Lactose Intolerance: an overrated disease concept?

Since I am involved with biestmilch/colostrum, the diagnosis of lactose intolerance seems to have spread like an epidemic. Self-diagnosis and the diagnosis made by physicians – sorry to say so – as an easy way out for all kinds of functional gastrointestinal disorders has become so common that one has to develop reservations.
If you take your time and read the latest research done on this topic …
… doubts about the reliability of this diagnosis appear more than justified. Don’t get me wrong, there is no questioning about people suffering gastrointestinal symptoms, only the given reason may be highly questionable.

The topic is of great relevance for athletes who very often suffer from functional gastrointestinal disorders due to stress, be it mechanical, biochemical or mental. My impression is that these problems are rarely adequately analyzed and diagnosed, but overhastily labelled either as infectious, lactose- or stress-induced (means vegetative). The following paragraphs can only give you a very superficial idea of a complex problem.

Lactose and lactase, what is it about? A more state-of -the art view on intolerance

As far as it is known, lactose has no special nutritional value for adults. It is the most important source of energy during the first year of a human’s life, providing almost half the total energy requirement of infants. Lactose has several applications in food industry. It is used in sweets, confectionery and sausages because of its physiological properties: lactose provides a good texture and binds water and color. To be absorbed it needs to hydrolyzed. This is what lactase is doing. Lactase is found abundantly at the beginning of the small intestines. It is found at the tip of the intestinal villi and is therefore more vulnerable to intestinal diseases that cause cell damage (other enzymes that degrade other sugars are located deeper in the cell lining).  If lactase secretion drops about one tenth or less of suckling level after weaning, then this is referred to as primary hypolactasia. Congenital lactase deficiency is extremely rare. Secondary hypolactasia or maldigestion may be due to operations or damaged mucosal lining of the gut (infections, inflammatory diseases). This is where biestmilch comes in. The minimum amount of lactose that may cause symptoms is not known, and may be a very subjective thing. On average amounts of dozens of grams have to be ingested to cause symptoms (e.g. 50 grams are used in the lactose tolerance test for diagnostic reasons). Don’t forget that you ingest lactose with many kinds of foods!

Biestmilch is low in lactose. It only contains 5% to 7% of the amount of lactose in milk.

Those of you who tolerate lactose in small to moderate amounts without remarkable discomfort, can take biestmilch without any problems. Of course, this only applies, if you are suffering from a proven lactose intolerance which is not part and parcel of a functional bowel disorder (see below). Our experience over many years has shown that in many cases the symptoms of lactose intolerance decrease or disappear. This may be well due to the therapeutic effect of biestmilch on the mucosal lining. Biestmilch works as an anti-inflammatory agent on epithelial cells. Moreover it has got the properties to regulate functional disorders.

The gut has not got so many choices of symptoms presentation

Regardless of the cause abdominal symptoms are loose stools, constipation, diarrhea, abdominal bloating and pain, flatulence, nausea, collywobbles and bowel sounds, dyspepsia etc. Visceral sensitivity and bowel motor abnormalities are very common phenomena in these cases too. The threshold when people with these symptoms perceive pain or discomfort is lower compared to healthy individuals. What’s not painful under normal conditions becomes painful for these people. All these symptoms may be caused by the most different illnesses, ranging form gastrointestinal infections to functional disorders, whereas the majority is suffering from functional gastrointestinal disorders. They are either chronic or recurrent without the findings of structural or biochemical abnormalities. The prevalence of functional bowel disorders in the Western society is very high. Only for irritable bowel syndrome it is around 17%. The symptoms for lactose intolerance are very similar, if not the same.

Recent well-controlled studies have shown that both lactose digesters and maldigesters experience symptoms after ingestion of very low -lactose or lactose-free milk. This suggests that many of the symptoms experienced by lactose maldigesters are not related to lactose digestion. It seems so the subjective lactose intolerance is strongly related with functional illnesses of the guts such as irritable bowel syndrome.

Does lactose intolerance cover up for a more complex illness underneath? Thinking out of the box

Lactose intolerance is not a straightforward simple diagnosis of measuring a lactase deficit. It stands for an underlying complex regulatory dysfunction of the gut. Among those physiological factors that affect the amount of lactose digested and its tolerance are gastrointestinal transit, intestinal lactase activity, visceral sensitivity and the presence of functional bowel disorders, and possibly the composition of the microflora in the colon. On top of this factors related to the sensory and central nervous system modify symptom perception. Just to give you an idea, what this means: Adults who complained a lot about abdominal pain in childhood, seem to be more prone to developing functional gastrointestinal problems later in life.

Reference:
Vesa TH, Marteau Ph, Kopela R: Lactose Intolerance. Journal of the American College of Nutrition, 19 (2), 165-175, 2000