Lactose intolerance

a common problem
For around 15-20% of people in Germany, milk is not a pleasurable experience but a cause of discomfort: They suffer from an intolerance to milk sugar (lactose), which is also known as lactose intolerance. We have compiled some information on the causes, symptoms and much more for you.

What is lactose intolerance?

When lactose causes problems

Scientists talk about lactose intolerance when consuming milk and milk products triggers symptoms. The cause is a deficiency of the enzyme lactase. In this case, lactase, which is responsible for breaking down milk sugar, is not produced at all or only produced in insufficient quantities in the body. As a result, the lactose cannot be digested or can only be partially digested: The lactose reaches the large intestine undigested, where it is fermented by the bacteria which live there into lactic acid, methane and hydrogen. These substances can cause discomfort such as abdominal pain, flatulence, diarrhoea and nausea. One interesting point to note is that lactose intolerance should not be confused with a milk protein allergy. An allergy is when antibodies are formed in the body, i.e. an immune reaction is triggered.

What does lactose contain?

Lactose is a natural component of milk. Chemically, it is a carbohydrate which is only found in the milk of mammals. Unfortunately, however, lactose is not only found in drinking milk, but is hidden in dairy products such as cheese or cream. It is also added to spice mixes, meat products and baked products and preserved vegetables. For people with lactose intolerance, food they haven’t eaten before poses a daily risk of experiencing discomfort. In the long term, it helps to eat a lactose-free diet because there is no treatment for the condition. However, in order to not have to give up dairy products, which are rich in calcium, vitamin D and protein, it can be useful to take a supplement of the enzyme lactase, for example in tablet form, to enable you to consume milk again.

Lactase is responsible for breaking down lactose

The enzyme lactase is produced in the small intestine and breaks down milk sugar, i.e. lactose, into its usable components: galactose and dextrose. These sugars can be absorbed by the small intestine, unlike the dual sugar lactose. However, about 75% of all people lose the ability to produce lactase in sufficient quantities as soon as they are no longer children.

How to recognise symptoms of lactose intolerance

What symptoms indicate lactose intolerance?

Bloating, diarrhoea, flatulence: Many people suffer from digestive problems during or after meals. If these symptoms occur regularly or last for a long period of time, it can significantly reduce your quality of life. And people are often still concerned whether there is a serious illness causing their symptoms. The causes of stomach complaints and intestinal complaints can be just as varied as the symptoms. There is a wide range of possibilities, from stress to inflammation or chronic disease. However, a stress-related disorder of the intestinal tract is not always the reason: food intolerance can also trigger similar symptoms. Common intolerances involve lactose (milk sugar) and fructose (fruit sugar). In this case, the causes of the complaints in the gastrointestinal tract are the gaseous products that are produced when large amounts of lactose or fructose are fermented by the intestinal flora whilst food is being broken down: Methane and hydrogen add gas to the intestine and can cause abdominal pain, nausea and flatulence.

What causes lactose intolerance?

There are two types of lactose intolerance: primary and secondary. The first is the most common form and is genetic. The lactase activity in the small intestine decreases continuously as we age. This is a very natural process. Older people therefore tolerate milk and dairy products less well than young people. Secondary lactose intolerance, on the other hand, develops as a result of other gastrointestinal diseases such as coeliac disease, Crohn’s disease or bacterial infections or after gastrointestinal surgery or antibiotic therapy. If the underlying disease has been successfully treated, lactase production can stabilise again in secondary lactose intolerance.

Lactose intolerance – what should I do now?

A lack of or reduced quantities of lactase has far-reaching consequences for those with the condition. On the one hand, the natural intestinal flora is severely stressed by regular diarrhoea. On the other hand, important calcium sources are lost if no milk or dairy products are consumed. Calcium contributes to the maintenance of normal bones and teeth as well as normal muscle function. Furthermore, it supports energy metabolism. People with lactose intolerance should therefore provide their body with other sources of calcium to meet their needs. Some vegetables, such as kale or broccoli, also contain calcium but the oxalic acid they contain makes it harder for the body to use the calcium. Dietary supplements or calcium-enriched foods are also an option. Since lactose intolerance cannot be cured, the only option is to switch to lactose-free foods or, if you do not want to give up foods containing lactose completely, to get the enzyme lactase externally.

