Lactose intolerance in adults and children

Milk and dairy products are not suitable for all people. Lactase deficiency, or lactose intolerance, is a condition in which the human body is unable to digest lactose and milk sugars. This condition develops in people whose intestines do not produce enough of the enzyme lactase: this enzyme is necessary for the normal digestion and assimilation of lactose. Scientists have found that only fully mature and actively functioning enterocytes provide sufficient enzyme activity.

Lactose intolerance leads to the development of malabsorption and maldigestion syndromes, which, in turn, causes a violation of all types of metabolic processes, mineral and vitamin deficiency. [1], [2]

Epidemiology

Decreased lactase production to very low levels in adults is a physiological condition that is common to about 70% of the world's population. The persistence of lactase production is most typical of people living in Northern Europe, North America and Australia, where only 5-20% of the population is lactose intolerant. In South American, African and Asian countries, up to half of the population suffers from hypolactasia, and in some regions (China, Japan) the figure reaches 100%.

The activity of enzyme production takes place already in the intrauterine period, reaching maximum values before the baby's birth. The highly active state is maintained during the first months of the baby's life, after which it gradually begins to decrease. Lactose intolerance in the newborn period is relatively rare - about one infant per 50,000, which is about 0.002%. Somewhat higher rates are reported in South-East Asia and Africa.

Chinese and Japanese lose the ability to produce lactase rather quickly, and lactose intolerance develops in 85% of cases by the age of 3-4 years. In European children, the decline does not occur until school age. [3]

Causes of the lactose intolerance

Specialists identify two basic causes of impaired lactase production by intestinal cells:

• The first cause is genetic malfunction or physiologically determined incomplete maturation of the enzyme mechanism (found in most premature infants due to an immature digestive system and an unformed ability to produce lactase). In this situation, we are talking about primary lactose intolerance, which is not characterized by damage to the cells of the small intestine.
• The second cause is inflammatory reactions or other pathological processes in the body (allergic, tumor), or surgical interventions on the intestine. Such cases are secondary lactose intolerance associated with direct damage to enterocytes. Such pathology is either transient or permanent.

If lactose intolerance is hereditary, it does not mean that the symptoms will become apparent from infancy: sometimes it happens in adulthood, which may depend on the type of heredity. In general, the polymorphism of the gene responsible for lactase production causes several variations in the symptomatology of the disorder. For example, in some cases lactase is not produced at all, while in others it is maintained, but to a lesser extent than required.

In adult patients, damage to the cells and villi of the small intestine can trigger the development of lactose intolerance, even if the person has previously consumed dairy products continuously and for a long time. In such a situation, it is often possible to restore enterocyte function by treating the underlying pathology: lactose intolerance is successfully cured as a result. This explains the importance of determining the primary source that caused the inhibition of enzyme production. [4]

Risk factors

Factors that increase the risks of developing lactose intolerance include:

• age (inhibition of enzyme production is associated with maturation processes and rarely occurs in newborn children);
• ethnicity (lactose intolerance is more common in North America, Africa, and Southeast Asia);
• Premature birth (premature babies are more likely to experience reduced enzyme production, as its activity is noted by the end of the third trimester);
• Pathologies affecting the condition and function of the small intestine (infectious digestive diseases, Crohn's disease - granulomatous inflammation of the GI tract, celiac disease - gluten intolerance, etc.).

Pathogenesis

The amino acid sequence of the lactase enzyme is encoded by the LPH gene (LCT). Lactase is produced in the small intestine and is involved in the breakdown of lactose, a milk sugar.

The carbohydrate composition of milk is mostly represented by lactose. As for the production of lactase by the intestinal cells, it can be impaired for such basic reasons:

• due to genetic malfunctions or physiologic incomplete maturation of the enzyme system in babies from newborn to 1 year of age;
• as a result of an inflammatory reaction or other damaging process (allergic, cancer, etc.).

Lactase is normally produced by children's intestines, and it is only with age (from about 3-10 years of age) that the production of the enzyme gradually decreases. When dairy products are consumed, various kinds of intestinal disorders occur due to non-absorption of milk sugar. If milk and other lactose-containing products are eliminated from the diet, health and digestive processes usually stabilize within 14-20 days.

