This article considers the scientific evidence on the prevalence and management of verified lactose intolerance and the growing misperception that dairy foods should be avoided because ethnic populations cannot tolerate them. Healthcare professionals, in particular, must understand why eliminating dairy foods is rarely necessary and is generally undesirable. The genetically programmed ability to digest the milk sugar lactose normally declines throughout childhood in all ethnic groups. Only rarely does lactase nonpersistence result in verifiable lactose intolerance. The intolerance-gastrointestinal symptoms, such as diarrhea, bloating, and abdominal cramping-is easily managed when it occurs and is not a barrier to the consumption of 2 to 3 servings of calcium-rich dairy foods, as encouraged by the Dietary Guidelines for Americans.
A survey of 150 healthcare professionals conducted in 2001 by the Dairy Council of California (Dairy Council of California. 2001 Functional Foods Study. Market Enhancement Group, Inc; June 2001) showed that dairy foods are generally regarded as healthful, yet practitioners expressed concerns about their patients' ability to tolerate them. When the data for obstetricians, gynecologists, and family practitioners were combined, 82% cited lactose intolerance as a drawback to using dairy foods. Among nurses, nurse practitioners, and health educators, 72% perceived lactose intolerance as a barrier to dairy food consumption. The data for pediatricians were particularly concerning, because 46% cited lactose intolerance as a barrier to using dairy foods. These practitioners' perceptions contrast sharply with the views of 5 internationally renowned experts in lactose intolerance, whose views are the basis for this commentary. These experts discussed the digestibility of dairy foods and prevalence of lactose intolerance in various ethnic populations. They explain why there is no scientific justification for avoiding milk or other dairy foods and offer practical guidance on how to achieve the 2-3 daily servings of milk or other dairy foods that are encouraged by the current US Dietary Guidelines.
This report was requested by the Public Information Committee (PIC), a joint committee of the two premier nutrition societies in North America-the American Society for Clinical Nutrition and the American Society for Nutritional Sciences. The author sought experts in lactose digestion identified by PIC to comment on the use of dairy foods containing significant amounts of lactose in all ethnic groups. This report captures their best collective thinking. There was striking agreement in their descriptions of the problem, public health implications, and recommendations. This report is intended to be useful to healthcare practitioners who are concerned about the spurious claims of animal rights' activist groups that dairy foods are injurious to health and cannot be tolerated by certain ethnic groups.