lactase deficiency. Causes, symptoms, signs, diagnosis and treatment of pathology

Lactose is a milk sugar found in breast milk and artificial milk formulas.

It is also found in large quantities in cow's milk.

There is much less milk sugar in fermented milk products. The enzyme lactase is responsible for the breakdown of lactose in the human body.

A common condition in children is lactase deficiency.

This is a disruption in the production of the lactase enzyme in the intestines, which causes the body to be unable to digest milk sugar.

Undigested lactose enters the large intestine and is processed by the microorganisms living there.

Insufficient production of the enzyme is scientifically called hypolactasia, and its complete absence is called alactasia.

Depending on the cause, there are two types of lactase deficiency: primary and secondary.

Primary

Primary deficiency is a congenital deficiency of the enzyme lactase. This type of lactase deficiency occurs in 6-10% of the world's inhabitants.

Often this pathology is inherited. If one of the child’s relatives has a lactase deficiency, then there is a high probability that the baby himself will face this problem.

Functional

This is the most common type of primary failure. Its cause is not a violation of enzyme production. Functional lactase deficiency is most often caused by a large amount of foremilk in the baby's mother. It is the foremilk that is rich in lactose. And to process excess milk sugar, there is simply not enough of the enzyme that is normally produced by the body.

Milk intolerance due to lactase enzyme deficiency

Sometimes the cause of symptoms of lactase deficiency is low fat content of milk. Such milk enters the intestines very quickly, so it does not have time to be digested. The result is the same as with a lack of lactase: diarrhea and discomfort.

Secondary

Secondary lactase deficiency occurs due to dysbiosis and inflammatory processes in the mucous membrane of the small intestine.

This failure entails a disruption in the production of lactase. Also, lactase deficiency can cause problems in the functioning of the thyroid and pancreas.

This type of hypolactasia is common in children under one year of age. It usually goes away after treatment of dysbiosis or as the child grows older.

These are types of pathology. But at the age of two years, the natural process of decreasing lactase production begins. It is a consequence of the body’s maturation and changes in diet and ends around the age of seven. With age, a person needs milk less, and the body gradually reduces the amount of enzyme for breaking down this product. Such lactase deficiency is called physiological, or normal.

Hypolactasia is often confused with cow's milk allergy: the symptoms of the diseases are very similar. But despite these similarities, the diseases are caused by different reasons and require different treatments.

Causes

Each type of hypolactasia has its own causes.

Primary is due to the structural features of the cells responsible for the production of lactase. These are the superficial cells of the epithelium of the small intestine - enterocytes.
Secondary occurs due to damage to enterocytes.
And the functional one is caused by too much volume of the “front reservoir” of the mother’s breast. Therefore, the baby receives a lot of foremilk, rich in milk sugar, and does not have time to process it.

Symptoms

The following symptoms will tell you about the problem of lactase deficiency.

Child's restlessness during or after meals.
Bloating.
Loose, foamy stools. Sometimes frequent - up to 10 times a day, sometimes rare. In some cases, the bowels may not move at all without stimulation.
The child either does not improve at all.
The baby becomes irritable.
A violation is observed.
Psychomotor development slows down.
Children with lactase deficiency are more likely to experience seizures, rickets, attention deficit disorder, etc.

If you have the following symptoms, you should immediately seek medical help!

Refusal to eat.
Vomiting after every meal.
Diarrhea.
Severe underweight, weight loss.
Lethargy of the child or, conversely, increased anxiety.
Dehydration.

A sunken fontanel in a child is a sure sign of dehydration!

Diagnostics

Lactase deficiency in a child can be determined using the following studies.

Genetic testing, or “lactase genotyping,” will help identify primary deficiency.
Diet diagnostics is a method that involves eliminating lactose from the diet. If the cause of the child’s poor health is lactase deficiency, then after switching to dietary nutrition, the symptoms of the disease will disappear.
Stool analysis. Problems with lactase production will be indicated by an increased content of hydrocarbons in the feces.

Treatment

Treatment is prescribed based on the severity of the pathology.

If the child feels well, develops correctly and gains weight, no treatment is required, the diet remains the same regardless of the test results.

If the baby’s weight is normal, but there is anxiety, tearfulness and bowel dysfunction, you can continue breastfeeding or formula feeding, but at the same time give the child a pharmacological drug containing lactase. For example, “Lactase baby” or “Lactase enzyme”.

Such drugs are taken before feeding; the dose is determined by the doctor based on the level of carbohydrates in the stool. Taking lactase usually lasts three to four weeks. Then the drug should be gradually eliminated: every four days, one dose should be removed. In this case, you need to monitor the child’s condition: if symptoms recur, you should return to the previous dose and extend treatment for another two weeks. Sometimes in severe cases, treatment can take several months.

