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1. World J Gastroenterol. 2011 Sep 14;17(34):3916-21.

Pediatric functional constipation treatment with Bifidobacterium-containing yogurt: a crossover, double-blind, controlled trial. Guerra PV, Lima LN, Souza TC, Mazochi V, Penna FJ, Silva AM, Nicoli JR, Guimares EV. Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130-100 Belo Horizonte, MG, Brazil. AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma III criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 10(9) colony forming unit/mL Bifidobacterium longum (B. longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed. RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most significant improvement in the first phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the first phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worsening stool consistency when using formula. However, the difference was not significant. A significant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more significant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015). CONCLUSION: An improvement in defecation frequency and abdominal pain was observed using both supplemented and non-supplemented yogurt, but an additional improvement with B. longum supplementation was obtained. PMCID: PMC3198021 PMID: 22025880 [PubMed - indexed for MEDLINE]

2. J Med Food. 2011 Jan-Feb;14(1-2):79-85. Beneficial effects of a synbiotic supplement on self-perceived gastrointestinal well-being and immunoinflammatory status of healthy adults. Nova E, Viadel B, Wrnberg J, Carreres JE, Marcos A. Department of Metabolism and Nutrition, Institute of Science and Technology of Food and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain.

The use of synbiotics as health promoters is still poorly defined, and human intervention studies are scarce. This study was designed to evaluate the effects of a commercialized synbiotic product containing Lactobacillus acidophilus La5, Bifidobacterium animalis ssp. lactis Bb-12, Lactobacillus delbrueckii ssp. bulgaricus, Lactobacillus paracasei ssp. paracasei, Streptococcus thermophilus, and fructooligosaccharides on the self-reported gastrointestinal well-being and the immunoinflammatory status of healthy human subjects. In this randomized, double-blind, placebo-controlled study, 20 women and 16 men (25-45 years old) received either three tablets per day of the synbiotic product (2.410(9) colony-forming units/day) or placebo during 6 weeks. Gastrointestinal symptoms and bowel habits were evaluated through a self-administered questionnaire. In those subjects suffering from any kind of digestive disturbance (mild dyspepsia, flatulence, postprandial bloating, constipation, etc.), improvements in symptoms after product consumption were also evaluated. Blood lymphocyte subsets, phagocytic activity, serum C-reactive protein, ceruloplasmin, and adhesion molecules concentrations were analyzed prior and after treatment. A significant improvement in overall self-reported gastrointestinal symptoms and bowel habit was found in the synbiotic group. A marginal effect of treatment (analysis of variance P=.050) was observed with L-selectin, which showed a significant decrease in the synbiotic group (P=.019). In addition, basal L-selectin levels correlated with final intercellular adhesion molecule (ICAM)-1 levels (r=0.468; P=.050), and basal ICAM-1 levels tended to correlate negatively with final L-selectin concentration (r=-0.457; P=.056). None of these correlations was found in the placebo group. The rest of the immunological parameters studied were not modified by the intervention. In conclusion, consumption of the synbiotic product improves self-perceived bowel habits and might facilitate a better profile of adhesion molecules in healthy adults. PMID: 21244240 [PubMed - indexed for MEDLINE]

3. Turk J Gastroenterol. 2010 Sep;21(3):212-7. Efficacy of probiotics in Helicobacter pylori eradication therapy. Yaar B, Abut E, Kayadb H, Toros B, Sezkl M, Akkan Z, Keskn , vn Kurda O. Department of Gastroenterohepatology, Haydarpasa Numune Training and Research Hospital, stanbul. BACKGROUND/AIMS: Triple therapy with a proton pump inhibitor, amoxicillin and clarithromycin in Helicobacter pylori eradication is widely accepted, but this combination fails in a considerable number of cases. Our aim was to evaluate whether probiotic-containing yogurt affects the success of eradication. The second aim was to investigate the efficacy of probiotics in the prevention of the side effects related to eradication therapy. METHODS: A total of 76 histopathologically proven H. pylori-positive patients enrolled in this study were randomized into two groups. The following regimens were recommended: Group A: pantoprazole (40 mg, b.i.d.), amoxicillin (1000 mg b.i.d.), clarithromycin (500 mg b.i.d.), and 125 ml of probiotic-containing yogurt (Bifidobacterium DN-173 010-1010 cfu/g) before breakfast for 14 days; and Group B: pantoprazole (40 mg, b.i.d.), amoxicillin (1000 mg b.i.d.) and clarithromycin (500 mg b.i.d.) for 14 days. Subjects were asked to report any side effects of therapy during the treatment period. H. pylori status was rechecked four weeks after the completion of the eradication therapy by 13C-urea

breath test. RESULTS: H. pylori eradication was achieved in 25 of the 38 patients in Group A (66%) and in 20 of the 38 patients (53%) in Group B. Although the success rate was higher in Group A than in Group B, the difference was not significant (p=0.350). The addition of probiotics to the triple therapy significantly lessened the frequency of stomatitis and constipation (p=0.037 and p=0.046, respectively). CONCLUSIONS: The addition of probiotic-containing yogurt to the triple therapy did not increase the H. pylori eradication rates for the evaluated dosage and model; however, it decreased the frequency of stomatitis and constipation. PMID: 20931422 [PubMed - indexed for MEDLINE]

4. Nutrition. 2010 Apr;26(4):367-74. Epub 2009 Jul 22. Improvement of constipation and liver function by plant-derived lactic acid bacteria: a double-blind, randomized trial. Higashikawa F, Noda M, Awaya T, Nomura K, Oku H, Sugiyama M. Department of Molecular Nutrition Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. OBJECTIVE: Lactic acid bacteria (LAB) contribute to human health; however, the probiotic properties vary among strains classified into the same species. The primary objective of this study was to evaluate the effects of yogurts made by different types of LAB on the gastrointestinal system. The yogurts were also evaluated by measuring serum lipid contents and liver functional indicators as a secondary objective. METHODS: Healthy human adults (n = 68) with some complaints with regard to intestinal health, including constipation and diarrhea, were randomly assigned to receive one of three types of yogurt in a double-blind manner: type A, a yogurt made by plant-derived LAB (mainly Lactobacillus [Lb.] plantarum SN35N); type B, a yogurt made by plant-derived LAB (mainly Lb. plantarum SN13T); and type C, a yogurt made by animal-derived LAB (mainly Lactococcus lactis A6 and Streptococcus thermophilus 510) as a control. The subjects consumed 100 g of yogurt daily for 6 wk. Data were collected from clinical visits at 2-wk intervals and by diaries used to record defecation and health conditions. RESULTS: Drastic and constant increments of defecation frequency in subjects with constipation were observed with type A and B yogurts but not with type C yogurt. Type B and C yogurts resulted in decreases in total and low-density lipoprotein cholesterol. The serum concentrations of liver functional parameters were improved by the type B yogurt (12-25% reduction). CONCLUSION: The present study suggests that Lb. plantarum SN13T exhibits a superior probiotic effect on constipation in addition to improving the serum lipid contents and liver function. Copyright 2010 Elsevier Inc. All rights reserved. PMID: 19628371 [PubMed - indexed for MEDLINE]

