Clinical Manifestations

The clinical manifestations of lactose intolerance include increasing abdominal discomfort, borboryg-mus, flatulence, and finally fermentative diarrhea. Although an inordinate amount of any carbohydrate in the diet will produce a similar symptomatology, intolerance to lactose is the most prominent of these clinical syndromes. The basis of this phenomenon is primarily the activity of the lactase relative to dietary lactose. The lower the activity, the less the capacity for the hydrolysis of the lactose, although other factors - such as intestinal motility and the presence of other nutrients — also play a role in this phenomenon.

When the capacity of the lactase is exceeded, the nonhydrolyzed dietary lactose passes into the large bowel where it is fermented by the myriad of colonic bacteria. This action in turn yields propionic acid, hydrogen, methane, and alcohols, and results in a watery diarrhea, the pH of which is acidic.

In general, the activity of lactase in the intestine in almost all mammals by the time of weaning has decreased to about 10 percent of that encountered during the perinatal period. This does not mean, however, that weaning is directly related to the decrease in activity of lactase. There has been no documentation indicating that there is any inductive relationship between the activity of the enzyme and the ingestion of milk. In fact, all the careful studies indicate that there is no relationship between the two events (i.e., the ingestion of milk and the activity of lactase).

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