Lactose intolerance tips for everyday life and nutrition

To make sure you don’t have to miss out on anything

Lactose intolerance affects patients’ quality of life. This is not only due to giving up foods containing lactose but above all because of the associated gastrointestinal complaints, which are often difficult to prevent entirely. The following tips should make it easier for you to deal with lactose intolerance in your everyday life.

Tip 1: Lactose is hidden in pretty much everything

Constantly checking labels when shopping, asking about ingredients in restaurants… it is often difficult or impossible to check the actual lactose content of dishes and foods. Depending on the origin and manufacturing process, the lactose content of milk and dairy products is not always the same: Yoghurts with live lactic acid bacteria or yoghurt cultures are easier to tolerate than normal yoghurts. The lactose content of cheese varies with its degree of maturity. Some varieties contain very little lactose, such as Parmesan, Camembert or Edam, and are therefore usually well tolerated.

Lactose is not only found in dairy products, but also in many convenience foods that appear to be lactose-free at first glance, such as ready-made soups, baked goods, spice mixes and meat products. Lactose is also used as a carrier substance in medicine. Labelling the ingredients “milk and products derived from milk (including lactose)” is compulsory on foodstuffs according to EU regulations. Lactose must be highlighted in any list of ingredients. In addition to milk sugar and lactose, terms such as lactose monohydrate, milk (powder), whole milk (powder), whey (powder), sweet whey (powder), sour whey (powder), skimmed milk, whey products, cream, cream powder, sour cream and butter also indicate the presence of lactose. People who suffer from lactose intolerance can be reassured that they are playing it safe if a product contains the label “lactose-free”. Numerous lactose-free foods have now found their way onto supermarket shelves. The portfolio ranges from soy-based or rice-based milk substitutes to lactose-free dairy products and ready meals (e.g. lactose-free pizza). Unfortunately, these products are often more expensive than their ordinary counterparts and many people do not think they taste as good. Our shopping guide shows you the lactose content of foods and makes your next shopping trip easier.

Tip 2: Trying things out and observing

Depending on the individual severity of the intolerance, patients must limit or consistently avoid the consumption of milk, dairy products and other foods containing lactose. Some find this easier and others find it difficult to give up some foods. After a short time of dealing with lactose intolerance, each person who experiences the condition finds out for themselves which restrictions are the most difficult for them. They also find out how much lactose they can still tolerate well and at what quantities problems occur. Our food diary can be an important tool here. By writing down the food and drinks you eat every day, you can quickly and clearly trace symptoms back to specific foods that may be triggering your discomfort.

Tip 3: Lactase tablets make many things easier

Avoiding milk and dairy products is often associated with massive restrictions in enjoyment for those who experience the condition. Even though lactose-free ice cream is now commercially available, many people think that this is not an adequate substitute for homemade chocolate ice cream from the gelato place around the corner. In addition, it is often difficult or impossible to check the actual lactose content of food: this is especially true when eating in a restaurant, canteen or buffet at a holiday resort. Even many foods and finished products that appear to be lactose-free at first glance contain certain amounts of lactose. Complete replacement is therefore not particularly achievable. Special lactase preparations in the form of swallowable and chewable tablets are an alternative and provide a significant relief in everyday life. They supply the required enzyme lactase from the outside and thus enable you to enjoy food which contains lactose without any worries. This has the advantage that, on the one hand, you continue to consume important nutrients from dairy products and, on the other hand, you do not run the risk of being confronted with the unpleasant side effects of food which contains lactose when you are out and about, for example at parties or in restaurants.

Frequently asked questions

What is lactose?

Lactose or milk sugar only occurs naturally in the milk of mammals such as cattle, sheep or humans. This serves as a source of nutrition for newborn babies in the first months of their lives. Chemically, lactose is a dual sugar composed of two simple sugars: glucose and galactose. Since the body can only absorb simple sugars, lactose must be broken down into its components in the intestine by the enzyme lactase.

What is lactose intolerance?

In Germany, about 15 to 20% of people have lactose intolerance. This means that their body cannot produce the enzyme lactase or cannot produce it in sufficient quantities. Therefore, the lactose enters their large intestine without having been broken down. It causes an increased influx of water into the intestine and thus has a laxative effect. In addition, the lactose is also broken down by intestinal bacteria. This causes gases to form, which can eventually lead to complaints such as abdominal pain, nausea, diarrhoea or flatulence.