5. J Nutr Biochem. 2010 Feb;21(2):133-9. Epub 2009 Feb 6. Lutein bioavailability from lutein ester-fortified fermented milk: in vivo and in

vitro study. Granado-Lorencio F, Herrero-Barbudo C, Olmedilla-Alonso B, Blanco-Navarro I, Prez-Sacristn B. Unidad de Vitaminas, Servicio de Bioqumica Clnica, Hospital Universitario Puerta de Hierro, 28035-Madrid, Spain. We assessed the bioavailability of lutein from lutein-fortified fermented milk using in vivo and in vitro approaches. Twenty-four volunteers were randomized to take lutein-fortified fermented milk at two levels of fortification. Single-dose bioavailability study (2x100 ml, ca. 8 or 16 mg of lutein) was performed using a three-point approach (baseline, 3.5 and 6.5 h). Multiple-dose study consisted of consuming one serving/day (ca. 4 or 8 mg/100 ml) for 14 days. Blood samples for biochemical, hematological and lutein analysis were drawn at baseline, Day 7 and Day 14. In vitro bioaccessibility was assessed by a static gastrointestinal digestion model. Lutein content, in vitro ester hydrolysis and micellarization, and lutein concentrations achieved in serum were analyzed by HPLC. In vivo, post-prandial response was higher using the high content fermented milk, but the percentage of absorption was not different according to the dose consumed. Net increments at Day 7 and Day 14 were significantly higher on consuming the high-dose milk as well. In vitro, lutein ester hydrolysis was incomplete regardless of the amount initially present. Free lutein released was higher using the high-dose fermented milk, but the percentage of hydrolysis was similar at both levels of fortification. In the micellar phase, the percentage of free and total lutein was not different according to the dose. Our results support the suitability of the fermented milk as a carrier of lutein esters and an in vivo dose-dependent effect upon regular consumption and suggest the usefulness of in vitro models to provide relevant information to predict in vivo responses. Copyright 2010 Elsevier Inc. All rights reserved. PMID: 19201183 [PubMed - indexed for MEDLINE]

6. Atherosclerosis. 2010 Jan;208(1):228-33. Epub 2009 Jun 18. Probiotic therapy to men with incipient arteriosclerosis initiates increased bacterial diversity in colon: a randomized controlled trial. Karlsson C, Ahrn S, Molin G, Berggren A, Palmquist I, Fredrikson GN, Jeppsson B. Food Hygiene, Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden. OBJECTIVE: This study aimed to clarify the microbial change in the intestinal microbiota in patients, with cardiovascular disease, consuming a drink with high numbers of live Lactobacillus plantarum. METHODS: Sixteen males, with atherosclerotic plaque on the carotid wall, were randomly selected from a larger cohort and included in this double blind, placebo controlled study. Colonic biopsies, taken before and after four weeks of probiotic treatment, were analysed with Terminal Restriction Fragment Length Polymorphism, including digestion with MspI and HaeIII. Microbial diversity was calculated, short-chain fatty acids in faeces, and blood markers were analysed. RESULTS: Consumption of one probiotic strain of L. plantarum (DSM 9843) increased intestinal microbial diversity. The probiotic group had an increased diversity

after consumption of the probiotic drink compared to the change in the placebo group when Shannon and Weaner diversity index (MspI and HaeIII, p=0.026) and Simpson index of diversity (MspI, p=0.044 and HaeIII, p=0.026) were calculated. The fermentation pattern of short-chain fatty acids in faeces were unaffected for most acids, but the probiotic group had decreased concentration of isovaleric acid (p=0.006) and valeric acid (p=0.029). Viable count of lactobacilli increased in the probiotic group (p=0.001), but no significant changes in blood markers were observed. CONCLUSION: Administration of a single-strain probiotic increases the bacterial diversity in the gut, and affects the concentration of some short-chain fatty acids. Consumption of the single strain L. plantarum DSM 9843 might be a strategy to favour a diverse intestinal microbiota, which is beneficial for the host. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved. PMID: 19608185 [PubMed - indexed for MEDLINE]

7. Br J Nutr. 2009 Dec;102(11):1654-62. Epub 2009 Jul 22. Fermented milk containing Bifidobacterium lactis DN-173 010 improves gastrointestinal well-being and digestive symptoms in women reporting minor digestive symptoms: a randomised, double-blind, parallel, controlled study. Guyonnet D, Schlumberger A, Mhamdi L, Jakob S, Chassany O. Danone Research, Palaiseau, France. The ability of probiotics to improve bowel habits or transit time has been shown in healthy populations. Additional data are required to support the use of specific probiotics to improve gastrointestinal (GI) well-being. The present study was designed to investigate the effect of consuming fermented milk (FM) on GI well-being, digestive symptoms and health-related quality of life (HRQoL) amongst women without diagnosed GI disorders. In this double-blind, controlled, parallel-design study, subjects were randomised to ingest daily either 2 x 125 g FM containing Bifidobacterium lactis DN-173 010 and yoghurt strains or a control non-fermented dairy product for 4 weeks followed by a 4-week wash-out period. GI well-being and digestive symptoms were assessed weekly. HRQoL was measured every 4 weeks. Data were analysed using analysis of covariance and logistic regression, correcting for baseline values on the full analysis set population of 197 women (aged 18-60 years). The percentage of women reporting an improvement in their GI well-being was significantly (P < 0.01) higher in the FM group v. the control group (OR 1.69; 95 % CI 1.17, 2.45). A significantly (P < 0.05) more pronounced decrease in the composite score of digestive symptoms was observed in the FM group when comparing with the control group (least squares mean - 0.57; 95 % CI 1.12, - 0.02). Among HRQoL dimensions, the digestive comfort score was significantly (P < 0.05) improved in the FM group compared with the control group. The present study showed that the daily consumption of a specific FM is able to improve GI well-being and digestive symptoms in adult women without GI disorders. PMID: 19622191 [PubMed - indexed for MEDLINE]

8. BMC Pediatr. 2009 Mar 18;9:22.

Effect of the consumption of a fermented dairy product containing Bifidobacterium lactis DN-173 010 on constipation in childhood: a multicentre randomised controlled trial (NTRTC: 1571). Tabbers MM, Chmielewska A, Roseboom MG, Boudet C, Perrin C, Szajewska H, Benninga MA. Department of Paediatric Gastroenterology and Nutrition, Emma's Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands. BACKGROUND: Constipation is a frustrating symptom affecting 3% of children worldwide. Randomised controlled trials show that both polyethylene glycol and lactulose are effective in increasing defecation frequency in children with constipation. However, in 30-50%, these children reported abdominal pain, bloating, flatulence, diarrhoea, nausea and bad taste of the medication. Two recent studies have shown that the fermented dairy product containing Bifidobacterium lactis strain DN-173 010 is effective in increasing stool frequency in constipation-predominant irritable bowel syndrome patients with a defecation frequency < 3/week and in constipated women with a defecation frequency < 3/week. Goal of this study is to determine whether this fermented dairy product is effective in the treatment of constipated children with a defecation frequency < 3/week. METHODS/DESIGN: It is a two nation (The Netherlands and Poland) double-blind, placebo-controlled randomised multicentre trial in which 160 constipated children (age 3-16 years) with a defecation frequency <3/week will be randomly allocated to consume a fermented dairy product containing Bifidobacterium lactis DN-173 010 or a control product, twice a day, for 3 weeks. During the study all children are instructed to try to defecate on the toilet for 5-10 minutes after each meal (3 times a day) and daily complete a standardized bowel diary. Primary endpoint is stool frequency. Secondary endpoints are stool consistency, faecal incontinence frequency, pain during defecation, digestive symptoms (abdominal pain, flatulence), adverse effects (nausea, diarrhoea, bad taste) and intake of rescue medication (Bisacodyl). Rate of success and rate of responders are also evaluated, with success defined as > or = 3 bowel movements per week and < or =1 faecal incontinence episode over the last 2 weeks of product consumption and responder defined as a subject reporting a stool frequency > or = 3 on the last week of product consumption. To demonstrate that the success percentage in the intervention group will be 35% and the success percentage in the control group (acidified milk without ferments, toilet training, bowel diary) will be 15%, with alpha 0.05 and power 80%, a total sample size of 160 patients was calculated. CONCLUSION: This study is aimed to show that the fermented dairy product containing Bifidobacterium lactis strain DN-173 010 is effective in increasing stool frequency after 3 weeks of product consumption in children with functional constipation and a defecation frequency < 3/week. PMCID: PMC2662858 PMID: 19296845 [PubMed - indexed for MEDLINE]

