LACTOSE INTOLERANCE

1.) What are the food sources of lactose?

Main sources of lactose are from milk or any other dairy products. There are also other foods that contain lactose and these foods are considered as hidden sources
of lactose since lactose is often added to prepared food.

2.) Discuss how the body normally digests and utilizes lactose.

In the young of mammals, an enzyme called lactase (β1-4 disaccharidase) is secreted by the intestinal villi, and this enzyme cleaves the molecule into its two subunits
for absorption. Lactase is a small intestinal enzyme which hydrolyses lactose. Lactose, milk sugar, is composed of glucose and galactose. The enzyme that digests
lactose is lactase, it is secreted in juvenile mammals, but levels usually decline in adults leading to lactose intolerance.

3.) Define lactose intolerance. Is it the same as lactase deficiency? Explain your answer.

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. Inability results from a shortage of the enzyme lactase,
which is normally produced by the cells that line the small intestine. Lactase breaks down the lactose, milk sugar, into glucose and galactose that can then be
absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, produce some uncomfortable symptoms. Some adults
have low levels of lactase and this leads to lactose intolerance. The ingested lactose is not absorbed in the small intestine, but instead is fermented by bacteria in the
large intestine, producing uncomfortable volumes of carbon dioxide gas. While not all persons deficient in lactase have symptoms, those who do are considered to
be lactose intolerant

4.) What are the three distinct clinical syndromes of lactase deficiency?

a.) Congenital Lactase Deficiency: two types of very rare genetic disorders ;

b.) Primary Lactase Deficiency: most common, around 75% of the world population

c.) Secondary Lactase Deficiency: caused by a disease or condition and may be only temporary

5. Enumerate and differentiate the different types of lactose intolerance.

a) Congenital Lactase Deficiency : inherited as an autosomal recessive trait, are rare genetic conditions. In this type there is a marked deficiency of lactase production
if any at all in the small intestine from birth. It is caused when a baby inherits two ineffective genes from the parents (one from each). The gene lies on chromosome 2
in humans. This results in an inability of the genes in the newborn to produce enough lactase or nothing at all is characterized by severe diarrhea, abdominal pain,
vomiting dehydration, renal tubular acidosis, aminoaciduria, liver damage, lactosuria, cataracts and distension that appear soon after birth when the diet begins to
contain lactose.

b) Primary Lactase Deficiency: also know as Adult Lactase Deficiency, far the commonest of them all. Enzyme levels are highest shortly after birth and decline with
aging, despite a continued intake of lactose. Late onset lactose intolerance occurs several years after birth and is unlikely to be a problem until after 5 to 7 years of
age. Caused by a slow decrease in the body's production of lactase, the enzyme that breaks down lactose (milk sugar)

c) Secondary Lactase Deficiency: also called acquired lactose intolerance or acquired hypolactasia . Sometimes a normal intestine can lose the ability to digest lactose
can appear at any age and occurs when the intestinal brush border is damaged.

5.) What are the characteristic clinical manifestations of lactose intolerance? Explain the molecular basis of each.

Inherited as an autosomal recessive trait, manifests as an inability to excrete lactase into the intestinal lumen at some time after weaning. Small number of people
have congenital alactasia (No lactase at all even from birth) i.e babies cannot digest lactose which is present in breast milk & standard infant milks, lactose can be
taken up by intestinal bacteria which produce CO2 gas from oxidative phosphorylation, produces excessive flatulence in the human. Adult had normal amounts of
lactase as a child but lactase production gradually declines as they get older, though hypolactasia can occur at any age . Lactase tends to decline more rapidly and
completely in some people originating from AFRICA and ASIA as compared to those from EUROPE

6.) What laboratory tests/procedures can be done to diagnose lactose intolerance and discuss their significance.

Lactose intolerance is difficult to diagnose solely on the basis of symptoms. The digestive symptoms that are associated with lactose intolerance may be due to other
malabsorption syndromes. The first diagnostic test to be carried out is to withdraw from eating milk, cream, ice cream, cheese, and other lactose-containing foods
and see if these digestive symptoms are relieved. Breath Hydrogen Test – which is most common, cheap and non-invasive. Oral Lactose Tolerance Test, Lactose-
Ethanol Load Test.