Secondary lactase deficiency. Ways to eliminate lactose deficiency. Why is lactase deficiency dangerous?

Does the baby have more frequent attacks of colic, diarrhea with characteristic frothiness and greenery in the stool, 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 organism.

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:

1. Primary lactase deficiency in newborns (it is also present in adults) is characterized by the absolute absence of an important enzyme. Causes of primary LN may be due to premature birth of the mother (in premature babies who were born at 28 weeks of fetal development and 34 weeks, the digestive system is immature and too low lactase levels) or caused by congenital genetic abnormalities.
2. 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.

It is worth warning about the reverse side of the coin 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:

1. 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.
2. 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.
3. 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.
4. A biopsy of the small intestine is one of the most reliable methods, but less common. Since the analysis requires anesthesia and the penetration of a special device into the intestines of the baby.
5. 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.

The 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, must be fixed by a pediatrician.

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 for 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 the help of 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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The wall of the duodenum consists of four layers, which are traced further along the small intestine.

The structure of the duodenum includes:

• mucous base;
• submucosa;
• muscle layer;
• serous layer.

Jejunum

The structure of the wall of the jejunum includes:

• mucous base;
• submucosa;
• muscle layer;
• serous layer.

Intestinal villi are miniature outgrowths of the mucous membrane, the length of which reaches 1.5 mm and a thickness of 0.1 mm. The presence of villi gives a velvety appearance to the small intestine. The main function of the villi is to increase the suction surface. So, thanks to the villi, the total area of ​​the small intestine reaches 500 square meters. On the surface of these villi are enzymes that carry out the process of parietal digestion. Another function of the villi is to guide food. By moving, they help food move far along the intestines in the right direction. On closer examination ( e.g. under a light microscope) the brush border of the villus is visualized. It is in this border that intestinal enzymes are localized.

Between numerous villi are crypts. Cryptos ( or intestinal glands) are called tubular invaginations of the mucous membrane. It has been established that there are about 10 thousand crypts per square centimeter. Crypts are located between the villi, and at their base are various types of cells. They also increase the surface of the intestines and take part in all stages of digestion.

Ileum

Functions of the small intestine

In addition to this function, the small intestine performs a number of others:

• secretory;
• endocrine;
• motor.

secretory function

Composition and functions of intestinal juice
Intestinal juice is a liquid consisting of mucus secreted by enterocytes ( intestinal cells), intestinal enzymes and mucosal cells. Enzymes are those substances that break down large molecules into smaller ones in order to be absorbed. Intestinal juice contains many different enzymes that break down heavy molecules and participate in the process of digestion.

Intestinal enzymes and their functions

endocrine function

motor function

Physiology of the small intestine

Food passes through the small intestine in four to five hours. During this time, under the action of numerous enzymes, food undergoes chemical processing, turning from complex components into simpler ones. Food consisting of proteins, fats and carbohydrates is difficult for the digestion process and in order for it to be absorbed by the body, it must be broken into smaller fragments. Under the action of enzymes, proteins break down into amino acids, fats into fatty acids, and carbohydrates into oligosaccharides and disaccharides. Oligosaccharides and disaccharides are then further broken down into even smaller parts - monosaccharides. Thus, the gradual disintegration of complex molecules into simpler ones is carried out. For example, a disaccharide such as lactose is further broken down into galactose and glucose. Subsequently, both galactose and glucose are transported to organs and tissues, where they participate in various metabolic processes. Initially, lactose itself ( synonym - milk sugar) cannot be absorbed by the intestines, as it is a complex molecule.

In order for this to happen, each component needs its own enzyme. One such enzyme is lactase. This enzyme breaks down lactose, the molecule of which consists of galactose and glucose, for its further digestion. If this does not happen, then lactose accumulates and becomes the cause of an upset gastrointestinal tract. Lactase deficiency is called lactase deficiency or lactose intolerance.

Colon

A well-developed mucosa, together with a powerful muscular layer, promotes the movement of feces. The large intestine is constantly contracting, sometimes accelerating, sometimes slowing down. Here food is neither digested nor absorbed. The main function of this department is the absorption of water and the formation of feces. In the large intestine, the processes of fermentation and putrefaction occur, which are carried out by the intestinal flora. Normally, these are moderate processes and do not pose a danger to the body. When unfermented lactose enters the intestinal lumen, these processes are enhanced.

Lactose and lactase

If lactose is not absorbed for one of the reasons, then it accumulates and enters the large intestine in this undigested form. In the large intestine, lactose activates several mechanisms at once. First, being a high molecular weight compound, it attracts water. Water begins to flow excessively into the large intestine ( where, on the contrary, should it be absorbed), which leads to the formation of loose stools. Secondly, it becomes a breeding ground for lactic acid bacteria, which are normal intestinal microflora. The fermentation process is activated, during which bacteria decompose lactose into water and gases. Water further thins the stool and causes loose stools. The more lactose, the more intense the process. The resulting gases fill the intestinal loops, stretching it, causing flatulence. When stretched, intestinal receptors are irritated, which stimulate the defecation process.

Causes of primary lactase deficiency

This pathology is detected in 5 - 6 percent of the population. It is characterized by a congenital deficiency of the enzyme lactase in a normal and intact intestinal mucosa. The reason for this is a congenital mutation of the genes.

Normally, the enzyme begins to show its activity as early as 12 weeks of fetal development. However, for some reason, the activity of the enzyme may decrease. The lactase enzyme, like other enzymes, is a protein and consists of a certain sequence of amino acids. When this sequence is disrupted, the enzyme is inactivated. It is known that the amino acid sequence of lactase is encoded by the LCT gene. This gene, in turn, is regulated by the MCM6 gene, which is located on chromosome 2q21.3. Thus, these two genes determine the subsequent functionality of the enzyme.

