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Lactose Intolerance Between thirty and fifty million Americans are lactose intolerant, meaning their bodies don’t produce enough lactase, the enzyme needed to digest lactose, the natural sugar found in milk and other dairy products. Certain ethnic and racial populations are more affected with lactose intolerance than others. Up to 80 percent of African Americans, 80 to 100 percent of American Indians, and 90 to 100 percent of Asian Americans are lactose intolerant. Lactose intolerance is least common among people of northern European descent. In addition some 7.5 million Americans suffer from severe lactose intolerance. Common symptoms of lactose intolerance include nausea, cramps, bloating, gas, and diarrhea, which may begin about 30 minutes to 2 hours after eating or drinking foods that contain lactose. Because of the probiotic bacteria they contain, fermented milk products, such as yogurt, can help decrease the symptoms of lactose intolerance. When present as live and active bacterial cultures in yogurt, probiotics reduce lactose content by “predigesting” some of the lactose (milk sugar), metabolizing it to lactic acid. The probiotic bacteria in yogurt that survive the trip to the intestinal tract also provide additional lactase enzyme activity. (Montalto et al., 2006) (de Vrese et al., 2001) (Savaiano et al., 1989) (Scrimshaw et al., 1988) (Alternative Medicine Review, 2002) Montalto M, Curigliano V, Santoro L, Vastola M, Cammarota G, Manna R, Gasbarrini A, Gasbarrini G. Department of Internal Medicine, Catholic University, Rome, Italy. mmontalto@rm.unicatt.it Lactose malabsorption is a very common condition characterized by intestinal lactase deficiency. Primary lactose malabsorption is an inherited deficit present in the majority of the world's population, while secondary hypolactasia can be the consequence of an intestinal disease. The presence of malabsorbed lactose in the colonic lumen causes gastrointestinal symptoms. The condition is known as lactose intolerance. In patients with lactase nonpersistence, treatment should be considered exclusively if intolerance symptoms are present. In the absence of guidelines, the common therapeutic approach tends to exclude milk and dairy products from the diet. However, this strategy may have serious nutritional disadvantages. Several studies have been carried out to find alternative approaches, such as exogenous beta-galactosidase, yogurt and probiotics for their bacterial lactase activity, pharmacological and non pharmacological strategies that can prolong contact time between enzyme and substrate delaying gastrointestinal transit time, and chronic lactose ingestion to enhance colonic adaptation. In this review the usefulness of these approaches is discussed and a therapeutic management with a flow chart is proposed. Return de Vrese M, Stegelmann A, Richter B, Fenselau S, Laue C, Schrezenmeir J. Institute of Physiology and Biochemistry of Nutrition, Federal Dairy Research Center, Hermann-Weigmann-Strasse 1, D-24103 Kiel, Germany. devrese@bafm.de Yogurt and other conventional starter cultures and probiotic bacteria in fermented and unfermented milk products improve lactose digestion and eliminate symptoms of intolerance in lactose maldigesters. These beneficial effects are due to microbial beta-galactosidase in the (fermented) milk product, delayed gastrointestinal transit, positive effects on intestinal functions and colonic microflora, and reduced sensitivity to symptoms. Intact bacterial cell walls, which act as a mechanical protection of lactase during gastric transit, and the release of the enzyme into the small intestine are determinants of efficiency. There is a poor correlation between lactose maldigestion and intolerance; in some studies, low hydrogen exhalation without significant improvement of clinical symptoms was observed. Probiotic bacteria, which by definition target the colon, normally promote lactose digestion in the small intestine less efficiently than do yogurt cultures. They may, however, alleviate clinical symptoms brought about by undigested lactose or other reasons. Return Savaiano DA, Kotz C. Lactose intolerance is a concern for the majority of the world's population. Persons who experience symptoms following the consumption of milk should consult with their physician. Symptoms may be eliminated or reduced with good dietary management that includes: 1. limiting milk consumption to one glass at a time; 2. drinking milk with other foods rather than alone; 3. eating yogurts instead of fluid milk; 4. using enzyme tablets to predigest the lactose in milk or to supplement the body's own lactase; 5. possibly eating small amounts of dairy foods each day to adapt the colonic bacteria. For an additional review of the research findings on lactose intolerance and milk drinking, the reader is directed to reference 4, a very recent and complete review by Scrimshaw and Murray. For information on dietary management of lactose intolerance suitable for the consumer, contact your local affiliate of the National Dairy Council. Return Scrimshaw NS, Murray E. Massachusetts Institute of Technology, Cambridge 02139. The disaccharide lactose, the principal carbohydrate of animal milks, requires the enzyme lactase to split it to glucose and galactose. Undigested lactose passes to the colon where fermentation produces hydrogen and short-chain fatty acids that can cause abdominal distention, pain and sometimes diarrhea. Persistence of intestinal lactase after early childhood, is inherited as a highly-penetrant autosomal dominant genetic characteristic. On the basis of a review of over 560 references, all