Nutrition for lactose intolerance
In the case of lactose intolerance, the affected person must follow a diet that is as low in lactose as possible, and in the case of severe symptoms even lactose-free. If the diet is low in lactose, less than 10g of lactose per day should be consumed. Milk and dairy products with a high lactose content should be avoided.
This includes whole milk as well as skim milk, condensed milk, cream, whey, cream and yoghurt. The affected person should consume as few industrially processed products as possible and closely examine lists of ingredients, because milk or milk powder can be added even to inconspicuous products. Some types of cheese naturally contain a lower proportion of lactose due to their manufacturing process, including hard cheeses such as Parmesan.
Butter is even almost lactose-free. More and more lactose-reduced products are also available in food stores. There is also the possibility to take lactase in tablet form. This can be helpful if you don’t want to eat meals that you have prepared yourself, for example, when you go to a restaurant or travel. However, there are many non-standardized preparations on the market that are not or hardly effective for lactose intolerance.For adolescents, it should be noted that a calcium deficiency can occur when avoiding dairy products; calcium must be supplemented if necessary.
Can lactose intolerance be cured?
Lactose intolerance occurs because the body of some people loses the ability to break down lactose in the course of life. Normally, the lactose is split by an enzyme in the wall of the small intestine and thus absorbed into the blood. Since evolutionary milk was only intended to be used in infant food, the gene for the enzyme is down-regulated in later life and is less or no longer active.
This natural process is irreversible, so lactose intolerance cannot be cured. The symptoms can be relieved with a low-lactose diet and a variety of lactose-free alternatives are available. Restaurants now also offer lactose-free meals, and lactase tablets can help with the calculated intake of dairy products.
Since lactose intolerance is genetically determined, there is no way to prevent the occurrence of lactose intolerance through specific behavioral or dietary measures. The suspicion of lactose intolerance can often be established by a thorough anamnesis of the patient. Especially if abdominal cramps, flatulence and diarrhoea occur after the consumption of dairy products, lactose intolerance is an obvious choice.
Before other tests are carried out, the patient is first trained in a lactose-free diet. A lactose-free diet should lead to freedom from symptoms. If the symptoms disappear when dairy products are strictly banned from the diet, lactose intolerance is very likely.
However, the patient should be informed exactly how to follow the low-lactose diet. If primary lactose intolerance is suspected, in which the gene for the lactose-cleaving enzyme lactase is defective and has never worked before, this can be detected by means of a genetic test. A lactose intolerance can be diagnostically confirmed by several tests.
1. hydrogen (H2) breath test: The most commonly used test is the H2 breath test. It is meaningful, easy and inexpensive compared to other tests. The patient is given lactose dissolved in water to drink.
Then a measuring device is used to determine the hydrogen content in the exhaled air. If lactose is not broken down in the small intestine, it is broken down in the large intestine by the natural bacterial flora, producing hydrogen. The measuring device detects the content of hydrogen in the exhaled air, which is formed in case of lactose intolerance after ingestion of lactose.
The test takes about two to three hours. It is performed on an outpatient basis and does not require any invasive measures such as blood sampling or anesthesia. However, the patient should appear fasting, i.e. avoid food for 12 hours.
He should only drink still water and avoid smoking and chewing gum. The patient may experience symptoms typical of lactose intolerance due to the lactose supplied: Abdominal pain, diarrhea and flatulence. The test costs about twenty euros, but can also be more expensive due to various fees charged by the center.
2. lactose tolerance test: There is also the lactose tolerance test, where you drink about 200 ml of a lactose powder dissolved in water. However, it is not very meaningful and is rarely used. Before drinking and every 30 minutes over a period of about 2 hours, the blood sugar level (glucose level) is determined.
Since lactose is split into glucose and galactose in the presence of lactase, the glucose level rises if one is not lactose intolerant. If the glucose level hardly or not at all rises over a period of two hours, this is a strong indication of lactose intolerance, since lactose cannot be broken down in the small intestine. 3. biopsy of the small intestine: By biopsy of the small intestine, i.e. taking tissue samples from the mucous membrane wall of the small intestine, the activity of the lactose splitting enzyme lactase can be measured.
Although the test is meaningful, it is costly and associated with risks. People with lactose intolerance are unable to break down lactose in the small intestine, or only partially. This is because they do not have the enzyme lactase, which breaks down lactose, or only in small quantities.
Lactose is a double sugar (disaccharide) and must therefore be split in the body into two simple sugars (monosaccharides) in order to be absorbed into the blood. There are three different causes that can lead to lactose intolerance due to lactase deficiency. A hereditary form of lactase deficiency, the so-called congenital lactase deficiency, is particularly rare.This is distinguished from the others by the fact that the affected persons do not possess the enzyme lactase at all.
This means that considerable complications can already arise during the breastfeeding period. The developmental lactase deficiency occurs in premature babies because lactase production only begins in the uterus in the last weeks of pregnancy. However, the most common cause of lactase deficiency is primary adult lactase deficiency.
This is inherited recessively, which means that as a child you have to get the gene with lactase deficiency from both the father and the mother and you have not got any of the “healthy” genes, because a “healthy” gene always switches off the gene with lactase deficiency, i.e. it is dominant against it. This form of lactase deficiency is characterized by the fact that the activity of the enzyme lactase continuously decreases after lactation and comes to a complete standstill until about the age of 20. In addition to the genetic causes of lactose intolerance, it can also be caused by certain diseases of the small intestine, such as Crohn’s disease, or by diseases of the mucous membrane of the small intestine (small intestinal mucosa), as this is where the regulated digestion of lactose normally takes place.
From a biochemical point of view, the cause of lactose intolerance is always due to the deficiency or complete absence of the enzyme lactase. Lactose is a bivalent sugar (disaccharide) consisting of glucose and galactose, which are linked together. Lactase is the enzyme that breaks this link in the small intestine, allowing the body to absorb glucose and galactose into the blood to produce energy.
If the enzyme lactase is missing, the lactose cannot be broken down in the small intestine. As a result, the lactose reaches the large intestine. By changing one’s diet and taking lactase preparations one can also live well with lactose intolerance.
Sometimes additional calcium preparations should be taken so that the body is not supplied with too little calcium through a change of diet. Even if lactose intolerance is commonly seen as an illness or intolerance, it is assumed today that because of the very high rate of people suffering from lactose intolerance worldwide, the so-called wild type of human being, i.e. the one with the original gene pool, did not have the ability to continue digesting lactose after breastfeeding. This is also confirmed by the fact that none of the mammals except humans themselves possess the enzyme lactase for lactose splitting after lactation.
The ability to digest lactose correctly after lactation is the result of a gene mutation, which has become more widespread because it has proven to be exemplary to enjoy milk without complaints even after lactation. Therefore, the distribution to people with lactose intolerance is particularly low where a lot of milk is still consumed after the breastfeeding period (e.g. Germany) and particularly high in regions (e.g. China) where little or no milk is consumed after the breastfeeding period.
Lactase deficiency prevents the lactose from breaking down, which leads to characteristic symptoms (flatulence, diarrhoea and/or abdominal pain). Lactose intolerance can be diagnosed with various test procedures and its severity, which varies from person to person, can be determined. As a therapy, it is recommended to limit the consumption of products containing lactose and/or to take lactase preparations in order to enable the proper digestion of lactose. It is advantageous to seek advice from a specialist.
