Dietary and biological factors influencing lactose intolerance

Effect of lactose-free milk powder on lactose intolerance symptoms and nutritional status of pet dogs

The effects of standard cow, goat and lactose-free cow milk powder on lactose intolerance symptoms and the nutritional status of dogs was studied. Forty adult Springer Spaniels with lactose intolerance were randomly allocated into four groups with ten dogs each and fed one of the milk powders or water for 21 d. The milk powders were reconstituted daily by diluting 10 g milk powder to 60 g water and 2 g milk powder/kg body weight was provided ad libitum and refusals were monitored daily. Lactose intolerance was assessed by faecal composition and pH, water and lactose contents. Biochemical markers for nutritional status were analysed. Feeding intolerance and lactose in faecal samples were observed in dogs fed the standard cow and goat milk powder, but not for the lactose-free milk powder or control groups. The high- and low-density lipoprotein cholesterol increased in all milk powder groups, while there were no other differences in nutritional status measurement. The results suggested that feeding lactose-free milk powder to dogs with lactose intolerance reduced the occurrence of symptoms, thereby enhancing the health and wellbeing of dogs.

The Association of Lactose Intolerance With Colon and Gastric Cancers: Friend or Foe?

Background: Lactose intolerance (LI) appears usually in later ages when the lactase enzyme becomes deficient or absent in the small intestine. Conflicting results have been reported in the literature about the association of lactose intolerance with various gastrointestinal malignancies. Hence, our aim was to study the association between LI, colon cancer (CCa), and gastric cancer (GC) using a large database. Methods: A cross-sectional study was performed using the National Inpatient Sample (NIS) database between 2004 and 2014. We identified adult patients (18-90 years) who were diagnosed with LI (study group) using appropriate International Classification of Diseases, Ninth Revision (ICD-9) codes. The control group comprised patients who did not have a diagnosis of LI. We identified the diagnosis of CCa and GC in both study and control groups using the ICD-9 codes. Univariable and multivariable logistic regression analyses were performed to assess the association between LI, CCa, and GC. Results: The total population comprised 71,360,501 patients, of which 57,909 (0.08%) were diagnosed with LI. LI patients were older (62 vs 51 years) with more females (61.5% vs 60.1%) and less African American patients (11.8% vs 14.3%) (p <0.0001 for all). In addition, LI patients had more smoking (12.4% vs 12%) and obesity (15% vs 8.9%). On the other hand, patients in the LI group had less alcohol use (3.8% vs 4.2%) (p <0.0001). After adjusting for the age, gender, race, smoking, alcohol, obesity, and inflammatory bowel disease, the LI group had a slightly lower rate of CCa (OR 0 .974, 95%CI 0.906-1.048, p = 0.486) and a lower rate of GC (OR: 0.993, 95%CI 0.924-1.068, p =0.853); however, the results were not statistically significant. Conclusion: Patients with lactose intolerance may have a lower risk of colon and gastric cancer. However, these findings were not statistically significant. Further studies are needed to understand this association.

The Effect of Salt Reduction and Partial Substitution of NaCl by KCl on Physicochemical, Microbiological, and Sensorial Characteristics and Consumers' Acceptability of Semi-Hard and Hard Lactose-Free Cow's Milk Cheeses

Increasing consumer demand for healthier foods prompts the development of cheeses reduced in salt. The aim of his study was to assess the effect of reducing the level of sodium chloride (NaCl) and their partial substitution by potassium chloride (KCl) on the biochemical, microbiological, and sensorial characteristics and consumer's acceptability of semi-hard and hard lactose-free cow's milk cheeses. To improve the possible lower salty taste or the development of bitter taste, the addition to yeast extract, as a flavor enhancer, was also checked. Different brining times and brine conditions were tested to obtain a reduction of >25% of salt with respect to conventional cheese. Reduced-salt cheeses were elaborated by reducing half the salting time used in conventional cheeses, and a ratio of 60 Na⁺:40 K⁺ was used to reduce Na concentration in substituted cheeses. The results obtained in this study show that the reduction of salt by both methods in semi-hard and hard lactose-free cheeses could be an alternative for the production of healthier and sensorial acceptable cheeses, without significantly affecting their physicochemical characteristics. The addition of yeast extract, as a flavor enhancer, increased the free amino acids (FAAs) levels but decreased the acceptability of cheeses.

