Page 9 - Swsthya Winter Edition Vol 1 Issu 3 DEC 2020 Circulation copy BP

OPINION

be considered, with stress on not modifying the breast hydrogen test-this adaptation may be due to changes in the
feeding (on the contrary, supporting to achieve more breast colonic microbiota or an upregulation of lactase. Most adults
feeding) at the same time. with lactase nonpersistence can tolerate 12 g of lactose
(240 ml of cow’s milk) in a single dose. As the dose of intake
There is a pattern of transient and secondary lactase increases, the likelihood of symptoms will increase. The type
deficiency due to loss of the brush border cells of the small and severity of the symptoms of lactose intolerance depend
intestine following an acute gastroenteritis-this usually upon a range of conditions including the dose of ingested
follows an episode of diarrhoea and leads to persistent loose lactose, residual lactase activity, gastric emptying rate,
stools, diaper rash etc. A brief period of low or lactose free intestinal transit time, presence of other food components
infant formula can help in this setting. Once the stool pattern together with lactose, the composition and metabolic
improves and the nappy rash has healed (zinc supplements activity of the colonic microbiota fermenting lactose, as well
could help too in this setting), gradual change back to the as psychological factors regarding perception of abdominal
previous feeding pattern is usually well tolerated over a 10- pain and discomfort. Most of these are self-resolving once
14 day period. we diagnose and reduce intake of lactose.

Most mammalian species stop producing lactase enzyme It is important to remember that milk protein intolerance
after the breast feeding phase. However, after domestication has features that are mostly different from simple lactose
of cow and intake of dairy products by humans, lactase intolerance-it needs more specific treatment, and if that
persistence has been noted in varying proportions-largely diagnosis is considered, the management approach is
related to proportion of milk intake in the population group different (not in the scope of this article).
(cultural and ethnic variations). Nearly 70% of adults in the
world are lactase non persistent to a degree-this proportion Summary:
is lower in Northern Europe (only around 2%) while in
other regions like South America, Africa and parts of Asia, The composition of breast milk and the reason why nature
it is as high as 50%. Very few children under 6 years of age has designed it this way is intriguing. Lactose in milk is one
have lactase non-persistence leading to lactose intolerance- such factor and though majority of older kids and adults
the incidence increases with age. When there is lactase have relative lactase deficiency due to non-persistence of
deficiency, there is more lactose that passes undigested lactase enzyme, a simple approach to the management as dictated
to the large bowel, and as mentioned above, there is more by common sense is adequate in majority of the situations. One
production of short chain fatty acids (SCFA) like acetic and very important message here is that breast feeding should not
butyric acids. This leads to flatulence, bloating, griping and be disturbed for transient lactose intolerance-supporting breast
in younger kids, frothy acidic stools which causes persistent feeding and helping the mother come out of this transient phase
diaper rash. In older kids, this can be overcome by reducing is very important.
the dose of dairy products to a level that is tolerated. It
has been suggested that lactose non-digesting adults and Dr Sridhar Kalyanasundaram
premature infants (with low and immature production of Dr Sridhar Kalyanasundaram is a consultant Neonatologist trained
lactase) should not avoid lactose fully but rather consume in India and UK. He worked as Consultant in a level 3 unit in
smaller amounts frequently to obtain the beneficial effects Scotland for 7 years before moving to Dubai, where he has been
and avoid lactose intolerance symptoms. In adults, it has working since 2012. He is chairman of scientific committees in
been shown that long-term ingestion of lactose can lead to many international conferences in the region, and has his Youtube
diminished lactose intolerance as measured by the breath channel for education, Sridhar K

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