Symptoms and treatment of lactase deficiency. lactase deficiency

Every fifth child is being treated for lactase deficiency in Russia today. This diagnosis, which a decade and a half ago was considered only a scientific term that has little to do with practice, has now become more than popular. However, pediatricians did not come to a consensus, and therefore it is difficult to find a more controversial and incomprehensible issue regarding the health of infants. The well-known pediatrician and author of books, articles Evgeny Olegovich Komarovsky.

About the problem

Lactase deficiency is the absence or temporary decrease in the body of a special enzyme called "lactase". It can break down milk sugar called lactose. When there is little enzyme, milk sugar remains undigested, its fermentation in the intestine begins.

Most often, such a diagnosis is made to children whose age is up to a year. Quite rarely, babies under 6-7 years old suffer from lactase deficiency. After this age, the physiological extinction of the production of the enzyme occurs, since nature does not provide for the consumption of milk by adults. It is extremely rare that the pathology persists in adults, but this is considered to be a variant of the norm, since milk is not an important product for their body.

Lactase deficiency can be congenital, primary. It is also secondary, acquired. Such failure occurs in case of damage to the walls small intestine. This may be the result of an infection (rotavirus, enterovirus), toxic poisoning, severe helminthic invasion, an allergic reaction to cow protein.

More often than others, premature babies and babies who are overfed and who receive more milk than they can digest suffer from lactase deficiency.

Regarding this diagnosis, modern medicine quite optimistic forecasts: in 99.9% of cases, enzyme deficiency resolves on its own, with the elimination of the causes that caused it.

Doctor Komarovsky about the problem

For adults, lactase deficiency is not a problem, Evgeny Komarovsky believes. Nothing bad will happen if a person simply does not eat dairy products. However, for babies in whom milk is the basis of nutrition, things are somewhat more complicated.

Decreased lactase levels may be genetically determined, says Evgeny Komarovsky. If mom or dad does not tolerate or did not like milk in childhood, then the likelihood of having a baby with a lactase deficiency is quite high.

However, Evgeny Olegovich emphasizes that medicine knows very little of real cases of congenital primary lactase deficiency (30-40). These are really very sick children who do not gain weight, constantly spit up profusely, and suffer from a tummy. The proportion of such cases is about 0.1%.

In all other cases, it was not without the influence of pharmaceutical magnates, who really need to sell lactose-free milk formulas for artificial feeding in large volumes. They cost much more than other food, but parents who have been put in a stalemate are ready to pay as much as they like, so long as the baby lives and develops normally.

In premature babies, lactase deficiency can be explained by the immaturity of the body, they often have transient insufficiency. It passes by itself - as the organs and systems mature. The severity of the disease can be complete or partial.

Evgeny Komarovsky emphasizes that real lactase deficiency is a rather rare case. For this reason, it is not worth stopping breastfeeding and transferring the child to lactose-free sweeps due to suspicions of a lactase enzyme deficiency.

To dispel doubts or confirm the diagnosis that has become so popular recently, Various additional diagnostic methods are used:

determination of the level of acidity of feces;
carbohydrate analysis;
diet tests.

During the tests, under the supervision of a doctor, breastfeeding is temporarily canceled, adapted mixtures.

The child is given only lactose-free or soy mixtures for 2-3 days. With a decrease clinical manifestations diagnosed with lactose intolerance.

In all cases (except for severe congenital ones, which, as already mentioned, occur only in 0.1% of cases), lactase deficiency is purely temporary.

The most common cause of milk sugar intolerance in children is banal overfeeding. Parents try so hard to feed their child that they give him the amount of formula or milk that exceeds all conceivable norms. As a result, a child whose enzymes are normal is diagnosed as "lactase deficiency" only because his small body cannot break down such a large amount of milk sugar.

Formula-fed babies are the most commonly affected by overfeeding because they make little effort to get bottle-fed.

Babies who suckle breast milk is much more difficult. Sometimes mothers and fathers do not understand what exactly the child wants. The child wants to drink and screams, and they give him food, believing that the baby is hungry. This can also lead to transient lactase deficiency.

Treatment according to Komarovsky

A temporary (transient) lack of the lactase enzyme does not need treatment, says Komarovsky. The production of the enzyme in the right amount will be restored immediately after the cause of the violation is eliminated (the baby will stop overfeeding, they will begin to observe the drinking regimen).

At secondary insufficiency lactase caused by intestinal viral infections, the child is prescribed special drugs. It is advisable to limit food, reduce its volume. Sometimes it is appropriate to start giving your baby probiotics.

A child with a genetically determined lactase deficiency is given lactose-free mixtures for up to six months, and then gently, gradually begin to introduce dairy products into the diet.

