Annals of nutrition & metabolism
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Lactose intolerance primarily refers to a syndrome having different symptoms upon the consumption of foods containing lactose. It is one of the most common form of food intolerance and occurs when lactase activity is reduced in the brush border of the small bowel mucosa. ⋯ When lactose is not digested, it can be fermented by gut microbiota leading to symptoms of lactose intolerance that include abdominal pain, bloating, flatulence, and diarrhea with a considerable intraindividual and interindividual variability in the severity of clinical manifestations. These gastrointestinal symptoms could be similar to cow's milk allergy and could be wrongly labeled as symptoms of "milk allergy." There are important differences between lactose intolerance and cow's milk allergy; therefore, a better knowledge of these differences could limit misunderstandings in the diagnostic approach and in the management of these conditions.
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While earlier food allergy prevention strategies implemented avoidance of allergenic foods in infancy, the current paradigm is shifting from avoidance to controlled exposure. This review focuses on the outcome of recent randomized controlled trials, which have examined the early introduction of allergenic foods for allergy prevention, and discusses the implementation of results in clinical practice. In infants at high risk of allergic disease, there is now direct evidence that regular early peanut consumption will reduce the prevalence of peanut allergy, compared to avoidance. ⋯ Although promising, optimal timing, doses, and if the feeding regimen should be stratified according to infant allergy risk remain to be determined. The single study that assessed introduction of multiple foods from 3 months whilst breastfeeding compared with exclusive breastfeeding until 6 months of age showed no reduction in food allergy prevalence. Future research should aim at optimizing infant feeding regimens and support a tolerogenic gastrointestinal microenvironment during the period of food allergen introduction.
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Prior to 1969, athletes were advised to avoid drinking during exercise. At least 4 subsequent events led to the adoption of a radically different approach. By 1996, all exercisers were advised to drink 'as much as tolerable' in order to insure that they did not lose any weight during exercise - the 'zero percent dehydration' doctrine. This advice requires that athletes drink enough to 'stay ahead of thirst'. The act of drinking is a basic survival instinct that has been regulated by complex, unconscious controls ever since the first fish-like creatures moved onto land and should not require conscious adjustment. ⋯ Drinking ad libitum appears to optimize performance and safety during exercise in many situations. The presence of thirst, not of water loss, may be the biological signal that impairs exercise performance in those who drink less than their thirst dictates during exercise.
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Knowledge about the relationship between exercise and appetite is important both for athletes wishing to optimise performance and for those interested in maintaining a healthy body weight. A variety of hormones are involved in appetite regulation including both episodic hormones, which are responsive to episodes of feeding, and tonic hormones, which are important regulators of energy storage over the longer term (e.g. insulin and leptin). Notable among the episodic appetite-regulating hormones is ghrelin, which plays a unique role in stimulating appetite and energy intake. ⋯ The lack of a full compensatory response of appetite to exercise may facilitate the development of a negative energy balance and weight loss although there is individual variability in the response to exercise. From a practical standpoint athletes should not feel concerned that exercise will cause overeating as there is limited evidence to support this. For those desiring weight loss there may be some merit in performing exercise in the postprandial period as a means of enhancing the satiating effect of a meal but additional evidence is required to confirm the effectiveness of this strategy.