Lactose Intolerance Final Presentation

7/27/2019 Lactose Intolerance Final Presentation

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SOLIS, Ianne Robin

SONACO, Angela Baye

SUAREZ, Jaennes

SUAYBAGUIO, Carl AngeloSUING, Essel Marie

Section E1- Group 7

LACTOSE INTOLERANCE


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The main objectives of thisreport is to able to define lactoseintolerance and to understandthe mechanisms involved in itsprogress. It also emphasizesmeasures to aid in the diagnosis

and proposes way to reduce andmanage symptoms of lactoseintolerance.


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Specifically, at the end of the discussion, students are expected to:

1. Identify the food sources of lactose.

2. Understand how the body normally digest and utilize lactose

3. To define lactose intolerance


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4. To enumerate the three distinct clinical syndromes of lactase deficiency.

5. Differentiate the three types of lactose intolerance;

6. Recognize the different clinical manifestations of lactose intolerance;


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7. Determine the laboratory tests or procedures that can be done ina diagnoselactose intolerance; and

8. Discuss the significance of the different procedures used in its diagnosis aswell as the different interventions that can be done.


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Outline

Case Introduction

Definition of Lactose Intoleranceand Lactase

Food Sources of Lactose

Normal Digestion and Utilization ofLactose

Definition and Differentiation of

Lactose and Lactase Deficiency


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Outline

Distinct Clinical Syndromes ofLactase Deficiency

Characteristic ClinicalManifestations of LactoseIntolerance

Laboratory Tests/Procedures toDiagnose Lactose IntoleranceTherapy & Treatment for Lactose

Intolerance


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Case Introduction

o

SALIENT FEATURESo 54 y/o, femaleo Chief complaint:o Abdominal distension & bloating after

mealso Associated w/:o flatulenceo Episodic diarrhea (30mins-4hours after

meals)o Mild suprapubic cramping & urgency

before BM relieved by defecating


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Case Introduction

o Past Medical History:

(-) DM(-) Prev GI surgery(-) History of foreign travel

(-) Radiation exposure(+) Osteoporosis-15months ago- dietary calcium intake(3cups of milk/day)


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Case Introduction

o Physical examination:-Unremarkable

o Stool examination:- (-) for occult blood

o Flexible sigmoidoscopy:- Normal


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Laboratory Test

Hemoglobin = 15 g/dL (normal = 14-16g/dL)

Hematocrit = 46% (normal = 44-50%)

Serum albumin = 4.5 g/dL (normal = 3.8-4.8g/dL)

Serum cholesterol = 210 mg/dL (normal=


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Laboratory Test

Serum beta-carotene = 35.7 ug/dL(normal = 20-60 ug/dL)

Stool ova and parasites = (-) negativegiardia and amoeba

Fecal leukocytes = (-) negative

Thyroid stimulating hormone (TSH) =

1mclU/ml (normal = 0.6-4.6 mclU/ml)


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Lactose

Lactose

(galactosyl-P- 1,4-glucose) in the milk ofmammals (including humans) is themajor dietary source of galactose.Lactose is hydrolyzed in the intestine bylactase. Galactose produced byhydrolysis of dietary lactose is mostly inthe form of the alpha-isomer.


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Lactase

Lactase

is the enzyme needed to digest Lactosein the intestine, with the absence ofLactase, the Lactose cannot be

digested and absorb in the body. And ifLactose cant be digested LactoseIntolerance could happen to a person.


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oMilk, Milk Productso

Bread and other baked goodsoWaffles, pancakes, biscuits, cookies, and

mixes to make themoProcessed breakfast foods such as

doughnuts, frozen waffles and pancakes,toaster pastries, and sweet rolls


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oProcessed breakfast cerealsoPotato chips, corn chips, and other

processed snacksoMargarineoSalad dressings


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Digestion

of Lactose


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Lactose

Stomach

Small Intestines(Brush border of Proximal

Jejunum)

Beta-glycosidase Complex


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Beta-glycosidase Complex

Lactase

Cleaves via Beta 1,4

Glycosidic bond

Lactose to glucose andgalactose

Active secondarysymporter

Glucose and Galactose

+ SGLT1

GlucosylCeramidase

Split Glucose

and Galactosefrom

Ceramides


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Absorption in the intestinalepithelium

GLUT5

Glucose and Galactose +GLUT2

Exit to the blood

capillaries


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Once broken down into the simple form ofsugars, they are now readily adsorbed.Glucose and galactose are taken into theenterocyte by cotransport with sodiumusing the same transporter.


