Lactose intolerance symptoms and therapy

Life with lactose intolerance

Lactose intolerance (lactose intolerance) is a special form of food intolerance in which people react to the consumption of milk and dairy products with various symptoms and disorders. The result is an enzyme deficiency that may be innate or acquired. More than every seventh inhabitant in Germany is affected by lactose intolerance.

contents

• Life with lactose intolerance
• Lactose intolerance - a brief overview
• Causes - How does it come to an incompatibility?
• Forms of lactose intolerance
• Lactose intolerance symptoms
• diagnosis
• Lactose intolerance treatment
• Lactose intolerance diet
• The three phases of the diet change

Lactose intolerance - a brief overview

Milk is part of a healthy diet because it contains many important minerals and vitamins. However, milk can not be fully recommended for all people, because for many people, consuming milk and dairy products causes severe digestive problems and bowel problems. According to the Institute for Quality and Efficiency in Health Care, up to 15 percent or 12 million people in Germany suffer from lactose intolerance. Here is a brief overview of the symptoms:

• definition: The milk sugar from the diet is no longer digested enough in the intestine due to the lacking or missing enzyme lactase. This often results in indigestion and discomfort in the gastrointestinal tract.
• Synonyms: Lactose intolerance, carbohydrate malabsorption, lactose intolerance, lactose malabsorption, lactose deficiency syndrome, alactasia.
• symptoms: Nausea and vomiting, indigestion, stomach problems, diarrhea, fatigue, headache, bloating, insomnia and / or rashes occur immediately after consumption of milk or within 24 hours of consumption.
• diagnosis: The Hydrogen Breath Test provides information on the enzyme deficiency via the respiratory air, in the lactose tolerance test the blood sugar level is measured before and after taking a milk sugar solution.
• therapy: Largest or total abstinence from foods that contain lactose, follow a nutritional plan, keep a food diary, occasionally lactose supplements for assistance.

Almost one in seven people in Germany can not tolerate milk or dairy products. Intolerance usually requires a far-reaching change in diet. (Image: absolutimages / fotolia.com)

Causes - How does it come to an incompatibility?

The lactose contained in dairy products (latin lactose) is a carbohydrate consisting of glucose (glucose) and mucilage (galactose). To break it down and digest it, we need lactase. Lactase is a specific enzyme that is produced in the small intestine villi. It breaks down the milk sugar into the building blocks glucose and galactose, which are then absorbed via the intestinal mucosa. If the digestive enzyme lactase is absent or inadequate, the lactose molecules as a whole get into the large intestine, where it then comes to fermentation processes by colon bacteria. These fermentation processes lead to various complaints. A distinction must be made between lactose intolerance and lactose allergy (see: food allergy), which causes immune reactions as a result of contact with the allergen.

Forms of lactose intolerance

It distinguishes the primary from the secondary form. Lack of lactase may be congenital (primary) or develop over time (secondary). Rarely infants are already affected by the complaints in the congenital form. In most cases, the primary deficiency only becomes apparent in adulthood when lactase production decreases and eventually stops.

The secondary form of lactose intolerance

The secondary form usually also shows up in adulthood. Here, the lactase-producing small intestine villi of the intestinal mucosa are attacked or destroyed. This may be due to chronic inflammatory bowel diseases such as Crohn's disease (CED) or infectious enteritis. But other food contraindications such as celiac disease (gluten allergy) can also lead to deficiencies in lactase enzymes.

In addition, the lactose intolerance may also be based on functional disorders, namely indigestion (functional dyspepsia), colonization of the intestinal mucosa (intestinal dysbiosis), the leaky-gut syndrome or fungal infection (intestinal mycosis). These can occur individually or side by side and are often recorded after acute infections, medication (especially antibiotics) and persistent poor nutrition.

