Lactose malabsorption can be classified into three categories:

1. Congenital malabsorption of lactase, a rare phenomenon, which has been documented in only a few cases.

2. Primary malabsorption of lactose, a worldwide situation that is encountered in humans after the age of 5 to 7 years, and in other animals after weaning. (This is considered to be a normal physiological process, transmitted genetically; indeed it resembles a classical Mendelian recessive trait.)

3. An acquired malabsorption of lactose that can be encountered at any age in infants and children under 7 years, as well as in adults who had previously been lactose absorbers. This form can also be associated with nonspecific and specific diarrhea of infancy, drugs that affect the intestinal mucosa, and diseases such as cystic fibrosis and gluten-sensitive enteropathy.

An interesting phenomenon is that the colonic flora of the lactose-intolerant individual seems able to adapt to a nonfermentive type of bacteria. A study was launched in Nigeria in which six medical students, all proven lactose nondigesters, were fed graded doses of 5 grams of lactose to a final amount of 50 grams over a 6-month period. At the end of this time, all six of the individuals could tolerate the 50 grams of lactose, but were shown to be unable to digest it. Adults who should be intolerant to lactose can drink a glass, or even a pint, of milk with relative impunity, but nonetheless manifest no increase in lactase activity and consequently cannot digest the lactose.

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