Nutritional management of lactose intolerance: the importance of diet and food labelling

Abstract

Worldwide, 70% of the adult population has limited expression of lactase enzyme with a wide variation among different regions and countries. Lactase deficiency may lead to lactose intolerance (LI). Depending both on the amount of lactose ingested and on the lactase activity, people who suffer from lactose malabsorption might experience numerous gastrointestinal and extra-intestinal symptoms and manifestations. Treatment of LI mainly consists of reducing or eliminating lactose from the diet until the symptoms disappear as well as supplementing lactase, and inducing colon microbiome adaptation by probiotics. Cow's milk is one of the major source of calcium and several other vitamins and minerals. Thus, a complete exclusion of dairy products may favor the development of bone diseases such as osteopenia and osteoporosis. Therefore, the dietetic approach has a crucial role in the management of LI patients. Additionally, the use of lactose and milk-derived products in non-dairy products (e.g., baked goods, breakfast cereals, drinks, and processed meat) has become widespread in the modern industry (the so-called "hidden lactose"). In this regard, a strict adherence to the lactose-free diet becomes challenging for LI patients, forced to continuous check of all products and food labels. In fact, lactose-free product labeling is still controversial. Considering that nowadays a specific cutoff value establishing "lactose-free" labeling policy is lacking and that there is no universal law regulating the production and commercialization of "delactosed" products, identification of specific safe and suitable products with a well-recognized lactose-free logo might help consumers. This narrative review aims to identify the dietary management for lactose intolerant people, avoiding symptoms and nutrients deficiencies, helped by the use of specific labelling to guide them to choose the safer product on the market.

Production of naturally ‘‘lactose free” fresh cheese”

“…This intolerance is result of low levels of the enzyme lactase in the intestine and consequent inability to digest lactose. It is characterized as a metabolic disorder when people are unable to digest significant amounts of lactose due to a genetic insufficiency in the production of the enzyme lactase (Facioni et al, 2020). People with lactose intolerance present abdominal symptoms, such as diarrhea, nausea, disorders and pain, consequence of ingestion of lactose, normally associated with dairy products.…”

The Effect of Self-Reported Lactose Intolerance and Dairy Consumption on Bone Mineral Density among American Hip Arthroplasty Patients: A Cross-Sectional Study

“…However, neither group differed in egg, fish, poultry, or meat consumption, indicating that lactose-intolerant individuals did not significantly substitute animal products for dairy. It is, therefore, possible that lactose-intolerant individuals either require less dietary calcium than the non-LIIs, used more of lactose or milk derived non dairy products such as breakfast cereal [ 53 ], or that plant-based alternatives provided enough supply of calcium [ 47 ].…”

Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management

“…A further challenge in the translation of PN is the current lack of harmonized regulation of certain food labels, lactose-containing products being a typical example of how labeling can compromise the willingness of consumers to make informed decisions on which foods are more suitable for them and on available alternatives food options [53]. Indeed, there is no agreement so far on a specific "lactose-free" or "low-lactose" logo, nor on a precise cut-off value for establishing a "lactose-free" labeling policy, except for infant formula [53,182,183]. Consequently, it is necessary to reinforce health claims legislation and food law regulation for such products in order to achieve adequate consumer protection and maintain personal freedom of choice [184,185].…”

“…In order to manage their symptoms, people with LI should avoid eating high-lactose foods, such as fresh milk or cream [ 51 ], while ensuring an adequate intake of nutrients from other foods [ 52 ]. It is also recommended that individuals with LI eat lactose-containing foods together with other foods and that they favor small repeated intakes of lactose over one single meal with a high amount of lactose [ 53 ]. Fermented dairy products like hard cheese, quark, or yogurt are suitable for the majority of individuals with LI [ 54 ].…”

“…It should also be noted that lactose is a common additive in many processed foods, such as frozen meals, sweets, cakes, and sauces [ 53 ]. This so-called “hidden lactose” is used for its texture and flavor enhancing properties.…”