Lactose intolerance also known as lactose malabsorption is a condition where one develops signs and symptoms after consuming dietary products containing lactose. Commonly, when lactose is ingested, the lactase enzyme that is in the small intestine brush border will hydrolyze the sugar into its two components: glucose and galactose. The signs of lactose sensitivity involve stomach and abdominal discomfort, as well as pain, flatulence, gas, diarrhea, and borborygmi.
Epidemiology
Although it is a common condition, lactose intolerance is uncommon in children under five. Young adults and adolescents are most frequently affected. Approximately 65% of individuals worldwide are lactose intolerant. Among several racial and ethnic groups, lactose intolerance varies in prevalence. Hispanics, Asians, and African Americans are most likely to experience it, whereas European Americans are least likely to. Although the age-related fall in lactase activity often peaks during childhood, it has sometimes been observed to occur later, in adolescents, especially in Whites. Patients of mixed ethnicity have a low lactase non-persistence, whereas the native ethnic group has a higher prevalence. Many patients first observe intolerance symptoms in late adolescence or early adulthood, and the condition often manifests itself gradually and subtly at first.
Anatomy
Pathophysiology
The brush border of the small intestine mucosa contains the lactase enzyme. Unabsorbed lactose accumulates in the gut due to lactase deficiency. Osmotic diarrhea is the result, which is an influx of fluid into the gut lumen. Intestinal bacteria break down lactose, which is hydrolyzed into simple sugars producing gas that is not absorbed (carbon dioxide, hydrogen, and methane). This results in an increase in fluid flow in the lumen. The combined effect of these pathways causes a range of abdominal symptoms.
Etiology
Primary Lactase Deficiency
It is the most typical cause of lactase insufficiency, also called non-persistence. With advancing age, lactase enzyme activity gradually decreases. Infancy signifies the beginning of the loss in enzyme function, while adolescence or early adulthood marks the onset of symptoms. Recent research has revealed that lactase persistence results from mutation, whereas lactase non-persistence is of the ancestral form (typical Mendelian inheritance).
Secondary Lactase Deficiency
Injury to the intestinal mucosa can result from several viral, inflammatory, or other conditions, leading to secondary lactase deficiency. Common causes include Celiac disease, Ulcerative Colitis, Gastroenteritis, Antibiotics, and chemotherapy.
Developmental Lactase Deficiency
It occurs in newborns delivered prematurely between 28 and 37 weeks of gestation. Due to the infant’s undeveloped gut, lactose cannot be hydrolyzed. Age-related improvements in this condition are attributed to the development of the gut and the resulting appropriate lactase activity.
Congenital Lactase Deficiency
Due to autosomal recessive genetics, lactase enzyme activity has decreased or been absent from birth. It appears in a newborn following milk consumption. It is an uncommon cause of insufficiency, and little is known about its genetics.
Prognosis
The prognosis for lactose intolerance is good. With dietary changes alone, most patients see a significant improvement in their indications and symptoms. Osteopenia may result from lactose intolerance. The LCT-13910C>T gene variation of lactose intolerance in Whites is associated with vitamin D insufficiency.
Genetics
Prognostic Factors
Thе prognosis for lactosе intolеrancе is positivе. Most patiеnts noticе a significant improvеmеnt in thеir indications and symptoms aftеr making only diеtary changеs. Lactosе intolеrancе may lеad to ostеopеnia. Thе LCT 13910C>T lactosе intolеrancе gеnе variant in Whitеs is associatеd with vitamin D dеficiеncy. Â
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Clinical History
Age Group: Adolescents and Adults
Primary Lactase Deficiency: Most cases of lactose intolerance develop after childhood, typically in late adolescence or adulthood. This is due to a natural decline in lactase production, a condition known as lactase non-persistence. The age of onset varies widely depending on genetics and ethnicity
Mild Symptoms: Most commonly, lactose intolerance presents with mild bloating, diarrhea, gas, or abdominal discomfort after consuming lactose-containing foods. Symptoms typically develop within 30 minutes to a few hours.
Moderate Symptoms: More pronounced gastrointestinal distress may occur if larger quantities of lactose are consumed or in individuals with severe lactase deficiency.
