Lactose Intolerance Research Articles

Balancing the cart: Milk, plant‐based alternatives and nutrient availability in New Zealand households

AbstractMilk is a near‐universal source of essential nutrients and contributes significantly to global nutrient availability. Global demand for milk continues to rise, driven by population growth, rising household incomes and favourable consumption patterns. Plant‐based alternatives (PBAs) to milk seek to cater to the preferences of a share of consumers regarding sustainability, lifestyle or health‐related matters (e.g. allergies and lactose intolerance). Though popular, PBAs do not stand as suitable nutritional substitutes for milk. These considerations emphasise the complex relationships between nutritional content and consumer preferences. This paper estimates a demand system for milk and PBAs in the New Zealand (NZ) market. We explore patterns of complementarity or substitutability between standard milk, reduced‐fat milk and organic milk, and an aggregate group of PBAs. We use these results to calculate nutrient elasticities and assess changes in nutrient availability in response to prices and expenditure variations. We estimate a Quadratic Almost Ideal Demand System using purchase records for 2460 NZ households in 2021. We find that demand for standard milk does not show any substitutional relationship with PBAs. On the contrary, increases in the PBAs price lead households to switch towards standard milk, thereby increasing the availability of essential nutrients. That is, in the case of price increases, milk effectively offsets the reduction in essential nutrients as households switch away from PBAs, but PBAs cannot offset any reduction in essential nutrients as households do not find them to be adequate substitutes for milk.

Evaluating the influence of parental atopy on the effectiveness of a maternal dairy-free diet in alleviating infantile colic: a before-and-after study

BackgroundInfantile Colic (IC) poses a significant challenge for parents as it manifests through repeated and extended episodes of fussiness, crying, or irritability occurring before the age of 5 months. The precise cause of IC is currently unknown. The association between IC, a family history of atopy, and the development of individual atopy in the future remains uncertain, given conflicting findings from prior studies.ObjectivesThis study aimed to investigate the impact of parental atopy on IC severity and the effectiveness of the mother’s hypoallergenic Dairy-Free Diet in alleviating pain in infants with colic.MethodsThis non-randomized trial conducted at Amirkabir Hospital in Arak, Iran, from January 2023 to October 2023, involving 206 eligible IC patients non-randomly assigned to two groups based on parental atopy history. Breastfed infants were prescribed a dairy-free diet, involving the removal of dairy products from the mother’s diet. Pain severity was assessed using the FLACC scale at baseline and after one-month of intervention.ResultsThe research initially involved 206 subjects with an average age of 28.77 ± 9.99 days, evenly distributed based on parental atopy history. However, there was a 28.6% loss to follow-up, resulting in a final analyzed population of 147 individuals. The intervention, a maternal dairy-free diet, demonstrated a significant reduction in pain symptoms within both groups and overall (P = 0.001), with no significant difference in efficacy between infants with and without parental atopy history (P = 0.219). Parental history of atopy did not exhibit a significant association with colic pain severity (P = 0.404). The study revealed that the impact of the diet on colic severity varied, with more pronounced effects observed in cases of severe and moderate colic compared to mild cases.ConclusionsAdopting a Dairy-Free Diet significantly reduced colic symptoms, irrespective of parental atopy history. The severity of colic appears unrelated to parental atopy, and the observed improvement with a Dairy-Free diet is potentially attributed to milk intolerance rather than milk allergy.

How to Keep Lactose Avoiders Healthy

A large portion of the world’s population has lactose intolerance. Fundamentally, this condition occurs when the small intestine does not produce enough of the lactase enzyme, which digests the disaccharide lactose in milk. Lactose avoiders might unconsciously decide to limit or exclude milk and dairy products from their diets. This group includes people with lactose intolerance, people with an allergy to milk protein, vegans, and those expressing personal preferences. Lactose avoiders are often self-reported as being milk intolerant. In this review, specific amounts of lactose in different types of milk and milk products are presented. The amounts of micro- and macronutrients in them are compared with the daily requirements established by accepted sources. Foods are suggested that can play vital roles in permanently avoiding lactose-containing dairy products, for example, brussels sprouts, as a good source of vitamin B1; kale, as a source of vitamin K; and cereals at breakfast for vitamin B6. Attention is paid to mature cheeses as they are extremely beneficial for health due to their rich vitamin and elemental compositions, and they are also suitable for people with lactose intolerance due to their low lactose content. This information is rarely provided on packaging. In addition, the current state of labeling for the presence of lactose in food and pharmaceutical products is discussed. The term “hidden lactose” is introduced to include added lactose in unexpected foods, drinks, and even medicines.

