Search Results (61)

Irritable bowel syndrome (IBS) is a gut–brain axis chronic disorder, characterized by recurrent abdominal pain and altered bowel habits in the absence of organic pathology. Nutrition plays a central role in symptom management, yet no single dietary strategy has demonstrated universal effectiveness. This narrative review critically evaluates current nutritional approaches to IBS. The low-Fermentable Oligo-, Di-, Mono-saccharides and Polyols (FODMAP) diet is the most extensively studied and provides short-term symptom relief, but its long-term effects on microbiota diversity remain concerning. The Mediterranean diet, due to its anti-inflammatory and prebiotic properties, offers a sustainable, microbiota-friendly option; however, it has specific limitations in the context of IBS, particularly due to the adverse effects of certain FODMAP-rich foods. A gluten-free diet may benefit individuals with suspected non-celiac gluten sensitivity, although improvements are often attributed to fructan restriction and placebo and nocebo effects. Lactose-free diets are effective in patients with documented lactose intolerance, while a high-soluble-fiber diet is beneficial for constipation-predominant IBS. IgG-based elimination diets are emerging but remain controversial and require further validation. In this review, we present the 10 dietary commandments for IBS, pragmatic and easily retained recommendations. It advocates a personalized, flexible, and multidisciplinary management approach, avoiding rigidity and standardized protocols, with the aim of optimizing adherence, symptom mitigation, and health-related quality of life. Future research should aim to evaluate, in real-world clinical settings, the impact and applicability of the 10 dietary commandments for IBS in terms of symptom improvement and quality of life Full article

The digestion of A1 β-casein present in conventional milk releases β-casomorphin-7 (βCM-7), a bioactive peptide with potential implications for gastrointestinal and neurological health. A scoping review was performed to respond to the following research question: What are the health effects of consuming milk containing the A1 β-casein variant compared to the exclusive consumption of the A2 variant in humans? The evidence collected in this review of human studies with different populations (i.e., children, middle-aged adults, athletes) suggests that the consumption of milk containing A1 β-casein may negatively influence gut health by altering microbial composition, reducing intestinal motility, and increasing colonic fermentation, leading to elevated gas production and altered short-chain fatty acid (SCFA) profiles. The release of βCM-7 upon digestion can also compromise intestinal-barrier integrity, which may exacerbate symptoms of lactose intolerance, irritable bowel syndrome (IBS), or other allergy-related sensitivities. Its ability to cross the blood–brain barrier raises concerns about potential neurological effects. In contrast, milk containing exclusively A2 β-casein is associated with improved gastrointestinal outcomes, including the enhanced abundance of beneficial bacteria such as Bifidobacterium spp. and reduced inflammatory markers. Full article

Background: Previous research indicates that gastrointestinal discomfort from milk consumption may be attributable to A1 β-casein, rather than lactose intolerance alone. A2 milk (free of A1 β-casein) consumption may result in fewer symptoms compared to conventional milk containing both A1/A2 β-casein. Objective: In this five-week, double-blind, double-crossover study, we assessed the physiological responses to doses escalating in volume of lactose-free conventional milk (Lactaid), A2 milk, and lactose-free A2 milk in fluid milk-avoiding participants. Methods: Each milk type was consumed over three separate weeks with three increasing doses across five days per week, >one week washout. Gastrointestinal symptoms, blood glucose, and breath gases were monitored for twenty-four, two-, and three-hours post-consumption, respectively. Sensory evaluation was completed for each sample. Results: Fifty-three participants consented and were randomized, with forty-eight participants completing the study. Overall, symptoms were minimal. On Days 1 and 3, lower ratings of bloating and flatulence were observed in A2 compared to lactose-free A2. Breath hydrogen responses reflected lactose content, but were higher in lactose-free A2 than Lactaid on Day 5. Thirty-three participants were deemed lactose-intolerant and had higher fasting and average breath hydrogen for all samples. The only symptom corresponding to the increase in breath hydrogen among these participants was flatulence after A2 consumption. Surprisingly, flatulence was apparently higher for lactose-tolerant individuals when consuming Lactaid compared to A2. Conclusions: These findings suggest that adults who avoid conventional fluid milk consumption may experience minimal GI discomfort from lactose-free and/or A1-free milks. Full article

