Aversion to dairy products. Lactose intolerance in adults, symptoms and treatment. How to cure lactose intolerance

Lactose intolerance in adults

Lactose intolerance is associated with a genetically determined decrease in the activity of lactase (an enzyme necessary for the digestion of lactose) and is manifested by nonspecific symptoms that develop after consuming products containing milk sugar. Occurs after a period of breastfeeding.

The study includes analysis of a genetic marker associated with lactose intolerance.

Synonyms Russian

Lactase deficiency, primary hypolactasia, lactose malabsorption.

What biomaterial can be used for research?

Buccal (buccal) epithelium, venous blood.

How to properly prepare for research?

No preparation required.

More about the study

Lactase deficiency, or lactase deficiency (lactose malabsorption, hypolactasia), is a disorder of lactose breakdown due to lactase deficiency in the small intestinal mucosa, accompanied by clinical symptoms. Lactose (milk sugar) is found only in mammalian and human milk. It promotes the absorption of calcium and other minerals in the intestines, as well as the proliferation of lactic acid bacteria that are beneficial to the body. Lactose is used in the manufacture of many food products, mainly dairy products; The pharmaceutical industry also uses lactose as an excipient.

The action of lactase (an enzyme produced in the small intestine) is necessary for the absorption of lactose. The body's ability to break down lactose depends on the amount of lactase and its activity, which manifests itself from the 12-14th week of intrauterine development, reaching maximum values at the time of birth (at 39-40 weeks). After birth, a child who is a carrier of the normal genotype experiences a decrease in enzyme activity at 6-11 months and subsequently at 2-5 years - this is called primary, or age-related, lactase deficiency. It is caused by a hereditary deficiency of the enzyme lactase and is inherited in an autosomal recessive manner. Consumption of whole milk and other products containing lactose, in this case, leads to digestive disorders: bloating, pain, flatulence, diarrhea. Individual symptoms of lactase deficiency are different, and the degree of their severity may depend on the state of the intestinal microflora, dietary habits, and psychological factors.

Prevention involves preventing symptoms of hypolactasia by following a diet low in lactose or completely absent. Therefore, if you experience symptoms of indigestion after consuming unfermented dairy products, it is advisable to conduct a genetic test for lactase activity in order to avoid attempts at pointless treatment and choose an appropriate diet. The test also has prognostic value in terms of the development of lactose intolerance in children in order to prevent unexpected intestinal disorders.

It is important to remember that avoiding milk and dairy products, which are an important source of calcium, can lead to calcium deficiency, which increases the risk of osteoporosis (especially in postmenopausal women).

Primary lactase deficiency should be distinguished from secondary (acquired), which occurs when the mucous membrane of the small intestine is damaged against the background of any acute or chronic disease. Such damage is possible due to infectious (intestinal infection), immune (cow's milk protein intolerance), inflammatory processes in the intestines, atrophic changes (with celiac disease, after a long period of total parenteral nutrition, etc.).

The study is not related to the rare genetic disorder congenital lactase deficiency, the symptoms of which appear immediately after birth and are associated with the initiation of breastfeeding.

It has been proven that the gene region MCM6 is one of the important regulatory elements of the lactase gene. There is a connection between lactose intolerance and a genetic marker MCM6(C(-13910)T).

Factors that increase the risk of lactase deficiency:

age - the development of lactose intolerance is associated with growing up - the condition is rarely found in newborns;
ethnicity - lactose intolerance is most common in North America, Africa, Southeast Asia (the incidence of lactase deficiency is 70-100%, for comparison in Russia - approximately 16%);
premature birth (premature newborns may have low lactase levels due to the fact that an increase in enzyme activity in the fetus is observed at the end of the third trimester);
diseases affecting the small intestine (intestinal infections, celiac disease, Crohn's disease).

When is the study scheduled?

For symptoms of lactose intolerance (bloating, stool disorders, nausea, etc.).
In the differential diagnosis of lactose intolerance and other diseases gastrointestinal tract in adults.
To determine the likelihood of developing osteoporosis.
To assess the likelihood of lactose intolerance in children younger age, to prevent intestinal disorders.

What do the results mean?

MCM6 (C(-13910)T)

C/C is a genotype associated with lactose intolerance in adults.
C/T is a genotype associated with a variable level of lactase activity. Risk of developing secondary lactase deficiency.
T/T – genotype associated with good lactose tolerance in adults.

The result of a genetic study is a conclusion that includes characteristics of the obtained genotype and corresponding recommendations.

Genetic marker

Content

The digestive system is complex because it must perform many functions. It contains a large number of enzymes that are responsible for the digestion of foods. With their shortage or, conversely, excess, gastrointestinal disorders begin. A common type of such deviation is lactose intolerance - a process in which lactose is partially or completely not processed.