The 13910 CT polymorphism of the lactase (LPH) gene affects lactase synthesis in adult humans. This region of the genome is an element of internal regulation of transcriptional activity of the lactase gene promoter. The normal C polymorphism is associated with decreased production of the enzyme in adults, while the mutant T form is associated with preservation of sufficient lactase activity in adulthood. It can be concluded that a homozygous carrier of type C lacks the ability to digest lactose (the degree of mRNA production of the lactase gene in such people is reduced to 10% on average), while a homozygous carrier of type T continues to digest dairy products well and tolerates them well. [5], [6]

Symptoms of the lactose intolerance

Most people with lactose intolerance cannot consume any dairy products at all. After consuming milk, they notice not only a deterioration of well-being, but also a disorder of the digestive process: the gastrointestinal tract reacts to lactose as a foreign substance to the body. However, some patients can still consume small amounts of dairy products, and unfavorable symptoms appear if the proportion of milk in the diet increases.

The symptomatology may vary, depending on the age of the patient and the degree of lactase production by the intestinal glandular system. The less enzyme is produced, the broader the clinical picture of the disease.

The first signs of the disorder are detected about 30-90 minutes after consuming a lactose-containing product. These are usually:

• abdominal bloating;
• abdominal pain (constant, spasmodic, attack-like);
• increased gas;
• diarrhea, loose stools;
• nausea (sometimes to the point of vomiting).

Diarrhea is usually "fermented", stools are frequent, frothy, accompanied by a "sour" odor.

In order to make sure that these symptoms are a reaction to lactose intolerance, it is necessary to remove dairy products from the diet for a while. Then, after normalization of health, you should resume the consumption of milk in small quantities and pay attention to whether the same symptoms will again bother you. [7]

Lactose intolerance in an infant is determined using the rule of three:

• onset of intestinal colic from the third week after birth;
• duration of intestinal colic - approximately 3 hours per day;
• the appearance of intestinal colic mainly in babies in the first three months of life.

Children are usually restless and may develop signs of dehydration and/or weight gain deficits.

Lactose intolerance in children

The intensity of manifestations of lactose intolerance is determined by the degree of decrease in enzyme activity, the state of the microbiome, individual indicators of intestinal sensitivity, nutritional peculiarities and health status in general.

In infants, the problem is manifested by restlessness, increasing for several minutes from the start of feeding, frequent regurgitation, frothy liquid and "sour" stools. Appetite is preserved, weight and height indicators are often within normal limits.

Congenital lactose intolerance is accompanied by severe diarrhea in the first days of life. At the forefront are signs of dehydration and weight loss. Fecal masses contain an increased level of lactose. With the transfer of the baby to a lactose-free diet, stools quickly normalize, development stabilizes. Against the background of such a diet, morphological intraintestinal changes do not occur, lactase activity in the mucosal biopsy is insignificant or absent.

Lactose intolerance in adults

Lactose intolerance can occur not only in infants but also in adults, and this phenomenon is not uncommon. It depends on genetic predisposition, as well as on disorders and diseases of the digestive tract.

Thus, secondary lactose intolerance develops as a result of intestinal infectious diseases and other causes leading to damage to the structures of the small intestine. Depending on the degree of manifestation of the disorder, hypolactasia (partial enzyme deficiency) and alactasia (complete lactase deficiency) are distinguished.

The main clinical signs of the problem are diarrhea, increased gas, and digestive distress occurring immediately or within 24 hours of consuming a dairy product (most commonly whole milk). In addition, if there is intestinal dysbacteriosis, the substances that are formed during the bacterial breakdown of milk sugar in the large intestine have a toxic effect, which is manifested by a general deterioration of health, headache, irritability.

Among the most common complaints:

• diarrhea, frequent liquid stools;
• discomfort in the intestinal area;
• abdominal bloating;
• spastic abdominal pain;
• nausea;
• a feeling of exhaustion, general weakness.

The severity of symptoms depends on the amount of milk sugar ingested and the enzyme activity of the intestine.

Complications and consequences

Lactose, or milk sugar, is an organic carbohydrate composed of a pair of glucose and galactose molecules. It is one of the main ingredients in the milk of all mammals, including humans. Unabsorbed lactose is unable to be absorbed by intestinal cells. In order for it to be digested, it must be broken down into glucose and galactose: it is they that easily penetrate into the cells of the small intestine and further into the circulatory system and liver. The liver synthesizes and accumulates glycogen, which plays the role of a kind of "energy" for various reactions in the body.

