# Low-Lactose Diet Does Not Benefit IBS Patients With Lactose Intolerance



## eric (Jul 8, 1999)

FYILow-Lactose Diet Does Not BenefitIBS Patients With Lactose Intolerance WESTPORT, CT (Reuters Health) Mar 26 - Patients withirritable bowel syndrome (IBS) who have lactosemalabsorption fare no better on a low-lactose diet than IBSpatients without lactose intolerance, according to a report byUK researchers. Among patients with IBS, lactose intolerance occurs in 6% to24%, according to previous studies, and "many centersspecifically seek to detect hypolactasia and treat it bylow-lactose diets," Dr. John O. Hunter from Addenbrooke'sHospital, Cambridge, and colleagues note in the March issue ofthe European Journal of Gastroenterology and Hepatology. To evaluate whether this effort is worthwhile, Dr. Hunter'sgroup had 122 consecutive IBS patients take lactose hydrogenbreath tests, placing those who tested positive on a low-lactosediet for 3 weeks. To confirm lactose intolerance, patients who improved on thediet were given double-blind, placebo-controlled challengeswith 5 g, 10 g and 15 g of lactose. Patients who did not respondto the low-lactose diet were put on a lactose-exclusion diet ora low-fiber diet. Of the 33 patients with a positive breath test, 23 completed alow-lactose diet, but only 9 showed reduction in symptomscores to less than 50% of the baseline level. Six of the patientswho did not improve completed a lactose-exclusion diet andthree of these then improved; all these patients were intolerantto milk. In addition, three patients completed a low-fiber dietand two improved. The other five patients either did not acceptfurther dietary intervention or were noncompliant. The results of the lactose challenges were not conclusive, Dr.Hunter's team found. Of the patients who had negative resultson the breath test, 35 were compliant with either alactose-exclusion or low-fiber diet. Twenty-four of thesepatients improved. "There appears to be little advantage in attempting to separatelactose malabsorbers from other with IBS but simply toconsider all patients with IBS for treatment with an exclusionor low-fiber diet," Dr. Hunter and colleagues conclude. Eur J Gastroenterol Hepatol 2001;13:219-225. ------------------I work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## Mike NoLomotil (Jun 6, 2000)

The study is/was another good illustration that the whole "enzymatic lactose intolerance component" is usually "over weighted" when assessing and addressing apparent bowel dysfunction.To wit:"Of the 33 patients with a positive breath test, 23 completed alow-lactose diet, but only 9 showed reduction in symptomscores to less than 50% of the baseline level"So this investigator set the level of significance at 50% reduction in reported symptoms and only 9% of the test positive subjects reached that...simply illustrating on the one hand the validity of contribution to the overall symptom set in these patients, and on the other hand placing it in perspective by quantifying it.Again, if present in multiple symptom sets it is clearly contributory but hardly the sole, much less primary, source of the symptoms.I would have loved to check everything else this group was reactive to..heck as long as you have them isolated keep on banging away...ah, but money, time, effort, and the fact that the dosing in the oral challenges used, while fine for enzymatic challenge or allergy challenge, will not uncover many of the other forms of reactivity, and the study objectives themselves...[sigh]...such silly things to hold us back.MNL________________ www.leapallergy.com


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## bonniei (Jan 25, 2001)

You might want to also read this articleFructooligosaccharides and lactulose cause more symptoms in lactose maldigesters(those who test positive for lactose intolerance) and subjects with pseudohypolactasia ( lactose digesters who report milk to be the source of their gastrointestinal symptoms) than in control lactose digesters Ulla Teuri, Heikki Vapaatalo and Riitta Korpela American Journal Of Clinical NutritionVol. 69, No. 5, 973-979, May 1999 For e.g they say"Flatulence after the lactulose load was more severe in the lactose maldigesters and pseudohypolactasic subjects than in the control lactose digesters (P = 0.04 and P = 0.008, respectively) during the first 6 h after ingestion (Table 2T2T2). Lactose maldigesters also experienced more borborygmi than the control lactose digesters after ingesting lactulose (P = 0.02). Lactulose caused loose stools or diarrhea during the 6-h period in about half of the subjects in all groups. The symptoms caused by lactulose continued to increase for 6 h after its intake in all groups (Figure 2F2F2). "The article suggest that in subjects with pseudohypolactasia, the cause of symptoms may be indigestible carbohydrates rather than lactose


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