Shahnaz Indian Cuisine

Around 70 to 80 percent of the world’s population can only digest lactose in small quantities. Lactose intolerance is particularly common in regions where dairy products are rarely eaten due to local eating habits: in Africa, Asia and South America. Up to 90 percent of people there tolerate little lactose.

But even in this country, more and more people are reacting to lactose with complaints. In 2008 the Techniker Krankenkasse recorded a diagnosis of lactose intolerance in 29 243 members. In 2011 there were already 56 446 patients. Adjusted for the changes in the number of insured persons, there is still an increase of 69.2 percent, calculates Stephan Mayer from the Bavarian State Representation.

The numbers are increasing

The increased awareness of the topic of lactose intolerance due to the high media presence only partly explains the growing number of those affected – around two thirds of them are women. For the Munich-based nutritionist Imke Reese, the increase is also related to changed eating habits. “Let’s take coffee as an example: in the past, you added a shot of milk, today you pour three-quarters of it with milk,” she explains.

Lactose intolerance is diagnosed with a test: If this detects hydrogen in the breath after drinking a lactose solution, this is a sure indication that the body is producing too little lactase. In the small intestine, this enzyme is responsible for breaking down lactose into galactose and glucose. If insufficient lactase is produced in the intestine, the milk sugar remains undigested and reaches the large intestine. There it is broken down by bacteria, which release gases – including hydrogen. This causes stomach pain, gas and diarrhea.

There is no need to give up milk completely

Because many of those affected do not want to risk these symptoms, she refrains from eating all foods that contain lactose, such as milk, cream and soft cheese, but also some ready-made products. Most of those affected can tolerate small amounts of lactose. “The aim of the therapy is therefore not to eat largely lactose-free, but to be as low in lactose as your own tolerance allows,” says Imke Reese.

It is not easy to diagnose a disease when the patient cannot speak. Norman Kalesse from Lemgo in East Westphalia was 18 months old when he was constantly suffering from flatulence . “I was always in a bad mood, I often screamed and didn’t want to eat anything,” says the 19-year-old. Several visits to the doctor were necessary before a doctor came up with the idea of ​​mirroring the little boy’s small intestine in order to then make the diagnosis: celiac disease . His body is sensitive to the gluten contained in some types of grain.

Eating can cause pain

Eating is both a basic desire and a basic need. And yet it can cause pain. If the intestines are going crazy, if diarrhea, stomach ache or flatulence torment after a meal, then there may be a food intolerance behind it. This means: the digestive system cannot process part of the food consumed, or only very poorly.

Around 20 percent of Germans suffer from food intolerance

It is estimated that such complaints are very common. Around 20 percent of Germans suffer from food intolerance. Some find it tweaking when they consume milk or dairy products.

Some abdomen rebel after eating sweet strawberries or apples – at least temporarily. “The clinical pictures can reduce the quality of life considerably, but with a change in diet you can live with it very well,” says Diana Rubin, a specialist in internal medicine at the Vivantes Humboldt Clinic in Berlin.

Gluten-free food is expensive

Gluten, in particular, has come into focus in recent years. More and more people are voluntarily giving up grain or only buying products that do not contain the adhesive protein, i.e. are gluten-free. This can usually be seen on the packaging by a crossed-out ear of wheat.

The precautionary measure is not only expensive – it is also unnecessary in the vast majority of cases. “Only one percent of the population is really affected by celiac disease,” says Yurdagül Zopf, internist and nutritionist at the University Hospital in Erlangen. “And so far there is no scientific evidence that a gluten-free diet has a positive effect on healthy people.”

Only a visit to the doctor gives you certainty

Only a visit to the doctor can bring about final clarity as to whether possible symptoms are actually due to gluten intolerance. “In celiac disease, we do a blood test for antibodies,” says Zopf. “If this is positive, we take a tissue sample as part of a biopsy to be sure.”

Celiac disease is a serious condition. It is an inflammation of the small intestine. “The surface of the organ shrinks and is then no longer able to absorb sufficient nutrients,” explains Zopf.

