Content uploaded by Dennis A Savaiano
Author content
All content in this area was uploaded by Dennis A Savaiano
Content may be subject to copyright.
A preview of the PDF is not available
Lactose Intolerance: An Unnecessary Risk for Low Bone Density
Abstract
The potential for lactose intolerance causes 25-50 million Americans and an unknown number of people around the world to avoid milk. Milk avoidance is a significant risk factor for low bone density. Individuals who avoid milk, due to intolerance or learned aversion, consume significantly less calcium and have poorer bone health and probable higher risk of osteoporosis. Lactose intolerance is easily managed by: (1) regular consumption of milk that adapts the colon bacteria and facilitates digestion of lactose; (2) consumption of yogurts and cheeses and other dairy foods low in lactose; consumption of dairy foods with meals to slow transit and maximize digestion, and use of lactose-digestive aids. As dairying spreads around the world to new markets and dairy foods become the dominant source of calcium in these markets, the potential for lactose intolerance will grow. Management of lactose intolerance globally will require both education and product development.
... Bone mass is also decreased by the use of glucocorticosteroids, which directly cause osteoblast dysfunction and accelerate osteoblast apoptosis and reducing calcium absorption from the gastrointestinal tract and increasing renal calcium excretion (stimulating parathyroid hormone release in the parathyroid glands) [2]. Puberty (Tanner stages 2, 3, 4) has been shown to be the most sensitive period in which glucocorticoid use may lead to irreversible bone loss [2,3]. ...
... In addition, dairy products are also a source of protein, phosphorus, potassium, and vitamins A, D, B2 (riboflavin), and B12 (cobalamin) [5]. Multiple observational studies show that consumers who avoid milk have lower bone mineral density (BMD) and a 2.7-fold higher risk of bone fractures in pre-pubertal children compared to individuals with higher milk consumption [3,[6][7][8]. ...
... Disturbances in the parameters of calcium and phosphate metabolism can be reflected in disturbances in bone mineralization [7]. Both IBD alone and the dairy-restricted diet are considered risk factors for bone mineralization disorder [2,3,7]. In the analyzed group of patients, the results of bone mineral density measurements in lactose-intolerant patients on a low-lactose/lactose-free diet were similar to those obtained in lactose-tolerant patients and not on an elimination diet. ...
Background:
A diet restricted in dairy products can cause calcium and vitamin D deficiency and, secondarily, lead to malnutrition and low bone mass. The aim of the study was to determine the incidence hypocalcemia and vitamin D deficiency in children with inflammatory bowel diseases and lactose intolerance (LI).
Material and methods:
A total of 107 patients were enrolled to the study (mean age 14.07 ± 3.58 years; 46.7% boys): 43 with Crohn's disease (CD), 31 with ulcerative colitis (UC), and 33 with functional abdominal pain (AP-FGID). Hydrogen breath test with lactose and laboratory tests to assess the calcium-phosphate metabolism were performed in all patients. The results of densitometry were interpreted in 37 IBD patients.
Results:
LI was diagnosed in 23.2% patients with CD, 22.6% with UC, and 21.2% children with AP-FGID, (p = 0.9). Moreover, 9.5% patients with CD, in 21.4% with UC, and in 51.5% with AP-FGID had optimal concentration of 25(OH)D (p = 0.0002). Hypocalcemia was diagnosed in 21% of patients with CD, 16.1% with UC patients, AP-FGID patients had normal calcium levels (p = 0.02). There was no difference in concentrations of total calcium, phosphorus, and 25(OH)D between patients on low-lactose diet and normal diet (p > 0.05). BMD Z-score ≤ -1 SD was obtained by 12 CD patients (48%), and 6 with UC (50%).
Conclusion:
The use of a low-lactose diet in the course of lactose intolerance in children with inflammatory bowel diseases has no effect on the incidence of calcium-phosphate disorders and reduced bone mineral density.
... Nevertheless, milk is calcium and nutrient-rich food and an important part of a healthy diet (6). Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). ...
... Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). Some studies have suggested that the prevalence of lactose intoler-ance is a global issue. ...
... Lactose intolerance is an inability to digest lactose (LI) due to deficiency of lactase or β-galactosidase enzyme in the small intestine (Harrington et al. 2008). In lactose intolerance, undigested lactose in the colon could be fermented by some gut bacteria, producing acid and gas, leading to the development of lactose intolerance symptoms (Horner et al. 2011;Savaiano et al. 2011). Probiotic bacteria provide health benefits to the host gut, like protection from pathogen colonization, restoration of the gut microbiome composition, and prevention of gastrointestinal disorders (Matthews et al. 2005;Heyman 2006;Gayathri and Vasudha 2018). ...
