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Frequency of IBS, dyspepsia, anemia, weight loss, and autoimmune diseases in the 314 study subjects, grouped according to the LHBT results as "Lactose tolerant", "Lactose intolerant", and "Lactose digesters/intolerant", and in the IBS controls who did not report milk intolerance.
Source publication
Background:
Lactose intolerance is the most frequent food intolerance, but many subjects with self-reported milk intolerance (SRMI) are asymptomatic at lactose hydrogen breath test (LHBT). The aim of this study was to evaluate the frequency of lactose intolerance in SRMI patients and their clinical characteristics.
Methods:
In a retrospective st...
Context in source publication
Context 1
... certain percentage of patients also self-reported extraintestinal symptoms following milk ingestion: fatigue (5% of cases) and sweating (4%) were the most frequent among the "lactose tolerant". Table 2 shows the frequency of IBS, dyspepsia, anemia, weight loss, and autoimmune diseases in the three SRMI groups and in the IBS controls. Two hundred and fourteen (68%) of the SRMI subjects were found to have IBS, with a similar frequency in the tolerant and intolerant groupings at the LHBT. ...Citations
... Відомо, що лактазна активність з'являється внутрішньоутробно в перші 3 міс гестації, а до моменту народження дитини досягає максимуму і перевищує рівень дорослої людини [9]. Набір ферментів, що виробляються кишечником, залежить від віку та типу харчування людини. ...
... Отже, надалі після введення прикорму та переходу на дорослий тип харчування, активність лактази знижується з одночасним підвищенням активності сахарази та мальтази. Зниження активності лактази починається з 1-го року життя, у дошкільний період рівень її активності є стабільним, і після 5-річного віку зниження активності лактази є значним (у дорослих рівень лактази становить 5-10% від початкового рівня) [3,9]. ...
The article is devoted to one of the most urgent problems of pediatrics – the malabsorption syndrome caused by lactose intolerance in children of different age periods. Lactose intolerance refers to the inability of the intestinal enzyme systems to break down lactose, which manifests itself clinically. In fact, lactose intolerance is a clinical manifestation of lactase deficiency (LD), that is, a decrease in the activity of lactase in the intestine, which can be congenital or acquired. The purpose of the study is to analyze literature data on the factors of occurrence and clinical manifestations of lactase deficiency in children and to summarize the tactics of managing children with this pathology. In the world literature it is noted that lactase deficiency can be primary and secondary and is clinically manifested both in children and adults, depending on the degree of activity of the lactase enzyme. Depending on the amount of lactose consumed and lactase activity, people with lactose malabsorption experience numerous gastrointestinal manifestations. Treatment for LD consists of reducing or eliminating lactose from the diet until symptoms resolve, supplementing the diet with enzyme substitutes or lactase supplements, and eating lactose-free alternatives (lactose-free products). Cow’s milk is one of the main sources of calcium and a number of other vitamins and minerals. Thus, the complete elimination of dairy products may contribute to the development of bone diseases such as osteopenia and osteoporosis, so the dietary approach plays a critical role in the management of patients with LD. In this regard, great attention is now being paid to the use of lactose-free milk in children and adults with LD.
... wheat, onions, garlic, chili, beans and coffee (Böhn et al., 2013;Laatikainen et al., 2020;Black et al., 2020;Fikree and Byrne, 2021). However, transient gastrointestinal discomfort (GID) after consuming cow milk occurs in the general population even in the absence of DGBIs (Pasqui et al., 2015) or lactose intolerance (Suchy et al., 2010;Laatikainen et al., 2020;Carroccio et al., 2021), leading to a prevalence of self-perceived lactose intolerance estimated to range between 8% and 20% (Porzi et al., 2021;Nicklas et al., 2011). Due to their symptoms and self-perception of lactose intolerance, these people adopt a restrictive diet that could impact on health (Nicklas et al., 2011). ...
Many healthy people suffer from milk-related gastrointestinal discomfort (GID) despite not being lactose intol-
erant; the mechanisms underpinning such condition are unknown.
This study aimed to explore milk protein digestion and related physiological responses (primary outcome), gut
microbiome and gut permeability in 19 lactose-tolerant healthy nonhabitual milk consumers [NHMCs] reporting
GID after consuming cow milk compared to 20 habitual milk consumers [HMCs] without GID.
NHMCs and HMCs participated in a milk-load (250 mL) test, underwent blood sample collection at 6 time
points over 6 h after milk consumption and collected urine samples and GID self-reports over 24 h. We measured
the concentrations of 31 milk-derived bioactive peptides (BAPs), 20 amino acids, 4 hormones, 5 endocannabi-
noid system mediators, glucose and the dipeptidyl peptidase-IV (DPPIV) activity in blood and indoxyl sulfate in
urine samples. Subjects also participated in a gut permeability test and delivered feces sample for gut microbiome
analysis.
Results showed that, compared to HMCs, milk consumption in NHMCs, along with GID, elicited a slower and
lower increase in circulating BAPs, lower responses of ghrelin, insulin, and anandamide, a higher glucose
response and serum DPPIV activity. The gut permeability of the two groups was similar, while the habitual diet,
which was lower in dairy products and higher in the dietary-fibre-to-protein ratio in NHMCs, possibly shaped the
gut microbiome; NHMCs exhibited lower abundance of Bifidobacteria, higher abundance of Prevotella and lower
abundance of protease-coding genes, which may have reduced protein digestion, as evidenced by lower urinary
excretion of indoxyl sulfate.
In conclusion, the findings showed that a less efficient digestion of milk proteins, supported by a lower pro-
teolytic capability of the gut microbiome, may explain GID in healthy people after milk consumption.
