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[Milk intolerance, lactose intolerance and lactase deficiency in partial resection of the stomach].

Of 40 patients with a partial gastrectomy (Billroth-II) 10 developed a milk intolerance and 11 had a lactase deficiency, the latter in 4 cases appearing together with a decrease in other disaccharidases. Only 2 of the 11 lactase-deficient patients complained of milk intolerance. The Ethanol lactose tolerance test (ELTT) was performed in 21 patients and was found to be abnormal in 6. Whereas cases of abnormal ELTT usually (4 of 6 cases) showed a lactase deficiency, only 2 patients with milk intolerance showed an abnormal ELTT and lactase deficiency. Milk intolerance can therefore only exceptionally be explained by lactase deficiency, and lack of lactase in the upper jejunum usually does not produce intolerance symptoms. Moreover, in comparable determinations from the afferent and efferent jejunal loop no differences in enzyme activities could be observed.

Adult

Lactose intolerance.

Lactose intolerance is a prevalent clinical problem. Low lactase levels result either from intestinal injury, or as in the majority of the world's adult population, from alterations in the genetic expression of lactase-phlorizin hydrolase. Progress is being made in the basic understanding of the molecular and cellular biology of this enzyme and of the scientific basis of clinical syndromes involving low lactase activity.

Animals

Reinvestigation of lactose intolerant children: lack of correlation between continuing lactose intolerance and small intestinal morphology, disaccharidase activity, and lactose tolerance tests.

Thirty children on a lactose-free diet aged from 2-38 months who had previously been diagnosed as having secondary lactose intolerance were reinvestigated on 32 occasions by an oral lactose tolerance test, small intestinal biopsy, and measurement of disaccharidase activity in order to detect the presence of continuing lactose intolerance before reintroduction of milk. No correlation was found between continuing lactose intolerance, as diagnosed by the development of watery stools containing excess reducing substances after an oral load of lactose, and maximum blood glucose rise during a lactose tolerance test, lactase levels, and small intestinal morphology.

Child, Preschool

Relationship of milk consumption to blood glucose rise in lactose intolerant individuals.

Lactose intolerant populations are heterogeneous with respect to their milk-drinking habits. A gradation of lactase activity in the intolerant population may result in sufficient lactose hydrolysis to obviate symptoms and lead to continued milk consumption. This paper reports on differences in maximum blood sugar rise in lactose intolerant children who are observed to consume or reject milk. Of the 89 black elementary school children, 48 (54 per cent) evidenced a flat lactose tolerance curve. Twenty-eight of these 48 children (58 per cent) were defined as nonmilk drinkers. The maximum blood sugar rise was 12.3 mg/100 in the 20 lactose malabsorbers who were defined as milk drinkers. It appears that some lactose malabsorbing children may have sufficient, albeit lower, levels of lactase to hydrolyze moderate amounts of milk.

Adolescent

The practical significance of lactose intolerance in children.

Lactose intolerance is observed in black and Mexican-American children by age 3 years, and it probably occurs in other non-northern European ethnic groups at a similar age. However, intolerance to the consumption of 250 ml of milk apparently is rarely seen in preadolescents. Current research on the response of adolescents to hydrolyzed lactose milk suggests that the symptoms observed in lactose-intolerant subjects after milk ingestion may be unrelated to lactose or may be mild enough to be of little practical significance. The effects of undigested lactose on nutrient absorption has received little attention, but preliminary data suggest that this is not a problem, except perhaps when overall intakes are marginally adequate.

Adolescent

Relative lactose intolerance. A clinical study of tube-fed patients.

A relative intolerance of lactose was demonstrated in 14 of 16 patients receiving nasogastric tube feedings following surgery for head or neck carcinoma. Two liquid diets differing only in the presence or absence of lactose, were administered for eight to 20 days per patient in a double-blind crossover study. Increased stool frequency, decreased stool consistency, and more frequent flatulence, borborygmi, and distention were found with the lactose diet, although classic lactose intolerance (plasma glucose rise of less than 26 mg/dl) was indicated in only two patients. Differences between amounts and times of peak rise following the glucose tolerance test and lactose tolerance test for each patient indicated the advisability of locating patients on a continuum of ability to hydrolyze lactose. The results indicate that lactose should be reduced or eliminated from tube-feeding diets to improve patient tolerance and comfort and to reduce diarrhea.

Aged

Beta-galactosidase tablets in the treatment of lactose intolerance in pediatrics.

