LACTOSE INTOLERANCE
Products for lactose intolerant
Lactose intolerance is one of the most common food intolerances and should not be confused with milk allergy, which instead comes from an immune system reaction to proteins in it and is expressed in completely different clinical manifestations.
The causes
Is due to the inability of the intestines to break down the complex sugar, lactose, the disaccharide present in cow's milk, goat, donkey, into two simple sugars: glucose and galactose can be assimilated by the intestines.
The problem is caused by a shortage or absence of lactase, an enzyme present on the edge of the intestinal cells whose activity decreases passing from the pre-school to adulthood, making it difficult or impossible for the digestion of milk and dairy products.
In the absence of the enzyme, the lactose passes undigested in the intestine and in the colon is attacked by the bacterial flora that ferments, producing slag and gas (hydrogen and methane) which are the cause of intestinal disorders.
The origin
The lactase deficiency is divided into congenital, primary, secondary. Congenital (hypolactasia) is very rare and occurs at birth and results in a total inability to digest lactose and all foods that contain it.
The primary defict consists of physiological decline after weaning of enzyme activity, on the basis of genetic and ethnic diversity. All children up to the age of two about producing lactase to digest milk. Then, with weaning, the enzyme is no longer produced, or is produced in quantity gradually more and more limited. The signs and symptoms usually become clinically apparent until the age of 6-7 years and may remain so until adulthood depending on the amount of lactose ingested in the diet and the rate of decrease of intestinal lactase. Very often, the lactase deficiency is only partial and the amount of lactose tolerated varies from individual to individual and may change over time.
The deficit is a secondary disorder often transient, due to a pathological condition that compromises the regular and physiological absorption of lactose. Some diseases (acute gastroenteritis, celiac disease, diverticular disease, Crohn's disease, etc.)., In fact, can destroy the intestinal microvilli, the seat of the enzyme lactase. This intolerance may be transient (3-4 months) or permanently being linked to the state of bowel disease base.
The symptoms
The most common symptoms, which usually appear from thirty minutes to two hours after ingestion of milk, or other foods that contain significant amounts of lactose, consisting of abdominal pain and cramping type of forms associated with feeling of bloating and abdominal increased peristalsis with bowel sounds, flatulence, bloating, diarrhea with discharge or watery stools poltacee. It is, as you can see, the symptoms are not particularly specific patologpie also present in many of the gastrointestinal tract (IBS, IBD, celiac disease), therefore it is very important to the classification of the patient from a clinical-laboratory and pathophysiological.
Being lactose intolerant does not mean experiencing symptoms at the first ingestion of as intolerance is related to the dose and the individual reactivity. So we find subjects who have had trouble at a minimum dose of lactose ingested, while others can tolerate higher doses prior to a crisis. In practice, each patient has their own tolerance level.Should also be noted that higher doses, the tolerance limit, do not cause harmful effects on the intestine as happens in patients who are intolerant to gluten.
The diagnosis
The test commonly used to measure the absorption of lactose by the digestive system is the hydrogen breath test, commonly known as "breath test", a simple and non-invasive examination, executable on an outpatient basis, with reasonable diagnostic accuracy . The principle of the test is based on evidence that if a sugar is not absorbed in the small intestine is fermented by the intestinal flora with the formation of large quantities of hydrogen, which in part is absorbed in the colon in the blood and a part of it will be eliminated with breathing. If you administer to a subject lactose intolerant and performing the breath test will be possible to find a share in the exhaled breath hydrogen higher than that observed prior to administration. The test normally takes 3-4 hours to be completed.