A nursing mother should not sound the alarm when she sees a greenish liquid feces with a sour smell. This is a reason to go to the pediatrician, but not a reason to wean the baby from the breast. Moms should not start to mock themselves. The opinion that maternal nutrition affects the lactose content in milk is nothing more than a myth. Lactose in breast milk always contains the same amount, which does not depend on the gastronomic preferences of the woman, the time of day and the frequency of feeding.

So that the artificial person does not overeat, you need to give him a mixture from a bottle with a nipple with a small hole. The harder it is for him to suckle, the faster he will feel full. The less likely he is to overeat.
If you are going to reduce the amount of lactose in food, you need to find out which foods contain it the most. The undisputed leader in the percentage of lactose is women's breast milk (7%), cow and goat milk sugar contains approximately the same amount (4.6% and 4.5%, respectively). In the milk of a mare and a donkey, lactose is almost the same as in women's - 6.4%.
If you have thoughts about acquiring a lactose-free mixture, you should first try giving your child low-lactose Nutrilon and the same Nutrilak.

Dr. Komarovsky will tell more about lactase deficiency in the video below.

In this article:

In order for breast milk to be absorbed in the body of a newborn baby, the lactase enzyme is needed, which breaks down milk sugar - lactose. It is necessary to distinguish between these consonant concepts in order to avoid terminological confusion. The concept of "lactose deficiency" does not exist. When infants have a clinical picture of a violation of the digestion of breast milk, doctors make a diagnosis of lactase deficiency.

When it comes to this pathological disorder, they mean the development of a syndrome that is formed against the background of the absence of lactase and is accompanied by the occurrence of specific symptoms.

General ideas about the disease

Lactose tolerance in humans was formed in the process of evolution and became possible due to the appearance of a certain gene in the DNA chain. In different ethnic groups inhabiting the globe, the frequency of distribution of this gene is different.

The presence of this type of fermentopathy can be guessed by the appearance of certain symptoms when eating dairy products, which disappear on the background of a dairy-free diet and reappear when returning to a normal diet.

In what cases can the disease occur

Depending on the causes, there are several types of fermentopathy that can form in absolutely any age category of patients.

First of all, there are two types of lactase deficiency - primary and secondary.

The causes of lactase deficiency in newborns in the first case are a decrease in the level of the enzyme while maintaining the integrity of the intestinal cells and can lead to the formation of the following pathological conditions:

Lactase deficiency in preterm infants is due to the immaturity of all systems of a child born before the 35th week of pregnancy, as well as insufficient enzyme activity in case of premature birth.
Congenital lactase deficiency in infants develops as a result of mutations in the milk sugar tolerance gene.

The secondary form of the disease develops as a result of damage under the influence of various adverse factors of the cellular structures of the intestine:

The development of pathogenic processes in this section of the digestive tract, which are dystrophic or inflammatory in nature. The precipitating factors may be allergic reactions food, intestinal infections, or side effect some medicines.
Decrease in the surface area of the intestinal mucosa, for example, as a result of surgery.
Changes in hormonal levels and disruption of metabolic processes in the body.

Establishment true reasons development pathological condition plays an important role in determining the principles of further treatment.

What are the consequences of the disease

In the absence of specific treatment for fermentopathy, a lack of lactase can lead to the development of the following disorders:

weakening of the immune system;
dehydration of the body as a result of massive fluid loss due to incessant;
development of dysbacteriosis;
creation favorable conditions in the intestines for the growth of putrefactive microflora;
decrease in the intensity of absorption processes of mineral substances, primarily calcium;
violation of peristalsis.

During the neonatal period and up to 1 year of age, the most dangerous complication the development of this type of fermentopathy is the threat of dehydration (dehydration) of the child's body.

What indicates the development of the disease

How is lactase deficiency manifested in infants? The symptoms of the pathological condition in babies are almost the same, the only difference between the manifestation of primary and secondary fermentopathy is due to the amount of dairy products consumed, which provokes the appearance characteristic features diseases.

In the secondary form of the disease, specific symptoms appear when using small amounts of products containing lactose. Primary fermentopathy manifests itself when consumed a large number breast milk.

Signs of lactase deficiency in infants are as follows:

violation of peristalsis in a child - the appearance of vomiting, rumbling in the abdomen and pain;
flatulence;
loss of appetite;
decrease in the intensity of weight gain in the baby;
stool with lactase deficiency in infants is watery, frothy (due to the accumulation of gases in the intestines), contains an admixture of greenery, and has an unpleasant sour smell.

A rash with lactase deficiency in infants is possible only in clinical cases of the development of a secondary form of the disease, when food allergy is its provoking factor.

