Lactase deficiency in adults. Symptoms, diagnosis

Intolerance natural sugar from milk called lactase deficiency. Deficiency of this enzyme in adults requires specific therapy. To get rid of its symptoms, they switch to the use of fermented milk products, in which lactose is usually absent or its percentage is very small. With this approach, digestion is completely restored, and the pathology itself is also eliminated.

Fermentopathy, in which adults lack the ability of the intestines to break down milk sugar, is called "lactase deficiency." Its main symptoms are loosening of the stool and increased gas formation. The natural sugar found in milk is misunderstood by the body. This is due to the lack of such an enzyme as lactase, which is responsible for the breakdown of milk carbohydrates.

For the normal functioning of the gastrointestinal system, the disaccharide entering the human body with milk must decompose into galactose and glucose. This is how lactose is converted under the influence of a special enzyme. This is lactase. And if its amount is not enough for such a breakdown, then all kinds of intestinal problems begin to arise in the body. In this case, lactose is not digested and leads to digestive disorders.

Lactase deficiency, which is a type of malabsorption syndrome, is the cause of:

• the secretion of water in the intestine;
• lowering the acidity of the body;
• increased gassing.

Views

There are 2 types of lactase deficiency: congenital (primary) and acquired (secondary).

Primary

Primary lactose intolerance occurs in children and develops with age. Such an enzymatic deficiency occurs in a person from birth. This type of deficiency manifests itself especially in those whose relatives do not tolerate dairy products. That is, this means that primary lactose intolerance is inherited.

Congenital primary lactase deficiency occurs due to impaired enzyme synthesis at the genetic level. This pathology is transmitted from adults to newborns in an autosomal recessive manner. Lactase deficiency is also age-related. It begins to manifest itself from 3-5 years old and continues as a person grows up. Transient lactase deficiency is characteristic of premature babies and is temporary.

Secondary

Acquired lactase deficiency occurs due to several factors that affect the cells of the small intestine. Secondary lactose intolerance is the result of damage to intestinal enterocytes. It can be permanent or temporary.

Secondary lactase deficiency can occur due to:

• surgical interventions;
• tumors;
• food allergies.

Stages and degrees

Lactase deficiency is partial (hypolactasia) and complete (alactasia).

Alactasia

At the first degree of pathology, its symptoms are eliminated after appropriate therapy. Permanent or complete lactose intolerance remains with a person forever. It occurs in the complete absence of a digestive enzyme or after bowel surgery. The congenital type of pathology also belongs to alactasia. Another deficiency of the enzyme responsible for the digestion of milk sugar is subdivided into persistent and transient.

Hypolactasia

Partial enzymatic deficiency is when lactase is produced in the body, but in very small quantities. Patients with such a pathology can moderately consume milk and products with it without any special problems for themselves.

Lactase deficiency in adults (its symptoms make themselves felt not only in childhood) has a slow onset, which is set after the end of breastfeeding. The disease lends itself to special diet therapy, as well as drugs with enzymes that break down milk sugar. To replenish the calcium deficiency with a lactose-free diet, it is recommended to use medications containing this element.

The constitutional

Along with congenital, primary lactase deficiency can also be constitutional. This is when, with age, the digestion of milk sugar is more and more disrupted due to the natural weakening of enzyme production.

Symptoms and Signs

From the table below, you can find out that the symptoms of lactase deficiency in children and adults are different:

Signs of lactase deficiency in adults	Symptoms of a lack of lactase in children
general weakness; intestinal colic; heart and headaches; diarrhea; sweating; flatulence; joint pain; nausea; stomach cramps; vomit; long stool retention	general anxiety; bloating; problems with weight gain; diarrhea with a foamy consistency

Increased gas production in adults occurs due to the breakdown of lactose in the large intestine and the accumulation of carbon dioxide and hydrogen. At the same time, flatulence is manifested by rumbling and bloating. After this process, intestinal colic begins to make itself felt. They are due to the enlargement and irritation of the colon.

From increased osmotic pressure and concentration of fatty acids in the intestine, water begins to accumulate. This causes frothy, sour-smelling diarrhea. Incomplete digestion of milk disaccharide is characterized by nausea and a feeling of heaviness in the stomach. In this case, a gag reflex also sometimes occurs.

Causes

Lactose intolerance occurs due to the fact that this disaccharide from milk is not absorbed into the bloodstream, but enters the colon. There he begins to interact with bacteria, which leads to unpleasant symptoms of lactase deficiency. Normally, milk sugar, once it gets into the body, should break down into 2 components.

The probable appearance of a lactase deficiency can also lead to:

1. Radiation therapy for intestinal tumors.
2. The age of the patient (the older the patient, the greater the possibility of pathology).
3. Intestinal diseases (such as Crohn's syndrome or celiac disease).
4. Ethnic predisposition, complication symptoms are more common in:

• Americans;
• Africans;
• the Spaniards;
• Asians.

