lactase
Place in Therapy
Place in Therapy
The etiology of infant colic remains unclear, which explains the number of treatment strategies ranging
from pharmacological, nutritional, naturopathic and behavioural interventions. One of these theories
suggests that infant colic may be caused by transient lactose intolerance. 1 Incomplete lactose absorption
by the small intestine provides a carbohydrate substrate for bacteria such as lactobacilli and
bifidobacteria in the colon who metabolize the lactose and produce lactic acid and hydrogen. 12 The
increase in breath hydrogen levels is a recognized indirect biomarker for hypolactasia and has been
reported in infants with colic. 2,12,14 Increased lactic acid and hydrogen lead to abdominal distension,
causing pain for infants. 6 It’s also thought that lactose and lactic acid in the colon can produce osmotic
pressure. 6 The subsequent influx of water can lead to additional abdominal distension and acidic
diarrhea. 6
This theory suggests that infant colic symptoms could be managed by reducing lactose levels in either
breast milk or formula by introducing the lactase enzyme to aid in the digestion of lactose. This
hypothesis has been explored in several small studies, however these led to conflicting results. Evidence
for the addition of lactase enzyme supplementation in breast milk or formula is not sufficient to draw
any conclusions about efficacy for the treatment or management of infant colic. 3,4,5
References:
1. Barr RG, Hanley J, Patterson D, Kingsnorth WJ. Breath hydrogen excretion in normal newborn
infants in response to usual feeding patterns: Evidence for ‘functional lactase insufficiency’
beyond the first month of life. J. Pediatr. 1984;104:527-533.
2. Barr RG. The normal crying curve – what do we really know. Dev. Med. Child Neurol. 1990;32:368-372.
3. Dattani S. Infant Colic. In: Canadian Pharmacists Association, 2 nd Edition. Patient Self-Care – Helping Your Patients Make Therapeutic Choices. Ottawa, ON: Canadian Pharmacists Association; 2010: Chapter 36.
4. Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics. 2000;106:184-190.
5. Hall B, Chester J, Robinson A. Infantile colic: A systematic review of medical and conventional therapies. Journal of Paediatrics and Child Health. 2012;48:128-137.
6. Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet. 2001;14:359-363.
7. Kearney PJ, Malone AJ, Hayes T, Cole M, Hyland M. A trial of lactase in the management of infant colic. Journal of Human Nutrition and Dietetics. 1998;11:281-285.
8. Lactaid. e-CPS. https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=lactase#. Accessed July 1, 2013.
9. Lactaid. http://www.lactaid.ca/en/. Last updated April 23, 2010. Accessed July 1, 2013.
10. Lactase. http://well.ca/searchresult.html?keyword=lactase. Accessed July 1, 2013.
11. Lactase. Lexicomp. http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/7142. Accessed July 1, 2013.
12. Lewitt MD. Production and excretion of hydrogen gas in man. New Eng. J. Med. 1969;281:122-127.
13. Miller J, McVeagh P, Fleet GH, Petocz P, Brant JC. Effect of yeast lactase enzyme on “colic” in infants fed human milk. The Journal of Pediatrics. 1990; 117:261-263.
14. Miller J, McVeagh P, Fleet GH, Brant JC. Breath hydrogen excretion in infants with colic. Arch. Dis. Child. 1989;64:725-729. 15. Stahlberg MR, Savilahti E. Infantile colic and feeding. Arch Dis Child. 1986;61:1232-1233.
16. Lacteeze. http://lacteeze.com/products/lacteeze-drops/. Accessed July 1, 2013.
The etiology of infant colic remains unclear, which explains the number of treatment strategies ranging
from pharmacological, nutritional, naturopathic and behavioural interventions. One of these theories
suggests that infant colic may be caused by transient lactose intolerance. 1 Incomplete lactose absorption
by the small intestine provides a carbohydrate substrate for bacteria such as lactobacilli and
bifidobacteria in the colon who metabolize the lactose and produce lactic acid and hydrogen. 12 The
increase in breath hydrogen levels is a recognized indirect biomarker for hypolactasia and has been
reported in infants with colic. 2,12,14 Increased lactic acid and hydrogen lead to abdominal distension,
causing pain for infants. 6 It’s also thought that lactose and lactic acid in the colon can produce osmotic
pressure. 6 The subsequent influx of water can lead to additional abdominal distension and acidic
diarrhea. 6
This theory suggests that infant colic symptoms could be managed by reducing lactose levels in either
breast milk or formula by introducing the lactase enzyme to aid in the digestion of lactose. This
hypothesis has been explored in several small studies, however these led to conflicting results. Evidence
for the addition of lactase enzyme supplementation in breast milk or formula is not sufficient to draw
any conclusions about efficacy for the treatment or management of infant colic. 3,4,5
References:
1. Barr RG, Hanley J, Patterson D, Kingsnorth WJ. Breath hydrogen excretion in normal newborn
infants in response to usual feeding patterns: Evidence for ‘functional lactase insufficiency’
beyond the first month of life. J. Pediatr. 1984;104:527-533.
2. Barr RG. The normal crying curve – what do we really know. Dev. Med. Child Neurol. 1990;32:368-372.
3. Dattani S. Infant Colic. In: Canadian Pharmacists Association, 2 nd Edition. Patient Self-Care – Helping Your Patients Make Therapeutic Choices. Ottawa, ON: Canadian Pharmacists Association; 2010: Chapter 36.
4. Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics. 2000;106:184-190.
5. Hall B, Chester J, Robinson A. Infantile colic: A systematic review of medical and conventional therapies. Journal of Paediatrics and Child Health. 2012;48:128-137.
6. Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet. 2001;14:359-363.
7. Kearney PJ, Malone AJ, Hayes T, Cole M, Hyland M. A trial of lactase in the management of infant colic. Journal of Human Nutrition and Dietetics. 1998;11:281-285.
8. Lactaid. e-CPS. https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=lactase#. Accessed July 1, 2013.
9. Lactaid. http://www.lactaid.ca/en/. Last updated April 23, 2010. Accessed July 1, 2013.
10. Lactase. http://well.ca/searchresult.html?keyword=lactase. Accessed July 1, 2013.
11. Lactase. Lexicomp. http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/7142. Accessed July 1, 2013.
12. Lewitt MD. Production and excretion of hydrogen gas in man. New Eng. J. Med. 1969;281:122-127.
13. Miller J, McVeagh P, Fleet GH, Petocz P, Brant JC. Effect of yeast lactase enzyme on “colic” in infants fed human milk. The Journal of Pediatrics. 1990; 117:261-263.
14. Miller J, McVeagh P, Fleet GH, Brant JC. Breath hydrogen excretion in infants with colic. Arch. Dis. Child. 1989;64:725-729. 15. Stahlberg MR, Savilahti E. Infantile colic and feeding. Arch Dis Child. 1986;61:1232-1233.
16. Lacteeze. http://lacteeze.com/products/lacteeze-drops/. Accessed July 1, 2013.