To date, it is not known what exactly leads to the breakdown of these genes. It is believed that congenital deficiency of this enzyme is a manifestation of a separate disease. That is, lactase deficiency is just a symptom of a genetic disease, which is still unknown to science. Evidence of a genetic anomaly is the C13910T marker. Carriers of this marker are characterized by low lactose concentration in adulthood. Another argument in favor of the etiology of this disease is the absence of damage at the intestinal level. The enzyme lactase is known to be secreted by enterocytes ( intestinal cells) in the region of the brush border of the villi. When enterocytes are damaged, the process of lactase synthesis is also disturbed. This mechanism is observed in secondary or acquired lactase deficiency. However, with congenital it is absent. When examining the small intestine such as fibroscopy) the mucosa of the small intestine is not damaged, and no symptoms of inflammation are detected.

Lactase deficiency in premature babies

Causes of secondary lactase deficiency

The causes of acquired (secondary) lactase deficiency are:

• resection of the small intestine;
• lactose overload.

Intestinal infections

Diarrhea for several days is the cause of dysbacteriosis. Dysbacteriosis is an imbalance between good and bad intestinal flora. It is known that a healthy intestinal microflora consists of lactobacilli and bifidobacteria, which perform a number of beneficial functions in the body. These bacteria prevent the growth of bad bacteria, participate in the process of digestion and stimulate the immune response. In addition, they are involved in the process of digestion and, in particular, in the absorption of galactose.

The balance between “bad and good” is disturbed due to frequent bowel movements. Along with feces and fluid, the intestines lose their good microorganisms. The consequence of this is an imbalance between the amount of lactose that needs to be fermented and the amount of bacteria that must do so. As a result, a kind of relative lactase deficiency develops. This type of insufficiency is the most common and at the same time the easiest. It is corrected immediately after the dysbacteriosis is eliminated.

Another mechanism of lactase deficiency is associated with damage to enterocytes. Bacteria or viruses in this case can have a direct cytopathic ( cell-destroying) Effect. This effect manifests itself differently in different microorganisms and depends on the degree of pathogenicity of the bacterium or virus. For example, rotavirus penetrates the epithelium of microvilli, in the brush border of which lactase is located. Its penetration is accompanied by the destruction of the cell and its rejection ( there is a process called desquamation of the epithelium). It should be noted that rotavirus penetrates already into mature, differentiated epithelial cells. Therefore, after their rejection, functionally immature cells remain in the intestine that do not secrete lactase.

A slightly different mechanism of lactase deficiency is observed in dysentery. The causative agent of this disease is Shigella. These microorganisms are able to produce and release toxins that have a toxic effect on the nervous, intestinal and other human systems. Once in the small intestine, Shigella attach to its walls and release an enterotoxic toxin. It got its name because of the special toxic effect on the intestines ( entero - intestines). At the same time, part of the Shigella penetrates into enterocytes ( predominantly ileum) and begins to multiply there intensively. By producing various lytic enzymes, Shigella destroy the cell. After that, they move to other enterocytes, causing an inflammatory process in the entire small intestine. Then they pass to the large intestine and also massively affect the mucosa.

Giardiasis is also a common infection among children, especially those aged 1 to 4 years. Having penetrated the intestines, Giardia clings to the intestinal villi and causes irritation. This disrupts the process of parietal digestion, part of which is the breakdown of lactose. A feature of the reproduction of Giardia in the intestines is that they affect the intestines not in width, but in depth. In this case, deep inside, but not extensive outside lesions of the intestine are formed.

Thus, each type of infection is characterized by its own mechanism of damage to the enterocyte. The common thing is that by damaging it, they cause a deficiency of lactase, since its secretion is disturbed.

celiac disease

With celiac disease, the amount of all enzymes, including lactase, decreases in the mucous membrane of the small intestine. Lactose intolerance is the most common companion of this disease. Severe lactase deficiency is noted in the acute period of celiac disease. During remission, when the child or adult follows a gluten-free diet, the symptoms of lactase deficiency subside.
It is worth noting that both celiac disease and lactase deficiency are manifested by liquid, frothy stools. For a long time, these pathologies can mask each other, which will lead to extensive damage to the intestine.

Crohn's disease

The difference between granulomatous enteritis and enteritis of infectious etiology is that the inflammation affects the entire intestinal wall. Such a lesion is called transmural and is characteristic only of Crohn's disease. In segments where inflammation is localized, wide tortuous ulcers are observed. The mucosa itself thickens, narrows and loses its architectonics. Folding, villi, crypts disappear in it, and visually it takes on the appearance of a “cobblestone pavement”. Thus, in the segments where inflammation develops, the mucosa completely loses its functions. The secretion of enzymes, including lactase, is completely stopped. If the disease progresses, scar tissue develops in place of the mucosa and lactase synthesis is completely lost.

Chronic pancreatitis

food allergy

Food allergies are based on an antigen-antibody complex. Various food products act as an antigen. Most often these are products containing dyes and various food additives. In response to their penetration, the body produces special substances called antibodies. These antibodies are very specific. Each antigen produces its own antibodies. Further, when the antigen re-penetrates, the antibody, trying to neutralize it, binds to it. With the formation of the "antigen-antibody" complex in the body, a series of immunological reactions is launched. It unfolds on the intestinal mucosa, but can also occur on the bronchi or skin. This process is based on the infiltration of enterocytes by inflammatory cells and the release of a large amount of neurotransmitters. All this leads to damage to enterocytes as immune complexes ( antigen-antibody), which settle on the intestinal mucosa, and inflammatory cells. As a result, the functional ability of enterocytes to secrete lactase decreases.

