Effect of fiber on breath hydrogen response and.pdf

1347 Effect of fiber on breath hydrogen response and symptoms after oral lactose in lactose malabsorbers1 Khoi N. Nguyen, M.D., Jack D. Welsh, M.D., Carl V. Manion, M.D., and Vernon J. Ficken, M. S. ABSTRACT The effect of ingesting cellulose, pectin, and psyhhium with orally administered lactose in water or milk was tested in six lactose mahabsorbers. Breath hydrogen tests were used to evaluate lactose malabsorption and mouth-to-cecum transit times. Addition of psyllium significantly reduced the breath hydrogen response, and symptoms in each subject: whereas, less diminution of expired hydrogen was seen after cellulose or pectin was added. The effect of each fiber on gastric emptying rates of an equal volume liquid meal was evaluated in three volunteers. Pectin had no effect, while the cellulose and psyhlium modestly delayed emptying at approximately 30 mm. Am J (‘un Nuir 1982;35:1347-l35I. KEY WORDS Fiber, breath hydrogen. lactose malabsorption Introduction Adult lactose malabsorbers frequently ex- hibit wide variations in symptom severity (1), which appear to be related to the dose of lactose ingested (2), the lactose vehicle (3), and to foods consumed at the same time. Several dietary fibers have a beneficial influ- ence on carbohydrate metabolism (4), dimin- ish carbohydrate malabsorption in postgas- trectomy patients (5, 6), and decrease diar- rhea from tube feeding (7). Therefore, studies of the effects of three fibers (cellulose, pectin, and psyllium) on lactose malabsorption were undertaken. The responses from lactose and fiber coadministration were assessed using the breath hydrogen test (8) and development of symptoms. In addition, the influence of the same fibers on gastric emptying was evalu- ated. Patients and methods Six men, three Black and three Vietnamese, ranging in age from 18 to 49 yr, participated in the study of fiber’s effect on lactose ma!- absorption. The diagnosis of lactose malab- sorption in each subject was established by an oral lactose