Lactose Intolerance Presentation

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Learn about lactose intolerance and why it doesn't mean dairy avoidance.

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  • Welcome and thank you for joining today’s presentation on Lactose Intolerance.
    I hope today’s talk clears up any confusion or questions you may have about lactose intolerance; better prepares you to discuss this condition with patients and/or colleagues; and provides you with simple strategies on how people with lactose intolerance can continue to enjoy and consume milk and milk products to help meet their nutrient needs.
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  • Today’s conversation will include:
    Background on key definitions and terms
    Potential health implications that may result when people avoid milk, cheese and yogurt
    The latest data on lactose intolerance prevalence
    Simple strategies to manage lactose intolerance and help improve nutrient intake
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  • First, let’s take a look at key definitions.
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  • Lactose intolerance is often a misunderstood condition. So what is it exactly?
    As a reminder, lactose is a carbohydrate in milk and milk products. During digestion, an intestinal enzyme called lactase breaks down lactose into smaller, more easily-digested sugars (glucose and galactose).
    Lactose maldigestion occurs when an individual produces too little lactase to fully digest the amount of lactose consumed. However, not everyone with a shortage of lactase is lactose intolerant. Some people with lower levels of lactase may not experience digestive discomfort at all when they consume milk or milk products. So the term “lactose maldigestion” simply refers to the incomplete digestion of lactose.
    Lactose intolerance, on the other hand, refers to the gastrointestinal disturbances that may occur following the consumption of more lactose than the body is able to digest. Left undigested, lactose is fermented by “healthy” bacteria in the intestinal tract. This fermentation produces uncomfortable symptoms such as gas, abdominal pain or bloating.
    It’s important to note that there are varying degrees of sensitivity to lactose. Some people may experience gastrointestinal disturbances every time they eat foods with lactose, while others may only experience this disturbance if they consume a large amount of lactose on an empty stomach.
    Keep these definitions in mind as I will be coming back to them when we talk about lactose intolerance prevalence later in the presentation.
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    Lactose Intolerance, National Digestive Diseases Information Clearinghouse. 2006. http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/ (accessed January 2010).
    National Medical Association. Lactose Intolerance and African Americans: Implications for the Consumption of Appropriate Intake Levels of Key Nutrients. J Natl Med Assoc. Supplement to October 2009; Volume 101, No. 10.
  • While many health professionals know that being lactose intolerant is not the same as having a cow’s milk allergy, many individuals confuse the two conditions.
    Let’s take a look at some key differences:
    Lactose intolerance is a sensitivity to the carbohydrate (sugar) found naturally in milk and milk products (called lactose), while a milk allergy is an allergic reaction to the protein found in milk and milk products.
    Lactose intolerance is related to the incomplete digestion of lactose in the gastrointestinal system while a milk allergy, like all allergies, is triggered by the immune system.
    There are also differences in the age of onset. If milk allergies were to manifest, it most commonly would occur in young children.
    On the other hand, lactose intolerance is rare in young children and if it were to emerge it would most likely happen in late adolescence or adulthood, as lactase efficiency decreases.
    Another key difference involves management of the conditions. While people with milk allergies need to avoid milk and milk products, people with lactose intolerance can – and should – continue to enjoy foods like milk, natural cheeses and yogurt.
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    Lactose Intolerance, National Digestive Diseases Information Clearinghouse. 2006. http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance. Accessed December 15, 2011.
    *Allergy and Asthma Foundation of America. Milk Allergy. Available at: http://www.aafa.org/display.cfm?id=9&sub=20&cont=516. Accessed December 15, 2011.
  • Now that we’ve discussed what lactose intolerance is, let’s switch gears and talk about the potential impact it may have when people choose to avoid milk and milk products, like cheese and yogurt, because of it.
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  • Based on a 2008 survey (GFK, 2009), the majority of health professionals (at least 80% of pediatricians and registered dietitians) surveyed agree that lactose intolerance is a major reason some population groups avoid milk and milk products.
    This research also shows that only half of RDs and less than half of pediatricians (44%) and family practice health professionals (28%) agree that they should recommend three daily servings of dairy as part of a healthy diet and lifestyle for patients with lactose intolerance
    This tells us that it’s important for both health professionals and the public, alike, to become more familiar with lactose intolerance and management strategies that can help individuals with lactose intolerance enjoy the recommended servings of milk and milk products every day – which is 2 cups for children 2 to 3 years, 2.5 cups for children 4 to 8 years, and 3 cups for those 9 years and older, according to the 2010 Dietary Guidelines for Americans.