9. World J Gastroenterol. 2008 Oct 28;14(40):6237-43. Effect of a fermented milk containing Bifidobacterium lactis DN-173010 on Chinese constipated women. Yang YX, He M, Hu G, Wei J, Pages P, Yang XH, Bourdu-Naturel S.

Institute of Nutrition and Food Safety, China CDC, No. 29, Nanwei Road, Xuanwu District, Beijing 100050, China. AIM: To investigate the effect of a fermented milk containing Bifidobacterium lactis DN-173010 and yogurt strains (BIO(R)) on adult women with constipation in Beijing. METHODS: A total of 135 adult females with constipation were randomly allocated to consume for 2 wk either 100 g of the test fermented milk or 100 g of an acidified milk containing non-living bacteria (control). Stool frequency, defecation condition scores, stool consistency and food intake were recorded at baseline and after 1 and 2 wk in an intention-to-treat population of 126 subjects. In parallel, safety evaluation parameters were performed. RESULTS: At baseline, no differences were found between groups. Following consumption of test product, stool frequency was significantly increased after 1 wk (3.5 +/- 1.5 vs 2.4 +/- 0.6, P < 0.01) and 2 wk (4.1 +/- 1.7 vs 2.4 +/- 0.6, P < 0.01), vs baseline. Similarly, after 1 and 2 wk, of test product consumption, defecation condition (1.1 +/- 0.9 vs 1.9 +/- 1.2, P < 0.01 and 0.8 +/- 1.0 vs 1.9 +/- 1.2, P < 0.01, respectively) and stool consistency (1.0 +/- 0.8 vs 1.5 +/1.1, P < 0.01 and 0.6 +/- 0.8 vs 1.5 +/- 1.1, P < 0.01, respectively) were significantly improved. Compared with the control group, stool frequency was also significantly increased (3.5 +/- 1.5 vs 2.5 +/- 0.9, P < 0.01 and 4.1 +/- 1.7 vs 2.6 +/- 1.0, P < 0.01, respectively), and defecation condition (1.1 +/- 0.9 vs 1.6 +/- 1.1, P < 0.01 and 0.8 +/- 1.0 vs 1.6 +/- 1.1, P < 0.01, respectively) and stool consistency (1.0 +/- 0.8 vs 1.4 +/- 1.0, P < 0.05 and 0.6 +/- 0.8 vs 1.3 +/- 1.0, P < 0.01, respectively) significantly decreased after 1 and 2 wk of product consumption. During the same period, food intake did not change between the two groups, and safety parameters of the subjects were within normal ranges. CONCLUSION: This study suggests a beneficial effect of a fermented milk containing B. lactis DN-173010 on stool frequency, defecation condition and stool consistency in adult women with constipation constipated women after 1 and 2 wk of consumption. PMCID: PMC2761588 PMID: 18985817 [PubMed - indexed for MEDLINE]

10. Am J Clin Nutr. 2008 May;87(5):1365-73. Assessment of the safety, tolerance, and protective effect against diarrhea of infant formulas containing mixtures of probiotics or probiotics and prebiotics in a randomized controlled trial. Chouraqui JP, Grathwohl D, Labaune JM, Hascoet JM, de Montgolfier I, Leclaire M, Giarre M, Steenhout P. Gastroenterology and Nutrition Unit, Department of Pediatrics, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. BACKGROUND: Probiotics and prebiotics are considered to be beneficial to the gastrointestinal health of infants. OBJECTIVE: The objective was to evaluate infant formulas containing probiotics and synbiotics (combinations of probiotics and prebiotics) for safety and tolerance. DESIGN: In a prospective, controlled, double-blind, randomized trial, healthy full-term infants were exclusively fed a control formula or study formulas containing Bifidobacterium longum BL999 (BL999) + Lactobacillus rhamnosus LPR

(LPR), BL999 + LPR + 4 g/L of 90% galactooligosaccharide/10% short-chain fructooligosaccharide (GOS/SCFOS), or BL999 + Lactobacillus paracasei ST11 (ST11) + 4 g/L GOS/SCFOS from < or = 2 to 16 wk of age (treatment period). Safety and tolerance were assessed based on weight gain during the treatment period (primary outcome) as well as recumbent length, head circumference, digestive tolerance, and adverse events (secondary outcomes), which were evaluated at 2, 4, 8, 12, 16, and 52 wk of age. RESULTS: Two hundred eighty-four infants were enrolled. During the treatment period, difference in mean weight gain between control and study formula groups in both the intention-to-treat and per-protocol populations were within the predefined equivalence boundaries of +/-3.9 g/d, indicating equivalent weight gain. Secondary outcomes did not show significant differences between groups during the treatment period. CONCLUSION: Infants fed formulas containing probiotics or synbiotics show a similar rate in weight gain compared with those fed a control formula and tolerate these formulas well. PMID: 18469260 [PubMed - indexed for MEDLINE]

11. Acta Gastroenterol Latinoam. 2008 Mar;38(1):16-25. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. De Paula JA, Carmuega E, Weill R. Gastroenterology Division, Hospital Italiano of Buenos Aires, Argentina. BACKGROUND/AIMS: functional constipation is a prevalent problem within the western population. There is evidence supporting the fact that the inclusion of pre and probiotics in the diet can favorably modify the intestinal function. The present study evaluates the effect of the consumption of Activia, a yogurt containing 10(8) UFC/g of Bifidobacterium animalis (DN-173 010) and fructoligosaccharide, in women between the ages of 18 and 55 with and without functional constipation (Rome II criteria). METHODS: after a stabilization and a basal period, women were randomized to receive 2 units/day of Activia or a lacteous dessert without probiotics (control) for a period of 14 days. Afterwards the groups were intercrossed for another 14 days. RESULTS: of the 399 women who started the study, 378 were eligible for study participation. In the group of women with functional constipation (n=266), the consumption of the symbiotic was associated with a higher bowel evacuation rate (6.1+/-2.7 depositions/week with Activia vs. 5.0+/-2.6 dep./week in the control group; P<0.01), an improvement in the quality of the stools according to the Bristol scale (3.6+/-1.0 vs. 3.4+/-1.0; P<0.01), a reduced perception of straining effort (1.9+/-0.8 vs. 2.2+/-0.9; P<0.01) and a reduced perception of pain associated with defecation (0.1+/-0.2 vs. 0.2+/-0.3; P<0.01). In the group of women without constipation (n=112) there were statistically significant variations in equal sense but of smaller magnitude, with the exception of pain which, having a very low value in the basal period, did not experience changes. CONCLUSION: the consumption of a symbiotic yogurt by women with functional constipation showed a significant improvement in the parameters related with bowel evacuation. The use of this symbiotic food can result in a useful and safe tool for managing constipation.

