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What is lactose intolerance in children? Life of a child with lactase deficiency

As a doctor, I sometimes have to deal with lactase deficiency in adults. This is not to say that the disease is serious, but it gives patients a lot of anxiety. Based on my own experience and reliable sources, I will try to tell you as clearly as possible about milk intolerance and methods of treatment.

What is lactase deficiency

Lactose- from the Latin “lactis” - milk - sugar, which is found in free form in the milk of all species of mammals.

Lactase- an enzyme formed by the cells of the inner mucous membrane of the small intestine and is involved in the digestion and breakdown of lactose.

Lactase deficiency- a condition in which the amount or activity of the enzyme that breaks down lactose - milk sugar - is reduced in the small intestine. As a result, the body does not fully digest foods containing lactose, mainly dairy, and it passes unchanged into the large intestine.

The large intestine is home to a huge number of bacteria - different, “bad” and “good”. Normally, “good” ones dominate; they are involved in the digestion of food and the formation of immunity, which protects against infections, cancer and other diseases.

Unsplit milk sugar becomes an excellent source of nutrition for “bad” bacteria, which leads to their rapid proliferation and suppression of “good” microbes. A condition occurs that doctors call dysbiosis, or dysbiosis.

Digestion is normal and with lactose intolerance

By actively “eating” lactose, “bad” bacteria release large amounts of gas and various acids into the intestinal lumen, which irritate the mucous membrane and attract water. The process is similar to the fermentation of yeast dough. The contents of the intestine are filled with small gas bubbles and increase in volume many times over. All this provokes bloating, rumbling, abdominal pain and diarrhea.

Lactase deficiency is a lack of lactase

Who is at risk of lactase deficiency?

If your close relatives had or have lactase deficiency, the likelihood that you will continue the “traditions” of the family is extremely high. I'll tell you why a little later.
Lactose intolerance is rare among peoples who traditionally had cows on their farms and fresh milk on the table. Thus, among Europeans and Russians, only 6-16% have lactase deficiency. But among the peoples of Southeast Asia and North America this figure is 70-100%.
People over 60 years of age do not tolerate dairy products well. With age, the intestinal mucosa becomes thin and produces little of the enzyme that breaks down lactose.
Finally, all diseases that affect the small intestine are accompanied by lactase deficiency in every third case. Thus, for intestinal infections, food poisoning and inflammation of the small intestine, dairy products are recommended to be excluded from the diet.

Congenital lactase deficiency is rare. But it has been noticed that almost all people with age do not tolerate dairy products well.

Why does lactase deficiency occur and what happens?

Lactose intolerance can be complete or incomplete:

In the first case, there is no lactase at all; even tiny amounts of milk can cause bloating, rumbling in the stomach and diarrhea.
In the second, when enzyme activity is reduced, you can consume dairy products in limited quantities, focusing on your well-being.

Congenital lactase deficiency- a hereditary disease that makes itself felt immediately after birth and requires a lifelong exclusion from the diet of foods containing lactose.

Adults are faced with another type of genetically determined lactose intolerance - constitutional lactase deficiency, which develops gradually. The cause of this disease is the “weakness” of the gene that encodes the activity of the lactase enzyme. If your father and mother passed this “weak” gene on to you, then the likelihood of the disease will be extremely high.

Doctors call both variants of lactase deficiency described above primary, that is, their appearance is not influenced by lifestyle, nutrition, or other diseases.

Secondary lactase deficiency appears against the background of intestinal diseases and disappears as soon as the body copes with the disease.

Congenital lactase deficiency is forever. Secondary lactase deficiency goes away on its own along with the disease that caused it

How does lactose intolerance manifest?

Symptoms of lactase deficiency They are somewhat reminiscent of an intestinal infection, with the difference that they occur 1-2 hours after consuming dairy or other products containing lactose.

Bloating and rumbling of the abdomen, while gases are practically not released from the intestines;
Abdominal pain that occurs here and there;
Diarrhea up to 10-12 times a day;
Feces are liquid, foamy, light yellow, with a sour odor;
Possible nausea.

If you experience abdominal discomfort every time you drink a glass of milk, ice cream, or another lactose-containing product, consult your doctor.

What to do if you suspect lactase deficiency

On one's own

Keep a food diary and each time, note in it exactly what product you ate and in what quantity, what you felt, how many times and how you went to the toilet.

After a couple of weeks of keeping a diary, you will understand how much lactose your body tolerates

Try to eliminate foods containing lactose as much as possible. and write down your feelings. Then add them to your diet and gradually increase the amount. Record the moment when abdominal discomfort and diarrhea appear. This way you can independently assess the degree of lactose intolerance.

What can a doctor do?

