Lunch program

Schools participating in the National School Lunch Program must serve milk, and Chicago Public Schools officials say the only way a student can receive a substitute drink is for a doctor to say he or she has a milk allergy. (José M. Osorio, Chicago Tribune)

Khalil Beckwith has never been formally diagnosed with lactose intolerance. He just knows that drinking milk makes him feel lousy.

"When I drink milk with nothing else ... finishing the carton can be a nauseating endeavor," said Beckwith, a senior at King College Prep High School in Chicago.

Yet when Beckwith takes a meal through the federal school lunch program, milk is the only beverage available. Usually he avoids drinking it, but sometimes he said he feels pressure to take the milk. Then he either throws it away or winds up feeling queasy.

People with lactose intolerance lack the enzymes needed to digest lactose, resulting in bloating, cramping, nausea and diarrhea after milk consumption. The condition is common among African-Americans like Beckwith, as well as Hispanics, Asians and Native Americans — groups that make up 91 percent of students in the Chicago Public Schools.

Schools participating in the National School Lunch Program must serve milk, and CPS officials say the only way a student can receive a substitute drink is for a doctor to say he or she has a milk allergy. That is a different condition, which qualifies as a disability.

But the U.S. Department of Agriculture, which runs the lunch program, says it is acceptable to give students an alternative (such as lactose-free milk, soy milk or almond milk) if a parent submits a simple request.

"USDA provides schools with the flexibility to offer milk substitutes that meet federal nutrition requirements to accommodate students' nondisabling allergies, culture, religion or ethical beliefs," a spokeswoman said.

Estimated rates of lactose intolerance among minority groups range from 50 to 100 percent, though a national conference on the topic in 2010 concluded that good data on prevalence remain elusive. Even the lowest estimates, however, suggest that millions of children in the federal lunch program could experience gastrointestinal problems after consuming milk.

And although the USDA allows schools to provide a substitute, those products tend to be more expensive, discouraging officials from publicizing the option. For example, the Broward County Public Schools in Florida have been offering soy milk to any lactose-intolerant child whose parent requests it, but officials say the option is not widely advertised because of the costs involved.

In Chicago elementary schools, milk is the only beverage offered at lunch. High school students often can buy bottled water and juices in the lunchroom at their own expense but cannot take them as part of a federally funded lunch.

The lack of choices worries parents and health advocates who believe it will contribute to massive waste — an audit at one CPS school found that a third of the milk taken at lunch was thrown away — and leave lactose-intolerant students feeling sick and unfocused.

"If they are required to take milk during the lunchtime and actually drink it, how are they going to feel after lunch sitting in that classroom?" said Amy Lanou, a University of North Carolina at Asheville assistant professor of nutrition. "Are they going to behave? Are they going to be focused on their studies?"

Yasmin Gorelku, of Evanston, sends her 8-year-old daughter, Belise, to school with a water bottle every day, "or else she will have nothing to drink." For Belise, drinking milk triggers nausea, vomiting and diarrhea, Gorelku said.

Gorelku said Belise's school complied with her request not to give the girl milk at meals. But Gorelku says the lunch line should offer alternatives — even cups of water — to students who get sick when they drink milk.

"It all comes down to asking, 'Are your students comfortable during that day?'" she said. "If they are there to learn, you should have acceptable foods and beverages to support that."

A spokeswoman for Evanston-Skokie School District 65 says it requires a physician's note to consider offering a different drink.

Lactose-intolerant students got some federal help last year, when the USDA began requiring schools to provide free drinking water in all lunch service locations. CPS says the district is in partial compliance with the provision but would not specify when it plans to comply fully.

At Beckwith's school, all water fountains are outside the cafeteria, and students who want cups "have to go to the nurse's office to get them," he said.

The USDA says milk is a required part of the lunch program because it provides "children with the calcium and vitamin D, as well as protein, needed to develop strong bones, teeth and muscles." In most districts, students don't have to take milk with lunch, but it must be offered.

In addition, the USDA will not reimburse schools for a lunch unless it contains a certain number of food items. So if a student reaches the end of the cafeteria line with, say, a meat patty and broccoli, the lunch worker is likely to suggest adding a milk to complete the meal.