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Lactose Intolerance in Adults: Biological Mechanism and Dietary Management.

Abstract

Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016 Hangzhou, China. dengyanyong@163.com.

    ,

    Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, Division of Gastroenterology & Hepatology, University Hospital Zürich, Zürich CH-8091, Switzerland. benjamin.misselwitz@usz.ch.

    ,

    Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, 310016 Hangzhou, China. ndaicn@yahoo.com.

    Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, Division of Gastroenterology & Hepatology, University Hospital Zürich, Zürich CH-8091, Switzerland. dr.mark.fox@gmail.com. Division of Gastroenterology, St. Claraspital, 4058 Basel, Switzerland. dr.mark.fox@gmail.com.

    Source

    Nutrients 7:9 2015 Sep 18 pg 8020-35

    MeSH

    Adult
    Dairy Products
    Diet, Carbohydrate-Restricted
    Digestion
    Fermentation
    Gastrointestinal Absorption
    Gastrointestinal Microbiome
    Gastrointestinal Tract
    Genetic Predisposition to Disease
    Humans
    Lactase
    Lactose
    Lactose Intolerance
    Phenotype
    Predictive Value of Tests
    Risk Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    26393648

    Citation

    Deng, Yanyong, et al. "Lactose Intolerance in Adults: Biological Mechanism and Dietary Management." Nutrients, vol. 7, no. 9, 2015, pp. 8020-35.
    Deng Y, Misselwitz B, Dai N, et al. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015;7(9):8020-35.
    Deng, Y., Misselwitz, B., Dai, N., & Fox, M. (2015). Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients, 7(9), pp. 8020-35. doi:10.3390/nu7095380.
    Deng Y, et al. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients. 2015 Sep 18;7(9):8020-35. PubMed PMID: 26393648.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. AU - Deng,Yanyong, AU - Misselwitz,Benjamin, AU - Dai,Ning, AU - Fox,Mark, Y1 - 2015/09/18/ PY - 2015/07/14/received PY - 2015/09/07/revised PY - 2015/09/14/accepted PY - 2015/9/23/entrez PY - 2015/9/24/pubmed PY - 2016/6/30/medline KW - FODMAP KW - genetic test KW - hydrogen breath test KW - irritable bowel syndrome KW - lactase deficiency KW - lactose intolerance KW - lactose malabsorption SP - 8020 EP - 35 JF - Nutrients JO - Nutrients VL - 7 IS - 9 N2 - Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/26393648/full_citation L2 - http://www.mdpi.com/resolver?pii=nu7095380 DB - PRIME DP - Unbound Medicine ER -