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    GFK Custom Research North America. DMI: Health Professionals Dairy Nutrition Tracking Study, January 2009.
  • Unfortunately, when people avoid milk and milk products due to lactose intolerance, they miss out on the many nutritional and health benefits that milk and milk products provide. Specifically, without milk, cheese and yogurt in the diet, it is difficult for people to meet the recommended intake level of several essential nutrients.
    Milk contains nine essential nutrients and provides three of four “nutrients of concern” to the diet identified by the 2010 Dietary Guidelines for Americans: calcium, vitamin D and potassium. Low-fat and fat-free dairy foods have high nutrient-to-calorie ratio.
    Also, studies show that dairy foods, when consumed as part of a healthy diet over a lifetime, may help to reduce the risk of certain chronic diseases. For example, as an important contributor of calcium, vitamin D, potassium and magnesium to the diet, Americans who avoid dairy foods may increase their risk of osteoporosis and hypertension.
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    Van Loan M. The Role of Dairy Foods and Dietary Calcium in Weight Management. JACN, 2009; 28:120S-129S
    Miller GD, et al. Handbook of Dairy Foods and Nutrition, 2007.
    National Dairy Council. Dairy Communications Manual. Key Messages – Dairy Nutrition, Health Benefits and Disease Risk Reduction. Pg 21.
    National Dairy Council. Healthy Weight with Dairy. http://www.nationaldairycouncil.org/HealthandWellness/DairysHealthBenefits/Pages/HealthyWeight.aspx. Accessed December 15, 2011.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC.
    Ballew C, Kuester S and Gillespie C. Beverage choices affect adequacy of children's nutrient intakes. Arch Pediatri Adolesc Med, 2000; 154: 1148-1152.
    Weinberg LG, Berner LA and Groves JE. Nutrient contributions of dairy foods in the United States food supply. J Am Diet Assoc, 2004; 104: 895-902.
    Ranganathan R, Nicklas TA, Yang S-J, et al. The nutritional impact of dairy product consumption on dietary intakes of adults (1995-1996): The Bogalusa Heart Study. J Am Diet Assoc, 2004; 105: 1391-1400.
  • Unfortunately, African Americans and Hispanics – who are disproportionately impacted by a number of the chronic diseases I just mentioned – and who could benefit most from nutrient-rich foods, such as low-fat and fat-free milk, cheese and yogurt, are also the groups that are not getting enough of these types of foods in their diets.
    Only half of African Americans eat one or more servings of dairy foods a day. Of particular concern, 83% of African American children 2-17 years of age are not getting enough calcium. (NMA Wooten, 2004)
    A survey conducted in 2004 found that on average, U.S.-born Hispanic adults over 45 years consume only 1.5-1.6 servings of dairy a day (JADA, Sharma, 2004). And, another study shows that between 38% and 40% of Hispanics 2 years and older consume less than one serving of dairy a day.(USDA ARS, 1999)
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    Wooten, WJ and Price, W. Consensus Report of the Nationals Medical Association: The Role of Dairy and Dairy Nutrients in the Diet of African Americans. J Natl Med Assoc. 2004; 96:1S-31S
    Sharma S, et al. J Am Diet Assoc. 2004;104:1873-1877
    U.S. Department of Agriculture, Agricultural Research Service. February 1999 Data Tables: Food and Nutrient intakes by Hispanic Origin and Race, 1994-96. ARS Food Surveys Research Group. Available at : http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/Origin94.PDF (accessed May 28, 2008)
  • There is a consensus among experts that people with lactose intolerance should still consume dairy, in order to help meet recommended intakes of essential nutrients – many of which are found in dairy foods products – that help reduce the risk for certain chronic diseases.
    2010 Dietary Guidelines for Americans: 2010 Dietary Guidelines for Americans and ChooseMyPlate.gov: Recognizing the low intake of dairy products across the U.S. population, especially in certain ethnic groups, the Dietary Guidelines identifies milk and other dairy products as a food group to increase and, along with ChooseMyPlate.gov, recommends three cups of low-fat or fat-free milk or equivalent milk products (i.e., cheese, yogurt) a day for most people. ChooseMyPlate.gov notes that people with lactose intolerance may be able to consume smaller portions of dairy foods, choose lactose-free and lower- lactose products, or use enzyme preparations to lower the lactose content. It states, “Calcium- fortified foods and beverages such as cereals, orange juice, or rice or almond beverages may provide calcium, but may not provide the other nutrients found in dairy products.”
