This question was posed by an NIH Consensus Development panel convened February 22-24 to examine the available evidence on lactose intolerance and health.
 
We certainly know that lactose intolerance is a leading barrier to health professionals recommending dairy, yet the panel noted in its draft consensus development conference statement that inadequate consumption of dairy and dairy nutrients may increase the risk for chronic health problems, including osteoporosis and decreased bone health, and that eliminating nutrient-rich dairy foods may be unnecessary to managing the condition.
 
Without low-fat and fat-free milk and milk products in the diet, it’s hard to meet nutrient needs, and available research suggests people diagnosed with lactose malabsorption can tolerate at least 12 grams of lactose (the amount in about one cup of milk) with no or minor symptoms. Experts also suggest drinking low-fat or fat-free milk (regular or flavored) with meals or a snack instead of on an empty stomach, trying small, frequent portions or buying lactose-free or lactose-reduced milk – which contain all the same nutrients as regular milk, and that yogurt and hard cheeses (the panel suggests Cheddar, provolone and mozzarella) may also be more easily digested. Lastly, the panel encouraged health professionals to offer personalized, culturally-sensitive management strategies based on individual preferences. 

Last month I was pleased to moderate a National Dairy Council-hosted webinar on lactose intolerance which drew participation by over 1,500 dietitians, physicians and nutrition educators. Based on the interest in the topic, and the 150+ questions asked, the panel’s report will provide welcome guidance. For additional resources on lactose intolerance see the National Dairy Council Web site and http://www.nichd.nih.gov/milk.

Have you ever heard anyone say “I like dairy, but it doesn’t like me!”? As a registered dietitian who has counseled thousands of patients and now works for the dairy council, I have heard this from time to time. What strikes me the most is that people talk about how much they want to eat dairy foods for the sheer enjoyment if not the nutritional benefits, but they avoid them in order to avoid the symptoms of lactose intolerance. 

When I speak with people about how they can still include dairy foods in their diet by following a few simple strategies, they are usually relieved and excited. And when I talk to them about how health experts encourage people with lactose intolerance to still choose dairy foods for their important nutrients, they are even more compelled to get dairy back into their diets. However, I’ve found that even health professionals are often unaware of these recommendations and strategies identified through research that may help make dairy foods easier to digest. I wanted to share them here so other health professionals can share them with patients to help them enjoy nutrient-rich dairy.

Try these tips that may help dairy foods fit in your daily diet:
• Try lactose-free milk. Lactose-free milk and other dairy foods are available in most local supermarkets in the dairy aisle. Traditionally, lactose-free milk has been made by adding the enzyme lactase to the regular form of milk, thus it provides the same package of nine essential nutrients as regular milk, just without the lactose. 
• Try drinking small amounts of milk with meals.  Consuming milk with other foods or a meal can make it easier to digest, so try milk on cereal, in smoothies or licuados, and enjoy a glass of milk with lunch or dinner.
• Try cooking with milk. Make oatmeal with milk instead of water and add milk to soups, sauces and casseroles.
• Try eating yogurt. Yogurts that contain live and active cultures can make it easier for the body to digest lactose.
• Try aged cheeses. Aged cheeses like Swiss, Parmesan, Gouda, Colby, provolone, Cheddar, Edam, Fontina, Gruyere, Muenster and Monterey Jack have very little lactose.

In my role as a registered dietitian for the Midwest Dairy Council in Chicago, I work with health professional groups such as the Illinois Chapter of the American Academy of Pediatrics and the Illinois Chapter of the American Academy of Family Physicians, and the Illinois Dietetic Association. I have recently started doing taste tests with these groups at their annual meetings. By serving them lactose-free milk with their dinner or dessert they can experience one of the suggested options for people with lactose intolerance. The feedback has been very positive. Most health professionals comment that they “had never tried lactose-free milk before,” that it “tastes very good.” They also comment that they would be more likely to “recommend it to patients” now that they themselves have tasted it. The activity provides an opportunity for health professionals to discuss the other recommended strategies as well, since no two patients are alike.   

