Lactose intolerance is the inability to metabolize lactose, which is the main sugar found in milk and dairy products. Lactose intolerance is caused by the complete absence or lack of lactase, an enzyme necessary for the breakdown of lactose in the small intestine. This condition is not life threatening, but it can cause upset stomach and intestinal discomfort (bloating, pain, flatulence) and limit food choices. Many adults are lactose intolerant and have no other medical conditions. However, remember that some diseases can cause gastrointestinal problems, so it is very important to distinguish the symptoms of these diseases from those of lactose intolerance.
Steps
Symptoms of lactose intolerance
- If you have a bloated stomach and gas after both meals, it means that you most likely have a stomach or intestinal problem (such as intestinal inflammation or Crohn's disease).
- If you feel good after both meals, chances are that you have a food allergy or intolerance to another food.
- This is commonly referred to as the elimination diet: you eliminate dairy from your diet to determine which substances are causing the reaction.
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Distinguish between lactose intolerance and milk allergy. Lactose intolerance is a condition caused by a lack of enzymes that causes undigested sugar (lactose) to build up in the large intestine. When it gets there, the bacteria in the intestines begin to consume sugar and produce hydrogen and some methane, which causes bloating and flatulence. Milk allergy is an abnormal reaction of the immune system to dairy products. Most often it occurs in the first minutes of contact with casein or whey. Symptoms of milk allergy include wheezing, severe rashes, swelling of the lips, mouth and throat, runny nose, watery eyes, vomiting, and trouble digesting food.
- Cow's milk allergy is one of the most common allergies among children.
- Usually cow's milk triggers the reaction, but goat's, sheep's and other mammals' milk can also cause allergies.
- Adults with hay fever or food allergies to other foods are more prone to adverse reactions to milk.
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Find out how lactose intolerance is related to ethnicity. Although the amount of lactase in the small intestine decreases with age, its amount is also associated with genetics. In some ethnic groups, lactose intolerance is much more common. For example, about 90% of Asians and 80% of African Americans and Native Americans have this trait. Lactose intolerance is least common among northern European peoples. If you are from an ethnic group with an increased risk of this disease and experience discomfort after eating, the chances are high that you have lactose intolerance.
- Lactose intolerance is rarely seen in infants and young children of all nationalities. This problem usually manifests itself later in life.
- However, in premature babies, the ability to produce lactase may be reduced because the gastrointestinal tract is not yet fully formed.
Confirmation of the diagnosis
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Pass the hydrogen exhalation test. This is the most common way to test for lactose intolerance. This test is done in a hospital or health center, but it is usually only done after you try to eliminate milk from your diet. You will be asked to drink a small amount of lactose (25 grams), and then your doctor will measure the amount of hydrogen in your breath several times (every 30 minutes). A person whose body can break down lactose will produce little or no hydrogen. If a person is lactose intolerant, there will be much more hydrogen, since sugar is fermented in the intestines with the participation of bacteria that produce this gas.
- It is a convenient way to diagnose an intolerance and gives accurate results.
- You will have to do not smoke or eat for a while in the morning.
- If a person consumes too much lactose, the result may be false positive due to the large amount of bacteria in the intestines.
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Get a blood test for glucose and lactose. The analysis allows you to assess the body's response to the consumption of large amounts of lactose (usually 50 grams). Fasting blood glucose is measured first, and then 1–2 hours after eating lactose. If your blood sugar does not rise by 20 grams or 1 deciliter above your fasting reading, your body is unable to digest and absorb lactose.
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Take a stool test for acidity. Undigested lactose forms lactic acid and other fatty acids in the intestines and ends up in the feces. Stool acidity testing is usually done for young children and can detect acid in the stool. The child is given a small amount of lactose and then tested several times in succession. A young child may also have glucose in the stool due to the fact that the lactose is not digested.
- This test is suitable for children who cannot get other tests to diagnose lactose intolerance.
- Despite the effectiveness of this test, the breath test is more commonly used because it is simpler and more convenient.
Pay attention to gastrointestinal symptoms. As with other medical conditions, it is sometimes difficult to know if your feelings are unusual. For example, if a person always experiences discomfort after eating, he considers this to be his normal state, and it seems to him that everything is exactly the same for everyone. However, bloating, flatulence, cramps, nausea or diarrhea after eating are not normal - all of these symptoms indicate gastrointestinal problems. Many diseases of the gastrointestinal tract have similar symptoms, so the diagnosis is sometimes difficult. To begin with, you must acknowledge that your post-meal sensations are not normal and can be prevented.
