Monday, January 30, 2012

SCIENTIFIC PAPER:


Milk Consumption and Lactose Intolerance in Adults



INTRODUCTION

Lack of lactase in the body is the cause of Lactose Intolerance (LI) due to Lactase Deficiency (LD), often leading to symptoms like abdominal cramps, diarrhea and flatulence. Patients thus have to exclude lactose in their diet, which can cause nutrition-related diseases.

This article discusses the relationship between milk consumption and LI in adults, and also how lactase activities are affected by milk consumption behaviors.


SUBJECTS AND METHODS

Subjects
- 182 subjects.
- Age: 20-70 years old, without milk protein allergies, gastrointestinal/pulmonary diseases.
- Selected via cluster random sampling method, from various parts of Sichuan.
- Do not have any antibiotic treatment 15 days prior to experiment.

Questionnaires
Milk consumption habits of subjects, (how often and how much milk was consumed), and any effects that occur after consumption were obtained through questionnaires which were created and tested out on. The responses were then used to find out the accumulative milk intake (AMI) of the subjects by multiplying 365 with amount of milk consumed per sitting, frequency of consumption per day and duration of milk consumption. In the questionnaire, subjects were divided into groups of various frequencies of milk consumption.

Identification of Subjects with Lactose Intolerance
Subjects have to go through a challenge dose whereby they are given 25g of lactose to digest in their body. Fecal and gaseous samples were then collected and analysed.

Hydrogen breath test (HBT) was performed to all subjects to determine lactase activities. Changes in hydrogen values collected at the end of the test (ΔH) were calculated. If the ΔH >1.786mg/m³ (equivalent to 20 ppm) or fecal lactose was positive, then that subject is said to have LD.

Subjects with LD were to determined to have LI if they have symptoms (flatulence, abdominal pain and diarrhea) and how severe they are after the challenge dose.

Statistical Analyses used to categorise subjects:
- χ² test: Analyze differences in the milk consumption behaviours in subjects.
- Correlation between severity of symptoms and AMI calculated by rank correlation analysis.
- Statistical significance for all tests: P<0.05.


RESULTS

Milk Drinking Behavior and Prevalence of Lactose Intolerance in Adults
Results showed that those who do not consume milk is more likely to suffer from LI than those who consume milk every day since it has the highest chi-squared value (χ² =21.452).

Severity of LI Symptoms and AMI in Adults
AMI and severity of symptoms (4 different levels: lactose tolerant, LD, LI without diarrhea, LI with diarrhea) were shown to vary inversely. The more milk an individual consumes, the less severe the symptoms (r = –0.2884).

Effects of Milk Drinking Behaviors on Lactose Intolerance in Adults

In all subjects, single factor analysis was used to study variables (educational background, frequency of milk intake, amount of milk consumed per sitting) related to milk consumption habits, which gave a significant statistical significance of P<0.1. This was further analysed using binary logistic regression, that concluded the frequency of milk consumption and amount of milk consumed per sitting are variables that affect LI, but not educational background.


DISCUSSION

Results obtained above are rather accurate as they can be supported by findings from other papers, experiments and surveys.

Results also suggest that individuals having difficulty digesting lactose can gradually tolerate the sugar by introducing more lactose. This induces metabolic changes to the body in the long run, since severity of symptoms varies indirectly with amount of milk consumption, which could be supported by external researches done on the same topic. This explains why the Chinese have higher percentage of LI, due to less lactose consumption in their dietary habits, compared to populations from other countries.


REFERENCE

Qiao Rong, Huang ChengYu, Du HuiZhang, Zeng Guo, Li Ling and Ye Sheng. 2011, Milk Consumption and Lactose Intolerance in Adults, Biomed Environ Sci, 24(5), p.512517.


Saturday, December 31, 2011

INTRODUCTION

What is lactose intolerance?
Lactose intolerance is the inability of the body, like the cells lining the small intestine, to digest the lactose sugar, which is found in milk, especially from cows. Lactose is a main source of nutrition for infants and growing children. With normal lactose tolerance, which means having sufficient amounts of lactase, all of the lactose can be digested and then absorbed in the small intestine, preventing it from reaching the colon.


However, those individuals who lack or have insufficient amount of that particular intestinal enzyme that breaks down lactose, it can neither be digested nor absorbed in the small intestine and thus will end up in the colon where it will take part in the metabolism of bacteria there. These bacteria can produce chemicals that lead to diarrhea, bloated belly and abdominal pain. Lactic and other kinds of acids can also be produced to turn the stool acidic.


CAUSES (biochemistry behind it) AND SYMPTOMS

Lactose:

- A type of sugar found in milk and other dairy products.
- Is a polysaccharide made up by glucose and galactose.