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Lactase has two activities. It hydrolyzesphlorizin, a disaccharide found in rootsand bark of plants of the family Rosaceaeand some seaweeds and it alsohydrolyzes -galactoside or put simply,

lactose.


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Lactose Metabolism


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Lactase hydrolyses (binds water

chemically H2O) the linkage. Once lactoseis hydrolysed by the interaction of thelactase enzyme, the enzyme then moves

onto the next lactose molecule and doesthe same each time.


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The result of the hydrolysed lactose

disaccharide is the formation of glucoseand galactose as seen in the imageabove. These monosaccharides are

readily adsorbed by the transportmechanism of the enterocytes in thesmall intestine.


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Transport Mechanism


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LactoseIntolerance


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Lactose

Stomach (Small

Intestine)

Absence of Glycosidase Complex

Normal flora ferment to Lactose toLactase

Attracts water tolarge intestine

causing osmoticdiarrhea and

bloating

Producing gasesand flatulence


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Differences of LactoseIntolerance and Lactase

Deficiency

Lactose Intolerance

Is usually a disease of adults and is mostoften associated with an inadequateamount of an enzyme lactase in thesmall intestines, which is essential todigest lactose. Without enough lactase,there is LACTOSE INTOLERANCE


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Lactase Deficiency

Not enough of an enzyme calledLACTASE in the small intestine to digestlactose.


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Lactoferrin

also known as LACTOTRANSFERRIN

Found in milk, saliva, tears, and nasalsecretionHuman Colostrum has the highest

concentration


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Component of Immune system(antimicrobial)Provide antibacterial activity to infant


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3 Distinct Clinical Syndromes ofLactase Deficiency

Congenitalo Very rare inborn error of metabolismo Autosomal recessive patterno

Alactasia


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Primary, adult lactase deficiency orhypolactasia Most common type

Begins to fall after weaning Almost completely lost by lateadolescence

Also called Late Onset Lactase Deficiency Other type is Developmental LactaseDeficiency


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Secondary Disease or damage to the small intestinevillous structure or its function

e.g.Celiac disease, Cystic Fibrosis, Shortgut syndrome (small bowel resection),Parasitic infection, - Gardia, ZollingerEllison Syndrome, Whipples disease

Cli i l


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Clinical

Manifestatio

ns of

Lactose

Intolerance


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Meteorism

Borborygmi FlatulenceAbdominal

pain/Colickypains

Dyspepsia

Bloating/Fullness

NauseaDiarrhea


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DiagnosticTests


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Breath Hydrogen Test

A sensitive testbased on the

metabolism ofundigested lactoseby colonic bacteria.

Bacterialfermentationreleases a largequantity of

hydrogen, which is


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Breath Hydrogen Test

End-expiratory samples are taken at 30minute intervals and compared with

zero-time level

Hydrogen breath >20 ppm above zero-time level HYPOLACTASIA

Water solution of 50 grams of lactose(32 oz of milk) is then ingested

After an overnight fast, patient exhalesthrough a breath analyzer


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Oral Lactose Tolerance Test

A test fordeficiency of the

enzyme lactase,which metabolizeslactose into

glucose, in whichplasma glucoselevels are

measured after a


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Oral Lactose Tolerance Test

Ingestion of 50 grams lactose

Serum glucose is measured in

fasting state, then every 30minutes thereafter 2 hoursfollowing lactose ingestion

Blood glucose rise of less than 1.1mmol/L (20 mg/dL)HYPOLACTASIA


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Blood glucose rise greater than

1.7 mmol/L (30mg/dL)

LACTOSEPERSISTENCE

Blood glucose incremental rise of1.1 mmol/L INCONCLUSIVE


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Lactose Ethanol Test

This test measures the blood galactose

and is a more specific test for lactaseactivity.Because of the rapid conversion of

galactose to glucose in the liver, there isno significant increase in bloodgalalactose after oral administration oflactose.


