Skip to main content
SpringerLink
Log in

Improved Parameters of Lactose Maldigestion Using Lactulose

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Lactulose is a disaccharide derived from lactose. There has been recent rekindling of interest in the possible benefits of pro- and prebiotics: mainly, lactic acid-producing bacteria and lactulose for the lower intestine. Since lactose maldigestion is a common genetic trait, we undertook this study to delineate similar effects between these two disaccharides. Nine healthy lactose maldigesting subjects underwent two separate periods of three weeks adaptation, first with 10 g twice daily lactulose and then 1.5 g twice daily lactose (in milk). Adaptation was defined by reduced breath Hydrogen (BH2) and symptoms after 50 g lactose challenges. In six subjects fecal β-galactosidase was measured. All subjects consumed some lactose daily. In the first period, eight subjects improved symptoms and reduced BH2 significantly, while in the second period they did not. Fecal β-galactosidase significantly increased after lactulose. This study supports the notion that lactulose and lactose may have similar clinical effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Habte D, Sterby G, Hijalmarsson B: Lactose malabsorption in Ethiopian children. Acta Paediatr Scand 62:649–654, 1973

    Google Scholar 

  2. Sadre M, Karbasi K: Lactose intolerance in Iran. Am J Clin Nutr 32:1948–1954, 1979

    Google Scholar 

  3. Suarez FL, Savaiano DA, Levitt MD: A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med 333:1–4, 1995

    Google Scholar 

  4. Suarez FL, Savaiano D, Levitt MD: Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr 65:1502–1506, 1997

    Google Scholar 

  5. Gilat T, Russo S, Gelman-Malachi E, Aldor TAM: Lactase in man: A non adaptable enzyme. Gastroenterology 62:1125–1127, 1972

    Google Scholar 

  6. Hertzler S, Savaiano DA: Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr 64:232–236, 1996

    Google Scholar 

  7. Hertzler SR, Savaiano DA, Levitt MD: Fecal hydrogen production and consumption measurements. Response to daily lactose ingestion by lactose maldigesters. Dig Dis Sci 42:348–353, 1997

    Google Scholar 

  8. Collins MD, Gibson GR: Probiotics, prebiotics and synbiotics: Approaches for modulating the microbial ecology of the gut. Am J Clin Nutr 69:10525–10575, 1999

    Google Scholar 

  9. De Roos NM, Katan MB: Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: A review of papers published between 1988 and 1998. Am J Clin Nutr 71:405–411, 2000

    Google Scholar 

  10. Rafter JJ: The role of lactic acid bacteria in colon cancer prevention. Scand J Gastroenterol 30:497–502, 1995

    Google Scholar 

  11. Saavedra J: Probiotics and infectious diarrhea. Am J Gastroenterol 95:S16–S18, 2000

    Google Scholar 

  12. Pochapin M: The effects of probiotics on Clostridium difficile diarrhea. Am J Gastroenterol 95:511–513, 2000

    Google Scholar 

  13. Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon ATR: Nonpathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: A randomised trial. Lancet 354:635–639, 1999

    Google Scholar 

  14. Schultz M, Sartor B: Probiotics and inflammatory bowel diseases. Am J Gastroenterol 95:519–521, 2000

    Google Scholar 

  15. Madsen KL, Doyle JS, Jewell LD, Tavernini MM, Fedorak RN: Lactobacillus species prevents colitis in interleukin-10 gene-deficient mice. Gastroenterology 116:1107–1114, 1999

    Google Scholar 

  16. Florent C, Flourie B, Leblond A, Rautureau M, Bernier JJ, Rambaumd JC: Influence of chronic lactulose ingestion on the colonic metabolism of lactulose in man (an in vivo study). J Clin Invest 75:608–613, 1985

    Google Scholar 

  17. Flourie B, Briet F, Florent C, Pellier P, Maurel M, Rambaud JC: Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose. Am J Clin Nutr 58:369–375, 1993

    Google Scholar 

  18. Loguercio C, Abbiati R, Rinaldi M, Romano A, DelVecchio Blanco C, Coltorti M: Long term effects of enterococcus faecium SF68 versus lactulose in the treatment of patients with cirrhosis and grade 1-2 hepatic encephalopathy. J Hepatology 23:39–46, 1995

    Google Scholar 

  19. Uribe M, Marquez MA, Garcia-Ramos G, Escobedo V, Murillo H, Guevara L, Lisker, R: Treatment of chronic portalsystemic encephalopathy with lactose in lactose deficient patients. Dig Dis Sci 25:924–928, 1980

    Google Scholar 

  20. Stunkard AJ, Waxman M: Accuracy of self-reports of food intake. A review of literature and a report of a small series. J Am Diet Assoc 79:547–551, 1981

    Google Scholar 

  21. Karvetti RL, Knuts LR: Agreement between dietary interviews. Nutrient intake measured by dietary history and 24 hr and seven day recalls. J Am Diet Assoc 79:654–660, 1981

    Google Scholar 

  22. Van der Klei-Van Moorsel JM, Douwes AC, Van Oeveren JC: New principle for estimation of hydrogen in expired air. Eur J Pediatr 141:221–224, 1984