Resection of the small intestine

Lactose overload

Symptoms of lactase deficiency in infants

• liquid stool;
• painful bloating;
• child anxiety;
• poor weight gain or decrease in it.

loose stool

The symptoms of the disease increase as the milk supply increases. Initially, loose stools may be observed, which by the end of the day becomes watery and frothy. A feature of the stool with lactase deficiency is its sour smell. Sometimes lumps of undigested food may be present in the stool.

Loose, frequent stools are the result of undigested lactose entering the colon. Lactose itself is a high osmolar compound, which means that it will absorb water in large quantities. Once in the large intestine, whose main function is to absorb water, lactose attracts water. The intake of large amounts of water is the cause of frequent and loose stools. Another mechanism for the formation of foamy stools is the mechanism of fermentation. It is known that lactose is a substrate for the reproduction of lactic acid bacteria. When it enters the intestines in excess, the fermentation process is activated. As a result of this process, gases and water are formed. This further complicates the course of diarrhea. The sour smell, which is characteristic of lactase deficiency, indicates lactic acid bacteria and the fermentation process.

Sometimes a baby may have constipation or pass infrequent stools ( less than 5 times a day). Stool may appear after stimulation ( tummy massage clockwise, warm bath), but it will still be liquid and unformed.

Painful bloating

The stomach of such children is dense ( from a tense bowel) and painful. Because of this, children are often restless, especially during feeding, crying. A characteristic symptom is rumbling in the abdomen.

Child anxiety

Poor weight gain or loss

Poor weight gain or decrease in it is observed in complex cases of lactase deficiency and is an alarming symptom. Weight loss is due not only to poor satiety of the baby, but also to frequent bowel movements. Along with the feces, water also leaves the body. In severe cases, water loss leads to dehydration of the child. Symptoms such as dry skin, lethargy of the baby and lack of urination are alarming symptoms. When they appear, you should immediately consult a doctor.

Maternal risk factors for the development of lactase deficiency in children are (data are indicated as a percentage) :

• chronic fetoplacental insufficiency ( pathology of the placenta or fetus) – 62;
• complications during the first and second trimester of pregnancy - 38;
• maternal urinary tract infection, 25;
• taking a number of drugs during pregnancy - 22;
• threatened miscarriage - 22;
• chronic diseases of the gastrointestinal tract in the mother - 21.

• damage to the central nervous system - 75;
• violations of the microflora of the colon - 73;
• food hypersensitivity - 66;
• acute intestinal infection - 59;
• early weaning, 46;
• acute respiratory infections more than 6 times a year - 37;
• frequent use of antibiotics - 33;
• stay in the maternity hospital separately from the mother - 21.

In the acquired form of the disease, in addition to the symptoms of lactase deficiency, symptoms of the underlying disease are also observed. With food allergies, this is a rash on the skin and mucous membranes; with infections, these are symptoms of inflammation.

Primary lactase deficiency is much more severe. Diarrhea often causes dehydration. Rapidly increasing symptoms of acidosis ( smell of acetone, lethargy). Sometimes vomiting, profuse regurgitation and convulsions can be observed.

Symptoms of lactase deficiency in adults

In 60 - 70 percent of adults suffering from lactase deficiency, symptoms of the disease appear when consuming up to 200 milliliters of dairy or sour-milk products. In about 5 percent of cases, the symptoms are pronounced.
In 10 to 12 percent of adults, symptoms of lactase deficiency appear almost exclusively when eating milk. Dairy products in moderate doses do not cause clinical signs.

There is also a group of people 5 - 10 percent of patients with lactase deficiency), which calmly tolerate up to 200 milliliters of milk and consume sour-milk products in unlimited quantities.

Lactase deficiency in adults is characterized by the manifestation of a number of symptoms of dyspeptic disorder ( digestive disorders) and signs of general malaise of the body. Symptoms appear 1.5 to 2 hours after ingestion of food containing dairy or sour-milk products.

Symptoms of dyspeptic disorder in lactase deficiency in adults include:

• increased gas formation;
• osmotic diarrhea;
• feeling of nausea;
• reflex vomiting.

The second link in the mechanism is the "fermentation" of lactose in the large intestine under the action of enzymes of anaerobic bacteria. A large number of different bacteria live in the large intestine, which make up its healthy microflora. They are involved in the process of normal digestion. When lactose enters the large intestine, bacteria break it down into fatty acids, carbon dioxide, and hydrogen. Thus, a large amount of gas and fatty acids accumulate in the intestinal lumen.
With excessive gas formation, the large intestine increases due to the stretching of the walls. Constant overstretching of the large intestine leads to irritation of pain receptors from the muscle layer of its walls.

The third link is the increase in osmotic pressure in the large intestine due to the high concentration of fatty acids. High osmotic pressure draws water from the body into the intestinal lumen. The accumulation of a large volume of water leads to diarrhea.
In some patients, with age, a developed protective reflex of the body appears when dairy products are ingested - reflex vomiting. In the patient's subconscious, dairy products are associated with unpleasant symptoms of dyspeptic disorders. Therefore, the body is trying in every possible way to get rid of the "harmful" product.

Symptoms of lactase deficiency in adults and the mechanism of their occurrence

The general malaise of the body with lactase deficiency leads to the appearance of:

• general weakness;
• dizziness;
• weakness in muscles and joints;
• increased sweating;

Diagnosis of lactase deficiency

There are the following methods for diagnosing lactase deficiency:

• coprological analysis;
• analysis of feces for carbohydrates;
• determination of the hydrogen content in the inhaled air after taking lactose;
• lactose curve;
• biopsy of the small intestine;
• genetic tests;
• elimination diet.

Coprological analysis

Microscopic examination examines such parameters as muscle fibers, fiber, connective tissue, microflora. These parameters do not affect the diagnosis of lactase deficiency, but may reflect its causes. So, disturbed microflora ( dysbacteriosis) may be one of the causes of lactose intolerance.

