Lactose Intolerance & Cultural Competency Considerations

Dairy foods and health in Asians: Taiwanese considerations

Meei-Shyuan Lee DrPH1,2, Mark L Wahlqvist MD, FRACP, FAFPHM1,2,3, Cheau-Jane Peng MS, MPH4,5

            I came across an interesting article (cited above for interested readers) which considered genetic variants in relation to dairy product consumption. It is known that historically, humans were all lactose intolerant and it wasn’t until recently that we evolved to produce more enzymes to break down lactose found in dairy products. As a result of husbandry animal relationships and herding lifestyles, it became advantageous for us to produce lactase outside of childhood for a better chance of survival. There are many populations that have evolved at different rates, as Europeans seem to have the highest levels of lactose tolerance, while many Asian populations are very intolerant. It is easy to see why this has happened for many different reasons. Some Asian cultures did not adopt husbandry or the consumption of animal products based on religion. Others simply did not find the need to consume lactose-containing food sources as their diet already served them practically.

Now we know there can be some benefits for some people regarding the consumption of diary products. This article was a very enlightening read that gave insight on when it would be appropriate for a nutritionist to advocate dairy consumption in lactose sensitive populations. When disease or deficiencies are present, it could be helpful and warranted to use dairy to absolve these shortages. The article shed some light on some of the different ways we have to look at each individual based on their cultural and genetic makeups. For instance, it might not be appropriate to tell a woman with osteoporosis from Taiwan to drink two glasses of milk a day. Looking into some other healthy sources of vitamin D and calcium would show more cultural competency. That same suggestion may be appropriate for a European child or adolescent who depends on the same vital minerals for proper growth.

There are so many considerations a health care provider must make in regards to each individual. I believe the first step is recognizing that no matter who is in your clinic, you can’t possibly fully understand their personal experience that is unique to them only. If you understand this you can approach everyone in a humble manner, to meet each person where they are. When cultural humility is valued, ego is left at the door. In order to be an effective healer, we all must understand the multi-faceted/factorial nature of health and illness and the presence of both in this world. Whether the issue at hand is regarding ethnicity, socioeconomic brackets, gender etc., one thing is for sure; each person’s experience is different, each person’s illness is different, each path to health is different. Keeping an open mind is an avenue for being able to help each person in the way they want to be guided to health. Healing should take place on the client’s/patient’s terms.

Kate Stoddard