    Google Scholar 

  23. Metz G, Gassell MA, Leeds AR, Blendis LM, Jenkins DT: A simple method of measuring breath hydrogen in carbohydrate malabsorption by end-expiratory sampling. Clin Sci Mol Med 50:237–240, 1976

    Google Scholar 

  24. Szilagyi A, Salomon R, Martin M, Fokeef K, Seidman E: Lactose handling by women with lactose malabsorption is improved during pregnancy. Clin Invest Med 19:416–426, 1996

    Google Scholar 

  25. Barr RG, Watkins JB, Perman JA: Mucosal function and breath hydrogen excretion: Comparative studies in the clinical evaluation of children with nonspecific abdominal complaints. Pediatrics 68:526–532, 1981

    Google Scholar 

  26. Yuen CT, Price RG, Chattagoon L, Richardson AC, Praill PFG: Colorimetric assays for N-acetyl b-D glucosaminidase and b-D-galactosidase in human urine using newly-developed v-nitrosyl substrates. Clin Chim Acta 124:195–204, 1982

    Google Scholar 

  27. Montgomery EM, Hudson CS: Relations between rotatory power and structure in the sugar group XXVII synthesis of a new disaccharide ketose. (lactulose) from lactose. J Am Chem Soc 52:2101–2106, 1930

    Google Scholar 

  28. Pain JA, Cahill CJ, Gilbert JM, Johnson CD, Trapnell JE, Bailey ME: Prevention of post-operative renal dysfunction in patients with obstructive jaundice: A multicentre study of bile salts and lactulose. Br J Surg 78:467–469, 1991

    Google Scholar 

  29. McCutcheon J, Fulton JD: Lowered prevalence of infection with lactulose therapy in patients in continuing hospital care. J Hosp Infect 13:81–86, 1989

    Google Scholar 

  30. Fulton JD: Infection limitation with lactulose therapy. J Clin Exp Gerontol 10:117–124, 1988

    Google Scholar 

  31. Greeve JW, Gouma DJ, von Leeuwen PAM, Buurman UA: Lactulose inhibits endotoxin induced tumor necrosis factor production by monocytes. An in vitro study. Gut 31:198–203, 1990

    Google Scholar 

  32. Bouhnik Y, Attar A, Telott A, Franchisseur C, Riottot M: Lactulose ingestion increases fecal bifido bacterial cocents in healthy humans. Gastroenterology 116:A541, 1999

    Google Scholar 

  33. Bovee-Oudenhoven IMJ, Termont DSML, Heidt PJ, Vander Meer R: Increasing the intestinal resistance of rats to the invasive pathogen salmonella enteritides: Additive effects of dietary lactulose and calcium. Gut 40:497–504, 1997

    Google Scholar 

  34. Liao W, Cui XS, Jin XY, Florén CH. Lactulose–a potential drug for the treatment of inflammatory bowel disease. Med Hypoth 43:234–238, 1994

    Google Scholar 

  35. Garcia-Lafuente A, Antolin M, Crespo E, Guarner F, Malagelada J-R: Improvement of colonic barrier function by colonization with lactobacilli in the rat. Gastroenterology 114:A1096, 1998

    Google Scholar 

  36. Schultz M, Veltkamp C, Dielman LA, Wyrick PB, Tonkonogy SL, Sartor B: Continuous feeding of Lactobacillus plantarum attenuates established colitis in interleukin-10 deficient mice. Gastroenterology 114:A770, 1998

    Google Scholar 

  37. Lidbeck A, Geltner Allinger, Orrhage KM, Ottova L, Brismar B, Gustafsson JA, Rafter JJ, Nord CE: Impact of Lactobacillus acidophilus supplements on the faecal micro flora and soluble faecal bile acids in colon cancer patients. Microb Ecol Health Dis 4:81–88, 1991

    Google Scholar 

  38. Van Berge Hennegouwen GP, Van der Werf SDJ, Ruben ATH. Effect of long term lactulose ingestion on secondary bile salt metabolism in man: Potential protective effect of lactulose in colonic carcinogenesis. Gut 28:675–680, 1987

    Google Scholar 

  39. Riggio O, Varriale M, Testore GP, DiRosa R, DiRosa E, DiRosa E, Merli M, Romiti A, Candiani C, Capocaccia L: Effect of lactitol and lactulose administration on the fecal flora in cirrhotic patients. J Clin Gastroenterol 12:433–436, 1990

    Google Scholar 

  40. Saltzman JR, Russell RM, Golner B, Baraleat B, Barakul S, Oallal GE, Goldin BR: A randomized trial of Lactobacillus acidophilus BGF04 to treat lactose intolerance. Am J Clin Nutr 69:140–146, 1999

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, The Sir Mortimer B. Davis Jewish General Hospital Faculty of Medicine, McGill University, Montreal, Quebec, Canada

    Andrew Szilagyi & Julie Rivard

  2. Department of Dietetics, The Sir Mortimer B. Davis Jewish General Hospital Faculty of Medicine, McGill University, Montreal, Quebec, Canada

    Kira Fokeeff

Authors
  1. Andrew Szilagyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Rivard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kira Fokeeff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Szilagyi, A., Rivard, J. & Fokeeff, K. Improved Parameters of Lactose Maldigestion Using Lactulose. Dig Dis Sci 46, 1509–1519 (2001). https://doi.org/10.1023/A:1010652223705

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1010652223705

Search

Navigation