Lactose is a type of sugar mainly found in milk, and some processed foods.
It is a disaccharide made up of one glucose molecule and one galactose molecule.
In order to get absorbed into the body, lactose should be hydrolyzed to its precursors, glucose and galactose in the small intestine.
This process is catalyzed by an enzyme called lactase, which is secreted by the small intestine.
However, in some individuals, the secretion of this enzyme is either reduced or completely absent.
This will lead to inability of absorbing lactose into the body, and its associated consequences, which is known as lactose intolerance.
Lactose intolerance can be divided in to 3 types according to the underlying pathology.
Primary lactose intolerance typically occurs due to aging, usually begins after childhood.
Secretion of lactase enzyme in these people gradually reduces over time.
Secondary lactose intolerance occurs due to an underlying cause that disrupts the integrity of the small intestine.
Common diseases causing this disruption include gastroenteritis, celiac disease, and Crohn’s disease.
In addition, long-term use of antibiotics, and cancer chemotherapy may also cause damage to the small intestines, and consequently, lactose intolerance.
Congenital lactose intolerance is the rarest type and symptoms start to appear soon after birth when the newborn is breastfed.
Congenital lactose intolerance is an inherited condition, and the secretion of lactase enzyme is minimal, or completely absent.
When lactose cannot be broken down into its precursors, it accumulates within the small intestine.
Lactose is an osmotically active compound, meaning that it drags the water towards it from the nearby blood vessels supplying the intestines.
Lactose within the intestinal lumen drags fluid and electrolytes towards it, giving rise to clinical features of lactose intolerance.
Too much content in the small intestine leads to malabsorption of other nutrients.
In addition, diarrhea occurs due to high fluid content in the intestines.
As a result of profuse diarrhea, person may become dehydrated.
Moreover, free lactose within the intestines is fermented to short chain fatty acids and hydrogen gas by intestinal bacteria, causing bloating and flatulence.
Many patients experience abdominal pain.
Nausea & vomiting is also a frequent complain in lactose intolerance.
The primary treatment option for lactose intolerance is dietary modifications.
People with lactose intolerance should avoid lactose containing foods, mainly dairy milk.
However, other dairy products such as cheese are well tolerated by these individuals as they contain lactic acid, and not lactose.
For secondary lactose intolerance, the underlying pathology should be corrected.

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