Risk for Low Bone Density.pdf

36 Lactose Intolerance: An Unnecessary Risk for Low Bone Density Dennis Savaiano The potential for lactose intolerance causes 25–50 million Ameri- cans 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, (3) consump- tion of dairy foods with meals to slow transit and maximize digestion, and (4) use of lactose digestive aids. Lactose intolerance can cause moderate and acute symptoms of excessive flatulence, stomach discomfort and diarrhea. The occur- rence of symptoms depends on: 1 The dose of lactose consumed. Typically, one cup of milk (con- taining 12 g of lactose) served with a meal is well tolerated by maldigesters, even those claiming severe intolerance. If milk is consumed with breakfast and dinner, it remains well tolerated. Dairy sources vary considerably in lactose content. Lactose is water soluble and thus found in the whey portion when curds and whey are separated. Thus, hard cheeses have minimal lac- tose and soft cheeses are intermediate in lactose content. Yogurts are well tolerated due to microbial -galactosidase that is active in vivo during digestion, supplementing the body’s own lactase activity. The primary source of lactose in the diet is fluid milk. 2 The rate at which the lactose passes into the large intestine. This is a function of stomach emptying and meal feeding. Lactose tol- erance is significantly improved when lactose is fed with a meal. The effect is more difficult to demonstrate with individual foods such as whole milk compared to fat-free milk. 3 The residual lactase activity in the small in