Sensitivity is 78% and specificity is > 95% (1 Diagnosis reference Carbohydrate intolerance is the inability to digest certain carbohydrates due to a lack of one or more intestinal enzymes. An example of this combination is a fatty cheese dip with a starchy vegetable. Good choices of these types of dietary starch are whole grain breads or those made with stone-ground flour instead of processed and refined white breads. Exclude any processed foods from your diet that have added sucrose. Want to view more content from Cancer Therapy Advisor? 2012; 55(2):S28-S30. Drugs, inflammatory diseases and pathogens can cause direct damage to the enterocytes or adversely affect cell turnover in the small intestine. Well-known starchy fruits and vegetables include bananas, corn, carrots, legumes (beans), and potatoes. Secondary deficiency: If you have damage to the intestinal cells caused by infection, food allergy, or strong drugs, then it is usually temporary. hA 04Fq\GczC. The osmotic gap is best determined by measuring the stool electrolytes and using the calculation gap= 290- 2x(Stool Na. What caused this disease to develop at this time? Pediatrics (1966) 38 (1): 127-141. 0000018999 00000 n In the case of margarines, it is always a good idea to read labels carefully for potential starch or sucrose content. 0000045274 00000 n A registered dietitian can assist you in using a food log and determining food tolerances. fraction of milk and other dairy products. After doing bit of research, heres what I found: Disaccharidases are enzymes that break down complex sugars (like lactose) into simple sugars (like glucose) so that the intestine can absorb the nutrients. ), (Patients with congenital sucrase-isomaltase deficiency who consume sucrose can ameliorate the malabsorption by subsequently ingesting a small amount of viable yeast cells, preferably on a full stomach. Sucrase deficiency in Green- Starchy foods break down more easily if exposed to salivary amylase in the mouth for an extended period. Some rats of the ZD group . You may also find sucrose hidden in your breakfast cereal or yogurt. Thank you for any help you can provide. While limiting disaccharide carbohydrates in your diet may seem difficult, there are a variety of foods you can still enjoy. Disaccharidase deficiency | Oxford Textbook of Medicine | Oxford Academic Skip to Main Content Subject Journals Books Oxford Textbook of Medicine (6 edn) John Firth (ed.) She holds a master's degree in food science and human nutrition and is a certified instructor through the NRA. 0000032824 00000 n BMC Evol Biol. Treatment read more , acute intestinal infections [see Gastroenteritis Overview of Gastroenteritis Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. The specificity of the LTT ranges from 7796% and sensitivity from 7694%. What are the possible outcomes of disaccharidase deficiences? ), Wang, L.H., Hartman, P.A. Undigested disaccharides cause an osmotic load that attracts water and electrolytes into the bowel, causing watery diarrhea. Malabsorption of disaccharides is not life-threatening, but you may experience episodes of watery diarrhea and abdominal discomfort when you eat foods containing disaccharides 3. Tell your doctor if you have diabetes, as your blood glucose levels may change if you begin taking Sucraid. In most cases, a disaccharide intolerance is dose-related. It may be beneficial for you to keep a copy of your or your childs disaccharidases small bowel biopsy results. Other acquired diseases are rotavirus enteritis, giardia infestation, eosinophilic gastroenteritis, Crohns disease, small intestinal bacterial overgrowth, tropical sprue, post-infectious gastroenteropathy, autoimmune enteropathy and pancreatic insufficiency. patients. 80% of Africans. IMPORTANT SAFETY INFORMATION FOR SUCRAID(SACROSIDASE) ORAL SOLUTION. Lactose tolerance is determined by consuming complete milk and dairy products containing complete milk. In infants, temporary secondary disaccharidase deficiency may complicate enteric infections or abdominal surgery. 1998. pp. Maldigestion of carbohydrates. 2003. pp. Once it starts, removal of all maldigested carbohydrate is needed to interrupt the cycle and allow the system to return to normal. 