What is lactose (milk sugar) and lactose intolerance?

Some people cannot or cannot fully digest lactose (milk sugar). If this causes complaints when using the recommended amounts of milk (products), then there is lactose intolerance.

A lactose-restricted diet is usually sufficient to prevent complaints. A dietitian can help with this.

Usually, it is not necessary to eat or drink any milk and milk products at all. Also, it is often not necessary to avoid products with milk or lactose as an ingredient.

What is lactose intolerance?

If you are lactose intolerant, you cannot tolerate lactose well because you cannot digest it well. You only speak of lactose intolerance if complaints arise when taking the recommended amount of milk (products) per day. If you can’t digest lactose properly, it’s called lactose malabsorption.

A third to half of the people with lactose malabsorption have lactose intolerance.

What is lactose?

Another word for lactose is milk sugar. This type of sugar (carbohydrate) occurs naturally in all milk. Lactose is found in milk, milk products, and products with milk components.

Does a lactose allergy exist?

There is no such thing as a lactose allergy. An intolerance is not an allergy. In an allergy, the immune system makes antibodies against a protein. In the case of a cow’s milk allergy, the immune system makes antibodies against the proteins in milk. The immune system is not involved in lactose intolerance. You, therefore, do not react to the proteins in the milk, but to the lactose (milk sugar).

What are the causes of lactose intolerance?

When the body produces too little lactase, lactose cannot be digested or not completely. Lactase is an enzyme that is made in the lining of the small intestine.

Lactose consists of 2 linked parts, namely glucose and galactose. Normally, the enzyme lactase splits the lactose into these 2 separate parts. They can therefore easily be absorbed into the blood. If this splitting is insufficient (due to too little lactase), the remaining lactose ends up in the large intestine. This causes complaints.

The extent to which complaints arise depends on:

  • the amount of lactase made in the small intestine; and
  • how much lactose a person ingests.

Usually, lactose intolerance is hereditary and does not go away. There is also a form of lactose intolerance that is temporary. This occurs after the intestinal wall is damaged, for example during an intestinal infection, intestinal inflammation, or an intestinal operation. In those cases, the lactose intolerance disappears after recovery.

Lactose intolerance worldwide

At birth, each infant has sufficient lactase to properly digest the lactose in breast milk or infant formula. In more than 80% of the world’s population, the production of lactase gradually decreases after the third year of life. In the Far East, almost the entire adult population has very low or even no intestinal lactase production. Around the Mediterranean, this is about 50% of the population. In Western Europe and North America, this percentage is much lower.

What are the symptoms of lactose intolerance?

Symptoms of lactose intolerance arise in the large intestine, such as:

  • bowel rumblings
  • bloated feeling
  • flatulence
  • nausea
  • stomach ache
  • diarrhea
  • constipation

These complaints are caused by the gases that are formed when the naturally present bacteria break down the remaining lactose. In addition, the undigested lactose attracts water, causing watery stools and diarrhea.

Lactose Intolerance Diet

With lactose intolerance, you first check how much dairy such as milk and yogurt you can still tolerate. You supplement the rest of the recommended daily amount with dairy substitutes. This way you ensure that you get all the nutrients from dairy.

Doctor and dietitian

Do you suspect you have lactose intolerance? Then go to your doctor to see if that is indeed where your problems are coming from. Perhaps there is another cause. And cutting dairy products from your diet is a big decision. With this, you impose a strict diet on yourself and you miss a source of important nutrients.

Has the diagnosis been made? Then we recommend going to a dietician. A dietitian helps with the new diet and makes sure that you do not become deficient in nutrients.

Why dairy?

Dairy is an important source of protein, calcium, vitamin B2, and vitamin B12. In addition, with your daily portion of dairy, you reduce the risk of colon cancer. If you eat yogurt, you also reduce the risk of type 2 diabetes. This beneficial effect may be due to the calcium, but it could also be due to other substances.

Lactose-free diet: how much lactose can you tolerate?

Because of the positive effects of milk and yogurt on your health, we advise you to investigate how much lactose your body can still tolerate. On average, people with lactose intolerance can consume 10 to 15 grams of lactose without experiencing any symptoms. This is about a large mug of milk.

What is the right amount for you can be determined step by step with the help of a dietitian? If you can tolerate some lactose, it is wise to spread this amount over the day.

Lactose-free food

Usually, it is not necessary to completely avoid products with lactose. In exceptional cases, someone can develop symptoms after a very small amount of lactose. Only then is a lactose-free diet necessary. In such a case, a dietitian is even more important.

Recipes without milk

On our recipe site, you will find recipes without milk.

Dealing with dairy in lactose intolerance

The Wheel of Five contains the following products with lactose:

  • skimmed and semi-skimmed milk
  • buttermilk
  • skimmed and semi-skimmed yogurt
  • low-fat quark
  • dairy spread
  • cottage cheese
  • some brands of mozzarella and fresh goat cheese

There is also lactose in products that are not in the Wheel of Five, such as butter, cream cheese, custard, chocolate mousse, and other dairy desserts.

