Gastrointestinal Disease
Praveen S. Goday, Cassandra L. S. Walia in Pediatric Nutrition for Dietitians, 2022
Lactose is a disaccharide composed of galactose and glucose, and is the main carbohydrate in milk. Lactose intolerance refers to the inability to digest lactose due to inadequate activity of the lactase enzyme, the most common form of disaccharide deficiency. Primary lactase deficiency is a common condition in which lactase activity falls after weaning and can happen at any point in childhood, adolescence, or adulthood, although it is rare under age 6 years of age. Primary lactose intolerance is highly prevalent in African-American, Native-American, and Asian populations and less common in Northern-European, certain African, and Indian populations. Secondary lactase deficiency is usually due to mucosal injury associated with disease, such as celiac disease or Crohn’s disease.
Do I Have IBS?
Melissa G. Hunt, Aaron T. Beck in Reclaim Your Life From IBS, 2022
Another diagnostic test for lactose intolerance is the hydrogen breath test. Undigested lactose is broken down by bacteria in the gut, leading to the production of hydrogen and methane gases, which can be detected in the breath. Unfortunately, the results of those tests are sometimes borderline or equivocal, and there are often long wait times to have the test done. Sometimes the test is combined with a lactose tolerance test, in which you undergo a blood test to measure the amount of glucose in your blood. If you’re digesting lactose, your glucose levels should rise after consuming a lot of it. If your blood sugar doesn’t rise, it suggests that you’re not breaking the lactose down. Eventually, a simple genetic test may be used to identify individuals who are lactose-intolerant, but that is not available in routine clinical practice yet. Because the hydrogen breath test, like the celiac blood test, is not particularly invasive, it may be worth doing to rule out the possibility that your symptoms are being caused by lactose intolerance.
Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Irritable bowel syndrome is a primarily functional disorder which covers a large number of intestinal symptoms and classically was a diagnosis of exclusion. Whilst aetiology is not certain, gastrointestinal motility and visceral perception problems are mooted as possibilities. Commoner in young females, symptoms include left-sided or central abdominal pain, bloating, changing bowel habit, nausea and symptoms of reflux. Symptoms may be cyclical with menstruation or related to psychological stressors. Treatment is symptomatic and many specialties may be involved. Constipation can be treated with increased dietary fibre with ispaghul husk, whilst diarrhoea can be treated with bulking agents and loperamide. Antispasmodics such as mebeverine can be used if colicky pain or spasm is prominent. Exclusion diets can help if lactose intolerance is involved. Psychological therapy can help with concurrent stress and depression. It is important however to screen for worrying symptoms such as weight loss and per rectal bleeding that may have a serious cause.
Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem?
Published in Scandinavian Journal of Gastroenterology, 2020
F. Westerink, H. Beijderwellen, I. L. Huibregtse, M. L. A. De Hoog, L. M. De Brauw, D. P. M. Brandjes, V. E. A Gerdes
This is the first study to investigate lactose intolerance after RYGB. Lactose intolerance originates from lactose malabsorption because of primary or secondary lactase deficiency. Where primary lactase deficiency is due to decreasing lactase production in the intestines, starting months after birth and regulated by the lactase-gene on chromosome 2 [15], secondary lactase deficiency is caused by several gastrointestinal diseases. These lead to mucosal damage, resulting in a reduction of lactase production [16,17]. Several studies were performed after Billroth gastroduodenostomy and gastrojejunostomy which showed an increase in lactose intolerance postoperatively [8,9]. It was suggested that the gastrointestinal changes caused diminished lactase production. RYGB could have similar effects. The results of this study contradict this.
A Randomized Controlled Pilot Exercise and Protein Effectiveness Supplementation Study (EXPRESS) on Reducing Frailty Risk in Community-Dwelling Older People
Published in Journal of Nutrition in Gerontology and Geriatrics, 2021
Agathe Daria Jadczak, Renuka Visvanathan, Robert Barnard, Natalie Luscombe-Marsh
Participant retention is often cited as another issue affecting the quality of studies. In our research we found that whilst the interventions were safe, there were tolerability issues related to the nutritional supplementation; this is something that we46 and other groups47 had noted previously when using commercial products.46,47 Difficulty ingesting the protein drinks, and tolerability of the drinks once consumed resulted in early withdrawals from this study. Therefore, sample size estimation for future studies of this nature should allow for a dropout rate of ∼25%. Those that remained in the study reported high compliance with both types of protein supplements (i.e., 90.3%), which conforms to findings from other studies that investigated the effects of dairy proteins. For example, Fielding et al.,47 as well as Collins et al.,48 also reported high compliance to twice daily 20 g supplements of whey protein in combination with resistance-based exercise despite undesirable gastrointestinal effects. Lactose intolerance is often cited as the cause of gastrointestinal issues in response to dairy. However, the whey protein isolate used in this study had negligible lactose, and known lactose intolerance was an exclusion criterion. Since whey has been demonstrated to empty from the stomach more rapidly than other proteins,49 it is plausible that rapid gastric emptying caused the bloating, nausea and diarrhea experienced by some participants in this study; these are all symptoms of idiopathic accelerated gastric emptying.50
Cow milk protein allergy and other common food allergies and intolerances
Published in Paediatrics and International Child Health, 2019
Wiparat Manuyakorn, Pornthep Tanpowpong
The clinical presentations of food intolerance overlap those of many other common conditions, e.g. migraine headache, psychiatric and behavioural conditions (presenting with fatigue, mood instability, behavioural changes), rash or flushing, respiratory tract symptoms (presenting with rhinitis, cough or wheezing), irritable bowel syndrome (IBS) or abdominal pain-related functional gastrointestinal disorders (FGIDs) [41]. These non-specific symptoms may occur hours after ingestion and can last for days. A high index of suspicion is crucial for diagnosis. Currently, no single simple test has been shown to confirm this non-immunological condition. Furthermore, in routine clinical practice, the gold standard double-blind placebo-controlled food challenge (DBPCFC) is seldom performed in children with food intolerances. Some older children and adolescents with previously known medical conditions such as IBS or psychiatric disorders may even have exaggerated symptoms in conjunction with food intolerance [42,43] which makes diagnosis even more difficult. Individuals with IBS sometimes think that they have an intolerance to dairy produce when they do not [44]. For example, patients with lactose intolerance may have abdominal symptoms similar to those of IBS [45]. Self-reporting of lactose intolerance does not always correlate well with the hydrogen breath test [46]; symptoms can be owing to other underlying conditions such as IBS or FGIDs. Those whose symptoms improve with dietary avoidance should just continue to avoid the causative foods.