Rare Acute Symptoms: Severe dehydration or electrolyte imbalances are uncommon but may occur in vulnerable populations (e.g., young children, older adults) after persistent diarrhea.
Dietary Modifications:
Lactose-Free Diet: The main approach is to avoid foods and drinks with lactose or to limit the consumption of such products in some way. This category includes milk products such as cheese, yogurt as well as milk itself. Some of the lactose-free products include lactose-free milk, almond milk, soy milk, and lactose-free cheese.
Reading Labels: Lactose intolerant individuals need to look at food labels. Lactose may be included among the ingredients added during the processing and packaging of certain types of food products.
Lactase Supplements:
Lactase Enzyme Supplements: Lactase can be taken over the counter in different forms including tablets, capsules, drops, etc. These supplements have lactase enzyme and can be taken before consuming lactose rich food.
Gradual Reintroduction:
Gradual Exposure: For some people, it is possible that a small quantity of lactose poses no harm to the body. Both types of patients may be best served by a gradual reintroduction of lactose containing foods in small servings over time.
Probiotics:
Probiotic Supplements: Some Lactobacilli and bifidobacterium strains of probiotics can reduce lactose digestion intolerance. These supplements may increase the presence of the bacteria that creates lactase in the gut.
Medical Advice:
Consulting a Healthcare Professional: Those who have signs of lactose intolerance, should consult their doctor. They can offer a diagnosis; assist in making the right treatment plan and rule out other GI problems.
Avoidance of Dairy: Eliminate or reduce the consumption of dairy products. Instead, opt for lactose-free alternatives such as lactose-free milk, plant-based milk alternatives, almond milk & soy milk.
Read Labels: Be vigilant when reading food labels to identify and avoid products containing lactose. Many packaged and processed foods may contain hidden sources of lactose.
Meal Planning Cooking at Home: Cooking at home allows for more control over the ingredients used, thereby avoiding accidental consumption of lactose.
Plan Lactose-Free Recipes: Learn and include lactose-free recipes in your meal plans.
Communication:
Inform Others: Let friends, family, and coworkers know about the lactose intolerance so that they can provide suitable food options during gatherings or events.
Restaurant Awareness: When dining out, inform the restaurant staff about lactose intolerance and ask for menu options or modifications to accommodate your needs.
Supplements:
Lactase Supplements: Consider taking lactase supplements before consuming dairy products. These supplements can help reduce symptoms and aid in the breakdown of lactose.
Educational Resources:
Educate Others: Share information about lactose intolerance with those around you to increase awareness and understanding.
Online Resources: Access reliable online resources or attend support groups to learn more about managing lactose intolerance.
Healthcare Support:
Consult a Dietitian: Work with a registered dietitian who can provide personalized advice on managing lactose intolerance and ensuring a balanced diet.
Regular Health Checkups: A healthcare provider should be consulted on a regular basis to assess your nutritional state and general health.
Role of digestive enzymes in treating lactose intolerance
Gastroenterology Lactase enzymes (Lactrase, Dairy Ease, LACTAID)
To address individuals experiencing a deficiency in lactase enzyme, it is crucial to mitigate the occurrence of osmotic diarrhea in those who lack the necessary enzyme when consuming milk.
Seek medical advice if you suspect lactose intolerance based on symptoms such as bloating, diarrhea, and abdominal pain after consuming dairy products.
Healthcare professionals may perform tests such as the hydrogen breath test or lactose tolerance test to confirm the diagnosis.
Education: Be educated about lactose intolerance, the role of lactase, and lactose sources in foods.
Dietary Alteration: Avoid high-lactose foods, opt for lactose-free alternatives, and reintroduce small amounts to monitor tolerance.
Supplementation: Take lactase as a supplement before consuming foods containing lactose; try different alternative to find which helps best.
Monitoring: Keep a record of dietary habits, watch for symptoms, and make dietary alterations by using a food diary.
Nutritional Support: Ensure adequate calcium and vitamin D from fortified foods, leafy greens, or supplements; consult a dietitian for balanced diets.
Regular Follow-up: Schedule check-ups to refine strategies and stay updated on research.
