How Dairy Is DESTROYING Your Gut Health! Mark Hyman

It's really important to remind people that there's so many other ways to get their calcium.

Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Farm is with an F, a place for conversations that matter. And if you've ever suffered stomach trouble or tummy trouble from eating dairy, you might want to listen up because it's a common problem and we're going to talk a lot about it, what to do about it, how to diagnose it and how to get rid of the problem. So, welcome Dr. Boham. Dr. Boham is joining me today. She's our medical director at Tel Aviv Wellness Center, an incredible physician, friend and colleague for decades, who's also an RD and an exercise physiologist and teaches nutrition all over the world and is on the faculty of the Institute for Functional Medicine and has created some of the most important nutrition curriculum we have in the world, I think. Anyway, I am so excited to have you, Liz, again on another episode of House Call. on the doctor's pharmacy and to talk about this nasty problem called lactose intolerance. So get us up to speed about what this is, how common is it, and what causes it, and is it something we're born with or we can develop and how does it all work?

Lactose intolerance is so common. It's at least 65% of the world population, you know, and it increases as we get older. It's not, you know, what lactose intolerance means is the inability to digest the lactose in dairy products, that carbohydrate in dairy products. And it really does vary amongst different racial groups and ethnic groups. So it's more common in, we've seen in Africa and South America and Asia. It's less common in Europe, but it is It is throughout the whole world, we see lactose intolerance. And as people get older, we see more and more lactose intolerance. In fact, you know, some people think that by once we reach age 99, everybody has some degree of lactose intolerance. As I mentioned, it's uncommon in younger kids, but there are young kids who have lactose intolerance. And anything that damages the intestines, if you damage the villi in the intestines, so if you get a gastroenteritis, so if you get an infection in the, an inflammation in the intestines, sometimes if people take antibiotics or have chemotherapy or have inflammation in their intestines, that can result in lactose intolerance starting. So people will always say to me, well, I used to have no problem with dairy, but now I'm having trouble with dairy. And it's because that can happen after a round of antibiotics or after an infection or we just as we get older. The other thing to recognize about lactose intolerance is it's dose dependent. So that's what sort of throws people off sometimes is that they may have a little bit of dairy and be fine, but at some amount of dairy, then they start to have a problem. So it is, we have this enzyme in our intestines called lactase and it digests our lactose. And if we don't have enough lactase or if we eat too much lactose, then we get problems with lactose intolerance.

Okay, so I don't know why they call it lactose intolerance because the fact is that most of the world is intolerant to dairy and lactose. And the abnormal situation is to be able to consume it and tolerate it. And also, you know, there's an ethic, ethic component to this. If you're African, South American, Asian, you're more likely to be lactose intolerant. If you're of European descent, particularly Northern European, you're certainly better. But, but, you know, we, we don't really think about the fact that most of the, you know, world's population doesn't really do well with dairy. And it also, the dairy we're eating is not the greatest dairy. I've talked a lot about that in previous podcasts in my and my book, the Pegan Diet as well as food, what the heck should I eat? And the other factors that are causing it to be more common are things that you said, such as damage to our gut from antibiotics and bad diet and bacterial overgrowth and all these other problems.

So.

How do we sort of begin to think about helping people diagnose it and then treating it?