During digestion, the small intestine breaks down food into its components. The nutrients then get into the blood through the mucous membranes. The body’s own defense system, however, sees the protein gluten as an enemy and triggers an immune reaction in the intestinal mucosa. As a result, the lining of the intestine becomes inflamed and the villi regress

When the surface of the small intestine shrinks, the body’s nutrient supply suffers. This particularly affects iron, zinc , folic acid, calcium and vitamin D. Zinc deficiency leads to skin problems, a lack of calcium and vitamin D have a negative effect on bone density, and a deficiency in folic acid reduces the formation of white blood cells, which are important for a person well-functioning immune system.

Disease is genetic

The disease is genetic. Anyone who has sufferers in the family is one of the risk patients. Women get sick more often than men.

Classic symptoms include diarrhea, abdominal pain, and weight loss – they should get any doctor on the trail of the disease. But there are also non-classic symptoms such as anemia, constant fatigue and muscle and joint pain. They don’t directly indicate celiac disease . It takes some experience to recognize them.

The only solution is a change in diet

If an intolerance to food components is diagnosed, neither medication nor an operation will help, only a change in diet. “Especially celiac patients should consistently avoid gluten in their food,” advises specialist Rubin. “Otherwise the clinical picture will worsen, celiac disease can lead to cancer and even death.”

The waiver works smoothly today. Unlike in the past, the supermarket shelves are now well stocked with gluten-free products. With pure oats, millet, corn, amaranth and quinoa there are also tasty and gluten-free alternatives.

Strawberries with glucose are tolerable

For the other food intolerances, it is often sufficient to reduce the ingredients that cause problems. For example, the situation with fructose intolerance (15 percent affected) is not a problem. Anyone who suffers from it can still tolerate some fructose, namely 15 to 25 grams per meal.

This amount can be increased with a little trick, namely by consuming grape sugar at the same time. “So just sweeten the beloved strawberries with a little glucose”, advises Rubin.

Ready-made products contain large amounts of lactose

The situation is similar with lactose intolerance , which plagues roughly one in five Germans. Here, too, it is unnecessary to completely avoid dairy products. However, it is advisable to use products that have a low milk sugar content. This includes fermented milk products such as natural yogurt, quark and aged cheese. Soy, grain and almond milk and all vegan products are even completely lactose-free.

Those who do not want to do without their cow’s milk will find many lactose-free products on the supermarket shelves today, but these are usually much more expensive. On the other hand, caution is advisable with finished products. They often contain large amounts of lactose and also fructose.

Only the hamburger has been removed from the menu

Norman Kalesse has been on a gluten-free diet for more than 17 years. The inflammation in the bowel did not return “I don’t actually have to do without, with one exception,” says the future urban planning student. “When I go to the fast-food restaurant with my friends, I can usually only eat French fries, although I would like to bite into a hamburger with buns.”

Common diseases such as obesity, type 2 diabetes , arteriosclerosis, some types of cancer, but also signs of aging, have something in common: They are partly based on so-called silent inflammation. These are inflammations without acute signs of inflammation, but recognizable in the blood by a slight increase in inflammation markers.

“With classic chronic inflammation, such as inflammatory bowel disease or rheumatic disease, the patient has pain and fever , i.e. clear signs, but not with silent inflammations such as obesity and type 2 diabetes,” explains study doctor Stefan Kabisch in more detail.

These silent inflammations can occur anywhere in the body, “for example in the brain there are also connections with the development of dementia , or fatty liver can turn into fatty liver inflammation,” adds the expert from the German Institute for Nutritional Research Potsdam-Rehbrücke, Clinical Working Group Nutrition.

Silent inflammations promote illness and typical signs of aging

Why silent inflammations favor chronic diseases, accelerate the aging process and demonstrably cost years of life: Among other things, they are related to shortened telomeres, the end sequences of the chromosomes. Telomeres are considered a mirror of biological age – they are long in young people and shorten as they age.

Diet helps determine the risk of silent inflammation

Inflammation, especially silent inflammation, is also dependent on nutrition. This means that the right meal plan can reduce the risk of inflammation – and thus perhaps also the risk of many diseases, but also premature signs of old age and a shorter life expectancy.

“A lot of nutritional factors have an effect on inflammatory processes,” explains Stefan Kabisch. Dietary fiber from grains, vegetables and polyphenols, i.e. certain secondary plant substances, such as in fruit and wine, have anti-inflammatory effects. The scientist names sugar and saturated fatty acids as drivers of inflammation.

