Lactose malabsorption and lactose intolerance: implications for general milk consumption.

A total of 194 publications related to lactose malabsorption or intolerance were reviewed. The poor correlation between lactose malabsorption and intolerance to the amounts of milk ordinarily ingested in a meal, indicates that the assumption of milk tolerance by many populations is exaggerated. The methods for the diagnosis of these conditions were critically evaluated and it is suggested that, a) "physiological" doses of lactose be used; b) milk is the vehicle of choice; c) tests of intolerance be double-blind, and d) analysis of breath hydrogen be used for malabsorption. Most of the evidence indicates that milk consumption allows adequate growth of children, even when they are malnourished and have diarrhea. Nevertheless, it is recommended to substitute temporarily non-human milk by other good sources of dietary protein and energy during episodes of severe diarrhea, and to reintroduce milk to the diet gradually during convalescence. Breast feeding, however, should not be interrupted. These is not enough scientific nor epidemiological support to justify discouraging the use of milk in food supplementation programs, but several aspects that must be considered in such programs are outlined.