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ANDREA S. WILEY
is despite variation in adult populations' abilities to digest milk, which has been documented by biological anthropologists. This article
assesses various U.S. "stories" about milk consumption and its relationship to biological variation against the biological anthropological
explanation of variation in lactase activity/lactose tolerance. Many of these serve as normalizing discourses that ultimately pathologize
biological difference and may undermine the dietary traditions of some ethnic groups. In particular, the close relationship between
government and the dairy industry leads to policies that fail to seriously consider variation in digestive physiology among the diverse U.S.
T HATpacity
POPULATIONS
VARYin with
respect
to their
cato digest milk
adulthood
is well
known
biologies.
First, I outline the state of knowledge about the bi-
to milk derives from genetic regulation of lactase, the enulations, lactase activity declines during childhood; in rel-
this genetic information and seeks to understand the evolutionary causes of population variation. Next, describe the
zyme that breaks down the milk sugar lactose. In most pop-
(2) a central role for milk production in the domestic economy; (3) positive evaluation of milk and other dairy products; and (4) physiological capacity to digest and, hence, tolerate lactose. This article is primarily concerned with how
Department of Agriculture (USDA) and the dairy induseticians, and antimilk coalitions. Despite widespread acknowledgement that a substantial minority of people in
the United States-and the majority in the world-are lactase impersistent as adults, it appears that the strong cul-
tural value placed on cow's milk and governmental support of the dairy industry inhibit policies that put the
anthropological understanding of lactase persistence into
practice. Thus, while the latter emphasizes biological variation in milk digestive physiology and the unique histor-
American Anthropologist, Vol. 106, Issue 3, pp. 506-517, ISSN 0002-7294, online ISSN 1548-1433. C 2004 by the American Anthropological Association.
All rights reserved. Send requests for permission to reprint to: Rights and Permissions, University of California Press, Journals Division, 2000 Center Street,
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Wiley * Biological Diversity and Milk Consumption in the United States 507
facilitate its consumption by all U.S. citizens throughout
life.
could be maintained or induced by a diet containing lactose. Although a few studies suggested that it could be, most
(Bayless and Rosensweig 1966, 1967), and that lactase activity in adults could not be increased by providing lactose.
It is now well understood that the age-related decline in
lactase production is regulated genetically, and that there is
both individual and population variation in this trait. While
frequencies of adult lactase activity are somewhat continuously distributed across populations, two patterns are eas-
ily distinguished: (1) populations in which high frequencies of adults continue to produce high levels of lactase in
Europeans; South Asians; herding populations of the Middle East, Arabian Peninsula, and sub-Saharan Africa; and
descendents of these populations.
TERMINOLOGY
A number of terms are employed to describe the biological phenomenon of lactase activity in adults, and their usage provides insights into how various authors or institu-
sus on which are best. In recognition that low levels of lactase activity are modal for the human species, many authors
prefer lactase persistence/nonpersistence, lactase restriction, or
high/low lactose digestion capacity.
relatively value free, implying neither pathology nor having too much or too little or high or low lactase activity.
THE ANTHROPOLOGICAL STORY OF LACTASE
PERSISTENCE
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G in the 9th intron (these two introns being eight kilobases apart) within a neighboring gene about 14 kilobases
upstream from the lactase gene were lactase impersistent,
idence points to their action at the level of gene transcription, as most studies demonstrate variation in mRNA levels
between those who are lactase persistent or impersistent, a
pattern that becomes evident during childhood (Wang et al.
1998).
It is widely accepted that the origins of animal domestication set the stage for selection favoring the ability to digest lactose in adulthood-for without exposure
to mammalian milk in adulthood, presumably no advantage would derive from continued production of lactase.
Indeed, all populations with high rates of lactase persis-
posed that lactase impersistence was selected for as a defense against falciparum malaria, the most deadly form of
the parasitic disease. Milk is a very rich source of the Bvitamin riboflavin, and malarial parasites require riboflavin
to multiply in red blood cells. In the context of riboflavin
earlier termination of breastfeeding; this in turn would generate riboflavin deficiency (from decreased milk intake) suf-
would have been sufficient to generate the high frequencies of lactase persistence found in dairy-dependent popu-
Noting that lactase persistence and fresh milk consumption correlated with latitude, Durham (1991) proposed that the low levels of UV light found at high latitudes
would have selected for lactase persistence among dairying
populations living there. This hypothesis was based on the
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Wiley * Biological Diversity and Milk Consumption in the United States 509
played an enormous role among historical and contemporary populations, especially in areas colonized by northern European populations (Flatz 1987). Collectively, these
forces have generated the more-or-less continuous distribution in population frequencies of lactase persistence.