The benefits of milk sugar are as follows:

• has the properties of a prebiotic, optimizes the composition of the intestinal microbiome;
• is involved in the production of B vitamins;
• helps absorb calcium, magnesium and other trace elements;
• acts as a source of energy.

Lactase is an enzyme produced by small intestinal structures that regulates the breakdown of lactose. If the production of this enzyme is reduced, the undecomposed milk sugar enters the small intestine, where fermentation begins, accompanied by abundant gas. In addition, if such enzyme deficiency is repeated regularly, an inflammatory reaction starts, subsequently causing the development of sluggish duodenitis or functional disorders of the digestive system, changes in the composition of intestinal microflora.

In addition to digesting dairy products, lactase helps to assimilate micronutrients, and impaired production of this enzyme can provoke a number of health problems.

Among the possible delayed complications:

• Osteopenia is a condition accompanied by a decrease in bone mineral density. Osteopenia is not osteoporosis, but a decrease in bone strength is associated with an increased risk of bone fracture.
• Osteoporosis - weakness and brittleness of the bones and their tendency to break down.
• Poor physical development, underweight, chronic fatigue, weak immunity.

Diagnostics of the lactose intolerance

Diagnostic measures are based on the typicality of the symptomatology, but the diagnosis of lactose intolerance should additionally be confirmed by other methods of investigation.

Lactose intolerance stool is taken to determine the pH: a decrease in this value below 5.5 may be a sign of lactase deficiency.

Today, many doctors rush to diagnose lactose intolerance based only on the fact of an increased amount of carbohydrates in the feces. But it is important to realize that a high level of carbohydrates can only indicate incomplete digestion by the intestine. Specialists consider the indicator of the norm the content of carbohydrates in the feces is not more than 0.25%. Exceeding this indicator is a reason for additional research in the assumption of lactose intolerance. The patient is prescribed a diet with a restriction of lactose-containing products. If the baby is breastfed, the mother's diet is also adjusted. However, there are many cases when practically healthy children are found to have an increased level of carbohydrates in the feces.

During the diagnostic process, more attention is paid to the clinical symptoms and condition of the patient. The degree of physical development, the presence of diarrhea and abdominal pain are evaluated. If the hereditary anamnesis is aggravated (there are or were patients with lactose intolerance in the family), the child's lagging behind in physical development, pronounced symptoms, we can think of a primary genetically conditioned lactase deficiency. If the hereditary history is not aggravated, the baby gains weight well and is physically developed, the diagnosis of lactose intolerance is questionable, even in the presence of diarrhea, abdominal pain and an increased percentage of carbohydrates in the feces.

The load-glycemic test is used quite successfully in the diagnosis of this pathology. It consists of determining the patient's blood sugar level and then giving him/her a warm lactose solution (1 g of lactose/1 kg of weight, but not more than 50 g). After that, the blood sugar level is redetermined three times: after 15 minutes, half an hour and an hour. In the norm, the glucose indicator should increase by at least 20% of the original (about 1.1 mmol per liter). If the indicator is lower, it indicates the presence of lactase deficiency. This test is noteworthy because lactose intolerance can be suspected already after using the solution: the patient has abdominal bloating, increased gas formation, abdominal pain and so on. Before testing, it is advisable to check the degree of glucose tolerance.

In many foreign clinics, tests such as the level of hydrogen, methane or 14c-labeled carbon dioxide in exhaled air are common. The levels of gases are tested after a dosed load of plain or 14c-labeled lactose. The criterion for the diagnosis of lactose intolerance is a 20 ppm (parts per 1000000) increase in hydrogen in exhaled air. The technique is actively used to diagnose the disorder in older children and adults.

Instrumental diagnosis of lactase deficiency has its own "gold standard", i.e. Determination of enzyme activity in biopsy specimens of intestinal mucosa. This method is particularly accurate and informative, but it has obvious disadvantages, such as invasiveness, complexity and cost.

Genetic test for lactose intolerance can be an alternative informative technique. The presence of genes ST-13910 and ST-22018 localized on chromosome 2q21(1-3,7) is typical for the primary pathological process. The results are interpreted as follows:

• Lactose intolerance genotype CC - detectable polymorphism with association of lactase deficiency, in homozygous form.
• Lactose intolerance genotype ST - detectable polymorphism with association of lactase deficiency, in heterozygous form.
• TT genotype - polymorphism with association of lactose intolerance is not detectable.