Absolutely. So, you know, one of the things is we start to pay attention to what symptoms somebody has. So when somebody comes in and they complain of abdominal pain, maybe they get fullness or bloating after they eat, maybe they have diarrhea after they consume or just diarrhea during the day, and they might feel nauseous or have excess gas. And so then you get a good detailed history of what they're eating. Sometimes people, it throws somebody off because they may not have had problems with dairy prior to when they, you know, at a younger age, and then they developed. And so they, they, they're confused as to why they have started to have problems now. But as I mentioned, you can develop problems with lactose, issues with lactose and digesting dairy at any point in your life. It increases as we get older and it often can increase after after we've had some sort of infection or inflammation or antibiotics in our system. And so you want to just figure out what is somebody dealing with, the abdominal pain, the bloating, the gas, and then you want to say, okay, when do your symptoms occur? Because typically when there's problems with lactose, it's a half an hour to two hours after you consume the lactose containing food, so the dairy. And the symptoms usually resolve five to seven days after you've removed the dairy from the diet. And what's happening is there's low levels of this lactase enzyme in the small intestine, then the carbohydrate component of dairy, the lactose, does not get broken down. And when it's not absorbed as it should be, it goes into the colon and in the colon it gets It gets consumed, the bacteria in the colon eat it and produce a lot of gas and a lot of water goes into the colon to deal with these food particles that are too large. And as a result, you get a lot of gas and bloating and diarrhea. So it is a very hard food to digest and absorb. We see it all the time. And so it's the reason we wanted to talk about it and do this podcast is because it's so common and patients are really struggling with it all the time. and even though to you and I, it's like, okay, of course go off dairy. People often come in in denial. They're like, oh, no, it's not the dairy. And I'm like, yeah, you got to give it a try.

One of the things that often people wonder about is, well, what about black-taste-free milk? Or what about yogurt? Or what about cow or sheep or what about A2 versus A1 casein? How do we figure all that out? And how do we determine what people should be doing if they want to include dairy? Because I know, for example, if I eat regular milk, I'll be in trouble. But if I have goat or sheep yogurt, I seem to do okay. So I wonder, how does that work? And can you explain a little bit about that?

It's such a great question. I mean, what we often start with is pulling away all dairy for somebody because that's that's how we can see, okay, how much is this going to improve your symptoms? But you're correct, there are some better quality dairies, like the A2 milk, that people tolerate better. If the dairy is fermented like yogurt, it's broken down. And so many times people can tolerate some plain whole fat yogurt without problem, but they couldn't drink a glass of milk, for example. Because that fermenting process breaks it down. For other people, they can't tolerate anything.

So.

Some people even have to be a little, they have to watch even butter intake and they have to go with something like a ghee instead. So, there's many ways you can react to dairy. So, we're talking about reacting to the lactose in dairy, which is the carbohydrate component of dairy. That's what we're talking about here. But people also react to the proteins in dairy, and they can have food sensitivities or food allergies to that dairy as well. So there's multiple ways people can react to dairy. So we always start with pulling it all out and then maybe adding back in some easier to digest dairy if somebody really wants it and they don't have a problem with it. such as a full fat, non-sweetened yogurt.

Hey everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Now back to this week's episode. And so what about people taking enzymes like lactase? Is that a good idea? Should people just avoid dairy? Are there other issues that happen? And what are the consequences of sort of consuming dairy if you are lactose intolerant?

You know, that's a great question. So the enzymes that are in that, like the lactase enzyme is, the enzyme in lactate is a beta-galactosidase. and that can help people break down their dairy and tolerate it better. But that's a good question. I typically recommend that people don't consume a lot of these enzymes if they're having problems and just avoid the food. But some people choose to have some of these digestive aids and then have a little bit of the dairy from time to time.

Yeah, I sometimes cheat and eat ice cream and then of course I pay for it later.

Yeah, right?

Yeah.

Yeah. So, you know, I think that these enzymes may be helpful for some people.

But.

I think the reason that we're so focused on dairy is, you know, everybody was like, you got to get your calcium, you got to get your calcium. It was a huge marketing campaign to promote the amount of dairy that we needed to consume. And so it's really important to remind people that there's so many other ways to get their calcium. You know, almonds, almond butter, great sources of calcium. Sardines, great source of calcium. Salmon in a can has bones in it, great source of calcium. Broccoli and your greens are a good source of calcium. And so there's lots of ways you can get good calcium in your diet and you don't have to feel like you need to be getting it from dairy products.

