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<tablep> <tbody> <tr> <th colspan="2"strong> Lactose intolerance</th> </tr> <tr> <th scope="row">Synonyms</th> <td>Lactase deficiency, hypolactasia</td> </tr> <tr> <td colspan="2"strong> is a condition in which people have symptoms due to the decreased ability to digest <a href="https://en.wikipedia.org/wiki/File:Lactose_Haworth.svgLactose"><img alttitle="Lactose Haworth.svg" src="https://upload.wikimedia.org/wikipedia/commons/thumb/3/36/Lactose_Haworth.svg/300px-Lactose_Haworth.svg.png" style="height:265px; width:300px" />lactose</a></td> </tr> <tr> <td colspan="2">Lactose is made up of, a sugar found in <a href="https://en.wikipedia.org/wiki/DisaccharideDairy_product" title="DisaccharideDairy product">two simple sugarsdairy products</a>.</td> </tr> <tr> <th scopespan style="row"><a href="httpsfont-size://en.wikipedia10.org/wiki/Specialty_(medicine)" title="Specialty (medicine)8333px">Specialty</a></th> <tdspan>Those affected vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include <a href="https://en.wikipedia.org/wiki/GastroenterologyAbdominal_pain" title="GastroenterologyAbdominal pain">Gastroenterologyabdominal pain</a></td> </tr> <tr> <th scope="row">Symptoms</th> <td>Abdominal pain, <a href="https://en.wikipedia.org/wiki/Bloating" title="Bloating">bloating</a>, <a href="https://en.wikipedia.org/wiki/Diarrhea" title="Diarrhea">diarrhea</a>, gas, <a href="https://en.wikipedia.org/wiki/NauseaFlatulence" title="NauseaFlatulence">nauseagas</a><sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row"><a href="https://en.wikipedia.org/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th> <td>Does not cause damage to the GI tract<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-Heyman2006-2">[2]</a></sup></td> </tr> <tr> <th scope="row">Usual onset</th> <td>30–120 min after dairy products<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row">Causes</th> <td>Decreased ability to digest, and <a href="https://en.wikipedia.org/wiki/LactoseNausea" title="LactoseNausea">lactose</a>(genetic, small intestine injury)<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row"><a href="https://en.wikipedia.org/wiki/Diagnostic_method" title="Diagnostic method">Diagnostic method</a></th> <td>Symptoms resolve following eliminating lactose<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row"><a href="https://en.wikipedia.org/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosisnausea</a></th> <td><a href="https://en.wikipedia.org/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">Irritable bowel syndrome</a>, <a href="https://enThese symptoms typically start 30 minutes to two hours after eating or drinking milk-based food.wikipedia.org/wiki/Celiac_disease" title="Celiac disease">celiac disease</a>, <Severity typically depends on the amount a href="https://enperson eats or drinks.wikipedia.org/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a>, <a href="https://en.wikipedia.org/wiki/Milk_allergy" title="Milk allergy">milk allergy</a><sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row">Treatment</th> <td>Decreasing lactose in Lactose intolerance does not cause damage to the diet, <a href="https://en.wikipedia.org/wiki/Lactase_supplementsGastrointestinal_tract" title="Lactase supplementsGastrointestinal tract">lactase supplementsgastrointestinal tract</a>, treat the underlying cause<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup></td> </tr> <tr> <th scope="row">Frequency</th> <td>10% (Northern Europe) to 95% (parts of Asia and Africa)<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-Deng2015-3">[3]</a></sup></td> </tr> </tbody></tablep>
