Fateh Srajeldin N.D.*
The healthy small intestine is a barrier that separate the
outside world environment from the body's internal environment. Its function
is to selectively absorb healthy nutrients across the intestinal wall into
the portal system or the lacteal into the intestinal lymphatic. Four factors
determine the small intestine's function:
1- Motility of the intestine is composed of two types of
motilities, the gross motility of the intestine and the motility of
microvilli. Motility helps nutrients to maintain contact with the epithelial
cells of the intestine, influence absorption of such nutrients and maintain
one direction flow to prevent back up (down gradient absorption) of the
nutrients from portal system into the intestine.
2- Flora of the intestine is of a great importance not only
for nutrients digestion but for nutrients absorption.
3- Production of specific digestive enzymes which
hydrolyze nutrients into smaller nutritional units to facilitate its
absorption.
4- PH level of the intestinal acidity may determine
whether absorption would take place or not. The small intestine is
imbalanced when one of its functions is disturbed.
Lactose is a disaccharide (two sugars) which is split into
two monosaccharides (single sugar) namely, glucose and galactose in order to
be absorbed across the intestinal wall. An intestinal enzyme found in the
brush borders of the microvilli of the epithelial cells is responsible for
lactose hydrolysis into two single sugars. The enzyme is called
ß-galactosidase which is commonly known as lactase.
Patients who have abused their body over the years with
excessive dairy products consumption, should abstain from dairy products
consumption to rebuild their bodies reserve of lactase.
Unlike other disaccharides which are hydrolyzed in the small
intestine at a fast rate, lactose is hydrolyzed at a slower rate. Therefore,
lactase production in the small intestine is governed by its hydrolysis
rate. The byproducts of lactose hydrolysis (glucose and galactose) are
absorbed across the intestinal wall by active transport mechanism.
This mechanism requires the body to spend energy because it
moves the resultant two sugars uphill against concentration gradient. This
means that the body must spend energy every time the individual uses dairy
products.
Within one hour of ingesting milk the patient may produce
on or more of the following symptoms: flatulence, bloatness, cramps and
diarrhea.
The body may be deficient in lactase due to the following
reasons:
1- Genetic factors permanently prevents the body from
lactase synthesis. This is a genuine lactase deficient patient who needs to
utilize exogenous lactase when ingesting dairy products. The alternative
treatment to exogenous supplementation of lactase is to completely abstain
from the usage of dairy products.
Abstaining from dairy products consumption is the answer not
exogenous supplementation. Despite of exogenous supplementation, repeated
introduction of undigestible food would set the stage for the immune system
to be triggered every time the individual eats such food. Some form of
allergies would settle in the body sooner or later.
2- inability of the intestinal brush borders of the
epithelial cells to synthesis lactase. This is due to one of the following
reasons.
a) poor dietary intake preventing the body from efficiently
synthesizing lactase and
b) bleaching the enzyme from the intestine due to excessive
and prolonged use of dairy products. This use would tax the body with high
demand for lactase and reduced supply of nutrients to manufacture the
enzyme. Many children in our society suffer from this problem.
3- gastrointestinal diseases which results in intestinal
mucosa damage such as:
-giardiasis
-cystic fibrosis
-regional enteritis
-ulcerative colitis
-tropical sprue
-nontropical sprue
-a beta lipoproteinemia
-viral and bacterial infections
4- drugs interaction, some patients are using several
medication for several ailments. Some of These drugs may interact producing
an antagonistic factor that may hinder or stop the production of certain
enzymes and hormones. Drug interactions are studied and listed individually.
However, two or three drugs interaction in human body is not studied yet.
Blood tests, stool test, food elimination or food rotation
are not a diagnostic tools to diagnose lactose deficiency. The only factor
that determine patient's lactose deficiency is the patient's history of
symptoms, duration of symptoms and periodicity of symptoms.
Proper symptoms and history taking are the keys to successful diagnosis and
consequently a successful treatment. Any lab test is utilized to confirm the
physician's suspicion.
1- Symptoms Observation
The patient ingests 200 ml of milk which contains
approximately 10 g of lactose. Shortly after, the patient presents symptoms
such as flatulence, bloatness and cramps but no diarrhea. There strong
probability that this patient is lactose intolerant.
2- Serum Testing
The patient ingests an amount of lactose proportional to
the patient's weight (1 g per kilogram of body weight). Shortly after
ingestion, several blood samples are obtained from the patient at constant
intervals to measure the rise in the total amount of glucose. In a positive
case the patient would produce flatulence, bloatness, cramps, diarrhea and
an increase in blood glucose greater than 20 mg/dl above the fasting level
within 1 hr. following in milk ingestion.
3- Urine Dipstick
A urine dipstick impregnated with galactose oxidase is used
to test the patient's urine after ingesting 100 g of milk. a positive case
would change the color of the strip.
4- Breath Test
The patient ingests 50 g of lactose. Shortly after, the
patient is given a container to blow in it. In a positive case, Hydrogen is
released from the fermentation of unabsorbed lactose by colonic bacteria
leading to intestinal symptoms and increase in hydrogen production. This
test is reliable due to the following factors.
1- sensitive.
2- non-invasive.
3- independent of gastric emptying.
4- independent of metabolic factors.
A study 1978 by Newcomer AD, Hodgson SF, McGill DB, Thomas
PJ to determine prevalence in osteoporosis and lactase deficiency This test
was utilized to study the link between idiopathic postmenopausal
osteoporosis and lactase deficiency in females. The test indicated that
approximately 25% of females in the study who were deficient in lactate had
developed osteoporosis.
False negative results could be due to:
- ascites.
- renal insufficiency.
- intestinal bacteria overgrowth.
- drugs administration such as aspirin and indomethacin.
High prevalence of lactase deficiency occurs in African
Americans, Oriental, Jews and Native Americans
Lactase deficiency is treated according to its cause not
its symptoms. Dairy products are not mandatory for healthy life. Other
natural products such as vegetables and fruits may substitute for dairy
products use. On the other hand, those who choose to take lactase
supplementation without proper diagnosis may not be to their best interest.
Those patients whose body can not synthesize lactase due to
genetic reasons are advised to abstain from dairy products. On the other
hand, those who choose to play some tricks with their body may use
supervised exogenous supplementation.
Patients who
have abused their body over the years with excessive dairy products
consumption, should abstain from dairy products consumption to rebuild their
bodies reserve of lactase. Proper diet is mandatory for any patient who
suffers with lactase imbalance.
Many patients claim that they have some allergies to dairy
products. Simply, they base their statement on the fact that they react to
dairy consumption by flatulence, bloatness, cramps and diarrhea.
Lactase deficiency is not an allergy.
Naturopathic doctor and the director of the Naturopathic
and Allergy Clinic in the city of Toronto.