Yeah, and I would just underscore that anybody listening who wants to hear about dairy should listen to the podcast I did with David Ludwig where he dug into the article that he wrote with Walter Willett who was one of the leading scientists at Harvard called Milk and Health. And, if you want to Google it, it's New England Journal of Medicine, Milk and Health. We'll put in the show notes, but there's also a great Medium article he wrote about it as well. And, bottom line is that all the propaganda about milk needing for your bones, it actually increases fractures. you know, it doesn't do a lot of things that it was promoted to do by the Dairy Council and the Got Milk ads. It's not a great sports drink. It's not great for weight loss. It's not great for osteoporosis. In fact, it may cause osteoporosis. It may cause allergies, digestive issues, as we mentioned, even autoimmune diseases, cancer. So I think there's a lot of reasons to be cautious about dairy. And again, I think just underscore the fact that when we're talking about dairy, we're talking about sort of modern cow dairy. Sometimes heirloom cows have different, you know, grass finished cows have different properties and better tolerated. Sometimes sheep and goat is better tolerated. So it really depends on, on sort of you and a personal decision. But it's not nature's perfect food unless you're a calf. And it's also, you know, problematic in many, many ways.

Absolutely. As we see here with some of these cases, like this first one here was a 25 year old gentleman. who came to see me and, you know, he was relatively, he was really healthy actually. And he was doing well until about a year ago. And he had like a stomach bug. He was traveling and he got some stomach bug. He didn't really think much of it. He recovered from it. But at the time he had like a fever and some diarrhea. He recovered from the bug. But then since that point in time, he still had episodes where he was rushing to the bathroom and had diarrhea and bloating and gas production. And he really couldn't figure out what foods were involved at all. And he didn't think any food was involved. And he was, you know, so he wanted to figure it out. So based on his timeline of symptoms, and you know, that we gathered from him, we said, you know, even without any testing, we said, let's just do a trial off a dairy and see what happens. And within a week, His symptoms got all better and he thought, I, you know, was just, you know, did a wonderful job at fixing all his diarrhea. I know, right? I fixed his diarrhea and gas and bloating and, you know, he just avoids really most dairy because he feels better at this point in his life. So, it's, you know, it's sometimes.

Can.

Make a huge difference and something that we really encourage a lot of people to give a trial for.

Yeah, I think we've all been sort of brainwashed that we can't live without milk and dairy and then it's important for all these reasons which turns out not to be. I would say that clinically practicing functional medicine for plus 30 years and you also, it's one of those foods that is really problematic for a lot of people, not just lactose intolerance but eczema, asthma, just general digestive discomfort. acne, autoimmune diseases, all kinds of problems clear up when you stop dairy. So, if you've never done it, I would encourage people to think about just taking a holiday for three or four weeks and just then adding it back and seeing what happens. You'll know. Your body will tell you very quickly whether or not you are intolerant of dairy. Well, I mean, because it may not cause lactose intolerance, but you can get other reactions like congestion, sinus infections, all kinds of skin issues, eczema, and so forth. And we did a Pegan diet challenge with Katie Couric, and she has eczema, and she's like an arthritis, and she got off all that junk and it got better.

Oh, good for her.

Good for her.

You know, it is amazing, like you were mentioning, you can have a hard time digesting the carbohydrate in the dairy and have the lactose intolerance, and you can also have a sensitivity to the proteins in the dairy. And with a sensitivity with the proteins, a lot of times that will cause acne or it'll cause the eczema or asthma or inflammation in the skin. And of course, you can have an immediate reaction to dairy too. You can have an IgE allergy. So you can have an allergy, a sensitivity, or a lactose intolerance. There's so many ways that people react to dairy. And my second case here was a 20-year-old woman who came in and she got bloated every time she ate. She felt full and she sometimes had diarrhea and stomach pains. So she was just really struggling with her digestion. It would sometimes be constipated, but then sometimes diarrhea, sometimes rushing to the bathroom, really feeling bloated a lot. And when we got her history, we realized that she had this long history of acne. Well, that is, she's only 20, so it wasn't that long, but a few, you know, a history of acne. And so she was placed on antibiotics for the acne at age 18, and she had been on antibiotics for a couple of years. And what we know is that even though those antibiotics may clear up the acne for, you know, immediately at that time, long term, that's a huge concern because it's getting rid of all the good bacteria on our skin that prevents acne in the future. And it's also getting rid of all the good bacteria in our digestive system. that is keeping our digestive system working well. And so that can really mess up the microbiome and result in lots of issues. And for her, over time, she started to have a lot more issues being on those antibiotics with her digestion. So for her, we did a dairy-free trial just for both her skin and her digestion. And we saw a good improvement in her digestion and her skin, like her digestion got about 50% better her skin got 60 to 70% better, but she was not 100% better. So then we needed to do more testing. We did testing for small intestinal bacterial overgrowth. We did stool testing, and we found that she had this small intestinal bacterial overgrowth that we needed to treat. And so, you know, I think a lot of times those long-term antibiotics like that can result in this overgrowth of bacteria. that then just snowballs into more and more problems. And so we needed to treat that with an herbal approach. And it was at that point when we kept her off of the dairy, treated her bacterial overgrowth, that she started to get much better in terms of her digestion. Her skin improved, her digestion improved, and her pain in her belly improved significantly as well. And you know what? She sometimes at this point cheats with a little bit of healthy yogurt, but she mostly stays off of all dairy and is doing much better.