Lactose intolerance also known as lactose malabsorption is a condition where one develops signs and symptoms after consuming dietary products containing lactose. Commonly, when lactose is ingested, the lactase enzyme that is in the small intestine brush border will hydrolyze the sugar into its two components: glucose and galactose. The signs of lactose sensitivity involve stomach and abdominal discomfort, as well as pain, flatulence, gas, diarrhea, and borborygmi.
Although it is a common condition, lactose intolerance is uncommon in children under five. Young adults and adolescents are most frequently affected. Approximately 65% of individuals worldwide are lactose intolerant. Among several racial and ethnic groups, lactose intolerance varies in prevalence. Hispanics, Asians, and African Americans are most likely to experience it, whereas European Americans are least likely to. Although the age-related fall in lactase activity often peaks during childhood, it has sometimes been observed to occur later, in adolescents, especially in Whites. Patients of mixed ethnicity have a low lactase non-persistence, whereas the native ethnic group has a higher prevalence. Many patients first observe intolerance symptoms in late adolescence or early adulthood, and the condition often manifests itself gradually and subtly at first.
The brush border of the small intestine mucosa contains the lactase enzyme. Unabsorbed lactose accumulates in the gut due to lactase deficiency. Osmotic diarrhea is the result, which is an influx of fluid into the gut lumen. Intestinal bacteria break down lactose, which is hydrolyzed into simple sugars producing gas that is not absorbed (carbon dioxide, hydrogen, and methane). This results in an increase in fluid flow in the lumen. The combined effect of these pathways causes a range of abdominal symptoms.
Primary Lactase Deficiency
It is the most typical cause of lactase insufficiency, also called non-persistence. With advancing age, lactase enzyme activity gradually decreases. Infancy signifies the beginning of the loss in enzyme function, while adolescence or early adulthood marks the onset of symptoms. Recent research has revealed that lactase persistence results from mutation, whereas lactase non-persistence is of the ancestral form (typical Mendelian inheritance).
Secondary Lactase Deficiency
Injury to the intestinal mucosa can result from several viral, inflammatory, or other conditions, leading to secondary lactase deficiency. Common causes include Celiac disease, Ulcerative Colitis, Gastroenteritis, Antibiotics, and chemotherapy.
Developmental Lactase Deficiency
It occurs in newborns delivered prematurely between 28 and 37 weeks of gestation. Due to the infant’s undeveloped gut, lactose cannot be hydrolyzed. Age-related improvements in this condition are attributed to the development of the gut and the resulting appropriate lactase activity.
Congenital Lactase Deficiency
Due to autosomal recessive genetics, lactase enzyme activity has decreased or been absent from birth. It appears in a newborn following milk consumption. It is an uncommon cause of insufficiency, and little is known about its genetics.
Prognosis
The prognosis for lactose intolerance is good. With dietary changes alone, most patients see a significant improvement in their indications and symptoms. Osteopenia may result from lactose intolerance. The LCT-13910C>T gene variation of lactose intolerance in Whites is associated with vitamin D insufficiency.
Thе prognosis for lactosе intolеrancе is positivе. Most patiеnts noticе a significant improvеmеnt in thеir indications and symptoms aftеr making only diеtary changеs. Lactosе intolеrancе may lеad to ostеopеnia. Thе LCT 13910C>T lactosе intolеrancе gеnе variant in Whitеs is associatеd with vitamin D dеficiеncy. Â
Â
Age Group: Adolescents and Adults
Primary Lactase Deficiency: Most cases of lactose intolerance develop after childhood, typically in late adolescence or adulthood. This is due to a natural decline in lactase production, a condition known as lactase non-persistence. The age of onset varies widely depending on genetics and ethnicity
General examination
Abdominal examination
Mild Symptoms: Most commonly, lactose intolerance presents with mild bloating, diarrhea, gas, or abdominal discomfort after consuming lactose-containing foods. Symptoms typically develop within 30 minutes to a few hours.
Moderate Symptoms: More pronounced gastrointestinal distress may occur if larger quantities of lactose are consumed or in individuals with severe lactase deficiency.
