Lactose Intolerance (And Yes, It’s a FODMAP!)

Lactose Intolerance (And Yes, It’s a FODMAP!)
(Last Updated On: February 19, 2020)
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If you experience stomach and/or gut problems, chances are you have a non-IgE mediated 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 complaints 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.

Non-IgE Food intolerances are quite common, and between 1-4% of the world population has it. Lactose intolerance is one of the non-IgE mediated food intolerances. In this article, I’ll tell you more about this intolerance, and how to deal with it.

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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 in 2 separate sugar molecules, which we can then absorb. 
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 acids (which attract liquid to the bowel, and creates diarrhea). 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.

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
Loss of concentration
Stiff and sore joints
Muscle aches
Skin rashes and allergy symptoms such as a runny nose

If none of the symptoms describe you, take a look at my article ‘Common Gut Issues (The List)’ and you may find something that suits you better.

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.

A lot of the people around the world become lactose intolerant during their first 20 years of life. But it’s very rare among children up to 3 years of age since their main form of nutrition is milk. (Milk allergy is more common in this group than with adults) Mostly people from Asia and Africa are more likely to experience lactose intolerance due to genetics. Also, the amount of lactase enzyme that your body can produce, will diminish as you get older. So lactose intolerance can show itself at any age.

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 the home tests however, 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.
Also, everyone has a different tolerance level where the symptoms express themselves, so it is important to test individually. One person may be able to use 1 glass of milk (7 grams of lactose) a day, while for the other 1/2 glass is too much. However, most individuals with lactose intolerance are able to digest up to 4 grams of lactose. In this case, it is not necessary to be ultra-strict while reading labels. Because the traces of lactose in most products won’t harm you.

Also, your body can 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.

Are you having difficulties doing the FODMAP diet all by yourself and would you like guidance from a specialized dietitian? Schedule an online consultation at my online dietitian practice Darm diëtist, and I will help you with all your questions!

List Of Lactose Containing Foods

As said, lactose is only to be 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, there are bacteria 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 milk products, it is possible to get deficiencies of calcium and vitamin B2. 
Options to prevent that 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.

Eating Out With Lactose Intolerance

There are ways to use lactose, 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 is to be found on the packaging. You can recognize it as a number with FCC behind it. For example, 2,300 FCC is dosed reasonably low and 10,000-14,500 FCC is dosed high. To be safe, I’d usually advice the higher dosed ones.

For a high dosed lactase supplement I recommend LactoJoy with 14.500 FCC per capsule. Somewhat lower with 9.000 FCC the Lamberts Super Strength Lactase is a good option. If you’re not that intolerant, you could get tnvitamins with 4.000 FCC. Usually the lower the dose, the lower the price. So it’s wise to find out the right dosage that works for you.

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.

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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