The diagnosis has arrived: lactose intolerance. From that moment onwards, we will move on to dietary therapy or the use of enzymes with dietary limitation of foods containing lactose. These include dairy products such as cheese. However, are all cheeses considered the same for a person who is intolerant or can some dairy products be consumed without risk? We asked Dr. Beatrice Salvioli, a Humanitas gastroenterologist.
This condition is one of the most common food intolerances and may or may not be associated with a deficiency of the lactase enzyme, the molecule that allows the breakdown of lactose, the milk sugar also contained in many other products derived from milk. This sugar is also often used as an additive in the food industry. However, if you are “only” intolerant, it is not always necessary to keep a high level of attention and read the label of the products, unlike allergic people, who must have control over the composition of all foods.
In subjects who have this deficiency on a genetic basis or secondary to other conditions, such as viral gastroenteritis, the intake of lactose causes a series of non-specific symptoms mainly of gastrointestinal nature. These, however variable from patient to patient, include abdominal swelling, meteorism, abdominal pain, and bowel irregularities with constipation or diarrhea. Other extra-intestinal symptoms may also arise, such as fatigue, recurrent cystitis and headache.
There are two tests that can be used to diagnose the presence of the lactase enzyme. The most common is the respiratory test, the “breath test”: a small amount of lactose is administered to the subject before it is exhaled in a tube at regular intervals for a few hours. The other test is genetic, with DNA analysis generally taken from a salivary sample or blood sample. Both tests check whether the enzyme lactase is still present. If it is absent, we are talking about malabsorption. If symptoms such as swelling, heavy abdominal weight or dysentery appear during the breath test, we are also in the presence of intolerance.
No milk. What about cheeses?
The therapy does not exclude foods containing lactose, as it is commonly thought; unless the subject is allergic. The limitation concerns mainly milk and dairy products (‘soft cheeses’). Cheeses whose intake must be limited include soft, fresh cheeses such as mozzarella, stracchino, casatella, etc., as well as yoghurt and kefir. These are the cheeses that can make the symptoms of a lactose intolerant subject more annoying,” explains Dr. Salvioli.
Which cheeses can be eaten with less concern? “Matured cheeses – continues the specialist – are low in lactose, such as Parmesan cheese from Reggio Emilia, and they are generally well tolerated”.
The advice is always to consult a specialist doctor to obtain precise information about the foods allowed in light of your condition.