Well, I mean, basically the message you're saying is when in doubt, cut it out. And I think everybody should think about just a trial of no dairy because of the challenges we often see. I think this is such a common problem and people suffer with, I mean, the digestive complaints are the number one reason people go to the doctor. So I think this is an easy thing to try and fix and I think we just want to highlight in our podcast, I'm super happy that you brought it up and that we got to talk about it in some of the cases.

Much that at least half of the world's population doesn't consume milk or milk products on a regular basis. And yet the children seem to be able to grow up without suffering continuous bone fractures or have short stature or other problems. So we know that milk is not required to be a healthy child or a healthy adult. And of course, before 10,000 years ago, when perhaps the first dairy animals were domesticated, no humans would have ever consumed any dairy products.

And you wouldn't be milking a saber-toothed tiger?

You know, good luck. So, but then, so we know that milk isn't necessary to survive, to keep our bones from crumbling. But that doesn't mean that milk is inherently harmful or that we shouldn't be drinking it. And a point that I'd like to continue to return to during our talk today is an interaction with diet quality. To understand the impact of a food like milk or really many other foods, because there's essentially no one, there's no one food that you have to eat in order to live. So the question is, how do these foods support health for a specific population. And to understand that, we need to think about what foods are being traded off. So for a child that's consuming junk foods all day long, you know, sugary beverages and packaged savory snacks, cheeseburgers and like dairy products might be among the healthiest things that they eat. These are whole foods for the most part, as long as they're not loaded up with sugar, as actually does still happen in schools. So dairy products would tend to increase diet quality, displace some of these highly processed junk foods, and would be good for health.

Compared to what is really the question. What are you eating instead of it?

Yeah, for somebody who's got a really healthful diet based on whole foods, who's avoiding a lot of processed carbohydrates, and others, just dumping in more dairy products to reach some kind of theoretical nutrient balance may miss the mark. And with regard to calcium, which is the most commonly cited- so basically what.

You'Re saying is basically saying dairy is better than a Coke is not saying much, right?

Well, no. I mean, there's a lot of, you know, two-thirds of what's consumed in the US is highly processed poor quality. And so I think what we want to do is ask, what is the background diet we're talking about? To simply say don't drink milk would, I think, produce a lot of harm because there are children in the United States and even more so in countries with borderline nutritional status where milk provides one of the best sources of protein, of fats, of slow digesting carbohydrates, potassium, calcium, and other nutrients. So to remove milk from the diet of people, either in the United States, kids with borderline nutrition quality, or overseas, Africa, South America, where nutrient deficiency is a real problem, I think could cause great harm. But let's drill down on calcium, because that's the one that that's the nutrient that is driving fear of low milk intake. It's driving milk intake.

Yeah.

