Abstracts
Lactose Sensitive
Lactose Intolerance
The result of a deficiency in intestinal lactase, lactose intolerance affects 50 million Americans, most of whom are African-American, Asian, Hispanic, Native American, or of southern European descent. Undigested lactose can lead to abdominal cramps, bloating, borborygmi, increased flatulence, and other symptoms. Eliminating lactose-containing foods or supplementing the diet with lactose-digestive aids can help this condition. Milk substitutes can be used along with lactase supplements. Calcium and vitamin D may also be important for the lactase-deficient individual. Diagnosis of lactose intolerance includes a diet/symptom diary, hydrogen breath test, intestinal brush border biopsy, stool test for pH and sugars, and a lactose tolerance test.
Griffith, Ceabert J., PA-C: Lactose Intolerance, Physician Assistant, November 1997;56-62.
African Americans
African Americans
Lactose-maldigesting (# 25) and lactose-intolerant African Americans, ranging in "age" from 13 to 39 y, were given gradually increasing amounts of lactose in milk over a "period" of time until the maximum lactose dose tolerated was determined.
Suggests that the majority of African-American young adults who claim intolerance to moderate amounts of milk can ultimately adapt and tolerate > or = 12 g lactose in milk (the equivalent of 8 oz of full-lactose milk) with minimal or no "discomfort" if milk is ingested in gradually increasing amounts. The mechanism of adaptation is assumed to be an increased tolerance to colonic lactose-fermentation products.
Johnson-AO et al: Adaptation of lactose maldigesters to continued milk intakes. Am-J-Clin-Nutr. 1993 Dec; 58(6): 879-81
Colonic Adaptation
Colonic Adaptation
To determine the effect of daily lactose feeding on colonic adaptation and intolerance symptoms.
There was no difference in the mean severity of the reported symptoms between the test milks and the lactose-free milk in the group of lactose maldigesters, of whom one-third did not experience any symptoms from any of the test doses.
The same proportion (64%) of the maldigesters experienced symptoms after both the lactose-free milk and the milk with 7 g lactose. However, the symptoms occurred inconsistently with the different test doses in 59% of the maldigesters.
The "gastrointestinal" symptoms in most lactose maldigesters are not induced by lactose when small amounts (0.5-7.0 g) of lactose are included in the diet.
Hertzler-SR & Savaiano-DA: Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am. J. Clin. Nutr. 1996 Aug; 64(2): 232-6.
Diarrhea & Lactose Intolerance
Diarrhea
Lactose intolerance is frequently encountered in children with persistent diarrhoea (PD). Selection of an appropriate milk-based formulation is a major management problem in the developing world.
Evaluated the role of feeding a traditional rice-lentil (khitchri) diet alone (KY) or in combination with either soy formula (KY-Soy) a dilute buffalo milk (KY-B), in children (age 6 months-3 years) with PD.
While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children.
Bhutta ZA et al., Lactose intolerance in persistent diarrhoea during childhood: the role of a traditional rice-lentil (Khitchri) and yogurt diet in nutritional management. JPMA J Pak Med Assoc, 1997 Jan, 47:1, 20-4.
Digestive Aids
Digestive Aids
Microbial-derived "beta-galactosidase" (beta-gal) "enzyme" preparations improve in vivo lactose digestion and tolerance through enhanced gastrointestinal digestion of lactose. Three different beta-gal preparations, Lactogest (soft gel capsule), Lactaid (caplet), and DairyEase (chewable tablet) and placebo were fed to lactose maldigesters with either 20 g or 50 g of lactose to compare the efficacy of these products and to further establish a dose-response relationship for use.
All enzyme preparations dramatically reduced both the peak and total breath hydrogen production when fed with milk containing 20 g of lactose.
Symptoms were significantly less severe with all the beta-gal products. Furthermore, symptom scores for bloating, "cramping", "nausea", pain, diarrhea, and flatus were not different between treatments and the control.
The 50-g lactose dose appeared to overwhelm the ability of either 3,000 or 6,000 IU of beta-gal to assist significantly with lactose digestion.
Results demonstrate the relative equivalency of chewable, caplet, and soft-gel beta-gal products, based on IUs of enzyme fed.
Lin-MY et al: Comparative effects of exogenous "lactase (beta-galactosidase)" preparations on in vivo lactose digestion. Dig-Dis-Sci. 1993 Nov; 38(11): 2022-7.
Egyptian Ethnic Groups
Egyptian Ethnic Groups
The study consisted of 172 subjects belonging to ethnic groups from Sinai in the Eastern Desert and the New Valley in the Western Desert (mean ages of 36.7).
