Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy-rich diet

Prebiotic Strategies to Manage Lactose Intolerance Symptoms

Lactose intolerance, which affects about 65-75% of the world's population, is caused by a genetic post-weaning deficiency of lactase, the enzyme required to digest the milk sugar lactose, called lactase non-persistence. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. Genetic variations, namely lactase persistence, allow some individuals to metabolize lactose effectively post-weaning, a trait thought to be an evolutionary adaptation to dairy consumption. Although lactase non-persistence cannot be altered by diet, prebiotic strategies, including the consumption of galactooligosaccharides (GOSs) and possibly low levels of lactose itself, may shift the microbiome and mitigate symptoms of lactose consumption. This review discusses the etiology of lactose intolerance and the efficacy of prebiotic approaches like GOSs and low-dose lactose in symptom management.

Human adaptation, demography and cattle domestication: an overview of the complexity of lactase persistence in Africa

Lactase persistence (LP) is a genetically-determined trait that is prevalent in African, European and Arab populations with a tradition of animal herding and milk consumption. To date, genetic analyses have identified several common variants that are associated with LP. Furthermore, data have indicated that these functional alleles likely have been maintained in pastoralist populations due to the action of recent selection, exemplifying the ongoing evolution of anatomically modern humans. Additionally, demographic history has also played a role in the geographic distribution of LP and associated alleles in Africa. In particular, the migration of ancestral herders and their subsequent admixture with local populations were integral to the spread of LP alleles and the culture of pastoralism across the continent. The timing of these demographic events was often correlated with known major environmental changes and/or the ability of domesticated cattle to resist/avoid infectious diseases. This review summarizes recent advances in our understanding of the genetic basis and evolutionary history of LP, as well as the factors that influenced the origin and spread of pastoralism in Africa.

Comparing Response of Sheep and Cow Milk on Acute Digestive Comfort and Lactose Malabsorption: A Randomized Controlled Trial in Female Dairy Avoiders

Background: Sheep milk (SM) is a possible alternate dairy source for those who experience digestive symptoms with cow milk (CM). While both the milks contain lactose, one of the causes for self-reported intolerance to CM, the composition of SM and CM also differs across proteins and fats, which have been shown to impact digestive processes. Objective: To compare the acute digestive comfort and lactose malabsorption of SM to CM in female dairy avoiders. Method: In a double-blinded, randomized cross over trial, 30 dairy-avoiding females (aged 20-30 years) drank 650 mL of SM or CM (each reconstituted from spray dried powder) following an overnight fast, on two separate occasions at least 1 week apart. Blood samples were collected for glucose and insulin assessment, and single nucleotide polymorphisms of the lactase (LCT) gene (C/T₁₃₉₁₀ and G/A₂₂₀₁₈). Breath H₂ and visual analog scale (VAS) digestive symptom scores were recorded at fasting and regular intervals over 4 h after ingestion. Results: Eighty percentage of study participants were lactase non-persistent (LNP; CC₁₃₉₁₀ and GG₂₂₀₁₈ genotype). Digestive symptoms, including abdominal cramps, distension, rumbling, bloating, belching, diarrhea, flatulence, vomiting, and nausea, were similar in response to SM and CM ingestion (milk × time, P > 0.05). Breath H₂ was greater after CM than SM (72 ± 10 vs. 43 ± 6 ppm at 240 min, P < 0.001), which may be due to greater lactose content in CM (33 vs. 25 g). Accordingly, when corrected for the lactose content breath H₂ did not differ between the two milks. The response remained similar when analyzed in the LNP subset alone (n = 20). Conclusions: Despite a higher energy and nutrient content, SM did not increase adverse digestive symptoms after ingestion, relative to CM, although there was a reduced breath H₂ response, which could be attributed to the lower lactose content in SM. The tolerability of SM should be explored in populations without lactose intolerance for whom underlying trigger for intolerance is unknown.

Lactose digestion in humans: intestinal lactase appears to be constitutive whereas the colonic microbiome is adaptable

Globally, ∼70% of adults are deficient in intestinal lactase, the enzyme required for the digestion of lactose. In these individuals, the consumption of lactose-containing milk and dairy products can lead to the development of various gastrointestinal (GI) symptoms. The primary solution to lactose intolerance is withdrawing lactose from the diet either by eliminating dairy products altogether or substituting lactose-free alternatives. However, studies have shown that certain individuals erroneously attribute their GI symptoms to lactose and thus prefer to consume lactose-free products. This has raised the question whether consuming lactose-free products reduces an individual's ability to absorb dietary lactose and if lactose-absorbers should thus avoid these products. This review summarizes the current knowledge regarding the acclimatization of lactose processing in humans. Human studies that have attempted to induce intestinal lactase expression with different lactose feeding protocols have consistently shown lack of enzyme induction. Similarly, withdrawing lactose from the diet does not reduce intestinal lactase expression. Evidence from cross-sectional studies shows that milk or dairy consumption is a poor indicator of lactase status, corroborating the results of intervention studies. However, in lactase-deficient individuals, lactose feeding supports the growth of lactose-digesting bacteria in the colon, which enhances colonic lactose processing and possibly results in the reduction of intolerance symptoms. This process is referred to as colonic adaptation. In conclusion, endogenous lactase expression does not depend on the presence of dietary lactose, but in susceptible individuals, dietary lactose might improve intolerance symptoms via colonic adaptation. For these individuals, lactose withdrawal results in the loss of colonic adaptation, which might lower the threshold for intolerance symptoms if lactose is reintroduced into the diet.