Because, you know, especially women, you know, they want to get enough calcium to avoid milk fractures. And if you go by the calcium balance studies that were used to come up with this recommendation, you know, you need a gram, a thousand milligrams or more calcium a day to meet new comets. It's almost certainly flat-out wrong. These balance studies were based on very short-term studies, 21 days, where, yes, if you dump in a lot more calcium, the body will absorb some of that calcium and put it into bones. But what it's basically doing is filling up temporary spaces in bones. They don't stay there. If you did longer-term studies, You would see that adding more and more calcium doesn't keep building a bone. You have this short-term boost in bone calcium, but then you fill up all these little temporary niches and there's no more benefits. The thing is that those transient spaces don't stay there. You don't have a calcium bank for life by consuming a lot of milk as a kid. and we can talk more about that. Yeah, I have to confess here.

I hope it doesn't let it bias my opinion about milk. It's more hopefully medical and scientific, but when I was a kid, I hated milk and I just didn't like the taste of it. My mother's like, how are you going to grow up to be big and strong if you don't drink milk? Well, I never drank milk and I'm six foot three and maybe I would be an NBA player instead of a doctor if I did drink milk. Who knows? I really never did.

And my bone density is great and.

I think that It is a bit of a mythology about that.

So we do need calcium. There's no question. The bones are made primarily of calcium and phosphate, but how much calcium? And the minimum requirement to have perfectly healthy bones, probably at most a half of what has been traditionally viewed as necessary in the United States. In the UK, their minimum calcium requirements are about a half of what they are here. And in some populations, like in South America, the adults do perfectly well getting even a third or a quarter of the amount of calcium, like 300 milligrams a day. So you mentioned that level of calcium can be obtained from... So if you're going to get a gram or more a day of calcium, milk is sort of the obvious source. But if you accept that we don't need that much, 500, 600 milligrams a day are probably more than sufficient. Well, that's easily obtained from just a basic diet. A serving of kale is going to get you a third to a halfway there.

Serving of sardines, nuts, seeds, chia seeds, tahini, those are my favorite. I mean, one of the things you said that I just want to come back to, which is really important, is this whole idea of calcium balance. And when you look at countries like Sweden that you wrote about in your paper, they have the highest intakes of calcium and the highest risk of fractures. And countries like Indonesia and China have the lowest intakes of calcium and the lowest risk of fractures. So, one of the things I remember when I was a medical director at Canyon Ranch, I often talked about was osteoporosis. And it was really clear that there are a lot of things in our culture that drove calcium loss. so it's not just about how much you take in, it's how much you pee out, right? So caffeine, alcohol, sugar, phosphoric acid from sodas, too much meat perhaps, I don't know if that's true, but that's what it seemed to be, the high protein acid load. All these things, stress, all these things cause bone loss. And if you mitigate those, in other words, you cut those out of your diet or you reduce them and you, you deal with stress and you deal with the fact of how you're losing calcium, that your net net may be better than if you're taking super high levels of calcium. And the other thing that's interesting to note is that cows get their calcium and have great bones. Where do they get it from? Grass.

They're drinking milk. They're drinking three servings a day.

For a little bit and then they don't. And they're getting it from grass. So why not get second hand calcium?

So, green leafy vegetables are actually a very good source of calcium. A serving of kale has almost as much calcium as a serving of milk. And you get many fewer total calories that way. But let's go back to these ecological comparisons. Those are the comparisons where you look at different countries and see different risks. It's important to understand that there are limitations to those kinds of analyses. What they do convincingly tell us is that you can It's possible to be a human being, consume no milk, relatively low levels of calcium, and have low fracture risk. The problem with these studies is that they're very confounding. So when you look compared the Swede to the Filipino, there's a big difference in height, and height is a major risk factor for bone fracture. So ironically, It may be that milk consumption in adolescence, in childhood and adolescence, actually increases risk for fracture in adulthood. So how could that be? We've talked about that you don't really put away a calcium bank in childhood. You don't get that benefit. But the one thing that is pretty clear that milk does in childhood is accelerate growth. It's not hugely, it's not going to turn a, you know, a horse racing jockey into a baseball player. But you get about an extra centimeter for every additional serving glass of milk a day. So maybe, and this is a population average, but so maybe for comparing low and high consumers, you grow an extra inch. But on a population basis, that increased height is one of the major risk factors of having a fracture. Simply put, the bigger they come, the harder they fall.

So I'm kind of screwed. I'm like six foot three.