Have you also heard about lactose intolerance being a common problem? Well, new research suggests the rate of perceived lactose intolerance may be lower than previously thought. The research is the topic of Judy Jarvis’ post and was also reported by fellow dietitian and writer, Christine Palumbo, in the February issue of Chicago Parent.

The bottom line is that low-fat and fat-free dairy is nutrient-rich, and people enjoy dairy foods and beverages. People who avoid dairy because of lactose intolerance are at risk of lacking important nutrients in their daily diets. By helping people enjoy more dairy foods through better nutrition education and these simple strategies, we can empower people to get more nutrients in their diets to support better health. For me, that’s what being a dietitian is all about!

As research supporting the health benefits of vitamin D flood nutrition and medical journals, it is important to remember that synergy between nutrients often determines health outcomes. Two recent reports in the medical/nutrition literature demonstrate this for calcium and vitamin D. 

A study in Denmark published January 12 online in the British Medical Journal, reported results of a meta-analysis of seven large randomized controlled trials. It investigated the role of vitamin D supplementation of the diet, with or without calcium, on the risk of fractures. 

Results showed that vitamin D with calcium reduced the overall risk of fracture, and probably hip and clinical vertebral fractures, irrespective of sex and fracture history.  Daily supplementation of the diet with 10-20 µg (400-800 IU) vitamin D alone was not significantly associated with fracture risk. However, when 10 µg of vitamin D was given with calcium, there was a significant reduction in both overall fracture and hip fracture risk.

Unfortunately, the authors do not report dietary intakes of vitamin D (or sunlight exposure) and calcium – so we don’t know if these study populations were being supplemented on top of adequate or inadequate intakes. However, based on the results of this meta-analysis, the researchers recommend supplementing the diet with at least 400 IU of vitamin D and 1,000 mg of calcium daily. 

The authors say previous studies also confirm the importance of both calcium and vitamin D for reducing fracture risk – further emphasizing the synergy between calcium and vitamin D for bone health. 

Another study helps us understand the mechanisms that underlie calcium and vitamin D synergy. An invited review in the European Journal of Clinical Nutrition explains the molecular and cellular processes by which vitamin D and calcium insufficiency have been shown to be linked to the pathogenesis of various chronic diseases. 

According to this review, “Impairment of cooperative signaling from the 1,25-OH2D3-activated vitamin D receptor (VDR) and from the extracellular calcium sensing receptor (CaR) in vitamin D and calcium insufficiency causes cellular dysfunction in many organs and biological systems, and, therefore, increases the risk of diseases, particularly of osteoporosis, colorectal and breast cancer, inflammatory bowel disease, insulin-dependent diabetes mellitus type I, metabolic syndrome, diabetes mellitus type II, hypertension and cardiovascular disease.”

Clearly, these articles speak to the need for adequate calcium and vitamin D intake to promote health.  Many dairy foods provide both. Both milk and yogurt (8-ounce serving) and many cheeses (1 ½ ounce serving) are excellent sources of calcium.  Virtually all fluid milk, many brands of yogurt, and some cheeses are currently fortified with vitamin D – with more continuing to enter the marketplace. However, Americans are consuming only about half the recommended three servings of dairy foods each day. Enjoying three servings of low-fat or fat-free milk, cheese or yogurt—is a deliciously easy way to help families build stronger bones and healthier bodies.

An age-related decrease in skeletal muscle and bone mineral content can increase the risk for falls and fracture. Few studies have evaluated the effects of protein intake on both bone and muscle in elderly women long-term. Recent results from an observational study conducted in Australia provides support for the possible benefit of higher protein intake for this age group. 
 
The researchers examined the association of protein consumption at baseline with bone-free lean mass, muscle size, and bone mass five years later in a group of 862 community-dwelling elderly women (average age 75 years). The average baseline protein intake was 81 gm/day contributing 19 percent of total energy. 
 
