In recogni tion of individuals with

In recogni tion of individuals with

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usda.gov/publications/fanrr27/fanrr27d.pdf). In recogni- tion of individuals with "special" dietary needs, WIC allows lactose-reduced or lactose-free milk, or the substitution of more cheese for milk in its food packages, but no nondairy substitutes. Professional Medical Associations Given that government nutrition policy explicitly targets milk for consumption by U.S. citizens to maintain optimal health, how do medical institutions, whose members are involved in clinical practice, assess the issue of milk con- sumption and lactase impersistence? Publicly available ma- terials from three relevant medical organizations (American Academy of Pediatrics [AAP]; American Academy of Fam- ily Practitioners [AAFP]; and American College of Gastroen- terology [ACG]) provide insight into this issue. These groups all make the crucial distinction between lactose intolerance and lactase impersistence but tend to focus on lactose intoler- ance. This makes sense in that from their perspective, lactose intolerance is the relevant clinical condition; individuals experiencing uncomfortable or painful symptoms because of underlying lactase impersistence would be those most likely seek medical help. While medical organizations appear to consider lactase impersistence as "normal" for the human species, citing the usual surveys of its frequency in different populations, their language nonetheless tends to medicalize it and treat it as the deviant condition. For example, the AAP uses the lan- guage lactose maldigestion, but in the discussion of global variation, it refers to lactase deficiency: late-onset lactase deficiency (adult hypolactasia) is a com- mon disorder. Approximately 90% of adult American blacks and 60% to 80% of Mexican-Americans, native American Indians, Asians, and most middle-Eastern and Mediterranean populations have abnormal findings on lactose tolerance tests. [AAP 1985, emphasis added]5 Likewise, lactase impersistence is described by the ACG as: "a shortage of the enzyme lactase, which is nor- mally produced by the cells that line the small intes- tine" (, emphasis added). Note that these are descriptions of lactase impersistence, not specifically the clinical symptoms asso- ciated with lactose intolerance. Unlike the NDC, which recommends an objective lactose-challenge test by a clinician, medical organizations tend to favor self-diagnosis of lactose intolerance. In their educational materials, both the AAFP and ACG recommend that individuals diagnose themselves by eliminating all dairy products from their diet for several weeks to ascer- tain whether this eases their symptoms. This is followed by a dairy challenge to see if symptoms reappear. If they do, the "treatment" is simple: Avoid dairy products. How- ever, they also suggest that by trial and error individuals should figure out how much of which dairy products they can tolerate without negative symptoms. Those who find themselves reacting to most dairy products are advised to take exogenous lactase before they consume them.
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