Occupational sensitization to lactase in the dietary supplement industry

Aerogen lactase exposure carries a risk for the development of allergic asthma and rhinitis; only a few occupationally affected patients have been reported. The authors report the results of allergy testing with employees of a lactase tablets manufacturing plant. The survey involved 13 workers, including a questionnaire, spirometry, basophil activation test (BAT), and skin prick tests (SPTs) with lactase and a panel of common aeroallergens. Furthermore, lactase-specific immunoglobulin E (IgE) antibodies were analyzed. Sensitization to lactase could be proven for 9 workers by SPT and BAT; specific IgE antibodies could be detected in serum samples of all sensitized. However, IgE levels ≥0.35 kU/L were only found in 4 sera. These data confirm that occupational exposure to lactase can induce IgE-mediated respiratory sensitization resulting in allergic diseases. Protective measures should thus be obligatory when working with lactase.

Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters

OBJECTIVE

To determine whether a 21-day milk-drinking intervention could reverse milk aversion.

DESIGN

Participants consumed increasing amounts of cow's milk for 21 days. Milk and dairy consumption, aversion, and likeness were assessed pre- and post-intervention and at 3 and 6 months post-intervention.

SETTING

A large Midwestern university.

PARTICIPANTS

Twenty-seven milk-averse individuals completed the intervention, 26 completed the 3-month follow-up, and 24 completed the 6-month follow-up.

MAIN OUTCOMES MEASURED

Participants self-reported milk and dairy consumption, aversion, and degree to which they liked milk.

ANALYSIS

Analysis of variance determined between-subject effects. Independent samples t test determined the effect of time. Fisher exact test determined factors affecting milk consumption.

RESULTS

Lactose digesters and maldigesters showed a significant decrease in overall symptom scores after the milk intervention, with no significant difference between groups. Independent of digestive status, subjects demonstrated a significant decrease in aversion, an increase in the amount to which they liked milk, and an increase in milk and overall calcium consumption at 3 and 6 months post-intervention.

CONCLUSIONS AND IMPLICATIONS

The results suggest a reversal of milk avoidance and the possibility that milk avoiders can increase likeness and incorporate milk into their diet after exposure.

Survey to determine why people drink raw milk

Background:

Fragility fractures associated with osteoporosis extract a large financial and personal toll on society. Pharmaceutical or dietary calcium intake is needed to increase bone mineral density to prevent fragility fractures. Although dairy products are a good source of calcium, patients who are unable to digest lactose tend to avoid them and are put at a greater risk for fracture than the general population. Anecdotal reports suggest that lactose maldigesters, when consuming raw milk, have a dramatic reduction in symptoms relative to pasteurized milk. The mechanism of the reported reduction in symptoms, if true, is unknown. The purpose of the current study was to survey raw milk drinkers to ascertain their health-related motivations for consuming raw milk, especially as they relate to lactose maldigestion.

Methods:

An online survey regarding raw milk was completed by 153 of 1527 members of a raw milk–buying community.

Results:

The primary reason the respondents cited for drinking raw milk was that they believed it was more healthful; 30% reported some gastrointestinal discomfort when drinking pasteurized milk, yet almost all (99%) reported consuming raw milk without discomfort. Despite the reports of gastrointestinal discomfort, only 5% of respondents had been diagnosed as lactose intolerant by a medical professional, and only 1% had been diagnosed as lactose intolerant via the gold-standard hydrogen breath test.

Conclusions:

The primary motivation for drinking raw milk is its perceived health value, not its digestibility. Although raw milk appears to be more easily digested than pasteurized milk in our survey sample, the mechanism of digestibility remains unknown.

Improving lactose digestion and symptoms of lactose intolerance with a novel galacto-oligosaccharide (RP-G28): a randomized, double-blind clinical trial

Background

Lactose intolerance (LI) is a common medical problem with limited treatment options. The primary symptoms are abdominal pain, diarrhea, bloating, flatulence, and cramping. Limiting dairy foods to reduce symptoms contributes to low calcium intake and the risk for chronic disease. Adaptation of the colon bacteria to effectively metabolize lactose is a novel and potentially useful approach to improve lactose digestion and tolerance. RP-G28 is novel galacto-oligosaccharide (GOS) being investigated to improve lactose digestion and the symptoms of lactose intolerance in affected patients.

Methods

A randomized, double-blind, parallel group, placebo-controlled study was conducted at 2 sites in the United States. RP-G28 or placebo was administered to 85 patients with LI for 35 days. Post-treatment, subjects reintroduced dairy into their daily diets and were followed for 30 additional days to evaluate lactose digestion as measured by hydrogen production and symptom improvements via a patient-reported symptom assessment instrument.

Results

Lactose digestion and symptoms of LI trended toward improvement on RP-G28 at the end of treatment and 30 days post-treatment. A reduction in abdominal pain was also demonstrated in the study results. Fifty percent of RP-G28 subjects with abdominal pain at baseline reported no abdominal pain at the end of treatment and 30 days post treatment (p = 0.0190). RP-G28 subjects were also six times more likely to claim lactose tolerance post-treatment once dairy foods had been re-introduced into their diets (p = 0.0389).

Conclusions

Efficacy trends and favorable safety/tolerability findings suggest that RP-G28 appears to be a potentially useful approach for improving lactose digestion and LI symptoms. The concurrent reduction in abdominal pain and improved overall tolerance could be a meaningful benefit to lactose intolerant individuals.

Study registration

ClinicalTrials.gov NCT01113619.

Dairy intake, dietary adequacy, and lactose intolerance

Despite repeated emphasis in the Dietary Guidelines for Americans on the importance of calcium in the adult American diet and the recommendation to consume 3 dairy servings a day, dairy intake remains well below recommendations. Insufficient health professional awareness of the benefits of calcium and concern for lactose intolerance are among several possible reasons, This mini-review highlights both the role of calcium (and of dairy, its principal source in modern diets) in health maintenance and reviews the means for overcoming lactose intolerance (real or perceived).

Thermal, chemical and pH induced denaturation of a multimeric β-galactosidase reveals multiple unfolding pathways

BACKGROUND

In this case study, we analysed the properties of unfolded states and pathways leading to complete denaturation of a multimeric chick pea β-galactosidase (CpGAL), as obtained from treatment with guanidium hydrochloride, urea, elevated temperature and extreme pH.