Try to analyze the relationship of symptoms to dairy consumption. The main symptoms of lactose intolerance (bloating, abdominal pain, flatulence, diarrhea) usually appear 30–120 minutes after eating or drinking lactose-containing beverages. Therefore, you should try to find a link between symptoms and dairy consumption. Eat a lactose-free breakfast in the morning (read the ingredients on the package if you are not sure) and evaluate how you are feeling. Eat something with lactose during the day, such as cheese, yogurt, and / or milk. If you notice a significant change in sensation, you probably have lactose intolerance.
For some people, a persistent dislike for milk is not associated with taste preferences and whims, but with the state of their body. Drinking even a few sips of milk can lead to symptoms ranging from mild bloating to temporary mental disturbances. The most common cause of this intolerance is lactase deficiency.
The main sugar in human and mammalian milk is lactose. To break it down into galactose and glucose molecules (they are absorbed from the intestine into the blood), nature has created a special enzyme - lactase (its full name is lactase-phlorizin-hydrolase). With its lack or absence, insufficiently digested lactose enters the colon and becomes food for bacteria there. These microbes metabolize lactose into excess gases and water.
Causes
Lactase deficiency can be congenital (as a result of gene mutations), and acquired (occur against the background of a number of diseases).In the young of many animals, after completing their breastfeeding and switching to a different type of nutrition, the production of this enzyme in the intestine stops, as unnecessary for further life. Therefore, some scientists even believe that maintaining tolerance (normal tolerance) to milk in people over 2 years old is not quite the norm, but the result of gene mutations that occurred many millennia ago. Scientists explain the occurrence of these genetic breakdowns by the development of dairy farming. They also associate this hypothesis with the existing ethnic differences in the frequency of lactase deficiency. So, it is practically absent among the indigenous people of Northern Europe, Mongolia and India. But its frequency exceeds 70% in Hispanics, Asians, Israelis and American Indians. In Russia, lactase deficiency is detected in approximately 16% of the population.
Lactase deficiency is subdivided into:
- congenital (primary, alactasia of newborns);
- acquired (secondary).
Congenital lactase deficiency is usually associated with genetic disorders. The reasons for the secondary deficiency of this enzyme can be:
- viral gastroenteritis;
- bacterial intestinal infections;
- food allergy;
- amyloidosis;
- ulcerative colitis.
Such lactase deficiency can disappear in case of recovery or remission of the listed ailments. As a rule, it is partial (that is, the patient can tolerate a certain amount of milk and fermented milk products quite satisfactorily).
Symptoms
The severity of clinical signs of lactase deficiency is extremely variable. It is due to the degree of enzyme deficiency (its complete or partial absence) and the amount of lactose in the food consumed by patients.
The most difficult manifestation is congenital lactase deficiency, which is often characterized by a complete absence of lactose in the body (alactasia). Within 1–2 hours after the first intake of milk (breast milk, cow milk, etc.) or milk mixtures, an infant has:
- diarrhea (watery, frothy, copious, sour-smelling bowel movements);
- severe bloating;
- rumbling;
- colic;
- vomit.
Further feeding aggravates the symptoms, signs of dehydration, sweating, tachycardia appear, and weight loss increases.
In adults, hypolactasia (partial deficiency) is more often observed, therefore these phenomena are less colorful and occur only after drinking 1-1.5 glasses of milk. In addition, extraintestinal symptoms are possible:
- weakness;
- chills;
- dizziness;
- pain and a feeling of interruption in the work of the heart.
If you stop using lactose-containing products, then all clinical symptoms disappear after 3-4 hours.
Diagnostics
In many cases, no specific diagnostic procedures are required to verify lactase deficiency. After all, the appearance of complaints is clearly associated with the intake of milk or various dairy products, and their removal from the diet leads to the normalization of health. But in controversial cases, doctors may advise the following examination:
- assessment of lactase activity in mucosal samples (biopsies) of the small intestine (biopsies are obtained during endoscopic examination: fibrogastroduodenoscopy or fibroenteroscopy);
- genetic blood test;
- breath test (hydrogen);
- stress lactose test;
- determination of galactose in urine and blood.