Unsaturated fatty acids – but not all of them are beneficial to health

Saturated fat has long been known to increase unfavorable blood lipids such as LDL cholesterol and triglycerides. “But they are also an important driver of inflammation,” summarizes Stefan Kabisch. Saturated fatty acids are mainly found in animal foods such as meat and sausage, dairy products such as butter and cheese, but also in coconut fat and palm oil. These should therefore only be consumed very little.

In contrast, unsaturated fatty acids are considered healthier. The most important unsaturated fatty acids are:

• monounsaturated fatty acids (e.g. in olive oil)
• Trans fats, i.e. unsaturated fats with one or more double bonds (naturally in meat and dairy products, but also artificially produced when vegetable fat is hardened), are known to be unhealthy
• polyunsaturated fatty acids such as omega-3 fatty acids (fatty fish, linseed oil, hemp oil, in small amounts in rapeseed oil) and
• other polyunsaturated omega-6 fatty acids (sunflower oil, soybean oil, corn seed oil, pumpkin seed oil, but also meat and sausage)

“We can almost certainly regard the omega-3 fatty acids as the healthiest,” says the expert. Biochemistry shows that enzymes in the body convert them to anti-inflammatory tissue hormones.

It is a little different with omega-6 fatty acids. “In contrast to the omega-3 fatty acids, they are precursors of inflammation-promoting substances, and although they are converted by the same enzymes as the omega-3 fatty acids, they become inflammatory hormones,” warns Stefan Kabisch. Although they are also polyunsaturated fatty acids, they tend to turn into something bad, as biochemical studies show. There are hardly any studies that compare the effects of omega-3 fatty acids in humans with that of omega-6 fatty acids in the diet.

Omega-6 to Omega-3 in the ideal ratio for health and a long life

What does this mean for the daily diet? In general, we take in much more omega-6 than omega-3 fatty acids. Therefore, consumers should make sure that they consume enough omega-3 and not too much omega-6. Stefan Kabisch recommends: “The ideal ratio is currently 5: 1, ie 5 parts omega-6 to one part omega-3.” This means that the effects of the anti-inflammatory and inflammatory hormones are in balance.

At the moment, however, the ratio for most Germans would be around 15: 1. So the omega-6 intake is three times higher than it would be good. One of the reasons for this is that numerous ready-made foods, processed foods and fast foods are prepared with (inexpensive) vegetable oils such as sunflower oil and foods rich in omega-3s (linseed oil, oily fish) are barely consumed.

Using fatty acids intelligently – just two rules

In practice, it can be difficult to calculate this ratio of fatty acids on the basis of the foods consumed, to bring it into the correct ratio and to integrate it into a daily menu. “But you can start with simple, clear rules that apply correctly to all parts of the metabolism,” suggests the expert. His tips:

1. Reduce saturated fatty acids, i.e. avoid meat, sausage, but also coconut and palm oil as much as possible. Even if these vegetable fats are still considered healthy by many consumers: They are saturated fatty acids and are therefore hardly inferior to butter and lard.

2. Eat fish twice a week because of the polyunsaturated cheap omega-3 fatty acids. But that should be a really fatty fish, not pangasius, but salmon, mackerel, tuna, herring. If vegetable oils are used in the kitchen , the following applies: the higher the proportion of unsaturated fatty acids, the more heat-labile the oil is. That means, for example, linseed and walnut oil only for the cold kitchen, hemp and rapeseed oil for stewing and cooking and olive and sunflower oil for cooking and frying. 

Is it an option to take supplements then? “There is no evidence of a health-relevant benefit for food supplements with omega-3 fatty acids, “ explains the expert.

Organic meat and fatty acids

On the subject of meat: It should also depend on the form of production – organic meat and meat from species-appropriate husbandry can provide fatty acids in a more favorable ratio than conventional goods. According to the expert, species-appropriate or inappropriate to species hardly influence the fatty acid pattern. It could be different with organic. If the fatty acid in the feed is favorable, it also works in the meat. However, the effect would not be very pronounced. “In connection with omega-6 / omega-3 content, organic does not make linseed oil from beef”, he cushions expectations that are too high.

