Question #2
What enticing dietary recommendations would you have for lactose intolerant adolescents trying to meet calcium recommendations and other nutrient recommendations?
posted by Unknown @ 8:45 PM
19 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
19 Comments:
If tolerated, I would recommend adolescents attempt to still consume dairy products such as yogurt and lactose-hydrolyzed milk. Other examples such as fermented products (buttermilk, natural or aged cheese, yogurt with active cultures, cottage cheese, or sour cream) can be used. Yogurt with active cultures may be better tolerated than milk by many children. In addition, frozen yogurt has little or no lactase activity. Whole milk may be better tolerated than skim because it slows gastric emptying more effectively. supplements may be taken 30 minutes before the consumption of a lactose-containing product. Kosher foods will also indicate if products are non-milk products.
I would provide recommendations for lactose intolerant adolescents to reach the AI of 1,300 mg/day, but I would also discuss the importance of calcium consumption for their immediate (optimal stature, decreased risk of bone fractures) and long-term health (lower blood pressure and decreased risk of colon cancer and osteoporosis).
I would also stress the importance of consuming adequate calcium, especially during the growing years. Like Breine said some forms of dairy can be tolerated by lactose intolerant individuals. However, if this is not possible, I would encourage the person to take a supplement and to consume some fortified foods like O.J., soymilk, etc. I would also recommend the Viactiv chews to kids who don't like to take Calcium supplements. Some bottled waters nowadays even have calcium added to them (ie; Propel fitness water), so there are numerous options.
Breine: I never thought of whole milk as an option for those who can tolerate some quantities of milk. Maybe this will be more enticing since many complain of the taste of lower fat milks. With that being said, as long as done with moderation, chocolate whole milk maybe an option (I would go for it anyway!)
Nisa: Good thinking on the Propel. Again, moderation may also need to be emphasized with Chocolate or carmel flavored supplements and Flavored waters like Propel. Over consumption may become a seperate concern. Embarrassingly, as a kid I would climb up to our medicine cabint and eat multiple Flinstones vitamins because they were the closest thing to candy! It happens!
Interesting points ladies!
I would also recommend that adolescents try to consume yogurt and other dairy foods that have been shown to be better tolerated than milk by lactose intolerant individuals. If this is not a option for the child I would recommend no more than two servings of calcium fortified citrius juice per day. Other calcium fortified foods are also an option such as calcium fortified cereal, breakfast bars, bread, and snacks. Leafy greens and broccoli are also possible sources of calcium however, these are probably not included in the average adolescents diet.
I agree with Breine, since most of those who are lactose intolerant can still tolerate lactose in different forms or smaller amts, I would recommend they try yogurt, cottage cheese, cheese, frozen yogurt or small amounts of milk to see what they can tolerate. I would also encourage a lactase supplement if that's something they would be willing to do, but there are definitely still ways for them to eat dairy unless they are very severely lactose intolerant.
I agree with what was said. First to try eating what you can tolerate and if a person still can not get enough calcium then it may be important to use a supplement. I also agree with Kalee that people should try the lactase supplement because I have known a few people who have used them and like being able to consume dairy products.
Lactase supplements are a good option. Does anyone have any idea how much these cost, just to have a range to tell clients?
Lactaid supplements cost anywhere from $5-$15 for 60 caplets, so they're really not that expensive!
I also found that very interesting about whole milk as an option for lactose intolerants. I knew that solid dairy foods can be more tolerated than milk products. In addition to yogurts, I would also recommend string cheese. I know that a lot of cheeses are low in calcium and high in fat but string cheese for a one ounce serving (one string) has as much calcium as a glass of milk and is low fat as well. While there may be some good calcium fortified options available (like the calcium OJ) I think sometimes foods are fortified with calcium so moms feel better about them. While in fact their bioavailability is not too high and they don't have all the other powerful nutrients found in milk. Foods like calcium fortified cereal bars and hot chocolates can't have that much bioavailable calcium in them to make a big difference.
