Is Lactose Intolerance Stopping Your Dairy Intake?

July 16, 2013  2:15 – 3:15 pm

Connie Diekman, M.Ed, RD, CSSD, LDDirector of University NutritionWashington University in St Louis

Academy of Nutrition and Dietetics Past President

• Board /Advisory Panel Member

o Health and Wellness Advisory Panel for National Dairy Council

o International Experts Movement for Essential Fatty Acid Education (Educational Grant from Unilever)

o Aspartame Advisory Panelo California Walnut Commission Health Professionals Network

Disclosures

Objectives• Discuss and dispel myths surrounding lactose intolerance 

• Outline the status of current science

• Review tips that help reduce fears about lactose tolerance in order to enjoy dairy foods and their nutrition

Lactose Intolerance• Lactase enzyme needed for digestion of lactose

• Lactose intolerance is rare in younger children1, 2

• Lactase begins to decline between ages 3 and 5

• Lactose intolerance typically emerges in late-adolescence or adulthood2

1. Bhatia J et al. Pediatrics, 2008; 121:1062-10682. Heyman MB. Pediatrics, 2006; 118(3):1279-86.

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Lactose IntolerancePrevalence Study

Source: Nicklas, TA, et al. Nut Today, Sept/Oct 2009.

19.50%

12% of Adults ReportBeing Lactose Intolerant

19.5%African

Americans

10.05%Hispanic

Americans

7.72%European Americans

Percent of Adults, by Ethnic Group, Who Self‐Reported Lactose Intolerance

12%

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Why Rates May Have Been Over-Estimated

New Estimates (2009)1

• Based on self-reports• Reflect real life consumption

Previous Estimates (1988)2

• Lactose maldigestion breath tests • Based on unrealistic amounts of lactose • Findings widely misinterpreted

1. Nicklas, TA, et al. Nut. Today, Sept/Oct2009.2. Scrimshaw NS, et al. Am J Clin Nutr. 1988;48: 1083‐1140.

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Varying Degrees of Lactose Sensitivity

LactoseMaldigestion

Incomplete digestion of lactose, the natural sugar in milk, due to low activity of the lactase enzyme; may be asymptomatic

LactoseIntolerance

Gastrointestinal disturbances following the consumption of an amount of lactose greater than the body’s ability to digest and absorb

Source: Lactose Intolerance, National Digestive Diseases Information Clearinghouse. December 15, 2011.http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/

J Natl Med Assoc. 2009;101:1S-24S

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Lactose Intolerance vs Milk Allergy

Key differences…Lactose intolerance Milk allergy

A sensitivity An allergyOccurs in gastrointestinal system Triggered by immune systemA sensitivity to milk carbohydrate

(lactose) A reaction to milk protein

Rare in young children Generally impacts young children; may be outgrown*

Can enjoy milk and milk products with simple management

strategies

Should avoid milk and milk products

(unless allergy is outgrown)Source: Lactose Intolerance, National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance. Accessed: December 15, 2011,

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*Allergy and Asthma Foundation of America. Milk Allergy, http://www.aafa.org/display.cfm?id=9&sub=20&cont=516, Accessed: December 15, 2011

Amount of Lactose in Common Dairy Foods

Note: these averages are supplied by the USDA. Lactose content varies by product and the lactose content of a specific product would need to be verified by a vendor.

Product

Whole, 2%, 1%, Skim Milk (1 cup)Lactaid® Milk, low-fat, lactose-free (1 cup)Cottage Cheese, low-fat, 2% milkfat (1/2 cup)Cheddar Cheese, sharp (1 oz)

Swiss Cheese (1 oz) Mozzarella (1 oz)American Cheese, pasteurized, processed (1 oz)

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Lactose (g)

12 g0 gA

3g <0.1 g

<0.1 g<0.1 g

1 g

Unless otherwise indicated, data sourced from: USDA / ARS, Nutrient Data Laboratory, Standard Reference, 24, Accessed December 15, 2011. Lactose content varies by product and the lactose content of a specific product would need to be verified by a vendor.

A. http://www.lactaid.com/page.jhtml?id=/lactaid/products/products.inc#1pct_Milk. Accessed: December 15, 2011.

What Science Knows about LI?• NIH Conference on Lactose Intolerance – 2010‐ Consumption of 1 cup of milk seems to yield few if 

any symptoms‐ Tolerance of intake higher when consumed w/meals or distributed throughout the day‐ 2 cups seem to trigger symptoms in most adults‐ Tolerance of hard cheese, yogurt and reduced lactose foods generally good

NIH Consensus Development Conference: Lactose Intolerance and Health. Annals of Internal Medicine. 2010; 152: 792 ‐ 796

The Unintended ConsequencesPeople who avoid milk and milk products due

to lactose intolerance miss many benefits

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Dairy and its essential nutrientsare associated with:• Improved nutrient intake and diet quality• Better bone health • Weight management• Reduced risk of certain chronic diseases

Source: Miller GD, et al. Handbook of Dairy Foods and Nutrition, 2007U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DCU.S Government Printing Office, December 2010.Van Loan M. JACN, 2009; 28:120S‐129S

Comparison of Consumption to Recommendations

Impacts of Low Calcium Intake

• Those with LI do not have impaired absorption of calcium

• Limiting factor in those with LI is poor calcium intake

• Low calcium intake impacts bone accretionand bone mass – affecting young to old

There’s More than One Way to Enjoy Dairy

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• Lattes, warm milk, hot chocolate

• Natural cheeses such as Cheddar, Parmesan, Swiss

• Cold beverages such as smoothies/ licuados

• Cereal and milk (hot or cold)

Simple Strategies toManage Lactose Intolerance

Sip it – Introduce dairy slowly

Try it – Opt for lactose-free products

Stir it – Mix milk with food

Slice it – Choose natural cheeses

Spoon it – Try easy-to-digest yogurt

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Health & Nutrition Authorities Support Dairy

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February 22-24, 2010

Lactose Lowdown

Make Lactose Fit

Resources• White paper, “Unintended Consequences of Dairy Avoidance”

• National Dairy Council Lactose Intolerance Health Education Kit on www.NationalDairyCouncil.org

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Thank You!

July 16, 2013