Lactose intolerance FODMAP
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Lactose Intolerance (and the FODMAP diet)

Lactose, is a type of sugar that is found in almost all goodies made from milk. Yogurt, ice cream, cookies, cake, pie, cheese, and so on. However, there is a large group of people who cannot digest lactose properly, and who will get intestinal symptoms when they eat it. What is lactose intolerance and how can you keep a delicious diet while avoiding lactose? I’ll show you!

Food Intolerance

If you experience stomach and/or gut issues, chances are you have a food intolerance. This means your body is not responding well to a certain food substance, without your immune system being activated. Apart from the real physical symptoms you have, there is no damage done to your body or gut (thank god!). The solution to this intolerance is usually to stop eating the product you suspect to give you symptoms. But that is often easier said than done.

What Is Lactose and Lactose intolerance?

Lactose is a sugar that is naturally occurring in milk and milk products. For the digestion of this sugar, we need an enzyme called lactase. The lactase will break down the lactose into 2 separate sugar molecules (glucose and galactose), which we can then absorb through our intestinal wall.

If there is not enough lactase, or if lactase is not being produced by the body, the breakdown of lactose will not happen. The lactose will not be absorbed and stays in the intestine and moves on to the large intestine. In the large intestine, the lactose will be broken down by your friends, the gut bacteria. And they produce gas (which will leave you bloated) and short-chain fatty acids which can alter gut motility. However, there are more symptoms that can indicate lactose intolerance.

If you have been experiencing gut issues for a longer time, it is possible that you recognize lactose as a part of the FODMAP diet. For more information on the FODMAP diet, click here.

Symptoms of Lactose Intolerance

The symptoms of lactose intolerance can start from straight after you ate the lactose to up to 2 hours after you’ve eaten it. The symptoms can stay present until the lactose has gone all the way through your digestive tract and has left your body with the stools.

Most people who experience lactose intolerance seem to be able to digest up to 12 grams of lactose. If someone has Irritable Bowel Syndrome (IBS) it often seems that smaller portions are already troublesome.

The chances of getting symptoms seem to be dependent on the amount of lactose that is ingested, the spread of ingested lactose throughout the day, and whether or not other foods are eaten at the same time. It seems that anyone is susceptible to symptoms if they ingest a lot of lactose in 1 sitting. For example, 50 grams in one go.

Lactose intolerance pin
Lactose intolerance symptoms:
Nausea and/or vomiting
Stomach aches and cramps
A rumbling noise in your gut caused by the movement of your intestine
Excessive gas in the intestine

If none of the symptoms describe you, please schedule a free symptom assessment and we can talk about how I can help.

Different Types of Lactose Intolerance

There are 3 types of lactose intolerance:
Primary lactose intolerance. Where your body can’t make enough lactase to break down the lactose.
Secondary lactose intolerance. Where there is not enough lactase because of damage to the intestinal mucosa. For example, caused by celiac disease or bacterial overgrowth. Usually, if the intestinal mucosa repairs itself, the lactase will also return. 
Congenital lactase deficiency. This is a very rare condition.

Lactose intolerance is a common food intolerance. Worldwide, many people become lactose intolerant during their first 20 years of life. It is very rare that lactose intolerance occurs in children up to 3 years old, partly because their main form of diet is milk (milk allergy is more common in young children than in adults).

The estimation is that 68% of the world’s population has some form of lactose intolerance. It is more common in various parts of the world, for example, people of Asian or African descent are much more likely to suffer from lactose intolerance than people of European or American descent. This is the result of a gene in the DNA that can ensure that you can still break down lactose in adulthood.

The amount of the lactase enzyme your body can produce decreases with age. So lactose intolerance can manifest itself at any age. And there is an increase in lactose intolerance in the elderly.

Diagnosis of Lactose Intolerance

There are different ways to test if you are lactose intolerant. The most common approach is to either do a hydrogen breath test or an elimination diet. Based on those results you can decide whether you need to avoid lactose. 

Lactose breath

Hydrogen breath test. In this test, the amount of hydrogen (H2) in the exhaled air is measured before and after drinking a solution with lactose. H2 gas is produced by intestinal bacteria during the breakdown of sugars such as lactose. This gas is absorbed by the blood, passes through the lungs and is then exhaled. By determining the amount of H2 gas in the exhaled air at different times after drinking the sugar solution, doctors can determine whether there is lactose intolerance.

The H2 breath test can be done in most hospitals, but nowadays you can also order a home test. I do not have experience with home tests, so I can’t provide any information on the use and reliability of those. Also, all H2 breath tests have a chance of a ‘false negative’ outcome, which means that a negative test could in some cases still mean you have lactose intolerance. This percentage is very low though, but if you notice symptoms after lactose even though you had a negative test. Then this is something to take into account.