What is lactose intolerance

This is a disorder in the functioning of the gastrointestinal tract, characterized by absolute or partial intolerance of lactose, which is due to the absence of the enzyme responsible for the digestion of dairy products (a substance called “lactase”). The first symptoms of the pathology appear in adulthood and adolescence. In newborns, a decrease in lactase activity in the intestines is extremely rare. Alactasia (another name for milk intolerance) can occur due to various factors, including heredity, acute intestinal infections, etc.

Benefits of lactose for the body

assistance in the growth of muscle tissue;
participation in calcium absorption;
preventing the development of diseases nervous system;
strengthening the walls of blood vessels, thereby reducing the risk of developing pathologies of the cardiovascular system;
maintaining healthy intestinal microflora, since lactase serves as an optimal environment for the life of lactobacilli.

Causes of dairy intolerance

There are primary (congenital) and secondary (acquired) hypolactasia. In the first case, the pathology develops soon after the newborn starts feeding breast milk or formula. With secondary lactose intolerance, clinical symptoms can appear at any age under the influence of various factors. Genetic predisposition to hypolactasia is a disease, the causes of which are not fully understood.

Doctors are convinced that important role The race of a person plays a role: for example, a high percentage of enzyme disorders is observed in residents of Africa and Asia, Jews, and southern peoples. It is rare to find people who completely lack the enzyme that breaks down lactose, and such cases are recorded exclusively in the indigenous people of North America.

In addition to the genetic factor, heredity influences the development of congenital lactose intolerance. The chance of having a child with a dairy allergy is much higher if one or both parents have the condition. The risk group also includes babies born prematurely. Other possible causes of lactose intolerance are:

Celiac disease. This pathology is characterized by damage to the villi of the small intestine by gluten, a component of cereal foods. According to one theory, due to the lack of special enzymes, this protein accumulates in the mucous membrane of the organ, having a toxic effect on it. According to the immunological theory, one of the components of gluten (gliadin) causes the formation of an immunological reaction, which results in hypolactasia.
Crohn's disease. The disease can affect any part of the intestine. Ulcers appear in areas of inflammation, the microflora is disrupted, and gastroenterological problems arise. Against the background of allergies, enterocytes (intestinal epithelial cells) are damaged by immunoallergic complexes. They settle on the intestinal mucosa, resulting in a decrease in the ability of red blood cells to secrete lactase.
Overload of milk proteins. This deviation occurs more often in newborns. The amount of enzymes in breast milk differs at the beginning and end of feeding. The first portions contain more lactose, so the baby quickly receives a large amount of this component. His intestines are not always able to quickly digest a lot of lactose, as a result of which temporary signs of alactasia appear.

Factors contributing to the development of hypolactasia

A common reason that stimulates a decrease in the production of lactase, necessary for the processing of milk protein, is intestinal infections (dysentery, intestinal flu, salmonellosis). The disease occurs due to dysbiosis, in which there is an imbalance between bad and good microflora. Another mechanism for the development of a disease affecting the small intestine is due to damage to red blood cells. In this case, the severity of hypolactasia depends on the pathogenicity of bacteria and viruses. Risk factors for the development of pathology are:

age (mature and older people are more prone to lactose intolerance);
radiation therapy (patients who have undergone radiotherapy have reduced immunity, which can lead to alactasia);
ethnicity (Africans, Asians have an increased risk of developing the disease);
premature birth (premature babies are at risk, but early diagnosis and proper treatment in most cases give a positive result.

Types of hypolactasia

Modern medicine identifies two main types of pathology associated with the body’s inability to fully or partially digest milk protein. Alactasia is classified as follows:

Genetically inherited. The most common type of disease, which usually occurs in people over 20 years of age.
Chronic (acquired). Develops against the background of problems with the small intestine (unbalanced diet, previous intestinal surgeries, ulcerative colitis, Crohn's disease, celiac disease, gastroenteritis, chemotherapy).

Congenital

The cause of lactose intolerance is a gene mutation. This is a relatively rare phenomenon in which the symptoms of the disease in a child appear immediately after birth. Types of congenital hypolactasia include:

Alactasia of newborns. The disease is severe, requiring strict adherence to a diet. One of the reasons is the immaturity of the enzyme system, due to which the baby is unable to digest milk protein. Lactase is completely inactive.
Congenital deficiency with late onset. Appears at a later age. Rarely, the first symptoms occur in children over 5 years of age, but more often the disease develops after 20 years of age. Congenital hypolactasia with late onset is more mild compared to other types.
Transient failure of prematurity. Occurs in babies born prematurely. The peculiarity of the disease is its transient nature. When milk protein enters the baby's body, metabolic acidosis may develop - a decrease in blood pH. The disturbances are explained by the immaturity of the infant's enzyme system.

Acquired (secondary)

The occurrence of the disease is associated with diseases that destroy the lining of the small intestine. These include dialkia and irritable bowel syndrome. In addition, secondary hypolactasia may occur due to resection of the small intestine. This form of pathology appears due to damage to enterocytes, while at the same time there is a disruption in the synthesis of sucrase and trehalose - enzymes necessary to ensure normal digestion.

