High lactose tolerance in North Europeans: a result of migration, not in situ milk consumption

The main carbohydrate in milk is lactose, which must be hydrolyzed to glucose and galactose before the sugars can be digested. While 65% or more of the total human population are lactose intolerant, in some human populations lactase activity commonly persists into adulthood. Lactose tolerance is exceptionally widespread in Northern European countries such as Sweden and Finland, with tolerance levels of 74% and 82%, respectively. Theoretically, this may result either from a strong local selection pressure for lactose tolerance, or from immigration of lactose tolerant people to Northern Europe. We provide several lines of archaeological and historical evidence suggesting that the high lactose tolerance in North Europeans cannot be explained by selection from in situ milk consumption. First, fresh cow milk has not belonged to the traditional diet of Swedes or Finns until recent times. Second, not enough milk has been available for adult consumption. Cattle herding has been neither widespread nor productive enough in Northern Europe to have provided constant access to fresh milk. We suggest that the high prevalence of lactose tolerance in Finland in particular may be explained by immigration of people representing so-called Corded Ware Culture, an early culture representing agricultural development in Europe.     

Nutrition,population growth and disease: a short history of lactose

Food and nutrition have played a crucial role in biological evolution. Lactation in mammals was one key invention. A central role in milk is played by lactose, otherwise an exotic sugar in nature. Lactose digestion needs the induction of specialized gut enzymes. This enzyme is shut off in a precisely timed developmental step leading to lactose malabsorption promoting weaning in the young and ovulation in the mother. The lactose–lactase system could thus regulate optimal birth spacing in land mammals. The domestication of cattle promoted milk as a food item also for adult nutrition. This was only possible by two further key inventions: the concomitant domestication of lactic acid bacteria which ferment the non‐digestible lactose to the easily absorbed lactic acid and the mutation to lactase persistence (LP) in adults from dairy societies. This mutation represents one of the strongest selected loci of the human genome. Since no crucial nutritional selective advantage is conferred by LP, its dominance might be the result of indirect effects like the spread of cattle pathogens into humans. Lactase is also temporarily lost in rotavirus and Escherichia coli childhood diarrhoea and persistent diarrhoea is consequently best treated with lactose‐free diets.     

A worldwide correlation of lactase persistence phenotype and genotypes

Background  

The ability of adult humans to digest the milk sugar lactose - lactase persistence - is a dominant Mendelian trait that has been a subject of extensive genetic, medical and evolutionary research. Lactase persistence is common in people of European ancestry as well as some African, Middle Eastern and Southern Asian groups, but is rare or absent elsewhere in the world. The recent identification of independent nucleotide changes that are strongly associated with lactase persistence in different populations worldwide has led to the possibility of genetic tests for the trait. However, it is highly unlikely that all lactase persistence-associated variants are known. Using an extensive database of lactase persistence phenotype frequencies, together with information on how those data were collected and data on the frequencies of lactase persistence variants, we present a global summary of the extent to which current genetic knowledge can explain lactase persistence phenotype frequency.     

Utilization of Lactose, Glucose, and Galactose by a Mixed Culture of Streptococcus thermophilus and Lactobacillus bulgaricus in Milk Treated with Lactase Enzyme

The mechanism responsible for an increased rate of acid production when yogurt starter cultures are grown in milk treated with lactase enzyme was investigated by studying carbohydrate utilization and acid development by a pure culture of Streptococcus thermophilus and a mixed yogurt starter culture consisting of S. thermophilus and Lactobacillus bulgaricus. In milk containing glucose, galactose, and lactose, glucose and lactose (but not free galactose) were fermented. Fermentation of lactose in control milk was accompanied by the release of free galactose, with the result that carbohydrate utilization was less efficient than in treated milk. This phenomenon also occurred when lactose was fermented by S. thermophilus in broth culture. Carbohydrate utilization by the mixed yogurt culture was more rapid when the lactose in milk was partially prehydrolyzed. Our results suggest that the more rapid acid development that took place when a mixed yogurt starter culture was grown in milk containing prehydrolyzed lactose was the result of a more rapid and efficient utilization of carbohydrate by S. thermophilus when free glucose in addition to lactose was available for fermentation. The evidence presented also suggests that uptake and utilization of glucose and lactose by S. thermophilus are different in broth and milk cultures.     

Gene-dosage effect on intestinal lactase activity demonstrated in vivo.

The activities of the disaccharidases lactase, maltase, and sucrase were determined in upper jejunal biopsies of 65 healthy adult German males. The study was an attempt to demonstrate the gene-dosage effect on lactase activity expected from the presence of a "hypolactasia" (l) and a "lactase-persistence" (L) allele in the German population. In contrast to lactase/sucrase ratios, lactose/maltose ratios showed a trimodal distribution in proportions of presumed genotypes LL, Ll, and ll compatible with Hardy-Weinberg equilibrium. The frequency of homozygotes ll (13.8%) was similar to the average frequency of lactose malabsorbers in Germany reported in the literature. The importance of considering the lactase gene-dosage effect in population studies of lactase activity is discussed.     