Lactaste:
Degrades lactose into smaller components in the small intestine, so that the body can absorbed them more easily.



Symptoms:
- Often occur 30 minutes to 2 hours after consumption of lactose-containing products.
- Could be relieved by abstaining from lactose-containing products.
- Increased intake of lactose-containing products could worsen the condition.
- Includes:
  • Abdominal bloating
  • Abdominal cramps
  • Diarrhea
  • Gas (flatulence)
  • Nausea
Could result in slow growth or weight loss in children or infants.


If someone is lactose intolerant, the lactose consumed by him/her is unable to break down into smaller components completely in the small intestine, due to the lack or insufficient amount of lactase in the small intestine. This may result in unpleasant reactions when the lactose that is not broken down enters the large intestine e.g. wind/passing gas.


In the large intestine, the lactose is degraded by bacteria to lactic acid, short chained fatty acids and wind gases such as methane, hydrogen and carbon dioxide. Some of the hydrogen is taken in by the large intestine into the body and expelled out via the lungs. However most of it is used up by other bacteria in the large intestine. A small portion of hydrogen or methane is discharged by the body in the form of flatulence(wind/passing gas)

At the same time, unbroken lactose in the large intestine could also draw water from the cells into the gut via osmosis, hence leading to loose watery stools(diarrhea).


Undesirable digestion problems may happen. Length and intensity of symptoms could differ from individual to individual, and subjected to the amount consumed.


LACTOSE INTOLERANCE CAN START AT DIFFERENT STAGES OF LIFE

Babies’ bodies produce lactase so they can digest milk, especially breast milk.

Premature babies may suffer from lactose intolerance. Children who are lactose intolerant and were born at full term usually do not show signs of lactose intolerance until they are at least 3 years old.


Lactose intolerance starts at different periods of life. In Caucasians, those with the disorder will show symptoms after age 5. However in African Americans, it usually occurs as early as age 2.

Lactose intolerance is more common in people with Asian, African, Native American, or Mediterranean ancestry than it is among northern and western Europeans.

It is generally common in adults but is not lethal. For example, about 30 million American adults develop some amount of lactose intolerance by age 20.


*Sidenote
People sometimes confuse lactose intolerance with cow milk allergy.
There are differences between these two incidents, like milk allergy is a reaction by the body's immune system to one or more milk proteins and can be life threatening when just a small amount of milk or milk product is consumed, unlike lactose intolerance as its symptoms are not fatal. Milk allergy usually will occur during early stages of life, while lactose intolerance occurs more often in adulthood.


DIAGNOSIS

Effects of lactose intolerance can contribute to the unusual proportions of certain substances found in our body. These can be used to diagnose for lactose intolerance.



Methods:

Hydrogen Breath Test. This method is rather widely used, whereby the person drinks a lactose-loaded beverage and then the breath is analyzed and measured for the amount of hydrogen. Those without lactose intolerance will have low amounts of hydrogen gas found, but those who have undigested lactose produces high levels of hydrogen. However, this method may not be totally accurate as results could be affected by certain factors, like smoking and certain medication intake.







Stool Acidity Test.
This test is generally used for infants and young children to measure the amount of acid in the stool. Undigested lactose produces lactic acid and other fatty acids that can be detected in a stool sample.






Lactose Endurance Test.
This test works by consuming a certain amount of milk sugar after starving the body from lactose. A blood sample is taken to analyse the glucose level in the blood. If the blood glucose level does not exceed a certain limit ( < 20 mg/100 ml) a lactose intolerance exists.


The process of a diagnosis currently may not be pleasant. However, technology has changed and since then, such diagnosis no longer has to affect daily life as much as it did in the past.


ANY CURES AVAILABLE?

It is impossible to cure lactose intolerance.

However, the condition can be reduced to a stage of less severity, by carrying out therapies that mainly focuses on reducing the lactose intake to a level which could be tolerated by the patient.

Lactose tolerance varies greatly from individual to individual. Patients should thus try to find out what is their body’s limit of lactose intake and change their diet accordingly.


Patients can find out by first having a 100% lactose-free diet for 4 to 6 weeks. As soon as the patient is free of any symptoms of lactose intolerance, she/he may begin to slowly introduce lactose-containing food into their diet in small portions and increase intake depending on tolerance levels.


Lactase tablets can also be consumed by patients to help cope with symptoms of lactose intolerance, however the effectiveness varies for everyone. A better way is to have a lactose-free foods and dairy products yet still make sure to have a healthy and balanced diet.