Diagnostic measures

How to determine lactase deficiency in infants? First of all, in differential diagnosis, much attention is paid to the symptoms that are noted in the baby:

Primary fermentopathy often manifested as intestinal colic in a child. In most clinical cases, the baby's body eventually adapts to lactase deficiency by stimulating the growth of certain microflora in its intestines, and the manifestation of pathological signs in the future is possible only with excessive milk consumption.
With secondary fermentopathy symptomatology of the underlying disease comes first. You can guess about the decrease in the level of lactase in the body of a child by using a dairy-free diet. At the same time, there is a significant improvement in the clinical picture of the pathological condition.
congenital form The disease manifests itself after the first feeding of the baby in the form of uncontrollable vomiting and diarrhea.

How to identify lactase deficiency in infants on your own? To suspect the development of this particular type of fermentopathy, and not the usual colic of newborns, the mother can on such grounds as the stability of pathological symptoms and the absence therapeutic effect from drugs that reduce the manifestations of flatulence: massage the tummy, performing a bicycle exercise, holding a child in a column, and others. With the development of lactase deficiency, the baby's condition is normalized only if a dairy-free diet is observed.

Specific tests for lactase deficiency in infants are as follows:

analysis of feces for lactase deficiency in infants - the content of carbohydrates in it is determined, and the pH level is also set;
biochemical study of feces to determine the type of microflora that inhabits the intestines;
biopsy examination of biological material obtained from the small intestine to determine the activity of lactase;
urine analysis to detect the presence of lactose in it;
medical genetic testing.

Timely conduct of specific diagnostics helps to exclude the development of severe pathological disorders in the baby, which can provoke the formation of extremely serious complications. Also, differentiation of the root cause of the development of fermentopathy determines the principles of how to treat lactase deficiency in infants.

Therapeutic measures

When, after the examination, lactase deficiency is nevertheless established in the baby, what should I do next? In no case should such a violation be ignored. Correction of lactase deficiency is required using a medical approach, otherwise the growing child will lag far behind in terms of intellectual and physical development.

Treatment, when certain symptoms indicate the development of lactase deficiency in a newborn or in an infant, is determined only by a doctor:

With the development of primary fermentopathy, one of the main principles of therapeutic measures is the organization of a diet - special mixtures are used for lactase deficiency in infants, which do not contain lactose.
Additionally, certain medications are prescribed for lactase deficiency in infants, active substance served by lactase.
Bifidumbacterin or Linex with lactase deficiency in infants are used under the condition of a mild course of the disease. In this case, probiotics help to normalize the microflora present in the intestine.
Treatment of secondary lactase deficiency in infants involves, first of all, the elimination of the root cause of the development of fermentopathy.
How to replenish calcium in lactase deficiency in infants? In this case, experts recommend using vegetables, bean curd, legumes, which have an increased content of the mineral, as complementary foods. It is strictly forbidden to use complementary foods from dairy products for this purpose.

On condition breastfeeding baby, the mother's diet for lactase deficiency in infants provides for limiting the consumption of dairy products, but not a complete rejection of them. In addition, from the mother's diet with lactase deficiency in infants, it is necessary to remove foods that provoke increased gas formation in the intestines (black bread, sweets, grapes).

When does lactase deficiency in infants go away? Complete recovery of the child is possible only if fermentopathy is not caused by genetic factors. In all other cases, dietary correction allows you to improve the baby's condition after 3-4 days, and complete recovery occurs a week after the start of therapeutic measures.

As a preventive measure for the development of fermentopathy, it is recommended to follow the rules of breastfeeding (replacement of the breast only after it is completely empty, the inadmissibility of interrupting the feeding process) and not to eat foods that can cause the development of allergic reactions to the mother.

Useful video about lactase deficiency in children

Lactose deficiency in infants occurs in rare cases due to the peculiarities of digestion. Breast milk is not suitable for such children, and mothers are worried about what they can feed their child and how this intolerance will affect the development of the newborn. If breastfeeding causes your baby to cry, spit up, lose weight, have problems with digestion and stool, you should see a doctor to examine your baby. He will determine if these symptoms are signs of lactose intolerance.

Lactase deficiency is a type of disease that is manifested by a lack of the lactase enzyme, which performs the function of breaking down sugar. And lactose is a disease in which the intestines cannot cope with the digestion of the carbohydrate lactose. Both diseases are characterized by the absence of the lactase enzyme in the intestines of the baby, which breaks down the carbohydrate lactose into two components - glucose and galactose.

Lactose is important for the development of the child, as it gives the baby 40% of the energy he needs, normalizes the work of the microorganisms necessary for the intestines and helps the brain and eyes of the newborn to develop properly. Lactase deficiency does not allow lactose to be absorbed in the intestines of the baby. It leads to a deficiency of the necessary substances and energy, as a result of which the development of the child may slow down.

Types of lactose intolerance

There is a congenital and acquired intolerance to this enzyme.