    2009 NMA Report: A 2009 report from the National Medical Association (NMA) recommends dairy foods as the first choice for people with lactose intolerance to avoid “nutrient deficits” in their diets. The paper concludes that “it is essential for physicians to communicate [this message] to their patients.” (NMA 2009)
    2006 AAP Report: In September 2006, the American Academy of Pediatrics (AAP), issued a report (“Lactose Intolerance in Infants, Children and Adolescents”) recommending that children with lactose intolerance still consume dairy foods in order to get enough calcium, vitamin D, protein and other nutrients essential for bone health and overall growth. (Heyman 2006)
    According to this report, lactose intolerance does not typically require avoiding dairy foods. Many children who are sensitive to lactose can still drink small amounts of milk without discomfort, especially when accompanied by other foods. Other dairy options, which are often well-tolerated, include natural cheeses (Most cheese is naturally low in lactose, such as Cheddar or Swiss), yogurt containing live and active cultures, or lactose-free or lactose-reduced milk.
    WIC: New changes to the WIC food package recognize dairy first for lactose intolerance. Lactose-free and lactose-reduced dairy products are covered in the new WIC package, without a note from an MD. Additional cheese allowance may be substituted for individuals with lactose intolerance (with medical documentation). Additionally, soy-beverage must be fortified with the nutrients found in cows’ milk and tofu must be calcium-set and a doctor must recommend the substitution for children. (USDA, FNS)
    2010 NIH Lactose Intolerance and Health Consensus Conference: In February 2010, the NIH Consensus Development Conference on Lactose Intolerance and Health was convened to examine the latest research on lactose intolerance, strategies to manage the condition and the health outcomes of diets that exclude dairy foods. The panel of experts assembled by the NIH concluded that eliminating nutrient-rich milk and milk foods due to lactose intolerance may not only be unnecessary to manage the condition – it could impact diet and health.
    European Food Safety Authority (EFSA) Scientific Opinion: In September 2010, EFSA adopted a scientific opinion on lactose thresholds in lactose intolerance (LI) and galactosaemia, which included a similar review of the evidence as the report from the NIH Consensus Conference. The scientific opinion concludes discourages avoidance of milk and milk products and also points to lactose-reduced and lactose-free dairy products as a solution.
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    U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC
    National Medical Association. Lactose Intolerance and African Americans: Implications for the Consumption of Appropriate Intake Levels of Key Nutrients. JNMA. Supplement to October 2009; Volume 101, No. 10.
    Heyman MB. Lactose Intolerance in Infants, Children and Adolescents. Pediatrics, 2006; 118(3):1279-86.
    USDA, FNS. Special Supplemental Nutrition Program for Women, Infants and Children: Revisions in the WIC Food Package, Interim Rule; 7 CFR, Part 246.
    National Institutes of Health Consensus Development Conference Statement. NIH Consensus Development Conference: Lactose Intolerance and Health. Available at: http://consensus.nih.gov/2010/images/lactose/lactose_finalstatement.pdf, Accessed December 15, 2011.
    European Food Safety Authority Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on lactose thresholds in lactose intolerance and galactosaemia. Available at: http://www.efsa.europa.eu/en/scdocs/doc/1777.pdf, Accessed December 15, 2011.
  • The impact of dairy avoidance is clear – but who is at most risk for lactose intolerance?
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  • Despite circulating misinformation on the prevalence of lactose intolerance among children, the condition is not common in childhood.
    Lactose intolerance is rare in young children (Bhatia J, 2008). All babies are typically born with the ability to digest lactose (unless there is an underlying disorder). While it is absolutely natural for some children to produce less lactase as they age, with declines likely to begin in early childhood, this is genetically determined and most will not develop lactose intolerance until late-adolescence or adulthood, if ever (Scrimshaw NS, 1988; and Heyman MB, 2006).
    While lactose intolerance is rare among children, a report by the American Academy of Pediatrics (Heyman MB, 2006) encourages children with lactose intolerance to still consume dairy foods in order to get enough calcium, vitamin D, protein, and other nutrients essential for bone health and overall growth. According to the report, lactose intolerance does not typically require avoiding dairy foods.
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    Bhatia JJ, Greer F, Committee on Nutrition. Use of Soy Protein-Based Formulas in Infant Feeding. Pediatrics, 2008; 121:1062.1068.
