Search tips
Search criteria 


Logo of jnmaLink to Publisher's site
J Natl Med Assoc. 2002 February; 94(2): 55–66.
PMCID: PMC2594135

Overcoming the barrier of lactose intolerance to reduce health disparities.


Federal health goals for the public have focused on reducing health disparities that exist between whites and various racial and ethnic groups. Many of the chronic diseases for which African Americans are at greater risk- hypertension, stroke, colon cancer, and obesity-may be exacerbated by a low intake of calcium and/or other dairy-related nutrients. For example, a low intake of dairy food nutrients, such as calcium, potassium, and magnesium, may contribute to the high risk of hypertension seen in African Americans. The Dietary Approaches to Stop Hypertension (DASH) study demonstrated that a low-fat diet rich in fruits and vegetables (8 to 10 servings) and low-fat dairy foods (3 servings) significantly reduced blood pressure-and was twice as effective in African-American participants. Calcium and dairy food consumption is particularly low among African-American, Hispanic, and Asian populations. Average intakes are near the threshold of 600 to 700 mg/day, below which bone loss and hypertension can result. Although lactose intolerance may be partly to blame for the low calcium intakes due to reduced dairy food consumption by minority populations, culturally determined food preferences and dietary practices learned early in life also play a role. The high incidence figures for primary lactose maldigestion among minority groups grossly overestimates the number who will experience intolerance symptoms after drinking a glass of milk with a meal. Randomized, double-blind, controlled clinical trials have demonstrated that by using a few simple dietary strategies, those who maldigest lactose (have low levels of the lactase enzyme) can easily tolerate a dairy-rich diet that meets calcium intake recommendations. Physicians and other health professionals can help their minority patients and the general public understand how to improve calcium nutrition by overcoming the surmountable barrier of lactose intolerance. At the same time they will be helping to reduce the incidence of calcium-related chronic diseases for which minority populations are at high risk.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Appel LJ, Miller ER, 3rd, Jee SH, Stolzenberg-Solomon R, Lin PH, Erlinger T, Nadeau MR, Selhub J. Effect of dietary patterns on serum homocysteine: results of a randomized, controlled feeding study. Circulation. 2000 Aug 22;102(8):852–857. [PubMed]
  • Moore TJ, Conlin PR, Ard J, Svetkey LP. DASH (Dietary Approaches to Stop Hypertension) diet is effective treatment for stage 1 isolated systolic hypertension. Hypertension. 2001 Aug;38(2):155–158. [PubMed]
  • McCarron DA, Metz JA, Hatton DC. Mineral intake and blood pressure in African Americans. Am J Clin Nutr. 1998 Sep;68(3):517–518. [PubMed]
  • Lee SK, Sobal J, Frongillo EA., Jr Acculturation and dietary practices among Korean Americans. J Am Diet Assoc. 1999 Sep;99(9):1084–1089. [PubMed]
  • Rorick MH, Scrimshaw NS. Comparative tolerance of elderly from differing ethnic backgrounds to lactose-containing and lactose-free dairy drinks: a double-blind study. J Gerontol. 1979 Mar;34(2):191–196. [PubMed]
  • Rosado JL, Allen LH, Solomons NW. Milk consumption, symptom response, and lactose digestion in milk intolerance. Am J Clin Nutr. 1987 Jun;45(6):1457–1460. [PubMed]
  • Horowitz M, Wishart J, Mundy L, Nordin BE. Lactose and calcium absorption in postmenopausal osteoporosis. Arch Intern Med. 1987 Mar;147(3):534–536. [PubMed]
  • Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr. 1994 May;59(5 Suppl):1238S–1241S. [PubMed]
  • Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999 Sep;70(3 Suppl):543S–548S. [PubMed]
  • Fleming KH, Heimbach JT. Consumption of calcium in the U.S.: food sources and intake levels. J Nutr. 1994 Aug;124(8 Suppl):1426S–1430S. [PubMed]
  • Devine A, Prince RL, Bell R. Nutritional effect of calcium supplementation by skim milk powder or calcium tablets on total nutrient intake in postmenopausal women. Am J Clin Nutr. 1996 Nov;64(5):731–737. [PubMed]
  • Barr SI, McCarron DA, Heaney RP, Dawson-Hughes B, Berga SL, Stern JS, Oparil S. Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults. J Am Diet Assoc. 2000 Jul;100(7):810–817. [PubMed]
