Lactose intolerance

Types of lactose intolerance

Lactose intolerance can be divided into primary and secondary lactose intolerance.

Primary lactose intolerance is the most common, where lactase production naturally decreases with age. This form usually develops in the first few years of life and is common in Asia, Africa and southern Europe, but less common in the Nordic countries. A rare form called primary congenital lactose intolerance involves a lack of lactase production from birth.

Secondary lactose intolerance is temporary and can be caused by inflammatory conditions and diseases of the gastrointestinal system, including gastroenteritis, celiac disease and chronic intestinal disorders.

Symptoms of lactose intolerance

The symptoms of lactose intolerance can vary from person to person, but they typically occur 30 minutes to two hours after consuming dairy products or lactose-containing foods. The most common symptoms include:

• Stomach pain – from mild to intense
• Bloating or a feeling that the stomach is “full”
• Flatulence (increased formation and release of intestinal gas through the anus)
• Diarrhea (frequent, loose, or watery stools)
• Cramps around the abdominal region

(Source: Sundhed.dk)

Diagnostic methods for lactose intolerance

There are several diagnostic methods to detect lactose intolerance:

• Lactose load: Measurement of blood sugar levels after consuming lactose.
• Small intestine biopsy: Examines the presence of the lactase enzyme in the small intestine.
• Breath test: Measures the amount of hydrogen in exhaled air after consuming lactose.
• Lactose-reduced diet: Temporary removal of lactose from the diet to assess improvement in symptoms, as well as worsening after reintroduction.

Most often, you should consult your own doctor for advice on the most appropriate diagnostic method based on your individual symptoms and health history.

Irritable bowel syndrome (IBS) can cause some of the same problems as lactose intolerance – read more about IBS here.

Lactose-free diet – basic principles and tips

Identify lactose-containing foods by reading ingredient descriptions carefully, including dairy products such as milk, cream, yogurt, cheese, and ice cream.

Be aware that lactose can also be found in non-dairy products such as certain types of bread, cakes, sauces and snacks, such as some types of chips – many processed foods can contain hidden lactose.

Choose lactose-free alternatives such as lactose-free milk, cream, cheese and yoghurt, as these products have been treated with the lactase enzyme to break down the lactose. There are also non-dairy alternatives such as soy, almond, coconut, oat and rice drinks, which are usually lactose-free and may be suitable for a lactose-free diet. (Source: Region Midtjylland).

Some people with lactose intolerance may be able to tolerate small amounts of lactose or find certain dairy products easier to digest than others. A Functional Medicine consultation can help you learn more about your body and your genes.

Managing lactose intolerance in everyday life

Managing lactose intolerance in everyday life involves lifestyle changes and dietary adjustments to minimize symptoms and ensure a nutritionally adequate diet. It is recommended to consult a healthcare professional with knowledge of lactose intolerance, e.g. your GP, dietitian, osteopath, etc., for advice and guidance.

Lactase enzyme supplements can also be helpful if you eat lactose-containing foods. These supplements are available as capsules or powders at the pharmacy and can improve your digestion, reducing symptoms and discomfort from lactose-containing foods.

When eating out, you can ask restaurants about the lactose content of the dishes and whether they can be adapted to be lactose-free, although many restaurants inform about their lactose-free dishes on their menus. This advice can also be used when eating privately with family or friends who are not familiar with your lactose intolerance.

What is the difference between lactose intolerance and milk allergy?

Lactose intolerance and milk allergy are two different conditions, although both can cause unpleasant symptoms after consuming dairy products.

The difference between the two conditions is that in milk allergy, an immune reaction occurs to proteins, primarily casein and whey, found in milk.

The immune system of a person with a milk allergy thus perceives milk proteins as harmful, leading to an allergic reaction. Therefore people with milk allergy may experience symptoms such as hives, itchy skin, swelling, difficulty breathing, vomiting and in severe cases anaphylactic shock, in addition to symptoms similar to lactose intolerance, such as stomach cramps, diarrhea or constipation. These symptoms can also occur within minutes to hours of consuming dairy products.

