Preparations with the enzyme lactase. Lactase deficiency. Lactase and lactose – which is correct? Drugs for lactose intolerance
« Lactose intolerance" or " lactase deficiency“- many mothers search the Internet for information on these queries. It happens both ways, how is that right?
First of all, let's find out what each of these definitions means.
Lactose is “milk sugar” or scientifically a disaccharide contained in animal milk, including human breast milk. Lactose gives milk its sweet taste.
Lactase- an enzyme in the human body produced by the intestines.
What do they have in common? Why are their table names similar?
The point is that Lactose (a component of milk) is processed in the human body by lactase! This is precisely the difference between lactose and lactase.
How does this work?
Lactase is found in the human body already at the embryonic stage; it is located in the epithelial cells in the small intestine. The enzyme is actively involved in the baby's digestion process for about a year, that is, in the first year of the child's life. Later, when the baby grows up and begins to eat not only milk and formulas, but, so to speak, switches to adult nutrition, the activity of the lactase enzyme gradually decreases.
So, a newborn baby eats the most suitable food for him - milk. Lactose as an element of milk, entering the child’s body, must be “digested” by him. This is exactly what lactase does. It breaks down lactose into two elements - glucose and galactose, which are absorbed by the body and provide it with the energy necessary for life.
Lactose is also useful for the newborn’s body because it has a beneficial effect on the development of the central nervous system and the functioning of the digestive tract. Lactose also helps improve the absorption of B vitamins and calcium into the body.
Problems with the lactase enzyme are called lactase deficiency..
In what cases does this happen?
Firstly, lactase may be present in the body in sufficient quantities, but its activity may be low and as a result, lactose from milk is not completely processed. This also applies to the case when lactase deficiency is observed in premature infants. The enzyme lactase begins to be produced in the intestines at approximately the 34th week of life, and by the 37th week it begins to function fully. Therefore, premature babies are more likely to suffer from this disease than others.
Secondly, lactase may not be fully produced by the body and, as a result, it cannot fully break down lactose. This happens when infectious or inflammatory processes occur in the intestines.
As a result of “reduced” volumes of lactose processing, unprocessed milk appears in the newborn’s body, which passes through the small intestine (where the enzyme lactose is supposed to process it) and enters the large intestine, where, with the help of bacteria, it is broken down into water, acids and gases.
– fermentopathy, characterized by the inability to break down milk sugar (lactose) due to decreased activity or absence of the lactase enzyme. Lactase deficiency in infants and young children is characterized by regurgitation, intestinal colic, flatulence, stool disorders (diarrhea, constipation), insufficient weight gain, changes in the central nervous system (irritability, excitability, sleep disturbance). To diagnose lactase deficiency, stool examination (for carbohydrates, pH), dietary diagnostics, and genotyping are performed. In case of lactase deficiency, breastfed children are given replacement therapy with the enzyme lactase; for artificial feeding, lactose-free and low-lactose mixtures are prescribed; For older children, a low-lactose diet is recommended.
General information
Lactase deficiency is a type of malabsorption syndrome caused by intolerance to the disaccharide lactose. Lactase deficiency in various regions affects from 10 to 80% of the population. Lactase deficiency is of particular importance for children in the first months of life who are breastfed, since lactose is contained in breast milk, which is the basis of nutrition for infants. Considering the importance and priority of natural feeding in the first year of life, the problem of prevention and treatment of lactase deficiency in children is an extremely urgent task in pediatrics and pediatric gastroenterology.
Causes of lactase deficiency
Normally, milk sugar (lactose) supplied with food is broken down in the small intestine by the enzyme lactase (lactazoflorizine hydrolase) to form glucose and galactose, which are then absorbed into the blood. Glucose serves as the body's main energy resource; galactose is part of galactolipids necessary for the development of the central nervous system. In case of lactase deficiency, undigested milk sugar enters unchanged into the large intestine, where it is fermented by microflora, causing a decrease in the pH of the intestinal contents, increased gas formation and water secretion.
Secondary lactase deficiency occurs when enterocytes are damaged due to diseases of the small intestine (enteritis, rotavirus infection, acute intestinal infections, giardiasis, etc.).
Classification
Thus, a distinction is made between primary (congenital) lactase deficiency (alactasia, hereditary intolerance to disaccharides); adult type hypolactasia; transient lactase deficiency of prematurity and secondary lactase deficiency associated with damage to enterocytes.
Based on the severity of enzyme deficiency, it is customary to speak of hypolactasia (partial decrease in enzyme activity) and alactasia (complete absence of the enzyme). The course of lactase deficiency can be transient or persistent.
Symptoms of lactase deficiency
Lactase deficiency is characterized by intolerance to dairy products, therefore all symptoms of digestive disorders develop against the background of consumption of foods rich in lactose, primarily whole milk.
The main clinical sign of lactase deficiency is fermentative diarrhea in the form of frequent, liquid, foamy stools with a sour odor. The frequency of bowel movements with lactase deficiency reaches 10-12 times a day; Less commonly, constipation is a manifestation of fermentopathy. Dyspeptic syndrome in newborns is usually accompanied by intestinal colic and other digestive disorders - regurgitation, flatulence, abdominal pain.