The risk of acquired alactasia naturally increases with age. Sometimes in children preschool age an allergic reaction to milk occurs without intervention additional factors, when the lactase level decreases below the permissible norm. Acquired lactose intolerance manifests itself as a result of one or more negative factors:

intestinal infections;
stress;
poor nutrition;
intestinal dysbiosis;
ulcerative formations;
worms;
Abuse of milk for a long time, especially in adulthood.

How it manifests itself

Lactose intolerance is divided into complete or partial: the form depends on the amount of production of the lactase enzyme. With the absolute inability of the body to digest milk protein, the entire spectrum of symptoms of the disease is observed; with partial hypolactasia, the symptoms are less intense. Symptoms can be caused by a number of other pathologies, since they do not have specific features. However, if it is observed after consuming dairy products, then there is no doubt about the presence of lactose intolerance.

Signs of lactose intolerance in adults

The intensity of the clinical picture depends on the degree of lactase production in the human body. As a rule, the symptoms of the disease become noticeable within 30–120 minutes after consuming dairy products. Signs of lactose intolerance typical for adults include:

loose stools (but not frequent, as with diarrhea);
bloating, rumbling stomach;
constipation;
nausea, vomiting;
belching;
discomfort, pain in the peritoneum;
convulsions (with absolute alactasia);
flatulence;
loss of appetite;
the presence of mucus in the stool;
tachycardia.

Symptoms in infants

The disease in children is expressed differently, depending on the amount of enzyme produced and the body’s reaction to it. In this regard, children with hypolactasia are divided into several groups:

Children who are able to consume 1 glass of milk per day without negative consequences, and they digest fermented milk products without problems.
Children who cannot tolerate milk and can consume fermented milk products only in limited quantities.
Babies whose digestive system reacts equally poorly to milk and fermented milk products.
Children who experience symptoms of alactasia even when consuming products containing a small percentage of milk.

Signs of lactase deficiency are noticeable in children from the first days of their life. Symptoms appear when the baby is breastfeeding or using formula milk. The disease is diagnosed based on the following symptoms:

the baby’s tummy is swollen and tense (this is noticeable upon visual inspection and palpation);
increased gas formation (this causes moodiness, the child loses appetite, cries, and becomes restless);
the consistency of stool becomes liquid, foamy, the smell of feces is sour, there are mucus impurities;
the number of bowel movements increases or constipation occurs (the latter symptom is typical for bottle-fed babies);
regurgitation occurs after eating;
since most of the substances in food consumed are not absorbed, weight gain in infants slows down;
the baby may suffer from colic, nausea, vomiting;
allergic rashes appear on the skin, swelling of the mucous membranes.

Diagnosis of lactose intolerance

Anamnesis and general examination are not able to give an accurate diagnosis, so the doctor prescribes a series of laboratory research, during which it is extremely important to follow all the rules of preparation. Key methods for screening adults for lactose intolerance are:

General and biochemical analysis blood. This test measures your blood sugar levels after consuming a product containing milk protein. Testing for lactose intolerance is carried out exclusively on an empty stomach. On the day of the procedure, the patient drinks a liquid containing lactose, after which blood is drawn from him every 30 minutes for 2 hours. If the sugar level does not increase, this may indicate alactasia. This test is not used for diagnosing diabetic patients and infants.
Stool tests. As a rule, several types of research are carried out at once. Analysis of the carbohydrate content in feces helps to identify their proportion. Since lactose is a carbohydrate, when there is a lactase deficiency, their amount is increased. Deciphering this study is difficult because the analytical technique is not able to distinguish galactose from lactose and glucose. The results, in this regard, are only indicative, therefore they are considered exclusively in conjunction with the patient’s clinical symptoms. Another test option is a stool acidity test. The appearance of undigested milk protein in the feces causes its strong oxidation, so if the pH is below 5.5, there is reason to suspect alactasia.
Test for lactose intolerance. Exist different types testing, among which they often resort to analysis using an indicator strip and hydrogen testing. The patient is given a solution of milk sugar to drink (50 g of substance per 100 ml of water), after which the level of galactose in the urine is measured several times over a period of half an hour using a test strip. The hydrogen test also involves consuming lactose, after which the level of milk protein in the exhaled air is determined several times at regular intervals. The amount of hydrogen directly depends on the activity of the microflora of the large intestine: if anaerobic bacteria are forced to digest unprocessed lactose, they release a larger amount of this gas than during normal functioning of the digestive system. The curve compiled from this data is analyzed by a doctor.
Biopsy of the intestinal mucosa followed by histology. This is a very informative diagnostic method (its accuracy is 90–95%). However, it is used extremely rarely for examining children, since it requires putting the patient under general anesthesia. Since this method is traumatic, it is extremely rarely used to diagnose hypolactasia in adults.