If the child is underweight, it is necessary to completely or partially replace milk or formula with products low in lactose.

There are special milk formulas, such as Nutrilon low-lactose or NAN lactose-free.

You can also offer your baby a medicinal mixture containing prebiotics.

Therapeutic and dietary mixtures, as well as lactase preparations, can be gradually replaced with conventional mixtures.

You should start by replacing one scoop at each feeding. Every day, increase the amount of the usual mixture by one spoon. If the condition worsens, it is necessary to return to dietary nutrition.

In case of lactase deficiency, hydrolyzed milk formulas are contraindicated as they slow down the production of enzymes.

By eliminating milk from your diet, you can continue to consume fermented milk products: the bacteria that are involved in their preparation break down lactose themselves.

Small changes should be made to the menu of a nursing mother. She needs to give up cow's milk and limit her consumption of sweets. And fermented milk products on the mother’s table will not bring any harm to the baby.

Forecast

Signs of primary lactase deficiency may persist throughout life. Absolute lactose intolerance is rare.

Therefore, most people with this pathology can drink cow's milk in small quantities.

They remember about intolerance only if the permissible amount of milk is exceeded.

You can also replace milk with fermented milk products, which are digested without problems.

Secondary lactase deficiency disappears without a trace over time. This usually occurs by the age of six to seven months.

Impaired lactase production can cause a lot of trouble for both the baby and his loved ones. But if you approach diagnosis and treatment with all responsibility, you can minimize the manifestations of this disease.

What to do if your baby cannot tolerate breast milk? Should I really give up breastfeeding? Or is there still a way out?

Lactase deficiency (lactose intolerance) is a disease whose main symptom is impaired absorption of dairy products. The disease is diagnosed from the first months of life, because at this age breast milk is the main food product of the child. It must be remembered that the severity of symptoms increases as the amount of milk consumed increases. Lactose intolerance can also occur in adults.

Lactase is an enzyme synthesized by intestinal enterocyte cells. The main function of this enzyme is the breakdown of lactose, the main constituent of any milk. Lactase, breaking down lactose, converts it into simpler sugars: glucose and galactose, which are then absorbed through the intestinal wall. If there is not enough lactase, or there is none at all, then lactose is not broken down in the intestines. It contributes to the accumulation of water in it and the development of diarrhea - loose stools.

Lactase deficiency can be primary and secondary.

In primary deficiency, lactase is secreted in sufficient quantities by healthy intestinal cells, but the activity of the enzyme is reduced, so lactose remains undigested. Primary lactase deficiency, in which production enzyme, is very rare. There is a so-called transient lactase deficiency. It is typical for premature and full-term, but immature babies. This is explained by the fact that high enzyme activity is needed only at the time of birth, therefore, starting to increase from 34 weeks of pregnancy, lactase activity reaches a maximum at 37-39 weeks. It is for this reason that a premature baby may have lactose intolerance, which, being transient, goes away after some time.

Secondary lactase deficiency occurs when enterocytes are damaged, which is characterized by impaired lactase secretion. Most often, cell dysfunction is caused by various types of inflammation in the intestines (including allergic ones).

Symptoms of lactase deficiency

Liquid, yellowish, frothy, sour-smelling stools, which can be either frequent (up to 8-10 times a day) or rare. The stool looks like yeast dough. After settling in a glass container, the separation of the stool into two fractions is noticeable: liquid and dense. Remember: when using diapers, the liquid part is absorbed, and a violation of the stool can be overlooked!
The child is restless during or after feeding.
Bloating, colic.
The child is not gaining weight well or even losing it.

A child with lactase deficiency usually has a good appetite. Often, he begins to suckle greedily, but after a while he throws his chest, tightens his legs and stomach and starts to cry.

Since the symptoms of lactose intolerance increase as the amount of milk consumed increases, the disease may not manifest itself in the first weeks of life. Then there is bloating and increased gas formation, then abdominal pain and, finally, loose stools.

The symptoms described above are characteristic of primary lactase deficiency. With secondary lactose intolerance, these signs are complemented by the presence of a large amount of mucus, greens in the stool, and there may be undigested lumps of food.

Diagnosis of lactase deficiency

Determination of the amount of carbohydrates in feces. This is the most accessible, fastest and cheapest method for determining carbohydrates in feces. But this analysis is nonspecific, since it does not talk about the causes of the disease, and based on the results of this research method, it is not even possible to say which carbohydrate is not tolerated by the child. But since the young children who are undergoing this study most often drink only breast milk, we can say with a high degree of confidence that they are lactose intolerant. The normal carbohydrate content in feces for a child under 1 year of age is 0 – 0.25%. Deviations from the norm are considered insignificant if the carbohydrate content ranges from 0.3 - 0.5%, average 0.6 - 1.0%, significant - more than 1%.
Determination of lactase activity in a fragment of the small intestinal mucosa (biopsy) is the “gold standard” for diagnosing lactose intolerance. However, this method is carried out more for differential diagnosis with other diseases than as a routine research method.
Examination of feces for dysbacteriosis.
If you suspect an allergy, a blood test for specific antibodies.

