Lactose Intolerance—Old and New Knowledge on Pathophysiological Mechanisms, Diagnosis, and Treatment

Abstract

Lactose intolerance is a pathology frequently encountered today. It occurs when the activity of lactase in the intestine is reduced or absent, with consequent failure to digest lactose. The global prevalence of this clinical condition is estimated of about 57% with instrumental methods, while the real prevalence exceeds 65%. The absence of lactase determines both the excessive osmotic load in the small intestine and the fermentation of lactose by the bacterial flora with consequent production of short-chain fatty acids and gas. This latter process is responsible for the onset of symptoms associated with lactose intolerance (abdominal pain, bloating, flatulence, etc.) which arise after the intake of lactose. Several studies have shown an increased risk of developing various pathologies for lactose-intolerant subjects (some types of cancer, osteoporosis, etc.). Therefore, it is essential to diagnose and properly treat this pathology. Various options exist for diagnosing lactose intolerance: Hydrogen Breath Test, genetic test, Quick Lactose Intolerant Test, Lactose Tolerance Test, Gaxilose Test. Like diagnostic methods, there are several options for treating intolerance. In addition to a food restriction, the use of exogenous enzymes and/or probiotic and the selection of milk containing specific types of beta-caseins less correlated to the appearance of gastrointestinal symptoms are very useful. The aim of this review is to illustrate the main and most modern diagnostic and therapeutic choices for lactose intolerance currently available.

Isolation and Identification of Bacterial and Fungal Spoilage Organisms in Branded and Unbranded Milk; Consumer Perception of Safety Hazard for Milk

“…The exchange of moisture and O 2 and the influx of light are not possible. According to [41] powders with a higher fat content are more susceptible to oxidation, and most powders are susceptible to deteriorative effects such as lumping and caking from moisture ingress. With adequately constructed cans, a shelf life in excess of 5 years is realistic, particularly when FMP products have been gas flushed with N 2 to minimize the amount of available O 2 .…”

“…Furthermore, the use of sachets (Nylon) is well positioned to exploit the opportunities for convenience food markets. Flexible packages like reduce the volume of traditional packaging such as metal cans, reduce transport costs, reduce the cost of the packaging, and require less material, thus minimizing postconsumer waste [41]. To maintain the quality of the milk powder in such small sachets is a challenge given the very high surface area: volume ratio.…”

Clinical guidelines “Chronic diarrhea in adults”

“…Фактически, наличие предрасполагающего полиморфизма (C / C или G / G) не позволяет нам предсказать, разовьется ли и когда непереносимость. Более того, при наличии симптоматики, указывающей на непереносимость лактозы, отрицательный результат генетического теста не позволяет выявить возможную вторичную непереносимость, в то время как важно отличить первичную гиполактазию от вторичной [219]. Быстрый тест на непереносимость лактозы заключается в выполнении биопсии слизистой оболочки на постбульбарном уровне двенадцатиперстной кишки и их последующей инкубации с лактозой на тестовой пластине.…”

“…Эта инкубация направлена на проверку наличия или отсутствия активности лактазы. Если активность лактазы присутствует, происходит реакция темно-синего цвета; если есть небольшая гиполактазия, будет светло-голубой; если окрашивание не развивается, этот результат свидетельствует о тяжелой гиполактазии [220].…”

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders

“…Individuals with LI should restrict lactose instead of avoiding lactose, so as not to lose the nutritional value of dairy products in the diet. Therefore, consideration should be given to a temporary lactose-free diet with the goal of reducing symptoms, followed by a gradual introduction of dairy products as tolerated [ 44 ].…”