lactose intolerance final presentation
TRANSCRIPT
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SOLIS, Ianne Robin
SONACO, Angela Baye
SUAREZ, Jaennes
SUAYBAGUIO, Carl AngeloSUING, Essel Marie
Section E1- Group 7
LACTOSE INTOLERANCE
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The main objectives of thisreport is to able to define lactoseintolerance and to understandthe mechanisms involved in itsprogress. It also emphasizesmeasures to aid in the diagnosis
and proposes way to reduce andmanage symptoms of lactoseintolerance.
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Specifically, at the end of the discussion, students are expected to:
1. Identify the food sources of lactose.
2. Understand how the body normally digest and utilize lactose
3. To define lactose intolerance
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4. To enumerate the three distinct clinical syndromes of lactase deficiency.
5. Differentiate the three types of lactose intolerance;
6. Recognize the different clinical manifestations of lactose intolerance;
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7. Determine the laboratory tests or procedures that can be done ina diagnoselactose intolerance; and
8. Discuss the significance of the different procedures used in its diagnosis aswell as the different interventions that can be done.
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Outline
Case Introduction
Definition of Lactose Intoleranceand Lactase
Food Sources of Lactose
Normal Digestion and Utilization ofLactose
Definition and Differentiation of
Lactose and Lactase Deficiency
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Outline
Distinct Clinical Syndromes ofLactase Deficiency
Characteristic ClinicalManifestations of LactoseIntolerance
Laboratory Tests/Procedures toDiagnose Lactose IntoleranceTherapy & Treatment for Lactose
Intolerance
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Case Introduction
o
SALIENT FEATURESo 54 y/o, femaleo Chief complaint:o Abdominal distension & bloating after
mealso Associated w/:o flatulenceo Episodic diarrhea (30mins-4hours after
meals)o Mild suprapubic cramping & urgency
before BM relieved by defecating
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Case Introduction
o Past Medical History:
(-) DM(-) Prev GI surgery(-) History of foreign travel
(-) Radiation exposure(+) Osteoporosis-15months ago- dietary calcium intake(3cups of milk/day)
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Case Introduction
o Physical examination:-Unremarkable
o Stool examination:- (-) for occult blood
o Flexible sigmoidoscopy:- Normal
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Laboratory Test
Hemoglobin = 15 g/dL (normal = 14-16g/dL)
Hematocrit = 46% (normal = 44-50%)
Serum albumin = 4.5 g/dL (normal = 3.8-4.8g/dL)
Serum cholesterol = 210 mg/dL (normal=
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Laboratory Test
Serum beta-carotene = 35.7 ug/dL(normal = 20-60 ug/dL)
Stool ova and parasites = (-) negativegiardia and amoeba
Fecal leukocytes = (-) negative
Thyroid stimulating hormone (TSH) =
1mclU/ml (normal = 0.6-4.6 mclU/ml)
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Lactose
Lactose
(galactosyl-P- 1,4-glucose) in the milk ofmammals (including humans) is themajor dietary source of galactose.Lactose is hydrolyzed in the intestine bylactase. Galactose produced byhydrolysis of dietary lactose is mostly inthe form of the alpha-isomer.
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Lactase
Lactase
is the enzyme needed to digest Lactosein the intestine, with the absence ofLactase, the Lactose cannot be
digested and absorb in the body. And ifLactose cant be digested LactoseIntolerance could happen to a person.
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Food Sources of Lactose
oMilk, Milk Productso
Bread and other baked goodsoWaffles, pancakes, biscuits, cookies, and
mixes to make themoProcessed breakfast foods such as
doughnuts, frozen waffles and pancakes,toaster pastries, and sweet rolls
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Food Sources of Lactose
oProcessed breakfast cerealsoPotato chips, corn chips, and other
processed snacksoMargarineoSalad dressings
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Digestion
of Lactose
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Lactose
Stomach
Small Intestines(Brush border of Proximal
Jejunum)
Beta-glycosidase Complex
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Beta-glycosidase Complex
Lactase
Cleaves via Beta 1,4
Glycosidic bond
Lactose to glucose andgalactose
Active secondarysymporter
Glucose and Galactose
+ SGLT1
GlucosylCeramidase
Split Glucose
and Galactosefrom
Ceramides
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Absorption in the intestinalepithelium
GLUT5
Glucose and Galactose +GLUT2
Exit to the blood
capillaries
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Once broken down into the simple form ofsugars, they are now readily adsorbed.Glucose and galactose are taken into theenterocyte by cotransport with sodiumusing the same transporter.