    Scrimshaw NS, et al. Prevalence of Lactose Maldigestion. Am J Clin Nutr, 1988; 48:1086-1098.
    Heyman MB. Lactose Intolerance in Infants, Children and Adolescents. Pediatrics, 2006; 118(3):1279-86.
  • The National Institutes of Health (NIH) held a Consensus Development Conference on Lactose Intolerance and Health in February 2010 to assess the available scientific evidence to answer a handful of questions, including what the true prevalence of lactose intolerance is among Americans and how it differs by race, ethnicity and age. The expert panel convened by the NIH was not able to definitively answer the prevalence question based on the available science (“Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known.”). However; they did conclude that “the majority of people with lactose malabsorption do not have clinical lactose intolerance and that many individuals who think they are lactose intolerant are not lactose malabsorbers.”
    Prevalence of lactose intolerance in Americans has previously been estimated to occur in approximately 15% of whites, 50% of Mexican Americans, and 80% of African Americans . However, results of a study conducted at Baylor College of Medicine titled, Prevalence of Self-reported Lactose Intolerance in a Multiethnic Sample of Adults (Nicklas TA, 2009), published in the September/October 2009 issue of Nutrition Today, suggest that the prevalence of lactose intolerance may be far lower than previously estimated from studies of lactose maldigestion.
    The study, which surveyed a national sample of adults in three ethnic groups found that the age-adjusted, self-reported lactose intolerance rates were 12 percent of total respondents – with 7.72 percent of European Americans, 10.05 percent of Hispanic Americans and 19.50 percent of African Americans considering themselves to be lactose intolerant.
     
    These new findings suggest that the prevalence of lactose intolerance in practical life settings may be lower than originally suggested.
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    Nicklas, TA, et al. Prevalence of Self-reported Lactose Intolerance in a Multi-ethnic Sample of Adults. Nut Today, Sept/Oct 2009.
  • Previous estimates were based on a lactose maldigestion study – not a lactose intolerance study – where patients were given a 50 gram solution of lactose mixed with water (Scrimshaw NS, 1988). This would be the equivalent of drinking about a quart of milk!
    This type of test is used to show how well an individual is able to digest lactose. Undigested lactose ends up in the large intestine, where it is fermented by bacteria, which produces hydrogen (and other gases) that leave the body through exhalation. Normal exhalation does not contain hydrogen – so its presence is an indication of lactose maldigestion.
    But remember, lactose maldigestion is not the same thing as lactose intolerance. There are varying degrees of sensitivity among individuals: some people may experience gastrointestinal disturbances every time they eat foods with lactose, while others may only experience this disturbance if they consume a large amount of lactose on an empty stomach.
    The results of the lactose maldigestion study from 1988 (Scrimshaw, NS, 1988) were never intended to be used to show prevalence of lactose intolerance in Americans. In fact, the researcher’s specifically note that “A positive standard lactose test is not a reliable predictor of the ability of an individual to consume moderate amounts of milk and milk products without symptoms. In usual situations the quantity of lactose ingested at any one time is much less than in the lactose-tolerance test.*” Unfortunately, the misinterpretation of these results have led to some of the confusions around the prevalence of lactose intolerance we still see today.
    The most recent study in Nutrition Today (Nicklas TA, 2009), uses self reports of lactose intolerance prevalence, which provides a clearer picture of the percentage of people that may be lactose intolerant following the consumption of a normal amount of milk and milk products.
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    Nicklas, TA, et al. Prevalence of Self-reported Lactose Intolerance in a Multi-ethnic Sample of Adults. Nutrition Today, Sept/Oct 2009.
    Scrimshaw NS, et al. Prevalence of lactose maldigestion. Am J Clin Nutr. 1988;48: 1083-5.
    * Scrimshaw NS, et al. Prevalence of lactose maldigestion. Am J Clin Nutr. 1988;48: 1140.
  • As health and nutrition professionals, what can we do to help people manage lactose intolerance and achieve the recommended servings of dairy every day –3 daily servings of low-fat or fat-free milk and milk products for adults and children nine years and older. For children ages 4-8, the recommendation was increased from 2 to 2.5 servings, and for children ages 2-3, the recommendation remains 2 servings.
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  • Many people who say they have trouble digesting milk have actually never been diagnosed as lactose intolerant by a health professional.
    While gas, bloating or abdominal discomfort can be uncomfortable and disruptive to a person’s lifestyle, it is difficult to confirm lactose intolerance based on digestive discomfort alone. GI disturbances are common in many disease states and conditions, therefore it is important to identify the true source of discomfort.
