As you know from our previous posts, lactose is the main source of sugar in milk and dairy products. It is also present in some industrial products as a preservative or additive. It can be found in processed meats such as sausages or pates, margarines, ice cream, sauces, some cold cuts and sausages, enriched cereals, instant soups, prepared foods and meals, medicines, etc. In other words, lactose is present not only in milk but also in a large number of products that we consume on a daily basis.

It is essential not to confuse the meaning of lactose intolerance (LI) with that of lactose malabsorption (MAL). Not only is it essential to be clear about the differences between the two pathologies, but the approach to treatment is completely different and it is vital to know what one is suffering from in order to be able to solve it.

 

When we talk about a person being intolerant to lactosawe are referring to the defect in the manufacturing of the enzilactase productionwhich, as described in previous posts, is responsible for dissociating lactose into galactose and glucose, which occurs normally in the small intestine. For our body to absorb lactose correctly, the activity of this enzyme must be adequate, because the body can only absorb simple sugars.

The lactose intolerant person, lacking this enzyme, does not digest lactose, so it reaches the colon intact instead of being digested in the small intestine.

In the colon, colonic bacteria ferment this lactose. It is here that two different situations can occur.

 

 

  • On the one hand, if despite malabsorption in the small intestine, we are dealing with an individual with a healthy microbiota in the colon, undigested lactose will be metabolized. Therefore, we would be dealing with an individual who is a poor absorber of lactose, but thanks to his microbiota, he does not suffer any associated symptoms.
  • On the other hand, if we are dealing with an individual with an unbalanced microbiota in the colon, when lactose fermentation occurs, it will generate a high amount of gas, symptoms of abdominal distension, diarrhea or constipation, pain ... among others, but may also appear extra-digestive symptoms such as headache, chronic fatigue, due to the internal inflammatory state. This would be a case of lactose intolerance.

Being lactose intolerant is not irreversible, since it can be solved temporarily by taking a lactase pill, to be able to ingest foods with lactose, but it is not a treatment to the deficit, deficiency or malfunction of this enzyme. However, how your microbiota tolerates lactose is something that we ourselves can take care of to a certain extent. Digestive rest in the dark hours, aerobic physical exercise, stress management, eating a balanced diet and the use of prebiotics have been shown to improve the microbiota significantly.

Therefore, lactose absorption, which is what will determine whether the individual is a good or bad absorber, occurs at the small intestine level, thanks to or as a consequence of the lactase enzyme. Thus, if there is no lactose absorption and we are dealing with an individual with an altered microbiota, we diagnose lactose intolerance, which brings with it all the associated symptoms.

Therefore, an individual can be a bad absorber of lactose for not having the capacity to dissociate it in its monosaccharides and nevertheless be tolerant to it for having a healthy microbiota and therefore being able to consume this sugar. Just as there can be an individual, who having the ability to absorb lactose, be intolerant due to the state of his microbiota, and that eventually solving the problem with their bacteria and or colonic archaea can tolerate lactose without any associated problem.