Lactose Intolerance - When The Body Suffers From Milk Consumption

Author: Marko Balašević Time for reading: ~4 minutes Last Updated: August 08, 2022

Lactose Intolerance - When The Body Suffers From Milk Consumption

Lactose intolerance is a common enzyme defect in adults that impairs the breakdown of lactose into glucose and galactose.

Lactose intolerance is a common enzyme defect in adults that impairs the breakdown of lactose into glucose and galactose. In Asians, Latinos, and Africans / African-Americans, there is a tendency for the enzyme activity to decrease with age and clinical intolerance between the ages of 20 and 40 with a frequency of about 75 to 90%. In contrast, the European race does not have such dynamics or at least is not so pronounced and the condition is observed in no more than 20% of the population.

The enzyme lactase is located in the apical membrane of the epithelial cells of the intestinal tract, where it performs its hydrolytic (degrading) action. The defect does not allow the breakdown of the main disaccharide present in milk and dairy products - lactose. This limits the absorption of lactose in the intestinal tract, and retention in it leads to osmotic fluid retention, and when it reaches the colon - it and other metabolites that have reached it, undigested due to the accelerated passage, are treated by the available there. flora. This increases the formation of additional end products, including carbon dioxide, methane, hydrogen sulfide, hydrogen gas.

The gene encoding the enzyme lactase is located on the second chromosome. The maturity of the enzyme occurs in the third semester of pregnancy, with the highest in the first and second year of life and a gradual reduction in action thereafter.

There are several types of lactose deficiency. The congenital form of the enzyme defect is the rarest. Like most enzyme defects, this is a mutation inherited in an autosomal recessive manner. The clinical picture occurs soon after breastfeeding or milk feeding in the newborn - with vomiting and diarrhea, colic, dehydration of the child with secondary damage to the kidneys, liver, electrolyte and alkaline-acid balance, with stunted growth and development.

Primary lactose intolerance develops in later childhood as well as in adults. It is this form that has the highest frequency. Enzyme activity is high immediately after birth and in early childhood and gradually decreases, with a clinically significant loss of activity and occurs at least after 7 years of age, usually after 20 years. Temporary lactase deficiency may also be present in premature babies due to enzyme immaturity.

Secondary lactose intolerance is due to damage to the small intestinal epithelium by another noxa. These are infectious gastroenteritis with viral, but more often bacterial and even parasitic etiology, due to gluten enteropathy, autoimmune diseases of the intestine (Crohn's disease), diabetic autonomic neuropathy, tumors producing hormonally active substances - carcinoids, HIV-associated etc.

The clinical picture of lactose intolerance is manifested in bloating, wheezing and colic-like pain, flatulence, flatulence and diarrhea, nausea and vomiting soon (up to 1 hour) after consumption of milk and dairy products. It should be distinguished from milk allergy, which debuts in early childhood and in addition to symptoms of the gastrointestinal tract is manifested by rashes and swelling on the body, less often involves the respiratory organs due to bronchospasm and extremely rarely anaphylaxis. (violent allergic reaction).

The most easily accessible approach to diagnosing lactose intolerance is the lack of a clinical picture in limiting risky foods from the menu and recurrence of complaints soon after consumption. It is possible to measure serum glucose after oral lactose loading. It can be false negative in diabetes as well as bacterial overgrowth in the intestinal tract. Similarly, the test can be performed with 500 ml of milk.

The breath test consists of fasting lactose and determining the level of hydrogen in the exhaled air at baseline and every 30 minutes until the third hour. The test is based on the release of hydrogen gas in the colon due to fermentation processes, which easily passes through the intestinal wall into the blood and is exhaled through the lungs. Faecal analysis showed low pH (<5) and the presence of reducing substances - a sign of impaired carbohydrate absorption. The test is suitable for infants.

Genetic analysis for an enzyme defect is rarely performed. Small bowel biopsy - too, but can be very informative in the differential diagnosis with other diseases of the gastrointestinal tract, including those that provoke secondary lactose intolerance.

Excluding milk and dairy products from the diet is a basic principle for avoiding gastrointestinal discomfort. The clinical picture in each is individually severe and this determines how strict the diet should be. Yogurt, cheese and yellow cheese are better tolerated. Appropriate nutritional formulas are used for babies. The enzyme lactase in the form of a food supplement can be taken as drops, capsules, tablets before the consumption of dairy products to reduce malabsorption and the corresponding symptoms.

The growth of lactose-metabolizing bacteria can facilitate the absorption of lactic carbohydrates and, although incomplete, control the clinical picture. However, they are very suitable as a probiotic in diseases of the gastrointestinal tract with secondary involvement of absorption.

Lactose intolerance may impair the absorption of other nutrients and minerals due to disturbances in the intestinal passage. Dietary calcium intake is reduced as a result of the diet and requires additional intake from other sources.

Lactose Intolerance - When The Body Suffers From Milk Consumption

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