... Because of this complex diagnostic process, in the absence of a specific diagnostic biomarker, CMPA diagnosis is almost never taken into consideration in SRMI subjects, and instead, a diagnosis of lactose intolerance or irritable bowel syndrome (IBS) is "automatically" made [7,8]. ...
... Recently, we demonstrated that a large percentage of SRMI adult patients were not suffering from lactose intolerance. They tested negative on LHBT, but a double-blind placebo-controlled (DBPC) milk-protein challenge revealed clinical reactions after CM intake [8]. Some studies have shown the presence of slightly elevated fecal calprotectin (FCP) values in patients with food allergy, especially in pediatric IgE-mediated CM allergy [9][10][11]. ...
... On the other hand, little is known about those patients who report symptoms after consuming CM and dairy products, including aged ones (therefore, lactose-free), and are asymptomatic after LHBT, regardless of the test results (i.e., lactose-tolerant patients) [8]. ...
Citation: Seidita, A.; Mansueto, P.; Giuliano, A.; Chiavetta, M.; Soresi, M.; Carroccio, A.; the Internal Medicine Study Group. Fecal Calprotectin in Self-Reported Milk Intolerance: Not Only Lactose Intolerance. Nutrients 2023, 15, 1048. Abstract: The hypothesis is that inflammatory/allergic conditions should be considered in self-reported milk intolerance (SRMI) patients who test negative and/or are asymptomatic at Lactose Hydrogen Breath Test (LHBT). We analyzed fecal calprotectin (FCP) values in SRMI patients to investigate the frequency of a "positive" intestinal inflammation marker and its correlation with lactose tolerance/intolerance. Data from 329 SRMI patients were retrospectively analyzed; according to the positive/negative results (maldigester/digester) and the presence/absence of symptoms reported during LHBT (intolerant/tolerant), patients were divided into: 'lactose tolerants' (n. 104), 'maldigesters/intolerants' (n. 187), 'digesters/intolerants' (n. 38). FCP values were analyzed in all three subgroups. A percentage of SRMI patients complained of constipation (>15%), extraintestinal symptoms (>30% including anemia), multiple food hypersensitivity (7.6%) and had intraepithelial lymphocytic infiltration at duodenal biopsy (>50%). Over 50.0% showed FCP values above the normal limit. Lactose tolerants and maldigesters/intolerants had higher positivity frequencies (p < 0.0001, for both) and absolute values (p = 0.04, for maldigesters/intolerants) of FCP compared to digesters/intolerants. FCP was not useful to differentiate tolerant from intolerant subjects (AUC 0.58). Our data suggest the existence of an allergic/inflammatory pathogenetic mechanism in a subset of SRMI subjects. FCP results are in keeping with this hypothesis, even if they cannot differentiate lactose tolerant from intolerant patients.
... Since there are known differences in the clinical appearance of LIT, some phenotypes may be caused by a varying digestive response between isolated lactose and whole milk. LIT-caused symptoms seem influenced by the food matrix of milk or by individual GI digestion and absorption properties [26]. Milk has been used as a substrate to find LIT in several studies, and the additional milk ingredients besides lactose, including fats, may reduce gastric emptying and influence LIT. ...
Lactose intolerance (LIT) is one of the major causes of irritable bowel syndrome (IBS)
spectrum complaints. Differences in inadequate lactose digestion are described as various LIT
phenotypes with basically unknown pathophysiology. In LIT patients, we retrospectively assessed
the effect of histamine intolerance (HIT) on expiratory hydrogen (H2
) during H2
lactose breath tests.
In a retrospective evaluation of charts from 402 LIT patients, 200 patients were identified as having
only LIT. The other 202 LIT patients were found to additionally have diamine oxidase (DAO) values of
<10 U/mL, which indicates histamine intolerance (HIT). To identify HIT, standardized questionnaires,
low serum DAO values and responses to a histamine-reduced diet were used. Patients were separated
into three diagnostic groups according to the result of H2 breath tests: (1) LIT, with an H2
increase
of >20 parts per million (ppm), but a blood glucose (BG) increase of >20 mg/dL, (2) LIT with an H2
increase of 20 ppm in combination with a BG increase of <20 mg/dL, and (3) LIT with an exhaled H2
increase of <20 ppm and BG increase of <20 mg/dL. Pairwise comparison with the Kruskal Wallis
test was used to compare the areas under the curve (AUC) of LIT and LIT with HIT patients. Exhaled
H2 values were significantly higher in H2 > 20 ppm and BG < 20 mg/dL patients with LIT and HIT
(p = 0.007). This diagnostic group also showed a significant higher number of patients (p = 0.012) and
a significant higher number of patients with gastrointestinal (GI) symptoms during H2 breath tests
(p < 0.001). Therefore, low serum DAO values, indicating HIT, influence results of lactose tolerance
breath tests.
Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders. Cow's milk protein allergy (CMPA) is the most common food allergy, especially in infancy and childhood, which may persist into adulthood. There are three main types of CMPA; immunoglobulin E (IgE)-mediated CMPA, non-IgE-mediated CMPA, and mixed type. CMPA appears before the first birthday in almost all cases. Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis. CMPA (often non-IgE mediated) can present with symptoms of gastroesophageal reflux, eosinophilic esophagitis, hemorrhagic gastritis, food protein-induced protein-losing enteropathy, and food protein-induced enterocolitis syndrome. Most CMPAs are benign and outgrown during childhood. CMPA is not as common in adults as in children, but when present, it is usually severe with a protracted course. Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose. Lactose intolerance has four typical types: Developmental, congenital, primary, and secondary. Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults. They are also common in inflammatory bowel diseases. Milk consumption may have preventive or promoter effects on cancer development. Milk may also become a source of microbial infection in humans, causing a wide array of diseases, and may help increase the prevalence of antimicrobial resistance. This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.