Congenital is the absence or decrease in the amount of lactase, so it can often be determined during the first 30 days of a newborn's life.
Acquired intolerance is caused by diseases of the digestive system, in which the level of lactase decreases. With proper treatment, it resolves within 60 days.

Reasons for the appearance

The most severe form of the disease develops due to a hereditary predisposition, when the baby's body suffers from lactase deficiency and cannot provide enough enzyme due to genetic disorders. This disease It is diagnosed when an increase in the amount of breast milk consumed by a child, which usually occurs at 3-4 weeks of age. With this form of the disease, there is no treatment, and the baby is prescribed a special diet and medications containing lactase.
If a child was born prematurely, then there is not enough lactase in his body, since this enzyme begins to be produced in the baby even inside the mother's womb from 6 to 9 months of pregnancy.
With the defeat of enterocytes that produce lactase, acquired lactase deficiency develops in the intestine of the newborn. This disease can occur due to rotavirus infection, giardiasis, viral or drug enteritis.

Symptoms

Symptoms include the following:

poor appetite;
sluggish sucking of the breast by the child, accompanied by crying and frequent breaks;
after feeding, the child spits up, vomiting is possible;
increased gas formation;
the baby pulls its legs to the stomach, cries;

Congenital lactase deficiency has the following symptoms:

frequent colic;
the presence of flatulence;
the presence of a frothy greenish watery stool with undigested lumps, which has an unpleasant sour smell, up to 10-12 times a day.

If lactose intolerance is observed for a long time, there may be a lag in the development, growth and weight of the baby.

Diagnostics

For exact definition diagnosis during the examination, it is necessary to pass certain tests.

Feces for carbohydrates. This analysis is assigned to all infants who have symptoms of lactose intolerance. However, such a study does not have accuracy due to the lack of norms and the identification of the type of sugars.
Carrying out a coprogram. Responsible for defining advanced level acidity and increased presence of undigested lumps of milk.
Breath test. The analysis is aimed at examining the inhaled air when the baby drinks a lactose solution. An elevated hydrogen level resulting from a reaction to bacteria in the gut is the diagnosis.
Drinking sugar solution. This analysis, using regular blood sampling to determine the level of glucose, builds a lactose curve. However this method difficult to implement with babies.
Biopsy of the intestinal mucosa. This analysis is rarely performed, as it requires anesthesia. It is the most accurate way to determine the disease.

With each diagnostic method, it is necessary to compare the results that the analysis gave with the state and course of the disease. The main study is the reaction of the baby to milk intake. If there are no signs of lactose intolerance, the diagnosis is called into question.

How to treat

Treatment of lactase deficiency is prescribed only by a doctor and after diagnosis. With this disease, when feeding the baby, dairy products are excluded, constant monitoring of changes in his condition is carried out.

If the analysis showed a severe course of the disease, instead of breast milk, mothers can offer the child therapeutic lactose-free or soy mixtures that normalize the baby's condition.
If the amount of lactase in the baby’s body is reduced, treatment is carried out with special preparations containing this enzyme. A diet is being developed for the mother. Also, a woman should express the anterior portion of milk, because the posterior portion contains more lactase.
If a child is diagnosed with acquired lactase deficiency, the underlying disease that affects the intestinal mucosa is treated. The disease gradually disappears when the disease is exposed proper treatment and eventually all symptoms disappear.

Food

After the parents have passed the necessary analysis, which confirmed lactose intolerance, a diet and specific nutritional methods are prescribed for both the mother and the baby. The diet consists in the exclusion of this carbohydrate from the diet. First, you need to stabilize breastfeeding, for which the baby needs to be fed with more fat milk. There are several ways:

expressing foremilk;
give the baby only one breast;
try to attach the newborn to the chest in the correct position;
try to feed more often at night, when milk has a high fat content;
stop feeding the baby when he comes off the breast.

Moms need to remove cow's milk from their diet, the protein of which can disrupt the functioning of the intestinal cells of the baby and reduce the formation of lactase. Also, the doctor may exclude other products, which during the study will determine the analysis to identify allergens.

When the disease recedes

If the baby has hereditary lactose intolerance, the child will be prescribed a lactose-free diet for life, adhering to which, he will ease the symptoms of the disease.

Acquired intolerance due to special treatment recedes by the age of one, but in rare cases, the symptoms disappear only by 3 years. To diagnose recovery at the end of treatment, a re-analysis is performed.

So that lactase deficiency does not develop in a severe form, leading to a lag in the growth and development of the child, it is necessary to notice the signs of the disease in the child in time, diagnose and, when the doctor prescribes treatment, strictly adhere to it.

The baby had more frequent attacks of colic, diarrhea appeared with characteristic frothiness and greenery in feces Decreased appetite and weight? If at the same time the baby is also breastfed (HB), the mother falls into no less excitement.