The consequences of diarrhea in young children are dehydration, insufficient weight gain and malnutrition. Excessive intake of undigested lactose into the large intestine causes quantitative and qualitative changes in the composition of microflora and the development of dysbiosis.
With lactase deficiency, changes in the central nervous system develop, which is explained by impaired nutritional status, deficiency of vitamins and minerals, and endogenous intoxication due to fermentation processes in the gastrointestinal tract. In this case, children may experience hyperexcitability, tearfulness, irritability, sleep disturbances, and a lag in psychomotor development from the age norm.
It has been noted that children with lactase deficiency are more likely to have muscle hypotonia, cramps, vitamin D deficiency rickets, and ADHD - attention deficit hyperactivity disorder.
Diagnostics
For a reliable diagnosis of lactase deficiency, characteristic clinical data must be confirmed by additional laboratory tests.
The so-called “diet diagnosis” is based on the disappearance of clinical signs of lactase deficiency (diarrhea, flatulence) when lactose is excluded from the diet and the appearance of symptoms when drinking milk. After a lactose load, the level of hydrogen and methane in the exhaled air also increases.
Biochemical examination of stool in children with lactase deficiency reveals a decrease in pH<5,5, увеличение (у грудных детей) или появление (у детей старше 1 года) содержания лактозы и углеводов в кале. Золотым стандартом диагностики лактазной недостаточности считается определение активности лактазы в биоптатах тонкой кишки, однако сложность и инвазивность метода ограничивают его использование в педиатрической практике. Первичная лактазная недостаточность может быть выявлена в ходе генетического исследования («лактазного генотипирования»).
Treatment of lactase deficiency
The approach to the treatment of lactase deficiency in children of different ages has its own characteristics. The basic principles are based on the organization of therapeutic nutrition, optimization of the breakdown of lactose, and prevention of the development of complications (hypotrophy, multivitamin and polymineral deficiency).
To preserve natural feeding, infants are prescribed replacement therapy with the enzyme lactase. Children receiving artificial feeding are transferred to low-lactose and lactose-free formulas or soy-based milk substitutes. When introducing complementary foods in the form of cereals and vegetable purees, lactose-free products should be used. Monitoring the correctness of diet therapy is carried out by determining the carbohydrate content in feces.
Whole and condensed milk, confectionery products containing milk fillers, some medications (probiotics), etc. are completely excluded from the diet of older children. With minor hypolactasia, the use of fermented milk products, yoghurts, and butter is allowed if they do not cause clinical symptoms of lactase deficiency. insufficiency.
Forecast
Children with primary congenital lactase deficiency require lifelong diet and enzyme replacement therapy. In premature infants with transient lactase deficiency, maturation of enzyme systems allows a return to milk feeding by 3-4 months. Secondary lactase deficiency is eliminated as the underlying disease is relieved and lactase activity is restored.
Observation of a child with lactase deficiency is carried out by a pediatrician and pediatric gastroenterologist. The criteria for the effectiveness of treatment of lactase deficiency are the disappearance of dyspepsia syndrome, age-appropriate weight gain, normal rates of physical development, and a decrease in the level of carbohydrates in feces.
Lactase is a dietary supplement containing the enzyme of the same name, which promotes better absorption of dairy products.
Release form and composition
Lactase is produced in the form of capsules of 230 mg each containing 3450 units of the lactase enzyme, the source of which is purified mold higher aerobic fungi Aspergillus of two species (A. niger and A. Orizae). 100 capsules per package.
Indications for use
Lactase is an enzyme that breaks down and ensures the absorption of the disaccharide lactose. There are primary (congenital enzyme deficiency) and secondary (enzyme deficiency acquired due to immune, infectious, atrophic and inflammatory changes in the intestines) lactase deficiency
Lack of lactase leads to digestive disorders in the form of flatulence, diarrhea, and intestinal cramps when consuming foods containing lactose.
The use of lactase in infants helps to digest breast milk more efficiently and avoid the development of infant colic and bloating. In adults and older children, taking the enzyme allows them to fully use dairy products in their diet.
In addition to poor milk tolerance in adults, Lactase is used for permanent or temporary (summer season) changes in diet. As an additional source of enzyme, the dietary supplement is also prescribed:
- Elderly people;
- During recovery from intestinal infections.
Contraindications
Lactase, according to the instructions, is contraindicated for use against the background of individual intolerance to the components of the dietary supplement.
Directions for use and dosage
Adults should take Lactase capsules orally with every meal containing dairy products or lactose. Single dosage – 1 capsule.
Children who are breastfed are advised to use Lactase 1/6 capsule. A single dose is added to 30 ml of previously expressed breast milk. It is recommended to first give fermented milk from a bottle, and then breastfeed the baby.
Side effects
No side effects were identified when using Lactase.