METHODOLOGY/PRINCIPAL FINDINGS

CpGAL, a heterodimeric protein with native molecular mass of 85 kDa, belongs to α+β class of protein. The conformational stability and thermodynamic parameters of CpGAL unfolding in different states were estimated and interpreted using circular dichroism and fluorescence spectroscopic measurements. The enzyme was found to be structurally and functionally stable in the entire pH range and upto 50 °C temperature. Further increase in temperature induces unfolding followed by aggregation. Chemical induced denaturation was found to be cooperative and transitions were irreversible, non-coincidental and sigmoidal. Free energy of protein unfolding (ΔG(0)) and unfolding constant (K(obs)) were also calculated for chemically denatured CpGAL.

SIGNIFICANCE

The protein seems to use different pathways for unfolding in different environments and is a classical example of how the environment dictates the path a protein might take to fold while its amino acid sequence only defines its final three-dimensional conformation. The knowledge accumulated could be of immense biotechnological significance as well.

Lactose malabsorption

OPINION STATEMENT

Lactose malabsorption is a syndrome producing constellation of symptoms, including abdominal pain, bloating, flatulence, diarrhea, and sometimes nausea and/or vomiting. Primary causes of lactose malabsorption due to loss of intestinal lactase activity include genetic/racial lactase nonpersistence, congenital lactase deficiency, and developmental lactase deficiency. Secondary lactose malabsorption can be caused by any disorder that injures the small intestinal mucosa, such as viral gastroenteritis, celiac disease, allergic (eosinophilic) gastroenteritis, and radiation enteritis. The diagnosis depends on careful clinical evaluation and is customarily confirmed with a lactose breath hydrogen test. As the symptoms are nonspecific, many adults diagnosed with lactose malabsorption actually have irritable bowel syndrome. Treatment consists of a trial of eliminating lactose-containing dairy foods, with supplementation of alternative calcium and protein sources. Commercial enzyme products containing β-galactosidases can be prescribed to help patients digest dietary lactose. Long-term lactose restriction usually is not necessary and can lead to reduced bone mineral density.

Gastrointestinal disturbances and their management in miglustat-treated patients

Miglustat (Zavesca®) is approved for the oral treatment of adult patients with mild to moderate type 1 Gaucher disease (GD1) for whom enzyme replacement therapy is unsuitable, and for the treatment of progressive neurological manifestations in adult and paediatric patients with Niemann-Pick disease type C (NP-C). Gastrointestinal disturbances such as diarrhoea, flatulence and abdominal pain/discomfort have consistently been reported as the most frequent adverse events associated with miglustat during clinical trials and in real-world clinical practice settings. These adverse events are generally mild or moderate in severity, occurring mostly during the initial weeks of therapy. The mechanism underlying these gastrointestinal disturbances is the inhibition by miglustat of intestinal disaccharidase enzymes (mainly sucrase and maltase), leading to sub-optimal hydrolysis of carbohydrates and subsequent osmotic diarrhoea and altered colonic fermentation. Transient decreases in body weight, which are often observed during initial miglustat therapy, are considered likely due to gastrointestinal carbohydrate malabsorption and associated negative caloric balance. While most cases of diarrhoea resolve spontaneously during continued miglustat therapy, diarrhoea also responds well to anti-propulsive medications such as loperamide. Dietary modifications such as reduced consumption of dietary sucrose, maltose and lactose have been shown to improve the gastrointestinal tolerability of miglustat and reduce the magnitude of any changes in body weight, particularly if initiated at or before the start of therapy. Miglustat dose escalation at treatment initiation may also reduce gastrointestinal disturbances. This article discusses these aspects in detail, and provides practical recommendations on how to optimize the gastrointestinal tolerability of miglustat.

Lack of effect of lactose digestion status on baseline fecal micoflora

BACKGROUND

The genetics of intestinal lactase divide the world's population into two phenotypes: the ability (a dominant trait) or inability (a recessive trait) to digest lactose. A prebiotic effect of lactose may impact the colonic flora of these phenotypes differently.

OBJECTIVE

To detect and evaluate the effects of lactose on subjects divided according to their ability to digest lactose.

METHODS

A total of 57 healthy maldigesters (n=30) and digesters (n=27) completed diet questionnaires, genetic and breath hydrogen testing, and quantitative stool analysis for species of bacteria. Log10 transformation of bacterial counts was compared with lactose intake in both groups using multiple regression analysis.

RESULTS

There was a significant relationship between genetic and breath hydrogen tests. Daily lactose intake was marginally lower in lactose maldigesters (median [interquartile range] 12.2 g [31 g] versus 15 g [29.6 g], respectively). There was no relationship between lactose intake and breath hydrogen tests in either group. There were no differences in bacterial counts between the two groups, nor was there a relationship between bacterial counts and lactose intake in either group.

CONCLUSION

The differential bacterial effects of lactose were not quantitatively detected in stool samples taken in the present study.

"Most people are simply not designed to eat pasta": evolutionary explanations for obesity in the low-carbohydrate diet movement

Low-carbohydrate diets, notably the Atkins Diet, were particularly popular in Britain and North America in the late 1990s and early 2000s. On the basis of a discourse analysis of bestselling low-carbohydrate diet books, I examine and critique genetic and evolutionary explanations for obesity and diabetes as they feature in the low-carbohydrate literature. Low-carbohydrate diet books present two distinct neo-Darwinian explanations of health and body-weight. First, evolutionary nutrition is based on the premise that the human body has adapted to function best on the diet eaten in the Paleolithic era. Second, the thrifty gene theory suggests that feast-or-famine conditions during human evolutionary development naturally selected for people who could store excess energy as body fat for later use. However, the historical narratives and scientific arguments presented in the low-carbohydrate literature are beset with generalisations, inconsistencies and errors. These result, I argue, from the use of the primitive as a discursive "blank slate" onto which to project ideals perceived to be lacking in contemporary industrialised life.

