THE EFFECT OF COLIEF INFANTS DROPS ON BABIES WITH LACTOSE INTOLERANCE

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Lactose, which is a disaccharide naturally found in milk and dairy products, supplies about 40% energy needs for human babies. However, due to a lack of lactase enzyme in the digestive system, lactose cannot be broken down in the small intestine and then will ferment in the large intestine, producing lactic acid and hydrogen gas. This results in severe discomfort, cramps, bloating, wind, and diarrhoea.

Lactose intolerance can lead to serious complications in an infant, such as persistent diarrhoea and failure to gain weight. Infants often suffer from transient lactose intolerance, especially after an infection. According to recent studies in the Department of Paediatrics, Guy's Hospital, London, and a report on the British Journal of Community Nurses have shown that nearly half the babies suffered colic due to lactose intolerance. In most cases, temporary lactose intolerance resolves itself within four weeks, although some infants take up to eight weeks to fully recover.

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Following research at Guys Hospital, which successfully identified transient lactase deficiency as one possible cause of Colic, Colief® Infant Drops are increasingly being prescribed by Doctors on the NHS. Nonetheless, many parents have reported that Colief® does not seem to work on their babies. (sjfksjd)

RESEARCH AND RATIONALE:

The investigation is to test whether Colief works or not. ???

Briefly, lactase breaks lactose into glucose and galactose:

I would measure the changes in lactose concentration after adding the enzyme into milk solutions but in fact I did not have the equipments to measure lactose content. Therefore a blood glucose meter was used instead. Concentration of glucose formed due to lactose was broken down can be then determined by the meter.

However, the meter needed to be checked that it was functioning well.

Planning:

Equipments:

ACCU-CHEK Aviva blood glucose meter from Roche.

Test trips for Accu-chek Aviva

Normal semi-skimmed milk

Solgar Lactase 3500 tablets

Colief® Infant Drops

Thermometer (to maintain the temperature)

Measuring syringes

Electric Balance

Measuring cylinders

Method

Diluted the milk solution by adding water to milk until a point, where a suitable glucose concentration is reached- in reading range of the meter. Every time the milk was diluted, the glucose concentration was checked.

Put the milk solution in a glass beaker. Then place the beaker in a water bath (in this case - was a jug)

Keep topping up hot water to the jug to maintain the temperature (at 370C). A mercury thermometer was used to check the temperature in between.

Glucose concentration of milk solutions were tested before and after adding the enzyme. Carefully dipped the top of the test strip into the solution.

The data was recorded every one minute up to the fifth minute and every five minutes up to the 35th or 40th minute.

Plot the data. The change in the concentrations would prove whether lactose had been broken down and the enzyme did worked.

Risk assessments:

I used the boiling water to add to the jug to keep the temperature the same - I had to be very careful when doing that. I did take everything unnecessary that can accidentally be broken.

Glass beakers were use instead of the plastic ones - because the plastic ones' are heat insulate - make the milk solution's temperature different. I also had to be very careful when doing this. Otherwise I might have broken the beaker.

It also needed to be extremely careful when working with the thermometer as when it broken the mercury can leak out which is very dangerous and toxic.

Practical:

A trial experiment was carried out to make sure the meter worked and to find out the suitable measure range of the meter.

Using semi-skimmed milk.

Dilution of milk

Meter's Reading

Neat

Too high

1 in 2 (5 ml milk + 5 ml water)

Too high

1 in 4 (5 ml milk + 15 ml water)

Too high

1 in 8 (5 ml milk + 35 ml water)

26.0 mmol/l

1 in 16 (5 ml milk + 75 ml water)

13.5 mmol/l

1 in 32 (5 ml milk + 155 ml water)

07.2 mmol/l

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A further step was needed to check whether the meter was measuring specifically the glucose itself or included glucose in the disaccharides, too.

Sucrose, which is also a disaccharide, is made of glucose and galactose. A solution of sucrose was tested with the meter. A negative result of 0 mmol/l proved that the meter only measured glucose in milk.

(Protein - 0.1ml = 20.6mg)

7 ml = 160 drops. 4 drops each time = 0.175ml - milk has been diluted - 0.1ml is used instead.

The second trial was to estimate how long it would take for the enzyme to break down all the lactose:

A ground Soglar tablet was added into milk solution.

Dilution of milk

Reading

Neat

30.3 mmol/l

1 in 2 (half cup of milk + half cup of water)

17.9 mmol/l

After adding Soglar lactase 10 mins

26.5 mmol/l

After adding lactase 40 mins

Too high

From the two trials, we knew that milk solution needed to be diluted and the measuring time for each solution was about 40 minutes.

