Lactose intolerance - how to get through life symptom-free

Lactose is the natural sugar in milk. It is a double sugar, i.e. it consists of two sugars: glucose and galactose.

Lactose cannot be absorbed (ingested) by the body in its compound form and is therefore firstly broken down into glucose and galactose in the intestine. This happens through the enzyme lactase, which is present in the small intestine.

As infants, humans are able to produce enough lactase to properly process the lactose in breast milk.

After an infant stops breastfeeding, lactase production in their body decreases. The body can no longer process as much lactose as it did when breastfeeding.

This does not cause a problem for around 80% of the people in the UK. But there are also many people whose lactase production is so low that they can hardly process any lactose, if at all.

The result is what we call lactose intolerance. The lactose reaches the large intestine untreated, where it is finally broken down by bacteria through a “fermentation process”.

(Tip: Learn more about human digestion in our coach article)

The difference is evolution: milk and dairy products have been a staple for northern Europeans for thousands of years. The bodies of Northern Europeans have become accustomed to consuming lactose and as a result keeps producing the enzyme lactase. The ability to process lactose thus emerged as an evolutionary advantage.

• Without lactose intolerance: an average of 20-30g lactose / day
• “Conventional” lactose intolerance: 8-10g lactose / day
• Severe lactose intolerance: 5g lactose / day

When processing lactose, everyone has a different tolerance limit. Even people with lactose intolerance can often tolerate small amounts of lactose. Others, however, have to cut out dairy products completely.

• Flatulence – The gases that are produced escape as farts
• Diarrhoea – The lactose in the intestine binds with water, which can lead to diarrhoea
• Pressure discomfort in the intestinal area – The resulting gases inflate the large intestine and press heavily on the intestine
• Nausea
• Vomiting
• General complaints – e.g. Dizziness, tiredness, headaches

The safest and most direct way to diagnose a lactose intolerance is to see a doctor. There are a few ways in which a lactose intolerance can be identified. We will introduce you to the two most common procedures:

A breath test with a before / after test is carried out.

• First, a breath sample is taken on an empty stomach (after 12 hours of fasting).
• The patient then drinks a lactose solution.
• Breath samples are now taken every 10-30 minutes.
• If the patient cannot process lactose, the lactose is broken down in the large intestine. Among other things, hydrogen (H2) is produced. Some of the hydrogen is passed on to the lungs via the bloodstream and exhaled from there.
• If the hydrogen content in the breath sample is higher than in the test sample before, it is often concluded that there is lactose intolerance.

In this test procedure, the patient is also given a lactose solution. After a while, blood is taken and is checked for a change in the blood sugar level.

If you are lactose intolerant, the blood sugar level does not change because the lactose has not been processed and the glucose does not get into the blood. Note, this test is very inaccurate with diabetics.

First of all, it is important to avoid lactose. Those who do not consume any or only small amounts of lactose will not have any symptoms. With a lactose-free diet, it is extremely important to know which products are safe to consume.

If you don’t want to cut out dairy products completely, you can ask about lactase supplements at your pharmacy. These are industrially manufactured lactase tablets or powders that are supposed to help your body process the lactose.

Important: Before taking these supplements, you should speak to your doctor or pharmacist. In addition, you should not see the lactase supplements as a substitute for a lactose-free or low-lactose diet.

Another form of lactose intolerance is a secondary lactose intolerance. This is usually caused by a previous illness of the intestine. In such cases, the intestine is damaged by the original disease and is no longer able to function as it should.

Among other things, the enzyme activity is reduced. The important enzyme lactase is produced in smaller quantities and the lactose can no longer be processed.

Secondary intolerance can often indicate intestinal diseases or inflammation (such as Crohn’s disease). Once the main reason has been found and treated, the lactose intolerance will usually improve.

Since lactose is the natural sugar found in milk, it is therefore present in almost all dairy products. You should even be careful with products that have been processed in the same factory as milk.

You may not have to give up dairy products completely! Due to their processing, some products contain little or no lactose.

Milk is processed into yoghurt or cheese with the help of lactic acid bacteria. During this process, the lactic acid bacteria consumes the lactose contained in the milk.

As a result some dairy products can still be consumed because the natural lactose is no longer present in the product.

This includes e.g. cheese (as a rule the harder the cheese, the less lactose). Unfortunately, it does not always mean that there is no lactose anymore. Sometimes lactose is added back in to improve the texture of the food. However, manufacturers must specifically label this.