Photo courtesy of Danilo-Rizzuti/FreeDigitalPhotos.net.
I love milk. I’ve been drinking it since I was a kid. I love nonfat milk in my cereal, especially, and as an adult have taken to organic, low fat chocolate on most if not all days (except when I’m on vacation, like right now). To get my three-a-day dairy as recommended by current Dietary Guidelines for Americans, I consume milk, eat cheddar, mozzarella, and other cheese, and yes–I do get calcium from broccoli and some leafy greens.
My husband and children drink lots of nonfat milk too, and they also get calcium from low fat or nonfat yogurt and beans, especially black beans and lentils.
As for vitamin D, we all take 1,000 IUs a day, smother ourselves with sunscreen, and we do eat some fatty fish (like salmon and tuna) and eggs to get vitamin D as well.
We all try to eat a healthful diet. We’re not perfect, but we try. And we’re also extremely active, and exercise in some way shape or form practically every day.
This morning I came across “Got Milk? You Don’t Need It!” by Mark Bittman in this morning’s New York Times (online). As a registered dietitian, I felt compelled to respond, and provide at least a partial counterpoint to his arguments. [In the interest of full disclosure, a year and a half ago, I worked as a spokesperson for the Got Milk? campaign. I've done some talks on behalf of the Dairy Industry. BUT I did all these things, representing the industry, because I was already a lover and consumer of milk and dairy products--it wasn't the other way around. Representing them was a true pleasure for me because I truly believed--and continue to believe--in the virtues of milk and dairy foods in the context of a healthy diet and lifestyle.]
As a lover of dairy–but even moreso, wearing my hats as a registered dietitian and health professional who wants to provide information to consumers to help them make their own decisions about what a healthy diet looks like for them as individuals–I wanted to a few moments to share my thoughts about the Bittman piece. The article struck a chord with me, and I’d be remiss not to voice my opinion as should you (if you have strong thoughts about it, one way or another). Whether you agree or disagree with my points below, I look forward to our conversation, so please share your thoughts below.
In Bittman’s article, he shared his experience with reflux and the fact that he is finding that a no-dairy diet dramatically helps his symptoms. I’m truly happy for him, because I imagine living with reflux is very difficult and challenging to say the least.
I agree with the point he makes about how water is the perfect beverage (I drink tons of it myself), and that certain people–those with milk allergy–cannot and should not have milk, since that’s a matter of life and death. (So far, we are on the same page.)
But I take issue with a few of Bittman’s points.
First and foremost, while lactose intolerance is prevalent in the US, studies support the idea that those with lactose intolerance can tolerate small amounts of dairy–milk, yogurt, and hard cheese. Having small amounts with meals can help with tolerance, and for those who have a problem digesting lactose, the sugar in milk, there are lactose-free dairy products that contain the same composite of nutrients found in dairy foods (namely calcium, and in the case of milk and many yogurts, vitamin D–not to mention several other key nutrients including protein, potassium, riboflavin..but I digress).
Bittman concedes that for those who like dairy, one or two servings a day is probably fine. I agree and disagree with this. While I encourage consumers to aim for three a day of dairy as recommended in current Dietary Guidelines for Americans, if you only consume one or two a day, it’s important to consume other foods rich in those nutrients, primarily calcium and vitamin D, to meet current needs (for adults, the current RDAs are 1,000 to 1,200 mg calcium and 600 to 800 IU vitamin D). In the case of calcium, that includes beans, leafy greens, fish with bones; calcium fortified foods including fortified soy beverages are also an option, though I believe the absorption of calcium from those foods may not be as high as it is from milk. Non-dairy foods rich in vitamin D include fatty fish (salmon, tuna, sardines, and mackerel); eggs, and even mushrooms, contain some too as does fortified margarine and ready-to-eat cereals. Children’s needs for calcium and vitamin D are lower than adults (see Institute of Medicine recommendations here), but it’s critical for growing bodies to meet their needs for these key nutrients during their bone-building years to lay the best foundation for strong, capable bones.
If you see, based on a look at your diet or those of your children, that you cannot meet current needs, I urge you to discuss supplementation with a physician and, ideally, a registered dietitian.
One of Bittman’s statements that I disagree with is, “You don’t need milk, or large amounts of calcium, for bone integrity.” As it is, many Americans fall short on both calcium and vitamin D. Milk is a great vehicle for these nutrients, and even though this was not mentioned in the article, while dairy foods ARE a big source of saturated fat in the American diet, low- and non-fat dairy foods provide little fat and saturated fat to the diet and are loaded with key nutrients that optimize bone health and can help prevent osteomalacia (softening of the bones) and eventual osteoporosis. However, these nutrients can’t work their magic alone…an overall healthful dietary pattern that includes plenty of foods, namely fruits, veggies, beans, nuts and seeds, fish and lean meats, and in my opinion, low fat dairy if you like it and can tolerate it, plus exercise (on that point, Bittman and I agree) not only optimize not only bone health, but overall health as well. (Let’s not forget the other elements of a healthy life–love, laughter, and purpose.)
One other point I take issue is with the blanket statement in which Bittman says you can get Vitamin D from sunshine. Yes, of course that’s true–but most experts agree that relying on the sun for vitamin D ups skin cancer risk. In my opinion, it’s best to look first at food to get the vitamin D you need. The problem is that there are few food sources naturally rich in vitamin D, and many of us don’t consume nearly enough fatty fish to meet our vitamin D needs. If we don’t eat enough fish and also exclude dairy from our diet, as many vegetarians and those with lactose intolerance do, it’s very hard to get enough. Fortified foods are a backup option, as are supplements.