Trying to find the cause of her bloodline's anxiety, she goes through dozens of different diagnoses, until she stops at the question: what are lactase deficiency symptoms in infants (LN)?

And although such a statement is not entirely correct, the bottom line is this: the reason for the ailments of a little man can lie precisely in breast milk - the baby cannot cope with its digestion.

How to understand why this happens and what to do, read on.

Most often, mothers, especially new ones, have two misconceptions.

Firstly, it is difficult for a woman to get used to the fact that breast milk, the benefits of which are thousands of odes and which, without a doubt, is the best product for the baby and the source of all kinds of “usefulness”, can cause at least some harm to the tiny body.

The second misconception is that having independently diagnosed lactase deficiency in a child, the mother decides to change breastfeeding to artificial. Meanwhile, the best way out, for starters, will be a visit to the pediatrician.

What is the difference between lactose and lactase

Breast milk nourishes the baby with energy and contains many trace elements that are important for the proper formation of the skeleton, nervous and cardiac systems and all internal organs. Milk sugar (a carbohydrate from disaccharides), called lactose, is also very useful. To digest lactose, splitting it into glucose with galactose, helps a certain enzyme that "lives" in the small intestine - lactase.

Sometimes the enzyme fails to process milk sugar, and then the remaining (unsplit) part of the lactose passes further into the large intestine. There, thanks to her stay, there is an active formation of dairy non-pathogenic bifidus and lactobacilli.

All these Lactobacillus are very useful, because they act as a kind of protector of the gastrointestinal tract from harmful fungi.

But because of their fermenting nature, these bacteria provoke the active formation of gases, liquefaction of the stool.

That is why the main symptoms of lactase deficiency in infants are associated with increased bloating, intestinal pain and watery diarrhea.

This is not only very uncomfortable for the newborn, but also harmful:

intestinal peristalsis and the growth of beneficial microflora are disturbed;
diarrhea threatens with dehydration of the body and a failure in the absorption of calcium;
the growth of putrefactive microflora is enhanced;
the child is lagging behind in weight gain;
Immunity can be drastically reduced.

Causes of the "conflict" of lactose with lactase

Why lactase does not want to be "friends" with lactose and what is lactase deficiency (hypolactasia), a logical question arises.

Of the main ones, two types of LN are distinguished, each of which is due to certain reasons:

Primary lactase deficiency in newborns (it is also present in adults) is characterized by the absolute absence of an important enzyme. The causes of primary LN may be due to premature birth of the mother (in premature babies who were born on the 28th week of intrauterine development and on the 34th, digestive system immature and too low lactase levels) or are caused by congenital genetic abnormalities.
Secondary, which is characterized by a partial deficiency of lactase. Infections (rotavirus, giardiasis), gluten intolerance, drug and food allergies can lead to such LN.

Among other things, it affects the formation of the enzyme and the hormonal background (thyroid and pancreas).

And, in addition, there is another type of hypolactasia associated with an elementary "overeating" of lactose.

In this state of affairs, the baby produces the required amount of the enzyme, but either the mother concentrates a lot of “front” milk rich in carbohydrates, or the child is overfed.

In this case, lactose deficiency in children is the easiest to eliminate: by adjusting breastfeeding approaches, there is a chance to save the baby from suffering and pain in the tummy in just 48 hours.

What should alert mom

Each mother is informed in the maternity hospital that a nursing baby is prone to colic, so it will not always occur to a woman to associate bloating with lactase deficiency in a child.

Here is a list of symptoms that seem to signal: “Attention, lactose deficiency in newborns is possible!”:

excessive gas formation and colic;
bowel movements eight to twelve times a day (while the contents of the diaper are liquid, foamy and with a sharp sour smell);
systematic regurgitation, cases of vomiting;
poor rate of weight gain or sudden weight loss;
apathetic state, tearfulness.

In primary and secondary LN, the above symptoms are identical.

Worth cautioning about reverse side medals, when the above symptoms of lactose deficiency indicate any food intolerance in the crumbs (in the case when the mother eats incorrectly or if the complementary feeding regimen fails) or indicate other diseases of the baby.

Therefore, it is important for the mother to show the baby directly to the pediatrician, to pass an analysis to the child in order to try to find out for sure if there is a lactase deficiency.

What tests will tell about LN syndrome

How to determine that lactase deficiency in children is for sure in order to prevent subsequent problems in the development of the baby in time? The surest way is to conduct a special diagnosis.

