Lactose allergy

Lactose intolerance is a common digestive problem in Poland, affecting many people of all ages. This comprehensive guide aims to provide comprehensive information and practical tips on how to deal with this ailment. Whether you suspect you have lactose intolerance, have recently received a diagnosis, or just want to learn more about it, this article is for you.

What Is Lactose and How Does It Work in Your Body?

• Definition of Lactose:
  Lactose is a disaccharide also known as milk sugar, which is naturally found in the milk of all mammals . It can be found primarily in cow’s milk and its products, but also in goat’s, sheep’s and even human milk. Chemically, lactose is made up of two simpler sugars: glucose and galactose, which are linked together by a chemical bond. Understanding this basic structure is crucial to understanding why dairy products are a problem for people with lactose intolerance.
  
• Role of Lactase in Lactose Digestion:
  In order for lactose to be absorbed by the body, it must be broken down into these simpler sugars in the small intestine. An enzyme called lactase is responsible for this process. Lactase acts as a catalyst by breaking the bond between glucose and galactose. Only in this simplified form can sugars be absorbed through the walls of the intestine into the bloodstream and used as a source of energy for our body. Without the right amount or activity of lactase, the process of lactose digestion is disturbed, which leads to further problems.
  
• Role of Lactose in the Body (when broken down):
  When broken down, glucose and galactose perform important functions in the body. Lactose, by providing galactose, contributes to the construction of cells of the nervous system. In addition, it promotes the growth of beneficial Lactobacillus bacteria in the intestines, which has a positive effect on their function. Interestingly, lactose also aids in the absorption of important minerals such as calcium, magnesium, and zinc. In the fermentation process of undigested lactose, butyric acid is formed in the intestines, which nourishes intestinal cells, which is important in the case of lactose intolerance. . These diverse roles show that lactose is not harmful in itself; The problem arises when the body is unable to digest it properly.

Lactose Intolerance: Causes and Mechanisms of Formation

• Definition of lactose intolerance:
  This is a food intolerance that affects people who do not produce enough lactase – an enzyme needed to digest lactose.
  Lactose intolerance is a food hypersensitivity that occurs when the body is unable to digest lactose sufficiently due to insufficient activity of the enzyme lactase . People with this ailment experience a range of gastrointestinal symptoms after consuming foods that contain lactose. This is because undigested lactose is fermented by bacteria in the gut, leading to characteristic ailments.
  
• Mechanism of lactose intolerance:
  The causes and symptoms of lactose intolerance are related to a lack of lactase – an enzyme that breaks down lactose in the body. The main mechanism for the formation of lactose intolerance is the absence or deficiency of the enzyme lactase, which is produced in the mucous membrane of the small intestine . When there is not enough lactase, the ingested lactose is not properly broken down and goes to the large intestine in an unchanged form. There, it becomes a breeding ground for bacteria, which in the fermentation process break it down into gases (mainly hydrogen, and in some people also methane) and lactic acid. The accumulation of these fermentation products is the cause of unpleasant symptoms.
  
• Types of lactose intolerance:
  There are different types of lactose intolerance, which differ in cause and time of occurrence.
  
  • Primary lactose intolerance (hypolactasia): This is the most common type of lactose intolerance. It is often genetic and is characterized by a natural decrease in lactase activity with age, after childhood. Genetic predisposition related to polymorphisms in the LCT gene encoding lactase plays a key role here. For many people, symptoms may not appear until puberty or early adulthood, when lactase levels gradually decrease.
    
  • Secondary lactose intolerance (acquired): This type of lactose intolerance is a consequence of damage to the mucous membrane of the small intestine, which produces lactase . The cause of such damage can be various diseases and conditions, such as bacterial or viral infections of the gastrointestinal tract, celiac disease, Crohn’s disease, food allergies, as well as the use of certain medications, for example, antibiotics or acetylsalicylic acid, and even surgical procedures. In many cases, secondary lactose intolerance is temporary and resolves with the regeneration of the damaged intestinal mucosa.
    
  • Congenital lactose intolerance (alactasia): This is a very rare form of lactose intolerance, which has a genetic basis and can also be associated with an allergy to cow’s milk proteins. . Babies are born with a complete or almost complete lack of the ability to produce the enzyme lactase . Symptoms appear already in newborns after milk consumption, which requires specialized dietary management from the first days of life.
    
  • Developmental lactase deficiency: This type of lactose intolerance occurs in premature babies who were born between 28 and 37 weeks of gestation. Their intestines are not yet fully developed and they do not produce enough lactase . This is usually a temporary state, and the ability to digest lactose improves as the infant’s digestive system continues to develop.

Symptoms of lactose intolerance: how to recognize them?

• Common Symptoms in Adults:
  The symptoms of lactose intolerance in adults can be varied, but most often include digestive ailments that occur after eating dairy products. The most common symptoms include abdominal pain, bloating, excessive gas, a feeling of overflowing in the intestines, abdominal cramps and diarrhea. It is also common to have a feeling of fullness in the abdomen . Typically, these symptoms appear within 30 minutes to 2 hours after eating foods that contain lactose.
  
