Abstract
Lactose or milk sugar is a disaccharide composed of glucose and galactose, and is the primary carbohydrate found in mammalian milk. Lactose must be hydrolyzed into the simple sugars (galactose and glucose) to be absorbed by the small intestine. Lactase is an enzyme produced in the mucosa of the intestine that catalyzes the breakdown of lactose. Lactose intolerant children show low levels of lactase activity, and as a result, undigested lactose moves into the distal bowel. Here, symptoms such as bloating, cramps, diarrhea, flatulence and the production of gases occur in children (and lactose intolerant individuals’ in general) as the undigested lactose is fermented by bacteria. One of the health consequences of lactose intolerance (LI) in children is a reduction in calcium intake due to their avoidance of mammalian milk. Because of the problems associated with LI, many lactose-free food products are manufactured by the food industry. This chapter discusses LI in children, key symptoms of LI, methods to diagnose lactase insufficiency, lactase supplements, lactose-free food products and their health benefits and risks, and finally, the world market for these products and regulations and guidelines for industrial manufacturers.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Academy of Pediatrics. (1978). The practical significance of lactose intolerance in children. Pediatrics, 62(2), 240–245. https://pediatrics.aappublications.org/content/pediatrics/62/2/240.full.pdf.
Bailey, R. K., Fileti, C. P., Keith, J., Tropez-Sims, S., Price, W., & Allison-Ottey, S. D. (2013). Lactose intolerance and health disparities among African Americans and Hispanic Americans: An updated consensus statement. Journal of the National Medical Association, 105(2), 112–127. Available in: https://www.milkmeansmore.org/wp-content/uploads/2016/05/lactose_intolerance_and_health_disparities.pdf
Barr SI. (2013). Perceived lactose intolerance in adult Canadians: A national survey. Applied Physiology, Nutrition, and Metabolism, 38(8), 830–835. https://doi.org/10.1139/apnm-2012-0368.
Boll, W., Wagner, P., & Mantei, N. (1991). Structure of the chromosomal gene and cDNAs coding for lactase-phlorizin hydrolase in humans with adult-type hypolactasia or persistence of lactase. American Journal of Human Genetics, 48(5), 889–902. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1683064/pdf/ajhg00089-0075.pdf
Campbell, A. K., & Matthews, S. B. (2008). Tony’s–lactose-free cookbook. Nutrition & Food Science, 38(5), 518–519. https://doi.org/10.1108/nfs.2008.38.5.518.2.
Corleone, J. (2018). What are the benefits of lactose-free milk?. Available in: https://healthyeating.sfgate.com/benefits-lactosefree-milk-7284.html.
Deng, Y., Misselwitz, B., Dai, N., & Fox, M. (2015). Lactose intolerance in adults: Biological mechanism and dietary management. Nutrients, 7(9), 8020–8035. https://doi.org/10.3390/nu7095380.
de Vrese, M., Stegelmann, A., Richter, B., Fenselau, S., Laue, C., & Schrezenmeir, J. (2001). Probiotics—compensation for lactase insufficiency. The American Journal of Clinical Nutrition, 73(2), 421s–429s. https://doi.org/10.1093/ajcn/73.2.421s
Diet for Lactose Intolerance Johns Hopkins Medicine Health Library. (2019) – https://www.hopkinsmedicine.org/.../allergy.../diet_for_lactose_intolerance_85,P000
Enattah, N. S., Sahi, T., Savilahti, E., Terwilliger, J. D., Peltonen, L., & Järvelä, I. (2002). Identification of a variant associated with adult-type hypolactasia. Nature Genetics, 30(2), 233–237. https://doi.org/10.1038/ng826.
Gifford Jones, W. (2004 March 21). 10 Health benefits of dairy products.
Griffin, A., & Annaliese, G. (2018 April). Oat Milk is poised to take over the US. Retrieved from http://www.com/quartzy/1253566/oat-milk-is-poised-to-take-over-the-us.
He, T., Venema, K., Priebe, M. G., Welling, G. W., Brummer, R. J., & Vonk, R. J. (2008). The role of colonic metabolism in lactose intolerance. European Journal of Clinical Investigation, 38(8), 541–547. https://doi.org/10.1111/j.1365-2362.2008.01966.x.
Health Benefits of Dairy. (2019). Retrieved from https://thedairyalliance.com/health-benefits-of-dairy/.
Henderson, J. M., Kutner, M. H., & Bain, R. P. (1982). First-order clearance of plasma galactose: The effect of liver disease. Gastroenterology, 83(5), 1090–1096. https://doi.org/10.1016/s0016-5085(82)80078-4.
Heron V. (2018). Calcium, Phosphate and Magnesium disorders. In: Fluid and Electrolyte Disorders. Mahmood, U. (Ed.). IntechOpen (pp. 87–108). https://doi.org/10.5772/intechopen.81173.
Heyman, M. B. (2006). Lactose intolerance in infants, children, and adolescents. Pediatrics, 118(3), 1279–1286. https://doi.org/10.1542/peds.2006-1721.
Hochwallner, H., Schulmeister, U., Swoboda, I., Spitzauer, S., & Valenta, R. (2014 March 1). Cow’s milk allergy: From allergens to new forms of diagnosis, therapy and prevention Methods. Methods, 66(1), 22–33. https://doi.org/10.1016/j.ymeth.2013.08.005.
Ingram, C. J., Mulcare, C. A., Itan, Y., Thomas, M. G., & Swallow, D. M. (2009). Lactose digestion and the evolutionary genetics of lactase persistence. Human Genetics, 124(6), 579–591. https://doi.org/10.1007/s00439-008-0593-6.