2. vol. Food allergy affecting the digestive tract 0000020664 00000 n In experimentally induced diarrhea a fecal pH of <5.3 indicates carbohydrate malabsorption is the major cause of diarrhea. I removed breads, flour products, sugars, and carbohydrates from my diet. In the long-term elimination of all dairy products can result in decreased calcium intake. If the baby is not allergic to milk, a milk-based formula that is free from lactose and sucrose is suitable. While limiting disaccharide carbohydrates in your diet may seem difficult, there are a variety of foods you can still enjoy. The osmotic gap provides an indirect indication of a disaccharidase deficiency and does not identify the causative sugar. Tell your doctor if you are allergic to, have ever had a reaction to, or have ever had difficulty taking yeast, yeast products, papain, or glycerin (glycerol). What other disease/condition shares some of these symptoms? My son is 14 and has had severe GI symptoms for over a year. Plain protein means foods that have been prepared with no sauce or seasonings. Iron deficiency anaemia depressed jejunal and ileal lactase . In whites the CC genotype of the SNP -13910 T/C upstream of the lactase gene is associated with adult-type hypolactasia while the TC and TT genotypes are linked with lactase persistence. Complete dietary elimination of the symptom causing disaccharidase is curative. o [teenager OR adolescent ], , MD, The Medical City, Pasig City, Philippines. Most contain negligible amounts of lactose and are tolerated by most lactose-intolerant individuals. Consult your individual lab report for what is considered abnormal for the particular lab that conducted your disaccharidase testing. Torniainen S, Savilahti E, Jrvel I. Congenital lactase deficiencya more common dis- *Our current doctor is addressing the low Disaccharidase levels, it was the first GI doctor that never really addressed them. vol. Structural and functional damage to the intestine and the potential beneficial effects of dexamethasone (Dex) and thyroxine (T4) were examined in zinc-deficient rats. You are encouraged to report negative side effects of prescription drugs to the FDA. She said if it is it is an atypical presentation. This doctor is finally taking these disaccharidase levels seriously and obviously it is causing a lot of his symptoms since he can not properly digest any sugars or carbohydrates. The Meta- bolic Basis of Inherited Disease. This type of deficiency cannot be prevented. This involves challenge with foods containing the suspect disaccharide and monitoring for the recurrence of abdominal symptoms. In addition, organic acids are produced by microbial fermentation in the bowel, which tend to increase motility in the digestive tract. It manifests during infancy after the introduction of sucrose in fruits and juices or glucose polymers in infant formula. The disadvantages are that the test is time consuming and requires a separate study for each individual sugar under consideration. Some can tolerate regular, non-diet sodas that are sweetened with high fructose corn syrup. Twenty to 40% is regulated by the disaccharidase (enzyme), maltase-glucoamylase. As contact with intestinal enzymes is reduced because of inadequate churning and mixing, more undigested starches and sugars move into the colon. Primary forms of lactase deficiency (congenital lactase deficiency or primary hypolactasia) will have complete symptom resolution if therapeutic recommendations are followed. 316. Recovery from the underlying disease is followed by an increase in activity of the enzyme. Inherited (Congenital) Disaccharidase Deficiencies. Use OR to account for alternate terms Connect with thousands of patients and caregivers for support, practical information, and answers. We are so ready for answers as this has pretty much taken over our lives. The enzyme that breaks down sucrose, sucrose alpha-glucosidase, or sucrase, splits sucrose into the two monosaccharides or single sugars: glucose and fructose. In general, most individuals with CSID tolerate salt. 26 Disaccharidase Deficiency ideas in 2022 | low fodmap diet, low fodmap recipes, fodmap recipes Disaccharidase Deficiency 26 Pins 30w L Collection by Elizabeth Herndon Similar ideas popular now Fodmap Diet Diet Low Fodmap Food List Low Fodmap Recipes Dinner Fodmap Diet Plan Ibs Fodmap Low Fodmap Foods Low Gluten Foods Healthy Fodmap Recipes 0000037251 00000 n Maltose restricted: vitamin B complex. 53. 0000028403 00000 n He felt really good for a couple of days after this scope, we dont know if it was from his system being cleaned out & he was also given Decadron during the procedure. However, because the degree of lactose malabsorption varies greatly, many . There is no complication associated with the management of disaccharidase deficiencies. If you know your disaccharidase assay results, the finding may be used as an initial indication of starch-digestion capacity, based on your level of maltase-glucoamylase activity. Nutrition for Special Needs You can read the full article here: http://wb.md/2hNQBcj. Gradual reintroduction of disaccharides, one by one, should determine exactly which disaccharide is not tolerated. 