PMID: 18533353 [PubMed - indexed for MEDLINE]

12. Int J Food Microbiol. 2008 Feb 29;122(1-2):16-22. Epub 2007 Nov 21. Impact of consumption of probiotic lactobacilli-containing yogurt on microbial composition in human feces. Uyeno Y, Sekiguchi Y, Kamagata Y. Institute for Biological Resources and Functions, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki 305-8566, Japan. An in vivo study was carried out to determine the effect of consuming probiotic lactobacilli-containing yogurt on the composition of microbiota in the human gut. Fifteen healthy adults ingested a daily serving of one of three commercial yogurts (two of the products contained a probiotic lactobacilli strain) for 20 days. Fecal samples at defined time points before, during, and after the period of yogurt ingestion were collected and analyzed. The fecal population of lactobacilli was determined by a culture-based method and subsequent colony PCR for the identification of species. Six predominant bacterial groups in the fecal samples were quantitatively determined based on a sequence-specific SSU rRNA cleavage method coupled with a suite of oligonucleotide probes, which was optimized for the target-specific detection of bacterial groups inhabiting human feces. In the ingestion period, one probiotic strain was detected in the feces of all five subjects who consumed the yogurt containing the strain, while the other strain was detected in three of another five subjects. The population levels of the two major groups (Bacteroides and Prevotella, and the Clostridium coccoides-Eubacterium rectale group) in the fecal samples tended to change in response to the ingestion but the change did not seem to be dependent on the product-specific property of each yogurt. These results suggest that the human fecal bacterial community could be altered by ingesting yogurt, although whether probiotic lactobacilli are present or absent in the yogurt does not seem to be a factor in this change. PMID: 18077045 [PubMed - indexed for MEDLINE]

13. J Appl Microbiol. 2008 Feb;104(2):595-604. Epub 2007 Oct 9. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects. He T, Priebe MG, Zhong Y, Huang C, Harmsen HJ, Raangs GC, Antoine JM, Welling GW, Vonk RJ. Center for Medical Biomics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. AIMS: Colonic metabolism of lactose may play a role in lactose intolerance. We investigated whether a 2-week supplementation of Bifidobacterium longum (in capsules) and a yogurt enriched with Bifidobacterium animalis could modify the composition and metabolic activities of the colonic microbiota in 11 Chinese lactose-intolerant subjects.

METHODS AND RESULTS: The numbers of total cells, total bacteria and the Eubacterium rectale/Clostridium coccoides group in faeces as measured with fluorescent in situ hybridization and the faecal beta-galactosidase activity increased significantly during supplementation. The number of Bifidobacterium showed a tendency to increase during and after supplementation. With PCR-denaturing gradient gel electrophoresis, in subjects in which B. animalis and B. longum were not detected before supplementation, both strains were present in faeces during supplementation, but disappeared after supplementation. The degree of lactose digestion in the small intestine and the oro-caecal transit time were not different before and after supplementation, whereas symptom scores after lactose challenge decreased after supplementation. CONCLUSIONS: The results suggest that supplementation modifies the amount and metabolic activities of the colonic microbiota and alleviates symptoms in lactose-intolerant subjects. The changes in the colonic microbiota might be among the factors modified by the supplementation which lead to the alleviation of lactose intolerance. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides evidence for the possibility of managing lactose intolerance with dietary lactose (yogurt) and probiotics via modulating the colonic microbiota. PMID: 17927751 [PubMed - indexed for MEDLINE]

14. Digestion. 2008;78(1):13-7. Epub 2008 Aug 14. Bifidobacterium longum PL03, Lactobacillus rhamnosus KL53A, and Lactobacillus plantarum PL02 in the prevention of antibiotic-associated diarrhea in children: a randomized controlled pilot trial. Szymaski H, Armaska M, Kowalska-Duplaga K, Szajewska H. Department of Pediatrics, St. Hedwig of Silesia Hospital, Trzebnica, Poland. Comment in Digestion. 2008;78(1):10-2. AIM: To determine the efficacy of a combination of Bifidobacterium longum PL03, Lactobacillus rhamnosus KL53A and Lactobacillus plantarum PL02 for the prevention of antibiotic-associated diarrhea in children. METHODS: Seventy-eight children (age: 5 months to 16 years) with otitis media, and/or respiratory tract infections, and/or urinary tract infections were enrolled in a double-blind randomized control trial in which they received standard antibiotic treatment plus a food supplement containing 10(8) colony-forming units of B. longum, L. rhamnosus and L. plantarum (n = 40) or a placebo (n = 38) orally twice daily for the duration of antibiotic treatment. RESULTS: Patients receiving probiotics had a similar rate of diarrhea (> or =3 loose or watery stools/day for > or =48 h occurring during or up to 2 weeks after the antibiotic therapy) as those receiving placebo (relative risk 0.5, 95% CI 0.06-3.5). The mean number of stools per day was significantly lower in the experimental group (mean difference -0.3 stool/day, 95% CI -0.5 to -0.07). No adverse events were reported. CONCLUSION: The administration of the 3 probiotics did not significantly alter the rate of diarrhea, although it reduced the frequency of stools per day. As the overall frequency of diarrhea was surprisingly low, these results should be interpreted with caution.

2008 S. Karger AG, Basel. PMID: 18701826 [PubMed - indexed for MEDLINE]

15. Br J Nutr. 2007 Nov;98(5):991-7. Epub 2007 Sep 3. Viable, lyophilized lactobacilli do not increase iron absorption from a lactic acid-fermented meal in healthy young women, and no iron absorption occurs in the distal intestine. Bering S, Sjltov L, Wrisberg SS, Berggren A, Alenfall J, Jensen M, Hjgaard L, Tetens I, Bukhave K. Department of Human Nutrition, University of Copenhagen, Frederiksberg C, Denmark. Lactic acid-fermented foods have been shown to increase Fe absorption in human subjects, possibly by lowering pH, activation of phytases, production of organic acids, or by the viable lactic acid bacteria. In this study the effect of a heat-inactivated lactic acid-fermented oat gruel with and without added viable, lyophilized Lactobacillus plantarum 299v on non-haem Fe absorption was investigated. Furthermore, Fe absorption in the distal intestine was determined. In a randomized, double-blinded crossover trial eighteen healthy young women aged 22 (SD 3) years with low Fe status (serum ferritin < 30 microg/l) were served the two test gruels, extrinsically labelled with 59Fe and served with two enterocoated capsules (containing 55Fe(II) and 55Fe(III), respectively) designed to disintegrate in the ileum. The meals were consumed on two consecutive days, e.g. in the order AA followed by BB in a second period. Non-haem Fe absorption was determined from 59Fe whole-body retention and isotope activities in blood samples. The concentrations of Fe, lactate, phytate, and polyphenols, and the pH were similar in the heat-inactivated lactic acid-fermented oat gruels with and without added L. plantarum 299v, and no difference in Fe absorption was observed between the test gruels (1.4 and 1.3%, respectively). Furthermore, no absorption of Fe in the distal intestine was observed. In conclusion, addition of viable, lyophilized lactobacillus to a heat-inactivated lactic acid-fermented oat gruel does not affect Fe absorption, and no absorption seems to occur in the distal part of the intestine from low Fe bioavailability meals in these women. PMID: 17764597 [PubMed - indexed for MEDLINE]