Itan, Y., Jones, B. L., Ingram, C. J., Swallow, D. M., & Thomas, M. G. (2010). A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evolutionary Biology, 10(1), 36. https://doi.org/10.1186/1471-2148-10-36.
Järvelä, I. E. (2005). Molecular genetics of adult-type hypolactasia. Annals of Medicine, 37(3), 179–185. https://doi.org/10.1080/07853890510007359.
Kundu, P., Dhankhar, J., & Sharma, A. (2018). Development of non dairy milk alternative using soymilk and almond milk. Current Research in Nutrition and Food Science Journal, 6(1), 203–210. https://doi.org/10.12944/crnfsj.6.1.23.
Leloir, L. F. (1951). The enzymatic transformation of uridine diphosphate glucose into a galactose derivative. Archives of Biochemistry and Biophysics, 33(2), 186–190. https://doi.org/10.1016/0003-9861(51)90096-3.
Lomer, M. C. E., Parkes, G. C., & Sanderson, J. D. (2008). Review article: Lactose intolerance in clinical practice-myths and realities. Alimentary Pharmacology & Therapeutics, 27(2), 93–103. https://doi.org/10.1111/j.1365-2036.2007.03557.x.
Lordan, R., Tsoupras, A., Mitra, B., & Zabetakis, I. (2018). Dairy fats and cardiovascular disease: Do we really need to be concerned? Food, 7(3), 29. https://doi.org/10.3390/foods7030029.
Luyt, D., Ball, H., Makwana, N., Green, M. R., Bravin, K., Nasser, S. M., & Clark, A. T. (2014). BSACI guideline for the diagnosis and management of cow’s milk allergy. Clinical & Experimental Allergy, 44(5), 642–672. https://doi.org/10.1111/cea.12302.
Nadeau, K. J., Maahs, D. M., Daniels, S. R., & Eckel R. H. (2011). Childhood obesity and cardiovascular disease: links and prevention strategies. Nature Reviews Cardiology, 8(9), 513–525. https://doi.org/10.1038/nrcardio.2011.86
Paige, D. M., Bayless, T. M., Mellitis, E. D., & Davis, L. (1977). Lactose malabsorption in preschool black children. The American Journal of Clinical Nutrition, 30(7), 1018–1022. https://doi.org/10.1093/ajcn/30.7.1018.
Rasinperä, H., Savilahti, E., Enattah, N. S., Kuokkanen, M., Tötterman, N., Lindahl, H., Järvelä, I., & Kolho, K. L. (2004). A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut, 53(11), 1571–1576. https://doi.org/10.1136/gut.2004.040048.
Rasinperä, H., Kuokkanen, M., Kolho, K. L., Lindahl, H., Enattah, N. S., Savilahti, E., Orpana, A., & Järvelä, I. (2005). Transcriptional downregulation of the lactase (LCT) gene during childhood. Gut, 54(11), 1660–1661. https://doi.org/10.1136/gut.2005.077404.
Robayo-Torres, C. C., & Nichols, B. L. (2007). Molecular differentiation of congenital lactase deficiency from adult-type hypolactasia. Nutrition Reviews, 65(2), 95–98. https://doi.org/10.1111/j.1753-4887.2007.tb00286.x.
Ruggeri, C. (2017). Dairy-free diet benefits + 6 dairy alternatives. Available in: https://draxe.com/diets/dairy-free-diet.
Scrimshaw, N. S., & Murray, E. B. (1988). The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. The American Journal of Clinical Nutrition, 48(4), 1142–1159. https://doi.org/10.1093/ajcn/48.4.1142
Segal, S., & Blair, A. (1961). Some observations on the metabolism of D-galactose in normal man. The Journal of Clinical Investigation, 40(11), 2016–2025. https://doi.org/10.1172/jci104428.
Shulman, R. J., Wong, W. W., & O’Brian Smith, E. (2005). Influence of changes in lactase activity and small-intestinal mucosal growth on lactose digestion and absorption in preterm infants. American Society for Clinical Nutrition, 81, 472–479. Printed in USA. © 2005 American Society for Clinical Nutrition.
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), 7312–7331. https://doi.org/10.3390/nu7095340
Storhaug, C. L., Fosse, S. K., & Fadnes, L. T. (2017). Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 2(10), 738–746. https://doi.org/10.1016/s2468-1253(17)30154-1
Symptoms and Causes of Lactose Intolerance – National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/lactose-intolerance/symptoms-causes.
Tidke, S. A., Ramakrishna, D., Kiran, S., Kosturkova, G., & Ravishankar, G. A. (2015). Nutraceutical potential of soybean. Asian Journal of Clinical Nutrition, 7(2), 22–32. https://doi.org/10.3923/ajcn.2015.22.32.
Torniainen, S., Freddara, R., Routi, T., Gijsbers, C., Catassi, C., Höglund, P., Savilahti, E., & Järvelä, I. (2009). Four novel mutations in the lactase gene (LCT) underlying congenital lactase deficiency (CLD). BMC Gastroenterology, 9, 8. https://doi.org/10.1186/1471-230X-9-8.
Acknowledgments
We sincerely thank the Vellore Institute of Technology, Vellore for their support and assistance in preparing this chapter.
Conflicts of Interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sekar, R., Selvasekaran, P., Kar, A., Varalwar, T., Godli, C., Chidambaram, R. (2020). Lactose-Free Food Products for Lactose Intolerant Children. In: Gutiérrez, T. (eds) Food Science, Technology and Nutrition for Babies and Children. Springer, Cham. https://doi.org/10.1007/978-3-030-35997-3_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-35997-3_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-35996-6
Online ISBN: 978-3-030-35997-3
eBook Packages: Chemistry and Materials ScienceChemistry and Material Science (R0)