C13 and H2 Breath Test for lactose intolerance. Preparation, development and results.

INTRODUCTION

Lactose intolerance occurs in the case of partial or total deficiency of the enzyme lactase, an enzyme capable of breaking down lactose, the main milk sugar, also present in other dairy products or derivatives.

Symptoms arise from 1-2 hours to a few hours after ingestion of foods containing lactose, and those that most characterize lactose intolerance are the following:

• Abdominal pain
• Nausea
• Headache
• Abdominal swelling
• Diarrhea or constipation
• Tiredness
• Skin rashes
• Meteorism, flatulence

However, this symptomatology is not specific but common to other similar disorders. It is also important to specify that it differs from patient to patient with manifestations of different entities depending on the degree of deficiency of the lactase enzyme.

Under normal conditions, lactose (disaccharide consisting of glucose and galactose) is digested in the small intestine by an enzyme, lactase, which releases the two monosaccharides, which are then absorbed in the small intestine. The monosaccharides are transported to the liver where galactose is converted with high clearance into glucose which undergoes oxidation to CO2, which is eliminated in the breath.

In case of lactose intolerance, the partial / total lack of lactase does not allow the absorption of the lactose which descends into the gastrointestinal tract causing distension.

THE TWO TESTS

Until a few months ago there was, or at least was widespread, only one type of Breath Test for diagnosing lactose intolerance: the H2 Breath Test, or Hydrogen test for lactose intolerance.

We will cover this test in the second part of the article while in this first part we present the innovative C13 Breath Test, or Carbon test for lactose intolerance.

There is a sure way to understand if you are lactose intolerant and it is called the Breath Test , also called, in Italian, the Breath Test . From personal experience I can say: it is not pleasant!

It is not pleasant for lactose intolerant people because the test involves, on an empty stomach, the intake of a quantity of lactase dissolved in a glass of water equal to 30 grams (for adults) for the hydrogen test and 15 grams for the Carbon test.

It is clear to everyone that a person intolerant to a product, who takes the product itself, will not have comfortable reactions (LINK to common symptoms). Having a bathroom nearby for the duration of the test is therefore essential. The more lactose you take, the more you will suffer from the discomfort associated with intolerance.

What timing are we talking about? The test duration is 4 hours for the H2 version and 2 hours for the C13 version.

Do you have to go fasting? Yes, for the H2 test it is necessary to abstain from food for 8 hours before the test, for the C13 only 3.

So the Carbon test already has 3 advantages over the Hydrogen test: it lasts less and you have to take less lactose (less suffering).

This is also why we support and have introduced the new Breath Test C13 on our e-commerce, in a format that can be easily carried out at home, where we have our favorite bathroom and the assistance of our loved ones.

CARBON BREATH TEST

Breath Test C13 for lactose intolerance

Lactose intolerance now has a new ally, this is the revolutionary Carbon test to discover the condition of lactose intolerance.

This test is faster, easier, less "painful" and possible to do at home. It is so innovative that we at Lactosolution wanted to offer it to our customers through the e-commerce of our website.

It is a breath test based on the oral administration of lactose labeled with the stable non-radioactive 13C isotope. It is a direct and semi-quantitative method in which the increase in the 13CO2 / 12CO2 isotope ratio measured in the breath is directly related to the quantity of lactose metabolized and absorbed, therefore to the activity of the lactase enzyme.

The amount of lactose is lower than in the hydrogen breath test (15 grams versus 25 grams) and this allows you to have fewer disorders associated with the test.

The test has a low degree of invasiveness and a high degree of safety : it can also be used in pediatric patients (Amarri, 1999; Casellas, 1999) and in pregnant women. The 13C lactose breath test is a more direct method . compared to the hydrogen test, as it gives a measure of the amount of glucose and galactose absorbed (not the hydrogen emitted due to lack of absorption of lactose), so it is safer and more accurate.

This test, compared to others, is less subject to interference from other pathologies and to false positives in patients with bacterial overgrowth or false negatives in patients defined as "non H2-producers".

The novelty also consists in doing it at home. You will no longer have to wait to blow the door of the diagnostic laboratory forward, whether it is in the hospital or clinic, but you will be comfortably seated at home ... just a few steps from your favorite bathroom!

How does the Carbon 13 test for lactose intolerance work?

