Dairy: The Good, Bad and the Ugly

Dairy is hopefully the start of some quality discussions on certain hot-topic foods items in the future on this blog.Dairy Examples

People often ask me what my thoughts are on Dairy, Meat, Eggs, blah…blah…blah… and to be honest I’m mostly moderate in my recommendations as a baseline. Not always, but usually.

There isn’t a hell of a lot to it really, there are few facts in nutrition that are so incredibly correct (eat more veggies) or so incredibly wrong (avoid hydrogenated trans fat).

Mostly recommendations have to fall somewhere in the middle and be suited the individual.

The problem online is that you will see a lot of information either completely in favour of or totally opposed to the consumption of these hotly contested food items.

Usually because someone ignored data that didn’t agree with their beliefs…

There is an alarmist attitude that generate clicks for being controversial, rather than providing context or an objective look at research.

Usually on the erroneous basis of “health” which is more than the food you eat and is a very complicated subject to maneuver.

Let me define health: “The Absence of Disease.”

You can debate this all you want and bring up what you think “health” is in the comments if you like, but the reality is that most of that frame of reference revolves around subjective personal arguments. AKA Beliefs.

Subjective measures are hard to use for the sake of argument. So for our intents and purposes, health is the absence of disease.

Which means, despite popular opinion, the majority of people right now are healthy.

Unless you’re on blood pressure medication, a statin, or have an ailment like type 2 diabetes, all of which have special dietary needs that should be discussed with a dietician.

What I’m about to present can’t be applied to those populations, you might have reduce your saturated fat intake — which is commonly found in good quantities of dairy — for example if you have high cholesterol.

There are other dietary considerations you should make too but please don’t read this and think it applies to you if you are regularly taking a prescribed drug.

A lot of this was already featured here, but this is a more personal reiteration.

I generally don’t see the need to stress or struggle over the nitty gritty details, when the body of evidence on most things paints a fairly moderate picture already.

I try to look at things as objectively as possible, but I’ll be honest and upfront, I consume dairy.

Not all the time, but in moderation.

If I had to guess I’d say on average I have about a cup (250 ml) of plain Milk a day — possibly more on training days or at least some kind of milk based protein powder — about 1-2 servings of aged high quality cheese (30 g or so); 1-2 TBSP of butter every other day maybe; I occasionally put half and half cream in my coffee (1-2 TBSP) and maybe 125 ml of plain greek yogurt a few times a week.

Nothing crazy, but probably more than some. Every now and then I’ll have some ice cream (few times a year, it’s not really my bag).

I’m not lactose intolerant, stemming from my western european heritage no doubt.

I have no obvious excessive fermentation or clearing issues that might cause gastrointestinal discomfort from lactose either, as some lactose tolerant people do either.

Now that we have that out of the way!

Dairy: Good or Bad?

Dairy can be good or bad for you, and it mostly depends on dosage, your physical objectives and your ability to tolerate it’s consumption.

I think it’s a great substitute for protein powders if they aren’t your bag. It yields a very high quality mix of two very potent and bioavailable proteins — Whey and Casein.

Like anything, rather than a black and white issue, it’s really a spectrum.

It’s easy to overdo dairy for some folks, while some might benefit greatly from it depending on objectives.

Consuming a pound of cheese a day probably isn’t good for you. Eating 1–2 servings (30–60 grams) a day? Maybe even a little more, probably not a big deal…

I think the mistake that lot of opponents to dairy or those heavily in favour, is an inability to look at something fairly objectively.

We’re just going to ignore all of this data here — I’ll link to a bunch in my footnotes — and focus on this data — I’ll still link to this too — that confirms our bias.

Mind you I’m not presenting every bit of research out there on dairy, there is a ton of it, there is probably more of it than on any other food. I honed my search in on pertinent concerns and high quality meta-analysis data as best I could.

This isn’t going to be an article that makes nonsensical arguments like: “Well no other animals consume another species milk…

Point of fact, dogs and cat will both consume cow’s milk when it’s available but that’s not the point.

It’s a logical fallacy to look towards other animals in nature to logically justify human behavior; human beings defy logic as compared to pretty much every other animal.

