Milk: Love It, Hate It, or Whatever?

Just in case you’ve grown tired of fighting about meat, Walter Willett and David Ludwig would like to have a word with you about milk. With a review in the New England Journal of Medicine, they tell us we don’t need so much of it:

In our opinion, the current recommendation to greatly increase consumption of dairy foods to 3 or more servings per day does not appear to be justified.

The upcoming issue of Nutrition Reviews has a paper by Elizabeth Jacobs et al with a similar recommendation. They think that U.S. Dietary guidelines should stop classifying milk as a separate food group. Canada did it and they’re now having a lovely fight about it. We need to join the fracas, the experts tell us.

Andrew Brown et al offer an excellent alternative to the food fight approach – scientific dialogue – in a new paper just now appearing online. They map out the knowledge and knowledge gaps using the technique of Dialogue Mapping. From this work, two key issues emerge: individual variability and the quality of evidence.

Thin Data?

One interesting feature of this war on milk is the call from Willett for stronger data. He says that the data supporting recommendations for the virtues of calcium in milk is thin:

If we’re going to recommend something, it obviously should be based on strong evidence. The basis of calcium recommendations is, I think, fundamentally flawed in the United States.

Often we see Willett defending the robustness of nutritional epidemiology from Philistines who raise questions about it.

The review article also concludes that the recommendation for low-fat over whole dairy has “no clear benefit.” Hallelujah! We’ve been saying this for some time. And every time an angry mob comes back at us, chanting about the dangers of saturated fat. Never mind that dairy fat is not the same as other saturated fats and doesn’t seem to carry the same risks.

One Size Doesn’t Fit All

People tend to feel righteous in their views about nutrition guidance. Vegans espouse adamant and harsh views against dairy products. Some people just love their diary-based coffee beverages. As Willett and Ludwig point out, dairy can be very beneficial for people with poor diets and for children.

On a more balanced note, pediatrics professor Jean Welsh urges caution in making sweeping recommendations:

What always makes me nervous when we talk about these key features of our diets is if we promote a change, what’s going to replace it? The study authors say that if you have a good-quality diet, you don’t need milk. Well, yeah, but it’s not like we’re eating well.

To us, this seems like a sensible place to land. If you like milk, drink it. Especially for young children, it has important benefits. But if you don’t enjoy milk, think about what else in your diet is giving you the nourishment and pleasure you need from food. If you need help with that, a good dietitian is the best place to start.

Click here for the review in NEJM, here for the paper in Nutrition Reviews, and here for the paper by Brown et al. For further perspective from Medscape, click here.

Child Drinking Milk, painting by Mary Cassatt / WikiArt

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February 20, 2020