Treatment
The basic treatment for patients with a lack or lack of lactose is elimination diet therapy (elimination of sources of lactose from the diet or their restriction). Pharmacological drugs are of secondary importance.
Health food
When alactasia is confirmed, the only treatment is a complete and lifelong rejection of milk in any form and dairy products. Infants are transferred to artificial feeding with special mixtures. Such lactose-free options can be found among the mixtures Nan, Babushkino Lukoshko, Nutrilon, etc. Usually, the abbreviations "BL" or "FL" can be seen on their packages. With hypolactasia, low-lactose mixtures are prescribed.
Subsequently, such patients should beware of sources of latent lactose (they may contain whole, powdered or condensed milk). They may be:
- margarine;
- mashed potatoes from powder;
- confectionery;
- bakery;
- omelets;
- cream soups;
- canned soups;
- semi-finished products;
- white sauces;
- iris;
- lollipops;
- mixtures for making biscuits, muffins, pancakes;
- ready-made seasonings.
People with severe lactase deficiency need to carefully analyze the composition of foods and even drugs (for example, lactose is included in some) before taking them.
In addition, due to the exclusion or significant limitation of milk in such patients, increased, and, consequently, the occurrence of osteoporosis, bone loss and pathological fractures. To prevent this, patients need to regularly eat foods high in calcium and / or vitamin D, which helps assimilate calcium:
- leafy greens (lettuce, spinach, etc.);
- broccoli;
- soy products;
- turnips;
- white cabbage;
- canned fish with soft bones (salmon, etc.);
- eggs;
- rice milk;
- liver.
In addition, today you can find special lactose-free milk on the shelves of supermarkets, it was created especially for such patients.
In the case of hypolactasia, patients are advised to determine their individual milk dose. Some patients can drink 200 ml (not on an empty stomach, in several doses, slowly, 1-2 times a week). At the same time, it was noticed that with a gradual increase in the amount of whole milk drunk, its tolerance also improves. If the tolerance to milk is not high, but fermented milk products are possible, then you need to include cheeses (especially feta cheese) and yoghurts in your diet. They are distinguished by their low lactose content and high nutritional value.
Pharmacotherapy
Today, there are preparations containing lactase. Their reception allows patients with a- or hypolactasis not to give up products that contain lactose. Some patients prefer not to limit themselves, but to use the achievements of the modern pharmaceutical industry. There are 2 types of medicines:
- preparations with lactase, which should be taken simultaneously with milk or dairy products (Lactraza, etc.);
- medicines with lactase, which are added to milk before it is consumed (Lactaid et al.).
The prognosis of the disease (with timely diagnosis and diet therapy) is favorable.
Lactose is one of the complex sugars found in milk and all dairy products. During the digestive process, lactose is broken down by lactase (an enzyme secreted in the small intestine) into simple sugars (monosaccharides and galactose), which are absorbed into the bloodstream. " Intolerance"Means an inability to digest lactose, often associated with deficiency of the enzyme lactase... About 30 minutes after consuming milk or dairy products such as ice cream or cottage cheese and homemade cheese, people with lactose intolerance may have diarrhea (diarrhea) or cramping pains (abdominal cramps) and bloating (increased gas production in the intestines). the severity of which depends on the level of enzyme deficiency. However, a person with mild enzyme deficiencies may not experience any symptoms at all.
It is widely believed that lactose intolerance it's for milk. In fact, this is not the case, and the difference between the two is very great. People with lactose intolerant do not have to remove milk and dairy products from their diet, but they do need to control the amount of dairy products. But people suffering from milk allergies should not consume even the smallest amount of milk. Symptoms of milk allergy include shortness of breath, tightness in the throat, nasal discharge, puffy eyes and eyelids, skin rashes, etc. Lactose intolerance manifests itself in a different way.
Causes of lactose intolerance
Congenital deficiency of the enzyme lactase, distributed mainly among persons belonging to the Asian race.
Natural decrease in lactase levels, which begins in childhood (after 3 years). How significant this decrease will be depends on the characteristics of the organism of a particular person. However, it's safe to say that the older a person is, the more likely they are to suffer from lactose intolerance.
Any disease that affects the cells of the small intestine that produce lactase, such as inflammatory diseases and even. This condition causes " secondary lactase deficiency". This is a temporary problem that disappears as soon as the disease passes, the damaged cells regenerate and begin to produce enzymes again.