Lactose-intolerant children manifest diminished or nonexistent intestinal lactase activity, resulting in flatulence, abdominal pain, and diarrhea. To assess the hydrolytic capability of lactase-containing tablets taken immediately before oral lactose challenge, we studied 18 children previously identified as being lactose intolerant and having no underlying organic gastrointestinal disease. Subjects had a mean (+/- SEM) age of 11.4 +/- 3.4 years; 72% were male. At time of the study, lactase-containing tablets or placebo tablets were ingested (double-blind) immediately before drinking a solution of lactose. Breath samples were obtained for hydrogen analysis at 30-minute intervals during a 2-hour period, and clinical symptoms were monitored. In lactose-intolerant patients, hydrogen production was significantly greater following placebo (maximum hydrogen excretion, approximately 60 ppm) compared with lactase-containing tablets (maximum hydrogen excretion, 7 ppm). Increased hydrogen production was associated with clinical symptoms including abdominal pain (89% of subjects following placebo ingestion), bloating (83%), diarrhea (61%), and flatulence (44%). These results indicate, therefore, that coingestion of lactose and lactase-containing tablets significantly reduces both breath hydrogen excretion and clinical symptoms associated with lactose intolerance.

Abdominal Pain

Intolerance of eight ounces of milk in healthy lactose-intolerant teen-agers.

The ability of lactose-intolerant individuals to tolerate 8 ounces of milk was determined in healthy teen-agers. Thirty-two blacks were studied with 50-gm lactose tolerance tests. Nineteen (59%) had a flat blood sugar curve and 13 (39%) also developed bloating, cramps, loose stools, or diarrhea with the test. These latter 13 were defined as lactose-intolerant. Seven of the 13 lactose-intolerant teen-agers (54%) developed abdominal bloating and/or cramps after drinking 8 ounces of milk (half-pint). None had diarrhea. Eight were symptomatic with the equivalent amount of lactose (12 gm) while only one had symptoms with the monosaccharide components of lactose, glucose and galactose. The symptoms with milk and 12 gm of lactose were less severe than with the 50-gm tolerance test. A history of a prior awareness of milk intolerance was obtained from 11 of the 13 lactose-intolerant subjects. At least one half of lactose intolerant teen-agers might be expected to be symptomatic after drinking 8 ounces of milk without other food. Milk intolerance should be considered in the nutritional planning for teen-agers with special attention to members of population groups with a high prevalence of lactose intolerance.

Adolescent

Cows' milk protein intolerance: a possible association with gastroenteritis, lactose intolerance, and IgA deficiency.

Twenty-five children with cows' milk protein intolerance were studied. Twenty had presented with an illness clinically indistinguishable from infantile gastroenteritis; an enteropathogenic Escherichia coli was isolated from the stools in two children, and in six another member of the family simultaneously developed acute diarrhoea and vomiting. Twenty-three children had lactose intolerance secondary to cows' milk protein intolerance. Eight out of 20 children were found to be partially IgA deficient. An acute attack of gastroenteritis, in damaging the small mucosa, may act as a triggering mechanism in cows' milk protein intolerance, and a deficiency in IgA may be a predisposing factor in so far as it allows the patient to become sensitised to foreign protein.

Animals

Relationship of lactose intolerance to milk intolerance in young children.

The prevalence of lactose intolerance as revealed by the standard lactose tolerance test was compared with the occurrence of intolerance to graded amounts of milk in 69 black and 30 white children. Of the black children studied, 11% of those 4 to 5 years old, 50% of those 6 to 7 years old, and 72% of those 8 to 9 years old were found to be lactose-intolerant, yet no child was intolerant to 240 ml of milk. Symptom responses to greater amounts of milk did not suggest that the frequency of primary lactose intolerance might be a reason for limiting existing milk programs for young children. No significant differences were found between the milk intakes of black lactose-tolerant and black lactose-intolerant children, nor between milk intakes of 6- and 7-year-old black and white children in Boston. However, 8- to 9-year-old black children drank significantly less milk than 8- to 9-year-old white children did. The blood glucose response at 0, 20, and 45 min after the ingestion of 2 g lactose/kg (maximum 50 g) was unreliable as an indicator of an individual's symptomatic response to lactose.

Age Factors

[Incidence of lactose intolerance in postmenopausal osteoporosis].

The incidence of lactose intolerance was determined in 31 women with idiopathic postmenopausal osteoporosis. Nine subjects exhibited a pathological rise in blood glucose (less than 20 mg/100 ml) after receiving 50 g lactose. The absorption of glucose and galactose, xylose, and fat was normal in the 31 patients. Daily intake of calcium was below the normal range in 3 subjects with and in 6 subjects without lactose intolerance. The association between lactase deficiency and osteoporosis is stressed.

Adult

[Lactose intolerance in adults (author's transl)].

A study on the lactose intolerance of adults was carried out through dietary survey, clinical data and tolerance tests. It was performed in 24 healthy persons, aged 19 to 39 years. Only one of the participants referred milk intolerance since childhood. Eleven of the 24 adults had signs of lactose intolerance through clinical symptoms and/or low increase of blood sugar after the load test. It was noteworthy that the majority of the intolerants were white people. It is discussed the practical importance of these lactose tolerance tests as an index of milk tolerance, considering the high recommended amount of lactose used in the tests.

