What is Lactose Intolerance and How Does it Develop?

Definition: 

The inability to digest and absorb lactose (the sugar in milk) causes gastrointestinal symptoms when milk or products containing milk are consumed.

Types: 

It may be primary or secondary:

Primary–

It is characterized by congenital absence of lactase enzyme due to a mutation in the gene that is responsible for the production of lactase.

Secondary–

more common than primary and self-limiting. There is the destruction of microvilli in the intestine resulting in lactase deficiency (which is present at the tip of microvilli). After the regeneration of the new cells, the condition is corrected. As lactase enzyme is present in the newly regenerated cells.

Clinical Features of Lactose Intolerance:

The child is usually stable and presents with pain abdomen, flatulence, and passage of frequent small amounts of stools soon after the feeds with perianal excoriation (due to acidic stools).

Stools have typical characteristics  (soapy, syrupy, and soundly borborygmi).

Diagnosis: Typical history plus Investigations

Investigations-

1. Stool examination– 

stools become normal once the food containing lactose is stopped.

    Stool for reducing substances– Positive

    Stool pH– Decreased 

2. Oral tolerance test–

 lactose 2 g/kg is given orally. 

    The rise in blood sugar <20 mg/dL indicates lactose intolerance.

3. Hydrogen breath test–

    Based on the fact that-  The hydrogen breath test measures the amount of hydrogen and/or methane gas excreted in breath after a Child drinks a lactose solution. If the levels of hydrogen and/or methane in breath are high, it suggests that the child is not able to digest lactose properly. This is called carbohydrate malabsorption or lactose intolerance. The test involves collecting breath samples every 10-15 minutes for 3-5 hours after drinking the lactose solution.

Procedure: Hydrogen excretion is measured after giving oral lactose 2 g/kg (maximum 50 g) with water after an overnight fast. 

Treatment:

1. Diet modification:

 Primary lactose intolerance- babies should be fed with a lactose-free diet lifelong. Stop milk and products containing lactose. 

Secondary lactose intolerance- milk and products containing lactose are stopped temporarily for a few days. As the gut cells regenerate, these can be reintroduced.

2. Lactase enzyme- lactase can be taken with milk-containing foods.

3. Calcium and vitamin D supplements-

 both to be given in cases of primary lactose intolerance since milk and its products are stopped lifelong.

Common dairy products include milk, curd, cheese, yogurt, milk chocolate, and cream.

FREQUENTLY ASKED QUESTIONS

Q-What foods trigger lactose intolerance?

Answer – milk and milk-related products contain lactose

Q-How do I know if I’m lactose intolerant?

 Ans- pain, loose stool after taking milk and related products with flatulence, and stool for   reducing substance become positive

Q- Can lactose intolerance be cured?

Ans – Secondary lactose intolerance is curable but not primary

Q-Do eggs have lactose?

Q-How do you fix lactose intolerance?

Ans – simply by diet modification

Q-How can I test for lactose intolerance at home?

      It has a typical history.No homemade test

Q-What foods contain lactose?

Ans – milk and milk-related products contain lactose

Q-Am I secretly lactose intolerant?

Q-Is lactose in chocolate?

 Ans – yes

Q-What are common symptoms?

Q-क्या आप अचानक लैक्टोज असहिष्णु हो सकते हैं?

 Answer –ha ho sakte yadi intestine ka infection lag jaaye