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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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... O declínio nos níveis de lactase é progressivo durante a infância e a adolescência, havendo um aumento nas taxas de má-absorção de acordo com a idade 7,8 . Nos casos em que a má-absorção de lactose avança para o estágio de Intolerância à Lactose (IL), os indivíduos portadores apresentam uma série de reações adversas após ingestão de leite e de seus derivados: diarreia, flatulência, náusea, dor e distensão abdominal 9,10 . A presença dessas reações pode levar a um menor consumo de leite e de derivados e, consequentemente, a uma ingestão insuficiente de cálcio, predispondo seus portadores a maiores riscos para o desenvolvimento da osteoporose 10,11 . ...
... Nos casos em que a má-absorção de lactose avança para o estágio de Intolerância à Lactose (IL), os indivíduos portadores apresentam uma série de reações adversas após ingestão de leite e de seus derivados: diarreia, flatulência, náusea, dor e distensão abdominal 9,10 . A presença dessas reações pode levar a um menor consumo de leite e de derivados e, consequentemente, a uma ingestão insuficiente de cálcio, predispondo seus portadores a maiores riscos para o desenvolvimento da osteoporose 10,11 . ...
... O acúmulo de lactose no intestino induz à fermentação por microrganismos intestinais, o que resulta na formação de gases como metano, dióxido de carbono e hidrogênio, que são responsáveis pela flatulência, distensão e dor abdominal, sintomas característicos da IL. Além disso, a presença de lactose não absorvida no lúmen intestinal aumenta a pressão osmótica, retendo água e aumentando o trânsito intestinal, o que resulta em fezes amolecidas e diarreia, podendo levar a uma absorção comprometida de cálcio 17 e à utilização do cálcio ósseo para a manutenção desse mineral no sangue e dos níveis de cálcio neural 10 . ...
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Objective This study compared the calcium intake and bone mineral density of adult women with lactose intolerance with those of their counterparts without the condition. Methods Sixty adult women aged 20 to 40 years were divided into two groups: 30 diagnosed with lactose intolerance and 30 without the condition. Calcium intake was assessed by three 24-hour recalls and bone mineral density of the femur was determined by dual energy x-ray absorptiometry. Results The bone mineral density of the femoral neck (M=0.86, SD=0.13g/cm(2) versus M=0.77, SD=0.12g/cm(2)) and femoral total (M=1.14, SD=0.14g/cm(2) versus M=1.06, SD=0.12g/cm(2)) were lower (p<0.05) for the lactose-intolerant group than for the control, but there was no significant difference for the bone density of the entire body (M=1.14, SD=0.15g/cm(2) versus M=1.08, SD=0.09g/cm(2), p>0.05). Also, calcium intake was lower for the lactose intolerant than for the control group (M=250.5, SD=111.7mg/day(-1) versus M=659.7, SD=316.1mg/day(-1), p<0.05). Conclusion The results of this study suggest that the onset of intolerance symptoms may influence bone mineral density due to low calcium intake.
... 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. ...
... 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. ...
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Lactose intolerance is a common disorder affecting an individual’s ability to digest lactose present in milk or any food product. Lactose intolerance is caused by the deficiency of β-galactosidase (lactase) in the digestive tract. Diagnosis of lactose intolerance is not so simple and straightforward clinically. Many biochemical and genetic tests have been developed for the determination of lactose intolerance. Several case reports indicate wherein subjects have self-diagnosed being lactose intolerant. There is an emerging link of this disorder with human gene polymorphism, where genetic basis has been used as a diagnostic tool. The high prevalence of this condition among children and adults has compelled the production of lactose-free foods. Additionally, external enzyme supplementation has been looked at as an alternative protective mechanism in lactose intolerant subjects. This review highlights the genetic variants of lactase polymorphism and theranostic (therapeutic and diagnostic) strategies for lactose intolerance.
... 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. ...
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The aim of this study was to verify the effect of physical activity level on bone mineral density (BMD) in pre-menopausal women with lactose intolerance. Sixty women was engaged in this study (age: 31.9±6.9 years) and were initially separated into two groups: 30 women with lactose intolerance (LI) and 30 controls (C). The groups were further subdivided into less and more active using the median of weekly total energy expenditure, estimated by the International Physical Activity Questionnaire (IPAQ-long version). The LI diagnosis was confirmed by lactose intolerance test (oral lactose overload with monitoring of blood glucose and associated clinical manifestations). BMD was assessed by dual energy X-ray absorptiometry (DXA). As expected, physical activity score was higher in both groups for women classified as more active (p>0.05). The BMD at hip and pelvis was lower in LI than in C group (p<0.05). In addition, there was a tendency for a lower BMD in L2, L4, femoral neck and total hip for LI compared to C group (p<0.10). However, there was no main effect of physical activity level or interaction for the BMD at any other bone sites (p<0.10). The LI group had lower (p<0.05) absolute free-fat mass, independently of physical activity level. Therefore, the results of the present study suggest that LI reduces BMD in pre-menopausal women and this reduction is independent of physical activity level.
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Aim: This study described outcomes following treatment for lactose intolerance, which is common in children. Methods: The medical records of children aged 6-18 years who underwent lactose hydrogen breath testing at Dana-Dwek Children's Hospital, Tel Aviv, Israel, from August 2012-August 2014 were analysed. We compared 154 children with gastrointestinal symptoms and positive lactose hydrogen breath tests to 49 children with negative test results. Results: Of the 154 children in the study group, 89 (57.8%) were advised to follow a lactose restricted diet, 32 (20.8%) were advised to avoid lactose completely, 18 (11.7%) were instructed to use substitute enzymes and 15 (9.7%) did not receive specific recommendations. Only 11 patients (7.1%) received recommendations to add calcium-rich foods or calcium supplements to their diet. Lactose reintroduction was attempted in 119/154 patients (77.3%), and 65/154 (42.2%) experienced clinical relapses. At the final follow up of 3.3 years, 62.3% of the study children were still observing a restricted diet. Older children and those who were symptomatic during lactose hydrogen breath testing were more likely to be on a prolonged restricted diet. Conclusion: Our long-term follow up of lactose intolerant children showed that only a third were able to achieve a regular diet. This article is protected by copyright. All rights reserved.
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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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Chapter
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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Full-text available
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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Full-text available
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