Adult

Dietary treatment of lactose intolerance in infants and children.

During the past several years there have been many reports of alternative dietary therapies for primary and secondary lactose intolerance. We have learned that it is useful to feed through most episodes of mild diarrhea that previously would have been treated with clear liquid diets. Infant formulas, including both soy-protein and hydrolysate formulas with specially designed carbohydrate, protein, and fat components, are available to treat the infant with diarrheal syndromes and secondary lactase deficiency. Also, the diet can be supplemented with lactase. Specialized lactose-reduced products as well as cultured and fermented dairy products may be used in varying degrees for lactose-intolerant children. The ingestion of milk with food and fiber components in the diet has also been shown to improve symptoms of lactose intolerance. This review summarizes the essentials of diagnosis of and dietary therapy for lactose intolerance. Our findings indicate that a number of specialized formulas and products are available for successful dietary management of lactose intolerance in infants and children.

Child

Lactose intolerance among Mexican Americans.

Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.

Adolescent

[Lactose intolerance in chronic inflammatory bowel diseases].

In 124 patients with Crohn's disease (69 women, 55 men; mean age 33.7 [11-66] years) and 53 with ulcerative colitis (30 women, 23 men; mean age 36.2 [19-74] years) the incidence of lactose intolerance, as measured by the H2 breath test and blood sugar concentration, was determined prospectively. To exclude abnormal bacterial colonization of the small intestine or rapid small-intestine transit after partial resection of the small intestine as a cause of lactose intolerance, the oro-caecal transit time for lactulose (H2 breath test) was measured. While 21 of 124 patients with Crohn's disease (16.9%) had the expected incidence of lactose intolerance, this was present in only 2 of 53 patients with ulcerative colitis (3.8%; P < 0.05). The lactose intolerance was independent of the site of any inflammatory changes, disease activity and extent of small-intestine resection. Oro-caecal transit time for lactose was similar for all patients. There was no lactose intolerance in two patients with abnormal small-intestinal bacterial colonization.--Because of their considerable diagnostic and prognostic significance, tests for lactose intolerance should be performed routinely in all cases of Crohn's disease or ulcerative colitis.

Adolescent

Effect of a single dose of lactase on symptoms and expired hydrogen after lactose challenge in lactose-intolerant subjects.

The effect of a single dose or oral lactase on symptoms, breath hydrogen concentration, and glucose absorption in lactose-intolerant subjects challenged with lactose was studied. Volunteers underwent a lactose challenge test; those whose breath hydrogen concentrations increased 20 ppm or more and who met other criteria were admitted as subjects. After fasting, the subjects were given three chewable lactase tablets (total lactase dose, 9900 FCC units) or placebo tablets in a randomized, double-blind, crossover manner. The subjects also consumed 8 oz of whole milk in which 37.5 g of lactose powder was dissolved (total lactose content, 50 g). The washout period between lactose challenges was at least one week. Breath hydrogen and plasma glucose concentrations were measured before and at intervals after the challenges, and the subjects completed symptom-evaluation questionnaires every eight hours for four days. Twenty-four subjects completed the study. The maximum mean breath hydrogen concentration was significantly lower after lactase treatment than after placebo treatment. In 21 subjects, the area under the hydrogen concentration-time curve (AUC) was lower after lactase than after placebo; three subjects had hydrogen AUCs more than 300 ppm.hr lower. There were no significant differences in plasma glucose levels. Subjective ratings of the severity of abdominal cramping, belching, flatulence, and diarrhea were lower during the first eight hours after challenge in lactase-treated subjects; ratings for bloating were lower during the next eight hours. Single doses of a chewable lactase tablet reduced the concentration of expired hydrogen and symptoms of lactose intolerance after a lactose challenge.

Abdominal Muscles

Symptom response to lactose-reduced milk in lactose-intolerant adults.

The possible usefulness of low-lactose milk for those lactose-intolerant subjects who develop symptoms from milk consumption was investigated. In the first part of the study, 16 intolerant subjects (blood glucose rise less than 25 mg/100 ml) received low-lactose skim milk containing 15 g lactose (2.5 cups) and 7.5 g lactose (2.5 cups), regular skim milk containing 30 g lactose (2.5 cups), and all three milks plus a small breakfast. The low lactose milks produced significantly fewer symptoms. The food given with the milk had no significant effect on symptomatic response. The second group of 17 subjects received 25 g lactose in water (250 ml), skim milk (500 ml) and whole milk (500 ml); 10 g lactose in lactose-reduced skim (500 ml) and whole milk (500 ml) and whole milk (500 ml); and a placebo (250 ml). There was a significant positive relationship between amount of lactose consumed and symptom response. The form in which the lactose was administered (e.g., whole versus skim milk) was not significantly related to symptoms. It is concluded that in a symptomatic subjects a significantly greater quantity of low-lactose milk than regular milks can be consumed.

Adult