Where’s lactose?

What can I and can’t I eat? With this traffic light as a guide we will try to provide advice, but remember that any product that is apparently lactose-free (as its natural state doesn’t have it) can have ingredients and additives added to it that convert it into a product that is not suitable for the lactose-intolerant. Therefore, our recommendation is always to carefully read the label on the ingredients and ask the manufacturer in case of any doubt. If you want to learn about the levels of lactose in various lactose products, consult our thermometer

(0) ALLERGENS ON LABELS FOR PACKAGED AND NON-PACKGED PRODUCTS
EU Regulation 1169/2011 on food information offered to the consumer establishes that for packaged foods, the information on allergens (listed in annex II and including milk and derived-products including lactose) must appear on the list of ingredients, and must be highlighted through a typographical composition that clearly differentiates it from the rest of the list of ingredients (e.g. through the font, style or background colour). In the absence of a list of ingredients, in the case of a product with a single ingredient, the word “contains” must be included followed by the substance or product indicated in annex II.

And also, as indicated in the EU Regulation 1169/2011 (art.44) and in the subsequent R.D. 126/2015 (art.2) developed by the Spanish level “General Standard for food information on unpackaged foods for sale to the final consumer…”, the allergens in Annex II must also be indicated on unpackaged foods:
· That they are presented without packaging for sale to the final consumer and to the communities.
· Packaged in the places of sale at the request of the buyer.
· Packaged by retail stores for immediate sale in the establishment or establishments.
· The above assumptions when offered for sale through remote communication (for example, online).

(1) EXCEPTION TO THE ENFORCEABILITY OF INCLUSION ON LABELS (DAIRY)
Regulation (EU) 1169/2011 on food information offered to the consumer, in annex II, specifies the only two exceptions (in the case of dairy) that are established in the enforceability of inclusion on the labels for food products:

· Lactitol Derived from lactose. This is used as a low-calorie sweetener for sweets, sugar-free gum, biscuits, ice cream, low-calorie foods and laxatives.
· Whey Only when is used in the process of elaborating distilled alcoholic drinks

(2) ALCOHOLIC DRINKS
EU Regulation 1169/2011 on food information offered to the consumer establishes (art.16.4) that alcoholic drinks that contain over 1.2%/1.2º in alcohol volume (the majority of alcoholic drinks, both fermented and distilled) are exempt from the obligation for the manufacturer to include the nutritional information and list of ingredients on the label but are obliged to specify the presence of allergens as ingredients or technological adjuvants presents in the finished product.

Alcoholic drinks are divided by their manufacturing process and final alcohol level into two categories:
· Fermented drinks – those with an alcohol level of <15º/<15% such as wine, beer, cider, cava, etc. · Distilled or spirit drinks – those with an alcohol level of >15º/>15% such as gin, whisky, rum, etc. Spirits

(3) MARGARINE
Margarine must be 100% plant-based, but on the market the majority of margarines have added dairy, therefore it is best to only consume those where the manufacturer explicitly guarantees the absence of lactose

(4) MEDICINES
Although medicines are not included in the specific regulations for allergens included in EU Regulation 1169/2011 on food information offered to the consumer, there is an obligation to declare the so-called Excipients of Obligatory Declaration (EOD) which will be updated in the regulation in accordance with the scientific and technical advances that occur and in accordance with the establishments from the European Union in this sense (art. 34 of RD 1345/2007). “Procedure for authorization, registration, conditions for dispensing medicines for human use” establishes that the mandatory declaration excipients are included in the declaration of the composition of the medicine on the label. In this sense, the Spanish Agency for Medication and Health Products in its newsletter 1/2018 on “Upgrade information on excipients in the labelling, prospectus and technical datasheet of medicines for human use“, which included the following sugars for obligatory declaration: Glucose, Fructose, Lactose, Lactitol, etc.

In the pharmaceutical industry, lactose is the base for 40% of authorized medicines. Currently 7,451 drugs contain lactose as an excipient -of a total of 19,676-. Lactose as an excipient helps the active ingredient of the medicine to work in a stable, efficient and safe manner for the patient taking it. It is used in tablets due to its solubility and pleasant flavour, although it can also be found in other presentations (vials, suspensions, inhalers). Source AEMPS (07/08/2020).

We must take into consideration that a standard tablet contains less than 500mg of lactose (0.5 g), a small amount but that may be sufficient to cause a reaction in people with hypersensitivity or with a high intolerance, particularly if their daily medication includes more than one tablet per day or they are polymedicated. Therefore, in these cases the doctor must assess the replacement of the medicine with lactose with a medicine that uses other excipients.

You can check the presence of lactose in medicines in the medicine leaflet itself (sections 2 and 6) or through the AEMPS web-search engine (CIMA) AEMPS (CIMA)

(5) CURD
A ferment that we can find in the stomach lining of some mammals (goats, sheep or cows) which is used to curdle milk. The active substance in curd is chymosin, which when added to milk causes separation of the casein and the milk whey. This process is necessary for the elaboration of any cheese. Although nowadays animal curd is still produced, the cheese industry has found ways of producing chymosin through bacterial cultivation or fermentations and we must monitor its origin and always ask the manufacturer in each case before use.

(6) CROSS CONTAMINATION INGREDIENTS OF DAIRY ORIGIN
Precaution with ingredients of dairy origin. Although they don’t have any relation to lactose, there may be cross contamination with lactose in the case of the same dairy origin. We must always contact the manufacturer so that they can guarantee that there is no cross contamination of lactose and that the product is suitable for the lactose-intolerant.