You just can’t make the comparison. Human beings do a lot of things that aren’t found elsewhere in nature, and it doesn’t mean it’s unnatural and unnatural isn’t a good argument anyhow. It’s an emotional one.

Another concern often voiced is that of estrogenic compounds found in milk (the same concerns are overblown in Soy) but this is mostly overstated.

Only about 5% of estrogenic estradiol makes it through the first stages of the gastrointestinal tract, which puts absorption at about 0.25% of the World Health Organizations upper limit.

Though not equally significantly scientific, it’s noteworthy that two of the longest lived cultures in the world (Sardinians and Ikaria, Greece) have cheese (pecorino and feta respectively) as relative staples in their diets and apparently none of those concerns?

This is probably more suggestive as evidence of genetic adaptation than a specific all encompassing consideration, the Okinawans (another long lived culture) are almost 99% lactose intolerant and no dairy is a staple.

In other words, you might be able to to eat it, you might not. You don’t have to eat it to live long, and you probably won’t live long just because you eat it.

There are just too many things contributing you’d have to consider…

There is a great deal of misinformation out there like this, like humans haven’t evolved for consumption. False… 

Dairy Lactase Evolution

Many human beings have adapted just fine, while others have not. [1] [2]

It’s referred to as lactase persistence, as lactase is the really the primary reason a person can tolerate milk or not, and it appears to be the result of an epigenetic mutation typically in cultures where milk became a staple.

All of which can be moot if a person chooses to use oral lactase — which can help people who are simply lactose intolerant digest lactose.

Lactose intolerance is extremely common in many countries (Native Americans, Southeast Asians, etc…) that simply didn’t have access to dairy nor the gene pool that could tolerate it and extremely uncommon in populations that had access and generally a climate that encouraged its regular consumption (Scandinavians, Western Europeans, etc…).

Your heritage may provide some clues about whether consuming dairy is worth it for you.

If you drink milk or consume cheese and you get bloating, cramping, nausea then you may want to consider seeing your doctor to test and discuss. Dairy might not be for you.

Quick side note: It’s interesting that lactose can often appear to be a dosage related issue even in those with lactose intolerance. Hard cheeses for instance have less lactose and appear more tolerable to some with lactose intolerance. Clarified butter yields a similar effect. It’s just worth noting for anyone suffering from lactose intolerance while still appreciating/desiring dairy based foods.

Besides lactose intolerance, which you may or may not have, I believe the biggest problem with dairy is that it’s energy dense. This makes it easy to overconsume.

Milk is liquid, it’s dense and not particularly filling. Other forms of dairy are very high in fat, serving sizes are smaller than you think and they can be easily over consumed.

Almost no one only eats a single proper serving of cheese for instance.

This means it can be great for gaining weight, if that’s your objective. A popular hardgainer approach to gaining weight is a Gallon of Milk a Day or the GOMAD diet; Which I have reservations about largely due to huge quantities of dairy and potentially saturated fat for a long-duration but that’s another article.

And it works in this population, for this objective, and I can’t argue with that…

Obviously the same thing that makes dairy useful for weight gain is a much bigger problem for people trying to lose weight. You need to be careful.

Interestingly enough though, besides the fact that calories can certainly be a problem (as they can with anything), dairy consumption is is often linked heavily to people maintaining a normal healthy weight. [3] [4]

This is kind of odd, given how calorically dense dairy can be. Most likely it’s the same level of evidence as ‘those who eat breakfast tend to have lower food intakes throughout the day’ though. Take it with a grain of salt.

Going out on a limb here, I’d say this correlation is probably from specific types of dairy.

So if I had to make a recommendation, consume your dairy in its fermented form, high protein form (cottage cheese), or small doses of fat from things like butter or cream. Milk, Cream, etc… add up more quickly and don’t provide as much satiation if you’re attempting to lose weight.

Of course, energy balance is still the biggest factor here. Even if dairy consumption did provide a seemingly mystical advantage for maintaining your weight, nobody magically lost weight just by consuming dairy.