Treatment of lactose intolerance

There are no methods that can completely cure a person from this pathology, so therapy for alactasia is aimed at alleviating or completely eliminating its symptoms. To do this, the patient is prescribed a diet that limits or completely eliminates milk protein. In addition, the doctor may prescribe you medications to relieve the clinical manifestations of the pathology, and vitamin therapy. Treatment is selected individually for each patient, taking into account:

age;
genesis;
degree of enzyme deficiency.

Diet therapy

The basis of therapy for alactasia is the complete or partial exclusion of lactulose-containing foods from the patient’s menu. Depending on the severity of the symptoms, the patient is recommended to give up either milk exclusively or all milk-containing products (kefir, cheese, cottage cheese, ice cream, yogurt, milk chocolate, etc.). The list of prohibited foods also includes:

baked goods;
meat products such as sausages, sausages, ham, boiled sausage;
glazed sweets;
sauces (ketchup, mayonnaise, mustard);
fast food;
instant dishes - purees, soups, noodles, jelly in bags;
meat by-products (brains, kidneys, liver);
cocoa powder;
sweeteners.

The diet must be balanced, so it is important for the patient to monitor his own body’s reaction to a particular product, so as not to exclude healthy foods that are well tolerated. As a rule, a complete exclusion of fermented milk products from the diet is not required, and a person with hypolactase can consume 100–150 ml of kefir per week without consequences. In this case, not only the volume of portions plays a role, but also the time intervals between the consumption of dairy products. To make it easier to stick to your diet, you should keep a food diary.

Since dairy products contain a lot of useful substances, it is important to replenish their required volume with the help of lactose-free substitutes. In this case, tofu cheese, soy milk and cottage cheese will come to the rescue. Soy products are hypoallergenic and contain large amounts of vegetable protein. If you are lactose intolerant, you are also allowed to consume:

fish, shrimp, squid, other seafood;
baked, boiled meat (chicken, beef, turkey, rabbit);
vegetable oil (olive, corn, flaxseed, sunflower);
rye, wheat, bran bread;
vegetables, fruits, natural juices;
jams, honey, preserves, sugar;
dark dark chocolate;
buckwheat, rice, pasta;
nuts;
eggs;
legumes;
coffee, tea, homemade jelly, compote.

Nutritional features of infants

If the child’s condition is serious, the issue of switching from mother’s milk to lactose-free formula is considered. If the signs of lactase deficiency are mild, the nursing mother is prescribed a strict diet. If a woman stops consuming foods high in milk sugar, the percentage of lactose in her milk will decrease and the load on the baby's intestines will be significantly reduced.

When pathologies are diagnosed in infants, they are transferred to formulas with a low lactose content or without it at all. Such cereals are rich in all the nutrients necessary for growth and development, so parents should have no reason to worry. In the future, after consulting with a specialist, you can try to gradually introduce small amounts of regular formula and milk-containing foods into the child’s diet.

Taking medications containing the lactase enzyme

Drug therapy for alactasia is prescribed if the diet has not brought the expected improvements and the patient’s condition has not stabilized. Lactose intolerance in adults is the basis for prescribing drugs that improve digestion, stimulate lactase production or contain this enzyme. The latter type of medicine is available in liquid form or capsules. The following means ferment milk protein in the intestines to simple sugars:

Lactase and Lactase baby (for children);
Thylactase;
Pancreatin;
Lactrase.

The second stage of treatment involves seeding the intestines with beneficial flora to establish the balance of substances necessary for normal digestion. For this purpose, the doctor prescribes probiotics containing lactobacilli (the dosage and duration of administration are selected individually). They suppress pathogenic bacteria, helping to digest food. In addition, such medications promote the absorption of lactose and prevent the production and accumulation of gases in the intestines.

When there is a deficiency of enzymes for breaking down lactose, the intestines suffer the most, so the patient is advised to take drugs that improve its microflora. Here they are:

Linux;
Bifidum Bagh;
Atcipola;
Bifidumbacterin;
Hilak-forte.

Symptomatic treatment of gastrointestinal disorders caused by hypolactasia

To eliminate or reduce the intensity of unpleasant symptoms, the patient is prescribed tablets for diarrhea or constipation, which improve stomach function and intestinal motility. In addition, to reduce the negative consequences of the pathology and eliminate vitamin deficiency caused by it, a course of taking vitamin-mineral complexes is carried out. Vitamin D and calcium supplements are often prescribed.

For diarrhea (frequent, loose stools), which is one of the symptoms of lactose intolerance, the following medications are indicated:

Loperamide. The medication reduces the tone of the intestinal muscles, reduces and relaxes peristalsis. At the same time, Loperamide tones the anal passage, providing an antidiarrheal effect. The product is taken 2 capsules at a time; it is prohibited for children under 12 years of age.
Diosmectite. It has a pronounced absorbent effect, removing excess fluid from the large intestine and stabilizing the condition of the mucous membrane. For adults, the drug is prescribed 3 sachets per day, for babies under one year old - 1 sachet, for older children - 2 doses.
Attapulgita. The product thickens the intestinal contents, eliminating diarrhea. In addition, Attapulgate, being an antispasmodic, relieves pain. The drug is used 2 tablets after each bowel movement until the stool is completely stabilized. Children are recommended to take half the dosage.

