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 milk4 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 youre able to drink small amounts of milk or eat yogurt,
choose varieties that have vitamin D added.
Its 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 milk4 ounces or
lessat 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.