The material for the study is venous blood. The rules of preparation for the diagnostic procedure correspond to the recommendations for general clinical and biochemical blood tests. [8]

Differential diagnosis

The fundamental difference between lactose intolerance and an allergic reaction to milk sugar is that intolerance is caused by a lack of enzyme to digest lactose. As for allergy, it is an aggressive response of the body to the ingestion of unacceptable milk sugar. Such allergies are much more common in children who are artificially fed with nutritional mixtures.

Cow's milk contains about two and a half dozen different protein substances that can provoke an immune reaction from the child's body. Whey proteins and casein are considered to be the most allergenic proteins.

• Lactalbumin is a protein component that is present in cow's milk and is destroyed when the temperature of the product is brought to +70°C. Causes allergy in 50% of cases.
• Lactoglobulin is a heat-resistant protein, even when boiled, it is only partially destroyed. It provokes allergies in 60% of cases.
• Bovine whey albumin - undergoes transformation during heat treatment, but due to its relatively small amount in milk causes allergy in less than 50% of cases.
• Casein is the best known protein component of milk, which often causes allergies. It can be present in many industrial products such as confectionery, baked goods, ice cream, sauces, etc.

Milk sugar allergy is a much more dangerous condition than lactose intolerance. If a child with intolerance drinks milk, he or she will only have digestive disorders, to a greater or lesser extent. But a child with an allergy can die of anaphylactic shock after drinking dairy products.

Gluten and lactose intolerance

Lactose and gluten intolerance in adult patients has a genetic basis in most cases. In order for the body to digest milk sugar, it must first be broken down into galactose and glucose molecules. This process requires lactase, an enzyme produced by the mucosal cells of the small intestine. It is encoded by the LCT gene. The activity of this gene is controlled by the regulatory gene MCM6. Both of these genes are inherited from both parents. If two segments in the region of link 13910 have cytosine (labeling C), the regulatory gene turns off the LCT gene and the production of the enzyme is blocked, which is the reason for the development of age-related lactose intolerance. If at least one segment has thymine instead of cytosine (labeling T), then LCT continues to function actively, the enzyme works, and milk sugar absorption does not suffer.

Not only genetics, but also the functional state of the intestine is important for milk digestion. For example, damage to the mucosal tissue (due to worm infestation, tumor or inflammatory process) leads to deterioration or cessation of enzyme activity, which leads to the development of secondary lactose intolerance. In such a situation, special attention should be paid to the treatment of the pathology that provoked the intraintestinal damage: with timely intervention, there is every chance to restore the absorption of milk sugar in the future.

Gluten intolerance is often associated with celiac disease, otherwise known as gluten enteropathy. It is a chronic pathology of autoimmune origin, when the body begins to perceive the cereal protein gluten as a foreign pathogenic substance, like a bacterial or viral pathogen. It is noteworthy that when consuming a gluten-containing product, the patient's immune system reacts not only to the specified protein, but also to other objects - in particular, to transglutaminase, which helps in the digestion of gluten, as well as to small intestinal tissues (reticulin, endomysium). As a result, the intestinal mucosal tissue is damaged, which in turn can cause lactose intolerance.

Treatment of the lactose intolerance

Only those cases of lactose intolerance that are accompanied by painful symptoms require treatment. The basic therapeutic principle is considered to be a comprehensive therapeutic approach, depending on:

• the age category of the patient (if it is a child, it plays a role of prematurity, natural or artificial feeding, etc.);
• the degree of enzyme production deficiency (complete or partial lack of enzyme production);
• the primary or secondary nature of the offense.

The main therapeutic measures in complete alactasia are inextricably linked to the absolute exclusion of dairy products from the diet. At the same time, therapy is indicated to correct the intestinal microbiome, as well as symptomatic and substitution treatment with the use of lactase preparations (Lactraza, Lactaida, Tilactase, etc.).

In patients with primary or secondary lactase production disorders, the degree of restriction of dairy products is determined on an individual basis, since some people with intolerance to whole milk have a fairly good tolerance to fermented milk products. In such cases, it is recommended to consume dairy products not on an empty stomach, in small amounts, to begin with - no more than 1-2 times a week. The intake regimen is weakened if the patient is found to have a good susceptibility to such products.

