The 2005 Dietary Guidelines for Americans recommends dairy products as the primary strategy for individuals who are lactose intolerant (10). The Guidelines state “if a person wants to consider milk alternatives because of lactose intolerance, the most reliable and easiest ways to derive the health benefits associated with milk and milk product consumption is to choose alternatives within the milk food group, such as yogurt or lactose-free milk, or to consume the enzyme lactase prior to the consumption of milk products” (10). The Guidelines add that non-dairy calcium-containing alternatives may be selected by individuals who choose to or must avoid all milk products.
The U.S. Department of Agriculture’s Food and Nutrition Service, in its interim final rule revising regulations governing the WIC (Special Supplemental Nutrition Program for Women, Infants and Children) food packages, recommends lactose-reduced or lactose-free dairy products as an important first option before non-dairy choices for WIC mothers and their young children with lactose intolerance. It also allows amounts of cheese that exceed the maximum substitution amounts for those who obtain medical documentation of lactose intolerance (54).
The U.S. Department of Agriculture’s Food and Nutrition Program allows lactose-free milk without requiring documentation for children with lactose intolerance as part of the reimbursable school meal program (55).
Several government and national medical organizations recommend dairy foods (e.g., yogurt with active cultures, aged cheeses, lactose-free milk) as the first option for individuals with lactose intolerance.
The U.S. Surgeon General’s report on Bone Health and Osteoporosis cautions that bone health may be adversely affected in individuals with lactose intolerance who avoid dairy products and do not replace these foods with other good sources of calcium (56). The report identifies some non-dairy sources of calcium including canned salmon with bones, turnip greens, tofu with calcium, calcium fortified orange juice, and calcium-fortified breakfast cereal (56). These foods generally contain less calcium per serving or in some cases the calcium may be less bioavailable than from milk and milk products (57,58).
The American Academy of Pediatrics (AAP), in its report on lactose intolerance, encourages children and adolescents with lactose intolerance to still consume dairy foods to obtain enough calcium, vitamin D, protein, and other nutrients essential for bone health and overall health (18). The reports emphasizes that lactose intolerance does not require avoiding dairy foods and points out that many children sensitive to lactose can consume small amounts of milk, especially with other foods; hard cheeses (e.g., Cheddar, Swiss); yogurt with live, active cultures; and lactose-free or lactose-reduced milk (18). Although rice and soy beverages are generally free of lactose, the report indicates that the nutrient content of these beverages is not equivalent to cow’s milk (18). Likewise, in its report on optimizing bone health and calcium intakes of infants, children, and adolescents, the AAP recognizes that many children with lactose intolerance can comfortably drink small amounts of milk, especially when accompanied by other foods (59).
The National Medical Association recommends that everyone, especially African Americans, many of whom are lactose maldigesters, consume three to four servings/day of low-fat milk, cheese, or yogurt, and/or lactose-free milk to help reduce the risk of nutrient-related chronic diseases (21).
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