Human and clinical nutrition

Human and Clinical Nutrition

Raising Milk Energy Content Retards Gastric Emptying of Lactose in Lactose-Intolerant Humans with Little Effect on Lactose Digestion1,2
Tuula H. Vesa,* Philippe R. Marteau,3 Francoise B. Briet, Marie-Christine Boutron-Ruault ¸ and Jean-Claude Rambaud
INSERM U290, Hopital St. Lazare, Paris, France and *Department of Biochemistry and Food Chemistry, ˆ Universityof Turku, Turku, Finland
ABSTRACT Lactose digestion improves when the energy content of a meal is raised, perhaps due to delayed gastric emptying; however, this has not been demonstrated directly. It is not known whether lactose-intolerant subjects should consume full-fat or high energy milk instead of half-skimmed milk. In this study, breath 13CO2 and hydrogen (H2) measurements were combined toassess simultaneously the effect of increasing milk energy content on gastric emptying, digestion, and tolerance of lactose. On two separate days, 11 adult lactose maldigesters ingested, in the fasting state, a single dose of 710 kJ half-skimmed milk or 1970 kJ high energy milk. Both contained 18 g lactose and were supplemented with 100 mg 13C-glycine for breath 13CO2 measurement. For 6 h aftermilk ingestion, samples of expired breath were collected, and subjects scored their symptoms on a fourgrade questionnaire. Gastric emptying was measured from excretion of breath 13CO2 . The mean gastric emptying half-time was significantly longer after ingestion of high energy milk than after half-skimmed milk (84 { 4 vs. 64 { 4 min, P Å 0.004). The mean area under the breath H2 excretion curvemeasured for 6 h was 330 { 61 mL/L after subjects consumed high energy milk vs. 470 { 82 mL/L after they consumed half-skimmed milk (P Å 0.07). Mean symptom scores did not differ after ingestion of the two milks, but only two subjects experienced disturbing symptoms after high energy milk ingestion compared with five subjects after ingestion of half-skimmed milk (P Å 0.56). Although ingestion of highenergy milk delayed the gastric emptying of lactose for significantly longer than the ingestion of half-skimmed milk (P õ 0.01), it did not lead to significant improvement in symptoms and reflected only a trend toward improved lactose digestion (P Å 0.07), as measured by the area under the breath H2 excretion curve. These results indicate that it is not beneficial for most lactose-intolerantsubjects to replace consumption of half-skimmed milk by milk with a higher energy content. J. Nutr. 127: 2316–2320, 1997. KEY WORDS: • lactose intolerance • gastric emptying • milk • energy content • humans

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Most of the world’s adult population exhibits partial lactose maldigestion as a result of the physiologic decline in intestinal lactase andmay suffer from intolerance symptoms upon lactose ingestion (Suarez et al. 1995). Theoretically, the following three mechanisms can improve this digestion: 1) stimulation of endogenous lactase, a mechanism that has not been shown to be relevant in humans, 2) the presence of exogenous lactase in the meal, and 3) slowed gastric emptying, which can be obtained by modifying the product consumed or byingesting it with other food. An improvement in lactose digestion was demonstrated when lactose was ingested in milk instead of an aqueous solution (Solomons et al. 1979, Welsh et al. 1981), or when it was ingested with a meal, rather than with milk alone or in aqueous lactose solution (Martini and Savaiano 1988). In these situations, the improved digestion was thought to result from slowedgastric emptying due to the increased
Supported by an EU Research Training Grant (T.H.V.). The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked ‘‘advertisement’’ in accordance with 18 USC section 1734 solely to indicate this fact. 3 To whom correspondence should be addressed at Laennec Hospital, Department of...