Intolerancia a la lactosa


¿Tienes digestiones pesadas cuando tomas leche? ¿Crees que podrías ser intolerante? Hoy hablamos de la intolerancia a la lactosa, una patología cada vez más frecuente en la población.

¿Qué es la intolerancia a la lactosa?
Se trata de un déficit de una enzima llamada lactasa, la cual nos permite digerir el azúcar de la leche, que es la lactosa, naturalmente presente en la leche de los mamíferos.
Por ello, si consumimos un lácteo éste no nos sienta bien , ya que no digerimos bien sus componentes, dando síntomas como el dolor de tripa, sensación de hinchazón , diarreas, náuseas o vómitos.
¿Es lo mismo que alergia a la leche?
No.

  • La alergia a la leche es una reacción de nuestro sistema inmunitario a la proteína de la leche.
  • La intolerancia a la lactosa es un déficit de lactasa, necesaria para digerir el azúcar de la leche.

La alergia a la proteína de la leche se suele manifestar antes (durante el primer año de vida del niño), mientras que los síntomas de la intolerancia a la lactosa no suelen aparecer antes de los dos años, apareciendo incluso por primera vez en la edad adulta.
Los síntomas pueden ser similares con dolor de estómago, pero también presentar diferencias como sarpullidos o ronchas en la piel, que son más comunes en la alergia a la leche.

¿Cómo sé si tengo intolerancia a la lactosa?

  • Normalmente se presentan síntomas después de haber consumido leche o sus derivados, y se presenta una mejora si se elimina dichos productos de nuestra dieta.
  • Los síntomas más comunes son: hinchazón de la tripa, flatulencias, dolor abdominal, náuseas, diarrea o estreñimiento.
  • También puede producir síntomas más inespecíficos como la fatiga, dolor de cabeza, dolor muscular y articular, falta de concentración o nerviosismo.

No todas las personas tienen los mismos síntomas ni en la misma intensidad, ya que depende de los niveles de lactasa que tengamos, del tipo de lácteo y cantidad (la leche por ejemplo tiene más lactosa que un yogur o queso curado), de si lo comemos simultáneamente con otro alimento y del estado de nuestra flora intestinal.
SI SOSPECHA QUE PUEDA SER INTOLERANTE:  acuda a su médico, este le preguntará por sus hábitos alimenticios, le explorará y si es necesario le realizará una prueba llamada el “Test del aliento de hidrógeno espirado” para comprobar si es intolerante.
Esta consiste en respirar en un recipiente que mide el nivel de hidrógeno en el aliento antes y después de tomar una bebida que contiene una cantidad conocida de lactosa. Un aumento en los niveles de hidrógeno se considera un resultado positivo en la prueba para detectar la intolerancia a la lactosa.

¿Puedo tomar leche si soy intolerante a la lactosa?
La mejor opción es reducir la ingesta de productos lácteos, según tolerancia,  incluso puede ser necesario suprimirlos de la dieta.
Es preferible consumir lácteos con menor cantidad de lactosa, como el yogur o los quesos curados.
La lactosa no solo está presente en la leche y sus derivados, por lo que es importante mirar la etiqueta de información nutricional de los alimentos procesados (como pasteles, embutidos, pan, helados, sopas, saldas, golosinas), en busca de estos términos:

  • Leche
  • Derivados de la leche
  • Lactosa
  • Leche en polvo/ desnatada
  • Suero de leche
  • Lactitol
  • Caseinatos (calcio, sodio, potásico, magnésico)
  • Cuajo, cuajada

¿Existe algún medicamento que lo cure?
La principal medida a seguir es limitar la ingesta de leche y, en menor medida, la de sus derivados (queso, yogur,), ya que estos, al sufrir un proceso de fermentación, tienen menor cantidad de lactosa.
Puede comenzarse con una restricción estricta de la lactosa e ir aumentando hasta llegar al nivel de tolerancia que nos corresponda.
Si no quisiera renunciar al sabor y propiedades de la leche de vaca podría consumir lácteos “sin lactosa” , pudiendo encontrar leche, yogures, natillas, mantequilla, nata o quesos.
De forma esporádica, si se quisiera consumir algún alimento con lactosa  en un evento o si se comiera fuera de casa, se podría adquirir en la farmacia lactasa (Nutira) en forma de pastilla/cápsula/gotas.

¿Cómo se  puede obtener suficiente calcio sin tomar leche?
La reducción de leche en la dieta puede producir falta de minerales  y  vitaminas. Por tanto, es importante consumir otros productos ricos en ellos.

  • Fuentes ricas en minerales:
    · Calcio: Pescado, espinacas, almendras.
    · Fósforo: Nueces, huevos, sardinas.
    · Potasio: Plátanos, pollo.
    · Magnesio: Frutos secos, alubias.
  • Fuentes ricas en vitaminas:
    · A: Zanahoria, legumbres.
    · D: tomar el sol, hígado bacalao.
    · E: Aceite de oliva, frutos secos.
    · K: Tomates, apio, moras.

¿La intolerancia a la lactosa es por vida?
Hay casos en los que la intolerancia a la lactosa es temporal, como por ejemplo si ésta se produce tras una infección viral o se asocia a otras enfermedades como la celiaquía.
Sin embargo, es más frecuente que se trate de una intolerancia duradera y requiere que muchas personas realicen cambios en sus dietas para evitar los síntomas.


Ingrid Asuar Greisselmann
Estudiante 6 curso. Facultad de Medicina. Valladolid

Elpidio García Ramón
Médico de Familia. Centro de salud. Arturo Eyries. Valladolid

REFERENCIAS:

  • Lactose intolerance. Vandenplas Y1. Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium (2015)
  • Understanding food allergies and intolerances. Asociación Americana de Gastroenterología. (2010).
  • Lactose intolerance. Instituto Nacional de Diabetes y Enfermedades Digestivas y Renales (2009).
  • Dietary supplement fact sheet: Calcium. Oficina de Suplementos Dietéticos NIH (2011).

REVISADO: enero 2018

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