Lactase deficiency in children and adults:symptoms, treatment, causes

Update: December 2018

Lactase deficiency is a syndrome that occurs due to
impaired digestion of lactose and characterized by watery
diarrhea Pathology appears when there is a shortage of intestines.
lactase enzyme capable of digesting milk sugar (lactose).
Therefore, it should be understood that the term lactose deficiency is not
There is a mistake. Lactose is milk sugar and disadvantage
enzyme for its breakdown (lactase) and is called lactase
insufficiency.

There are several signs that indicate lactase
failure in children and who should immediately alert the young
mom:

  • baby age 3-6 months
  • the chair is liquefied, foamy
  • the stool has a sour smell
  • abdominal distention

Surprisingly, this pathology is most common in
Vietnamese and Indians, but the Dutch and the Swedes
practical it does not suffer. In Russia, up to half of the population has
the lack of this enzyme in varying degrees, and lactase
failure can periodically appear and disappear.

Most of all, children are suffering from lactase deficiency. She is
is one of the common causes of exhausting intestinal colic (see
what to do with colic in a newborn) and a frequent reason for
termination of breastfeeding. Dairy sugar in nutrition
child covers up to 40% of energy needs.

Types of enzyme deficiency

Primary lactase deficiency is a deficiency syndrome.
enzyme in intact intestinal cells enterocytes. Here
concerns:

  • congenital LN – very rare, occurs due to
    genetic mutation
  • transient LN of premature babies – appears in
    Newborns born to the 34th-36th week:
    enzyme activity is not sufficient
  • lactase deficiency in adults is not a pathology,
    and reflects the natural process of decreasing lactase activity with
    by age.

The same Swedes and the Dutch and other northern Europeans
lactase retains a high activity throughout life, which
can not be said about the inhabitants of Asia.

Secondary lactase deficiency is an enzyme deficiency
resulting from damage to intestinal cells. Exactly
Lactase deficiency is the most common form of deficiency.
intestinal enzymes, as a feature of the structure of intestinal villi
such that lactase is located closest to the lumen, the first
gets hit by adverse factors.

What is dangerous lactase deficiency?

  • Dehydration develops as a result of diarrhea, a special
    danger is in infants
  • Absorption of calcium and other minerals is impaired.
  • Growth of beneficial microflora due to lack of
    the nutrients produced by splitting the dairy
    Sahara
  • Reputable rotten microflora
  • Disrupted intestinal motility regulation
  • Immunity suffers

The reasons

CongenitalLN Mutation of the gene controlling lactase activity
Transient LN Insufficient enzyme activity at the time of birth
LN in adults
  • Natural involution (reverse development) activity
    an enzyme
  • Bowel disease (inflammatory, infectious,
    dystrophic), which led to the destruction of enterocytes
Secondary LN 1. Inflammatory and dystrophic processes in the intestine,
resulting from:

  • infections: rotavirus, giardiasis and others
  • food allergies
  • gluten intolerance (celiac disease)
  • Crohn’s disease
  • radiation injury
  • drug exposure

2. Reducing the area of ​​the intestinal mucosa after removal of part
bowel or short bowel syndrome

Lactase activity may vary. Besides the main factors
the enzyme is affected by numerous biologically
active substances: thyroid and pancreatic hormones,
pituitary hormones, nucleotides, fatty acids and amino acids,
in the lumen of the intestine, glucocorticosteroid
hormones.

Symptoms

Symptoms лактазной недостаточности как первичной, так и
The secondary is usually similar. The only difference is that with primary LN
pathological manifestations are observed within a few minutes, their
severity depends on the amount of lactose consumed. Secondary LN
reveals itself by drinking even a small amount of milk
Sahara, так как отсутствие его расщепления сочетается с какой-либо
intestinal pathology.

Common signs of a lactase deficiency are:

  • diarrhea characterized by watery, frothy stools with greens
    and sour smell, a lot of gases
  • боль, урчание в stomach, рвота
  • abdominal distention, снижение аппетита
  • regurgitation in infants (causes), attacks of intestinal colic,
    restlessness, reduced weight gain, crying during feeding
    characteristic of lactase deficiency in infants.

Distinctive features of individual forms

Врожденная ЛН – это редкий, но тяжелый вид an enzymeтивной
failure, dangerous dehydration and severe toxicosis. Mama
can understand it from the first days of a child’s life when feeding
breast milk leads to vomiting and unstoppable diarrhea.
It helps only the abolition of breast feeding and drinking
lactose free mixtures.

Primary LN appears only after taking a large amount
milk At an early age, she may be disguised as normal.
intestinal colic that most babies bother. With growth
baby microflora can adapt to milk sugar with
using breeding relevant bacteria. With time
симптоматика проявляется только при излишнем употреблении milk
At the same time, dairy products are well tolerated, since
support the growth of milk sugar splitting bacteria.

Secondary LN может появиться в любом возрасте вследствие
any disease. Specific symptoms of lactase
deficiencies manifest badly, as the main role is played
the main pathology of the intestine. However, a non-dairy diet helps
slightly improve the condition.

How to determine for yourself that it is lactase
failure? Symptoms очень стойкие, отсутствует эффект от
treatment. Pathological manifestations disappear only when
diets with the exception of lactose.