16. Br J Nutr. 2007 Oct;98 Suppl 1:S101-4. Amino acid uptake from a probiotic milk in lactose intolerant subjects. Parra D, Martnez JA. Department of Physiology and Nutrition, University of Navarra, Edif. Investigacin, C/ Irunlarrea, s/n. 31008 Pamplona, Spain. This trial was designed to assess the effect of live probiotic consumption on leucine assimilation from fresh and pasteurised yoghurt in volunteers with different lactose digestibility. Thirty-three volunteers (mean age 32, s.d. 7 years) participated in this parallel single-blind study (16 of them with moderate lactose intolerance). Breath samples were taken before and at 15 min intervals

over 3-h after the ingestion of fresh and pasteurised yoghurt extrinsically labelled with (1-(13)C)leucine. The 13C enrichment in breath was measured by isotopic rate mass spectrometry and mathematically converted to a percentage of assimilated leucine (100-%13C-dose in breath) and the assimilation kinetic constant (min(-1)). The 13C-leucine assimilation was statistically higher after the fresh yoghurt intake than after the pasteurised product intake (P=0.032) while the kinetic constant of assimilation was slower in intolerance status (P=0.014) although a product-related effect (P=0.445) was not found. In conclusion, fresh yoghurt intake resulted in higher short-term leucine assimilation, while lactose intolerance appears to negatively affect the assimilation rate of leucine from dairy products. These findings offer new insight on acute in vivo amino acid assimilation in the presence of probiotics and moderate lactose intolerance. PMID: 17922944 [PubMed - indexed for MEDLINE]

17. Aliment Pharmacol Ther. 2007 Aug 1;26(3):475-86. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Guyonnet D, Chassany O, Ducrotte P, Picard C, Mouret M, Mercier CH, Matuchansky C. Danone Research, Route Dpartementale 128, 91767 Palaiseau, France. BACKGROUND: Health-related quality of life (HRQoL) has been rarely evaluated as a primary endpoint in the assessment of the effect of probiotics on the irritable bowel syndrome (IBS). AIM: To study the effects of fermented milk containing Bifidobacterium animalis DN-173 010 and yoghurt strains on the IBS in a multicentre, double-blind, controlled trial. METHODS: A total of 274 primary care adults with constipation-predominant IBS (Rome II) were randomized to consume for 6 weeks either the test fermented milk or a heat-treated yoghurt (control). HRQoL and digestive symptoms were assessed after 3 and 6 weeks on an intention-to-treat population of 267 subjects. RESULTS: The HRQoL discomfort score, the primary endpoint, improved (P < 0.001) in both groups at weeks 3 and 6. The responder rate for the HRQoL discomfort score was higher (65.2 vs. 47.7%, P < 0.005), as was the decrease in bloating score [0.56 +/- (s.d.)1.01 vs. 0.31 +/- 0.87, P = 0.03], at week 3 in the test vs. the control group. In those subjects with <3 stools/week, stool frequency increased (P < 0.001) over 6 weeks in the test vs. control group. CONCLUSIONS: This study suggests a beneficial effect of a probiotic food on discomfort HRQoL score and bloating in constipation-predominant IBS, and on stool frequency in subjects with <3 stools/week. PMID: 17635382 [PubMed - indexed for MEDLINE]

18. Digestion. 2004;69(1):53-6. Epub 2004 Jan 30. Probiotic treatment increases salivary counts of lactobacilli: a double-blind, randomized, controlled study.

Montalto M, Vastola M, Marigo L, Covino M, Graziosetto R, Curigliano V, Santoro L, Cuoco L, Manna R, Gasbarrini G. Institute of Internal Medicine, Catholic University, Rome, Italy. BACKGROUND/AIMS: Lactobacilli are used in the prevention and treatment of several diseases, but they are also known to play a role in the pathogenesis of dental caries. The aim of our study was to evaluate whether the oral administration of lactobacilli could change the salivary counts of these bacteria compared with placebo. Moreover, lactobacilli were administered in liquid and in capsule form to determine the role of direct contact with the oral cavity. METHODS: Thirty-five healthy volunteers were randomized into three groups to receive lactobacilli and/or placebo for 45 days: group A (n = 14) received probiotics in capsules and placebo in liquid form; group B (n = 16) took liquid probiotics and placebo in capsules, and group C (n = 5) used placebo in both liquid and capsule form. Streptococcus mutans populations served as control. The salivary counts of lactobacilli and S. mutans were measured semi-quantitatively using the CRT bacteria kit. RESULTS: Compared with placebo, the oral administration of probiotics, both in capsules and in liquid form, significantly increases salivary counts of lactobacilli (p = 0.005 and p = 0.02, respectively). S. mutans populations were not significantly modified. CONCLUSIONS: The increased salivary counts of lactobacilli may indicate the need to closely monitor the dental health of patients undergoing long-term probiotics treatment, even when this treatment is administrated in a form that avoids direct contact with the oral cavity. Copyright 2004 S. Karger AG, Basel PMID: 14755153 [PubMed - indexed for MEDLINE]

19. J Am Diet Assoc. 2003 May;103(5):582-7. Kefir improves lactose digestion and tolerance in adults with lactose maldigestion. Hertzler SR, Clancy SM. Medical Dietetics Division, School of Allied Medical Professions, The Ohio State University, Columbus 43210-1234, USA. OBJECTIVE: Kefir is a fermented milk beverage that contains different cultures than yogurt. The objective of this study was to determine whether kefir improves lactose digestion and tolerance in adults with lactose maldigestion. DESIGN: Randomized block design. SUBJECTS: Fifteen healthy, free-living adults with lactose maldigestion. MAIN OUTCOME MEASURES: Breath hydrogen excretion and lactose intolerance symptoms were monitored hourly for 8 hours after each test meal. INTERVENTION: Subjects were fed test meals consisting of 20 g lactose portions of milk (2% reduced fat), plain and raspberry flavored kefir, and plain and raspberry flavored yogurt, each following an overnight (12 hour) fast. STATISTICAL ANALYSIS: Mixed model ANOVA was performed on raw or transformed data, followed by Tukey HSD post hoc tests (when appropriate). Significance was defined

as P<.05. RESULTS: The breath hydrogen area under the curve (AUC) for milk (224+/-39 ppm x h) was significantly greater than for the plain yogurt (76+/-14 ppm x h, P<.001), the plain kefir (87+/-37 ppm x h, P<.001), and the flavored yogurt (76+/-14 ppm x h, P=.005). The flavored kefir had an intermediate response (156+/-26 ppm x h). The yogurts and kefirs all similarly reduced the perceived severity of flatulence by 54% to 71% relative to milk. Abdominal pain and diarrhea symptoms were negligible among the five treatments. APPLICATIONS/CONCLUSION: Because kefir improved lactose digestion and tolerance in this study, its use may be another potential strategy for overcoming lactose intolerance. Further studies of other types of kefir for improving lactose digestion are warranted. PMID: 12728216 [PubMed - indexed for MEDLINE]