available data on the primary loss of intestinal lactase in Latin American populations are presented in tabular form. Prevalence of lactose non-digesters in Latin American populations ranges from 45% to 100%. However, this is not a reliable predictor of the acceptability of milk and milk products containing lactose. Milk is being used successfully for the supplementary feeding of children worldwide, and most lactose non-digesters can tolerate at least 240 ml of milk or the lactose equivalent in other products. Lactose maldigestion does not interfere with the absorption of the protein and essential micronutrients in milk. Information is provided on the lactose content of milk and milk products, on the usual milk consumption of Latin American populations, and on worldwide experimental and field observations of milk acceptability. Both adaptation to continued use of milk and milk products and relationships of milk use to various disease states in which intestinal lactase activity may be reduced are discussed. Some types of yoghurts are better tolerated because of the lactase activity of the bacteria used in their fermentation. For unusually intolerant individuals commercial enzyme preparations are available for addition to milk products but for most persons the additional cost is unnecessary. Return Alternative Medicine Review August 7,2002 Description Lactobacillus sporogenes is a gram-positive, spore-forming, lactic-acid producing bacillus. It was originally isolated and described in 1933. The organism requires a complex mixture of organic substrates for growth, including fermentable carbohydrates and peptides. Pharmacokinetics Subsequent to oral administration, L. sporogenes passes through the stomach in its spore form and upon arrival in the duodenum, germinates and multiplies rapidly. Estimates suggest the average duration of time between oral dosing and germination is four hours. After germination, L. sporogenes is metabolically active in the intestines, producing lactic acid. L sporogenes is considered a semi-resident, indicating it takes up only a temporary residence in the human intestines. Spores of L. sporogenes are excreted slowly via the feces for approximately seven days after discontinuation of administration. Mechanisms of Action Despite the transient nature of this organism in the digestive tract, the changes this lactic acid bacillus produces shift the environment in support of a complex gastrointestinal flora. The mechanism of action is presumed to be a result of improving gastrointestinal ecology by replenishing the quantity of desirable obligate microorganisms and antagonizing pathogenic microbes. Two isomeric forms of lactic acid can be produced by lactic acid-producing bacteria--dextrorotatory (D (-)) lactic acid and levorotatory (L(+)) lactic acid. L(+) lactic acid is completely metabolized in the body; however, D(-) lactic acid is not completely metabolized, resulting in a degree of metabolic acidosis. L. sporogenes produces only L(+) lactic acid. L. sporogenes is assumed to produce bacteriocins and short chain fatty acids. As the organism grows, it assimilates and incorporates cholesterol into its cellular structure. L. sporogenes possesses significant [beta]-galactosidase (lactase) activity in vitro. Lipid Disorders Administration of L sporogenes to rabbits resulted in a 90-percent inhibition in the rise of serum cholesterol secondary to feeding of high cholesterol diets. Oral L. sporogenes supplementation (360 million spores/day) decreased total serum cholesterol from an average of 330 mg/dL to 226 mg/dL in 17 subjects with type II hyperlipidemia over a three-month time interval. HDL-cholesterol increased slightly. No changes in serum triglyceride levels were observed. Digestive Disorders In laboratory animals with bacterial dysbiosis, L. sporogenes supplementation inhibits growth of pathogenic microorganisms and results in renewal of desirable obligate gastrointestinal organisms to normal levels. Reports suggest that supplementation produces a rapid resolution of acute gastrointestinal infection induced by pathogenic bacteria in calves) It has been reported that the efficacy of treatment in patients with bacterial dysbiosis receiving L sporogenes was 20-30 percent higher than traditional probiotics such as Lactobacillus acidophilus of Bifidobacteria. Seventy percent of individuals suffering from chronic constipation treated with 300-750 million spores per day of L. sporogenes for two to 10 days experienced an amelioration of abdominal distention and a normalization of stools. Reports suggest a benefit in neonatal diarrhea. Aphthous Stomatitis Reports suggest efficacy in the treatment of aphthous stomatitis with resolution occurring within two to three days. Vaginitis Vaginal administration of L. sporogenes was investigated in non-specific vaginitis. Subjects with Trichomonas or Candida vaginitis were excluded from the study. Complete relief of pruritis and discharge was reported by 93 percent of subjects. Postmenopausal subjects had a slower response to therapy. Toxicity and Side Effects Acute toxicity studies in animals have been conducted with doses as high as 50 g/kg for seven days. No abnormalities, either during supplementation or in the period after withdrawal of the supplement, were observed. Chronic supplementation of doses as high as 5 g/kg for 15 months in animals results in no observed toxicity. In humans, adverse reactions following supplementation have not been reported. Dosage A reasonable dose is 100 mg two to three times daily. Each 100 mg contains approximately 1.5 billion colony-forming units. Return 
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