<p><strong>Lactose intolerance</strong> is a condition in which people have symptoms due to the decreased ability to digestlack of <a href="https://en.wikipedia.org/wiki/LactoseEnzyme" title="LactoseEnzyme">lactoseenzyme</a>, a sugar found in <a href="https://en.wikipedia.org/wiki/Dairy_productLactase" title="Dairy productLactase">dairy productslactase</a>.<sup> in the <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1Small_intestines">[1]</a></sup>Those affected vary in the amount of lactose they can tolerate before symptoms develop.<sup><a hreftitle="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1Small intestines">[1]small intestines</a></sup> Symptoms may includeto break lactose down into <a href="https://en.wikipedia.org/wiki/Abdominal_painGlucose" title="Abdominal painGlucose">abdominal painglucose</a>, and <a href="https://en.wikipedia.org/wiki/BloatingGalactose" title="BloatingGalactose">bloatinggalactose</a>. There are four types: primary,secondary, developmental, and congenital. Primary lactose intolerance occurs as the number of lactase declines as people age.<a hrefspan style="httpsfont-size://en.wikipedia10.org/wiki/Diarrhea" title="Diarrhea8333px">diarrhea</aspan>Secondary lactose intolerance is due to injury to the small intestine such as from infection, <a href="https://en.wikipedia.org/wiki/FlatulenceCeliac_disease" title="FlatulenceCeliac disease">gasceliac disease</a>, and <a href="https://en.wikipedia.org/wiki/NauseaInflammatory_bowel_disease" title="NauseaInflammatory bowel disease">nauseainflammatory bowel disease</a>, or other diseases.<sup><a hrefspan style="httpsfont-size://en10.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-18333px">[1]</a></supspan>Developmental lactose intolerance may occur in These symptoms typically start 30 minutes to two hours after eating or drinking milk-based food.<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1Premature_babies" title="Premature babies">[1]premature babies</a></sup> Severity typically depends on the amount and usually improves over a person eats or drinks.<sup><a href="https://en.wikipediashort period of time.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1">[1]</a></sup> Lactose Congenital lactose intolerance does not cause damage to theis an extremely rare <a href="https://en.wikipedia.org/wiki/Gastrointestinal_tractGenetic_disorder" title="Gastrointestinal tractGenetic disorder">gastrointestinal tractgenetic disorder</a> in which little or no lactase is made from birth.<sup><a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-Heyman2006-2">[2]</a></sup></p>
<p> </p> <p><strong><span style="font-size:20px">Causes</span></strong></p> <hr /><p>Lactose intolerance is due to a consequence of <a href="https://en.wikipedia.org/wiki/Lactase" title="Lactase">lactase</a> deficiency, which may be genetic (<a href="https://en.wikipedia.org/wiki/Lactose_intolerance#Primary_hypolactasia">primary hypolactasia</a> and <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#Primary_congenital_alactasia">primary congenital alactasia</a>) or environmentally induced (<a href="https://en.wikipedia.org/wiki/Lactose_intolerance#Secondary_hypolactasia_or_acquired_hypoalactasia">secondary or acquired hypoalactasia</a>). In either case, symptoms are caused by insufficient levels of lactase in the lack lining ofthe <a href="https://en.wikipedia.org/wiki/EnzymeDuodenum" title="EnzymeDuodenum">enzymeduodenum</a>. Lactose, a <a href="https://en.wikipedia.org/wiki/LactaseDisaccharide" title="LactaseDisaccharide">lactasedisaccharide</a> molecule found in milk and dairy products, cannot be directly absorbed through the wall of the small intestine into the bloodstream, so, in the absence of lactase, passes intact into the <a href="https://en.wikipedia.org/wiki/Small_intestinesColon_(anatomy)" title="Small intestinesColon (anatomy)">colon</a>. <a href="https://en.wikipedia.org/wiki/Gut_flora" title="Gut flora">small intestinesBacteria</a> to break in the colon can metabolize lactose down into, and the resulting <a href="https://en.wikipedia.org/wiki/GlucoseFermentation_(biochemistry)" title="Glucose">glucosefermentation</a> andproduces copious amounts of gas (a mixture of <a href="https://en.wikipedia.org/wiki/GalactoseHydrogen" title="GalactoseHydrogen">galactosehydrogen</a>, <a href="https://en.wikipedia.org/wiki/Carbon_dioxide" title="Carbon dioxide">carbon dioxide<sup/a>, and <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-Deng2015-3Methane" title="Methane">methane</a>) that causes the various abdominal symptoms. The unabsorbed sugars and fermentation products also raise the <a href="https://en.wikipedia.org/wiki/Osmotic_pressure" title="Osmotic pressure">[3]osmotic pressure</a> of the colon, causing an increased flow of water into the bowels (diarrhea).