Rare Acute Symptoms: Severe dehydration or electrolyte imbalances are uncommon but may occur in vulnerable populations (e.g., young children, older adults) after persistent diarrhea.
Dietary Modifications:
Lactose-Free Diet: The main approach is to avoid foods and drinks with lactose or to limit the consumption of such products in some way. This category includes milk products such as cheese, yogurt as well as milk itself. Some of the lactose-free products include lactose-free milk, almond milk, soy milk, and lactose-free cheese.
Reading Labels: Lactose intolerant individuals need to look at food labels. Lactose may be included among the ingredients added during the processing and packaging of certain types of food products.
Lactase Supplements:
Lactase Enzyme Supplements: Lactase can be taken over the counter in different forms including tablets, capsules, drops, etc. These supplements have lactase enzyme and can be taken before consuming lactose rich food.
Gradual Reintroduction:
Gradual Exposure: For some people, it is possible that a small quantity of lactose poses no harm to the body. Both types of patients may be best served by a gradual reintroduction of lactose containing foods in small servings over time.
Probiotics:
Probiotic Supplements: Some Lactobacilli and bifidobacterium strains of probiotics can reduce lactose digestion intolerance. These supplements may increase the presence of the bacteria that creates lactase in the gut.
Medical Advice:
Consulting a Healthcare Professional: Those who have signs of lactose intolerance, should consult their doctor. They can offer a diagnosis; assist in making the right treatment plan and rule out other GI problems.
Gastroenterology
Dietary Changes:
Avoidance of Dairy: Eliminate or reduce the consumption of dairy products. Instead, opt for lactose-free alternatives such as lactose-free milk, plant-based milk alternatives, almond milk & soy milk.
Read Labels: Be vigilant when reading food labels to identify and avoid products containing lactose. Many packaged and processed foods may contain hidden sources of lactose.
Meal Planning Cooking at Home: Cooking at home allows for more control over the ingredients used, thereby avoiding accidental consumption of lactose.
Plan Lactose-Free Recipes: Learn and include lactose-free recipes in your meal plans.
Communication:
Inform Others: Let friends, family, and coworkers know about the lactose intolerance so that they can provide suitable food options during gatherings or events.
Restaurant Awareness: When dining out, inform the restaurant staff about lactose intolerance and ask for menu options or modifications to accommodate your needs.
Supplements:
Lactase Supplements: Consider taking lactase supplements before consuming dairy products. These supplements can help reduce symptoms and aid in the breakdown of lactose.
Educational Resources:
Educate Others: Share information about lactose intolerance with those around you to increase awareness and understanding.
Online Resources: Access reliable online resources or attend support groups to learn more about managing lactose intolerance.
Healthcare Support:
Consult a Dietitian: Work with a registered dietitian who can provide personalized advice on managing lactose intolerance and ensuring a balanced diet.
Regular Health Checkups: A healthcare provider should be consulted on a regular basis to assess your nutritional state and general health.
Gastroenterology
Gastroenterology Lactase enzymes (Lactrase, Dairy Ease, LACTAID)
To address individuals experiencing a deficiency in lactase enzyme, it is crucial to mitigate the occurrence of osmotic diarrhea in those who lack the necessary enzyme when consuming milk.
Gastroenterology
Diagnosis:
Seek medical advice if you suspect lactose intolerance based on symptoms such as bloating, diarrhea, and abdominal pain after consuming dairy products.
Healthcare professionals may perform tests such as the hydrogen breath test or lactose tolerance test to confirm the diagnosis.
Education: Be educated about lactose intolerance, the role of lactase, and lactose sources in foods.
Dietary Alteration: Avoid high-lactose foods, opt for lactose-free alternatives, and reintroduce small amounts to monitor tolerance.
Supplementation: Take lactase as a supplement before consuming foods containing lactose; try different alternative to find which helps best.
Monitoring: Keep a record of dietary habits, watch for symptoms, and make dietary alterations by using a food diary.
Nutritional Support: Ensure adequate calcium and vitamin D from fortified foods, leafy greens, or supplements; consult a dietitian for balanced diets.
Regular Follow-up: Schedule check-ups to refine strategies and stay updated on research.