They had maintained a healthy weight by maintaining an energy balance, and they lost weight by creating an energy deficit from somewhere.

Some thoughts as to why it might be beneficial here include dairy having a positive effect on gut microbiome —particularly why fermented dairy is recommended; Yogurt zealots rejoice! [5]

“In conclusion, our study sheds light on the potential of the bacteria conveyed by fermented milks to stimulate synthesis of beneficial metabolites and decrease abundance of pathobionts. These modifications can potentially improve health and are thus of importance for public health recommendations in western countries. It indicates that the role of food-ingested bacteria in gut homeostasis has been under-estimated, possibly because of methodological limitations that can, today, be overcome.” [6]

Other scientists think that there may be some metabolic advantage in its consumption, mostly given the very high quality nature of the protein it provides. [7]

Maybe it’s the 400 or so fatty acids unique in dairy? [8] Maybe it’s the high nutrient bioavailability. [9] I can’t say with certainty…

I think it’s probably a combination of factors — as gut microbiome research is still in it’s infancy it’s hard to say if that’s the real deal yet — ultimately leading energy balance to where it needs to be, and it might also have to do with the fact that normal consumption rates are a lot lower than most people think: [10]

  • Children: 1.25–1.5 cups daily
  • Adolescents: 0.75–1.25 cups daily
  • Adults: 0.5–0..75 cups daily

The average daily consumption of milk in the US according to the USDA is actually fairly low. The paper in footnote [9] suggests half a liter of consumption, but I’m not sure that going much above this is actually of any significant benefit.

Moderate amounts of milk as seen above and moderate amounts of cheese or other dairy products in the diet don’t seem to have any deleterious health effects as often propagated.

But big dairy is all a conspiracy right? I just don’t buy that nonsense… 

People can still make the big mistake of thinking, “if some is good, then more is better!”

I do worry about people consuming dairy for the sole purpose of calcium, which is an alarming trend that rarely works out without adequate amounts of Vitamin K and D to work it’s magic.

Unless you have a love affair with dairy, I’m not that concerned that you’ll hit your Upper Limit intake of Calcium (about 2500 mg in adults – a liter of milk is about 1200 mg).

People that experience problems with hypercalcemia (high levels of calcium in the blood) experience it more for pathological reasons like thyroid dysfunction, than because they consumed too much dairy.

What About Dairy and Bone Health?

Recently there has been some damning epidemiological [11][12] research on countries with high consumption rates of dairy and seemingly high rates of bone fractures and osteoporosis.

This is somewhat confusing based on what everyone thinks about calcium and bone health and it’s relatively suspect how the data was collected.

However, it’s also fairly well refuted by other evidence,  [13] [14] [15] [16] [17] some that is a little more cause and effect, [18] some that isn’t.

Higher quality cause and effect data doesn’t seem to show the same correlations and dairy largely looks like it works the way you’d expect it to.

“In conclusion, better-quality evidence reveals that milk and dairy products do not cause metabolic acidosis. Furthermore, dairy products do not produce acid upon metabolism, and our bodies do not become acidified by the modern diet. Additionally, evidence does not support associations of milk and dairy products with osteoporosis once physical activity and other factors are considered. Milk continues to be a good source of dietary protein, calcium, and other nutrients.”

I’d say as a whole, the relationship is weak in either direction.

Calcium isn’t the only thing that’s important for bone health, you also need Vitamin D, Vitamin K and preferably an exercise stimulus.

Resistance training in particular does wonders for bone density/health. I think there is a possibly a winning combination doing both resistance training and consuming a little dairy.

Correlational research makes it hard to show direct cause and effect either way.

The problem with the research showing the relationship could very well be low consumption of vegetables, low vitamin D, a lack of sunlight in the countries being studied and other confounding factors such as the sugar content of the dairy.

All hard to factor out in this kind of research.

Bottomline:
Do some resistance training, get outside into the sun a little bit, maybe take a Vitamin D supplement if you’re in a grey climate, make sure you eat more veggies, especially leafy greens and the potential problem is mostly solved.

Which brings me to my last ‘negative’ point.

The quality of the dairy you’re consuming matters and most people consume their dairy from poor sources.

