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__NOTOC__ | __NOTOC__ | ||
{{Lactose intolerance}} | {{Lactose intolerance}} | ||
{{CMG}}; {{AE}}{{MA}} | {{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for lactose intolerance is lifestyle modification that includes | The mainstay of treatment for lactose intolerance is lifestyle modification that includes decreasing the consumption of dairy products or switcing to lactose-free or reduced [[lactose]] dairy products. Pharmacologic medical therapies for lactose intolerance include [[lactase]] enzyme preparations such as lactaid, lactogest, dairyease. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapy is recommended for patients with lactose intolerance | *Pharmacologic medical therapy is recommended for patients with lactose intolerance who do not respond well to lifestyle modification. | ||
*Pharmacologic medical therapies for lactose intolerance include [[lactase]] enzyme preparations such as:<ref name="pmid6434367">{{cite journal |vauthors=Rosado JL, Solomons NW, Lisker R, Bourges H |title=Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime |journal=Gastroenterology |volume=87 |issue=5 |pages=1072–82 |year=1984 |pmid=6434367 |doi= |url=}}</ref> | *Pharmacologic medical therapies for lactose intolerance include [[lactase]] enzyme preparations such as:<ref name="pmid6434367">{{cite journal |vauthors=Rosado JL, Solomons NW, Lisker R, Bourges H |title=Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime |journal=Gastroenterology |volume=87 |issue=5 |pages=1072–82 |year=1984 |pmid=6434367 |doi= |url=}}</ref> | ||
**Lactaid | **Lactaid | ||
| Line 17: | Line 17: | ||
=== Lifestyle modification === | === Lifestyle modification === | ||
* Patients with lactose intolerance are treated with dietary restriction of [[lactose]] and adequate intake of calcium. <ref name="pmid26806042">{{cite journal |vauthors=Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G |title=Digestive Enzyme Supplementation in Gastrointestinal Diseases |journal=Curr. Drug Metab. |volume=17 |issue=2 |pages=187–93 |year=2016 |pmid=26806042 |pmc=4923703 |doi= |url=}}</ref><ref name="pmid22826639">{{cite journal |vauthors=Mattar R, de Campos Mazo DF, Carrilho FJ |title=Lactose intolerance: diagnosis, genetic, and clinical factors |journal=Clin Exp Gastroenterol |volume=5 |issue= |pages=113–21 |year=2012 |pmid=22826639 |pmc=3401057 |doi=10.2147/CEG.S32368 |url=}}</ref><ref name="pmid264043642">{{cite journal |vauthors=Silanikove N, Leitner G, Merin U |title=The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds |journal=Nutrients |volume=7 |issue=9 |pages=7312–31 |year=2015 |pmid=26404364 |pmc=4586535 |doi=10.3390/nu7095340 |url=}}</ref><ref name="pmid27882862">{{cite journal |vauthors=Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A |title=Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence |journal=Food Nutr Res |volume=60 |issue= |pages=32527 |year=2016 |pmid=27882862 |pmc=5122229 |doi= |url=}}</ref> | * Patients with lactose intolerance are treated with dietary restriction of [[lactose]] and adequate intake of calcium. <ref name="pmid26806042">{{cite journal |vauthors=Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G |title=Digestive Enzyme Supplementation in Gastrointestinal Diseases |journal=Curr. Drug Metab. |volume=17 |issue=2 |pages=187–93 |year=2016 |pmid=26806042 |pmc=4923703 |doi= |url=}}</ref><ref name="pmid22826639">{{cite journal |vauthors=Mattar R, de Campos Mazo DF, Carrilho FJ |title=Lactose intolerance: diagnosis, genetic, and clinical factors |journal=Clin Exp Gastroenterol |volume=5 |issue= |pages=113–21 |year=2012 |pmid=22826639 |pmc=3401057 |doi=10.2147/CEG.S32368 |url=}}</ref><ref name="pmid264043642">{{cite journal |vauthors=Silanikove N, Leitner G, Merin U |title=The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds |journal=Nutrients |volume=7 |issue=9 |pages=7312–31 |year=2015 |pmid=26404364 |pmc=4586535 |doi=10.3390/nu7095340 |url=}}</ref><ref name="pmid27882862">{{cite journal |vauthors=Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A |title=Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence |journal=Food Nutr Res |volume=60 |issue= |pages=32527 |year=2016 |pmid=27882862 |pmc=5122229 |doi= |url=}}</ref> | ||
