MALABSORPTION DISORDERS: LACTOSE INTOLERANCE
Congenital lactase deficiency
A small percentage of infants are born with a lack of lactase and therefore are unable to digest the lactose in milk. These infants become severely ill within a few days of birth. They must be given a formula that is free of all sources of lactose, such as meat-base, soybean, or amino acid hydrolysate.
Acquired lactase deficiency
Many individuals have adequate levels of lactase during infancy and preschool years but lose some of the ability to digest lactose in later years. The deficiency occurs frequently in Oriental and African populations and in the Middle East. It occurs in only a small per cent of Caucasians.
Lactose intolerance is sometimes seen in patients who consume large amounts of milk; for example, with excessive use of milk in diets for peptic ulcer and in tube feedings. Deficiency also occurs in some patients with ulcerative colitis, gluten-induced enteropathy, cystic fibrosis, kwashiorkor, following gastrectomy, and with therapy including neomycin or colchicine.
Lactose-restricted diet
Most children and adults with lactase deficiency can tolerate small amounts of lactose, and the diet should be adjusted to the individual’s tolerance. For example, a child may tolerate 1/2 cup of milk at a time but have symptoms of bloating, flatulence, cramps, and diarrhea when he drinks greater amounts of milk at each meal. Some people also tolerate the small amounts of lactose in cheeses and in butter and margarine that contains milk. Others tolerate fermented milks such as buttermilk and yogurt. A commercial preparation of lactase is available for addition to milk to convert the lactose to the sugars that can be absorbed.
When there is total absence of lactase, a rare occurrence, the diet must be planned to eliminate all sources of lactose. Calcium supplements must be prescribed for such dietary restriction. The foods to avoid include:
Milk in all forms: fresh; evaporated; dry; fermented; malted
Beverages containing milk or milk powder: Cocomalt, cocoa, chocolate, Ovaltine
Breads and rolls made with milk; sweet rolls; bread mixes; griddle cakes; waffles; zwieback
Cereals: any containing nonfat milk powder.
Desserts: any made with milk, including cakes, cookies, custard, ice cream, pies made
with milk, puddings, sherbets Fats: butter and margarines that contain milk, cream, cream substitutes Meat: frankfurters and luncheon meats with milk powder.
Sauces and soups: cream; dried soup mixes Sweets: caramel or chocolate candy Vegetables; seasoned with butter or margarine; with cream sauces
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GENERAL HEALTH
