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Discussion Starter · #1 ·
Breath testing to evaluate lactose intolerance in irritable bowel syndrome correlates with lactulose testing and may not reflect true lactose malabsorption Mark Pimentel M.D., F.R.C.P.(C.), a, Yuthana Kong M.P.H.a, b and Sandy Park B.A.a, b AbstractObjectivesAn increased prevalence of lactose intolerance is seen in irritable bowel syndrome (IBS). Recently, we demonstrated a high prevalence of abnormal lactulose breath test results in IBS suggesting bacterial overgrowth. Because symptoms of lactose intolerance result from bacterial fermentation, the purpose of this study was to determine whether an abnormal lactose breath test is reflective of malabsorption or early presentation to bacteria.MethodsSubjects with diarrhea-predominant IBS were enrolled. On day 1, subjects underwent a lactulose breath test after an overnight fast. Within 1 wk, subjects returned after fasting for a lactose breath test with simultaneous blood glucose measurements every 15 min to complete a lactose tolerance test (LTT). Symptoms were evaluated 3 h after lactose administration.ResultsTwenty subjects completed the study. One subject inadvertently received dextrose through the intravenous and was excluded. Of the remaining 19 subjects, three (16%) had an abnormal LTT suggesting malabsorption. In all, 10 subjects (53%) had an abnormal lactose breath test, 14 (74%) had an abnormal lactulose breath test, and 11 (58%) had symptoms after lactose administration. The agreement with symptoms was moderate ( = 0.47) and fair ( = 0.24) when compared to the lactose breath test and LTT, respectively. There was a fair correlation between lactose breath test and LTT ( = 0.29). However, lactose breath test hydrogen levels greater than 166 ppm were universally predictive of abnormal LTT. Finally, a significant correlation was seen between the hydrogen production on lactose and lactulose breath test (r = 0.56, p = 0.01).ConclusionsLactose breath testing in IBS subjects does not seem to reflect malabsorption; it may be an indicator of abnormal lactulose breath test, suggesting bacterial overgrowth.
 

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Discussion Starter · #2 ·
Relationship between lactose and lactulose breath testLactulose breath test results were noted to be abnormal in 14 of 19 subjects (74%). On comparing the maximum hydrogen production between the lactose and lactulose breath test, there was a significant correlation between these two tests, suggesting that the abnormality seen on lactose breath test could represent bacterial overgrowth rather than lactose intolerance
 

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Could they have possibly gotten any other result?
 

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Interesting abstract bonnie. Can you post the journal reference or the URL link in the future? It's good practice to credit your sources http://www.ncbi.nlm.nih.gov/entrez/query.f...0&dopt=Abstract I didn't see this abstract before. It could have helped me when I gave this to my GI doctor.As I said before, I believed I had small intestine bacterial overgrowth (SIBO) and that this was the cause of my lactose intolerance. I didn't take the lactose breath test, but I did take the lactulose breath test which Pimentel used to diagnose SIBO. My breath test came back normal (hydrogen and methane under 20 ppm) until T+90 mins when it spiked very high. After that I ended taking five different courses of broad spectrum antibiotics to get rid of the SIBO. Neomycin sulfate got rid of the bacteria for a month. During that month, I could eat all sorts of dairy products with no flatulence. After the bacteria returned, I took took different antibiotics to get rid of the problem.It's been about 3 months and I'm still lactard free.
skinny
 

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Discussion Starter · #7 ·
Hi skinny, if you have been following my posts I udsually cite my source as www.infotrieve.com as my source.I do apologize that I have been lax on this thread. I was too excited I guess. Usually I give the doi if I don't get it off infotrieve.com . I have been posting for over two years and following this practice. Jeez no need to jump all over me.
 

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Discussion Starter · #8 ·
skinny it is possible you did not have lactose Intolerance.It is just that the lactose was being exposed to the bacteria in the small intestine earlier than in the colon(as in the case of lactose malabsorption) and causing symptoms. i suppose you have ruled out fast transit because antibiotics helped you
 

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quote:can you forget for a minute who the authors are and please tell me which part of the study is flawed
First paper was so wrong it appeared to be intentional but the second paper was essentially perfect and they got the same results both times. Coincidence?
 

