NIH Consensus Development Conference Statement: Lactose Intolerance and Health

ABSTRACT OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of currently available data on latose intolerance and health. PARTICIPANTS: A non-DHHS, nonadvocate 14-member panel representing the fields of internal medicine, pediatrics, pediatric and adult endocrinology, gastroenterology, hepatology, neonatology and perinatology, geriatrics, racial/ethnic disparities, radiology, maternal and fetal nutrition, vitamin and mineral metabolism, nutritional sciences, bone health, preventive medicine, biopsychology, biostatistics, statistical genetics, epidemiology, and a public representative. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. EVIDENCE: Presentations by experts and a systematic review of the literature prepared by the University of Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. CONFERENCE PROCESS: The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. CONCLUSIONS: (1) Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known. (2) The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers. (3) Many individuals with real or perceived lactose intolerance avoid dairy and ingest inadequate amounts of calcium and vitamin D, which may predispose them to decreased bone accrual, osteoporosis, and other adverse health outcomes. In most cases, individuals do not need to eliminate dairy consumption completely. (4) Evidence-based dietary approaches with and without dairy foods and supplementation strategies are needed to ensure appropriate consumption of calcium and other nutrients in lactose-intolerant individuals. (5) Educational programs and behavioral approaches for individuals and their healthcare providers should be developed and validated to improve the nutrition and symptoms of individuals with lactose intolerance and dairy avoidance. The full statement is available at

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Available from: Julie A. Mennella, Feb 18, 2015
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    • "Dairy foods are excellent sources of calcium, potassium, vitamin D, B vitamins and high quality protein. In 2010, the United States Department of Health and Human Services reviewed 55 observational studies from 1967 to 2009 and indicated that low dietary milk and dairy intake was a risk factor for bone fracture, osteoporosis and other adverse health outcomes [3-5]. Dietary calcium supplements did not consistently increase bone mineral density or reduce fracture risk. "
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    ABSTRACT: Lactose intolerance (LI) is a common medical problem with limited treatment options. The primary symptoms are abdominal pain, diarrhea, bloating, flatulence, and cramping. Limiting dairy foods to reduce symptoms contributes to low calcium intake and the risk for chronic disease. Adaptation of the colon bacteria to effectively metabolize lactose is a novel and potentially useful approach to improve lactose digestion and tolerance. RP-G28 is a proprietary GOS mixture being investigated to improve lactose digestion and the symptoms of lactose intolerance in affected patients. A randomized, double-blind, parallel group, placebo-controlled study was conducted at 2 sites in the United States. RP-G28 or placebo was administered to 85 patients with LI for 35 days. Post-treatment, subjects reintroduced dairy into their daily diets and were followed for 30 additional days to evaluate lactose digestion as measured by hydrogen production and symptom improvements via a patient-reported symptom assessment instrument. Lactose digestion and symptoms of LI trended toward improvement on RP-G28 at the end of treatment and 30 days post-treatment. A reduction in abdominal pain was also demonstrated in the study results. Fifty percent of RP-G28 subjects with abdominal pain at baseline were free from pain at the end of treatment and 30 days post treatment (p = 0.0190). RP-G28 subjects were also six times more likely to claim lactose tolerance post-treatment once dairy foods had been re-introduced into their diets (p = 0.0389). Efficacy trends and favorable safety/tolerability findings suggest that RP-G28 appears to be a potentially useful approach for improving lactose digestion and LI symptoms. The concurrent reduction in abdominal pain and improved overall tolerance could be a meaningful benefit to lactose intolerant individuals.Study registration: NCT01113619.
    Nutrition Journal 12/2013; 12(1):160. DOI:10.1186/1475-2891-12-160 · 2.60 Impact Factor
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    • "Lactose intolerance develops when afflicted individuals experience abdominal pain, diarrhea, bloating, flatulence, and other gastrointestinal symptoms following lactose consumption [5]. Avoidance of dairy products by lactose intolerant individuals often leads to insufficient calcium and vitamin D consumption and may cause adverse health outcomes, especially reduced bone mineral density and fractures [4,6]. "
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    ABSTRACT: Lactose intolerance is a common health concern causing gastrointestinal symptoms and avoidance of dairy products by afflicted individuals. Since milk is a primary source of calcium and vitamin D, lactose intolerant individuals often obtain insufficient amounts of these nutrients which may lead to adverse health outcomes. Production of lactose-free milk can provide a solution to this problem, although it requires use of lactase from microbial sources and increases potential for contamination. Use of thermostable lactase enzymes can overcome this issue by functioning under pasteurization conditions. A thermostable beta-glucosidase gene from Pyrococcus furiosus was cloned in frame with the Saccharomyces cerecisiae a-factor secretory signal and expressed in Pichia pastoris strain X-33. The recombinant enzyme was purified by a one-step method of weak anion exchange chromatography. The optimum temperature and pH for this beta-glucosidase activity was 100[degree sign]C and pH 6.0, respectively. The enzyme activity was not significantly inhibited by Ca2+. We tested the additive amount, hydrolysis time, and the influence of glucose on the enzyme during pasteurization and found that the enzyme possessed a high level of lactose hydrolysis in milk that was not obviously influenced by glucose. The thermostablity of this recombinant beta-glucosidase, combined with its neutral pH activity and favorable temperature activity optima, suggest that this enzyme is an ideal candidate for the hydrolysis of lactose in milk, and it would be suitable for application in low-lactose milk production during pasteurization.
    BMC Biotechnology 09/2013; 13(1):73. DOI:10.1186/1472-6750-13-73 · 2.03 Impact Factor
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    ABSTRACT: Self-perceived lactose intolerance may result in adverse dietary modifications; thus, more studies are needed to understand the prevalence of self-perceived lactose intolerance and how it relates to calcium intake and selected health conditions. The objective was to examine the effects of self-perceived lactose intolerance as it relates to calcium intake and specific health problems that have been attributed to reduced intakes of calcium and dairy foods in a nationally representative multiethnic sample of adults. This was a cross-sectional study in a national sample of 3452 adults. The relation between self-perceived lactose intolerance, calcium intakes, and physician-diagnosed health conditions was analyzed by using linear regression analyses. Of the total sample, 12.3% of respondents perceived themselves to be lactose intolerant. The age-adjusted prevalence of self-perceived lactose intolerance was 7.8% for non-Hispanic whites, 20.1% for non-Hispanic blacks, and 8.8% for Hispanics. Respondents with self-perceived lactose intolerance had significantly lower (P < 0.05) average daily calcium intakes from dairy foods than did those without self-perceived lactose intolerance. A significantly higher (P < 0.05) percentage of respondents with self-perceived lactose intolerance than of respondents without self-perceived lactose intolerance reported having physician-diagnosed diabetes and hypertension. The odds of self-reported physician-diagnosed diabetes or hypertension decreased by factors of 0.70 and 0.60, respectively, for a 1000-mg increase in calcium intake from dairy foods per day. Self-perceived lactose-intolerant respondents had a significantly lower calcium intake from dairy foods and reported having a significantly higher rate of physician-diagnosed diabetes and hypertension.
    American Journal of Clinical Nutrition 07/2011; 94(1):191-8. DOI:10.3945/ajcn.110.009860 · 6.77 Impact Factor
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