How do I know if I should cut out gluten or lactose?

For some, eating a plate of pasta, a slice of crusty bread, a slice of cheese, or a scoop of ice cream is a sweet treat. For others, the procedure causes digestive discomfort at best and debilitating pain at worst. Under the question mark? Gluten, a protein found in certain grains, and lactose, a sugar found in dairy products that some eaters have little or no tolerance for. It’s enough to make them want to end the story and consider cutting out gluten and lactose. How do we know if the exclusion path is correct? What symptoms should alert you?

Symptoms:

The first consideration to be made is our digestive comfort. Lactose and gluten intolerance have similar symptoms: loose or even diarrheal stools, bloating, gas, intestinal cramps, pain… and all this happens a few hours after eating. “Our levels of lactase, an enzyme produced by the intestines to digest lactose, decrease with age,” explains Professor Stephane Schneider, a gastroenterologist at the University Hospital of Nice and professor of nutrition at the University of the Côte d’Azur. This explains why we tolerate it less. In fact, lactose is the only sugar we can absorb at birth, but less so as adults. Undigested, it reaches the colon “entirely” and is fermented. The principle is the same for gluten. the carbohydrates it contains are also not absorbed and fermented in the colon.

According to Martine Cotinat, a nutrition and micronutrition-trained gastroenterologist and author Living Earth’s Guide to Belly Health (1), symptoms alone are not always sufficient to question consumption and stop it. And this is for a simple reason: we can find the same symptoms in the case of other pathologies. “It is better to follow the circumstances in which they appear and disappear,” advises the doctor. Is the anxiety caused by a diet high in gluten or lactose? Does it stop completely when you stop using it?” Moreover, the gastroenterologist warns about two biases. the eater may think he is lactose intolerant, when in fact he is more intolerant to cow’s milk proteins, particularly casein, which can cause similar symptoms. As for gluten, the eater may think he is hypersensitive to it, while he is more sensitive to modern wheat. “Wheat has evolved over time and is now completely transformed,” explains Dr. Martin Cotinat. Gluten is not the same as in the grain products of the ancestors, and it is less tolerated by the body.

Lactose is the only sugar we can absorb at birth, but less so as adults

Professor Stephan Schneider, Gastroenterologist at the University Hospital of Nice

For calculations, the gastroenterologist recommends a test. eliminate all foods that contain gluten and lactose from your diet and see if the symptoms disappear. Then we introduce them again, but slowly and in a different way. “We reintroduce ancestral grains such as einkorn or kamut in moderation,” explains Martin Cotinat. As for dairy, we tend to turn to low-lactose yogurts and certain cheeses, preferably sheep or goat, that don’t contain the same casein. Good to know. the firmer the cheese, the less lactose it contains. You can also spread your dairy consumption throughout the day to get the enzyme activity working. Pay attention also. wheat in pasta is often better tolerated than wheat in bread.

Exclusion mode

To detect gluten intolerance (also called celiac disease, which affects 1% of the French population), you see your doctor to measure your antibodies. Please note that it is necessary to perform the test before eliminating gluten from your diet, at the risk of skewing the result. “If celiac disease is present, biology will highlight the presence of IgA-type transglutaminase antibodies,” informs the gastroenterologist. And in adults, biopsy during fibroscopy will confirm villous atrophy, which allows absorption of nutrients. Absence of antibodies is observed in case of hypersensitivity to gluten.

Celiac disease requires us to cut out gluten for life, hypersensitivity and modify our diet to some extent by reducing the frequency of its use. As for lactose intolerance, the diagnosis is made with a breath test, “it is only valuable if the patient is experiencing symptoms at the time of the examination,” emphasizes Stephan Schneider, professor at the University Hospital of Nice.

Then the doctor claims. If you are starting an elimination diet, you should be referred to a registered dietitian. If you’re gluten intolerant, “we replace starchy foods that contain it with rice, quinoa, sweet potatoes, potatoes, buckwheat, or any grain,” says nutritionist Hannah Bensemhoun. Those who are lactose intolerant can turn to plant-based dairy products such as soy or coconut milk yogurts. “They can also eat hard cheeses that are low in lactose, or sheep’s or goat’s cheese,” adds the nutritionist. They contain a little, so everything depends on everyone’s intolerance, but they are still more digestible.

Replace starchy foods that contain gluten with rice, quinoa, sweet potatoes, potatoes, buckwheat, or any legumes.

Hannah Bensemhou, dietician, nutritionist

What about bread? In the case of celiac disease, it is better to refuse to visit traditional bakeries, because it is necessary to avoid contact with gluten. So we choose specialty “gluten-free” bakeries whenever possible. “We find bread labeled like this in supermarkets, but they often contain additives and are not filling,” emphasizes Hannah Bensemhoun. In the case of gluten sensitivity, we choose the bread that contains the least amount, particularly small font, in traditional bakeries. Finally, instead of buying industrial pie crusts, an expert recommends making them yourself. The nutritionist assures him. “The recipes are easy to find and you can use all kinds of flour, like quinoa or even chestnut.”

(1) The Living Earth Guide to Belly Health, More 40 digestive disordersDr Martine Cotinat, (Ed. Terre Vivante), 29 euros.