Analysis of feces for carbohydrates

If an additional chromatographic analysis is carried out, then not the total carbohydrate content is determined, but the lactose content in the feces. In infants, this figure should not exceed 0.07 percent, while in older children and adults it should be completely absent. The presence of lactose in the feces of an adult and its increase in an infant is direct evidence of lactase deficiency.

Determination of hydrogen content in exhaled air after taking lactose

The concentration of hydrogen is measured with a special analyzer after the patient takes 50 grams of lactose in liquid form. The test is considered positive if the hydrogen concentration after exercise increases by 0.002 percent. The method in one fifth of cases gives false positive results. The downside is also that the hydrogen content in children under three months and in adults is identical.

lactose curve

An hour after the patient has taken the necessary solution of lactose, the concentration of glucose in the blood is measured. Prior to this, determine the initial level of glucose in the blood. Normally, after loading with lactose, the glucose level should rise by 20 percent or more compared to the initial concentration. If this does not happen, then lactose has not been fermented by lactase and, accordingly, there is a deficiency of this enzyme.

To obtain the most accurate result, initially carry out a load with glucose, and then with lactose. Glucose levels are recorded 15, 30 and 60 minutes after lactose and glucose loading. Using the data obtained, a curve is built that reflects how the glucose concentration rose or fell. After that, the obtained curves are compared. If the curve does not show an increase in glucose ( flat curve view), this indicates that lactose is not utilized by the enzyme and lactase deficiency is present.

Biopsy of the small intestine

Genetic tests

Elimination Diet

In addition to these methods, methods are used to identify pathologies that have caused lactase deficiency. Fibroscopy is used for Crohn's disease, for celiac disease - determination of fatty acids in feces, for dysbacteriosis - analysis of feces for microflora, for intestinal infections - bacteriological methods.

Diet therapy for lactase deficiency

Nutritional correction is the main treatment for patients with lactase deficiency. Features of the diet and its duration depend on the clinical picture of this disorder and the age of the patient.

• Adults;
• infants;
• breastfeeding mothers of children with this disease.

Diet for older children and adults

Lactose content ( in grams) in some foods ( per 100 grams)

• kefir - from 4.1 to 6 ( depending on fat);
• yogurt - from 3.1 to 4 ( depending on the type of product and the fillers used);
• margarine - 0.1;
• butter - 0.6;
• condensed milk - from 9.2 to 12.5 ( with a fat content of 7.5 percent to 10 percent);
• powdered milk - 51.5;
• whole milk - 4.8 ( cow), 4,5 (goat), 4,8 (sheep), 6,4 (mare);
• milk chocolate - 9.5;
• ice cream - from 1.9 to 6.9 ( depending on the type);
• sour cream ( ten percent) – 2,5;
• cottage cheese - from 2.6 ( at 40 percent fat) up to 3.2 for a fat-free product;
• cream - from 3.3 ( at 30 percent) to 4.8 ( at 10 percent);
• buttermilk - 3.5 ( liquid), 44,2 (dry);
• serum - 3.4 ( whole), 70 (dry);
• cheeses ( gouda, camembert, roquefort) – 2;
• cottage cheese - 2.6 ( 40 percent), 2,7 (20 per cent), 3,2 (skimmed);
• curd cheese - 1.5.

• Dishes containing lactose should be consumed with other foods. Larger volumes of food move more slowly through the gastrointestinal tract, which gives the lactulose molecules time to break down the milk sugar.
• Symptoms of lactose intolerance are more pronounced when eating foods with a contrasting temperature ( hot tea and cold butter sandwich). Therefore, food should be of medium temperature.
• The daily norm of dairy products should be divided into several doses, because the intensity of the manifestations of the disease depends on the amount of milk sugar consumed. In some patients, small portions of lactose products do not cause any complications.
• Pasteurized fermented milk yogurts are less digestible, so you should eat foods that contain live lactic acid bacteria.
• When choosing cheeses, preference should be given to hard and semi-hard varieties, since most of the lactose is lost during the ripening process.
• Heavy cream contains less milk sugar than milk. Therefore, in some cases, cream can be used in the preparation of omelettes or other types of dishes.
• The higher the percentage of fat in the products, the less lactose it contains. This factor should be taken into account when choosing cottage cheese, yoghurts and other dairy products.

Principles of building nutrition for lactose intolerance

Products that contain lactose as a natural ingredient are:

• dry and whole milk cow, goat, sheep, mare);
• cheeses;
• cream;
• sour cream;
• koumiss;
• butter;
• cottage cheese;
• serum;
• buttermilk.

When purchasing finished products, attention should be paid to the composition indicated by the manufacturer on the packaging.

Store-bought products in which milk sugar is added during cooking are:

• sausages, boiled ham, ham;
• jam, jam, jam;
• instant soups and mashed potatoes;
• bread, breadcrumbs, biscuit dough products ( cakes, pastries);
• ketchup, mustard, mayonnaise;
• bouillon cubes, seasonings, flavor enhancers;
• chocolate, chocolate icing, cocoa.

Products that do not contain lactose are:

• fruits vegetables;
• coffee Tea;
• vegetable oils;
• soy and products from it ( cheese, milk, cottage cheese);
• pasta;
• eggs;
• nuts;
• peas, beans and other legumes;
• corn, wheat, buckwheat;
• wine, beer, cider.

Essential foods and vitamins

Foods rich in vitamin A
Retinol performs a large number of functions in the body. The need for this vitamin increases with intestinal diseases, against which lactose intolerance often develops. Therefore, patients with this disease must include dishes in the menu that include this element. During cooking and canning, foods lose from 15 to 35 percent of vitamin A. It is also destroyed during long-term storage in the cold. These factors must be taken into account when preparing food. The daily requirement of a vitamin in adults is from 1.5 ( among women) up to 2 milligrams ( in men).