20. Digestion. 2001;63(1):1-7. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Armuzzi A, Cremonini F, Ojetti V, Bartolozzi F, Canducci F, Candelli M, Santarelli L, Cammarota G, De Lorenzo A, Pola P, Gasbarrini G, Gasbarrini A. Department of Internal Medicine, Catholic University, Rome, Italy. BACKGROUND: One-week triple therapy is currently regarded as the reference of anti-Helicobacter pylori treatment. However, antibiotic-associated gastrointestinal side effects are among the major pitfalls of such regimens. Probiotic supplementation may be regarded as a therapeutic tool to prevent or reduce these troublesome drug-related manifestations. AIM: To determine whether the addition of the probiotic Lactobacillus GG to an anti-H. pylori standard triple therapy could help to prevent or minimize the occurrence of gastrointestinal side effects. METHODS: One hundred and twenty healthy asymptomatic subjects screened positive for H. pylori infection and deciding to receive eradication therapy were randomized either to 1-week pantoprazole (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), tinidazole (500 mg b.i.d.) or to the same regimen supplemented with Lactobacillus GG for 14 days. Patients filled in validated questionnaires during follow-up to determine the type and severity of side effects and to judge overall tolerability. RESULTS: Bloating, diarrhea and taste disturbances were the most frequent side effects during the eradication week and were significantly reduced in the Lactobacillus GG-supplemented group (RR = 0.4, CI 0.2-0.8; RR = 0.3, CI 0.1-0.8; RR = 0.3, CI 0.1-0.7, respectively). The same pattern was observed throughout the follow-up period. Overall assessment of treatment tolerability showed a significant trend in favor of the Lactobacillus GG-supplemented group (p = 0.03). CONCLUSIONS: Lactobacillus GG supplementation beneficially affects H. pylori therapy-related side effects and overall treatment tolerance. Copyright 2001 S. Karger AG, Basel PMID: 11173893 [PubMed - indexed for MEDLINE]

21. Am J Clin Nutr. 1999 Jan;69(1):140-6.

A randomized trial of Lactobacillus acidophilus BG2FO4 to treat lactose intolerance. Saltzman JR, Russell RM, Golner B, Barakat S, Dallal GE, Goldin BR. Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University and the Tufts University School of Medicine, Boston, USA. Comment in Am J Clin Nutr. 2000 Feb;71(2):600-2. BACKGROUND: Lactose intolerance is the most common disorder of intestinal carbohydrate digestion. Lactobacillus acidophilus BG2FO4 is a strain of lactobacilli with properties of marked intestinal adherence and high beta-galactosidase activity. OBJECTIVE: This study was designed to determine whether oral feeding of Lactobacillus acidophilus BG2FO4 leads to a lactose-tolerant state. DESIGN: We studied 42 subjects with self-reported lactose intolerance and performed breath-hydrogen tests to determine whether they were lactose maldigesters. Subjects with established lactose maldigestion (n = 24) were invited to be randomly assigned to an omeprazole-treated (hypochlorhydric) group or a non-omeprazole-treated group, but 6 subjects chose not to participate. All randomly assigned subjects (n = 18) ingested Lactobacillus acidophilus BG2FO4 twice per day for 7 d and stool samples were collected. Breath-hydrogen tests were performed and symptom scores were recorded at baseline and after lactobacilli ingestion. RESULTS: Lactose maldigestion was established in 24 of 42 subjects (57%) with self-reported lactose intolerance. In 18 lactose-maldigesting subjects, overall hydrogen production and symptom scores after ingestion of Lactobacillus acidophilus BG2FO4 were not significantly different from baseline values. Live Lactobacillus acidophilus BG2FO4 was recovered in stool samples from 7 subjects. CONCLUSIONS: Lactose intolerance is overreported in subjects with gastrointestinal symptoms after lactose ingestion. Treatment of lactose-maldigesting subjects with and without hypochlorhydria with Lactobacillus acidophilus BG2FO4 for 7 d failed to change breath-hydrogen excretion significantly after lactose ingestion. PMID: 9925136 [PubMed - indexed for MEDLINE]

22. Digestion. 1999;60(3):203-9. Effect of whey-based culture supernatant of Lactobacillus acidophilus (johnsonii) La1 on Helicobacter pylori infection in humans. Michetti P, Dorta G, Wiesel PH, Brassart D, Verdu E, Herranz M, Felley C, Porta N, Rouvet M, Blum AL, Corthsy-Theulaz I. Division of Gastroenterology, Department of Medicine, University Hospital, Lausanne, Switzerland. BACKGROUND: Specific strains of Lactobacillus acidophilus are known to inhibit intestinal cell adhesion and invasion by enterovirulent bacteria. As L. acidophilus can survive transiently in the human stomach, it may downregulate

Helicobacter pylori infection. METHODS: The ability of L. acidophilus (johnsonii) La1 supernatant to interfere with H. pylori bacterial growth, urease activity, and adhesion to epithelial cells was tested in vitro. Its effect on H. pylori infection in volunteers was monitored in a randomized, double-blind, controlled clinical trial, using a drinkable, whey-based, La1 culture supernatant. H. pylori infected volunteers were treated 14 days with 50 ml of La1 supernatant four times a day combined with either omeprazole 20 mg four times a day or with placebo. Infection was assessed by breath test, endoscopy, and biopsy sampling, performed at inclusion, immediately at the end of the treatment (breath test only), and 4 weeks after the end of the treatment. RESULTS: La1 supernatant inhibited H. pylori growth in vitro, regardless of previous binding of H. pylori to epithelial cells. In 20 subjects (8 females, 12 males, mean age 33.1 years) a marked decrease in breath test values was observed immediately after treatment with La1 supernatant, both in the omeprazole and in the placebo group (median 12.3 vs. 28.8 and 9.4 vs. 20.4, respectively; p < 0.03). In both treatment groups, breath test values remained low 6 weeks after treatment (omeprazole treated 19.2, placebo treated 8. 3; p < 0.03 vs. pretreatment), but the persistence of H. pylori infection was confirmed in gastric biopsies. CONCLUSION: La1 culture supernatant shown to be effective in vitro has a partial, acid-independent long-term suppressive effect on H. pylori in humans. PMID: 10343133 [PubMed - indexed for MEDLINE]

