A test of intestinal mucosal function which utilizes the differential permeability of L-rhamnose and lactulose has been reported to be helpful in the diagnosis of gluten-sensitive enteropathy. We have applied this test to 48 male subjects with diabetes mellitus to evaluate its usefulness as a screening test in diabetic patients and to further study sugar absorption in these individuals. Total urinary lactulose excretion in the 13 healthy control subjects was 54.5 +/- 8.5 mg/5 h, while excretion by diabetic patients was increased at 116.1 +/- 15.7 mg/5 h (p less than 0.01). Similarly, total L-rhamnose excretion by diabetic patients was significantly higher (139.7 +/- 14.3 mg/5 h vs 84.3 +/- 18.4 mg/5 h, p less than 0.05). The ratio of percent urinary excretion for lactulose/L-rhamnose (L/R ratio) for diabetic patients (0.197 +/- 0.024) was not different from the control subjects (0.151 +/- 0.2). Nine out of 48 diabetic patients studied had lactulose/L-rhamnose ratios higher than the mean plus two standard deviations of the control group, which might lead to the diagnosis of small bowel mucosal disease. Although we may have been detecting subclinical mucosal disease or gluten sensitive enteropathy in a subgroup, it appears that this test of intestinal mucosal function should be interpreted with caution in diabetic patients.

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nized factors in cholesterol gallstone formation; bile which is Obese persons are at risk for cholesterol gallstones saturated with cholesterol is essential for crystals to form, because their bile is saturated with cholesterol. The risk nucleation factors can influence whether crystals form in satincreases during rapid weight loss by means of certain urated bile, and gallbladder stasis can allow crystal growth. very-low-calorie diets or gastric bypass surgery. GallObesity is associated with increased bile cholesterol secrestone risk factors during rapid weight loss include intion and saturation index. 6 Several studies suggest that bile creased bile cholesterol saturation index and gallbladsaturation index increases further during rapid weight der stasis. Obese subjects were randomized to one of two loss. 1,6,7 In one study, 10 subjects losing weight on a 1,000-low-calorie liquid diets for rapid weight loss: a 520-kcal kcal diet showed reduced output of all bile lipids, but 6 of the diet with less than 2 g fat/d, and a 900-kcal diet with 30 10 increased their bile saturation index. 6 On the other hand, g fat/d (including one 10-g fat meal to stimulate maximal several studies have reported decreased bile saturation index gallbladder emptying). Bile and blood lipids, saturation after 6 to 20 days of fasting. 8,9 Cholesterol may be mobilized index, leukocyte 3-hydroxy-3-methylglutaryl coenzyme from tissue stores to be secreted into bile during rapid weight A (HMG CoA) reductase activity, and ultrasonographic loss. 6 Decreased bile acid synthesis has also been detected gallbladder emptying were measured repeatedly during during diet-induced weight loss and fasting. 6,9,10 Thus, rapid dietary treatment. Both diets produced comparable weight loss may alter secretion of cholesterol and bile acids weight loss of 22%. Bile cholesterol saturation index inin a manner conducive to gallstone formation. creased during both diets (26%), but fell to 15% below Pro-and antinucleating proteins and mucins are described prediet level after weight loss. Compared with subjects' in gallbladder bile, and may predispose to gallstones. These maximal gallbladder emptying fraction of 66%, the 520-factors could change during rapid weight loss. Shortened kcal diet provided poor gallbladder emptying (35%), crystal nucleation time has been observed during very-lowwhereas the 10-g fat meal of the 900-kcal diet provided calorie liquid diets. 7 Mucin and calcium increased in gallbladmaximal emptying. Gallstones developed in four of six der bile of obese subjects forming gallstones after gastric by-520-kcal subjects and none of seven 900-kcal subjects (P pass. 11,12 Å .021), an unanticipated difference that resulted in preGallbladder emptying may also participate in gallstone formature study termination for ethical reasons. Blood lipmation. 13 Studies of meal-stimulated gallbladder emptying in ids and HMG CoA reductase activity in mononuclear leuobese subjects have given variable results. [14][15][16][17] We and others kocytes fell at week 8 durin...

Specific activities of five enzymes were measured in intestinal mucosa of zinc-deficient rats and compared to activities in appropriate zinc-sufficient controls. Three disaccharidases were found to be significantly reduced in zinc deficiency. Alkaline phosphatase, a zinc metalloenzyme, also showed reduced activity. Activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme of cholesterol synthesis, was elevated. It is possible that impaired carbohydrate digestion (reflected in disaccharidase activity) and even defective lipid absorption (reflected in reductase activity) may contribute to the poor nutrition and diarrhea of zinc deficiency.