Special instructions
Analogues
According to the mechanism of action, analogues of the dietary supplement Lactase are Senna-D, Kanalgat, Potassium-algalan, Hyalact, Zosterin, Pekcecom, Glyukosil, Dilaxo, Magnesium-algalan, Hyalact, Vitanar, Hitolan, Ahillan, Bionorm, Pektovit, Natalgin, Calcilan, Katrel, Lacto -Ecosorb, Liquorice, Hitovit, Lactusan, Laktazar, Fitosorbovit, Pectibon, Pankramin, Rialam.
Terms and conditions of storage
Lactase, according to the instructions, is dispensed from pharmacies without a doctor’s prescription. The shelf life of the capsules is 24 months, provided they are stored in accordance with the manufacturer's recommendations.
Lactase and lactose are the difference when written in one letter, but how do they differ in meaning? Of course, these words are related, but they mean completely different concepts. Lactose is the milk sugar found in dairy products, and lactase is the enzyme that breaks it down. With a detailed acquaintance with these terms, you can discover a lot of interesting things.
Lactose
Lactose is a disaccharide with the chemical formula C12H22O11, found in free form in the milk of all mammals. One hundred milliliters of a woman's breast milk contains about seven grams of lactose. The same amount of cow's milk contains five, sheep's and goat's milk four, mare's milk six, monkey's milk ten grams. Colostrum contains half as much lactose as mature milk. Lactose has a sweet taste, but the intensity of sweetness is only half that of glucose and a third that of sucrose.
Lactose in industry
Lactose is obtained from whey using membrane technology and drying methods, and then used:
- in the dairy industry;
- in baby food;
- in the confectionery industry to improve the base of caramels, marmalade, glazes and sweets, since the addition of lactose to the product leads to its increased viscosity, which gives the consumer a pleasant chewing sensation; in biscuits, jams and chocolate - as a flavoring agent and flavor enhancer;
- in bakery production to increase the volume of baked goods and obtain a beautiful golden brown crust;
- in the alcohol industry to enhance and at the same time soften the taste of an alcoholic drink, reduce the negative consequences of an overdose;
- in the meat industry to increase shelf life and mask unpleasant tastes;
- in the pharmaceutical industry as a basis for many medications, as well as for the production of lactulose, a laxative.
Products high in lactose: whey, whey products, milk powder.
Products that do not contain lactose: fruits, vegetables, honey, coffee, tea, vegetable oil, rice, vermicelli, soy milk, lactose-free dietary products, raw fresh meat, raw fresh fish, eggs, potatoes, legumes, grains, spices and nuts.
Lactase
Lactase is an enzyme from the group of carbohydrases, produced by mature human enterocytes, necessary for the breakdown of lactose into two simple elements - glucose and galactose, which are well absorbed by the body.
Lactase is first detected already in the tenth week of intrauterine development; from the seventeenth week its activity is maximum in the jejunum; from the twenty-fourth week lactase activity is the same in both the distal and proximal parts of the intestine. However, its level of activity is low and increases progressively by the time of birth, maintaining maximum activity for ten to twelve months. With the transition to an adult type of diet, lactase activity begins to decrease. At two years old, lactase activity is already two times lower than in a newborn. The second period of sharp decline in activity occurs at the age of five to seven years.
The level of lactase is influenced by genetic factors, the integrity and usefulness of enterocytes, as well as the level of damaging factors, which primarily include stress hormones. Breast milk contains many substances that directly affect the renewal of the mucous membrane and its full functioning, which helps lactase to fully break down lactose.
When lactase levels decrease below the age norm or are completely absent, lactase deficiency develops, which causes discomfort in adults and is very dangerous for young children whose main diet is dairy products.
LACTOSE IS MILK SUGAR. Have you ever wondered why milk raises blood sugar well in most children and poorly in most adults? Actually there is no secret. It's all about the enzyme lactase, which lives in the small intestine. Do you remember in previous articles that I told you that disaccharides are absorbed only in the intestines?
Lactose is a disaccharide consisting of glucose and galactose molecules. And in order to be absorbed into the blood, it needs to be broken down using lactase.
In children, the lactase enzyme is still active, unless, of course, there is lactase deficiency. But in adults, the ability to absorb milk disappears and causes not so much a strong increase in SC, but rather a strong desire to run to the restroom.
It is precisely because of this feature of children that in SOME cases even hypoglycemia can be stopped with milk. But this doesn’t happen in adults. Although there are adults who consume a lot of milk and everything is OK, then milk will increase SC and... INSULIN (if it is not insulin-dependent diabetes). Do you know that all dairy products have a high INSULIN INDEX? Interesting?
Where does galactose go?
By and large, it is not used anywhere in the form of galactose. As a result of complex biochemical reactions in the liver, it is converted into glucose. Which explains the additional increase in blood pressure after a couple of hours.
There are also genetic defects in galactose metabolism - galactosemia. This is not lactase deficiency!
In this case, there is a defect in the enzymes: Galactokinase, Galactose-1-phosphate uridyltransferase, Uridylphosphate-4-epimerase.
The disease manifests itself in childhood. Treatment is the exclusion of products containing galactose.
Would you like to tell me about lactase deficiency and why I am against most dairy products?