When you look at dairy trends [19] you see that intakes have dropped by 200 lbs per person since the 50’s, so that can mean that drop is correlated with obesity changes as some people allude to.

It’s either we should eat more dairy, or in greater likelihood, dairy intake itself hasn’t had much of an impact on American Obesity rates as much as climbing levels of refined sugar/grain intake, total calories and refined fat intakes.

And some dairy items certainly contain too much of some of these.

Irrespective of other food groups what you do see is an increase in cheese intake, and if I could find some more specific research I’d be willing to make an educated guess that this is predominantly of the shredded heavily processed type with added fats and sugars.

This is probably not a great source of dairy and it’s dominant intake these days. I’m not saying never eat it, but do so sparingly as you would with other low spectrum foods.

Likewise Ice Cream consumption is higher than milk these days. Particularly low fat high sugar varieties. I’d bet that more chocolate milk is also being consumed these days than before as well.

It might be fine for an active athlete, but sugary milk isn’t great for most people who want to stay taute.

When you look a little closer, I’d recommend that you emphasize these:

  • Milk Plain (<500 ml)
  • Yogurt Plain (<1 cup)
  • Cottage Cheese Plain (<1 cup)
  • Kefir Plain (<1 cup/250 ml)
  • Aged Cheeses (<60 g) with 3 ingredients (Salt/Rennet/Cream and time…)
  • Butter (<1–2 TBSP’s)

Please keep in mind that the above does not necessarily represent one serving, it’s actually more like two, and two servings is commonly recommended as a daily dose.

The biggest problem with all that other stuff is how easily refined fats and added sugars creep into flavoured yogurts, processed cheeses.

All of which also increase calorie intake significantly.

And it’s not that these things once and while are an issue; It’s that people eat them in excess.

Ice cream (and other things) can be a treat, but eating 250 ml of it a day is a little overboard. Amirite?

Dairy: The Bright Side

To something a little more cheerful!

Dairy is surprisingly “healthy” according to a lot of specific research, in at least the arbitrary sense of the word.

There is actually a lot of research out there on it. Lots of good research on casein and whey proteins (the two main proteins in milk) as being positively correlated with muscle mass (prevents Sarcopenia). [20] [21]

Though you should add resistance training for optimal effect.

It appears to prevent type 2 diabetes, especially yogurt. [22]

It might lower gastric cancers (dairy, but not milk apparently). [23] This might be attributable to gut microbiome health (try saying that ten times fast) I mentioned above but more research is needed.

Milk and cheese is associated with a lower stroke risk. [24]

It might prevent childhood obesity, [25] or at least is very much associated with maximizing growth and development. [26]

For some strange reason it lowers your risk of metabolic syndrome. [27] I suspect protein and quality dietary fats (among other things) play a role here, provided intake is where it needs to be.

Increased dairy, but not milk associated with lower incidence of Breast Cancer. [28]

And on top of this all it doesn’t appear to affect mortality rates from all causes, including cardiovascular disease and cancer. Meaning, having it in your diet doesn’t seem to put you at any risk of say dying young from something you don’t want. [29]

“In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality.”

And the benefits kind of go on and on…

Wrapping Up

Honestly after sifting through research for hours, I found very little concern and a lot of potential upside.

I don’t think I’d call dairy a superfood or anything — realistically speaking no such thing exists.

However, like the commercials it seems to do a body good, especially an active body. It’s protein rich, good for recovery from exercise, etc…etc…

You just have to be careful with it if you’re trying to lose weight, as I mentioned above. It has more of a place once you hit maintenance maybe.

Literally you can go on and on and on about the value of dairy as opposed to ‘concerns’ according to a HUGE somewhat intimidating body of research.

Dairy is one of the most researched foods out there, which makes it prone to conspiracy theory attacks. I wouldn’t be surprised if someone trolled this post claiming I’m in the pocket of the Big Bad Dairy industry.

The reality is, I spent hours looking at the highest quality research I could get my hands on and wrote freaking giant article on Quora, so it made sense to expand here.

