Secondary lactose deficiency. Symptoms of lactose deficiency in adults.

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To breast milk assimilated in the body of a newborn baby, the enzyme lactase is needed, which breaks down milk sugar - lactose. It is necessary to distinguish between these consonant concepts in order to prevent terminological confusion. The concept of "lactose deficiency" does not exist. When a clinical picture of a violation of the digestion of breast milk is observed in infants, doctors make a diagnosis of lactase deficiency.

If you experience digestive symptoms and suspect lactose intolerance, ask your gastroenterologist who can ask questions and from which you can get the necessary medical information. Removing dairy products from a daily diet without medical advice can lead to an imbalance in the body. Text: primary gastroenterologist, specialist in internal medicine, doctor of medicine.

Different ethnic groups and breeds are more likely to be affected than others. Up to 75% of African Americans, Mexicans, Jews, and Native Americans are lactose intolerant. This clinical condition is found in northern European adults. Lactose intolerance occurs due to a deficiency in an enzyme called lactase, physiologically produced by cells that cover the small intestine.

When it comes to this pathological disorder, they imply the development of a syndrome that forms against the background of the absence of lactase and is accompanied by the occurrence of specific symptoms.

General ideas about the disease

Human lactose tolerance was formed during evolution and became possible due to the appearance of a specific gene in the DNA chain. In various ethnic groups inhabiting the globe, the frequency of distribution of this gene is different.

Lactose digests milk sugars, reducing them to simpler forms that can be absorbed from the digestive tract into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results can be unpleasant, although in general they are unsafe.

You can access the article at any time, on any device, from your website or from a mobile application. Recommendations from a doctor. . Some causes of lactose intolerance are known. For example, various digestive disorders can reduce the amount of enzymes produced. In some cases, babies are born without the ability to produce lactose. For most people, lactase deficiency is a condition that occurs naturally over time. After two years, the body begins to produce less lactase.

The presence of this type of fermentopathy can be guessed by the appearance of certain symptoms when eating dairy products that disappear on the background of a dairy-free diet and reappear when returning to a normal diet.

In what cases can the disease occur?

Depending on the reasons, there are several types of fermentopathies that can form in absolutely any age category of patients.

The causes of this phenomenon are unknown and little studied. Common symptoms are cramps, which begin about 30 minutes later or 2 hours after a meal or liquids containing lactose. Many people who have not been diagnosed as lactose intolerant or have a lactase deficiency have noticed that milk or other dairy products cause problems that do not occur when other products are swallowed. The severity of the symptoms depends on the amount of lactose carried by each person.

The most common tests used to measure lactose absorption in the digestive tract are the lactose intolerance test, the tested hydrogen hydrogen test, and the seat acidity test. Your family doctor can tell you where to do these tests, which can be done on an outpatient basis, in a hospital or clinic.

First of all, there are two types of lactase deficiency - primary and secondary.

The causes of lactase deficiency in newborns in the first case are a decrease in the level of the enzyme while maintaining the integrity of the intestinal cells and can lead to the formation of the following pathological conditions:

Fortunately, lactose intolerance is relatively easy to treat. There are no known ways to increase the amount of lactase that the body produces, but symptoms can be controlled. Children born with lactose intolerance should be protected from lactose-containing products. Most older children should not completely avoid lactose, but there are individual variations in the amount of lactose tolerated.

For example, a person may suffer from these symptoms after drinking a small glass of milk, while others may drink a glass, but not two. Diet control depends on each person’s knowledge, tests, the amount of lactose and what forms it can be tolerated. For those who respond to a small amount of lactose or who have problems with diet control, lactase supplements are available in pharmacies without a prescription. One form is a liquid for drinking with milk. A few drops are added to 250 ml of milk, and after 24 hours, the lactose content is reduced by 70%.

Lactase deficiency in premature infants - due to the immaturity of all systems of a child born earlier than 35 weeks of pregnancy, as well as insufficient enzyme activity subject to premature birth.
Lactase deficiency in infants is congenital - develops as a result of mutations in the milk sugar tolerance gene.