Lactose-free milk products

The easiest alternative is the various lactose-free cow’s milk products, such as lactose-free semi-skimmed milk and lactose-free yogurt. There is no official guideline when a product can be called lactose-free or low-lactose. The NVWA uses a maximum of 0.01 gram lactose per 100 gram/ml for lactose-free and a maximum of 1 gram lactose per 100 gram/ml for lactose-free.

Making low-lactose milk

It is also possible to make your own low-lactose milk. Preparations containing the enzyme lactase are available online. You add this to the milk. It still contains lactose, but much less. It differs per person how well these products are tolerated.

Cheese without lactose

Hard cheese contains very little to no lactose. This is because the lactose is completely broken down during the ripening of the cheese. So you can just eat the hard cheeses. The Wheel of Five contains hard 20+ cheese and 30+ cheese.

Cheeses with little or no lactose that are not in the Wheel of Five are feta, mascarpone, Parmesan cheese, gorgonzola, Roquefort, and camembert. They are not well tolerated by everyone.

Sour milk products

Sour milk products, such as yogurt and buttermilk, contain less lactose. This is because the lactose is partly broken down during fermentation. You can tolerate these products better if you are lactose intolerant.

Plant-based protein drinks and desserts

Plant-based protein drinks and desserts with sufficient protein, calcium, vitamin B2, and vitamin B12 are an alternative to milk. There is no lactose in it. These products do not provide the health benefits of dairy products. But they can provide the nutrients you lack if you don’t consume dairy. Then choose products that are fortified with calcium and vitamins. Soy drink with added vitamin B12 and calcium is in the Wheel of Five. Other vegetable drinks such as almond drinks and oat drinks contain little protein.

You can check on the label whether it contains a comparable amount of nutrients as in milk. 100 grams of semi-skimmed milk contains:

  • 3.4 grams of protein
  • 123 milligrams of calcium
  • 0.17 milligrams of vitamin B2
  • 0.45 micrograms of vitamin B12

Tablet or capsule with lactase

There is also the option of taking a tablet or capsule with the enzyme lactase before a meal. In your gastrointestinal tract, the lactase breaks down the lactose. You can buy these tablets without a prescription at the pharmacy or drugstore or online. The tablets are useful if you want to continue using regular dairy products. Or when you are on holiday or going out to eat somewhere and it is less easy to avoid lactose. Do you want more information about this? Ask a dietitian.

Lactose in bread and in margarine and low-fat margarine

Many manufacturers process milk, milk powder, or milk components in their products, for example for the taste. That is why there may be lactose in bread, margarine, or low-fat margarine. Because it usually involves little lactose, it is usually not necessary to avoid bread, low-fat margarine, and margarine. Some people may experience problems if they eat several products with a small amount of lactose.

If you are very sensitive, these products are also available without lactose. You can find out which products are lactose-free by carefully reading the label.

Lactose in other products

Also in cakes, pastries, snacks, and ready-made products such as sauces and soups often contain lactose. For example, because the manufacturer uses butter or milk components. Because it usually involves little lactose, in most cases it is not necessary to avoid these products. If you are very sensitive to lactose, these products are also available without lactose. Whether there is lactose in a product depends on the manufacturer. There are cookies available with and without butter.

How do you read the label?

The label states whether a product contains milk or milk components. If so, the product almost always contains lactose. Hard cheese, such as Gouda cheese, is the exception. It does contain milk, but (almost) all the lactose has been removed.

Milk ingredients

Milk solids are the different parts that are in milk. These can be extracted from the milk and added to a portion of food as a separate part. How much trouble you have from milk components depends on your sensitivity to lactose and the amount of lactose in a product.

The milk components are listed below. The law states that it must be clearly visible when there are milk or milk components in a product. It is often immediately clear, such as with milk powder or butter oil. Unclear names, such as casein and whey, must be clarified by the law. For example, the label will state casein (milk).

Milk solids with lactose:
lactose actual
milk derivative whey
lactalbumin butter concentrate
milk sugar recent
casein whey powder
lactoferrin butter oil
skimmed milk ingredients transglutaminase
caseinate milk powder
beta-lactoglobulin butter (powder)
dry milk solids nisin (E234)
milk protein skimmed milk powder
lactoperoxidase milk fat
curd full milk powder
hydrolyzed milk protein milk salt

Exception: lactate/lactic acid

Based on the name, lactate/lactic acid appears to contain lactose. That is not true. It does not come from milk and does not contain lactose. Lactate is used as an acidity regulator and added to, for example, bread.

Furthermore, the sweetener lactitol is prepared from lactose, but due to the preparation it no longer contains lactose.

Cream, yogurt, and butter

If the ingredient list says cream, yogurt, or butter, the product contains milk. But with these ingredients, milk does not have to be mentioned separately on the label.

Traces of…

Sometimes the packaging says ‘may contain traces of milk. Then it is not an ingredient, but the product comes, for example, from a factory where they also make milk products. As a precaution, the manufacturer puts this on the packaging. You can eat products that mention this if you have lactose intolerance.