There may be several such studies. For clarity, all the main possible methods are presented below:

Breath test - an analysis to identify the percentage of hydrogen and methane in the air exhaled by the baby after taking lactose. Fermentation processes in LN will provoke an increase in these substances. For reliability, the test is done every half hour for three hours after taking milk sugar.
Coprology - will show the carbohydrate content and acid reaction. Indicators of carbohydrates over 0.25 g% and pH less than 5.5 are typical for LN.
Lactose curve - the method is based on drawing up a curve that demonstrates the dynamics of the body's work on the breakdown of milk sugar. For this, the baby is given milk on an empty stomach. The results are seen in an hour, half an hour and fifteen minutes immediately after eating.
Biopsy small intestine- one of the most reliable ways, but less common. Since the analysis requires anesthesia and the penetration of a special device into the intestines of the baby.
Genetic test - the study is designed to detect genes that can produce a reduction in lactose production.

The most common and inexpensive method of research for lactose intolerance is scatology. But it is extremely difficult to give an accurate diagnosis on the basis of only one analysis.

A correct diagnosis is possible after a complex of studies in combination with an analysis of symptoms.

The diagnosis is certain. How to treat?

It is worth emphasizing that treatment for lactose intolerance is not started based on just a few signs of LN and the result of carbohydrate content in the feces.

clinical picture, and this is frequent foamy stools, and flatulence, and anxiety of the crumbs during each feeding, and weight loss (or low weight gain), and certain laboratory confirmation, the pediatrician must necessarily fix.

So, what treatment will help with lactase deficiency? A distinction is made between natural and artificial aid. Natural treatment includes the correct organization of breastfeeding and the elimination of irritants from the diet.

The artificial form involves the use of enzyme preparations, specialized lactose-free mixtures and drug therapy dysbacteriosis. Each of these types of treatment should be discussed separately.

What will the correct organization of GW give

Symptoms of lactose deficiency can be eliminated by organizing breastfeeding differently. What is the connection? Milk composition! At the beginning and at the end of feeding, the secreted milk is completely different in taste, composition and density.

Fore milk is more watery and moves more rapidly out of the milk ducts, which is why it is so easy to drink.

But the enzyme does not have time to process such a stream of milk sugar.

And unsplit lactose, having got directly into the large intestine, immediately begins to create "trouble" in the form of fermentation, gas formation, and frequent sour stools.

But more fatty milk comes from the stomach to the intestines of the crumbs much more slowly, and therefore lactose has time to be processed.

Based on the foregoing, GV experts make the following recommendations:

feed with one breast until absolute devastation. It is unacceptable for one feeding to shift the baby from one breast to another and back, making it easier for him to absorb food. This leads to the fact that the baby is saturated with only one “front” milk and does not have time to suck out more fat;
say no to pumping after feeding. Otherwise, the child will get less fat milk with a high content of milk sugar, which leads to LN;
say yes to pumping just before feeding. This will increase the serving of higher fat milk;
to apply the baby to the breast correctly (do not know how, experts on breastfeeding or video lessons will help). So the crumbs have every chance to suck out the "hind" milk;
leave night feedings. It has been proven that at this time more "rear" fatty milk is produced;
do not interrupt the process of taking the "food" of the child before he is completely satiated. At least up to four months.

Compliance with all the rules does not guarantee, but helps eliminate signs of lactose deficiency in infants within a few days.

Drive away allergens

When a mother eats without thinking about the consequences for the child, a problem arises. For example, cow's milk protein, a well-known allergen, can provoke lactase deficiency in a newborn and disrupt intestinal function caused by the “under-splitting” of lactose.

As soon as she sees the manifestations of LN in a baby, the mother should take care of the diet, excluding not only whole milk, but dairy products completely (butter, cottage cheese, cheese, sour milk).

Also, experts insist on minimizing, and it is better not to use eggs, chocolate, honey, nuts, exotic dishes, red-skinned fruits and vegetables, caffeine and alcohol, food with spices-flavor enhancers, marinades-salts.

In addition, you should minimize the consumption of foods that promote flatulence - all varieties of grapes, black bread, muffins, sugar.

External assistance and drug therapy

If the first two methods do not solve the problem, the pediatrician prescribes lactase. It is very important to choose the right dose, otherwise, if the enzyme is too small, the symptoms of LN will only intensify, and if it is too high, the stool will become excessively thick, which is fraught with constipation. Therefore, you need to resort to this method only as prescribed by the doctor.

If enzyme preparations have not coped with the task, then special lactose-free milk mixtures are prescribed, which are given before breastfeeding in an amount of one to two thirds of the volume of milk that the child eats at a time.

If it becomes necessary to give a special formula, it is advisable to remember that using bottles during temporary supplementation can lead to permanent refusal of the breast.

Restoration of intestinal microflora with pharmaceutical preparations should be carried out exclusively under the supervision of a pediatrician and may include several stages:

drug assistance to the pancreas;
correction of intestinal dysbacteriosis with the help of various prebiotics-probiotics;
medicinal relief for colic, bloating and diarrhea.

