Acta Scientific Nutritional Health 8.11 (2024): 39-40.
[breadcrumb]
PUBLICACION PARA MÉDICOS u OTROS PROVEEDORES DE SALUD, como NUTRICIONISTAS, ENTERMERAS/OS, BIÓLOGOS.....Transcripción del artículo aceptado y publicado en el Acta Scientific Nutritional Health 8.11 (2024): 39-40.
Acta Scientific NUTRITIONAL HEALTH (ISSN:2582-1423) Volume 8 Issue 11 November 2024:
Review Article Physiological Lactose Tolerance Test RC Tormo*, SM Lagar and MA Falgás Unit of Gastroenterology and Nutrition, Via Augusta, 158, 4, 08006 Barcelona, Spain *Corresponding Author: RC Tormo, Unit of Gastroenterology and Nutrition, Via Augusta, 158, 4, 08006 Barcelona, Spain. DOI: 10.31080/ASNH.2024.08.1454 Abstract Received: September 25, 2024 Published: October 26, 2024 © All rights are reserved by RC Tormo., et al.
This study evaluates a more accurate method for assessing lactose intolerance by comparing traditional lactose breath tests with a new physiological approach using whole milk.
Traditional tests, based on hydrogen (H₂) and methane (CH₄) levels in exhaled breath after ingesting powdered lactose, often yield inaccurate results due to factors like gastric emptying and intestinal transit time, which distort lactase activity assessments. Involving 20 children (ages 5–11), the study shows that using whole milk provides a more reliable correlation between clinical symptoms and test results, avoiding the inaccuracies associated with powdered lactose. Keywords: Lactose Intolerance; Physiological Tolerance Test; Hydrogen Breath Test; Methane Breath Test; Whole Milk; Gastrointestinal Disorders
Summary To assess the degree of lactose tolerance, the measurement of hydrogen (H₂), methane (CH₄), and CO₂ in exhaled breath after lac tose administration is commonly used. However, the test proposed by Ali Rezaie et al. (Guidelines: Hydrogen and MethaneBased Breath Testing in Gastrointestinal Disorders: The North American Consensus, Ali Rezaie, MD, MSc, FRCP) [1] does not accurately reflect the true nature of lactose intolerance. The results of lactose digestion based on H₂ and CH₄ levels in breath do not depend solely on intestinal lactase activ ity, but are instead influenced by gastric emptying and intestinal transit time. The administration of powdered lactose dissolved in water (1 or 2 g/kg body weight) induces accelerated gastric emptying and an abnormal secretion pattern of gastrointestinal hormones, such as motilin, pancreatic polypeptide, somatostatin, and cholecysto kinin [2-4], as well as a decrease in glucagon-like peptide (GLP-1) secretion, which occurs after consuming fat-containing milk. This slower gastric emptying, which is not observed when lactose is administered in water [5], justifies the different results. This hor monal interplay [2-4] is responsible for rapid gastric emptying and increased intestinal transit speed, leading to distorted results due to undigested lactose reaching the colon, a phenomenon indepen dent of lactase activity at the brush border of the small intestine. As a result, the hydrogen and methane produced in large quan tities in the colon and partially exhaled reflect a temporary state, influenced by various factors, especially the fat content, but also the salt, protein, and carbohydrate content of the test milk, as well as previous diet, which may vary from day to day. These results, therefore, do not directly reflect lactase activity.
We propose a more physiological lactose tolerance test by ad ministering a glass of cow’s milk, or milk from another mammal, containing fats, proteins, and carbohydrates. The dietary fat in duces the secretion of GLP-1 receptor agonists, resulting in delayed gastric emptying [5] and improved lactose digestion.
Materials and Methods In a group of 20 children and adolescents, aged between 5 and 11 years, and weighing between 18 and 42 kg, 2 grams of lactose per kilogram of body weight, dissolved in water, were administered. Exhaled breath samples were collected at 3, 4, 5, and 6 hours after administration. Hydrogen, methane (ppm), and CO₂ were measured (Quintron, BreathTracker, Milwaukee, USA), and unpleasant symptoms following the lactose overload were recorded. Four weeks later, the same group was given a 200 ml glass of whole cow's milk, containing 9 grams of lactose. Exhaled breath samples were collected and analyzed as done previously with powdered lactose. Post-overload symptoms and clinical correlation were noted.
