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Lactose intolerance – Abstract
Lactose intolerance is a disorder with symptoms, such as diarrhea, bloating, nausea and abdominal pain, which are observed in persons with lactose malabsorption after blinded ingestion of lactose but not after ingestion of placebo. Lactose intolerance can be diagnosed with the mucosal biopsy lactose testing, commercial lactase assay, genetic tests and H2-breath test (together with measurement of CH4).
Symptoms caused by lactose intolerance can be reduced by consuming probiotics and tablets of lactase enzyme, but the proper modification of diet is the main treatment of lactose intolerance. Firstly, it is necessary to reduce the consumption of lactose choosing lactose-free or fermented dairy products. In the review done by Misselwitz et al., it is not recommended to entirely exclude lactose since it was shown that up to 12g of lactose could be tolerated (one glass of milk) by the patients with lactose intolerance. Also, one of the reasons why lactose reduction is a better solution than total exclusion is that dairy products are one of the main sources of calcium. Since numerous studies evidenced that reduced intake of dairy products can increase chances of fractures in women and can lead to osteoporosis, it is necessary for patients on dairy restriction to take calcium from other sources. In some patients, symptoms persist despite the reduction of lactose intake. For those patients, it is recommended to modify the diet and to consume food low in FODMAPs (Fermentable Oligo-, Di- and Mono-saccharides And Polyols), since there are other fibers and carbohydrates in the diet that are hard to digest. Also, in this review, it was pointed out that a combination of lactose with other foods can reduce the symptoms of lactose intolerance.
Since it was shown that microflora from unpasteurized yogurt could reduce symptoms of lactose malabsorption in comparison to pasteurized yogurt, in the pilot study done by Mummah and colleagues it was hypothesized that raw milk could improve lactose malabsorption or reduce symptoms of lactose intolerance compering to pasteurized milk. The effects of three types of milk (raw, pasteurized and soy milk) on lactose intolerance symptoms were investigated, and results showed that raw milk didn’t reduce symptoms of lactose intolerance.
Although proper dietary interventions can help in the reduction of lactose intolerance symptoms, further investigation of long-term modification of diet and optimization of the diagnostic method are needed.
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