Lactose intolerance

Lactose intolerance is the inability to digest and absorb lactose (milk sugar) and causes gastrointestinal symptoms after eating or drinking dairy foods.

This condition should not be confused with a milk allergy.
Lactase is an enzyme produced in the wall of the small intestine.
This enzyme splits lactose into two simple sugars: glucose (glucose) and galactose (mucus sugar). Both sugars are rapidly absorbed by the small intestine. If a person suffers from lactase deficiency, the small intestine can only digest part of the lacotse. The undigested part reaches the intestine (colon), where it is fermented by the bacterial flora.

A lactase deficiency is usually responsible for lactose intolerance.
Many people have low lactase levels, but only those who also develop symptoms and signs have lactose intolerance.

When lactose passes through the colon (colon) without being adequately digested, it can cause symptoms such as meteorism, pain, and bloating.
Some people who are lactose intolerant cannot digest dairy. Others can easily eat and drink small amounts of dairy products.


Types of lactose intolerance

Primary lactose intolerance
After weaning, the production of the lactase enzyme decreases, but is still sufficient to digest the dairy products that a person consumes on average.
In people suffering from primary lactose intolerance, lactase production breaks down completely and dairy products cannot be digested.

Secondary lactose intolerance
This disorder is caused by a disease, therapy or surgery on the small intestine, such as: celiac disease, Crohn’s disease, some chemotherapy products, etc.

Congenital lactose intolerance In rare cases, lactose intolerance
persists from birth due to insufficient lactase levels.

Lactose intolerance in children

About two-thirds of breastfed or bottle-fed children have a lactase deficiency in the first months of life without showing symptoms.
Human breast milk contains about seven percent lactose. The amount of lactose in breast milk is not affected by the mother’s diet, even if it reduces or avoids dairy products.
An attack of gastroenteritis can lead to the excretion of the enzyme lactase. In this case, infants can drink lactose-free milk.

Lactase drops are another option, but they don’t always make sense.
Some newborns are born without the enzyme lactase. You should therefore drink lactose-free milk.
Lactose intolerance does not cause vomiting in children. However, this can be a symptom of an allergy to cow’s milk.

What are the symptoms of Lacot intolerance?

Symptoms of lactose intolerance can be mild to severe, depending on the amount of lactase produced.
Symptoms usually begin 30 minutes to 2 hours after eating or drinking dairy products.
Lactose intolerance manifests itself with the following complaints:

  • Abdominal bloating
  • Pain or cramps
  • Gurgling or growling sounds in the stomach
  • Meteorism
  • Diarrhoea (diarrhoea))

Are there complications of lactose intolerance?

Most people have no problems for a long time. Infants with a large deficit of lactase may develop dehydration or malnutrition if the condition is not diagnosed in time.

Diagnosis of lactose intolerance

Various methods can be used to diagnose lactose intolerance, including:

H2 test (breath test)
This test measures the amount of hydrogen exhaled. When the lactose ferments in the gut instead of being converted by lactase, it produces more hydrogen.

Exclusion diet
Many people who suffer from increased intestinal gases, abdominal pain, meteorism and diarrhea are suspected of lactose intolerance. The best way to find out is to cut out milk and dairy products to see if the symptoms pass.
If you feel better, you can start by taking in small amounts of dairy products to see if the symptoms return.
If you feel bad after drinking a single glass of milk, you probably won’t be lactose intolerant.
If there is pain every time you eat milk, ice cream or dairy products, lactose intolerance could be present.

Stool acid test
The examination of acid in the stool is a test for lactase deficiency in infants and newborns.
In the stool acid test, the newborn or infant must drink a small amount of lactose. After that, various stool samples are examined to determine the acidity.
With lactase deficiency, the unabsorbed lactose enters the colon and is converted into acids by bacteria, for example, the resulting product is lactic acid.
Lactic acid makes the stool acidic.
That is why an infant or child with lactase deficiency produces acidic stools after the lactose test.
The stool acid test is rarely performed, today the breath test is also carried out on children.

Another simple and inexpensive test is to drink lactose-free milk and observe the reaction to it.

What is the therapy for lactose intolerance?

Lactose intolerance can be easily treated. The goal of treatment is to control symptoms through the change in diet.
One can learn through trial and error how the quantity and type of dairy products must be in order to be tolerated.

Even if the amount of lactase produced by the body cannot be changed, the symptoms of lactose intolerance can be controlled with the change in diet.
Most people with lactose intolerance tolerate small amounts of lactose in their diet without showing symptoms.
Gradually introducing small amounts of milk and dairy products helps people get used to a smaller number of symptoms. Often, people tolerate dairy products better if they are eaten during meals.
There are distinct differences among people, one may have serious symptoms after drinking a small glass of milk, while another may drink a whole glass without any problems.
Others can eat yogurt and hard cheese without complaints, but no milk or other dairy products.
The Dietary Guidelines for Americans recommend that people with lactose intolerance choose those dairy products that are lower in lactose than regular milk, such as yogurt and hard cheese.

Dairy products without lactose or with low lactose content are available in most supermarkets. They are identical to normal milk, but the enzyme lactose has been added to them.
Lactose-free milk stays fresh for as long or longer if it is ultra-pasteurized.
Lactose-free milk may have a slightly sweeter taste than regular milk. Soy milk and other soy products may be recommended by the doctor.
Parents and educators of children with lactose intolerance follow a diet recommended by the doctor or dietician.

