Lactose Intolerance Research Paper

Nutrition: Barriers to Digestion

Lactose Intolerance:
- Lactase is one of the many enzymes required for complete digestion of lactose (a disaccharide).
- Lactose intolerance is not an allergy, and is not to be confused with a milk allergy, which initiates an immune reaction when milk is ingested. Lactose intolerance instead is an enzyme deficiency (lactase).
- S/s including gas, bloating, cramping, nausea, and diarrhea. Some people can ingest small amounts, and others none. Some can take small pills with lactase enzyme before they consume dairy products.
- It’s rare for Caucasians to develop lactose intolerance, but common for Asians, Africans, Middle Eastern, and non-Caucasian Australians.
- It is very common in adults (30 million
American adults).
- Not having milk in the diet can lead to a shortage of calcium, vitamin D, riboflavin, and protein. You can get this by taking calcium supplements, eating foods that have more calcium (leafy greens, oysters, sardines, canned salmon, shrimp, and broccoli), and drinking orange juice with added calcium. It is possible to have a healthy diet without dairy products.

Constipation:
- Constipation is defined as a decrease in frequency of bowel movements from what is “normal” for the individual; hard, difficult-to-pass stools; a decrease in stool volume; and/or retention of feces in the rectum.
- Constipation can be caused by insufficient dietary fiber, inadequate fluid intake, decreased physical activity, and ignoring defecation urge. Medications including opioids cause constipation as well as diseases slowing GI transit such as diabetes, Parkinson’s, and MS. Depression and stress can also contribute.
- Many cases of constipation can be prevented by increasing fiber, fluid intake, and exercise. Recommendations for constipation include laxatives and enemas, but overuse of these can lead to chronic constipation. Many patients experience an improvement in s/s when they increase fiber and fluids (3000ml/day). Wheat bran and prunes are especially effective for prevention and treatment. Stool softeners and lubricants lubricate the intestinal tract, making it easier to pass. Osmotic solutions cause fluid retention. Stimulants increase peristalsis by stimulating enteric nerves.
Diarrhea:
- Diarrhea is defined as the passage of loose, watery stools, often three or more times a day.
- Foods that aggravate diarrhea are high-fiber, including bran, broccoli, beans, peas, lentils, figs, whole, wheat flour, and lentils.
- The biggest concern in a patient with diarrhea is fluid loss/dehydration. Individuals can lose large quantities of water and minerals like sodium.

GERD:
- GERD is not a disease but a syndrome. It is a condition/alteration secondary to reflux of gastric contents into the lower esophagus. It results when the defenses of the lower esophagus are overwhelmed by the reflux of acidic gastric contents into the esophagus. The lower esophageal sphincter (LES) is the anti-reflux barrier. It is classified as GERD when it occurs more than twice per week.
- Lifestyle changes include cessation of smoking and alcohol use. Do not lie down after a meal. Weight loss will help reduce incidence. Consumption of foods contributing to LES pressure such as caffeine and chocolate should be decreased.

Inflammatory Bowel Disease:
- Both diseases are characterized by chronic inflammation of the intestine with periods of remission interspersed with periods of exacerbation. The cause is unknown and there is no
cure.
- Crohn’s Disease: inflammation involves all layers of the bowel wall. It can occur anywhere in the GI tract from the mouth to the anus, but occurs most commonly in the terminal ileum and colon. It has a classic “cobblestone” appearance. Microscopic leaks can lead to peritonitis. Fistulas can develop between bowel and bladder or bowel and vagina. UTI’s are usually the 1st sign of bowel/bladder fistulas. Healthy tissue is interspersed with inflamed tissue. Rectal bleeding sometimes occurs. Diarrhea and colicky abdominal pain are common. A mass is sometimes felt in the right iliac fossa.
- Ulcerative Colitis: This usually starts in the rectum and moves in a continual fashion toward the cecum. It is a disease of the colon and rectum. This spreads in a continuous pattern, and occurs in the mucosal layer, so fistulas and abscesses are rare. Water and electrolytes are absorbed thru healthy mucosal epithelium, so absorption is difficult thru inflamed mucosa. Diarrhea and fluid/electrolyte loss is a characteristic feature of damage. Abdominal pain and rectal bleeding are primary symptoms. 4-5 stools per day are characteristic.
- Recommended nutritional therapy: High-calorie, high-vitamin, high-protein, low-residue diet.

Peptic Ulcer Disease:
- PUD is characterized by erosion of the GI mucosa resulting from the digestive action of HCl acid and pepsin. Almost always, it is located in the gastric or duodenal area. It causes a burning pain typically 1-3 hours after eating.
- “H. pylori play a key role in the development of most peptic ulcers…Treatment usually involves antibiotics and acid-suppressing medications. Special diets and stress-reduction techniques are no longer typically recommended because they do not reduce acid secretion. However, people with ulcers should avoid specific foods they identify as causing them discomfort.”
- Smoking has an irritating effect on the mucosa and should be eliminated. Aspirin and other NSAIDs should also be discontinued.
- 6 small meals a day is recommended. Alcohol and caffeine are irritating, as well as foods high in roughage like raw fruit, salads, and veggies.

Gastric Ulcers: less common than duodenal, occur in the lesser curvature of the stomach, burning in high left epigastrium and back and upper abdomen, pain 1-2 hrs after a meal, aggravation or discomfort with food, more common in persons of lower socioeconomic status, increased with smoking, drug use, and alcohol use.

Duodenal Ulcers: usually penetrating in 1-2 cm of duodenum, associated with psychologic stress and other diseases, burning, cramping, pressure-like pain across mid-epigastrium and upper abdomen, pain 2-4 hrs after meals, midmorning, mid-afternoon, middle of night, pain relief with antacids and food.