The Milk Debate Goes On and On and On!
Neal D. Barnard, MDPhysicians Committee for Responsible Medicine
Washington, DC 20016, USA
To the Editor.—
The observations by Goldberg et al1 regarding milk’s possible contribution to diabetes and gastrointestinal disturbances merit comment. First, however, it may be useful to recognize what should be common ground for all concerned about children’s health: although milk’s potential risks are investigated, a sensible policy would provide that, in addition to vigorously promoting breastfeeding, we should, at a minimum, encourage all nutritional programs serving children to offer nondairy alternatives for those who request them.
With regard to type 1 diabetes, Goldberg et al speculate that perhaps only genetically susceptible children are at risk after exposure to cow’s milk proteins. They neglect to note, however, that it is essentially impossible to differentiate these children from others before antigen exposure. Most cases occur with no family history. Encouraging the widespread use of bovine-based infant formulas, except for children with a family history of diabetes, forfeits the possibility of prevention.
Regarding milk’s gastrointestinal effects, Goldberg et al are correct that some individuals tolerate milk despite laboratory findings of lactose intolerance. However, many do not. Although lactose intolerance is now known to be the biological norm, occurring in approximately 70% of blacks and Native Americans and >90% of Asian Americans,2 most nutrition programs still mistakenly regard it as a disease. Many schools demand that children produce a physician’s note before they will provide an alternative beverage. The National School Lunch Program reimburses for lunches including dairy milk, but not those including the more digestible soy or rice milks, despite the availability of highly palatable, calcium-fortified varieties.
Nutritional policies must also account for new evidence from large prospective studies indicating that milk-drinking men have increased risk of prostate cancer.3,4 The likely explanations are milk’s tendency to increase serum concentrations of insulin-like growth factor I, which is strongly associated with cancer risk, and its tendency to flood the body with calcium, causing a reactive drop in vitamin D activation (vitamin D helps maintain prostate cell maturity).4,5
Risks aside, does milk ensure bone integrity? A prospective study of children during their peak bone-building years (ages 12–18) showed that increased calcium intake—from dairy products or any other source—made no difference in bone density, in contrast to exercise, which had a major effect.6 Prior studies suggesting a benefit of milk for bone integrity are, in nearly every case, flawed by either the use of calcium supplements, rather than milk itself (supplements lack milk’s animal protein and sodium, both of which aggravate renal calcium losses) or by the use of vitamin D-fortified products. Vitamin D has marked effects on calcium economy, regardless of its vehicle.
At the other end of the age spectrum, Harvard’s Nurses’ Health Study, including 78 000 women followed over a 12-year period, found that women who got the most dairy calcium actually suffered more fractures than women who got little or none.7
A cautious approach demands taking milk’s risks seriously and providing other beverage choices.
REFERENCES
1. Goldberg JP, Folta SC, Must A. Milk: can a "good" food be so bad? [Commentary].
Pediatrics.2002; 110
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2. Scrimshaw NS, Murray EB. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance.
Am J Clin Nutr.1988; 48
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3. Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study.
Am J Clin Nutr.2001; 74
:549
–554
4. Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer.
Cancer Res.1998; 58
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5. Heaney RP, McCarron DA, Dawson-Hughes B, et al. Dietary changes favorably affect bone remodeling in older adults. J Am Dietetic Assoc.1999; 99 :1228 –1233[CrossRef][Web of Science][Medline]
6. Lloyd T, Chinchilli VM, Johnson-Rollings N, Kieselhorst K, Eggli DF, Marcus R. Adult female hip bone density reflects teenage sports-exercise patterns but not teenage calcium intake.
Pediatrics.2000; 106
:40
–44
7. Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study.
Am J Public Health1997; 87
:992
–997
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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