{"id":5163,"date":"2020-03-23T03:24:37","date_gmt":"2020-03-23T00:24:37","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=5163"},"modified":"2020-03-29T19:34:38","modified_gmt":"2020-03-29T16:34:38","slug":"laktoz-intoleransi-siz-de-75in-icinde-misiniz","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/laktoz-intoleransi-siz-de-75in-icinde-misiniz\/","title":{"rendered":"Laktoz \u0130ntolerans\u0131: Siz de %75’in \u0130\u00e7inde Misiniz?"},"content":{"rendered":"\n
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Kaynak: Harvard Health-Harvard University
https:\/\/images.app.goo.gl\/9B4tSNemUAydooK66
<\/figcaption><\/figure>\n\n\n\n

D\u00fc\u015f\u00fcn\u00fclenin aksine, Laktoz intolerans\u0131 toplumda olduk\u00e7a yayg\u0131n g\u00f6r\u00fclen bir hastal\u0131kt\u0131r. D\u00fcnya pop\u00fclasyonunun yakla\u015f\u0131k %75’inin bu rahats\u0131zl\u0131ktan muzdarip oldu\u011fu bilinmektedir (1). <\/p>\n\n\n\n

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D\u00fcnyada laktoz intolerans\u0131 prevalans\u0131n\u0131 g\u00f6steren harita
Kaynak: Wikiwand
https:\/\/images.app.goo.gl\/ooziFMq3bvMaeKdZ9<\/figcaption><\/figure>\n\n\n\n

Laktoz intolerans\u0131n\u0131n bir di\u011fer ad\u0131 “laktoz malabsorpsiyonu”dur. Bunun sebebi, laktoz intolerans\u0131 olan bireylerin s\u00fct ve s\u00fct \u00fcr\u00fcnlerinin i\u00e7erisinde bulunan laktoz ad\u0131ndaki \u015fekeri tamamen sindirememeleridir. Bu y\u00fczden bu hastalarda s\u00fct ve s\u00fct \u00fcr\u00fcnleri t\u00fcketimi sonras\u0131nda diyare (ishal), gaz ve \u015fi\u015fkinlik g\u00f6r\u00fcl\u00fcr. Bunun sebebini fizyoloji derslerimizde g\u00f6rd\u00fc\u011f\u00fcm\u00fcz, hipotonik-hipertonik ortam mant\u0131\u011f\u0131yla anlayabiliriz. Ba\u011f\u0131rsak l\u00fcmeninde sindirilememi\u015f laktoz bulundu\u011fundan, artan ozmotik bas\u0131nca kar\u015f\u0131l\u0131k olarak l\u00fcmene s\u0131v\u0131 salg\u0131s\u0131n\u0131n artt\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnebiliriz.<\/p>\n\n\n\n

Laktoz intolerans\u0131, ince ba\u011f\u0131rsaklar\u0131n yeterince laktaz enzimi salg\u0131lamamas\u0131 sonucu olu\u015fur. Normalde laktaz sayesinde laktoz; glukoz ve galaktoz ad\u0131nda 2 adet monosakkarite d\u00f6n\u00fc\u015f\u00fcr ve b\u00f6ylece ba\u011f\u0131rsak duvar\u0131ndan emilerek kan dola\u015f\u0131m\u0131na kar\u0131\u015f\u0131r. Laktoz intolerans\u0131 olan bir bireyde ise laktozun emilememesinden dolay\u0131 kolonda bulunan bakterilerin sindirilmemi\u015f laktozla etkile\u015fimi sonucu \u015fi\u015fkinlik vb. semptomlar ortaya \u00e7\u0131k\u0131yor.<\/p>\n\n\n\n

3 farkl\u0131 laktoz intolerans\u0131 tipi vard\u0131r:<\/p>\n\n\n\n

1.Primer hipolaktazi\/Primer laktoz intolerans\u0131:<\/h4>\n\n\n\n
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S\u00fct ve s\u00fct \u00fcr\u00fcnleri
Kaynak: Pinterest
https:\/\/images.app.goo.gl\/rL9mdq2PAyk2G7Jz5<\/figcaption><\/figure>\n\n\n\n