Principles of treatment

Lactose intolerance is not a reason to stop breastfeeding. You can continue to breastfeed your baby, and lactase enzyme preparations (for example, Lactase Enzyme, Lactase Baby) will help him cope with lactose, which should be taken approx. Take at every feeding. The dosage of the drug is selected by the doctor individually in each case. Gradually, as the baby’s enzymatic systems mature, the dosage decreases. Here are the basic rules for using lactase enzyme preparations:

Express 10-15 ml of milk.
Pour the prescribed amount of Lactase Baby (or Lactase Enzyme) into the expressed milk. Lactase Baby dissolves easily, but Lactase Enzyme is more difficult.
Leave for 3-5 minutes to ferment. At this time, all carbohydrates contained in the foremilk are broken down.
Start feeding with this part of the milk fermented with Lactase Baby (or Lactase Enzyme).
Continue feeding as usual.
Use at every feeding.

Lactase deficiency is a syndrome that results from the interruption of lactase and is accompanied by watery diarrhea. This pathology manifests itself when there is not enough lactase enzyme in the human intestine, which digests lactose (milk sugar). Therefore, it is worth distinguishing that there is simply no such term as lactose deficiency, this is a mistake. Lactose is nothing more than milk sugar, and the lack of an enzyme (lactase) is called lactase deficiency.

There are several symptoms that indicate lactase deficiency in children. They should alert the young mother:

child age 3-6 months;

sour-smelling stool;

foamy, liquefied stools;

bloating.

Scientists have noticed that this pathology is most common among the native Indians and Vietnamese, but the Swedes and the Dutch almost do not suffer from it. In our country, up to half of the population is found with a lack of such an enzyme to a certain extent, while lactase deficiency periodically manifests itself or disappears.

Unfortunately, children suffer the most from lactase deficiency. It is one of the common causes of severe intestinal colic and a reason to stop breastfeeding.

What are the types of lactase enzyme deficiency?

Primary lactase deficiency is an enzyme deficiency syndrome with intact intestinal cells, enterocytes. This may include:

transient LN of premature babies - manifests itself in newborns who were born before 34 or 35 weeks (insufficient enzyme activity);

congenital LN - often occurs, occurs as a result of a genetic mutation;

lactase deficiency in adults - does not act as a pathology, but reflects the natural process of decreasing lactase activity with age.

In the same Dutch and Swedes, lactase remains highly active throughout life, which cannot be said about the inhabitants of Asian countries.

Secondary lactase deficiency is an enzyme deficiency that occurs due to damage to intestinal cells. Such a lack of lactase is the most common form of deficiency of intestinal enzymes, since the peculiarity of the structure of the intestinal villi is that lactase is closer to the lumen, and, accordingly, receives a blow from adverse factors.

What danger does lactase deficiency pose?

Immunity suffers.

As a result of diarrhea, dehydration of the body develops, it is especially dangerous for infants.

The normal growth of beneficial microflora is disrupted due to the lack of nutrients that are obtained as a result of the breakdown of milk sugar.

The regulation of intestinal motility is disrupted.

Putrefactive microflora multiplies.

The absorption of calcium and other beneficial minerals is impaired.

Causes of lactase deficiency

Congenital LI	Mutation of the gene that controls lactase activity.
Transient LN	Poor enzyme activity at birth
LN in adults	Natural involution of enzyme activity. Intestinal diseases (infectious, inflammatory, dystrophic), which lead to the destruction of red blood cells.
Secondary LN	Dystrophic and inflammatory processes in the intestines that arise as a result of: food allergies; infections: lumbliasis, rotavirus and other manifestations of food allergies; celiac disease (gluten) intolerance; radiation stress; Crohn's disease; medicinal effects. 2. Reduction in the size of the intestinal mucosa due to short bowel syndrome or after removal of part of the intestine.

It is worth noting that lactase activity may vary. In addition to the main factors, many biologically active substances influence the enzyme: pancreatic and thyroid hormones, nucleotides, pituitary hormones, glucocorticosteroid hormones, amino acids and fatty acids in the intestinal lumen.

Symptoms of lactase deficiency

Symptoms of both types of lactase deficiency are usually observed. The only difference is that with primary lactase deficiency, pathological manifestations can be seen within a few minutes; their level of severity largely depends on the amount of lactose consumed. As for secondary LN, it manifests itself when consuming even a small amount of milk sugar, since the absence of its breakdown goes well with a certain intestinal pathology.