I would just advise you don't fall.

Well, I'm working on my core strength and muscle mass, and that also helps mitigate it.

Yeah, but this is a big, this is one of the first myths to go. The drinking a lot of milk as a kid is going to reduce your risk of getting a fracture in his adulthood. And if anything, it's the opposite.

So these are the basis for our recommendations, which is you need calcium prevent osteoporosis. And that's why our guidelines tell us to have three glasses of milk a day.

Yeah. Well, you do need calcium. You just don't need that much. And the amount that you need can be obtained from other sources.

And so what about the idea of weight?

Because, which again is not to say that milk is inherently bad or toxic. We talked about one situation where it could be helpful, people with borderline nutritional status who when they drink milk, they're drinking, you know, drinking like a glass of milk and maybe you just have two cookies after school as a kid instead of having the whole package without milk or with fat-free milk, which doesn't taste very good, and isn't very satiating.

Yeah, I want to get into the fat-free thing in a minute. I know that's your favorite topic, but I just want to sort of summarize here about the calcium story because what you're saying essentially is that all the data and there were over 100 papers you reviewed, all the data really didn't point to a benefit of increased calcium intake through supplements or through dairy, and that there was potential risks as well. And then it wasn't just a benign intervention that there may be increased risks with increased calcium intake in different situations, whether it's cancer or whether it's from perhaps the high levels of calcium causing greater growth and fracture risk, we don't know, but it's not a slam dunk. So you think based on the current data that you reviewed in the New England Journal of Medicine, do you think that the government should change its dietary guidelines?

Well, let me just say, so we talked about the trade-offs. Milk, so one downside of extra growth we talked about was fracture risk. But another downside of being tall is cancer risk. Being taller you are, the higher your risk of cancer. Maybe partly it's more so, you're okay, you're taking good care of yourself. But first of all, you've got a bigger body. But the other thing about milk is to consider why how milk has evolved. I mean milk, the purpose of milk is to help grazing animals on the plains of Africa. You know, the infants that are at high risk of being eaten by the local carnivores grow rapidly so they can be strong enough and fast enough to be free of predation. So that's a very strong selective, you know, fitness factors, evolutionary drive. to get these baby ruminants, you know, the gazelles and the other grazing animals to grow very quickly. So that's a good thing, except if you're consuming these foods that stimulate growth, you know, in children, but in adults these growth factors that may be stimulating biological systems that relate to cancer. And while the data are definitely not are not clear yet. There seems to be evidence of cancer, of high levels of dairy consumption causing prostate cancer in men, especially aggressive forms of prostate cancer and endometrial cancer. Although interestingly, milk intake may protect against colorectal cancer, and that may be an effect of calcium. There is no evidence basis for all adults eating three servings of dairy a day, milk or milk equivalents. And we recommend zero to two, you know, which takes into account that milk and dairy products have been traditionally part of many cultures. They can be delicious. Cheese, yogurt and fermented dairy products actually look very good. They tend to be in epidemiology, in the best epidemiologic studies, consistently popping up as among the most protective foods we eat. Now, that might not have to do with the inherent dairy per se, but the fact that yogurt is one of the few naturally fermented foods that remain in our diet.

Yeah.

100 years ago, most cultures Germany or France, where a lot of what we would have eaten would have been fermented at least through the winter.

Yeah, I mean, yeah.

But now very, even the foods that people think are like pickles aren't naturally fermented. They might be chemically treated to pickle them. Whereas yogurt, especially if it's not sugar sweetened, is one of those traditional fermented products that may be beneficial to the gut microbiome. and have other, you know, help.

Yeah, I mean, that's important. We just said the sweetened ones. I mean, there's more sugar per ounce in sugar sweetened yogurt, like fruit sweetened yogurt, than a per ounce of soda. So it's definitely not a health food.

When you add the sugar in. And I think that the question then. So we're not arguing to get rid of dairy products, but we just don't think that this super intense consumption, I mean, three servings a day. which would make dairy products among the most dominant source of calories for any single food in many people's diets. We think there's no evidence basis for that. And for people who we don't think that there's going to be much harm from consuming one or two servings a day. But for people who are not consuming any dairy products and eating a high quality diet, they shouldn't feel badly about that choice. There's no reason to suddenly dump in a lot of dairy.

