Primary adult lactose intolerance and the milking habit: A problem in biologic and cultural interrelations

II. A culture historical hypothesis


The principal conclusion reached in Part I of this article (1) was that the group differences found in primary adult lactose intolerance among the world's peoples are largely genetic in origin. In this part, after a review of recent research that adds to Part I in important ways, we turn to a consideration of the conditions of genetic selection that may have led some groups of men to have persistently high levels of intestinal lactase throughout life, and others not. Low incidence of intolerance, it is held, would develop over time in a group that has an abundant milk supply, that has alternate foodstuffs inadequate in amount and quality, and that consumes milk in lactose-rich forms. Since such selection cannot have occurred among groups that did not use milk, areas of nonmilking in the modern world are first delimited. The origins and diffusion of dairying are then sketched to determine the length of time that milk was consumed in various regions. With the background thus gained, the present-day occurrence of various Old World groups with high and low incidences of intolerance is explained. All groups studied so far within the traditional areas of nonmilking are found to have high incidences of intolerance. Overseas groups, such as American Negroes, whose ancestors came from nonmilking regions also have high incidences of intolerance. Within the areas of milking in Africa and Europe, moreover, the known group differences in tolerance are found to be in accord with the hypothesis. Then, that the hypothesis may further be confirmed, specific additional research efforts are suggested.

This is a preview of subscription content, log in to check access.


  1. 1.

    Simoons FJ: Primary adult lactose intolerance and the milking habit: A problem in biological and cultural interrelations. I. Review of the medical research. Amer J Dig Dis 14:819, 1969

    PubMed  Google Scholar 

  2. 2.

    Gudmand-Höyer E, Dahlqvist A, Jarnum S: Specific small-intestinal lactase deficiency in adults. Scand J Gastroent 4:377, 1969

    PubMed  Google Scholar 

  3. 3.

    Calloway DH, Murphy EL, Bauer D: Determination of lactose intolerance by breath analysis. Amer J Dig Dis 14:811, 1969

    PubMed  Google Scholar 

  4. 4.

    Keusch GT, Troncale FJ, Miller LH, et al: Acquired lactose malabsorption in Thai children. Pediatrics 43:540, 1969

    PubMed  Google Scholar 

  5. 5.

    Keusch GT, Troncale FJ, Thavaramara B, et al: Lactase deficiency in Thailand: effect of prolonged lactose feeding. Amer J Clin Nutr 22:638, 1969

    PubMed  Google Scholar 

  6. 6.

    Desai HG, Chitre AV, Parekh DV, et al: Intestinal disaccharidases in tropical sprue. Gastroenterology 53:375, 1967

    PubMed  Google Scholar 

  7. 7.

    Desai HG, Chitre AV, Jeejeebhoy KN: Lactose loading. Gastroenterologia 108:177, 1967

    PubMed  Google Scholar 

  8. 8.

    Alzate H, González H, Guzmán J: Lactose intolerance in South American Indians. Amer J Clin Nutr 22:122, 1969

    PubMed  Google Scholar 

  9. 9.

    Gudmand-Höyer E, Jarnum S: Laktosemalabsorption hos grönlaendere. Ugeskrift for Laeger 131:917, 1969

    PubMed  Google Scholar 

  10. 10.

    Alzate H, Ramirez E, Echeverri MT: Intolerancia a la lactosa en un grupo de estudiantes de medicina. Antioquia Medica 18:237, 1968

    Google Scholar 

  11. 11.

    Cook GC: Lactase deficiency: a probable ethnological marker in East Africa. Man: The Journal of the Royal Anthropological Institute 4:265, 1969

    Google Scholar 

  12. 12.

    Alpers DH: Inhibition of intestinal lactase. A possible role in lactose intolerance. Clin Res 17:296, 1969

    Google Scholar 

  13. 13.

    Bolin TD, Pirola RC, Davis AE: Adaptation of intestinal lactase in the rat. Gastroenterology 57:406, 1969

    PubMed  Google Scholar 

  14. 14.

    Broitman SA, Thalenfeld BE, Zamcheck N: Alterations in gut lactase activity in young and adult rats fed lactose. Fed Proc 27:573, 1968

    Google Scholar 

  15. 15.

    Ferguson A, Maxwell JD: Genetic aetiology of lactose intolerance. Lancet 2:188, 1967

    Article  PubMed  Google Scholar 

  16. 16.