</p> <p>The <em>LCT</em> gene provides the instructions for making lactase. The specific DNA sequence in the <em>MCM6</supem> There gene helps control whether the <em>LCT</em> gene is turned on or off. At least several thousand years ago, some humans developed a mutation in the <em>MCM6</em> gene that keeps the <em>LCT</em> gene turned on even after breastfeeding is stopped. Populations that are lactose intolerant lack this mutation. The LCT and <em>MCM6</em> genes are four typesboth located on the long arm (q) of chromosome 2 in region 21. The locus can be expressed as 2q21.<span style="font-size: primary10.8333px"> </span>The lactase deficiency also could be linked to a certain heritage. It is more common in Asian Americans, secondaryAfrican Americans, developmentalMexican Americans, and congenitalNative Americans. Analysis of the DNA of 94 ancient skeletons in Europe and Russia concluded that the mutation for lactose tolerance appeared about 4,300 years ago and spread throughout the European population.<sup/p> <p>Some human populations have developed <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-NIH2014Dig-1Lactase_persistence" title="Lactase persistence">[1]lactase persistence</a>, in which lactase production continues into adulthood probably as a response to the benefits of being able to digest milk from farm animals. Some have argued that this links intolerance to <a href="https://en.wikipedia.org/wiki/Natural_selection" title="Natural selection">natural selection</supa> Primary lactose intolerance occurs as the amount favoring lactase-persistent individuals, but it is also consistent with a physiological response to decreasing lactase production when it is not needed in cultures in which dairy products are not an available food source. Although populations in Europe, India, Arabia, and Africa were first thought to have high rates of lactase persistence because of a single mutation, lactase persistence has been traced to a number of mutations that occurred independently. Different alleles for lactase declines as persistence have developed at least three times in East African populations, with persistence extending from 26% in <a href="https://en.wikipedia.org/wiki/Tanzania" title="Tanzania">Tanzania</a> to 88% in the <a href="https://en.wikipedia.org/wiki/Beja_people" title="Beja people age">Beja</a> pastoralist population in <a href="https://en.wikipedia.org/wiki/Sudan" title="Sudan">Sudan</a>.</p> <p>The accumulation of <a href="https://en.wikipedia.org/wiki/Epigenetics" title="Epigenetics">Epigenetic<sup/a> factors, primarily <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_noteDNA_methylation" title="DNA methylation">DNA methylation</a>, in the <em>LCT</em> and <em>MCM6</em> gene may also contribute to the onset of lactose intolerance in adults.</p> <p>Lactose intolerance is classified according to its causes as:</p> <h3><span style="font-NIH2014Digsize:16px">Primary </span><span style="font-1size:16px">[1]hypolactasia</span></h3> <p>Primary hypolactasia, or primary lactase deficiency, is genetic, only affects adults, and is caused by the absence of alactase persistence allele. In individuals without the lactase persistence allele, less lactase is produced by the body over time, leading to hypolactasia in adulthood. The frequency of lactase persistence, which allows lactose tolerance, varies enormously worldwide, with the highest prevalence in Northwestern Europe, declines across southern Europe and the Middle East and is low in Asia and most of Africa, although it is common in pastoralist populations from Africa.