The impact of lactose intolerance diagnosis: costs, timing, and quality-of-life.

Lactose intolerance (LI) is a very common condition but, despite many efforts of the Italian National Health Service to reduce diagnostic delay of chronic disorders and provide prompt treatments, its early diagnosis remains an unmet need. In addition, the COVID-19 pandemic has exacerbated this problem, due to the conversion of many public health services to COVID centers. This study aims to analyze the diagnostic journey of patients suffering from LI, taking into account the duration of the process, associated costs, and impact on quality of life. Anonymous surveys were designed and distributed to patients with LI as well as physicians involved in LI management. The data were analyzed to determine the time required for a reliable LI diagnosis and average costs. Diagnostic delay of LI proved to be longer than 2years, its impact on quality of life proved to be moderate to high in most of participants, especially in their psychosocial domain, and average costs proved to be high. Further investigations are needed to determine the economic burden of maintaining an asymptomatic status in patients with LI.

Topical issues of etiology, consequences, and treatment of secondary lactase deficiency in children: literature review and results of our research

Topical issues of etiology, consequences, and treatment of secondary lactase deficiency in children: literature review and results of our research

Emerging non-thermal treatment approaches for camel milk: A review

Camel milk (CM) has recently gained popularity in international dairy markets. According to projections, the global market for CM products is expected to reach USD 18.3 billion by 2027 with a compound annual growth rate of 6.8 % during the forecast period. The increasing demand for CM among people with lactose intolerance is expected to positively impact the industry. Despite efforts to develop a range of products from CM, its processing is generally considered challenging, and the resulting products are not comparable to those made from bovine milk. For decades, the dairy industry has relied primarily on conventional methods to process various dairy products; however, these methods can affect the organoleptic quality and nutritional profiles. This review focuses on innovative non-thermal processing methods for CM, including high-pressure processing, pulsed electric fields, ultrasonication, UV pasteurization, cold plasma technology, and microwave processing. These approaches can provide viable alternatives to thermal treatments, offering several benefits, such as enhanced nutrient retention, improved organoleptic properties, and better microbial safety, thus supporting the industry's growth in response to increasing consumer demand for high-quality dairy products.

Lactose intolerance awareness among adults in Riyadh, Saudi Arabia

Lactose intolerance awareness among adults in Riyadh, Saudi Arabia

Prevalence and Pathophysiology of Loose Stools and Their Impact on Clinical Severity and Quality of Life in Women With Fecal Incontinence.

To compare the impact of fecal consistency with anorectal sphincter dysfunctions on clinical severity and quality of life (QoL) in women with fecal incontinence (FI). FI affects up to 24% of middle-aged women, significantly impacting their QoL. Pathophysiological studies have focused more on sphincter and anorectal dysfunctions than on the role of fecal consistency. A cross-sectional observational study evaluating anorectal physiology, neurophysiology, and fecal consistency with regard to clinical severity and QoL. Patients with a Bristol Stool Chart (BSC) score of 5 or more (BSC ≥5) underwent a breath test to detect bacterial overgrowth (small intestinal bacterial overgrowth), lactose or fructose/sorbitol malabsorption, and/or a cholestyramine test to detect bile acid malabsorption. We compared anorectal physiology, clinical severity, and QoL of those with BSC ≥5 with BSC <5. The study included 150 women with an average age of 64.81 ± 11.96. FI types varied: 64.38% had urge FI, 15.06% had passive FI, and 19.18% had both. Among them, 56.2% had BSC ≥5, linked to bile acid malabsorption (20.5%), lactose malabsorption (17.9%), small intestinal bacterial overgrowth (14.3%), and fructose/sorbitol malabsorption (14.3%). Anorectal dysfunctions were highly prevalent, with 49.1% showing external anal sphincter insufficiency, 9.8% internal, and 34.7% both. Those with BSC ≥5 experienced significantly worse clinical severity and QoL (St. Mark 17.3 ± 2.69 vs 12.9 ± 3.27), and more pronounced issues in Fecal Incontinence Quality of Life Scale dimensions of lifestyle, coping, depression, and EuroQol 5-dimension of anxiety/depression and pain/discomfort. Fecal consistency of BSC ≥5 significantly worsens clinical severity and QoL in women with FI. Specific diagnostic and therapeutic approaches addressing loose stools are needed before any rehabilitation treatment.