Genetic analysis for congenital lactose intolerance. For research, a scraping is taken from the inner surface of the cheek or blood from a vein. There is no need to prepare for the study. The analysis will show whether you have a lactase “weakness” gene, whether it is active or “turned off.”

This is what a laboratory report confirming lactose intolerance looks like

Lactose tolerance test. The analysis is done on an empty stomach. First, your blood is drawn to determine your baseline blood sugar level. You then drink the lactose solution and the blood test is repeated. If the blood sugar level remains the same, it means that lactose has not been absorbed, and this indicates lactase deficiency.
Hydrogen content test in the exhaled air. During the fermentation process in the intestines with lactase deficiency, a large amount of hydrogen is released. You are given a special lactose solution to drink. If after some time “labeled” hydrogen molecules are found in the exhaled air, it means that lactose is not broken down by enzymes, but is involved in fermentation.
Stool acidity analysis reflects the body’s ability to digest carbohydrates in general and lactose in particular. An increase in acidity speaks in favor of lactase deficiency.

The diagnosis of “lactase deficiency” can only be made by a doctor after examination and exclusion of diseases of the intestines, pancreas and other digestive organs

How to treat lactase deficiency

The main thing is diet

For lactase deficiency, it is recommended to limit or completely eliminate foods that contain large amounts of lactose. In most cases, doctors allow the consumption of lactose-free and fermented milk products. Kefir and yogurt, natural yoghurts without additives and sour cream, cottage cheese and cheeses contain a minimal amount of lactose. It is broken down by lactic acid bacteria during the fermentation of milk and the preparation of these products.

In stores, look for shelves with lactose-free dairy products, they are more expensive, but do not cause digestive upset

Enzymes in tablets to replace the missing ones

Enzyme medications will definitely be selected and prescribed by a doctor if your body reacts to even minimal amounts of milk sugar. The enzymes in the tablets act in the same way as lactase and help the body digest lactose sugar. In case of congenital lactose intolerance, they will have to be taken for life.

For secondary lactase deficiency, diet is usually sufficient. Enzymes in tablets can supplement it while the body recovers from illness and restores lactose synthesis.

Treatment of symptoms

Symptomatic therapy treats not the disease itself, but its consequences. The need to take medications arises if unpleasant symptoms persist even while following a diet. For diarrhea, fixing drugs are prescribed, for bloating and intestinal colic - drugs that relieve painful spasms and remove excess gases from the intestines, to support the “useful” microflora - drugs of lactic acid bacteria, to avoid hypovitaminosis - vitamins.

Treatment of intestinal disease causing lactase deficiency

Treatment is always prescribed only by a doctor; amateur actions are unacceptable here. For example, for intestinal infections, antibiotics and drugs are prescribed that adsorb and remove bacteria, viruses and toxic products from the body.

Treatment of lactase deficiency is based on diet therapy. It is selected individually for each patient, taking into account the nature of the disorders and the effect that the diet gives.

What not to eat if you are lactose intolerant

Everything is individual. The need to completely abandon dairy products, as the main carrier of lactose, arises very rarely. In most cases, it is enough to give up whole (sweet) milk, but you can freely eat fermented milk products, cream and butter. Sometimes the body is hostile to a large amount of “milk”, but 50-100 ml. milk a day does not react in any way. In such cases, you can safely add milk to your coffee and allow yourself one serving of ice cream once a week.

When choosing dairy products, focus on fat content. The fattier the product, the less lactose it contains. For example, everyone can eat butter. It contains a large amount of fat (up to 83%) and practically no protein or carbohydrates.

It is better to take butter with the highest fat content, it contains the least lactose

From fermented milk products, choose those that contain live lactic acid bacteria - they will help restore normal acidity and “useful” intestinal microflora. Prefer mature hard varieties to soft young cheeses. The longer the cheese matures, the less lactose it contains.

Hard cheeses contain less lactose, and the Dzhugas cheese in the photo does not contain lactose at all

Most lactose is found in whole milk and its concentrates. Fermented milk products contain little lactose because it is broken down by lactic acid bacteria when the milk is fermented.

Carefully! Lactose is not only found in dairy products

Milk is added to bread, confectionery, sausages, pates, purees and ready-made sauces. When baked, milk sugar gives the product an appetizing golden color, and can even be found in French fries, chips, crackers and croquettes. What’s sad is that lactose is not always indicated on the label, so it’s better to avoid these “goodies” a priori.

Moreover, lactose is often used as a bulking agent, sweetener, flavor enhancer and flavoring agent in pharmaceutical preparations in tablets, pills, powders and syrups. Therefore, I recommend reading the annotations carefully.

Products that almost always contain milk sugar:

Sausages and ham. Not only the “meat” itself, but also its packaging;

Powdered milk or whey is added to the sausage.