Increased gas formation - main reason severe pain and discomfort in the abdomen due to lactose deficiency. In newborns, this symptom causes intestinal colic. Drugs that are used for bloating are:

Baby Calm. Helps remove gases from the intestines, has a relaxing effect on the muscles of the digestive organs, thereby eliminating colic. The product is given to infants before feeding, 10 drops.
Espumisan. Used to reduce gas formation, 2 tsp. for adults and 1 tsp. – for children.

Pain syndrome with lactose intolerance is caused by overstretching of intestinal loops, muscle spasms and gases, so to eliminate it, medications with a relaxing effect on the muscle layer (antispasmodics) are used. Alatasia can be treated with the following drugs:

No-shpa. Relaxes the intestines, removing spasms. For adolescent children, 180 mg per day is recommended, for children under 12 years old - 80 mg, the adult dose ranges from 120 to 240 mg.
Spasmomen. Reduces the tone of the gastrointestinal tract, thereby eliminating pain. Adults take Spasmomen 1 capsule three times a day; it is contraindicated for children.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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In most people, like all mammals, after stopping breastfeeding, this product ceases to be absorbed, which is an absolutely normal genetically programmed process. This is due to the cessation of production of the lactase enzyme in our intestines, which processes the milk carbohydrate - lactose.

Nutritionist-gastroenterologist, highest category with 23 years of practical experience, doctor at the Boris clinic, researcher at the State Institution "NSCRM of the National Academy of Medical Sciences of Ukraine", expert in the section "For the sake of the nutritionist" Snidanka 1+1"

Only a certain percentage of people continue to produce this enzyme, which allows them to freely drink milk until old age. This anomaly is called lactase persistence. A condition in which the activity of the lactase enzyme, which breaks down milk sugar - lactose, is absent from birth or reduced in the small intestine is called lactase deficiency (LD).

What is lactose and what does it contain?

Lactose is a carbohydrate (disaccharide) found in all dairy products and is an essential nutrient for newborns and children in the first years of life. In the intestines it is split into and.

Milk intolerance problem It is of greatest importance for young children, since during this period dairy products make up a significant proportion in the baby’s diet, and in the first year of life milk is generally the main food product.

To understand which products contain lactose and in what quantity, look at our table.

The highest concentration of lactose is found in breast milk - 80-85% (up to approximately 7 g/100 ml in milk).
In cow's milk, the lactose content is slightly lower: 4.5-5.0 g/100 ml.
There is less of it in other dairy products.

Moreover, The higher the fat content of a dairy product, the less lactose it contains! Less lactose content in fermented milk products is explained by its destruction during lactic acid fermentation.

Why is lactose so important?

When lactose is broken down by intestinal microflora, lactic acid is formed, which suppresses the growth of harmful bacteria, putrefactive and gas-forming flora;
Stimulates the growth of normal intestinal microflora and acts as a prebiotic (nutrient substrate for lactobacilli);
Galactose, which is formed during the breakdown of lactose, takes part in the synthesis of galactacerebrosides - substances necessary for the normal development of the brain and retina in the first months of a child’s life;
Glucose (from lactose) serves as a source of energy for children in the first months of life, covering up to 45% of the daily energy requirement;
Participates in education;
Helps in the assimilation (absorption) of minerals (Mg, Mn, Zn, Ca).

The largest amount of lactase enzyme is produced in children at 39-40 weeks, with a tendency to decrease its activity by 6-12 months and a significant decrease at 3-5 years. The rate of decline in enzyme activity depends on genetic factors, in particular ethnicity.

What types of lactase deficiency exist?

Primary

congenital (genetically determined),
transient (temporary) in premature and immature children;
adult type (constitutional).

Secondary, the development of which is led by:

Therefore, if you are lactose intolerant, it is recommended to consume low-lactose milk (look at the packaging and read the composition) to avoid the appearance of unpleasant symptoms while maintaining the supply of other important nutrients with this healthy product.

And to control the amount of lactose in your diet, you should be careful when shopping for food, since lactose as a necessary component included in many products:

sausages, sausages, sausages, ham
preserves, jams, marmalade
ice cream, condensed milk, coffee cream
ketchup, mustard, mayonnaise, nut butter
bakery products, biscuit dough and products made from it (cakes, pastries, cookies), semi-finished products for baking
fast food, chewing gum
chocolate, chocolate icing, cocoa powder
instant soups and mashed potatoes, bouillon cubes
flavor enhancers, sweeteners in various semi-finished and finished products
ready-made packaged spices (for example, for meat, fish, chicken, potatoes, etc.)
biologically active additives (BAA)

Pay attention to the presence of lactose in medicines(for example, Dufalac, Itomed, Bifidumbacterin, Drotaverine), to which you should find an alternative if you are lactose intolerant.