Blinded Oral Challenges with Lactose and Placebo Accurately Diagnose Lactose Intolerance: A Real-Life Study

Lactose intolerance (LI) is characterized by diarrhea, abdominal pain, or bloating occurring after lactose consumption in patients with lactose malabsorption. The National Institute of Health (NIH) proposed a double-blind placebo testing to identify LI individuals correctly. However, until now, no study used this approach in a real-life setting. We aimed to assess double-blind placebo challenge accuracy in diagnosing LI in patients with self-reported symptoms of LI. 148 patients with self-reported LI were consecutively enrolled and blindly underwent hydrogen breath test (HBT) after 25 g lactose or 1 g glucose (placebo) load. One week later, the subjects were challenged with the alternative substrate. Each subject completed a validated questionnaire, including five symptoms (diarrhea, abdominal pain, vomiting, bowel sounds, and bloating) scored on a 10-cm visual analog scale. Home questionnaire (HQ) referred to symptoms associated with the consumption of dairy products at home, while lactose questionnaire (LQ) and placebo questionnaire (PQ) referred to symptoms perceived throughout the 4-h after the administration of the substrates, respectively. After lactose load, HBT was positive in 81 patients (55%), of whom 60 (74%) reported relevant symptoms at LQ (lactose malabsorbers, LM). After placebo challenge, 45 out of 60 with a positive lactose challenge did not complain of symptoms and therefore were diagnosed as lactose intolerant, according to NIH definition. The blinded oral challenges with lactose and placebo accurately diagnose LI and identify patients who will likely benefit from a lactose-free diet.

Effect of lactose intolerance severity on food intake and quality of life in adults with lactose intolerance in Turkey

Purpose

Lactose intolerance is lactose digestive disorder due to lactase enzyme deficiency. This can affect the quality of life by restricting the intake of certain foods. The aim of this study is to show the lactose intolerance to the restriction in food intake and quality of life.

Design/methodology/approach

This study was conducted with adults aged 18–60 years. A survey was used to gather information on the demographic characteristics of the patients and their symptoms related to lactose intolerance. In addition, the Visual Analog Scale was administered to identify common symptoms and the World Health Organization Quality of Life (WHOQOL)-Bref Quality of Life Scale to determine their quality of life.

Findings

The average quality of life subscale scores was 56.25 ± 14.06 for physical, 58.29 ± 11.72 for mental, 63.28 ± 21.35 for social and 62.36 ± 16.37 for environmental. When VAS scores obtained for the common digestive system symptoms in lactose intolerance were compared with Quality of Life scores; it was found that physical life quality scores decreased (r = −0.239, p = 0.030) as the complaints of diarrhea increased and physical and environmental life quality decreased (r = −0.316, p = 0.004/r = −0.277, p = 0.012, respectively) as abdominal pain increased.

Originality/value

People reduce dairy consumption due to digestive system complaints. Therefore, it is important to inform the people about the effects of lactose intolerance because discomfort caused by intolerance can affect nutrient intake and lower the quality of life.