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Lactase has two activities. It hydrolyzesphlorizin, a disaccharide found in rootsand bark of plants of the family Rosaceaeand some seaweeds and it alsohydrolyzes -galactoside or put simply,
lactose.
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Lactose Metabolism
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Lactase hydrolyses (binds water
chemically H2O) the linkage. Once lactoseis hydrolysed by the interaction of thelactase enzyme, the enzyme then moves
onto the next lactose molecule and doesthe same each time.
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The result of the hydrolysed lactose
disaccharide is the formation of glucoseand galactose as seen in the imageabove. These monosaccharides are
readily adsorbed by the transportmechanism of the enterocytes in thesmall intestine.
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Transport Mechanism
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LactoseIntolerance
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Lactose
Stomach (Small
Intestine)
Absence of Glycosidase Complex
Normal flora ferment to Lactose toLactase
Attracts water tolarge intestine
causing osmoticdiarrhea and
bloating
Producing gasesand flatulence
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Differences of LactoseIntolerance and Lactase
Deficiency
Lactose Intolerance
Is usually a disease of adults and is mostoften associated with an inadequateamount of an enzyme lactase in thesmall intestines, which is essential todigest lactose. Without enough lactase,there is LACTOSE INTOLERANCE
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Lactase Deficiency
Not enough of an enzyme calledLACTASE in the small intestine to digestlactose.
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Lactoferrin
also known as LACTOTRANSFERRIN
Found in milk, saliva, tears, and nasalsecretionHuman Colostrum has the highest
concentration
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Component of Immune system(antimicrobial)Provide antibacterial activity to infant
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3 Distinct Clinical Syndromes ofLactase Deficiency
Congenitalo Very rare inborn error of metabolismo Autosomal recessive patterno
Alactasia
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Primary, adult lactase deficiency orhypolactasia Most common type
Begins to fall after weaning Almost completely lost by lateadolescence
Also called Late Onset Lactase Deficiency Other type is Developmental LactaseDeficiency
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Secondary Disease or damage to the small intestinevillous structure or its function
e.g.Celiac disease, Cystic Fibrosis, Shortgut syndrome (small bowel resection),Parasitic infection, - Gardia, ZollingerEllison Syndrome, Whipples disease
Cli i l
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Clinical
Manifestatio
ns of
Lactose
Intolerance
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Meteorism
Borborygmi FlatulenceAbdominal
pain/Colickypains
Dyspepsia
Bloating/Fullness
NauseaDiarrhea
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DiagnosticTests
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Breath Hydrogen Test
A sensitive testbased on the
metabolism ofundigested lactoseby colonic bacteria.
Bacterialfermentationreleases a largequantity of
hydrogen, which is
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Breath Hydrogen Test
End-expiratory samples are taken at 30minute intervals and compared with
zero-time level
Hydrogen breath >20 ppm above zero-time level HYPOLACTASIA
Water solution of 50 grams of lactose(32 oz of milk) is then ingested
After an overnight fast, patient exhalesthrough a breath analyzer
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Oral Lactose Tolerance Test
A test fordeficiency of the
enzyme lactase,which metabolizeslactose into
glucose, in whichplasma glucoselevels are
measured after a
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Oral Lactose Tolerance Test
Ingestion of 50 grams lactose
Serum glucose is measured in
fasting state, then every 30minutes thereafter 2 hoursfollowing lactose ingestion
Blood glucose rise of less than 1.1mmol/L (20 mg/dL)HYPOLACTASIA
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Blood glucose rise greater than
1.7 mmol/L (30mg/dL)
LACTOSEPERSISTENCE
Blood glucose incremental rise of1.1 mmol/L INCONCLUSIVE
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Lactose Ethanol Test
This test measures the blood galactose
and is a more specific test for lactaseactivity.Because of the rapid conversion of
galactose to glucose in the liver, there isno significant increase in bloodgalalactose after oral administration oflactose.