Background/Objectives: There is scattered information in the scientific literature regarding the characterization of probiotic bacteria found in fermented milk beverages and the beneficial effects of probiotic bacteria on human health. Our objective was to gather the available information on the use of probiotic bacteria in the prevention of civilization diseases, with a special focus on the prevention of obesity, diabetes, and cancer. Methods: We carried out a literature review including the following keywords, either individually or collectively: lactic acid bacteria; probiotic bacteria; obesity; lactose intolerance; diabetes; cancer protection; civilization diseases; intestinal microbiota; intestinal pathogens. Results: This review summarizes the current state of knowledge on the use of probiotic bacteria in the prevention of civilization diseases. Probiotic bacteria are a set of living microorganisms that, when administered in adequate amounts, exert a beneficial effect on the health of the host and allow for the renewal of the correct quantitative and qualitative composition of the microbiota. Probiotic bacteria favorably modify the composition of the intestinal microbiota, inhibit the development of intestinal pathogens, prevent constipation, strengthen the immune system, and reduce symptoms of lactose intolerance. As fermented milk beverages are an excellent source of probiotic bacteria, their regular consumption can be a strong point in the prevention of various types of civilization diseases. Conclusions: The presence of lactic acid bacteria, including probiotic bacteria in fermented milk beverages, reduces the incidence of obesity and diabetes and serves as a tool in the prevention of cancer diseases. Full article

Background: Malnutrition is a major issue in hospitals, impacting over 25% of patients. It can arise from a range of factors, such as chronic underfeeding, diseases, aging, and inappropriate nutritional care. Unnecessary fasting and the use of incorrect dietary prescriptions can also contribute to malnutrition, regardless of a patient’s underlying health conditions. Methods: A search strategy was applied to identify pertinent articles on the prescription and management of therapeutic diets in hospital settings from the last 10 years (2014–2024) using the PubMed database. The following English terms and their combinations were used: hospital diet, non-evidence-based dietary restriction, hospital food service, and therapeutic diets. Only national or international guidelines published in English were considered. Results: The narrative review was developed through the analysis of two guidelines on the prescription and management of therapeutic diets in hospital settings. The main non-evidence-based therapeutic diets that should have limited prescriptions are low-calorie, low-carbohydrate, low-protein, and low-sodium diets because they inevitably lead to a reduction in caloric and/or protein content, limit menu choices, and make recipes less palatable. The preventive total elimination of lactose without diagnostic confirmation should be avoided in the prescription of hospital therapeutic diets for lactose intolerance without symptoms and confirmation of diagnosis. Fasting after surgery should be avoided. The two guidelines differ in part in terminology and the bromatological composition of the diet. Conclusions: The heterogeneity of terminologies and bromatological composition leads to further confusion in determining the correct procedure for managing and prescribing therapeutic diets. Deepening and increasing research in the field of management and prescription of therapeutic diets is necessary to overcome the problem of hospital malnutrition, as the food provided through hospital food service is a very effective medicine for providing calories, macronutrients, and micronutrients. Full article

Lactose malabsorption (LM) refers to the incomplete absorption of lactose in the small intestine, resulting in the arrival of ingested lactose in the colon, which can give rise to symptoms defined as lactose intolerance (LI). The lactose breath test (LBT), thanks to its low cost, availability, and noninvasiveness, is the most used diagnostic method. However, the LBT is a tedious tool, requiring prolonged involvement of patients, qualified staff, and infrastructure, of which the most time-consuming factor is the frequency and number of breath samples needed. Objectives: To simplify the current LBT methodology, compliant with the current guidelines’ statements, by reducing the test duration or the number of breath samples, without compromising the test’s accuracy. Methods: The results of the standard LBT were compared with two simplified tests: a “shortened” test, lasting three hours, with samples taken every 30 min; and a “five-sample” test, lasting four hours, with samples taken every hour. Patients were stratified into three grades of malabsorption (mild, moderate, severe) based on the amount of gas exhaled. A clinical severity score was introduced to assess the clinical relevance of LI using a specific questionnaire. Results: Among the 543 patients enrolled (F 71.5%, mean age 43.7 ± 17.6 yrs), 60.4% (328/543) tested positive for LM. A total of 70.5% (383/543) presented LI, with 32.1% of those being true intolerants (LI without LM). The shortened test demonstrated an accuracy of 93.9%, with a sensitivity of 89.9% and a false negative rate of 10.1% (33/328). The five-sample test showed higher accuracy and sensitivity than the shortened test (96.5% and 94.2%, respectively; p = 0.03) with a false negative rate of 5.8% (19/328). Of the 19 false negatives in the five-sample test, 95% (18/19) were categorized as mild malabsorbents. No statistical correlation was found between the clinical severity score and LBT results. Conclusions: The five-sample test, involving hourly breath measurements, is a reliable option for simplifying the LBT without significantly reducing the procedure’s sensitivity. Full article

