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Lactose intolerance |
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What is lactose
intolerance?
Lactose intolerance is an inability to digest and absorb lactose
(the sugar in milk) that results in gastrointestinal symptoms when
milk or products containing milk are drunk or eaten.
What causes lactose intolerance?
Lactose is a larger sugar that is made up of two smaller sugars,
glucose and galactose. In order for lactose to be absorbed from
the intestine and into the body, it must first be split into
glucose and galactose. The glucose and galactose then are absorbed
by the cells lining the small intestine. The enzyme that splits
lactose into glucose and galactose is called lactase, and it is
located on the surface of the cells that line the small intestine.
Lactose intolerance is caused by reduced or absent activity of
lactase that prevents the splitting of lactose (lactase
deficiency). Lactase deficiency may occur for one of three
reasons, congenital, secondary or developmental.
How is lactose intolerance treated?
Dietary changes
The most obvious means of treating lactose intolerance is by
reducing the amount of lactose in the diet. Fortunately, most
people who are lactose intolerant can tolerate small or even
moderate amounts of lactose. It often takes only elimination of
the major milk-containing products to obtain sufficient relief
from their symptoms. Thus, it may be necessary to eliminate only
milk, yogurt, cottage cheese, and ice cream. Though yogurt
contains large amounts of lactose, it often is well-tolerated by
lactose intolerant people. This may be so because the bacteria
used to make yogurt contain lactase, and the lactase is able to
split the lactose during storage of the yogurt as well as after
the yogurt is eaten (in the stomach and intestine). Yogurt also
has been shown to empty more slowly from the stomach than an
equivalent amount of milk. This allows more time for intestinal
lactase to split the lactose in yogurt, and, at least
theoretically, would result in less lactose reaching the colon.
Lactase enzyme
Caplets or tablets of lactase are available to take with
milk-containing foods.
Adaptation
Some people find that by slowly increasing the amount of milk or
milk-containing products in their diets they are able to tolerate
larger amounts of lactose without developing symptoms. This
adaptation to increasing amounts of milk is not due to increases
in lactase in the intestine. Adaptation probably results from
alterations to the bacteria in the colon. Increasing amounts of
lactose entering the colon change the colonic environment, for
example, by increasing the acidity of the colon. These changes
alter the way in which the colonic bacteria handle lactose. For
example, the bacteria produce less gas. There also may be a
reduction in the secretion of water and, therefore, less diarrhea
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