And what about the school lunch guidelines? Do you think those need to be changed too?

Well, you know, they get it wrong in two ways. First of all, as you said, that they have this obligatory drop of the milk carton on the plate for the meal to be reimbursed. And it also has to be reduced fat. So whereas it's perfectly acceptable to serve sugary fat-free milk, you can't serve, you're prohibited from serving unsweetened plain whole milk. Now, what's the sense of that? Well, I guess if you're thinking in a simplistic way of calories in, calories out, you're giving kids fewer calories, fewer fat calories, and maybe that's a good thing. Unfortunately, the clinical trials that we have in the epidemiology that we have suggest the opposite. But the kids who are drinking whole milk tend to gain less weight than the kids who are drinking non-fat milk. And that's even after taking into account something, a concept called reverse causality. You might think that people are drinking non-fat milk because they're gaining too much weight. Maybe these are the heavier kids and they switched to non-fat milk. But there's ways of taking that into account and research. and even with that, whole milk, if anything, looks better than fat-free milk. We need better research. We've applied like five times to the government to do a definitive randomized control trial, and we keep having trouble getting funded. I mean, it's only, you know, for two or three million dollars, we could do a very high quality randomized control trial to look at fat free versus whole milk versus no milk at all in children over, say, a year, and, you know, get some real hard data on this. And if there are any philanthropists out there that want to fund this kind.

Of-- Take a couple of million.

Just, you know, two, three million.

I'm mowing. To David.

We'll get you some high quality research.

Well, you know, David, what you brought out was really, really important. I just want to sort of highlight it because we all are, under the belief that skim milk is great for weight loss and that if you drink more skim milk, you'll do better. And I think this is the, the whole era of low fat that you've been fighting against for so long that's made us believe that. And low fat and skim milk are what's recommended in schools. And it's what you've found actually doesn't lead to weight loss. In fact, it may lead to weight gain because it affects kids appetite. And the more sugar they eat and the sugar sweetened milks and the less fat, the more hungry they get. And that's why you wrote your book called Always Hungry, which everybody should get, which describes the mechanism by which increased starch and sugar and low fat diets drive weight gain and hunger. And we're going to do another podcast for those who are listening with David on his life's work. Milk is just a sideline here, but his life's work is really understanding the role of carbohydrates and fat in weight and metabolism in a way that I think nobody else has done. So we're gonna, we're gonna come back to that, but this is such a big issue to underscore that we're pushing all these low fat sugar sweetened milks in kids and it's actually harming them.

Yeah, well, thank you for the book plug. So, right, if it were simply a question of calories in, calories out, well, then we have this simple solution to obesity. Just stop eating for a while, right? Calories in will be zero and you'll lose weight and be fine. It doesn't tend to work that way. When people stop eating, they get, what happens, it starts with an H, hungry, right? So what we need to start thinking about is not calories per se, but the ratio relationship between calories and satiety. It does no good to eat, let's say you could eat 100, consume 100 calories from eight ounces of sugary beverage. We're twice those calories from a serving of nuts. Okay? So from a calorie and calorie out perspective, go with the sugary beverage, right? But how are you going to feel an hour later, let alone, you know, five hours later? Probably much hungrier after the sugary beverage. And you may, even worse, your metabolism might start slowing down. So from that perspective, we really want to look at food quality. and ask how does the foods, how do the calories we're eating affect our hunger, our satiety, our well-being for the next at least five hours? And from that perspective, the fat-free craze has been a total failure. I mean, we know this. Almost everybody in the United States wanting to lose weight was on a fat, on a low-fat diet in the 1980s, 90s, and the beginning of the century, we know that things didn't work out very well. Now that we have the clinical trials that compare low and high fat diets, we see a consistent advantage to high fat diets. These trials don't tend to produce very dramatic results because many of these trials, people don't change their diets very much. So these trials don't let us know how much benefit you can get But they do tell us that the low fat approach to eating does not work for most people.

