The low-down on lactose
Lactose is the sugar found in cow, goat and sheep milk. But is it really that common to not be able to drink milk? Or is it a condition that is over-hyped? This blog gives you the low-down on lactose, lactose intolerance and malabsorption and what it really means for you.
What is lactose?
Lactose is a carbohydrate (sugar) that is made up of two parts. In the body, we have an enzyme called lactase. Lactase is responsible for splitting apart the two parts of the lactose so that it can be digested and absorbed.
What is lactose malabsorption?
Lactose malabsorption is when the lactose moves through from the small intestine to the large intestine without being broken down by the lactase enzyme. Because it has not been broken down by the lactase enzyme, it cannot be absorbed. Not all lactose malabsorption results in intolerance, or symptoms.
What is lactose intolerance?
Lactose intolerance then describes the symptoms that pop up after the unabsorbed lactose makes its way into the large intestine. Symptoms can start anywhere from 30 minutes to 2 hours after eating lactose containing food.
Symptoms can include:
Diarrhoea
Nausea
Abdominal pain
Flatulence/gas
Bloating
A lot of the time, symptoms will show up depending on how much lactose you have consumed and what other foods are consumed alongside the lactose.
Is lactose intolerance like having an allergy to milk?
Lactose intolerance is not an allergy. There are two other issues that people can experience when consuming dairy but they are very different to lactose intolerance. They are galactosemia and cow milk-protein sensitivity. A milk allergy is related to the protein in the milk, not the lactose.
How come I can’t eat lactose now but I could before?
There are two main types of lactose intolerance in adults, called primary lactase deficiency and secondary lactase deficiency.
Primary lactase deficiency is when you have less lactase enzyme overall and this can be seen as early as 5 years of age. This varies hugely by ethnicity and occurs across several years from childhood to adulthood.
Secondary lactase deficiency is triggered if the gut is damaged. The issues that can trigger this deficiency are viruses or bugs like those that cause gastroenteritis or giardia, coeliac disease, crohn's disease or if there is an injury to the small intestine. In this situation, there is less lactase enzyme being produced in the body but it is often only temporary. Once the underlying issue is managed or treated then this often means lactose containing food and drinks can be included again.
How do I get diagnosed with lactose intolerance?
Some gastroenterologists will take biopsies of the duodenum when completing an endoscopy to look at the amount of lactase enzyme you have. However, not all do. Another option is to take a hydrogen breath test which will test for malabsorption of lactose. Neither the biopsy or breath test are looking at your personal tolerance level of lactose.
Often a gastroenterologists will refer you to a dietitian to complete the low FODMAP diet and this will determine whether lactose is a trigger for your particular symptoms and helps work out your tolerance level.
Why is it important to actually get diagnosed for lactose intolerance?
Many people mistake their gut symptoms for lactose intolerance without getting tested. Some may think they have lactose intolerance because they have many of the symptoms mentioned above, but these symptoms are related to a number of other common conditions so it is important to get the right diagnosis.
Avoiding dairy without a true diagnosis and proper guidance on the right replacement foods means it’s likely you won’t get enough calcium and vitamin D in your diet.
If parents self-diagnose lactose intolerance they may then also self-diagnose their children and put them on restrictive lactose-free diets without having symptoms as they believe the condition is passed on.
Does lactose intolerance mean I have to go dairy free?
Absolutely not! Lactose free doesn’t mean dairy free as there are many low-lactose foods made from dairy as well as lactose-free dairy foods.
In addition to the amount of lactose you eat, your level of symptoms or intolerance can be affected by a number of things.
Things that will affect your tolerance and symptoms include how the lactase enzyme is working in your gut, what foods you’re eating or drinking that contain lactose, what other foods you’re eating alongside the lactose containing foods, any sensitivity in the gut and the composition of your gut microbiota.
I always recommend working with a dietitian to determine your tolerance level for lactose-containing foods as it is always best to have as much variety and diversity as possible in the foods you eat.
To find out more about how you can take control of your symptoms and still eat the foods you love book your FREE mini-consult today.
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References
Heyman MB, Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006;118(3):1279-86.
Wilt TJ, Shaukat A, Shamliyan T, Taylor BC, MacDonald R, Tacklind J, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep). 2010 Feb;(192):1-410.
National Digestive Diseases Information Clearinghouse. Lactose intolerance. NIH Publication No. 09-2751. 2009 Jun.
National Institutes of Health Consensus Development Conference Statement. NIH Consensus Development Conference: Lactose Intolerance and Health. 2010 February 22-24;27(2).
Mattar R, de Campos Mazo DF, Carrilho FJ. Lactose intolerance: diagnosis, genetic, and clinical factors. Clin Exp Gastroenterol. 2012;5:113-21.