May pose diet and health risks, concludes National Institutes of Health consensus development conference panel
People may avoid milk and other dairy products due to concerns about lactose intolerance, but eliminating these nutrient-rich foods may not only be unnecessary to manage the condition – it could impact diet and health, concludes a panel of experts assembled by the National Institutes of Health (NIH).
The NIH Consensus Development Conference on Lactose Intolerance and Health was convened to examine the latest research on lactose intolerance, strategies to manage the condition and the health outcomes of diets that exclude dairy foods. Lactose is the natural sugar in milk and some people lack sufficient amounts of an enzyme that is needed to comfortably digest lactose.
After a thorough review of the scientific evidence, the Consensus Development Conference panel completed a draft consensus statement that is intended to correct some of the common misperceptions about lactose intolerance, including the belief that dairy foods need to be excluded from the diet.
Without lowfat and fat free milk and milk products in the diet, it's hard to meet nutrient needs, and available research suggests people with lactose intolerance can tolerate at least 12 grams of lactose (the amount in about one cup of milk) with no or minor symptoms. Plus, gradually re-introducing dairy into the diet can help manage symptoms and help those diagnosed benefit from dairy's unique nutrient package, including calcium, vitamin D, protein, potassium and other nutrients that are critical for bone health and beyond.
Experts also suggest drinking lowfat or fat free milk (regular or flavored) with meals or a snack instead of an empty stomach, trying small, frequent portions or buying lactose-free or lactose-reduced milk – which contain all the same nutrients as regular milk. Yogurt and hard cheeses (the panel suggests cheddar, provolone and mozzarella) may also be more easily digested.
Conducted by the National Institutes of Health since 1977, the Consensus Development Program is an unbiased, independent, evidence-based assessment of complex medical issues. The purpose is to evaluate the available scientific evidence on a medical topic and develop a statement that will advance the understanding of the issue and help guide the advice given by health professionals and directed to the public.
Lactose intolerance is a topic that is frequently misunderstood, according to Dr. Robert P. Heaney, a prominent researcher at Creighton University who presented findings to the panel on the health outcomes of dairy exclusion diets.
"With modern diets, eliminating dairy from the diet – for any reason whatsoever – will result in poor nutrition with long-term consequences for health," said Heaney.
Heaney said people need a steady supply of calcium, vitamin D and other bone-building nutrients in milk early in life to lay a sturdy foundation. Depriving the body of these nutrients has the potential to impact bone health throughout the lifecycle. Additionally, lowfat and fat free milk is the top food source of vitamin D, which has been linked to a growing range of health benefits.
African Americans have been found to have lower intakes of vitamin D, which is likely linked, in part, to their concerns about lactose intolerance. Yet, even if you have lactose intolerance – and fewer people likely have symptoms of this condition than previously believed – it's still important to find ways to incorporate milk and milk products into the diet.
This is the same conclusion made by the National Medical Association (NMA), the nation's largest group of African American physicians. Dr. Wilma Wooten, president of the San Diego chapter of the National Medical Association, presented research on the ethnic prevalence of lactose intolerance to the panel. She said the NMA released its own policy statement that alerted African-Americans that they may be at risk for nutrient deficits as a result of under-consumption of dairy foods.
"Individuals with lactose intolerance should not avoid dairy products," Wooten said. "This message should be reinforced to prevent the missed opportunity provided by the nutrient-rich package of low- and non-fat milk, hard cheese and yogurt with live active cultures."
Prevalence Estimates for Lactose Intolerance
While the panel concluded that there's insufficient evidence to determine a true prevalence of the condition, one new study presented at the conference suggested the age-adjusted, self-reported prevalence may be as little as 12 percent of the U.S. population, on average. This recent data from a national sample of three ethnic groups indicated that 7.7 percent of European Americans, 10.1 percent of Hispanic Americans and 19.5 percent of African Americans currently consider themselves lactose intolerant.
These self-reported prevalence rates are in contrast with previous higher estimates based on lactose maldigestion studies that over-estimated by wide margins the proportion of people who experience symptoms after consuming usual amounts of dairy foods.
Avoiding Health Risks
Beyond the recommendations of the NIH panel, several major health authorities agree that it is critical for people with lactose intolerance to consume dairy products every day to benefit from the unique nutrient profile of these foods.
The Dietary Guidelines for Americans encourage people with lactose intolerance to try lower-lactose dairy options (such as lactose-free milk, yogurt and hard cheeses) to ensure they get the important nutrients found in dairy.
The American Academy of Pediatrics recommends children with lactose intolerance still consume dairy foods to help meet calcium, vitamin D, protein and other nutrient needs that are essential for bone health and overall growth. The group cautions that lactose intolerance usually does not require avoidance of dairy foods.
Additionally, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) supports lactose-reduced or lactose-free milk as a first choice before non-dairy options for those with lactose intolerance.