Surgery to the stomach and intestines, which can completely destroy the body's ability to produce lactase.
Symptoms of lactose intolerance
- diarrhea, loose stools;
- increased gas formation;
- abdominal cramps.
What can you do
Find out the extent of your lactose intolerance... Aside from monitoring your body's response to milk and dairy products, there are two accurate ways to test for lactose intolerance:
- oral tolerance test;
- hydrogen breath test (includes measuring the level of hydrogen in exhaled air, which depends on the amount of undigested lactose).
Try lactose-reduced or lactose-free foods. You should not completely deprive yourself of lactose-containing dairy products. not only does this drastically reduce the amount of calcium in your diet, but it also reduces your body's ability to absorb calcium from non-dairy foods (as lactose helps the intestines absorb and retain calcium).
Keep in mind that skim milk is not safer because it is less fatty. The problem of intolerance is not associated with fat content, but with lactose. Buttermilk and acidophilus milk also contain lactose, so you should also be careful with them.
Try yogurt. Many people suffering from lactose intolerance can normally digest the lactose contained in yogurt. At the same time, yogurt is an excellent source of calcium. Use trial and error to determine which type of yogurt you tolerate best. Avoid pasteurized yoghurts as the benefits from them are much less, and the harm from lactose remains.
Drink chocolate milk. Calcium from such milk is perfectly absorbed, and the chocolate taste makes it more pleasant. What's more, cocoa can even stimulate lactase activity.
Certain cheeses, especially cheddar, parmesan, Swiss cheese, and mozzarella, are excellent sources of calcium. Moreover, they are not dangerous from the point of view of lactose, because The whey, which contains the most lactose, is separated during the cheese making process. But cottage cheese, cottage cheese and ricotta are rich in lactose, so they should not be overused.
Drink milk with food or cereals. Taking lactose with food makes it easier to digest and has fewer consequences.
Drink milk in small portions (half a cup) several times a day with meals. This will replenish the required dose of calcium and will not cause any particular problems.
Be attentive and watch what you eat. Lactose can be found in breads, frozen vegetables, canned soups, salad dressings and sauces, spaghetti, etc., breakfast cereals, cakes, candy, and even pharmaceuticals.
Watch closely for signs lactose intolerance... If you have such a problem, it is very likely that your children will also have it. In infants, congenital lactose intolerance can be life threatening. As soon as a child suffering from lactose intolerance is fed with breast milk or formula containing milk, he develops colic, gas formation, and stops gaining weight. A special lactose-free formulation is available today. Talk to a pediatrician who can provide nutritional support and a balanced diet for your child to replenish the required amount of calcium in his diet.
However, some simple precautions can help people with mild lactase intolerance to avoid unpleasant symptoms without completely depriving themselves of milk and dairy products.
If you are lactose intolerant, do not deprive yourself of all dairy products. Try to eat calcium-rich foods, such as milk, but in small doses (less than a cup) and drink it with meals. Usually cheese and yoghurt in small quantities are quite easily tolerated by people with lactose intolerance.
You can also try lactose-free milk, cheese and cottage cheese, or other sources of calcium, such as soy milk, almonds, broccoli and other green vegetables, fish, etc.
If a person is allergic to milk, then eating dairy products is harmful to yourself.
Can adults digest milk protein?
For reference:
The assimilation of the product is due to the breakdown of proteins. To break down proteins, it is necessary to act on the protein with an enzyme that will break the chain of amino acids. Proteins are made up of amino acids and peptides. The smaller the pieces into which the enzyme cuts the protein, the higher their bioavailability. And assimilation depends on the balance of certain amino acids.
So, a person is born with the minimum required set of enzymes. The original food of the child is milk. And the enzymes in his body are highly specialized. Aimed at digesting milk and getting the most out of it in a minimum amount of time. Therefore, children have an active enzyme rennin... He's rennet, he's chymosin.
The child is growing. The enzymatic system is being improved. The baby's diet becomes more varied, and the production of rennin fades. However, instead of it, another enzyme begins to be produced that can break down any proteins (except collagens). It is called pepsin.
Pepsin is also great at breaking down milk protein. But for a longer time than rennin breaks down. Therefore, dairy products often leave a long feeling of satiety.
Conclusion - milk protein is broken down in adulthood by the universal proteolytic enzyme pepsin!