Products that contain retinol are (vitamin content is indicated in milligrams per 100 grams of product):

• liver - 8.2 ( beef), 12 (chicken), 3,5 (pork);
• carrots - 8;
• sorrel - 8;
• parsley - 8;
• soy - 6;
• viburnum - 2.5;
• green onions - 6;
• green garlic feathers - 2.4;
• wild garlic - 4.2;
• broccoli - 0.39;
• eggs - 0.5 ( quail), 0,35 (chicken).

Functions of vitamins and their daily intake

Foods that contain calcium are (the amount of the trace element is indicated in milligrams per 100 grams of product):

• sesame - 1474;
• poppy - 1667;
• rosemary ( dry) – 1280;
• parsley ( dry) – 1140;
• tofu ( soy cheese) - from 683 to 345 depending on the species;
• almonds - 273;
• flax seeds - 255;
• mustard - 254;
• pistachios - 250;
• garlic - 180.

Foods that contain vitamin D are (the amount is indicated in milligrams per 100 grams of product):

• mackerel - 1;
• trout - 0.64;
• tuna - 0.27;
• cod liver - 0.1;
• sea ​​bass - 0.92;
• herring - 0.086;
• cedar oil - 0.07;
• saithe - 0.042.

Factors that reduce the effectiveness of calcium intake are:

• the absorption of calcium is hindered by the abundance of such products in the diet as salt, sugar, starch;
• caffeine, alcohol, tobacco products destroy this element;
• whole grain bran in combination with calcium form a calcium salt, which is not absorbed in the gastrointestinal tract;
• violates the process of absorption of calcium by aluminum, so you should stop using dishes made of this metal;
• reduces the quality of assimilation of this microelement by taking such drugs as tagamet, zantac, peptide.

• the use of products that contain vegetable acids ( vegetable oils, nuts);
• the inclusion in the diet of such elements as iron, potassium, magnesium vitamins A, C, E;
• reduction of heat treatment time;
• beetroot juice, which should be consumed 250 - 300 milliliters every day.

Diet for young children

• if there is weight gain and the child feels satisfactory, breastfeeding should be continued, observing a number of rules;
• if the baby is gaining weight, but frequent loose stools are noted, breastfeeding must be supplemented with special pharmacological agents that contain lactase. The amount of the drug depends on the test results;
• if the child is not gaining weight well, milk should be partially or completely replaced with lactose-reduced or lactose-free products ( low-lactose and lactose-free formulas, soy milk nutrition, hydrolysed formulas).

Recommendations for breastfeeding with lactase deficiency in a child

The rules for breastfeeding with lactose intolerance are:

• after feeding, pumping is not recommended;
• the breast should be changed after the child has completely emptied it;
• you should not take long breaks when changing the mammary glands, since with long pauses a larger amount of foremilk is formed in the breast;
• when feeding, the correct attachment to the breast should be monitored, as this will help the child to suck better and receive back milk;
• at night, more hindmilk is produced, so night feedings are recommended;
• The baby should be weaned from the breast after he has had enough.

Enzyme lactase

Drugs that contain lactase are:

• lactase enzyme;
• baby lactase;
• lactazar;
• kerulak;
• lactase;
• lactade.

Lactose-free and low-lactose formulas

Low-lactose baby foods include:

• Nutrilon low lactose;
• nutrilak low-lactose;
• humana LP;
• humana LP + MCT.

Lactose-free formulas are prescribed for primary lactose intolerance, which is a rare genetic disease. Such products do not contain lactose, since even a small amount of it causes vomiting, diarrhea, and weight loss in a child.

Lactose-free mixtures are:

• grandmother's basket ( lactose free blend);
• nan ( lactose-free);
• nutrilak lactose-free;
• mamex lactose-free;
• enfamil lactofre.

Soy milk based baby food products

Soy milk formulas are:

• enfamil soy;
• bona-soy;
• heinz soy mixture;
• humana soy;
• NAN soy.

Hydrolyzed lactose-free infant formula

Brands of hydrolyzed lactose-free formulas are:

• alfare;
• pepti junior;
• pregestimil;
• nutramigen;
• Humana GA 1, Humana GA 2;
• frisopep AS.

Complementary foods for children with lactose intolerance

Diet of a nursing mother with lactase deficiency in a child

Gas generating products include:

• black bread;
• grape;
• rich sweet pastries;
• sugar and confectionery.

Duration of diet therapy for lactase deficiency

Treatment of lactase deficiency with medications

With lactase deficiency, the following medicines are used:

• preparations containing lactase - to compensate for its deficiency;
• antidiarrheal drugs - with severe diarrhea;
• carminative drugs - with painful swelling;
• antispasmodics - to eliminate pain;
• vitamins and minerals - for the correction of immunity;
• prebiotics - to restore intestinal microflora.

Products containing lactase

Drugs used for diarrhea

Drugs used for bloating

Medications to relieve stomach pain

Drugs used to restore the intestinal microflora

Drugs used to correct immunity

The baby suffers with a tummy, cries, arches, and his mother treats him for colic. Gives syrups, drink dill water. Often, pediatricians are also advised to take a stool test to rule out lactase deficiency (LN) in infants.

In our country, every fifth baby is diagnosed with this disease. While the latest modern research suggests that lactose intolerance is a rather rare disease. Who to believe?

What is lactase deficiency?

Lactose is an important component of breast milk. In fact, it is a sugar that is found only in mammals, and in human milk it is the most.

Lactose makes milk taste good, gives the baby energy, affects the development of the brain. It stimulates the formation of colonies of beneficial bacteria in the gastrointestinal tract.

And it is very important that in the body of a little man there is enough enzyme (lactase), which breaks down lactose.

