Lactose is a sugar, a disaccharide carbohydrate in most mammals’ milk (except California sea lions and hooded seals) that the body digests using a substance. This substance, called ‘lactase’, breaks down the lactose into two sugars called ‘glucose’ and ‘galactose’ so the body can absorb it quickly into the bloodstream. To be able to digest the lactose, the body must contain enough lactase enzymes. But when the body does not have an efficient amount of it, it cannot absorb the lactose, eventually, it causes gas, bloating, stomach pains or cramps, diarrhea, and sometimes vomiting1,3. So, when these problems occur with the lacy of enzyme deficiency, we diagnose this person with lactose intolerance. Over 60% of people have lactose intolerance, and about 70% are undiagnosed1.
Lactose intolerance was first found by Hippocrates around 400 years BC, but it was clinically recognized and reported in the last 50 years. It is mostly happening when the body is not producing enough lactase. The cause of the symptoms differs individually due to the amount of lactose. But we should know that it has four different types of deficiencies. So, to understand it more efficiently, we need to define this deficiencies:
- Primary lactase deficiency is diagnosed when a person has a lack of or an absence of lactase in childhood ages, and it’s the most common when we analyze data of people who have lactose intolerance1.
- Secondary lactase deficiency means a person has lactose intolerance due to a pathophysiologic reason. These include infections l that affect the gastrointestinal system like rotavirus or immune system diseases like celiac disease. When the diagnosis of these diseases is early enough to recover the patient, some research shows that the person may be able to continue to consume regular milk1.
- Developmental (neonatal) lactase deficiency is diagnosed in less than 34 weeks of the gestational period1.
- Congenital lactase deficiency is not a common lactose intolerance type; newborns usually have symptoms like diarrhea when they consume milk. So, the diagnosis and treatment should be made as quickly as possible to avoid severe consequences like death due to electrolyte loss and dehydration1.
Diagnosis And Management
Lactose intolerance symptoms are very noticeable, and to summarise them one more time, we can give some examples like abdominal pain and diarrhea. To diagnose correctly, a diary-free diet for 2 weeks is one of the common ways to interpret it. In this situation, the person is not allowed to eat any lactose to see if there are any differences in symptoms. Another way to diagnose it is by doing hydrogen breath tests. It is one of the most trustable and non-expensive ways to test it. The person is suggested to have a carbohydrate-restricted dinner the day before the test and should be fasting for at least 12 hours. Smoking and exercise are also not allowed 30 minutes before the tests. It is possible but scarce to have false-positive test results due to carbohydrate consumption, medicine usage, etc. This test aims to analyze and record the symptoms during and after the test for 8 hours using VAS (visual analog test)1,4,5.
This intolerance can be managed by nourishing the boy with a lactose-free diet. But when we come to the treatment, there is no actual treatment. The suggestion is to solve digestion problems rather than consume a lactose-free diet. Reducing lactose intake rather than eliminating lactose consumption is suggested because most people with the diagnosis can consume about a cup of milk4.
The consequences of lactose restriction should be considered seriously, especially for long-term decisions, because calcium needs 4,5. Also, drug therapy (using enzyme supplements) is a considerable treatment to decrease symptoms. Therefore, that person can consume lactose using lactase enzyme supplements and probiotics5.
In conclusion, lactose intolerance has 4 different definitions, and it occurs by lactose maldigestion1. Symptoms like abdominal pain and diarrhea are prevalent, and these symptoms can help diagnose intolerance using hydrogen breath tests. Another way to diagnose lactose intolerance is using standard lactose intolerance tests or 2 trial weeks with a lactose-restricted diet to see if the symptoms are decreasing1,4,5. To manage it, nourishing the body with a lactose-free diet or using enzyme supplements and probiotics to consume the lactose without symptoms1,4. We need to find a decent solution and treatment even though we have many alternative answers to make life better for lactose intolerance-positive people.
References:
- Heyman MB, Nutrition for the C on. Lactose Intolerance in Infants, Children, and Adolescents. Pediatrics. 2006;118(3):1279-1286. doi:10.1542/PEDS.2006-172
- Fox PF, Uniacke-Lowe T, McSweeney PLH, O’Mahony JA. Lactose. Dairy Chem Biochem. Published online 2015:21-68. doi:10.1007/978-3-319-14892-2_2
- Lomer MCE, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice – myths and realities. Aliment Pharmacol Ther. 2008;27(2):93-103. doi:10.1111/J.1365-2036.2007.03557.X
- Misselwitz, B., Pohl, D., Frühauf, H., Fried, M., Vavricka, S. R., & Fox, M. (2013). Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment. United European Gastroenterology Journal, 1(3), 151–159. https://doi.org/10.1177/205064061348446
- DI RIENZO, G. D., F. D’AVERSA, M. C. C., v. CESARIO, M. M., & A.GASBARRINI. V. OJETTI. (2013). Lactose intolerance: from diagnosis to correct management. European Review for Medical and Pharmacological Sciences. https://www.metsol.com/wp-content/uploads/Lactose-breath-testing-in-clinical-practice.pdf
Insoector: Ece YARDIMCIEL