23. Am J Clin Nutr. 1998 Nov;68(5):1118-22. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. Suarez FL, Adshead J, Furne JK, Levitt MD. Minneapolis Veterans Affairs Medical Center, MN 55417, USA. Comment in Am J Clin Nutr. 1998 Nov;68(5):995-6. Am J Clin Nutr. 1999 Jun;69(6):1289-91. Am J Clin Nutr. 1999 Aug;70(2):301-303. BACKGROUND: A National Institutes of Health consensus conference concluded that a daily calcium intake of 1500 mg reduces the severity of osteoporosis. Because dairy products are the main natural source of dietary calcium, a diet providing 1500 mg Ca must contain large quantities of dairy products. However, it is widely believed that the lactose content of these products will not be tolerated by persons with lactose maldigestion (approximately 30% of the adult US population). OBJECTIVE: We evaluated the symptoms of lactose maldigestion and digestion when the diet was supplemented with dairy products providing 1300 mg Ca/d. DESIGN: Sixty-two women (31 with lactose maldigestion and 31 without) were studied in a double-blind, randomized protocol. Symptoms were compared during 1-wk periods when the diet was supplemented with 480 mL (2 cups) milk, 56 g cheese, and 240 mL yogurt provided as conventional products (34 g lactose/d) or as lactose-hydrolyzed products (2 g lactose/d). RESULTS: Women who digested lactose reported no significant difference in symptoms between the 2 treatment periods. Women with lactose maldigestion reported significantly increased flatus frequency and subjective impression of

rectal gas during the period of high lactose intake; however, bloating, abdominal pain, diarrhea, and the global perception of overall symptom severity were not significantly different between the 2 treatment periods. CONCLUSION: The symptoms resulting from lactose maldigestion are not a major impediment to the ingestion of a dairy-rich diet supplying approximately 1500 mg Ca/d. PMID: 9808231 [PubMed - indexed for MEDLINE]

24. Ann Nutr Metab. 1998;42(6):319-27. Galacto-oligosaccharides relieve constipation in elderly people. Teuri U, Korpela R. Valio Ltd, R&D Centre, Department of Pharmacology and Toxicology, University of Helsinki, Finland. The aim of the study was to investigate whether galacto-oligosaccharides (GOS) relieve constipation in elderly people. The final study population consisted of 14 female subjects, mean age 79.6 (69-87) years, who suffered from constipation. The study was a double-blind two-period cross-over study. Both study periods lasted 2 weeks. The subjects ingested either 2 control yoghurts or 2 GOS-containing yoghurts daily. The yoghurts were otherwise similar, but the daily dose of GOS (Elix'or, BWP, Holland) from the GOS yoghurt was 9 g. The regular use of laxatives was stopped during the study periods and laxatives were used only when necessary. All the subjects reported the function of their intestines daily in a questionnaire. The defecation frequency per week (mean, range) was higher during the GOS period (7.1, 3-15) than during the control period (5.9, 1-14). GOS had no statistically significant effect on the use of laxatives, the consistency of feces or the ease of defecation, although GOS seemed to make defecation easier (p = 0.07). The adverse gastrointestinal symptoms were similar during both the control and the GOS periods. GOS seem to relieve constipation in most elderly people but the responses differ individually. PMID: 9895419 [PubMed - indexed for MEDLINE]

25. J Dairy Sci. 1997 Aug;80(8):1537-45. Improvement of lactose digestion by humans following ingestion of unfermented acidophilus milk: influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus. Mustapha A, Jiang T, Savaiano DA. Department of Food Science and Human Nutrition, University of Missouri, Columbia 65211, USA. The influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus on in vivo digestion of lactose was investigated. Four strains of L. acidophilus exhibiting varied degrees of lactose transport, beta-galactosidase activity, and bile sensitivity were used to prepare unfermented acidophilus milks. Lactose malabsorption was evaluated by measuring breath H2 excretion off 11 lactose maldigesting subjects following ingestion of

four acidophilus test milks. Test meals were fed in a randomized double-blind protocol. Consumption of acidophilus milk (2% fat) containing strains B, N1, and E significantly reduced mean total H2 production compared with that of the control reduced-fat (2% fat) milk, but milk containing strain ATCC 4356 did not differ from the control. Acidophilus milk containing L. acidophilus N1 was the most effective of the four acidophilus milks in improving lactose digestion and tolerance. Strain N1 exhibited the lowest beta-galactosidase activity and lactose transport but the greatest bile and acid tolerance of the four strains. The results indicated that bile and acid tolerance may be important factors to consider when L. acidophilus strains are selected for improving lactose digestion and tolerance. PMID: 9276791 [PubMed - indexed for MEDLINE]

26. Eur J Clin Nutr. 1996 Nov;50(11):730-3. Digestion and tolerance of lactose from yoghurt and different semi-solid fermented dairy products containing Lactobacillus acidophilus and bifidobacteria in lactose maldigesters--is bacterial lactase important? Vesa TH, Marteau P, Zidi S, Briet F, Pochart P, Rambaud JC. INSERM U 290, Hpital Saint-Lazare, Paris, France. OBJECTIVE: To compare the digestibility and tolerance of lactose from three semi-solid fermented dairy products with the same amount of lactose but different lactase contents and bacterial cultures in lactase deficient adults. DESIGN: Measurement of breath hydrogen (H2) concentration and of clinical symptoms after consumption of the test meals. SETTING: Metabolic ward for healthy volunteers, INSERM U290, Hpital St. Lazare, Paris. SUBJECTS: Fifteen lactase-deficient healthy adult volunteers (20-45 y) started the study. One subject became a non-H2-producer during the study; therefore the results of 14 subjects are presented. INTERVENTION: Each subject consumed, on four different days and in random order, after a 12 h fast, three semisolid test meals containing 18 g of lactose, and a 10 g dose of lactulose which allowed calculation of lactose malabsorption. The three meals were: traditional yoghurt, fermented milk (Ofilus) that contained Lactobacillus acidophilus and Bifidobacterium sp., and a similar product 'Bulgofilus' enriched with Lactobacillus bulgaricus to increase the lactase content. RESULTS: Compared with lactulose, the sum of symptoms was significantly lower for Bulgofilus (P = 0.05), and bloating was less severe for Ofilus (P = 0.06). Between the fermented milks, there were no differences. The area under the breath H2 curve was significantly lower for each fermented milk when compared to lactulose (P < 0.0001). The degree of maldigestion of lactose did not differ significantly between the products; it was 21 +/- 3% (range 6-52) for Ofilus, 21 +/- 3% (range 6-44) for Bulgofilus, and 18 +/- 3% (range 3-43) for yoghurt. CONCLUSION: Despite the differences in the lactase and bacterial content, lactose was as well digested and tolerated from the three different semi-sold fermented dairy products. This could be due to a slow gastric emptying of the semi-solid milk. PMID: 8933119 [PubMed - indexed for MEDLINE]

27. Br J Nutr. 1995 Aug;74(2):251-60. Exogenous and endogenous nitrogen flow rates and level of protein hydrolysis in the human jejunum after [15N]milk and [15N]yoghurt ingestion. Gaudichon C, Mah S, Roos N, Benamouzig R, Luengo C, Huneau JF, Sick H, Bouley C, Rautureau J, Tome D. Unit INRA de Nutrition Humaine et de Physiologie Intestinale, Facult des Sciences Pharmaceutiques et Biologiques, Paris, France. Milk and yoghurt proteins were 15N-labelled in order to measure the flow rate of exogenous N during digestion in the human intestine. After fasting overnight, sixteen healthy volunteers, each with a naso-jejunal tube, ingested either [15N]milk (n 7) or [15N]yoghurt (n 9). Jejunal samples were collected every 20 min for 4 h. A significant stimulation of endogenous N secretion was observed during the 20-60 min period after yoghurt ingestion and the 20-40 min period after milk ingestion. The endogenous N flows over a 4 h period did not differ between the groups (44.3(SEM 6.5) mmol for milk and 63.5(SEM 5.9) mmol for yoghurt). The flow rates of exogenous N indicated a delayed gastric emptying of the yoghurt N compared with N from milk. The jejunal non-protein N (NPN) flow rate increased significantly after milk and yoghurt ingestion due to an increase in the exogenous NPN flow rate. The NPN fraction of exogenous N ranged between 40 and 80%. The net gastro-jejunal absorption of exogenous N did not differ significantly between milk (56.7(SEM 8.5)%) and yoghurt (50.9(SEM 7)%). The high level of exogenous N hydrolysis is in accordance with the good digestibility of milk products. Fermentation modifies only the gastric emptying rate of N and does not affect the level of diet hydrolysis, the endogenous N stimulation or the digestibility rate. PMID: 7547842 [PubMed - indexed for MEDLINE]