Textural characteristics and sensory evaluation of yogurt fortified with pectin extracted from steeped hawthorn wine pomace

To comparatively investigate the applications potential of pectin from steeped hawthorn wine pomace (SHP), pectin-enriched yogurt was produced at set/stirred form using apple-sourced commercial pectin (CP) as control. The focus was mainly on the effect of pectins on the texture and stability of yogurt, as well as the analysis of appearance and taste, which were mainly characterized by texture analysis and sensory evaluation. Texture analysis indicated that the performance of SHP was better than that of CP, which could increase the gel rupture strength and rupture distance of set yogurt. SHP could also improve the firmness, denseness and viscosity of stirred yogurt. In other respects, SHP could also significantly increase the water holding capacity and sensory acceptance of both types of yogurt. The utilization of SHP for improving the quality of yogurt demonstrated its great potential in developing the sustainable applications of the by-product from steeped hawthorn wine.

Giardia intestinalis and Fructose Malabsorption: A Frequent Association

Nowadays, scientific studies are emerging on the possible etiological role of intestinal parasites in functional digestive disorders. Our study was carried out with healthy individuals (control group; n = 82) and symptomatic patients with lactose or fructose malabsorption, including positive (malabsorbers; n = 213) and negative (absorbers; n = 56) breath test, being analyzed for the presence of intestinal parasites. A high parasitic prevalence was observed in malabsorbers (41.8%), exclusively due to single-cell eukaryotes but not helminths. Giardia intestinalis was the predominant parasite in cases of abnormal absorption (26.5%), significantly associated with fructose malabsorption and doubling the probability of developing this pathology. Within controls, Blastocystis sp. (13.4%) was almost the only parasite, being the second among patients (12.6%), and Cryptosporidium parvum, the last species of clinical relevance, was detected exclusively in two malabsorbers (0.9%). The consumption of ecological food and professions with direct contact with humans arose as risk factors of parasitism. A diagnosis of carbohydrate malabsorption in adulthood is the starting point, making the search for the primary cause necessary. Accurate parasitological diagnosis should be considered another tool in the clinical routine for patients with recurrent symptoms, since their condition may be reversible with adequate therapeutic intervention.

Characteristics of lactose-free frozen yogurt with κ-carrageenan and corn starch as stabilizers

Frozen yogurt is a type of dairy product that is considered to be a more healthful alternative to conventional ice cream due to its lower fat content and the presence of viable lactic acid bacteria. Lactose-free products are a growing trend in the dairy industry, and lactose-free yogurts and ice creams can both be found on the market. However, lactose-free frozen yogurt has not yet reached the market. In this study, we aimed to investigate the effect of adding κ-carrageenan (0.05, 0.1, and 0.15%) and corn starch (1, 2, and 3%) on acidity, texture, viscosity, overrun, melting properties, color attributes, and sensory characteristics of lactose-free frozen yogurts. Lactose was reduced by enzymatic hydrolysis during the fermentation process. The effectiveness of the hydrolysis was measured by HPLC, and lactose was reduced to 0.05% after 80 min of incubation with the enzyme. The addition of stabilizers did not change overrun and melting properties of frozen yogurt, but it did affect pH, titratable acidity, and color parameters. The product with 0.15% κ-carrageenan had the highest hardness and stickiness values. Moreover, κ-carrageenan had a positive effect on sensory attractiveness of lactose-free frozen yogurt, and it reduced the coarse texture in comparison with the control without stabilizers. A lactose-free frozen yogurt with good quality and nutritional characteristics was produced, particularly with the use of κ-carrageenan as stabilizer.

