Why Most Everything We Were Told About Dairy Is Wrong

This is one of the first myths to go. That 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.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's Pharmacy with an F-A-R-M-A-C-Y, a place for conversations that matter. And if you ever wondered if you should drink milk, if it's nature's perfect food or if it's the devil, this podcast is one you're going to want to listen to because with an extraordinary physician, scientist, and good friend of mine, Dr. David Ludwig. He is one of the giants in the field of nutrition. He's a Harvard professor. He's MD, PhD, endocrinologist, researcher at Boston Children's Hospital. He's a professor of pediatrics at Harvard Medical School, professor of nutrition at Harvard School of Public Health. David and I first met, oh gosh, 20 plus years ago. I was this little young wimpersnapper who read one of his papers that was published in kind of blew my mind, which was the first threat to the notion that calories are calories are calories. And it was a very elegant study on young overweight little boys where he gave them three different breakfasts. One was eggs, one was steel cut oats, and one was oatmeal. And they were exactly the same calories. And what he did was find something that blew my mind, which was that the kids who ate exactly the same calories of oatmeal had much more hunger. They ate over 80% more food that day. They had higher levels of insulin and blood sugar and also the stress hormones like cortisol and adrenaline. So it really made clear that calories are not the same. And that is what led me to call him. And he actually took my call. I was this young kid who was at Canyon Ranch and didn't know much, but I wanted to talk to him. He took my call and the rest is history. We've been good friends ever since and I've learned so much from him. In fact, I probably wouldn't have my career without him because he's the guy who's figured out this whole calorie is not a calorie, carbohydrates and fats are not what we thought they were and how we need to really think differently about weight loss. He's an expert in the field of obesity. He runs the New Balance Foundation Obesity Prevention Center. He's the founder of the Optimal Weight for Life or OWL program, one of the country's oldest and largest clinics for the care of overweight kids. And sadly, there's more and more of them every year. He's studied for 25 years the effects of dietary composition on metabolism and body weight and the risk for chronic disease with a focus on the low glycemic diet, low carbohydrate, ketogenic diets. And a lot of studies are done out there, just for those of you who aren't scientists, that are studies of populations and nutrition, which give you a general sense of where you might want to look, what correlations are, what possibilities are, but they don't provide definitive proof because they're not experiments. they don't take different groups of people and randomize them in a way that is rigorously done so that we can draw conclusions that are more bulletproof. And so David is that guy who does the hard work of doing experiments on humans, not bad ones, but good ones, and finds out exactly how diet and different dietary compositions affect metabolism and weight. some of them have been just staggering studies. One I just quickly mentioned was where he did a feeding study and found that given the same calories swapped out at different times over a period of time, but one group of one of the calorie groups was 60% fat and 20% carbs, the other was 60% carbs and 20% fat, that the group that had the same calories of fat actually burned about 250 calories more a day, which essentially would solve the entire obesity obesity crisis. So these are very impactful studies. And Time Magazine has called him an obesity Warrior. He's fought for fundamental policies on how to change our food system, and he's inspired me in that way. He's been a principal investigator in many grants from the National Institutes of Health. He's got lots of philanthropy money. He's published over 200 scientific articles. I might have read about half of them, I don't know, but I try to read most of his stuff because it makes me look smart. And he's a contributing writer at JAMA Journal of the American Medical Association for 10 years, and he serves as an editor. Now, I have the American Journal of Clinical Nutrition, the British Medical Journal, or BMJ. And he's written three amazing books for the general public, including the number one New York Times bestseller, Always Hungry, Conquer Cravings, Retrain youn Fat Cells, and Lose Weight Permanently. And I encourage you all to buy that book because it is a groundbreaking.

Book that will help you understand why people struggle to lose weight and are always hungry. So welcome, David. Well, thank you for the really generous introduction. It's been great knowing you. past 20 plus years, and I've been inspired by your ability to connect state-of-the-art concepts to clinical care. You're in the front lines. You're seeing patients. You observe chronic disease. Medicine is very good at dealing with broken arms and appendicitis. We're not so good in those other 80% of conditions that cause people to not feel good. from diagnosed heart disease and diabetes to just chronic inflammation. And you have an inquisitive mind and you're looking for new connections in the clinic. And we as scientists, and I'm a clinician too, but we have scientists have a lot to learn from you and people who are actually seeing the patients.