Women, like females of other mammals, feed their babies with breast milk, which contains milk sugar - lactose. Lactose provides up to 30% of the energy value of milk. Normally, in all youngsters, milk sugar is broken down in the small intestine by a special enzyme - lactase. When all mammals grow up, including some people, the enzyme ceases to be produced. Nature is thrifty: before the advent of animal husbandry, milk was not available to adults, and producing an unnecessary enzyme would mean wasting resources.
If the enzyme lactase is absent, when milk is consumed from the small intestine, unbreakable milk sugar enters the large intestine, which causes unpleasant symptoms: flatulence, bloating, diarrhea, abdominal pain, in some people this is accompanied by a headache. Surprisingly, not all people with such symptoms associate them with drinking milk. In Russia, milk has been considered a useful product for a long time, and sometimes it does not come to mind to associate something unpleasant with it.
Why do these symptoms occur?
Milk sugar lactose is a disaccharide composed of interconnected monosaccharide molecules: glucose and galactose. In the small intestine, lactase cuts the disaccharide into components, and the resulting monosugar is absorbed by the intestinal wall and enters the bloodstream. But disaccharides cannot penetrate the intestinal wall. If lactose has not been broken down in the small intestine, then it enters the large intestine and gets to the bacteria living there for lunch. Unlike delicate lactase, bacteria carry lactose to pieces, producing carbon dioxide, methane, hydrogen and water. Gases stretch the intestines - this causes flatulence and pain, and still unbroken lactose draws water into the intestinal lumen, which causes diarrhea.
If a person with an intolerance drinks a liter of whole milk in the morning, then he will return to working condition only the next day. However, about a glass of milk can be assimilated without consequences even with intolerance, especially if you do not drink it immediately or use it in the form of milk porridge and other dairy dishes. Entering the stomach with food, lactose is retained in the stomach and enters the intestines in small portions. Symptoms do not have time to develop. However, there are people who are so sensitive to lactose that even a small amount of milk, or even cheese, or butter makes them sick. In the absence or reduced amount of the lactase enzyme, the amount of milk that will be assimilated without unpleasant consequences depends on the nature of the diet and the composition of the intestinal microbiome. Some bacteria break down lactose with less severe effects.
How do genes determine milk intolerance?
Milk intolerance is congenital and acquired. Congenital is divided into alactasia and primary hypolactasia. Alactasia is a complete absence of lactase from birth, a disease associated with a violation of the structure of the lactase gene. Babies with alactasia used to die, but now there are lactose-free formula for feeding. Fortunately, this condition is very rare. More often in newborns, functional immaturity of the enzyme system is found, and this can also give the effect of milk intolerance, which passes after a while in the infant.
Primary hypolactasia is milk intolerance associated with a genetically determined age-related decrease in the activity of the lactase gene and, as a consequence, with a decrease in the synthesis of lactase in the intestine.
Acquired intolerance to milk sugar is called secondary hypolactasia. It can occur with helminthic invasion, after some past diseases, after surgery. When the cause is eliminated, which is not always possible, the intolerance goes away.
In the 1970s, it was shown that milk intolerance, widespread among some peoples, is not a disease, as European doctors had previously believed, but a genetically determined variant of the norm. In 2002, Finnish researchers discovered a specific region in front of the lactase gene in the human genome, which determines whether the gene will work in an adult or stop working as an adult. In front of all genes there are regions that do not encode a protein, but determine when and where the gene should work, when and where the protein encoded by the gene should be synthesized.
The area in front of the lactase gene discovered by Finnish scientists determines whether the gene will be turned off with age or will work like a baby for the rest of his life. Another region in front of the lactase gene determines that the gene works in certain cells of the lining of the small intestine and does not work in other tissues. All these areas are a "genetic text", a sequence of nucleotides. Age-related disconnection of the lactase gene defines a region of about 100 nucleotides in length. In people of European descent, the nucleotide C (cytosine) in this region, at position LCT-13910, determines the gene deactivation with age. And if T (thymine) is in this position, then the gene becomes "non-switchable". A person has two copies of the lactase gene: one from the mother, the other from the father. One copy of a working gene is enough to preserve the ability to drink milk.
How can you determine if a person has milk intolerance?
