Report from the LI Conference, part 6

The next presentation went to the heart of the whole conference. (Why wasn't it first?)

What Is Lactose Intolerance and How To Measure It
Richard J. Grand, M.D.
Professor of Pediatrics
Harvard Medical School
Program Director
Clinical and Translational Study Unit Director
Center for Inflammatory Bowel Disease
Children's Hospital Boston
[You might remember Children's Hospital Boston from my posts pointing to the research they've done to use injections to reduce milk allergy symptoms.]

What causes the different type, amount, intensity, and duration of lactose intolerance symptoms?

•Quantity of ingested milk
•Fat content of the milk
•Rate of stomach emptying
•Rapidity with which the milk is transported through the intestine
•Individual sensitivity to abdominal discomfort
•Capacity of bacteria in the colon to digest lactose not absorbed in the small intestine
•Psychological impact of anticipation of symptoms in those who have had previous symptoms during milk intake.

Quantity of ingested milk is obvious. The next three are related, and interrelated. As I said on Friday, it's critical to remember that most adults who are lactose malabsorbers still have some residual lactase activity. Anything that slows down the transit time of lactose gives the system more time for the lactose to interact with and be digested by that lactase. Whole bunches of factors regulate how fast food empties from the stomach and goes through the intestines, and one factor that is known to slow transit time is the fat content of the milk.

Items five, six, and seven are also related. The quantity of gases and bloating produced by the bacteria fermenting undigested lactose will depend on what types of bacteria you have and also on how sensitive you might be to intestinal rumblings. Knowing - or thinking that you know - that dairy causes problems might increase your discomfort. And there may be physical differences in your sensitivity to pain. We know for sure that people with Irritable Bowel Syndrome, for example, are far more sensitive to pain and pressure in the colon than people who don't have it. That may also be true for people with LI.

Dr. Grand also explained why an ordinary family physician might not want to send you for formal LI testing. The standard, simple Hydrogen Breath Test costs an average of $773. Somebody has to pay that.

The Hydrogen Breath Test

It makes my life easier when I get to quote from myself. I have a page on my website titled Tests for Lactse Intolerance and I'm going to quote an important piece of it everybody should know.

The Hydrogen Breath Test (HBT)

The HBT is the best around, simple, direct, and non-invasive (meaning no needles). It works because your breath normally never contains hydrogen gas. You find it there only when the bacteria in your colon ferment carbohydrates, exactly what happens when a load of undigested lactose hits.

Testing is typically done first thing in the morning after a 12-hour fast. You'll likely be asked to blow into a small mouthpiece connected to a laminated foil bag that resembles a pillow-shaped mylar balloon (although several variations may be found).

That first bag is set aside to be used as a baseline. You then drink a solution of lactose in water, although some doctors use milk itself. The amount of lactose may range from 10 to 50 grams: The larger amounts will identify a greater number of people as LI but will also cause more symptoms in those who are sensitive. (Be prepared. You may feel quite ill during and after.)

It takes time for the lactose to reach the colon and for the bacteria to build up a supply of hydrogen in the breath. Various labs will take further breath samples at intervals of 15-60 minutes and for up to two to six hours. Longer is usually better, and the use of milk requires a longer test.

While the test itself is so simple that it can be done almost anywhere, the collected samples are usually shipped off to a specialized laboratory that can afford the several thousand dollars needed to purchase the analyzer. Don't bother to ask for exact results. All that matters is whether you are over a certain threshold. How high doesn't matter and doesn't even relate to how bad your symptoms will be.

This test is extremely accurate. It can be even be used on very young children. But it does have a few flaws.

People on antibiotics should not take it because the antibiotics may knock out the very bacteria which would otherwise produce the hydrogen. Using aspirin before the test may create a misleading rise in hydrogen. Smoking will do the same. A certain percentage of the population don't even have the right kind of bacteria to make hydrogen.

The test is also used to discover other conditions, including bacterial overgrowth in the intestines and rapid transit. Other sugars, including glucose, fructose, sorbital and lactulose, may be used in place of the lactose. You need to talk with your doctor about these if you get a reaction that is not attributed to lactose intolerance. A good article on the test is available on MedicineNet.com.

In any case, unless something disqualifies you, in the U.S. the HBT is the one you want.

The HBT has been around literally for decades. So I was stunned when I read a press release from the University of Cincinnati's University Hospital.

A person’s breath can tell you a lot of things, like whether they are garlic lovers or regularly chew gum.

But according to doctors at the University of Cincinnati, it can also help uncover problems in the gastrointestinal (GI) tract.

Ralph Giannella, MD, and colleagues in the digestive diseases division are now offering hydrogen/methane breath testing at University Hospital to help patients discover whether they have bacterial overgrowth in their small intestines or are lactose or fructose intolerant.

He says University Hospital is the first facility to offer this test in the Cincinnati area.

The Cincinnati metropolitan area is the 24th largest in the country, more than twice the size of Rochester's. How is it possible that an area that large could have been without so simple and standard a test for so long? What other major metro areas might not give their inhabitants easy access to the HBT?

I'm glad the population of Cincinnati can now get this better test done, which may mean an increase in the number of people correctly diagnosed as LI.

If you can't get the HBT done locally wherever you live, make a fuss. Tell your doctor that the local hospitals need to offer this as a basic service. Tens of millions of Americans are Lactose Intolerant, and many may not even realize it. Stop being backward. LI is a a serious issue that is easily helped by an inexpensive pill - if you know you should be taking it. The help you need should be close at hand. Make it happen.