Elimination-provocation diet. If there are symptoms that indicate lactose intolerance, a dietitian or specialist asks you to do the elimination provocation diet. The diet consists of 2 parts. You first use a lactose-free diet (elimination). Subsequently, it is evaluated whether the complaints decrease or disappear. If so, this indicates lactose intolerance. Then the amount of lactose in the diet is slowly rebuilt (provocation). When the symptoms return, the diagnosis ‘lactose intolerance’ can be made.

Foods Containing Lactose

Because lactose is milk sugar, it is found in most products containing milk. Sour milk products (such as yogurt, kefir, buttermilk) and Gouda cheese, contain less lactose than milk because bacteria have already partially digested the lactose during the preparation of the product.

Everyone has a different tolerance level where the symptoms express themselves, so it is important to test individually where yours is. One person may be able to use 1 glass of milk a day, while for the other 1/2 glass is too much.
In most cases, it is not necessary to be ultra-strict while reading labels. Because the traces of lactose in most products won’t harm the majority of people with lactose intolerance. Make sure to know your tolerance level though!

Also, your body could get used to the use of lactose. Certain bacteria in your gut help you digest lactose. If you slowly build up your use of lactose, you feed those bacteria and they will multiply. This can reduce your symptoms.

List Of Lactose Containing Foods

As said, lactose is only found in products containing milk. All other products (like fruits, vegetables, meat, fish, nuts, oils, etc.) I will not discuss since there is no lactose in there. Be aware of processed foods though! Lactose-containing ingredients can be present there. 

Milk and lactose
Foods containing lactose:
Cow, sheep, goat, horse and donkey milk and milk powder
Soft cheese like feta
Cream cheese
Fresh cheese like cottage cheese
Custard, pudding, mousse
Cream and whipped cream
Creme fraiche
Butter, margarine (very low lactose, usually not a problem)
Possibly containing lactose:
Sausage and processed meat
Premade soup and meals
Salad dressing
Candy and biscuits

During the production of yogurt and kefir, bacteria are added to the milk. These bacteria break down some of the lactose, and the end-product has a smaller amount of lactose. Most people with lactose intolerance, have fewer symptoms while using these products.

If you are not using any dairy products, it is possible to get deficiencies of calcium and vitamin B2. 

Lactose-free replacement options are:

  • Lactose-free dairy
  • Gouda Cheese
  • Calcium and vitamin B2 enriched plant-based dairy
  • Green leafy vegetables for calcium
  • Vitamin and mineral supplements to add nutrients to your diet.

The Gouda (or aged) cheese is a good product to use if you have lactose intolerance. During the ripening of the cheese, the lactose is almost completely broken down. Which basically makes the cheese lactose-free. 
French cheeses also often contain very small amounts of lactose. Because the fungi in blue cheese, for example, break lactose down.

Lactose Intolerance Supplements

There are ways to use lactose-containing products, without triggering your symptoms. It is possible to use a lactase enzyme supplement to help you digest the lactose. These supplements can be taken with a lactose-containing product or meal. This way, the lactase enzymes can digest the lactose for you. 

If you’re choosing a supplement, it is important to pay attention to the dosage. If you are a little bit intolerant, you can probably make do with a lower dose than someone who is very intolerant. The dosage can be found on the packaging. You can recognize it as a number with FCC behind it. For example, 2,300 FCC is a reasonably low dose and 10,000-14,500 FCC is high. To be safe, I’d usually recommend the higher-dose ones.

When buying lactase supplements, look for any fillers that have been added. For example, some supplements are not low FODMAP because they contain mannitol.

The lactase enzymes are completely safe for use. If you do not feel comfortable using them and still want to eat out, it’s advisable to call the restaurant or your host before you’re going there to discuss the options you have. Most of the time, if you announce your intolerance beforehand, it is no problem and they can come up with a solution for you.

Probiotics and Lactose Intolerance

In recent years, more and more information has emerged about the possible effectiveness of probiotics and/or prebiotics in the fight against lactose intolerance. With a probiotic (click here to read more about probiotics) you can supplement specific bacteria that help with the breakdown of lactose (eg bifidobacteria and lactobacilli).
With a prebiotic (click here to read more) you stimulate the growth of your healthy bacteria.

The science behind this mechanism is still very new, but it can certainly be worth a try if you are a milk, ice cream, cheese, or cookie lover.

Are you lactose intolerant? Or do you have family or friends who are? Let me know your best tips in a comment!

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