Lactose intolerance also known as lactose malabsorption is a condition where one develops signs and symptoms after consuming dietary products containing lactose. Commonly, when lactose is ingested, the lactase enzyme that is in the small intestine brush border will hydrolyze the sugar into its two components: glucose and galactose. The signs of lactose sensitivity involve stomach and abdominal discomfort, as well as pain, flatulence, gas, diarrhea, and borborygmi.
Although it is a common condition, lactose intolerance is uncommon in children under five. Young adults and adolescents are most frequently affected. Approximately 65% of individuals worldwide are lactose intolerant. Among several racial and ethnic groups, lactose intolerance varies in prevalence. Hispanics, Asians, and African Americans are most likely to experience it, whereas European Americans are least likely to. Although the age-related fall in lactase activity often peaks during childhood, it has sometimes been observed to occur later, in adolescents, especially in Whites. Patients of mixed ethnicity have a low lactase non-persistence, whereas the native ethnic group has a higher prevalence. Many patients first observe intolerance symptoms in late adolescence or early adulthood, and the condition often manifests itself gradually and subtly at first.
The brush border of the small intestine mucosa contains the lactase enzyme. Unabsorbed lactose accumulates in the gut due to lactase deficiency. Osmotic diarrhea is the result, which is an influx of fluid into the gut lumen. Intestinal bacteria break down lactose, which is hydrolyzed into simple sugars producing gas that is not absorbed (carbon dioxide, hydrogen, and methane). This results in an increase in fluid flow in the lumen. The combined effect of these pathways causes a range of abdominal symptoms.
Primary Lactase Deficiency
It is the most typical cause of lactase insufficiency, also called non-persistence. With advancing age, lactase enzyme activity gradually decreases. Infancy signifies the beginning of the loss in enzyme function, while adolescence or early adulthood marks the onset of symptoms. Recent research has revealed that lactase persistence results from mutation, whereas lactase non-persistence is of the ancestral form (typical Mendelian inheritance).
Secondary Lactase Deficiency
Injury to the intestinal mucosa can result from several viral, inflammatory, or other conditions, leading to secondary lactase deficiency. Common causes include Celiac disease, Ulcerative Colitis, Gastroenteritis, Antibiotics, and chemotherapy.
Developmental Lactase Deficiency
It occurs in newborns delivered prematurely between 28 and 37 weeks of gestation. Due to the infant’s undeveloped gut, lactose cannot be hydrolyzed. Age-related improvements in this condition are attributed to the development of the gut and the resulting appropriate lactase activity.
Congenital Lactase Deficiency
Due to autosomal recessive genetics, lactase enzyme activity has decreased or been absent from birth. It appears in a newborn following milk consumption. It is an uncommon cause of insufficiency, and little is known about its genetics.
Prognosis
The prognosis for lactose intolerance is good. With dietary changes alone, most patients see a significant improvement in their indications and symptoms. Osteopenia may result from lactose intolerance. The LCT-13910C>T gene variation of lactose intolerance in Whites is associated with vitamin D insufficiency.
Thе prognosis for lactosе intolеrancе is positivе. Most patiеnts noticе a significant improvеmеnt in thеir indications and symptoms aftеr making only diеtary changеs. Lactosе intolеrancе may lеad to ostеopеnia. Thе LCT 13910C>T lactosе intolеrancе gеnе variant in Whitеs is associatеd with vitamin D dеficiеncy. Â
Â
Age Group: Adolescents and Adults
Primary Lactase Deficiency: Most cases of lactose intolerance develop after childhood, typically in late adolescence or adulthood. This is due to a natural decline in lactase production, a condition known as lactase non-persistence. The age of onset varies widely depending on genetics and ethnicity
General examination
Abdominal examination
Mild Symptoms: Most commonly, lactose intolerance presents with mild bloating, diarrhea, gas, or abdominal discomfort after consuming lactose-containing foods. Symptoms typically develop within 30 minutes to a few hours.
Moderate Symptoms: More pronounced gastrointestinal distress may occur if larger quantities of lactose are consumed or in individuals with severe lactase deficiency.
