NIH Panel Examines Lactose Intolerance; Concerned
Too Many Skipping Diary Products
Generally thought that this problem increases as we
age due to bodies producing fewer lactase enzymes
Feb. 25, 2010 – It sometimes seem there are at
least a million bad things that happen to people as they pass from
middle age to becoming senior citizens and one of those is becoming
lactose intolerant. That’s when consuming dairy products changes from an
enjoyable and healthy experience to one of stomach gas and cramping.
But, a panel of experts gathered by the National Institutes of Health
says eliminating these nutrient-rich foods may not only be unnecessary -
it could negatively impact diet and health.
Review of 28 studies finds the vitamin associated
with a substantial decrease in cardiovascular disease, type 2 diabetes
and metabolic syndrome for seniors and middle aged
Dietary Approaches to Stop Hypertension (DASH) diet appears to lower
risk of coronary heart disease and stroke; low animal protein, moderate
low-fat dairy products, high in plant proteins
Many individuals with diagnosed or perceived
lactose intolerance avoid dairy products, which constitute a readily
accessible source of calcium, other nutrients, and vitamin D (when
fortified). Inadequate consumption of these nutrients may increase the
risk for chronic health problems, including osteoporosis and decreased
bone health. This is of significant concern to senior citizens and
senior women in particular.
Lactose is the natural sugar in milk and some
people lack sufficient amounts of an enzyme that is needed to
comfortably digest lactose.
Lactose intolerance is a real and important
clinical syndrome, but quantifying its public health burden is
challenging, according to the NIH Consensus Development panel. It
convened this week to assess the available evidence on lactose
intolerance and health across the age spectrum and across racial and
ethnic groups.
National Dairy Council
“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,” according to a news
release from the National Dairy Council.
“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.”
Many individuals with diagnosed or perceived
lactose intolerance avoid dairy products, which constitute a readily
accessible source of calcium, other nutrients, and vitamin D (when
fortified). Inadequate consumption of these nutrients may increase the
risk for chronic health problems, including osteoporosis and decreased
bone health.
The panel defined lactose intolerance as the onset
of gastrointestinal symptoms—diarrhea, abdominal pain, flatulence,
and/or bloating—after ingesting lactose-containing foods and beverages;
this is due to deficient levels of lactase, an enzyme necessary to break
down lactose. Lactose malabsorption occurs when reduced levels of
lactose are incompletely broken down in the intestine, which may or may
not result in gastrointestinal symptoms after eating dairy products.
Reduction of lactase in humans occurs in childhood
and persists through the lifespan in most individuals (lactase
nonpersisters). These individuals may or may not have the
gastrointestinal symptoms of lactose intolerance. Understanding the
distinction and interplay between these conditions is important when
considering ways to meet nutritional needs.
"A lot of people who think they have lactose
intolerance don't," said panel and conference chairperson Dr. Frederick
J. Suchy, chief of pediatric hepatology at Mount Sinai School of
Medicine.
"They may have other conditions, or they may just
need to consume smaller amounts of dairy products. Whether they are
truly lactose intolerant or not, it is important that they meet
recommended intakes of calcium and other essential nutrients."
Many individuals mistakenly ascribe symptoms of a
variety of intestinal disorders, including irritable bowel syndrome and
inflammatory bowel disease, to lactose intolerance and avoid
lactose-containing foods without undergoing testing. This misconception
becomes intergenerational when self-diagnosed lactose-intolerant parents
place their children on lactose-restricted diets in the mistaken belief
that they will experience symptoms.
"It is startling and disappointing to learn how
little we know about the consequences of avoiding lactose-containing
products," Dr. Suchy added.
"Health care providers are concerned, but we don't
have good data on bone health outcomes in people who have lactose
intolerance or who avoid dairy products for other reasons."
For diagnosed lactose intolerant individuals,
multiple management strategies have been proposed. These include
distributing lactose intake throughout the day and/or combining it with
other foods, choosing non-dairy foods rich in the nutrients found in
dairy products, taking nutritional supplements, ingesting incremental
amounts of dairy products over time to increase tolerance, consuming
reduced-lactose dairy products, and using probiotics (in supplements and
foods).
Major Conclusions
● Lactose intolerance is a real and important
clinical syndrome, but its true prevalence is not known.
● The majority of people with
lactose malabsorption do not have clinical lactose intolerance. Many
individuals who think they are lactose intolerant are not lactose
malabsorbers.
● Many individuals with real or perceived lactose
intolerance avoid dairy and ingest inadequate amounts of calcium and
vitamin D, which may predispose them to decreased bone accrual,
osteoporosis, and other adverse health outcomes. In most cases,
individuals do not need to eliminate dairy consumption completely.
● Evidence-based dietary approaches with and
without dairy foods and supplementation strategies are needed to ensure
appropriate consumption of calcium and other nutrients in
lactose-intolerant individuals.