Don’t forget vitamins and fiber

The composition of the fats in food is therefore very important in order to avoid silent inflammation and in this way a number of diseases and aging symptoms. But that alone is not enough. In addition, other measures are important to prevent silent inflammation, and there are two main ones:

1. Eat a diet rich in vegetables and eat some fruit every day – this provides vitamins A, C and E, which act as free radical scavengers, as well as polyphenols. “Vegetables play an active role here and can do much more than just fill the stomach with low calories. Fruit supplements the vitamin requirement ”, emphasizes the researcher.

2. Consume whole grain products – they not only cause the blood sugar level to rise slowly, so that food cravings do not occur and sustained satiety occurs. “Above all, the fiber in cereals can have an anti-inflammatory effect,” emphasizes the expert. Why they can do this is not entirely clear, but large studies show a measurable link between high-fiber diets and health, as well as low-fiber diets, inflammatory diseases, and even cancer.

If you want to stay healthy and grow old as healthy as possible, you should therefore eat in a way that does not promote inflammation. You can do this with the right ratio of fatty acids, vitamins and fiber.

Vitamin B12 is perhaps the most underrated vitamin . Some time ago, the German Nutrition Society (DGE), together with the specialist societies in Switzerland and Austria, raised the reference value for vitamin B12 (display) from three to four micrograms per day.

“This is an estimated value based on studies in which several parameters were measured in the blood,” reports Silke Restemeyer, qualified ecotrophologist and consultant at the DGE.

According to the data of the National Consumption Study (NVS II) , most adult men and women consume sufficient vitamin B12, but risk groups are often undersupplied.

Who is at risk for vitamin B12 deficiency

These are people aged 65 and over because the absorption and utilization of vitamin B12 from food no longer works so well for them. They only produce the so-called intrinsic factor in smaller quantities. This is an enzyme that acts as a transporter and brings the vitamin to the intestinal cells for absorption . Only a fraction of the vitamin can therefore develop its effect.

Other risk groups:

• vegan
• Vegetarians, especially during pregnancy and breastfeeding
• People in whom the absorption of vitamin B12 in the stomach and intestines is disturbed, for example with chronic inflammation in this area such as gastritis , Crohn’s disease , ulcerative colitis
• Anyone who takes certain medications on a long-term basis, such as proton pump inhibitors (against too much stomach acid), metformin (diabetes medication)
• Who is constantly under stress: Because the vitamin is involved in the formation of stress hormones, among other things. That is why the vitamin B12 stores are emptied with constant psychological overload.
• Who drinks a lot of alcohol : Many people who consume a lot of alcohol have a vitamin B12 deficiency.

Vitamin B12 essential for low homocysteine

Vitamin B12 is actually a collective term for various cobalamins, such as hydroxy and adenosylcobalamin in fish and meat, and methylcobalamin in milk. As a coenzyme, vitamin B12 is involved in various metabolic processes in the body. The problem: the body cannot produce it itself and it is essential for life. The main roles of vitamin B12:

• It is involved in cell renewal and blood formation.
• It stabilizes the DNA.
• It protects nerves and the brain.
• It supports the protein and fat metabolism.
• Vitamin B12 converts the unfavorable homocysteine ​​into the less harmful methionine. Homocysteine ​​is an amino acid that damages blood vessels, promotes arteriosclerosis and is associated with heart attacks and strokes.

The role of vitamin B12 as lowering homocysteine ​​levels is particularly interesting. Various studies have shown that an elevated homocysteine ​​level significantly increases the risk of heart attack and stroke. Low homocysteine ​​levels, as made possible by vitamin B12, are therefore beneficial.

Vitamin B12 Deficiency – The Signs

According to its diverse functions, the signs of a vitamin B12 deficiency are also very different and range from all symptoms of anemia (paleness, tiredness) to concentration problems, dizziness, muscle weakness and neurological disorders and nerve damage such as neuropathy with sensory disorders in the legs. This nerve damage can be irreversible if the vitamin deficiency persists for a long time.

The main topic of discussion is how a vitamin B12 deficiency is related to an increased risk of dementia such as Alzheimer’s . “Studies show that cognitive performance is often reduced when there is a vitamin B12 deficiency, but the data situation is contradictory when it comes to preventing these changes with vitamin B12 supplements,” states nutrition expert Restemeyer.

Have vitamin B12 status checked professionally

Anyone who notices one of the symptoms mentioned and / or belongs to the risk groups should ideally have a corresponding blood test carried out by a doctor. “It is important to measure at least two biomarkers, for example total vitamin B12 and holo-TC (holo-transcobalamin) in the serum or plasma, as well as a meaningful functional parameter such as methylmalonic acid (MMA) or homocysteine ​​in the serum,” advises Silke Restemeyer. The blood test costs from 16 euros.