And then the whole low fat thing around milk is also going to get rid of saturated fat and cholesterol because saturated fat causes heart disease and stroke and dementia and all these various things. So one of the things that I found really interesting in the last few years is increasing data coming out looking at various studies on dairy fat and heart disease. and diabetes. And dairy saturated fats are different than saturated fats from meat or from coconut or from other sources. So dairy fat has very unique types of saturated fats. And when they found looking at the data was that those who had higher levels of these fats in their blood seem to have lower risk of diabetes and no increased risk of heart disease. In fact, your colleague, Dr. Mazafarian, who's been on the podcast, wrote an article called butter back, I think is what it was called. And it is really looking at millions of years of patients history and finding no correlation with heart disease and an inverse correlation with diabetes. So can you talk about that? And is there any yeah, I think.

The truth is probably in the middle.

And.

Certainly butter, I don't think should be demonized. So butter actually, so dairy fat, is not all saturated fat. It's about two-thirds saturated fat and about one-third monos with some polys. And so even in the trade-off of saturated fat and sugar, I think sugar looks worse. And with dairy fat, some of it is this very healthful monos and polys. And then you raise the point that some of those dairy saturated fats may not be adverse at all compared to other fats. And then there's the issue of what gets traded off with it. Are you eating butter versus olive oil? That's one trade off. Are you eating butter versus bread? If you eat less butter and twice as much bread, that might not get us anywhere.

Yeah. This is fascinating. It's very complex and I think the the dairy fat question has always intrigued me because I think there's also a lot of genetic variation in the population and some people do better, some people do worse. So, these large studies, it's hard to understand how it's going to affect any one person. So, anybody listening, I encourage them to make sure that they check their own numbers in response to whatever dietary changes they make because what may be good in a population study or in a randomized control trial may not apply to.

You because we're all different. And, I think that's a key point is to me, the combination of saturated fat and processed carbohydrate is bad. So I don't think we can say butter is like good across the board. Saturated fat, like I've been advocating for a lower carbohydrate diet, but there's some in the low carb community that's saying saturated fats perfectly fine. And I don't think that's the case. When you combine saturated fat and processed carbohydrates, which is how Americans eat, bread and butter, or the hundreds of versions of that.

Ice cream.

I think it's really clear that the risk goes up. But when you reduce processed carbohydrates, your insulin levels drops. And so when your insulin level drops, the oxidation of the burning of fat goes way up. And so on a low carb diet, the saturated fat you eat, which typically tends to be high in amount, gets burned very quickly. So the saturated fat you eat doesn't raise the saturated fat in your blood on a low carb diet. And in addition, your triglycerides and HDL tend to improve. So that's a really different situation than just, you know, feeling good about putting more butter on your bread. Yeah.

Well, I want to just highlight something that you said, which people, I think, don't understand. I certainly understand. So I started researching this, which is that the saturated fat in your blood doesn't come from the saturated fat that you eat. It comes from the sugar and processed carbohydrates that actually raise the saturated fat in your blood, which I thought was fascinating.

No, it can't. On a traditional high carb saturated fat diet, yes, you're going to be getting saturated fat in your blood from what you eat. But in the case of a low carb diet, the saturated fat you eat gets oxidized very, very quickly. faster actually than the mono and polyunsaturated fats, I believe. And so a key another source is something called de novo lipogenesis. That just means making fat new. And the way it's made on a standard diet is from carbohydrates.

That's right.

The sugar breaks down in the liver and gets built back up into fat and the kinds of fats that are built are really unhealthy and they include saturated fat. Yeah, exactly right.

And, that's what was a big aha for me when I was like, wow, when you eat a lot of starch and sugar, it turns to fat in your belly and it turns to fat in your blood. It's not the fat you eat that makes you have high fat levels in your blood, which was so fascinating to me.

Yeah, well, it's both. On a high carb diet, it's both.

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You know, you need a gram, a thousand milligrams or more calcium a day to meet new demands. It's almost certainly flat-out wrong. These balance studies were based on very short-term studies, 21 days.