Lactose absorption was assessed by measurement of urinary "galactose" in pooled 2-hr urine samples following ingestion of an oral lactose dose of 40 g.
The proportion of lactose malabsorbers was 11.1% in Sinai and 51.0% in the New Valley.
Hussein-L; Ezzilarab-A: The frequency distribution of lactose malabsorption among adult populations from the eastern and western Egyptian deserts. Biochem-Genet. 1994 Oct; 32(9-10): 331-42.
L-Acidophilus
L-Acidophilus
Investigated the influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus on in vivo digestion of lactose.
Lactose malabsorption was evaluated by measuring breath H2 excretion off 11 lactose maldigesting subjects following ingestion of four acidophilus test milks
Acidophilus milk containing L. acidophilus N1 was the most effective of the 4 acidophilus milks in improving lactose digestion and tolerance.
Bile and acid tolerance may be important factors to consider when L. acidophilus strains are selected for improving lactose digestion and tolerance.
Mustapha A et al., Improvement of lactose digestion by humans following ingestion of unfermented acidophilus milk: influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus. J Dairy Sci, 1997 Aug, 80:8, 1537-45.
Lactose Malabsorption (1) [Italy)
Lactose Malabsorption (1) [Italy]
Lactose malabsorption may induce abdominal symptoms indistinguishable from those of the irritable bowel syndrome (IBS), however the exact relationship between the two conditions and the optimal differential diagnostic workup are still to be defined.
Lactose malabsorption was diagnosed in 68% of the patient group.
A test for diagnosing lactose malabsorption should always be included in the diagnostic workup for IBS and a long-term lactose-free regimen recommended if the test is positive.
Vernia P et al., Lactose malabsorption and irritable bowel syndrome. Effect of a long-term lactose-free diet. Ital J Gastroenterol, 1995 Apr, 27:3, 117-21.
Lactose Malabsorption (2) Netherlands
Lactose Malabsorption (2) [Netherlands]
The prevalence of lactose malabsorption (LM) in the Caucasian population of northern Europe is estimated to be low. Irritable bowel syndrome (IBS) is a very common diagnosis, and its symptoms are nearly identical to those of LM.
LM was detected in 17 out of 70 (24%) IBS patients, in comparison with 2 out of 35 (5.7%) controls.
The mean symptom score of the LM positive group showed a marked decrease after 6 weeks of dietary therapy.
A substantial number of IBS patients showed a clinically unrecognized lactose malabsorption, which could not be discriminated by symptoms and dietary history, and which can be treated with a lactose-restricted diet. Therefore LM has to be excluded before the diagnosis IBS is made.
B”hmer CJ & Tuynman HA The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol, 1996 Oct, 8:10, 1013-6.
Maldigesters
Maldigesters
To test the hypothesis that complete elimination of lactose is not necessary to ensure tolerance by lactose maldigesters.
Hydrogen production after consumption of the 0- and 2-g lactose doses was not significantly different. Hydrogen production increased with the 6-g dose. Intensity of abdominal pain increased when the dose of lactose was 12 g. Episodes of flatulence did not increase until the dose reached 20 g. No significant differences in the occurrence of diarrhea were observed after the five treatments.
No significant increase in breath hydrogen production or intolerance symptoms occurred after consumption of a 2-g dose of lactose. Up to 6 g was tolerated, even though maldigestion could be measured at the 6-g dose. Thus, lactose maldigesters may be able to tolerate foods containing 6 g lactose or less per serving, such as hard "cheeses" and small servings (120 mL or less) of milk.
Hertzler-SR: How much lactose is low lactose? J-Am-Diet-Assoc. 1996 Mar; 96(3): 243-6.
Nutritional Management & LI
Nutritional Management
"Nutritional" management plays a vital role in many gastrointestinal problems commonly seen in primary care. "Irritable bowel syndrome", lactose intolerance, and celiac sprue are three problems that are best managed by dietary changes.
Spollett-GR: Nutritional management of common gastrointestinal problems Nurse-Practitioner-Forum. 1994 Mar; 5(1): 24-7. (19 ref)
Short-bowel Syndrome
Short-bowel Syndrome
Compared the tolerance of a diet providing 20 g/d lactose and a lactose-free diet in 14 patients with short-bowel syndrome.
A diet providing 20 g/d lactose with no more than 4 g/d as milk is well tolerated in the majority of patients with short-bowel syndrome, and that a lactose-free diet has usually no benefit in these subjects.
Marteau P et al., Do patients with short-bowel syndrome need a lactose-free diet? [see comments]. Nutrition, 1997 Jan, 13:1, 13-6.
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