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What is lactose and what is the problem with it?
Lactose, also known as milk sugar, is nothing more than a disaccharide that occurs naturally in mammalian milk. It consists of one galactose and one glucose molecule. A specialized enzyme produced in our small intestine – lactase – is responsible for the metabolism of milk sugar. It is the deficiency or lack of the enzyme responsible for breaking down this disaccharide into “primary factors” that is the problem that determines all the ailments and causes the lactose intolerance mentioned in the title. What’s more, the effect of congenital lactase (complete lack of lactase) can be death! However, this is an incredibly rare issue, so far only a few cases of this condition have been observed (in Scandinavian countries).
The most common "milk problem" is adult hypolactasia, or inappropriately low enzyme production/activity in our intestine. The causes can be primary or secondary. Primary causes include a reduction in the activity of a specific enzyme due to a decrease in the consumption of milk sugar in favor of other carbohydrates over the course of life (it is estimated that this affects up to 37% of the population of our country). Secondary causes are caused by other "external" factors - these include celiac disease or non-specific inflammatory bowel diseases, as well as chronic use of alcohol or medications, especially broad-spectrum antibiotics and NSAIDs.
On average, about 30% of the world's population (not Poland!) is characterized by high lactase activity throughout adulthood, in the remaining 70% the activity gradually decreases.
How do you know that the problem is with you?
In short – if you do not experience unpleasant symptoms after a glass of sweet milk (overflow, bloating, crampy abdominal pain, diarrhea – you probably have nothing to worry about and if you do not give up milk “because it is fashionable” for a long time or use substances that can lead to secondary intolerance – you can enjoy the comfort of consuming milk and dairy products at will. However, if any of the symptoms concern you – it is worth considering a doctor’s consultation and carrying out a lactose tolerance test. It consists of measuring the glucose level in the blood several times after consuming 100g of lactose (correctly, after digesting lactose, glucose should pass into the blood and cause an increase in glycemia). I will add that this type of test is worth doing when you “only” feel discomfort. If you cannot leave the toilet even after a little milk in your coffee – administering 100g of milk sugar may end in a hard “session”…
Is it worth drinking milk at all?
Thorning et al. undertook a review of the available scientific evidence in 2016. They checked whether the consumption of milk and dairy products in the human diet makes sense at all in the context of the risk of obesity, type 2 diabetes, cardiovascular disease, osteoporosis, cancer and all-cause mortality. They were prompted to conduct this review by the widespread skepticism about the healthiness of dairy products and the significant increase in interest in beverages based on plant products. They noted that the consumption of milk and dairy products contributes to meeting the demand for essential nutrients (not very groundbreaking, let's be honest...), but they also observed a trend of reducing the risk of common diseases related to lifestyle thanks to the supply of this group of products. It is impossible not to notice that the authors are supported by the dairy industry, at the same time they emphasize the lack of interference of external companies in the research results.
But this wasn't supposed to be about milk, but about the sugar contained in it and protein supplements!
It should be noted that only milk derivatives will be problematic (theoretically) - in the case of plant or other animal proteins (egg albumin or even beef protein - but I do not recommend it) - there is no problem with lactose (unless it is added, for example, as a filler or sweetener - check the ingredients!).
In the context of milk supplements, the biggest "problem" may be concentrates. They are a product of full value and worth considering, but they contain some carbohydrates (including lactose, of course) and, especially when consumed in larger quantities per portion, may cause discomfort or gastrointestinal disorders. Isolate, on the other hand, is a more highly purified compound, with a lower (often trace) content of carbohydrates and lactose, and a higher protein content. Choosing it will be much safer. However, if you also do not tolerate WPI - there are alternative proteins or those with added lactase (or supplementation on your own). You can also consider introducing probiotics to your diet - a systematic review from this year documented the greatest usefulness of Bifidobacterium animalis strains.
Do I have to use lactose-free supplements?
It is difficult to answer this question unequivocally, because everything will depend on your individual tolerance of lactose in general and its doses. It is possible that drinking milk will cause you flatulence, but cheese or protein supplements will not cause a problem - in such a case there is no point in "fiddling around". However, if you feel discomfort after WPC, even WPI does not do you much good, and you do not feel like eating other proteins - the only option is to choose lactose-free supplements. You have nothing to worry about - Thai studies from 2014 conducted using lactose-free milk confirmed the results of those conducted with "classic" - it is a good drink for athletes!
Be careful!
However, avoid products such as "dairy whey", even if they are sold (supposedly) as a product for athletes! This is a completely different raw material from whey protein concentrate/isolate/hydrolysate - yes, they are made from whey , but whey is only a substrate that requires purification and concentration of the protein (and "depletion" of the amount of lactose). The concentration of lactose in whey can reach 60-70%, so if you have problems with its tolerance - a quick visit to the toilet is guaranteed!
Summary
Lactose intolerance affects a large part of society - if you are among them and feel discomfort after consuming a classic whey protein concentrate - try isolate. If this procedure does not help - the choice should fall on either non-dairy proteins or those with added lactase/lactose-free. A supply of probiotics may also be useful.
Literature:
http://www.pzp.umed.wroc.pl/en/article/2014/4/3/273/
http://cejsh.icm.edu.pl/cejsh/element/bwmeta1.element.desklight-4c4ab5b5-8844-455e-a482-068dbf9ac759
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122229/
https://www.ncbi.nlm.nih.gov/pubmed/15777735
https://gastrologia.mp.pl/diagnostyka/132263,lactose-tolerance-test
https://www.ncbi.nlm.nih.gov/pubmed/29425071
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220048/
Paweł Szewczyk - Master of Dietetics specializing in sports nutrition. Dietician of Polish National Team and European Champions. Participant and speaker at trainings, conferences and seminars throughout the country. Lecturer at the State Medical Higher Vocational School in Opole and the Institute of Psychodietetics in Wrocław. On a daily basis, he deals with professional counseling in the field of nutrition and supplementation, publishes scientifically and popularly, and trains athletes and dieticians.
Author of the blog: szewczykpassion.wordpress.com
More information in the education and experience tab https://szewczykpassion.wordpress.com/wyksztalcenie/
