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University of Khartoum
College of Graduates study
MSC of dairy production and te

Seminar about:
LACTOSE INTOLERANCE

½


ëShimaa Ahmed Ibrahim
ëSafinaz Aadel
ëEilaf Suliman Khalil
 Contents
0 Introduction
0 Definition of lactose
0 Nutritional aspect of lactose
0 Definition of lactose intolerance
0 Occurrence of lactose intolerance
0 Lactase
0 Types of lactose intolerance
0 Prevalence of Lactose Maldigestion
0 Symptom, diagnosis and treatment
0 Summary and conclusion
0 References
 Introduction

0 Dairy products are an important source of

many nutrients including calcium, high-
quality protein, potassium, phosphorus,
and riboflavin. Dairy foods are an
important part of the diets of children and
adults
 
 
¦ Lactose(milk sugar) is the principle
carbohydrate in human and animal milk.
Human milk contains an average of 7% lactose,
while whole cow·s milk contains 4.8%.
¦ Lactose is a disaccharide made up of equal
portions of two monosaccharide, glucose and
galactose .
Average content of lactose in
different dairy products
¦ Lactose is not only present in milk at 5%,
but also in a broad range of dairy products
and processed foods such as ice cream or
even salad sauces and sausages, as well as
pharmaceuticals.
 Nutritional aspect of lactose

0 Lactose has 2 major nutritionally

undesirable consequences:
ëLactose intolerance
ëGlactosaemia

Tolerance to milk is sometimes affected by

factors unrelated to its lactose content, such as
psychological factors or cultural attitudes
toward milk.
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Lactose intolerance:
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Milk allergy:
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¦ A unique intestinal enzyme, lactase, a beta-

galactosidase, is needed to hydrolyze lactose and
one of the five disaccharidases enzymes located
on the brush border of the intestinal epithelium.
¦ Lactase (also known as lactose-phlorizin
hydrolysis, or LPH), a part of the ǃ-galactosidase
family of enzymes .
0 * 27 amino acids
0 Lactase Structural Gene, LCTthe gene is located
on the second chromosome
¦ it is a glycoside-hydrolase involved in the
hydrolysis of the disaccharide lactose into
constituent galactose and glucose monomers.
 
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0 The surface of the small intestine composed of hundreds
of ¶villi·, tiny finger-like structures and have additional
extensions called microvilli which make up ¶brush
border· of the absorptive epithelial cells (enterocytes)
0 This arrangement of the epithelium maximises the
surface area through which the body may absorb
nutrients. The enzymes, such as lactase, are anchored to
the surface of the brush border.
Lactose digestion
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¦ Lactase deficiency may occur because of a

congenital absence (absent from birth) of
lactase due to a mutation in the gene that is
responsible for producing lactase.
¦ This is a very rare cause of lactase
deficiency, and the symptoms of this type of
lactase deficiency begin shortly after birth.
 Primary lactase deficiency
0 Develops over time and begins after about
age 2 when the body begins to produce less
lactase.
0 Most children who have lactase deficiency
do not experience symptoms until late
adolescence or adulthood
0 Some people inherit a gene from their
parents that makes it likely they will
develop primary lactase deficiency
(Genetic link)
  
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¦ A temporary lactase deficiency can develop in
babies when there is inflammation or injury in
the digestive tract that damages the cells that
produce the enzyme.
¦ The inflammation may be caused by a bacterial
or viral infection, or a food allergy. to
distinguish it from primary congenital
alactasia.
¦ The cells rapidly return to normal when the
infection subsides, or the food allergen is
removed from the child's diet, and the usual
level of lactase production is quickly re-
established.
Prevalence of Lactose Maldigestion
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The prevalence of lactase deficiency
coincides with the ethnic background

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0 The undigested lactose remains in the
intestines and eventually finds its way
into the large bowel, millions of bacteria
use any undigested food for their own
nourishment, multiplying rapidly, and
producing a large number of by-products.
Usually a variety of gases, organic acids,
and other irritating chemicals result from
the activity of these micro-organisms.
 ecificests

DIRECT INDIRECT

Enzyme Assay è




¦'

 

 Lactose Tolerance




 
 Tests
¦;
  
