Lactose intolerance

28. September 2021

What’s behind it?

What’s behind it?

In our last post we dealt extensively with the health consequences of fructose intolerance. A huge number of people suffer from food intolerances which cause significant symptoms and make their everyday lives more complicated.

Lactose, fructose and histamine intolerances are widespread, and are the most common cause of complaints.

What’s behind lactose intolerance?

For decades, milk was considered a kind of miracle juice. As the legendary German advert stated, “Milch macht müde Männer munter” (“Milk perks up tired men”). However: milk can cause serious complaints of the gastrointestinal tract, skin and blood vessels. Around 15 percent of Europeans are affected by lactose intolerance, which is an inability of the human gastrointestinal tract to digest breast milk and animal milk

Northern Europeans are least affected

Northern Europeans have the best tolerance for milk, with 90 percent having no issues. The further south you go, the worse it gets: more than two-thirds of southern Europeans are lactose intolerant, while in Asia a mere six percent of the population can tolerate milk.

In other words: a large part of the world’s population can’t digest milk. Around three-quarters of all people worldwide are lactose intolerant. In Africa and China, it’s almost the entire population. In Sweden, however, just two percent of the population is lactose intolerant, while in Denmark the figure is five percent. 

The website www.gesundheitsinformation.de provides information about the causes of lactose intolerance: “In infancy, the body is designed to survive solely on breast milk. In order to digest it, infants produce the enzyme lactase. It breaks down lactose in the intestine so that the body can use it.

When a child is weaned off milk, the digestive system gradually adjusts to processing other foods. The body then starts to produce significantly less lactase – and is therefore only able to break down smaller amounts of milk sugars.

If an adult ingests more milk sugars than the lactase is able to break down, they remain in the intestine. When they reach the large intestine, they are broken down by intestinal bacteria (so-called fermentation). This creates gas and other breakdown products in the intestine, which causes the symptoms of lactose intolerance.” Symptoms include a feeling of fullness, pelvic pain, flatulence, nausea with vomiting and outbreaks of cold sweat.

Similar symptoms occur in people who suffer from fructose intolerance, also known as fructose malabsorption, although these symptoms can also be triggered by irritable bowel syndrome. Other symptoms of lactose intolerance include tiredness, headaches, dizziness, palpitations, itchy skin and night sweats.

How can you find out if you suffer from lactose intolerance? There are various tests that can be used to check for lactose intolerance. The most reliable method is the H2 breath test combined with a blood sample. To take the test, you should contact a gastroenterologist, a specialist in gastrointestinal diseases. Nutritional tests can also confirm suspected lactose intolerance.

The three forms of lactose intolerance

The Techniker-Krankenkasse makes an important point: there are three forms of lactose intolerance:

Firstly: primary lactose intolerance – this is usually hereditary. It can exist from birth or develop gradually. The sufferer’s genes produce an insufficient amount of the enzyme lactase, which can lead to pronounced lactose intolerance. This form is common worldwide.

Secondly: secondary lactose intolerance – in this case, lactose intolerance is the consequence of another disease. In the case of gluten intolerance, for example, the mucous membrane of the small intestine, where lactase is formed, is attacked. Other diseases that can lead to secondary lactose intolerance include chronic inflammatory bowel disease or gastrointestinal infections.

Thirdly: congenital lactase deficiency – here the body suffers from a congenital genetic defect which completely prevents it from producing lactase. In such cases, sufferers must follow a strict lactose-free diet. However, this form of lactose intolerance is very rare. 

Those affected should avoid the following products: milk protein is contained in drinking milk, buttermilk, sour milk, yoghurt, kefir, powdered milk, coffee creamer, cheese, hot chocolate powder, condensed milk, cream, whey, quark, cottage cheese and processed cheese. 

However, there are also dairy products that are low in lactose, for example, cheese that has matured for longer. The milk sugars are broken down and converted into lactic acid as the cheese matures. In other words, the longer a cheese is left to mature, the less lactose it contains. All types of cheese with long maturation periods such as Emmental, Appenzell, Brie, Camembert or sheep’s cheese, contain hardly any lactose because the milk sugars are broken down during the maturation process. 

The general rule of thumb is that the fresher a dairy product is, the higher its lactose content. However, if you avoid all dairy products you can quickly be at risk of developing a calcium deficiency. Therefore, experts recommend foods rich in calcium such as meat, broccoli, kale, tomatoes, tofu, and soy products as a balance.

You should also be aware that milk sugars are added to a range of food products. For example, they can be found in ready meals, cereal bars, marinated meats, sausage products, bread, ice cream, chocolate, instant products, dough and even in spice mixes. We owe this fact to food designers who want to create a particular mouthfeel in order to improve the flavour of foods. Fortunately, most people can tolerate small amounts of lactose and remain symptom-free.

Be careful with baked goods. Germany’s bread culture in particular causes the most problems for people with lactose intolerance. Many types of bread, rolls and cakes contain milk, milk powder or cream. If concerned, consumers should get ingredient lists from the bakery. The best way to treat lactose intolerance is to adjust your diet. Your doctor can refer you for nutritional therapy or advice. There are also medications containing the missing enzyme lactase, which can significantly improve your symptoms. 

Milk alternatives are booming

Current plant-based alternatives to milk include soy milk, oat milk and almond milk, and more are being added all the time. One Berlin-based company is even producing a milk substitute made from peas. Some of these products are fortified with vitamins and calcium, as well as the vital vitamin B12. Vegans in particular are in urgent need of B12 because a purely plant-based diet does not provide it. 

You should know, however: lactose-free alternatives are not healthier than normal milk and dairy products. They improve the quality of life of people who suffer from lactose intolerance and alleviate their symptoms. They have no health benefits for people who do not suffer from lactose intolerance.

According to data analysts from the market research institutes GfK and NielsenIQ, both turnover and sales volumes for plant-based milk alternatives in the German retail sector grew by well over 40 percent in 2020. “Plant-based drinks in particular are booming.”

More than one in three households in Germany already buys plant-based milk alternatives, reports Steven Brechelmacher from GfK. Last year alone, a further two million households joined the trend. Young consumers in particular were very attracted to oat or soy alternatives due to their increased awareness of the environment and sustainability.

Stay healthy!