Lactose intolerance

Lactose is a natural milk sugar. It occurs in the following milk products:

• Full, semi-skimmed, skimmed milk and buttermilk.
• Goat’s milk, sheep’s milk, horse’s milk and donkey’s milk.
• Soft goat and sheep cheese (e.g. feta).
• Chocolate milk, yogurt drink and fruit dairy drinks.
• Processed cheese, cheese spread, foreign cheese, fresh cheese, cottage cheese and cottage cheese.
• Yogurt, cottage cheese and milk kefir.
• Custard, porridge, pudding and mousse.
• Whipped cream, sour cream and crème frache.

There is no lactose in Dutch hard cheese, such as Gouda cheese. Lactose breaks down in your gut into sugars, which can be absorbed throughout the body.

Lactase is needed to digest lactose. Lactase breaks down lactose into the sugars glucose and galactose, which your body uses as building blocks or energy.

Lactose intolerance

Lactose intolerance means that lactose is not broken down into digestible sugars in your intestines. This leads to symptoms such as excessive gas and acid production, bloating, flatulence and diarrhea.

This is because the enzyme lactase is insufficient or not present at all. Whether complaints occur depends, among other things, on the amount of lactase that your body still produces.

It also depends on the composition of the diet and the types of bacteria that live in your gut. If the production of lactase falls short, then the lactose from the diet is insufficiently digested.

The body cannot absorb undigested lactose. This is called ‘lactose malabsorption’. Lactose malabsorption does not always cause symptoms. Many people probably have a lactase deficiency without noticing it. Coming to Europe lactose intolerance in about 2 percent of the total population. The production of the enzyme lactase is highest immediately after birth, because the food then consists exclusively of breast milk.

The production of the enzyme lactase decreases between the second and fifth year of life, because children then start eating more vegetables and meat. Even if you stop drinking milk at all, your body continues to produce lactase. This is hereditary. In older people, the production of lactase can decrease sharply.

Lactose malabsorption

Every baby has enough lactase at birth to properly digest lactose in breast milk or food. In more than 80 percent of the world’s population, the production of lactase gradually decreases after the third year of life. In fact, lactose malabsorption is a normal phenomenon.

Research among 400 white Dutch people has shown that 9 percent of the age group from 18 to 30 years and 15 percent of the age group over 40 years can not or not completely digest lactose.

Still, few people with lactose malabsorption experienced intestinal symptoms, even though they consumed a normal amount of milk products. This means that a lactose-restricted diet is not always necessary in the event of a lactose malabsorption.

For a healthy diet, you should consume two to three glasses of milk or milk products every day. If you take much more milk or milk products than the recommended amount, you may experience symptoms if you suffer from lactose malabsorption.

Causes of lactose malabsorption

In most cases, lactose malabsorption is hereditary. There are also other causes, such as an intestinal infection, intestinal inflammation or intestinal surgery, which can damage the intestinal wall.

This greatly reduces the production of lactase and a temporary lactose malabsorption occurs. The intestinal wall will recover once you have recovered from the disease or surgery. Lactase production then returns to normal levels.

Evidence for lactose intolerance

If you want to know if you are lactose intolerant, you can have it tested. You must then consume a certain amount of lactose. You can see from your blood whether the blood sugar level is rising, because the lactose is converted into sugars after ingestion, which end up in the blood again.

Does your blood sugar level remain below 20 mg/100 ml after consuming lactose? Do you suffer from the aforementioned symptoms? Then you are probably lactose intolerant. These symptoms can already occur if you drink one glass of milk.

Research methods into lactose intolerance

• Hydrogen Breath Test

In this test, you measure the amount of hydrogen in your exhaled air before and for three hours after the administration of a certain amount of lactose. If the amount of hydrogen in the exhaled air increases during that period, the lactose does not digest properly.

• trial diet

Has lactose intolerance been determined by means of a hydrogen test? Then you can use a test diet to determine the amount of lactose that does not cause any complaints.

This trial diet consists of a complete diet without milk and lactose-containing milk products. You can increase the amount of lactose in the diet to that amount at which the complaints do not yet occur.

Do you get stomach and intestinal problems again after consuming a small amount of milk or milk products? Then you can definitively say that you are lactose intolerant.

• Research methods on lactose intolerance in infants

The hydrogen breath test is unreliable for infants under 12 months of age. However, the doctor can measure the acidity of the stool and determine whether the infant is lactose intolerant. Based on the results of the examinations performed, the doctor will determine which infant formula is most suitable.

Resolve the complaints

It would be easiest to avoid milk and other lactose-containing foods, but this is almost impossible. Lactose is in many products and the minerals you also need those that are in milk. Another solution is to convert lactose before drinking the milk. You can also temporarily supplement the lack of lactase in your body with tablets, so that lactose is broken down.

Glossary

lactose – The sugar found in most milks, such as breast milk and cow’s milk. Lactose is a so-called ‘double sugar’. It consists of a molecule of glucose and a molecule of galactose.

Lactase – The substance (enzyme) that splits the lactose into glucose and galactose, so that the sugar molecules can be absorbed into the body.

Lactose malabsorption – Is there too little lactase active in the gut? Then the lactose from your diet does not break down or does not completely break down. Usually this does not cause any complaints.

Lactose intolerance – This is the case if intestinal complaints develop after the use of ‘normal’ amounts of milk and milk products. That’s two to three glasses a day.