Background Ingestion of a large dose of the milk sugar lactose-- for example, the 50-g load in 1 liter of milk -- causes symptomssuch as abdominal pain, diarrhea, bloating, and flatulence inthe majority of people with lactose malabsorption. It is uncertainwhether the ingestion of more common doses of lactose, suchas the amount in 240 ml (8 oz) of milk, causes symptoms. Somepeople insist that even smaller quantities of milk, such asthe amount used with cereal or coffee, cause severe gastrointestinaldistress.
Methods In a randomized, double-blind, crossover trial, we evaluatedgastrointestinal symptoms in 30 people (mean age, 29.4 years;range, 18 to 50) who reported severe lactose intolerance andsaid they consistently had symptoms after ingesting less than240 ml of milk. The ability to digest lactose was assessed bymeasuring the subjects' end-alveolar hydrogen concentrationafter they ingested 15 g of lactose in 250 ml of water. Subjectsthen received either 240 ml of lactose-hydrolyzed milk containing2 percent fat or 240 ml of milk containing 2 percent fat andsweetened with aspartame to approximate the taste of lactose-hydrolyzedmilk; each type of milk was administered daily with breakfastfor a one-week period. Using a standardized scale, subjectsrated the occurrence and severity of bloating, abdominal pain,diarrhea, and flatus and recorded each passage of flatus.
Results Twenty-one participants were classified as having lactosemalabsorption and nine as being able to absorb lactose. Duringthe study periods, gastrointestinal symptoms were minimal (meansymptom-severity scores for bloating, abdominal pain, diarrhea,and flatus between 0.1 and 1.2 [1 indicated trivial symptoms;and 2, mild symptoms]). When the periods were compared, therewere no statistically significant differences in the severityof these four gastrointestinal symptoms. For the lactose-malabsorptiongroup, the mean (±SEM) difference in episodes of flatusper day was 2.5 ±1.1 (95 percent confidence interval,0.2 to 4.8). Daily dietary records indicated a high degree ofcompliance, with no additional sources of lactose reported.
Conclusions People who identify themselves as severely lactose-intolerantmay mistakenly attribute a variety of abdominal symptoms tolactose intolerance. When lactose intake is limited to the equivalentof 240 ml of milk or less a day, symptoms are likely to be negligibleand the use of lactose-digestive aids unnecessary.
Source Information
From the Department of Food Science and Nutrition, University of Minnesota, St. Paul (F.L.S., D.A.S.), and the Minneapolis Veterans Affairs Medical Center, Minneapolis (M.D.L.).
Address reprint requests to Dr. Levitt at the Minneapolis Veterans Affairs Medical Center, 1 Veterans Dr., Minneapolis, MN 55417.
Lactose Intolerance
Medow M. S., Sloan H. R., Bayless T. M., Paige D. M., Bedine M. S., Roberts H.J., Morris D. L., Fenster D. L., Suarez F. L., Savaiano D. A., Levitt M. D.
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N Engl J Med 1995;
333:1358-1359, Nov 16, 1995.
Correspondence
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