OTHER STORIES: LACTASE PERSISTENCE AND HEALTH
POLICY IN THE UNITED STATES
the species and persistence is the unusual condition. Individuals in most populations experience declines in lactase production during childhood and, hence, have little of
the enzyme required to fully digest milk in adulthood. As
diets is unclear, it is now widely consumed in Europeanderived populations in the United States. Milk is especially
recommended for children, teenagers, and adult women; it
is considered necessary to support the needs of fetal growth
nutrition guidelines that promote the health of U.S. citizens. That these two missions might be at odds with one
another was apparently not considered when the USDA
tween these goals is becoming more visible as rates of obesity and its concomitant health problems continue to rise
(Nestle 2002).
to increase human consumption of milk and dairy products" (USDA 2002:5). In 1990, the Fluid Milk Promotion
Act specifically targeted fluid (fresh) milk. In justifying this
receive adequate nourishment; and (3) the dairy industry plays a significant role in the economy of the United
The USDA is also responsible for developing and promoting dietary guidelines for U.S. citizens. The food pyra-
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amounts of milk with meals to slow the process of absorption, starting with small servings and slowly working up to
(NDC 2003b).
In their publications, the USDA and the various dairy
promotion organizations first make a clear distinction between their preferred term lactose maldigestion and lactose
as their physiological capacity to digest lactose is not exceeded. Thus, according to the NDC, such people can-and
should-consume milk.
is much greater than that found in a glass of milk. Furthermore, many individuals may claim to be lactose intolerant not because they have physiological symptoms but,
rather, because of negative "culturally based attitudes to-
warns that "avoiding dairy foods can cause inadequate intakes of calcium and many other essential nutrients. A deficiency of calcium increases the risk of developing osteoporosis, hypertension, and possibly some types of cancer,"
Such people need not avoid all milk and milk prod-
The ADA presents a "fact sheet" on lactose intolerance, which was supported by a grant from McNeil Consumer Products, makers of Lactaid?. The fact sheet reviews population variation in lactase production-and, in
an interesting departure from NDC statements-suggests
that lactose intolerance is very common. It does, though,
go on to recommend that individuals adopt the various
strategies outlined by the NDC-for example, consuming
smaller amounts of dairy more frequently or choosing lower
lactose-containing dairy products, but, not surprisingly, two
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Wiley * Biological Diversity and Milk Consumption in the United States 511
associations, the ADA is more likely to promote food industry interests in its publications, and it is one of the links
the deviant condition. For example, the AAP uses the language lactose maldigestion, but in the discussion of global
variation, it refers to lactase deficiency:
late-onset lactase deficiency (adult hypolactasia) is a com-
to the Child Nutrition Act was approved that read: "Minimum nutritional requirements shall not be construed to
prohibit substitution of foods to accommodate the medical or other special dietary needs of individual students"
(USDA 2003). Presumably, this covered those with lactose intolerance. Of note is a presentation from the ASFSA
website that celebrates Boston schools' success at promoting lactose-free milk in their food programs, which resulted in increases in milk sales (Focus on Children: Boston
Public Schools 2003); also educational materials from the
org).4
rich foods for pregnant or breastfeeding women and infants and children up to five years of age. Fluid milk
and cheese are featured among the foods that are al-
substitutes.
as: "a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine" (www.acg.gi.org/patientinfo/cgp/cgpvol3.html#food,
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A and D), and, in the case of fresh milk, water for hydra-
cramps.
(www.acg.gi.org/patientinfo/cgp/pdf/food_I% 7E 1.pdf).
the AAP and others express concern about the use of lactose in medicines such as birth control pills, antacids, and
other prescription and over-the-counter drugs (AAP 1985).
Lactose is used as a filler, an anticaking agent, and a flavor
to make pills more palatable. While only a very few individuals with severe intolerance are likely to be sensitive
to these small amounts, including lactose among the inactive ingredients in medicines (estimated at up to 20 percent
of prescription drugs and six percent of over-the-counter
medicines; www.gastro.org/public/brochures/lactose.html)
indicates a lack of appreciation for population diversity in
physiological responses to lactose.
cure: NOTMILK!
