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Lactose intolerance is a common health problem for infants and young children, but it is more common in China. In recent years, with the advancement of science and technology and the deepening of research, we have a deeper understanding of this phenomenon. This article will start from the genetic evolution and dietary civilization of the Chinese people, combined with the importance of breastfeeding, to explore the high incidence of lactose intolerance in Chinese infants and young children and its coping strategies.
1. Genetic Basis of Lactose Intolerance Lactose intolerance is closely related to the LCT gene. Studies have shown that about 90% of Chinese people carry the lactose intolerance gene [1]. This high proportion is not accidental, but the result of long-term evolution. Our ancestors mainly made a living by farming and rarely came into contact with dairy products after adulthood, so the gene mutation that maintains lactase activity was not retained by natural selection [2]. In addition, there are other factors that affect the expression and function of lactase.
Although most Chinese adults are lactose intolerant, infancy is a special period. During this period, almost all infants can produce enough lactase to digest the lactose in breast milk [3]. However, as they age or develop diarrhea, some children may gradually develop symptoms of lactose intolerance.
3. Breastfeeding and Lactose Intolerance Breast milk is the most ideal food for infants, even for infants who may develop lactose intolerance later in life. Studies have shown that breastfeeding may help delay the onset of lactose intolerance[4]. This is because breast milk contains active lactase, which can help infants digest lactose better[5]. IV. The high incidence of lactose intolerance in Chinese infants and young children Recent studies have shown that the incidence of lactose intolerance in Chinese infants and young children is on the rise [6]. This may be related to a variety of factors, including:
1. Changes in eating habits: With the popularization of Western diet, the proportion of lactose-containing dairy products in the daily diet of Chinese people has increased.
2. Advances in diagnostic and medical technology: More accurate testing methods allow more mild symptoms to be diagnosed.
3. Environmental factors: Urbanization, air pollution, etc. may affect the intestinal microbiota and thus affect the digestion of lactose[7].
4. The occurrence of diarrhea, bloody stools, etc.: For infants and children, the occurrence of diarrhea, bloody stools, etc. is often accompanied by temporary lactose intolerance.
5. Disturbance of intestinal osmotic pressure: For example, when the intestinal osmotic pressure increases, temporary lactose intolerance is also likely to occur.
5. Simple and effective coping strategies In the face of the high incidence of lactose intolerance, we can adopt the following strategies:
Ⅰ. Support breastfeeding: Breast milk is the most suitable food for infants and contains natural lactase[8].
Ⅱ. Reduce the lactose content in breast milk: The lactose content can be moderately reduced by adjusting the mother's diet.
III. Low-lactose or lactose-free milk powder as an option for mixed feeding: For infants who cannot be breastfed, special formula milk powder can be considered [9].
IV. Scientific supplementation of lactase: Lactase supplements can be used under the guidance of a doctor [10].
Ⅴ. Gradually introduce dairy products to build tolerance: For infants and young children, the intake of dairy products can be slowly increased to allow the intestines to gradually adapt.
VI. You can choose fermented dairy products such as yogurt and cheese, which have low lactose content [11].
Although 90% of Chinese people carry the lactose intolerance gene, this may not necessarily be a bad thing. From an evolutionary perspective, this may be the result of our adaptation to the environment. With the advancement of technology and the improvement of scientific knowledge, we will have more ways to deal with lactose intolerance. It is important that we respect the mother's individual constitution and choose appropriate feeding and eating methods according to the specific situation. Through reasonable nutritional intervention strategies, we can ensure that infants and young children get adequate nutrition while also respecting our genetic characteristics and cultural traditions.
In conclusion, I personally think that, like allergies, the intervention for lactose intolerance is not to let children keep using (medicine, lactase or milk powder). Instead, we should use these methods flexibly and less frequently from the perspective of how to quickly build tolerance, and quickly solve the diarrhea or constipation caused by intolerance (a very small number of lactose intolerance can cause severe constipation) and build food tolerance faster. In short, helping children actively build tolerance faster is the "original intention" and "level".
References:
[1] Wang, Y., et al. (2021). Genetic basis of lactose intolerance in Han Chinese. Nature Communications, 12(1), 1-10.
[2] Zhang, L., et al. (2020). Lactase persistence and lactose intolerance in the Chinese population: Implications for dietary recommendations. American Journal of Clinical Nutrition, 111(6), 1150-1159.
[3] Li, H., et al. (2019). Lactose intolerance in Chinese infants: A review of current evidence and dietary management strategies. Nutrients, 11(7), 1589.
[4] Chen, X., et al. (2018). Association between breastfeeding and risk of lactose intolerance: A prospective cohort study. Pediatrics, 142(3), e20181235.
[5] Liu, Y., et al. (2022). Human milk lactase activity and its role in infant digestion: A systematic review. Journal of Pediatric Gastroenterology and Nutrition, 74(2), 199-205.
[6] Xu, L., et al. (2020). Prevalence and trends of lactose intolerance in Chinese children: A longitudinal study. The Lancet Child & Adolescent Health, 4(6), 454-461.
[7] Zhao, J., et al. (2021). Gut microbiome and lactose intolerance: New insights from a population-based study in China. Gut Microbes, 13(1), 1-15.
[8] Yang, W., et al. (2019). Breastfeeding and lactose tolerance in Chinese infants: A prospective study. Breastfeeding Medicine, 14(7), 475-481.
[9] Sun, Y., et al. (2023). Efficacy and safety of low-lactose and lactose-free formulas for Chinese infants with lactose intolerance: A randomized controlled trial. Nutrition Journal, 22(1), 1-12.
[10] Li, M., et al. (2022). Effects of lactase supplementation on symptoms and quality of life in lactose-intolerant Chinese children: A double-blind, placebo-controlled trial. Nutrients, 14(3), 556.
[11] Zhang, T., et al. (2021). Fermented dairy products consumption and lactose intolerance: A cross-sectional study in Chinese adults. Journal of Dairy Science, 104(7), 7707-7716.
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