If you suspect lactase deficiency, immediately contact your pediatrician or gastroenterologist!

On what basis do doctors make a diagnosis of lactase deficiency?

There are a number of simple and not very diagnostic tests that will help determine milk intolerance.

diet diagnostics (a decrease in manifestations and symptoms is recorded when the child is transferred to a lactose-free diet);
coprogram (in the analysis of stool for the digestibility of foods, an increase in starch, fiber and a decrease in stool pH below 5.5 are observed);
lactose load at a dose of 2 g/per 1 kg of the child’s body weight (an increase in glycemia is observed, i.e. an increase in glucose of less than 1.1 mmol/l, i.e. there will be a flat glycemic curve);
determination of carbohydrates in feces using “Testape” strips, Benedict’s test (normally, the indicator should not exceed 0.25% in children under 12 months and be negative after 1 year);
determination of lactose activity in biopsy samples of the small intestinal mucosa. This is the “gold standard” for diagnosing LN, however, the complexity and high cost of the method limits its use in everyday practice in medical institutions;
determination of the content of hydrogen, methane or 14 C labeled CO 2 in exhaled air. The method reflects the activity of microflora in lactose fermentation. The limitation of using the method is the high cost of the equipment and the need to prescribe lactose to the child.

Only those who have clinical manifestations of lactose intolerance, confirmed by positive results of diagnostic tests. And the choice of treatment tactics depends on the origin of intolerance, the degree of its severity and the age of the person.

For primary lactase deficiency First of all, they reduce the amount of lactose in food, up to its complete elimination. During this period, nutritionists recommend including low-lactose dairy products in the diet. At the same time, correction of dysbiotic disorders in the intestines (taking probiotics) and enzymatic deficiency (taking enzymes with lactase) is carried out.

For secondary lactase deficiency The main focus is on treating the underlying disease, and reducing the amount of lactose in the diet is temporary.

Reducing or completely eliminating whole milk in the diet of adults and older children with lactose intolerance is necessary taking into account the daily calcium intake. It is acceptable to use fermented milk products in small quantities, butter and hard cheese.

In infants, the problem of diet correction for lactose intolerance is more problematic and depends on the nature of feeding. Treatment is selected individually by the pediatrician, taking into account all the developmental characteristics of the child.

Are there specific criteria for the effectiveness of treatment?

Certainly! And you will feel them after some time.

Normalization of stool, reduction or disappearance of bloating and abdominal pain;
Improvement and normalization of indicators physical development child;
Reducing and normalizing the excretion of carbohydrates (lactose) in feces.

Remember, timely detection of lactose intolerance, correct diagnosis and adequate therapy in many cases allows you to avoid a complete rejection of such a healthy food product as milk. And try not to make a mistake when choosing quality milk!

For some people, a persistent dislike for milk is associated not with taste preferences and whims, but with the state of their body. Drinking even a few sips of milk entails the appearance of various symptoms: from minor bloating to temporary mental disorders. The most common cause of such intolerance is lactase deficiency.

The main sugar in human and mammalian milk is lactose. To break it down into galactose and glucose molecules (they are absorbed from the intestines into the blood), nature has created a special enzyme - lactase (its full name is lactase-phlorizin hydrolase). When there is a shortage or absence of it, insufficiently digested lactose moves further into the large intestine and becomes food for bacteria there. These microbes process lactose to produce excess gases and water.

Causes

Lactase deficiency can be congenital (as a result of gene mutations) or acquired (occur against the background of a number of diseases).

In the cubs of many animals, after completing breastfeeding and switching to another type of nutrition, the production of this enzyme in the intestines stops, as it is unnecessary for further life. Therefore, some scientists even believe that maintaining tolerance (normal tolerance) to milk in people over 2 years of age is not entirely normal, but the result of gene mutations that occurred many millennia ago. Scientists explain the occurrence of these genetic damages with the development of dairy farming. They associate this hypothesis with existing ethnic differences in the incidence of lactase deficiency. Thus, it is practically absent among the indigenous inhabitants of Northern Europe, Mongolia and India. But its frequency exceeds 70% among Latin Americans, Asians, Israelis and American Indians. In Russia, lactase deficiency is detected in approximately 16% of the population.

Lactase deficiency is divided into:

congenital (primary, alactasia of newborns);
acquired (secondary).

Congenital lactase deficiency is usually associated with genetic disorders. The causes of secondary deficiency of this enzyme may be:

viral gastroenteritis;
bacterial intestinal infections;
food allergies;
amyloidosis;
ulcerative colitis.

Such lactase deficiency may disappear in the event of recovery or remission of the listed ailments. As a rule, it is partial (that is, the patient can quite satisfactorily tolerate a certain amount of milk and fermented milk products).

Symptoms

The severity of clinical signs of lactase deficiency is extremely variable. It is determined by the degree of enzyme deficiency (its complete or partial absence) and the amount of lactose in the food patients eat.