● Educational programs and behavioral approaches
for individuals and their healthcare providers should be developed and
validated to improve the nutrition and symptoms of individuals with
lactose intolerance and dairy avoidance.
The panel emphasized the need for additional
research to better understand the effectiveness of these approaches for
decreasing symptoms, optimizing nutritional intakes, and improving
health outcomes, with special emphasis on diverse populations.
The panel encouraged health care providers to offer
personalized, culturally-sensitive management strategies based on
individual preferences.
Depending on a variety of factors, some affected
individuals could be counseled on ways to increase dairy intake while
others could be urged to meet nutrient requirements from other sources.
For example, studies show that when consumed with other foods, even
individuals diagnosed with lactose malabsorption can consume at least
one cup of milk with few or no symptoms.
An updated version of the panel's draft consensus
development conference statement, which incorporates comments received
during this morning's public session, will be posted at
http://consensus.nih.gov.
The conference was sponsored by the NIH Office of
Medical Applications of Research and the Eunice Kennedy Shriver National
Institute of Child Health and Human Development along with other NIH and
Department of Health and Human Services components.
This conference was
conducted under the NIH Consensus Development Program, which convenes
conferences to assess the available scientific evidence and develop
objective statements on controversial medical issues.
In addition to the material presented at the
conference by speakers and the comments of conference participants
presented during discussion periods, the panel considered pertinent
research from the published literature and the results of a systematic
review of the literature. The systematic review was prepared through the
Agency for Healthcare Research and Quality Evidence-based Practice
Centers (EPC) program, by the University of Minnesota Evidence-based
Practice Center.
The EPCs develop evidence reports and technology
assessments based on rigorous, comprehensive syntheses and analyses of
the scientific literature, emphasizing explicit and detailed
documentation of methods, rationale, and assumptions. The evidence
report on lactose intolerance and health is available at
http://www.ahrq.gov/clinic/tp/lactinttp.htm.
The panel's statement is an independent report and
is not a policy statement of the NIH or the federal government. The NIH
Consensus Development Program was established in 1977 as a mechanism to
judge controversial topics in medicine and public health in an unbiased,
impartial manner.
NIH has conducted 121 consensus development
conferences, and 33 state-of-the-science (formerly "technology
assessment") conferences, addressing a wide range of issues. A
backgrounder on the NIH Consensus Development Program process is
available at
http://consensus.nih.gov/backgrounder.htm.
Senior Citizens and Lactose Intolerance
As
people age, their bodies produce fewer lactase enzymes, so most
people don't have symptoms until they are adults, and this
number tends to increase with age.
Lactose intolerance is more common in some ethnic groups than
others. NIDDK estimates that up to 75% of all adult African
Americans and Native Americans and 90% of Asian Americans are
lactose intolerant.
Most people inherit the condition from their parents.
The NIH panel says, however, there needs to be more research on
this subject of who is a risk of this problem. They cited, in
particular, the lack of evidence supporting the belief that this
is a problem associated with old age.
The Office of the Director, the central office at
NIH, is responsible for setting policy for NIH, which includes 27
Institutes and Centers. This involves planning, managing, and
coordinating the programs and activities of all NIH components.
The
Office of the Director also includes program offices which are
responsible for stimulating specific areas of research throughout NIH.
Additional information is available at
http://www.nih.gov/icd/od.
The National Institutes of Health (NIH) — The
Nation's Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
www.nih.gov.
About Lactose
Intolerance
Also called: Dairy
product intolerance, Lactase deficiency, Milk intolerance
Lactose
intolerance means that you cannot digest foods with lactose in them.
Lactose is the sugar found in milk and foods made with milk. After
eating foods with lactose in them, you may feel sick to your stomach.
You may also have
● Gas
● Diarrhea
● Swelling in your stomach
Your doctor may do
a blood, breath or stool test to find out if your problems are due to
lactose intolerance.
Lactose
intolerance is not serious. Eating less food with lactose, or using
pills or drops to help you digest lactose usually helps. You may need to
take a calcium supplement if you don't get enough of it from your diet,
since milk and foods made with milk are the most common source of
calcium for most people.
National
Institute of Diabetes and Digestive and Kidney Diseases
>> For more information on lactose intolerance,
visit the National Digestive Diseases Information Clearinghouse’s Web
site at
http://digestive.niddk.nih.gov/index.htm
Keep up with the latest news for senior citizens, baby
boomers
Feb. 25, 2010 – It sometimes seem there are at
least a million bad things that happen to people as they pass from
middle age to becoming senior citizens and one of those is becoming
lactose intolerant. That’s when consuming dairy products changes from an
enjoyable and healthy experience to one of stomach gas and cramping.
But, a panel of experts gathered by the National Institutes of Health
says eliminating these nutrient-rich foods may not only be unnecessary -
it could negatively impact diet and health.