    Fine A, Willoughby E, McDonald GSA, et al: A family with intolerance to lactose and cold milk. Irish J Med Sci 1:321, 1968

    Google Scholar 

  17. 17.

    Siebner H: Klinik und genetik der laktose-intoleranz beim erwachsenen. Med Welt 45:2469, 1968

    PubMed  Google Scholar 

  18. 18.

    Hahn E: Die haustiere und ihre beziehungen zur wirtschaft des menschen. Leipzig, Verlag von Duncker & Humblot, 1896.

    Google Scholar 

  19. 19.

    Schwarz G, Mumm H: Untersuchungen über den milchsäuregehalt von milch und käse. Süddeutsche Molkereizeitung 68:302, 1947.

    Google Scholar 

  20. 20.

    Raadsveld CW: Het verloop van de omzetting van lactose tijdens de bereiding van Nederlandse kaas. The Netherlands Milk and Dairy Journal 11:313, 1957

    Google Scholar 

  21. 21.

    Budslawski J, Pogorzelski K: Fermentation du lactose dans les différentes variétés de fromages. Le Lait 44:496, 1964

    Google Scholar 

  22. 22.

    Yoshino U, Nisizawa S, Yamauchi K, et al: [On the methods for determining lactose in cheese and the lactose content in different types of cheese.] The Japanese Journal of Zootechnical Science 39:85, 1968

    Google Scholar 

  23. 23.

    Davis JG, Macdonald FJ: Richmond's Dairy Chemistry. London, Charles Griffin and Co., 1953

    Google Scholar 

  24. 24.

    Skrzyńska J: Mikrobiologiczna i chemiczna ocena kaukaskiego mleka sfermentowanego ‘maconi’. Przemsysl Spożywczy 3:7, 1949

    Google Scholar 

  25. 25.

    Galanos DS, Mitropoulos KA: Zucheränderungen während der dicklegung des joghurts. Zeitschrift für Lebensmittel-Untersuchung und-Forschung 116:407, 1961–62

    Article  Google Scholar 

  26. 26.

    Ray SC, De S: Indigenous milk products of India. II. Khoa. Indian Dairyman 4:27, 1952

    Google Scholar 

  27. 27.

    Kuchmi MI, Sagdieva SK: Gigienicheskaya tsennost kurta i ratsionalizatsiya tekhnologii ego prigotovleniya. Gig Sanit: 52, 1953

  28. 28.

    Shatin R: Lactase deficiency in Uganda. Lancet 2:498, 1966

    Article  Google Scholar 

  29. 29.

    Shatin R: The transition from food-gathering to food-production in evolution and disease. Vitalstoffe-Zivilisationskrankh 12:104, 1967

    Google Scholar 

  30. 30.

    Simoons FJ: The traditional limits of milking and milk use in southern Asia. Anthropos (in press)

  31. 31.

    Mirov NT: Notes on the domestication of reindeer. American Anthropologist 47:393, 1945

    Article  Google Scholar 

  32. 32.

    Sauer CO: Agricultural Origins and Dispersals (Bowman Memorial Lectures, Series 2). New York, The American Geographical Society, 1952

    Google Scholar 

  33. 33.

    Hahn E: Die wirtschaftsformen der erde. Petermanns Mitteilungen 38:8, 1892

    Google Scholar 

  34. 34.

    Hahn E: Demeter und Baubo. Versuch einer theorie der entstehung unsrer ackerbaus. Lübeck, published by the author, 1896

  35. 35.

    Mori F: Tadrart Acacus: Arte rupestre e culture del Sahara preistorico. Turin, Giulio Einaudi, 1965

    Google Scholar 

  36. 36.

    Ehret C: Cattle-keeping and milking in eastern and southern African history: the linguistic evidence. Journal of African History 8:1, 1967

    Google Scholar 

  37. 37.

    Ehret C: Sheep and Central Sudanic peoples in southern Africa. Journal of African History 9:213, 1968

    Google Scholar 

  38. 38.

    Simoons FJ: A Ceremonial Ox of India: The mithan in nature, culture, and history. Madison, University of Wisconsin Press, 1968

    Google Scholar 

  39. 39.

    Bökönyi S: Archaeological problems and methods of recognizing animal domestication, The Domestication and Exploitation of Plants and Animals. Edited by PJ Ucko, GW Dimbleby. Chicago, Aldine Publishing Co., 1969, pp 219–229

    Google Scholar 

  40. 40.

