Many of us think they are lactose intolerant. And actually some of us are. The percentage of adults with lactose intolerance (incidence) varies greatly between countries and continents. Whereas lactose intolerance affects about 10–15% of adults in Northern Europe and the United States, it affects up to 95% of all adults in Asia and Africa.
“Lactose intolerance affects about 10–15% of adults
in Northern Europe and the United States”
Lactose intolerance is a syndrome characterised by having symptoms upon the consumption of foods and drinks which contain lactose. Lactose is a simple sugar (disaccharide) which is mainly contained in dairy products.
“People with lactose intolerance have problems digesting
foods and drinks which contain lactose”
Like most diseases, also the syndrome lactose intolerance presents in (50) shades of grey. Depending on the degree of lactose intolerance, the amount of lactose that can be consumed before symptoms develop varies.
Lactose intolerance is not an allergy, because it is not caused by an immune response, but by the lack of the enzyme lactase. Furthermore, lactose intolerance does not cause any damage to the gastrointestinal tract, like other abdominal disorders or food allergies.
“Lactose intolerance is not an allergy”
Symptoms of lactose intolerance usually start half an hour to two hours after the consumption of foods containing lactose.
People with lactose intolerance may experience symptoms like abdominal pain, diarrhoea, nausea, bloating, and farting upon the consumption of foodstuffs which contain lactose. Depending on the degree of lactose intolerance, these symptoms can be more or less pronounced.
“Symptoms of lactose intolerance are abdominal pain,
diarrhoea, nausea, bloating, and farting”
Most lactose intolerant people can tolerate more than ≥9–12 g lactose, which is the equivalent of 200 ml (1 glass of) milk1, or even greater amounts. The majority of people with lactose intolerance can even tolerate up to 20 g lactose without any difficulty2.
The ultimate cause of lactose intolerance is a lack of lactase enzyme (lactase deficiency).
“The ultimate cause of lactose intolerance is lactase deficiency”
There are two types of the enzyme lactase in our small intestine
- Lactase produced by our own body and secreted by the pancreas (human lactase)
- β-galactosidase (bacterial lactase) produced by lactic acid bacteria in the small intestine
Both types of lactase, the human enzyme lactase and the bacterial β-galactosidase, catalyse the chemical breakdown of the disaccharide lactose in our gut into the simple sugars glucose and galactose. Thus, the total amount of these two enzymes determines the degree of lactose intolerance!
“The degree of lactose intolerance depends on
the total amount of lactase enzyme in your gut”
The degree of lactose intolerance depends on the total amount of these two lactose digesting enzymes available in your gut. If there is not enough of these two enzymes in total, not all the ingested lactose can be enzymatically broken down and the remaining lactose causes the typical symptoms of lactose intolerance.
There are indicators that point towards a central role of beneficial gut bacteria in the context of lactose intolerance. Antibiotic use or intestinal infections can lead to a disbalanced gut flora that is damaged and in turn a lack of beneficial gut bacteria that produce β-galactosidase (bacterial lactase) and greatly help to break down lactose in our gut. The beneficial gut bacteria that produce β-galactosidase in our gut are lactic acid bacteria.
“Antibiotic use or intestinal infections can reduce beneficial
gut bacteria that help us digesting lactose”
It is very likely that the symptoms of primary lactose intolerance are – to a certain extent – caused by a damaged gut flora3. This might explain why lactose intolerance often worsens with increasing age. With increasing age it is more likely that people frequently used antibiotics or experienced intestinal infections.
“Lactose intolerance often worsens with increasing age”
Both oral antibiotics and intestinal infections can damage the gut flora in a way that causes the relative amount of lactic acid bacteria to decrease. Furthermore, the disorders and diseases that can cause secondary lactose intolerance – like inflammatory bowel disease (IBD) and food allergies – are well known to be closely associated with a damaged gut flora.
“Oral antibiotics and intestinal infections can damage
our gut flora and reduce beneficial lactic acid bacteria”
Traditionally, management of lactose intolerance involves decreasing the amount of lactose in the diet, taking lactase enzyme supplements, or – in the case of secondary lactose intolerance – treating the underlying disease. However, decreasing the amount of lactose in the diet and taking lactase enzyme supplements is a therapeutic strategy that requires lifelong compliance and cannot lead to a cure of the syndrome lactose intolerance.
“Conventional therapeutic strategies cannot cure lactose intolerance”
An alternative therapeutic strategy is doing a gut restoration and introducing lactic acid bacteria by the consumption of probiotics and fermented foods that contain them. Numerous studies have shown that fermented milk products containing lactic acid bacteria such as probiotic yoghurts and kefir can efficiently improve lactose digestion in people with lactose intolerance1, 4-16.