Cheeseburgers, hamburgers, fast food;
Dry semi-finished products: soups, cereals, purees, sauces, puddings;
Cocoa powder, all types of chocolate, excluding extra-bitter chocolate;

If you can’t give up chocolate, give preference to extra-bitter chocolate, because milk contains several components containing lactose

Nut butters;
French fries, chips;
Bakery products, pastries, confectionery;

Almost all bread contains milk, and therefore lactose.

Dumplings, dumplings, croquettes;
Saccharin tablets;
Bulk spices with flavor enhancers. Often the manufacturer writes “flavor enhancer”, but does not indicate the substance; it could be lactose;

Pasta seasoning with flavor enhancer. Lactose is not listed on the label, but it may be there.

Ready-made sauces: ketchup, mustard, mayonnaise;
Nutritional supplements.

Milk sugar is not only found in dairy products. It is added to sausages, bakery products, confectionery products and even to some medications.

What can you eat without restrictions?

A large number of restrictions sometimes causes confusion in people with lactose intolerance. What is there? It's actually not that scary. A huge number of products do not contain milk sugar.

You can enjoy natural vegetables, fruits, nuts and unprocessed foods with confidence

If you have lactase deficiency, eat natural foods that, by their nature, are lactose-free. Read product labels, and when choosing semi-finished products, be sure to check their composition.

What about calcium?

By the way, milk is dangerous not only for patients with lactase deficiency, but also for completely healthy people. Back in 1997, Harvard Medical School published recommendations regarding milk consumption. Later in 2014, they were confirmed by the results of research by Swedish scientists.

As it turned out, the abuse of whole milk leads to the “leaching” of calcium from the bones and increases the chances of atherosclerosis, and with it, deadly diseases of the heart and blood vessels. 1 glass - 250 ml is recognized as safe for health. whole milk per day, which is equivalent to only 12 g of lactose.

Dairy products are one of the main sources of calcium, a microelement essential for the human body. And in case of intolerance to dairy products, many people wonder where to get calcium, if not from milk.

Products rich in calcium and its amount in milligrams per 100 g of product

Sesame is the leader in calcium content

Calcium is needed by the body for strong bones and teeth. It is involved in metabolism, muscle contraction, hormone formation and other important processes occurring in the body. While eliminating milk from your diet, you need to include other sources of calcium in your diet.

Memo

Some people are lactose intolerant from birth. But with age, it can develop in any person.
If you experience bloating, rumbling in the stomach and diarrhea every time after drinking a glass of milk, consult a doctor. He will conduct an examination, find the cause of your illness and prescribe treatment.
If you have lactase deficiency, you need to follow a diet. In the case of a congenital disease - throughout life. If lactase deficiency accompanies an intestinal disease - for the duration of treatment of this disease.
A diet for lactase deficiency involves excluding or limiting whole dairy products. Fermented milk products are allowed.
When buying products, carefully study their labels and choose only those that are lactose-free.
Some foods are best avoided because they may contain lactose, even if it is not listed on the label.
By eliminating milk from your diet, take care to provide your body with calcium.

Check to see if you have the right attitude towards food.

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Update: December 2018

Lactase deficiency is a syndrome that occurs due to impaired digestion of lactose and is characterized by watery diarrhea. Pathology appears when the intestines lack the enzyme lactase, which can digest milk sugar (lactose). Therefore, it should be understood that the term lactose intolerance does not exist, this is a mistake. Lactose is milk sugar, and the lack of the enzyme to break it down (lactase) is called lactase deficiency.

There are several signs that indicate lactase deficiency in children and which should immediately alert the young mother:

baby age 3-6 months
liquefied, foamy stool
stool has a sour smell
bloating

Surprisingly, this pathology is most common among the Vietnamese and indigenous Indians, but the Dutch and Swedes practically do not suffer from it. In Russia, up to half of the population has a deficiency of this enzyme to one degree or another, and lactase deficiency can periodically appear and disappear.

Children suffer the most from lactase deficiency, of course. It is one of the common causes of exhausting intestinal colic (see) and is a frequent reason for stopping breastfeeding. Milk sugar in a child’s diet covers up to 40% of energy needs.

Types of enzyme deficiency

Primary lactase deficiency- This is an enzyme deficiency syndrome in intact intestinal enterocytes. This includes:

congenital LI – very rare, occurs due to a genetic mutation
transient LN - appears in newborns born before the 34th-36th week: enzyme activity is insufficient
lactase deficiency in adults is not a pathology, but reflects the natural process of decreasing lactase activity with age.

In the same Swedes and Dutch and other northern Europeans, lactase remains highly active throughout life, which cannot be said about the inhabitants of Asia.

Secondary lactase deficiency is an enzyme deficiency that occurs as a result of damage to intestinal cells. It is lactase deficiency that is the most common form of intestinal enzyme deficiency, since the structural feature of the intestinal villi is such that lactase is located closest to the lumen and is the first to be hit by unfavorable factors.