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bonnie: It appears that I did not have lactose malabsorption. I did have lactose intolerance because eating lactose gave me gas which I could clearly not tolerate. After the antibiotics, I could eat lactose without gas. This indicates to me that I had bacterial overgrowth that was causing my lactose intolerance. I'm basing my self-diagnosis this article:Lactose Intolerance: Considerations for the ClinicianPRACTICAL GASTROENTEROLOGY � FEBRUARY 2003PDF: http://www.healthsystem.virginia.edu/inter...Crayarticle.pdf HTML version (Google cache): http://shorterlink.com/?5V65B5
quote:Lactose malabsorption occurs when lactose, the primary sugar in dairy products, is not completely digested and absorbed in the small bowel. Lactase, the enzyme required to hydrolyze lactose for intestinal absorption, is found primarily in tips of the villi in the jejunum (1). If lactase activity is decreased as a result of primary deficiency, altered anatomy, or an underlying disease process, malabsorption of lac-tose may occur. When unabsorbed lactose reaches the colon, colonic bacteria use this substrate for fermenta-tion, producing gas and short chain fatty acids. The water to be drawn into the bowel and accelerating the intestinal transit time (1). The symptoms of lactose intolerance may include bloating, diarrhea, flatulence, abdominal pain, distention and cramping.[...]There are several things to remember about the hydrogen breath test. First, it diagnoses lactose malabsorption. This may or may not translate into lactose intolerance. [...]Bacterial overgrowth of the small bowel may also make interpretation of this test more difficult.An earlier rise in hydrogen production would be expected in this setting (small bowel versus colonic production). Unfortunately, many conditions that are associated with bacterial overgrowth may also affect intestinal motility, further clouding the issue.
skinny
 

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quote:appears that I did not have lactose malabsorption. I did have lactose intolerance because eating lactose gave me gas which I could clearly not tolerate.
Is this an entirely new disease? Please tell us you are not Martian
 

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Discussion Starter · #14 ·
Perhaps it is time now to define lactose intolerance?The article I quoted at the start does it thusAn abnormal lactulose breath test was defined as a rise of >20 ppm in hydrogen or methane within 90 min of lactulose ingestion [16 and 20]. This was considered as suspicious for the presence of bacterial overgrowth.An abnormal Lactose Tolerance Test was defined as a rise in blood glucose of <20 mg/dl within the 3 h of measurement. This lack of adequate rise was considered to be representative of failed absorption of the carbohydrate [21]. An abnormal lactose breath test result was defined as a rise in hydrogen or methane of >20 ppm in the first 3 h of testing [22].Symptoms during testing were also taken into account. At the conclusion of the lactose tolerance test/breath test, subjects were asked to disclose whether they experienced excessive bloating, distension, or diarrhea. Any combination of these symptoms constituted symptomatic intolerance to lactose.So I suppose skinny has symptomatic intolerance to lactose by this paper. For it to be lactose malabsorption she would have to get an abnormal Lactose tolerance test- the one that tests the rise in blood glucose or according to this paper the maximal hydrogen production to be greater than 166 ppm in the lactose hydrogen breath test.Anyone care to define lactose intolerance?
 

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quote: Is this an entirely new disease?
it appears to be common despite your claim that there... "is none (bacteria) to begin with".sounds like the antibiotics wiped out whatever bacteria found its way to the middle or upper half of the intestines.i'd like to know the various reasons why bacteria can overtake the intestines. poor diet?poor immune function (leukoferon is one of the controls on bacterial growth)viral illness that decreases intestinal motility?poor pancreatic and enzyme function?any number of things can go wrong causing these problems.
 

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Discussion Starter · #19 ·
I see now where the confusion has been in your mind, skinny. It wasn't clear to me before this as I have not read your posts, skinny. It seems you interpreted an abnormal lactulose test as evidence of lactose malabsorption prior to this article. Don't know why you made that jump.
 

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Discussion Starter · #20 ·
Ok if anyone else is interested"The symptoms of lactose intolerance include loose stools, abdominal bloating and pain, flatulence, and gurgling noises produced by gas moving through the intestine (look under borborygmus in the medical dictionary). Loose stools occur because undigested lactose pulls water into the small intestine. The extra fluid also speeds up peristalsis, the wavelike movement of the small intestine, giving the lactose even less time to be digested. Once lactose reaches the large intestine, bacteria - not lactase - break it down, producing hydrogen and other gases that may contribute to the pain and diarrhea. Intolerance varies Lactase deficiency and lactose intolerance aren't the same. In fact, some people without much if any of the milk-digesting enzyme aren't bothered by lactose. Think of lactose intolerance as a collection of symptoms produced, in part, by the way the digestive system responds and adapts to the undigested milk sugar. A person with a naturally sensitive gut - perhaps one "wired" with a lot of easily stimulated pain receptors - might feel the effects of undigested lactose more. Some studies have found an overlap between lactose intolerance and conditions like irritable bowel syndrome, in which the digestive tract is overly sensitive to a variety of stimuli. Intolerance may also vary with the bacteria living in your colon. If you avoid milk and dairy foods, your colon may lose the bacteria best suited to processing undigested lactose. Finally, there may be a psychological component. Some people develop strong aversions to dairy food after experiencing mild intolerance symptoms. In experiments, researchers have shown that some people who believe they are lactose intolerant can, in fact, digest it without symptoms if they're not told the food contains lactose. "from Harvard Health Letter, Dec 2003 p0 Got milk? No thanks! lactose intolerance
 
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