Structural prediction and comparative docking studies of psychrophilic β- Galactosidase with lactose, ONPG and PNPG against its counter parts of mesophilic and thermophilic enzymes

Enzymes from psychrophiles catalyze the reactions at low temperatures with higher specific activity. Among all the psychrophilic enzymes produced, cold active β-galactosidase from marine psychrophiles revalorizes a new arena in numerous areas at industrial level. The hydrolysis of lactose in to glucose and galactose by cold active β-galactosidase offers a new promising approach in removal of lactose from milk to overcome the problem of lactose intolerance. Herein we propose, a 3D structure of cold active β-galactosidase enzyme sourced from Pseudoalteromonas haloplanktis by using Modeler 9v8 and best model was developed having 88% of favourable region in ramachandran plot. Modelling was followed by docking studies with the help of Auto dock 4.0 against the three substrates lactose, ONPG and PNPG. In addition, comparative docking studies were also performed for the 3D model of psychrophilic β-galactosidase with mesophilic and thermophilic enzymes. Docking studies revealed that binding affinity of enzyme towards the three different substrates is more for psychrophilic enzyme when compared with mesophilic and thermophilic enzymes. It indicates that the enzyme has high specific activity at low temperature when compared with mesophilic and thermophilic enzymes.

The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected

OBJECTIVE

To determine the self-reported incidence of lactose intolerance and its influence on dairy choices among African American adults.

DESIGN, SETTING, AND PARTICIPANTS

An online survey closely matched to the 2000 US Census was administered to a nationally representative sample of African Americans (2016 adults) and a comparison sample of the general population (1084 adults). Statistical analyses performed included pairwise t tests for proportion conducted on percent responses at the 95% confidence level.

RESULTS

African Americans were more likely to eat fewer dairy foods, experience physical discomfort after consumption, and believe they were lactose intolerant. While 49% of African Americans had ever experienced "some type of physical discomfort" after eating dairy foods, 24% believed they were lactose intolerant. Within this group, 85% of African Americans would be willing to consume more dairy products if they could avoid lactose intolerance symptoms.

CONCLUSIONS AND IMPLICATIONS

Dairy food, calcium, and vitamin D intake in African Americans and the general population are below US recommendations. Deficiencies of these nutrients are associated with chronic diseases that disproportionately affect African Americans. In the United States, dairy foods are the primary source of calcium and vitamin D, and lactose intolerance can be a significant barrier to dairy food intake. However, self-described lactose intolerance is less than commonly reported in African American populations. Low dairy intake may reflect concerns about lactose intolerance, other factors such as learned food habits and cultural preferences. Nutrition recommendations for African Americans and the general population should focus on the health benefits of dairy foods, provide culturally sensitive dietary options, and strategies to increase tolerance.

Differential impact of lactose/lactase phenotype on colonic microflora

BACKGROUND

The ability to digest lactose divides the world's population into two phenotypes that may be risk variability markers for several diseases. Prebiotic effects likely favour lactose maldigesters who experience lactose spilling into their colon.

OBJECTIVE

To evaluate the effects of fixed-dose lactose solutions on fecal bifidobacteria and lactobacilli in digesters and maldigesters, and to determine whether the concept of a difference in ability to digest lactose is supported.

METHODS

A four-week study was performed in 23 lactose maldigesters and 18 digesters. Following two weeks of dairy food withdrawal, subjects ingested 25 g of lactose twice a day for two weeks. Stool bifidobacteria and lactobacilli counts pre- and postintervention were measured as the primary outcome. For secondary outcomes, total anaerobes, Enterobacteriaceae, beta-galactosidase and N-acetyl-beta-D-glucosaminidase activity in stool, as well as breath hydrogen and symptoms following lactose challenge tests, were measured.

RESULTS

Lactose maldigesters had a mean change difference (0.72 log10 colony forming unitsg stool; P=0.04) in bifidobacteria counts compared with lactose digesters. Lactobacilli counts were increased, but not significantly. Nevertheless, reduced breath hydrogen after lactose ingestion correlated with lactobacilli (r=-0.5; P<0.001). Reduced total breath hydrogen and symptom scorestogether, with a rise in fecal enzymes after intervention, were appropriate, but not significant.

CONCLUSIONS

Despite failure to achieve full colonic adaptation, the present study provided evidence for a differential impact of lactose on microflora depending on genetic lactase status. A prebiotic effect was evident in lactose maldigesters but not in lactose digesters. This may play a role in modifying the mechanisms of certain disease risks related to dairy food consumption between the two phenotypes.

Enhancement of alpha- and beta-galactosidase activity in Lactobacillus reuteri by different metal ions

The hydrolysis of oligosaccharides and lactose is of great importance to the food industry. Normally, oligosaccharides like raffinose, stachyose, and verbascose which are rich in different plants like soy bean are considered indigestible by the human gut. Moreover, many humans suffer from lactose intolerance due to the absence of effective enzyme that can digest lactose. alpha-Galactosidase can digest oligosaccharides like raffinose, while beta-galactosidases can hydrolyze lactose. Therefore, selection of microorganisms safe for human use and capable of producing high levels of enzymes becomes an attractive task. The objective of this study was to investigate the enhancement of alpha- and beta-galactosidase activity in Lactobacillus reuteri by different metal ions. Ten millimolar of Na(+), K(+), Fe(2+), and Mg(2+) and 1 mM of Mn(2+) were added separately to the growth culture of six strains of L. reuteri (CF2-7F, DSM20016, MF14-C, MM2-3, MM7, and SD2112). Results showed that L. reuteri CF2-7F had the highest alpha- and beta-galactosidase activity when grown in the medium with added Mn(2+) ions (22.7 and 19.3 Gal U/ml, respectively). 0.0274% of Mn(2+) ions lead to 27, 18% enhancement of alpha- and beta-galactosidase activity over the control group, and therefore, it could be added to the growth culture of CF2-7F to produce enhanced levels of alpha- and beta-galactosidase activity. The addition of Fe(2+) led to a significant (P < 0.01) decrease in the activity of both enzymes for most strains. This study shows that modified culture medium with that 0.0274% Mn(2+) can be used to promote the production for alpha- and beta-galactosidase in L. reuteri CF2-7F, which may lead to enhancement of alpha- and beta-galactosidase activity and have a good potential to be used in the food industry.