Laktoz intolerans\u0131n\u0131n en s\u0131k g\u00f6r\u00fclen t\u00fcr\u00fcd\u00fcr. \u0130nfantlar (yeni do\u011fanlar) s\u00fctle beslendi\u011fi i\u00e7in hayat\u0131m\u0131z\u0131n ba\u015flang\u0131c\u0131nda hepimiz bol miktarda laktaz enzimi \u00fcretiriz. Eri\u015fkin ya\u015famda ise normalde minimum d\u00fczeyde de olsa g\u00fcnl\u00fck s\u00fct \u00fcr\u00fcn\u00fc t\u00fcketimimizi sindirmeye yetecek miktarda laktaz \u00fcretimi olmas\u0131n\u0131 bekleriz. Fakat primer hipolaktazi hastalar\u0131nda bir allel gen eksikli\u011finden dolay\u0131 (lactase persistence allele)<\/em> (2,3) eri\u015fkin ya\u015famda laktaz \u00fcretimi \u00e7ok sert bir \u015fekilde d\u00fc\u015fer ve hipolaktazi durumu g\u00f6r\u00fcl\u00fcr. Genetik olarak kodlanan bu durum, okudu\u011fum birka\u00e7 kaynakta farkl\u0131 belirtilmekle birlikte, en \u00e7ok Afrika, Asya ve Hispanik k\u00f6kenli insanlarda g\u00f6r\u00fcl\u00fcyor fakat primer hipolaktazinin ayn\u0131 zamanda Akdeniz ve Do\u011fu Avrupa k\u00f6kenli insanlarda da yayg\u0131n olarak g\u00f6r\u00fcld\u00fc\u011f\u00fcn\u00fc s\u00f6yleyebiliriz. (4)<\/p>\n\n\n\n

2.Sekonder hipolaktazi\/Sekonder laktoz intolerans\u0131:<\/h4>\n\n\n\n
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Primer hipolaktazi ve sekonder hipolaktazi aras\u0131 fark\u0131 g\u00f6steren \u015fema
Kaynak: IMD-Berlin
https:\/\/images.app.goo.gl\/xQEKw5dE7ji9Y2DG6
<\/figcaption><\/figure>\n\n\n\n

Sekonder hipolaktazi\/Sekonder laktoz intolerans\u0131n\u0131n bir di\u011fer ad\u0131 “akkiz hipolaktazi”dir (acquired hypolactasia).<\/em> Laktoz intolerans\u0131n\u0131n bu t\u00fcr\u00fc; ince ba\u011f\u0131rsakta bir hastal\u0131k, yaralanma veya ameliyat sonras\u0131nda laktaz \u00fcretiminin azalmas\u0131yla ger\u00e7ekle\u015fir. Sekonder hipolaktazi hem infant hem de eri\u015fkinlerde g\u00f6r\u00fclebilir ve primer hipolaktazinin aksine genellikle geri d\u00f6nd\u00fcr\u00fclebilir\/iyile\u015ftirilebilirdir. Sekonder laktoz intolerans\u0131; akut gastroenterit, \u00e7\u00f6lyak hastal\u0131\u011f\u0131, Crohn hastal\u0131\u011f\u0131, \u00fclseratif kolit, kemoterapi, giardia gibi ba\u011f\u0131rsak parazitleri veya ba\u015fka \u00e7evresel fakt\u00f6rler kaynakl\u0131 olabilir (2,5,6). Sekonder hipolaktaziye sebep olan hastal\u0131klara kar\u015f\u0131 tedavi uyguland\u0131\u011f\u0131 zaman laktaz \u00fcretimi eski h\u00e2line d\u00f6nd\u00fcr\u00fclebilir.<\/p>\n\n\n\n

3.Primer Konjenital Alaktazi\/Konjenital Laktoz \u0130ntolerans\u0131:<\/h4>\n\n\n\n