Well, it's very humbling seeing the patients. It's easy to look at a study and say, this is what's true, but when you actually have real humans, it's different. I think Roger Williams, who is the father of one of the fathers of biochemical individuality, said statistical humans are of little interest. I'm interested in real people. And I think there's a room for both. So today, David, we're going to talk about milk. And you always have been an iconoclast, breaking apart notions, for example, that calories are all equal, which is pretty much still in play right now that everybody thinks calories are equal except a few rogue scientists like you, although it's becoming more accepted. But milk, God, milk is nature's perfect food. It's what we should all be drinking three glasses a day of according to our government policy and kids at least two glasses a day if they're under nine. And it's supposed to be great for your bones. It's supposed to help you grow big and strong. It's supposed to help prevent disease. And somehow, It doesn't seem like that's actually what the science shows. When we take a good look at it, it's a different story. And you and your colleague, Walter Willett at Harvard, one of the most renowned nutrition scientists along with you, recently published a paper in the New England Journal of Medicine called Milk and Health, which I encourage everybody to read if they're a nerd like me, or if you want the easy version, go to Medium. And there's a fabulous article there in Medium about the the question about milk. Is milk truly healthy? Time to question everything you know about milk. So I encourage you to check that out. Now, David, what inspired you to write this article?

Well, people drink a lot of milk, and even though we're consuming a great deal of it, if we were to comply with USDA recommendations, three servings a day for virtually everybody, we would have to double our consumption, which we're talking about billions of gallons of milk produced more every year, which would have a massive impact on the food supply. The question is what impact would that have on health? Remarkably, there are astoundingly few clinical trials that have examined the impact of those recommendations on diseases today, obesity, type 2 diabetes, cardiovascular disease. So maybe a place to start is like where did we get these recommendations?

Yeah, I mean, you reviewed over 100 papers. So you've got these recommendations that our government gives us, but yeah, how do we get them?

Some of these recommendations to consume a minimum amount of things, date back to a different era, like 100 years ago, at least the philosophy did, when the big concern for many, much of the American public was not too much like we have today, obesity, but too little diseases of deficiency, vitamin C deficiency, vitamin A, vitamin D deficiency, protein deficiency, and in some cases calorie deficiency. People weren't getting enough food. So the questions became what was the minimum amount that we needed to assure the health of the population. Now we're in a very different era and that mindset of minimum recommended amount hasn't necessarily caught up because so many diseases today, it's not that we're completely free of deficiency syndromes and things like rickets, vitamin D deficiency is beginning to come back, especially in children amidst the obesity epidemic. But so we still of course need to pay attention to what the minimum amount of vitamins, minerals, other nutrients might be. But when we start thinking about foods like dairy, the question is shouldn't be what is the minimum amount based on these old notions of nutrients, but what amounts are optimal for the population today given the high prevalence of obesity, diabetes, and heart disease? Yeah.

So back then, I remember reading about the development of the four food groups, right? Milk was one of them. Dairy is one of the four food groups. But that was a construct of industry, not science, where big industrial producers of these products, meat, milk, produce, and grains, basically got together and said, well, how do we sell more of our stuff? Let's make the four food groups. And it really had nothing to do with science. And at the same time, we also have to understand that milk is something that most of the world's population doesn't tolerate. 75% or 70% are lactose intolerant. Most populations around the world don't consume milk on a regular basis like China and Asia and most Asian countries, Africa. There are some exceptions, obviously, the Masai, but I think that for the most part it's not a staple food after weaning. And yet somehow in the West we've come to think about it is, you know, just American as apple pie and, you know, and the American flag. And so, so, and in fact, you can't even get a school lunch authorized unless milk is included in the school lunch. But you really question that. I think, you know, you wrote an article a number of years ago, which was sort of a prelude to this one that was in, I think JAMA, also with Walter Willett, where you sort of questioned the, the guidelines and, and brought up some of this data. And I wrote an article that sort of kind of derived from that called Got Proof, which essentially was a spoof on the whole Got Milk campaign, which by the way, people don't understand that the Got Milk campaign wasn't an industry effort solely, that it was part of a government program called the Checkoff Program, which is where the United States Department of Agriculture supports industry to sell more of its products. It's supposed to help with research, right? The money is tied to the government by the industry, apparently to support research, but it actually went to marketing of these ads called Got Proof. And they were literally taken down by the Federal Trade Commission because there was no evidence for the claims we're making. Can you talk about that? And then how did we get to these three glasses?

Right. Well, so we began by looking at the mindset, the philosophy that gave rise to these minimum recommendations. And you point out that it's not just science, but it's also food politics. That the USDA, which has conventionally overseeing these recommendations has a dual message, dual mission. One is promotion of public health, but the other is to advance the financial interests of the big food commodity producers. And Dari is absolutely very, very powerful.

