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Lactose is a disacchride,which means it is composed of two sugars joined together. Lactose is the form of sugar present in milk .

It is the most important source of energy during the first year of a humans life, providing almost half the total energy requirement of infants.

To be absorbed,lactose needs to be broken down in the intestine by a galactosidase and lactase phloritzin,generall called lactase

Lactase is found most abundantly in the jejunum (at the beginning of the small intestine), and it specifically only hydrolyses lactose. It is found at the tip of the intestinal villi. The gene coding for lactase is located on chromosome 2

It is the inability to digest lactose due to deficieny of lactase so: Undigested lactose can exert an osmotic effect, drawing water into the small intestine. This may accelerate the passage of intestinal contents into the large intestine, and so contribute to the diarrhea associated with lactose intolerance. Colonic bacteria can then digest the lactose, forming first short-chain carboxylic acids (e.g., propionic, acetic, formic, and lactic acids). Formic acid is then cleaved by formic lyase to yield hydrogen gas and carbon dioxide. Furthermore, colonic bacteria may then form methane from the carbon dioxide and hydrogen gas. The result is copious amounts of gas in the large intestine, leading to the flatulence and "rumblings" associated with lactose intolerance .

Other names: Lactase deficiency. Lactose malabsorption. Lactose maldigestion. Hypolactasia.

Lactose intolerance
Congenital lactase deficiency

Primary lactase deficiency

Secondary lactase deficiency

Primary lactose malabsorption


Racial or ethnic lactose

Secondary lactose malabsorption


Bacterial

malabsorption Developmental lactase deficiency Congenital lactase deficiency

overgrowth/stasis Mucosal injury of GIT that causes villus flattening

Genetically determined reduction of lactase activity

Most common form of lactose malabsorption


The great majority of the worlds population develop

low intestinal lactase during mid-childhood (approximately at age 5 yrs) This finding is most prominent in Asian and African populations; rare in Caucasians of Scandinavian background Molecular basis remains unknown

Low lactase levels as a consequence of prematurity

Lactase activity in the fetus increases late in gestation


Premature infants born at 28-32 weeks of gestation

have a reduced lactase activity

Rare autosomal recessive disorder (Finnish

population) Characterized by the absence of lactase activity in the small intestine, with normal histologic findings A gene located on the same chromosome of the lactase gene, is responsible for CLD Affected infants have diarrhea from birth, hypercalcemia and nephrocalcinosis

Bacterial overgrowth or stasis syndromes


Increased fermentation of dietary lactose in the small

bowel, leading to symptoms of lactose intolerance


Suspected from clinical history and from a very early

peak of breath hydrogen during lactose challenge

Mucosal injury Villus flattening or damage to the intestinal epithelium


Celiac disease Crohns disease Radiation enteritis, chemotherapy HIV enteropathy Whipples disease

Lactase usually first affected disaccharidase in these

disorders, because of its distal location on the villus


Treatment of the primary disorder can lead to

restoration of lactase activity


Restoration of lactase activity lags behind the return of

normal intestinal morphology

Abdominal pain crampy, localized to periumbilical area, or lower

quadrant
Bloating Flatulence Diarrhea

Vomiting
Stools are usually bulky, frothy and watery

Meals with higher osmolality and fat content slow

gastric emptying and reduce the severity of symptoms Rapid intestinal motility rapid movement of sugar are more symptomatic Individuals have variable sensitivity to the abdominal distention produced when undigested lactose stimulates an influx of water into the lumen or to gas production

Irritable bowel disease


Inflammatory bowel disease Cystic fibrosis

Diverticulitis
Celiac sprue Acute gastroenteritis

Giardiasis

Test absorption (lactose absorption test) or malabsorption (lactose breath hydrogen test) Lactose tolerance test Oral administration of 50 gram lactose Blood glucose levels 0, 60 and 120 min Increase of blood glucose by less than 20mg/dl + symptoms diagnostic False negative diabetes, bacterial overgrowth, delayed gastric emptying Sensitivity of 75%, specificity of 96%

Lactose breath hydrogen test Oral lactose (2g/kg) Breath hydrogen sampled at baseline and at 30 min intervals for three hours Breath hydrogen value of 10ppm normal, 10-20ppm indeterminate unless symptomatic, >20ppm diagnostic False positive recent smoking, false negative recent use of antibiotics, lung disorders, 1% non-hydrogen producers

Under the age of 5 years abnormal test reflects an

abnormal intestinal mucosa or bacterial overgrowth, both of which require further evaluation by appropriate diagnostic tests
Normal breath hydrogen test psychologic factors,

intolerance to other factors in milk

1-hydrogen breath test. 2-stool acidity test. 3-lactose tolerance test. 4-milk tolerance test. 5-dietary elimination. 6-procedures. 7-histologic findings 8-smalll bowel biobsy.