Intestinal Biopsy ¦Ä
 

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iagnosis
*. Fecal Reducing Substances Test :
considered by many clinicians as the most
reliable. After a drink containing lactose, the
feces are collected and Fehling·s solution added.
The presence of undigested lactose in the stool
will be indicated by a change in color.
2. Hydrogen Breath Test
Test::
The person drinks a lactose-loaded beverage and
then the breath is analyzed at regular intervals to
measure the amount of hydrogen. Normally, very
little hydrogen is detectable in the breath, but
undigested lactose produces high levels of
hydrogen.
´. Stool Acidity Test:
Test
used for infants and young children to
measure the amount of acid in the stool.
Undigested lactose creates lactic acid and
other fatty acids that can be detected in a
stool sample. Glucose may also be present
in the stool.
Direct enzym assays in jejunal biopsy
 è 






*. Most people with lactose intolerance can

tolerate some amount of lactose in their
diet. Gradually introducing small
amounts of milk or milk products may
help some people adapt to them with
fewer symptoms.
2. It is interesting to note that both preterm
and term infants in the first few months
of life do not completely hydrolyze the
lactose in their mother·s milk.
 
 
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After a few days of storage, the

lactose is almost fully
hydrolyzed into glucose and
galactose. This has not become
a success. The product is
relatively expensive, and most
consumers consider the taste
too sweet. Lactose intolerant
people are better off
consuming fermented milks
´. Add lactase enzyme to fluid milk
LactaidTM
CactraseTM
DairyEaseTM

4. Lactose intolerant people are better off

consuming fermented milks and cheeses
which reduce the lactose about 25% and
contain ǃ-galactosidase.

5. Polymer Poly(D,L-lactide-co-glycolide) PLGA

microparticles.

6. Pharmaceutical preparations of fungal or

yeast-derived ±-galactosidase.
6. Lactose-free and lactose-reduced milk and
milk products :
- Although an increasing variety of such pre
treated low lactose dairy products is
available, it is still often inconvenient for
affected persons to avoid the uptake of
lactose.
- Moreover, omitting dairy products has the
disadvantage of losing a major source of
calcium and proteins.
7. Milk composition can be manipulated by
nutritional means or utilizing natural
genetic variation. Genetic improvement can
be attained through exploitation of
between- (cross-breeding) or within-
(selection) breed variation, while recent
advances in genetic engineering offer the
promise of changes not previously possible
using traditional nutritional and genetic
approaches .
 r Ë  



0 French researchers have developed transgenic

mice that expressed intestinal lactase in the
mammary gland and produced low-lactose milk.
0 A DNA construct containing the rat intestinal
lactase-phlorizin hydrolase cDNA under the
control of the mammary specific alpha
lactalbumin promoter was introduced into mice.
0 Transgenic mice expressed the foreign lactase
construct during lactation and secreted lactase
into milk.

 





 

 


 
  

¦ 70 % of the world adult population have
hypolactasia
¦ Feasible diagnostic methods are available
¦ The majority tolerate small amounts of
lactose
¦ The most sensitive need lactose-free
products
¦ More studies should be done
 
  
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0 Lactase Beta-galactosidase:
an enzyme of the hydrolase class that catalyzes the
hydrolysis (digestion) of lactose, a disaccharide, into its
monosaccharide components of glucose and galactose.
Lactase is present on the brush border of the intestinal
mucosa where such digestion takes place.
0 Lactose:
A disaccharide which yields upon hydrolysis the
monosaccharides, glucose and galactose. Since milk is the
sole natural source of lactose, it is commonly referred to as
ë r
  
0 Milk allergy:
is a reaction by the body·s immune system
to one or more milk proteins and can be life
threatening when just a small amount of
milk or milk product is consumed. Milk
allergy most commonly appears in the first
year of life, while lactose intolerance occurs
more often in adulthood.
0 Lactose maldigestion Reduced digestion of lactose due
to low lactase activity.
0 Low lactase activity or hypolactasia:
Low levels of the intestinal enzyme, lactase, in the
brush border membrane. Low lactase activity (lactase
deficiency) can be measured directly by small bowel
biopsy, or indirectly using the lactose tolerance test or
the breath-hydrogen test.
0 Lactose malabsorption (LM):
the inability to break down lactose because of reduced
concentrations of an enzyme called lactase phlorizin
hydrolase (lactase, or LPH) in the small intestine
is fairly common in adults (*, 2).
 eferences
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