How does lactose intolerance develop?

In principle, a distinction is made between two different forms: a genetically determined “primary” lactase deficiency and a “secondary” lactase deficiency as a result of certain conditions.

Primary lactase deficiency often occurs from the age of 5, but can also become apparent in later years. In older people, a decrease in lactase activity is part of the natural ageing process. Only in very rare cases does the defect already exist at birth, meaning that babies with the condition cannot tolerate breast milk and are dependent on special food.

Intestinal conditions can also lead to temporary lactose intolerance. Damage to the mucous membrane of the small intestine also disrupts the function of enzymes located here, such as lactase. Diseases of the small intestine such as Crohn’s disease, coeliac disease or bacterial infections, as well as gastrointestinal surgery or the use of antibiotics, can therefore lead to “secondary” lactose intolerance. The reduced lactase activity is therefore not genetic and usually returns to normal when the underlying condition is treated.

Is lactose intolerance an allergy?

A food intolerance should not be confused with a food allergy. Unlike an allergy, the symptoms of lactose intolerance are not caused by an excessive immune reaction.

How can lactose intolerance be diagnosed?

There are a number of different tests that can be used to determine whether a lactose intolerance is present:

H2 breath test

In the H2 breath test, a solution containing lactose is first drunk and then the hydrogen content in the breath is measured at regular intervals. If the lactose is not broken down by the enzyme lactase, the intestinal bacteria convert it into hydrogen and other substances. Therefore, the higher the proportion of hydrogen in the exhaled air, the less lactose the patient can tolerate.

Lactose load test

The lactose load test is often combined with the H2 breath test. The patient also takes a lactose solution and then the doctor measures the rise in their blood sugar level. If a patient can break down lactose normally, it will increase. If they are lacking in the enzyme lactase, a correspondingly lower amount of glucose enters the blood; their blood sugar level remains unchanged or rises only very slightly.

Genetic test

The simplest and most convenient method of identifying a lactase enzyme deficiency is gene analysis: The pharmacist takes a swab of the patient’s oral mucosa using a special cotton swab and has it examined in a certified specialist laboratory. The findings can be obtained in a very short time and often the patient’s journey to find the cause of their digestive complaints comes to an end. In addition to safety, one advantage of this procedure is that the patient does not have to take a solution containing lactose to prepare for the test, as is the case with the H2 breath test, and is thus spared the associated unpleasant symptoms.

What is the recommended intake of lactase products?

There are differences in the degree of lactose intolerance. The dosage and the choice of sanotact® lactase products depends, firstly, on how much of the enzyme lactase the body is still able to produce. Secondly, the intake depends on how much lactose is contained in the food and drinks that you want to consume. But the type of food, i.e. liquid or solid, also needs to be considered. The length of time the food remains in the digestive system and the condition of the intestinal flora also play an important role. It is therefore important to learn about the function of lactase.

If food containing lactose is consumed again later, it is necessary to use the lactase enzyme again. Lactase can only work if it is in the digestive tract at the same time as the food which contains lactose.

How much lactose do the lactase products break down?

One sanotact® lactase 7,000 mini tablet breaks down approximately 35 g of lactose, which corresponds to around 700 ml of milk, for example. One sanotact® lactase 12,000 mini tablet breaks down around 60 g of lactose, which corresponds to approximately 1,200 ml of milk. One sanotact® lactase 22,000 tablet breaks down about 110 g of lactose, which corresponds to about 2.2 litres of milk, for example. However, these are only rough orientation values which may vary from person to person.

Can you overdose on lactase products?

The added enzyme lactase is a protein from a structural perspective and is digested in the small intestine after performing its function of splitting lactose. Added lactase can neither be absorbed by the human body nor does it influence existing endogenous lactase production. Thus, no adverse effects are to be expected from prolonged or excess consumption.

From what age can lactase products be used?

Our sanotact® lactase products are suitable for children from 4 years of age.

What does "FCC units" mean?

FCC means Food Chemical Codex and is the measure of enzyme activity (biological activity).

Can lactase products also be consumed during pregnancy?

We are not aware of any findings that would prevent use in accordance with the recommended intake during pregnancy and breastfeeding. However, we recommend that you discuss this with your doctor as a precaution.