What is lactase deficiency. Symptoms of lactose deficiency in adults.

Lactose intolerance is a clinically pronounced condition associated with insufficient activity of lactase, an enzyme produced by intestinal mucosa cells, enterocytes.

The function of lactase is to break down the complex components of milk sugar into simple components - monosaccharides glucose and galactose. Further simple sugars are absorbed in the small intestine and enter the bloodstream.

The main treatment involves the exclusion from the diet of proteins responsible for allergies. If you remove the allergens, the symptoms disappear. In the case of newborn babies, breast milk should not be injected, and cow's milk, both in infants and adults, should not be replaced by breast milk of other animal species, either due to the high risk of allergies or inadequate nutrition. Soy protein proteins are not recommended for infants, although they can be a valuable substitute for adults.

It can be treated with the introduction of products with reduced allergenicity. Products with reduced allergenicity vary in lactose content, medium chain fatty acids do not have protein-stimulating hydrolysis formulas, or products containing free amino acids. Unfortunately, the presence of lactose in these products makes them inadequate for patients suffering from lactose intolerance. Diagnosis of this occurs by identifying the responsible immunopathogenic mechanism, when the mechanism is not found in the presence of allergy, we prefer to talk about "intolerance to milk protein."

What is lactose intolerance (hypolactasia): symptoms, causes ^

Lactose is a substance essential for the human body:

Milk sugar, getting into the intestine, stimulates the formation of beneficial to the body lactobacilli and bifidobacteria.
It is known that these microbes are an integral part of the intestinal biocenosis, therefore, the intake of lactose is necessary for the normal functioning of the digestive system and the prevention of dysbacteriosis.
Also, lactose stimulates the production of vitamin C and B vitamins, helps calcium absorption and contributes to the formation of the nervous system in children.
As a carbohydrate, lactose is a source of energy.

The harmful effect of lactose is manifested in some cases when there is a deficiency of the enzyme that breaks it down. Then a person has abdominal pain, rumbling, flatulence, and liquefied stools. Sometimes there is an allergy to lactose, the symptoms of which are similar to those that occur during lactase deficiency (hypolactasia).

Those who suffer from mild lactose intolerance can only destroy dairy and fresh dairy products, the rest of the products should be tolerated. Products that follow should be completely eliminated and replaced by those who suffer from the inability to adequately process milk proteins. Cow's milk and adapted dairy products Fresh or seasoned cheeses, with the exception of seasoned Parmesan cheese for 3 years, which would contain only hydrolyzed milk proteins. Spare foods There are many meal replacements for those who suffer from lactose intolerance or.

Products containing lactose

This carbohydrate is contained not only in dairy products - yogurt, sour cream, cottage cheese, whole milk.
It is added to chocolate, sweets, condensed milk, cookies, biscuits, used when baking bread to give a beautiful golden crust.
In the production of meat products, the use of milk sugar helps to extend the shelf life of the product and removes the salty taste.
Lactose is a constant component of infant formula, diabetic products and fast food.

Lactase deficiency, or lactase deficiency: causes

Insufficient activity of lactase - the main enzyme that breaks down milk sugar, is found in both children and adults. Causes of poor carbohydrate digestion should be sought in genetic susceptibility.

A patient with this meat has a horse, rabbit, child, sheep, chicken, turkey, lamb, and raw ham. All kinds of fish and eggs. Here is a list of food substitutes for those who suffer from intolerance or allergies. Special milk for lactose intolerance In the market there is milk without lactose. This milk is recommended for those who suffer from intolerance, but still contain milk protein, so it is forbidden in a patient suffering from food allergies to milk.

Milk is lactose, which can also be used by those who suffer from food allergies to cow's milk. Lactose intolerance, not to be confused with allergies, is a disorder associated with a decrease in the ability to digest the basic milk sugar due to a deficiency of the enzyme lactase responsible for the decomposition of lactose glucose and galactose. If this process does not work properly, lactose remaining in the intestine is fermented from the bacterial flora, causing a series of more or less serious disorders.

