Lactose intolerance affects approximately 30% to 40% of the Spanish population . It occurs because the body of certain people does not manufacture an enzyme called lactase or not in the proper amount, so they cannot digest lactose, present in dairy products, other foods and culinary preparations.
Lactase is responsible for dividing lactose into its two molecules: glucose and galactose , in order to be absorbed. If this does not happen (because there is not enough or no lactase at all), the lactose will continue its way without being absorbed, producing fermentation and gases. The symptoms of intolerance will be: abdominal distention accompanied by pain and sounds of bowel movements that can be associated with diarrhea and, in extreme cases, vomiting and constipation.
Lactase is lost in mammals when they reach adulthood “except in areas where milk intake is historically maintained throughout life through cows or herds of goats or sheep, such as the Nordic European countries. , the populations of North Africa and Arabia and with less intensity the inhabitants of Southern Europe ”, tells us Dr. Federico Argüelles Arias, President of the Spanish Foundation for the Digestive System (FEAD).
No. Lactose intolerance occurs when the person has a lactase deficiency that causes them to not absorb lactose well. Upon reaching the colon, poorly absorbed lactose is fermented by bacteria in the intestine and produces gas, among other things.
“Allergies are mediated by an immune reaction through immunoglobulins , the most common being allergy to cow’s milk proteins and it usually induces similar symptoms. However, on many occasions, allergic problems occur with skin, eye and respiratory reactions that do not appear in the case of lactose intolerance ”, Argüelles Arias tells us.
It is not the same either. The term malabsorption only refers to the fact that lactose is not absorbed , while with lactose intolerance we will refer to the appearance of symptoms caused by this malabsorption. In fact, there are people who have lactose malabsorption without symptoms.
What does it consist of? Federico Argüelles Arias explains: “There are cases of secondary lactose intolerance, which means that the intestine has temporarily lost lactase as a result of a problem in the intestine . Thus, for example, after severe gastroenteritis or celiac disease . In these cases, the villi of the intestine are lost, where lactase accumulates and until they are replaced, lactase does not reconcentrate. Here the patient can return to consume lactose little by little. In the rest of the cases, the lactase activity does not usually recover, in any case, the metabolization that the colon bacteria make of lactase can be improved, for example, by providing probiotics ”.
“Adults with lactase deficiency tend to maintain between 10 and 30% of intestinal lactase activity and develop symptoms only when they ingest enough lactose to overcome the compensatory mechanisms of the colon,” says Federico Argüelles Arias.
“Lactase deficiency is variable among lactose intolerant people. Most intolerant patients can bear the intake of at least 12 grams of lactose, equivalent to a glass of milk. But in reality, many patients complain of intestinal disturbances with intakes below this amount. Daily lactose intake should be limited to doses that do not produce side effects , ”says Ángel Ferrer Torres, allergist at the Quirón Salud Hospital in Alicante and a member of Top Doctors.
“Fermented products are better tolerated because the bacteria have hydrolyzed the lactose. Among the most common is cured or semi-cured cheese or some yogurts produced in an artisanal way since the bacteria that ferment them have lactase. Also ice creams and serums processed in a traditional way. Other dairy products such as curds, having fat and extracting the aqueous part where the lactose is, can also be perfectly tolerated, just like butter ”, declares Ferrer Torres.
It is a very widespread belief but is it an urban legend or does it happen? Federico Argüelles Arias tells us that there is no record of this statement .
The fact that a person is lactose intolerant can lead us to think that by not being able to ingest the same amount of dairy that someone with enough lactose in their body would take, they could suffer from a calcium deficiency. Well, it doesn’t have to.
According to Ferrer Torres, adults need 1000 mg of calcium a day. The allergist tells us that dairy provides almost half of this amount. However, there are other non-dairy foods that provide non-negligible amounts of calcium. In fact, they can provide more than the milk itself (100 mg of calcium / 100g of milk). Among them, the specialist highlights sesame seeds (700 mg of calcium / 100g of seeds), tofu (250 mg of calcium / 100g of tofu), oily fish such as anchovies, sardines or anchovies (250 mg of calcium / 100g of fish ), almonds and pistachios, steamed vegetables such as spinach, broccoli, lettuce, chard, parsley, and seaweed such as wakame, and legumes such as chickpeas (150 mg of calcium / 100g of food).
On the other hand, dairy products that are sold without lactose continue to provide calcium , in fact their nutritional values are exactly the same as those of dairy products, the only thing that differs is that those without lactose (they do contain lactose) It adds lactase to them to be able to be digested.
Lactose is not only present in dairy products but in culinary preparations in which these or their derivatives are used, such as in pastries made with milk or butter , in sliced bread or in flaked mashed potatoes . Of course, the béchamel, cream cakes, white sauce, preparations with milk cream, cream ice cream, fruit and chocolate shakes made with milk and milk chocolate will have lactose. According to the Top Doctors expert: “The intake of these foods often produces symptoms associated with intolerance .”
“Lactose is hidden in small amounts in drugs such as excipients (specified by the product), meal replacements (bars, powders) and protein supplements . Traces can also be found in products marked with the letter L , processed meats (cold cuts, patés), seasoning powder, margarines, breakfast cereals, prepared meals. As indicated, these foods usually contain traces and it is very difficult for the amount ingested to produce symptoms in a lactose intolerant . These indications are specified for patients allergic to cow’s milk proteins ”, points out the allergist Ángel Ferrer Torres.
There are lactose intolerant people who, for example, in meals in society take a pill and thus can eat foods that contain lactose without fear of disliking them. This pill is basically lactase and can be purchased at the pharmacy without a prescription. Asked if it is good or not to consume it regularly, Federico Argüelles Arias responds: “There is no evidence of adverse effects, although it is recommended that it not be ingested regularly , only on demand when it is known that a meal is going to be made with important amount of lactose ”.