Abdominal pain, flatulence and malaise are the leading symptoms of lactose intolerance. (Image: Dave_Pot / fotolia.com)

Lactose intolerance symptoms

Typical symptoms that can occur directly or up to a few hours after eating dairy products are abdominal pain, nausea and vomiting, diarrhea and flatulence. In addition, sometimes fatigue and fatigue, headache, sleep disorders, dizziness, constipation, painful intestinal colic and skin problems are called.

The intensity of the symptoms depends on it

1. how much lactose was consumed,
2. How many remaining lactose enzymes are still present in the intestine,
3. how the composition of the intestinal flora is
4. and how fast the stomach empties.

diagnosis

The lactose intolerance can be determined by means of various tests, for example the H2 breath test (especially suitable for small children), in which the hydrogen content of the fermentation processes in the large intestine is determined in the respiratory air. In the lactose tolerance test, a lactose solution is drunk and then the glucose content in the blood is checked. Relatively new is the genetic test, which is to determine a hereditary predisposition. In addition, it is advisable to keep a food diary and to record the well or poorly tolerated food, so to make their own nutrition plan.

Lactose intolerance treatment

Of course, a primary lactase deficiency can not be reversed. To avoid symptoms, it is advisable to avoid lactose or to prefer low-lactose foods. This means, at least in the initial phase, a great deal of attention when shopping, as lactose is present in countless foods, medicines and cosmetics, baked goods, ready meals, toothpastes or (even homeopathic) tablets. In addition, lactase preparations can sometimes be used to initiate lactose cleavage (for example, in the restaurant or while traveling). The therapy of the secondary form depends on the underlying disorder or illness.

If the intolerance has developed in the course of an illness, it can come again to improvements, if the underlying illness is treated. In the case of a congenital enzyme deficiency, intolerance usually persists for a lifetime. (Image: Coloures-Pic / fotolia.com)

Lactose intolerance diet

Nutrition plays a central role in the treatment of lactose intolerance. In particular, milk and dairy products should be avoided for the most part. According to the Federal Ministry of Food and Agriculture, for example, a lot of lactose is contained in (grams of lactose per 100 grams):

• Cow's milk (4.8 to 5 grams),
• Butter (0.6 to 0.7 grams),
• Milk ice, ice cream (5.1 to 6.9 grams),
• Condensed milk (9.3 to 12.5 grams),
• Quark (depending on fat content 2.0 to 4.1 grams),
• Buttermilk (3.5 to 4.0 grams),
• Cream cheese (depending on fat content 2.0 to 4.0 grams),
• Yogurt (depending on fat content 3.5 to 6.0 grams),
• Cream (2.8 to 3.6 grams),
• Creme fraiche (2.0 to 4.5 grams).

Beware of hidden lactose

For dairy products, it is obvious that they also include lactose. In addition, lactose also appears in a variety of products in which one does not suspect it, since lactose is used either as a binder or as a carrier in flavors, flavor enhancers and sweeteners. For this reason, lactose is also found, for example, in pizza, sausage, broth, baked goods, bread, crispbread, rolls, cakes, biscuits, cereals, croquettes, desserts, sweets, cottage soups, cream sauces, salad dressings, spice blends, spreads, mayonnaise, ketchup, mustard , Margarine, pesto, coffee blends, canned fish and vegetables.

In addition, lactose is used in some low-fat products to increase food volume and weight. Even in medications and toothpaste lactose can hide. In most cases, the proportion of the articles mentioned here is not as high as that of dairy products. Nevertheless, persons with lactose intolerance to these foods should be careful.

These foods do not contain lactose and are normally tolerated by people with lactose intolerance. (Image: heilpraxis.de/sharpnose/imagination13/fotolia.com)

The three phases of the diet change

After lactose intolerance has been detected, a change in diet must be made to relieve symptoms. This is normally implemented in three phases, the grace period, the test phase and the permanent diet. During the first qualifying phase, lactose sources should be consistently avoided over a period of at least two weeks. Patients suffering from chronic bowel problems should also temporarily refrain from bloating or hard-to-digest foods such as cabbage, onions and coarse-grained wholemeal bread. Meals should be taken in several small portions throughout the day, chewed thoroughly and taken with plenty of water to relieve the gastrointestinal tract.

