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Lactose Intolerance: An Unnecessary Risk for Low Bone Density

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Abstract

The potential for lactose intolerance causes 25-50 million Americans and an unknown number of people around the world to avoid milk. Milk avoidance is a significant risk factor for low bone density. Individuals who avoid milk, due to intolerance or learned aversion, consume significantly less calcium and have poorer bone health and probable higher risk of osteoporosis. Lactose intolerance is easily managed by: (1) regular consumption of milk that adapts the colon bacteria and facilitates digestion of lactose; (2) consumption of yogurts and cheeses and other dairy foods low in lactose; consumption of dairy foods with meals to slow transit and maximize digestion, and use of lactose-digestive aids. As dairying spreads around the world to new markets and dairy foods become the dominant source of calcium in these markets, the potential for lactose intolerance will grow. Management of lactose intolerance globally will require both education and product development.
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... Bone mass is also decreased by the use of glucocorticosteroids, which directly cause osteoblast dysfunction and accelerate osteoblast apoptosis and reducing calcium absorption from the gastrointestinal tract and increasing renal calcium excretion (stimulating parathyroid hormone release in the parathyroid glands) [2]. Puberty (Tanner stages 2, 3, 4) has been shown to be the most sensitive period in which glucocorticoid use may lead to irreversible bone loss [2,3]. ...
... In addition, dairy products are also a source of protein, phosphorus, potassium, and vitamins A, D, B2 (riboflavin), and B12 (cobalamin) [5]. Multiple observational studies show that consumers who avoid milk have lower bone mineral density (BMD) and a 2.7-fold higher risk of bone fractures in pre-pubertal children compared to individuals with higher milk consumption [3,[6][7][8]. ...
... Disturbances in the parameters of calcium and phosphate metabolism can be reflected in disturbances in bone mineralization [7]. Both IBD alone and the dairy-restricted diet are considered risk factors for bone mineralization disorder [2,3,7]. In the analyzed group of patients, the results of bone mineral density measurements in lactose-intolerant patients on a low-lactose/lactose-free diet were similar to those obtained in lactose-tolerant patients and not on an elimination diet. ...
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Background: A diet restricted in dairy products can cause calcium and vitamin D deficiency and, secondarily, lead to malnutrition and low bone mass. The aim of the study was to determine the incidence hypocalcemia and vitamin D deficiency in children with inflammatory bowel diseases and lactose intolerance (LI). Material and methods: A total of 107 patients were enrolled to the study (mean age 14.07 ± 3.58 years; 46.7% boys): 43 with Crohn's disease (CD), 31 with ulcerative colitis (UC), and 33 with functional abdominal pain (AP-FGID). Hydrogen breath test with lactose and laboratory tests to assess the calcium-phosphate metabolism were performed in all patients. The results of densitometry were interpreted in 37 IBD patients. Results: LI was diagnosed in 23.2% patients with CD, 22.6% with UC, and 21.2% children with AP-FGID, (p = 0.9). Moreover, 9.5% patients with CD, in 21.4% with UC, and in 51.5% with AP-FGID had optimal concentration of 25(OH)D (p = 0.0002). Hypocalcemia was diagnosed in 21% of patients with CD, 16.1% with UC patients, AP-FGID patients had normal calcium levels (p = 0.02). There was no difference in concentrations of total calcium, phosphorus, and 25(OH)D between patients on low-lactose diet and normal diet (p > 0.05). BMD Z-score ≤ -1 SD was obtained by 12 CD patients (48%), and 6 with UC (50%). Conclusion: The use of a low-lactose diet in the course of lactose intolerance in children with inflammatory bowel diseases has no effect on the incidence of calcium-phosphate disorders and reduced bone mineral density.
... Nevertheless, milk is calcium and nutrient-rich food and an important part of a healthy diet (6). Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). ...