There’s no one diet that fits all. I hope you take the advice in Bittman’s article with a grain of salt, think about your own current diet, food preferences, health status, and lifestyle and decide what’s best for you. If you like and enjoy dairy foods and don’t have any apparent adverse health effects from doing so, there’s no reason to exclude dairy from your diet. I’ll continue to do it–not overdo it–and feed it to my children, again in the context of an overall healthful dietary pattern and lifestyle. What about you?
Do you do dairy? Why or why not? Do you think Bittman is on to something or is missing the boat?
I read the article today , and i cant agree with you more as huge fan for dairy and as dietitian as dairy esp milk high nutritional value , esp i raised in Jordan and my family got the milk fresh from local farmer ,
What about the point regarding the countries with the highest osteoporosis being those with the highest dairy consumption? How can that be?
I totally agree with Bittman, though I also agree he could have added a lot more points to enforce his own argument. For example, neither of you mentions casein, which for many causes more digestive issues than lactose. He’s right — you don’t *need* dairy if you eat a diet that includes adequate fruits and vegetables. Most of us are short on vitamin D even if we do eat dairy, so many more would benefit from supplementation of vitamin D. It’s fine that you love dairy but there are a lot of processed foods that we don’t need and I count milk as one of them. I’m not suggesting that we all give it up, but the reality is we don’t *need* milk as the dairy industry would have us think. A lot more people would benefit their health by examining their relationship to dairy products in their diet.
Mike,
Thanks so much for your question.
To respond, I’d ask, “What do the rest of their diets look like? Are they consuming low fat or high fat dairy? Are they consuming more protein and sodium they need? Are they meeting recommended intakes of fruits and vegetables? Are they drinking lots of alcohol or caffeinated beverages? All of these factors should be addressed when interpreting what it means when a population consumes lots of dairy, and at the same time, has a high rate of osteoporosis.
It’s so important to consider the overall dietary pattern. No one food makes or breaks (no pun intended) a diet, and the context in which that diet is consumed is also important. The overall lifestyle should also be considered.
I see no reason, based on current scientific evidence as presented in current Dietary Guidelines for Americans (including the great DG advisory committee report that preceded the current 2010 guidelines) to suggest dairy in the context of a wholesome dietary pattern rich in fruits, vegetables, whole grains, and lean sources of protein (including milk) will harm health for most. Few people actually follow current dietary guidelines as it is! Thanks for your question–hope this answers it a bit. Appreciate anyone else’s input on this matter.
Have you read “Building Bone Vitality” by Amy Joy Lanou and Michael Castleman? It presents a well-documented case that high protein diets (meats, dairy, fish) produce weaker bones and higher rates of fractures. Such diets actually leach calcium out of bones in order to neutralize a high-acid protein diet. To quote the authors: “A high-protein Western diet draws so much calcium from bone that a diet high in milk, dairy foods, and calcium supplements can’t replace it. In other words, a high-protein diet—a typical American diet—sucks calcium from bone and eventually causes osteoporosis.” The book also takes up Mike’s question about why osteoporosis and hip fracture rates are highest in countries that consume the most calcium (U.S., Australia, NZ, W. Europe) and lowest in those that have little or no dairy or calcium supplements in their diet (much of Asia and Africa).
The milk producers are a powerful lobby in this country and have waged a successful campaign to convince us that you never outgrow your need for milk. My question is: Why are humans the only mammals that would need to continue to drink milk after weaning?
I think Bittman is wrong. Every sooften we have new and Weird ideas about good food..for no reason,except that someone has a name and/or money to make. These last awhile, but not long. I would rely on solid medical research by a reliable medical team and research Hospital. Johns Hopkins..Harvard, Emory, to name a few. To be sure there are some cases of allergy,etc., But those are included in valid research,andare never as common as poor research would have you believe. And using a little common sense doesn’t hurt at all.
Good points made by both sides of the argument. It’s no secret the dairy industry is pushing its agenda with million in advertising as well as recruiting dietitians as spokespeople. On the other hand, vilifying milk, which has sustained some parts humanity for generations, is also wrong.
As you said, people should find a diet and foods that match their needs. And dietitians can help in that respect.
As long as we can all agree that diet coke is not an option
Elisa,
Great rebuttal to the Bittman nonsense that we don’t need milk! Sad to see someone of celebrity status using anecdotal/personal information to sway the public on a scientific based topic. Maybe better to have an expert in metabolic bone disease to review and substantiate info for the public, i.e. someone whose name ends in PhD or MD.
Robert (and everyone), I appreciate your comments. I will check out the reference you mentioned, sounds interesting. The protein issue is an interesting one. Fortunately current guidelines recommend a wide range of protein intake, so in my opinion is to think of protein rich foods as a compliment to meals and snacks rather than the stars. Then again, occasionally I do like a big (6 ounce) piece of steak at dinner!!
Even though lactose intolerance is a widespread problem, it need not pose a serious threat to good health. People who have trouble digesting lactose can learn, by testing themselves, which dairy products and other foods they can eat without discomfort and which ones they should avoid. Many will be able to enjoy milk, ice cream, and other such products if they take them in small amounts or eat other kinds of food at the same time. Others can use lactase liquid or tablets to help digest the lactose Even older women and children who must avoid milk and foods made with milk can meet most of their special dietary needs by eating greens, fish, and other calcium-rich foods that are free of lactose. A carefully chosen diet (with calcium supplements if the doctor recommends them) is the key to reducing symptoms and protecting future health.
The China Study seems to contradict the benefits of milk . Both Dr Gregor and Dr Campbell push veganism. Could you please mail me a response as I am a physician trying to help my patients make appropriate lifestyle changes.
Thank you.