If there is little or no lactose at all, lactose becomes a breeding ground for microorganisms that provoke loose stools and pain in the intestines. The baby begins to suffer from increased gas formation.

And sour stools can damage the intestinal walls, causing other nutrients in breast milk to simply not be absorbed by the body. How milk sugar is not digested.

How does lactase deficiency manifest itself in infants?

Signs of lactase deficiency

In the pediatrician's office, mothers often describe the same complaints:

• babies are too restless during feeding;
• they have frequent liquid stools with a sour smell and mucus;
• constantly growling in the tummy.

Moreover, many women note that these symptoms appear on the rise.

If in the first weeks of life, babies behave normally, then over time, when the amount of milk drunk per day increases, anxiety increases. Children greedily kiss the breast, but after a couple of minutes they drop it and cry.

For lactase deficiency in infants, indeed, similar symptoms are characteristic.

As well as frequent profuse regurgitation, and poor weight gain.

But it should be noted that several signs of the disease do not mean that the child is sick. The diagnosis is made by the doctor only after the examination. The most reliable method is a biopsy of the small intestine, but the procedure is done only under anesthesia, so doctors rarely resort to it.

Basically, they offer to take a coprogram and analyze feces for carbohydrates. Doing them separately is not informative.

And it is also impossible to make a diagnosis based on only one analysis, without knowing the clinical picture.

Usually in children with a similar problem, the acidity of the stool below the norm, ph does not exceed 4, and it contains a lot of fatty acids, soap.

Important! Before the analysis for lactase deficiency, you can not give the baby a laxative. It should empty naturally. It is desirable that the child does this on an oilcloth, and not in a diaper.

Hand over feces to the laboratory within the first 4 hours after emptying.

Causes of lactase deficiency

Lactase deficiency is associated with a decrease in the activity of the lactase enzyme in the intestine or its absence. This is primary lactase deficiency, which is rarely congenital.

If there are those in the family who do not “digest” dairy products, it is possible that the disease was inherited by the baby.

Also, lactase deficiency is common among immature and premature babies, whose intestines are not ripe, and the production of lactase is small.

In secondary lactase deficiency, the cells that produce lactase are damaged, and for this reason, the production of the enzyme is impaired. It can be provoked by:

• intestinal infections;
• allergy to cow's milk protein (read an important article about allergy to cow's milk protein in infants >>>);
• gluten intolerance, etc.

There is another reason leading to lactase deficiency, and this is the most common variant. Relatively speaking, this is not even a deficiency, but "lactose intolerance."

The reason for this is the wrong organization of breastfeeding, when the baby drinks only lactose-rich foremilk. It enters in large volumes in the intestines, in which due to age, not disease until there is not enough enzyme to digest this very lactose.

It is important that the baby suck out both the anterior and hind breast milk, which will facilitate the process of its digestion and assimilation.

Also, due to the fact that the child gets used to extracting only the fore milk, which flows freely from the breast, he ceases to make efforts for effective sucking.

As a result, the breast is poorly stimulated, there is less and less milk, the baby does not fit into the norm for weight gain.

As a result: the mother transfers him to a lactose-free mixture, and the child begins to gain the cherished grams. And all you had to do was figure out breastfeeding, eliminate mistakes in the organization of feeding, and you would calmly breastfeed further.

Important! Signs of lactase deficiency in infants are not a reason to switch to a mixture. It is necessary to establish proper feeding, and the problem will be solved.

See also my video tutorial on the signs and causes of lactase deficiency.

How to treat ?

Moms always want to give the baby a magic pill to alleviate all his suffering.

In the case of lactase deficiency, it is important to start with the establishment of proper breastfeeding, and then engage in drug treatment. Here are some recommendations:

1. Check capture.

You can watch videos on the Internet or consult with a consultant on guards.

It will be difficult for the baby to get fatty hindmilk, and he will be content with the front, and then suffer from abdominal pain.

How to help a child with colic and gas without drugs, see the online course Soft tummy >>>

1. Feed until your breasts are completely empty.

The baby ate a little from one breast, and you are already offering him a second one? Wrong approach.

Wait until the child drinks milk from one and, perhaps, you won’t have to offer the second one - he will be full. Alternate breasts every 2-3 hours.

1. Do not feed according to the schedule.

Do not look at the clock, do not calculate how much time has passed. Give your baby a breast on demand. That is often.

Wait until the baby releases the nipple on its own.

Long breaks between feedings contribute to the fact that a large amount of foremilk will accumulate in the breast.

1. Be sure to feed at night! During this time, more hindmilk is produced.

If a mother actively eats dairy products, cow's milk protein can be absorbed into the bloodstream and enter breast milk.

If the protein is an allergen for the baby, a reaction will occur, and as a result, lactase deficiency.

The exclusion of dairy products from the mother's diet will solve the situation, the activity of the intestines will be restored.

On a note! An allergen in breast milk can be any other protein and even sweets. Therefore, it is better for the mother of a restless baby to keep a food diary.

If lactase deficiency in infants does not go away, the lactase enzyme is connected to the treatment.

The drug is given immediately before feeding or during breastfeeding. That's the only way you can see the effect.

If within 3 days you do not see the result and improvement from taking lactase, most likely you have been diagnosed incorrectly.

Important! Drugs for dysbacteriosis like Plantex and Bifidumbacterin contain lactose. With lactase deficiency, they can not be taken.

When exactly lactase deficiency will pass in a particular baby, it is impossible to say. Usually by 4-6 months the situation improves significantly.

Lactose deficiency in infants is a rather serious and even dangerous problem. After all, such a violation is associated with the inability of the body to absorb dairy products, including mother's milk. Therefore, every parent should be aware of the main symptoms of such a condition, because the sooner treatment is started, the greater the chances of a successful recovery.