Tasting is about studying

The waiting period should be carried out until the symptoms have improved significantly. Following this, foodstuffs containing small or medium lactose levels can be added in small portions. In this way, anyone can determine the amount and type of lactose-containing food that is tolerated. The results should be recorded in a personal food diary. You should allow at least six to eight weeks for this phase. Through this extensive test phase, sufferers can identify a range of foods that they can tolerate well and which are suitable for permanent nutrition after the test phase.

Food with no or low lactose

The following foods contain no lactose and can usually be safely consumed with lactose intolerance:

• potatoes,
• rice,
• Cereal products such as corn, oatmeal, wheat, spelled and rye,
• fruit and vegetables,
• Nuts, legumes and seeds,
• Vegetable milk from oats, rice, almonds, soy or coconut,
• Meat, fish and eggs,
• vegetable oils.

Lactose-free foods and specialty products

In addition to the lactose-free products, there are a number of foods that contain only a small proportion of lactose and are well tolerated by many sufferers. These include, for example, certain types of hard and cut cheeses in which the lactose has degraded during the ripening process. For example, some varieties of mountain cheese, Emmentaler, Gouda, Edamer and Tilsiter contain less than 0.1 grams of lactose per 100 grams of cheese. There are also certain natural yoghurts that contain live lactic acid bacteria such as Lactobacillus bulgaricus and Streptococcus thermophilus. The special thing about these bacteria is that they contain the lactase enzyme itself and release it in the intestine, which makes such yogurts tolerated by many people with lactose intolerance. In the supermarket, health food store or pharmacy you will also find specially labeled lactose-free dairy products.

Vegetable milk, for example, from the coconut does not contain lactose. (Image: Printemps / fotolia.com)

lactase preparations

Furthermore, the enzyme lactase can also be purchased as a drop, powder, tablet or capsule. These preparations can then be taken with lactose-containing food to facilitate digestion. However, they should not be used too often, but rather in exceptional cases, for example, during a restaurant visit, an invitation, on vacation or abroad.

How is lactose marked in the list of ingredients?

For packaged goods, lactose must be labeled as an ingredient. If terms such as lactose, lactose, milk powder, whole milk powder, skimmed milk powder, dry milk product, whey, whey product, whey powder, sweet whey powder, cream or cream are on the list of ingredients, the article contains lactose. Here, persons with lactose intolerance should exercise caution. If you buy sausage, cheese or baked goods at the bar, you should be informed about the ingredients. Substances from the list of ingredients such as lactic acid (E270), lactic acid salts (E325 to E327), milk proteins and mucilage (galactose) are well tolerated by many. (Vb)

Beware of calcium deficiency

Intolerance for milk and dairy products removes an important source of calcium. Calcium is an important mineral for stable bones and a healthy brain. For children over 10 years and for adults, the German Nutrition Society recommends a daily calcium intake of 1000 to 1200 milligrams. To avoid calcium deficiency, sufferers should resort to lactose-free dairy products, low-lactose cheeses and high-calcium vegetables such as broccoli, chard, spinach, kale or fennel. In addition, calcium-fortified fruit juices and mineral water can help meet your daily needs. (jvs; vb; updated 17 December 2018)

swell

• Internet presence of the Federal Association for Health Information and Consumer Protection (BGV), visited on 11 December 2018
• Consumer portal VIS of the Bavarian Ministry of the Environment and Consumer Protection
• German Nutrition Society (DGE): "Eating and drinking with lactose intolerance"
• Federal Food Code (BLS) of the Federal Ministry of Food and Agriculture
• Gesundheitsinformation.de; Portal of the Institute for
  Quality and Efficiency in Health Care (IQWiG)