Lactose Intolerance Management Guidelines Issued by NIH Panel

From Medscape Medical News
Emma Hitt, PhD

February 25, 2010 — Many lactose-intolerant individuals can tolerate up to 24 g lactose daily (the amount in 2 cups of milk) if it is ingested throughout the day, according to a National Institutes of Health (NIH) Consensus Development Conference Statement on Lactose Intolerance and Health.

"A lot of people who think they have lactose intolerance don't," noted panel and conference chairperson Frederick J. Suchy, MD, chief of pediatric hepatology at Mount Sinai School of Medicine, New York City, in a news release. "They may have other conditions, or they may just need to consume smaller amounts of dairy products."

The 14-member consensus development panel was convened earlier this week by the NIH's Office of Medical Applications of Research for 3 days. The panel addressed several issues regarding lactose intolerance, including the prevalence, health outcomes, amount of lactose likely to be tolerable, and strategies for managing lactose-intolerant individuals.

"The prevalence of lactose intolerance in the United States cannot be estimated," according to a draft statement from the conference.

A systematic review of all studies on lactose intolerance published in English from 1967 to November 2009 was conducted. Despite the identification of 54 articles, including 15 studies in the United States involving 4817 participants, evidence was insufficient to accurately assess prevalence in the US population. However, the authors did confirm that race and age differences exist in the prevalence of lactose intolerance.

The panelists also concluded that children with low lactose intake have worse bone outcomes compared with children assigned to receive supplemental dairy interventions.

"Research is needed to evaluate lactose intolerance prevalence, bone outcomes in adults in association with lactose intake, genetic predisposition, lactose malabsorption, and intolerance," the panelists say.

According to the draft statement, healthcare providers should offer "personalized, culturally-sensitive management strategies to lactose intolerant individuals to ensure that they ingest calcium, vitamin D, and other nutrients found in dairy products." An overall nutritional eating plan should be emphasized, focusing on nutrients potentially reduced by a dairy-free diet while maintaining appropriate caloric intake. Patients can be referred to http://www.mypyramid.gov for nutritional guidance. Lactose-reduced milk may be an effective strategy for preventing symptoms.

"Whether [patients] are truly lactose intolerant or not, it is important that they meet recommended intakes of calcium and other essential nutrients," Dr. Suchy pointed out.

A draft statement from the conference is available on the NIH Web site.

A summary of the systematic evidence review is available on the Agency for Healthcare Research and Quality Web site.

The full report, "Lactose Intolerance and Health," is also available on the agency's Web site.