Carbohydrate Malabsorption

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Lactose intolerance Lactose intolerance is defined by the occurrence of symptoms due to the inability to digest lactose, the main carbohydrate in milk. These symptoms may include abdominal pain, bloating, diarrhea, or flatulence. Lactose malabsorption is attributed to a relative deficiency of the di-saccharidase lactase. Primary lactase deficiency is a condition in which lactase activity declines after weaning. Secondary lactose intolerance is usually due to mucosal injury associated with a condition or disease such as infectious diarrhea, Crohn's disease, or short bowel syndrome.

Although people of Northern European ancestry commonly maintain the ability to digest lactose into adulthood, the majority of the world's population produces less lactase after weaning. In addition to the presence or absence of the lactase enzyme, other factors determine whether a person will have symptoms of lactose malabsorption, including the amount of lactose in the diet, the mixture of lactose with other foods, gastric emptying rate, colonic scavenge of malabsorbed carbohydrate, ethnic origin, and age. Primary lactose intolerance is prevalent in African American, Hispanic, Native American, and Asian populations.

Nutritional management of lactose intolerance consists largely of the removal of lactose from the diet. Lactose is a common ingredient in many foods, including breads, crackers, soups, cereals, cookies, and baked goods. Eliminating or reducing lactose-containing ingredients from one's diet is usually adequate to relieve symptoms. Individuals with primary lactose intolerance may require a permanent dietary change. Individuals with secondary lactose intolerance should eliminate all lactose from their diets for a short period of time ranging from 2 to 6 weeks. If symptoms resolve, lactose may be reintroduced slowly as tolerated by the individual. The amount of lactose that an individual can tolerate is highly variable. Many children can tolerate small amounts of lactose, particularly yogurt, hard cheese, or ice cream, without discomfort. Many adults who consider themselves lactose-intolerant can actually tolerate moderate amounts of milk.

For individuals who choose to restrict lactose in their diets, a variety of lactose-free and low-lactose food choices are available. Lactose-reduced products, containing 70-100% less lactose than standard foods, are available commercially. Individuals may also choose to consume dairy products with concomitant administration of lactase enzyme tablets or drops.

Frequent consumption of milk and other dairy foods has been associated with better bone health in some studies, and a strict lactose-free diet may not contain adequate amounts of calcium and vitamin D. Table 2 provides a list of some commercially available lactose-free calcium supplements.

Table 2 Commercial calcium supplements

Product

Manufacturer

mg Calcium/ tablet

IU vitamin D

Citracal + D

Mission

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