How to Prepare for the Hydrogen Breath Test
The following instructions are generic and can vary in individual centers where appropriate documentation will be released at the time of booking. They are still useful information to understand, in principle, how to prepare for Test
4 weeks before the test does not take antibiotics 4 weeks (or even 1 or 2 according to some protocols) before the test does not take laxatives or lactic acid bacteria and generally products that act on the consistency of the stool. Must not carry out investigations (colonoscopy, barium enema, etc..) That require bowel cleansing. 12 hours before the test absolute fast
Do not smoke the night before until the end of the test do not brush your teeth in the morning of the examination do not drink and Hungarian for the duration of the test do not perform physical exercises before and during the test
Conduct of the examination
A - Sampling of exhaled air baseline (before taking the Lactose) 1. The patient inhales deeply, air, 2. blowing in the first balloon, exhaling all the air contained in your lungs; B - The patient drinks a solution of lactose (25 g dissolved in 250 cc of water), C - Sampling of exhaled air at fixed intervals up to 4 hours after 'assumption of Lactose: 1. The patient is waiting, sitting, without smoke, drink, eat for the duration of the test; 2. after 30 minutes the patient inhales deeply air 3. blowing into the balloon (see A-2) 4. this operation is repeated 8 times in a span of 270 min after ingestion; 5. exhalation.
In children under 12Kg. weight the procedure for the execution of the test is identical but with half the adult dose of lactose (12.5 g.). The amount of lactose ingested is minimal and only in subjects particularly intolerant can determine a transient abdominal symptoms.
Therapy
The therapy "need" in case of intolerance to lactose is a diet that provides for the elimination or reduction of the lactose from the diet taking into account a "threshold value" of 12-15 gr according to a recent review, above which appears all the annoying symptoms procession, so it is important to identify the amount tolerated, relying also the reading of commercial labels. Eliminate lactose from the diet is not really as simple as it may seem, because although the milk and foods made from milk are the only natural source of lactose, the latter is often added to commercially prepared foods.
People with very low tolerance to lactose should be very attentive to the sources "hidden" lactose as this substance is also found small amounts in foods such as bread and other baked goods, breakfast cereals, instant mashed potatoes; margarine, salad dressings, meat, candy and other snacks; mixes for pancakes, biscuits and cakes, frozen. In addition, as the additive can also be found in the ham, the sausages and the sausages in general.
Do not forget the drug: lactose is used in more than 20 percent of drugs that require a prescription and about 6 percent of OTC drugs, as well as many types birth control pills contain lactose, but these products are contraindicated only for people with severe intolerance. Milk and dairy products are, unfortunately, the primary source of substances such as calcium. People intolerant to lactose should therefore try to compensate for the football does not take milk with other foods rich in minerals, in order to avoid problems later in life such as bone decalcification, osteoporosis, dental problems. In this context it is good to know that you can not delete indiscriminately all dairy products.
In fact, even the lactose intolerant, regardless of their threshold can trigger a crisis, will continue to will assume certain types of cheese and, more precisely, the seasoned ones as, for example, pecorino, provolone, parmesan reggiano and grana padano because, through the process of maturation which they are subjected, they have a lower content of lactose. On the contrary, are not tolerated fresh cheeses such as mozzarella, cottage cheese, painstaking because they are rich in lactose. A food is generally well tolerated parmesan cheese, which also has the advantage of being an excellent source of calcium (100 grams will provide 1,340 milligrams) and, therefore, consumed in the right amounts (but watch for fats) can cover the needs of Football is not satisfied by not consuming milk. It should be noted that the average daily dose of calcium an adult (19-50 years) is about 1000 mg. Even yogurt can be consumed, preferably in the natural and non-flavored, because inside there are bacteria that partially digest the lactose. Or, as an alternative to cow's milk, you can eat your milk lactose-free milk, to soy or rice or dairy products containing lactase deficiency or lactose predigested or those containing the "Lactobacillus acidophilus".
In the market there are also preparations based βgalattosidasi, caolinoe acacia fibers which assume together or before the food containing lactose to facilitate the assimilation and restrict the symptomatology
The recovery of foods with lactose can be at least one month after their suspension with the introduction of small doses: if there are no symptoms can gradually increase the administration taking care, in any case, to avoid excesses. The eventual return of symptoms that re-suspension.
of Rosamaria Bozzi, Domenico Cattaneo
UOC Surgery and Endoscopy Company "Dei Colli" Monaldi - Cotugno - CTO
References:
Methodology and Indications of the Breath testing in Gastrointestinal diseases: The Rome Consensus Conference - Aliment Pharmacol Ther 2009; 29: 1-19
Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, Wilt TJ.
Systematic review: effective management strategies for lactose intolerance Ann Intern Med 2010 Jun 15; 152 (12) :797-803.
Products for lactose intolerant