Lactose and lactase - what is it and what does it have to do with infant formula

— Valeria Maksimovna, please tell us the difference between lactose and lactase? How does lactase help digest lactose?

— Lactose (disaccharide)

- a carbohydrate in human breast milk that needs to be broken down into monosaccharides, which is what lactase does.

Lactase

- an enzyme that is formed in enterocytes on the surface of the mucous membrane of the small intestine. Its concentration is significantly lower than other enzymes of parietal digestion.

— How can you tell if there is not enough lactose in breast milk? Could this be possible?

— Theoretically, this is possible. When a mother very much limits herself in carbohydrates, some kind of lactose deficiency may occur in breast milk. However, this is a very rare case - each of us has reserves in our bodies, and one way or another they are activated in order to provide the child with everything necessary. Clinically, the child does not have a lack of lactose. Its level can only be detected by analyzing breast milk.

— Is lactase deficiency always observed in infants?

— Quite often, but usually everything goes away by the fourth to sixth month of life, when complementary foods are introduced. It happens that maximum enzyme activity appears only in the first year of life, but more often the deficiency is a passing moment.

There is a risk group for lactase deficiency

This:

• children who were born after a complicated pregnancy with their mother or as a result of a complicated birth with hypoxia;
• children whose immediate relatives show symptoms of adult-type lactase deficiency;
• children with hypoxic damage to the central nervous system (they most often experience lactase deficiency in a rare “constipated” form).

Basic properties

Research has shown that lactulose has a number of positive characteristics:

1. Causes activation of bifidobacteria - when consuming 3 g of the substance daily, there is an increase in beneficial bacteria several times. Two weeks of stable use changes the rates from 8.3% to 47.4%. Against the background of an increase in bifidobacteria, there is a sharp decrease in harmful pathogens.
2. Accelerates the absorption of minerals - when consumed, the body actively absorbs calcium. The studies were conducted on laboratory rats suffering from osteoporosis. Animals recovered faster after bone fractures.
3. Stabilizes liver function - impaired intestinal functionality provokes the accumulation of ammonia, negatively affecting the functioning of the organ. The drug neutralizes 25-50% of ammonia molecules and increases the performance of liver cells. As a result, the cleansing function of the liver improves.
4. Counteracts toxins and carcinogens - the ingredient accelerates the elimination of harmful substances, strengthens the immune system and improves the general condition of patients with liver cirrhosis. The effect is achieved by the active reproduction of bifidobacteria, the growth of which requires lactulose. There is a theory about the possibility of using the drug to prevent colon cancer.
5. Treats constipation - when the medicine enters the body, it binds water, reduces intestinal acidity, and activates peristalsis. The element works as a gentle laxative for 24-48 hours, which made it possible to include it in laxative medications.

Lactulose affects the production of bile acids. The peculiarity appears only in healthy people; diagnostics indicate a decrease in their production. In patients with pathologies, the result depends on the type of disease.

Signs of lactase deficiency

Lactase deficiency can appear from birth, or it can also occur at a certain age. To make an accurate diagnosis, it is necessary to conduct an examination. Specific symptoms will indicate that a specialist consultation is required:

• diarrhea that occurs every time after consuming a dairy product;
• increased gas formation in response to drinking milk;
• stomach ache;
• girdling intestinal spasms.

You can easily guess about lactase deficiency in a child when each feeding ends with screams, tucking in the legs, copious discharge of gases and voluminous loose stools. Despite the fact that the baby himself cannot yet talk about his problem, it is not difficult to guess that he has problems digesting milk. In such children, as a rule, there is no weight gain, since the intestines cannot absorb nutrients - the entire amount eaten is immediately released from the body with diarrhea. Lactose has an osmotic effect, and at high concentrations of its accumulation in the intestines, an influx of fluid occurs, an increase in feces and rapid emptying.

Therefore, if a child experiences suffering every time after drinking milk, his height and weight are significantly inferior to those of his peers and goes beyond the lower limit of the norm, it is worth undergoing an examination for lactase deficiency and, if confirmed, transfer the child to feeding dairy-free formulas.

Adults may also develop lactase deficiency over the years. After 35 years of age, the human body may reduce the production of the lactase enzyme due to growing older and no longer needing to consume milk. The first symptoms appear after consuming dairy products, including kefir, yogurt, cheese, and cottage cheese.

Separately, it is worth noting premature babies born prematurely. The first lactase enzymes appear in the fetal intestines from the 10th week of pregnancy, and with the growth of internal organs, its quantity also gradually increases. During the period from 28 to 34 weeks of pregnancy, only 30% of the amount of lactase required for normal digestion is found in the fetal intestines. Therefore, children born during this period cannot properly digest mother's milk or formula. During the first months of life, premature babies build up their lactose intake, and when they reach term, they can usually return to breast milk. The only exceptions are those children in whom lactase deficiency is a hereditary pathology.

The body's needs for prebiotics

When used regularly, lactulose increases the number of beneficial bacteria tenfold, while simultaneously reducing the number of harmful microbes by a hundredfold. To obtain a similar effect, daily use of dietary supplements with a prebiotic is required. The daily intake of the substance is 3-4 g for an adult.

Taking lactulose is justified for patients:

• with chronic constipation;
• dysfunction of the gastrointestinal tract;
• increased activity of pathogens in the intestines;
• liver dysfunction;
• elevated cholesterol levels;
• unstable metabolism - regular slowdown of metabolism.

