Effects of Prebiotic and Probiotic Supplementation on Lactase Deficiency and Lactose Intolerance: A Systematic Review of Controlled Trials

Abstract

Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of which is impaired due to a deficiency in the lactase enzyme. These clinical signs can be modified by several factors, including lactose dose, residual lactase expression, concurrent ingestion of other dietary components, gut-transit time, and enteric microbiome composition. In many of individuals with lactose malabsorption, clinical signs may be absent after consumption of normal amounts of milk or, in particular, dairy products (yogurt and cheese), which contain lactose partially digested by live bacteria. The intestinal microbiota can be modulated by biotic supplementation, which may alleviate the signs and symptoms of LI. This systematic review summarizes the available evidence on the influence of prebiotics and probiotics on lactase deficiency and LI. The literature search was conducted using the MEDLINE (via PUBMED) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included randomized controlled trials. For each study selected, the risk of bias was assessed following the Cochrane Collaboration methodology. Our findings showed varying degrees of efficacy but an overall positive relationship between probiotics and LI in relation to specific strains and concentrations. Limitations regarding the wide heterogeneity between the studies included in this review should be taken into account. Only one study examined the benefits of prebiotic supplementation and LI. So further clinical trials are needed in order to gather more evidence.

Genetics of Lactose Intolerance: An Updated Review and Online Interactive World Maps of Phenotype and Genotype Frequencies

“…Based on the fact that intestinal microbiota can be modulated by supplementation, many studies have tried to induce a "healthy" microbiota in LNP subjects, in order to alleviate the signs and symptoms of lactose intolerance. As a result, a positive relationship has been found between probiotics and lactose intolerance, in relation to specific strains and concentrations [105]. Taking all this into consideration, diet-induced particularities in human microbiota could be an additional explanation for those discrepancies encountered in LP/LNP phenotypes and discussed in the present review.…”

“…Another aspect of special relevance for the understanding of lactase phenotypes is the human microbiota, which has been described to elicit a direct influence on the appearance, or amelioration, of lactose intolerance clinical symptoms [104,105]. This relationship results from the ability of human colonic microbiota (the sum of all microorganisms present in the colon) and their genes (intestinal microbiome) to ferment undigested lactose.…”

Clinical Utility of LCT Genotyping in Children with Suspected Functional Gastrointestinal Disorder

“…Another aspect that can influence symptoms is the microbiota, as higher levels of Bifidobacterium species have been reported in CC versus TT or CT genotypes in European populations, a difference explained by the greater abundance of lactose available for bacterial fermentation in CC individuals due to lactose malabsorption [ 43 ]. Furthermore, probiotic supplementation in lactose-intolerant individuals has beneficial effects on HBT results and on symptoms of lactose intolerance [ 44 ].…”

Changes of intestinal microflora in neonatal necrotizing enterocolitis: a single-center study

“…5 Interestingly, studies have revealed that the use of intestinal probiotics can significantly reduce the incidence of neonatal NEC and severity of NEC, shorten the duration of the disease, and effectively reduce its mortality. 2,6 Thus, it is widely believed that the gastrointestinal flora and anomalous colonization of pathogenic bacteria are closely related to the incidence of NEC. 7 In recent years, it has been widely agreed that the diversity and dynamics of the intestinal microflora are altered in neonatal NEC, which is consistent with our research.…”