Iedereen kent wel iemand met ‘lactose-intolerantie’ en een baby met (het vermoeden van) koemelkallergie. Is dit terecht of krijgt lactose ten onrechte de schuld van allerhande buikklachten?
Lactose, ook wel ‘melksuiker’, komt van nature alleen voor in zoogdierenmelk. Het vormt ongeveer 40 procent van de moedermelkenergie (1-6).Ten opzichte van vet en eiwit is lactose het meest stabiele moedermelk macronutriënt (7). Vanaf vijftien dagen na de geboorte is het gehalte 6-7 gram per 100 mL (8-12). Van alle zoogdieren hebben mensen en apen de hoogste moedermelk lactosegehaltes. Koemelk bevat gemiddeld 4,8 g lactose per 100 mL (2a,5). Het zogende kind kan 60-70 gram lactose per dag prima verdragen. Dat is de hoeveelheid lactose in 1 liter moedermelk: de maximale dagproductie van een vrouw (13,13a).
Lactose heeft een speciale functie in het zogend kind voor wie de moedermelk is bedoeld. Hoe kan het dan dat we massaal denken dat lactose de oorzaak van ellende is?
In onze dunne darm wordt lactose door het enzym lactase gesplitst in glucose en galactose (1-6). Slechts een klein deel van de lactose belandt in de dikke darm. Daar draagt het bij aan de groei van Bifido- en melkzuurbacteriën die uiterst gunstig zijn voor de gezondheid van de zuigeling. Naast energiebron is lactose dus een belangrijk prebioticum (14-17).
Lactose die in de dikke darm terecht komt, wordt vaak gelinkt aan het ontstaan van krampjes (koliek) en ‘huilbaby’s (13,18-33). Vanwege een vermeende ‘lactose-intolerantie’ en zelfs ‘koemelkallergie’ kan zo’n borst-gevoede baby onterecht op een lactose-vrije of hypoallergene kunstvoeding worden gezet (2,13,22). Soms is er inderdaad een tijdelijk lactasetekort, zoals bij een voorbijgaande maagdarminfectie (5,13,17,34.34a,43a). Bijvoorbeeld vanwege het besmettelijke Rotavirus dat veel jonge kinderen treft (34a,35-37). In het uiterst zeldzame geval van ‘congenitale lactasedeficiëntie’ zal er nooit lactaseactiviteit zijn. Om ernstige buikklachten te voorkomen, is het dan écht nodig om lactose levenslang te vermijden (5,13,17,34).
Naast energiebron is lactose een belangrijk prebioticum voor zuigelingen
Krampjes zijn onschuldig, vergen geen geneesmiddelen (38) en dragen waarschijnlijk bij aan de ontwikkeling van het microbioom, het immuunsysteem, de darm-hersenas en de rijping van het maag-darmkanaal (28,30,39,40). Wie heeft gezegd dat de evolutie elegant is? Krampjes komen voor bij 10 tot 20 (33,39) procent van zowel borst als fles-gevoede baby’s (30), zijn bij de meeste rond tien tot twaalf weken verdwenen (25) en houden binnen vijf maanden vanzelf op (41). Geruststelling van de vaak zeer vermoeide ouders is het devies (30,38,42).
En hoe zit het met volwassenen? Evenals bij zuigelingen lijkt ook bij hen een epidemie van lactose-intolerantie aan de gang. In het grootste deel van de wereldbevolking daalt vanaf 3-5 jarige leeftijd de lactase-activiteit geleidelijk tot uiteindelijk 5-10 procent. Bij dertig procent blijft de lactaseactiviteit op sterkte: ze zijn ‘lactasepersistent’. Het gaat om 83-95 procent van de blanke bevolking en populaties in Eurazië en Afrika die vaak sinds de oudheid veeteelt hebben bedreven (1-3,14, 44-68a).
Lactose-intolerantie kan uitsluitend worden vastgesteld aan de hand van symptomen, lichamelijk onderzoek en een positieve uitslag van een lactose-tolerantietest (34,43,43a). Als je ‘lactase non-persistent’ bent, wil dat niet zeggen dat je ‘lactose-intolerant’ bent. Gemiddeld ‘tolereren’ lactase non-persistente volwassenen 1 glas koemelk (250 mL) in een keer of 1,5 glazen genomen over de dag.
In plaats van koemelk kan ook yoghurt worden genomen. De lactosegehaltes van koemelk en yoghurt zijn nagenoeg gelijk (2). Yoghurt is als ‘synbioticum’ gunstiger voor de darmen; het bevat levende melkzuurbacteriën samen met hun voeding (2a,5,12,17,51,61,69-71).
Zowel lactasepersistente als non-persistente personen kunnen (chronische) darmziektes krijgen (5,13,17,34,34a,43a). Lactose wordt dan al snel als schuldige aangewezen. Berucht is het prikkelbare-darm-syndroom dat bij 9 tot 12 procent van de bevolking voorkomt (17,34,72,73). Zoals cholesterol, verzadigd vet en zout worden aangewezen als boosdoeners voor hart en vaatziekten, heeft lactose bij darmziekten onterecht een slechte naam.
Foto door Helena Lopes
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MMV maakt wekelijks een selectie uit het nieuws over voeding en leefstijl in relatie tot kanker en andere medische condities.
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