“Doing a gut restoration and introducing lactic acid
bacteria can greatly improve lactose intolerance”
Unfortunately, until today, this treatment option for lactose intolerance hasn’t been implemented in conventional medicine and due to this reason, proper clinical trials are scarce.
If you are lactose intolerant, you should therefore consider restoring your gut flora to increase the level of lactic acid bacteria in your small intestine, which specifically help to break down lactose.
Gut restoration involves two steps,
By gut cleansing you create space in your gut for new (“good”) bacteria to settle. By rebuilding your gut flora you are giving your gut what it needs: lactic acid bacteria for improving lactose intolerance.
If you want to perform a gut restoration yourself, visit the website www.gutrestoration.com. On this website, you will find a 30 DAYS GUT RESTORATION PROGRAM for reducing lactose intolerance, that exactly uses those probiotic strains that have shown substantial beneficial effects in the treatment of lactose intolerance in clinical trials.
If you want to know more about food allergy, read more here
- de Vrese, M. et al. Probiotics–compensation for lactase insufficiency. Am J Clin Nutr 73, 421S-429S (2001).
- Deng, Y., Misselwitz, B., Dai, N. & Fox, M. Lactose Intolerance in Adults: Biological Mechanism and Dietary Management. Nutrients 7, 8020-35 (2015).
- Vonk, R. J., Reckman, G., A.R., Harmsen, H. J. M. & Priebe, M. G. Probiotics, Chapter 7: Probiotics and Lactose Intolerance, (InTech, 2012).
- Jiang, T., Mustapha, A. & Savaiano, D. A. Improvement of lactose digestion in humans by ingestion of unfermented milk containing Bifidobacterium longum. J Dairy Sci 79, 750-7 (1996).
- Kim, H. S. & Gilliland, S. E. Lactobacillus acidophilus as a dietary adjunct for milk to aid lactose digestion in humans. J Dairy Sci 66, 959-66 (1983).
- Lin, M. Y., Savaiano, D. & Harlander, S. Influence of nonfermented dairy products containing bacterial starter cultures on lactose maldigestion in humans. J Dairy Sci 74, 87-95 (1991).
- Martini, M. C. et al. Strains and species of lactic acid bacteria in fermented milks (yogurts): effect on in vivo lactose digestion. Am J Clin Nutr 54, 1041-6 (1991).
- McDonough, F. E., Hitchins, A. D., Wong, N. P., Wells, P. & Bodwell, C. E. Modification of sweet acidophilus milk to improve utilization by lactose-intolerant persons. Am J Clin Nutr 45, 570-4 (1987).
- Montes, R. G., Bayless, T. M., Saavedra, J. M. & Perman, J. A. Effect of milks inoculated with Lactobacillus acidophilus or a yogurt starter culture in lactose-maldigesting children. J Dairy Sci 78, 1657-64 (1995).
- Mustapha, A., Jiang, T. & Savaiano, D. A. Improvement of lactose digestion by humans following ingestion of unfermented acidophilus milk: influence of bile sensitivity, lactose transport, and acid tolerance of Lactobacillus acidophilus. J Dairy Sci 80, 1537-45 (1997).
- Onwulata, C. I., Rao, D. R. & Vankineni, P. Relative efficiency of yogurt, sweet acidophilus milk, hydrolyzed-lactose milk, and a commercial lactase tablet in alleviating lactose maldigestion. Am J Clin Nutr 49, 1233-7 (1989).
- Savaiano, D. A., AbouElAnouar, A., Smith, D. E. & Levitt, M. D. Lactose malabsorption from yogurt, pasteurized yogurt, sweet acidophilus milk, and cultured milk in lactase-deficient individuals. Am J Clin Nutr 40, 1219-23 (1984).
- Almeida, C. C., Lorena, S. L., Pavan, C. R., Akasaka, H. M. & Mesquita, M. A. Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients. Nutr Clin Pract 27, 247-51 (2012).
- He, T. et al. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects. J Appl Microbiol 104, 595-604 (2008).
- Hertzler, S. R. & Clancy, S. M. Kefir improves lactose digestion and tolerance in adults with lactose maldigestion. J Am Diet Assoc 103, 582-7 (2003).
- Zhong, Y., Huang, C. Y., He, T. & Harmsen, H. M. [Effect of probiotics and yogurt on colonic microflora in subjects with lactose intolerance]. Wei Sheng Yan Jiu 35, 587-91 (2006).