title: From 'lactose intolerance' to 'lactose nutrition'.
abstract: The concept of lactose intolerance has become embedded in Western medicine and developing economy medicine. It is based on evidence that intestinal lactase activity persists into later childhood and throughout life in only a minority of the world's population, notably northern European-derived populations. These people have the T single nucleotide polymorphism (SNP) of the rs49882359 allele (C/T), also known as C/T-13910, the MCM6 gene which positively influences the lactase LCT gene. Other lactase persistent (LP) populations are found in Africa and the Middle East with different genetic variants. These SNPs represent co-evolution with dairying since the agricultural revolution and nutrient-dependent ecological adaptation. That said, gastrointestinal symptoms considered due to small intestinal lactose malabsorption are poorly correlated with lactase non-persistence (LNP), the situation for most people. With LNP, colonic microbiome lactase enables lactose fermentation to occur so that none is found in faeces. Whether the short chain fatty acids (SCFAs) and gases (hydrogen, carbon dioxide and methane) produced cause symptoms is dose-dependent. Up to 25 g of lactose at any one time can usually be consumed by a LNP person, but its food and meal pattern context, the microbiomic characteristics, age and other factors may alter tolerance. Thus, the notion that lactose intolerance is a disorder or disease of LNP people is misplaced and has been one of cultural perspective. What actually matters is whether a particular dairy product as normally consumed give rise to symptoms. It is, therefore, proposed that lactose tolerance tests be replaced with dairy food tolerance tests.
authors.affiliation: Department of Nutrition/Human Nutrition Research Cluster-Medical Education and Research Center, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia. Email: wlukito298@gmail.com.|SEAMEO Regional Center for Food and Nutrition, University of Indonesia, Jakarta, Indonesia.
authors.forename: Widjaja
authors.initials: W
authors.lastname: Lukito
authors.affiliation: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors.forename: Safarina G
authors.initials: SG
authors.lastname: Malik
authors.affiliation: Food Technology Department, Bina Nusantara University, Serpong, Tangerang-Indonesia.
authors.forename: Ingrid S
authors.initials: IS
authors.lastname: Surono
authors.affiliation: Monash Asia Institute, Monash University, Melbourne, Victoria, Australia.|Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.|Fuli Institute of Food Science and Nutrition, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wahlqvist
mesh_terms: D000349:Africa; D000483:Alleles; D003611:Dairy Products; D003612:Dairying; D005060:Europe; D005285:Fermentation; D000069196:Gastrointestinal Microbiome / Q000502:physiology; D014644:Genetic Variation; D006304:Health Status; D006801:Humans; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000378:metabolism; D007422:Intestines / Q000201:enzymology; D043322:Lactase / Q000235:genetics*; D007785:Lactose / Q000378:metabolism*; D007787:Lactose Intolerance / Q000235:genetics* / Q000503:physiopathology; D008877:Middle East; D009747:Nutritional Physiological Phenomena; D020641:Polymorphism, Single Nucleotide
chemical_list: D043322:Lactase; D007785:Lactose