Inverse Dose Effect of Pretest Dietary Lactose Intake on Breath Hydrogen Results and Symptoms in Lactase Nonpersistent Subjects

Abstract

The aim of this study was to determine a relationship between pretest intake of lactose and outcome of lactose breath hydrogen test. Patients presented at a testing laboratory participated in the study. A 3-hour breath hydrogen, 50-g lactose challenge was carried out. Results were tabulated and patients completed a 3-day recall diet questionnaire. Daily lactose intake was independently calculated and was associated with breath hydrogen and total symptom score. Statistical analysis used Spearman's correlation, Mann-Whitney U-test and chi2 or Fisher exact test. Of 118 patients, 50% were lactose maldigesters. In these patients, measured breath hydrogen and symptom scores were significantly higher in the lowest intake group (< 5 g/d) than in the highest intake group (> 20 g/d) (P < .05). In the presumed lactose digesters, 59% experienced some symptoms during testing for unclear reasons. Pretest dietary intake of lactose inversely affects results of breath hydrogen.

Fructose Malabsorption May Be Gender Dependent and Fails to Show Compensation by Colonic Adaptation

“…Total symptom scores ( 3hTSS) in group 1 were higher than in group 4 but the difference was not statistically significant ( p = 0.187). An ad hoc comparison of participants from pattern group 4 of our previous lactose study [26] with those included in this group revealed that only 9 (30%) were classified here from both studies (data not shown). Overall, women complained significantly more of symptoms than men (40/61 vs. 12/29, p = 0.04).…”

“…Many of these subjects were included in a similar study with a 50-g lactose challenge test. Those tests were performed one to four weeks apart from the current challenge and analyzed independently partly because of the different dose of sugar used [26]. In a manner similar to the results of the lactose challenge, we grouped breath hydrogen and symptom scores into four categories as outlined in Table 1.…”

“…An apparent oral cecal transit time (AOCTT) was estimated based on the first time interval and sustained increase when breath hydrogen reached 10 ppm above the baseline [26,36]. This estimate is based on the notion that fructose shortens transit time and therefore is not a true reflection of unstimulated OCTT.…”

“…In fact, this adaptation to lactose may be demonstrated to be dose dependent [26]. Although we originally thought that clinical adaptation to a prebiotic is an important attribute to tolerating ingestion of a beneficial substance, this is clearly not the case.…”

Adult Lactose Digestion Status and Effects on Disease

“…Patients with IBS generally do not experience a higher frequency of lactose maldigestion than the background population (27). The frequency of lactose intolerance, although most likely worse in lactose maldigestion individuals, is seen almost as frequently in LP populations (27,28). These observations have led to a more recent concept of lactose sensitivity.…”