Why is lactase deficiency dangerous?

Develops as a result of diarrhea, this is especially dangerous in infants
Absorption of calcium and other beneficial minerals is impaired
The growth of beneficial microflora is disrupted due to the lack of nutrients obtained from the breakdown of milk sugar
Putrefactive microflora multiplies
The regulation of intestinal motility is disrupted
Immunity suffers

Reasons

Congenital LI	Mutation of the gene that controls lactase activity
TransientLN	Insufficient enzyme activity at birth
FN in adults	Natural involution (reverse development) of enzyme activity Intestinal diseases (inflammatory, infectious, dystrophic), which led to the destruction of enterocytes
Secondary LN	1. Inflammatory and dystrophic processes in the intestines resulting from: infections: rotavirus, giardiasis and others food allergies gluten intolerance (celiac disease) Crohn's disease radiation damage medicinal effects 2. Reduction in the area of the intestinal mucosa after removal of part of the intestine or short bowel syndrome

Lactase activity may vary. In addition to the main factors, the enzyme is influenced by numerous biologically active substances: thyroid and pancreatic hormones, pituitary hormones, nucleotides, fatty acids and amino acids located in the intestinal lumen, glucocorticosteroid hormones.

Symptoms

Symptoms of lactase deficiency, both primary and secondary, are usually similar. The only difference is that with primary LN, pathological manifestations are observed within a few minutes, their severity depends on the amount of lactose consumed. Secondary LN reveals itself when consuming even a small amount of milk sugar, since the lack of its breakdown is combined with some kind of intestinal pathology.

Common signs of lactase deficiency are:

diarrhea, characterized by watery, foamy stools with a green and sour odor, a lot of gas
pain, rumbling in the stomach, vomiting
bloating, decreased appetite
), attacks of intestinal colic, anxiety, decreased weight gain, crying during feeding are characteristic of lactase deficiency in infants.

Distinctive features of individual forms

Congenital LI is a rare but severe type of enzyme deficiency, dangerous due to dehydration and severe toxicosis. A mother can understand this from the first days of a child’s life, when breastfeeding leads to vomiting and unstoppable diarrhea. The only thing that helps is stopping breastfeeding and consuming lactose-free formulas.

Primary LN appears only after drinking a large amount of milk. At an early age, it can masquerade as normal intestinal colic, which worries most babies. As the child grows, the microflora can adapt to milk sugar through the proliferation of appropriate bacteria. Over time, symptoms appear only with excessive milk consumption. At the same time, fermented milk products are well tolerated, as they support the growth of bacteria that break down milk sugar.

Secondary LN can appear at any age due to any disease. Specific symptoms of lactase deficiency manifest themselves poorly, since the main intestinal pathology plays a major role. However, a dairy-free diet helps improve the condition slightly.

How can you determine for yourself that it is lactase deficiency? The symptoms are very persistent, there is no effect of treatment. Pathological manifestations disappear only when following a diet excluding lactose.

Tests for lactase deficiency

Lactose loading test: determine the increase in blood sugar by plotting a curve. With an enzyme deficiency, a flattened type of curve is visible on the graph, that is, there is no normal increase due to the lack of sugar absorption.
Stool analysis: stool for lactase deficiency is taken to determine the carbohydrate content. Normally, there should be no carbohydrates, 0.25% is allowed in infants, its pH is also assessed - with FN the level drops below 5.5.
Hydrogen breath test. Along with the loading test, you need to take an analysis to determine the concentration of hydrogen in the exhaled air: a sample is taken every 30 minutes for three hours after loading with lactose.
Determination of enzyme activity from a biopsy or washout from the intestinal mucosa. This is the most informative method for determining LN, but its use is not always justified due to the complexity of taking an analysis.
Genetic research to identify mutations in certain genes responsible for lactase activity.
Diagnostic (elimination) diet with the exclusion of milk sugar in the presence of lactase deficiency, the condition of the intestines improves, the symptoms of the disease disappear.

If lactase deficiency is suspected, other possible causes of diarrhea, which can be quite serious, must be excluded (see).

Treatment of lactase deficiency

It includes several stages:

Medical nutrition, taking the nutritional supplement Lactase Baby (370-400 rubles), Lactase Enzyme (560-600 rubles), Lactazar for children (380 rubles), Lactazar for adults (550 rubles).
Help the pancreas (enzymes: pancreatin, mezim forte, festal, creon and others)
Correction of intestinal dysbiosis (prebiotics and probiotics: bifidumbacterin, linex, hilak forte, etc. see)
Symptomatic treatment:
- Medicines for bloating - Espumisan, Subsimplex, Bobotik
- Diarrhea - see
- For pain - antispasmodics.

