A new perspective on lactose intolerance

By Lana Frantzen, Ph.D.
Director of Nutrition Communications at Dairy MAX, your local dairy council

Lactose intolerance is a real and important clinical syndrome, according to the National Institutes of Health. Last February, NIH convened an independent expert panel to examine the latest research. Their key findings were that the prevalence is unclear: lactose malabsorbers aren’t necessarily lactose intolerant, avoiding dairy can lead to nutrient shortfalls, and more research-based strategies are needed. The bottom line on the scientific consensus is “in most cases lactose intolerance shouldn’t limit dairy consumption when managed appropriately.”

The National Dairy Council recently hosted a dairy science forum to bridge from the science to practical solutions for health care professionals. Dr. Janet Taylor, a private practice psychiatrist based in New York, presented a new perspective on lactose intolerance. She is a former clinical instructor of psychiatry at Harlem Hospital, affiliated with Columbia University. She is also a frequent contributor to CBS’ “The Early Show” and NBC’s “Today.” She shared her perspective on lactose intolerance’s psychological impact.

Dr. Taylor began her presentation by explaining several factors that influence health behaviors. Here are some of her insights.

• One factor is social context; for example, what does a patient need to do to get to their doctor’s office and how does that affect their decision to seek medical treatment? They may need to take more than one mode of transportation to arrive at their final destination.
• Secondly, don’t underestimate the influence of cultural beliefs. I couldn’t agree more with this statement because I used to work as a clinic supervisor at a Women, Infants, and Children clinic in an area of Houston, Texas, that was a cultural melting pot. I remember when postpartum Hispanic women arrived at the clinic with little cotton balls stuffed in their ears not for medical reasons, but because of their specific cultural beliefs.
• Family education is another important factor since low socioeconomic status and poverty may lead to poor health outcomes.
• Health literacy also impacts health behaviors since patients may not be able to read or English is not their first language. Health-literate information is written at a fourth-grade level or less and may include diagrams and pictures. To change health outcomes, you need to take the time to adequately explain the necessary steps to improve one’s health.
• The food environment inevitably affects health behaviors. The term “food desert” has been used to describe a lack of accessibility to nutrient-rich foods and neighborhood bodegas may be void of fresh fruits and vegetables. These factors are like pieces of a puzzle that create and shift our health behaviors.

Dr. Taylor identified four important psychological factors related to lactose intolerance. The first factor, somatization preoccupation, is the potential culmination of a sudden onset of abdominal pain or gastro-intestinal complaints. As a psychiatrist, she asks what is going on, what the patient needs, and what is the secondary gain. There may be no relation to lactose intolerance or another factor may be influential. The second factor, mood dysfunction, may be reported with symptoms of depression and anxiety at home. Patients may feel different because they can’t eat what everyone else is eating. As a psychiatrist, Dr. Taylor may ask, “over the past two weeks, have you felt hopeless or lost interest in activities you usually enjoy?” The third factor, self-efficacy, is when you give clients the tools needed to increase their health knowledge and empower them to believe that they can complete, converse, or convey the necessary action to improve their health outcomes. Lastly, quality of life may be impaired due to situations where someone is in immediate need of a restroom at inconvenient times. Over time, this may affect relationships and lead to guilt, shame, or depression that may worsen if untreated.

The good news is there are several strategies that may be beneficial for individual and community intervention. One highly effective strategy, peer support, allows peers to share information among themselves. Along that same line, strong social networks may be very helpful. Encourage a formal diagnosis and personalized nutrition counseling since there are individual variations in the amount of lactose that can be comfortably consumed. Promoting the acceptance of one’s own physical state may help to increase self-efficacy. Taking an active role in making decisions regarding one’s health is another helpful strategy as well as managing beliefs. Educating communities about the health benefits of consuming three servings of low-fat or fat-free milk, yogurt, or cheese daily for individuals 9 years and older may help those who are lactose intolerant enjoy foods they may have thought they could no longer consume.

The strategies suggested for health care providers include employing the correct testing techniques to ensure a correct diagnosis and teaching patients how to minimize their lactose intolerant symptoms. Health professionals can improve their own self-efficacy by understanding the current scientific consensus, regularly educating themselves about the latest nutrition, calcium, and lifestyle risk factors research and practicing shared decision-making with their patients. (Checking in with our blog, The Dairy Report, regularly can help!) Always ask your patients and clients specific questions and don’t make assumptions about lactose intolerance. Collectively, these strategies may help close the gap of understanding and improve a patient’s overall health.

Dr. Taylor’s key considerations for health professionals include doing “what you can to help your clients understand health literacy,” meaning ask, don’t assume. “Be aware of the key influences and influencers in the household” by asking questions about who makes the meal-planning decisions. Dr. Taylor also suggested health professionals be “empathetic and encourage health empowerment by increasing health efficacy and health knowledge.” In other words, do not feel sorry for your patients, but instead have an ability to understand and impart power and wisdom. Dr. Taylor suggested offering information in the waiting room; however, be mindful of your patients’ ethnicity and reflect that in your nutrition education materials. Learn more about simple and memorable strategies to manage lactose intolerance or access our latest lactose intolerance health education toolkit at www.dairymax.org.