0000009875 00000 n Since milk foods are rich in lactose, having milk or other dairy product, may aggravate your digestive tract. Prescribing Information HCP Websites Nutritional Support Diet and Nutrition Resources Faith. var g = "dases?cc=MASTER"; J Am Diet Assoc. With disaccharidase deficiency, the easiest food to eliminated first is dairy. The condition was first recognized in 1958. As long as the amount consumed remains within an individuals limits, they should remain symptom free. Diarrhea may be severe enough to purge other nutrients before they can be absorbed. Lactose-intolerant patients must take calcium supplements (1200 to 1500 mg/day). Carbohydrate malabsorption. This doesnt mean that will help your son but be aware that Crohns starts at 14 years old typically. Legumes and beans can be added to your diet once sucrose and starch levels have been established. They will also be able to network with other registered dietitians who have experience with a CSID diet. PMID: 4554577 No abstract available. ), (Genetically programmed down-regulation of the lactase gene is detectable in children from the second year of life, although the onset and extent are somewhat variable. Most individuals with CSID can tolerate eggs. Also write down the timing of any gastrointestinal symptoms you experience, such as bloating, gas, diarrhea, or abdominal pain. How can disaccharidase deficiences be prevented? Primary causes are trehalase deficiency, maltase-glucoamylase deficiency, sucrase-isomaltase deficiency, sucrase-isomaltase deficiency which is onset from birth and related to sucrose or starch intake, primary adult type hypolactasia which is onset from 3 years up to early adulthood, and the rarely case of congenital lactase deficiency. Anyone have any experience with any of this? This type of malabsorption can lead to watery diarrhea with dehydration and acidosis (when your childs blood becomes acidic). Childrens Hospital of Philadelphia is a charitable 501(c)(3) nonprofit organization. Please login or register first to view this content. 0000010255 00000 n Genetic testing for the primary (adult-type) lactase deficiency is available in some commercial laboratories. What complications might you expect from the disease or treatment of the disease? Lindquist B, Meeuwisse G. Diets in disaccharidase deficiency and defective monosaccharide absorption. Foods made from milk will contain specific quantities of lactose, depending on the amount of whey in their composition, Hard cheeses are mainly casein; the whey (liquid) is removed in their manufacture. The LTT is rarely used since the introduction of breath tests. A deficiency of these enzymes in the duodenum (small intestine) results in a range of gastrointestinal symptoms. 1994. pp. Lactose and other disaccharides intolerances - Dr Janice Joneja. Identifying an often overlooked diagnosis, Advanced testing to pinpoint disaccharidase deficiency. CARBOHYDRATES provide a substantial proportion of the total caloric content of our diet. Thank you for the information. Rats were assigned to zinc deficient (ZD), control (C) or pair-fed (PF ) groups and fed for 40 d a zinc deficient (1 mg/kg) diet (ZD rats) or a similar diet supplemented with 50 mg Zn/kg (C and PF rats). Congenital lactase deficiency is extremely rare Disaccharides are a type of carbohydrate 23. 2. Second, combine a high-starch food with a fatty food at the time of ingestion. Bacterial fermentation of carbohydrates in the colon produces gases (hydrogen, carbon dioxide, and methane), resulting in excessive flatus, bloating and distention, and abdominal pain. In the information you provided it does look like Flagyl is one of the medications used to treat it. When introducing new food items, it is recommended that you wait at least three days before introducing an additional food item. Sucrose tolerance is determined by consuming vegetables, fruits, nuts, seeds, and refined sugars and syrups. %%EOF Ongoing controversies regarding etiology, diagnosis, treatment. Infant formulas that are lactose free and sucrose free can be given to a disaccharidase-deficient infant. If the condition is not recognized, dehydration and malnutrition can lead to death. var f = "https://testdirectory.questdiagnostics.com/test/test-detail/19701/disacchari"; CSID is an inherited deficiency of the ability to hydrolyze sucrose, maltose, and starch. Someone who produces very little lactase cannot break down large quantities of lactose. The amount of supplement that may be required will depend on individual tolerances to the disaccharide-containing food; some people will be able to tolerate a small amount of the food and so any deficiencies will be minimal. If the deficiency is a result of an inherited tendency, it is likely that the intolerance will be lifelong. The osmotic effect may be large enough to cause diarrhea, which is explosive when gas also accompanies the liquid stool. 