Medical nutrition

A diet for lactose intolerance involves completely eliminating lactose or limiting it in the diet in accordance with the level of carbohydrates in the feces. Complete exclusion of lactose is a temporary and necessary measure in case of a child’s serious condition (dehydration, persistent diarrhea, severe abdominal pain).

There is no need to avoid consuming lactose at all, as it is a natural prebiotic. Therefore, the main task at this stage is to individually, step by step, select a diet with such an amount of lactose that does not cause digestive disorders and does not provoke the release of carbohydrates in feces.

How to treat lactase deficiency if the child is breastfed? Modern standards do not imply a complete cessation of breastfeeding. For such children, enzyme replacement therapy is used: the drug is added to expressed milk, and after fifteen minutes the child is fed mother’s milk. To do this, use the food supplement Lactase Baby (price 370 rubles): one capsule is enough for one hundred milliliters of milk. After feeding with expressed milk, the baby is given the breast.

For bottle-fed or mixed-fed children, the optimal combination of lactose-free formula and regular formula is selected. The ratio of mixtures for lactase deficiency can be different: 2 to 1, 1 to 1, and so on (depending on the child’s reaction). If lactase deficiency is severe, only low- or lactose-free mixtures are used.

Low-lactose mixtures: Nutrilon low-lactose, Nutrilak low-lactose, Humana LP + MCT.
Lactose-free mixtures: Nan lactose-free, Mamex lactose-free, Nutrilak lactose-free.

Introduction of complementary foods

If you have lactase deficiency, you should especially carefully keep a diary of the introduction of complementary foods, since some foods can cause the same pathological reaction: bloating, diarrhea.

Start complementary feeding with vegetables, using one vegetable at a time for several days. Their quantity is increased to 150 grams within 14 days. Then water-based porridge with a low gluten content (rice, buckwheat, corn) is added to the diet, also increasing the amount of complementary foods eaten. The next step is to give the baby meat.

After 8-9 months, you can give some fermented milk products (kefir, yogurt), carefully monitoring the reaction. But cottage cheese is not recommended for sick children under one year of age (see).

Further nutrition

The further diet of a child, as well as an adult with enzyme deficiency, is selected individually, based on the body’s reaction. What signs indicate that the product can be consumed, even if it contains milk sugar:

normal stool - formed, without pathological impurities and sour odor
no increased gas formation
absence of rumbling and other uncomfortable sensations in the stomach

Initially, the diet should contain many foods that do not contain lactose: fruits, vegetables, rice, pasta, meat and fish, eggs, legumes, nuts, tea, coffee, buckwheat, corn.

Then you need to add products with lactose to the diet, but monitor the reaction to the product and its quantity:

dairy products - milk, cheese, yogurt, cottage cheese, sour cream, butter, ice cream (see).
other products in which lactose is added as an additional component - bread, sausages, cookies, cocoa, ketchup, mayonnaise, chocolate and many others

Sour cream, cream, low-lactose milk, three-day kefir, and hard cheese are considered low-lactose.

It must be remembered that the diet alleviates the condition of patients with LI, but also deprives them of the main source of calcium, so the issue of replenishing this microelement should definitely be resolved with the attending physician.

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

What are the dangers for babies?

To begin with, it is worth noting that milk (including breast milk) contains a sugar called lactose. It 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 the normal absorption of such a product impossible. At the same time, lactose is directly involved in the processes of brain development and the formation of the retina. That is why a deficiency of such a substance leads to unpredictable and often sad consequences.

Lactose deficiency in infants and its forms

Today it is customary to distinguish between two main forms of such a violation:

Primary, or congenital, deficiency 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. In this case, the feces are liquid, foamy, green in color with a sour odor. 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 abdominal pain, often refuses to eat, pulls his legs towards his stomach, constantly cries, and sleeps poorly. You can often notice excessive regurgitation, even vomiting. If left untreated, the baby slowly gains weight, and in the most severe cases, developmental delays are observed.

Lactose deficiency in infants and diagnostic methods

Today, there are many ways to check the functioning of a child’s body:

First of all, stool is analyzed for the level of carbohydrates;
in addition, the pH of the stool is checked - if it is insufficient, this indicator changes;
in some cases, the doctor prescribes dietary diagnostics - the child is prescribed a diet that does not contain lactose, and changes in the condition are monitored;
the most accurate is a biopsy of the intestinal mucosa followed by testing of samples for lactase activity.

What should the child do?

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

The condition caused by a child's inability to digest lactose (milk sugar) is called lactose intolerance. Since the cause of this condition is a lack of the enzyme lactase in the body, its second name is “lactase deficiency.” What are the causes of this pathological condition and what should parents do if it is detected in their baby?

In newborns and infants

In newborns, lactase deficiency is usually genetically determined. To a greater extent, such congenital intolerance develops in carriers of Asian genes. Also, in children under 6 months of age, lactase deficiency can be associated with intestinal infection, allergies or other diseases.