Lactase Supplements
Those who continue to feel symptoms after changing their diet can take over-the-counter drops or tablets of the enzyme lactase.
When tablets or drops of the enzyme lactase are taken with milk or dairy products, they become more tolerable for people with lactose intolerance.

Lactose intolerance and calcium intake
Milk and dairy products are an important source of calcium and other nutrients. Calcium is essential for the growth and regeneration of bone at any age. A lack of calcium absorption in children and adults can cause osteoporosis.

The amount of calcium a person needs to maintain their health is age-dependent. The recommendations are set out in the table below.

Table: Recommended calcium intake by life years

AgeRecommended daily allowance of calcium
0-6 months210 mg
7–12 months270 mg
1-3 years500 mg
4-8 years800 mg
9–18 years1,300 mg
19–50 years1,000 mg
51–70 years1,200 mg

Pregnant or lactating women should consume between 1,000 and 1,300 mg of calcium per day.
Many foods contain calcium and other nutrients that serve the body. Dairy-free products with a high calcium content are: fish such as salmon and sardines and dark green leafy vegetables such as spinach.

Nutrition for lactose intolerance

The following recommendations can help people who suffer from lactose intolerance:
Try cheese and yogurt, which are usually better tolerated than milk.
Drink whole milk because the fats in it slow down the passage through the intestines, giving lactase enzymes more time to digest the sugars.
Avoid skim milk or skimmed milk – it travels quickly through the intestines and causes symptoms in people with lactose intolerance.
In addition, many low-fat dairy products may contain skim milk powder, which has a higher proportion of lactose.

Milk should be drunk in moderate quantities. Most people with this condition can tolerate 240 ml of milk a day, but you have to find your own tolerance limit.

Eating fermented milk products such as some yogurts, aged or stored cheeses (for example, mozzarella) and butter usually do not cause any problems.
One should eat foods that contain lactose together with other foods or at different times of the day, rather than a large amount of it at once.
Products prepared with boiled or heated milk should be used, as they are better tolerated because the heating process breaks down (separates) parts of the lactose into glucose and galactose.
You can eat soy-based foods; they are lactose-free, contain a lot of calcium and are a good substitute for milk or dairy products.

Hidden lactose

Foods that may contain hidden lactose include:

  • Pastries and cakes (if milk has been added)
  • Breakfast cereals
  • Soups
  • Buttercream
  • Milk chocolate
  • Pancakes and pastries
  • Scrambled eggs
  • Muesli
  • Certain types of bread
  • Margarine (contains milk)

Foods high in lactose

The most common lactose-containing foods are:

  • Milk, milkshakes and other milk-based drinks
  • Buffalo milk
  • Coffee with whipped cream
  • Ice cream and sorbet
  • Cheese
  • Butter
  • Pudding, cream
  • Pizza
  • Ricotta
  • Yoghurt

Other foods that may contain lactose in smaller amounts include:

  • Bread and bakery products
  • Milk chocolate
  • Salad dressing
  • Breakfast cereals and granola bars
  • Rice and pasta
  • Candies and other snacks
  • Pancake
  • Pastry
  • Mascarpone
  • Sugar beets

How do I know if processed foods contain lactose?

If food is purchased, you should read the list of ingredients on the labels carefully.
Milk-derived ingredients containing lactose include:

  • Whey
  • Nougat
  • Cheese
  • Lactose
  • Butter
  • Quark
  • Yoghurt
  • Powdered milk

Depending on the severity of the symptoms, foods containing these ingredients should be avoided or restricted. Also, you should avoid foods whose labels state that they “may contain traces of milk”.

What are the alternatives?

The following foods are allowed:

  • You can eat hard cheeses such as Parmesan, which has matured for at least 30 months, rice or soy milk, and tofu (cheese made from soybeans).
  • Meat and fish, raw ham, eggs and sausages, but lactose is sometimes used as a preservative.
  • Oil from olives, peanuts, corn, sunflower, etc.
  • Breakfast cereals, flour, popcorn, some breads, pasta, rice, potatoes, dried legumes, crackers and rusks.
  • Fresh fruits and vegetables, as juice and frozen.
  • Homemade jam and honey.
  • Pastries prepared without milk, cream, butter and cream cheese.
  • Fruit sweets, dark chocolate and chewing gum that does not contain milk additives.
  • Goat’s milk has less lactose than cow’s milk, and it is also easier to digest due to its fat composition.
    Some people who have various intolerances may drink goat’s milk.

Medication for lactose intolerance

Lacdigest is a drug that contains the active ingredient tilactase.
This enzyme splits lactose into glucose and galactose. Thus, you can also digest milk and dairy products.
One tablet should be taken for 5 grams of lactose (equivalent to one cup of milk of 100 ml).
The maximum daily dose is 12 tablets, taking more than 6 tablets at a time should be avoided.

Lactose in drugs

Lactose is also found in about 20% of prescription drugs, such as birth control pills, and 6% of over-the-counter medications, such as some heartburn and meteorism tablets.
These drugs usually only affect people with severe lactose intolerance. One should ask the doctor which medications contain lactose and read the package leaflets on the over-the-counter medications to check the lactose content.

How long does lactose intolerance last?

Prognosis. For most people, lactose intolerance remains a constant problem. However, for some children, it may be a temporary illness that begins after taking antibiotics or after a gastrointestinal infection. If the disease is over, the infant may also be cured of lactose intolerance.

I know patients who have completely stopped eating dairy products. After that, they gradually started eating dairy products again and now they can tolerate small amounts of it.

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