1571-6. Sibley E. Carbohydrate intolerance. It has been noted that some individuals with CSID are able to increase their starch tolerance as they age and their digestive tract grows longer. Disaccharidase deficiency J Am Diet Assoc. Am J Hum Genet. With the exception of adult-onset lactase deficiency, hereditary disorders are rare and present at birth. However, 80 to 85% of whites of Northwest European descent produce lactase throughout life and are thus able to digest milk and milk products. Pua Hopson, D.O., discusses Mayo Clinic Labs new disaccharidase activity panel, which measures levels of five digestive enzymes to identify deficiencies that cause carbohydrate maldigestion and can lead to chronic conditions like celiac disease or inflammatory bowel disease. Lactase levels are high in neonates, permitting digestion of milk; in most ethnic groups (80% of blacks and Hispanics, > 90% of Asians), the levels decrease in the post-weaning period rendering older children and adults unable to digest significant amounts of lactose. Irritable Bowel Syndrome and Gastrointestinal Function. Inherited (congenital) deficiency in components of transport systems needed to move the sugars from the intestine into circulation. Some tolerate pepper and others do not since black pepper does have a small amount of sucrose and some starch. 0000013611 00000 n We do not control or have responsibility for the content of any third-party site. In some cases, the deficient enzyme can be provided as medication to be consumed with the food or as drops to be added to foods (e.g., lactase in the form of Lactaid or Lacteeze). *Artichokes, asparagus, broccoli, brussels sprouts, cabbage, and cauliflower can cause gastrointestinal gas in all individuals, not just individuals with CSID. ), (The molecular difference between lactase persistence and nonpersistence is caused by the mutation at position -13910), (Intestinal glucoamylase deficiency can be the cause of chronic diarrhea. These common symptoms are frequently misdiagnosed as a food allergy or intolerance. First, chew foods containing starch for a long period of time. 1998-2023 Mayo Foundation for Medical Education and Research. It is the result of a programmed reduction of lactase synthesis after three years of age and affects approximately half of the worlds population. All 5 disaccharides were low (like half of what they should be). Consult a physician and registered dietitian to see if test results indicate you are expected to tolerate milk products. I am learning that the liver loves vegetables specially raw and once fed that it removes inflammation. Enzyme supplements should be an adjunct to, not a substitute for, dietary restriction. The most common form of disaccharidase disorder is lactase deficiency, when your small intestine doesnt produce enough of an enzyme (lactase) to digest milk sugar (lactose). This restriction is necessary to determine your sucrose tolerance levels before introducing dietary starches. The most important disaccharidase in the newborn period is lactase. 1998;63:1078-1085. The increase in speed with which food passes through the digestive tract results in inadequate enzymatic breakdown (digestion) of the food, thus increasing the amount of substrate available for microbial fermentation in the large bowel. Had a CT scan that showed thickening of the ileum and mesenteric adenitis. It occurs in the whey (liquid) part of milk. In infants, additional causes may include immaturity of enzymes and transport components Digestion, Diet and Disease. 34 NEWCOMER A.D. MCGILL D.BDistribution of disaccharidase activities in the small bowel of normal and lactase deficient subjects Gastroenterology511966 481ANTONOWICZ, I., V. REDDY, K. T. KHAW AND H. SHWACHMAN. trailer Avoid eating foods that list these specific types of disaccharides as ingredients 3. However, gold . Based on material to be found in Dr Joneja's new book: Because the small intestine and large intestine are getting smaller amounts of starch at any given time, you may be better able to tolerate the dietary starch. Disaccharidases are enzymes that break down complex sugars, such as lactose, into simple sugars, like glucose, so the nutrients can be absorbed in the intestine. ), Harms, H.K., Bertele-Harms, R.M., Bruer-Kleis, D. Enzyme-substitution therapy with the yeast Saccharomyces cerevisiae in congenital sucrase-isomaltase deficiency. Undigested disaccharides, such as lactose, create an osmotic load that causes diarrhea. J Pediatr. They are hoping this helps in case of a bacterial or parasite infection and also it has an anti inflammatory property. There are no immediate adverse effects with elimination diets. The human maltase-glucoamylase gene (MGAM) is located on chromosome 7 at locus 7q34. Carbohydrate malabsorption occurs when the main dietary carbohydrates, sugars and starches, are not absorbed from the gastrointestinal (GI) tract. In determining your capacity to digest various fruits and vegetables, they can consult the food composition tables to determine acceptable food items within your sucrose and starch dietary limits. A single-nucleotide