  • McBean LD, Miller GD. Allaying fears and fallacies about lactose intolerance. J Am Diet Assoc. 1998 Jun;98(6):671–676. [PubMed]
  • Jackson KA, Savaiano DA. Lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. J Am Coll Nutr. 2001 Apr;20(2 Suppl):198S–207S. [PubMed]
  • Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 1988 Oct;48(4 Suppl):1079–1159. [PubMed]
  • Saavedra JM, Perman JA. Current concepts in lactose malabsorption and intolerance. Annu Rev Nutr. 1989;9:475–502. [PubMed]
  • Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS. Correlation of lactose maldigestion, lactose intolerance, and milk intolerance. Am J Clin Nutr. 1993 Mar;57(3):399–401. [PubMed]
  • Martini MC, Savaiano DA. Reduced intolerance symptoms from lactose consumed during a meal. Am J Clin Nutr. 1988 Jan;47(1):57–60. [PubMed]
  • Sahi T. Hypolactasia and lactase persistence. Historical review and the terminology. Scand J Gastroenterol Suppl. 1994;202:1–6. [PubMed]
  • Suarez FL, Savaiano DA, Levitt MD. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med. 1995 Jul 6;333(1):1–4. [PubMed]
  • Suarez FL, Savaiano D, Arbisi P, Levitt MD. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose intolerance. Am J Clin Nutr. 1997 May;65(5):1502–1506. [PubMed]
  • Suarez FL, Adshead J, Furne JK, Levitt MD. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. Am J Clin Nutr. 1998 Nov;68(5):1118–1122. [PubMed]
  • Perman JA, Dudley BS. Dairy products: try them--you'll like them? Am J Clin Nutr. 1998 Nov;68(5):995–996. [PubMed]
  • Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ. The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials. Am J Hypertens. 1999 Jan;12(1 Pt 1):84–92. [PubMed]
  • Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. 1999 Jan 15;149(2):151–161. [PubMed]
  • Dwyer JH, Dwyer KM, Scribner RA, Sun P, Li L, Nicholson LM, Davis IJ, Hohn AR. Dietary calcium, calcium supplementation, and blood pressure in African American adolescents. Am J Clin Nutr. 1998 Sep;68(3):648–655. [PubMed]
  • Pribila BA, Hertzler SR, Martin BR, Weaver CM, Savaiano DA. Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy-rich diet. J Am Diet Assoc. 2000 May;100(5):524–530. [PubMed]
  • Johnson AO, Semenya JG, Buchowski MS, Enwonwu CO, Scrimshaw NS. Adaptation of lactose maldigesters to continued milk intakes. Am J Clin Nutr. 1993 Dec;58(6):879–881. [PubMed]
  • Hertzler SR, Savaiano DA. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Am J Clin Nutr. 1996 Aug;64(2):232–236. [PubMed]
  • Karanja N, Morris CD, Rufolo P, Snyder G, Illingworth DR, McCarron DA. Impact of increasing calcium in the diet on nutrient consumption, plasma lipids, and lipoproteins in humans. Am J Clin Nutr. 1994 Apr;59(4):900–907. [PubMed]
  • Barr SI, McCarron DA, Heaney RP, Dawson-Hughes B, Berga SL, Stern JS, Oparil S. Effects of increased consumption of fluid milk on energy and nutrient intake, body weight, and cardiovascular risk factors in healthy older adults. J Am Diet Assoc. 2000 Jul;100(7):810–817. [PubMed]
  • Chan GM, Hoffman K, McMurry M. Effects of dairy products on bone and body composition in pubertal girls. J Pediatr. 1995 Apr;126(4):551–556. [PubMed]
  • Zemel MB, Shi H, Greer B, Dirienzo D, Zemel PC. Regulation of adiposity by dietary calcium. FASEB J. 2000 Jun;14(9):1132–1138. [PubMed]
  • Davies KM, Heaney RP, Recker RR, Lappe JM, Barger-Lux MJ, Rafferty K, Hinders S. Calcium intake and body weight. J Clin Endocrinol Metab. 2000 Dec;85(12):4635–4638. [PubMed]
  • Lin YC, Lyle RM, McCabe LD, McCabe GP, Weaver CM, Teegarden D. Dairy calcium is related to changes in body composition during a two-year exercise intervention in young women. J Am Coll Nutr. 2000 Nov-Dec;19(6):754–760. [PubMed]
  • Carruth BR, Skinner JD. The role of dietary calcium and other nutrients in moderating body fat in preschool children. Int J Obes Relat Metab Disord. 2001 Apr;25(4):559–566. [PubMed]
  • Miller GD, Jarvis JK, McBean LD. The importance of meeting calcium needs with foods. J Am Coll Nutr. 2001 Apr;20(2 Suppl):168S–185S. [PubMed]
  • Montes RG, Perman JA. Lactose intolerance. Pinpointing the source of nonspecific gastrointestinal symptoms. Postgrad Med. 1991 Jun;89(8):175–184. [PubMed]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association