Results showed:
•   A higher baseline protein intake was associated with significantly higher whole body and appendicular (upper and lower limbs) bone-free lean mass, bone mineral content, and upper arm muscle area.
•  “Compared with those in the lowest tertile of protein intake (<66 gm/day), women in the top tertile (>87 gm/day or 1.6 gm/kg/d) had 5.4-6% higher whole body and appendicular lean mass and upper arm muscle area, and 5.3-6% higher whole body and appendicular bone mineral content.”
 
The authors say these findings are consistent with a review of recent nitrogen balance studies in the healthy elderly, concluding that a protein intake of 1.0-1.3 gm/kg/d is necessary to maintain nitrogen balance, and a review of safe protein intake in the elderly suggesting 1.0-1.2 gm/kg/d of high-quality protein. “Providing further studies do not show adverse effects,” they conclude, “it would be reasonable to recommend such an increase in protein intake to elderly women.” 
 
For adults, the Institute of Medicine recommends a protein intake between 10 and 35 percent of total calories.  Most American adults are consuming protein at the lower end of this range, with median intakes of 14-16 percent of energy. So, there is room for adding more high-quality protein to their diet while still being in the recommended range.
 
Consuming milk, yogurt, and cheese, which are good sources of high-quality protein, is a way for older women to achieve an overall higher protein intake. Whey protein is a high-quality protein naturally found in dairy foods. Whey contains all of the essential amino acids necessary to build new muscle and reduce muscle breakdown. It is one of the best sources of naturally-occurring branched-chain amino acids, including leucine, which is unique in its ability to initiate muscle protein synthesis.

Including protein at each meal may be an easy and healthy way to help minimize age-related muscle loss. This may allow older people to be active longer. Isn’t that what we all want for ourselves and our clients?

On January 16th, I attended the Houston Wellness Association 2010 Wellness Symposium. The theme for the symposium was to offer strategies for companies & communities to impact health in a challenging economy. The goal of the symposium was to leave with solutions and tools for transforming Houston into a widely-modeled, innovative city for healthy living and thus a role model for the entire nation.

One of the major initiatives highlighted at the summit was the Healthy Kids, Healthy Schools (HKHS) program. DairyMax, National Dairy Council and leaders across Houston have joined together in a unique public-private partnership pioneering new ways to help students in Houston Independent School District (HISD) eat better and move more. As a result of Healthy Kids, Healthy Schools, an unprecedented, comprehensive and exciting campaign for wellness is underway in HISD. Stakeholders from a wide range of community, health, government and business organizations are working together to create a new “culture of wellness” through a range of coordinated communications, programs and activities – all geared toward empowering students to make better food choices and become more physically active. With collaboration as a guiding principle, this upbeat public-private partnership has a single goal: create a district-wide population of healthy, high-achieving students.

Concrete tools and programs have been collaboratively envisioned, piloted and rolled out including the HKHS Making Wellness Happen Guide for School Leaders, the HKHS Planner and identification of Health Coaches to help make change happen and monitor progress at the school building level. The student-led “Change the Game” social marketing campaign is underway to help spread the word. Direct student involvement in school meals is ramping up through the “Have a Say” effort.

One powerful component of HKHS in Houston ISD empowering leadership and action among students to shape a healthy school environment is Fuel Up to Play 60. Fuel Up to Play 60, is a new health and wellness program reaching youth created by National Dairy Council and National Football League (NFL) to help combat childhood obesity and help youth develop life-long healthy eating and daily physical activity habits. Fuel Up to Play 60 empowers students to make changes at school that will help them “get active and play” for 60 minutes daily and “fuel up” with critical nutrient-rich foods missing from their diets – like low-fat and fat-free dairy foods, fruits, vegetables and whole grains. The youth-led program uniquely reaches out directly to students for their help co-creating and leading the program at the school level. Schools choose physical activity and nutrition goals to implement within the school to help their students and staff create a healthy school environment. Students also use an interactive Web site (www.fueluptoplay60.com) where they can sign up and take the pledge, play games and track healthy behaviors while earning points towards the Fuel Up to Play 60 National Competition to win prizes.

