Lactose intolerance 101 - Causes, symptoms and treatment

Lactose intolerance is very common.

In fact, it is thought to affect about 75% of the world's population (1).

People with lactose intolerance experience digestive problems when they eat dairy products, which can have a negative effect on quality of life.

What is lactose intolerance?

Lactose intolerance is a digestive disorder caused by the inability to digest lactose, the main carbohydrate in dairy products.

It can cause several symptoms, such as bloating, diarrhea and abdominal cramps.

People with lactose intolerance do not produce enough lactase enzyme, which is necessary to digest lactose.

Lactose is a disaccharide, which means it consists of two sugars. It consists of a molecule, each of the simple sugars glucose and galactose.

The enzyme lactase is needed to break down lactose into glucose and galactose, which can then be absorbed into the bloodstream and used for energy.

Without enough lactase, lactose moves through your undigested intestine and causes digestive symptoms (2, 3, 4).

Lactose is also found in breast milk and almost all are born with the ability to digest it. It is very rare to see lactose intolerance in children under the age of five.

Currently, about 75% of the world population is lactose intolerant. The risk varies a lot between countries, as shown in this map:

Global prevalence of lactose intolerance

Source of the photo.

Bottom line: Lactose intolerance is the inability to digest lactose, the main carbohydrate in dairy products. It is caused by the reduced production of the enzyme lactase in your intestine.

Causes of lactose intolerance

There are two main types of lactose intolerance, which have different causes.

Primary lactose intolerance

Primary lactose intolerance is the most common. It is caused by a decrease in lactase production with age, which is why lactose is poorly absorbed (5).

This form of lactose intolerance can be partially caused by genes, because it is more common in some populations than in others.

Population studies have estimated that lactose intolerance affects 5-17% of Europeans, approximately 44% of Americans and 60-80% of Africans and Asians (1).

Secondary lactose intolerance

Secondary lactose intolerance is rare. It is caused by a disease, such as a stomach infection or a more serious problem such as celiac disease. This is because inflammation in the intestinal wall can lead to a temporary decrease in lactase production (6).

Bottom line: Primary lactose intolerance is common and involves reduced lactase production with age. Secondary lactose intolerance is caused by inflammation in the intestine, secondary to infection or disease.

What are the symptoms of lactose intolerance?

If not handled properly, lactose intolerance can cause serious digestive problems.

The most common symptoms are (3, 7, 8):

  • Swelling

  • Abdominal cramps

  • Gas

  • Diarrhea

Some people also experience urgency to go to the bathroom, nausea, vomiting, pain in the lower abdomen and, sometimes, constipation.

Diarrhea occurs due to undigested lactose in your small intestine, which causes water to move into your digestive tract.

Once it reaches your colon, lactose is fermented by bacteria in the intestine, forming short-chain fatty acids and gas. This causes swelling, flatulence and pain.

The severity of the symptoms may vary, depending on the amount of lactose you can tolerate and the amount you have eaten (9).

Bottom line: Lactose intolerance can cause digestive problems. The main symptoms are bloating, gas, abdominal cramping and diarrhea.

Avoid lactose media Avoid dairy products, which are high in nutrients

Dairy is the term used to describe milk or products made from milk.

Dairy products are important and nutritious sources of protein, calcium and vitamins such as A, B12 and D (10).

This combination of nutrients is excellent for your bones (11).

Including dairy products in your diet is linked to increased bone mineral density, which can help reduce the risk of bone fractures as you get older (12, 13, 14).

Dairy products have also been linked to a reduced risk of type 2 diabetes and obesity (15, 16, 17, 18).

However, people with lactose intolerance may need to reduce or eliminate dairy products from their diets, which could lose some nutrients (19, 20, 21, 22).

Bottom line: Dairy products contain many nutrients and are the best source of calcium in the world. Eliminating dairy products means you need to get these nutrients from other foods instead.

What foods contain lactose?

Lactose is found in dairy products and products that contain dairy products.

Dairy foods that contain lactose

The following dairy products contain lactose:

  • Cow's milk (all types)

  • Goat milk

  • Cheese (including hard and soft cheeses)

  • Frozen

  • Yogurt

  • Butter

Foods that sometimes contain lactose

Foods that have some type of dairy product as an ingredient may also contain lactose, including:

  • Foods made with a milky sauce, like the quiche.

  • Cookies and cookies

  • Chocolate and sweets, like sweets and boiled sweets.

  • Breads and baked goods

  • Pastry

  • Breakfast cereals

  • Instant soups and sauces

  • Processed meats, such as ham or pre-cut sausages

  • Ready meals

  • Sauces and sauces

  • Fried potatoes, nuts and flavored tortillas.

  • Desserts and custard

Other names for added dairy products

You can check if a product contains dairy by looking at the label.

In ingredient lists, added milk or dairy products can be described as:

  • Milk

  • Milk solids

  • Milk powder

  • Serum

  • Whey protein

  • Milk casein

  • Curd

  • Milk sugar

  • Buttermilk

  • cheese

  • Malted milk

  • Powdered milk solids

  • Sour cream

  • Concentrated serum protein

  • Milk byproducts

Do not get confused if a product contains lactic acid, lactalbumin, lactate or casein. These ingredients are not lactose.

Bottom line: Dairy products contain lactose. It is important to check the label of manufactured foods to see if they contain any hidden lactose.

