People with lactose intolerance cannot digest lactose, the sugar naturally found in milk. At a global context this is not the exception but the rule. Worldwide approximately 75% of the population are lactose intolerant. In Asia the number is even higher - 95%. In Europe the number of people affected by lactose intolerance is small in comparison; about 15% of the population has problems with lactose.
Originally, it was only natural for people to lose their ability to digest milk sugar after their childhood. Because in winter food was sparse in Northern Europe and people had to drink milk to consume enough calories a tolerance to lactose was developed with time. Many scientists believe the theory that a gene mutation made milk tolerable for some population groups.
Lactose intolerance can be genetic or it can develop over time. The genetic intolerance, also called primary lactose intolerance, is a rare condition where a newborn does not produce lactase from birth. Worldwide, adult-onset lactose intolerance is the most common form.
Normally, the body breaks down milk sugar with the help of the enzyme lactase. When not producing enough lactase, a person can have digestive problems such as diarrhoea or bloating after consuming foods containing lactose (milk sugar).
Because the enzyme lactase is produced in the lining of the small intestine, anything that damages the intestine can cause secondary lactose intolerance. For example: gastroenteritis, coeliac disease (intolerance to gluten in wheat and some other grain products), chemotherapy, intestinal operations and even harsh antibiotics. This kind of lactose intolerance is only temporary and often improves after several weeks as the lining of the gut heals.
People that suffer from lactose intolerance feel abdominal discomfort almost immediately after the consumption of milk and many dairy products. Typical symptoms of lactose intolerance include abdominal pain, bloating, flatulence, and sometimes diarrhoea and nausea.
These symptoms occur when the small intestine does not produce any or not enough lactase. Lactase is an enzyme that breaks down lactose into its simpler components, glucose and galactose. Glucose and galactose can be absorbed into the bloodstream and used as energy. If there is not enough lactase, undigested milk sugar ends up in the large intestine where it is partially broken down by bacteria. Through the processes of fermentation gases accumulate. This causes bloating, cramping flatulence and associated pain. Because lactose pulls water into the intestine, water is not removed from the faecal matter (poo). Diarrhoea is the result.
There are various methods to diagnose lactose intolerance.
Keeping a food diary is a simple method that can indicate lactose intolerance. Write down exactly what you ate and which symptoms occurred after the consumption. A food diary can be a great first step. But it is still recommended to visit a doctor/registered dietitian or doing a medical test at home.
A different ‘test’ is an elimination diet. This involves simply not eating any milk and dairy products to see if symptoms improve. If you feel better and symptoms reoccur once the foods are reintroduced, you know that it is milk. But you don’t know if the milk sugar or milk proteins are causing the problems.
H2 breath tests are most common and provides a more definite diagnosis. This tests the amount of hydrogen that is breathed out. Before the test the patient has to drink a beverage with milk sugar. Under normal conditions, after consuming dairy, people will have only a small amount of hydrogen in their breath. When lactose is fermented by bacteria in the bowel, instead of being broken down by lactase, more hydrogen is produced. If before and after drinking milk sugar the hydrogen difference is 20 ppm, the person is lactose intolerant.
Another way to diagnose lactose intolerance is a blood sugar test. For this test, patients will drink a lactose containing beverage. Afterwards a doctor measures the blood sugar. If a patient is lactose intolerant, blood sugar levels won’t rise because lactose is not broken down in the intestine.
Most people who are lactose intolerant can still consume some milk or dairy products. But every individual is different.
There are many ways you can cope with lactose intolerance. You can stop eating lactose containing foods or buy lactose free alternatives instead. Nowadays, many products are available ‘lactose free’. Hard and mature cheeses such as parmesan an cheddar contain almost no lactose. Similarly, butter contains very low levels of lactose.
In addition, many health food stores and even supermarkets offer a variety of plant based alternatives like soy, rice, and almond or oat milk.
Taking lactase pills or drops before you eat can also help manage symptoms. But it can be difficult to take the right amount. Therefore, lactase pills should not be used as a substitute for a diet change. A diet free from or with only small amounts of lactose helps the intestine to heal.
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