    A new report from the National Medical Association* recommends a two-step process for pinpointing lactose intolerance.
    First, include a question on screening tools that helps to identify patients who complain about GI disturbances or other discomforts after eating.
    Second, if a patient indicates that they are experiencing gastrointestinal disturbances that may relate to lactose intolerance, administer (or recommend they go to a doctor to administer) a Lactose Tolerance Test, a Hydrogen Breath Test, a Stool Acidity Test or one of the emerging methods of testing – all of which are reliable ways to measure the lactose absorption in the digestive system.
    These tests alone cannot confirm lactose intolerance, so it is important to obtain a verbal confirmation from the patient, too.
    It is important to reinforce that pinpointing the problem as lactose maldigestion and a verbal confirmation from the patient does not mean that milk, dairy products, and other lactose-containing foods should be eliminated from the diet.
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    NOTE: HOW HYDROGEN BREATH TEST WORKS**
    Undigested lactose is fermented by bacteria in the colon producing hydrogen gas, a portion of which is absorbed into the blood and exhaled in the breath. The hydrogen breath test, which can be performed on an outpatient basis, involves measuring baseline hydrogen breath levels after an overnight fast and again at regular intervals following intake of a dose of aqueous lactose or milk. The dose can be as high as 50g, but generally doctors use a dose equivalent to two 8-ounce glasses of milk (up to 25g). If hydrogen breath levels increase by 10 to 20ppm above baseline levels (a lower rise is used with a lower dose), a diagnosis of lactose maldigestion is made.
    National Medical Association. Lactose Intolerance and African Americans: Implications for the Consumption of Appropriate Intake Levels of Key Nutrients. JNMA. Supplement to October 2009; Volume 101, No. 10.
    J Natl Med Assoc. 2011 Jan;103(1):36-45. The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected. Keith JN, Nicholls J, Reed A, Kafer K, Miller GD.
    Lactose Intolerance and Minorities: The Real Story. National Dairy Council. Available at:http://www.nationaldairycouncil.org/SiteCollectionDocuments/education_materials/wic/LactoseIntoleranceAndMinorities.pdf: Accessed December 15, 2011.
  • Simple strategies have been identified that can help people with lactose intolerance enjoy milk and milk products without experiencing gastrointestinal disturbances. For example:
    Sip it
    Start with a small amount of milk daily and increase slowly over several days or weeks to build your tolerance.
    Try it
    Opt for lactose-free milk and milk products. They are real milk products, just without the lactose, providing the same nutrients as regular dairy foods, and they taste great.
    Stir it
    Mix milk with other foods, such as soups and cereal; blend with fruit or drink milk with meals. Solid foods help slow digestion and allow the body more time to digest lactose.
    Slice it
    Top sandwiches or crackers with natural cheeses such as Cheddar, Colby, Monterey Jack, mozzarella and Swiss. These cheeses are low in lactose.
    Spoon it
    Enjoy easy-to-digest yogurt. The live and active cultures in yogurt help to digest lactose.
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  • When talking to your patient/client about his or her daily eating habits, you can gain a better understanding of their typical food consumption – and customize your recommendations to fit his or her lifestyle.
    Whether cooking with milk, mixing it with cereal, blending it into smoothies or licuados, or using it to make a latte – typical consumption of milk and milk products varies by individuals and cultures – and it is important to recognize and address these differences when providing the strategies just discussed.
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  • Incorporating milk, natural cheeses or yogurt into meals, beverages, and snacks can be easy and enjoyable.
    Many traditional foods incorporate milk and milk products. For example, tacos or chilequiles naturally go well with cheese, while many traditional bisques are made with milk.
    Yogurt parfaits can be enjoyed for breakfast or dessert – and is an easy option for people who don’t like to cook
    Soups are also an easy way to add milk to any meal.
    A number of recipes featuring milk and milk products can be found at www.NationalDairyCouncil.org.
  • As you can see, the lactose in dairy products varies considerably.
    This is a great resource you can adapt and use with patients to clearly illustrate the amount of lactose there is in common dairy foods. This way, if a patient is apprehensive about reintroducing dairy into their diets, they can use this as a guide to clearly identify which products may be the most tolerated based on lactose content, and try to gradually incorporate more types of dairy products.
    Note that while yogurt ranks relatively high on this scale, its live and active cultures help make it easier to digest lactose, and therefore, is often well-tolerated by people with lactose intolerance. Also, it’s important to note that the lactose content for individual milk products is the same, no matter the fat content, For example, 1 cup of milk has 12 grams of lactose, no matter if it’s whole, 2%, low-fat or fat-free.
