Lactose Intolerance Research Articles

Non-Evidence-Based Dietary Restrictions in Hospital Nutrition and Their Impact on Malnutrition: A Narrative Review of International and National Guidelines

Background: Malnutrition is a major issue in hospitals, impacting over 25% of patients. It can arise from a range of factors, such as chronic underfeeding, diseases, aging, and inappropriate nutritional care. Unnecessary fasting and the use of incorrect dietary prescriptions can also contribute to malnutrition, regardless of a patient’s underlying health conditions. Methods: A search strategy was applied to identify pertinent articles on the prescription and management of therapeutic diets in hospital settings from the last 10 years (2014–2024) using the PubMed database. The following English terms and their combinations were used: hospital diet, non-evidence-based dietary restriction, hospital food service, and therapeutic diets. Only national or international guidelines published in English were considered. Results: The narrative review was developed through the analysis of two guidelines on the prescription and management of therapeutic diets in hospital settings. The main non-evidence-based therapeutic diets that should have limited prescriptions are low-calorie, low-carbohydrate, low-protein, and low-sodium diets because they inevitably lead to a reduction in caloric and/or protein content, limit menu choices, and make recipes less palatable. The preventive total elimination of lactose without diagnostic confirmation should be avoided in the prescription of hospital therapeutic diets for lactose intolerance without symptoms and confirmation of diagnosis. Fasting after surgery should be avoided. The two guidelines differ in part in terminology and the bromatological composition of the diet. Conclusions: The heterogeneity of terminologies and bromatological composition leads to further confusion in determining the correct procedure for managing and prescribing therapeutic diets. Deepening and increasing research in the field of management and prescription of therapeutic diets is necessary to overcome the problem of hospital malnutrition, as the food provided through hospital food service is a very effective medicine for providing calories, macronutrients, and micronutrients.

Rifaximin-Alpha Increases Lactase Activity in Patients with Irritable Bowel Syndrome Without Constipation and Small Intestinal Bacterial Overgrowth.

Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase. To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation. This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400mg rifaximin-alpha every 8h for 2weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated. After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34-13.7)mg/dL vs. 10.4 (IQR 7.1-17.3)mg/dL, p = 0.002. Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation.

Infantile nephrocalcinosis with chronic diarrhea.

A 3-month-old girl presented with symptoms indicative of dysuria, gross hematuria, chronic diarrhea, and nephrocalcinosis. She was born to fourth-degree consanguineous parents. The infant exhibited hypercalciuria and hyperoxaluria, and her stool tested positive for reducing sugars. She responded positively to dietary lactose restriction, and her hyperoxaluria improved over the course of 3months. This suggests an enteric hyperoxaluria phenotype, although her hypercalciuria persisted. Whole exome sequencing identified a homozygous variant in the LCT gene, which is associated with congenital lactase deficiency, as well as a heterozygous variant in the ADCY10 gene, which is linked to absorptive hypercalciuria.

Gastrointestinal disorders – Clinical challenges for the primary care clinician

Gastrointestinal (GI) associated symptoms are among the most common medical concerns resulting in visits to primary and specialty care. Especially challenging is the wide range of causative disorders and exposures associated with symptoms ranging from mild to life threatening - from within the GI tract as well as extra-gastrointestinal. Some of these are well described, and common, including infections, while others are newly emerging, such as cannabinoid hyperemesis syndrome. Others are well known but clinical success can remain elusive, such as food associated GI disorders - lactose intolerance and related. Although entire references have been written to address gastrointestinal diseases, in this edition of Disease a Month we will address some of the more challenging GI disorders; some of which are common but often difficult to control - food associated for example, and emerging GI illnesses such as radiation or cannabinoid hyperemesis, that lead patients to the Emergency Department, primary care clinician or specialty referral. What follows is a discussion of diverse but clinically important GI disorders, and the newer therapeutic strategies to help patients better manage their symptoms, and improve their quality of life.