Results The mean hydrogen and methane levels, corrected for CO₂, af ter the intake of powdered lactose dissolved in water were: mean 39.8, standard deviation (st. dev.) 7.84, n = 20. Fourteen children subsequently developed severe abdominal pain and diarrhea, showing a poor acceptance of the large amount of lactose. The mean hydrogen and methane levels, corrected for CO₂, after consuming a 200 ml glass of cow’s milk with 9 grams of lactose were: mean 4.10, st. dev. 1.44, n = 20. The difference between both re sults was significant (p < 0.05). None of the children experienced symptoms, showing a good correlation between clinical symptoms and test results.
Conclusions It is preferable to perform the physiological lactose intolerance test by administering a 200 ml glass of milk. This method significantly reduces the number of positive test results, and none of the children and adolescents studied experienced subsequent issues. A strong correlation between clinical symptoms and test results
Bibliography 1. 2. 3. 4. 5. Rezaie A., et al. “Guidelines: Hydrogen and Methane-Ba sed Breath Testing in Gastrointestinal Disorders: The North American Consensus”. The American Journal of Gastroentero logy 112.5 (2017): 775-784.
2.- Boyd KA., et al. “High-fat diet effects on gut motility, hormone, and appetite responses to duodenal lipid in healthy men”. American Journal of Physiology-Gastrointestinal and Liver Physiology 285 (2003): G188-G196.
3.- French SJ., et al. “Adaptation to high-fat diets: effects on eating behaviour and plasma cholecystokinin”. British Journal of Nutrition 73 (1995): 179-189.
4.- Spannagel AW., et al. “Adaptation to fat markedly increases pancreatic secretory response to intraduodenal fat in rats”. American Journal of Physiology-Gastrointestinal and Liver Physiology, 270 (1996): G128-G135.
5.- Mark L van Zuylen., et al. “Perioperative management of long acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying and pulmonary aspi ration”. British Journal of Anaesthesia 132.4 (2024): 644-648.
Citation: RC Tormo., et al. “Physiological Lactose Tolerance Test". Acta Scientific Nutritional Health 8.11 (2024): 39-40.
Acta Scientific NUTRITIONAL HEALTH (ISSN:2582-1423) Volume 8 Issue 11 November 2024:
Review Article Physiological Lactose Tolerance Test RC Tormo*, SM Lagar and MA Falgás Unit of Gastroenterology and Nutrition, Via Augusta, 158, 4, 08006 Barcelona, Spain *Corresponding Author: RC Tormo, Unit of Gastroenterology and Nutrition, Via Augusta, 158, 4, 08006 Barcelona, Spain. DOI: 10.31080/ASNH.2024.08.1454 Abstract Received: September 25, 2024 Published: October 26, 2024 © All rights are reserved by RC Tormo., et al.
This study evaluates a more accurate method for assessing lactose intolerance by comparing traditional lactose breath tests with a new physiological approach using whole milk.
Traditional tests, based on hydrogen (H₂) and methane (CH₄) levels in exhaled breath after ingesting powdered lactose, often yield inaccurate results due to factors like gastric emptying and intestinal transit time, which distort lactase activity assessments. Involving 20 children (ages 5–11), the study shows that using whole milk provides a more reliable correlation between clinical symptoms and test results, avoiding the inaccuracies associated with powdered lactose. Keywords: Lactose Intolerance; Physiological Tolerance Test; Hydrogen Breath Test; Methane Breath Test; Whole Milk; Gastrointestinal Disorders
Summary To assess the degree of lactose tolerance, the measurement of hydrogen (H₂), methane (CH₄), and CO₂ in exhaled breath after lac tose administration is commonly used. However, the test proposed by Ali Rezaie et al. (Guidelines: Hydrogen and MethaneBased Breath Testing in Gastrointestinal Disorders: The North American Consensus, Ali Rezaie, MD, MSc, FRCP) [1] does not accurately reflect the true nature of lactose intolerance. The results of lactose digestion based on H₂ and CH₄ levels in breath do not depend solely on intestinal lactase activ ity, but are instead influenced by gastric emptying and intestinal transit time. The administration of powdered lactose dissolved in water (1 or 2 g/kg body weight) induces accelerated gastric emptying and an abnormal secretion pattern of gastrointestinal hormones, such as motilin, pancreatic polypeptide, somatostatin, and cholecysto kinin [2-4], as well as a decrease in glucagon-like peptide (GLP-1) secretion, which occurs after consuming fat-containing milk. This slower gastric emptying, which is not observed when lactose is administered in water [5], justifies the different results. This hor monal interplay [2-4] is responsible for rapid gastric emptying and increased intestinal transit speed, leading to distorted results due to undigested lactose reaching the colon, a phenomenon indepen dent of lactase activity at the brush border of the small intestine. As a result, the hydrogen and methane produced in large quan tities in the colon and partially exhaled reflect a temporary state, influenced by various factors, especially the fat content, but also the salt, protein, and carbohydrate content of the test milk, as well as previous diet, which may vary from day to day. These results, therefore, do not directly reflect lactase activity.