Signs of lactase deficiency are as follows:

rumbling in the stomach, pain, vomiting;

diarrhea, characterized by foamy, watery stools with a sour odor and green, too much gas;

loss of appetite, bloating;

regurgitation in an infant, anxiety, attacks of intestinal colic, decreased weight gain, restlessness, crying during feeding.

Features of individual forms

Primary FN manifests itself after taking milk, and a large amount of it. At an early age, it disguises itself as simple intestinal colic, which worries most infants. As the child grows, the microflora can adapt to milk sugar through the proliferation of appropriate bacteria. In the future, symptoms appear exclusively with excessive milk consumption. Moreover, other fermented milk products are tolerated normally, since they support the growth of bacteria that break down milk sugar.

Secondary LI manifests itself at any age as a result of a particular disease. Certain symptoms of lactase deficiency are poorly manifested, since the main role is played by the main intestinal pathology. But a dairy-free diet helps improve the condition.

Congenital LI is a rare but extremely severe type of enzymatic deficiency, which is dangerous due to severe toxicosis and dehydration. The mother can notice this from the very first days of the baby’s life, when breastfeeding leads to vomiting and severe diarrhea. The only solution is to use lactose-free formulas and stop breastfeeding.

How can you independently determine that the symptoms are lactase deficiency? Very persistent symptoms, no effect of treatment. Pathological manifestations disappear only if you follow a strict diet with no lactose.

What tests need to be taken for lactase deficiency?

Analysis of stool: stool should be tested for lactase deficiency to determine the carbohydrate content. Normally, there are few carbohydrates; in infants, 0.25% is allowed; at the same time, the pH is assessed - with lactase deficiency, the level drops below 5.5.

Lactose load test: specialists determine the level and increase in blood sugar by drawing a curve. If there is a deficiency of the enzyme, the graph shows a simplified type of curve, that is, normal growth is not visible due to the lack of sugar absorption.

Water breath test. Along with the loading test, it is necessary to take an analysis for the concentration of hydrogen in the exhaled air: a sample is taken every thirty minutes after loading with lactose.

Genetic study to determine mutations of genes that are responsible for lactase activity.

Determination of enzyme activity from a washout from the intestinal mucosa or biopsy specimen. This is the most accurate method for determining LN, but its use is not always justified due to the complexity of taking the analysis.

An elimination (diagnostic) diet with the exclusion of milk sugar for LI improves the condition of the intestines, as a result of which the symptoms of the disease disappear.

If you suspect lactase deficiency, you can rule out other causes of diarrhea, which, by the way, can also be quite serious.

How does lactase deficiency occur?

Her treatment includes several stages:

Proper therapeutic nutrition, taking the dietary supplement Lactase Enzyme, Lactase Baby, Lactazar for adults, Lactazar for children.

Help the pancreas (enzymes such as Mezim Forte, Pancreatin, Creon, Festal, etc.).

Correction of intestinal dysbiosis (probiotics and prebiotics: Linex, Bifidumbacterin, Hilak Forte and others).

Symptomatic treatment:

Medicines for bloating - Bobotik, Subsimplex, Espumisan.

For pain - drotaverine hydrochloride, antispasmodics No-shpa.

Effective therapeutic nutrition

The diet for lactase deficiency involves the exclusion of lactose or its severe restrictions in the diet in accordance with the level of carbohydrates in the feces. The exclusion of lactose is a forced and temporary measure in a serious condition of the baby (persistent diarrhea, dehydration, severe abdominal pain).

You should not refuse the use of lactose, since it does not act as a natural prebiotic. Therefore, the main task at the current stage is to individually select a phased diet with such an amount of lactose that will not provoke the release of carbohydrates with feces and will not cause indigestion.

How to properly treat lactose deficiency if the baby is still feeding on mother's milk? Modern treatment standards do not imply giving up breastfeeding. Enzyme replacement therapy is used for infants: the drug is added to expressed breast milk, after 15 minutes the baby can be fed breast milk. For this, a food supplement called Lactase Baby is used: one capsule is intended for 10 ml of milk. As soon as the baby eats the expressed milk, he can be breastfed.

For mixed or bottle-fed babies, the optimal combination of regular formula and lactose-free formula is chosen. Their ratio for lactose deficiency is usually different: 1 to 1, 2 to 1, and so on (directly depends on the child’s reaction). In case of pronounced lactase deficiency, exclusively low- or lactose-free mixtures are used.

Lactose-free mixtures: Nutrilak lactose-free, Mamex lactose-free, Nan lactose-free.

Low-lactose mixtures: Nutrilak low-lactose, Nutrilon low-lactose, Humana LP + MCT.

Introduction of complementary foods

In the case of lactose deficiency, you should especially carefully keep a diary of the introduction of complementary feeding to the child, since some foods cause exactly the same pathological reaction: diarrhea, bloating.

