March 9, 2020

Over the past 60 years, Americans have been taught that milk is necessary for complete nutrition. That it is an important source of vitamin D and calcium. I am one of a growing voice of providers of care that emphatically disagree. I believe that the best way to achieve this nutrient goal is to spend a half hour in the sun without sunblocking creams and eat a diet rich in green leafy vegetables that are loaded with calcium, such as kale, greens, spinach and broccoli everyday.

Let us now turn to Dr. Willett and Dr. Ludwig's paper in the New England Journal of Medicine. According to the USDA choose my plate website, 3 eight ounce glasses of milk are recommended daily for adults, teens, preteens older than 9 years, and incrementally less for younger children. Where does this advice come from? I have no idea. We disagree with the my plate model and have produced our own based on the available nutritional research. See the picture to the left.

According to Dr. Willett, "because the natural function of milk is to nourish and promote growth of young mammals, it contains all essential nutrients as well as multiple anabolic hormones. To increase milk production, cows have been bred to produce higher levels of insulin like growth factor 1 (IGF-1) and they are pregnant for most of the time that they are milked, which greatly increases levels of progestins, estrogens, and other hormones in milk." "If breast milk is NOT AVAILABLE, cow's milk can add important nutritional value during early childhood. However, normal growth and development can be obtained throughout childhood without dairy products if attention is given to diet quality." (all quotations from here on out are from Willett W. et. al. 2020)

Milk is loaded with branched chain amino acids which trigger the mTOR pathway which is directly anabolic and growth promoting. BCAA's also increase IGF-1 in humans promoting growth via growth hormone activity. Dr. Willett's paper notes that humans that consume milk end up taller than their non milk drinking peers even if they have a great diet. This is an interesting reality likely produced by the actions of mTOR an IGF-1. He also notes that correlatively but not causally, tall stature is associated with less heart disease but significantly more cancers, hip fractures and lung clotting problems.

Forever, we have been told that bone health longitudinally is related to milk consumption. "Paradoxically, countries with the highest intakes of milk and calcium tend to have the highest rates of hip fractures." Dr. Willett notes that the studies that were used many years ago to make the milk recommendations were of poor quality and not worthy of being used to derive the stated recommendations. Furthermore, studies looking at calcium ingestion in the US population showed that it was absolutely unrelated to bone mineral health over time.

A very telling quote: "among men, milk intake during adolescence was linearly associated with a 9% greater risk of hip fracture later in life for every additional glass consumed per day."

The authors further use excellent examples of the study designs that are a mess from the outset. If you replace juice and soda with milk, what outcome would you expect. Likely the same as any whole foods diet replacing the refined standard American diet, solid benefit. This does not prove that milk is good for you. It proves that removing soda and juice is good for you. On the other hand, replacing milk for vegetables, legumes and other whole foods will have a net negative effect.

For example, years ago, I was in a weekend walk-in clinic, I walked into an exam room to evaluate a 3 year old child who was as pale as a ghost. My immediate reaction was "oh no - leukemia". After a blood evaluation showed pure anemia, I went back for more history. I was blown away to find out that this child was consuming over 50 ounces milk daily. Cause identified! Excessive dairy consumption causes a chronic and profound anemia by binding up all of the available iron stores. Not to mention that he was not consuming anything else including vegetables and fruits. He was profoundly constipated and sickly.


In our clinic, the number one cause of chronic constipation is dairy consumption. Removal of dairy is a must for any child suffering from constipation. If that does not completely correct the problem, then have your child evaluated for other causes including a very low fiber diet.

How do I put this data set all together? I think that the debate regarding the need for dairy should be settled by each individual based on their genetic history coupled with their nutritional needs and their reaction symptomatically to dairy. The time of milk for all is over as my prescription pad has been worn out writing notes to schools for countless children with milk allergy and intolerance.

I will opine on a few questions that I receive in the office everyday: First, water should be the beverage of choice in school for all children. Milk and juice are no longer necessary for caloric requirements as American children are no longer calorically challenged but are truly calorically overloaded.

I think that the use of rBGH, recombinant bovine growth hormone, that is used to increase milk production, is unlikely to be healthy and definitely unnatural. We would never use human analogues of such hormones to routinely increase maternal breast milk. It's use is banned in the European Union, Canada, New Zealand and Australia. Look for hormone free animal products until the safety is proven without a doubt.

In many studies, the over consumption of animal protein including milk has been linked to increases in prostate cancer, GI cancers and other diseases. See work by T. Colin Campbell, Walter Willett, Neal Barnard and others. I believe that animal fats and proteins are a vital part of the diet but only when consumed in reasonable amounts. Dairy after infancy is a personal choice and the volume should be limited. 80% of a child's diet should come from vegetables, fruits, nuts, beans, seeds and whole grains that they are known to tolerate. The remainder should be made up of fish, grass fed and well cared for animal meats and fats.

I am starting to believe that all humans after the age of one year old should try a dairy free month and assess how they feel. If they have no change in overall health, then a moderate dairy dietary budget sounds appropriate.

Don't believe the hype that you need dairy. You don't. It is a choice and one that each individual should make.

Fighting the system that thinks that juice and milk should be free for school kids while water is only available with a fee. What an illogical mess!


Dr. M

Willett NEJM Article