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Lactose intolerance, which is the sugar found in milk, is one of the most common food intolerances. It happens when the body lacks lactase - an enzyme necessary to break down lactose. Then, after consuming milk or other products containing lactose, digestive system problems appear. What are the causes and symptoms of lactose intolerance? What is the treatment?

Lactose intoleranceis an inappropriate reaction of the body that occurs after consuming products containing lactose - milk sugar. The reason for this type of food intolerance ismissing(alactasia) ordeficiency(hypolactasia)lactase- digestive enzyme, which is necessary for the proper breakdown of lactose into glucose and galactose.

When the body lacks lactase, lactose cannot be broken down and undergoes bacterial fermentation in the large intestine. As a consequence, acids and gases are formed, which increase the osmotic pressure of the intestinal contents and irritate the mucosa, resulting in unpleasant ailments from the digestive system.

Lactose intolerance - causes

The most common cause of lactose intolerance isprimary (hereditary) lactase deficiency(akaadult hypolactasia ). The essence of the disease is the progressive decrease in lactase activity from the age of 2 (and sometimes even earlier), which reaches at most5%of the initial activity.

The symptoms of this type of milk sugar intolerance are rarein infants and children.They usually appear in adolescence orin adults .

Adult lactose intolerance is caused by a polymorphism in the LCT (lactase gene) gene. The disease is inheritedrecessive .

Lactose intolerance can also be the result ofalactasia , meaningcongenital lactase deficiency.The disease is caused by a genetically inherited metabolic defect that prevents the body from producing lactase. Lactose is found in the milk of lactating women, as well as in milk from cows, goats, sheep and other mammals.

In this case, the symptoms of intolerance appearin newbornsafter the first administration of milkmother or formula milk containing lactose. The disease can be passed on to offspring.

This type of food intolerance can also be caused bysecondary (acquired) lactase deficiency(temporary or permanent deficiency of this enzyme). It is the result of diseases or various factors that damage the epithelium and intestinal villi that produce lactase, e.g.

  • Crohn's disease (especially in the acute phase and during the transition to remission)
  • necrotizing enteritis
  • Whipple's disease
  • short bowel syndrome
  • gastrointestinal infections, e.g. acute or chronic diarrhea - caused by bacteria (most oftenEscherichia coliandSalmonella ) or viruses ( usually rotaviruses and adenoviruses)
  • gastrointestinal parasitic infections: giardiasis, tapeworm disease
  • celiakia
  • Duhring's disease (cutaneous manifestation of gluten intolerance)
  • food allergy, e.g. cow's milk or soy protein allergy
  • cystic fibrosis

Destruction of intestinal epithelium and villi may also occur as a result of excessive use of certain medications, such as antibiotics, non-steroidal anti-inflammatory drugs, acetylsalicylic acid, chemotherapeutic agents, and alcohol. It can also occur under the influence of ionizing radiation in the course of malnutrition.

Temporary lactose intolerance may occur in babies born before 34 weeks of age (also known asdevelopmental lactase deficiency ). The organism of premature babies is not able to produce lactase. However, as soon as the gut produces this enzyme, the problem goes away.

The development of lactose intolerance may also be influenced by the long-term use of a dairy-free diet, which reduces the activity of lactase secretion.

Lactose intolerance - symptoms

The symptoms of lactose intolerance are non-specific and resemble symptoms of many gastrointestinal diseases (especially irritable bowel syndrome). They appear:

  • diarrhea (stools have a characteristic sour smell);
  • flatulence
  • stomach pains
  • "overflowing" in the abdominal cavity
  • excess gas flow
  • colic
  • nausea and vomiting (some);

The severity of these symptoms largely depends on the amount of lactose consumed (the higher the dose, the more severe the symptoms are), as well as the degree of lactase deficiency and the form of consumed lactose-containing food.

It should be noted that the symptoms of lactose intolerance usually appear after a few oreven several hours after consuming this sugar. Therefore, patients often do not see any connection between their ailments and the consumption of milk and milk products.

Important

Lactose intolerance and milk allergy

Lactose intolerance is not the same as a milk allergy. A milk allergy is an overreaction of the immune system that occurs when it comes into contact with an allergen (usually milk proteins). In addition, symptoms of milk allergy appear immediately after drinking it, and not after several hours, and one of the symptoms are skin changes - most often hives.

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Lactose intolerance - diagnosis

In order to diagnose lactose intolerance, your doctor may order the following tests:

  • hydrogen breath test- a fasting patient is given a specific dose of lactose, and then the hydrogen concentration in the exhaled air is measured. In people with lactose intolerance, the concentration of hydrogen in the exhaled air is exceeded. All because lactose is fermented in the large intestine, producing large amounts of hydrogen which is removed through the respiratory tract. It is the most helpful non-invasive diagnostic test;
  • stool pH test- acidic pH indicates food intolerance as undigested lactose acidifies the stool;
  • oral lactose load test- the test consists of administering lactose to the patient and then determining the blood glucose concentration;
  • elimination test -you should follow a lactose-free diet for two weeks. If the symptoms disappear during this time and reappear after lactose consumption, you may suspect an intolerance to this sugar;
  • molecular testlactase gene polymorphism (LCT) - a method confirming or excluding adult hypolactasia (ATH);

However, the most effective (but at the same time the most invasive) examination is endoscopic examination, during which a small fragment of the small intestine is removed to assess the lactase content.

Lactose intolerance treatment

In the case of congenital lactase deficiency, treatment iselimination from the diet for life products that containmilk sugar .

Patients with congenital lactase deficiency cannot tolerate even small amounts of lactose-containing foods and, if left untreated, the disease can be life-threatening. Lactase in tablets helps to digest dairy foods. It should be eaten before a meal containing milk and its products.

In the case of primary lactase deficiency, treatment may consist in the complete elimination of lactose-containing products from the menu or reducing the amount consumed. In some cases,lactase tablets .

may be included in your diet.

As with congenital lactase deficiency, a lactose intolerant diet should be followed throughout life.

In the case of secondary lactose intolerance, the therapy includes periodic elimination of products containing milk sugar, and in infants and young children the use of lactose-free milk formulas.

The lactose intolerance diet should be followed until the disease that caused the damage to the intestinal epithelium is cured (an exception may be, for example, Crohn's disease).

After it regenerates, the symptoms of intolerance should disappear. Then you can return to your normal diet.

Important

In children with lactose intolerance, there is a risk of developing diseases associated with calcium deficiency, such as rickets, osteoporosis and hyperparathyroidism.

ProbeAbout the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

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Category:

Gastrology