Lactase deficiency is often detected in premature babies, as a consequence of the immaturity of their digestive tract.

In older children

Most often, lactose intolerance develops in older children between the ages of 9 and 12. In babies who are no longer breastfed, the amount of lactase in the body gradually decreases. Although among Europeans there are many people whose bodies produce lactase normally until old age.

Among older children, many cannot tolerate milk sugar and do not suffer from it at all. They simply avoid dairy products to avoid symptoms of intolerance. But for a small child, such a pathological condition can become a problem, since milk is the main food product at an early age.

Signs and symptoms

Hypolactasia (insufficient lactase) can be identified by the following symptoms:

Stomach ache.
Nausea.
Flatulence, bloating, rumbling in the stomach.
Diarrhea that appears one to two hours after eating dairy products.
Restless behavior of the child after eating.

Classification

The following types of lactose intolerance are distinguished:

Congenital. A very rare condition in which the baby rapidly loses weight immediately after birth, suffers from dehydration and is at risk of death. To confirm the diagnosis, an intestinal biopsy is required, but it is rarely prescribed to newborns, most often simply by switching the baby to a lactose-free diet for 4-6 months, after which the baby is given lactose in small quantities.
Transitional. Occurs in babies who were born prematurely.
Primary. Develops after the end of breastfeeding. This form of lactose intolerance is very common. It is typical for people living in Asia, America, Australia, as well as on the African continent and islands in the Pacific Ocean. This is due to the history of human nutrition, since animal milk in the past was consumed mainly in European countries, parts of Africa and India. Such lactase deficiency is manifested by bloating, nausea, belching, diarrhea, and vomiting. Symptoms may change throughout life. Some people react to small amounts of lactose, while others are able to absorb larger amounts.
Secondary. Appears as a result of intestinal damage due to infection, allergies or other reasons. For example, after gastroenteritis, the body takes several days or weeks (depending on age) to restore lactase production.
Functional. Appears in a healthy child who is gaining weight, but suffers from gas and frequent watery stools with a greenish tint. Tests that detect lactase deficiency in such children will be false positive. The reason for this problem is the baby’s lack of hind (fat-rich) breast milk, as well as an immature enzymatic system.

Depending on the severity of the pathology, lactase deficiency can be complete or partial.

Reasons

The cause of lactase deficiency in newborns (the primary form of deficiency) is often a genetic predisposition.

The following reasons lead to the development of a secondary form of this pathology, which is acquired:

Inflammatory processes in the small intestine.
Past infections.
Surgical interventions on the stomach and intestines.
Having celiac disease.
Carrying out chemotherapy.
Development of ulcerative colitis.
Crohn's and Whipple's diseases.

Here are the processes that occur in the body in case of problems with digesting lactose:

Undigested lactose enters the large intestine, where water also enters through osmosis.
This milk sugar is processed by bacteria in the colon, resulting in the formation of gases.
Undigested fatty acids appear in the stool, which are also formed as a result of bacterial activity.
The lining of the intestine becomes irritated, leading to excess mucus production.
Since stool passes through the intestines too quickly, its color becomes green.
The result will be sour, foamy, greenish, liquid stool, tests of which will reveal sugar (undigested lactose).

Differences between lactose and lactase

The similarity of the name often leads to confusion between these two words:

Lactose is an important carbohydrate for a child, represented by a combination of two molecules - galactose and glucose.
In order for the body to break it down and digest it, it needs lactase. This is an enzyme produced in the small intestine.

If there is not enough lactase, then the breakdown of lactose does not occur, that is, it is not digested. That is why this condition can be called both lactase deficiency and lactose intolerance.

It's not a milk allergy

Lactase deficiency is often confused with the development of an allergy to dairy products. But these are completely different problems. Milk allergy is much less common than lactose intolerance and is a more serious condition with a risk of death.

If your baby is allergic to milk, then he is contraindicated to consume this product. Once in the body, even in small quantities, milk will cause the baby to develop rashes, itching, difficulty breathing and other allergy symptoms.

But if there is a lack of lactase, the body is able to process a small amount of dairy product, for example, if you drink 100 ml of milk at one time or eat up to 50 grams of yogurt.

What to do?

If the baby's stool has a greenish tint, while it is liquid and foamy, the mother of the breastfed baby is recommended to:

Make sure that the baby is attached correctly and that the breast is latched correctly.
Try feeding for three to five hours from only one breast.
Since in this case the mother often has a lot of milk, the second breast will have to be pumped a little at this time.

Treatment of lactose intolerance usually involves eliminating this disaccharide from the diet or using medications containing lactase. At the same time, symptoms are treated and the cause is eliminated (if lactase deficiency is secondary).

