Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The hydrogen breath test is the most convenient and reliable test for lactase
deficiency and lactose intolerance. For the breath test, pure lactose, usually
25 grams (the equivalent of 16 oz of milk), is ingested with water after an
overnight fast. In persons who are lactose intolerant, the lactose that is not
digested and absorbed in the small intestine reaches the colon where the
bacteria split the lactose into glucose and galactose and produce hydrogen
(and/or methane) gas. Small amounts of the hydrogen and methane are absorbed
from the colon into the blood and then travel to the lungs where they are
excreted in the breath. Samples of breath are collected every 10 or 15 minutes
for 3-5 hours after ingestion of the lactose, and the samples are analyzed
for hydrogen and/or methane. If hydrogen and/or methane are found in the breath,
it means that the small intestine of the person was unable to
digest and absorb all of the lactose. He or she is lactase deficient. The amount
of hydrogen or methane excreted in the breath is roughly proportional to the
degree of lactase deficiency, that is, the larger the amount of hydrogen and/or
methane produced, the greater the deficiency. The amount of hydrogen and/or
methane in the breath, however, is not proportional to the severity of the
symptoms. In other words, a person who produces little hydrogen and/or methane
may have more severe symptoms than a person who produces a large amount hydrogen
and/or methane.
The breath test is the best test for determining lactase
deficiency and lactose intolerance, but it has several weaknesses. The first is
that it is a long, boring test. The second is that it suffers from the same
issue as the milk challenge test with respect to the quantity of lactose that
should be used. (See previous discussion.) Lastly, the breath test can be
falsely abnormal when there is spread of bacteria from the colon into the small
intestine, a condition called bacterial overgrowth of the small bowel. When
overgrowth occurs, the bacteria that have
moved up into the small intestine get to the lactose in the intestine before there has
been enough time for the lactose to be digested and absorbed normally, and these
bacteria produce hydrogen and/or methane. This may lead erroneously to a
diagnosis of lactose intolerance. Other conditions also interfere with the
breath test. Thus, diseases that markedly speed up transit of lactose through
the small intestine prevent lactose from being fully digested and absorbed,
leading to a misdiagnosis of lactose intolerance. Recent treatment with
antibiotics can suppress colonic bacteria and their production of hydrogen or
methane and lead to a misdiagnosis of lactose tolerance. Fortunately, these
latter conditions are uncommon and usually can be anticipated on the basis of a
person's history or symptoms.
Lactose Intolerance - Symptoms at Onset of DiseaseQuestion: The symptoms of lactose intolerance can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Setting a good example for your children when it comes to diet and exercise will help them to make healthy decisions about nutrition and fitness. Eating calcium-rich foods and performing weight-bearing exercise will help your children prevent osteoporosis and fractures later in life.
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