1. Prematurity of newborns.
2. Genetic malfunctions and disorders.
3. Damage to enterocytes.
4. Intestinal dysbiosis (violation of the internal bacterial balance).
5. Pancreatitis
6. Intestinal infections:

• salmonellosis;
• dysentery;
• rotavirus.

1. Food allergies.
2. Lactose overload.
3. Small bowel surgery.
4. Intestinal inflammation.
5. Long-term intravenous nutrition after surgery.
6. Premature birth.

Lactase deficiency in adults (symptoms of the disease manifest clinically) is formed in the body due to enzymatic deficiency. Its signs are considered to be intestinal disorders, manifested after the intake of milk and products containing it. However, it has been proven that people, even with already identified lactase intolerance, are still able to consume a small amount of a poorly digestible carbohydrate component.

Diagnostics

When diagnosing lactase deficiency:

• compare the anamnestic data with the patient's complaints;
• with the help of endoscopic studies, enzymatic activity is determined;
• based on genealogical information;
• conduct a breath hydrogen test;
• investigate the presence of lactosuria;
• check Benedict's samples;
• scatology is prescribed;
• determine the carbohydrate level in feces;
• sometimes referred for genetic research (but this is done only in the absence of signs of the disease).

When monitoring lactose tolerance, which costs from 1,600 rubles in clinics, the reaction to the milk you drink is tested. 2 hours after drinking such a drink, a blood test is done to measure the amount of glucose in it. Its number remaining in place will indicate lactase deficiency in the body.

The patient is also given milk to drink for the breath test. Then, at regular intervals, the amount of hydrogen is measured in the air exhaled by the patient. For a healthy state, its number should be small. With lactose intolerance, the amount of hydrogen in the air during exhalation becomes very high.

When scatological analysis to detect lactase deficiency, various characteristics of feces are checked, namely:

• consistency;
• shape;
• smell and colors.

Feces with lactose intolerance will have:

• sour smell;
• foamy appearance;
• liquid consistency.

Decreased acidity of faeces also indicates enzymatic deficiency.

Microscopic tests of the intestines examine it:

• microflora;
• muscle fibers;
• connective tissue;
• fiber.

During dietary diagnostics, dairy products are excluded from the diet of patients with suspected lactase deficiency. With this turn, diarrhea and increased gas production completely disappear.

Treatment methods

Optimizing the conversion of lactose prevents the occurrence of:

• hypotrophy;
• muscle hypotension;
• mineral or vitamin deficiency;
• convulsions.

Lactase deficiency in adults (symptoms of pathology include diarrhea and flatulence), which is also called lactose intolerance, treated and prevented by a diet with no or little milk Sahara. Such a disease occurs when the production of a certain enzyme in the intestine is weakened or from damage to the epithelial cells of this organ. Doctors diagnose lactase deficiency only after a detailed examination of the patient.

The lactose content in certain products is different, namely, in 100 g:

• cottage cheese curds - 1.5 g;
• kefir - 4-6 g;
• cottage cheese - 2.5-3.5 g;
• yogurt - 3-4 g;
• cheeses - 3 g;
• margarine - 0.1 g;
• serum - 3.5 or 70 g;
• butter - 0.5 g;
• buttermilk - from 3 to 44 g;
• condensed milk - 9-13 g;
• cream - 3-5 g;
• powdered milk - 52 g;
• sour cream - 3 g;
• whole milk - 6.5 g;
• ice cream - 2-7 g;
• milk chocolate - 10 g.

Milk disaccharide is found not only in milk, but also in:

• cocoa;
• ham;
• chocolate;
• boiled ham;
• confectionery glaze;
• sausages;
• taste enhancers;
• jams;
• seasonings;
• jam;
• bouillon cubes;
• jam;
• mayonnaise;
• instant products;
• mustard;
• confectionery;
• ketchup;
• bread crumbs and bread;
• fast food;
• dietary supplements.

Lactose-free foods include:

• eggs;
• cider;
• vegetables and fruits;
• beer and wine;
• tea and coffee;
• buckwheat porridge and cereals;
• vegetable oils;
• wheat;
• rice and corn;
• soy products;
• legumes;
• pasta;
• nuts.

Lactase deficiency in adults (symptoms of this disease indicate low enzymatic activity) is diagnosed based on the results of scatology. Molecular genetic tests even reveal a predisposition to such a pathology. The test results also help to select the optimal therapeutic diet and diagnose the causes of the deficiency of the enzyme lactase.

With a lactose-free diet, many vitamins that milk is rich in are lost:

• folic and niacin;
• retinol;
• pyridoxine;
• thiamine;
• cyanocobalamin;
• riboflavin.

Intestinal disorders resulting from lactase deficiency require the use of foods with vitamin A (retinol).

Therefore, people with these problems need to eat:

• chicken and quail eggs;
• liver;
• broccoli;
• carrot;
• wild garlic;
• sorrel;
• garlic and onion feathers;
• parsley;
• viburnum;
• soy.

Thiamin or vitamin B1 can be found in:

• millet;
• pine nuts;
• oatmeal;
• pistachios;
• pork;
• peanuts.

