About Lactose Intolerance Signs, Diagnosis, Causes and Treatment

What is lactose?

The lactose is milk sugar, a disaccharide consisting of glucose and galactose. When lactose reaches the small intestine, the lactase enzyme acts on the lactose found in ingested food, dividing it into the two molecules that compose it, so they can be absorbed, digested and transported through the bloodstream.

Lactase deficiency: 

When the person has a lactase deficiency (lactase enzyme has a low concentration or does not occur), the dietary lactose cannot be digested in the small intestine directly passing into the large intestine where it is fermented by the bacterial flora, causing nausea, diarrhea, cramps, gas and bloating. This situation is known as lactose intolerance, hereditary lactase deficiency, congenital lactase deficiency or hypolactasia.

Lactose intolerance is very common and affects 75% of the population worldwide. There are certain more likely to develop this condition, as the Asian races, where about 90% of the population has these intestinal disorder ethnic groups. It is also common in African, Hispanic and from southern India groups. In Spain, the disorder affects approximately 19-28% of the population.

What causes lactose intolerance?

Lactose intolerance can be hereditary (primary) or acquired (secondary). In primary source intolerance lactase deficiency is inherited in a recessive occurs (the presence of two copies of an abnormal gene for the disorder is needed). In humans, ingestion of milk is vital during childhood, and therefore at this stage of life lactase usually has high levels, which decrease progressively with age. Therefore, primary lactose intolerance is often manifested from adolescence, but can begin before age seven.

The congenital lactase deficiency (present at birth) is common in premature babies, as full-term infants often do not show signs of lactose intolerance until about three years old; symptoms occur when starting the intake of milk and include diarrhea watery, abdominal pain and irritability, and resolved to eliminate lactose from the diet.

As for lactose intolerance or acquired secondary, stems damage of the intestinal mucosa or decreased absorption surface caused by different bowel diseases as gastroenteritis, malabsorption syndromes, Crohn's disease , celiac disease , malnutrition , short bowel, ETC.

You can also shop lactose intolerance transient , or functional impairment as a result of any intestinal disease or treatment with antibiotics has affected the gastrointestinal tract, and in patients who have undergone rapid gastric emptying, usually after surgery. In these patients the activity of the enzyme remains, however there is no complete digestion of lactose by reducing the time of contact with the intestinal mucosa.

Signs of lactose intolerance:

To identify this problem, think they can receive one or more of the following symptoms of lactose intolerance after the intake (between 30 minutes and two hours later) products containing lactose:

Sickness.
Abdominal swelling .
Abdominal pain.
Gases.
Diarrhea .
Foul-smelling stools.
Weight loss.

In some cases, it can also paradoxically, appear constipation by decreased gut motility due to methane-producing bacteria. These symptoms are similar to other digestive diseases such as celiac disease, the Crohn's disease or intolerance to milk proteins by other mechanisms, so that one must distinguish between them by relevant evidence, particularly in the case removing lactose diet and absence of symptom improvement.

Also, the intensity of the symptoms of lactose intolerance will not only depend on the threshold of each person, but also its intestinal motility activity lactose (responsible for metabolizing lactose) and its activity flora.

Lactose intolerance Diagnosis:

To diagnose lactose intolerance in any form several methods are used, and the simplest is to eliminate lactose from the diet and to assess whether the symptoms disappear.
The test lactose intolerance or plasma glucose is based on the increase in blood glucose greater than 20 mg / dL, after having consumed when a load of 50 g lactose. If this increase does not occur, the test is positive, as it means that the disaccharide has not been hydrolysed and absorbed.

In the hydrogen breath test lactose is administered to the patient orally. In subjects with lactose intolerance lack of intestinal absorption favors their arrival at colon, and results in the release of hydrogen and its elimination through the breath. Therefore, a high concentration of hydrogen in the breath after the administration of lactose intolerance indicates the same.

The stool acidity test is used mainly in young children and infants, where it is difficult to perform other tests. It is to analyze stool that in the event of lactose malabsorption, are more acidic than normal, because when lactose is metabolized by the bacterial flora of the large intestine, the lactic acid content increases in stool.

Other diagnostic methods are the intestinal biopsy to quantify enzyme activity and the genetic study.
It is customary for the lactose intolerance confused with irritable bowel syndrome , which should make the differential diagnosis to confirm that it is a lactase deficiency and no other type of intestinal disorder.

Treatment of lactose intolerance:

There are two alternatives for the treatment of lactose intolerance . The first is to remove from the diet all foods containing lactose, ie any products containing milk or cheese or has developed from these, either totally in very sensitive patients, or mild in patients less sensitive, they can afford to eat small amounts of lactose.

Lactase deficiency varies from person to person, and also throughout life, so they can determine the degree of lactose intolerance each patient, and determine the type and quantity of milk can consume.

It should be noted that lactose can be present in the composition of any food or drink and not only in dairy products. There may be lactose in bread, sweets, meats, desserts, soups, sauces and medicines, so it is recommended to always read food labels to identify the presence of lactose. The consumption of yogurt with live bacterial cultures produce bacterial lactase bioactive release in the intestine.

The other alternative is the administration of lactase substitutes. Taking supplements of the enzyme lactase before consuming milk products can prevent the onset of symptoms in some people; however, it is not effective in all patients with this disorder.