And finally

Now you know how to determine lactose deficiency and what is the algorithm for further action. The main thing is to be patient and not strive to immediately stop GV. Still, none of the mixtures, although close in composition to breast milk, can replace the benefits, including psychological ones, of natural feeding.

If the child does not have congenital LN due to genetic factors, then it will be possible to correct the problem. Symptoms will begin to disappear somewhere on the third day of treatment. The main thing is that the mother disciplinedly carried out the therapy prescribed by the doctor and followed a diet.

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“Dear editors, help me figure out how lactose deficiency manifests itself in adults, and its symptoms, and how it differs from lactose intolerance,” writes our reader. Let's figure it out.

"Lactose deficiency" is not such a diagnosis;
there is "Lactase deficiency", when there is not enough lactase enzyme,
and there is " lactose intolerance”, milk sugar intolerance LACTOSE

In short, the dark forest medical terms, but after reading this article, you will see: you do not have symptoms of lactose deficiency!

lactase deficiency leads to lactose intolerance. (Lactose intolerance) - this is what the syndrome is called in medical terms. international classification diseases ( in ICD10 - class E73)

A pathological condition, which is characterized by symptoms such as flatulence and rumbling in the abdomen after drinking milk, is commonly called lactose intolerance (and lactase deficiency is a pathophysiological process, the cause). This syndrome develops against the background of insufficient formation of the lactase enzyme, which is responsible for breaking down milk sugar - lactose. Lactose is a disaccharide that is normally broken down into more than two simple sugars - glucose and galactose in the small intestine at the level of the duodenum 12. That is, in adults it is often observed lactose intolerance or a “milk rejection” reaction.

Data

Very interesting spread of lactose intolerance syndrome.

Globally, 75% of the adult population cannot tolerate milk sugar, and with it, dairy products;
l actase deficiency often found among the indigenous population of South America and Asia (up to 90% of Hispanics);
75% of African Americans have this syndrome;
on average, 25% of adult Europeans have lactose intolerance (lactase deficiency) in adulthood;
while, for example, in the Netherlands and Sweden, such a problem is not known at all;
Russia got about 50%;
men and women are equally affected. The syndrome begins to manifest itself from the age of 20;
44% of pregnant women who were previously lactose intolerant regain the ability to digest lactose during pregnancy;
lactose intolerance is perfectly treated by eliminating milk from the diet;
nobody died from primary lactose intolerance;
Osteopenia can be a complication of lactose intolerance, which in old age can turn into osteoporosis.

Types of lactase deficiency

AT clinical practice There are three main types of pathology, these are:

congenital lactose intolerance is inherited as an autosomal recessive trait and is very rare. Manifested from birth;
primary lactose intolerance (lactase deficiency);
secondary lactose intolerance (lactase deficiency)

Primary lactose intolerance is associated with low level lactase enzyme, a decrease in the production of the enzyme occurs gradually and this form develops after childhood. Occurs only in adults. A type of syndrome characterized by insufficient production of lactase, in the absence of any damage to enterocytes.

In the animal kingdom, all mammals lose their ability to digest lactose as adults, and humans are no exception. Deficiency in adults is not pathological, it is a symptom of an age-related decrease in enzyme activity.

If we return again to the issue of nationality, then among the inhabitants of northern Europe, analyzes show a high activity of lactase at any age. But for Asians, it begins to decline quite early.

Secondary lactose intolerance (lactase deficiency).

This type of syndrome occurs in adults and children. Deficiency in lactase production develops against the background of damage to the cells of the small intestine. Secondary, or acquired, lactase deficiency can develop in a person with a healthy small intestine during episodes acute illness. This is due to damage to the mucous membrane or from drugs. Some causes of secondary lactase deficiency are:

acute gastroenteritis;
giardiasis;
ascariasis;
Crohn's disease;
celiac disease;
tropical sprue, gastrinoma;
radiation enteritis, for example, when irradiating cancer patients;
diabetic gastropathy;
carcinoid syndrome;
Whipple syndrome;
HIV enteropathy;
kwashiorkor;
chemotherapy;
pancreatic adenoma, which provokes the development of ulcers;
after a long forced feeding through droppers.

How dangerous is the lack of lactase enzyme for an adult organism

We figured out the primary enzyme deficiency - it does not threaten adults with anything. With secondary lactase deficiency, everything is almost the same.

DO NOT DRINK MILK and there will be no problems. Milk is not adult food - period!

All horror stories are like: dehydration, since prolonged diarrhea removes a huge amount of fluid, which is quite difficult to replenish; deficiency of calcium and many other trace elements, since the absorption of these substances practically stops in the intestine; the lack of nutrients from dairy products leads to a halt in development beneficial bacteria microflora; the population of putrefactive bacteria grows; peristalsis is significantly reduced; the general immunity of the body decreases - they concern ONLY children. They have nothing to do with adults!