The patient (if it is a child - his parents) should start a food diary. It will help to get information on the following issues:

• After consuming which particular product do unpleasant sensations and symptoms occur?
• What is the optimal amount of lactase to take to normalize well-being?

In addition, the so-called "training" of enzyme activity is practiced: the patient is dosed with fermented milk products, gradually increasing the threshold of tolerance to lactose.

It is important to know that the food industry allows lactose to be added to many food products, including sausages, instant food mixes, sauces, chocolate, baked goods, and so on. Since milk sugar is about 1/3 less sweet than sucrose, it is added in larger quantities. Milk sugar is added to many bakery and confectionery products not so much for sweetness as to give the products an appetizing brown color.

In addition to foods, lactose is used as an ingredient in pharmaceuticals, which is important for people with lactose intolerance to know.

The management of lactose intolerant infants is particularly difficult. Natural breastfeeding is always a priority, and conversion to artificial formula should be used only in extreme cases. The optimal solution in such a case is to add enzyme lactase preparations to decanted mother's milk. As a result, milk sugar is broken down without distorting the beneficial properties of the product. If the use of such preparations is impossible for any reason, only then the child is switched to lactose-free artificial formula.

The introduction of mixtures begins with low-lactose versions, changing and selecting their composition. If possible and normal tolerance in the diet is desirable to leave up to 2/3 of carbohydrates in the form of milk sugar: combine several types of mixtures or prescribe a fermented milk mixture. Selection of nutrition is carried out against the background of regular tests (presence of carbohydrates in the feces).

To date, the following types of low-lactose infant products are known:

• malt extracted formula for feeding infants from newborn to 2 months of age;
• a flour-based (rice, oatmeal, buckwheat) or tolokna mixture for feeding babies 2-6 months of age;
• low-lactose milk for feeding babies over six months of age and for adding to dishes instead of whole cow's milk;
• mixtures of own preparation on the basis of flour (rice, oatmeal) and eggs with sugar.

Commercial low-lactose formulae are powdered substances similar in appearance to milk powder. As a rule, the main ingredients of such mixtures include vegetable oils and milk fats, sucrose, malt extract, starch, maltose-dextrin, vitamins and microelements. The packaging of such mixtures is labeled "SL" or "LF" lactose-free. Malolactose-free mixtures are sometimes based on soy, casein and milk protein hydrolysates.

With secondary lactose intolerance in the baby in the foreground are disorders of digestion and assimilation of food, including fats. The child does not gain enough weight, his stool is extremely unstable. In this situation, it is recommended to offer the baby a lactose-free mixture based on protein hydrolysates and medium-chain triglycerides. If lactose intolerance is detected in a baby over one year old, or develops against the background of worm infestations or intestinal infectious diseases, the main principle of treatment is a diet that assumes:

• Avoidance of any dairy products, meat offal, beans, chocolate and candy;
• Adding lactose-free blends, white meat and fish, vegetable oils and lard, regular sugar, fructose, glucose (including in the form of fruit) to the diet.

The first optimal complementary food is vegetable puree. In many cases, baby kefir is well tolerated: it is offered to the baby not earlier than the third day after the preparation of the product. It is also allowed to use cottage cheese, freed from whey. [9]

The duration of dietary restrictions is determined individually, depending on the etiology of the disorder. Indications for a gradual expansion of the diet are considered to be:

• normalization of stool frequency;
• a thickening of its consistency;
• resumption of the rate of weight gain, normalization of physical development;
• Stabilization of fecal carbohydrate values.

Drugs for lactose intolerance

In both primary and secondary lactose intolerance, drugs correcting the dysbiotic imbalance are indicated. It is important to realize that lactase deficiency is not always associated with lactobacillus intolerance: this happens only if the lactose substrate is preserved in the preparation, which is very rare. Recommended probiotics for lactose intolerance: Bifiform baby, Normoflorin L-, B-, D-Bifiform, Primadofilus. Lactulose, which is a synthetic lactose stereoisomer, is not contraindicated in patients: it is not absorbed in the intestine due to the lack of appropriate enzymes-hydrolyzants in humans.