polymorphism (SNP) -13910 T/C upstream of the coding gene has been found to be involved in the regulation of enzyme activity. If the enzyme deficiency is a result of damage to the intestinal cells, caused by infection, food allergy, food protein enteropathy, or strong drugs, it is called a secondary deficiency and is usually temporary. Clin Chim Acta. There are multiple other conditions and diseases leading to similar symptoms. Congenital sucrase-isomaltase deficiency usually becomes apparent after an infant is weaned and starts to consume fruits, juices, and grains. The presence of abdominal pain or diarrhea during the test is supportive evidence for a positive test. Sucrase-isomaltase deficiency is the second most common disaccharidase deficiency. The activity of the enzyme is then calculated by measuring the amount of glucose released from each substrate, since all of the disaccharides contain glucose which is released by the action of the enzyme on the disaccharide. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. It is hypothesized that developmentally-regulated DNA-binding proteins down-regulate transcription or destabilize mRNA transcripts, causing decreased lactase expression after weaning. Kolars, J. C., Levitt, M. D., Aouji, M., Savaiano, D. A.. Yogurt an autodigesting source of lactose. Most affected patients have an increase in expired hydrogen of > 20 parts per million over baseline. Tell your doctor if you are allergic to, have ever had a reaction to, or have ever had difficulty taking yeast, yeast products, papain, or glycerin (glycerol). The only thing that has ever worked for my daughter is steroids- but the doctors dont think that is the answer and it is very frustrating when you see such a huge improvement (some times within hours) then as soon as they start to ween her off you see the decline then we end up full circle. It is absolutely amazing, he is a different kid! Coeliac disease that causes damage to the cells lining the small intestine, which include the cells that produce disaccharidase enzymes The test is offered by only a few laboratories in the United States and worldwide. In: Stanbury JB, Wybgaarden JB, Fredrickson DS, Goldstein JS, Brown MS eds. Of course its no fun to have this illness, but getting a firm diagnosis is probably the best news, so that your son can get the best treatment. Arch Dis Child. You can ask your doctor or the medical records department of your childs medical practice for a copy. with failure to thrive, hypercalcemia, and nephrocalcinosis. 0 0000001706 00000 n It is recommended that you avoid processed cheeses or cheese products since many of these food items contain sucrose or starch fillers. Usually the intestinal cells are producing a limited amount of enzyme, so that small doses of disaccharides in foods can be processed. 0000040856 00000 n Then he would go back to normal for the rest of the time. This enzyme is needed to hydrolyse sucrose, as well as limit dextrins from starches. He was started on Prednisone 40 mg (20mg BID) and Apriso on Tuesday (they had him take the first does of Prednisone Monday eve) and Wednesday he started feeling so much better. Most legumes and beans are starchy, so this content should be taken into consideration. Whole-wheat pasta, quinoa, lentils, brown rice, or wild rice are better options than more processed grains such as white rice. Thank, CCFA.org a lot of information is available. Some individuals with CSID have normal levels of lactase activity, while others are deficient in the lactase enzyme. 0000020358 00000 n The disadvantage is that it requires an endoscopy and biopsy of the small intestinal mucosa. Alternatively, the mother can pump her breastmilk and treat the milk with lactase drops (4 drops per 250 mL milk), and allow the enzyme to act for 24 hours in the fridge. Summary The effect of iron deficiency anaemia, protein deficiency and worm infestation upon intestinal disaccharidase activity in the rat was assessed following the . It is an autosomal recessive disorder. Since milk foods are rich in lactose, having milk or other dairy product, may aggravate your digestive tract. How should you interpret the results? The molecular basis for primary disaccharidase deficiencies still is unclear. Working with a registered dietitian is crucial to dietary success. The biopies came back as normal, except again the dissacharidase being low . What are the adverse effects associated with each treatment option? 