Lactase activity changes with age: the older the person, the smaller the amount of enzyme produced in the intestine. This is a normal reaction of the body during the transition from dairy feeding to mixed foods. However, it all depends on the individual characteristics of each individual. Some people are able to digest milk in adulthood, others lose this opportunity in 25 years.

In very rare cases, lactose intolerance is due to the complete absence of a genetic mutation, which, 7-8 thousand years ago, allowed to introduce cow's milk into the diet. However, in most cases, this disorder is caused by an enzyme deficiency. Often lactose intolerance is temporary and can be caused by infections of the gastrointestinal tract or changes in eating habits. In fact, the ability to digest milk sugar can be proportional to the amount it takes.

It may happen that there is celiac disease at the base of lactose intolerance, i.e. gluten intolerance, a condition that destroys the wild nature of the intestines, on top of which are the enzymes necessary for the breakdown of lactose. Stomach disease, nausea, diarrhea, flatulence, vomiting, and general fatigue can occur when foods containing this sugar are swallowed. However, not all lactase deficient patients are symptomatic. In fact, there are several degrees of deficiency, so there are those who can accept and digest a glass of milk and even half without symptoms.

Lactase deficiency can be a transitory condition, for example, it occurs after having had a flu, a viral infection. When the pathology of the digestive system - gastritis, enteritis, in violation of the composition of microflora in the intestine, symptoms of hypolactasia appear.

In children during the first months of life, transient lactase insufficiency often occurs, which disappears as the baby matures. This phenomenon is explained by the immaturity of the pancreas and impaired intestinal biocenosis. Most often, transient enzyme deficiency occurs in premature babies and those babies who are low in weight and lagging behind in development.

First, the specialist comes to the diagnosis, analyzing the symptoms with the patient. A test is then conducted, called a breath test, which is used to measure the amount of lactase produced. Since the quantitative and low-quality test must be interpreted by a specialist who can determine with the patient the severity of intolerance on which to establish a therapeutic route.

If the cause of lactose intolerance is a gastrointestinal disease, it must be treated. Otherwise, the specialist can help the patient to understand their limits, trying to create an individual diet regimen. The removal of milk and all its derivatives is a decisive and counterproductive choice. In fact, it is possible to help the body “work out” to produce more lactase, and then digest more lactose. For this purpose, lactase capsules in a pharmacy may be helpful, which can compensate for this deficiency and help the body restore proper balance.

Lactose intolerance: symptoms in adults

The following symptoms usually indicate hypolactasia in adults:

Cramping abdominal pain after consuming dairy products;
Diarrhea;
Nausea;
The accumulation of gas in the stomach.

Signs of lactose intolerance in newborns

The pathology debuts at 1-3 months of life, however, a newborn baby may not show signs of lactase deficiency. This is due to the fact that in the mother's milk in the first weeks after birth, there is a small amount of milk sugar. Then the clinical signs are enhanced:

Depending on the severity, limits can be set for the intake of products containing lactose. Lactose intolerance is the inability to absorb and absorb lactose and causes gastrointestinal symptoms when eating or drinking food containing milk.

This disease is not the same as milk allergy. The lactase enzyme is an enzyme produced by the intestinal intestinal wall. If a person does not have enough lactase, the small intestine can digest only part of the lactose. Dissolved lactose enters the colon, where it is fermented by bacterial flora. Many people have low lactase levels, but only those who have signs and symptoms are lactose intolerant. When lactose crosses the colon without being properly digested, it can cause symptoms such as abdominal pain and swelling.

The newborn child is disturbed by colic, manifested by sudden and strong crying, sleep disturbance.
When viewed revealed abdominal distension.
The frequent and frothy stools with high content of mucus attracts attention.
When the diaper is removed from the baby, a sharp sour smell of feces strikes the nose, which is caused by the presence of a large amount of organic acids.
Colic baby delivers great anguish to parents. Sometimes the crumb and completely refuses to breast, and if the mother manages to feed him, spits abundantly due to the accumulated gases in the intestines.