This process is faster if the milk is preheated, and adding a double amount of the product forms milk with only 10% lactose. A later breakthrough is a lactase tablet, which helps digest lactose-containing solid foods. One to three tablets are taken before meals. You can also buy low-lactose milk at most supermarkets. This milk contains all the other nutrients found in normal milk and stays fresh for about the same amount of time.

The secondary form of the disease develops as a result of damage under the influence of various unfavorable factors of the intestinal cell structures:

The development of pathogenic processes in this section of the digestive tract, which are dystrophic or inflammatory in nature. Provoking factors can be allergic reactions to food, infectious intestinal lesions, or side effect some drugs.
A decrease in the surface area of \u200b\u200bthe intestinal mucous membranes, for example, as a result of surgery.
Change in hormonal levels and metabolic disorders in the body.

Establishing the true causes of the development of a pathological condition plays a large role in determining the principles of further treatment.

Milk and other dairy products are the main source of nutrients for regular diets. The most important of these nutrients is calcium. It requires calcium and bone regeneration throughout life. With maturity and old age, calcium deficiency can lead to bone fragility. It is of concern to both children and adults with lactose intolerance how to ensure their calcium needs through a diet containing milk in large quantities or without them.

Therefore, it is important to ensure a daily calcium intake through diet, even if it does not include dairy products. Few foods are high in calcium and low in lactose. Great examples are lots of green and soft, edible fish.

What may be the consequences of the disease

In the absence of specific treatment for fermentopathy, a lack of lactase can lead to the development of the following disorders:

weakened immunity;
dehydration of the body as a result of massive loss of fluid due to uninterrupted;
development of dysbiosis;
creating favorable conditions in the intestine for the growth of putrefactive microflora;
a decrease in the intensity of the processes of absorption of minerals, primarily calcium;
violation of peristalsis.

In the neonatal period and up to 1 year, the most dangerous complication of the development of this type of fermentopathy is the threat of dehydration (dehydration) of the child's body.

Many recent studies have shown that it can be a very good source of calcium for patients with lactose intolerance, although they contain a large amount of lactose. There is evidence of bacterial cultures used to make yogurt because they produce the lactase needed for digestion. Although milk and dairy products are the only sources of lactose to consider, lactose is often added artificially to food. For people with very low lactose tolerance, it is important to know the lactose content of different foods, even in small quantities.

What indicates the development of the disease

How does lactase deficiency manifest in infants? Symptoms of the pathological condition in babies are almost the same, the only difference between the manifestation of primary and secondary fermentopathy is due to the amount of dairy products consumed, which provokes the appearance of characteristic signs of the disease.

Food products that may contain lactose include: - bread and other cakes - processed mussels - instant, instant soups or breakfasts. - margarine - cooked meat - salad dressings - sweets or other snacks - mixes for pancakes, cookies, cakes.

Some so-called non-dairy products, such as milk powder for coffee or vegetable cream, may contain ingredients derived from milk, and therefore may contain lactose. Food labels should be read carefully, not only for milk or lactose, but also for words such as whey, beaten milk, intermediate dairy products, skimmed milk powder, and skimmed milk powder. If any of these appears on the label, the product may contain lactose.

In the secondary form of the disease, specific symptoms appear when small amounts of products containing lactose are consumed. Primary fermentopathy appears when consumed a large number breast milk.

Individuals with lactose intolerance can take advantage of the available lactase available on the market. They are added to whole milk, skim milk or powdered reconstituted canned or fresh powder, a formula for children or sour cream, digest lactose to glucose and galactose. The liquid form is added in an amount of four or five drops to 250 ml of milk.

After shaking or mixing, the milk is cooled for 24 hours at this time, while 70% of the lactose is hydrolyzed. For patients with severe intolerance, a double amount of the enzyme is added to lactose. This will reduce lactose up to 10%. This processed milk, which is freshly stored as well as unprocessed, can be drunk, used for cooking, baking, cheese, yogurt and milk mixtures.