Riboflavin is found in:

• mackerel;
• beef liver;
• chicken eggs;
• champignons.

Pyridoxine hides in:

• tuna;
• garlic;
• walnuts and pine nuts;
• mackerel;
• sea ​​buckthorn.

Lactase deficiency in adults (the symptoms of this deficiency are usually due to the physiological characteristics of the body) can be complete or partial. It is also subdivided into primary and secondary. Therapy for any type of lactase deficiency should be differentiated. It is caused by factors and degrees of enzymatic deficiency.

The lack of folic acid will be replenished by:

• spinach;
• leaf salad;
• peanut;
• broccoli;
• beef liver;
• hazelnut;
• beans;
• walnuts.

Cyanocobalamin is rich in:

• sardines;
• beef and pork liver;
• mackerel;
• octopuses.

Lactase deficiency is primarily combated with the help of elimination diet therapy.

With her:

• reduce the use of dairy products;
• drugs are administered to normalize calcium metabolism;
• replace food and drink with lactose with fermented milk products;
• restore intestinal biocenosis;
• prescribe dietary fiber and enzyme agents to enhance the activity of lactase;
• complexes of vitamins are administered parenterally.

In case of primary (congenital) lactase deficiency, its treatment should be lifelong. Instead of diet, the enzyme galactosidase is sometimes prescribed. It is useful to take pro- and prebiotics to modulate the intestinal epithelium.

With a special lactose-free diet, the use of:

• confectionery products with dairy additives;
• probiotics;
• condensed and whole milk.

In the diet of patients with hypolactasia (partial enzymatic insufficiency), a small amount is allowed:

• butter;
• yoghurts;
• dairy products.

To replenish the amount of calcium with a lactose-free diet, it is recommended to consume more foods such as:

• spinach;
• broccoli;
• rhubarb;
• beans;
• mineral-fortified juices and breads;
• oranges;
• canned salmon;
• rice or soy milk;
• garlic;
• sesame;
• pistachios;
• almond;
• mustard;
• flax (seeds).

In adults, impaired enzymatic breakdown and absorption of milk sugar causes nausea and stomach pain. These and other symptoms are manifested precisely with lactase deficiency. This deficiency affects 70% of the earth's population. From which it can be seen that this pathology is quite common.

Vitamin D content in the body will help restore:

• yoghurts;
• liver;
• eggs;
• pollock;
• mackerel;
• Cedar oil;
• trout;
• herring;
• tuna;
• sea ​​bass;
• Cod liver.

For the rapid absorption of calcium, you need phosphorus, which is in:

• black and green tea;
• fatty fish;
• bran;
• dry mushrooms;
• pumpkin seeds.

But some foods break down calcium inside the body.

These include:

• starch;
• tobacco;
• salt;
• alcohol;
• sugar;
• caffeine;
• whole grain bran.

Together with calcium, it is undesirable to take medications such as:

• peptide;
• zantak;
• tagamet.

To improve calcium absorption:

1. Drink 300 ml of beet juice daily.
2. They eat nuts and vegetable oils.
3. Reduces the heat treatment time of products.
4. Consumed by:

• vitamin E;
• iron;
• ascorbic acid;
• magnesium;
• retinol;
• potassium.

With hypolactasia, milk is recommended to be consumed in the following ways:

• Reduce its single dose to 100 ml. Small portions of milk rarely irritate the intestines.
• Liquids containing lactose are drunk with food. At the same time, digestion slows down and signs of enzymatic deficiency are weakened.
• Milk can be replaced with live bacteria yoghurt or hard cheese.
• It is better to buy dairy products with little or no lactose.
• For good digestion of milk, you can use special products with lactase.
• Probiotics are added to milk before drinking.

Breastfeeding mothers with children suffering from lactase deficiency are not recommended to eat:

• grape;
• confectionery;
• black bread;
• sugar;
• sweet pastry.

Lactose intolerance is also treated with the following medications:

1. Prebiotics.
2. Antispasmodic drugs.
3. Enzymatic medicines with lactase.
4. Carminative and antidiarrheal agents:

• diosmectite;
• attapulgite;
• loperamide;
• espumisan.

Possible consequences and complications

With a lack of lactase, if ignored for a long time, milk sugar tends to remain inside the body for a long time. This unconverted carbohydrate is located in the small intestine and increases osmotic pressure. And this phenomenon contributes to the accumulation of water in the intestinal lumen.

Patients with severe lactose intolerance without optimal treatment begin to develop:

• sucroseuria;
• malabsorption syndrome;
• lactosuria;
• strengthening of the motor functions of the intestine;
• acidification of the intestinal environment.

Severe primary lactase deficiency can lead to:

• convulsions;
• dehydration;
• acidosis.

Almost all cases of lactose intolerance have blurred symptoms. They may resemble other pathologies in adults. Therefore, for the diagnosis and subsequent therapy of such enzymatic deficiency, more conservative methods and extended studies are used.

Video about lactase deficiency

Lactase deficiency during breastfeeding: