.

Because the amount of lactose in medications is so small, even the most sensitive people are unlikely to have any symptoms. It doesn’t significantly increase blood sugar levels either, so informing the user isn’t necessary.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.