... Avoidance of milk during childhood is a significant risk factor for retarded growth and development as well as low bone density (7). Those who avoid milk, due to lactose intolerance, consume significantly less calcium and suffer from poorer health and bone formation, and higher risk of osteoporosis (7). Some studies have suggested that the prevalence of lactose intoler-ance is a global issue. ...
... Lactose intolerance is an inability to digest lactose (LI) due to deficiency of lactase or β-galactosidase enzyme in the small intestine (Harrington et al. 2008). In lactose intolerance, undigested lactose in the colon could be fermented by some gut bacteria, producing acid and gas, leading to the development of lactose intolerance symptoms (Horner et al. 2011;Savaiano et al. 2011). Probiotic bacteria provide health benefits to the host gut, like protection from pathogen colonization, restoration of the gut microbiome composition, and prevention of gastrointestinal disorders (Matthews et al. 2005;Heyman 2006;Gayathri and Vasudha 2018). ...
Chapter
The gut of human beings is inhabited by a diverse group of microorganisms, around trillions, which makes it a new essential endocrine organ and shows a symbiotic connection with a host, and they metabolize the food ingested and produce diverse bioactive and dietary compounds. This may include organic acids, bacteriocins, and short-chain fatty acids, which provide potential to impact on physiological and pathological conditions of the host and maintain homeostasis. In recent times, due to rapid advancement in technology, our understanding about microbiome has also expanded. The modulation of the microbiome leads to disturbance in homeostasis, which causes imbalance and leads to dysbiosis, and the gut barrier integrity gets disturbed and immunological reaction leads to inflammation. This chapter reviews the current insights on various diseases and gastroenterological disorders associated with the modulation of the gut microbiome and how probiotics help in maintaining the healthy gut with intact gut barrier by regulating the expression of tight junction proteins, perhaps leading to good human health.
... Management of LI typically consists of reducing, or even avoiding, the consumption of dairy products [16,17]. However, because dairy products constitute a high-quality source of calcium, potassium, protein, and vitamin B and D, avoidance of these foods can increase the risk of morbidity, including bone fracture, osteoporosis, and nutrient deficiencies [18][19][20]. The most preferred and reliable treatment option involves the consumption of lactose-free dairy products. ...
Article
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Article
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Article
Lactose is a widely distributed disaccharide in the diet and pharmaceutical industries. It is the sugar from the milk of mammals. The loss of intestinal lactase activity with age is frequent. It varies between ethnic and genetic conditions, and may cause its malabsorption. It may also be secondary to intestinal mucosal damage and, rarely, to congenital deficiency. Malabsorption does not necessarily imply clinical intolerance, with gastrointestinal symptoms after its ingestion. The exclusion of lactose from the diet produces clinical improvement but it could lead to a defect in the recommended daily intake of other nutrients such as calcium. It can be reintroduced into the diet but there is an individual clinical threshold of tolerance.
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Nutrition plays an important role in skeletal health throughout the life cycle. This chapter addresses evidence-based nutrition recommendations that can be used to promote skeletal health. Maintaining bone health is a significant concern in the USA; healthful lifestyle is an opportunity to promote bone health. The total diet or overall pattern of food consumed is the most important focus of healthy eating (Freeland-Graves and Nitzke, J Acad Nutr Diet 113:307–317, 2013). A healthful dietary pattern is associated with prevention of chronic diseases as well promoting skeletal health. The Surgeon General’s report on bone health and osteoporosis recommendations include consuming recommended amounts of calcium and vitamin D, maintaining a healthful body weight, and being physically active, along with minimizing the risk of falls (USDHHS Surgeon General, 2004). Meeting calcium recommendations and weight bearing physical activity build strong bones, optimizes bone mass, and may reduce the risk of osteoporosis later in life. Nutrition counseling using the Nutrition Care Process is an effective structure for tailoring evidenced-based recommendations to an individual’s unique needs in the prevention, treatment, and maintenance of health and quality of life into old age.
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