Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?
BACKGROUND
Uncontrolled studies of lactose intolerant subjects have shown that symptom severity decreases after chronic lactose consumption. Adaptation of the colonic flora might explain this improvement.


OBJECTIVE
To compare the effects of regular administration of either lactose or sucrose on clinical tolerance and bacterial adaptation to lactose.


METHODS
Forty six lactose intolerant subjects underwent two 50 g lactose challenges on days 1 and 15. Between these days they were given 34 g of lactose or sucrose per day, in a double blind protocol. Stool samples were obtained on days 0 and 14, to measure faecal beta-galactosidase and pH. Symptoms, breath H2 excretion, faecal weight and electrolytes, and orofaecal transit time were assessed.


RESULTS
Except for faecal weight, symptoms were significantly milder during the second challenge in both groups, and covariance analysis showed no statistical difference between them. In the lactose group, but not in the sucrose group, faecal beta-galactosidase activity increased, pH dropped, and breath H2 excretion decreased.


CONCLUSIONS
Bacterial adaptation occurred when lactose intolerant subjects ingested lactose for 13 days, and all symptoms except diarrhoea regressed. Clinical improvement was also observed in the control group which displayed no signs of metabolic adaptation. This suggests that improved clinical tolerance may be just a placebo effect.
Briet
F
F
INSERM U290, Hôpital Saint-Lazare, Paris, France.
Pochart
P
P
Marteau
P
P
Flourie
B
B
Arrigoni
E
E
Rambaud
J C
JC
D000328:Adult; D001419:Bacteria / Q000378:metabolism; D001944:Breath Tests; D003106:Colon / Q000382:microbiology; D004311:Double-Blind Method; D005243:Feces / Q000201:enzymology; D005260:Female; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D006863:Hydrogen-Ion Concentration; D007785:Lactose / Q000008:administration & dosage*; D007787:Lactose Intolerance / Q000201:enzymology / Q000382:microbiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D013395:Sucrose / Q000008:administration & dosage*; D001616:beta-Galactosidase / Q000032:analysis
D013395:Sucrose; D006859:Hydrogen; D001616:beta-Galactosidase; D007785:Lactose