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    Unless otherwise indicated, data sourced from: USDA / ARS, Nutrient Data Laboratory, Standard Reference, 24, Accessed December 15, 2011.
    http://www.lactaid.com/page.jhtml?id=/lactaid/products/products.inc#1pct_Milk.
  • A wide variety of lactose-free dairy products are available in today’s marketplace, including reduced-fat, low-fat, fat-free and whole chocolate and white milk, cottage cheese, ice cream and licuados.
    It’s important to note that all of these products are made with real milk. Traditionally, lactose-free milk and milk products have been made by adding the enzyme lactase to the regular form of the product, thus lactose-free dairy foods provide the same essential nutrients as the equivalent form of regular dairy foods, just without the lactose.
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  • And when compared to non-dairy beverages, people like milk more.
    The results of a taste acceptance study of 893 adults aged 18-64 indicate that lactose-free milks score substantially better regarding taste acceptance and liking than do soy beverage products and that reduced-fat milk (lactose-free, 2%) scores substantially better than do the fat-free products.*
    These results are note-worthy given that milk-substitute beverages are often recommended for people with lactose intolerance, despite the low acceptance of such beverages.
    As health professionals we can help these individuals learn how to continue to enjoy the dairy foods they love.
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    * Moskowitz HR, et al. Consumer Acceptance of Cow’s Milk Versus Soy Beverages: Impact of Ethnicity, Lactose Tolerance and Sensory Preference Segmentation. J of Sens Studies, 2009; 24:5.
  • When working with patients with lactose intolerance, tailoring your message can help you effectively connect with your patients, as well as help promote behavior change. While not specific to individuals with lactose intolerance, a recent qualitative study provides useful insights on effective messaging concepts to communicate when addressing barriers to healthy eating. Based on the large qualitative study of African American, Latino and low-income white Caucasian middle school students and their parents, the following key message concepts were developed, to help address barriers to eating more nutrient-rich foods, like low-fat and fat-free dairy products.
     
    ·         Promote small sequential steps to change a lifestyle
    o   To help change the family diet, the process of change must include small, doable steps.
    o   For example, for individuals with lactose intolerance, you may want to suggest that they start small by trying a small amount of low-fat milk (either regular or lactose-free) with cereal, once a week. Then suggest they increase the amount or frequency, before moving on to another change.
    ·         Motivate parental change
    o   Research shows that parents are an important role model in influencing how their children eat – and parents understand that they play an important role.
    o   While lactose intolerance is rare in children, a parent who avoids dairy foods due to lactose intolerance, may inadvertently influence their child to avoid dairy.
    o   Help your clients understand that how they manage their lactose intolerance can help their children learn about healthy eating. For example:
    -  Continue to keep nutritious foods at home. For example, stocking the fridge with lactose-free milk can help parents manage lactose intolerance, while showing kids that various options are available.
    -  Understanding that parents are often too tired or overwhelmed to come up with creative dinner solutions, suggest they involve their children with dinner planning once a week. Part of the child’s challenge can be coming up with creative ways to incorporate dairy foods into the meal.
    ·         Keep culture and taste preferences top of mind
    o   As always, it’s important to incorporate culturally-based, nutrient-rich foods into heritage recipes, when making food or recipe suggestions to patients. For example,
    -  Suggest that Hispanic families substitute low-fat, lactose-free milk for whole or sweetened condensed milk for licuados (a blended beverage made with milk, fruit and ice) – and that African Americans make similar substitutions with traditional bisques.
    ·         Accentuate positive attributes in foods
    o   As health professionals, you already know the importance of accentuating positive attributes and behaviors vs negative ones. And this couldn’t be more true than when talking about lactose intolerance.
    o   For example, a person with lactose intolerance is likely fixated on what not to eat. Shift the dialog by showcasing what they can eat and enjoy.
    o   You also can suggest they seek tips from others who’ve made positive changes to manage their lactose intolerance..
    Source: Messaging concepts adapted from: MEE Productions Inc., Philadelphia, PA.  Multi-Cultural Audience Research.  Copyright National Dairy Council, 2009.
  • In conclusion, as health professionals and experts in the field of food and nutrition, you play an important role in helping to educate people with lactose intolerance on the critical role that at least three daily servings of dairy – milk, cheese or yogurt – can play in helping to meet recommendations for calcium, riboflavin, protein, potassium and other key nutrients.
