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Adult Human Milk Intolerance and Intestinal Lactase Deficiency. A Review

Metabolic Division, U.S. Army Medical Research and Nutrition Laboratory, Fitzsimons General Hospital, Denver, Colorado 80240

ABSTRACT

In man, the dietary milk sugar, lactose, is hydrolyzed to glucose and galactose by the small intestinal enzyme, lactase. This enzyme is located in the brush border of the small intestinal epithelial cell. Recent studies (2, 12,19) have called attention to the association between milk intolerance and a deficiency of lactase. This review will discuss briefly the clinical manifestations of this deficiency state, some etiologic considerations, and the geographic and ethnic distribution of this condition.

Clinical Manifestations

In lactase-deficient individuals the ingestion of one or two glasses of milk leads to abdominal bloating, rumbling, cramping, and often diarrhea. Symptoms may be insidious or explosive in onset and usually occur within one-half to three hours after ingestion, although, in some instances they may be delayed for as much as 12 hours.

This condition may occur in infants on a congenital basis and may appear in adults secondary to intestinal damage (22) or as a late manifestation of an inherited condition (2). The commonest cause of milk intolerance in adults is inherited and usually develops insidiously after puberty. In this type of intolerance, the intestine appears normal to light and electron microscopy.