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BMJ 2010; 340 doi: (Published 28 April 2010) Cite this as: BMJ 2010;340:c2235

Treatments for lactose intolerance: tried but not tested

Malabsorption of the lactose in milk and other dairy products can cause non-specific gastrointestinal symptoms such as bloating, flatulence, and diarrhoea. Plenty of treatments are available, but few have been properly evaluated in clinical trials, say researchers. A systematic review of 26 trials found little supporting evidence for probiotics, yoghurt containing live bacterial cultures, the antibiotic rifaximin, lactose reduced milk, or milk containing enzymes that hydrolyse lactose. Trials were small, poorly reported, inconclusive, and generally selected people with lactose malabsorption (diagnosed by hydrogen breath test), rather than lactose intolerance (malabsorption with symptoms). The researchers found no trials at all testing the long term effects of a lactose-free diet and just two testing colonic adaptation, a strategy of incremental increases in dose over a week or so. Both were negative and hard to interpret.

Twenty one studies tried to find out how much lactose people with established malabsorption could tolerate. Most were able to drink 12 g lactose—around one cup of milk—on an empty stomach without problems. The tolerable dose went up to 15 g—around half a pint of milk—when taken with food. Most studies reported a substantial increase in symptoms after doses of 50 g.

Risky serum lipid profiles linked to sugar in processed foods

Adults in the US eat a lot of sugar, much of it added to their food by manufacturers. New figures from national surveys suggest that added sugars make up roughly a sixth (15.8%, 95% CI 15.3% to 16.4%) of an average adult’s daily energy intake, possibly more given the well known tendency for people to under-report their intake of unhealthy food. These are essentially wasted calories, with no nutritional value other than energy. Weight gain is one obvious consequence. A cross sectional analysis of the survey data suggests that foods containing added sugars are also associated with adverse lipid profiles and increased risk …

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