What is dangerous in the chest?

To begin with, it is worth noting that milk (including breast milk) contains a sugar called lactose. It is he who covers almost 40% of the energy costs of the child's body. The process of digestion of this carbohydrate occurs with the participation of the enzyme - lactase. Lactose deficiency in infants is accompanied by a deficiency of this enzyme, which makes it impossible for the normal absorption of such a product. However, lactose is directly involved in the development of the brain and the formation of the retina. That is why the deficiency of such a substance leads to unpredictable and often sad consequences.

Lactose deficiency in infants and its forms

To date, it is customary to distinguish between two main forms of such a violation:

• Primary, or congenital, insufficiency is most often associated with genetic characteristics and is hereditary. The same form is often found among premature babies.
• Secondary develops after birth against the background of diseases of the digestive system, including some intestinal infections.

Lactose deficiency: symptoms of the disease

The main symptom of the disease is diarrhea - bowel movements occur 10 - 12 (sometimes more) times a day. At the same time, the feces are liquid, foamy, green in color with a sour smell. During illness, fermentation processes intensify in the digestive tract, resulting in the accumulation of excess gases in the intestines. Thus, the child constantly suffers from bloating and pain in the abdomen, often refuses to eat, pulls his legs to his stomach, constantly cries, sleeps poorly. Often you can notice abundant regurgitation, up to vomiting. In the absence of treatment, the baby slowly gains weight, and in the most severe cases, there is a developmental lag.

Lactose deficiency in infants and diagnostic methods

To date, there are many ways to check the work of the child's body:

• first of all, they analyze fecal masses for the level of carbohydrates;
• in addition, they also check the pH of feces - in case of insufficiency, this indicator changes;
• in some cases, the doctor prescribes diet diagnostics - the child is prescribed a lactose-free diet and the change in condition is monitored;
• the most accurate is a biopsy of the intestinal mucosa, followed by examination of samples for lactase activity.

What is the child to do?

In fact, the treatment here is individual and depends on the causes of the development of insufficiency and the age of the child. For example, quite often, special artificial mixtures with a low or zero lactose content are introduced into a child's diet. If the baby is breastfed, then you need to feed him only with expressed milk, after dissolving a tablet or powder containing the lactase enzyme in it.

Unfortunately, more and more children began to appear with problems of the digestive tract. One of the most common pathologies in children under one year old is lactose deficiency. In infants, ¾ is an intestinal disease, which consists in not digesting milk sugar ¾ of lactose.

In medical terminology, the term “lactase” deficiency is sometimes heard, and not “lactose”. Lactase is the enzyme responsible for the breakdown of lactose. It would seem that everything is logical: there is no or little enzyme that breaks down lactose, which means that lactose is not absorbed in the proper amount, and then, as a result, signs of lactose deficiency . But, having understood the pathogenesis of this disease, scientists came to the conclusion that manifestations of lactose sugar deficiency in newborns sometimes develop not only and not even so much due to a lack of the lactase enzyme. Hence the classification was developed.

Classification

This classification of lactose deficiency according to a causal relationship with a particular disease (condition) of the body is necessary not only to understand the mechanism of pathology development, but also to determine the tactics of treatment.

• Primary.
• Primary lactose deficiency in newborns, in turn, is divided into two subgroups:
• congenital, or true;
• transitory or temporary.
• Primary lactose deficiency in adults is:
• involutional;
• autoimmune.
• Secondary lactose deficiency in children and adults occurs for the same reasons:
• acute and chronic enteritis and colitis (including infectious nature);
• allergic diseases (antibodies against your own intestinal cells);
• celiac disease - intolerance to the cereal protein gluten;
• Crohn's disease - a pathology in which deep ulcers form in the intestinal wall;
• medicinal damage to the intestines - antibiotics, anti-tuberculosis drugs, antidepressants, cytostatics;
• radiation (radiation) damage to the intestine - exposure to external ionizing radiation or radiation therapy;
• operations to partially remove the intestine;
• short bowel syndrome.

Primary lactose deficiency in children

Congenital (true) lactose deficiency due to a genetic mutation leading to a defect in lactase synthesis. That is, the enzyme is not produced by intestinal cells in principle. This option is quite rare - about 1 case per several million newborns.

Transient (temporary) lactose deficiency- a condition that is no longer as rare as the previous one. It develops if the baby is premature. It is so "programmed" by nature that in the late stages of pregnancy in the fetus, the synthesis of the lactase enzyme begins to "start" in the intestinal cells. If preterm birth has taken place, then lactase does not have time to form in utero. It will be produced after birth, but a sufficient amount of time will pass until the enzyme begins to be synthesized in sufficient quantities. It is in this interval that the symptoms of lactose deficiency appear.

Primary lactose deficiency in adults

involutional insufficiency occurs due to the natural aging process, accompanied by a decrease in lactase activity. It is noteworthy that such a condition has not only an age limit, but also a territorial affiliation: Asians are much more likely to have lactase deficiency, but northern Europeans practically do not encounter it.

Autoimmune lactase deficiency- an infrequent pathology in which antibodies are produced in the body against its own protein-enzyme lactase. For what reason this occurs is not clear, but there is evidence of the appearance of autoimmune aggression after taking any potent drugs or exotic products.

Secondary lactose deficiency

In about 85% of cases, the cause of this condition is acute and chronic enteritis and colitis. They can occur due to infection by the oral route (Giardia, Staphylococcus aureus, Shigella, adenoviruses, rotaviruses, clostridia, etc.) and due to inflammatory pathology in the higher sections of the gastrointestinal tract.

How enteritis and colitis lead to lactase deficiency

With intestinal infections, the following occurs. Pathogenic microorganisms secrete special toxins that block the membranes of intestinal cells. They become unable to absorb the substances necessary for metabolism from the outside and at the same time they cannot excrete unnecessary (waste) products. As a result, intestinal cells (enterocytes) die. Fewer enterocytes means less lactase, which breaks down lactose.