Background: This study aimed to identify the specific areas of knowledge gaps regarding lactose intolerance among neonatologists in Chinese outpatient settings as well as to assess the availability of lactose intolerance testing in hospitals. Methods: A total of 278 neonatologists in outpatient settings from 144 hospitals were surveyed. To explore the awareness level, diagnosis, and treatment of neonatal lactose intolerance among neonatologists in outpatient settings, a multicenter cross-sectional survey was designed. Descriptive analysis based on frequency and percent distribution was performed for all variables. Results: Most respondents were senior doctors (256, 92.09%) from general hospitals and maternity/maternal and child health hospitals, had over 10 years of experience, and were dominantly associate chief physicians and chief physicians (211, 75.90%). A significant proportion of the participants (236, 84.89%) believed that neonatal lactose intolerance tends to be overlooked during clinical practice. When the most common symptoms of neonatal lactose intolerance were surveyed, diarrhea was selected by 142 (51.08%) respondents, followed by bloating and milk regurgitation or emesis (71, 25.54%). Other symptoms included unexplained crying (36, 12.85%), stool with milk flap or foam (15, 5.40%), and increased venting (14, 5.04%). Furthermore, the survey results indicated that the most common method for diagnosing neonatal lactose intolerance in the respondents’ hospitals was qualitative test for urinary galactose (78, 28.06%). Of the respondents, 137 (49.28%) stated that their hospital could not test for lactose intolerance. For treating lactose intolerance, the neonatologists primarily opted for exogenous lactase rather than lactose-free formula milk. Conclusions: This study sheds light on Chinese neonatologists’ awareness of neonatal lactose intolerance, revealing some knowledge gaps. The expeditious popularization and conduct of lactose intolerance-related examinations in hospitals will have a positive stimulative effect on the management of lactose intolerance in newborns. Full article

Objective: In this retrospective study, we assessed the efficacy of oral lactase in infants with lactose intolerance in terms of sex, birth weight, and interference by other medications. Methods: The study was conducted on patients aged 0–6 months who had been diagnosed with lactose intolerance on admission to the Department of Social Pediatrics at Dokuz Eylul University. Demographic data, the onset of symptoms, and medications used were recorded. Results: We found that 86.7% of the infants responded to lactase, with no significant differences based on sex, birth weight, or age at symptom presentation. We observed, however, that the efficacy of treatment did improve over time, thereby deriving benefits from intestinal development and adaptation. Interestingly, the response to lactase was reduced in infants receiving concomitant simethicone for colic symptoms, suggesting a potential drug interaction, while probiotics had no impact on treatment outcomes. Conclusions: We advise against using additional medications with oral lactase, pointing out a possible interaction with simethicone that might decrease the effectiveness of treatment. Full article

This case report examines the impact of a single session of functional neurology on a 35-year-old female patient diagnosed with lactose intolerance. The patient presented with severe gastrointestinal symptoms, including frequent diarrhea, bloating, and vomiting upon dairy consumption. The intervention aimed to reset dysfunctional neurological programs believed to contribute to her condition. The study utilized a standardized lactose intolerance breath test to measure the hydrogen and methane levels at various intervals before and after treatment. Post-treatment results showed symptomatic relief with the patient reporting normalized bowel movements and the absence of previous symptoms. Despite these improvements, the biochemical markers at higher time points (150 and 175 min) post-treatment remained similar to the pre-treatment values, indicating persistent lactose malabsorption and highlighting the variability of hydrogen measurements. This case report suggests that a single session of functional neurology can significantly alleviate the symptoms of lactose intolerance. However, the preliminary nature of these results underscores the need for further research involving larger sample sizes and long-term follow-up to fully understand the treatment’s efficacy and underlying mechanisms. Full article