The signs of lactase deficiency in infants are as follows:

violation of peristalsis in a child - the appearance of vomiting, rumbling in the abdomen and pain;
flatulence;
loss of appetite;
a decrease in the intensity of weight gain in the baby;
stool with lactase deficiency in infants is watery, foamy (due to the accumulation of gases in the intestines), contains an admixture of greenery, has an unpleasant sour smell.

A rash with lactase deficiency in infants is possible only in clinical cases of the development of the secondary form of the disease, when food allergy is its provoking factor.

The only taste change is a slightly sweet taste due to the higher monosaccharides. Lactase increases calories and carbohydrates in milk, and diabetics should be aware of a higher content of sugars absorbed faster. Tablets and encapsulated forms of lactase available on the market, used with dairy products, usually allow lactose intolerant to consume dairy products without symptoms. Alternatively, the contents of the capsule can be sprinkled food productscontaining lactose.

The following tips can improve the symptoms associated with lactose intolerance: - Gastric discomfort can be reduced if milk is drunk with the main course, and not as such. - It is recommended to use a cheddar or low lactose switcher. - Recommended with active crops. It is recommended to treat milk with drugs to restore lactose. Adding these substances and cooling the milk can hydrolyze up to 99% of lactose.

Diagnostic measures

How to determine lactase deficiency in infants? First of all, in differential diagnosis, much attention is paid to the symptoms that are noted in the baby:

Primary fermentopathy often manifested as intestinal colic in a child. In most clinical cases, the baby’s body over time adapts to a lactase deficiency by stimulating the growth of a certain microflora in its intestines and the manifestation of pathological signs in the future is possible only with excessive consumption of milk.
With secondary fermentopathy the symptoms of the underlying disease come first. You can guess about a decrease in the level of lactase in the body of a child using a dairy-free diet. At the same time, a significant improvement in the clinical picture of the pathological condition is noted.
Congenital form The disease manifests itself after the first feeding of the baby in the form of uncontrollable vomiting and diarrhea.

If lactose intolerance is suspected, the best solution is to prevent dairy products. However, it should be understood that lactose intolerance is sometimes a temporary problem. It can also occur as a result of diseases such as inflammatory disease, parasitic infection, any of which can cause the short-term lactase deficiency needed to digest lactose. The administration of certain drugs, such as various antibiotics, can also cause temporary lactase deficiency.

Whatever the mechanism, the fact that lactose tolerance may be a temporary clinical condition makes it impossible to use dairy products too radical a solution. This is the body’s inability to digest lactose, a type of sugar found in milk and, to a lesser extent, in dairy products. This is not a disease, but usually a genetically determined feature. People with this disease have insufficient levels of lactase, an enzyme that catalyzes the hydrolysis of lactose in glucose and galactose in the digestive system.

How to identify lactase deficiency in infants on their own? Mom may suspect the development of this particular type of fermentopathy, and not the usual colic of newborns, by such signs as the stability of pathological symptoms and the absence of a therapeutic effect from drugs that reduce flatulence: tummy massage, performing a bicycle exercise, holding a child with a column and others. With the development of lactase deficiency, the baby's condition is normalized only subject to a dairy-free diet.

Lactose intolerance is classified for reasons in 4 categories: - Primary intolerance, which is hereditary and affects only adults, is caused by the absence of alleles, which are the most common cause of lactose intolerance in the world. - Secondary intolerance, which is acquired by acting on part of the small intestine, usually in childhood. - Congenital intolerance is rare due to genetic dysfunction, which prevents the appearance of lactase from birth.

Affected babies cannot digest breast milk and therefore can be a problem. - Family intolerance when lactase production is suitable but not working properly. This intolerance is also acquired by hereditary. A problem that is characteristic of the infant’s period, but which can occur during the newborn’s period, is intolerance to cow's milk proteins. This is a hypersensitivity reaction of the child’s allergic type to cow’s milk proteins, which reach the mucous membrane of the digestive system, without decomposing due to the physiological immaturity of the baby’s digestive system and causing a reaction of protection against these allergens.