** Milk and ice cream have highest amount of [[lactose]], but due to high fat concentration and slower rate of gastric emptying rate in ice cream | ** Milk and ice cream have highest amount of [[lactose]], but due to high fat concentration and slower rate of gastric emptying rate in ice cream compared to the milk, the symptoms of lactose intolerance with ingestion of ice cream is very mild. | ||
** Levels of lactose is much lower in | ** Levels of lactose is much lower in cheese. | ||
*1 L of milk (equivalent to 50 grams of [[lactose]]) once a day, without any meals, usually cause symptoms in lactose intolerant persons.<ref name="pmid20404262">{{cite journal |vauthors=Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, Wilt TJ |title=Systematic review: effective management strategies for lactose intolerance |journal=Ann. Intern. Med. |volume=152 |issue=12 |pages=797–803 |year=2010 |pmid=20404262 |doi=10.7326/0003-4819-152-12-201006150-00241 |url=}}</ref> | *1 L of milk (equivalent to 50 grams of [[lactose]]) once a day, without any meals, usually cause symptoms in lactose intolerant persons.<ref name="pmid20404262">{{cite journal |vauthors=Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, Wilt TJ |title=Systematic review: effective management strategies for lactose intolerance |journal=Ann. Intern. Med. |volume=152 |issue=12 |pages=797–803 |year=2010 |pmid=20404262 |doi=10.7326/0003-4819-152-12-201006150-00241 |url=}}</ref> | ||
*Limitation in lactose intake, the equivalent of 240 ml (8 oz, one cup) of milk or less a day | *Limitation in lactose intake, the equivalent of 240 ml (8 oz, one cup) of milk or less a day causes less symptoms. <ref name="pmid7776987">{{cite journal |vauthors=Suarez FL, Savaiano DA, Levitt MD |title=A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance |journal=N. Engl. J. Med. |volume=333 |issue=1 |pages=1–4 |year=1995 |pmid=7776987 |doi=10.1056/NEJM199507063330101 |url=}}</ref> | ||
*Two cups of milk per day, divided in two doses with food can be tolerated well. <ref name="pmid9129483">{{cite journal |vauthors=Suarez FL, Savaiano D, Arbisi P, Levitt MD |title=Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance |journal=Am. J. Clin. Nutr. |volume=65 |issue=5 |pages=1502–6 |year=1997 |pmid=9129483 |doi= |url=}}</ref> | *Two cups of milk per day, divided in two doses with food can be tolerated well. <ref name="pmid9129483">{{cite journal |vauthors=Suarez FL, Savaiano D, Arbisi P, Levitt MD |title=Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance |journal=Am. J. Clin. Nutr. |volume=65 |issue=5 |pages=1502–6 |year=1997 |pmid=9129483 |doi= |url=}}</ref> | ||
* | *Yogurt containing live cultures which provides endogenous beta-galactosidase can be used as an alternative to milk products in patients with lactose intolerance. <ref name="pmid16482616">{{cite journal |vauthors=Montalto M, Curigliano V, Santoro L, Vastola M, Cammarota G, Manna R, Gasbarrini A, Gasbarrini G |title=Management and treatment of lactose malabsorption |journal=World J. Gastroenterol. |volume=12 |issue=2 |pages=187–91 |year=2006 |pmid=16482616 |pmc=4066025 |doi= |url=}}</ref> | ||
*Attention to daily ingestion of [[calcium]] and [[vitamin D]] is necessary . Dietary [[calcium]] recommendation for adolescents and adults is 1200–1500 mg. [[Calcium]] and [[vitamin D]] supplementation should be considered if | *Attention to daily ingestion of [[calcium]] and [[vitamin D]] is necessary . Dietary [[calcium]] recommendation for adolescents and adults is 1200–1500 mg. [[Calcium]] and [[vitamin D]] supplementation should be considered if it is not enough in diet. <ref name="pmid22826639" /> | ||
===Lactose intolerance=== | ===Lactose intolerance=== | ||
'''Adult and pediatric''' | '''Adult and pediatric''' | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3]
Overview
The mainstay of treatment for lactose intolerance is lifestyle modification that includes decreasing the consumption of dairy products or switcing to lactose-free or reduced lactose dairy products. Pharmacologic medical therapies for lactose intolerance include lactase enzyme preparations such as lactaid, lactogest, dairyease.