Tests for lactase deficiency

  • Нагрузочный тест с лактозой: определяют прирост Sahara в крови,
    building a curve. При дефиците an enzyme на графике виден уплощенный тип
    curve, that is, there is no normal increase due to lack
    всасывания Sahara.
  • Analysis of feces: feces for lactase deficiency pass for
    determine the content of carbohydrates. Normal carbohydrates should not be
    допускается 0,25% у грудничков, также оценивается его рН  —
    when LN level falls below 5.5.
  • Hydrogen breath test. Along with the load test need
    to pass an analysis to determine the concentration of hydrogen in the exhaled
    air: a sample is taken every 30 minutes for three hours after
    lactose load.
  • Определение активности an enzyme с биоптата или смыва со
    intestinal mucosa. This is the most informative method for determining LN, but
    its use is not always justified due to the difficulty of taking
    analysis.
  • Genetic research to identify mutations of certain
    genes responsible for lactase activity.
  • Diagnostic (elimination) diet with the exception of milk
    Sahara при наличии лактазной недостаточности улучшает состояние
    intestinal symptoms of the disease disappear.

If you suspect lactase deficiency should be excluded
other possible causes of diarrhea that may be enough
severe (see diarrhea and vomiting in a child without fever).

Treatment of lactase deficiency

It includes several stages: Лактозная недостаточность у детей

  • Medical nutrition, reception of food supplement Lactase Baby (370-400
    rubles), Lactase Enzyme (560-600 rubles), Lactazar for children (380 rubles)
    , Laktazar for adults (550 rubles).
  • Pancreas help (enzymes: pancreatin, mezim forte,
    festal, creon and others)
  • Correction of intestinal dysbiosis (prebiotics and probiotics:
    Bifidumbacterin, Linex, Hilak Forte and others. See the full list
    probiotics)
  • Symptomatic treatment:
    • Medications for bloating – Espumizan, Subsimplex, Bobotic
    • Diarrhea – see all medications for diarrhea
    • From pain – antispasmodics No-shpa, drotaverina hydrochloride.

Health food

Diet for lactose deficiency involves complete
elimination of lactose or limiting it in the diet in accordance with
carbohydrate level in feces. Complete elimination of lactose is temporary.
and a compulsory measure in a serious condition of the child (dehydration,
упорная диарея, сильная боль в stomach).

Refusing to use lactose should not be at all, since
It is a natural prebiotic. Therefore, the main task on
this stage – individually step by step to choose a diet with this
amount of lactose, which does not cause indigestion and does not
provokes the excretion of carbohydrates with feces.

How to treat lactase deficiency if the child is on
breastfeeding? Modern standards do not imply full
non-breastfeeding. For such children apply
replacement enzyme therapy: the drug is added to the expressed
milk, after fifteen minutes of exposure, the child is fed by her mother’s
milk To do this, use the food additive Lactase Baby (price
370 руб): одной капсулы хватает на сто миллилитров milk After
feeding expressed milk to a baby is given a breast.

Children on artificial or mixed feeding picked up
the optimal combination of a lactose-free mixture and the usual mixture.
The ratio of mixtures with lactase deficiency may be different:
2 to 1, 1 to 1 and so on (depends on the child’s reaction). If deficiency
lactase is strongly expressed, use only low or lactose free
mixes.

  • Low lactose mixture: Nutrilon low lactose, Nutrilak
    low lactose, Humana LP + SCT.
  • Lactose-free mixtures: Nan-lactose-free, Mamex lactose-free,
    Nutrilak lactose free.

Introduction of complementary foods

When lactase deficiency should be especially carefully lead
Complementary feeding diary, as some foods may cause
такую же патологическую реакцию: abdominal distention, диарея.

Begin priming with vegetables, using one vegetable for one
a few days. Their number is adjusted to 150 grams for 14
days Then add to the ration porridge on the water with a low content
gluten (rice, buckwheat, corn), also increasing the mass eaten
complementary foods. The next step is to give the baby meat.

After 8-9 months you can give a little dairy products.
(kefir, yogurt), carefully tracking the reaction. But the curd
sick children are not recommended for up to one year (see details on
introduction of complementary foods to healthy infants).

Further nutrition

Further diet of the child, as well as an adult with a deficiency
The enzyme is selected individually, based on the reaction of the body.
What signs indicate that a product can
use, even if it contains milk sugar:

  • normal stool – decorated, without pathological impurities and
    sour smell
  • no increased gas formation
  • lack of rumbling and other discomfort in
    stomach

First, there should be a lot of food in the diet, not
containing lactose: fruits, vegetables, rice, pasta, meat and fish,
eggs, beans, nuts, tea, coffee, buckwheat, corn.

Then in the diet you need to add products with lactose, but
track the reaction to the product and its quantity:

  • dairy products – milk, cheese, yogurt, cottage cheese, sour cream,
    butter, ice cream (see whether you can give whole milk
    to kid).
  • other products in which lactose is added as
    additional component – bread, sausages, biscuits,
    cocoa, ketchup, mayonnaise, chocolate and many others

Sour cream, cream, low lactose are considered low lactose.
milk, three-day kefir, hard cheese.

It must be remembered that the diet relieves the condition of patients with LN, but
also deprives them of their main source of calcium, so the issue of
Completion of this trace element must be solved with
by the attending physician.

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