Results:

With Lactose-free milk: as

The readings following were recorded at 200C

Milk dilution

Glucose concentration (mmol/L)

5ml milk + 35ml H2O

32.2

5ml milk + 75 ml H2O

17.5

As the result, dilution of 1 in 16 was used.

The apparatus was set up exactly the same as the previous one.

Temperature was kept at 370C.

0.1 ml Colief added.

Glucose Concentration

(mmol/l)

17.8

18.1

18.6

18.3

Time (minutes)

0

5

10

15

I decided to stop at the 15th minute as the glucose concentration seemed not to change anymore.

There should have been no change in glucose concentration in this milk solution because it is lactose-free, which means no lactose would have been broken down by the enzyme - no glucose made. However, the result showed there was a slight change in glucose concentration. This may be due to systematic error of the meter.

Semi-skimmed milk

Firstly, the milk was diluted.

Dilution of semi-skimmed milk

Glucose concentration

5ml milk + 5ml water

26.6 mmol/l

5ml milk + 15 ml water

18.1 mmol/l

5ml milk + 35 ml water

8.9 mmol/l

As the result, the dilution 1 in 8 was applied to another two procedures.

0.1ml of Colief was added.

Time/

Minutes

Glucose concentration (mmol/L)

No. 1

No. 2

No. 3

Average

0

8.9

7.8

6.8

7.8

1

12.7

11.3

10.6

11.5

2

15.0

13.2

14.2

14.1

3

17.5

15.7

16.7

16.6

4

19.6

17.5

19.3

18.8

5

23.1

19.1

21.4

21.2

10

26.3

22.8

23.6

24.2

15

28.8

25.5

27.4

27.2

20

29.1

25.2

30.4

28.2

25

30.3

26.1

31.4

29.3

30

29.2

26.6

27.9

35

30.2

25.4

27.8

1 Soglar tablet was added:

Glucose Concentration

(mmol/l)

6.9

14.7

20.6

22.6

25

27.7

28.6

30.6

30.9

Time (minutes)

0

5

10

15

20

25

30

35

40

Comment: Combine the results of two experiments;

When I ground and added the tablet to the milk solutions, the tablet only partially dissolved. In addition, the amount of enzyme calculated in one Soglar tablet is much more than in 0.1ml of Colief.

we can see that the tablet is not suggested to give to babies as it is not as effective as the Colief liquid.

With SMA baby milk:

The readings following were recorded at 200C

Milk dilution

Glucose concentration (mmol/L)

5ml milk

Too high

5ml milk + 35 ml water

12.3

As the result, dilution of 1 in 8 was used.

The apparatus was set up exactly the same as the previous one.

Temperature was kept at 370C.

0.1 ml Colief added.

Time/

Minutes

Glucose concentration (mmol/L)

No. 1

No. 2

No. 3

Average

0

14.8

14.4

15.4

14.9

1

15.0

15.9

13.6

15.3

2

16.4

14.8

14.8

15.7

3

17.6

16.2

14.8

15.6

4

15.9

17.0

14.3

16.2

5

17.4

17.0

14.3

16.6

10

18.4

17.3

15.4

17.2

15

18.8

18.9

16.0

17.4

20

17.4

16.8

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17.0

17.2

25

17.8

16.5

18.9

18.0

30

18.5

17.3

17.0

17.4

35

17.9

18.3

17.8

18.3

40

18.9

17.9

17.5

17.7

The results of these experiments with SMA formula baby milk were unexpected. The glucose concentration kept fluctuating. This led to questions: Was there any problem with the meter, was there anything that interfered the meter? Or was the enzyme inhibited?

............................

In the experiments, the temperature was kept at 37oC - this is apt for human temperature and meets the required temperature for the Colief to work properly.

About the pH, milk displays innate ability to resist the changes in the pH - its buffering capacity (this is mainly due to the presence of amino acid residues of caseins and whey protein and colloidal salts) . Therefore I did not worry to maintain the pH as the milk could do it itself.

The results can prove that Colief is not really effective - and this could be the reason why high proportions of parents having colicky babies (cause by transient lactose intolerance) have reported Colief did not work for their babies.

During the research I came across some products that were also recommended for colicky babies as Infacol, Lactase Enzyme Liquid.  

I will do other experiments with low pH - like in our stomach environment - then I can know whether the enzyme will work in adult's stomach when tablet (like Soglar) is swallowed