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Administration of ethanol just before

lactose ingestion inhibits galactosemetabolism.

Metabolism of ethanol by the liver

transiently depletes intracellular NAD+preventing epimerization reaction.


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Therapy


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Amount of lactose that can be toleratedvaries from person to persons.

Complete lactose restriction to confirmall symptoms are indeed related to theLactose Intolerance.


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Dietary management :Avoiding lactose-containing productsAlternative products

( Hard cheeze, Yogurt)Lactase supplementation( Tradenames: Lact- Aid, Dairy- Ease, Lac-

Trase)Division into several meal and combine itwith solid foods (ex. Fats/ dietary fiber)


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Treatment of lactose intolerance shouldnot be aimed at reducing malabsorptionbut rather at improving digestive

symptoms. Reduction of lactose intake rather than

exclusion is recommended because

long-term effects of lactose restrictionmay help improve gastrointestinalcomplaints but can lead to otherdamages.


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Treatment of lactoseintolerance should notbe aimed at reducingmalabsorption butrather at improving

digestive symptoms. Reduction of lactoseintake rather thanexclusion is

recommended becauselong-term effects oflactose restriction mayhelp improve

gastrointestinal


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Age group

Amount of calcium

to consume daily,

Age group inmilligrams (mg)

06 months 210 mg

712 months 270 mg

13 years 500 mg

48 years 800 mg

918 years 1,300 mg

1950 years 1,000 mg5170+ years 1,200 mg

Recommended calcium intake by age groupSource: Adapted from Dietary Reference Intakes, 2004, Institute of Medicine,

National Academy of Sciences.


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To help in planning a high-calciumand low-lactose diet, the table that

follows lists some common foodsthat are good sources of dietarycalcium and shows how much

lactose they contain.


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Vegetables Calcium Content Lactose Content

Calcium-fortified

orange juice, 1 cup

308-344 mg 0

Sardines, withedible bones,

270 mg 0

3 oz.

Salmon, canned,with edible bones, 3

oz.205 mg 0

Soymilk, fortified, 1cup

200 mg 0

Broccoli (raw), 1 cup 90 mg 0

Orange, 1 medium 50 mg 0

Pinto beans, 1/2 cup 40 mg 0Tuna, canned, 3 oz. 10 mg 0

Lettuce greens, 1/2cup

10 mg 0


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Summary

Lactose intolerance is the inability or

insufficient ability to digest lactose, asugar found in milk and milk products.Lactose intolerance is caused by a

deficiency of the enzyme lactase, whichis produced by the cells lining the smallintestine.


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Not all people with lactase deficiencyhave digestive symptoms, but those whodo may have lactose intolerance.Most people with lactose intolerance can

tolerate some amount of lactose in theirdiet.

Summary


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Summary

People with lactose intolerance may

feel uncomfortable after consumingmilk and milk products. Symptoms caninclude abdominal pain, abdominal

bloating, gas, diarrhea, and nausea.The symptoms of lactose intolerance

can be managed with dietary changes.


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Summary

Getting enough calcium and vitamin D isa concern for people with lactose

intolerance when the intake of milk andmilk products is limited. Many foods canprovide the calcium and other nutrients

the body needs.Milk and milk products are often added

to processed foods. Checking the

ingredients on food labels is helpful in


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Referrences

oLaboratory Manual and ConferenceGuide

oLecture Guide in Biochemistry, vol. 1oHarpers Illustrated Biochemistry 28th

edoBiochemistry 5th ed, StryeroBiochemistry 4th ed, LehningeroLippincott Biochemistry 3rd ed

oMedical Biochemistry: Human


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Lactose Intolerance Final Presentation

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