    These recommended strategies for health professionals are summarized from the National Medical Association’s 2009 report on lactose intolerance and African Americans, but they are relevant no matter what your patient’s ethnicity may be. Key points are:
    Get Informed
    Understand how to minimize lactose intolerance
    View dairy foods as an investment in human health and not just as food consumption
    Become educated on current guidelines
    Ask
    Include an inquiry about lactose intolerance as a core question when taking a medical history to help reduce dairy nutrient deficiencies
    Advise
    Encourage patients to be formally tested for lactose intolerance; OR
    Provide guidance on the gradual introduction of dairy into the diet
    Identify Those At Risk
    Review positive linkages between dairy products and key disease status
    Identify pregnant women, the elderly, hypertensives, diabetics and other risk groups whose health may be even marginally improved by protecting against nutrient insufficiency
    Educate
    Disseminate dietary guidelines to patients to educate them regarding the critical role of consuming 3 servings of dairy foods per day (for individuals 9 and older, per the guidelines) and emphasize how this helps them meet recommendations for calcium, riboflavin, protein, potassium and other nutrients.
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    Source: National Medical Association. Lactose Intolerance and African Americans: Implications for the Consumption of Appropriate Intake Levels of Key Nutrients. JNMA. Supplement to October 2009; Volume 101, No. 10.
  • In closing, I wanted to let you know that there are a few new tools in the National Dairy Council Lactose Intolerance Health Education Kit:
    The “Lactose Intolerance Among Different Ethnic Groups” education piece has been updated to include the NIH consensus conference findings, along with the 2010 Dietary Guidelines and MyPlate recommendations on lactose intolerance and dairy intake among minorities.
    A new white paper, “Unintended Consequences of Dairy Avoidance,” authored by Dr. Robert Heaney, Dr. Jeanette Newton Keith and Roberta Duyff, MS, RD was the subject of a recent webinar, also available in the kit. This paper could be shared with HP partner journals and newsletters in your region or used as a handout at any exhibit booths. If any of your regional organizations are interested in hosting one of the speakers for a session based on the white paper, please contact Karen Kafer.
    Please visit the NationalDairyCouncil.org to access the other components of the kit, which includes a variety of resources on lactose intolerance, including a listing of recent research and scientific summaries, presentations, handouts and more.
  • Lactose Intolerance Presentation

    1. 1. 1 Lactose Intolerance Dispelling Myths and Helping People Enjoy Milk, Cheese & Yogurt ©2011 National Dairy Council® Permission is granted to health professionals to reproduce for nonprofit educational purposes Place SR Logo Here
    2. 2. 2 Today’s Discussion • Lactose intolerance defined • The impact of dairy avoidance • Prevalence – who’s impacted • Managing lactose intolerance Place SR Logo Here
    3. 3. 3 Lactose Intolerance Defined Place SR Logo Here
    4. 4. 4 Varying Degrees of Lactose Sensitivity Lactose Maldigestion Incomplete digestion of lactose, the natural sugar in milk, due to low activity of the lactase enzyme; may be asymptomatic Lactose Intolerance 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 Place SR Logo Here
    5. 5. Lactose Intolerance vs Milk Allergy Key differences… Lactose intolerance Milk allergy A sensitivity An allergy Occurs in gastrointestinal system Triggered by immune system A 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, *Allergy and Asthma Foundation of America. Milk Allergy, http://www.aafa.org/display.cfm?id=9&sub=20&cont=516, Accessed: December 15, 2011 Place SR Logo Here 5
    6. 6. 6 The Impact of Avoiding Milk, Cheese and Yogurt Place SR Logo Here
    7. 7. 7 Lactose Intolerance: A Barrier to Dairy Consumption • More than 80 percent of pediatricians and dietitians agree that lactose intolerance is a major reason some people avoid milk and milk products • Lactose intolerance is the number one barrier to health professional recommendations for dairy Source: GFK Custom Research North America. DMI: Health Professionals Dairy Nutrition Tracking Study, January 2009 Place SR Logo Here
