P H Y S I C I A N S C O M M I T T E E F O R R E S P O N S I B L E M E D I C I N E
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actose intolerance is the inability to digest the milk sugarlactose, causing gastrointestinal symptoms of flatulence,bloating, cramps, and diarrhea in some individuals. Thisresults from a shortage of the lactase enzymes which breakdown lactose into its simpler forms, glucose and galactose.Virtually all infants and young children have the lactaseenzymes that split lactose into glucose and galactose, which canthen be absorbed into the bloodstream. Prior to the mid-1960s, most U.S. health professionals believed that these en-zymes were present in nearly all adults as well. When research-ers tested various ethnic groups for their ability to digest lac-tose, however, their findings proved otherwise: Approximately 70 percent of African Americans, 90 percent of Asian Ameri-cans, 53 percent of Hispanic Americans, and 74 percent of Na-tive Americans were lactose intolerant.
Studies showed that asubstantial reduction in lactase activity is also common amongthose whose ancestry is Arab, Jewish, Italian, or Greek.
In 1988, the
American Journal of Clinical Nutrition
reported,“It rapidly became apparent that this pattern was the geneticnorm, and that lactase activity was sustained only in a majority of adults whose origins were in Northern European or someMediterranean populations.”
In other words, Caucasians tol-erate milk sugar only because of an inherited genetic mutation.Overall, about 75 percent of the world’s population, in-cluding 25 percent of those in the United States, lose their lactaseenzymes after weaning.
The recognition of this fact has re-sulted in an important change in terminology: Those who couldnot digest milk were once called “lactose intolerant” or “lactasedeficient.” They are now regarded as normal, while those adultswho retain the enzymes allowing them to digest milk are called“lactase persistent.”There is no reason for people with lactose intolerance topush themselves to drink milk. Indeed, milk and other dairy products do not offer any nutrients that cannot be found in ahealthier form in other foods. Surprisingly, drinking milk doesnot even appear to prevent osteoporosis, its major selling point.
Milk Does Not Reliably Prevent Osteoporosis
ilk is primarily advocated as a convenient fluid source of calcium in order to slow osteoporosis. However, like theability to digest lactose, susceptibility to osteoporosis differsdramatically among ethnic groups, and neither milk consump-tion nor calcium intake in general are decisive factors with regardto bone health.The National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) reported that the age-adjustedprevalence of osteoporosis was 21 percent in U.S. Caucasianwomen aged 50 years and older, compared with 16 percent inHispanic Americans and 10 percent in African Americans.
A 1992 review revealed that fracture rates differ widely among various countries and that calcium intake demonstratedno protective role at all.
In fact, those populations with thehighest calcium intakes had higher, not lower, fracture ratesthan those with more modest calcium intakes.What appears to be important in bone metabolism is notcalcium intake alone, but the balance between calcium loss andintake. The loss of bone integrity among many postmeno-pausal white women probably results from genetics and fromdiet and lifestyle factors. Research shows that calcium lossesare increased by the use of animal protein, salt, caffeine, andtobacco, and by physical inactivity.Animal protein leaches calcium from the bones, leading toits excretion in the urine. Sodium also tends to encourage cal-cium to pass through the kidneys and is even acknowledged asa contributor to urinary calcium losses in the current
Dietary Guidelines for Americans
Smoking is yet another contributorto calcium loss. A twin study showed that long-term smokershad a 44-percent higher risk of bone fracture, compared to anon-smoking identical twin.
Physical activity and vitamin Dmetabolism are also important factors in bone integrity.The balance of these environmental factors, along with ge-netics, is clearly as important as calcium intake with regard tothe risk of osteoporosis and fracture. For most adults, regularmilk consumption can be expected to cause gastrointestinalsymptoms, while providing no benefit for the bones.
Commercial Lactase Enzymes: Not the Best Choice
actose-reduced commercial milk products are often depictedas the “solution” to lactose intolerance. These products areenzymatically modified to cleave lactose into glucose and galac-tose, preventing stomach upset and other symptoms of lactosemaldigestion. But even the lactase pills and lactose-reducedproducts don’t solve the problem, as individuals can still expe-rience digestive symptoms.Iron deficiency is more likely on a dairy-rich diet since cow’smilk products are so low in iron.
A recent study linked cow’s