Lactase deficiency - milk intolerance, symptoms, treatment

Lactase deficiency (alactasia) is milk intolerance associated with impaired absorption of lactose in the intestines.

Types of alactasia

There are four forms of congenital lactose malabsorption:

• congenital lactase deficiency in infants;
• congenital lactase deficiency in adults;
• congenital lactose intolerance associated with increased permeability of the gastric mucosa;
• violation of milk coagulation in the stomach.

Congenital lactase deficiency in infants

This disease is very rare, but poses a serious threat to the lives of infants. Therefore, it is extremely important to make a correct diagnosis in a timely manner.

The main symptom is profuse diarrhea.

Congenital lactase deficiency in adults (delayed onset)

This type of disease manifests itself at the age of 4 years and older. Until this age, people tolerate milk well.

Symptoms are mild:

• bloating,
• nausea,
• rumbling,
• stomach ache,
• increased formation of gases,
• pasty or watery stools.

Both types of milk intolerance are inherited.

General symptoms

Most patients with laboratory proven hypolactasia after drinking whole milk experience symptoms such as:

• profuse loose stools (one-time profuse diarrhea);
• weakness;
• nausea;
• feeling of lightheadedness;
• bloating;
• loud rumbling;
• transfusion in the abdomen;
• stomach pain after taking belly.

Diagnostics

The diagnosis is made using laboratory tests that reveal lactase deficiency in enterocytes.

A quick diagnosis can be made using a hydrogen breath test , which shows hydrogen in the exhaled air after drinking milk.

Treatment

The most common treatment method is nutritional adjustments.

It is recommended to consume dairy products that contain virtually no lactose (cheeses) or low levels of lactose (cottage cheese).

Numerous studies by domestic and foreign experts have shown that 240 ml of milk per day is well tolerated by all adults, including those with lactase deficiency.

However, patients are recommended to use milk in a mixture with other products, in small portions throughout the day (in porridges, casseroles, in vegetable purees).

Special dairy products have been developed for infants. In Russia, the dairy product “Alactosin N” was created for feeding children with lactase deficiency in the 1st year of life. The product is characterized by the introduction of whey proteins in a ratio of 60:40 in relation to casein, modification of the fat composition due to a combination of milk and vegetable fats, and the almost complete absence of lactose. Alactosin N is enriched with a complex of vitamins and minerals in accordance with the needs of children of the 1st year of life.

Yogurt containing Lactobacillus bulgaricus and Streptococcus thermophilus is well tolerated by patients.

To reduce intolerance, it is recommended to consume small amounts of dairy food daily to adapt the colon microflora to it.

Congenital lactose intolerance associated with increased permeability of the gastric mucosa

This disease occurs in children in the first year of life.

The disease is manifested by the following symptoms:

• diarrhea,
• vomit,
• massive lactosuria (appearance of lactose in the urine),
• renal failure,
• retardation in physical and mental development.

With increased permeability of the gastric mucosa, lactose penetrates into the blood and has a toxic effect. This disrupts the functions of the liver and kidneys.

Excluding lactose from food leads to the disappearance of liver and kidney symptoms. In this case, the disease disappears on its own at 12-18 months of life.

Disturbance of milk coagulation in the stomach

This disease is caused by insufficient action of factors that promote milk coagulation in the stomach.

These include:

• gastric proteases (enzymes);
• free hydrochloric acid;
• calcium ions;
• bile acids entering the stomach during duodenogastric reflux.

At the same time, milk coagulation slows down, which can cause diarrhea.

A rare form of milk intolerance is intestinal obstruction in newborns due to the curdling of cow's milk in the intestines, which is facilitated by the formation of calcium soaps from the fat of the milk. In most cases, such patients have to be operated on.

Secondary lactase deficiency

Milk intolerance can develop due to intestinal damage due to other diseases or toxic effects.

The degree of enzyme deficiency is proportional to the severity of intestinal damage. In this case, the activity of lactase decreases faster than the activity of other enzymes. If the condition of the intestine is completely normalized, the activity of all enzymes is gradually restored.

The development of lactose intolerance has been proven in the following diseases:

1. In infants and children suffering from kwashiorkor (a type of severe dystrophy caused by a lack of protein in the diet).
2. Giardiasis in infants and children is sometimes combined with villous atrophy, impaired absorption and membrane digestion, including lactase deficiency. In adults, damage to the villi, as a rule, with giardiasis is insignificant, with the exception of patients with reduced immunity.
3. With chronic alcoholism or alcohol poisoning, milk intolerance often develops.
4. With ulcerative colitis, eliminating milk from food often leads to remission. However, there is no strict evidence base for the development of lactase deficiency in this disease.
5. With Crohn's disease, this disease develops quite often, it depends on the area and degree of damage to the intestine.
6. Hypolactasia is observed in both children and adults with celiac enteropathy . Symptoms of the disease decrease if not only gluten, but also lactose is excluded from the diet. According to doctors, all people suffering from gluten intolerance are diagnosed with lactase deficiency.
7. In patients who have undergone gastrectomy, when lactose is excluded from the diet, diarrhea quickly stops, and dumping syndrome also decreases or disappears.
8. Relative lactase deficiency appears in patients after extensive resection of the small intestine.
9. Among patients with irritable bowel syndrome, hypolactasia is detected in 24-67% of cases. In the remaining patients, no relationship was found between lactose consumption and the development of disease symptoms.