The role of colonic metabolism in lactose intolerance

TI Food and Nutrition, Wageningen, The Netherlands.
European Journal of Clinical Investigation (Impact Factor: 2.73). 07/2008; 38(8):541-7. DOI: 10.1111/j.1365-2362.2008.01966.x
Source: PubMed


Lactose maldigestion and intolerance affect a large part of the world population. The underlying factors of lactose intolerance are not fully understood. In this review, the role of colonic metabolism is discussed, i.e. fermentation of lactose by the colonic microbiota, colonic processing of the fermentation metabolites and how these processes would play a role in the pathophysiology of lactose intolerance. We suggest that the balance between the removal and production rate of osmotic-active components (lactose, and intermediate metabolites, e.g. lactate, succinate, etc.) in the colon is a key factor in the development of symptoms. The involvement of the colon may provide the basis for designing new targeted strategies for dietary and clinical management of lactose intolerance.

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    • "Gastrointestinal symptoms after lactose ingestion are known as lactose intolerance (LI) and concern only a part of people with hypolactasia. The appearance and severity of these complains are due to lactase activity and the dose of lactose, gastrointestinal transit time, composition of gut microflora and the ability of products absorption by colon [1] [2]. There are few causes of lactase deficiency, but only two of them are the most common – primary and secondary hypolactasia. "
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    ABSTRACT: Background. Lactase is an enzyme involved in the hydrolysis of lactose. Deficiency of the enzyme (hypolactasia) may be determined genetically or arise secondarily to disease of small intestine. Under this condition, lactose enters the colon where it is fermented by intestinal microflora and turns to gases and short-chain fatty acids, causing gastrointestinal symptoms known as lactose intolerance (LI). Objectives. To investigate the incidence of lactose malabsorption (LM), LI and the coexistence of these two conditions in children with upper gastrointestinal tract diseases (UGTD), malabsorption syndrome, inflammatory bowel disease (IBD) and functional gastrointestinal disorders (FGID). Material and Methods. Hydrogen breath test (HBT) was conducted in 387 pediatric patients in years 2010–2013. Two hundred thirty two children with gastrointestinal tract diseases were selected and assigned to groups – UGTD, malabsorption syndrome, IBD or FGID. For each group the frequency of LM, frequency and severity of LI and the frequency of their co-occurrence were calculated. Results. Lactose malabsorption was observed in 37.08% of patients with gastrointestinal diseases. Positive HBT result was the most common in children with malabsorption syndrome (52.50%) and less common in UGTD (30.85%), especially in ulcer disease (23.53%). Symptoms after lactose ingestion affected 36.64% of the subjects, and were more specific to lactose malabsorbers than to lactose absorbers (72.10% vs. 15.75%). The higher frequency of LI was noted in children with FGID, especially in irritable bowel syndrome (IBS) (65.22%). The lowest incidence of symptoms was obtained in children with UGTD, especially in those with ulcer disease (27.44%). The incidence of LM with LI was noted in 27.16% of all patients and was the highest in IBS (47.83%) and the lowest in ulcer disease (15.78%). Conclusions. Lactose malabsorption is a common problem in children with gastrointestinal diseases, especially in children with bowel diseases. Lactose intolerance is related to LM, but does not affect all malabsorbers (Adv Clin Exp Med 2015, 24, 5, 863–871).
    Full-text · Article · Nov 2015 · Advances in Clinical and Experimental Medicine
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    • "The altered symptoms however may also be explained by motility changes noted in different thyroid states383940. Rapid gastric emptying and increased intestinal transit could deliver larger amounts of lactose across the ileocecal valve, leading to increase in bacterial metabolism and symptoms[12]. Proof of principle that altered intestinal motility could alter LI in LNP persons was shown in a study using different doses of the antidiarrheal and anti-motility agent (Loperamide HCL, Imodium McNeil Consumer Healthcare, Fort Washington, PA, USA)[41]. Table 3outlines the results. "
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    ABSTRACT: Dairy foods contain complex nutrients which interact with the host. Yet, evolution of lactase persistence has divided the human species into those that can or cannot digest lactose in adulthood. Such a ubiquitous trait has differential effects on humanity. The literature is reviewed to explore how the divide affects lactose handling by lactase non persistent persons. There are two basic differences in digesters. Firstly, maldigesters consume less dairy foods, and secondly, excess lactose is digested by colonic microflora. Lactose intolerance in maldigesters may occur with random lactose ingestion. However, lactose intolerance without maldigestion tends to detract from gaining a clear understanding of the mechanisms of symptoms formation and leads to confusion with regards to dairy food consumption. The main consequence of intolerance is withholding dairy foods. However, regular dairy food consumption by lactase non persistent people could lead to colonic adaptation by the microbiome. This process may mimic a prebiotic effect and allows lactase non persistent people to consume more dairy foods enhancing a favorable microbiome. This process then could lead to alterations in outcome of diseases in response to dairy foods in lactose maldigesters. The evidence that lactose is a selective human prebiotic is reviewed and current links between dairy foods and some diseases are discussed within this context. Colonic adaptation has not been adequately studied, especially with modern microbiological techniques.
    Full-text · Article · Aug 2015 · Nutrients
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    • "Lactose is hydrolyzed by lactase in intestines. Lactose intolerance is when a person has difficulty or is unable to digest milk due to lack of lactase (Harrington et al., 2008, Venema, 2008). Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. "
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    ABSTRACT: Carbohydrates are the major energy source in the body. In this review article, monosaccharides, disaccharides, sucrose, maltose, lactose, starch, dextrin, glycogen, cellulose, glycosaminoglycan, sialic acid and previous research study on carbohydrates has been given herewith
    Full-text · Article · Feb 2011
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