Healthy Kids, Healthy Schools demonstrates that there are creative and effective ways to engage children in the dialogue about wellness. Children do care about their health, and want to see their schools do more to improve nutrition, physical education and physical activity opportunities. Youth want and deserve a chance to help shape district wellness policies and school environments that affect their well-being. Best of all, students are an impressive source of innovative ideas for creating healthier schools and hopefully, through the collaboration of HKHS that will translate into healthier communities, workplaces and families. Health professionals seeking to combat childhood and youth obesity in their own communities should consider this collaboration a role model in shaping community wide efforts, get involved with Fuel Up to Play 60 and read more about Healthy Kids, Healthy Schools.

With holiday indulgences from family get-togethers, parties, gift baskets, and our own baking mostly behind us, many will be making the New Year’s resolution to lose weight – one more time.  Many are looking for foods that can assist their efforts. An article in the December issue of the American Dietetic Association tests the short-term satiating power of yogurt beverages. 

Researchers from the University of Washington, led by Adam Drewnowski, tested the effects of 6 gm of a soluble fiber, inulin, on the satiating properties of low-energy-density (180 kcal; 0.4 kcal/g) and high-energy-density (440 kcal; 0.9 kcal/g) 16-ounce strawberry flavored yogurt beverages against the same volume of orange juice or no beverage at all. The drinks were provided to participants (18 men and 20 women 18-35 years old) two hours before an ad libitum lunch. 

Results:
• Yogurt beverages -- whether or not they contained fiber or were low or high in calories -- had greater satiating power than did orange juice, as evidenced by higher satiety ratings and reduced energy intakes at lunch.
• The satiating power of low-energy-density yogurt with added fiber was comparable to that of high-energy-density yogurt. 

“Low energy-density foods with high satiating power may be useful tools for weight management,” say the researchers. Other characteristics of yogurt, such as protein content, thickness, or viscosity likely play a role in satiety, the authors note. 

Looking for other information on dietary strategies to promote satiety? It is generally accepted that calorie-for-calorie, protein intake increases satiety to a greater extent than carbohydrate or fat and that diets higher in protein are associated with satiety. The September/October 2009 issue of the Dairy Council Digest, Role of Protein in Satiety and Weight Management, reviews the science in this area.   

Today, the U.S. Department of Agriculture (USDA) has joined a campaign to fight and defeat childhood obesity in cooperation with the NFL, National Dairy Council, multiple health organizations and several major corporations. USDA secretary Tom Vilsack joined Roger Goodell, NFL Commissioner, and Tom Gallagher, CEO of Dairy Management Inc., the managing organization for National Dairy Council, at a New York City public school to support and promote the initiative.

To learn more about this exciting event, click here.

What better time to share current news than with a new year! I’m thrilled to announce that the newly updated NationalDairyCouncil.org is now live!

As you’ll see, the educational resources found on the earlier version of the Web site have been carried over, and the main page’s content has been refreshed to reflect the latest dairy research and match the new site’s overall tone. In addition, the new site is more easily searchable and is organized in a way that puts research and resources at visitors’ fingertips. With this new look, NationalDairyCouncil.org continues to serve as the destination for dairy nutrition and science information for health professionals and thought leaders.

The revitalized Web site also now offers exciting new functionality, including:
- A homepage marquee that highlights the site’s main navigational sections through six rotating images
- The Dairy Report blog content area, which features a feed of real-time posts
- RSS feeds
- Enhanced site search capabilities
- The complete 3-Every-Day™ of Dairy recipe catalogue
- The Dairy Council Directory, which continues to provide information on state and regional dairy councils

We’ll continue to frequently update NationalDairyCouncil.org moving forward, and will be rolling out additional content over the next few months. Please visit our new site and let me know what else you’d like to see on it, so NDC can best meet your needs.

Happy New Year!