Breath Hydrogen Testing in East and Southeast Asia

Breath hydrogen tests are popular, noninvasive tests for the assessment of carbohydrate fermentation in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). There is limited information regarding the utility of breath hydrogen and methane tests in IBS and FD patients in East and Southeast Asia. This review aims to summarize current literature about common indications of breath testing in this region, the genesis of functional gastrointestinal symptoms by provocative breath testing and provide suggestions for correct use. The most common testing indication is the assessment of lactose intolerance, followed by small intestinal bacterial overgrowth (SIBO) and differentiation of intestinal gas profiles in research setting. Studies in this region not only documented a high prevalence of lactose malabsorption but a population, both healthy and IBS, that is highly symptomatic to typical lactose intakes. Breath hydrogen assessment of other fermentable carbohydrates (FODMAPs) are fairly uncommon, whereas methane breath testing is almost nonexistent. Cumulative hydrogen production following lactulose was also not excessive in IBS patients compared with controls. The evidence however, for the detection of SIBO suggests limited reliability in the use of lactulose or glucose breath testing alone and inconclusive data on its correlation with symptoms. Conversely, little has been carried out in FD. In conclusion, breath testing should be limited in the predicting patients with SIBO for directing clinical management but can be considered in the objective assessment of lactose malabsorption within a low FODMAP diet. Recommendations to improve the interpretation of breath testing in research were also provided.

Association of Lactase Persistence Genotypes with High Intake of Dairy Saturated Fat and High Prevalence of Lactase Non-Persistence among the Mexican Population

BACKGROUND/AIM

Lactase (LCT) -13910 C>T and -22018 G>A polymorphisms associated with the lactase non-persistence (LNP)/persistence (LP) phenotypes vary globally. LP has been associated with obesity in Europeans. However, it has not been genetically evaluated in Mexico, a country with admixed population, recent introduction of dairy, and a high prevalence of obesity. Thus, we aimed to determine the distribution of the LCT polymorphisms and their association with the nutritional profile of West Mexico's populations.

METHODS

Genotyping of 1,196 individuals (natives and mestizos) was carried out by a Taqman allelic discrimination assay. Descriptive statistics and interpopulation analyzes were performed by SPSS, Arlequin, and Structure software. Demographic, anthropometric, biochemical and dietary data were analyzed in 212 mestizos.

RESULTS

LNP genotypes mainly prevailed (CC 68.7% and GG 68.2%); both predominated in native Huicholes and Nahuas (>97.7%). Among the mestizos, the LP genotypes were associated with a higher intake of saturated fat (9.9 ± 3.9% vs. 8.5 ± 4.0%, p = 0.018; OR = 2.55, 95% CI 1.29-5.03, p = 0.006) and a daily/more frequent consumption of dairy (88.8 vs. 78.0%; p = 0.049) than LNP genotypes.

CONCLUSION

The LNP trait was predominant in Mexicans with a major Amerindian ancestry. A daily consumption of dairy was associated with a higher intake of saturated fat in LP individuals.

Determination of reducing sugars in foodstuff applying multivariate second-order calibration

In the present report, a chemometrics-assisted second-order kinetic-spectrophotometric method has been developed for determining reducing sugars, glucose, fructose and lactose, in food samples, based on the reaction with hexacyanoferrate, HCF, at 70 °C in alkaline medium. A suitable experimental design helped us to establish the conditions (pH, temperature, and HCF concentration) for optimal sensitivity and selectivity among analytes. Second order data were recorded by measuring the absorbance of unreacted HCF in the spectral range of 370 to 470 nm for five minutes using a diode array. A calibration set of samples was prepared according to a central composite design containing the three sugars for training the algorithms. Validation samples containing only the analytes were prepared for checking the reliability of the algorithms. In this particular system, identical profiles for sample components are obtained in the spèctral dimension corresponding to unreacted HCF. Moreover, two kinds of interferents may be present: sample components active in the spectral region at which HCF absorbs as well as potential reducing interferents, causing linear dependence, since they provide identical profiles in spectral dimension to those of the analytes of interest. In the present work, MCR-ALS in the spectral augmentation mode was the only algorithm that could successfully resolve linear dependence. Satisfactory results were obtained by applying MCR-ALS in the spectral augmentation mode in order to achieve a second order advantage for the determination of fructose and glucose in validation samples, in test samples containing the two kinds of interferents and in real food samples, providing LODs of 4.0 and 5.0 mg L-1, respectively. However, bad results were obtained for lactose which may be due to its low sensitivity in the augmented dimension. Good results were also obtained by applying U-PLS/RBL and N-PLS/RBL for determining simultaneously the three sugars in validation samples and in test samples containing only active spectral interferents. Finally, lactose and also, glucose and fructose, were successfully quantified in real milk samples, with LODmin = 1.0 mg L-1, 1.0 mg L-1 and 0.1 mg L-1 and LODmax = 3.5, 3.8 and 4.4 mg L-1, respectively, using UPLS/RBL, and LODmin of 1.3, 1.1 and 0.1 mg L-1 and LODmax of 4.0, 4.3 and 4.9 mg L-1 for lactose, glucose and fructose, respectively, for NPLS/RBL. Results for real samples in all cases were statistically comparable to those obtained by applying a reference method based on HPLC (High Performance Liquid Chromatography).