Approximately 30% of milk protein is β-casein. We aimed to determine whether lactose maldigesters who chronically consumed two cups of A1/A2 milk (containing 75% A1 β-casein and 25% A2 β-casein) would adapt to have fewer intolerance symptoms, lower serum inflammatory markers, and/or altered glutathione levels similar to those consuming A2 milk (containing 100% A2 β-casein). A double-blinded, randomized, crossover trial was conducted. Sixteen confirmed lactose maldigesters consumed 250 mL of A1/A2 milk and A2 milk twice daily with meals for two weeks. At the end of the adaptation period on day 15, lactose maldigestion was measured after a challenge with the same milk used for adaptation (0.5 g of lactose per kg of body weight) with a hydrogen breath test. Fecal urgency was higher during the two-week consumption of A1/A2 milk compared to A2 milk (p = 0.04, n = 16). Bloating (p = 0.03, n = 16) and flatulence (p = 0.02, n = 16) were also higher on the 15th day with A1/A2 milk compared to A2 milk challenge. However, day-to-day symptoms, hydrogen, serum inflammatory markers, and antioxidant concentrations were not different after A1/A2 and A2 milk consumption adaptation periods. Adaptation over two weeks did not improve lactose digestion or tolerance of A1/A2 milk to match that of A2 milk. Full article

Lactose intolerance, which affects about 65–75% of the world’s population, is caused by a genetic post-weaning deficiency of lactase, the enzyme required to digest the milk sugar lactose, called lactase non-persistence. Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. Genetic variations, namely lactase persistence, allow some individuals to metabolize lactose effectively post-weaning, a trait thought to be an evolutionary adaptation to dairy consumption. Although lactase non-persistence cannot be altered by diet, prebiotic strategies, including the consumption of galactooligosaccharides (GOSs) and possibly low levels of lactose itself, may shift the microbiome and mitigate symptoms of lactose consumption. This review discusses the etiology of lactose intolerance and the efficacy of prebiotic approaches like GOSs and low-dose lactose in symptom management. Full article

The prevalence of adverse reactions to foodstuffs (ARFS), such as food allergy (FA) and food intolerance (FI), has been increasing worldwide during the past decades. Currently, strict food allergen avoidance is the principal recommended treatment of ARFS. However, individuals with ARFS following elimination diets have shown crucial micronutrient deficiencies. There is an emerging necessity for an effective ARFS strategy which may help mitigate the nutritional deficiency problem. To develop a strategy for the management of ARFS including a food allergen-specific substitutive diet (FASSD) together with the evaluation of the clinical picture, food consumption, food-allergen profile and quality of life (QoL) in adults with ARFS. The interest of this study is focused on current growing public health problems: FA and FI. The following measurements will be considered: (1) informed consent and inclusion/exclusion criteria forms; (2) symptomatology, food consumption and dietary intake: PSIMP-ARFSQ-10 and FBFC-ARFSQ-18 validated ARFS-specific questionnaires and a 24 h dietary recall interview; (3) immunology: food-allergen profile (IgE and IgG₄ antibodies against 82 common Mediterranean food and beverages) using HELIA^® Helmed line immunoassay analyzer (Aesku.Diagnostics, Wendelsheim, Germany); (4) enzymatic activity: lactose and fructose breath test using Cerascreen^® hydrogen and methane detector kit (Cerascreen GmbH, Schwerin, Germany); (5) QoL aspects: SF-12 and FAQLQ-AF validated questionnaires; (6) six-month FASSD intervention; (7) repetition of measurements from 1 to 6; (8) adjustment of the FASSD. The six-month FASSD was designed for adults aged 18 to 70 years according to individual immunological and enzymatic results. Substitutive foodstuffs were chosen using BEDCA, USDA and NCCDB food composition databases reference tables when they represented the same nutritional value as the foodstuff with positive IgE and IgG₄ reaction (≥3.5 kU_A/L). Particular attention was paid to vitamin A, D, E, C, folate, B1, B2, B3, B6, B12, calcium, iron, potassium, magnesium, sodium, phosphorus, iodine, selenium and zinc when choosing the substitutive foodstuffs. The FASSD was developed as a proposed tool to improve health and QoL of adults with symptoms associated with ARFS. Full article