The primary difference, in short, is therefore an enzyme deficiency in the case of lactose intolerance – and an immune reaction against milk proteins in the case of milk allergy.

Nutritional considerations and alternatives for lactose intolerant people

When you are lactose intolerant, there are nutritional considerations to take into account to ensure a healthy and balanced diet:

Dairy products are an important source of dietary calcium, so it is important to find alternative sources of calcium. Good sources can include green leafy vegetables, such as spinach and kale, almonds, sesame seeds, tofu (with calcium sulfate), sardines, salmon, and calcium-fortified foods such as soy milk and almond milk.

Vitamin D promotes the absorption of calcium, so you should make sure you get enough of it. In addition to sunlight, you can get vitamin D from fatty fish, eggs, mushrooms and fortified plant-based milk products.

Fiber aids healthy digestion and can help relieve symptoms of lactose intolerance such as diarrhea and bloating. Fruits, vegetables, whole grains, legumes, nuts, and seeds are good sources of fiber.

Protein is important for building and maintaining muscles, tissues, and organs in the body. Other good sources of protein include meat, fish, poultry, eggs, legumes, nuts, seeds, and plant-based protein sources like tofu and quinoa.

Lactose intolerance in children and teenagers

Children and teenagers go through a period of growth and development in their lives, and there is therefore an increased need for nutritional focus to support their physical and mental development. Lactose intolerance can affect their ability to obtain adequate nutrition from dairy products, which are normally an important source of nutrients such as calcium, vitamin D, protein and other important nutrients. (Source: Apotekeren).

The challenges of lactose intolerance in children and teenagers can thus include:

Calcium deficiency: Dairy products are a primary source of dietary calcium, which is essential for building strong bones and teeth. When dairy products are excluded from the diet due to lactose intolerance, concerns about inadequate calcium intake may arise.

Vitamin D deficiency: Dairy products can also be an important source of vitamin D, which helps regulate calcium absorption, which is important for bone growth and development. Children and teens with lactose intolerance may be at risk for vitamin D deficiency, especially if they have limited exposure to sunlight, another source of vitamin D.

Protein deficiency: Dairy products also contribute a significant amount of protein to the diet, which is important for muscle growth and development. Finding alternative protein sources may be necessary to maintain adequate protein intake in lactose-intolerant individuals.

Social and psychological aspects of living with lactose intolerance

Lactose intolerance can affect a person’s social and psychological well-being in several ways. Social interactions, especially around food and meals with family and friends in private and public spaces, can be challenging. Concerns about food restrictions and the difficulty or discomfort of explaining one’s condition to others can lead to feelings of isolation and otherness, and can create challenges such as difficulty participating in shared activities involving food.

This sense of separation can lead to psychological stress and anxiety in some, and some may even experience a change in their self-perception, identity, and their relationship with food due to their dietary restrictions.

This will reinforce the need for support from family, friends and healthcare professionals. Having someone to talk to about challenges, concerns and needs can help reduce stress and support coping with the condition.

Research into lactose intolerance

Probiotics are products that contain living organisms, typically bacteria, primarily lactic acid bacteria. By consuming these, you can prevent or counteract diseases. The bacteria bind to the cells in, for example, the intestine and remain there for a period of time. Here they create a balance in the microflora, which promotes health and digestion and counteracts the entry of harmful microorganisms. This happens because the probiotics occupy the space where the harmful bacteria would otherwise have settled, and this suppresses the bacteria that cause disease.

A study from 2023 based on a statistical analysis of results from several scientific studies focusing on the effects of administered probiotics in adults with lactose intolerance. The conclusion from the study shows that administered probiotics improve symptoms in adults with lactose intolerance. It is assumed that by making lactose easier to ingest, milk calcium intake also increases. However, this assessment requires further in-depth research to be more definitive.

Additionally, it is believed that probiotics may also be useful in other contexts, but further research is needed before further conclusions can be drawn. However, this study could potentially meet the nutritional needs of adults, as they may be more likely to consume dairy products in the future by supplementing with probiotics.