Children with lactose intolerance still need dairy's nutrients

The American Academy of Pediatrics (AAP) is recommending in a new report that children with lactose intolerance should include dairy foods as part of a healthy diet in order to get enough calcium, vitamin D, protein and other nutrients essential for bone health and overall growth.

Dr. Melvin B. Heyman, a professor of pediatrics at the University of California, San Francisco, and a member of the committee that wrote the guidelines, says the parents of children with lactose intolerance, in collaboration with pediatricians, should test how much milk, cheese and ice cream they child can tolerate.

Heyman says it is important young people get as much calcium as they can to lower the risk of problems with bones as they get older, and an equally important factor is the need for the calcium in dairy products.

The report warns that lactose intolerance should not require total avoidance of dairy foods and many children who are sensitive to lactose can drink small amounts of milk without discomfort, especially when consumed with other foods.

The report says research shows that dairy foods are often well tolerated and include hard cheeses such as Cheddar or Swiss, yogurt containing live active cultures, and lactose-free or lactose-reduced milk.

The report advises patients who think they may be sensitive to lactose to talk to their doctor and request a full evaluation, as dietary history alone is an unreliable tool for diagnosing the condition.

Lactase is an enzyme which enables people to digest lactose, the primary carbohydrate (sugar) naturally found in cow's milk.

The inability to digest lactose often results from a deficiency of the lactase enzyme.

Lactose intolerance is a clinical syndrome with one or more of the following symptoms: abdominal pain, diarrhea, nausea, flatulence, and/or bloating after the ingestion of lactose or lactose-containing substances.

The extent of the occurrence of the symptoms is dependent on the amount of lactose consumed, the degree of lactase deficiency and the types of of lactose containing foods.

The condition is rare in whites, but as many as 75 percent of blacks, 90 percent of Asian-Americans and nearly 100 percent of Native Americans suffer from it.

An estimated 30 million to 50 million Americans have some degree of intolerance to lactose.

Symptoms generally start appearing after the age of 2.

Primary lactose intolerance is the most common type and genetically determined and the symptoms do not usually appear until late adolescence or early adulthood.

Lactose intolerance should not be confused with milk allergies and when symptoms do appear, Heyman says the first step should be to make sure that they are not caused by another condition, such as irritable bowel syndrome, celiac disease, an infection or parasites.

Ann Marie Krautheim, a dietitian and senior vice president of nutrition and health promotion at the National Dairy Council, says she hopes the report will educate parents on how to continue to include dairy in the diets of children sensitive to lactose and also help improve their nutrient intake.

Krautheim says calcium-fortified beverages and other foods which seek to provide an alternative source of calcium, do not provide an equivalent nutrient package to dairy foods such as milk, cheese and yogurt.

The new guidelines were published in the September issue of the academy's journal, Pediatrics.