The gut of human beings is inhabited by a diverse group of microorganisms, around trillions, which makes it a new essential endocrine organ and shows a symbiotic connection with a host, and they metabolize the food ingested and produce diverse bioactive and dietary compounds. This may include organic acids, bacteriocins, and short-chain fatty acids, which provide potential to impact on physiological and pathological conditions of the host and maintain homeostasis. In recent times, due to rapid advancement in technology, our understanding about microbiome has also expanded. The modulation of the microbiome leads to disturbance in homeostasis, which causes imbalance and leads to dysbiosis, and the gut barrier integrity gets disturbed and immunological reaction leads to inflammation. This chapter reviews the current insights on various diseases and gastroenterological disorders associated with the modulation of the gut microbiome and how probiotics help in maintaining the healthy gut with intact gut barrier by regulating the expression of tight junction proteins, perhaps leading to good human health.
... Management of LI typically consists of reducing, or even avoiding, the consumption of dairy products [16,17]. However, because dairy products constitute a high-quality source of calcium, potassium, protein, and vitamin B and D, avoidance of these foods can increase the risk of morbidity, including bone fracture, osteoporosis, and nutrient deficiencies [18][19][20]. The most preferred and reliable treatment option involves the consumption of lactose-free dairy products. ...
Lactose intolerance (LI) is characterized by the presence of primarily gastrointestinal clinical signs resulting from colonic fermentation of lactose, the absorption of which is impaired due to a deficiency in the lactase enzyme. These clinical signs can be modified by several factors, including lactose dose, residual lactase expression, concurrent ingestion of other dietary components, gut-transit time, and enteric microbiome composition. In many of individuals with lactose malabsorption, clinical signs may be absent after consumption of normal amounts of milk or, in particular, dairy products (yogurt and cheese), which contain lactose partially digested by live bacteria. The intestinal microbiota can be modulated by biotic supplementation, which may alleviate the signs and symptoms of LI. This systematic review summarizes the available evidence on the influence of prebiotics and probiotics on lactase deficiency and LI. The literature search was conducted using the MEDLINE (via PUBMED) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and included randomized controlled trials. For each study selected, the risk of bias was assessed following the Cochrane Collaboration methodology. Our findings showed varying degrees of efficacy but an overall positive relationship between probiotics and LI in relation to specific strains and concentrations. Limitations regarding the wide heterogeneity between the studies included in this review should be taken into account. Only one study examined the benefits of prebiotic supplementation and LI. So further clinical trials are needed in order to gather more evidence.
La microbiota intestinal ejerce un papel fundamental en la regulación de la motilidad intestinal afectando al tiempo de tránsito, la frecuencia y consistencia de las deposiciones.
Estudios recientes han demostrado cambios en la composición y funcionalidad de la microbiota intestinal de pacientes con estreñimiento y motilidad intestinal limitada. En este
artículo se describen los mecanismos de acción e impacto que puede ejercer el consumo de prebióticos y probióticos en la prevención y tratamiento del estreñimiento y la motilidad
intestinal de distintos grupos poblacionales.
The aim of this study was to verify the effect of physical activity level on bone mineral density (BMD) in pre-menopausal women with lactose intolerance. Sixty women was engaged in this study (age: 31.9±6.9 years) and were initially separated into two groups: 30 women with lactose intolerance (LI) and 30 controls (C). The groups were further subdivided into less and more active using the median of weekly total energy expenditure, estimated by the International Physical Activity Questionnaire (IPAQ-long version). The LI diagnosis was confirmed by lactose intolerance test (oral lactose overload with monitoring of blood glucose and associated clinical manifestations). BMD was assessed by dual energy X-ray absorptiometry (DXA). As expected, physical activity score was higher in both groups for women classified as more active (p>0.05). The BMD at hip and pelvis was lower in LI than in C group (p<0.05). In addition, there was a tendency for a lower BMD in L2, L4, femoral neck and total hip for LI compared to C group (p<0.10). However, there was no main effect of physical activity level or interaction for the BMD at any other bone sites (p<0.10). The LI group had lower (p<0.05) absolute free-fat mass, independently of physical activity level. Therefore, the results of the present study suggest that LI reduces BMD in pre-menopausal women and this reduction is independent of physical activity level.
Aim:
This study described outcomes following treatment for lactose intolerance, which is common in children.
Methods:
The medical records of children aged 6-18 years who underwent lactose hydrogen breath testing at Dana-Dwek Children's Hospital, Tel Aviv, Israel, from August 2012-August 2014 were analysed. We compared 154 children with gastrointestinal symptoms and positive lactose hydrogen breath tests to 49 children with negative test results.
