metsol maia

 

A consortium of researchers have just published that emulsifiers, a class of additives used in many processed foods to improve texture and extend shelf life, may alter the composition of microbes found throughout the digestive tract.  The study showed that emulsifiers altered good bacteria in the gut which in turn initiated intestinal inflammation.  Inflammation is the root cause of inflammatory bowel disease and leaky gut syndrome.  Inflammation is also associated with obesity and type 2 diabetes.

In recognition of the growing interest to understand what causes and how to cure leaky gut a researcher at Case Western Reserve University has received $4 million in funding.  Leaky gut, medically known as intestinal permeability, is defined as damage to the intestinal tract that allows bacteria and other toxins which normally are contained to seep into the bloodstream.  The result is inflammation throughout the body.  Drug and alcohol abuse and prescription medicines are believed to cause leaky gut.   Inflammatory bowel disease has also been associated with leaky gut.  In addition to better understanding the causes of leaky gut the study will look to identify potential treatments.

A significant challenge for people with lactose intolerance is getting enough calcium.  If you are faced with that problem you might find that Greek yogurt might work in your diet. Yogurt is made by introducing bacteria to heated and pasteurized milk, but Greek yogurt takes the process a step further by straining the yogurt’s whey, removing the extra fat and, with it, a large portion of the lactose, leaving behind less than 7 grams of lactose per serving. Compare that to 11 grams in one cup of milk and you have a dairy treat that is a calcium option for some lactose intolerant consumers.

In this article Dr. Shawn Khodadadian, Lenox Hill Hospital, discusses his preference for using the hydrogen breath test to confirm diagnoses rather than start empirical treatment.  Dr. Khodadadian sites lactose intolerance, fructose malabsorption and small intestinal bacterial overgrowth as diseases that are often receive unwarranted treatment that can lead to adverse side effects.  He has found that the hydrogen breath test very useful in treating patients with gas and bloating and IBS because they allow patients to be placed on accurate and specific diets that are usually less restrictive than if testing was never done.

Dudodenal aspiration is the gold standard test for determining small intestinal bacterial overgrowth (SIBO).  It is not often used because it is very invasive (requiring endoscopy exam of the small intestine) and is very expensive.  Recently a study was conducted to compare the glucose hydrogen breath test with duodenal aspirations.  The research concluded that glucose breath test has lower sensitivity than duodenal aspirations but good specificity for detection of SIBO.  In conclusion, the researchers stated that hydrogen breath tests should be considered first in patients with suspected SIBO.

Many practitioners share the misguided belief that a 90 minute or longer lactulose hydrogen breath test will provide a measure of distal small intestinal bacterial overgrowth (SIBO).  This is an inappropriate use of the test.  In most cases a rapid oro-caecal transit time has been misinterpreted as distal SIBO. This point was demonstrated in a 25 person study with IBS patients. The study used serial measurements of breath hydrogen and oro-caecal scintigraphy following ingestion of a test meal containing lactulose and ^99mTc.  The result was that ^99mTc had already reached the caecum in 88% of the patients before the hydrogen breath levels reached the threshold for a positive result for SIBO.  In conclusion the hydrogen breath test for SIBO will produce a large number of false positive results when testing beyond 60 minutes and is not reliable for detecting distal SIBO.

This research studies goal was to determine whether there is a link between small intestinal bacterial overgrowth (SIBO) and abdominal pain related functional gastrointestinal disorders (AP-FGID) in children.  The study enrolled 161 children who were diagnosed with AP-FGID using the Rome III criteria.  Each child was given a glucose hydrogen breath test to determine the presence of SIBO.  The result was that 23 children (14.3%) were positive for SIBO.  Interestingly the children that tested positive had similar symptoms – change in frequency of form of stool, loss of appetite and belching.

Lactose intolerance is a very common problem those impact is compounded by loss of key nutrients especially calcium.  A recent study by the National Dairy Council showed that more than half of people with lactose intolerance fail to meet established standards for dairy intake.  While this message is a bid self serving it does correlate with other studies that have identified similar nutritional deficiencies in this population.  If you or a family member believes they have lactose intolerance the first consideration would be to confirm the condition using the hydrogen breath test.  It is very common for people to mistake gastric distress symptoms for lactose intolerance when it is in fact a different problem.  Don’t alter your diet without knowing for sure. But if you do have lactose intolerance be extra diligent to track your calcium intake and make sure you are adequately compensating for the lost nutrients provided by dairy.

The hydrogen breath test continues to be the best alternative for diagnosing small intestinal bacterial overgrowth (SIBO).  In this peer reviewed article the researchers critically reviewed papers from 1990 to the present concerning the topic of SIBO diagnosis.  There conclusion was that the hydrogen breath test – both the lactulose and glucose versions – remain the most viable testing method to determine SIBO.