Got Milk Anyway?

(Melina Mara/twp - Twp)
By Elizabeth Agnvall
Special to The Washington Post
Tuesday, September 19, 2006

The American Academy of Pediatrics (AAP) has new advice for parents of lactose-intolerant children: Give milk a chance.

New guidelines from the academy recommend that children with lactose intolerance try not only milk but other dairy products such as cheese and yogurt. The guidelines, which pediatricians and pediatric gastroenterologists often consult when deciding how to treat children and advise parents, appear in the September issue of the journal Pediatrics.

While the guidelines' authors received no dairy industry funding, the AAP has received dairy industry support for calcium and nutrition education programs.

"We felt we needed more emphasis on the fact that you could tolerate some lactose even if you are lactose-intolerant," said Melvin Heyman, a pediatric gastroenterologist at University of California, San Francisco, and lead author of the new guidelines. He points out that tolerance varies considerably among individuals.

Particularly worrisome, Heyman said, is the increasing evidence that children and adolescents, especially those who are lactose-intolerant, are not getting enough calcium. Insufficient calcium during the formative years can lead to poor bone development, elevated fracture potential and perhaps an increased risk of osteoporosis later in life.

When children are lactose-intolerant, their digestive systems are not able to break down lactose, a sugar found in milk and other dairy products. Symptoms can include nausea, cramps, gas and diarrhea.

Between 30 million and 50 million Americans are lactose-intolerant, according to the National Digestive Diseases Information Clearinghouse. The condition is uncommon in people of northern European descent, but as many as 20 percent of Hispanics, 60 to 80 percent of blacks and Ashkenazi Jews and 90 percent of Asians and American Indians have it. The problem is more common in adults and teens than in children, though symptoms may begin as early as age 2.

According to the report, complete avoidance of dairy products is not necessary for many lactose-intolerant children. Heyman recommends that children diagnosed with lactose intolerance try small amounts of dairy to see how much they can tolerate without triggering symptoms. Some can drink one to two glasses of milk each day without developing symptoms. Others can tolerate aged cheeses and yogurt more easily than other dairy products.

There is a debate among researchers about whether children's bodies absorb calcium better from dairy products than from supplements or fortified foods. Heyman said it's best for kids to get calcium from dairy, but if they can't tolerate such foods, they need to get it from other sources.

The report points out that lactose-free and lactose-reduced milks are widely available, although they are more expensive than regular milk. It also notes that milks made of rice, soy or other proteins are generally free of lactose, "although the nutrient content of most of these milks is not equivalent to cow milk."

But Nancy Chapman, executive director of the Soy Foods Association of North America, disagrees. Soy milk, she said, is fortified with calcium, giving children as much calcium as regular milk, if not more. She also pointed out that soy milk has no cholesterol, is low in saturated fat and contains the essential fatty acids children need for growth and development.

None of the authors of the AAP guidelines received dairy industry funding. But over the past three years, the AAP has received $100,000 from the National Dairy Council to support the industry group's "3-A-Day of Dairy for Stronger Bones" campaign and a new calcium information brochure. One of the authors of the guidelines, Jatinder J.S. Bhatia, is an unpaid AAP representative on the 3-A-Day advisory panel.

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