Results:
Of the 154 children in the study group, 89 (57.8%) were advised to follow a lactose restricted diet, 32 (20.8%) were advised to avoid lactose completely, 18 (11.7%) were instructed to use substitute enzymes and 15 (9.7%) did not receive specific recommendations. Only 11 patients (7.1%) received recommendations to add calcium-rich foods or calcium supplements to their diet. Lactose reintroduction was attempted in 119/154 patients (77.3%), and 65/154 (42.2%) experienced clinical relapses. At the final follow up of 3.3 years, 62.3% of the study children were still observing a restricted diet. Older children and those who were symptomatic during lactose hydrogen breath testing were more likely to be on a prolonged restricted diet.
Conclusion:
Our long-term follow up of lactose intolerant children showed that only a third were able to achieve a regular diet. This article is protected by copyright. All rights reserved.
Lactose is a widely distributed disaccharide in the diet and pharmaceutical industries. It is the sugar from the milk of mammals. The loss of intestinal lactase activity with age is frequent. It varies between ethnic and genetic conditions, and may cause its malabsorption. It may also be secondary to intestinal mucosal damage and, rarely, to congenital deficiency. Malabsorption does not necessarily imply clinical intolerance, with gastrointestinal symptoms after its ingestion. The exclusion of lactose from the diet produces clinical improvement but it could lead to a defect in the recommended daily intake of other nutrients such as calcium. It can be reintroduced into the diet but there is an individual clinical threshold of tolerance.
Cow' milk is a main food in human nutrition, even beyond the weaning period, at least in Causasian population. In the last few years, through the web or other non-conventional information technologies some negative ideas on the intake of cow's milk have arisen. Mostly they are aprioristic positions with little scientific evidence. In this paper we will review the role on cow's milk intake in the development of ferropenic anemia, the causes of lactose intolerance or the prevalence of cow's milk allergy beyond infancy. Some voices have pointed a disputable role of cow's milk in the development of metabolic syndrome or other chronic non-transmissible diseases. Even autistic disorders or mucous production have being associated with the intake of cow's milk. Strengthnesses and weaknesses of these arguments will be reviewed. Some practical points will be set at the end of the papers.
Nutrition plays an important role in skeletal health throughout the life cycle. This chapter addresses evidence-based nutrition recommendations that can be used to promote skeletal health. Maintaining bone health is a significant concern in the USA; healthful lifestyle is an opportunity to promote bone health. The total diet or overall pattern of food consumed is the most important focus of healthy eating (Freeland-Graves and Nitzke, J Acad Nutr Diet 113:307–317, 2013). A healthful dietary pattern is associated with prevention of chronic diseases as well promoting skeletal health.
The Surgeon General’s report on bone health and osteoporosis recommendations include consuming recommended amounts of calcium and vitamin D, maintaining a healthful body weight, and being physically active, along with minimizing the risk of falls (USDHHS Surgeon General, 2004).
Meeting calcium recommendations and weight bearing physical activity build strong bones, optimizes bone mass, and may reduce the risk of osteoporosis later in life. Nutrition counseling using the Nutrition Care Process is an effective structure for tailoring evidenced-based recommendations to an individual’s unique needs in the prevention, treatment, and maintenance of health and quality of life into old age.
Lactose tolerance tests were performed in 33 women with osteoporosis and 33 control women matched for age. A questionnaire was used to elicit any history of milk intolerance and the subjects' daily intake of calcium derived from milk and dairy products. Eleven patients and four controls gave a history of milk intolerance (p less than 0.01); 13 patients had lactose malabsorption compared with four controls (p less than 0.01). The daily intake of calcium derived from milk was significantly lower in patients (125 (SEM 20) mg v 252 (43) mg; p less than 0.05). Curves of blood glucose concentrations during the lactose tolerance test in subjects with lactose malabsorption were significantly flatter in patients than controls (p less than 0.05). The fasting blood glucose concentration was higher (5.44 (0.17) mmol/l (98 (3) mg/100 ml) in the patients than the controls (4.88 (0.11) mmol/l (88 (2) mg/100 ml); p less than 0.05), although body weight was significantly lower (61.6 (2.2) kg v 66.3 (1.6) kg; p less than 0.05). Absorption of lactose is significantly impaired in women with "idiopathic" osteoporosis; this combined with low consumption of milk and a subclinical disorder of glucose metabolism may be a major factor in the development of idiopathic osteoporosis in women.