Lactose intolerance: symptoms in infants

As the body's enzyme systems develop, the production of lactase increases with age. However, in some children, the symptoms persist longer. You can suspect the disease on the following grounds:

Primary lactose intolerance When breastfeeding ends, the production of lactase enzymes is reduced, but remains sufficient for the assimilation of average milk products. Those who suffer from primary lactose intolerance, the production of lactase is destroyed and, therefore, can not digest dairy products.

Secondary lactose intolerance This disorder is caused by illness, therapy or surgery in the intestinal tract, for example: some chemotherapeutic drugs, etc. Congenital lactose intolerance In rare cases, children are already born with this disorder due to insufficient lactose levels.

The child is lagging behind in development;
He has a big swollen belly;
Cal appears up to 10-12 times a day, has an unpleasant sour odor;
Bad weight gain;
Constipation due to increased intestinal motility due to dysfunction of the anus muscles;
The feces have an uneven composition: it contains mucus, lumps of undigested food, sometimes blood streaks.

Sometimes there are no vivid signs of lactase deficiency, the baby simply does not gain proper pounds or lose weight.

About two thirds of infants or breastfeeding babies have lactase deficiency in the first few months of life without symptoms. Human breast milk contains about seven percent lactose. The lactose content in breast milk is not affected by the mother’s diet, although it reduces or eliminates dairy products. Attacks of gastroenteritis can cause loss of the enzyme lactase, in this case, babies can drink milk without lactose.

Are there any complications of lactose intolerance?

Lactose vapors are another option, but this is not always helpful. Some babies are born without lactase enzymes, so they should drink lactose-free milk. Lactose intolerance does not cause vomiting in children. This can be a symptom of cow's milk. Symptoms of lactose intolerance may be minor or severe, depending on the amount of lactase produced. Lactose intolerance manifests itself with the following disorders. Abdominal swelling, pain or, Gorgoglia, Nausea or Mists. . Most people do not have long-term problems.

Activity level

Lactose intolerance: diagnosis and treatment in adults

Infants are analyzed for lactose intolerance by the following methods:

Test for hydrogen content in exhaled air. The child takes lactose, after which the concentration of hydrogen is measured during expiration. The lactose tolerance test is considered positive if the hydrogen concentration is more than 20 ppm. Since the baby experiences discomfort after taking milk sugar, this study is conducted in children older than 3 months.

Determination of carbohydrate concentration in feces. This test is not very informative, often false results of analysis. In addition, you can not figure out what exactly the content of carbohydrates is increased. It is believed that a concentration of more than 0.25% indicates pathology.

Analysis of stool acidity (coprogram). Indicator of lactase deficiency is the pH of feces below 5.5. Microscopic examination revealed a large amount of fatty acids and mucus.

Lactose curve - blood test for the concentration of milk sugar. After taking lactose, the baby takes blood several times, then the fluctuations of lactose are examined and a graph is drawn from them.

Intestinal biopsy is a method rarely used today. A piece of intestinal tissue is removed under general anesthesia and is further examined for lactase content in the mucosa.

Treatment of lactose intolerance in children

Pathology treatment is carried out with the help of substitution therapy, and much attention is paid to optimizing maternal nutrition. If the baby is bottle-fed, it makes sense to transfer it to low-lactose or lactose-free formulas.

Babies with severe lactase deficiency can develop and become malnourished if the disease is not diagnosed early. Breath test. This test measures the amount of hydrogen released. When lactose is fermented into the intestine, instead of being converted from lactase, more hydrogen is produced.

Elimination of the diet Many people suffering from gas, abdominal pain, flatulence and diarrhea, suspect that it is lactose intolerance. The best way to find out is to not drink milk and eat dairy products to see if the symptoms have disappeared. If this is normal, you can try adding a small amount of dairy to see if the symptoms return. If you feel bad after drinking a glass of milk once, you probably do not have lactose intolerance. If you feel pain every time you drink milk, ice cream or other dairy products, you may be intolerant to lactose.

