Letzte Aktualisierung am 11. December 2023 von Dr. Michael Zechmann-Khreis
Avoid lactose
The most important point in the treatment of lactose intolerance is, of course, the avoidance of products containing lactose.
elimination diet
In the first 3-4 weeks after the diagnosis, lactose (milk sugar, not milk protein!) should be completely avoided in order to allow the intestine a regeneration phase. This period is called the waiting period or elimination diet. You can then slowly start taking small amounts. During this time, you should generally eat gently, i.e. do not fry food, but steam it. Easily digestible food is preferable to food that is difficult to digest. In principle, a kind of light diet similar to that after a stomach flu. After this time, you can start eating a “normal” – but lactose-free – diet again. Some sufferers tolerate small amounts (approx. 1g) of lactose well, while others tolerate almost no lactose. Everyone has to test this for themselves, although it must be said that most people can tolerate larger amounts of lactose if they stick to their diet.
Nutrition with lactose intolerance
In the treatment of lactose intolerance, particular attention should be paid to hidden lactose in e.g. ready-made products, bread or sausage products! It is best to coordinate these weeks with a state-approved nutritionist (dietician, nutritionist, dietician, …).
A normal diet contains about 30g of lactose per day. A low-lactose diet consists of approx. 10g and a lactose-free diet of less than 0.1g of lactose per day. Many patients are afraid that they will only be able to eat completely lactose-free. But this is wrong. In most cases, a low-lactose diet is sufficient to treat lactose intolerance. In this context, it is important to mention that a diet failure, a “slip”, does not represent a health risk. So it doesn’t hurt to keep challenging yourself and your gut and to test a little more lactose in a self-test. Strict abstinence, i.e. scrupulous adherence to a strict lactose-free diet, can worsen the situation. The intestine then stops producing lactase completely, even if it could still produce it.
Lactase tablets: Taking the missing enzyme for treatment
The lactose-splitting enzyme lactase can be purchased in tablet, solution or powder form and taken with food. The preparations make it possible to enjoy a carefree visit to a restaurant or accept an invitation to dinner.
It is always best to read the ingredients of the lactase preparation in the pharmacy or drugstore to ensure that it does not contain any additives that you cannot tolerate.
How to take lactase products
The strength of these preparations is given in FCC. This abbreviation stands for “Food Chemical Codex“. This is a measure of the purity of food chemical substances. The FCC was developed in the USA at the end of the 1950s and first published in 1966. There are now many high-dose products (over 9,000 FCC). However, as you cannot take too much, there is no risk of overdosing. These products are usually taken directly with a meal.
1g of lactose is broken down under laboratory conditions by approx. 200 FCC of lactase, which is less than 20mg of enzyme. However, our body is not a laboratory, so this calculation is not correct for the daily use of the preparations. There are various reasons for this. On the one hand, the acidic environment in the stomach slowly but surely deactivates the lactase, on the other hand, the enzyme activity also depends on storage (time, temperature, …). And the effectiveness of the preparation depends on the composition of the diet, the time of intake, etc. This means that it is not possible to specify exactly how much FCC is required.
It is assumed that you should consume around five to seven times the amount of lactase compared to the laboratory, i.e. around 1,000-1,500 FCC for 1g of lactose. An average meal therefore contains around 6,000 – 14,000 FCC. However, it does not make sense to calculate FCC units exactly. After a while you will be able to estimate how much FCC you need for certain meals.
In a survey on the nmi portal in September 2014, most of the more than 500 respondents stated that they dosed with 5,000-15,000 FCC per meal. Lactase is usually ingested with the first few bites. If you have forgotten to take lactase, you can still take the preparation a few minutes after eating. Chewable tablets or powder can be used here and a small overdose usually does no harm.
Which lactase preparations work?
It should be noted here that all lactase preparations work well. The only differences are in the form of administration, dosage, price and additives. Cheaper preparations often have a poorer lactase quality, which means they have to be dosed higher and therefore lose their price advantage. Lactase preparations last for approx. 2 years, i.e. old packs should be disposed of as the enzyme activity is no longer present. If the preparation has been heated above 60°C, the enzyme activity is also no longer present and the preparation is no longer effective. This is particularly important if you leave the lactase in the car and the sun heats up the interior.
Caution: Iron supplements should be taken at least three hours after lactase. No other interactions are known to date.
Listen to our podcast episode on lactase here
No podcast to see? Then this is probably blocked by your local settings. No problem. Click here to find the episode about lactase on the “Nutrition Monologues” podcast page.
Lactose intolerance is not a disease!
Even a violation of the diet is not harmful (only unpleasant). However, as dairy products are an important source of calcium in our part of the world, you should ask your doctor or dietician about alternative sources of calcium (e.g. broccoli, mineral water, etc.). Thanks to the wide range of lactose-free dairy products available, this is no longer a major problem.
Consequential diseases
Lactose intolerance itself does not pose a direct risk to health. If it is recognized and you eat accordingly, there is usually no consequential damage. Long-term consequences are only to be expected if dairy products are consciously avoided over a long period of time. An increased risk of osteoporosis, for example, is described here, as is a vitamin D deficiency. This is different with small children. Permanent diarrhea can lead to dehydration!
Sources and others
(1) www.usp.org
(2) Package leaflet Sanvita lactobene 12.000 FCC capsules
(3) eBook “Lactose intolerance compact”, 8.12.2012, NMI Ratgeber, Kindle Edition
Scientific review of this article: Dr. Michael Zechmann-Khreis