Specific tests for lactase deficiency in infants are as follows:

analysis of feces for lactase deficiency in infants - the content of carbohydrates in it is determined, and the pH level is also established;
biochemical examination of feces to determine the type of microflora that inhabits the intestine;
biopsy examination of biological material obtained from the small intestine to establish lactase activity;
urinalysis to detect the presence of lactose in it;
genetic examination.

Timely carrying out specific diagnostics helps to exclude the development of severe pathological disorders in the baby, which can provoke the formation of extremely serious complications. Differentiation of the root cause of the development of fermentopathy determines the principles of how to treat lactase deficiency in infants.

Therapeutic measures

When lactase deficiency in infants is still established after the examination, what should I do next? In any case, it is impossible to ignore such a violation. Correction of lactase deficiency is required using a medical approach, otherwise the growing child will lag significantly behind in terms of intellectual and physical development.

Treatment, when certain symptoms indicate the development of lactase deficiency in a newborn or in an infant, is determined only by a doctor:

With the development of primary fermentopathy, one of the main principles of therapeutic measures is the organization of a diet - special mixtures are used for lactase deficiency in infants that do not contain lactose.
Additionally, certain medications are prescribed for lactase deficiency in infants, the active substance of which is lactase.
Bifidumbacterin or Linex for lactase deficiency in infants are used subject to a mild course of the disease. In this case, probiotics help normalize the microflora present in the intestines.
Treatment of secondary lactase deficiency in infants involves, first of all, the elimination of the root cause of the development of fermentopathy.
How to replenish calcium with lactase deficiency in infants? In this case, experts recommend using vegetables, bean curd, and legumes as a complementary food, in which an increased content of the mineral is noted. Use for this purpose complementary foods from dairy products is strictly prohibited.

On condition breastfeeding baby, the mother’s diet for lactase deficiency in infants restricts the consumption of dairy products, but does not completely abandon them. In addition, from the mother’s diet for lactase deficiency in infants, it is necessary to remove products that provoke increased gas formation in the intestines (brown bread, sweets, grapes).

When does lactase deficiency in babies go? A full recovery of the child is possible only if the enzyme is not due to genetic factors. In all other cases, the correction of the diet allows you to improve the condition of the baby after 3-4 days, and a full recovery occurs a week after the start of treatment.

As a preventative measure for the development of fermentopathy, it is recommended to follow the rules of breastfeeding (breast replacement only after complete emptying, inadmissibility of interruption of the feeding process) and not to eat foods that may cause the development of allergic reactions.

Useful video about lactase deficiency in children

Lactase deficiency is a violation of the breakdown of lactose due to insufficiency of the lactase enzyme in the mucous membrane of the small intestine, accompanied by clinical symptoms.

Lactose is milk sugar. An enzyme that breaks down lactose is called lactase.

Adult lactase deficiency develops after a period of breastfeeding. This is due to a gradual decrease in lactase activity with age. After taking dairy products or whole milk, intestinal disorders (, flatulence) usually occur. Prevention and treatment consists in following a diet with a low lactose content or its complete exception.

Russian synonyms

Congenital insufficiency of adult lactase (type with delayed onset), primary adult lactase deficiency, hypolactasia, lactose intolerance, lactose malabsorption.

English synonyms

#OMIM 223100, Lactose intolerance, adult type, Hypolactasia, adult type, Disaccharide intolerance III.

Symptoms

Lactase deficiency is characterized by the development of intestinal symptoms after taking milk and dairy products: flatulence, pain and rumbling in the abdomen, diarrhea, bloating. Possible. The stool is liquid or mushy, light yellow in color, with a sour smell.