Probiotic Milk and Oat Beverages with Increased Protein Content: Survival of Probiotic Bacteria Under Simulated In Vitro Digestion Conditions

Background: The increasing prevalence of plant-based dietary preferences, driven by lactose intolerance, allergies, and adherence to vegan diets, has necessitated the exploration of alternative food matrices for probiotic delivery. Objectives: This study aimed to evaluate the effects of whey protein isolate, pea protein isolate, and soy protein isolate on the viability of L. casei and L. johnsonii during simulated in vitro gastrointestinal digestion. Furthermore, the study investigated the impact of two distinct matrices—cow’s milk and an oat-based beverage—on the survival of these probiotic strains. Fermented products were prepared using cow’s milk and an oat-based beverage as matrices, with simulated digestion performed following a seven-day storage period at 5 °C. The in vitro digestion model encompassed oral, gastric, and small intestinal phases, with probiotic viability assessed using the plate-deep method at each stage. Methods: Before digestion, L. casei exhibited higher populations than L. johnsonii in both matrices. Including 3% soy and pea protein, isolates promoted the growth of L. casei in both fermented milk and oat beverages. However, a marked reduction in probiotic viability was observed during the gastric phase, with L. casei counts decreasing by 6.4–7.8 log cfu g−1 in fermented milk and 3.1–4 log cfu g−1 in oat beverages, while L. johnsonii demonstrated similar reductions. Conclusion: These findings underscore the protective role of dairy components on probiotic viability, while the oat-based matrix exhibited a reduced capacity for sustaining probiotic populations throughout digestion. Future research should focus on optimizing plant-based matrices to enhance probiotic stability during gastrointestinal transit.

The Pharmacokinetics of Subcutaneous Eprinomectin in Plasma and Milk in Dry Dairy Cattle.

Parasitic infections in dairy cattle reduce herd immunity, milk production, and conception rates. This leads to higher production costs, compromised animal welfare, and increased interest in extralabel drug use. The extralabel use of anthelmintics poses food safety risks for consumers since appropriate withdrawal intervals in milk have yet to be established. Although topical eprinomectin has no milk withdrawal time, more research is needed to determine the residues present in milk after subcutaneous administration. This study aimed to characterize the pharmacokinetics of injectable eprinomectin in dry dairy cows. We hypothesized that, when given at the labeled dose, eprinomectin residues in dry dairy cattle would be below the FDA milk tolerance at the onset of lactation. Plasma was collected daily from 13 mature dairy cattle for 7 days postadministration, followed by periodic samples for 90 days. After calving, milk was collected daily until 90 days. Eprinomectin concentrations were measured using HPLC-fluorescence detection. The maximum eprinomectin concentration in plasma and milk was approximately 36 ng/mL 43 h after administration and 3 ng/mL at the onset of lactation, respectively. The low eprinomectin levels in milk collected from these lactating dairy cattle suggest that administering eprinomectin at dry-off is unlikely to result in violative residues. However, subcutaneous eprinomectin in lactating dairy cattle would be hard to justify unless there is evidence that the approved topical formulation is clinically ineffective.

Diagnosis of lactose intolerance: concordance between 13910-C/T genotype and lactose tolerance test in a Danish population

The association between the MCM6-13910-C/T polymorphism and lactose intolerance in individuals of European descent is well known. However, the notion that having a single versus a double allelic mutation might influence one’s phenotype has been hypothesized. This study investigated whether patients with the three genotypes C/C, C/T, T/T differed in response to a lactose tolerance test (LTT) in a Danish setting. Anonymized data on 603 individuals with results for both genetic test and LTT were investigated. Mean delta glucose values were plotted for the time points of the LTT (0, 15, 30, 45 and 60 min) for the C/C, C/T and T/T genotype, respectively. Further, the agreement between the three genotypes and the diagnostic interpretation of the LTT were examined using a cut-off of > 1.4 mmol/L rise in glucose. In subjects with the C/C genotype, mean glucose delta levels were markedly lower compared to both the C/T and T/T genotypes at all time points. Overall, a difference between mean glucose delta values among the C/T and T/T genotype could not be shown. Using a LTT cut-off of > 1.4 mmol/L, the proportions of lactose intolerant LTT results for each genotype were as follows: 58% among C/C, 5% among C/T, and 7% among T/T. In a Danish healthcare setting, the C/C genotype was on average associated with a smaller glucose response during a LTT when compared to the C/T and T/T genotypes. A marked difference in the LTT response among the C/T and T/T genotype was not observed.