Previous studies on the role of lactose malabsorption in the pathogenesis of postmenopausal osteoporosis have yielded conflicting results and further information is needed. To date, all studies have been carried out on populations with a low prevalence of lactose malabsorption and the lactose intestinal absorptive capacity was tested using a non-physiological dose of lactose. In fifty-eight Italian postmenopausal women (mean age 57 (SD 7) years), bone mineral density (BMD) at lumbar spine, H2 breath response after ingestion of 20 g lactose, intensity of symptoms of intolerance after a lactose load and daily Ca intake were evaluated. No differences were found between women with or without a positive H2 breath test with regard to BMD (-1.2 (SD 0.9) v. -0.9 (SD 0.8)) and Ca intake (509 (SD 266) v. 511 (SD 313) mg/d). On the contrary, both BMD and Ca intake were significantly lower in women with lactose malabsorption and symptoms of intolerance (-1.5 (SD 0.7) and 378 (SD 220) mg/d) than in those with malabsorption without symptoms (-0.9 (SD 0.9) and 624 (SD 254) mg/d). Moreover, in lactose malabsorbers Ca intake was correlated inversely with symptom score (rs -0.31, P < 0.05) and positively with BMD (rs 0.42, P < 0.005). Our results show that in Italian postmenopausal women Ca intake and BMD are not influenced directly by lactose malabsorption; the appearance of symptoms of intolerance seems to influence BMD unfavourably through a reduced Ca intake.
Dietary calcium is critical for the development of the human skeleton and likely plays an important role in the prevention of osteoporosis. Dairy products provide approximately three-fourths of calcium consumed in the diet and are the most concentrated sources of this essential nutrient. One obstacle that likely interferes with calcium consumption among many ethnic soups is lactose maldigestion The real or perceived occurrence of intolerance symptoms after dairy food consumption may cause maldigesters to avoid dairy products. Several investigators have observed a relationship between lactose maldigestion, dietary calcium and osteoporosis in Caucasian populations. Research on ethnically diverse populations is necessary to better understand how lactose maldigestion influences the risk for osteoporosis. Low calcium intakes, a greater than previously thought potential for low bone density and extensive lactose maldigestion among Hispanic-American and Asian-American populations may create an elevated risk for osteoporosis. Dietary management strategies for lactose maldigesters to increase calcium consumption include consuming (I) dairy foods with meals, (2) yogurts, (3) calcium-fortified foods, (4) using lactose digestive aids and (5) including dairy foods daily in the diet to enhance colonic metabolism of lactose.
A national probability sample in their 60s (32%), 70s (38%), and 80s (30%) completed a telephone survey (N = 475). Subjective measures indicated that perceived milk intolerance occurred more often in Blacks vs. Whites (35% vs. 17%) and women vs. men (21% vs. 10%). Compared to milk tolerant individuals, milk intolerant individuals were more likely to “not try at all” to consume enough calcium (46% vs. 31%), and more likely to avoid milk during adolescence (30% vs. 15%) and currently (56% vs. 23%). Milk intolerant elders appear at risk for low calcium intakes because of their long history of milk avoidance and lack of concern about consuming enough calcium as adults.
Calcium intake is one of a number of factors that affect peak bone mass. Low bone mass is related to increased incidence of osteoporotic fractures. Data from the USDA 1987-88 Nationwide Food Consumption Survey were used to determine populations most at risk of less than optimal calcium intake and food sources of calcium intake. Mean per capita daily consumption of calcium for the total U.S. population was 737 mg and varied by region of the country, household income, ethnic group, sex, and age. For most groups of females, intake was substantially less than the RDA. About 50% of total dietary calcium was supplied by milk and milk products. Milk and cheese used as ingredients in meat, grain, and vegetable mixtures contributed another 20% of dietary calcium. The remaining 30% of calcium was provided by grains and grain products, meat, poultry, fish, vegetables, fruits, eggs, legumes, nuts, and seeds.
This paper examines the evidence that connects calcium intake and vitamin D status to bone fragility, hypertension, colon cancer, and breast cancer. Human calcium physiology, with an intestinal absorptive barrier and inefficient conservation, reflects the abundance of calcium in the primordial human food supply. The calcium intake of stone-age adults is estimated at 50 to 75 mmol/d, three to five times the median calcium intake of present-day U.S. adults. Long-term calcium restriction and/or insufficient vitamin D may promote the development of bone fragility, high blood pressure, colon cancer, and breast cancer in susceptible individuals. Conversely, improvement in calcium intake and/or in vitamin D status may help to prevent these serious health problems. At least 12 intervention studies have established the skeletal benefit of increased calcium intake among women in the late postmenopause. Other reports suggest that adequate calcium may protect against salt-sensitive and pregnancy-associated hypertension. High intakes of both dietary calcium and vitamin D are associated with reduced development of precancerous changes in colonic mucosa. Preliminary findings also suggest that vitamin D has a protective effect against breast cancer.