Ultrasonic Monitoring of Enzyme Catalysis; Enzyme Activity in Formulations for Lactose-Intolerant Infants

The paper introduces ultrasonic technology for real-time, nondestructive, precision monitoring of enzyme-catalyzed reactions in solutions and in complex opaque media. The capabilities of the technology are examined in a comprehensive analysis of the effects of a variety of diverse factors on the performance of enzyme β-galactosidase in formulations for reduction of levels of lactose in infant milks. These formulations are added to infant's milk bottles prior to feeding to overcome the frequently observed intolerance to lactose (a milk sugar), a serious issue in healthy development of infants. The results highlight important impediments in the development of these formulations and also illustrate the capability of the described ultrasonic tools in the assessment of the performance of enzymes in complex reaction media and in various environmental conditions.

Dairy in a sustainable diet: a question of balance

The demand for dairy products is growing rapidly, especially in emerging markets. Dairy products are nutrient rich and, therefore, an important food group for ensuring nutrient security in the future. In many countries, dairy contributes significantly to nutrient intake. Meta-analyses have shown that consumption of dairy may reduce the risk of chronic diseases and thereby lower healthcare costs. Milk production and processing contribute to greenhouse gas emissions, estimated at 2.7% (cradle-to-retail) of the world's total. Evaluating the position of dairy in the diet should take into account the impact of both nutritional and environmental factors. Local conditions are also important; in many parts of the world, the cow is an efficient converter of human-inedible resources into nutrient-dense food. Increased productivity of cows is a decisive factor in realizing sufficient milk production with optimal resource efficiency and minimal greenhouse gas emission. Models that optimize total diets, rather than individual food products, for their nutritional and environmental impact are the preferred approach for developing realistic alternative consumption strategies.

The Interrelationships between Lactose Intolerance and the Modern Dairy Industry: Global Perspectives in Evolutional and Historical Backgrounds

Humans learned to exploit ruminants as a source of milk about 10,000 years ago. Since then, the use of domesticated ruminants as a source of milk and dairy products has expanded until today when the dairy industry has become one of the largest sectors in the modern food industry, including the spread at the present time to countries such as China and Japan. This review analyzes the reasons for this expansion and flourishing. As reviewed in detail, milk has numerous nutritional advantages, most important being almost an irreplaceable source of dietary calcium, hence justifying the effort required to increase its consumption. On the other hand, widespread lactose intolerance among the adult population is a considerable drawback to dairy-based foods consumption. Over the centuries, three factors allowed humans to overcome limitations imposed by lactose intolerance: (i) mutations, which occurred in particular populations, most notably in the north European Celtic societies and African nomads, in which carriers of the lactose intolerance gene converted from being lactose intolerant to lactose tolerant; (ii) the ability to develop low-lactose products such as cheese and yogurt; and (iii) colon microbiome adaptation, which allow lactose intolerant individuals to overcome its intolerance. However, in a few examples in the last decade, modern dairy products, such as the popular and widespread bio-cultured yogurts, were suspected to be unsuitable for lactose intolerant peoples. In addition, the use of lactose and milk-derived products containing lactose in non-dairy products has become widespread. For these reasons, it is concluded that it might be important and helpful to label food that may contain lactose because such information will allow lactose intolerant groups to control lactose intake within the physiological limitations of ~12 g per a single meal.