Complementary feeding begins with vegetables, using one vegetable at a time for several days. Within 14 days, their quantity is increased to 150 grams. Then, water-based porridges that are low in gluten (corn, buckwheat, rice) are added to the child’s diet, thereby increasing the complementary foods eaten. At the next stage, the child is given meat.

After 8-9 months, the child is given a little bit of fermented milk products (yogurt, kefir), carefully monitoring the reaction. But keep in mind that cottage cheese should not be given to sick children under 1 year of age.

Further nutrition

The diet of a child and adult with lactase deficiency is selected exclusively individually, based on the body’s reactions. What signs indicate that the product is allowed to be consumed, despite the fact that it contains milk sugar:

no increased gas formation;

normal stool – formed, without sour odor and pathological impurities;

absence of rumbling and other uncomfortable sensations in the stomach.

At first, the diet must contain a lot of foods that do not contain lactose: rice, vegetables, fruits, pasta, fish and meat, nuts, legumes, eggs, coffee, tea, corn, buckwheat.

Then you can add products containing lactose, but carefully monitor the body’s reaction to a particular product and its consumed amount:

dairy products - cheese, milk, sour cream, cottage cheese, yogurt, ice cream, butter;

other products in which lactose is added as an additional component - sausages, bread, ketchup, cocoa, cookies, chocolate, mayonnaise and much more.

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

It is important to remember that the diet significantly alleviates the condition of patients with lactase deficiency, but also deprives them of their main source of calcium, so the issue of replenishing such a microelement should definitely be resolved with the attending physician.

Lactase deficiency is a syndrome caused by a deficiency in the body of the enzyme lactase, which can break down the milk sugar lactose.

First, we should emphasize the difference between lactase and lactose. This is not the same thing: lactose is a sugar that enters the baby’s body with milk (including breast milk), and lactase is a digestive enzyme for its breakdown.

With hypolactasia, lactase activity decreases; alactasia means the complete absence of the enzyme.

What is the danger of lactase deficiency?

True lactase deficiency manifests itself after the baby is born and can pose a serious danger to the health of the baby:

diarrhea can lead to dehydration;
malnutrition leads to (weight loss);
deficiency of microelements due to impaired absorption leads to disruption of metabolic processes and the function of many organs and systems;
undigested milk sugar contributes to an imbalance of intestinal microflora, leading to fermentation and gas formation;
forced refusal reduces the baby's body's defenses (the baby does not receive maternal antibodies with milk).

That is why it is very important to know the causes and manifestations of lactase deficiency.

Classification of lactase deficiency

There are two types of lactase deficiency: primary and secondary. Both types can occur in infants.

Primary hypolactasia and alactasia

Congenital genetically determined hypolactasia occurs, but is extremely rare.

In primary lactase deficiency, low activity or complete absence of the enzyme is not associated with damage to the intestinal mucosa.

There are several forms of primary lactase deficiency:

Congenital, or genetically determined. The occurrence of alactasia or hypolactasia is caused by gene mutation. It is extremely rare. In this case, too little enzyme is produced, or it is not synthesized at all.

The main symptom of the disease is weight loss in the newborn and the development of dehydration. With congenital lactase deficiency, infants need a strict lactose-free diet, otherwise the child may die in the first months of life.

A transient, or transient, form of lactase deficiency is usually observed in infants born with low birth weight and in children. The formation of the enzymatic system in the fetus begins at 12 weeks of pregnancy, and lactase activation occurs by the 24th week.

Insufficient development of the enzymatic system in a premature baby is the cause of lactase deficiency. But it is temporary, goes away on its own as the child develops, and does not require treatment.

Functional, the most common form of primary lactase deficiency. The production of the enzyme is not impaired. The baby does not have any pathology. There may be two reasons for its development:

overfeeding the child - lactase does not have time to break down too much lactose;
Low fat content of mother's milk causes milk to move too quickly through the digestive tract.

Lactose overload can also occur when a child sucks a large volume of foremilk, where there is a high content of milk sugar, which lactase cannot break down.

Undigested milk sugar enters the large intestine, causing symptoms of the disease. Sugars in the large intestine contribute to the active development of microflora, serving as a nutrient medium for it. Multiplying bacteria cause stool problems and bloating due to accumulated gases.

Secondary hypolactasia

In secondary lactase deficiency, the cause lies in damage and dysfunction of enterocytes - intestinal epithelial cells. It occurs more often than primary hypolactasia.

Damage to enterocytes can be caused by:

inflammation of the small intestine (enteritis);
rotavirus intestinal infections;
(for example, cow's milk protein);
intolerance to gluten (cereal protein);
radiation therapy;
resection of part of the small intestine;
congenital anomaly (short intestine);
atrophic changes in the mucosa with long-term tube feeding.