A nursing mother is recommended to carefully control the amount of food consumed, because the baby should be fed according to the physiological norm. It is advisable to purchase a special bottle to prevent colic, having a single-pass hole - it will help prevent air ingestion during feeding.

If the child is breastfed, the mother is prescribed lactase preparations, which are used in each feeding for replacement purposes.

Fatty acid test Fatty acidity is a test for lactase deficiency in infants and babies. The acidity test of a stool, baby or child should drink a small amount of lactose. Subsequently, several stool samples are analyzed for acidity. When lactase is deficient, lactose, which is not absorbed, enters the colon and is converted into acids by bacteria, for example, it is a derivative product. Lactic acid makes acid stools. Thus, a child with a child’s deficiency or lactase produces acid stools after the lactose test.

It is known that during hypolactasia the structure of the intestinal microflora is disturbed, so probiotics are prescribed to patients (Linex, Bifiform). These drugs compete with the pathological intestinal flora, interact with epithelial cells, synthesize bactericidal ingredients.

To eliminate colic in babies are used:

What is lactose intolerance therapy?

Stool acidity test is rare, today it is recommended to breathe even in children. Another simple cheap test is to try to drink lactose-free milk and evaluate the reaction. Lactose intolerance is simple. The goal of treatment is to control the symptoms with dietary modifications. You can find out through the trial version and the error what the quantity and type of lactose-containing products you can tolerate.

Although the body's ability to produce lactase cannot be altered, the symptoms of lactose intolerance can be controlled with changes in diet. Most people with lactose intolerance can tolerate a small amount of lactose in the diet without any symptoms. Small amounts of milk or dairy products are gradually introduced to help people adapt to fewer symptoms. Often it is better for people to have dairy products if they eat them while eating. There are significant differences between people, they may have serious symptoms after drinking a small glass of milk, and another may drink a glass without any symptoms.

antispasmodic (Drotaverine);
drugs that stop diarrhea;
preparations - defoamers, for example, Espumizan, Bobotik;
enterosorbing agents (Smecta).

Prevention of hypolactasia: how to eat when lactose intolerance ^

The danger of hypolactasia is the reproduction of putrefactive microbes in the intestinal cavity, depletion of the body and dehydration. Over time, immune deficiency, vitamin deficiency and osteoporosis develop.

To correct the condition, it is recommended to exclude products containing lactose from the diet. However, nutritionists believe that a diet with lactose intolerance impoverishes the diet with valuable ingredients. It is known that milk is not only a source of calcium, but also useful elements - phosphorus, magnesium and sodium.

Today, there are products with a lactase content that do not cause characteristic symptoms. To use are also recommended products that do not contain lactose: vegetables, fruits, cereals, potatoes, meat and lard, fish, nuts. In addition, many people painlessly tolerate the use of natural yogurt, which is a valuable dairy product.

“Dear editors, help me understand how lactose deficiency manifests itself in adults, and its symptoms, and how it differs from lactose intolerance,” writes our reader. Let's see.

“Lactic insufficiency” does not have such a diagnosis;
there is “Lactase deficiency” when there is a lack of the enzyme Lactase,
and there is " Lactic Fat Intolerance", Intolerance to milk sugar LACTOSES

In short, a dark forest of medical terms, but after reading this article, you will see: you have no symptoms of lactose deficiency!

Lactase deficiency leads to lactose intolerance. (Lactose intolerance) - this is the name of the syndrome in the international medical classification of diseases ( in ICD10 - class E73)

A pathological condition characterized by symptoms such as flatulence and rumbling in the stomach after drinking milk is commonly called lactose intolerance (and lactase deficiency is a pathophysiological process, the reason). This syndrome develops against the background of insufficient formation of the enzyme lactase, the responsibility of which is to break down milk sugar - lactose. Lactose is a disaccharide, normally split into more than two simple sugars - glucose and galactose in the small intestine at the level of the duodenum 12. That is, adults are often observed lactose intolerance or the "milk aversion" reaction.

