Lactose intolerant? Don’t ditch dairy!

By Teresa Wagner, M.S., R.D./L.D.
Director of Dairy Confidence and Medical Outreach, Dairy Max Incorporated

By 2020, half of all Americans over age 50 will be at risk for fractures from osteoporosis and low bone mass if no immediate steps are taken, according to the U.S. Surgeon General’s Report on Bone Health and Osteoporosis. In addition, health care professionals should recognize the importance of educating people of all ages about bone health, as an increased rate of bone fractures among children is emerging. A growing body of research demonstrates that low bone mass is contributing to fractures in children, including data that illustrate just as many forearm fractures among 13-year-old girls as among women ages 60 and older, due to low bone mass. Because of this, urging families to develop healthy lifestyle habits to reduce the risk of osteoporosis throughout life becomes imperative in the health care environment.

Unfortunately, minorities tend to have the highest incidence of lactose intolerance, a widely known condition, which may limit the use of milk, cheese and yogurt. These foods are critical in the supply of bone-building nutrients. People who don’t know the whole story can end up limiting their diets more than necessary and may put their health at risk. The health consequences may be especially serious for African-Americans, Hispanics, Asians and American Indians. Many minorities are at higher risk of hypertension, stroke, osteoporosis, obesity, diabetes and colon cancer—diseases for which a low intake of dairy foods and dairy nutrients can be a contributing factor.

Lactose intolerance is sometimes mischaracterized as an allergy, which typically requires complete avoidance of a food. Lactose intolerance is actually the group of symptoms some people experience resulting from the inability to digest lactose, the natural sugar in milk, because of a genetically low level of the enzyme lactase. Gas, bloating and diarrhea are common symptoms, which may occur as early as 3 years old or become more evident with advancing age. But no matter the onset, lactose intolerance is manageable and it is not an “all-or-nothing” condition. Some cases are even temporary, caused by medication or illness. With a few simple strategies, the majority of people can still enjoy dairy foods every day. Most people who believe they are lactose intolerant or who have experienced some symptoms can still enjoy milk, cheese and yogurt by taking some simple measures to select dairy foods low in lactose. The real risk lies in removing these foods totally from the diet, because they supply a variety of important nutrients.

The Dietary Guidelines identified calcium, potassium, fiber, magnesium, and vitamins A, C and E as “nutrients of concern” for adults, and calcium, potassium, fiber, magnesium and vitamin E as “nutrients of concern” for children. Dairy foods supply four of these significant nutrients that American adults are often lacking: vitamin A, calcium, magnesium and potassium. Three of these nutrients of which children have low intakes: calcium, potassium and magnesium.

The U.S. Department of Agriculture’s 2005 Dietary Guidelines recommends three daily servings of low-fat or fat-free milk or milk products for all Americans to help them meet their nutrient needs. For those with lactose intolerance, the guidelines suggest the most reliable and easy way to get all the health benefits of milk and milk products is to choose alternatives within the milk food group, such as low-fat yogurt with active cultures or lactose-free milk. Hard cheese, which is naturally low in lactose, is another calcium-rich source of dairy. For children, a clinical report from the American Academy of Pediatrics encourages even those with diagnosed lactose intolerance to consume dairy foods to obtain the nutrients essential for bone health and overall growth. The AAP report recommends several dairy options for children that are often well tolerated, including lactose-free or lactose-reduced milk, yogurt or hard cheese such as cheddar or swiss.

When people reduce or eliminate dairy foods, they usually have inadequate dietary intakes of calcium, vitamin D and the other nutrients that milk provides, which increases their risk of osteoporosis and other chronic diseases. It is the role of a health professional to intervene with a clinical diagnosis and professional guidance. Most people will be relieved to learn that not every digestive problem is dairy-related, and that even people who have difficulty digesting lactose can continue enjoying milk, cheese and yogurt. In other words, lactose intolerance does not mean dairy intolerance.