Lactase deficiency can also occur with endocrine pathology - dysfunction of the thyroid gland, pituitary gland, and pancreas.

Secondary lactase deficiency does not require early cessation of breastfeeding. In any case, if there are clinical manifestations similar to lactase deficiency, one should understand and decide whether there really is an enzyme deficiency.

Symptoms

A child suffering from lactase deficiency does not gain weight well.

Manifestations of lactase deficiency in infants are:

abnormal stool: it becomes liquid, foamy, green and sour;
bloating and rumbling in the stomach;
colic;
regurgitation;
baby's anxiety during and after feeding.

The child gains or even loses weight poorly. Frequent, profuse loose stools, vomiting after feeding, breast refusal, severe anxiety or lethargy of the child are dangerous signs. Infants easily develop dehydration. The severity of lactase deficiency is determined by the missing body weight and the degree of dehydration.

Primary hypolactasia may not appear immediately, but several weeks after birth. The first sign will be bloating, followed by colic and diarrhea.

For secondary hypolactasia, characteristic signs are also the presence in the stool of mucus in a significant amount, undigested lumps of food.

With functional lactase deficiency, that is, with lactose overload, the child may be bothered by abdominal pain (colic) and a sour smell, but the baby is gaining weight well.

Or maybe it's an allergy?

In some cases, an allergic reaction in a baby to breast milk (if not followed) or complementary foods is mistaken for lactase deficiency.

Food allergies can be caused by the following ingredients in the mother's diet:

gluten (cereal protein): despite the absence of celiac disease in the baby, it is advisable for the mother to limit gluten-containing foods in her diet during the first months of breastfeeding;
preservatives and dyes: during lactation, it is undesirable for the mother to consume any canned food, and sweets are allowed in limited quantities, without dyes;
herbal preparations and spices;
dairy products consumed by the mother: proteins in cow or goat milk can be an allergen for the baby.

That’s why you shouldn’t rush to switch to artificial nutrition for your baby; first you need to adjust the diet of the nursing mother.

When introducing complementary foods containing milk, they can cause an allergy in the child, the manifestations of which are similar to the symptoms of hypolactasia.

Diagnostics

In pediatric practice, the following methods can be used to diagnose hypolactasia:

The most accessible diagnostic method is dietary diagnostics. Its essence is the temporary exclusion of mother's milk or infant formula. Instead, the baby is prescribed lactose-free formulas. A decrease or complete disappearance of lactase deficiency manifestations confirms the diagnosis.

But sometimes problems arise with carrying out such diagnostics due to the baby’s refusal to accept the prescribed formula, or the mixture itself causes some undesirable reactions from the intestines due to the immaturity of the enzymatic system. This can make diagnosis difficult.

Testing stool for sugar content and acidity is the most popular method. The detection of carbohydrates (sugar) in the feces of more than 0.25% and a pH shift of less than 5.5 is confirmation of lactase deficiency.

But this is also the least reliable method, since these studies can give a false positive result due to non-specificity.

Hydrogen test: determination of hydrogen concentration in exhaled air. Hydrogen, formed in the intestines as a result of fermentation processes of lactose, first enters the blood and is then released from the body with air when exhaled. An excess amount of carbohydrates in the intestines and, accordingly, a higher hydrogen content indicates a deficiency of the lactase enzyme.

The lactose load test is more suitable for diagnosing lactase deficiency in older children, since preparation is required - you should not eat 10 hours before the test.

The glucose level in the blood is determined on an empty stomach, then the child is given lactose in solution to drink and the glucose level is determined again over a period of 2 hours at intervals of 30 minutes. Lactose is normally broken down into glucose, which leads to an increase in its level by 2 times.

With hypolactasia, lactose is not broken down and glucose levels do not change or increase slightly. The reliability of the analysis of the sugar curve (as well as the hydrogen test) in infants is relative, since during the first months of the baby’s life incomplete breakdown of lactose occurs, the results of the studies may be false positive.

The most reliable diagnostic method is a biopsy of the small intestinal mucosa. It is performed under anesthesia: special endoscopic equipment is required to insert biopsy forceps into the small intestine. The method is used in rare cases to confirm congenital severe lactase deficiency.

The presence of 1-2 symptoms of hypolactasia in a baby does not confirm it. Only a combination of all clinical manifestations and laboratory data can indicate lactase deficiency.

Treatment

Breastfeeding in case of lactase deficiency in a baby, as a rule, should not be stopped. It is simply necessary to give the child a special drug containing lactase before each breastfeeding.

Treatment is difficult for congenital alactasia. Absolute exclusion of lactose from a baby’s diet does not solve all problems, because lactose is a natural probiotic necessary to create a normal balance of microflora in the intestines.

