What you need to know about lactose intolerance

Lactose and milk, like gluten, often appear as food anti-heroes. Lactose-free products and plant milk are taking up more and more space on supermarket shelves, and lactose has been implicated in many health problems, from digestive disorders (which is at least logical) to autism (which is not proven at all).

What is lactose

Chemically, lactose is a disaccharide (a molecule made up of two molecules of simple sugars), consisting of glucose and galactose. In its structure, the molecule resembles ordinary sugar-sucrose, but instead of fructose, it contains galactose.

Lactose is found in milk – cow, goat, human, and any other. That is why it is called so (milk in Latin – lake). Lactose is a valuable source of carbohydrates for young mammals.

Physiology or why milk may not be digested

A whole molecule of lactose cannot be absorbed by the human body and therefore breaks down into two simple sugars – glucose and galactose – in the intestines. This is done by a special enzyme – lactase.

It is excreted in all newborns (congenital cases of lactose intolerance occur but are rare).

After two years, the amount of lactase produced decreases and by adulthood, about 68% of the population stops producing it.

In the absence of lactase, whole molecules of lactose are not digested and go to the intestinal microflora (which begins to actively multiply and secrete not always useful metabolic products) or begin to ferment directly in the intestine, increasing gas formation and causing discomfort in the stomach.

But! In addition to lactose, milk contains fats (which are digested normally in healthy people) and proteins – casein. Milk protein intolerance affects 2-7% of the population, a congenital condition similar to congenital lactose intolerance.

Therefore, milk intolerance is a very broad concept and lactose and casein allergy should not be confused with a lack of enzymes. Food and drug support (if needed) will be very different for these conditions.

History and ethical aspects

The mass consumption of milk for food began shortly after the shift from hunting and gathering to agriculture and the domestication of ruminants, according to various estimates, 8 to 10,000 years ago.

At the same time, people who continue to produce lactase into adulthood have received an evolutionary advantage. An affordable source of protein and calcium helped mankind survive and thrive after the transition from gathering to farming and a sedentary lifestyle, and for nomadic tribes, milk was one of the foods basic.

Now, the use of milk seems controversial from an ethical point of view – in fact, we are selecting a product for the baby of that same baby’s animal (they usually insert a picture of a big-eyed calf here to enhance the effect). Yes, of course, the milk is intended for small animals, while as always there are some “buts” further.

First, dairy cows, as a result of hundreds of years of breeding, produce far more milk than a calf can eat. And if this milk is not expressed, the cow will get sick and suffer.

Second, for a significant part of human (especially European) history, milk has been an essential commodity for survival. Even 100-150 years ago, many families survived largely on a cow or a pair of goats on the farm.

The conditions of keeping animals on farms, which are cited as another argument against milk consumption, are also highly regulated. Almost everywhere you can find products from small farms, where animals are kept in the most comfortable conditions.

Is milk necessary in the diet?

No, subject to a sufficient and varied diet. Protein can be obtained from meat and fish, and calcium from nuts, dried fruits, herbs, and mineral water.

In dairy products, these substances are available in a compact and well-digestible form, but full nutrition is possible without them.

And dairy products?

Lactose and casein in fermented milk products have already been partially broken down by lactic acid bacteria, their lactose content is low and the casein is partially broken down.

As a result, it is easier for people with lactase deficiency to assimilate them. It has been proven that even with poor lactose tolerance, a person can take 12-15 grams at a time (about 200 grams of milk), i.e. a glass of yogurt is likely to pass without consequences.

Cottage cheese, at least according to the classic recipe, is additionally heat-treated, so it is even easier to digest. Please note that the calcium in 100 grams of cottage cheese is approximately the same as in 100 grams of kefir or yogurt – a significant part of it remains in the whey during the cooking process.

Hard cheese isn’t exactly a fermented dairy product, but the casein and lactose it contains are also in a partially broken down state, so it’s quite well digested.

Milk substitutes

And here, firstly, everything is diverse, and secondly, it is very similar. Diversity in terms of a number of offerings, flavors, brands, and ingredients. The same – in a much lower nutritional value and usefulness of these products.

Rice, soy, almond, and chestnut milk have been studied there in infant nutrition. None of these plant foods met the requirements for protein, calcium, vitamins and calories. Such substitutes can perfectly diversify the diet, but they should not be considered a complete source of nutrients.

Goat’s milk is sometimes considered a healthier (hypoallergenic and nutrient-rich) alternative to cow’s milk. But this study does not support this view. The frequency of casein allergies and the nutritional composition of goat’s milk are similar to those of cows. The magic didn’t work.

lactose and bowel disease

If you have episodes of functional abdominal pain (not caused by disease), lactose restriction may improve the condition.

On the other hand, in inflammatory bowel diseases, lactose indigestion depends more on ethnicity (Europeans tolerate milk better than others) than on a particular pathology. That is, if you are a European, lactose restriction, even with bowel disease, may not affect your well-being.

Where is the comma?

And it looks like it doesn’t exist at all. Love dairy products and tolerate them well – drink.

Liked, but not well tolerated – use in small amounts, add probiotics to diet or take lactase tablets. In Ukraine there is such a drug, it is called Lactazik.

On the other hand, lactose intolerant and do not like milk, or intolerant and everything is fine, as long as you have a varied and nutritious diet, you will not lose anything.

The Ukrainian Ministry of Health (as well as the WHO) recommends including 2.5-3 servings of dairy products per day in your diet, preferably unsweetened and moderately fatty. This will provide almost 50% of the calcium requirement, as well as zinc, selenium, vitamin A and group B. It is also the prevention of rectal cancer and it is simply delicious.