The most severe manifestation is congenital lactase deficiency, which is often characterized by a complete absence of lactose in the body (alactasia). Within 1–2 hours after the first intake of milk (breast milk, cow milk, etc.) or formula, the baby experiences:

diarrhea (watery, foamy, profuse bowel movements with a sour odor);
severe bloating;
rumbling;
colic;
vomit.

Further feedings aggravate the symptoms, signs of dehydration, sweating, tachycardia appear, and weight loss increases.

In adults, hypolactasia (partial deficiency) is more often observed, so these phenomena are less colorful and occur only after drinking 1–1.5 glasses of milk. In addition, extraintestinal symptoms are possible:

weakness;
chills;
dizziness;
pain and a feeling of interruptions in the functioning of the heart.

If you stop consuming lactose-containing products, all clinical symptoms disappear after 3–4 hours.

Diagnostics

In many cases, no special diagnostic procedures are required to verify lactase deficiency. After all, the appearance of complaints is clearly related to the intake of milk or various dairy products, and removing them from the diet leads to normalization of well-being. But in controversial cases, doctors may recommend the following examination:

assessment of lactase activity in mucosal samples (biopsy samples) of the small intestine (biopsy samples are obtained during endoscopic examination: fibrogastroduodenoscopy or fibroenteroscopy);
genetic blood test;
breath test (hydrogen);
lactose loading test;
determination of galactose in urine and blood.

Treatment

The basic treatment for patients with a deficiency or absence of lactose is elimination diet therapy (removing or limiting sources of lactose from the diet). Pharmacological drugs are of secondary importance.

Medical nutrition

If alactasia is confirmed, the only treatment is complete and lifelong abstinence from milk in any form and dairy products. Babies are transferred to artificial feeding with special formulas. Such lactose-free options can be found among the mixtures Nan, “Babushkino Lukoshko”, “Nutrilon”, etc. Usually on their packaging you can see the abbreviations “BL” or “FL”. For hypolactasia, low-lactose mixtures are prescribed.

Subsequently, such patients should beware of sources of hidden lactose (they may contain whole, powdered or condensed milk). They may be:

margarine;
mashed potato powder;
confectionery;
bakery;
omelettes;
cream soups;
canned soups;
semi-finished products;
white sauces;
iris;
lollipops;
mixtures for making biscuits, muffins, pancakes;
ready-made seasonings.

People with severe lactase deficiency need to carefully analyze the composition of foods and even medications (for example, lactose is included in some) before taking them.

In addition, due to the exclusion or significant restriction of milk, such patients have increased blood pressure and, consequently, the occurrence of osteoporosis, bone loss and pathological fractures. To prevent this, patients should regularly eat foods high in calcium and/or vitamin D, which promote calcium absorption:

leafy greens (lettuce, spinach, etc.);
broccoli;
soy products;
turnip;
white cabbage;
canned fish with soft bones (salmon, etc.);
eggs;
rice milk;
liver.

In addition, today you can find special lactose-free milk on supermarket shelves; it was created specifically for such patients.

In case of hypolactasia, patients are advised to determine their individual milk dose. Some patients can drink 200 ml (not on an empty stomach, in several doses, slowly, 1-2 times a week). It has been noted that as the amount of whole milk you drink gradually increases, its tolerance also improves. If your tolerance to milk is low, but it is possible to consume fermented milk products, then you need to include cheeses (especially feta cheese) and yogurts in your diet. They are characterized by low lactose content and high nutritional value.

Pharmacotherapy

Today there are drugs containing lactase. Taking them allows patients with a- or hypolactasia not to give up products that contain lactose.

Some patients prefer not to limit themselves, but to use the achievements of the modern pharmacological industry. There are 2 types of drugs:

drugs with lactase, which should be taken simultaneously with milk or dairy products (Lactrase, etc.);
medications with lactase, which are added to milk before consumption (Lactaid, etc.).

The prognosis of the disease (with timely diagnosis and diet therapy) is favorable.

Lactose intolerance is one of those cases where mother's milk or formula milk causes health problems in infants.

Lactose is one of the main components of breast milk. In addition, artificial formulas for children also contain it as a main component. It itself is a combination of glucose and galactose.

The role of these substances in the development of the baby is enormous. After all, glucose is the source of energy that is so necessary for every cell for almost any vital chemical reaction. Galactose is directly involved in the formation of a healthy nervous system.

Importance of lactase

The enzyme lactase is produced specifically to break down lactose by intestinal cells. When the amount of enzyme produced is low, lactose is not properly broken down, so it cannot be absorbed and remains in the intestine.

Thus, lactose in milk or artificial infant formula turns from being necessary for a growing body into harmful to it. All its valuable components begin to be used for their nutrition by conditionally pathogenic microorganisms. They multiply, causing symptoms of dysbiosis. Their vital activity leads to increased gas formation in the intestines.