It is not advisable to completely give up milk sugar. Only in severe cases of lactase deficiency should it be eliminated completely.

With transient and functional hypolactasia, it is necessary to limit the amount of lactose entering the baby’s body, the permissible volume of which is determined and regulated based on the results of the sugar content in the child’s feces.

You should not immediately stop breastfeeding and switch your baby to artificial milk formula. Breastfeeding is not only possible to maintain, but even necessary.

Lactazar;
Thylactase;
Baby Doc;
Lactrase;
Lactase Baby et al.

The enzyme must be diluted in milk expressed from the breast and given to the baby to drink before breastfeeding. As a rule, enzymes are used until the baby is 3-4 months old, when the synthesis of his own lactase improves.

In case of severe clinical manifestations, you can use breast and lactose-free formula. When artificially feeding a baby, a lactose-free or low-lactose formula is selected with the doctor. Unfortunately, lactose-free formulas can cause the baby to refuse breastfeeding and cause an allergy to soy or milk proteins included in these formulas.

It is important not to overfeed the baby. In such cases, it is optimal to feed in small portions, but more often. After all, the enzyme is produced only in such quantities as is necessary to break down the lactose contained in a normal volume of milk. Sometimes (with normal weight gain) it is enough to reduce the amount of food to get rid of the symptoms of hypolactasia.

Of course, it is important to regulate the nutrition of a nursing mother. She should give up whole milk. The consumption of fermented milk products is allowed.

If there is a lot of milk in the breast, then before feeding you can express a little foremilk, which is rich in lactose, so that the baby receives more nutritious and fatty hind milk. It lingers longer in the digestive tract, and lactose has time to break down.
During one feeding you should not change breasts. This will also help the hindmilk to be sucked out.
There is no need to express breast milk after feeding.
It is recommended not to deprive the baby of night feedings.

If there are signs of lactase deficiency, the drug should be administered to the child with caution. It is recommended to start with, following all the rules for introducing complementary foods. Cook porridge (preferably buckwheat, corn, rice) in water.

Low-fat, in agreement with the pediatrician, begin to be introduced from 8 months, monitoring the reaction to them. If abdominal pain, bloating, or diarrhea appear, stop using them. Whole milk from any animal is prohibited. You can start introducing it little by little after a year.

The pediatrician may prescribe symptomatic treatment:

enzymatic preparations: Creon, Pancreatin, Mezim, etc. to improve the digestion of products;
probiotics: Bifiform Baby, Bifidum Bag, Acylact, Linex, Lactobacterin, etc. to correct intestinal microflora, normalize peristalsis (movement of food through the gastrointestinal tract), but they should not contain lactose;
dill water for bloating;
antispasmodics (Papaverine, etc.) for severe colic.

With secondary hypolactasia, much attention is paid to the treatment of the underlying disease that caused the enzymatic deficiency.

Summary for parents

Don’t despair and rush to stop breastfeeding if your pediatrician has diagnosed your baby with “lactase deficiency” - unfortunately, the diagnosis has become “fashionable” and not always justified.

Only congenital alactasia is fraught with serious consequences and poses a danger to the baby’s life, leading to a child’s developmental delay and damage to the nervous system. In these cases, switching to feeding the baby with lactose-free or low-lactose formulas is justified.

In other cases, competent correction of the mother’s and infant’s nutrition will help cope with this pathological syndrome while maintaining breastfeeding. The use of enzyme additives in milk and proper introduction of complementary foods will help ensure the full development of the child.

Program “Dr. Komarovsky’s School” on the topic “Lactase and lactose”:

A pediatrician talks about lactase deficiency:

– fermentopathy, characterized by the inability to break down milk sugar (lactose) due to decreased activity or absence of the lactase enzyme. Lactase deficiency in infants and young children is characterized by regurgitation, intestinal colic, flatulence, stool disorders (diarrhea, constipation), insufficient weight gain, changes in the central nervous system (irritability, excitability, sleep disturbance). To diagnose lactase deficiency, stool examination (for carbohydrates, pH), dietary diagnostics, and genotyping are performed. In case of lactase deficiency, breastfed children are given replacement therapy with the enzyme lactase; for artificial feeding, lactose-free and low-lactose mixtures are prescribed; For older children, a low-lactose diet is recommended.

General information

Lactase deficiency is a type of malabsorption syndrome caused by intolerance to the disaccharide lactose. Lactase deficiency in various regions affects from 10 to 80% of the population. Lactase deficiency is of particular importance for children in the first months of life who are breastfed, since lactose is contained in breast milk, which is the basis of nutrition for infants. Considering the importance and priority of natural feeding in the first year of life, the problem of prevention and treatment of lactase deficiency in children is an extremely urgent task in pediatrics and pediatric gastroenterology.