    Zervos C: Naissance de la civilization en Grèce. Paris, Éditions ‘Cahiers d'Art,’ 1962–63

  41. 41.

    Clark JGD: Prehistoric Europe. Stanford, Stanford University Press, 1966

    Google Scholar 

  42. 42.

    Tringham R: Animal domestication in the neolithic cultures of the south-west part of European USSR, The Domestication and Exploitation of Plants and Animals. Edited by PJ Ucko, GW Dimbleby. Chicago, Aldine Publishing Co., 1969, pp 381–392

    Google Scholar 

  43. 43.

    Hencken H: Indo-European Languages and Archeology (American Anthropological Association, Memoir No 84). Menasha, American Anthropological Association, 1955

    Google Scholar 

  44. 44.

    Phillips ED: The Royal Hordes: Nomad peoples of the steppes. London, Thames and Hudson, 1965

    Google Scholar 

  45. 45.

    Gimbutas M: The relative chronology of neolithic and chalcolithic cultures in eastern Europe north of the Balkan Peninsula and the Black Sea, Chronologies in Old World Archaeology. Edited by RW Ehrich. Chicago, University of Chicago Press, 1965, pp 459–502

    Google Scholar 

  46. 46.

    Allchin FR: Neolithic Cattle-Keepers of South India (University of Cambridge Oriental Publications No 9). Cambridge, Cambridge University Press, 1963

    Google Scholar 

  47. 47.

    Allchin FR: Cattle and economy in neolithic South India, Man and Cattle (Royal Anthropological Institute, Occasional Papers No 18). Edited by AE Mourant, FE Zeuner. London, Royal Anthropological Institute of Great Britain and Ireland, 1963, pp 149–155

    Google Scholar 

  48. 48.

    Eberhard W: Kultur und Siedlung der Randvölker Chinas (T'oung Pao, Supplement to Vol 36). Leiden, E. J. Brill, 1942

    Google Scholar 

  49. 49.

    Cook GC, Kajubi SK: Tribal incidence of lactase deficiency in Uganda. Lancet 1:725, 1966

    Article  PubMed  Google Scholar 

  50. 50.

    Cook GC, Dahlqvist A: Jejunal heter-β galactosidase activities in Ugandans with lactase deficiency. Gastroenterology 55:328, 1968

    PubMed  Google Scholar 

  51. 51.

    Cook GC: Lactase activity in newborn and infant Baganda. Brit Med J 1:527, 1967

    PubMed  Google Scholar 

  52. 52.

    Cook GC, Lakin A, Whitehead RG: Absorption of lactose and its digestion products in the normal and malnourished Ugandan. Gut 8:622, 1967

    PubMed  Google Scholar 

  53. 53.

    Cook GC, Howells GR: Lactosuria in the African with lactase deficiency. Amer J Dig Dis 13:634, 1968

    Article  PubMed  Google Scholar 

  54. 54.

    Guthrie M: Some developments in the prehistory of the Bantu languages. Journal of African History 3:273, 1962

    Google Scholar 

  55. 55.

    Oliver R: The problem of the Bantu expansion. Journal of African History 7:361, 1966

    Google Scholar 

  56. 56.

    Roscoe J: The Baganda. London, Macmillan and Co., 1911

    Google Scholar 

  57. 57.

    Allbaugh LG: Crete A: case study of an underdeveloped area. Princeton, Princeton University Press, 1953

    Google Scholar 

  58. 58.

    Seymour TD: Life in the Homeric Age. New York, Biblo and Tannen, 1963

    Google Scholar 

  59. 59.

    Stephanides CS: A sociological sketch of the village of Megali Vrisi, Macedonia, Greece. Unpublished MSc thesis in sociology. Ithaca, Cornell University, 1941

    Google Scholar 

  60. 60.

    Sanders IT: Rainbow in the Rock: The people of rural Greece. Cambridge, Harvard University Press, 1962

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr. Frederick J. Simoons PhD.

Additional information

The author wishes to thank Drs. Lucille Hurley and Kenneth Thompson for their useful suggestions for improvement of this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Simoons, F.J. Primary adult lactose intolerance and the milking habit: A problem in biologic and cultural interrelations. Digest Dis Sci 15, 695–710 (1970).

Download citation


  • Europe
  • Lactose
  • Research Effort
  • Additional Research
  • Modern World