All I could find, very specifically written about the health effects (good or bad) of dairy intake and not somewhat irrelevant evidence that is often used like calcium specific research, which isn’t milk or dairy.

I’ve seen a lot of strange rationalizations of research not even done on Milk, as justification for why you should or shouldn’t consume it and I wanted to stay away from all that as best I could.

Most writing ends up being contrived when you’re using unrelated research to make arguments that may or might not apply.

It’s easy to over-supplement calcium — and actually this is a problem with most supplements really — it’s hard to consume so much of it naturally that calcium becomes problematic as some zealots like to claim.

Even if bone leaching was a big concern, and I don’t believe it is when other things are accounted for; Would the benefits of good sources outweigh that singular cost?

I tend to think so, based on making my eyes bleed looking at epidemiological research for hours, but hey you be the judge about whether or not it works for you. I couldn’t read it all.

There is nothing wrong with not consuming it if that’s what you choose.

I’ll finish by repeating myself; The majority of the research appears to show better results from fermented dairy products like yogurt (again minus added sugars), kefir and cheese but milk itself still typically shows no adverse effect.

There are some odd bits here and there like how it can interfere with absorptions of specific nutrients from other foods, but ALL foods are like that. There are seemingly just as many showing that it improves absorption of other things too. Bit of a catch 22.

Grapefruit and cholesterol lowering statin drugs being the example that most people are familiar with — there are lots of examples though, influenced by everything from your gut health to how the food was prepared.

A sub-motto of mine that I rarely mention here is ‘Do No Harm.’ And ultimately there is very little evidence showing harm, outside of some fringe circumstances that probably warrant medical attention; Provided dosage is kept to a reasonable intake.

If you’re lactose intolerant, it might not be a great idea to consume a lot of it, or make sure you use lactase so you can still fit it in if you like.

You can certainly use a substitute if you like, like almond milk or soy milk or other non-dairy items but there doesn’t appear to be a specific “health” reason to do so. Sometimes I just like coconut milk or almond milk.

I won’t get into it here but generally the nutritional quality of such substitutes is lower, but there is certainly no reason you absolutely have to ingest dairy. You can find the nutrition from other sources, it just makes it a little easier for certain things.

If you don’t want to drink it, or consume it in other forms because you feel a moral obligation to not eat things from other animals, cool. Consume it, don’t consume it, justify it however you like, no wrong answer there really.

If you’re capable, getting a fairly balanced diet already, and eating enough other good foods (especially vegetables) then I personally see no reason why anyone would deny themselves the possible benefits.

The body of evidence just appears far too strong in it’s favour…

References:

[1] McCracken, Robert D. “Lactase Deficiency: An Example of Dietary Evolution.” Current Anthropology 12.4/5 (1971): 479-517. Web.

[2] Got Lactose? UC Berkley

[3] Mirmiran P1, Esmaillzadeh A, Azizi F. “Dairy consumption and body mass index: an inverse relationship.” Int J Obes (Lond). 2005 Jan;29(1):115-21.

[4] Rosell M, Håkansson NN, Wolk A. “Association between dairy food consumption and weight change over 9 y in 19,352 perimenopausal women.” Am J Clin Nutr. 2006;84(6):1481-8.

[5] David LA, Maurice CF, Carmody RN, et al. “Diet rapidly and reproducibly alters the human gut microbiome.” Nature. 2014;505(7484):559-63.

[6] Veiga P, Pons N, Agrawal A, et al. “Changes of the human gut microbiome induced by a fermented milk product.” Sci Rep. 2014 Sep 11;4:6328.

[7] Pasiakos SM. “Metabolic advantages of higher protein diets and benefits of dairy foods on weight management, glycemic regulation, and bone.” J Food Sci. 2015;80 Suppl 1:A2-7.

[8] Månsson, Helena L. “Fatty acids in bovine milk fat.” Food & Nutrition Research. 2008;52

[9] Haug A, Høstmark AT, Harstad OM. “Bovine milk in human nutrition–a review.” Lipids Health Dis. 2007;6(1):25.