The use of lactulose requires special caution in case of diabetes mellitus, increased or decreased acidity of gastric juice. The presence of these pathologies requires restrictions on the consumption of any fermented milk products or the intake of dietary supplements.

Lactulose is a substance that combines optimally with minerals. When taking the drug, accelerated absorption of individual elements in the intestine is observed. The list includes iron, calcium, magnesium, zinc. The prebiotic optimizes the production of secondary bile acids and lowers levels of bad cholesterol in the body.

What is this?

Lactulose is a drug for restoring microflora

Lactulose is an organic compound similar in nature to prebiotics. Its structural formula includes one molecule each of fructose and galactose, linked to each other by one of the types of glycosidic bonds. Lactulose is not broken down by many digestive enzymes of the stomach and enters the large intestine without changing its structure. In the human body, lactulose is responsible for the reproduction processes of microorganisms and lactobacilli that inhabit the intestines.

Under normal conditions, lactulose is found in the form of a white crystalline substance. It dissolves well in aqueous media and is odorless. It is obtained by long-term processing of milk, directly from its constituent lactose, which is milk sugar. Lactulose is also considered an isomeric compound of lactose. According to its properties, lactulose is classified as an oligosaccharide, since it is broken down by water into one molecule of fructose and galactose.

Lactulose was first isolated and studied by scientists Montgomery and Hudson by heating lactose with alkali dissolved in water. This discovery was made at the beginning of the twentieth century. Subsequently, lactulose began to be isolated from breast milk of nursing mothers, on the basis of which various infant formulas began to be produced.

Today, lactulose is an essential component of many substances necessary for the development of intestinal microflora in humans.

Symptoms of deficiency and excess

The leading clinical sign of insufficient lactulose intake is the presence of persistent constipation. The problem disappears spontaneously when taking a prebiotic for several days. Other symptoms of nutrient deficiency include:

• attacks of nausea and vomiting;
• a sharp decrease in body weight;
• unpleasant sensations in the abdomen, flashes of pain.

Disorders of the gastrointestinal tract provoke metabolic disorders and improper functioning of the digestive organs.

If the recommended amounts of lactulose are exceeded, the consequences are unpleasant, but do not cause significant dysfunction of the body. Excessive consumption of fermented milk products and dietary supplements leads to the formation of a chronic form of diarrhea, active gas formation (flatulence) and rapid weight gain. There is a risk of inflammatory processes in the urinary organs, requiring long-term treatment.

Signs of lactose intolerance in infants:

• frequent foamy, loose stools up to 8-10 times with a large water spot (lactose prevents water from being absorbed, which leads to diarrhea);
• sour smell of stool (the process of fermentation of microflora in the intestines starts);
• colic due to gas formation;
• in severe cases, dehydration accompanied by severe diarrhea;
• malnutrition, when, with severe degrees of lactase deficiency, nutrients are not absorbed.

— What tests need to be done to determine lactose and lactase intolerance/insufficiency?

— The gold standard for diagnosis is coprogram. The disease is confirmed by the presence of carbohydrates in the feces (more than 0.25% in children under 1 year of age) and an acidic reaction of the feces (pH less than 5.5). There are no other specific signs for transient lactase deficiency. In case of secondary lactase deficiency, depending on the clinical symptoms, a number of tests are done to confirm the presence of the causative disease.

— Valeria Maksimovna, what to do if a child has lactose intolerance to breast milk?

— In addition to therapy aimed at the underlying disease, if present, symptomatic therapy should be prescribed.

• With colic,
  it is necessary to ease the situation for the child and make sure that the gases move through the intestines and come out. Abdominal massage, heat on the tummy, a gas tube, special positions for sleeping or on the stomach, cocoons for newborns, and simethicone-based products will help.
• Child's refusal to eat.
  Loss of appetite is often associated with pain due to swollen intestinal walls - the child may develop a negative association with feeding, after which abdominal problems begin.
• Digestive disorders
  - colic, problems with stool, regurgitation. In case of transient lactase deficiency, replacement therapy is carried out.
• Allergy to cow's milk proteins.
  A breastfeeding mother is prescribed a dairy-free diet, and a bottle-fed baby is prescribed therapeutic nutrition. In case of acute allergies, self-treatment is unacceptable; you need to urgently go to the doctor.

Lactulose: what products contain it?

For proper and stable functioning of the body, it is important to eat foods rich in fiber. Some of them also contain lactulose. Fiber and lactulose are not absorbed by the body, but they create a feeling of fullness and help you avoid overeating. They also improve intestinal motor function and promote the elimination of toxins.

In food products, lactulose is found in:

• breast milk;
• yogurt;
• cottage cheese;
• apricots and dried apricots;
• asparagus;
• lettuce leaves;
• daikon;
• cauliflower;
• broccoli;
• corn;
• garlic;
• onions;
• black currant;
• lingonberries;
• papaya;
• beans;
• pineapple

Diagnosis of inability to digest lactose

The fact that a person cannot digest milk sugar can be guessed from the symptoms, but in order to confirm the diagnosis, a certain examination is required. The easiest and fastest way is by measuring blood sugar.

First, you need to find out your fasting glucose level. Then they load the intestines with lactose, at the rate of 1 g per 1 kg of the patient’s weight. An hour later, a repeat blood test is performed to determine the sugar content, and if its amount increases by 20% compared to the initial state, we are not talking about lactase deficiency.