0000010370 00000 n Melodie Anne Coffman specializes in overall wellness, with particular interests in women's health and personal defense. Our doctor says it is most likely from an infection (bacteria or parasite probably from the zoo) or an atypical presentation of Crohns. For people with primary (permanent) deficiencies, or those who need to follow the diet for an extended period of time, the following supplements should be considered: The outcome in cases of secondary disaccharidase deficiencies is dependent on the underlying cause of the intestinal mucosal damage. You can also enjoy a variety of vegetables such as asparagus, salad greens, eggplant, peppers and onions. Thank you for sharing the improvement! Similarly, maintenance of appropriate nutrition during and after infectious gastroenteritis has been shown to minimize prolonged mucosal damage. 1987. pp. 1995-2023 Mayo Foundation for Medical Education and Research. Gut. If you or your child has problems with normal disaccharide absorption, consult a registered dietitian. Thanks again & if you know of anyone who has dealt with low disaccharidase pI would love to talk with them & see what ended up being helpful for them. Philadelphia, PA 19104, Know My Rights About Surprise Medical Bills, Division of Gastroenterology, Hepatology and Nutrition, 2022 The Childrens Hospital of Philadelphia. 1987;22:24-28. He basically cleaned my liver. The test is not very sensitive and a positive result merely indicates the presence of an unabsorbed sugar in the stool but cannot identify the specific sugar. Lactose and sucrose are the most common disaccharides in the diet. Jarvela I, Enattah NS, Kokkonen J, Varilo T, Savilahti E, Peltonen L. Assignment of the Gray G. Intestinal disaccharidase deficiencies and glucose-galactose malabsorption. @kanaazpereira Thank you for the information! He seems to really respond to anti inflammatories. The test also does not reflect the absorptive capacity of small intestine for the individual sugars and the results can be misleading in cases where the intestinal mucosal abnormality is patchy, as for example, in celiac disease. There was a good correlation between the C/C(-13910) genotype and low lactase activity (<10 U/g protein) in the majority of children tested at 8 years of age and in every child older than 12 years of age, giving a specificity of 100% and sensitivity of 93% for the genetic test. Unabsorbed sugars can be detected in the stool. Salivary amylase, the first enzyme in the process of starch digestion, is released in the mouth. The dietary carbohydrates of quantitative importance are the polysaccharide starch and the disaccharides sucrose and lactose. These digestive problems can lead to failure to gain weight and grow at the expected rate (failure to thrive) and malnutrition9. When the cause is removed, the cells will start to heal and gradually resume production of the enzymes. It is important to determine starch tolerance by introducing starch-containing foods gradually. Knowing disaccharidase levels of activity can help in developing the best diet for each individuals unique situation. Lactase deficiency has been observed in 30% to 40% of patients with Crohn's disease. jQuery(document).ready(function() { She can make recommendations for a diet plan that limits disaccharides while incorporating foods you love 3. In this way, these dietary starch challenges help determine your starch digestion capacity. There is no significant risk associated with enzyme replacement therapy. Almost all those with CSID have decreased sucrase activity, even if such sucrase activity is not entirely absent. Infections in the digestive tract with parasites such as amoebae, helminths, nematodes, microorganisms such as Giardia lamblia, and viruses such as the rotavirus group Patients with disaccharidases deficiencies in the duodenum can experience intolerances to foods containing complex sugars, resulting in a range of gastrointestinal symptoms including diarrhea, constipation, abdominal pain and cramping, gas, bloating, and nausea. False negative tests may occur due to prior bacterial fermentation of the sugar in the colon. It has been noted that some individuals with CSID are able to increase their starch tolerance as they age and their digestive tract grows longer. Clinitest tablets cannot detect sucrose, lactulose, sorbitol, and mannitol as these are non-reducing sugar or sugar alcohols. If so, which ones? Typically these cases will manifest symptoms of pain or diarrhea during the test but are without a rise in breath hydrogen or methane levels. Primary causes of disaccharidase deficiencies cannot be prevented. Diagnosis is clinical and by a hydrogen breath test. See Figure 1. . 0000044436 00000 n 8. 1983;58:246-252. The lactose tolerance test is less sensitive, about 75%, although specificity is > 95%. You can buy all of Dr Joneja's books here or here in the US. In general, you can consume most fats and oils, such as butter, margarine, olive oil, and vegetable oil, without restriction. Consuming whole milk or chocolate milk, rather than skim milk, and drinking milk with meals can reduce symptoms of lactose intolerance presumably as a result of prolongation of gastric emptying.
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