[Milk intolerance syndrome. Correlation between the clinical antecedents and the lactose, lactic acid and fecal pH curves].
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Allergies and food intolerance together comprise the manifestations of "adverse food reaction". The best known and most common are: allergy to cow's milk proteins (prevalence 0.5% to 7.5%), intolerance to lactose (prevalence after weaning 5 to 100%) and gluten intolerance (prevalence 0.5%). Treatment of these conditions is based on management of the diet by exclusion (or reduction) of the responsible food or antigen.
UNLABELLED: A small desktop electrochemical H2 analyzer (EC-60-Hydrogen monitor) was compared with a stationary electrochemical H2 monitor (GMI-exhaled Hydrogen monitor). RESULTS: The EC-60-H2 monitor shows a high degree of precision for repetitive (n = 10) measurements of standard hydrogen mixtures (CV 1-8%). The response time for completion of measurement is shorter than that of the GMI-exhaled H2 monitor (37 sec. vs 53 sec.; p < 0.0001), while reset times are almost identical (54 sec. vs 51 sec. n.s). In a clinical setting, breath H2-concentrations measured with the EC-60-H2 monitor and the GMI-exhaled H2 monitor were in excellent agreement with a linear correlation (Y = 1.12X + 1.022, r2 = 0.9617, n = 115). With increasing H2-concentrations the EC-60-H2 monitor required larger sample volumes for maintaining sufficient precision, and sample volumes greater than 200 ml were required with H2-concentrations > 30 ppm. CONCLUSION: For routine gastrointestinal function testing, the EC-60-H2 monitor is an satisfactory and reliable, easy to use and inexpensive desktop breath hydrogen analyzer, whereas in patients with difficulty in cooperating (children, people with severe pulmonary insufficiency), special care has to be applied to obtain sufficiently large breath samples.
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The addition of microbial beta-galactosidases directly to milk at mealtime represents a potential "enzyme replacement therapy" for primary lactase deficiency. We used the hydrogen breath test as the index of incomplete carbohydrate absorption to assess the efficacy of two enzymes--one from yeast, Kluyveromyces lactis (LactAid), and the other from the fungus Aspergillus niger (Lactase N)--to assist in the hydrolysis of 18 g of lactose in 360 ml (12 oz) of whole milk when consumed by an adult lactose malabsorber. Graded amounts of Lactase N produced, at best, a 53% relative reduction in breath hydrogen excretion, whereas quantitative elimination of excess hydrogen excretion was produced by 1 and 1.5 g of LactAid. A double-blind, controlled, crossover trial was subsequently performed in 50 healthy, unselected Mexican adults, to whom 360 ml of cow's milk was presented in the three forms in a randomized order: intact milk, prehydrolyzed milk, and milk to which 1 g of LactAid was added immediately before consumption. Among the 25 subjects with incomplete carbohydrate absorption with intact milk, adding enzyme 5-min before consumption produced a 62% reduction in breath hydrogen excretion, and symptoms of intolerance were significantly reduced. The feasibility of effective enzyme replacement therapy with a beta-galactosidase from K. lactis is demonstrated.
The postingestive reinforcing and satiating effects of intragastric (i.g.) infusions of 16% galactose, glucose, and fructose were compared in adult female rats. In Experiment 1, food-restricted rats were trained to drink (30 min/day) flavored solutions (the CS+Gal and CS+Glu) paired with intragastric (i.g.) infusions of galactose and glucose; other flavors (the CS-) were paired with IG water infusions. In subsequent choice tests, the rats strongly preferred (91%) the CS+Glu to the CS-, but avoided the CS+Gal (21%) in favor of the CS-. In Experiment 2, the rats were trained with a CS+Fru paired with i.g. fructose infusions and a CS- paired with i.g. water. In the choice test they consumed similar amounts of CS+Fru and CS- (CS+Fru preference = 51%). In other choice tests they preferred the CS+Glu (>80%) to CS+Fru and CS+Gal, and the CS+Fru (81%) to CS+Gal. Satiation tests were performed in Experiment 3 by adapting the rats to drink a 3% sugar + 0.2% saccharin solution paired with i.g. water infusions (30 min/day). On different test days 16% sugar instead of water was infused. IG galactose, glucose, and fructose produced comparable reductions in sugar+saccharin intake in the first test session. These findings demonstrate that, while the three sugars had similar satiating effects, they differed substantially in their postingestive flavor conditioning effects. The glucose and fructose results confirm prior data indicating that only glucose generates potent postingestive reinforcing stimuli. The galactose-induced flavor avoidance indicates that this sugar has a negative postingestive consequence. This may be due to the slow and incomplete hepatic metabolism of this sugar in adult rats. Conceivably, galactose intolerance may contribute to the lactose avoidance in adult animals.
We have studied a population of 60 children with acute diarrhea. In order to evaluate the benefit of lactose suppression from the diet on the clinical course of the disease, these children were randomly assigned to either the control group or the experimental group. No differences were found in respects to the duration of the illness (lactose containing formula 4.8 +/- 2 days vs lactose free formula 4.4 +/- 3.1 days). Similarly, body weight change did not change significantly (12.5 +/- 235.8 gr vs 55.9 +/- 238.0 gr, t-test non-significant). Children fed with the lactose free diet voided less frequently than did children in the control group (12.8 +/- 10.5 vs 19.8 +/- 9.5 times; p < 0.01). This difference disappeared when only invasive diarrheas were considered (26.6 +/- 12 vs 21.5 +/- 9.5 voidings; t-test nonsignificant). Finally, only 2 of the 32 cases fed with lactose containing formula showed clinical intolerance to lactose. Therefore, we conclude that in patients with mild-to-moderate acute diarrhea, the resumption of feeding should be undertaken with the same formula that they were previously fed, restricting the use of lactose free formulas to selected cases and to those children in whom a standard milk made symptoms reappear.
Observation of two sibling rhesus monkeys, Macaca mulatta, indicated that they were intolerant to lactose. While on a lactose formula the monkeys had severe diarrhea and weight loss but were otherwise healthy. When a lactose-free formula was instituted, the diarrhea abated and there was a steady weight gain.
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