Symptoms

The severity of hypolactasia occurs in each person individually. Symptoms of lactase deficiency in adults are similar in both forms of milk intolerance. The difference is that:

primary form and severity of symptoms depend on a large number milk ingested,
and in the secondary form, the symptoms flourish even when a minimal amount of milk sugar is ingested, since its splitting is completely disturbed in the inflamed mucosa of the small intestine.

But basically, the symptoms that indicate lactose intolerance, which causes lactase deficiency, come down to the following manifestations.

The symptoms are always related to the consumption of milk. or dairy products;
there may be diarrhea, but constipation is no less common, sometimes alternation of symptoms:;
constant uterine rumbling, pain, possibly nausea;
loss of appetite and a feeling of severe bloating -

An adult can himself suspect lactose intolerance, even before taking tests, if he knows the main symptoms, and also that no treatment methods help with this pathology, except for strictly following a lactose-free diet.

If there are symptoms, but you did not drink milk, then you need to look for another cause of indigestion.

The symptoms are very similar to irritable bowel syndrome, and the only way to tell one condition from another is to completely eliminate dairy products. Sometimes these two pathologies get along together.

Laboratory studies confirming lactase deficiency in adults

In adults, the symptoms of primary lactose intolerance, lactase deficiency are the norm, not a disease, and international recommendations of nutritionists, gastroenterologists are offered as the first diagnostic test:

exclude milk;
if milk was excluded and it got better, then no in-depth “diagnosis” is needed! Unless, if you want to support a medical laboratory with your finances

In some dubious cases, the same "international standards" recommend a couple more tests:

blood test for lactose. The patient drinks 50 ml of lactose and then the blood sugar level is measured, with the data entered on a graph and a curve is built. The lack of lactase makes the curve straightened, the graph does not show an increase in glucose after 60 and 120 minutes, since it is not absorbed in the intestine.
milk load test give 500 ml of milk and measure the level of sugar in the blood. If the blood sugar level is less than 9 mg/dl, then this confirms malabsorption of glucose in the intestine.

All other tests may be needed only for differential diagnosis with other more serious disorders, to investigate secondary lactose intolerance, such as celiac disease.

Fecal analysis. This test shows the amount of carbohydrates, and the pH level. At healthy person there are no carbohydrates in the stool. With lactase deficiency syndrome, their presence is determined, and the pH drops to a level of 5.5 and below.
analysis for the concentration of exhaled hydrogen. It is also performed with a lactose load. Samples are made every half hour up to six times.
biopsy and enzyme activity analysis. For its implementation, a wash is taken from the mucous membrane. The result of this test is considered the most reliable. (in practice this is not used, as it is an invasive method and has complications).
sometimes genetic testing is done to find out the cause of secondary lactose intolerance, such as in the case of celiac disease.

In addition to specific tests in adults, other diseases are excluded, the symptom of which may be diarrhea and bloating. Only after receiving all the answers to the tests, together with a nutritionist, a therapeutic diet menu is developed. Enzymes are prescribed and measures are taken to relieve symptoms.

Diet for people intolerant to milk sugar

It is recommended to read labels and limit the consumption of products containing milk sugar: for example, mayonnaise, sauces, sweets
Most patients can safely drink one glass of milk without developing unpleasant symptoms.
Yogurt and cheese usually do not cause unpleasant symptoms.
You can use fermented milk, soy milk,
A calcium supplement is recommended.
Fatty milk and chocolate milk are generally better tolerated than skim milk.

Acute Disorder Treatment

As we have already agreed, primary natural lactose intolerance should not be treated with pills. Secondary lactase deficiency is treated as follows:

exclude the intake of lactose, that is, milk and dairy products;
treat a disease - a source of enzyme deficiency (for example, acute gastroenteritis);
provide the body with the necessary enzymes for the digestion of lactose, use the lactase enzyme in tablets or capsules.

And in the end, a little more linguistics: "Lactose deficiency", from the point of view of the language, means "lack of milk sugar" in the body, theoretically, lactose deficiency - this could be called a lack of milk sugar in mother's milk in a newborn or some kind of eating disorder in starving children in Africa. My inquisitive mind forced me to find in medical journals a study of lactose deficiency in infants (Lactose Deficiency (lactose deficiency) in Infants Clinical Pediatrics 11/2008); BUT this term has nothing to do with the topic of our article and the fact that adults cannot digest milk sugar.

Sincerely, Doctor A.Novocidou

Dear friends! The medical information on our website is for informational purposes only! Please note that self-medication is dangerous for your health! Sincerely, Site Editor