So.

You made another very important point that really cuts to the chase, that much, that at least half of the world's population doesn't consume 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 that then, so we know that milk isn't necessary for, you know, 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 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, sugary beverages and packaged savory snacks, cheeseburgers and 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 U.S. 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 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 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, 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. And so if you did longer term studies, you would see that adding more and more calcium doesn't keep building up bone. You have this short term boost in bone calcium, but then you fill up all these little temporary niches and nothing there's no more benefits. The thing is 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. I had to confess here.

I hope it doesn't 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 want to be an NBA player. instead of a doctor if I did drink milk, Kuna. 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 be, you know, 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, you know, 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 gonna 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 half way 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, you know, 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 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. 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?

Second hand calcium. 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 analysis. 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 confounded. So when you look compared the Swede to the Filipino, you know, there's a big difference in height and height is a 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? Yeah, well 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 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.

But this is a big, this is one of the first myths to go. That 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 to 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?

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 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, you think that the government should change its dietary guidelines?

Well, let me just say, so, you know, we talked about the trade-offs and 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 cell, 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 think 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, of 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 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 the calcium.

Hi, everyone. Hope you're enjoying the episode. Before we continue, we have a quick message from Dr. Mark Hyman about his new company, Farmacy, and their first product, the 10-Day Reset. Hey, it's Dr. Hyman. Do you have FLC? What's FLC? It's when you feel like crap. It's a problem that so many people suffer from. and often have no idea that it's not normal or that you can fix it. I mean, you know the feeling. It's when you're super sluggish, your digestion's off, you can't think clearly, or you have brain fog, or you just feel run down. Can you relate? I know most people can. But the real question is, what the heck do we do about it? Well, I hate to break the news, but there's no magic bullet. FLC isn't caused by one single thing, so there's not one single solution. However, there is a systems-based approach, a way to tackle the multiple root factors that contribute to FLC. and I call that system the 10 Day Reset. The 10 Day Reset combines food, key lifestyle habits, and targeted supplements to address FLC straight on. It's a protocol that I've used with thousands of my community members to help them get their health back on track. It's not a magic bullet. It's not a quick fix. It's a system that works. If you want to learn more and get your health back on track, click on the button below or visit getpharmacy.com that's getpharmacy with an F. A-R-M-A-C-Y.com Now back to this week's episode. You know, the issue around growth is very interesting because there are 60 different naturally occurring hormones in milk, not including the ones that they pump into the cows or that they milk them all pregnant or that they give them for growth factors. So these are just naturally occurring and the purpose of these is to grow a little baby calf into a big cow very rapidly. like you said. So I think, you know, that might be good for infants, but it's probably not good for long term, long term health.

And it's worse now because of modern industrial farming because in the, you know, 100 years ago, you'd, you know, send the cows out, they'd get pregnant, and you wouldn't be breast, you wouldn't be milking them during pregnancy. The baby cow would be born, would feed a little bit. and then you'd milk for a while until the next cycle. But now in hyper accelerate, hyper efficient industrial agriculture, cows are being milked throughout their pregnancy. And so those hormones that would be normally present in pregnancy, estrogens and progesterones and other hormones get dumped into milk. So the milk supply is, even though milk normally has many growth promoting factors. It has even more so today. So that's something to bear in mind.

And even if you're having organic milk, it could still be this case where you're milking organic milk.

Unless you're getting it from a local farm that's using more traditional low intensity dairy agricultural practices, organic milk's not going to be any different in that regard.

David, in terms of the recommendations, I'm going to sort of press a little bit on that because I think, you know, we have a government that's telling us we should be having three glasses of milk a day and we can't have school lunches without milk. Do you think that's the right policy? Do you think it needs to be modified? What should we do?

It's wrong. We came forth in our paper, at least in our opinion, quite clearly, that 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, 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 healthy 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 is, would make dairy products like among the most the 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, you know, 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 suggests the opposite. That 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. Like 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 in research. and even with that, whole milk, if anything, looks better than factory 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 get some real hard data on this. And if there are any philanthropists out there that want to fund this kind of research.

Take a couple of million. Just- just- just- you- know, two, three million. I'm going 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. It'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 gonna do another podcast for those who are listening with David on his life's work. Milk is 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 going to come back to that. But this is such a big issue to underscore that we're pushing all this 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. 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. 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 you know, eat—let's say you could eat 100—consume 100 calories from eight ounces of sugary beverage or 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 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 been 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. Mazzafran, who's been on the podcast, wrote an article called, Is Butter Back? I think that's 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. Butter, actually, so dairy fat is not all saturated fat. It's about two-thirds saturated fat and about one-third monounsaturated fats with some polys. Even in the trade-off of saturated fat and sugar, I think sugar looks worse. With dairy fat, some of it is this very healthy ful 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.