The procedure is similar to that of the Hydrogen Breath Test. That is, you must exhale into a machine that detects the isotope of Carbon at regular time intervals, intervals that will be indicated by the assistant or in the package.

Specifically, the machine will be able to understand the metabolization rate of the 13C substrate, expressed in dose / h (%).

After the first blow, whose value will take the name of basic value, a quantity of lactose with a percentage of atoms marked at C13 * must be taken in liquid form (powder dissolved in water).

* 13C lactose is prepared according to a natural process that involves feeding the cows with corn, separating lactose from milk and freeze-drying. Unlike other plants, corn has a C4-type metabolic cycle of photosynthesis, which determines the preferential use of 13C-labeled molecules over 12C, with consequent enrichment. There is no need to be afraid of carbon-labeled lactose !

The analysis for the determination of the presence in our breath of C 13 elements can be performed by mass spectrometry (IRMS) or infrared spectrometry (IR), that is two different machines but which return the same result.

The values analyzed by the instrument will then be displayed in a graph that can indicate our condition of intolerance.

In this graph we will have on the abscissa axis (X axis) the time and on the ordinate axis (Y axis) the metabolization rate of the substrate 13C, expressed in dose / h (%). This data is called cDPR.

With C13, am I lactose intolerant when?

A cDPR value greater than or equal to 5 dose / h (%) means that the subject has normal lactose absorption, so he is not lactose intolerant.

A value of less than 5 dose / h (%) means that the subject has lactose malabsorption and is therefore lactose intolerant.

Unlike H2 tests, in this case, in order to be intolerant, one must therefore not exceed a certain threshold.

Let's now look at a couple of real test examples, found on the web. The first is positive for lactose intolerance, the second negative.

The C13 test at home

If you choose the "home test" solution, once you open the package you will discover a jar with lactose powder, test tubes and instructions.

The test is simple and the instructions provided and updated will show you the steps to follow.

Normally, as we have already seen, you must first exhale (blow) into 2 of the 6 tubes provided, then prepare the drink with the lactose powder (15 g of lactose + 200 ml of water) and drink it. The procedure ends by exhaling (blowing) every 30 minutes into one of the remaining tubes, until all are finished (2 hours).

Once the material is ready, just send a WhatsApp message to make you collect the test directly at home, in its original packaging. All that remains is to wait for the results to arrive and will be delivered to your email address within a maximum of 15 days.

Do we need to prepare for the carbon test?

The test, to be valid, cannot be carried out under certain conditions, from which the following simple but important rules arise:

Before the test:

For the maximum reliability of the test the patient:

• He must have fasted for a minimum of 3 hours, he can only drink non-carbonated water.
• You must not smoke, sleep, or do strenuous exercise for at least half an hour before and during the test.
• You shouldn't take any medications as some may affect the test result.
• You must not take lactic ferments for at least a week.

During the test:

• Avoid physical exertion;
• Fasting (small amounts of water are allowed);
• Do not leave the test site (you are called every 30 minutes if done in the hospital);
• Be prepared for any abdominal pain and diarrheal discharges.

After the test:

After completing the test you can resume all daily activities, including your preferred diet. As with the hydrogen test, symptoms of lactose intolerance may continue to occur in the first hours after the test, with the need to go to the toilet frequently.

Purchase link: Breath Test C13

BREATH TEST WITH HYDROGEN

Breath Test H2 for lactose intolerance

The test takes a long time because, at intervals of 30 minutes, the quantity of Hydrogen (H2) present in the breath is measured with a special instrument, called a gas chromatograph.

Why hydrogen?

In intolerant people, or in whom for genetic reasons or due to external factors the enzyme that must metabolize it is missing, lactose ferments in the colon creating some well-recognizable gases including hydrogen (H2). The latter circulates in the blood and through the circulatory system, in fact, reaches the lungs where it is exchanged with the air of the breath.

During the test it will be necessary to exhale the air into a nozzle or into a bag connected to the measuring instrument, which will be able to indicate the quantity of hydrogen detected in the breath (Breath).

This quantity, expressed in parts per million (ppm), is shown on the ordinates of a graph, which has time as its base (abscissa).

The evolution of the quantity of hydrogen over time , compared with the initial value - before the intake of lactose, also called basal value - indicates if, and how much, one is lactose intolerant .