Lactose Breath Test: Possible Strategies to Optimize Test Performance, Accuracy, and Clinical Impact.

Lactose malabsorption (LM) refers to the incomplete absorption of lactose in the small intestine, resulting in the arrival of ingested lactose in the colon, which can give rise to symptoms defined as lactose intolerance (LI). The lactose breath test (LBT), thanks to its low cost, availability, and noninvasiveness, is the most used diagnostic method. However, the LBT is a tedious tool, requiring prolonged involvement of patients, qualified staff, and infrastructure, of which the most time-consuming factor is the frequency and number of breath samples needed. Objectives: To simplify the current LBT methodology, compliant with the current guidelines' statements, by reducing the test duration or the number of breath samples, without compromising the test's accuracy. Methods: The results of the standard LBT were compared with two simplified tests: a "shortened" test, lasting three hours, with samples taken every 30 min; and a "five-sample" test, lasting four hours, with samples taken every hour. Patients were stratified into three grades of malabsorption (mild, moderate, severe) based on the amount of gas exhaled. A clinical severity score was introduced to assess the clinical relevance of LI using a specific questionnaire. Results: Among the 543 patients enrolled (F 71.5%, mean age 43.7 ± 17.6 yrs), 60.4% (328/543) tested positive for LM. A total of 70.5% (383/543) presented LI, with 32.1% of those being true intolerants (LI without LM). The shortened test demonstrated an accuracy of 93.9%, with a sensitivity of 89.9% and a false negative rate of 10.1% (33/328). The five-sample test showed higher accuracy and sensitivity than the shortened test (96.5% and 94.2%, respectively; p = 0.03) with a false negative rate of 5.8% (19/328). Of the 19 false negatives in the five-sample test, 95% (18/19) were categorized as mild malabsorbents. No statistical correlation was found between the clinical severity score and LBT results. Conclusions: The five-sample test, involving hourly breath measurements, is a reliable option for simplifying the LBT without significantly reducing the procedure's sensitivity.

AncestryGrapher toolkit: Python command-line pipelines to visualize global- and local- ancestry inferences from the RFMIX version 2 software.

Admixture is a fundamental process that has shaped levels and patterns of genetic variation in human populations. RFMIX version 2 (RFMIX2) utilizes a robust modeling approach to identify the genetic ancestries in admixed populations. However, this software does not have a built-in method to visually summarize the results of analyses. Here, we introduce the AncestryGrapher toolkit, which converts the numerical output of RFMIX2 into graphical representations of global and local ancestry (i.e., the per-individual ancestry components and the genetic ancestry along chromosomes, respectively). To demonstrate the utility of our methods, we applied the AncestryGrapher toolkit to visualize the global and local ancestry of individuals in the North African Mozabite Berber population from the Human Genome Diversity Panel (HGDP). Our results showed that the Mozabite Berbers derived their ancestry from the Middle East, Europe, and sub-Saharan Africa (global ancestry). We also found that the population origin of ancestry varied considerably along chromosomes (local ancestry). For example, we observed variance in local ancestry in the genomic region on chromosome 2 containing the regulatory sequence in the MCM6 gene associated with lactase persistence (LP), a human adaptive trait tied to the cultural development of adult milk consumption. Overall, the AncestryGrapher toolkit facilitates the exploration, interpretation, and reporting of ancestry patterns in human populations. The AncestryGrapher toolkit is free and open source on https://github.com/alisi1989/RFmix2-Pipeline-to-plot. Supplementary data are available at Bioinformatics online.

Treatment of anal fissures using the new TRPM8 receptor therapy - own experience.

