Lactose Intolerance

Dr. Yousef Elshrek

• Milk and milk products contain high concentrations of the disaccharide lactose (galactose and glucose linked by a beta- galactoside bond).

• Intestinal absorption of lactose requires that the disaccharide be hydrolyzed to its component monosaccharaides, both of which are rapidly transported across the small bowel mucosa.

• Lactase nonpersistence results in incomplete digestion of an ingested load of lactose; hence lactose is malabsorbed and reaches the colon.

• If sufficient lactose enters the colon, the subject may experience symptoms of abdominal pain, bloating, excess flatulence, and diarrhea, a condition known as lactose intolerance (LI).

Symptoms of Lactose Intolerance

Abdominal pain Bloating

Diarrhoea

Nausea,

Vomitting flatulence

• A brush border beta- galactosidase, lactase, carries out this hydrolysis.

• While infants virtually always have high concentrations of lactase, sometime after weaning a genetically programmed reduction in lactase synthesis results in very low lactase activity in some adult subjects, a situation known as lactase nonpersistence.

• Diseases of the small bowel mucosa (infection, celiac disease) may also be associated with low brush border lactase, with resultant lactose malabsorption (LM) and LI.

in lactase persistence lactase phlorizin

hydrolase in the brush border ..

World wide of populations that have primary lactase deficiency

• The percentage of populations that have primary lactase deficiency are considerable throughout the world

• It Estimated that the following percentage of specific ethnic are considered to be lactase deficient 1. 85 – 100 of Asian 2. 80 – 100% of American Indians 3. 60 – 80 % of Africans 4. 50 – 60 % of Latinos 5. 2 - 15 % of Northern Europeans

Occurence of lactose-intolerance

• The amount of lactase available at birth and decrease with age

• Yet, lactose-intolerant adults

began their lives drinking milk

from a bottle or breast and

digesting it completely.

• Babies produce the enzyme

lactase in their small intestine.

This enzyme breaks down

lactose.

• Therefore: Babies are lactose

tolerant

• Secondary lactase deficiency can occur at the following:-

1. Disease and Infection

2. Injury to small Intestine

3. Surgery

4. Malnutrition

How is lactose intolerance managed?

• You can change your diet to manage your symptoms.

• Most people with lactose intolerance do not have to give up milk or milk products.

• You may be able to tolerate milk and milk products if you

• Drink small amounts of milk—4 ounces or less—at a time

• Drink small amounts of milk with meals

• Gradually add small amounts of milk and milk products to your diet and see how you feel

• Eat milk products that are easier for people with lactose intolerance to digest, such as yogurt and hard cheeses like cheddar and Swiss

• You can also use over-the-counter products that may help you digest milk and milk products.

• You can take a tablet that contains the lactase enzyme when you eat foods that contain lactose Add liquid lactase drops to liquid milk products

• You can also find lactose-free and lactose-reduced milk and milk products at the grocery store.

• These products have the same nutrients and benefits as regular milk.

How will I know if a food has lactose?

• Lactose is found in milk and all foods made with milk, such as 1. Ice cream 2. Cream 3. Butter 4. Cheese 5. Cottage cheese 6. Yogurt

• Rarely, people with lactose intolerance are bothered by small amounts of lactose.

• Canned, frozen, packaged, and prepared foods contain small amounts of lactose.

• These foods include 1. Bread and other baked goods, pancakes, biscuits,

cookies

2. Prepared or frozen breakfast foods such as doughnuts, frozen waffles and pancakes, toaster pastries, and sweet rolls

3. Boxed breakfast cereals

4. Instant potatoes, soups, and breakfast drinks

5. Potato chips, corn chips, and other packaged snacks

6. Prepared meats, such sausage, hot dogs, and lunch meats

7. Margarine

8. Salad dressings

9. Liquid and powdered milk-based meal replacements

10. Protein powders and bars

11. Candies

12. Non-dairy liquid and powdered coffee creamers

13. Non-dairy whipped toppings

14. Look for certain words on food labels. These words mean the food has lactose in it:

• Milk

• Lactose

• Whey

• Curds

• Milk by-products

• Dry milk solids

• Non-fat dry milk powder

How will I get the calcium I need?

• Milk and milk products are the most common sources of calcium. Calcium is a mineral the body needs for strong bones and teeth. If you are lactose intolerant, make sure you get enough calcium each day. Other foods contain calcium, such as 1. Canned salmon or sardines with bones

2. Broccoli and other leafy green vegetables

3. Oranges

4. Almonds, Brazil nuts, and dried beans

5. Soy milk and tofu

6. Products with added calcium, such as orange juice

• To absorb calcium, your body needs vitamin D.

• Be sure to eat foods that contain vitamin D, such as eggs, liver, and certain kinds of fish like salmon and tuna. Also, getting enough sun helps your body make vitamin D.

• Vitamin D is added to some milk and milk products.

• If you’re able to drink small amounts of milk or eat yogurt, choose varieties that have vitamin D added.

• It’s hard to get enough calcium and vitamin D even if you eat and drink milk and milk products.

• Talk with your doctor about how to get calcium and vitamin D in your diet.

• Ask if you should also take a supplement to get enough calcium, vitamin D, or other nutrients.

Points to Remember 1. Lactose intolerance means you have trouble digesting lactose.

2. If you have lactose intolerance, you may not feel well after you eat or drink milk and milk products. Many people with lactose intolerance can tolerate small amounts of milk—4 ounces or less—at a time, especially with meals.

3. You may be able to gradually add small amounts of milk and milk products to your diet.

4. You can use over-the-counter products that may help you digest milk and milk products.

5. If you are lactose intolerant, make sure you get enough calcium each day. Talk with your doctor about how to get enough calcium in your diet. Ask if you should take a calcium supplement.