Due to the prevalence of such patients, lactose-free dairy products are now available in almost all supermarkets and many chemists is able to prescribe it. Also, there are many online shops specialising in lactose-free products.

But why is there a need for better variety of lactose-free dairy products?

Quote by Univ. Prof. Dr. Dr. Jürgen Stein, Frankfurt University Clinic:
“Dairy products have a special significance in controlling the symptoms of lactose intolerance as they are essential, at all ages, for covering our required amounts of calcium needed for healthy bone formation. In a diet which fully excludes this food group, the recommended necessary amounts of calcium can barely be covered by food.”


ALTERNATIVES TO LACTOSE-CONTAINING PRODUCTS

These products may be easier to digest for lactose intolerant people:
  • Buttermilk and cheeses (they contain less lactose than milk)
  • Fermented milk products e.g. yogurt etc.
  • Goat's milk (drink it with meals; make sure it is taken together with essential amino acids and vitamins if it is for children)
  • Ice cream, milkshakes, and aged or hard cheeses
  • Lactose-free milk and milk products
  • Lactase-treated cow's milk. For example, Lactaid. (for older children and adults)
  • Soy formulas (for infants younger than 2 years)
  • Soy or rice milk (for toddlers)


PREVENTION

To date, there is no absolute prevention for lactose intolerance. However, reducing the intake of lactose-containing products or completely staying away from them can help to minimize the severity of the symptoms, e.g. having less serious or no diarrhea etc.


REFERENCES

National Digestive Diseases Information Clearinghouse: Lactose intolerance. (June 2009). Retrieved from:
http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/#diagnosed [Accessed on 21 Dec 2011].

National Digestive Diseases Information Clearinghouse: Lactose intolerance. (June 2009). Retrieved from: http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/#what [Accessed on 21 Dec 2011].

Pubmed Health: Lactose intolerance. (7 July 2010). Retrieved from:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001321/ [Accessed on 21 Dec 2011].

MedicineNet Inc: Stool Acidity Test Information. (1996-2011). Retrieved from: http://www.medicinenet.com/stool_acidity_test/article.htm#stool [Accessed on 21 Dec 2011].

MedicineNet Inc: Lactose intolerance symptoms, causes, treatment. (1996-2011). Retrieved from: http://www.medicinenet.com/lactose_intolerance/page2.htm [Accessed on 21 Dec 2011].

Laktoseintoleranz-hilfe: Symptoms. (2009). Retrieved from: http://www.laktoseintoleranz-hilfe.de/symptoms.html?L=1 [Accessed on 21 Dec 2011].

Laktoseintoleranz-hilfe: Treatment. (2009). Retrieved from: http://www.laktoseintoleranz-hilfe.de/treatment.html?L=1 [Accessed on 21 Dec 2011].

Laktoseintoleranz-hilfe: Diagnosis. (2009). Retrieved from: http://www.laktoseintoleranz-hilfe.de/diagnosis.html?L=1 [Accessed on 21 Dec 2011].



VIDEOS

http://www.youtube.com/watch?v=EeXsPYp13UM&feature=related



PICTURES

http://www.laktoseintoleranz-hilfe.de/uploads/pics/symptoms.jpg

http://www.laktoseintoleranz-hilfe.de/symptoms.html?L=1

http://www.cooking-free.com/2011/03/review-lactaid-and-coconut-milk-ice.html

http://www.arla.com/products/milk/lactofree-milk-intolerance/lactofree-whole-milk/

http://www.liddells.com.au/lactose-free-dairy/liddells-lactose-free-dairy/

http://www.cooking-free.com/

http://dairyintolerance.org/archives/150/

http://forums.vr-zone.com/photopost/showphoto.php?photo=216&nojs=1

http://main.nc.us/cartoons/lactose-intolerance.jpg

http://ibstreatmentcenter.blogspot.com/2011/09/most-dairy-reactions-are-not-lactose.html

http://aspireptc.blogspot.com/2011/02/digestive-enzymes.html

http://www.cartoonstock.com/directory/s/stomach_problems.asp

http://www.goodreads.com/author/show/2958547.Edain_Duguay/blog

http://www.fanpop.com/spots/milk-allergy-and-lactose-intolerance/images/1297777/title/lactose-photo

http://browse.deviantart.com/?qh=&section=&q=lactose+intolerance#/d360s4o

http://browse.deviantart.com/?qh=&section=&q=lactose+intolerance#/d2pi0lh

http://cheezburger.com/View/2722728960
http://gastrowellbeing.com.au/cms/wp-content/uploads/2010/07/Hydrogen-Breath-Testing.jpg
http://upload.wikimedia.org/wikipedia/commons/c/c3/Stool_transport.JPG