Data

Very interesting spread of lactose intolerance syndrome.

Globally, 75% of the adult population cannot tolerate milk sugar, and with it, dairy products;
l aktaznaya failure often found among the indigenous population of South America and Asia (up to 90% of Hispanics);
75% of African Americans have this syndrome;
on average, 25% of adult Europeans have adult lactose intolerance (lactase deficiency) as adults;
while, for example, in the Netherlands and Sweden, they do not know about such a problem at all;
russia accounted for about 50%;
men and women suffer equally often. The syndrome begins to appear from 20 years;
44% of pregnant women who had not previously tolerated milk, regain the ability to digest lactose during pregnancy;
lactose intolerance is perfectly treated with the exception of milk from the diet;
nobody died of primary lactose intolerance;
osteopenia can be a complication of lactose intolerance, which in old age can turn into osteoporosis.

Types of lactase deficiency

In clinical practice, there are three main types of pathology:

congenital lactose intolerance is inherited as an autosomal recessive trait and is very rare. Manifested from birth;
primary lactose intolerance (lactase deficiency);
secondary lactose intolerance (lactase deficiency)

Primary lactose intolerance is associated with a low level of the lactase enzyme, a decrease in enzyme production occurs gradually and this form develops after childhood. Occurs only in adults. A type of syndrome characterized by insufficient lactase production in the absence of any damage to the enterocytes.

In the animal world, all mammals lose their ability to digest lactose, reaching adulthood, and man is no exception. Deficiency in adults is not pathological, it is a symptom of an age-related decline in enzyme activity.

If you go back to the issue of nationality, then the inhabitants of northern Europe show high lactase activity at any age. But for Asians, it begins to decline quite early.

Secondary lactose intolerance (lactase deficiency).

This type of syndrome occurs in adults and children. Lactase production deficiency develops on the background of damage to the cells of the small intestine. Secondary, or acquired, lactase deficiency can develop in a person with a healthy small intestine during episodes of acute illness. This is due to damage to the mucous membrane or from drugs. Some causes of secondary lactase deficiency:

acute gastroenteritis;
giardiasis;
ascariasis;
crohn's disease;
celiac disease;
tropical sprue, gastrinoma;
radiation enteritis, for example, when cancer patients are irradiated;
diabetic gastropathy;
carcinoid syndrome;
whipple syndrome;
HIV enteropathy;
kwashiorkor;
chemotherapy;
pancreatic adenoma, provoking the development of ulcers;
after a long forced feeding through droppers.

How dangerous is the lack of the enzyme lactase to the adult body?

We dealt with the primary deficiency of the enzyme - it does not threaten adults. With secondary lactase deficiency, everything is almost the same.

DO NOT DRINK MILK and there will be no problems. Milk is not the food of adults - and the point!

All horror stories like: dehydration, as long-term diarrhea removes a huge amount of fluid, which is difficult to fill; deficiency of calcium and many other trace elements, since the absorption of these substances practically ceases in the intestine; the lack of nutrients from dairy products leads to the cessation of the development of beneficial microflora bacteria; the population of putrefactive bacteria grows; peristalsis is significantly reduced, the overall immunity of the body falls - they concern ONLY children. For an adult organism have nothing to do!

Symptoms

The severity of hypolactasia occurs in each person individually. The symptoms of lactase deficiency in adults are similar in both forms of lactic intolerance. The difference is that:

primary form and brightness of symptoms depend on a large number received milk
and in the secondary form, the symptoms bloom in full bloom even when the minimum amount of milk sugar is released, since its splitting is completely impaired in the inflamed mucosa of the small intestine.

But in general, the symptoms indicating lactose intolerance, which are caused by lactase deficiency, are reduced to the following manifestations.