General information about the disease

Lactase deficiency, or primary lactase deficiency, is a violation of the lactose cleavage due to insufficiency of the lactase enzyme of the small intestine mucosa, accompanied by clinical symptoms. It is caused by a genetically determined decrease in its production, which is manifested in the inability to absorb milk sugar (lactose).

Lactase activity manifests itself from the 12-14th week of fetal development and reaches its maximum values \u200b\u200bat the time of birth (at a period of 39-40 weeks). After birth, lactase is produced in large quantities, but by the end of the first year of life, its production is reduced. This is the primary, or congenital, lactase deficiency with a late onset, which is inherited in an autosomal recessive manner.

Non-specific abdominal symptoms (bloating, upset stools, nausea) develop after eating foods containing lactose, mainly whole milk and dairy products. But today, lactose is added to other food products (for example, meat, confectionery). The pharmaceutical industry also uses it as an excipient.

The severity of the symptoms of hypolactasia depends on the individual physiological characteristics of the person, intestinal microflora, diet, psychological factors. The deliberate avoidance of milk, which is an important source of calcium, can lead to a deficiency of this element and, as a result, to osteoporosis. This should be remembered and the daily requirement should be reimbursed at the expense of other calcium-rich foods. This is especially important for 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 with infectious (intestinal infection), immune (intolerance to cow's milk protein), inflammatory processes in the intestines, atrophic changes (after, after a long period of complete parenteral nutrition, etc.).

Also, this disorder should not be confused with congenital lactase deficiency - a rare genetic disorder, the symptoms of which appear immediately after birth and are associated with the onset of breastfeeding.

There is a genetic diagnosis of late-onset primary lactase deficiency. The region of the MCM6 gene is one of the important regulatory elements of the lactase gene. The genetic marker MCM6 (C (-13910) T) is associated with lactose intolerance.

Who is at risk?

Persons with relatives with intolerance to milk and dairy products.
Certain ethnic groups. Lactose intolerance is most common in North America, Africa, Southeast Asia (the incidence of lactase deficiency is 70-100%). In the Russian population, lactase deficiency is observed in about 16%.
The condition is rare in the first year of life, the development of lactose intolerance is associated with growing up.

Diagnostics

The diagnosis can be assumed on the basis of genealogical data, results (increase in starch, fiber, iodophilic microflora, decrease in fecal pH less than 5.5), determination of carbohydrates in feces. Diagnostics uses a hydrogen breath test. The concentration of hydrogen in exhaled air is determined before and after loading with lactose. In patients with lactase deficiency, an increase in hydrogen content is recorded, which is associated with increased bacterial cleavage of lactose in the colon. That is, lactose, which is not fully absorbed in the small intestine, reaches the colon, where it is cleaved by anaerobic microflora.

Important in the diagnosis is a molecular genetic study for a predisposition to lactase deficiency. The analysis will help in the differential diagnosis of the causes of lactose malabsorption and in the selection of an appropriate diet.

Treatment

Diet Therapy: Limiting Lactose Products

Perhaps the appointment of enzyme preparations that break down lactose.

It is allowed to use fermented milk products with a reduced amount of lactose (yogurt, yogurt), cottage cheese, butter, hard cheeses, as well as lactose-free.

It is important to consider the possible lack of calcium intake on a dairy-free diet, which is recommended to compensate for other foods rich in it, or medications.

In children early age often lactase deficiency is combined with intolerance to cow's milk proteins. In this case, special mixtures are prescribed based on the complete hydrolyzate of milk protein.

According to indications - antidiarrheal drugs, enzyme preparations, vitamin D preparations and others vitamin complexes, drugs for the restoration of intestinal biocenosis.

Prevention

Prevention consists in preventing the symptoms of hypolactasia by following a diet with a low or no lactose content. Therefore, when symptoms of digestive upset are detected after consuming unfermented dairy products, it is advisable to conduct a genetic test for lactase activity in order to avoid attempts at meaningless treatment and choose the appropriate diet. The test also helps predict lactose intolerance in children in order to prevent unexpected intestinal disorders.