The alteration of hydrogen (H2) metabolism, which accounts for the large decrease in breath H2 excretion following prolonged ingestion of malabsorbed carbohydrate (lactulose, lactose in lactose maldigesters) was studied in six lactose-maldigesting adults. Metabolic inhibitors of the three main H2-consuming reactions (methanogenesis, sulfate reduction, and acetogenesis) were used to independently measure H2 production and consumption in fecal samples obtained after 10 days of either dextrose or lactose feeding. Absolute fecal H2 production (net of production minus consumption) after 3 hr of incubation with lactose was approximately threefold lower after lactose adaptation (242 +/- 54 microliters) compared to dextrose adaptation (680 +/- 79 microliters, P = 0.006). Fecal H2 consumption was not affected by either feeding period. We conclude that decreased absolute H2 production, rather than increased H2 consumption, is responsible for the decrease in breath H2 observed with lactose feeding.