</p> <h3><span style="font-size:16px">Secondary </span><span style="font-size:16px">hypolactasia</supspan></h3> <p>Secondary lactose intolerance hypolactasia or secondary lactase deficiency also called acquired hypolactasia or acquired lactase deficiency, is due to caused by an injury to the <a href="https://en.wikipedia.org/wiki/Small_intestine" title="Small intestine">small intestine such as from infection</a>. This form of lactose intolerance can occur in both infants and lactase persistent adults and is generally reversible. It may be caused by acute <a href="https://en.wikipedia.org/wiki/Gastroenteritis" title="Gastroenteritis">gastroenteritis</a>, <a href="https://en.wikipedia.org/wiki/Celiac_diseaseCoeliac_disease" title="Celiac Coeliac disease">celiac coeliac disease</a>, <a href="https://en.wikipedia.org/wiki/Inflammatory_bowel_diseaseCrohn%27s_disease" title="Inflammatory bowel Crohn's disease">inflammatory bowel Crohn's disease</a>, <a href="https://en.wikipedia.org/wiki/Ulcerative_colitis" title="Ulcerative colitis">ulcerative colitis</a>, <a href="https://en.wikipedia.org/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a>, <a href="https://en.wikipedia.org/wiki/Intestinal_parasites" title="Intestinal parasites">intestinal parasites</a> (such as <a href="https://en.wikipedia.org/wiki/Giardia" title="Giardia">Giardia</a>), or other diseasesenvironmental causes.</p> <h3><span style="font-size:16px">Primary congenital </span><span style="font-size:16px">alactasia</span></h3> <p>Primary congenital alactasia, also called congenital lactase deficiency, is an extremely rare, <a href="https://en.wikipedia.org/wiki/Autosomal_recessive" title="Autosomal recessive">autosomal recessive</a> enzyme defect that prevents lactase expression from birth. People with congenital lactase deficiency cannot digest lactose from birth, so cannot digest breast milk. This genetic defect is characterized by a complete lack of lactase (alactasia). About 40 cases have been reported worldwide, mainly limited to <a href="https://en.wikipedia.org/wiki/Finland" title="Finland">Finland</a>. Before the 20th century, babies born with congenital lactase deficiency often did not survive, but death rates decreased with <supa href="https://en.wikipedia.org/wiki/Soybean" title="Soybean">soybean</a>-derived <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_noteInfant_formula" title="Infant formula">infant formulas </a>and manufactured lactose-NIH2014Digfree dairy products.</p> <p><span style="font-1size:20px">[1]<strong>Management</strong></aspan></supp> <suphr /><p>When lactose intolerance is due to secondary lactase deficiency, treatment of the underlying disease may allow lactase activity to return to normal levels. In people with coeliac disease, lactose intolerance normally reverts or improves several months after starting a <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_noteGluten-BerniCananiPezzella2016free_diet" title="Gluten-4free diet">[4]gluten-free diet</a>, but temporary dietary restriction of lactose may be needed.</supp> <p>People with primary lactase deficiency cannot modify their body’s ability to produce lactase. Developmental In societies where lactose intolerance is the norm, it is not considered a condition that requires treatment. However, where dairy is a larger component of the normal diet, a number of efforts may be useful. There are four general principles in dealing with lactose intolerance: avoidance of dietary lactose, substitution to maintain nutrient intake, regulation of calcium intake, and use of enzyme substitute. Regular consumption of dairy food by lactase-deficient individuals may occur also reduce symptoms of intolerance by promoting colonic bacteria adaptation.</p> <h3><span style="font-size:16px">Dietary avoidance</span></h3> <p>The primary way of managing the symptoms of lactose intolerance is to limit the intake of lactose to a level that can be tolerated. Lactase deficient individuals vary inthe amount of lactose they can tolerate, and some report that their tolerance varies over time, depending on health status and pregnancy. However, as a rule of thumb, people with primary lactase deficiency and no small intestine injury are usually able to consume at least 12 grams of lactose per sitting without symptoms, or with only mild symptoms, with greater amounts tolerated if consumed with a meal or throughout the day.