Lactose intolerance, or sensitivity to milk sugar, is a very common digestive problem that can lead to bloating, abdominal pain and diarrhoea. Many people experience these unpleasant symptoms without realising what is causing them. This article provides a detailed guide to diagnosing lactose intolerance, the principles of a lactose-free diet and how to put it into practice, so that you too can regain your sense of well-being and enjoy your food without having to worry about the consequences.
What is lactose intolerance and what causes it?
Lactose intolerance is a condition in which the body is unable to properly digest lactose, the type of sugar found in milk and dairy products. This is caused by a lack of, or reduced production of, the lactase enzyme in the small intestine. The role of the lactase enzyme is to break down lactose into simpler sugars, glucose and galactose, which can then be absorbed from the digestive tract into the bloodstream.
If there is an insufficient level of the lactase enzyme, lactose passes undigested into the large intestine. There, gut bacteria begin to ferment it, leading to the production of gases (hydrogen, carbon dioxide, methane) and short-chain fatty acids. These processes cause the characteristic and unpleasant symptoms.
It is important to distinguish between lactose intolerance and a milk protein allergy. Whilst the former is a digestive disorder, the latter is an abnormal reaction of the immune system to the proteins in milk, which is much more serious and can even lead to life-threatening symptoms.
Symptoms and diagnosis of lactose intolerance
The severity of symptoms varies from person to person and depends on the amount of lactose consumed and the individual’s level of lactase production.
Typical clinical symptoms
Symptoms that may occur between 30 minutes and a few hours after consuming dairy products may include the following:
- Bloating (flatulence): Abdominal distension and a feeling of fullness are caused by increased gas production.
- Abdominal cramps and pain: Discomfort caused by tension in the intestinal wall and gas.
- Excessive flatulence: The release of gases produced during fermentation.
- Diarrhoea: The osmotic effect of undigested lactose draws water into the large intestine, resulting in looser, waterier stools.
- Nausea, and occasionally vomiting.
These symptoms often overlap with other gastrointestinal conditions, such as irritable bowel syndrome (IBS), which is why an accurate diagnosis is essential.
Diagnostic methods
If you experience any of the above symptoms, you are strongly advised to consult a specialist, such as a gastroenterologist. The Endomedix Gastroenterology Centre It offers patients modern and gentle diagnostic procedures.
The most common and most reliable method for diagnosing lactose intolerance is the hydrogen (H₂) breath test. This is a non-invasive, i.e. non-surgical, pain-free examination.
- Procedure for the examination: The patient must drink a lactose-containing solution on an empty stomach.
- Measurement: After that, you will need to blow air into a special device at regular intervals (usually every 15–30 minutes).
- Assessment: The device measures the hydrogen content of exhaled air. If the body is unable to break down lactose, it passes into the large intestine, where it is fermented by bacteria, a process which produces hydrogen gas. This gas is absorbed into the bloodstream and then exhaled via the lungs. An elevated level of hydrogen in exhaled breath therefore indicates lactose intolerance.
Once an accurate diagnosis has been made, targeted dietary therapy can begin, with the aim of effectively alleviating the symptoms.
The principles of a lactose-free diet
The basis of treating lactose intolerance is to reduce or completely eliminate the intake of foods containing lactose. The strictness of the diet depends on the individual’s level of tolerance. Some people can tolerate small amounts of lactose without experiencing any symptoms, whilst for others even the smallest amount causes symptoms.
List of foods to avoid
Foods with a high lactose content that are best avoided or substituted:
- Milk: Cow’s, goat’s and sheep’s milk all have a high lactose content.
- Dairy products: Cream, sour cream, yoghurt, kefir (although these are fermented products, their lactose content may still be significant).
- Soft and fresh cheeses: Cottage cheese, cream cheese, ricotta, mozzarella.
- Milk powder: It may be an ingredient in many processed foods.
- Whey and whey powder: A common additive in industrial products.
- Writer.
- Ice lollies, milk-based ice creams.
