ATLANTA (AP) _ Americans should drink three cups of milk a day, the government says. Kiesha Diggs ignores that advice.
Diggs, who is black, is lactose-intolerant, meaning she can't easily digest dairy products. Three cups of milk would wreak havoc on her intestines.
``Bloating, gas, diarrhea. The whole thing,'' said Diggs, 36, of Atlanta.
Her sons Denzell and Armonni have the same problem. So do as many as 75 percent of African-Americans and 90 percent of Asian-Americans, according to the National Institutes of Health.
Government dietary guidelines include advice for people with lactose intolerance that note other calcium-containing foods like fish, broccoli and fortified orange juice. But critics say information on milk alternatives is sometimes buried.
The debate was raised a notch this past month when a vegetarian advocacy group filed a lawsuit aimed at getting milk producers to label their products with a warning that milk may cause digestive problems in lactose-intolerant people.
Milk industry officials called the lawsuit frivolous, and said scaring people away from milk is not good health policy.
Many people already aren't eating enough fruits and vegetables, so it's not likely they will increase vegetable intake to replace the calcium they could get from milk, said Kelly Schriver, a registered dietitian with the Southeast United Dairy Industry Association.
People on both sides agree that it's a public health problem, because many people who cut milk out of their diet don't replace it with other sources of calcium and nutrients.
However, they don't agree on how to deal with it.
One group _ which includes some nutritionists, public health professors and animal welfare advocates _ believes dietary recommendations should acknowledge the problems and try to work around them. The government should clearly explain to minority groups that they can get needed calcium and other nutrients like vitamin D from vegetables and other sources, they say.
Among them is Joyce Guinyard, who works for an organization trying to improve health education in black communities in the Los Angeles area.
``There is no real understanding that there's a substitute (for milk),'' said Guinyard.
The other group _ which includes other nutritionists, the dairy industry and a national black physicians organization _ wants to get out the message that most blacks don't suffer symptoms if they consume small amounts of dairy products.
``Since nutritionists are not ready to give up recommending milk as a nourishing food, I guess the message is to help people who see themselves as lactose-intolerant to take a cup of milk,'' said David Schardt, nutritionist at the Center for Science in the Public Interest.
Lactose intolerance is the inability to digest significant amounts of lactose, a sugar in milk. It stems from a shortage of the enzyme lactase, produced by cells that line the small intestine. Lactase breaks down milk sugar so it can be absorbed into the blood.
When there's not enough lactase, undigested lactose travels to the large intestine where it draws water (which can cause bloating and diarrhea) and bacteria (which can cause flatulence).
Worldwide, most people are unable to produce large amounts of lactase. It's mainly northern Europeans and a few populations in Africa who developed the genetic mutation that allows them to comfortably consume milk after childhood, experts say.
The prevalence of lactose intolerance probably hasn't gotten a lot attention because many policy makers and media members are Caucasian and don't think of it as a common problem, said Dr. Hetal Karsan, a specialist at Atlanta's Emory University.
``It's Caucasian bias,'' said Karsan, a gastroenterologist who was born in India and is lactose-intolerant.
Late last year, the National Medical Association, comprising black physicians, issued a special report _ funded by the National Dairy Council _ on the role of dairy in the diet of blacks.
It cited unpublished research that concluded only 49 percent of blacks report ever feeling discomfort after eating dairy. It said 44 percent of black adults say they eat one or more servings of dairy each day and that blacks get only 66 percent of the daily recommended amounts of calcium.
The medical group recommended blacks consume three to four servings a day of low-fat milk, cheese and/or yogurt _ more than the three servings the government recommends for the general public.
The group felt that the higher recommendation might go further in getting blacks to meet minimum guidelines, said Dr. Winston Price, a New York pediatrician who was one of the study's co-authors.
Price said the report was spurred by recent research that suggests dairy products help reduce the risk of high blood pressure and other chronic diseases in blacks.
However, an executive with the dairy council said that group approached the doctors' association with the idea.
Public-private partnerships are necessary to get out important public health messages, said the official, Greg Miller. He wouldn't say how much money the group gave the doctors' association.
``It's really outrageous that a medical association would take money from an industry group and then give out medical advice contrary to well-understood scientific evidence,'' said Dan Kinburn, a lawyer for the Physicians Committee for Responsible Medicine, the vegetarian group that sued to try to force warning labels on milk cartons.
Price insisted the dairy council funding didn't influence the health recommendations.
The U.S. Department of Agriculture this year revised the nation's food pyramid and provided a Web site _ http://www.mypyramid.gov _ which allows individuals to type in their sex and age to get specially tailored dietary guidelines.
The simplified list includes a recommendation for 2 or 3 cups of milk for everyone, but only by clicking on a ``tips'' link can people learn that other foods provide the same nutrients. USDA officials say that's an improvement; information on milk alternatives previously were given in a little-read 32-page booklet.
As for Kiesha Diggs, she forgoes most dairy products, except for cream with coffee, accompanied by a Lactaid tablet. She and her sons, ages 14 and 11, keep a balanced diet by loading up on vegetables and drinking calcium-fortified orange juice.
She feels better off, she said. ``It's not practical when you suffer.''