Dairy food at the first occasion of eating is important for total dairy food intake for Australian children

The cross-sectional 2007 Australian National Children’s Nutrition and Physical Activity Survey collected detailed dietary information from a representative sample of more than 4400 children by 24-h dietary recall. Dairy food intake by Australian children is substantially lower than recommendations, and decreases as a percentage of energy intake as children grow older. Children aged 2 to 16 years are, on average, 2.3 times more likely to have a dairy food at the first daily occasion of eating, than at the second occasion. For children who consumed any dairy food at the first occasion of eating, the total daily intake of dairy foods was 129% (95% CI 120%–138%) greater than for children who did not consume a dairy food at the first occasion of eating. Their dairy food intake for the rest of the day following the first occasion of eating was also greater by 29% (95% CI 21%–37%). Younger age group, male sex, location of eating being at home or in a residence and starting the first occasion of eating from 6 a.m. to 9 a.m. are all jointly associated with having a dairy food at the first occasion of eating. A simple strategy to increase Australian children’s intake from the dairy and alternatives food group may be to make sure that the first occasion of eating each day includes a dairy food or a nutritional equivalent.

The role of food in the functional gastrointestinal disorders: introduction to a manuscript series

Functional gastrointestinal disorders (FGIDs) are characterized by the presence of chronic or recurrent symptoms that are felt to originate from the gastrointestinal (GI) tract, which cannot be attributed to an identifiable structural or biochemical cause. Food is associated with symptom onset or exacerbation in a significant proportion of FGID patients. Despite this, the role of food in the pathogenesis of the FGIDs has remained poorly understood. For this reason, diet has largely played an adjunctive rather than a primary role in the management of FGID patients. In recent years, there has been a rapid expansion in our understanding of the role of food in GI function and sensation and how food relates to GI symptoms in FGID patients. In a series of evidence-based manuscripts produced by the Rome Foundation Working Group on the role of food in FGIDs, comprehensive reviews of the physiological changes associated with nutrient intake, and the respective roles of carbohydrates, fiber, protein, and fats are provided. The series concludes with a manuscript that provides guidance on proper clinical trial design when considering the role of food in FGIDs.

Milk inhibits the biological activity of ricin

Ricin is a highly toxic protein produced by the castor plant Ricinus communis. The toxin is relatively easy to isolate and can be used as a biological weapon. There is great interest in identifying effective inhibitors for ricin. In this study, we demonstrated by three independent assays that a component of reconstituted powdered milk has a high binding affinity to ricin. We discovered that milk can competitively bind to and reduce the amount of toxin available to asialofetuin type II, which is used as a model to study the binding of ricin to galactose cell-surface receptors. Milk also removes ricin bound to the microtiter plate. In parallel experiments, we demonstrated by activity assay and by immuno-PCR that milk can bind competitively to 1 ng/ml ricin, reducing the amount of toxin uptake by the cells, and thus inhibit the biological activity of ricin. The inhibitory effect of milk on ricin activity in Vero cells was at the same level as by anti-ricin antibodies. We also found that (a) milk did not inhibit ricin at concentrations of 10 or 100 ng/ml; (b) autoclaving 10 and 100 ng/ml ricin in DMEM at 121 °C for 30 min completely abolished activity; and (c) milk did not affect the activity of another ribosome inactivating protein, Shiga toxin type 2 (Stx2), produced by pathogenic Escherichia coli O157:H7. Unlike ricin, which is internalized into the cells via a galactose-binding site, Stx2 is internalized through the cell surface receptor glycolipid globotriasylceramides Gb3 and Gb4. These observations suggest that ricin toxicity may possibly be reduced at room temperature by a widely consumed natural liquid food.