Lactose intolerance and African Americans: implications for the consumption of appropriate intake levels of key nutrients

Lactose intolerance is a complex condition that is complicated by cultural beliefs and perceptions about the consumption of dairy products. These attitudes about dairy may contribute to inadequate intake of key nutrients that may impact conditions that contribute to health disparities in African Americans. While a complex health problem, lactose intolerance is easy to treat. However, no treatment can improve the body's ability to produce lactase. Yet, symptoms can be controlled through dietary strategies. This position paper emphasizes the importance of using patient and provider-level strategies in order to reduce the risks to the health of African Americans that may accrue as a result of dairy nutrient deficiency. Evaluation and assessment of interventions tested is critical so that evidence-based approaches to addressing dairy nutrient deficiency and lactose Intolerance can be created. Lastly, it is essential for physicians to communicate key messages to their patients. Since dairy nutrients address important health concerns, the amelioration of lactose intolerance is an investment in health. Lactose intolerance is common, is easy to treat, and can be managed. It is possible to consume dairy even in the face of a history of maldigestion or lactose intolerant issues. Gradually increasing lactose in the diet--drinking small milk portions with food, eating yogurt, and consuming cheese--are effective strategies for managing lactose intolerance and meeting optimal dairy needs.

Growth patterns in children with sickle cell anemia during puberty

BACKGROUND

Previous studies of children with homozygous sickle cell anemia (SCA) show impaired growth and maturation. The correlation of this suboptimal growth with metabolic and hematological factors during puberty is poorly understood.

PROCEDURE

We studied a group of pre-adolescent children with SCA (19 males, 14 females) and healthy controls (16 males, 15 females) matched for race, sex, body size, and pubertal development. Height, weight, body mass index (BMI), and body composition changes were longitudinally assessed over a 2-year period and compared between the groups and with Z scores based on US growth charts. These changes were correlated with hemoglobin (Hgb) concentration and with energy expenditure (EE) measured using indirect whole-room calorimetry.

RESULTS

Children with SCA progressed through puberty slower than control children. While, after 2 years, pubertal males with SCA were shorter, their annual increases in weight were not different from controls. The mean fat free mass (FFM) increments were significantly less in males and females with SCA than in control children. In males with SCA, growth in height declined over time and was significantly slower than in matched controls (P < 0.05).

CONCLUSION

Growth delays were present during puberty in children with SCA. Decreased growth velocity in children with SCA was independently associated with decreased Hgb concentration and increased total EE.

Lactose Maldigestion Revisited: Diagnosis, Prevalence in Ethnic Minorities, and Dietary Recommendations to Overcome It

Currently, an estimated 25% of Americans and 75% of individuals worldwide seem to suffer from lactose maldigestion. The authors' objective was to evaluate current prevalence of lactose maldigestion/intolerance in populations of various ethnic groups, examine the severity of symptoms, and recommend ways in alleviating them. In the United States, 25% of people who are lactose maldigesters are ethnic minorities. Earlier estimates report that ∽50% of Hispanic, almost 100% of Asian, and ∽80% of African Americans suffer from lactose maldigestion. There is evidence linking lactose maldigestion as a factor contributing to low calcium intake, leading to subsequent osteoporotic fractures. Although bone mineral density is higher in African and Hispanic American men and women compared to white and Asian Americans, osteoporosis is still a concern in those populations. Recent studies suggest that current estimates of lactose maldigestion may be grossly overestimated. Clinical trials show that even those individuals who do maldigest lactose could overcome adverse symptoms by a few simple dietary strategies. In addition, new research points to possible manipulation of colonic microflora toward alleviating symptoms.

Counseling parents on feeding their children

PURPOSE OF REVIEW

The high-nutrient needs of children for normal growth and development are matched by ready access to low-nutrient high-energy foods. Parents are often confused by new and at times conflicting information. This review discusses three recently published papers that offer specific and important dietary information for school-aged children.

RECENT FINDINGS

Lactose intolerance is common in some populations and there are misconceptions about dairy intake. Most lactose-intolerant children can consume some dairy products without symptoms. Fruit-juice intake can predict increased weight gain in children, especially those who are already overweight or at risk for being overweight. Hypertension is a serious disease with onset likely in childhood. This paper discusses the importance of dietary sodium as a contributor to the development of hypertension, and the sodium content of children's diets.

SUMMARY

Advice to parents on feeding children should be based on the food pyramid and include information on exercise. Recent publications suggest that children consume dairy products, even if lactose intolerant, restrict juice intake, remove sweetened beverages from their diets and reduce sodium consumption.

Lactose intolerance in infants, children, and adolescents

The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. 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. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided.

The myth of increased lactose intolerance in African-Americans

In the United States, approximately three fourths of African-Americans have the potential for symptoms of lactose intolerance because lactose digestion depends on the presence of the enzyme lactase-phlorizin hydrolase which is reduced by up to 90-95% in individuals with lactase nonpersistence. The 'African-American diet' is more likely to be low in a variety of vitamins and minerals, including calcium. African-Americans consume low amounts of dairy foods and do not meet recommended intakes of a variety of vitamins and minerals, including calcium. Low intake of calcium and other nutrients put African-Americans at an increased risk for chronic diseases. The 2005 Dietary Guidelines recommend consuming three servings of dairy foods per day to ensure adequate calcium intake, among other nutrients, and the National Medical Association has recently published a similar recommendation of three to four servings of dairy per day for the African-American population. Research has shown that lactose maldigesters, including African-American maldigesters, can consume at least one cup (8 oz) of milk without experiencing symptoms, and that tolerance can be improved by consuming the milk with a meal, choosing yogurt or hard cheeses, or using products that aid in the digestion of lactose such as lactase supplements or lactose-reduced milks.