[10] “Fluid Milk Consumption in the United States” – USDA

[11] Michaëlsson K, Wolk A, Langenskiöld S, et al. “Milk intake and risk of mortality and fractures in women and men: cohort studies.” BMJ. 2014;349:g6015.

[12] Abelow BJ, Holford TR, Insogna KL. “Cross-cultural association between dietary animal protein and hip fracture: a hypothesis.” Calcif Tissue Int. 1992;50(1):14-8.

[13] Wadolowska L, Sobas K, Szczepanska JW, Slowinska MA, Czlapka-matyasik M, Niedzwiedzka E. “Dairy products, dietary calcium and bone health: possibility of prevention of osteoporosis in women: the Polish experience.” Nutrients. 2013;5(7):2684-707.

[14] Tai V, Leung W, Grey A, Reid IR, Bolland MJ. “Calcium intake and bone mineral density: systematic review and meta-analysis.” BMJ. 2015;351:h4183.

[15] Fenton TR, Lyon AW, Eliasziw M, Tough SC, Hanley DA. “Phosphate decreases urine calcium and increases calcium balance: a meta-analysis of the osteoporosis acid-ash diet hypothesis.” Nutr J. 2009;8(1):41.

[16] Fenton TR, Lyon AW. “Milk and acid-base balance: proposed hypothesis versus scientific evidence.” J Am Coll Nutr. 2011;30(5 Suppl 1):471S-5S.

[17] Wadolowska, Lidia; Sobas, Kamila; Szczepanska, Justyna W.; Slowinska, Malgorzata A.; Czlapka-Matyasik, Magdalena; Niedzwiedzka, Ewa . “Dairy Products, Dietary Calcium and Bone Health: Possibility of Prevention of Osteoporosis in Women: The Polish Experience.” Nutrients. 2013;5(7):2684.

[18] Kanis JA, Johansson H, Oden A, et al. “A meta-analysis of milk intake and fracture risk: low utility for case finding.” Osteoporos Int. 2005;16(7):799-804.

[19] Profiling Food Consumption in America – USDA 

[20] Wolfe RR, Miller SL, Miller KB. “Optimal protein intake in the elderly.” Clin Nutr. 2008 Oct;27(5):675-84

[21] Paddon-jones D, Short KR, Campbell WW, Volpi E, Wolfe RR. “Role of dietary protein in the sarcopenia of aging.” Am J Clin Nutr. 2008;87(5):1562S-1566S.

[22] Gijsbers L, Ding EL, Malik VS, De goede J, Geleijnse JM, Soedamah-muthu SS. “Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies.” Am J Clin Nutr. 2016;103(4):1111-24.

[23] Guo Y, Shan Z, Ren H, Chen W. “Dairy consumption and gastric cancer risk: a meta-analysis of epidemiological studies.” Nutr Cancer. 2015;67(4):555-68

[24] De goede J, Soedamah-muthu SS, Pan A, Gijsbers L, Geleijnse JM. “Dairy Consumption and Risk of Stroke: A Systematic Review and Updated Dose-Response Meta-Analysis of Prospective Cohort Studies.” J Am Heart Assoc. 2016;5(5):e002787

[25] Lu L, Xun P, Wan Y, He K, Cai W. “Long-term association between dairy consumption and risk of childhood obesity: a systematic review and meta-analysis of prospective cohort studies.” Eur J Clin Nutr. 2016;70(4):414-23.

[26] Okada T. “Effect of cow milk consumption on longitudinal height gain in children.” Am J Clin Nutr. 2004;80(4):1088-9.

[27] Chen GC, Szeto IM, Chen LH, et al. “Dairy products consumption and metabolic syndrome in adults: systematic review and meta-analysis of observational studies.” Sci Rep. 2015;5:14606.

[28]Dong JY, Zhang L, He K, Qin LQ. “Dairy consumption and risk of breast cancer: a meta-analysis of prospective cohort studies.” Breast Cancer Res Treat. 2011 May;127(1):23-31.

[29] Larsson, Susanna C.; Crippa, Alessio; Orsini, Nicola; Wolk, Alicja; Michaëlsson, Karl. “Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis.” Nutrients. 2015;7(9):7749.

#29 is really the big daddy of them all…