The 2013 Consensus Report on Lactose Intolerance
By Densie Webb, PhD, RD
In 2009, the National Medical Association (NMA), which represents black health care providers, released its consensus statement on lactose intolerance. Earlier this year, the NMA updated its consensus statement to provide the most current information on lactose intolerance and health, with specific reference to the black and Hispanic communities.
Cramps, intestinal grumbling, nausea, and gas are symptoms everyone experiences periodically for any number of reasons. However, these symptoms can indicate lactose intolerance, the body’s inability to digest the milk sugar lactose, which is especially common among blacks and Hispanics.
Though consumers and health care professionals casually use the term to describe these symptoms, lactose intolerance may be one of the most misunderstood, mislabeled, and misdiagnosed diet-related conditions.
Whether patients diagnose themselves or are diagnosed by a physician, the result is the same: they reduce or eliminate nutrient-rich dairy foods from their diets. Not only are blacks and Hispanics far more likely to be affected by lactose intolerance than whites, they’re more likely to develop diabetes and hypertension, two conditions that are less likely to occur with an increased intake of low-fat and nonfat dairy foods. And while calcium-fortified foods can help meet calcium recommendations, they don’t provide other key nutrients found in dairy products, such as potassium, phosphorous, magnesium, zinc, protein, riboflavin, and vitamins A, B12, and D.
According to the NMA report,1 lactose maldigestion occurs when insufficient amounts of the enzyme lactase are available in the small intestine to hydrolyze lactose into its two constituents: galactose and glucose. The medical community doesn’t know the true prevalence of lactose intolerance, but here are some facts about the condition and about dairy avoidance among the US black and Hispanic populations:
• Among self-reported lactose intolerant individuals, only 19% of blacks report being diagnosed by a medical professional.
• Whether real or perceived, lactose intolerance is a primary reason for limiting or avoiding dairy foods.
• Blacks consume, on average, 1.2 servings of dairy food per day, with 26% consuming less than one serving per day, far below the recommended three servings per day. Hispanics consume an average of 1.5 servings of dairy food per day, also falling short of the recommended daily servings. The result for both populations is a lower intake of important nutrients found in dairy foods.
• Blacks suffer the highest rate of hypertension in the United States. The DASH diet, which includes almost three servings of dairy per day, has been shown to be especially effective at lowering blood pressure among this population.
• Diabetes is twice as common among Mexican Americans and Puerto Ricans compared with whites, and more than 10% of all Hispanics have diabetes. Consuming low-fat and nonfat dairy has been associated with a reduced risk of type 2 diabetes.
Since the 2009 NMA report was released, the National Institutes of Health held the Consensus Development Conference on Lactose Intolerance and Health and concluded that individuals with lactose intolerance can ingest 12 g of lactose in a single dose when consumed with food with minimal or no symptoms. This is equivalent to a full serving of dairy (low-fat milk or yogurt). The NMA Consensus Report supports that recommendation.
Strategies for Health Care Practitioners
Based on these facts, the NMA recommends the following to all health care practitioners:
• If lactose intolerance is suspected, standardized and objective testing (hydrogen breath test) should be used to determine whether the patient has lactose maldigestion.
• If lactose intolerance is confirmed, encourage patients to try to keep dairy foods in their diets by consuming small amounts of dairy products and individualize their treatment as needed; up to 1 cup of milk may be well-tolerated.
• Suggest patients consume milk, cheese, and yogurt with meals. Natural cheeses, such as mozzarella, Swiss, cheddar, and queso fresco, contain virtually no lactose and should be well tolerated.
• Recommend patients try lactose-free dairy products, such as lactose-free milk and cottage cheese.
• Yogurt is semisolid and contains live and active cultures, which may be easier to digest for those with lactose intolerance.
— Densie Webb, PhD, RD, is a freelance writer, editor, and industry consultant based in Austin, Texas.
1. Bailey RK, Fileti CP, Keith J, Tropez-Sims S, Price W, Allison-Ottey SD. Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement. J Nat Med Assoc. 2013;105(2):112-127.