Report from the LI Conference, part 2

The number of articles on the big NIH LI conference keep multiplying. Google News lists 249, all reading more or all about the same.

• Lactose intolerance misunderstood

• Got milk intolerance? US experts say it's unclear

• Lactose intolerance: Too Little Is Known

• Think You're Lactose Intolerant? Maybe Not

As I reported earlier, these articles are based on a quick telebriefing after the conference along with a draft statement that the panel put out after hearing the presenters and the discussion.

The conclusions in the draft statement are striking.

• Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known.

• The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers.

• Many individuals with real or perceived lactose intolerance avoid dairy and ingest inadequate amounts of calcium and vitamin D, which may predispose them to decreased bone accrual, osteoporosis, and other adverse health outcomes. In most cases, individuals do not need to eliminate dairy consumption completely.

• Evidence-based dietary approaches with and without dairy foods and supplementation strategies are needed to ensure appropriate consumption of calcium and other nutrients in lactose-intolerant individuals.

• Educational programs and behavioral approaches for individuals and their healthcare providers should be developed and validated to improve the nutrition and symptoms of individuals with lactose intolerance and dairy avoidance.

Unlike all the other quickie articles, I'm going to talk in depth about the presentations that led to these conclusions. That's going to take a while, because twenty-two separate speakers provided the information that led to these conclusions. The path along the way will be as meandering and repetitious as the plot of Lost but with fewer shirtless hot actors. Bad example, since I gave up on Lost halfway through the first season when it became clear to me that they had no answers and were going to make it up on the fly.

Or maybe good example. I don't want you to bail on me, so I know I'm going to have to share the ending here at the beginning. Let's talk about those conclusions one by one.

• Lactose intolerance is a real and important clinical syndrome, but its true prevalence is not known.

That's starting at the very basics. Obviously LI is real, you might be thinking. Think about this, though. Think about the huge national arguments over whether hyperactivity is real or whether we're dosing kids unnecessarily. Over whether antidepressants should be used for depression or people just need to be told to feel better. Over whether diet or vaccines or the mother's age is a factor in autism. Some problems seem obvious, until you try to find the right box to put them in for definition, for treatment, for cures. Then suddenly they get too slippery to pin down. Everybody feels down some days. That's not the same as depression. Everybody has mood swings, but that's not being bipolar. And everybody has digestive trouble after some foods, but that doesn't mean you have a specific syndrome, condition, disease, or genetic heritage.

What this statement does, as basic as it sounds, is say that LI is real and physicians who see patients complaining about it, i.e. in a clinical setting, should take notice.

• The majority of people with lactose malabsorption do not have clinical lactose intolerance. Many individuals who think they are lactose intolerant are not lactose malabsorbers.

This is important. Not news, but important. We've known this for so long that I talked about in the first chapter of my book Milk Is Not for Every Body. Here's where pinning it down in the box starts. Begin with definitions.

Lactose malabsorption is a genetic condition. At some point in your life, normally in childhood or adolescence but sometimes in late adulthood, your body will reduce the amount of the enzyme lactase that it makes. This condition is also known as lactase non-persistence.

Lactose intolerance is a clinical condition. If you get the symptoms of diarrhea, gas, bloating, and flatulence from dairy products, then you are lactose intolerant.

The two definitions overlap, but they're not at all identical. If you are a lactase malabsorber but never encounter dairy, you'll never have symptoms. Even if you do have dairy products, there's no guarantee you'll have symptoms. You might still have enough lactase left to digest the lactose you've eaten, especially if you're having dairy in a low-lactose form. The bacteria in your colon may be primarily the lactose-digesting varieties that take away most of the symptoms. I've been reporting that dairy is a fast-growing industry in east Asian countries where most of the population are lactose malabsorbers. That's because most people can have some dairy without suffering any symptoms.

I know I have readers who avoid milk for other reasons, but if you're reading this, the chances are high that you're in the group that considers itself lactose intolerant. You have symptoms from dairy products. Lots of symptoms. Bad symptoms. You know it because you've lived through it. Here's the hitch. When formal studies are conducted, some of the people reporting lactose intolerance turn out to be lactase persisters. They make lactase, just as much as the milk drinkers around them. When other people who report symptoms are given a blind taste test - products that may or may nor contain lactose - they often don't have any symptoms at all, even when drinking real milk. What's going on? Nobody really knows.

• Many individuals with real or perceived lactose intolerance avoid dairy and ingest inadequate amounts of calcium and vitamin D, which may predispose them to decreased bone accrual, osteoporosis, and other adverse health outcomes. In most cases, individuals do not need to eliminate dairy consumption completely.

Forget the formal testing. No more than a small percentage of us have ever been formally tested, after all. Most of us get symptoms from milk and then have to decide what to do next. A lot of us stop drinking milk. Some of us avoid all dairy products and even try to cut individual tablets of medications containing lactose out of our diets. You shouldn't. Even though people can get perfectly adequate amounts of all nutrients from a dairy-free diet, the fact remains that the normal American diet doesn't work that way. Without dairy way too many people wind up short of critical nutrients like calcium and vitamin D. Keeping dairy in the diet is easy. Having regular small amounts of dairy works. (I know, because you tell me, that you still keep ice cream and pizza and other good stuff in your supposedly lactose-free diets. That's a good thing, except for the lactose-free product industry.) If you're worried about symptoms, there are lactase pills and probiotics that you can take.

One of the fascinating aspects of the conference is that it seemed to take place in a different world than the "milk is poison" mentality I face out here. The word vegan was never spoken. Dairy was a positive. Not one speaker broke out into nonsense babbling like "humans were never designed to drink the milk of other mammals." Intelligence and science pervaded the air. Visit? Heck, I wanted to live there.

• Evidence-based dietary approaches with and without dairy foods and supplementation strategies are needed to ensure appropriate consumption of calcium and other nutrients in lactose-intolerant individuals.

One thing about the real world. Our digestive tracts rule us. If your digestive system explodes with dairy, then my telling you to have more isn't going to fly. What then? Would taking pills and supplements work just as well as getting the nutrients from dairy products? Again, nobody knows.

• Educational programs and behavioral approaches for individuals and their healthcare providers should be developed and validated to improve the nutrition and symptoms of individuals with lactose intolerance and dairy avoidance.

You tell me, over and over, that doctors don't know anything about LI. And you're right. About half of all doctors will simply tell you to go off dairy if you say you think you're lactose intolerant. They probably won't even send you for testing. An enormous gap exists between the elite researchers in the field and the ordinary primary physicians who see average patients. Lactose intolerance is a punch line. Everybody "knows" what it is, because it makes you fart. And that's funny to almost everybody - except the one farting. We're got to take LI past the fart jokes.

Unless life gets in the way again, I'll start doing that tomorrow.