&lt;b&gt;Introduction:&lt;/b&gt; Anal fissure, a longitudinal or oval crack in the anal anoderm above the dentate line, is one of the most common diseases of the anal area. The following article shows the effectiveness of anal fissure treatment based on our own experience, using new receptor therapy in the form of Procto-Zac Memethol Barrier Spray [(1R,2S,5R)-2-isopropyl-5-methylcyclohexanol, sodium hydrogen carbonate, 7-(dimethylamino) phenothiazin-3-ylidene]- dimethylazanium; chloride, 1,2-propanediol, purified water], preparation containing soluble fiber and oral probiotic.&lt;b&gt;Aim:&lt;/b&gt; The aim of the following article is to present our experience and observations in the conservative treatment of acute and chronic anal fissure using Procto-Zac Memethol Barrier Spray and preparations containing soluble fiber and oral probiotic.&lt;b&gt;Material and methods:&lt;/b&gt; The study included a group of 120 patients with anal fissure between 18 and 45 years of age. Each patient in the group received a therapy consisting of Procto-Zac Memethol Barrier Spray (8 sprays once a day, 2 packages) and preparation containing fiber and oral probiotic. A high-fiber, gluten-free and lactose-free diet was also recommended. A follow-up was carried out in our clinic after 4 and 8 weeks. If the symptoms do not disappear completely, also after 3 months from the start of treatment.&lt;b&gt;Results:&lt;/b&gt; Complete relief of symptoms was achieved in 62 patients after 4 weeks of treatment. After 8 weeks, complete relief of symptoms was achieved in another 49 people. In 6 people, after 3 months of treatment, the symptoms were partially relieved, but the anal fissure was not completely healed. Three people did not come for a follow-up visit. In 20 patients, skin burning around the anus was observed during the above therapy.The above symptoms did not require discontinuation of Procto-Zac Memethol Barrier Spray therapy and disappeared after completion of treatment. No other side effects of the preparations used were found.&lt;b&gt;Conclusions:&lt;/b&gt; According to our observations, the use of new TRPM8 receptor therapy MemeThol Barrier Spray, a preparation containing soluble fiber and oral probiotic, turned out to be an effective method of treating anal fissure. In the future, it is advisable to conduct further studies, including multicenter studies, to assess the full tolerability and effectiveness of the described therapy.

Encapsulation of β-Galactosidase into Polyallylamine/Polystyrene Sulphonate Polyelectrolyte Microcapsules.

More than half of the global population is unable to consume dairy products due to lactose intolerance (hypolactasia). Current enzyme replacement therapy methods are insufficiently effective as a therapeutic approach to treating lactose intolerance. The encapsulation of β-galactosidase in polyelectrolyte microcapsules by using the layer-by-layer method could be a possible solution to this problem. In this study, adsorption and co-precipitation methods were employed for encapsulating β-galactosidase in polyelectrolyte microcapsules composed of (polyallylamine /polystyrene sulphonate)₃. As a result, the co-precipitation method was chosen for β-galactosidase encapsulation. The adsorption method permits to encapsulate six times less enzyme compared with the co-precipitation method; the β-galactosidase encapsulated via the co-precipitation method released no more than 20% of the initially encapsulated enzyme in pH 2 or 1 M NaCl solutions. In contrast, when using the sorption method, about 100% of the initially encapsulated enzyme was released from the microcapsules under the conditions described above. The co-precipitation method effectively prevents the complete loss of enzyme activity after 2 h of incubation in a solution with pH 2 while also alleviating the adverse effects of ionic strength. Consequently, the encapsulated form of β-galactosidase shows promise as a potential therapeutic agent for enzyme replacement therapy in the treatment of hypolactasia.

Influence of Brown Rice, Pea, and Soy Proteins on the Physicochemical Properties and Sensory Acceptance of Dairy‐Free Frozen Dessert

ABSTRACTFat and protein derived from milk are prime ingredients in a frozen dessert such as ice cream conferring multiple desirable functionalities. However, this frozen dairy dessert is not suitable for individuals having lactose intolerance, cow milk allergy, or vegans. Hence, the study aimed to formulate dairy‐free frozen desserts using plant oils and plant proteins and compare their physicochemical characteristics and sensory acceptance against an ice cream containing milk fat and milk protein. Results indicated that the types of protein significantly influenced the physicochemical properties and sensory acceptance of the frozen dessert samples. Frozen desserts containing brown rice, pea, and soy protein showed greater resistance to melting (0.29, 0.12, and 0.19%/min vs. 1.95%/min), but they scored lower in sensory quality than ice cream made with milk protein; although they remained at an acceptable level. When compared among the plant proteins, the physicochemical characteristics of frozen desserts containing brown rice, pea, and soy protein varied because of the differences in the respective protein composition. Frozen dessert with brown rice protein showed higher overrun (47.50% vs. 40.78% and 37.8%), lower hardness (20.02 N vs. 22.24 and 26.37 N), and higher melting rate (0.29%/min vs. 0.19 and 0.12%/min) than frozen desserts containing soy and pea protein. Additionally, the brown rice protein frozen dessert received lower sensory acceptance than soy and pea protein frozen desserts. In summary, brown rice, pea, and soy proteins showed potential to be used as viable alternatives to milk protein for dairy‐free frozen dessert applications.