Development And Evaluation Of A Vegetable Drink Based On Rice Milk, Quinoa And Passion Fruit Pulp

A portion of the Brazilian population has an inability to digest, metabolize, or absorb food or some of its nutrients. Lactose intolerance is a disorder that occurs at all ages. Lactose-free products are a necessity to meet the needs of individuals who suffer from this disorder. Due to the demand for lactose-free foods, a plant-based beverage based on rice milk, quinoa, and flavored with passion fruit was developed as a nutritional beverage option. Formulations (F1, F2, and F3) were developed by varying the amounts of rice and quinoa and fixing the amounts of passion fruit pulp, water, and sucrose. The physicochemical analysis followed the physicochemical methods for food analysis of the Adolfo Lutz Institute and the microbiological analysis followed the Manual of Methods for Microbiological Analysis of Foods. In order to verify whether there were significant differences, the ANOVA analysis of variance was applied using the SISVAR program version 5.6. The Principal Component Analysis (PCA) was performed with the PAST software. The plant-based beverage made from rice milk, quinoa and passion fruit pulp had a low lipid index and low ash concentration, an acidic pH and 4.01% of the daily protein intake required for individuals aged 4 to 8 years. It was produced naturally, without stabilizers, thickeners or industrial emulsifiers. Its production could be a feasible technological possibility for small manufacturers. The rice and quinoa beverage flavored with passion fruit pulp could be a viable alternative for people seeking a balanced, nutritious diet or for people who are lactose intolerant or allergic to animal milk or soy proteins

Lactose Intolerance – A practical approach, Part 2 An approach to foods

Lactose Intolerance – A practical approach, Part 2 An approach to foods

Mothers’ Perception Regarding their Children with Lactose Intolerance

Mothers’ Perception Regarding their Children with Lactose Intolerance

Difficulties in diagnosing lactose malabsorption

Difficulties in diagnosing lactose malabsorption

Lactose intolerance – A practical approach, Part 1

The toxicology, immunology and gastroenterology aspects of food remain important in clinical practice, as anyone treating food related anaphylaxis, or chronic intolerance syndromes can attest. Although entire editions of journals could focus on any one aspect of adverse effects from food, the following review addresses the important and prevalent gastrointestinal condition lactose intolerance and gastrointestinal (GI) conditions that have similar presentation but require different treatment.

Development and Evaluation of Lactose-Free Single-Unit and Multiple-Unit Preparations of a BCS Class II Drug, Rivaroxaban.

Background/Objectives: The aim of the present study was to develop lactose-free formulations of rivaroxaban, a novel oral anticoagulant used for the treatment and prevention of blood clotting. As a BCS Class II drug, rivaroxaban is characterized by poor solubility in aqueous media, posing a significant formulation challenge. Methods: To address this, phosphate-based excipients were employed to prepare both traditional single-unit dosage forms (tablets) and modern multiple-unit pellet systems (MUPS). These formulations were successfully developed and thoroughly evaluated for their physical properties and performance. Results: The resulting formulations demonstrated very good mechanical strength, including appropriate hardness and friability, alongside strong chemical stability. Their dissolution profiles met the requirements of the compendial monograph for Rivaroxaban Tablets and were comparable to those of the reference product, Xarelto® film-coated tablets. Conclusions: This study shows the potential for producing effective, stable, and patient-friendly medications that meet the needs of contemporary society, where an increasing number of individuals suffer from lactose intolerance or seek vegan-friendly alternatives.

Modulation of the Gut-Lung Axis by Water Kefir and Kefiran and Their Impact on Toll-like Receptor 3-Mediated Respiratory Immunity.

