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Lactase

Lactose Intolerance

Lactose intolerance is a deficiency of the intestinal enzyme, lactase. Lactase is responsible for digesting the sugar found in milk called lactose. Lactose intolerance is characterized by uncomfortable gastrointestinal symptoms such as nausea, gas, bloating, diarrhea, and intestinal cramping. Lactose is comprised of two smaller sugars called glucose and galactose. Lactose alone cannot by absorbed successfully by the body through the intestine until it has been split into glucose and galactose. Lactase is an enzyme found on the surface of the cells lining the small intestine and acts as the scissors that cut the glucose and galactose apart for proper digestion. Lactose intolerance is indicative of a lactase deficiency in the intestines.

Lactose Intolerance Symptoms

The symptoms of lactose intolerance are most commonly gas, bloating, diarrhea, nausea, and cramping. The presence of these symptoms does not necessarily mean that lactose intolerance is the culprit as these can be common symptoms for a variety of gastrointestinal disorders. In the case of lactose intolerance, what causes the above mentioned abdominal symptoms? First, lactose passes through the small intestine and into the colon. Once in the colon, the bacteria containing lactase split the lactase into glucose and galactose. In the process, however, these bacteria also release hydrogen gas. Some of the gas is absorbed from the colon and into the body and is then expelled by the lungs in the breath. Most of the hydrogen is used up in the colon by other types of bacteria. A small amount of the hydrogen gas is expelled as flatulence. Some people have an additional type of bacteria in their colons that change the hydrogen gas into methane gas, and these people will excrete only methane or both hydrogen and methane

gas in their breath and during flatulence.

Colonic bacteria does not use all of the lactose that reaches the colon. The unsplit lactose draws water into the colon by osmosis, causing loose, diarrhea stools.

Three Main Causes of Lactose Intolerance

There are several causes for the development of lactose intolerance. Lactose intolerance can be congenital, secondary, or developmental. Congenital lactose intolerance is very rare and will be noticed very early in infancy. It is a lack of lactase caused by a mutation in the gene that is responsible for producing lactase. Secondary causes of lactose intolerance are the onset of diseases that strips the intestines of lactase and destroys the lining of the small intestine. Developmental lactose intolerance is the most common of the three causes and is a decrease in the amount of lactase produced over time. It occurs during or after childhood and into adulthood. This process is usually referred to as adult-type hypolactasia. It is a genetically programmed condition and will affect different ethnic groups in varying degrees. Additionally, the symptoms and severity of symptoms can vary greatly.

Lactase Deficiency

It is important to note that lactose intolerance and lactase deficiency is not necessarily the same thing. Someone who is lactose intolerant is deficient in lactase. However, many people can be deficient in lactase that are not lactose intolerant. There are varying degrees of lactase deficiency and the degree of the deficiency will dramatically impact the severity of symptoms. Some people who are mildly lactase deficient might not experience any uncomfortable symptoms at all.

Diagnosis of Lactose Intolerance

Many people erroneously believe they are lactose intolerant because it is a well-known condition to explain otherwise unexplainable gastrointestinal symptoms. However, there are multiple gastrointestinal disorders that can cause painful symptoms similar to those associated with lactose intolerance. There are several ways to determine if lactose intolerance is truly to blame for the symptoms. First, elimination of all milk related products from the diet can help to evaluate the effects of lactose on the body. The key to remember when using this method is that lactose can be found in many prepackaged foods. Therefore, it is necessary to carefully read the ingredients of all food before consumption to be sure that all lactose is actually eliminated from the diet. Many products will list ingredients such as whey, curds, milk by-products, dry milk solids, and nonfat dry milk powder. Lactose is commonly found in bread and other baked goods; processed breakfast cereals; instant potatoes, soups, and breakfast drinks; margarine; lunch meats (except those that are kosher); salad dressings, candies and other snacks; and mixes for pancakes, biscuits, and cookies. Additionally, many over the counter medications will contain lactose. A lactose elimination diet should also be done over a long period of time as lactose intolerance symptoms and severity can vary greatly and it could take a long and consistent test to accurately determine the results. Perhaps an easier test for lactose intolerance is the milk test where a person fasts overnight and then drinks a glass of milk in the morning. They should then wait 3-5 hours before eating or drinking anything else as symptoms caused by true lactose intolerance will present within a couple of hours of lactose being ingested. A physician can also do a hydrogen breath test, blood glucose test, or stool acidity sample (most commonly used for infants and young children).

Treatment

Lactose intolerance is primarily treated by dietary changes. It is usually recommended to cut out food and drinks containing lactose. Some people have found success in gradually and slowly increasing consumption of lactose to become more capable of eating dairy products. There are also lactase supplements that can be taken when consuming lactose.

Lactase Side Effects and Dosage

Lactase is widely considered to be safe. Most lactase supplements are recommended to take one, two, or three pills with meals or as needed. Over dosage on lactase is not likely. Lactase can be an effective and safe way of enjoying foods containing lactose without the painful gastrointestinal symptoms.

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