Unlike the dairy industry, which claims that the prevalence of lactose intolerance is overestimated, Cohen suggests
that it is underdiagnosed as a source of gastrointestinal com-
Antimilk Groups
Despite overt sponsorship of milk consumption by state
and federal governments, there is vigorous-if not wellcoordinated-antimilk sentiment, suggesting that milk's
merits are not entirely uncontested within the United
States. Two primers for this "movement" with intentionally sensationalist titles are Milk: The Deadly Poison by Robert
compuserve.com/homepages/stevecarper/). On Carper's
"lactose planet," the lactose intolerance clearinghouse has
an extensive array of information, much of which reads
like the discussion in an introductory biological anthropol-
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Wiley * Biological Diversity and Milk Consumption in the United States 513
policies do not yet address the needs of all Americans.
[Bertron et al. 1999:156]
European-derived norms of dietary behavior, which the authors contend are associated with increased risk for various
ficient evidence that milk was a significant threat to individuals with lactose intolerance, arguing further that
Milk is one of the most nutritious foods in the nation's
DISCUSSION
At the heart of these various stories about lactase persistence/impersistence are two key issues. One is the nature
and significance of biological diversity in lactase production in adulthood and its relationship to milk consumption. The second, and related, issue is the appropriateness
of milk in the diet of contemporary U.S. citizens, which
should be reflected in food and nutrition policies. All of
the stories contain some appreciation for biological diversity of adult lactase production. They acknowledge that lactase impersistence is very common in the world and that
there are substantial minorities within the U.S. who are lac-
tase impersistent. Some go further in describing the evolutionary scenarios that might have generated differences
in lactase activity, focusing on the nutritional benefits that
tury when milk consumption was more often than not as-
care costs in minority populations by committing themselves to helping their clients overcome the barrier of lactose
intolerance" (Jarvis and Miller 2002:64). This is to be accomplished by providing such clients with "several simple
strategies that allow those with low lactase activity to consume dairy products," as outlined previously. Furthermore,
inherent goodness of milk. The current justification for promoting milk rests almost exclusively on this mineral, and
sis" (NDC 2003b). This crisis-whether real or imaginedcorrelates with a decline in milk consumption and evidence
cause of fears of symptoms (often misplaced, the NDC researchers claim) from lactose maldigestion are at risk of major chronic diseases and well-known health deficits because
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knowledge that a large portion of adults-particularly in minority populations in the United States-are likely to have
spread throughout the day (Suarez et al. 1997, 1998). Anthropological studies have also noted discordance between
lactase status and symptoms of intolerance. For example,
Susan Cheer and John Allen (1997) found that Tokelau
islanders in New Zealand had high frequencies of lactase
impersistence, as diagnosed in breath hydrogen tests, but
lactase status was not highly correlated with either consumption of dairy products or perceived symptoms of lac-
groups, the NDC and the USDA constitute the main voice
in shaping the dominant rhetoric about biological diver-
tose intolerance.
to do so regularly. One can and should "overcome" this biological deficit to achieve full participation in U.S. culinary
culture and its self-evident salutary consequences.
noted this same trend in epidemiological studies: "Ethnic/racial groups are often seen as having misperceptions
for discussion of the analogous example of sickle-cell anemia). To be fair, lactose intolerance, which may result from
lactase impersistence, is a cluster of uncomfortable physiological symptoms for which a person might seek medical
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Wiley * Biological Diversity and Milk Consumption in the United States 515
diversity while simultaneously unifying it into a common
understand how human biology, especially human biological variation, is constructed and elaborated within a cultural
they tell about lactase persistence has become the dominant story; challenges to it are trivialized or described as
subversive. This axis of biological variation, so celebrated
by biological anthropologists, is relegated to a somewhat
ist for those who wish to consume dairy, but at the same
time, an increasingly diverse U.S. public is being led to believe that they must consume milk to be healthy, and tradi-
CONCLUSION
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mustaches.
246.
Cohen, Robert
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1998 Lactose Intolerance. Electronic document, www.notmilk.
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Comaroff, John, and Jean Comaroff
DuPuis, E. Melanie
2(8463):1040-1043.
Eaton, S. Boyd, S. B. Eaton III, and Melvin J. Konner
87:992-997.
Flatz, Gebhard
1987 Genetics of Lactose Digestion in Humans. Advances in Human Genetics 16:1-77.
2003 Marketing-Best Practice. Boston Public Schools LactoseFree Milk Public Awareness and Education Campaign. Elec-
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