Probiotics contain lactose. Can babies who are lactose intolerant still eat them?

Recently, I often receive inquiries from parents about whether their baby is lactose intolerant, but the probiotics prescribed by the doctor contain lactose. Can the baby still take this probiotic? Are there any probiotics that do not contain lactose?

Today I want to talk to you about lactose intolerance.

Q1: What is lactose? What are its uses?

A1: Lactose is a unique carbohydrate found in human and mammalian milk. It is a disaccharide composed of glucose and galactose. During the growth and development of infants and young children, lactose not only provides energy (glucose), but is also an important source of components for the synthesis of brain and nerve tissue (galactose).

Lactose is mainly used in the manufacture of baby food and in the preparation of medicines (for example, as a diluent in the manufacture of tablets).

Q2: What is lactose intolerance?

A2: Lactose intolerance refers to the difficulty in digesting lactose due to the lack of lactase in the small intestinal mucosa. The undigested lactose enters the colon and is fermented by bacteria in the colon that express β-galactosidase. The lactose that enters the colon and the metabolites produced when these colon bacteria ferment lactose and the changes in the intestinal environment they cause lead to the occurrence of digestive tract symptoms such as diarrhea, bloating, and abdominal pain.

The main clinical manifestation of lactose intolerance in infants is diarrhea, which is yellow or green, egg drop soup-like or thin and mushy gas-containing stool with a sour and smelly smell. The number of diarrhea episodes varies, up to dozens of times. Severe cases may even have mucus and blood in the stool and small intestinal necrosis.

Q3: How to treat lactose intolerance?

A3: The treatment of lactose intolerance is closely related to its clinical classification. For those with congenital lactase deficiency, lactose should be abstained from for life, while for those with secondary lactase deficiency, the primary disease should be treated. However, not all children with lactose intolerance need treatment. If the digestive tract symptoms of the child are not severe and do not affect growth and development, special treatment is generally not required.

If the symptoms are severe, such as frequent diarrhea (4 times/day) and slow weight gain in newborns and infants, appropriate treatment measures should be taken: 1. Dietary avoidance: mainly includes low-lactose or lactose-free formula feeding, and the feeding method should be selected according to the severity of the symptoms. For children with congenital lactase deficiency, lactose-free milk powder feeding is required for a long time; for those with primary lactase deficiency, because their clinical symptoms are closely related to the amount of lactose eaten, if there are severe symptoms, lactose-free milk powder can be used for feeding first, and low-lactose formula feeding can be used after the symptoms are relieved, and then the amount of lactose intake can be gradually increased or small amounts can be taken multiple times to increase lactose tolerance. 2. Add appropriate amount of lactase: For babies with lactose intolerance, an appropriate amount of lactase can be taken before or during milk drinking to improve lactose intolerance and lactose non-absorption. 3. Take probiotics.

Q4: Why can probiotics treat lactose intolerance?

A4: Some colonic bacteria in the human intestine (mainly including Bacteroides, Bifidobacterium, Lactobacillus and Eubacterium rectum) have β-galactosidase activity, which can break down lactose and improve the body's metabolism and absorption of lactose, playing an important role in the colon metabolism of lactose.

Under the fermentation action of these colon bacteria, gas and short-chain fatty acids are finally generated. The latter are easily absorbed and utilized in the colon. The process of lactose being converted into short-chain fatty acids and absorbed and eliminated causes the osmotic pressure in the intestine to decrease. In addition, the absorption of short-chain fatty acids also promotes the reabsorption of sodium and water, thereby eliminating the adverse factors caused by lactose.

At the same time, lactic acid bacteria can slow down the gastric emptying rate and intestinal transit time, prolong the time for the residual lactase in the small intestine to digest lactose, and promote the decomposition and absorption of lactose; Bifidobacteria and Lactobacilli only produce acid but not gas when fermenting lactic acid, which can also alleviate the clinical manifestations of lactose intolerance. Yeast and fungi are also important sources of lactase.

After reading this, I believe you may have the answer in your mind. Lactose is used as an excipient in medicines in very small amounts, so unless there is an absolute contraindication to lactose, there is no need to avoid medicines containing lactose. In addition, probiotics themselves have a fermentation effect on lactose, so there is no need to worry that the lactose in the excipients will have an adverse effect on the treatment.

Finally, here are some tips for scientific milk drinking for all parents:

1. Increase lactase: Drink yogurt every day to increase the lactase content, or add lactase to milk to promote the decomposition of lactose.

2. Slow down the absorption of lactose: Eat steamed bread, eggs, bread and other foods that can delay digestion and absorption while drinking milk to slow down the absorption of lactose.

3. Consume an appropriate amount of milk: Find the appropriate amount of milk intake. To prevent lactose intolerance, do not drink too much milk. To increase the intake of high-quality calcium, insist on drinking milk. Do not drink too little milk or even no milk.

4. Do not drink milk on an empty stomach.

(Duan Tingting, Qingdao Women and Children's Hospital)