There is a direct way to determine if lactase is being synthesized in the small intestine. To do this, take a piece of the intestinal mucosa (do a biopsy) and measure the activity of the lactase present there. It is impossible to apply this method widely, such studies can only be done during operations or other vital interventions. Therefore, indirect methods for determining the activity of lactase are usually used. For example, a test is carried out with a load of lactose: on an empty stomach they give to drink 50 grams of lactose dissolved in 0.5 liters of water. This amount of milk sugar is found in a liter of cow's milk. Prior to this, blood glucose is determined. 40 minutes after ingestion, the glucose content is re-determined. If lactose is broken down by lactase into glucose and galactose and these monosaccharides are absorbed into the blood, then the glucometer will show an increase in blood glucose. If it does not change, then nothing was absorbed and lactase does not work. To this is added the appearance or absence of symptoms of hypolactasia. So that patients do not suffer, the symptoms that appear can be relieved by taking several tablets of activated carbon. There are methods that measure not glucose, but the level of galactose in the urine or exhaled hydrogen using special devices. Finally, with the discovery of the LCT-13910 site, it became possible to determine which variants of the gene in humans: shutdown (in both copies of C) or permanently working (a combination of CT or TT). For this, blood sampling is not even necessary - it is enough to scrape off mucosal cells from the inner surface of the cheek or collect saliva, and the DNA isolated from these materials is sufficient for analysis. Genetic analysis takes several hours and does not cause inconvenience to the patient. However, this analysis cannot determine whether the gene is already disabled in the adolescent or is still working, or to establish whether the patient has secondary hypolactasia with working variants of the gene.
At what age does a gene turn off?
Studies of geneticists and doctors in different countries have shown that in Southeast Asia, where hypolactasia is almost complete (98% of the population), the gene is disabled in some children at the age of 5–6 years. In Finland, the age of gene deactivation is about 22–25 years. In some people, the gene is switched off a little earlier, in others later. The studies were carried out by comparing the gene variant and lactase activity in people of different ages, determined using the tests described above.
We conducted such a study in Russia. We did not have the opportunity to use the lactose load test, so we made an indirect assessment of the change in the frequency of consumption of whole milk by people aged 18 to 50 years. It turned out that before the age of 22, the average frequency of consumption of whole milk is the same for all genotypes, and after this age it sharply decreases in those who are genetically predetermined to turn off the lactase gene.
However, we cannot say at what age milk intolerance develops in representatives of the indigenous population of the Caucasus or Siberia. Among them, primary hypolactasia is common, but at what age it manifests itself - no one knows. This can be important for students, especially in high school. It is necessary to carefully monitor whether symptoms appear after milk, and if they do, you need to discard it. Even with a non-switched off variant of the gene in old age, there is a decrease in lactase activity as part of a general decrease in the activity of digestive enzymes.
Does milk intolerance affect your health?
According to some studies, almost half of people with milk intolerance are unaware of their characteristics. Some of them do not like milk and do not drink it, and some of them drink, despite their ailments.
If, with intolerance, you exclude foods containing lactose, there will be no harm to health. Lactose contains not only whole milk, but now it is added to instant products, confectionery and meat products. Some medicines also contain lactose, and this is always indicated on the label. In fermented milk products, butter, cheese, the lactose content is reduced due to the breakdown by lactic acid bacteria. However, in a number of products, it can remain quite high. In case of intolerance, one can only determine from one's own experience which foods cause a reaction, what and in what quantities can be consumed.
Milk is considered a valuable source of calcium. With a lack of calcium and vitamin D (which is necessary for calcium absorption) in older people, bone mineral density may decrease and the risk of fractures may increase. A recent large-scale study in Denmark showed that people with genetically determined hypolactasia are more likely to have a decrease in bone mineral density in the femoral neck compared to those who can consume milk, but the decrease in density is very small. This study did not indicate whether hypolactasia and dairy withdrawal were compensated for with vitamins and calcium supplements. There are other studies with rather conflicting results. It is not yet possible to conclude whether hypolactasia affects the condition of the bones. Most likely it does, when dairy products have to be eliminated, other sources of calcium are not available in sufficient quantities and the lifestyle does not provide for the production of vitamin D.
The most unpleasant consequences can be obtained if you constantly drink milk during hypolactasia. Even if these are amounts that do not cause violent diarrhea, but are accompanied by minor disturbances, indigestion can reduce the absorption of nutrients in the intestines.
