Lactose intolerance syndrome and the role of probiotics

Lactose is the main source of calories in conventional milk, an essential nutritional supplement for infants, and an important source of calcium in the adult diet.

The severity of lactose intolerance depends on the dose of lactose, lactase deficiency, and gut microbiota. The gut microbiome can be regulated by probiotic supplementation, which can reduce the signs and symptoms of lactose intolerance.

1. Lactose malabsorption and its causes

a. Lactose malabsorption and lactose intolerance

Lactose malabsorption (LM) is a condition in which lactose is introduced into the large intestine as a result of lactase deficiency.

Lactose Intolerance (LI) is characterized by the presence of clinical signs mainly in the gastrointestinal tract such as abdominal pain, bloating and diarrhea due to intestinal absorption and fermentation of lactose. Lactose is depleted because of a deficiency of the enzyme lactase.

LM is a necessary prerequisite for LI. However, people with LM do not necessarily have LI. Many people with LM have no symptoms after consuming a standard serving of dairy products while others develop symptoms (LI).

The severity or appearance of these clinical symptoms following lactose ingestion may be altered by a number of factors, including lactose dose, lactase production, and concomitant use of other dietary ingredients, intestinal transit time and gut microbiota composition.

b. Causes of LM

– Congenital lactase deficiency: Very rare genetic disorder (typically a frameshift mutation) leading to underexpression of the lactase fusion gene and severe symptoms when breastfeeding is started soon after birth such as severe diarrhea, acidosis and hypercalcemia.

– Lactase deficiency in premature babies: In premature babies, intestinal lactase may not be fully developed. This type of LI usually goes away after a short time.

– Primary malabsorption: The most common form of malabsorption due to lactase deficiency (dominant worldwide phenotype). This is due to several polymorphisms in the transcription promoter region of the lactase gene. The reduced ability to digest lactose in adulthood, which affects about one-quarter to one-third of the world’s population, may be due to adaptations to weaning.

– Secondary malabsorption: LM due to lower lactase expression, typically in (reversible) inflammatory bowel conditions. Diseases or toxins affecting the proximal small intestine that lose surface area of the intestine can lead to lactase deficiency.

After recovery, the surface may improve, if there is no genetic predisposition, lactose digestion may be improved. Some examples of diseases are viral diseases, for example, rotavirus infection in children, protozoan parasites like Giardia, celiac disease, malnutrition, radiation exposure, upper gastrointestinal surgery, and certain medications such as olmesartan.

2. Effect of probiotic supplementation in LI
   

Probiotics are defined by the World Health Organization as live microorganisms that, when administered in sufficient quantities, produce beneficial effects on the host. Probiotics can be taken orally through probiotics such as probiotics.

a. Mechanism of probiotics in LI

First, when reaching the digestive system, probiotics act as a source of lactase enzyme in the intestinal tract, increasing the overall hydrolysis and fermentation in the large intestine.

– Second, probiotics have an antagonistic effect on gas-producing (gas-producing) bacteria, enhancing colonic compensation by secreting antibiotic-like substances that compete for mucosal adhesion sites, and modulate intestinal barrier permeability.

b. Probiotics reduce the symptoms of LI

Strain-specific bacterial metabolism may act in the selection of probiotics and symbionts for the relief of symptoms of gastrointestinal disorders, including LI.

Previous studies have demonstrated that Bifidobacterium longum, as well as Lactobacillus rhamnosus, improve general gastrointestinal symptoms, promote lactose tolerance, and stimulate positive changes in gut microbiota composition.

Probiotic supplementation in people with LI significantly reduced abdominal pain, diarrhea, vomiting, bloating, and/or bloating.

Common criteria used to select probiotic strains, species, and strains include tolerance to the gut environment, ability to adhere to the intestinal mucosa, and ability to eliminate pathogens.

In a systematic review of randomized controlled trials, most of the probiotic species used (including L. acidophilus, L. reuteri, L. rhamnosus and L. bulgaricus, S. thermophilus and B. longum) were effective in alleviating clinical symptoms.

The effects of B. animalis have been demonstrated both in vitro and in vivo, B. animalis is one of the most common bacteria found in the gut microbiota and one of the best-studied bifidobacteria.

This bacterium has potent mucoadhesive properties, inhibits pathogens and improves barrier function, as well as enhances lactose digestion and increases transit time in LI patients.

Prebiotics are functional foods that stimulate the growth of beneficial gut bacteria and increase colon permeability, potentially reducing the symptoms of LI. Specifically, galacto-oligosaccharides (GOS) have been shown to increase the abundance of lactose-fermenting Bifidobacterium species, Faecalibacterium, Lactobacillus and Roseburia in the gut.

It should be noted that the mechanism by which gut bacteria utilize GOS is not fully understood, and efficacy and response vary between strains.

References:

[1] A. Szilagyi and N. Ishayek, “Lactose Intolerance, Dairy Avoidance, and Treatment Options”, Nutrients, vol. 10, p.h. 12, p. 1994, December 2018, doi: 10.3390/nu10121994.

[2] R. Leis, M.-J. de Castro, C. de Lamas, R. Picáns, and M. L. Couce, “Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials”, Nutrients, vol 12, p.h 5, p. 1487, May 2020, doi: 10.3390/nu12051487.

Article source: Nutrition Research and Development Institute (https://inrd.vn/)

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