Symptoms are always associated with drinking milk. or dairy products;
there may be diarrhea, but constipation does not occur at all, sometimes alternation of symptoms:;
constant uterine rumbling, pain, nausea possible;
loss of appetite and a feeling of severe abdominal distension -

An adult can himself suspect lactose intolerance, even before passing tests, if he knows the main symptoms, and also that this treatment does not help any treatment methods, except strictly adherence to a lactose-free diet.

If the symptoms are, and you did not drink milk, then you need to look for another cause of indigestion.

Symptoms are very similar to irritable bowel syndrome, and it is possible to distinguish one condition from another only by completely eliminating dairy products. Sometimes these two pathologies get along together.

Laboratory studies confirming lactase deficiency in adults

In adults, symptoms of primary lactose intolerance, lactase deficiency are the norm, and not the disease, and international recommendations of dieticians are offered by gastroenterologists as the first diagnostic test:

exclude milk;
if milk is excluded, and it became better, then no in-depth "diagnosis" is needed! Is it that if you want to support your medical laboratory with your finances?

In some doubtful cases, the same “international standards” recommend a couple more tests:

blood test with lactose load. The patient absorbs 50 ml of lactose and then measures the level of blood sugar, with the recording of data on the graph and the construction of the curve. The lack of lactase makes the curve straight, the graph does not show an increase in glucose after 60 and 120 minutes, as it does not absorb in the intestine.
milk load test give 500 ml of milk and measure blood sugar levels. If the blood sugar level is less than 9 mg / dl, this confirms a violation of the absorption of glucose in the intestine.

All other tests may be needed only for differential diagnosis with other more serious disorders, for the study of secondary lactose intolerance, for example, in celiac disease.

Analysis of feces. This test shows the amount of carbohydrates, and the pH level. A healthy person has no carbohydrates in the stool. In the syndrome of lactase deficiency is determined by their presence, and the pH drops to a level of 5.5 and below.
analysis on the concentration of exhaled hydrogen. It is carried out also with lactose loading. Samples are made every half hour up to six times.
biopsy and enzyme activity analysis. For its holding is taken from the mucous membrane wash. The result of this test is considered the most reliable. (in practice it does not apply, since it is an invasive method and has complications).
genetic testing is sometimes performed to find out the cause of secondary lactose intolerance, for example, in the case of celiac disease.

In addition to specific tests for adults, other diseases are excluded, a symptom of which may be diarrhea and bloating. Only after receiving all the answers to the analyzes, together with a nutritionist, is a menu of a therapeutic diet developed. Enzymes are prescribed, and measures are taken to relieve symptoms.

Diet for people who don’t tolerate milk sugar

It is recommended to read the labels and limit the consumption of products that include milk sugar: for example, mayonnaise, sauces, sweets
Most patients can safely drink one glass of milk without developing unpleasant symptoms.
Yogurt and cheese do not usually cause unpleasant symptoms.
You can use fermented milk, soy milk,
Calcium is recommended as an additive.
Fat milk and chocolate milk are generally better tolerated than skimmed milk.

Treatment of acute disorder

As we have already agreed, you should not treat the primary natural lactose intolerance with pills. Secondary lactase deficiency is treated as follows:

exclude intake of lactose, that is, milk and dairy products;
they treat the disease - a source of enzyme deficiency (for example, acute gastroenteritis);
provide the body with the necessary enzymes for the digestion of lactose, apply the enzyme lactase tablets or capsules.

And by the curtain a little more linguistics: “Lactose deficiency”, from the point of view of the language, means “lack of milk sugar” in the body, theoretically, lactose deficiency - so one could call the lack of milk sugar in the breast milk of a newborn or some kind of eating disorder have starving children in Africa. My inquisitive mind made me find a study on lactose deficiency in babies (Lactose Deficiency in Infants Clinical Pediatrics 11/2008) in medical journals; But this term has nothing to do with the topic of our article and the fact that adults do not digest milk sugar.

Yours sincerely, doctor A.Novotsidu

Dear friends! Medical information on our website is intended for reference only! Pay attention, self-treatment is dangerous for your health! Sincerely, Editorial Site