Probiotics—compensation for lactase insufficiency

The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided.

/pdf/lactose-intolerance-in-infants-children-and-adolescents-21abwqjj9t.pdf

Lactose Intolerance in Infants, Children, and Adolescents

The prevalence of adult-type hypolactasia varies from less than 5% to almost 100% between different populations of the world. The lowest prevalence has been found in northwestern Europe, around the North Sea, and the highest prevalence in the Far East. The reason for the variation is that selective (primary) hypolactasia is genetically determined by an autosomal recessive single gene. It is assumed that thousands of years ago all people had hypolactasia in the same way as most mammals do today. At that time in cultures where milk consumption was started after childhood, lactase persistence had a selective advantage. Those people with lactase persistence were healthier and had more children than people with hypolactasia, and the frequency of the lactase persistence gene started to increase. The present prevalence of hypolactasia can be explained fairly well by this culture historical hypothesis. This article reviews the evidence for the inheritance of adult-type hypolactasia and the occurrence of hypolactasia in different countries and populations of the world.

Genetics and Epidemiology of Adult-type Hypolactasia

Reviewed in this article is evidence bearing on the geographic hypothesis advanced eight years ago to explain the striking ethnic or racial differences in prevalence of primary adult lactose malabsorption that are found around the world. Most evidence is found to support the hypothesis and the likelihood that some human groups came to have low prevalences of such lactose malabsorption because of selective pressures over a long historical period that favored the adult lactose absorber under particular ecological conditions.

The geographic hypothesis and lactose malabsorption. A weighing of the evidence.

Humans learned to exploit ruminants as a source of milk about 10,000 years ago. Since then, the use of domesticated ruminants as a source of milk and dairy products has expanded until today when the dairy industry has become one of the largest sectors in the modern food industry, including the spread at the present time to countries such as China and Japan. This review analyzes the reasons for this expansion and flourishing. As reviewed in detail, milk has numerous nutritional advantages, most important being almost an irreplaceable source of dietary calcium, hence justifying the effort required to increase its consumption. On the other hand, widespread lactose intolerance among the adult population is a considerable drawback to dairy-based foods consumption. Over the centuries, three factors allowed humans to overcome limitations imposed by lactose intolerance: (i) mutations, which occurred in particular populations, most notably in the north European Celtic societies and African nomads, in which carriers of the lactose intolerance gene converted from being lactose intolerant to lactose tolerant; (ii) the ability to develop low-lactose products such as cheese and yogurt; and (iii) colon microbiome adaptation, which allow lactose intolerant individuals to overcome its intolerance. However, in a few examples in the last decade, modern dairy products, such as the popular and widespread bio-cultured yogurts, were suspected to be unsuitable for lactose intolerant peoples. In addition, the use of lactose and milk-derived products containing lactose in non-dairy products has become widespread. For these reasons, it is concluded that it might be important and helpful to label food that may contain lactose because such information will allow lactose intolerant groups to control lactose intake within the physiological limitations of ~12 g per a single meal.

/pdf/the-interrelationships-between-lactose-intolerance-and-the-2bdnq5qhqw.pdf

E Weser

Papers

Lactose malabsorption in Mexican-American children.

Lactose malabsorption in Mexican-American adults.