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Genetic manipulation for enhancing calcium content in potato tuber

Increased calcium (Ca) in potatoes may increase the production rate by enhancing tuber quality and storability. Additionally, increased Ca levels in important agricultural crops may help ameliorate the incidence of osteoporosis. However, the capacity to alter Ca levels in potato tubers through genetic manipulations has not been previously addressed. Here we demonstrate that potato tubers expressing the Arabidopsis H+/Ca2+ transporter sCAX1 (N-terminal autoinhibitory domain truncated version of CAtion eXchanger 1) contain up to 3-fold more Ca than wild-type tubers. The increased Ca appears to be distributed throughout the tuber. The sCAX1-expressing potatoes have normally undergone the tuber/plant/tuber cycle for three generations; the trait appeared stable through successive generations. The expression of sCAX1 does not appear to alter potato growth and development. Furthermore, increased Ca levels in sCAX1-expressing tubers do not appear to alter tuber morphology or yield. Given the preponderance of potato consumption worldwide, these transgenic plants may be a means of marginally increasing Ca intake levels in the population. To our knowledge, this study represents the first attempts to use biotechnology to increase the Ca content of potatoes.

Diagnosis, symptoms, and calcium intakes of individuals with self-reported lactose intolerance

OBJECTIVE

To determine methods of diagnosis, symptoms, and calcium intake from food and supplements for individuals with self-reported lactose intolerance.

METHODS/DESIGN

Cross-sectional survey using a mailed questionnaire.

SUBJECTS/SETTING

A convenience sample of 189 adults with self-reported lactose intolerance living in the metropolitan area of Vancouver Canada responded to posters or advertisements, and 159 returned completed questionnaires.

MEASURES OF OUTCOME

Methods of diagnosis, symptoms experienced and their severity were self-reported. Estimated calcium intake from food and supplements was assessed using a food frequency questionnaire. Data were analyzed using descriptive statistics, chi-square, Pearson correlation analysis, t-tests and Analysis of Variance.

RESULTS

Participants were 47 +/- 15 years of age; 72% female and 28% male; 67% Caucasian; and 54% had self-diagnosed their lactose intolerance. Of the 42% diagnosed by a physician, only 10% had been diagnosed by valid tests. Mean estimated food calcium intake was 591 +/- 382 mg/d and did not differ between those who were self- or physician-diagnosed. Only 11.5% of participants met their age-appropriate Adequate Intake (AI) from food calcium sources alone. Calcium supplements were used by 65% and provided an average of 746 +/- 703 mg calcium/day to those who used them; mean intakes of this group met the AI.

CONCLUSIONS

Calcium intake from food sources alone is inadequate to meet the AI in individuals with self-reported lactose intolerance. Physicians managing lactose intolerance need current information on how the AI can be met through appropriate food choices and possible supplementation.

Effects of a medical food containing an herbal α-glucosidase inhibitor on postprandial glycemia and insulinemia in healthy adults

OBJECTIVE

To determine the effect of different doses of Salacia oblonga extract, an herbal alpha-glucosidase inhibitor, on postprandial glycemic, insulinemic, and breath hydrogen responses in healthy adults.

DESIGN

Double-masked, randomized crossover design.

INTERVENTION

Subjects, after fasting for 12 hours, consumed four test meals consisting of 480 mL of study beverage (14 g fat, 82 g carbohydrate, and 20 g protein) with 0, 500, 700, or 1,000 mg of S oblonga extract on four separate occasions. Capillary finger-prick plasma glucose and venous serum insulin concentrations were measured at baseline and for 2 hours postprandially. Breath hydrogen excretion was measured at baseline and hourly for 8 hours postprandially.

SUBJECTS/SETTING

Thirty-nine healthy, nondiabetic adults (body mass index=23.7+/-0.4, age=25.7+/-0.9 years.

STATISTICAL ANALYSES PERFORMED

Repeated-measures analysis of variance was applied to the raw data or data that had been transformed (log, rank) when necessary due to nonnormality. The Tukey-Kramer post hoc test was used for pairwise comparisons.

RESULTS

Compared with the control, the 1,000-mg S oblonga extract dose reduced the plasma glucose and serum insulin incremental areas under the curve (0 to 120 minutes postprandial) by 23% ( P =.32) and 29% ( P =.01), respectively. The other doses of S oblonga extract did not impact glycemia or insulinemia. Breath hydrogen excretion increased linearly as the dose of S oblonga extract was advanced.

CONCLUSIONS

The presence of S oblonga extract tended to lower postprandial glycemia and significantly reduced the postprandial insulin response. The increase in breath hydrogen excretion suggests a mechanism similar to prescription alpha-glucosidase inhibitors. Future studies of S oblonga extract in patients with diabetes are needed.