• Symptoms in Infants and Children:
  In infants and children, lactose intolerance can manifest itself through loose, foamy stools after each feeding, colic, abdominal pain, bloating and excessive gas. Infants may also develop nappy rash due to frequent diarrhea . In older children, lactose intolerance can lead to fatigue and weakness, which can result from nutrient deficiency. In severe cases, dehydration and malnutrition can occur in infants.
  
• Less common symptoms:
  In addition to the typical gastrointestinal symptoms, lactose intolerance can sometimes cause less frequent symptoms such as nausea and vomiting. In some cases, especially when more methane than hydrogen is produced in the fermentation process, constipation can occur instead of diarrhea. Some people also report unusual symptoms such as headaches .
  
• Factors Influencing the Severity of Symptoms:
  The severity of lactose intolerance symptoms is very individual and depends on several factors. The degree of lactase deficiency in a person’s body plays a key role. The lower the enzyme production, the more likely it is that the symptoms will be stronger. The amount of lactose consumed is also important – the more lactose in a meal, the more severe the ailments may be in the case of intolerance. The individual sensitivity of the body is also important. Some people can tolerate small amounts of lactose, especially when consumed in combination with other foods that slow down the digestive process. Age, genetic factors, and the coexistence of other intestinal conditions, such as irritable bowel syndrome (IBS), can also affect the intensity of symptoms.

Diagnosis of lactose intolerance: available testing methods

• Hydrogen Breath Test:
  It is considered the gold standard in the diagnosis of lactose intolerance. The test consists in measuring the level of hydrogen in the exhaled air after consuming a lactose solution. Before the test, it is necessary to prepare properly, including, m.in, staying on an empty stomach for at least 12 hours, avoiding certain foods and medications. An increase in hydrogen levels in the exhaled air indicates that undigested lactose has fermented in the intestines. Sometimes methane levels are also measured, as some gut bacteria produce this gas instead of hydrogen.
  
• Lactose tolerance test (blood test):
  In this test, blood glucose levels are measured before and after consuming a lactose solution. If the increase in glucose levels is small, it may suggest lactose intolerance, since it means that lactose has not been properly broken down into glucose and galactose, which are then absorbed into the blood. This test is sometimes used as a complementary or alternative test.
  
• Stool pH test:
  Undigested lactose, reaching the large intestine, can cause acidification of the stool (lowering the pH). Stool pH analysis can be one of the elements supporting the diagnosis of lactose intolerance, especially in infants and young children.
  
• Elimination test (lactose-free diet):
  This method involves excluding all lactose-containing products from the diet for about 2-3 weeks and observing whether the symptoms subside. If the symptoms return after reintroducing lactose into the diet, lactose intolerance can be diagnosed with a high probability. It is important to carefully note the foods eaten and the body’s reactions observed during the elimination test.
  
• Small Intestine Endoscopy with Biopsy:
  It is a more invasive diagnostic method that involves taking a sample of the mucous membrane of the small intestine during endoscopy to measure the activity of the enzyme lactase . Due to its invasiveness and cost, it is not a routine test and is usually used in cases where other diagnostic methods do not give conclusive results.
  
• Genetic test:
  Genetic tests can identify mutations in the LCT gene that are associated with primary lactose intolerance. They can be especially useful in confirming congenital lactose intolerance in newborns . A genetic test can provide definitive information about a genetic predisposition to lactose intolerance.

Living with Lactose Intolerance: Dietary Advice and Lifestyle

• General principles for lactose intolerance management:
  The basis for dealing with lactose intolerance is to modify your diet. It is crucial to determine the individual level of lactose tolerance in adults. . Lactose-free products and supplements containing lactase are also helpful in managing symptoms.

Lactose-free and low-lactose diet: what to eat, what to avoid?

• Products to avoid (high lactose content):
  People with lactose intolerance should avoid or limit their consumption of milk (cow’s, goat’s, sheep’s) and milk-based products such as yogurt, kefir, buttermilk, sour cream, cream, ice cream, and cheeses (especially soft and fresh). You should also be on the lookout for processed foods that may contain hidden lactose, such as breads, confectionery, processed meats, sauces, instant soups, and breakfast cereals. It’s important to read food labels carefully and pay attention to ingredients like lactose, whey, powdered milk, and casein.
  
• Products that can be eaten (low or lactose-free):
  There are lactose-free dairy products (milk, yogurt, cheese, butter) on the market that can be safely consumed by people with lactose intolerance in infants. . Plant-based drinks (soy, almond, oat, rice, coconut) and their preserves (yoghurts, cream) are also a good alternative. Hard, long-ripened cheeses (e.g. Parmesan, cheddar, gouda) often contain very small amounts of lactose and can be tolerated by many people. Clarified butter (ghee) is usually lactose-free. Fermented dairy products, such as kefir and some yogurts, may be better tolerated due to their lower lactose content.
  
• Low-lactose diet vs. Lactose-free: it’s important to understand the differences when it comes to lactose intolerance.
  Many people with primary lactose intolerance do not need to completely eliminate lactose from their diet and can tolerate small amounts, which is important for symptoms and treatment. . In contrast, in the case of secondary and congenital lactose intolerance, a more restrictive lactose-free diet may be necessary. It is recommended to consult with a doctor or nutritionist to determine the best dietary approach tailored to your individual needs and tolerance level.