Breastfed children Lactase preparations are often prescribed, since it is undesirable to reduce the amount of human milk in the baby’s diet. If it is impossible to use such drugs, the child is transferred to a low-lactose formula (at first partially, keeping a maximum of breast milk in the baby’s diet, which will not cause symptoms of lactase deficiency).

When feeding your baby with formula select a product that contains the maximum amount of lactose that does not cause clinical manifestations of deficiency. You can combine a regular mixture and a lactose-free one, or transfer the baby to a fermented milk mixture. If lactase deficiency is significant, the child is given only a low-lactose mixture.

When preparing complementary foods for a child with lactase deficiency, not milk, but a lactose-free mixture is used, and after a year, dairy products are replaced with low-lactose analogues.

If hypolactasia is secondary, then a low-lactose diet is maintained during the period of treatment of the underlying pathology. Products containing lactose are introduced gradually over 1-3 months after recovery.

Necessary tests

There are several ways to determine if you have lactose intolerance:

Coprogram. The analysis determines the amount of fatty acids as well as the pH reaction. If you are lactose intolerant, the stool will be acidic and the concentration of fatty acids will increase.
Detection of carbohydrates in feces. Most often used to detect lactose intolerance, but often results in false negatives or false positives. The method detects carbohydrates, but cannot show for sure that it is milk sugar. Its results are taken into account only in conjunction with other tests and clinical manifestations.
Hydrogen breath test. A very common method involves using a special device that checks the air a person exhales after consuming glucose. The test is not used for children under 3 months.
Lactose curve. Blood is taken on an empty stomach in the morning, then lactose is consumed and a few hours later a blood test is performed again. Based on the results, a graph is constructed, which is called the lactose curve. The method is not very informative, and its use in an infant is associated with some difficulties.
Intestinal biopsy. This is a very accurate method for diagnosing lactase deficiency. It involves taking small sections of the mucous membrane of the small intestine. Lactase activity is determined in these microscopic areas. The method is rarely used due to its traumatic nature and the need for general anesthesia.
Genetic research. Helps determine primary deficiency. The disadvantage of the method is its high cost.

How to live with this?

The prognosis for people with this pathological condition is usually favorable. Most of those who are lactose intolerant do not consume dairy products by choice (without asking questions, they say that they simply do not like them).

There is no lactose in the following products:

Vegetables;
Vegetable oils;
Pasta;
Fruits;
Raw fish;
Eggs;
Raw meat;
Vegetable and fruit juices;
Nuts;
Cereals;
Legumes;
Soy drinks, soy meat and soy curd;

You can find milk on sale that does not contain lactose. The sugar in this milk has already been broken down into galactose and glucose, so this milk product can be consumed if you have lactase deficiency.
If you have lactose intolerance, you should consume more dairy products in which this carbohydrate is already fermented. Such products are hard cheeses, yoghurts and other fermented milk products.
Chocolate milk is a good choice because cocoa has the ability to stimulate lactase production, which improves milk absorption.
If you have lactase deficiency, it is recommended to drink milk with meals. It’s great if milk is combined with cereals. The volume of milk per serving should be up to 100 milliliters.
Remember that skim milk contains milk sugar. This milk has the fat removed, not the lactose.
Lactose is found not only in milk, but also in other products - products for diabetics, confectionery, sauces, bread, margarine, cream, condensed milk, chips and many others. Even if the list of ingredients does not say that the product contains lactose, the presence of this carbohydrate can be judged by other components - the presence of milk powder, whey or cottage cheese.
You should also be aware that lactose is included in some medications. Milk sugar can be found in no-shpe, bifidumbacterin, motilium, cerucal, enap, contraceptives and other drugs.
Lactose is one of the important components of nutrition for children. It must be added to milk formulas to bring their composition closer to human milk.

Lactose deficiency in infants occurs in rare cases due to the peculiarities of digestion. Breast milk is not suitable for such children, and mothers worry about what they can feed their baby and how this intolerance will affect the development of the newborn. If feeding milk causes your baby to cry, regurgitate, lose weight, or have problems with digestion and stool, you should consult a doctor to examine the baby. He will determine whether these symptoms are signs of lactose intolerance.

Lactase deficiency is a type of disease that is manifested by a lack of the enzyme lactase, which performs the function of breaking down sugar. And lactose is a disease in which the intestines cannot cope with the digestion of the carbohydrate lactose. Both diseases are characterized by the absence of the lactase enzyme in the infant's intestines, which breaks down the carbohydrate lactose into two components - glucose and galactose.

Lactose is important for the development of a child, as it gives the baby 40% of the energy he needs, normalizes the functioning of microorganisms necessary for the intestines and helps the newborn’s brain and eyes develop correctly. Lactase deficiency prevents lactose from being absorbed in the baby's intestines. It leads to a deficiency of necessary substances and energy, as a result of which the child's development may slow down.

