Acceptability and feasibility of probiotic and prebiotic supplementation in alleviating symptoms of lactose maldigestion in lactose intolerant subjects

Background: The efficacy and acceptability of some probiotic strains for the management of lactose intolerance remains to be established, and the synbiotic combination of probiotic and prebiotic intervention in lactose maldigesters is not well known. The aims of this study were as follows: Aim 1. To evaluate the effect of a 5-week probiotic treatment on gastrointestinal symptoms and breath hydrogen exhalation followed by the 5 weeks of the same probiotic blend in combination with a prebiotic product in lactose intolerant (LI) subjects. Aim 2: To determine whether probiotic and prebiotic supplements are feasible to use and acceptable to subjects. Aim 3: To provide calcium education catered to a lactose intolerant population and measure effectiveness of educational sessions.;Methods: Twenty female and male LI participants underwent hydrogen breath tests and symptom assessment at baseline, midpoint, and endpoint following a 25g lactose challenge. Midpoint analysis was performed following 5 weeks of supplementation with a probiotic blend containing 10 billion CFU of a blend of Lactobacillus and Bifidobacterium strains. This was followed by a 5-week supplementation of the same probiotic blend combined with 750mg fructooligosaccharides (FOS) as prebiotics. For each time point, the area under curve (AUC) for breath hydrogen concentration vs. time (AUC 180 min) was calculated, and symptom scores were recorded using two validated forms; a lactose intolerance rating scale (LIRS) which measured overall gastrointestinal symptoms, and a visual analog scale (VAS) which assessed 5 specific symptoms of lactose intolerance one hour following the lactose challenge. These results were compared to a group (n= 18) of lactose digesters (LD) who underwent the same supplemental protocol. Surveys evaluating acceptability and symptoms of synbiotic supplementation were administered at each time point, along with calcium knowledge assessments after an initial educational session. The data were analyzed by SPSS version 21 and included paired-test, independent t-test, and repeated measures ANOVA. A p-value <.05 was considered significant.;Results: The probiotic blend significantly reduced gastrointestinal symptom scores compared with baseline in both LI and LD groups. Addition of prebiotics to the treatment, further reduced (p = .049) LIRS symptoms in the LI group compared to the LD group. VAS assessment showed a significant decrease in symptoms of diarrhea (p=.046) and abdominal cramping (p=.032) with the addition of prebiotics to the treatment compared to probiotics treatment alone. Supplements were well-tolerated with most participants reporting they were willing to continue taking the synbiotics. Calcium education improved calcium knowledge scores compared to baseline (p < .05).;Conclusion: Five-week consumption of a probiotic blend improved gastrointestinal distress associated with a lactose load in LI subjects. Symptoms were further reduced with the addition of prebiotics to the treatment. Probiotic and prebiotic supplementation was safe and well tolerated with no serious side effects reported in this group of subjects. To our knowledge, this is the first study showing the beneficial effect of synbiotic mix in alleviating gastrointestinal symptoms in LI individuals.