Genetic variation and lactose intolerance: detection methods and clinical implications

The maturational decline in lactase activity renders most of the world's adult human population intolerant of excessive consumption of milk and other dairy products. In conditions of primary or secondary lactase deficiency, the lactose sugars in milk pass through the gastrointestinal tract undigested or are partially digested by enzymes produced by intestinal bacterial flora to yield short chain fatty acids, hydrogen, carbon dioxide, and methane. The undigested lactose molecules and products of bacterial digestion can result in symptoms of lactose intolerance, diarrhea, gas bloat, flatulence, and abdominal pain. Diagnosis of lactose intolerance is often made on clinical grounds and response to an empiric trail of dietary lactose avoidance. Biochemical methods for assessing lactose malabsorption in the form of the lactose breath hydrogen test and direct lactase enzyme activity performed on small intestinal tissue biopsy samples may also be utilized. In some adults, however, high levels of lactase activity persist into adulthood. This hereditary persistence of lactase is common primarily in people of northern European descent and is attributed to inheritance of an autosomal-dominant mutation that prevents the maturational decline in lactase expression. Recent reports have identified genetic polymorphisms that are closely associated with lactase persistence and nonpersistence phenotypes. The identification of genetic variants associated with lactase persistence or nonpersistence allows for molecular detection of the genetic predisposition towards adult-onset hypolactasia by DNA sequencing or restriction fragment length polymorphism analysis. The role for such genetic detection in clinical practice seems limited to ruling out adult-onset hypolactasia as a cause of intolerance symptoms but remains to be fully defined. Attention should be paid to appropriate interpretation of genetic detection in order to avoid potentially harmful reduction in dairy intake or misdiagnosis of secondary lactase deficiency.

Girls on a high-calcium diet gain weight at the same rate as girls on a normal diet: A pilot study

OBJECTIVE

To determine whether pubertal girls assigned to calcium-rich diets or their usual calcium intakes differ significantly in weight gain.

DESIGN

This is a pilot study conducted on data from an experimental research project.

SUBJECTS/SETTING

The sample included 59 girls, 9 years of age, from Omaha metropolitan communities.

INTERVENTION

Participants were randomly assigned to a calcium-rich diet supplying at least 1,500 mg of calcium per day or their usual diet.

MAIN OUTCOME MEASURE

The outcome measure was change in weight during 2 years of study.

STATISTICAL ANALYSES

Data were analyzed using descriptive statistics, Mann-Whitney U, t tests of paired and independent samples, and analysis of covariance.

RESULTS

The girls in the calcium-rich diet group had a mean (+/-standard deviation) calcium intake of 1,656+/-191 mg/day, whereas the girls on their usual diets averaged 961+/-268 mg/day. Although the participants in the treatment group consumed nearly twice as much dietary calcium--primarily from dairy foods--they did not have greater increases in body weight, body mass index, or fat or lean mass than the control group. These findings held when the data were grouped by tertile of calcium intake. Compared with girls on their usual diets, the girls who consumed the calcium-rich diet also significantly increased their intake of essential nutrients.

CONCLUSION

We conclude that calcium-rich diets do not cause excessive weight gain in pubertal girls but do contribute positively to overall nutrition. These findings provide support for programs to promote calcium-rich diets, which are critical for attaining peak bone mass.

Racial differences in the effect of early milk consumption on peak and postmenopausal bone mineral density

Studies of the effect of milk consumption on bone density have focused on white women. The applicability to other races is unclear. This study of 4316 women found a racial difference in the effect of early milk consumption on bone. Further study is required to evaluate the etiology of this difference.

INTRODUCTION

Early milk consumption has been found to influence bone mineral density positively throughout life. Previous studies leading to this finding focused on white women; there are no data to support the view that black women also gain an equivalent benefit from early milk consumption.

MATERIALS AND METHODS

Using data from the Third National Health and Nutrition Examination Survey (NHANES III), we analyzed the relationship between reported childhood and teenage milk consumption and current hip bone mineral density at four sites (femoral neck, trochanter, intertrochanter, and total hip) among postmenopausal and 20- to 39-year-old non-Hispanic white (NHW) and black (NHB) women. Potential confounding variables were accounted for in the analysis.

RESULTS

Controlling for age and body mass index, teenage milk consumption was significantly associated with higher bone mineral density at all four sites among both postmenopausal and 20- to 39-year-old white women, but was not associated with bone mineral density at any site among black women. A similar pattern was observed for childhood milk intake. The interaction between race and teenage milk consumption significantly explained postmenopausal bone mineral density at all sites, whereas the interaction between race and teenage milk consumption was significant at two of the four sites among the 20- to 39-year-old women.

CONCLUSION

The results show racial differences in the effect of early milk consumption on peak and postmenopausal bone mineral density.

Guest Editorial: Does Good Nutrition Conflict With Cultural Sensitivities?

In this era of political correctness, we avoid giving the best dietary advice for optimal health and disease prevention for all population groups.

Tolerance of symptomatic lactose malabsorbers to lactose in milk chocolate

OBJECTIVE

To study tolerance to lactose in milk chocolate among symptomatic lactose maldigesters.

DESIGN

Randomized cross-over study.

SUBJECTS

Twenty-seven adult lactose maldigesters with symptomatic lactose intolerance.

METHODS

A 100 g chocolate sample prepared with whole milk (12 g lactose), whole-milk powder (12 g lactose), low-lactose milk powder (2 g lactose) or lactose-free milk powder was eaten after an overnight fast. Gastrointestinal symptoms (flatulence, abdominal bloating, abdominal pain, borgorygmi and nausea) were recorded in a questionnaire during the following 8 h. Bowel movements and stool consistency were also registered during the test day.

RESULTS

The numbers of persons reporting different gastrointestinal symptoms or any of the symptoms did not differ significantly after eating the chocolate samples. No statistical differences were found in the estimated strength of the different symptoms or the total strength of all symptoms combined. Differences in the bowel frequency and stool consistency were also non-significant.

CONCLUSIONS

Lactose malabsorbers with self-reported lactose intolerence did not differ in their response to milk chocolate samples containing different amounts of lactose.

Kefir improves lactose digestion and tolerance in adults with lactose maldigestion

OBJECTIVE

Kefir is a fermented milk beverage that contains different cultures than yogurt. The objective of this study was to determine whether kefir improves lactose digestion and tolerance in adults with lactose maldigestion.

DESIGN

Randomized block design.