Olduk\u00e7a nadir, otozomal resesif enzim defektidir ve bebeklerde do\u011fumla birlikte laktaz ekspresyonunu engeller. Alaktazi dedi\u011fimiz laktaz enziminin hi\u00e7 \u00fcretilmemesi s\u00f6z konusudur. Bu y\u00fczden bu bebekler s\u00fct\u00fc hi\u00e7 sindiremezler (2). A\u011f\u0131rl\u0131kl\u0131 olarak Finlandiya’da olmak \u00fczere d\u00fcnyada bu hastal\u0131\u011fa sahip 40 vaka bildirilmi\u015ftir. 20.y\u00fczy\u0131l \u00f6ncesinde Primer Konjenital Alaktazi’yle do\u011fan bebekler genellikle ya\u015famla ba\u011fda\u015fm\u0131yordu fakat 20.y\u00fczy\u0131lda laktozsuz s\u00fctler, soya s\u00fct\u00fc gibi alternatifler \u00fcretilmeye ba\u015flan\u0131nca bebeklerdeki \u00f6l\u00fcm oranlar\u0131 azald\u0131 (7).<\/p>\n\n\n\n

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Laktoz intolerans\u0131 testleri
Kaynak: Ixcela
https:\/\/images.app.goo.gl\/wYebUBdXiLQsuQg18<\/figcaption><\/figure>\n\n\n\n

Primer laktoz intolerans\u0131 olmayan bireylerin tek oturu\u015fta en az 12 gram laktozu semptom g\u00f6stermeden t\u00fcketebildi\u011fi bilinmektedir (8, 9). <\/p>\n\n\n\n

Kar\u015f\u0131la\u015ft\u0131rma olmas\u0131 a\u00e7\u0131s\u0131ndan a\u015fa\u011f\u0131ya Virginia \u00dcniversitesi’nin yay\u0131nlad\u0131\u011f\u0131 bir tabloyu koyuyorum, gram i\u00e7in tablonun en sa\u011f taraf\u0131ndaki s\u00fctuna bakabilirsiniz.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Not:<\/strong> A\u015fa\u011f\u0131daki tablonun kayna\u011f\u0131 \u00e7ok net olmamakla birlikte birka\u00e7 \u00fcniversite ders sunumunda da bulunuyordu. Virginia \u00dcniversitesi’nin yay\u0131nlad\u0131\u011f\u0131 tablodan daha anla\u015f\u0131l\u0131r oldu\u011funu d\u00fc\u015f\u00fcnd\u00fc\u011f\u00fcm i\u00e7in koydum. G\u00fcvenilirli\u011fi konusunda endi\u015felerimi de sizinle payla\u015fmak isterim.<\/em><\/p>\n\n\n\n
Dairy product<\/th>Serving size<\/th>Lactose content<\/th>Percentage<\/th><\/tr><\/thead>
Milk, regular<\/td>250 ml\/g<\/td>12 g<\/td>4.80%<\/td><\/tr>
Milk, reduced fat<\/td>250 ml\/g<\/td>13 g<\/td>5.20%<\/td><\/tr>
Yogurt, plain, regular<\/td>200 g<\/td>9 g<\/td>4.50%<\/td><\/tr>
Yogurt, plain, low-fat<\/td>200 g<\/td>12 g<\/td>6.00%<\/td><\/tr>
Cheddar cheese<\/td>30 g<\/td>0.02 g<\/td>0.07%<\/td><\/tr>
Cottage cheese<\/td>30 g<\/td>0.1 g<\/td>0.33%<\/td><\/tr>
Butter<\/td>5 g<\/td>0.03 g<\/td>0.6%<\/td><\/tr>
Ice cream<\/td>50 g<\/td>3 g<\/td>6.00%<\/td><\/tr><\/tbody><\/table>\n\n\n\n

Laktoz intolerans\u0131n\u0131z\u0131n oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyorsan\u0131z \u00f6ncelikle doktorunuza ba\u015fvurman\u0131z\u0131 \u00f6neriyoruz.<\/strong><\/h3>\n\n\n\n

