Most children who are lactose intolerant can and should eat some dairy foods to ensure they get enough calcium and vitamin D, the nation’s leading pediatric group says.
In a report published today, the Committee on Nutrition for the American Academy of Pediatrics recommends against eliminating dairy products as the primary treatment for lactose intolerance. The condition is extremely common among many racial and ethnic groups, including Asians, Native Americans, Hispanics, and blacks.
“Not enough kids are getting enough calcium in their diets, and one of the reasons is that parents often eliminate dairy, thinking that it is the cause of stomach pains and the other discomforts that are associated with lactose intolerance,” committee member Melvin B. Heyman, MD, MPH, tells WebMD.
Instead of banning dairy foods from a sensitive child’s diet, the report recommends slowly introducing them to determine the child’s level of tolerance.
“Some children are able to tolerate one glass of milk, but get symptoms with a second,” Heyman says. “Some can’t tolerate milk, but can tolerate yogurt because the lactose is partly broken down by bacteria; and some can tolerate hard cheese.”
People often confuse lactose intolerance, in which the body has a hard time digesting milk sugar (lactose), with cow’s milk protein intolerance, which is an allergic reaction triggered by the immune system.
Lactose intolerance is caused by a shortage of the enzyme lactase, which breaks down lactose in the small intestine.
Typical symptoms of lactose intolerance include abdominal pain, nausea, bloating, flatulence, and other digestive discomforts.
While uncomfortable, the symptoms do no permanent damage to the bowel, Heyman points out.
The AAP report stresses the importance of accurately diagnosing lactose intolerance.
Parents can get a good feel for their child’s tolerance by systematically eliminating and then reintroducing specific dairy foods over time, carefully recording changes in symptoms.
Other recommendations include:
Drink small portions of milk (4 to 8 ounces) with meals and other foods throughout the day. Try yogurt, which may produce fewer lactose intolerance symptoms. Choose aged cheeses, which have less lactose than other varieties. Drink lactose-free or lactose-reduced milk, which is easily found in most grocery stores; or take lactase-replacement capsules.
Alternate Calcium Sources
Although it is possible for children to get the calcium they need for strong bones without dairy, it isn’t easy.
Broccoli, brussels sprouts, dried figs, and sardines are among the most calcium-rich nondairy foods -- but good luck getting the typical child to eat them.
Calcium-fortified cereals and orange juice may be a more realistic option. But the AAP has also warned parents to limit fruit juices, which contain a lot of sugar.
The group recommends no more than 6 ounces per day of fruit juice for children age 1 to 6, and 12 ounces for older kids and teens.
While calcium supplements may help, children on lactose-free diets appear to have a harder time absorbing calcium in this or any form.
“Recent evidence indicates that dietary lactose enhances calcium absorption and, conversely, that lactose-free diets result in lower calcium absorption,” the report says.
Thus, lactose intolerance (and lactose-free diets) may, in theory, predispose people to inadequate bone development.
The Racial Divide
According to the AAP report, as much as 70 percent of the world’s population is lactose intolerant to some degree, meaning they are deficient in the lactase enzyme.
Not surprisingly, racial and ethnic groups which have historically had little exposure to dairy foods are the most intolerant, while those with the most exposure are the least.
Nearly 100 percent of Asians and Native Americans have a lactase deficiency, while 80 percent of Hispanics and 60 percent to 80 percent of blacks produce insufficient quantities of the enzyme. Only 2 percent of northern Europeans are lactose intolerant.
Children in high-risk ethnic groups may develop symptoms with dairy exposure as early as age two or 3, but white children rarely develop symptoms before 4 or 5, the report states.
While most people with lactase deficiency develop symptoms in their teens or adult years, approximately 20 percent of Hispanic, Asian, and black children younger than age 5 show evidence of the deficiency.
By Salynn Boyles, reviewed by Louise Chang, MD
SOURCES: Heyman, M. Pediatrics, September 2006; vol 118: pp 1279-1286. Melvin B. Heyman, MD, MPH, professor of pediatrics, University of California, San Francisco. AAP report on fruit juice consumption, May 7, 2001.