What does lactose intolerance mean?
Lactose intolerance (milk sugar intolerance) is caused by a deficiency of the enzyme lactase. Due to insufficient lactase activity in the small intestine, lactose is not broken down into the easily digestible sugars galactose and glucose. Instead, it passes into the large intestine, where the lactose is fermented by bacteria. Fermentation produces lactate (lactic acid) and the gases methane and hydrogen.
Symptoms of lactose intolerance
Lactose intolerance usually leads to bloating, a feeling of fullness, abdominal cramps, and, due to osmotic lactic acid, an influx of water into the intestines. This triggers the diarrhea typical of lactose intolerance. An imbalance in the intestinal flora will lead to increased susceptibility of the intestines, resulting in chronic infections. It is also discussed whether this can cause leaky gut syndrome (intestinal permeability) and allergic reactions. However, lactose intolerance does not always result in specific symptoms. In these cases, it is referred to as lactose maldigestion. Due to the resulting dysbiosis (bacterial overgrowth), the bacteria produce toxins, which can cause various symptoms, such as lumbar spine pain, body aches, fatigue, difficulty concentrating, acne, or even dizziness. Headache can trigger.
Natural lactose digestion
Humans and all mammals can naturally digest lactose through breastfeeding and produce sufficient amounts of the enzyme lactase in the small intestine. After breastfeeding, the amount of lactase produced drops to just 10-15% of the original amount. While in colder regions large parts of the population can still digest milk in adulthood thanks to traditional dairy farming, a large part of the population in Africa and Asia is naturally unable to digest milk adequately in adulthood. Lactose intolerance is only spoken of in sections of the population that live in regions where the majority of the population can digest lactose. Intolerance to dairy products is considered normal. Nevertheless, in Germany around 10-20% of the population cannot digest lactose. In old age the figure is probably 60-80%. The natural activity of lactase decreases proportionally with increasing age.
Types of lactose intolerance:
absolute lactose intolerance (congenital lactase deficiency)
In this case, a genetic defect causes a severe enzyme deficiency at birth. This manifests itself after just a few days with severe diarrhea. There are also likely cases where infants ingest lactose while still in the stomach. This toxic effect can lead to eye, liver, and brain damage. Infants with congenital lactase deficiency absolutely require intensive medical care from a pediatrician!
Primary lactose intolerance (natural lactase deficiency)
Primary lactose intolerance refers to the natural breakdown of lactose activity in old age. Natural lactose intolerance is not a disease, but it still requires dietary measures or enzyme replacement with lactase (e.g., Lactase 5000 Pronatura). People with certain genetic predispositions develop lactase deficiency at an early age.
Secondary lactose intolerance (acquired lactose intolerance)
Secondary lactose intolerance refers to an enzyme deficiency that has developed as a result of other pathologies (diseases). In many cases, enzyme activity improves after recovery, allowing dairy products to be reintroduced into the diet. In some cases, however, lactose intolerance persists lifelong.
The following diseases are considered triggers:
- Intestinal parasites (e.g. amoeba, lamblia or schistosomiasis)
- bacterial intestinal infections
- Chemotherapy and radiotherapy
- Celiac disease / sprue (intestinal atrophy due to gluten intolerance)
- Gastrectomy
- Alcohol abuse
- Malnutrition
Diagnosis of lactose intolerance:
H 2 breath test for lactose intolerance
After ingesting a defined amount of lactose, hydrogen (H2) is measured in the breath. In lactose intolerance, the hydrogen content in the breath increases significantly. Since 15% of lactose-intolerant individuals (non-response types) produce methane due to the presence of harmless intestinal bacteria, making it impossible to determine the hydrogen level, this is not a reliable diagnostic method.
Blood test for lactose intolerance
Because lactose is broken down into galactase and glucose after ingestion, normal lactose digestion results in a subsequent rise in blood sugar levels. Therefore, blood sugar levels are measured after administration of a defined amount of lactose. If the blood sugar level does not rise, or only slightly, lactose intolerance is likely. False negative results occur in latent or manifest diabetes mellitus (a blood sugar disorder).
Genetic test for lactose intolerance
A genetic test for the LCT genotype can also be performed. A cheek swab is sufficient as the test material. Since secondary lactose intolerance cannot be diagnosed with a genetic test, false negative results are common.
Kinesiology and lactose intolerance
Through Kinesiology It is possible to make a reliable diagnosis. Typically, the rectus femoris muscle is hypertonic and becomes weak with TL of the small intestine. A normo-reactive muscle becomes weak with oral administration of lactose and becomes normo-reactive again with the additional administration of lactase. False negative results can occur if the patient has not consumed lactose in the last few days, as small amounts are still tolerated. Many therapists lack the necessary experience, and the procedure is not scientifically recognized.
Self-test for lactose intolerance
In the self-test, if symptoms suggestive of lactose intolerance, such as flatulence and diarrhea, occur, the patient records the frequency and intensity of symptoms on a tally sheet over a period of seven days while maintaining an unchanged diet. The test subject then consistently avoids all foods containing lactose for 7 days. After two weeks of lactose abstinence, 14 grams of lactose in an aqueous solution are taken. If the self-test reveals a significant change in symptoms, lactose intolerance is likely. Since intestinal complaints are often multifactorial, false negative results can occur here as well.
Lactose content of foods:
| Dark chocolate (80% cocoa) | 0-0,6 |
| Mozzarella cheese | 0,8 |
| Brie cheese | 0,6 |
| Butter | 0,2-1g |
| clarified butter | <0,1 |
| Camembert cheese | 0,0 (up to ~1g) |
| Feta cheese (40% fat) | 0,3- 0,8 |
| Mature hard cheese | 0,1-0,5 |
| Parmesan cheese | 0,1 |
| Ricotta cheese | 0,2-1,2 |
| Lactose content 1-5g/100g | grams/100g |
| buttermilk | 3-5 |
| cottage cheese | 5 |
| lowfat quark | 3-4 |
| Mascapone | 2,5 |
| Nutella | 1,4-3 |
| Sour cream (18% fat) | 3 |
| Quark (20% fat) | 2,5-3,8 |
| Yogurt | 3-5 |
| Fresh milk (3,8% fat content) | 4,5-5 |
| Lactose content over 5g/100g | grams/100g |
| Milk ice cream | 5-8 |
| Condensed milk | 8-12 |
| Skimmed milk powder | 50 |
| Magermilch | 47 |
| Chocolate (milk) | 9,5 |
| Whey powder | 73 |
| Processed cheese, 50% fat content | 6,5 |
Contrary to popular belief, sheep's and goat's milk contains only slightly less lactose than cow's milk. Many sausages, marinades, convenience foods, breads, and sauces also contain lactose.