Causes of lactase deficiency

Normally, milk sugar (lactose) supplied with food is broken down in the small intestine by the enzyme lactase (lactazoflorizine hydrolase) to form glucose and galactose, which are then absorbed into the blood. Glucose serves as the body's main energy resource; galactose is part of galactolipids necessary for the development of the central nervous system. In case of lactase deficiency, undigested milk sugar enters unchanged into the large intestine, where it is fermented by microflora, causing a decrease in the pH of the intestinal contents, increased gas formation and water secretion.

Secondary lactase deficiency occurs when enterocytes are damaged due to diseases of the small intestine (enteritis, rotavirus infection, acute intestinal infections, giardiasis, etc.).

Classification

Thus, there are primary (congenital) lactase deficiency (alactasia, hereditary disaccharide intolerance); adult type hypolactasia; transient lactase deficiency in preterm infants and secondary lactase deficiency associated with damage to enterocytes.

According to the severity of enzyme deficiency, it is customary to speak of hypolactasia (partial decrease in enzyme activity) and alactasia (complete absence of the enzyme). The course of lactase deficiency can be transient or persistent.

Symptoms of lactase deficiency

Lactase deficiency is characterized by intolerance to dairy products, so all the symptoms of indigestion develop against the background of the use of foods rich in lactose, primarily whole milk.

The main clinical sign of lactase deficiency is fermentative diarrhea in the form of frequent, liquid, frothy stools that have a sour smell. The frequency of bowel movements with lactase deficiency reaches 10-12 times a day; Less commonly, constipation is a manifestation of fermentopathy. Dyspeptic syndrome in newborns is usually accompanied by intestinal colic and other digestive disorders - regurgitation, flatulence, abdominal pain.

The consequence of diarrhea in young children is dehydration, insufficient weight gain and malnutrition. Excessive intake of undigested lactose into the large intestine causes quantitative and qualitative changes in the composition of microflora and the development of dysbiosis.

With lactase deficiency, changes in the central nervous system develop, which is explained by impaired nutritional status, deficiency of vitamins and minerals, and endogenous intoxication due to fermentation processes in the gastrointestinal tract. In this case, children may experience hyperexcitability, tearfulness, irritability, sleep disturbances, and a lag in psychomotor development from the age norm.

It has been noted that children with lactase deficiency are more likely to have muscle hypotonia, cramps, vitamin D deficiency rickets, and ADHD - attention deficit hyperactivity disorder.

Diagnostics

For a reliable diagnosis of lactase deficiency, characteristic clinical data must be confirmed by additional laboratory tests.

The so-called "diet diagnostics" is based on the disappearance of clinical signs of lactase deficiency (diarrhea, flatulence) with the exclusion of lactose from the diet and the appearance of symptoms when drinking milk. After loading with lactose, the level of hydrogen and methane in the exhaled air also increases.

In a biochemical study of feces in children with lactase deficiency, a decrease in pH is determined.<5,5, увеличение (у грудных детей) или появление (у детей старше 1 года) содержания лактозы и углеводов в кале. Золотым стандартом диагностики лактазной недостаточности считается определение активности лактазы в биоптатах тонкой кишки, однако сложность и инвазивность метода ограничивают его использование в педиатрической практике. Первичная лактазная недостаточность может быть выявлена в ходе генетического исследования («лактазного генотипирования»).

Treatment of lactase deficiency

The approach to the treatment of lactase deficiency in children of different ages has its own characteristics. The basic principles are based on the organization of therapeutic nutrition, optimization of the breakdown of lactose, prevention of the development of complications (hypotrophy, multivitamin and polymineral deficiency).

Breastfeeding infants are prescribed lactase enzyme replacement therapy to maintain natural feeding. Formula-fed babies are switched to low-lactose, lactose-free formulas or soy-based milk replacers. When introducing complementary foods in the form of cereals, vegetable purees, lactose-free products should be used. Monitoring the correctness of diet therapy is carried out by determining the carbohydrate content in feces.

Whole and condensed milk, confectionery products containing milk fillers, some medications (probiotics), etc. are completely excluded from the diet of older children. With minor hypolactasia, the use of fermented milk products, yoghurts, and butter is allowed if they do not cause clinical symptoms of lactase deficiency. insufficiency.

Forecast

Children with primary congenital lactase deficiency require lifelong diet and enzyme replacement therapy. In premature infants with transient lactase deficiency, maturation of enzyme systems allows a return to milk feeding by 3-4 months. Secondary lactase deficiency is eliminated as the underlying disease is relieved and lactase activity is restored.

Observation of a child with lactase deficiency is carried out by a pediatrician and pediatric gastroenterologist. The criteria for the effectiveness of treatment of lactase deficiency are the disappearance of dyspepsia syndrome, age-appropriate weight gain, normal rates of physical development, and a decrease in the level of carbohydrates in feces.