I agree with Mary Ellen, in that fortified foods don't have the same bioavailability as foods naturally containing calcium. I think if you recommend a calcium fortified food, you might as well just recommend a calcium or multivitamin supplement, especially if the fortified food isn't very healthy to begin with.
Thanks Kalee for the information about lactaid supplements. That really is an inexpensive way that allows a person to consume dairy products. It will be something I will keep in mind when counseling clients.
Lisa: I agree that is important as dietitians to know what a child is more likely to eat than not. I mean, why would you waste your time trying to convince a child to eat broccoli if you already know they hate it. You're right there are plenty of other options out there, but educating your population on modification might also be important with this.
Kalee, Brittany, and Breine: My personal experience with some lactose intolerant clients were not willing to try lactose products in any amount. Obviously at this point there are other solutions available like the lactaid or lactase supplement. On the otherhand, I have notice that some who are lactose intolerant do love lactose products and for them it is hard not to consume. In which case, I could see myself encouraging to try in small amounts occasionally. In the meantime, I would definetely try other methods such as the lactase supplement.
As for cost, we need to be sensitive and aware of what our clientele can afford and/or they are willing to do. For example, many clients who are lactose free are those of low income. Being sensitive to comments like "it really is not that expensive" could turn clients away. Just for fun, I looked up on Walgreens.com for lactaid prices. Kalee your right that they range from $5-$15 but for a $5 package you only get 12 capsules...even if consuming once a day that is still relatively expensive for someone who is living off of $30/day. Something to be senstive to when counseling lower income populations.
Mary Ellen and Kalee: Nice recommendation on the string cheese. I love string cheese and loved it as a kid, too. I can definitely see kids digging this option.
I think overall there are plenty of calcium options out there for lactose intolerant adolescents. One option not mentioned was the encouragement of exercise. Science has shown us that by exercising we utilize calcium more efficiently thus increases bioavailability. So for those who are not consuming enough calcium, exercise is an option in addition to other recommendation.
Nisa,
I thinkt I also thinkt the propel is a good suggestion. I don't know what the bioavalibility of the calcium in it is but, I think that it is pretty popular amoung teenagers. My sixteen year old brother can't get enough of it. Not only is he getting his water in but also his calcium. Overall, I think it just depends on the individual client; what their likes and dislikes are and what their willing to do.
Suzie, I thinkt that the recommendation of exercise is very important. Many adolescents may find it hard to get calcium in their diets from food, but are very active.
Andrea said...
Is propel fortified with calcium and vitamin D? We all know the vitamin D is just as important.
Andrea said...
Yes, I agree that a great route to take would be exercise emphasis. As it is, we are having so much trouble getting people who do like/tolerate lactose to consume adequate amounts.
Basically we're darned if we do and darned if we don't. Plant based sources of calcium are absorbed less easily than diary sources. I do want to point out that in addition to those mentioned, beans are an excellent non-dairy source of calcium (and very cheap for low-income households) However, a large amount of the calcium from dairy products is used in order to absorb the milk protein casein. So the question remains: Do we place more emphasis on promoting calcium intake, especially from dairy products (I know the dairy council would like that option) or place more emphasis on plant based sources of calcium and physical activity. Well, I say the latter is the better choice, especially with many growing numbers of those who are lactose intolerant.
Andrea said...
oops, that's my anonymous comment above (still working on logging in).
Lisa and Andrea:
Thank god we have so many options with recommendations. As a professional it is our job to be able to find the best solution to the individuals situation. Good points!
Andrea: you had asked if Propel with Calcium had Vit D as well. I looked on their website and it states that the 3 flavors that have calcium contain 10% of the DV of calcium and a good source of the B vitamins. Nothing is mentioned of Vit. D.
There is a also a really need ‘Calcium Calculator’ on their website, which allows you to put in the amount of a variety of different foods and it calculate how much calcium you ate that day compared to your recommended needs. However, there is no mention of the bioavailability aspect of calcium as you all mentioned above. Another area for us as dietitians to educate consumers!
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