Genetic aspects of lactase deficiency in indigenous populations of Siberia.

The ability to metabolize lactose in adulthood is associated with the persistence of lactase enzyme activity. In European populations, lactase persistence is determined mainly by the presence of the rs4988235-T variant in the MCM6 gene, which increases the expression of the LCT gene, encoding lactase. The highest rates of lactase persistence are characteristic of Europeans, and the lowest rates are found in East Asian populations. Analysis of published data on the distribution of the hypolactasia-associated variant rs4988235-C in the populations of Central Asia and Siberia showed that the frequency of this variant increases in the northeastern direction. The frequency of this allele is 87 % in Central Asia, 90.6 % in Southern Siberia, and 92.9 % in Northeastern Siberia. Consequently, the ability of the population to metabolize lactose decreases in the same geographical direction. The analysis of paleogenomic data has shown that the higher frequency of the rs4988235-T allele in populations of Central Asia and Southern Siberia is associated with the eastward spread of ancient populations of the Eastern European steppes, starting from the Bronze Age. The results of polymorphism analysis of exons and adjacent introns of the MCM6 and LCT genes in indigenous populations of Siberia indicate the possibility that polymorphic variants may potentially be related to lactose metabolism exist in East Asian populations. In East Asian populations, including Siberian ethnic groups, a ~26.5 thousand nucleotide pairs long region of the MCM6 gene, including a combination of the rs4988285-A, rs2070069-G, rs3087353-T, and rs2070068-A alleles, was found. The rs4988285 and rs2070069 loci are located in the enhancer region that regulates the activity of the LCT gene. Analysis of paleogenomic sequences showed that the genomes of Denisovans and Neanderthals are characterized by the above combination of alleles of the MCM6 gene. Thus, the haplotype discovered appears to be archaic. It could have been inherited from a common ancestor of modern humans, Neanderthals, and Denisovans, or it could have been acquired by hybridization with Denisovans or Neanderthals. The data obtained indicate a possible functional significance of archaic variants of the MCM6 gene.

Is there dietary macronutrient malabsorption in children with environmental enteropathy?

Assessing the digestive and absorptive capacity of the gastro-intestinal tract (GIT) using minimally- or non-invasive methods, particularly in children, has been difficult owing to the complex physiology and variability in functional measurements. However, measuring GIT function is increasingly important with the emerging relevance of childhood environmental enteropathy (EE) as a mediating factor in linear growth faltering, severe acute malnutrition, poor oral vaccine uptake and impaired cognition. In EE, sub-optimal nutrient digestion and absorption (malabsorption) forms the critical link to the conditions mentioned above. The present narrative review discusses probable mechanisms that can cause malabsorption of macronutrients, along with mechanistic and experimental evidence, in children (if not, in adults) with EE. The strengths and limitations of the human experimental studies are examined in relation to a battery of existing and potential tests that are used to measure malabsorption. From the available studies conducted in children, lactose and fat malabsorption are more likely to occur in EE. Breath tests (non-invasive) measuring carbohydrate (13C-starch/sucrose/lactose), fat (13C-mixed triglyceride) and dipeptide (benzoyl-L-tyrosyl-L-1-13C-alanine) malabsorption with modifications to the existing protocols seem suitable for use in children with EE. Future research should focus on understanding the degree of macronutrient malabsorption using these tests, in different settings, and link them to functional outcomes (such as growth, muscle strength, cognition).