SUBJECTS

Fifteen healthy, free-living adults with lactose maldigestion.

MAIN OUTCOME MEASURES

Breath hydrogen excretion and lactose intolerance symptoms were monitored hourly for 8 hours after each test meal.

INTERVENTION

Subjects were fed test meals consisting of 20 g lactose portions of milk (2% reduced fat), plain and raspberry flavored kefir, and plain and raspberry flavored yogurt, each following an overnight (12 hour) fast.

STATISTICAL ANALYSIS

Mixed model ANOVA was performed on raw or transformed data, followed by Tukey HSD post hoc tests (when appropriate). Significance was defined as P<.05.

RESULTS

The breath hydrogen area under the curve (AUC) for milk (224+/-39 ppm x h) was significantly greater than for the plain yogurt (76+/-14 ppm x h, P<.001), the plain kefir (87+/-37 ppm x h, P<.001), and the flavored yogurt (76+/-14 ppm x h, P=.005). The flavored kefir had an intermediate response (156+/-26 ppm x h). The yogurts and kefirs all similarly reduced the perceived severity of flatulence by 54% to 71% relative to milk. Abdominal pain and diarrhea symptoms were negligible among the five treatments.

APPLICATIONS/CONCLUSION

Because kefir improved lactose digestion and tolerance in this study, its use may be another potential strategy for overcoming lactose intolerance. Further studies of other types of kefir for improving lactose digestion are warranted.

Fructose prefeeding reduces the glycemic response to a high-glycemic index, starchy food in humans

The study objective was to determine whether a small dose of fructose administered before or simultaneously with a high glycemic index, starchy food decreases postprandial glycemic response. Nondiabetic healthy adults (n = 31; mean +/- SEM: age, 26 +/- 1 y; weight, 66.1 +/- 2.6 kg; body mass index, 23.3 +/- 0.6 kg/m(2)) were studied in a randomized crossover design. Treatments consisted of 50 g available carbohydrate from instant mashed potatoes fed alone (control) or with 10 g fructose fed 60, 30 or 0 min before the potato meal. Capillary finger-stick blood samples were analyzed for glucose concentration at -60, -30, 0, 15, 30, 45, 60, 90 and 120 min relative to the ingestion of the potato meal. Compared with the control, the positive incremental area under the glucose curve was reduced 25 and 27% (P < 0.01) when fructose was fed either 60 or 30 min before the meal, respectively. In contrast to previous studies demonstrating that immediate administration of a small amount of fructose lowers the glycemic response to a glucose solution, we found that fructose must be consumed before a starchy food to reduce postprandial glycemia.

Beverage choices of young females: changes and impact on nutrient intakes

OBJECTIVE

To examine trends in beverage consumption and evaluate the impact of beverage choices on the nutrient intakes of females ages 12 to 19 years.

DESIGN

Dietary intake data from the USDA's Nationwide Food Consumption Surveys, including the Continuing Survey of Food Intakes by Individuals (CSFII), were assessed for trends in beverage consumption. The CSFII 1994-1996 data was used to examine the diets of young females grouped based on their milk and soda consumption status. Mean energy, nutrient, and beverage intakes were compared.

SUBJECTS

Females with complete dietary intake information on Day 1 of the survey were included in the study. There were 732 females ages 12 to 19 years in the CSFII 1994-1996. Statistical Analysis Percentages of females consuming specific beverages were estimated. Pairwise mean comparisons were made between groups based on milk and soda consumption status.

RESULTS

Milk intakes decreased by 36% whereas that of sodas and fruit drinks almost doubled from the late 1970s to the mid 1990s. The CSFII 1994-1996 data showed that between ages 12 and 19 years, intakes of fruit juices, soda, tea, fruit drinks, and alcoholic beverages either increased or remained relatively steady, while milk intakes decreased with an increase in age. At age 12 years, 78% drank milk and had the lowest soda intake (276g), while at age 19-years, only 36% drank milk and drank a high amount of soda (423g). Those who did not drink milk had inadequate intakes of vitamin A, folate, calcium, phosphorus, and magnesium.

APPLICATION

A rapid decrease in milk intake during the early adolescent years indicates a need for interventions at this age. Dietitians should identify barriers to drinking milk and recommend strategies for including appropriate food sources to increase calcium intakes during growing years. Nutrition educators should provide parents of adolescent children with ideas for ensuring the adequacy of their children's calcium intakes. J Am Diet Assoc. 2002; 102: 1234-1239.

Dietary calcium intake in lactose maldigesting intolerant and tolerant African-American women

BACKGROUND

The relationship between lactose maldigestion, lactose intolerance, and calcium intake in premenopausal African American women is unknown.

OBJECTIVE

To determine how intolerance of lactose and dairy products affects intake of calcium in lactose maldigesting premenopausal African American women.

DESIGN

Dietary intake of calcium was assessed in 50 premenopausal lactose maldigesting African American women as determined by the breath hydrogen test. Twenty-six women were lactose intolerant and 24 were lactose tolerant by self-reports.

RESULTS

The average intake of calcium in lactose maldigesting and intolerant women was significantly lower than in lactose tolerant women (388 +/- 150 mg/day vs. 763 +/- 333 mg/day, p < 0.0001, t test). Neither group reached the newly established Dietary Reference Intake (DRI) for calcium (1,000 mg/day). Major source of dietary calcium in lactose tolerant women were milk and dairy products (45%), and mixed foods containing calcium from non-dairy sources (30%). In lactose intolerant women, 46% of calcium was from mixed foods and only 12% was from milk and dairy products. Lactose intolerant women had higher body mass index (BMI) than lactose tolerant women (p = 0.008, t test), and calcium intake was negatively associated with BMI (R2 = 0.470).

CONCLUSIONS

In African American premenopausal women, lactose tolerance facilitates the dietary intake of calcium when compared with their lactose intolerant counterparts. Low calcium intake is associated with higher BMI.