A geographic approach to senile cataracts: possible links with milk consumption, lactase activity, and galactose metabolism.

Examined in this article is presently available evidence for the hypothesis that some types of senile cataracts may be brought on by decades-long consumption of milk and milk products. The author approaches the question from a background of research in the geography and history of dairying as these relate to present-day differences among the world's peoples in prevalence of primary adult lactose malabsorption, which is based on a deficiency of the enzyme lactase in adulthood. Among peoples who have consumed milk in lactose-rich forms over a long historical period, there seems to have been a mutation for persistence of high lactase activity throughout life (PHLA), which distinguishes them from human populations of nonmilking tradition and from most land mammals. PHLA permits greater intestinal hydrolysis of lactose and absorption of galactose by adults. The mutation for PHLA, however, was not accompanied by a second one raising galactokinase activity to high levels through life. The result may be that adults who consume large quantities of milk, who have high lactase activity, lactose hydrolysis, and galactose absorption, suffer repeated small galactose challenges, accumulation of galactitol in the lens, and a greater likelihood of developing senile cataracts.