People with lactose intolerance could eat some dairy

All dairy products contain lactose, but this does not mean that they are totally out of bounds for people with lactose intolerance.

Most people with lactose intolerance can tolerate small amounts of lactose. For example, some people may tolerate the small amount of milk in the tea, but not the amount they would get from a bowl of cereal.

It is thought that people with lactose intolerance can tolerate up to 18 grams of lactose, spread throughout the day (23).

In fact, research has shown that many people with lactose intolerance can tolerate up to 12 grams of lactose in a single session, which is approximately the amount in 1 cup (230 ml) of milk (2, 23, 24, 25, 26, 27). ).

Some types of dairy products are also naturally low in lactose when eaten in their usual portions. Butter, for example, only contains 0.1 gram of lactose per 20 gram serving.

Certain types of cheese also have less than 1 gram of lactose per serving. This includes cheddar cheese, swiss cheese, Colby, Monterey Jack and mozzarella.

Interestingly, yogurt tends to cause fewer symptoms in people with lactose intolerance than other types of dairy products (28, 29, 30, 31).

Bottom line: Most people with lactose intolerance can tolerate small amounts of lactose. Dairy products such as butter, yogurt and some cheeses are often better tolerated than milk.

Good non-dairy sources of calcium

Dairy products are excellent sources of calcium, but eating dairy products is not essential.

It is still possible to have a very healthy diet without dairy products. It should only include other foods with a high calcium content (32, 33).

The recommended intake of calcium is 1,000 mg per day.

Some good non-dairy sources of calcium include:

  • Food fortified with calcium: There are many foods fortified with calcium, including juices, breads and non-dairy milks, such as almond milk, soy or oatmeal. Shake the box before use, since calcium can settle to the bottom.

  • Boneless fish Canned fish with bones, such as sardines or whitebait, has a high calcium content.

  • Plant foods with high calcium content: Many plant foods contain reasonable amounts of calcium. However, this calcium is often poorly absorbed due to the presence of antinutrients such as phytate and oxalate.

Here is a list of lactose-free foods that are rich in bioavailable calcium:

  • Fortified non-dairy milk: 300 mg of calcium in an 8 oz. Serving (240 ml)

  • Fortified fruit or vegetable juice: 300 mg of calcium in an 8 oz. Serving (240 ml)

  • Fortified Tofu: 200 mg of calcium in a 1/2 cup serving

  • Cooked cabbage leaves: 200 mg of calcium in a 1/2 cup serving

  • Dried figs: 100 mg of calcium in five figs.

  • Kale: 100 mg of calcium in a 1/2 cup serving

  • Broccoli: 100 mg of calcium in a 1/2 cup serving

  • Soy: 100 mg of calcium in a 1/2 cup serving

  • Tempeh: 75 mg of calcium in a 1/2 cup serving

  • Cooked bok choy or mustard leaves: 75 mg of calcium in a 1/2 cup serving

  • Almond butter: 75 mg of calcium in 2 tablespoons

  • Tahini: 75 mg of calcium in 2 tablespoons

Bottom line: If you eliminate dairy products from your diet, you should replace them with adequate alternative sources of calcium.

Treatments for lactose intolerance

If you do not want to give up dairy products, there are some natural treatments that can help you.

Enzyme supplements

It is possible to buy enzymes to help digest lactose. These are tablets that you swallow or drops that you add to foods and beverages.

However, the effectiveness of these products seems to vary from person to person (34, 35, 36, 37, 38, 39, 40, 41).

However, lactase enzyme supplements can be very effective for some people.

One study examined the effects of three different types of lactase supplements in lactose intolerant people who took 20 or 50 grams of lactose (42).

Compared to placebo, the three lactase supplements improved overall symptoms when taken with 20 grams of lactose.

However, they were not effective with the highest dose of 50 grams of lactose.

Exposure to lactose

If you are lactose intolerant, including it regularly in your diet may help your body adapt to it (43).

So far, studies on this subject are scarce, but initial studies have shown some positive results (44, 45, 46).

In a small study, nine people intolerant to lactose experienced a threefold increase in lactase production after 16 days of lactose ingestion (47).

More rigorous trials are needed before definitive recommendations can be made, but it may be possible to train Your intestine to tolerate lactose.

Probiotics and Prebiotics

Probiotics are microorganisms that provide health benefits when consumed (48).

Prebiotics are types of fiber that work as food for these bacteria. They feed the beneficial bacteria that they already have in their intestines, so that they thrive.

It has been shown that both probiotics and prebiotics reduce the symptoms of lactose intolerance, although most studies so far have been small (49, 50, 51).

Some types of probiotics and prebiotics may be more effective than others for people with lactose intolerance (52).

It is believed that one of the most beneficial probiotics is Bifidobacteria, they are often found in yogurts and probiotic supplements (53, 54).

Bottom line: There are several ways to reduce lactose intolerance, including enzyme supplements, exposure to lactose and the consumption of probiotics or prebiotics.

Bring the message home

Eliminating dairy products from your diet can mean you lose important nutrients. However, it is not always necessary to completely avoid dairy products if you are lactose intolerant.

Most people with lactose intolerance can tolerate small amounts of dairy products.

If you need to eliminate dairy completely, it is perfectly possible to have a healthy and balanced diet without them.

Just be sure to include other sources of calcium to get everything you need.

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