Can You Eat Cheese If You Are Lactose Intolerant?
There is a great inter-individual variation in tolerance to lactose, which implies that it is the individual himself who self-regulates the quantity of dairy products that is able to consume. Dairy products such as treated/cured or semi-cured cheese can be consumed by intolerant people, as they lack or have very small amounts of lactose.
Lactose is a disaccharide that, when hydrolyzed and broken, becomes in two monosaccharides, glucose and galactose.
The human intestine does not absorb disaccharides, only monosaccharides, therefore lactose needs to be hydrolyzed and it does so thanks to a hydrolase or enzyme, called lactase, which topographically resides attached to the brush border of intestinal enterocytes. In humans, lactase begins to be detected towards the third month of gestation and the newborn presents it in sufficient quantity to digest lactose from the diet (7% of human milk and 4% of cow’s milk). Once the lactose is hydrolyzed, the monosaccharides glucose and galactose are absorbed by active transport, with energy consumption.
People who have a lower than normal lactase activity in their intestine, studied by biological detection in the intestinal biopsy, are deficient in lactase. This can happen in a primary way (congenital alactasia or hypolactasia) or secondarily to any process that occurs with intestinal atrophy, a situation in which the brush border of the intestinal mucosa is damaged and, as a result, its enzymatic activity decreases. The secondary lactase deficiency is usually transient, until the cause of the atrophy disappears and the mucosa recovers all its enzymatic potential, achieving the integrity of the brush border of mature enterocytes.
When the lactase activity is low, its function of lactose hydrolyzing cannot be carried out well and the lactose of the diet persists as such inside the intestine, without being digested, producing a lactose malabsorption, which can cause pathological symptoms in the subject that suffers it and only when these symptoms appear the patient shows lactose intolerance.
The persistence of undigested lactose, within the intestinal lumen, produces an increase in osmolarity and to compensate it, there is a water outflow from the body into the digestive tract, which stimulates peristalsis and lactose and water progression to the large intestine, appearing diarrhea. The intestinal flora is responsible for hydrolyzing lactose and also digests monosaccharides by anaerobic glycolysis. As a result, gases (H2, methane and CO2) and acids (lactic, acetic, propionic) from which a part is absorbed in the colon and another part goes out with faeces.
The stools are liquid, in relation to the amount of ingested lactose, greenish yellow, foamy, acid and noisy. Its contact with the perineal skin can cause burn, known as diaper rash. Due to hyperperistalsis, the intestinal transit time is shortened and this causes abdominal pain and increased hydroaerous noises, with a sense of urgency to defecate. Lactose intolerance is very easy to diagnose it.
Once the diagnosis is confirmed, the permanent exclusion of lactose from the diet is not recommended, as it has been proven that its presence improves the absorption of calcium and this is essential for bone metabolism and growth. Therefore, each case should be evaluated individually and, thus, the treatment will vary from advising to take small amounts of milk or dairy products, spaced, until taking digested lactose and fermented into lactic acid. An alternative source of calcium can be yogurt, which is well absorbed and has less lactose than milk or ingest milk with commercial lactase derived from fungi or with lactic bacilli.
What About Cheese?
Cheese contains most of the nutrients present in milk in a concentrated form except lactose. This concentration of nutrients is due to the water loss in the cheese making process.
The protein value is not altered by the manufacturing process. The contribution of calcium is greater than in milk, in mature cheeses it can be 10 times higher.
It is also rich in phosphorus and zinc. The contribution in liposoluble vitamins is greater than in milk and yogurt, comparing per 100 g of food.
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