Beja And Nilotes: Nomadic pastoralist groups in the Sudan with opposite distributions of the adult lactase phenotypes

Lactose tolerance tests with breath hydrogen determination were performed on 585 apparently healthy adolescents and adults in the Democratic Republic of the Sudan. Out of the total, 303 probands belong to the tribal group Beja, traditional nomadic pastoralists in the desert zone between the Nile and the Red Sea. The 282 Nilotes (mainly Dinka) are members of seminomadic cattle breeding tribes in the south of the Sudan. In both populations milk consumption is substantial but only in the Beja true milk dependence, sufficient to result in selective pressures in favour of the lactase persistence allele, is likely to exist. The proportion of lactose malabsorbers was 16.8% in the Beja and 74.5% in the Nilotes. The high prevalence of lactose malabsorption among the Nilotes fits into a converging gradient of lactase gene frequencies along the Nile Valley. The Beja are the first nomadic desert population in North Africa in whom a high prevalence of lactase persistence has been demonstrated on a numerically sufficient sample.     

Separation and characterization of four enzyme forms of beta-galactosidase from Saccharomyces lactis

beta-Galactosidase from Saccharomyces lactis has been purified to serve as a model for the kinetic behavior of human lactase in adult lactase deficiency. Enzymes from both species are neutral and follow Michaelis-Menten kinetics. beta-Galactosidase of S. lactis is more readily available than the human lactase. An enzyme preparation from S. lactis (Maxilact 40,000), which is used commercially to hydrolyze lactose in milk, has been found to contain four isozymes of beta-galactosidase. Methods have been developed for the separation and purification of each of the four enzymes. The enzymes were found to differ in molecular mass, kinetic behavior, isoelectric point, response to pH, specific volume and sensitivity to metal ions. The four enzymes had apparent molecular masses of 630 kDa, 550 kDa, 41 kDa and 19 kDa. Their specificity constants (kcat/Km) were found to be 42.0, 355.2, 0.38 and 0.48 mM-1 s-1, respectively. The techniques of reiterated ultrafiltration used for the isolation of these isozymes may be applicable to other purification processes.     

Production of low-lactose milk by ectopic expression of intestinal lactase in the mouse mammary gland

We have investigated, in mice, an in vivo method for producing low-lactose milk, based on the creation of transgenic animals carrying a hybrid gene in which the intestinal lactase-phlorizin hydrolase cDNA was placed under the control of the mammary-specific alpha-lactalbumin promoter. Transgenic females expressed lactase protein and activity during lactation at the apical side of mammary alveolar cells. Active lactase was also secreted into milk, anchored in the outer membrane of fat globules. Lactase synthesis in the mammary gland caused a significant decrease in milk lactose (50-85%) without obvious changes in fat and protein concentrations. Sucklings nourished with low-lactose milk developed normally. Hence, these data validate the use of transgenic animals expressing lactase in the mammary gland to produce low-lactose milk in vivo, and they demonstrate that the secretion of an intestinal digestive enzyme into milk can selectively modify its composition.     

Molecular diagnosis and frequencies of primary hypolactasia in populations of Russia and neighboring countries

Normally, the ability to digest milk sugar (lactose) is present in every child, but not in every adult. The decrease in lactase synthesis (hypolactasia) results in the inability to digest whole milk. Recent studies of the Finnish population have associated lactase persistence in adults with allele T of the C/T_?13910 polymorphism located upstream of the lactase gene; a 100% correlation of primary hypolactasia with genotype C/C has been proved. In this study, the allele and genotype frequencies of C/T_?13910 were determined in populations of Russia. The frequencies of genotype C/C, varying from 36.6% in Russians to 88.2% in Chukchi, were close to the published medical and epidemiological data on the hypolactasia frequencies in these populations. Genotyping was carried out by three different methods to determine the optimal one. Genotype C/C proved to be the key determinant of primary hypolactasia. It was assumed that DNA diagnosis of genotype C/C provides a predictive test to detect primary hypolactasia long before its clinical manifestation.     

Distribution of adult lactase phenotypes in the Tuareg of Niger.

The adult lactase phenotype, lactose absorber or malabsorber, was determined using the lactose tolerance test with breath hydrogen assay in a group of Tuareg, a traditionally nomadic pastoralist population in the central Sahara. Out of a total of 118 subjects, 103 (87.3%) were lactose absorbers and 15 (12.7%) lactose malabsorbers. The frequency of the "lactase suppression gene" in this population sample was .357 (SD .043). The low frequency of lactase suppression in the Tuareg supports the hypothesis of natural selection in favor of the "lactase persistence gene" in milk-dependent nomadic pastoralist.     