Hidden sources of lactose
Many processed foods may contain lactose without this being clearly stated. Always read product labels carefully! Look out for the following ingredients:
- Milk, milk powder, cream powder
- Whey, whey powder, milk whey
- Skimmed milk powder
- Lactose, milk sugar
- Butter, cream
Examples of foods containing hidden lactose:
- Bakery products, cakes, biscuits
- Cold cuts, sausages, liver patés
- Salad dressings, sauces, soup powders
- Chocolates, sweets and candies
- Breakfast cereals
- Breaded, ready meals
- Certain medicines and dietary supplements may also contain lactose as a carrier.
Authorised and alternative foodstuffs
Fortunately, there is now a wide range of lactose-free products available, making it easy to stick to the diet.
- Lactose-free milk and dairy products: These are products made from cow’s milk to which the enzyme lactase has been added, meaning the lactose has already been broken down. Lactose-free milk, yoghurt, sour cream, quark and cheese are available.
- Plant-based „milks” and products:
– Soya milk, soya yoghurt
– Rice milk
– Oat milk, oat yoghurt („oatgurt”)
– Almond milk
– Coconut milk, coconut cream
- Ripened, hard cheeses: During the long maturing process, most of the lactose breaks down. Examples include Parmesan, Cheddar and Swiss cheese. People who are lactose-intolerant can eat these in small quantities.
- Vaj: Although it is made from milk, its lactose content is very low, as it consists mainly of fat. It does not cause any problems for most people.
Practical advice for everyday life
Changing your lifestyle can be a challenge at first, but a few practical tips can make the transition easier.
1. Introduction of a phased approach
There is no need to cut out all dairy products straight away. Start by cutting out foods with the highest lactose content (e.g. milk, soft cheeses) and monitor any changes in your symptoms. Try small amounts of fermented products (e.g. natural yoghurt, kefir), as the live cultures they contain may help with the digestion of lactose.
2. Mastering label reading
Make it a regular part of your shopping routine to read product labels carefully. Look for the words „lactose-free”, or check the list of ingredients to identify any hidden sources of lactose. Allergen information (usually highlighted in bold) can also be helpful, as milk must be listed as an allergen.
3. Cooking at home
If you prepare your own meals, you have complete control over the ingredients. You can easily adapt traditional recipes to make them lactose-free: use plant-based milk in your morning coffee, lactose-free cream in vegetable stews, or coconut cream in cream soups.
4. Be mindful when eating out
Eating out at a restaurant? Don’t be afraid to ask! Let the waiter know about your sensitivity and ask for advice on which dishes are safe for you. Most places are now well prepared to cater for such requirements. Choose grilled meats or fish served with fresh salad and steamed vegetables, or dishes that do not contain milk as a standard ingredient.
5. Lactase enzyme supplementation
In exceptional circumstances, such as at a social event where you are unsure of the ingredients in the food being served, lactase enzyme tablets or drops available from a chemist may be of help. Taken before a meal, these replace the missing enzyme and help prevent symptoms. It is important, however, that this should not become part of your daily routine, but should only be used as an occasional solution.
Ensuring an adequate intake of calcium
Dairy products are an excellent source of calcium, so when following a lactose-free diet, particular attention must be paid to ensuring an adequate calcium intake in order to maintain bone health.
Excellent lactose-free sources of calcium:
- Fortified plant-based milks: Many lactose-free and plant-based milks are fortified with calcium.
- Green leafy vegetables: Spinach, kale, broccoli.
- Oily seeds: Almonds, sesame seeds (and tahini made from them).
- They are thin: Soya beans, white beans.
- Halak: Sardines, salmon (if eaten with the bones).
If necessary, and on medical advice, taking calcium supplements may also be advisable.
Final thoughts: a lactose-free life
A diagnosis of lactose intolerance does not mean the end of enjoying good food. With a well-planned, informed diet, you can lead a full and symptom-free life. The key is to stay informed, read product labels carefully and find out about the alternatives. Thanks to today’s wide range of products, almost any traditional dish can be prepared in a lactose-free version.
If you are also experiencing digestive problems, do not hesitate to seek professional help. An accurate diagnosis is essential for starting the right treatment. The Endomedix Gastroenterology Centre Its specialist doctors and modern diagnostic procedures will help you get to the root of the problem and find a personalised solution, so that you can once again enjoy your meals without any worries.