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Administration of ethanol just before
lactose ingestion inhibits galactosemetabolism.
Metabolism of ethanol by the liver
transiently depletes intracellular NAD+preventing epimerization reaction.
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Therapy
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Amount of lactose that can be toleratedvaries from person to persons.
Complete lactose restriction to confirmall symptoms are indeed related to theLactose Intolerance.
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Dietary management :Avoiding lactose-containing productsAlternative products
( Hard cheeze, Yogurt)Lactase supplementation( Tradenames: Lact- Aid, Dairy- Ease, Lac-
Trase)Division into several meal and combine itwith solid foods (ex. Fats/ dietary fiber)
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Treatment of lactose intolerance shouldnot be aimed at reducing malabsorptionbut rather at improving digestive
symptoms. Reduction of lactose intake rather than
exclusion is recommended because
long-term effects of lactose restrictionmay help improve gastrointestinalcomplaints but can lead to otherdamages.
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Treatment of lactoseintolerance should notbe aimed at reducingmalabsorption butrather at improving
digestive symptoms. Reduction of lactoseintake rather thanexclusion is
recommended becauselong-term effects oflactose restriction mayhelp improve
gastrointestinal
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Age group
Amount of calcium
to consume daily,
Age group inmilligrams (mg)
06 months 210 mg
712 months 270 mg
13 years 500 mg
48 years 800 mg
918 years 1,300 mg
1950 years 1,000 mg5170+ years 1,200 mg
Recommended calcium intake by age groupSource: Adapted from Dietary Reference Intakes, 2004, Institute of Medicine,
National Academy of Sciences.
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To help in planning a high-calciumand low-lactose diet, the table that
follows lists some common foodsthat are good sources of dietarycalcium and shows how much
lactose they contain.
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Vegetables Calcium Content Lactose Content
Calcium-fortified
orange juice, 1 cup
308-344 mg 0
Sardines, withedible bones,
270 mg 0
3 oz.
Salmon, canned,with edible bones, 3
oz.205 mg 0
Soymilk, fortified, 1cup
200 mg 0
Broccoli (raw), 1 cup 90 mg 0
Orange, 1 medium 50 mg 0
Pinto beans, 1/2 cup 40 mg 0Tuna, canned, 3 oz. 10 mg 0
Lettuce greens, 1/2cup
10 mg 0
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Summary
Lactose intolerance is the inability or
insufficient ability to digest lactose, asugar found in milk and milk products.Lactose intolerance is caused by a
deficiency of the enzyme lactase, whichis produced by the cells lining the smallintestine.
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Not all people with lactase deficiencyhave digestive symptoms, but those whodo may have lactose intolerance.Most people with lactose intolerance can
tolerate some amount of lactose in theirdiet.
Summary
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Summary
People with lactose intolerance may
feel uncomfortable after consumingmilk and milk products. Symptoms caninclude abdominal pain, abdominal
bloating, gas, diarrhea, and nausea.The symptoms of lactose intolerance
can be managed with dietary changes.
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Summary
Getting enough calcium and vitamin D isa concern for people with lactose
intolerance when the intake of milk andmilk products is limited. Many foods canprovide the calcium and other nutrients
the body needs.Milk and milk products are often added
to processed foods. Checking the
ingredients on food labels is helpful in
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Referrences
oLaboratory Manual and ConferenceGuide
oLecture Guide in Biochemistry, vol. 1oHarpers Illustrated Biochemistry 28th
edoBiochemistry 5th ed, StryeroBiochemistry 4th ed, LehningeroLippincott Biochemistry 3rd ed
oMedical Biochemistry: Human
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