Molecular diagnosis and frequencies of primary hypolactasia in populations of RUSSIA and neighboring countries

The digestion of the milk sugar (lactose) is observed every normal child but not in every adult. The decreased lactase synthesis in some adults results in problems with digestion of the whole milk (primary hypolactasy). An association of lactase activity in adults with carrying of the allele T within the polymorphism C/T-13910 located upstream of the lactase gene and 100% association of hypolactasy with the genotype C/C has recently been shown for a Finnish sample. In the present work we determined the LCT* C/T_13910 genotypes and allele frequencies in populations from Russia. The genotype C/C frequencies varied from 36.6% for Russians to 88.2% for Chukchi and were close to the published medical and epidemiological data on hypolactasy frequencies in respective populations. Genotyping was performed by three different methods to identify the optimal one. Our results have shown that the studied locus is the key determinant for the primary hypolactasy development in various human populations. Consequently, the DNA diagnostics of the C/C genotype carrying is a promising predictive test to detect the primary hypolactasy long before its clinical development. Practical application of this type of diagnostics would be a step towards the individual-oriented medicine.     

Persistence of high intestinal lactase activity (lactose tolerance) in Afghanistan

Summary Two hundred and seventy apparently healthy adult subjects from Afghanistan, mainly from the central and eastern parts of the country, were subjected to a lactose tolerance test. The change of blood glucose from the fasting concentration at 20 min after the administration of lactose showed a bimodal distribution. Forty-seven subjects had a rise of blood glucose concentration of more than 1.1 mmol/l and were classified as persistence of high intestinal lactase activity (PHILA), a term which lays emphasis on the fact that high lactase activity in the adult is an unusual state whose prevalence in some populations requires explanation. In the Afghan sample there were no significant differences of the frequency of PHILA in different ethnic groups.Support by Stiftung Volkswagenwerk, Hannover.     

Distribution of human adult lactase phenotypes in the population of Austria

Summary A total of 528 unrelated, apparently healthy, adult and adolescent Austrians (270 females, 258 males, mean age 22.1 years) were examined for lactose absorption capacity employing a noninvasive field test based on breath hydrogen (H₂) determination. Subjects exhibiting a change of breath hydrogen concentration of less than 15 volumes per million (vpm) after a load of 50 g lactose (n=422) were classified as lactorse absorbers, 106 probands (20.1%) showing increases of breath hydrogen concentration between 16 and 111 vpm were diagnosed as lactose malabsorbers. The distribution of the lactase phenotypes was independent of age and sex. Intolerance symptoms after lactose administration were significantly more frequent in lactose malabsorbers. Grouping of probands according to the birth-places of their grandparents revealed significant differences in the distribution of the lactase phenotypes in East and West Austria (East 25%, West 15% lactose malabsorbers). These differences are discussed in the light of the population history of these regions.     

Lactose intolerance in captive nocturnal prosimians (Perodicticus potto): A twenty-one year record

A colony of pottos was captured in December 1959 and brought to the United States. At that time part of their diet consisted of a high protein porridge made with whole milk. In addition, their drinking water contained an antibiotic to protect them from possible infection resulting from the change in habitat. No intestinal incontinence resulted from this treatment. Antibiotic addition to the diet ceased in 1961. In 1971 the remaining pair of animals developed a calcium deficiency. This was alleviated by adding 5 g calcium lactate to the drinking water and serving whole milk every other day. In 1977 the male developed acute lactose intolerance. His feces became bacteriologically sterile. His mate, who died on January 9, 1979, produced feces containing enteric organisms throughout her life. A large number of dairy products were served the animals in the attempt to alleviate this problem. Acidophilus milk or tinned 2% milkfat containing milk with 100% of the lactose hydrolyzed, produced no intestinal incontinence in the animal. It is suggested that sterile stools resulted from a fungal infection that killed theEscherichia coli. In addition it is proposed that non-pathogenic bacteria brought about an alteration of the brush border of the columnar epithelial cells of the villi which synthesize the enzyme lactase, such that lactase production was seriously reduced.     

A proposed mechanism of normal intestinal lactase decline in the postweaned mammal

Intestinal lactase declines to low levels in the postweaned mammal as an adaptation to normal termination of lactose ingestion. Although a well known phenomenon and presumably the basis of milk intolerance among most human adults, the mechanism of this decline has remained obscure. Evidence is presented to support a proposal that temporally related cytokinetic changes, which effect a generally corresponding reduction in enterocyte life-span, serve as the causal basis of lactase decline in the postweaned mammal.