We propose a more physiological lactose tolerance test by ad ministering a glass of cow’s milk, or milk from another mammal, containing fats, proteins, and carbohydrates. The dietary fat in duces the secretion of GLP-1 receptor agonists, resulting in delayed gastric emptying [5] and improved lactose digestion.
Materials and Methods In a group of 20 children and adolescents, aged between 5 and 11 years, and weighing between 18 and 42 kg, 2 grams of lactose per kilogram of body weight, dissolved in water, were administered. Exhaled breath samples were collected at 3, 4, 5, and 6 hours after administration. Hydrogen, methane (ppm), and CO₂ were measured (Quintron, BreathTracker, Milwaukee, USA), and unpleasant symptoms following the lactose overload were recorded. Four weeks later, the same group was given a 200 ml glass of whole cow's milk, containing 9 grams of lactose. Exhaled breath samples were collected and analyzed as done previously with powdered lactose. Post-overload symptoms and clinical correlation were noted.
Results The mean hydrogen and methane levels, corrected for CO₂, af ter the intake of powdered lactose dissolved in water were: mean 39.8, standard deviation (st. dev.) 7.84, n = 20. Fourteen children subsequently developed severe abdominal pain and diarrhea, showing a poor acceptance of the large amount of lactose. The mean hydrogen and methane levels, corrected for CO₂, after consuming a 200 ml glass of cow’s milk with 9 grams of lactose were: mean 4.10, st. dev. 1.44, n = 20. The difference between both re sults was significant (p < 0.05). None of the children experienced symptoms, showing a good correlation between clinical symptoms and test results.
Conclusions It is preferable to perform the physiological lactose intolerance test by administering a 200 ml glass of milk. This method significantly reduces the number of positive test results, and none of the children and adolescents studied experienced subsequent issues. A strong correlation between clinical symptoms and test results
Bibliography 1. 2. 3. 4. 5. Rezaie A., et al. “Guidelines: Hydrogen and Methane-Ba sed Breath Testing in Gastrointestinal Disorders: The North American Consensus”. The American Journal of Gastroentero logy 112.5 (2017): 775-784.
2.- Boyd KA., et al. “High-fat diet effects on gut motility, hormone, and appetite responses to duodenal lipid in healthy men”. American Journal of Physiology-Gastrointestinal and Liver Physiology 285 (2003): G188-G196.
3.- French SJ., et al. “Adaptation to high-fat diets: effects on eating behaviour and plasma cholecystokinin”. British Journal of Nutrition 73 (1995): 179-189.
4.- Spannagel AW., et al. “Adaptation to fat markedly increases pancreatic secretory response to intraduodenal fat in rats”. American Journal of Physiology-Gastrointestinal and Liver Physiology, 270 (1996): G128-G135.
5.- Mark L van Zuylen., et al. “Perioperative management of long acting glucagon-like peptide-1 (GLP-1) receptor agonists: concerns for delayed gastric emptying and pulmonary aspi ration”. British Journal of Anaesthesia 132.4 (2024): 644-648.
Citation: RC Tormo., et al. “Physiological Lactose Tolerance Test". Acta Scientific Nutritional Health 8.11 (2024): 39-40.