</p> <h3><span style="font-size:16px">Milk substitutes</span></h3> <p>Further information: <a href="https://en.wikipedia.org/wiki/Milk#Reduction_or_elimination_of_lactose" title="Milk">Milk § Reduction or elimination of lactose</a>, and <a href="https://en.wikipedia.org/wiki/Milk_substitute" title="Milk substitute">Milk substitute</a></p> <p><a href="https://en.wikipedia.org/wiki/Plant_milk" title="Plant milk">Plant-based "milks"</a> and derivatives such as <a href="https://en.wikipedia.org/wiki/Premature_babiesSoy_milk" title="Premature babiesSoy milk">soy milk</a>, <a href="https://en.wikipedia.org/wiki/Rice_milk" title="Rice milk">rice milk</a>, <a href="https://en.wikipedia.org/wiki/Almond_milk" title="Almond milk">almond milk</a>, <a href="https://en.wikipedia.org/wiki/Coconut_milk" title="Coconut milk">coconut milk</a>, <a href="https://en.wikipedia.org/wiki/Hazelnut" title="Hazelnut">hazelnut</a> milk, <a href="https://en.wikipedia.org/wiki/Oat_milk" title="Oat milk">oat milk</a>, <a href="https://en.wikipedia.org/wiki/Hemp_milk" title="Hemp milk">hemp milk</a>, macadamia nut milk, and <a href="https://en.wikipedia.org/wiki/Peanut_milk" title="Peanut milk">premature babiespeanut milk</a> are inherently lactose-free. Low-lactose and usually improves over lactose-free versions of foods are often available to replace dairy-based foods for those with lactose intolerance.</p> <h3><span style="font-size:16px">Lactase supplements</span></h3> <p>When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then enzymatic lactase supplements may be used.</p> <p>Lactase enzymes similar to those produced in the small intestines of humans are produced industrially by <a href="https://en.wikipedia.org/wiki/Fungi" title="Fungi">fungi</a short period > of timethe <a href="https://en.wikipedia.org/wiki/Genus" title="Genus">genus</a> <em><a href="https://en.wikipedia.org/wiki/Aspergillus" title="Aspergillus">Aspergillus<sup/a></em>. The enzyme, <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_noteBeta-NIH2014Diggalactosidase" title="Beta-1galactosidase">[1]β-galactosidase</a>, is available in tablet form in a variety of doses, in many countries without a prescription. It functions well only in high-acid environments, such as that found in the human gut due to the addition of gastric juices from the stomach. Unfortunately, too much acid can denature it, so it should not be taken on an empty stomach. Also, the enzyme is ineffective if it does not reach the small intestine by the time the problematic food does. Lactose-sensitive individuals can experiment with both timing and dosage to fit their particular needs.</p> <p>While essentially the same process as normal intestinal lactose digestion, direct treatment of milk employs a different variety of industrially produced lactase. This enzyme, produced by <ahref="https://en.wikipedia.org/wiki/Yeast" title="Yeast">yeast</supa> Congenital from the genus <em><a href="https://en.wikipedia.org/wiki/Kluyveromyces" title="Kluyveromyces">Kluyveromyces</a></em>, takes much longer to act, must be thoroughly mixed throughout the product, and is destroyed by even mildly acidic environments. Its main use is in producing the lactose-free or lactose-reduced dairy products sold in supermarkets.</p> <h3><span style="font-size:16px">Rehabituation to dairy products</span></h3> <p>Regular consumption of dairy foods containing lactose can promote a colonic bacteria adaptation, enhancing a favorable microbiome, which allows people with primary lactase deficiency to diminish their intolerance and to consume more dairy foods. The way to induce tolerance is an extremely rarebased on progressive exposure, consuming smaller amounts frequently, distributed throughout the day. Lactose intolerance can also be managed by ingesting live yogurt cultures containing <a href="https://en.wikipedia.org/wiki/Genetic_disorderLactobacillus_acidophilus" title="Genetic disorderLactobacillus acidophilus">genetic disorderlactobacilli</a> that are able to digest the lactose in which little or no lactase other dairy products. This may explain why many South Asians, though genetically lactose intolerant, are able to consume large quantities of milk without any symptoms of lactose intolerance, since consuming live yogurt cultures is made very common among the South Asian population.</p> <p> </p> <p><span style="font-size:20px"><strong>Reference</strong></span></p> <hr /><p>1. <a href="https://en.wikipedia.org/wiki/Lactose_intolerance#cite_note-Vandenplas2015-5">"Lactose intolerance"</a>, from birth.Wikipedia</p>
