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Lactose intolerance and intestinal fructose intolerance appear to have been on the increase for some time. In this article, which was written as part of the UGB Conference 2022, I want to explore the question of the extent to which there has actually been such an increase in food intolerances in recent years. Can it be proven or what factors could play a role?
Fact or feeling
In the post-factual age, we also have to look very closely at nutritional issues to see whether statements are fact or feeling. What is scientifically verifiable and what is just hearsay or conjecture. With regard to the question “Are carbohydrate intolerances increasing?”, the data situation is currently still extremely weak. Studies on this topic are rare. What we can currently gather is evidence that could bring us closer to an answer. Ultimately, more studies will be needed in the future, especially with regard to consistent documentation of prevalence.
Number of publications
Studies on the subject of carbohydrate intolerances do exist. The number of publications on this subject has been increasing for a good 30 years. Lactose intolerance has been researched in more detail since the 1960s, whereas fructose malabsorption has only been studied since the early 2000s (cf. Born, 2007). A search for “fructose malabsorption” and “lactose intolerance” in PubMed clearly shows this.
This means that there are more and more studies on certain questions about intolerances and therefore more awareness in the scientific community. However, this is not an increase in intolerances, but an increase in interest in intolerances. And this interest is manageable. In the last five years, for example, there has been an average of 55 new studies per year on fructose malabsorption and only around 83 on lactose intolerance, compared to around 30,000 on breast cancer and over 100,000 on COVID on a three-year average.
Sensitivity
There is no denying the impression that we as a society are becoming increasingly sensitive when it comes to our normal bodily functions. Our intestines make noises. It pinches, sometimes it hurts a little, it bubbles and gurgles and its winds and excretions smell unpleasant. Our chair has different shapes and cannot be assigned to type 3 or type 4 of the Bristol Chair Shape Scale (Lewis & Heaton, 1997) every day. That is normal. But our society declares every noise, every soft stool and every intestinal wind to be a symptom. The saying “Every little bean makes a little sound” has now become “Every little sound makes a little symptom”. This contributes to the feeling that there are more and more intolerances. However, we actually react more sensitively to intestinal mechanisms that are normal in themselves.
Diagnostics
Awareness of intolerances has also increased among doctors, especially in Austria and Germany, over the last 20 years. This means that patients with classic intolerance symptoms are recognized more quickly as potential sufferers and are correctly diagnosed much more often and more quickly. This in turn means that significantly more people have been diagnosed in recent years. However, this does not mean that there are more people affected overall.
The gold standard for diagnosing these two intolerances is the H2 breath test, which can now also be carried out in GP surgeries. Normally, monosaccharides such as glucose or fructose are absorbed relatively quickly by the body in the small intestine and do not come into contact with the bacteria in the large intestine at all or only to a small extent. If there is malabso…