Gelecek ay g\u00f6r\u00fc\u015fmek \u00fczere, bilimle kal\u0131n!<\/p>\n\n\n\n

KAYNAK\u00c7A:<\/strong><\/p>\n\n\n\n

  1. N S Scrimshaw, E B Murray, The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance, The American Journal of Clinical Nutrition<\/em>, Volume 48, Issue 4, October 1988, Pages 1142\u20131159, https:\/\/doi.org\/10.1093\/ajcn\/48.4.1142<\/a> <\/li>
  2. Heyman MB (September 2006). “Lactose intolerance in infants, children, and adolescents”. Pediatrics. <\/em>118<\/strong> (3): 1279\u201386. <\/em>doi<\/a>:<\/em>10.1542\/peds.2006-1721<\/a>. <\/em>PMID<\/a>16951027<\/a>.<\/em><\/li>
  3. Enattah NS, Sahi T, Savilahti E, Terwilliger JD, Peltonen L, J\u00e4rvel\u00e4 I (February 2002). “Identification of a variant associated with adult-type hypolactasia”. Nature Genetics. <\/em>30<\/strong> (2): 233\u20137. <\/em>doi<\/a>:<\/em>10.1038\/ng826<\/a>. <\/em>PMID<\/a>11788828<\/a>.<\/em><\/li>
  4. https:\/\/www.mayoclinic.org\/diseases-conditions\/lactose-intolerance\/symptoms-causes\/syc-20374232<\/a> <\/li>
  5. Swagerty DL, Walling AD, Klein RM (May 2002). <\/em>“Lactose intolerance”<\/a>. American Family Physician. <\/em>65<\/strong> (9): 1845\u201350. <\/em>PMID<\/a>12018807<\/a>.<\/em><\/li>
  6. Lawson M, Bentley D, Lifschitz C (2002). <\/em>Pediatric gastroenterology and clinical nutrition<\/em><\/a>. London: Remedica. p. 109. <\/em>ISBN<\/a>978-1-901346-43-5<\/a>. <\/em>Archived<\/a> from the original on 2016-12-19.<\/em><\/li>
  7. Sinden AA, Sutphen JL (December 1991). “Dietary treatment of lactose intolerance in infants and children”. Journal of the American Dietetic Association. <\/em>91<\/strong> (12): 1567\u201371. <\/em>PMID<\/a>1960350<\/a>.<\/em><\/li>
  8. Szilagyi A (August 2015). <\/em>“Adaptation to Lactose in Lactase Non Persistent People: Effects on Intolerance and the Relationship between Dairy Food Consumption and Evalution of Diseases”<\/a>. Nutrients (Review). <\/em>7<\/strong> (8): 6751\u201379. <\/em>doi<\/a>:<\/em>10.3390\/nu7085309<\/a>. <\/em>PMC<\/a>4555148<\/a>. <\/em>PMID<\/a>26287234<\/a>.<\/em><\/li>
  9. Silanikove N, Leitner G, Merin U (August 2015). <\/em>“The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds”<\/a>. Nutrients (Review). <\/em>7<\/strong> (9): 7312\u201331. <\/em>doi<\/a>:<\/em>10.3390\/nu7095340<\/a>. <\/em>PMC<\/a>4586535<\/a>. <\/em>PMID<\/a>26404364<\/a>.<\/em><\/li><\/ol>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    D\u00fc\u015f\u00fcn\u00fclenin aksine, Laktoz intolerans\u0131 toplumda olduk\u00e7a yayg\u0131n g\u00f6r\u00fclen bir hastal\u0131kt\u0131r. D\u00fcnya pop\u00fclasyonunun yakla\u015f\u0131k %75’inin bu rahats\u0131zl\u0131ktan muzdarip oldu\u011fu bilinmektedir (1).<\/p>\n","protected":false},"author":188,"featured_media":5178,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"acf":[],"views":2210,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5163"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/188"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=5163"}],"version-history":[{"count":18,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5163\/revisions"}],"predecessor-version":[{"id":5208,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/5163\/revisions\/5208"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/5178"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=5163"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=5163"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=5163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}