Medical Therapy
- Pharmacologic medical therapy is recommended for patients with lactose intolerance who do not respond well to lifestyle modification.
- Pharmacologic medical therapies for lactose intolerance include lactase enzyme preparations such as:[1]
- Lactaid
- Lactogest
- DairyEase
- Lactase enzyme preparations have bacterial or yeast beta-galactosidases
- In secondary lactase deficiency, treatment is based on the underlying cause.
Lifestyle modification
- Patients with lactose intolerance are treated with dietary restriction of lactose and adequate intake of calcium. [2][3][4][5]
- Milk and ice cream have highest amount of lactose, but due to high fat concentration and slower rate of gastric emptying rate in ice cream compared to the milk, the symptoms of lactose intolerance with ingestion of ice cream is very mild.
- Levels of lactose is much lower in cheese.
- 1 L of milk (equivalent to 50 grams of lactose) once a day, without any meals, usually cause symptoms in lactose intolerant persons.[6]
- Limitation in lactose intake, the equivalent of 240 ml (8 oz, one cup) of milk or less a day causes less symptoms. [7]
- Two cups of milk per day, divided in two doses with food can be tolerated well. [8]
- Yogurt containing live cultures which provides endogenous beta-galactosidase can be used as an alternative to milk products in patients with lactose intolerance. [9]
- Attention to daily ingestion of calcium and vitamin D is necessary . Dietary calcium recommendation for adolescents and adults is 1200–1500 mg. Calcium and vitamin D supplementation should be considered if it is not enough in diet. [3]
Lactose intolerance
Adult and pediatric
- Lactaid (caplet), DairyEase (chewable tablet), Lactogest (soft gel capsule) : 3,000-9,000 units PO with meals or dairy[1][10]
- Lactaid drops: 5–15 drops in quart ( 946 ml ) of milk
References
- ↑ 1.0 1.1 Rosado JL, Solomons NW, Lisker R, Bourges H (1984). "Enzyme replacement therapy for primary adult lactase deficiency. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime". Gastroenterology. 87 (5): 1072–82. PMID 6434367.
- ↑ Ianiro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G (2016). "Digestive Enzyme Supplementation in Gastrointestinal Diseases". Curr. Drug Metab. 17 (2): 187–93. PMC 4923703. PMID 26806042.
- ↑ 3.0 3.1 Mattar R, de Campos Mazo DF, Carrilho FJ (2012). "Lactose intolerance: diagnosis, genetic, and clinical factors". Clin Exp Gastroenterol. 5: 113–21. doi:10.2147/CEG.S32368. PMC 3401057. PMID 22826639.
- ↑ Silanikove N, Leitner G, Merin U (2015). "The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds". Nutrients. 7 (9): 7312–31. doi:10.3390/nu7095340. PMC 4586535. PMID 26404364.
- ↑ Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A (2016). "Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence". Food Nutr Res. 60: 32527. PMC 5122229. PMID 27882862.
- ↑ Shaukat A, Levitt MD, Taylor BC, MacDonald R, Shamliyan TA, Kane RL, Wilt TJ (2010). "Systematic review: effective management strategies for lactose intolerance". Ann. Intern. Med. 152 (12): 797–803. doi:10.7326/0003-4819-152-12-201006150-00241. PMID 20404262.
- ↑ Suarez FL, Savaiano DA, Levitt MD (1995). "A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance". N. Engl. J. Med. 333 (1): 1–4. doi:10.1056/NEJM199507063330101. PMID 7776987.
- ↑ Suarez FL, Savaiano D, Arbisi P, Levitt MD (1997). "Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance". Am. J. Clin. Nutr. 65 (5): 1502–6. PMID 9129483.
- ↑ Montalto M, Curigliano V, Santoro L, Vastola M, Cammarota G, Manna R, Gasbarrini A, Gasbarrini G (2006). "Management and treatment of lactose malabsorption". World J. Gastroenterol. 12 (2): 187–91. PMC 4066025. PMID 16482616.
- ↑ Lin MY, Dipalma JA, Martini MC, Gross CJ, Harlander SK, Savaiano DA (1993). "Comparative effects of exogenous lactase (beta-galactosidase) preparations on in vivo lactose digestion". Dig. Dis. Sci. 38 (11): 2022–7. PMID 8223076.