How to eat enough vitamin B12 every day

If the deficiency is not pronounced, it is usually sufficient to modify your nutritional plan a little and focus on the B vitamin. The following foods are rich in vitamin B12: meat, fish, dairy products, eggs.

The DGE gives an example of a daily schedule with which the reference value of four micrograms can be achieved:

• 150 ml milk with 1.5% fat i. Tr. = 0.6 micrograms of vitamin B12
• 1 small cup of yogurt with 1.5% fat i. Tr. = 0.6 micrograms of vitamin B12
• 1 boiled egg = 1.14 micrograms of vitamin B12
• 60 gr Camembert with 30% fat i. Tr. = 1.86 micrograms of vitamin B12

Total = 4.2 micrograms of vitamin B12

or

• 100 grams of cooked, lean beef = 4.5 micrograms of vitamin B12
• 60 gr cream cheese with 50% fat i. Tr. = 0.3 micrograms of vitamin B12
• 30 gr Gouda with 30% fat i. Tr. = 0.66 micrograms of vitamin B12

Total = 5.46 micrograms of vitamin B12

Incidentally, vitamin B12 is quite heat-stable, so it is hardly lost when heating, frying or cooking.

Vegetarians and vegans shouldn’t rely on sauerkraut and algae

Those who consciously avoid meat, or even eggs and dairy products, are at great risk of developing a vitamin B12 deficiency. Many vegans and vegetarians then trust that some plant-based foods also contain the nerve vitamin, such as fermented vegetables or certain algae. Because all other vitamins, including some B vitamins, are also contained in plant foods.

“However, this does not apply to vitamin B12, it is the only vitamin that occurs in significant amounts (almost exclusively) in meat, fish, seafood, eggs and dairy products – but not in plant-based products,” explains the nutritionist.

Sauerkraut (through fermentation with the help of bacteria) and algae actually provide vitamin B12, but either in such small quantities that they are hardly a source – or they are so-called vitamin B12 analogues. These forms do not work like the vitamin, but block the B12 transport in the body and thus even trigger the opposite: The body cannot utilize the little effective vitamin B12 that may be present.

The body often uses vitamin B12 from tablets better

“Vegans should definitely and permanently take a vitamin B12 preparation and have the supply checked regularly by a doctor,” advises the nutritionist. Vegetarians who have an increased need for nutrients, for example during pregnancy and breastfeeding, should also ensure that they have a sufficient supply of vitamin B12.

If a vitamin B12 deficiency has been proven, it should be compensated for with appropriate dietary supplements. This can be done orally as tablets and capsules. Tolerance and bioavailability are good. Vitamin B12 and “cyanocobalamin as a crystalline substance, as is often found in food supplements, is even better utilized by patients with gastritis than vitamin B12 from food,” reports the expert.

Overdosing with the commercially available vitamin B12 food supplements is hardly possible if handled sensibly. Silke Restemeyer: “In a study with dialysis patients, no undesirable effects were recorded after years of intake of 2.5 milligrams after each dialysis (i.e. a multiple of the estimated value of 4 or 5 micrograms).” Still important: with long-term intake of vitamin B12 -Preparations, the vitamin B12 status should be checked from time to time.

Vitamin B12 as an injection

However, sometimes this active supplementation is not enough. This can be the case if there are one or more factors such as: 

• The deficiency is very pronounced.
• Absorption disorders – for example due to old age or chronic inflammation of the digestive tract
• Drugs that prevent the vitamin from being absorbed but cannot be suspended or replaced

Then the doctor recommends taking a vitamin B12 injection treatment. The vitamin is given muscularly at intervals of a few days or a week. Depending on the product, an injection costs around five to ten euros.

Vitamin B12 has as yet unknown potential

So far, vitamin B12 has been an underestimated vitamin. How important and diversified its effect is is only gradually being revealed by studies . A clear, preventive effect of vitamin B12 in combination with B6 and folic acid against strokes has been proven.

The vitamin could also play a role in cancer. However, there are still few and sometimes contradicting studies. But this is where its ability to stabilize DNA and thus prevent mutations could come into play.