Dairy Substitutes: Tasty and Healthy Alternatives

• Plant-based milk:
  There are many types of plant-based milk available, such as soy, almond, oat, rice, coconut, cashew or hazelnut milk. It is worth choosing options enriched with calcium and vitamin D to ensure an adequate supply of these nutrients. Plant-based milk can be successfully used in various recipes, for coffee, cooking and baking.
  
• Vegetable yoghurts and kefirs:
  There are also plant-based alternatives to yogurt and kefir on the market, produced on the basis of soybeans, coconut, oats and other plant ingredients. Some of them may contain probiotics, just like traditional dairy products .
  
• Plant-based cheeses (vegan cheeses):
  For people who do not want to give up cheese, there are plant-based cheeses, made from soybeans, nuts and other plant ingredients. Their taste and texture can vary depending on the ingredients and production method.
  
• Butter and Vegetable Cream:
  There are lactose-free versions of butter and plant-based alternatives to cream (e.g. soy, coconut, oat). They can be used in the kitchen for cooking and baking, replacing traditional dairy products.
  
• Sources of Calcium in a Lactose-Free Diet:
  Eliminating dairy products from the diet may be associated with the risk of calcium deficiency. It is important to include other sources of this element in the menu, such as green leafy vegetables (kale, broccoli), almonds, sesame, fortified vegetable drinks and juices, canned fish with bones (sardines, sprats), beans and figs. Ensuring an adequate supply of calcium is crucial for bone health.

Lactase supplementation: when can it help?

• How Lactase Supplements Work:
  Lactase supplements contain the enzyme lactase, which promotes the breakdown of lactose in the digestive tract. They are usually taken just before eating meals containing lactose. They are available in various forms, such as tablets, capsules and drops for babies.
  
• When to consider supplementation:
  Lactase supplements can be helpful in situations where lactose is difficult to avoid or when small amounts are consumed. They do not treat the cause of intolerance, but they help to alleviate the symptoms. Before using lactase supplements regularly, it is recommended to consult a doctor, especially for people with diabetes, as lactase can affect the effects of diabetes medications .
  
• Popular Lactase Preparations in Poland: Various lactase-containing preparations are available in Poland, such as Lactocontrol, Lactaza Tabs, Delicol and Kolzym.

Long-Term Effects of Untreated Lactose Intolerance and Treatment Benefits

• Effects of untreated lactose intolerance:
  Although lactose intolerance is not a life-threatening disease in itself, ignoring symptoms for a long time can significantly reduce quality of life. If left untreated, intolerance can lead to impaired absorption of nutrients, especially calcium, which in turn can increase the risk of osteoporosis in the future. Infants with severe, untreated lactose intolerance are at risk of dehydration and malnutrition. Interestingly, avoiding lactose by healthy individuals can lead to a decrease in natural lactase production and secondary intolerance over time.
  
• Benefits of Lactose Intolerance Treatment:
  Treatment of lactose intolerance, through a proper diet and possible lactase supplementation, brings significant relief from digestive ailments such as bloating, gas, diarrhea and abdominal pain . It improves the overall comfort of life and well-being. In the case of secondary intolerance, effective treatment of the underlying disease can lead to the resolution of the symptoms of lactose intolerance. The use of lactose-free products and lactase supplements increases flexibility in the diet.

Practical Buying Tips for People with Lactose Intolerance

• Reading product labels:
  It is extremely important to read food labels carefully and look for information about the lactose content and potential hidden sources such as milk powder, whey or casein. It is worth paying attention to the “lactose-free” markings and understanding what they mean. Products labelled “lactose-reduced” may still contain some lactose.
  
• Selection of lactose-free products:
  It is worth focusing on products that naturally do not contain lactose, such as meat, fish, eggs, legumes, cereals, fruits and vegetables. You should also explore the growing range of lactose-free alternatives for dairy products available in stores, such as formula, yogurt, cheese, butter, which are safe for people with lactose intolerance. . Plant-based products are also a good solution.
  
• Shopping in Restaurants and Travel:
  When eating in restaurants, it is worth being aware that lactose can be present in many dishes, even those in which we do not expect it (e.g. in the case of allergies). sauces, soups, creams). Do not hesitate to ask about the ingredients and the way the dishes are prepared. When traveling and when eating out, it is a good idea to have lactase supplements with you.

Summary: How to Deal with Lactose Intolerance on a Daily Basis?

Lactose intolerance is an ailment that can be effectively managed through conscious food choices and, if necessary, the use of lactase supplements. It is crucial to understand your body and establish an individual tolerance level. If you suspect lactose intolerance, it is worth consulting a doctor or dietician who will help you make a diagnosis and develop a personalized action plan. Remember that with the right approach, living with lactose intolerance – symptoms can be minimized, and everyday functioning can be fully comfortable and satisfying.

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Table 1: Lactose Content of Common Dairy Products

Table 2: Examples of substitutes for dairy products