If the child is breastfed, lactase preparations are prescribed. They are mixed with breast milk and left for a few minutes for fermentation. Up to 800 mg of enzyme per 100 ml of decanted milk is used. Lactase dosage: 1/6-1 capsule for children under 12 months of age. The most popular lactase-containing preparation Lactosar for lactose intolerance is given at every feeding. One capsule contains 700 U of enzyme, which is enough for 100 ml of milk. If such therapy does not lead to a positive effect, then only then the baby is transferred to artificial feeding with lactose-free mixtures. They are selected individually, depending on the state of health and the degree of underweight of the child. Examples of such mixtures can be: Nutrilon Pepti, Damil Pepti, Alfare, Frisopep, Nutramigen, Pregestimil, Humana, Nanni, Cabrita, etc.

To eliminate increased gas formation and dyspepsia, which are common in children with lactase deficiency, preparations with simethicone are used - in particular, Espumizan, which reduces the surface tension of gas bubbles in the intestinal cavity and contributes to their disappearance. Espumizan is not absorbed into the circulatory system, it does not contain sugars and lactose, it is well tolerated. It is prescribed with food or immediately after a meal, if necessary - before bedtime. The average frequency of use is 3-5 times a day.

In addition to probiotics, the therapeutic course sometimes includes choleretic drugs - for example, Hofitol. The question of its use is decided individually. [10]

Diet for lactose intolerance

The production of lactase enzyme in the human intestine cannot be corrected or increased. But it is possible to correct the diet in such a way as to minimize the ingestion of lactose into the body and thereby alleviate the manifestations of intolerance. For example, dairy products can be replaced with soy or nut products, or special lactose-free options can be purchased.

In primary lactose intolerance, the proportion of milk sugar in the diet should be drastically reduced, up to absolute exclusion. This can be achieved primarily by avoiding dairy products. This approach is more relevant for adult patients and older children.

It is important to realize that there is practically no correlation between the indicators of enzyme activity and the intensity of the clinical picture. However, the amount of milk sugar in the diet does affect the severity of symptoms.

In secondary lactose intolerance, it is often possible to leave in the diet sour milk products, butter, hard cheeses. It is noteworthy that the assimilation of pasteurized fermented dairy products is somewhat worse, since during thermal processing, the microbiological properties of the enzyme are leveled. It is necessary to add to the diet products containing live lactobacilli - in particular, it can be yogurt, sourdough, kefir.

Cheeses are divided according to their maturity: the greater the degree of maturity, the less milk sugar the product will contain. This means that hard and semi-hard cheeses (in particular, Swiss cheese, Cheddar cheese, etc.) are the most preferable for consumption.

Butter and heavy cream often contain a relatively small percentage of milk sugar when compared to whole milk. Thus, the higher the fat content of a product, the less lactose it contains.

If the patient is still recommended to completely exclude lactose-containing products, in many cases, calcium preparations are additionally prescribed. [11]

What should not be eaten in lactose intolerance?

A list of foods that always have milk sugar in them to some degree:

• whole milk and any dairy products;
• sausages;
• packaged convenience foods;
• industrially prepared sauces (mayonnaise, ketchup, mustard);
• baked goods (bread, rolls, gingerbread, cookies, etc.);
• chocolate-hazelnut spreads;
• ice cream;
• ready-made breadcrumbs;
• Confectionery (pastries, cakes, pies, cookies, etc.);
• snacks;
• fast food;
• condensed milk;
• combined packet spices;
• chocolate, chocolates and candy bars;
• lollipops

Foods for lactose intolerance

Patients with lactose intolerance should favor the following products:

• Soy products (milk, meat, etc.);
• lactose-free infant formula;
• white meat, sea fish (self-cooked);
• eggs;
• lard;
• vegetable oils;
• any greens, berries, fruits, vegetables;
• cereal;
• beans;
• nuts;
• honey, jams and jams, syrups;
• sorbitol, fructose;
• tea, coffee, fruit and vegetable juices;
• vermicelli, pasta with no additional ingredients;
• rye and wheat bread prepared by yourself without the use of dairy products.

Nannie or Cabrita for lactose intolerance

Sometimes lactose intolerance makes it almost impossible to breastfeed the baby. In such a situation, the solution can only be the use of infant formula, the most popular of which are Nanny and Cabrita - products based on goat's milk.