With H2, am I lactose intolerant when?

An increase in gas production greater than 20 parts per million (ppm) from baseline (red line below, varies from person to person), after ingestion of lactose, indicates that the subject is lactose intolerant.

Finally, based on the amount of H2 produced, lactose intolerance can be described as mild, severe and moderate.

Let's look at some trends and example values:

(values to be understood as a mere example in no way binding, it is interesting to observe the deviation from the personal limit value or from the basal value + 20 ppm shown in red )

Mild lactose intolerance

Moderate lactose intolerance

Severe lactose intolerance

No lactose intolerance

The red line shown above to improve the understanding of the data will not be present in the graphs that will be provided to us as a test response (sometimes there is not even the graph but only the numerical values). This can be found mentally by simply adding "20" to the first value obtained during the test (baseline value). Red line = baseline + 20 .

Let's now look at a couple of examples of real tests, found on the web and both positive for intolerance:

Do we need to prepare for the hydrogen test?

The test, to be valid, cannot be carried out under certain conditions, from which the following simple but important rules arise:

Before the test:

• Fast for at least 8 hours and avoid, in the 24 hours preceding the exam, milk, dairy products and all food products that may contain lactose (water is allowed, only MEAT, FISH and RICE are recommended);
• Avoid taking antibiotics in the 15 days before the exam;
• Avoid taking laxatives and lactic ferments in the 7 days before the exam;
• Avoid tobacco intake for at least 8 hours;
• Not having intestinal pathologies in progress or having recently had invasive colon examinations;
• Limit the intake of cane sugar, corn flakes, corn derivatives, peanuts, peas, foods rich in fiber in the 24 hours preceding the exam.

During the test:

• Avoid physical exertion;
• Fasting (small amounts of water are allowed);
• Do not leave the test site (you are called every 30 minutes);
• Be prepared for any abdominal pain and diarrheal discharges.

After the test:

After completing the test you can resume all daily activities, including your preferred diet. In the first few hours after the test, symptoms of lactose intolerance may continue to occur, with the need to use the toilet frequently.

CONCLUSIONS

In summary, the Breath Test is a non-invasive and economical test approved by the scientific community and offered by the main hospitals to investigate the ability to digest lactose. It hardly returns false positives but beware, a positive result indicates our current condition of intolerance but does not indicate whether we will be in the future as well.

As you can read in our guide, lactose intolerance can also be transient and due to momentary malfunctions of our internal system.

The innovative Breath Test C13 for lactose intolerance is even simpler and faster and is currently the reference test to diagnose the presence of intolerance to milk and dairy products (remember that it is not an allergy to milk or lactose). It can be carried out safely at home and guarantees an excellent result.

On the other hand, a genetic test (DNA Test for lactose intolerance) will tell us whether or not we are genetically exposed (now or in the future) to lactose intolerance even if it does not tell us when we will become one. In the presence of the symptoms of lactose intolerance, the DNA Test is also a valid test to diagnose the condition of lactose intolerance.

The sum of the two tests (Breath Test + DNA Test) assures us a complete picture regarding our conditions of lactose intolerance . If you want to know the genetic test for lactose intolerance click here .

Are you scared of a positive intolerance result?

Or already tired of being lactose intolerant? Thanks to the lactase supplement Lactosolution 15000 the solution is at your fingertips.

Click here to try the revolutionary food supplement specific for lactose maldigestion or let's study the functioning of the lactase enzyme here .

Purchase link: Breath Test C13 .

Bibliography

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• Adult-type hypolactasia genotyping in Northern Italy: prevalence of C / T-13910 polymorphism and questions after comparison with existing data. Ghidini C, Sottini A, Zanotti C, Serana F, Marini M, Caimi L, Imberti L. Minerva Gastroenterol Dietol. 2010
• Effect of C / T -13910 cis-acting regulatory variant on expression and activity of lactase in Indian children and its implication for early genetic screening of adult-type hypolactasia. Kuchay RA, Thapa BR, Mahmood A, Mahmood S. Clin Chim Acta. 2011
• Meta-analysis: the diagnostic accuracy of lactose breath hydrogen or lactose tolerance tests for predicting the North European lactase polymorphism C / T-13910. Marton A, Xue X, Szilagyi A. Aliment Pharmacol Ther. 2012
• Analysis results provided by Google and friends
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