7370 Review of the Literature, and Report of a Series of Patients with Lactose Intolerance and Levothyroxine Malabsorption in Treatment with Liquid L-T4

Abstract Disclosure: S. Ferrari: None. A. Patrizio: None. V. Mazzi: None. F. Ragusa: None. C. Botrini: None. G. Elia: None. E. Balestri: None. E. Barozzi: None. L. Rugani: None. F. Bracchitta: None. G. Stoppini: None. G. Frenzilli: None. E. Baldini: None. C. Virili: None. S. Benvenga: None. P. Fallahi: None. A. Antonelli: None. Intolerance to lactose-containing foods is frequent, with a prevalence of 7-20% in Caucasians, and of 80-95% among Native Americans. Therefore, lactose intolerance (LI) issue needs to be taken in account in the management of hypothyroid patients needing large doses of levothyroxine (L-T4) (&amp;gt; 1.7-2 μg/kg/day) to achieve euthyroidism. Indeed, the absorption of oral T4 may be affected in patients with LI, by following a diet containing lactose, whereas it is resulted to be improved with a lactose-free diet. Lactose is often present as a supplementary ingredient in many commercially available drugs, as L-T4 preparations. In susceptible individuals, drugs containing lactose can cause LI symptoms, and lactose in L-T4 preparations could impair thyroxine absorption. Moreover, it has been shown that patients with LI requiring an increased dosage of L-T4 benefit from a treatment with a lactose-free L-T4 formulation. The lactose-free liquid L-T4 formulation is able to circumvent LI malabsorption leading to the normalization of thyroid-stimulating hormone (TSH) in patients with subclinical hypothyroidism, and long term stable TSH levels. Further studies will be needed to evaluate the liquid L-T4 formulation in larger numbers of patients with hypothyroidism and LI. Presentation: 6/3/2024

8183 An Unusual Cause of Fluctuating Thyroid Hormone Levels

Abstract Disclosure: V. Taqi: None. W. Akhter: None. J.L. Gilden: None. Background: Thyroid disease, especially congenital hypothyroidism is a common endocrine problem with an estimated global prevalence of 4.25%. Since every organ system is affected by thyroid hormones, untreated hypothyroidism can lead to profound adverse outcomes. Many drugs, hormones, and dietary supplements have been noted to affect the efficacy of thyroid hormones, yet there was always concern about the effect of the excessive growth of intestinal flora in the small intestine on thyroid supplement absorption. Drugs, malabsorption, celiac disease and increased excretion are common causes of fluctuating thyroid hormones. In this case, we present a young male patient with congenital hypothyroidism, who required fluctuating doses of levothyroxine due to abnormal thyroid hormone levels, despite compliance with proper administration, and dramatic improvement of thyroid hormone levels after starting probiotic therapy. Case : An 18-year-old Caucasian male with congenital hypothyroidism had been treated with varying doses of thyroid hormone replacement by a Pediatric Endocrine Center. Due to his recall that TSH=4.13 mIU/L and he was “tired of taking medication”, he stopped taking 125 mcg of levothyroxine. Four months later, TSH was &amp;gt; 200 mIU/L (nl=0.48-4.17). Levothyroxine 137 mcg was then started. However, 11 months later, TSH=14.2 mIU/L, Free T4=1.6 ng/dL (nl=1.03-1.64). He was then referred to our Endocrine Clinic. He denied symptoms of hypo or hyperthyroidism or other medical issues. His grandfather was known to have hypothyroidism and diabetes mellitus (details unknown). On exam: Wt. was 149 Ib, Ht= 67 Inch. VS: BP 98/46, P 69, R:16,temp: 97.9F, Physical exam showed normal findings without thyromegaly, but there was a delay in tendon reflexes. Laboratory-unremarkable CBC, CMP panels with normal thyroid antibodies, and Celiac titers. TSH initially improved from 14.2 to 8.4 mIU/L after increasing the thyroxine dosage from 137 to 150 mcg for 2 weeks, then to 175 mcg after 4 weeks, but TSH increased to 12.1 mIu/L, despite being compliant with medication and ensuring proper way of administration. He continued to deny symptoms of hypo or hyperthyroidism, or any other medical issues, including lactose intolerance or malabsorption. However, probiotics were then added to his regimen, and continuation of the current dose resulted in a suppressed TSH=0.15 mIU/L. The levothyroxine was then decreased to 150 mcg with continuation of probiotics. One month later, TSH was 1.31 mIU/L with Free T4 of 1.5 ng/dL. Conclusion : Common causes for fluctuating thyroid hormone levels include intestinal malabsorption, celiac disease, nephrotic syndrome, drugs, and food interaction. This case demonstrates that despite proper administration, fluctuating thyroid hormone levels can result from some uncommon causes, such as lactose intolerance, which can be unmasked by co-administration of probiotics. Presentation: 6/2/2024