Due to its very early introduction, cow’s milk is one of the first foods that can cause adverse reactions in human beings. Lactose intolerance (LI) and cow’s milk allergy (CMA) are the most common adverse reactions to cow’s milk. While LI is due to insufficient small intestinal lactase activity and/or a large quantity of ingested lactose, CMA is an aberrant immune reaction to cow’s milk proteins, particularly casein or β-lactoglobulin. However, the clinical manifestations of LI and CMA, particularly their gastrointestinal signs and symptoms, are very similar, which might lead to misdiagnosis or delayed diagnosis as well as nutritional risks due to inappropriate dietary interventions or unnecessary dietary restriction. Formula-fed infants with LI should be treated with formula with reduced or no lactose, while those with CMA should be treated with formula containing extensive hydrolyzed cow’s milk protein or amino acids. This review is therefore written to assist clinicians to better understand the pathophysiologies of LI and CMA as well as to recognize the similarities and differences between clinical manifestations of LI and CMA. Full article

Most adverse reactions to food are patient self-reported and not based on validated tests but nevertheless lead to dietary restrictions, with patients believing that these restrictions will improve their symptoms and quality of life. We aimed to clarify the myths and reality of common food intolerances, giving clinicians a guide on diagnosing and treating these cases. We performed a narrative review of the latest evidence on the widespread food intolerances reported by our patients, giving indications on the clinical presentations, possible tests, and dietary suggestions, and underlining the myths and reality. While lactose intolerance and hereditary fructose intolerance are based on well-defined mechanisms and have validated diagnostic tests, non-coeliac gluten sensitivity and fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intolerance are mainly based on patients’ reports. Others, like non-hereditary fructose, sorbitol, and histamine intolerance, still need more evidence and often cause unnecessary dietary restrictions. Finally, the main outcome of the present review is that the medical community should work to reduce the spread of unvalidated tests, the leading cause of the problematic management of our patients. Full article

Background and objectives: Globally, about 70% of the adult population is lactase non-persistent (LNP), lacking the enzyme required for lactose digestion. The main consequence of intolerance is withholding nutrient-rich dairy foods, while the literature shows that many LNPers are able to consume ≤12 g of lactose, comparable to 250 mL of milk, without experiencing gastrointestinal discomfort. Repetitive consumption of lactose may improve intolerance symptoms even further via colonic adaptation. This study aimed to assess the effects of daily consumption of incremental lactose doses on microbiota composition and function, and intolerance symptoms. Methods: Twenty-five healthy adults of Asian origin (age 22–44 yrs, BMI 19–28 kg/m²), carrying the LNP genotype and avoiding lactose in their habitual diet, were included in this 12-week single-blinded intervention trial. Participants consumed lactose twice daily, with doses being gradually increased from 3 to 6 g, to finally 12 g twice daily, each dose being provided for 4 consecutive weeks. Before and after the 12-week intervention, participants underwent a 25 g lactose challenge hydrogen breath test (HBT) and handed in stool samples. Daily gastrointestinal symptoms and acute intolerance symptoms during the HBT were recorded. Results: There was a significant increase in Bifidobacterium after 12 weeks of lactose consumption (p = 0.009), accompanied by a two-fold increase (p < 0.001) in fecal β-galactosidase activity. There was a 1.5-fold decrease (AUC; p = 0.01) in expired hydrogen during the second compared to the baseline HBT. There was a non-significant decrease in total symptom score (p = 0.09) during this second HBT, which was already relatively low during the baseline HBT. Daily consumption of lactose was generally well tolerated, with mild to no gastrointestinal complaints reported during the intervention. Discussion: Repetitive consumption of incremental doses of lactose increases lactose tolerance in LNP individuals via colonic adaptation, most likely through increasing the relative abundance of lactose-fermenting Bifidobacterium. Repetitive lactose consumption is well tolerated and able to reduce expired hydrogen during a 25 g lactose HBT. Here, we show that regular and incremental exposure to lactose in LNP individuals leads to colonic adaptation without any increase in gastrointestinal symptoms. This lifts the necessity to remove dairy foods completely from the diet. Full article