Lactose intolerance – causes, symptoms and holistic approaches to treatment

Lactose intolerance – along with fructose and sorbitol intolerance – is one of the so-called carbohydrate intolerances. In Germany, around 15 % of the population is affected, worldwide even significantly more. This intolerance can have a significant impact on quality of life, as it restricts the enjoyment of many foods and manifests itself in numerous, often unspecific symptoms. In this article, you will find out what exactly is behind lactose intolerance, how it develops, how it is diagnosed and what treatment options are available – both from a conventional medical and holistic perspective.

What is lactose?

Lactose is a so-called disaccharide, which occurs naturally in the milk of mammals. It is made up of two simple sugars: Glucose (dextrose) and galactose. In order for the body to be able to utilize this lactose, it must be broken down into its two components in the small intestine with the help of the enzyme lactase. Only in this form can they be absorbed via the intestinal mucosa.

How does lactose intolerance develop?

Lactose intolerance occurs when the body does not produce enough lactase or the enzyme is completely absent. The unsplit lactose then reaches deeper parts of the intestine, where it is broken down by bacteria – forming gases and acids. This leads to typical symptoms such as flatulence, abdominal cramps and diarrhea.

There are two main forms:

1. primary lactose intolerance

This form is genetically determined. In many people, lactase production naturally decreases in the course of life – an evolutionarily normal process, as humans originally only consumed breast milk during infancy. In Europe, however, the primary form is rarer than in other parts of the world.

2. secondary lactose intolerance

Secondary lactose intolerance is caused by damage to the mucous membrane of the small intestine, for example by:

  • Celiac disease (gluten intolerance)
  • Chronic inflammatory bowel diseases (e.g. Crohn’s disease, ulcerative colitis)
  • bacterial or viral intestinal infections
  • Antibiotic therapies
  • other drugs or toxins

If the underlying disease is treated, lactase production can return to normal – the intolerance is therefore often reversible.

Symptoms: How does it manifest itself?

Typically, symptoms occur between 30 minutes and three hours after eating foods containing lactose. Common symptoms are

  • Flatulence and bloating
  • Abdominal pain or cramps
  • Diarrhea
  • Nausea
  • Constipation (less common)
  • Fatigue (“leaden tiredness”)

If lactose intolerance is not recognized or ignored, it can lead to chronic symptoms that are often not directly linked to the diet:

  • Irritability, inner restlessness
  • Concentration and sleep disorders
  • Headache
  • Joint pain
  • depressive moods
  • Skin problems (e.g. neurodermatitis)
  • Chronic exhaustion

In children in particular, an undetected lactose intolerance can impair growth and development.

How can it be determined?

If you suspect that you suffer from lactose intolerance, the following methods will help to clarify the situation:

1. food diary

A simple and often very revealing method: over a period of two weeks, note what you eat and how you feel afterwards. If you repeatedly feel unwell after eating dairy products, this is an indication of a possible intolerance.

2. H2 breath test

The so-called hydrogen breath test is considered the gold standard. You drink a lactose solution and the hydrogen content in your exhaled air is measured. If the value rises, this means that unsplit lactose has been fermented in the large intestine – a clear sign of lactose intolerance.

3. genetic test

A genetic blood test can provide information on the primary form of lactose intolerance. This will show whether you have a genetic lactase persistence or non-persistence.

What to do with lactose intolerance?

The treatment depends on the cause.

Adapt your diet

In most cases, a low-lactose or lactose-free diet is the first step. However, you don’t have to give up pleasure completely:

  • There are many lactose-free dairy products on the market.
  • Plant-based alternatives such as oat, soy, almond or rice milk are well tolerated.
  • Hard cheeses such as Parmesan or Emmental are almost lactose-free by nature.
  • Yoghurts with probiotic cultures can sometimes be better tolerated.

Lactase preparations

Lactase enzymes are available in pharmacies in tablet form. These can be taken before meals to support lactose digestion. However, they should be seen as an emergency solution, not a permanent solution.

Holistic approaches

In the case of secondary lactose intolerance in particular, it is worth taking a look at the gut as a whole. The microbiome is often out of balance – for example after taking antibiotics or chronic inflammation. In such cases, a gut cleanse can be helpful:

  • Build up the intestinal flora with targeted probiotics
  • Detoxification of the body with natural remedies (e.g. zeolite, chlorella, bitter substances)
  • Avoid acid-forming foods such as sugar, white flour and alcohol

In the long term, this can stabilize intestinal health and improve tolerance to dairy products.

Criticism of dairy products – even beyond lactose

The debate about dairy products goes far beyond the issue of lactose intolerance. Critics complain that milk contains many ingredients that are difficult for the human body to digest:

  • foreign animal protein
  • Hormones and growth signals
  • Acidifying effect in the body

Milk is also being discussed as a potential trigger of chronic inflammatory diseases – especially in people with a weakened intestinal environment.

The widespread opinion that milk is the best source of calcium is now also outdated. Many plant-based foods also contain plenty of calcium – for example:

  • Kale
  • Broccoli
  • Almonds
  • Sesame
  • Mineral water with a high calcium content

These forms are often even more bioavailable than calcium from milk.

Lactose – the hidden sugar

Important to know: Lactose is not only found in obvious dairy products, but is also hidden in many processed foods:

  • Ready meals
  • Baked goods (e.g. bread rolls, croissants)
  • Sausage and meat products
  • Chocolate
  • Sauces, puree powder
  • Medication and dietary supplements

It’s worth taking a look at the list of ingredients – it often says “lactose”, “milk sugar” or “whey powder”.

Conclusion

Lactose intolerance is not a rare phenomenon and can lead to considerable discomfort for those affected – both in the digestive tract and beyond. The good news is that with the right diagnosis and an adapted diet, it is very easy to live with. It is even better to understand the cause – especially in the case of secondary lactose intolerance – and to support the gut holistically by means of gut rehabilitation. In the long term, this can not only improve tolerance, but also increase overall well-being.