In our time, the prevalence of food intolerances has risen to the point where it is considered a public health problem. In Hungary, one in five people are affected, usually with more than one type of sensitivity.
Almost a third of the adult population develop gastrointestinal symptoms with minimal or low intake of dairy products. The most common forms in our country are the primary and secondary forms, which will be discussed later. The true prevalence is estimated to be at least 40 %, but as with other chronic diseases, the undiagnosed rate is very high.
The widespread nature of the disease is reflected in the high number of intolerant people worldwide. In the United States, lactase deficiency affects 22% of the white population. In Northern Europe, adult intolerance affects 15 percent of the population, in Central Europe 30 percent.
In Mediterranean countries, which otherwise have a good average health status, around 70 percent of the population is affected. Almost all ethnic groups of Asian and African origin are affected. Although no representative survey has yet been carried out in Hungary, experience and the high proportion of the population of Asian origin suggest that at least 30-40% are affected in adulthood.
It can therefore be seen to be a serious problem, yet it does not receive as much attention in the press or in prevention as it should.
So what is lactose intolerance?
Lactose, or milk sugar, is a disaccharide, a sugar found in milk, made up of two parts – galactose and glucose. When it is absorbed, it is broken down into glucose and galactose by the enzyme lactase in the lining of the small intestine. It is therefore a digestible substance that requires a specific enzyme -and the right amount of it- otherwise the body cannot use it.
It should be noted that milk contains various allergenic components such as casein, myoglobin, albumin, lactic and fatty acids. Lactose sensitivity does not refer to these substances, only to the lactose content.
The enzyme lactase – if not congenitally deficient – loses its activity over time, so that after milk consumption, lactose remains in the intestinal tract. It is highly osmotic, i.e. it binds water, the intestinal contents are diluted by the fluid sucked from the blood and a sudden onset of watery diarrhoea with severe abdominal cramps and wind.
The activity of the lactase enzyme often begins to decline at a few months of age, but the disease is usually detected after the age of six years.
What are the possible causes of lactose sensitivity?
Primary, birth enzyme deficiency is a lifelong disorder where the newborn is born without lactase enzyme. This gene defect is recessively inherited and is relatively rare.
Much more common is the primary late form, a gradual loss of lactase enzyme production. This process usually starts at a few months to 2 years of age.
It is more often discovered in adulthood, when it is already causing serious complaints and co-morbidities.
Contemporary research suggests that late onset primary lactose intolerance is a natural phenomenon. It is based on the fact that mammalian genes are programmed to require milk, and therefore lactose, only early in human life.
Thus the activity of the enzyme is lost over time.
Secondary lactose intolerance is usually caused by damage to the mucous membrane of the small intestine. Most often it is the result of gastroenteritis due to pathogenic causes – infections, viruses – during which the mucosa of the small intestine is fundamentally damaged.
The damage also involves the loss of lactase embedded in the membrane of the epithelial cells of the small intestine. The ability to digest lactose usually returns a week after the underlying disease has healed. However, if the condition persists for longer, lactase production fluctuates, causing bloating and dysbiosis, which also damages the mucosa, which again produces less and less enzyme as a consequence of the vicious circle.
Prevalence of lactose intolerance
1. Gastrointestinal symptoms due to the osmotic process: bloating, abdominal pain, strong winds, which occur about one hour after consumption of dairy products.
2. Interaction with other foodstuffs consumed: if symptoms are severe, digestion cannot take place properly. So, inadequate digestion of lactose is not just an isolated problem, but one in which the absorption of other nutrients is not impaired! In fact, the emptying of the stomach is proportional to the severity of the symptoms. And inadequate digestion leads to a myriad of diseases: vitamin deficiencies, imbalances in the microbiome, malnutrition. In the case of intolerance, it is therefore not the right attitude to indulge: a small dietary error or crime, even if it is not symptomatic, does its harmful work internally.
3. Other food intolerances, especially additional grain or protein allergies. Food intolerances often do not go it alone – sometimes, to great surprise, the diagnosis you receive does not only include one food group, and some allergens with a similar structure may be added later. This is the autoimmune mimicry phenomenon.
Life expectancy of food intolerances
With a personalised diet, diagnosed in time and maintained with sufficient discipline, the patient’s life prospects can be trouble-free. If neglected and inadequately treated in childhood, poor absorption can lead to physical and mental retardation, learning difficulties and behavioural disorders.
A neglected patient may have multiple deficiency syndrome. Autoimmune processes may result in increased susceptibility to infectious diseases and poor physical and mental performance.
According to current scientific knowledge, lactose intolerance is not a curable disease, but the length and quality of human life is not affected by it, provided that the right lifestyle is followed with some awareness.
What should a lactose intolerant person avoid?
Many commercial products contain additives that contain milk and therefore lactose. People should therefore check the ingredients of the food they are eating.
These are the ingredients to avoid:
- Cow’s milk (total fat content)
- Organic cow’s milk
- Goat’s milk
- sheep’s milk
- Buffalo milk
- Cow’s milk
- Rabbit milk
- Condensed milk
- Milk powder
- Coffee cream powder
- Milk drinks
- Buttermilk, buttermilk powder
- Whey, whey powder (lactic acid is not the same as whey)
- Cream in all forms
- Butter cream
- Milk desserts
Milk sugar is one of the components of milk that starts to break down during the cheese-making process. … During the breakdown of lactose, lactic acid, volatile acids, aldehydes, carbon dioxide (which makes some cheeses punchy) and other flavourings are produced by lactic acid bacteria.
● Relatively little lactose is transferred from milk to hard cheeses, most of it is removed with the acid. The remaining lactose is virtually degraded by the end of pressing.
emental, parmesan, cheddar
● In semi-hard cheeses, it takes a few days for the remaining minimal amount of milk sugar to break down.
Trappista, Eidami, Maasdamer, Gouda, Tilsiter
● In soft cheeses, depending on the type of cheese, the breakdown of lactose is completed after one to two weeks.
Brie, Camembert, Göcseji
However, you should be very aware that many other foods may contain lactose as an ingredient:
- Bread and pastries
- Biscuits, cakes, pastries, sweets
- Cakes, biscuits, cakes, cakes and confectionery: soup powders, beverage powders, spices, salad dressing powders, coatings for vegetables
- And as a carrier for many types of medicines and vitamins.
Always mention intolerance to your pharmacist or doctor, as there are alternatives for many products.
There are now many conscientious manufacturers who claim exemption and guarantee the continued quality of their products, but a food intolerant cannot avoid taking their own responsibility and checking labels thoroughly on a regular basis.