Symptoms:
Abdominal pain - cramps, often localised to the per-umbilical area or lower quadrant Bloating - caused by the formation of gases that expand in the warm conditions of the digestive system Flatulence - caused by the gases produced by the bacteria. H2S is the gas associated with the odour . Diarrhea - stools are usually bulky, frothy and watery Vomiting - particularly adolescents Nausea - may be present, probably due to acidity and gases escaping backwards Weight loss - if kept unattended Malnutrition - especially in babies

In the absence of a correctable underlying disease, the treatment includes four general principles:
Reduced dietary lactose intake Substitution of alternative nutrient sources to maintain

energy and protein intake Administration of a commercially available enzyme substitute Maintenance of calcium intake

There is no cure for lactose intolerance, but you can treat your symptoms by limiting or avoiding milk products. Some people use milk with reduced lactose, or they substitute soy milk and soy cheese for milk and milk products. Some people who are lactose-intolerant can eat yogurt without problems, especially yogurt with live cultures. You can also take dietary supplements called lactase products that help digest lactose. In time, most people with lactose intolerance get to know their bodies well enough to avoid symptoms. Lactose intolerance is usually treated through the diet, By not eating or drinking more dairy products than the body can handle, or choosing products with low levels of lactose, the symptoms can be controlled. The lactase enzyme can also be ingested together with the food to make the lactose more digestible.

Complications of lactose intolerance:


Dairy products, such as milk, are an important part of a healthy diet. Dairy products contain calcium, protein, and vitamins, such as vitamins A, B12, and D. For adults, the recommended daily allowance (RDA) for calcium is 700mg,Lactose is also important because it helps your body to absorb a number of other minerals, including magnesium and zinc. These vitamins and minerals are important for the development of strong, healthy bones If you are lactose intolerant, getting the (RDA) of important vitamins and minerals can prove difficult. This may put you at increased risk of developing the following conditions: Osteopenia:a condition where you have a very low bone mineral density. If is not treated, it can develop into osteoporosis Osteoporosis:a condition that causes your bones to become thin and weak. If you have osteoporosis, your risk of getting fractures and broken bones is increased. Malnutrition:occurs when the food that you eat does not give you the nutrients that are essential for a healthy functioning body. If you are malnourished, wounds can take longer to heal and you may start to feel tired or depressed. Weight loss:excessive weight loss can damage your health, and it can also lead to conditions such as osteoporosis.

some tips for dealing with lactose intoleranceChoose :


1.choose lactose-reduced or lactose-free milk. 2.Take a lactase enzyme supplement (such as Lactaid) just before you eat dairy products. These can be taken in drops or tablets and even added directly to milk (they tend to make milk taste a bit sweeter if left for a long time). 3.when you do drink milk or eat lactose-containing foods, eat other non-lactose foods at the same meal to slow digestion and avoid problems. (For example, if you are going to have a milkshake, don't drink it by itself. Have something else with it like a healthy sandwich).

4.Drink juices that are fortified with calcium.


5.Eat a variety of dairy-free foods that are rich in calcium, such as broccoli, beans, tofu, or soy milk. Consider hard cheeses such as cheddar, which are lower in lactose. 6.Yogurts that contain active cultures are easier to digest and much less likely to cause lactose problems. 7.Learn to read food labels. Lactose is added to some boxed, canned, frozen, and prepared foods like bread, cereal, lunchmeats, salad dressings, mixes for cakes and cookies, and coffee creamers. Be aware of certain words that may mean the food has lactose in it: butter, cheese, cream, dried milk, milk solids, powdered milk, and whey, for example.

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