28. Br J Nutr. 1994 Feb;71(2):169-80. Intestinal nitrogen and electrolyte movements following fermented milk ingestion in man. Mah S, Marteau P, Huneau JF, Thuillier F, Tom D. Institut National de la Recherche Agronomique, Unit de Nutrition Humaine et de Physiologie Intestinale, Facult des Sciences Pharmaceutiques et Biologiques, Paris, France. The present study focuses on the digestion and absorption of milk and fermented milk (FM) reflected by gastro-ileal N and electrolyte movements in six healthy volunteers. The N and electrolyte content of the intestinal effluents were analysed both at the beginning of the jejunum and in the distal ileum. The gastric half-emptying time of the liquid phase was significantly (P < 0.05) shorter for milk (35 (SE 2) min) than for FM (60 (SE 2) min). The N balance showed that 58 and 50% of ingested proteins, milk and FM respectively were absorbed between the stomach and the proximal jejunum and that 91 and 90% respectively were absorbed between the stomach and the terminal ileum in 240 min. Evaluation of mineral absorption indicated that 44 and 67% of Ca was absorbed in the duodenum after milk and FM ingestion respectively, and 41 and 11% of Ca

disappeared between the jejunum and the ileum respectively. With regards to N and Ca intestinal availability, the present study confirms that FM products represent an interesting source of N as well as minerals for man. This confers on FM a beneficial effect compared with milk especially for lactase (EC subjects and children with persistent diarrhoea. PMID: 8142329 [PubMed - indexed for MEDLINE]

29. Am J Clin Nutr. 1989 May;49(5):823-7. Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects. Lerebours E, N'Djitoyap Ndam C, Lavoine A, Hellot MF, Antoine JM, Colin R. Groupe de Biochimie et de Physiologie Digestive et Nutritionnelle, Rouen, France. Lactase-deficient subjects absorb lactose in yogurt more effectively than lactose in other dairy products. However, as all previous studies were performed without a double-blind design and only after a single ingestion of the test product, the mechanism of this enhanced absorption remains unclear. The aims of this double-blind study were 1) to evaluate lactose absorption after prolonged ingestion of yogurt and fermented-then-pasteurized milk (FPM) and 2) to assess the modification of the lactase activity of the duodenal mucosa. In 16 lactase-deficient subjects we confirmed that yogurt enhances lactose digestion, this beneficial effect being destroyed by pasteurization. Moreover, the long-term (8 d) ingestion of either yogurt or FPM does not modify the results of hydrogen breath tests in comparison with a 24-h ingestion. The mucosal lactase (Dahlquist method) and beta-galactosidase (ONPG method) activities were not significantly modified by yogurt or FPM ingestion. These results suggest that in lactase-deficient subjects no adaptation occurs after eating yogurt or FPM and that the increased lactose absorption in yogurt must be mainly related to an intraluminal process. PMID: 2497632 [PubMed - indexed for MEDLINE]

30. Am J Clin Nutr. 1987 Oct;46(4):636-40. Lactose digestion from flavored and frozen yogurts, ice milk, and ice cream by lactase-deficient persons. Martini MC, Smith DE, Savaiano DA. Department of Food Science and Nutrition, University of Minnesota, St Paul 55108. Lactose digestion from and tolerance to flavored and frozen yogurts, ice cream, and ice milk were evaluated (20 g lactose/meal) in lactase-deficient subjects by use of breath hydrogen techniques. Unflavored yogurt caused significantly less hydrogen production than milk (37 vs 185 delta ppm X h, n = 9). Flavored yogurt was intermediate (77 delta ppm X h). Subjects were free of symptoms after consuming flavored and unflavored yogurts. Of seven commercial yogurts tested, all contained significant levels of microbial beta-galactosidase (beta-gal). In addition, eight subjects were fed meals of milk, ice milk, ice cream, and frozen

yogurts with and without cultures containing high levels of beta-gal. Peak hydrogen excretion after consumption of frozen yogurt with high beta-gal was less than one-half of that observed after the other five test meals and intolerance symptoms were absent. Tolerance to frozen yogurt, produced under usual commercial procedures, was found to be similar to that of ice milk and ice cream. PMID: 3116836 [PubMed - indexed for MEDLINE]

31. Am J Clin Nutr. 1987 Mar;45(3):570-4. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. McDonough FE, Hitchins AD, Wong NP, Wells P, Bodwell CE. Enhanced digestion of yogurt by lactose-intolerant individuals is believed to be due to inherent beta-galactosidase (lactase) in the culture organisms that aids in the hydrolysis of ingested lactose. However, sweet acidophilus milk, which contains lactase-rich organisms, does not enhance lactose digestion. Using breath-hydrogen measurements to indicate malabsorption in 14 human subjects, we compared utilization of: milk, yogurt, heated yogurt, yogurt plus lactose, heated yogurt plus lactase, sweet acidophilus milk (SAM), and SAM made with sonicated cells. Results indicate that both the reduction of lactose during fermentation and the presence of indigenous bacterial lactase are responsible for the increased ability to tolerate lactose in yogurt. Improved utilization of SAM by sonication suggests that intracellular lactase is not available during digestion and that sonication releases the lactase activity from the cells. PMID: 3103415 [PubMed - indexed for MEDLINE]

32. Am J Clin Nutr. 1984 Dec;40(6):1219-23. Lactose malabsorption from yogurt, pasteurized yogurt, sweet acidophilus milk, and cultured milk in lactase-deficient individuals. Savaiano DA, AbouElAnouar A, Smith DE, Levitt MD. The use of fermented dairy foods is common in areas of the world where lactase deficiency is prevalent. Recently, we have shown that the digestion of lactose from yogurt is enhanced as compared to that from milk. This enhanced digestion is apparently due to inherent B-galactosidase in yogurt which is active in the gastrointestinal tract after consumption of the yogurt. Furthermore, yogurt is well tolerated by lactase-deficient subjects resulting in little or no gastrointestinal distress. Since other fermented and microbial-containing dairy foods are consumed worldwide and may also contain some "lactase" activity, we chose to evaluate the digestion of lactose from three of these products: pasteurized yogurt, cultured milk (buttermilk), and sweet acidophilus milk. Breath hydrogen techniques were used to evaluate lactose malabsorption in nine lactase-deficient subjects. The studies demonstrated that yogurt is unique among the products tested in enhancing the digestion of lactose. Furthermore, pasteurization of yogurt eliminated the enhanced digestion of lactose, reduced the inherent lactase activity of the yogurt by 10-fold and reduced cell counts by 100-fold. Interestingly, eight of nine subjects fed cultured milk experienced gastrointestinal distress, whereas all subjects fed pasteurized yogurt were

symptom free, even though the amount of malabsorbed lactose was similar. PMID: 6439026 [PubMed - indexed for MEDLINE]