Why is milk sugar not absorbed?
Lactase is produced by the cells of the villi of the small intestine. Babies have a lot of it, and for most people in the world, after weaning, production gradually decreases - this is a genetically programmed process. If enzyme activity drops below a certain level, lactose from milk is not completely absorbed. The severity of complaints depends on the amount of lactose eaten, the speed of food passage and the composition of the intestinal microflora.
- Primary (adult type) - age-related decrease in lactase
- Secondary - damage to the mucosa due to intestinal infection, celiac disease, Crohn's disease, giardiasis
- Transient in premature infants
- Congenital alactasia is a very rare hereditary form
Symptoms
Complaints occur after milk, ice cream, soft cheeses, cream, as well as products with hidden lactose. Fermented milk products and hard, aged cheeses are better tolerated because they contain less lactose. In infants, signs may include frequent foamy, sour stools, fussiness, and regurgitation with normal weight gain.
- Bloating and rumbling in the stomach
- Cramping pain around the navel
- Loose or mushy stools
- Increased gas formation
- Sometimes nausea
How is it different from a milk allergy?
Lactose intolerance is due to an enzyme and sugar, while allergies are due to an immune reaction to cow's milk protein. Allergies are more common in children in the first year of life and can manifest as rash, vomiting, blood in the stool, cough, and in severe cases, swelling and difficulty breathing. For allergies, lactose-free milk is not suitable because the protein is retained in it. Therefore, before changing the child’s diet, it is important to show him to the pediatrician.
- Lactase deficiency is dose-dependent, small amounts of milk are tolerated
- Allergy - a reaction to even traces of protein
- Lactase deficiency does not cause urticaria or swelling
Diagnostics
The simplest way is a trial elimination of lactose for 2–4 weeks, followed by the return of dairy products: if the complaints go away and return, the diagnosis is likely. A more objective method is a hydrogen breath test: after taking a lactose solution, the hydrogen content in the exhaled air is measured. A stress test with blood glucose determination is also used. If there are alarming signs, the doctor will rule out celiac disease, inflammatory bowel disease and parasitosis.
- Trial lactose-free diet
- Hydrogen breath test with lactose
- Blood glucose stress test
- Coprogram, in children - stool analysis for carbohydrates
- According to indications - tests for celiac disease and giardiasis
Treatment and nutrition
There is no treatment that restores lactase production in the primary form, and it is not necessary: it is enough to select a tolerable amount of lactose. Most adults have no problem drinking a small portion of milk with their meals. It is not recommended to completely eliminate dairy products, as they are an important source of calcium. In the secondary form, the underlying disease is treated, after which milk tolerance is usually restored. For infants, the doctor may recommend lactase preparations; There is usually no need to stop breastfeeding.
- Drink milk in small portions and with other foods
- Choose kefir, yogurt, katyk, hard cheeses
- Use lactose-free milk
- If necessary, take lactase tablets before meals
- Ensure sufficient calcium and vitamin D intake