The beneficial effect of milk kefir on respiratory heath has been previously demonstrated; however, water kefir and kefiran in the context of respiratory viral infections have not been investigated. Water kefir and kefiran could be alternatives to milk kefir for their application in persons with lactose intolerance or milk allergy and could be incorporated into vegan diets. Using mice models, this work demonstrated that the oral administration of water kefir or kefiran can modulate the respiratory Toll-like receptor (TLR3)-mediated innate antiviral immunity and improve the resistance to respiratory syncytial virus (RSV) infection. The treatment of mice with water kefir or kefiran for 6 days improved the production of interferons (IFN-β and IFN-γ) and antiviral factors (Mx2, OAS1, RNAseL, and IFITM3) in the respiratory tract after the activation of the TLR3 signaling pathway, differentially modulated the balance of pro- and anti-inflammatory cytokines, reduced RSV replication, and diminished lung tissue damage. Maintaining a proper balance between anti-inflammatory and pro-inflammatory mediators is vital for ensuring an effective and safe antiviral immune response, and the results of this work show that water kefir and kefiran would help to maintain that balance promoting a controlled inflammatory response that defends against infection while minimizing tissue damage.

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

Lactose intolerance awareness among adults in Riyadh, Saudi Arabia

IntroductionLactose intolerance is a common medical condition characterized by malabsorption of lactose. Despite the considerable impact of lactose intolerance on affected persons, studies on its awareness are limited. The aim of study was to assess the awareness of lactose intolerance and its associated factors among the general population of Riyadh City, Saudi Arabia. The prevalence of lactose intolerance in the study population was also assessed. MethodsThis was a cross-sectional study conducted in Saudi Arabia. An online questionnaire, which included 15 questions on lactose intolerance awareness and the risk factors for lactose intolerance, was administered. The prevalence of lactose intolerance was assessed using a validated five-question screening tool. The student's t-test and analysis of variance were used to compare quantitative variables, whereas the chi-square test was used to determine the association between qualitative variables. ResultsA total of 2150 adult participants were included. The mean percentage of correct answers to questions regarding lactose intolerance awareness was 28.9 % (±21.9). Participants with a previous lactose intolerance diagnosis had the highest lactose intolerance knowledge scores (46.9 [±18.3]). Regarding the prevalence of lactose intolerance, 14.7 % of the participants responded that they were likely lactose intolerant, whereas 7.3 % reported that they were diagnosed with lactose intolerance by a physician. Results of the assessment performed using the screening tool, which had a sensitivity of 47 % in this study, showed that women were more likely to have lactose intolerance than men. In addition, women and younger participants had greater knowledge of lactose intolerance than men and older participants. ConclusionThe Saudi Arabian population has a low awareness of lactose intolerance. The findings of this study provide valuable information regarding level of lactose intolerance awareness among the Saudi population and can be used for the development of effective programs for increasing lactose intolerance awareness in Saudi Arabia.

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.

Formulation and Sensory Evaluation of Symbiotic Kulfi with Lactobacillus lactis, Banana (Musa paradisiaca) Powder and Flaxseed (Linum usitatissimum) Powder as a Functional Ingredients

Kulfi was one of the old frozen dessert earlier which was popular in rural area, nowadays that scope increased in both rural and urban area. Many probiotic dairy products are present in market but probiotic ice cream extending their space widely, some alterations were made to slight increase the viability of probiotic microorganisms that provide wide health benefits to consumers and peoples were more sensitive lactose intolerance by breakdown of complex sugars into simpler form. In this study made to production of symbiotic kulfi by incorporation of probiotic culture lactobacillus lactis (0.05g/100g), Banana powder (musa paradisiaca) (8g, 16g. 24g), and Flax seed (Linum usitatissimum) powder as a prebiotic source (2g, 4g, 6g). Banana powder and flax seed powder, not only act as prebiotic source along with provides good texture and taste with increased color and appearance of the kulfi samples. The effect of banana powder and flax seed powder reveals the survivability of probiotic microorganisms, variation in nutritional composition and sensory property. Viability of probiotic microorganisms was slight decreased by increasing in days of storage at freeze condition. In comparison of C1, P1, P2, P3 the acidity was decreased (0.22, 0.20, 0.16), Total soluble solid (50.1, 57.1, 62.5) and total carbohydrate increased. The increase in prebiotic concentration, saturated fat (5.30, 4.80, 4.30), total fat and sodium concentration was decreased. By comparing all kulfi samples, P1 sample got the highest score in both sensory attributes and nutritional analysis.

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.