Types of lactose intolerance

There is congenital and acquired intolerance to this enzyme.

Congenital is the absence or decrease in the amount of lactase, so it can often be determined during the first 30 days of a newborn’s life.
Acquired intolerance is caused by diseases of the digestive system, in which the level of lactase decreases. With proper treatment, it goes away within 60 days.

Reasons for appearance

The most severe form of the disease develops due to a hereditary predisposition, when the baby's body suffers from lactase deficiency and cannot provide enough enzyme due to genetic disorders. This disease is diagnosed when the amount of breast milk consumed by a child increases, which usually occurs at 3-4 weeks of life. With this form of the disease there is no treatment, and the baby is prescribed a special diet and medications containing lactase.
If a child was born premature, then his body does not have enough lactase, since this enzyme begins to be produced in the baby inside the mother’s womb from 6 to 9 months of pregnancy.
When enterocytes that produce lactase are damaged, acquired lactase deficiency develops in the newborn's intestines. This disease can occur due to rotavirus infection, giardiasis, viral or drug-induced enteritis.

Symptoms

Symptoms include:

poor appetite;
sluggish breastfeeding by the child, accompanied by crying and frequent interruptions;
after feeding, the child burps, vomiting is possible;
increased gas formation;
the baby pulls his legs to his stomach and cries;

Congenital lactase deficiency has the following symptoms:

frequent colic;
presence of flatulence;
the presence of foamy greenish watery stools with undigested lumps, having an unpleasant sour odor, up to 10-12 times a day.

If lactose intolerance is observed for a long time, a lag in the development, height and weight of the baby may occur.

Diagnostics

To accurately determine the diagnosis during the examination, it is necessary to undergo certain tests.

Feces for carbohydrates. This test is prescribed to all infants who exhibit symptoms of lactose intolerance. However, such a study is not accurate due to the lack of standards and identification of the type of sugars.
Carrying out a coprogram. Responsible for detecting increased levels of acidity and increased presence of undigested lumps of milk.
Breath test. The analysis is aimed at examining the inhaled air when the baby drinks a lactose solution. When the hydrogen level is elevated, resulting from a reaction to bacteria in the intestines, a diagnosis is made.
Drinking sugar solution. This test uses regular blood draws to determine glucose levels to create a lactose curve. However, this method is difficult to implement with infants.
Biopsy of the intestinal mucosa. This analysis is rarely performed as it requires anesthesia. It is the most accurate way to determine the disease.

With each diagnostic method, it is necessary to compare the results given by the analysis with the condition and course of the disease. The main study is the baby’s reaction to receiving milk. If there are no signs of lactose intolerance, the diagnosis is questioned.

How to treat

Treatment of lactase deficiency is prescribed only by a doctor and after a diagnosis has been established. With this disease, dairy products are excluded when feeding the baby, and changes in its condition are constantly monitored.

If the analysis shows a severe course of the disease, instead of breast milk, mothers can offer the child medicinal lactose-free or soy formulas, which normalize the baby’s condition.
If the amount of lactase in the baby’s body is reduced, treatment is carried out with special preparations containing this enzyme. A diet is being developed for the mother. Also, a woman should express the front portion of milk because the back portion contains more lactase.
If a child is diagnosed with acquired lactase deficiency, the underlying disease that affects the intestinal mucosa is treated. The disease gradually resolves when the disease is properly treated and eventually all symptoms disappear.

Nutrition

After the parents have passed the necessary test, which confirmed lactose intolerance, a diet and specific nutritional methods are prescribed for both mother and baby. The diet consists of eliminating this carbohydrate from the diet. First, it is necessary to stabilize breastfeeding, for which the baby needs to be fed with richer milk. There are several ways:

expressing foremilk;
give the baby only one breast;
try to place the newborn to the breast in the correct position;
try to breastfeed more often at night, when the milk has a high fat content;
stop feeding the baby when he comes off the breast.

Mothers need to remove cow's milk from their diet, the protein of which can disrupt the functioning of the baby's intestinal cells and reduce the formation of lactase. The doctor can also exclude other products, which during the study will be determined by an analysis to identify allergens.

When the disease subsides

If a baby has hereditary lactose intolerance, the child will be prescribed a lactose-free diet for the rest of his life, following which he will reduce the symptoms of the disease.

Acquired intolerance, thanks to special treatment, recedes by the age of one year, but in rare cases, symptoms disappear only by 3 years. To diagnose recovery, a repeat analysis is performed at the end of treatment.

To prevent lactase deficiency from developing in a severe form, leading to retarded growth and development of the child, it is necessary to notice the signs of the disease in the child in time, carry out a diagnosis and, when the doctor prescribes treatment, strictly adhere to it.