Both varieties are adapted mixtures, similar in composition to breast milk and at the same time well accepted by the child's body suffering from enzyme deficiency. Regarding these mixtures, doctors offer the following recommendations:

• The composition of Cabrita takes into account the proportions recommended by the World Health Organization: the ratio of whey protein to casein is 60:40. In comparison, Nanni has 80% casein, but no whey at all.
• There is no palm oil in Nannie, but Cabrita does.
• Cabrita has probiotics among its ingredients. Meanwhile, Nanny doesn't.
• Maltodextrin, a known thickener, is present in Nannie, and there is nothing wrong with it. But if your baby suffers from diabetes, this fact cannot be ignored.
• Nucleotides are important components that help boost immunity and improve the digestive system. Well, Cabrita has twice as many nucleotides as Nanni.

Which formula should be chosen? This will help pediatrician, as it is necessary to take into account not only the age and the fact of lactose intolerance, but also individual characteristics and in general the state of health of the baby.

Kefir and lactose intolerance

Lactose intolerance is conditionally divided into complete and partial intolerance, depending on the degree of production of the corresponding enzyme. In partial intolerance there is enzyme activity, but it is insufficient, and discomfort appears only after a person consumes whole milk or cream. In such a situation, it is quite possible to consume kefir and other fermented milk products: in this case, there are no problems.

In the case of complete intolerance, in which lactase is not produced at all or is produced in extremely small amounts, dairy products are completely contraindicated for such patients, including fermented dairy products. The only way out in this situation is to use lactose-free products. Today in stores everywhere you can buy as lactose-free milk, as well as kefir, yogurt and cheese. These products are completely safe, they contain all the necessary vitamins and microelements, just like regular dairy products.

Can goat's milk be used for lactose intolerance?

Goat's milk is a nutritious and healthy product that is often tried to be actively used as a substitute for cow's milk. For patients with lactose intolerance, this is not always an option: goat's milk also contains lactose, although slightly less - about 4% compared to 5% in cow's milk. However, for some people, this substitution really pays off, as the low content of milk sugar significantly improves its absorption. Lipid molecules in goat's milk are smaller than in cow's milk, so it is easier to digest even for people with impaired digestive processes. However, experts warn: in severe lactose intolerance, both cow's and goat's milk should be avoided. In case of mild intolerance, it is allowed to consume a small amount of goat milk products (up to 250 ml of milk per day), including cheese and yogurt.

Prevention

It is not possible to prevent the onset of primary lactose intolerance, but measures can be taken to prevent the onset of symptoms in the presence of lactase deficiency: it is important to follow a lactose-reduced or lactose-free diet.

If the first signs of digestive failure appear after eating non-fermented dairy products, it is necessary to consult a doctor and conduct a genetic test for lactase activity, without wasting time trying to self-treat. The doctor will help to choose an appropriate diet, and based on the results of the genetic test will give recommendations on further behavior of the patient in order to prevent unexpected intestinal disorders.

To prevent the development of secondary lactase deficiency, it is necessary to timely undergo diagnosis and treatment of diseases of the digestive system.

Forecast

Lactose intolerance is often found in infants and young children. The treatment strategy for this problem is selected depending on its cause, symptomatic intensity, so it is determined individually. The use of medications containing lactase, in most cases is reasonable and helps to relieve the patient's well-being quite quickly, and in infants preserves the possibility of continuing breastfeeding. The duration of taking enzyme preparations is also determined individually. If the use of such drugs for some reason is impossible, then babies are transferred to artificial feeding with the use of low-lactose mixtures.

Lactose intolerance is a certain discomfort, which does not even always require a complete refusal of dairy products. Only lactose should be rejected, as the rest of the milk composition does not cause a problem. On the shelves of stores you can often find several variants of lactose-free products, in which lactose is replaced by a vegetable analog - the industry produces both lactose-free milk and yogurt, cream, infant formula and so on. Lactose-free milk is just as useful and perfectly suitable for people with lactose intolerance.

Practically harmless for such patients are hard cheeses, but cottage cheese and processed cheese should be excluded.

Complete avoidance of lactose is only necessary in patients with milk sugar allergy and absolute lactase deficiency. Lactose intolerance is a case in which, if possible, complete avoidance should not be necessary. In most cases, one should only severely limit the intake of dairy products in the body. Lactose plays an important role for children's health, it takes part in strengthening bones and teeth. In adults, it supports mental activity and strengthens the body's energy potential.