The Causes of Lactose Intolerance

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What causes lactose intolerance? It occurs when the small intestine doesn’t make enough of the enzyme lactase. The lactase is needed to break down lactose so it can be digested. Symptoms occur when the lactose isn’t absorbed, so it passes through the small intestine and into the colon. Bacterium containing lactase in the colon is able to split the lactose into glucose and galactose for its own use. The problem is when this takes place, the bacterium release hydrogen gas. Some of the hydrogen is absorbed into the body and most of it’s used up by other types of bacteria. A small amount is expelled and this is what causes flatulence or passing gas. Some people have bacteria in their colon that changes the hydrogen gas to methane gas. The methane gas appears in the flatus and the breath.

Not all of the lactose that reaches the colon is used by colonic bacteria. The unused lactose draws water into the colon, which leads to loose stools or diarrhea.

Chronic digestive diseases can lead to lactose intolerance. A chronic digestive disease is defined as a condition or disorder that causes continual digestive problems. Examples of such diseases are celiac disease, Crohn’s disease, gastroenteritis, diverticulitis and ulcers.

Celiac disease is more prominent in the Italian race. It’s a genetic condition causing digestive intolerance to gluten in the diet, which is caused by damage to the intestinal villi with an underlying autoimmune cause. Celiac disease is believed to be one of the most under-diagnosed and misdiagnosed conditions in the United States. It’s poorly understood by many American doctors and often times misdiagnosed as other digestive disorders such as irritable bowel syndrome. Although the diagnoses rate in that country is about 1 in 5000, the actual estimated rate may be as high as 1 in 250.

Crohn’s disease, which is also called ileitis or enteritis, is an ongoing disorder that causes inflammation to the digestive or GI tract. It can affect any area of the GI tract from the mouth to the anus, but the most common area is the lower part of the small intestine or ileum. The swelling extends deep into the lining of the organ. The swelling can cause pain and can make the intestines empty frequently. This results in diarrhea.

Because the symptoms of Crohn’s disease are similar to other intestinal conditions such as ulcerative colitis and irritable bowel syndrome, it can be difficult to diagnose. In ulcerative colitis the inflammation is in the top layer of the lining of the large intestine. Ulcers are also present. But in Crohn’s disease all layers of the intestines may be involved and normal healthy bowel can exist between sections of diseased bowel.

Crohn’s disease can affect men and women equally and it seems to run in some families. About 20 percent of people with Crohn’s disease have a blood relative with some form of inflammatory bowel disease. Most often it’s a brother or sister and sometimes a parent or child. Crohn’s disease can occur in people of all age groups, but it is most often diagnosed in people between the ages of 20 and 30. People of Jewish heritage have an increased risk of developing Crohn’s disease, while African Americans have a decreased risk for developing the disease.

Gastroenteritis is acute stomach or intestine inflammation. The symptoms of the condition are nausea, vomiting, diarrhea, abdominal pain, weakness, loss of appetite, fever, tiredness, muscle aches, headache and dehydration

Many people have small pouches in the lining of the colon, or large intestine, which bulge outward through weak spots. Each pouch is called a diverticulum, while multiple pouches are called diverticula. The condition of having diverticula is called diverticulosis. About ten percent of Americans older than 40 have diverticulosis, as the condition becomes more common as people age. About half of all people older than 60 have diverticulosis.

Diverticula are most common in the lower portion of the large intestine, which is called the sigmoid colon. When the pouches become inflamed it’s called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis. Diverticulosis and diverticulitis together are called diverticular disease.

Lactose intolerance commonly runs in families, with symptoms developing during teen or adult years. Generally people with this type of lactose intolerance can eat some milk or dairy products.

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Ancestors that kept dairy animals, in Europe and some African areas, are thought to have produced the modern people who are lactose absorbers throughout adult life. These groups relied almost exclusively on milk and dairy products for nutrition during shortages of other foods. It’s been about 10,000 years since the milking of domestic animals began. Nigeria is a good example on how lifestyle affects lactose tolerance. In the southern region, where conditions aren’t favorable for cattle, milk isn’t part of the diet. People there will develop lactose intolerance. In contrast, nomadic tribes, that have been raising milk cattle for thousands of years, will remain lactose tolerant. Most African Americans are descendants of the non-pastoral tribes from Western Africa and don’t tolerate lactose well.

A Fulani Nomad Herds Cattle at Dusk in Abuja, Nigeria
A Fulani Nomad Herds Cattle at Dusk in Abuja, Nigeria

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A genetic link to lactose intolerance has been identified; therefore, some people are born with a good chance of developing it. This is caused by a mutation in the gene related to the production of lactase. A person can be born with total lactose intolerance, but this is rare. These people can’t eat or drink anything containing lactose.

Primary lactase deficiency develops over time. The body begins to produce less lactase after the age of two, but most people don’t notice symptoms until much later. The genetic difference seems to be in a regulatory gene and not a structural gene. It’s a common autosomal recessive condition, which results from the decline in activity of lactase-phlorizin hydrolase (LPH) in intestinal cells after weaning. LPH hydrolyzes lactose into glucose and galactose. This is referred to as adult-type hypolactasia or lactase non-persistence.

Primary adult lactase deficiency leads to lactose malabsorption. Lactose intolerance results from the malabsorption. It produces symptoms that may cause the person to avoid milk and other dairy products.

Secondary lactase deficiency develops when there is some injury to the small intestine, which causes a reduction in lactase production. It’s a condition, which is temporary and the result of a nutritional deficiency or digestive tract disease. Crohn’s disease, inflammatory bowel disease and celiac disease are examples. Other reasons include the disease cystic fibrosis or removal of a small part of the intestine.

Sometimes after a short bout with an intestinal virus, commonly called the stomach flu, the intestine will stop making lactase. These people can’t eat or drink anything containing lactose.

Symptoms can vary from person to person because of differences in the amount of lactose in the diet or because different people have different amounts of lactase in their intestines. Also, people will have different responses to the lactose that reaches their colon. This is probably due to the differences in colonic bacteria.

About 50 million people in the United States and 70% of adults worldwide have some magnitude of lactose intolerance. It’s most prevalent in Asians, South Americans, Africans and Native Americans, as opposed to people of European descent. The prevalence in Caucasians is about 20%. Authorities on the subject believe that this is due to how long ago the person’s ancestors were introduced to dairy products.

Some premature babies will be lactose intolerant, because they aren’t making lactase, but the condition usually goes away. Sufficient levels don’t develop until the third trimester of pregnancy.

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Hold the Cheese Please!: A Story for Children about Lactose Intolerance


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