Rare Acute Symptoms: Severe dehydration or electrolyte imbalances are uncommon but may occur in vulnerable populations (e.g., young children, older adults) after persistent diarrhea.
Dietary Modifications:
Lactose-Free Diet: The main approach is to avoid foods and drinks with lactose or to limit the consumption of such products in some way. This category includes milk products such as cheese, yogurt as well as milk itself. Some of the lactose-free products include lactose-free milk, almond milk, soy milk, and lactose-free cheese.
Reading Labels: Lactose intolerant individuals need to look at food labels. Lactose may be included among the ingredients added during the processing and packaging of certain types of food products.
Lactase Supplements:
Lactase Enzyme Supplements: Lactase can be taken over the counter in different forms including tablets, capsules, drops, etc. These supplements have lactase enzyme and can be taken before consuming lactose rich food.
Gradual Reintroduction:
Gradual Exposure: For some people, it is possible that a small quantity of lactose poses no harm to the body. Both types of patients may be best served by a gradual reintroduction of lactose containing foods in small servings over time.
Probiotics:
Probiotic Supplements: Some Lactobacilli and bifidobacterium strains of probiotics can reduce lactose digestion intolerance. These supplements may increase the presence of the bacteria that creates lactase in the gut.
Medical Advice:
Consulting a Healthcare Professional: Those who have signs of lactose intolerance, should consult their doctor. They can offer a diagnosis; assist in making the right treatment plan and rule out other GI problems.
Gastroenterology
Dietary Changes:
Avoidance of Dairy: Eliminate or reduce the consumption of dairy products. Instead, opt for lactose-free alternatives such as lactose-free milk, plant-based milk alternatives, almond milk & soy milk.
Read Labels: Be vigilant when reading food labels to identify and avoid products containing lactose. Many packaged and processed foods may contain hidden sources of lactose.
Meal Planning Cooking at Home: Cooking at home allows for more control over the ingredients used, thereby avoiding accidental consumption of lactose.
Plan Lactose-Free Recipes: Learn and include lactose-free recipes in your meal plans.
Communication:
Inform Others: Let friends, family, and coworkers know about the lactose intolerance so that they can provide suitable food options during gatherings or events.
Restaurant Awareness: When dining out, inform the restaurant staff about lactose intolerance and ask for menu options or modifications to accommodate your needs.
Supplements:
Lactase Supplements: Consider taking lactase supplements before consuming dairy products. These supplements can help reduce symptoms and aid in the breakdown of lactose.
Educational Resources:
Educate Others: Share information about lactose intolerance with those around you to increase awareness and understanding.
Online Resources: Access reliable online resources or attend support groups to learn more about managing lactose intolerance.
Healthcare Support:
Consult a Dietitian: Work with a registered dietitian who can provide personalized advice on managing lactose intolerance and ensuring a balanced diet.
Regular Health Checkups: A healthcare provider should be consulted on a regular basis to assess your nutritional state and general health.
Gastroenterology
Gastroenterology Lactase enzymes (Lactrase, Dairy Ease, LACTAID)
To address individuals experiencing a deficiency in lactase enzyme, it is crucial to mitigate the occurrence of osmotic diarrhea in those who lack the necessary enzyme when consuming milk.
Gastroenterology
Diagnosis:
Seek medical advice if you suspect lactose intolerance based on symptoms such as bloating, diarrhea, and abdominal pain after consuming dairy products.
Healthcare professionals may perform tests such as the hydrogen breath test or lactose tolerance test to confirm the diagnosis.
Education: Be educated about lactose intolerance, the role of lactase, and lactose sources in foods.
Dietary Alteration: Avoid high-lactose foods, opt for lactose-free alternatives, and reintroduce small amounts to monitor tolerance.
Supplementation: Take lactase as a supplement before consuming foods containing lactose; try different alternative to find which helps best.
Monitoring: Keep a record of dietary habits, watch for symptoms, and make dietary alterations by using a food diary.
Nutritional Support: Ensure adequate calcium and vitamin D from fortified foods, leafy greens, or supplements; consult a dietitian for balanced diets.
Regular Follow-up: Schedule check-ups to refine strategies and stay updated on research.
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