And with concomitant pathology, for example, with chronic gastritis, accompanied by pancreatitis and cholecystitis, high-quality mechanical processing and full-fledged enzymatic breakdown of food does not occur. Poorly digested remnants of food go to the intestines. Since the food did not receive proper processing in the previous sections of the gastrointestinal tract, plus the motility of the digestive tube is disturbed due to inflammation, the process of decay begins in the intestine. Decay products (toxins) are released that damage intestinal cells - enterocytes.

Other causes of secondary lactase deficiency

The remaining 15% belong to other causes of secondary lactase deficiency. In second place after infectious colitis and enteritis against the background of diseases of the upper gastrointestinal tract is allergic colitis (5% of cases of lactase deficiency). It occurs when the body produces antibodies against intestinal cells. It is sometimes called eosinophilic colitis, since special types of leukocytes ¾ eosinophils accumulate in the intestinal wall during allergic inflammation.

After allergic colitis, the remaining 10% of the causes are distributed more or less evenly among themselves.

Conclusion: There are many reasons for secondary lactose deficiency, but the chain of development of the pathological process is the same in all cases: intestinal cells are destroyed - there is no one to produce lactase - a decrease in the amount of lactase - a decrease in the amount of split lactose sugar - lactose deficiency.

Negative consequences of lactose deficiency:

• dysbacteriosis;
• malabsorption of essential substances and trace elements;
• dehydration (violation of water and electrolyte metabolism);
• intestinal atony (impaired peristalsis);
• decrease in immunity.

Pathogenetic chain of processes and consequences occurring in the intestine with lactase deficiency

Dysbacteriosis occurs like this. Lactose from the small intestine in unchanged form reaches the large intestine, where it begins to be absorbed by the microflora. Unsplit lactose is an excellent sugar substrate for the nutrition of opportunistic microorganisms. Carbohydrate environment promotes the reproduction of "bad" bacteria. As a result, the vital activity of beneficial microflora is suppressed, and all processes of digestion and absorption are disturbed.

As a result of the action of waste products and toxins of pathogenic intestinal bacteria, disturbances in peristalsis occur. There are 2 options: the intestinal wall can contract sluggishly (hypotension and atony) or too actively (intestinal hypertonicity or irritable bowel syndrome).

Further, violations in the work of the intestines go along the chain. Due to dysbacteriosis, the absorption of water, necessary organic substances, vitamins and microelements (calcium, potassium, copper, iron, zinc, etc.) is difficult through the intestinal wall. The body faces a double trouble: hypovolemia (dehydration) and a violation of the ion-electrolyte balance. For example, a lack of calcium leads to the fact that an infant can "get" a convulsive syndrome. Iron deficiency will lead to anemia, and a lack of potassium ¾ to disturbances in the functioning of the heart muscle.

It has been proven that it is thanks to the beneficial intestinal microflora that an adequate immune response is produced. And if it is replaced by "harmful" bacteria, plus peristalsis is disturbed, there can be no talk of any full-fledged immunity. The baby begins to get sick with various colds, sometimes occurring with severe complications such as pneumonia or panbronchitis (total bronchitis).

All mothers should pay attention: if various infections often “stick” to the child, it is worth checking the intestinal microflora and taking an analysis for dysbacteriosis.

Symptoms

If there is lactase deficiency in infants, the symptoms may not appear immediately and increase gradually. The following signs are noteworthy.

• The age of a child from 2.5 to 6 months is the most risky for the occurrence of lactase deficiency.
• During an external examination, the baby has bloating, a strong rumbling, flatulence is heard.
• Often there are intestinal colic, especially at night.
• A symptom arising from the previous two symptoms: the child becomes restless and whiny. The psychosomatic reaction of the body to the ongoing internal pathology is connected.
• The stool becomes mushy or completely liquid, frothy, with a greenish tinge and an unpleasant putrefactive odor.
• Frequent regurgitation - associated with a violation of the peristalsis of the digestive tube.
• Long-term consequences of lactose deficiency - weight loss, developmental delay.

Diagnosis of lactose deficiency and its treatment

Diagnosis of lactose deficiency goes in several directions. The tactics of further treatment depends on the true cause of this pathological condition.

Diagnostic tests:

• Test load with lactose. After its use, the blood sugar level is monitored. If lactose is digested normally, sugar should rise. If not, something is preventing the lactose from being digested;
• Coprogram with determination of carbohydrate content. Normally, feces should not contain carbohydrate compounds;
• Molecular genetic study - used to determine gene mutations and detect true lactase deficiency;
• Elimination diet - foods that may contain milk sugar are excluded from the diet. After that, the patient's condition should improve, and the symptoms should disappear;
• Biopsy of the intestine or taking a wash from it. The most informative method, but due to the technical complexity of performing in children, it is rarely used by doctors.

If the diagnosis is confirmed, it is necessary to find out what the baby eats. When breastfeeding is in progress, the mother's diet for lactose intolerance should be strict, but balanced.

Products desirable for use by a nursing mother if a child has lactase deficiency:

• vegetables in all types of heat treatment (fresh, boiled, stewed, baked);
• dried fruits. They are rich in potassium, calcium, magnesium. With lactose deficiency, these trace elements are especially lacking for the child;
• almonds, jelly, marshmallows, marshmallows and dark chocolate can be eaten in small quantities;
• grain products (cereals, bread, bread, durum wheat pasta);
• hypoallergenic meat - turkey or chicken fillet.

Treatment of lactose deficiency cannot begin without finding out the cause that led to it. After a full examination, it is urgent to correct the intestinal imbalance in order to prevent deviations in the development of the child.