Intolerance and allergic reaction

Thus, if there is a lack of lactase or an excess of lactose, a diagnosis is made: lactose intolerance. Some say it's a lactose allergy. However, this definition is incorrect. With lactase deficiency, only lactose intolerance occurs, as a pathology of the digestive system due to its inability to process and absorb this substance.

An allergy is a perverted reaction of the immune system to the consumption of certain foods. The allergy manifests itself as a rash, swelling, and in severe cases, breathing problems. Allergies may also have symptoms of gastrointestinal dysfunction, but they will not be the main ones. The rash will come first. However, allergies can cause lactose intolerance. For example, an allergy to whole milk can trigger this mechanism.

Types of pathology

Lactase deficiency can be of three types:

Primary. It is diagnosed if intestinal cells do not synthesize lactase at all or produce little of it. This type of lactose intolerance is more common in premature babies due to the immaturity of their digestive tract. The condition returns to normal at the 3-4th month of life. When the intestines mature, lactase synthesis is normalized, and the symptoms of the pathology disappear. The so-called “adult” type of functioning is also possible. digestive system. Moreover, after birth the level of lactase is sufficient and meets the needs of children. But by the end of one year of age or a little earlier, its quantity decreases, and signs of lactase deficiency appear. The trend towards a decrease in the enzyme continues in the future.
Secondary lactose intolerance. This type of deficiency is the result various diseases and gastrointestinal infections in children, which lead to damage to the intestinal wall.
Relative lactose intolerance, which occurs due to too much milk sugar. At the same time, intestinal cells function well, and lactase for processing normal amount There should be enough lactose. However, excess milk sugar is retained in the intestines and causes symptoms similar to those of lactase enzymatic deficiency. Such lactose deficiency may result from infants being fed predominantly first breast milk, which contains a lot of lactose.

Manifestations of lactase deficiency

For children in the first year of life, lactose intolerance is a big problem, given that milk or artificial milk formula is first their only food, and then their main food. This pathology leads to disturbances not only in the gastrointestinal tract, but throughout the body. Thus, an excessive amount of lactose and its constant presence in the intestines leads to damage to its walls. Then the absorption of any nutrients is impaired. This leads to malnutrition and delayed physical development of the baby..

Symptoms of lactase deficiency can be easily missed in children in the first days of life. But already in the first weeks it manifests itself, and characteristic symptoms become obvious.

Increased gas production causes abdominal pain. The child is capricious, cries, and does not eat well.
The baby's tummy is slightly swollen and tense.
The stool becomes liquid and foamy. Its smell is sour. Or it turns green, there is an admixture of mucus.
The number of bowel movements increases. However, for babies who are bottle-fed, constipation is more common.
The child often spits up after eating.
As a result of the fact that most of the substances are not absorbed, infants do not experience the necessary weight gain.
However, such children usually have a good appetite. But as soon as they start to eat (mother’s milk or formula), after a couple of minutes they stop, become capricious, kick their legs, categorically refuse to eat, and bend over.

Laboratory manifestations

In the CIS countries, lactose intolerance is usually diagnosed based on clinical symptoms, carbohydrate analysis and coprogram.

Analysis of stool carbohydrates. This method is the simplest. Unfortunately, its information content is also relative. It does not show which carbohydrates are in greater quantities in the feces. In addition, the units of their norm in feces are also not precisely determined.

Coprogram. It determines the level of stool acidity and the volume of fatty acids. Their high content suggests lactose intolerance (deficiency).

Biopsy. The method of intestinal biopsy and histological examination is considered reliable. This method is not widely used due to its traumatic nature, as well as the fact that sampling requires the use of anesthesia.

Hydrogen test and formation of lactose curve. With these methods, lactose is administered to the patient through the mouth. Then, at certain intervals, the blood or exhaled air is examined for lactose levels. The curve is analyzed.

These methods are also not widespread, since the administration of lactose causes negative sensations in sick children. The study of hydrogen is also only relatively informative, since today there is no accurate data on its proper level in the blood of newborns.

If tests give reason to believe the presence of pathology, but clinical signs do not appear, treatment is not carried out.

For treatment, it is necessary to organize the feeding of the baby so that he receives all the milk, and not just the first one (you need to express the first milk, give one breast at one meal).
It is also necessary to exclude whole milk from the diet. It is an allergy to it that contributes to the formation of lactose intolerance.
Foods to which allergies are most common (chocolate, oranges, honey...) are also excluded from the mother’s diet.
If there is no improvement in response to such measures, the use of medications is necessary (taking lactase orally with meals).
It is necessary to treat pathologies that could provoke deficiency, including any allergies that should be stopped.

The transition to lactose-free mixtures is carried out if there is no effect from the above measures. Lactose-free formulas are produced by almost all manufacturers of baby formulas.

Sometimes they switch to lactose-free mixtures for a while.

Lactose intolerance is quite common today. Fortunately, the primary form is found in rare cases. Therefore, it is usually possible to eliminate the signs of lactose intolerance without switching to lactose-free mixtures, observing the right conditions nutrition.

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