Studies of the relationship between milk consumption and health are interesting. Milk was once suspected of increasing the risk of certain types of cancer, but it is now reliably shown that this is not the case. At the same time, the studies used both estimates of milk consumption (they are established according to questionnaires, therefore they are not very accurate), and the genotype for the lactase gene. It has previously been shown that people with genetically determined lactose intolerance drink less milk. This means that by dividing the subjects according to the variants of the lactase gene, you can get two groups, one of which consumes obviously less milk than the other. There were no differences in the incidence of cancer between these groups. The gene turned out to be a very good research tool.
Do people with lactose intolerance need to replace it with something?
It is best to consult a dietitian to find a balanced diet. For those who love milk but are lactose intolerant, lactose-free milk is produced. If you really want to try milk, you can first drink a lactase tablet, then the experiment will pass without unpleasant consequences. It is not worth taking drugs and vitamins without a doctor's prescription. Studies have shown that not everyone needs them and may not only not have a beneficial effect, but also worsen the state of health when taken without indications.
What is the difference between primary hypolactasia and milk allergy?
Allergies can be caused by milk proteins. At the same time, an allergy to milk has all the signs of an allergy: skin rashes, a runny nose, Quincke's edema and other symptoms. Hypolactasia does not cause such symptoms. In both cases, the exclusion of milk eases the condition. In case of allergies, it is also necessary to exclude products containing milk proteins, and in case of hypolactasia, milk sugar.
Is lactose intolerance related to race?
Differences in the ability to absorb milk between racial groups were first recorded in 1965 in a survey in Baltimore of black adolescents and adults, among whom 73% were unable to break down lactose, as opposed to 16% in the control group of whites. The inability to drink milk at that time was considered as a consequence of the disease or as inhibition of the enzyme activity due to the peculiarities of the national cuisine. However, it is now clear that the ability to break down lactose in adults does not depend on race, but on the environmental conditions in which the ancestors of modern people inhabiting different regions lived, and whether they had dairy farming.
That the Romans used milk as a laxative, with mare's milk being considered the strongest. Now we know that it contains one and a half times more lactose than cow's milk.
A study of the DNA of ancient skeletons showed that until 4-6 thousand years ago no one in Europe could drink milk, everyone had only genes with the C variant. The mutation, replacing C with T, arose once in one of the ancestors of the modern population of Europe and spread widely not later than 4 thousand years ago and not earlier than the appearance of dairy farming about 10 thousand years ago. Genetic studies show that this substitution, which enables adults to drink milk, was picked up by selection, and its frequency increased rapidly (on an evolutionary scale). This means that the "mutants" had significant advantages in survival and reproduction, leaving more viable offspring.
How common is milk intolerance in Russia?
The studies that we conducted with the specialist in medical anthropology Andrei Igorevich Kozlov, who devoted many years to the study of hypolactasia, show that the lowest incidence of primary hypolactasia (36%) occurs in Russians from the northwest of Russia. In the Russian southern regions, it reaches 50%. Hypolactasia occurs with about the same frequency in our western neighbors - Belarusians and Ukrainians. The indigenous peoples of Siberia and the Far East have hypolactasia at the level of 70–80% and higher. In the Ural region - about 50%, among the inhabitants of the Caucasus (so far few groups have been studied) - up to 70–80%.
Interestingly, Wikipedia maps show the frequency of hypolactasia for a significant part of the territory of Russia as 20%. This estimate was obtained by a group of researchers who used other criteria for the diagnosis of hypolactasia and received underestimated figures. The articles have been published in medical journals, so this is the score that doctors use. According to our data, there is no such frequency in any of the regions of Russia, the lowest - 36% - among the northern Russians. The estimates of the frequency of hypolactasia obtained by Kozlov for representatives of different ethnic groups based on the stress test completely coincide with the frequencies of the CC genotype that we independently established, which determines hypolactasia. Therefore, we believe that our estimates are correct, and the data indicated in Wikipedia and the resources copying it are inaccurate.
Can lactose intolerance be cured?
In some cases, secondary hypolactasia can be cured together with the underlying disease that led to its development. But it is impossible to get rid of genetically determined hypolactasia, except perhaps to replace the gene. But primary hypolactasia is considered a normal variant, not a disease. You can live great with it if you do not get carried away with the absorption of lactose. Milk intolerance is not harmful. It is harmful not to know that you have it.
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