Wish and Cook — Oct. 12, 2020, 10:52 a.m.

What we should know about lactose intolerance

Lactose intolerance is the malabsorption of the lactose and may affect around 1/3 of the people worldwide. Know more about this food intolerance: what it is, the causes, the symptoms and the treatments.

1. What is lactose intolerance?

Lactose is a disaccharide consisting of d-glucose and d-galactose (1). The intolerance of this nutrient can be defined as gastrointestinal symptoms due to lactose malabsorption.

In Northern Central Europe, the lactose intolerance is found in between 2% and 20% of the general population, while it accounts for approximately 40% of the population in Mediterranean countries, 65–75% in a large part of Africa and up to more than 90% in Asia (2,3).

2. Lactose may be maldigested in four main situations:

a) Recessive genetic mutations in the intestinal lactase enzyme.

b) Adult onset hypolactasia (it's the most common form).

c) Diseases causing loss or injury to the small bowel (gluten sensitive enteropathy, lymphoma infections like giardia, small bowel bacterial overgrowth and others) which leads to reduction of lactase.

d) Related to bacterial proliferation, degradating lactose and producting gases, responsible for the symptoms. In that case, the cause is not related to the lactase but to the excess of bacteria (1).

3. Lactose intolerance symptoms

Lactose intolerance can decrease the life's quality of the people who suffer from this food intolerance. Lactose intolerance is defined as a clinical syndrome characterized by the most frequent symptoms that are abdominal pain (~100%), gut distension (~100%), borborygmi (~100%), flatulence (~100%) but also diarrhea (70%), constipation (30%), nausea (78%), vomiting (70%) and other systemic symptoms as headache, tiredness, asthenia, muscle pain joint and/or muscle pain, loss of concentration, skin lesions, and mouth ulcers (3). Besides that, bacteria also ferments lactose into gases: hydrogen carbon dioxide, and in those who contain an abundance of Achea- methane. In addiction, short-chain fatty acids are produced which contribute to symptoms of lactose intolerance (1).

4. Therapeutic

Dietary restriction of lactose-containing foods is the main therapeutic intervention for lactose intolerant people. The avoidance of all dairy products is no longer recommended. The restriction will depend on lactose tolerance.

Most of the lactose intolerant people tolerate up to 12-15g of lactose per day. So, people with lactose intolerance should be encouraged to restrict rather than avoid lactose, allowing to include some dairy foods in their diet (1).

5. Lactose products and lactose-free products

Lactose is in milk and derivated food products, even non-dairy products, once that lactose is used as a food additive in different products.

Most intolerant patients can tolerate 5g of lactose per single dose, with an increase in the tolerance threshold when lactose is consumed together with other nutrients (4). Lactose in fermented dairy products contains quantitatively less lactose per volume. Products like yogurt contains lactic acid bacteria which reduces the lactose content through bacterial galactosidase metabolism.

Lactose free dairy products has been made which allow to enjoy the taste of dairy without the uncomfortable intestinal symptoms and provide essential nutrients present in dairy products to people that are lactose intolerant. For example, cheese without lactose content is made by incubating lactose during manufacturing; ice cream without lactose is made with milk without lactose content.

6. Combining with other ingredients can help or be harmful

The combination with other ingredients can be helpful to tolerate more lactose like fat in milk as it slows gastric emptying, reducing the quantity of lactose exposure to the small intestine per unit time (5,6).

On the other hand, some foods could be harmful like coffee or hot peppers, increasing intestinal transit delivering lactose to the lower intestine and increasing symptoms.

7. When reading the label, be careful with those ingredients

It must be emphasized, moreover, that lactose is also a widely used food additive (the so-called “hidden lactose”), which makes it even harder for patients to cope with this kind of intolerance, as lactose is frequently added to meats, frozen vegetables (including French fries), ready-made meals, sweets, and cakes.

8. Our website has a solution to find recipes without lactose content

At our website, lactose intolerant people have recipes without lactose content and without missing the taste of the recipe! If you have lactose intolerance, sign in and include lactose intolerance in your dietary settings! Our algorithm will make the changes of the ingredients automatically in every recipe.

1. Szilagyi, Andrew, and Norma Ishayek. "Lactose intolerance, dairy avoidance, and treatment options." Nutrients 10.12 (2018): 1994
2. Swallow, Dallas M. "Genetics of lactase persistence and lactose intolerance." Annual review of genetics 37.1 (2003): 197-219
3. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). "Scientific opinion on lactose thresholds in lactose intolerance and galactosaemia." EFSA Journal 8.9 (2010): 1777
4. Shaukat, Aasma, et al. "Systematic review: effective management strategies for lactose intolerance." Annals of internal medicine 152.12 (2010): 797-803
5. Dehkordi, N., et al. "Lactose malabsorption as influenced by chocolate milk, skim milk, sucrose, whole milk, and lactic cultures." Journal of the American Dietetic Association 95.4 (1995): 484-486
6. Laxminarayan, Srinivas, et al. "Bolus estimation—rethinking the effect of meal fat content." Diabetes technology & therapeutics 17.12 (2015): 860-866