Lactose intolerance is the inability
to digest significant amounts of lactose, the predominant
sugar of milk. This condition affects an estimated 50
million Americans. Lactose intolerance results from
a shortage of the enzyme lactase that is normally found
in the small intestine. At birth, humans have abundant
lactase activity in the small intestine but in most
ethnic groups this activity decreases significantly
during childhood between ages 3 to 5. When there is
not enough lactase to digest the amount of lactose consumed
the person will experience nausea, cramps, bloating,
gas, and diarrhea. In children this can result in dangerous
dehydration.
Milk and other dairy products are a major source of
nutrients in the American diet. The most important of
these nutrients is calcium. Calcium is essential for
the growth and repair of bones throughout life, but
is a particular concern during the developmental years.
Studies have shown that nearly 50% of people who self-report
milk intolerance are not maldigesters. Instead they
suffer from a functional bowel disorder such as irritable
bowel syndrome (IBS), recurrent abdominal pain (RAP)
in children or some other gastrointestinal complication.
Recurrent abdominal pain (RAP) occurs in 10 to 15% of
school-age children. In self-reported milk intolerants,
it has been found that there is a significant, unnecessary
reduction in milk consumption and insufficient dietary
calcium intake.
The diagnosis of lactose intolerance has relied on an
interview process coupled with removing milk (and milk
products) from the diet, laboratory tests and jejunal
biopsy. The interview process is overly simplistic and
quite imprecise. First, nearly 50% of people who self-report
milk intolerance are normal digesters of lactose and
secondly, 70% of the people with lactase-deficiency
(although symptomatic) fail to correlate the broad gastrointestinal
symptoms of this disease to the intake of lactose.
The Lactose Breath Test
offered by Metabolic Solutions is a new version
of the hydrogen breath test. It can be performed
in a doctor’s office or given to patients
to do at their convenience and in their own homes.
It provides a safe, non-invasive and cost-effective
solution to diagnose lactose intolerance with
an emphasis on convenience for the doctor and
patient.
The production of hydrogen (H2) by
bacterial fermentation of carbohydrate substrate
in the colon is the basis for the Lactose Breath
Test. This test seeks to quantify the changes
in breath-hydrogen concentration prior to and
after the ingestion of lactose. Normally, very
little hydrogen is detectable in the breath. However,
in the case of the lactose maldigesters, the lactose
passes into the colon unmetabolized where bacteria
ferment it and various gases, including hydrogen
are produced. The hydrogen is absorbed from the
intestines, carried through the blood stream to
the lungs and exhaled. In this test, the patient
drinks a lactose-loaded beverage, and the breath
is analyzed at regular intervals over several
hours. Raised levels of hydrogen in the breath
indicate that the lactose is not being properly
digested. In a healthy subject the difference
(measured in parts per million) in H2
production between baseline and post lactose ingestion
measurements will be small.
The majority, but not all malabsorbers produce H2.
In most cases, non-hydrogen producing patients when
exposed to lactose will generate methane (CH4).
These patients will be properly diagnosed by measuring
for CH4. As a result, each breath specimen
is measured by Metabolic Solutions for H2
and CH4. |