    8. 8. 8 The Unintended Consequences People who avoid milk and milk products due to lactose intolerance miss many benefits Dairy and its essential nutrients are 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, 2007 U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC U.S Government Printing Office, December 2010.Van Loan M. JACN, 2009; 28:120S-129S Place SR Logo Here
    9. 9. 9 Low Dairy Intake Among Ethnic Groups Only half of African Americans eat one or more servings of dairy a day1 1. Wooten WJ, et al. J Natl Med Assoc. 2004; 96:1S-31S 2. On average, U.S.-born Hispanics consume only 1.5 – 1.6 servings of dairy a day2 Sharma S, et al. J Am Diet Assoc. 2004;104:1873-1877 Place SR Logo Here
    10. 10. 10 Health & Nutrition Authorities Support Dairy February 22-24, 2010 Place SR Logo Here
    11. 11. 11 Who Experiences Lactose Intolerance? Place SR Logo Here
    12. 12. 12 An Adult Condition • Lactose intolerance is rare in younger children1, 2 • Lactose intolerance typically emerges in late-adolescence or adulthood2 1. 2. Bhatia J et al. Pediatrics, 2008; 121:1062-1068 Heyman MB. Pediatrics, 2006; 118(3):1279-86. Place SR Logo Here
    13. 13. Lactose Intolerance Prevalence Study 12% of Adults Report Being Lactose Intolerant Percent of Adults, by Ethnic Group, Who Self-Reported Lactose Intolerance 12% 19.50% 19.5% 10.05% 7.72% African Americans Hispanic Americans European Americans Source: Nicklas, TA, et al. Nut Today, Sept/Oct 2009. Place SR Logo Here 13
    14. 14. 14 Why Lactose Intolerance 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. 2. Nicklas, TA, et al. Nut. Today, Sept/Oct2009. Scrimshaw NS, et al. Am J Clin Nutr. 1988;48: 1083-1140. Place SR Logo Here
    15. 15. 15 What Can Health & Nutrition Professionals Do To Help? Place SR Logo Here
    16. 16. 16 Pinpointing the Problem: Moving Beyond Belly Aches Two-Step Process 1. Verbal or written confirmation 2. Hydrogen Breath Test, Lactose Tolerance Test or Stool Acidity Test Source: J Natl Med Assoc. 2009;101:1S-24S Place SR Logo Here
    17. 17. 17 Simple Strategies to Manage 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 Place SR Logo Here
    18. 18. 18 There’s More than One Way to Enjoy Dairy • Lattes, warm milk, hot chocolate • Natural cheeses such as Cheddar, Parmesan, Swiss • Cold beverages such as smoothies/licuados • Cereal and milk (hot or cold) Place SR Logo Here
    19. 19. Easy Ways to Cook with Dairy • Traditional foods with milk, natural cheeses and yogurt • Soups made with milk Place SR Logo Here 19
    20. 20. Amount of Lactose in Common Dairy Foods Product Lactose (g) Whole, 2%, 1%, Skim Milk (1 cup) 12 g Lactaid® Milk, low-fat, lactose-free (1 cup) 0 gA Cottage Cheese, low-fat, 2% milkfat (1/2 cup) 3g Cheddar Cheese, sharp (1 oz) <0.1 g Swiss Cheese (1 oz) <0.1 g Mozzarella (1 oz) <0.1 g American Cheese, pasteurized, processed (1 oz) 1g 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. 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. Place SR Logo Here 20
    21. 21. 21 Lactose-Free Products Provide Delicious Options • Real milk without the lactose • Same essential nutrients Place SR Logo Here
    22. 22. 22 People Like Lactose-Free Milk Individuals with lactose intolerance rated their beverage liking as follows: Liking Beverage Varieties Included #1 Reduced-fat (2%) lactose-free cow’s milk White #2 Fat-free lactose-free cow’s milk White White, fortified #3 Soy-based milk-substitute beverage Plain, organic Vanilla Plain, fortified Source: Moskowitz HR, et al. J Sens.Studies, 2009; 24:5. Place SR Logo Here
    23. 23. 23 Adapting Your Message Can Lead to Success • Promote small sequential steps to change a lifestyle • Motivate parental change • Keep culture and taste preferences top of mind • Accentuate the positives Source: Messaging concepts adapted from: MEE Productions Inc., Philadelphia, PA. MultiCultural Audience Research. Copyright National Dairy Council, 2009. Place SR Logo Here
    24. 24. 24 Strategies for Health Professionals to Help Patients Manage Lactose Intolerance • • • • • Get informed Ask Advise Identify those at risk Educate Source: J Natl Med Assoc. 2009;101:1S-24S Place SR Logo Here
    25. 25. 25 Resources • • White paper, “Unintended Consequences of Dairy Avoidance” National Dairy Council Lactose Intolerance Health Education Kit on www.NationalDairyCouncil.org 25

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