So this is really, this is fascinating. So 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, 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 randomized controlled trial may not apply to you because we're all different. And I think that's a key point.

And 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 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 say 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 level 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. And I certainly didn't understand until 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.

Sugar breaks down in the liver and gets built back up into fat. And, the kinds of fats that are built are really unhealthy. 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.

So let's talk about a few other things because one of the challenges that I see as a functional medicine doctor is people come in with chronic inflammatory problems and chronic digestive problems, reflux, irritable bowel worse or inflammatory bowel disease, and they come in with allergies and asthma, eczema and congestion, postnasal drip, and sinus issues, they come in with acne and all these issues. And over the years, you know, there's been a real clear pattern in my practice, and I think many other functional medicine doctors, that if you take people off dairy, a lot of these problems get better, right? Whether they have lactose intolerance, that's the obvious one, or whether the food sensitivity, or whether it's causing increased mucus and inflammation. I think there was some data you talked about in your paper that you reviewed about asthma and eczema and some of these allergic diseases. So, what did you find around that? I think how do you see that as playing a role in this? Because if we're telling people to drink milk, it's causing all these health issues, it's one thing if it was benign and didn't help you and maybe increase your risk of fractious risk, but if it actually causes a lot of people health issues, and for me, it's one of the magic wizard tools that I have. I just tell people stop eating dairy, A lot of people get better from all sorts of things. And I'm like, well, this is real. And if you're 10,000 patients, I'm like, well, there's a there, there, but maybe there's no data.

But what did you find in terms of the data? Yeah, so I think the truth is going to be in the middle here.

And I'm not going to argue with your clinical experience, although you're like the Goldilocks doctor.

Everything's perfect in the middle. Well, you know, one man's middle ground is another person's extreme position. So it's all a matter of perspective. but you're also seeing people who there's a lot of selection bias. They have come to you because they've been through three or four other doctors. And so you're seeing, let's take a step back. We looked at evolution and said that humans have no requirement for dairy products at all. At the same time, we know that there are some populations, the European, that flourished on dairy products for thousands of years. And in fact, it was probably the dairy products that let them flourish to the degree that mutations evolved very quickly, such as lactase persistence. That's the enzyme in the gut that helps humans digest milk protein lactose, which would normally only be present in infants, and then it goes away. So if you don't have lactase as an adult and you drink milk, you'll develop intensive malabsorption.

Diarrhea, gas, miserable.

You get very sick. So there was such an advantage of being able to consume dairy products that humans, a lot of populations, not all of course, but at least a third of the world's population, has developed this rapid, evolutionarily rapid mutation, which tells us that milk has been consistent. Milk dairy products have allowed cultures and populations to flourish. And so I don't think we can say that milk especially, you know, well produced, you know, which, you know, less industrial, you know, especially the fermented products that would have been consumed a lot, you know, that there are going to be bad allergic responses for everybody. That's probably not the case. A lot of French would go down fighting for their cheese plate at the end of the meal if you tried to say that. But at the same time, there's no question that there are enough, not just case reports, but randomized controlled trials, in which some people, when they eliminate dairy products, experience improvements in asthma, eczema or other allergic conditions. And that is also true among children as to whether this is 1%, 10% or 30%, we can't say, but some people do. Certainly not everybody.

It's also very linked to acne, right?

You know, I think one could make an argument because that the growth factors in milk that are going to be stimulating rapid growth are also going to be leading to issues with skin, but I haven't seen as much of it.

I see it clinically, it's hard to save the data, but I just for sure see it. And this brings up a bigger point, David. You're talking about the evolution of Northern Europeans and dairy in our diet. And I think just like anything, and your work really underscores the importance of food quality, not just quantity. is the quality of the dairy we're eating today different than the quality of the dairy we ate 100 or 200 or 500 years ago? And, you know, I just, just, just a couple of things about that. One is, is that the type of breeding we do now homogenizes the cows. It's not homogenized milk, but homogenize the cows. They're all the same. And they produce a different form of casein, which is called A1 casein. That seems to be more inflammatory than A2 casein, which is found more in traditional heirloom cows and sheeps and goat. And second, the way in which we process milk, the pasteurization, which I think is necessary, but the homogenization of milk is relatively a new phenomenon. We used to have raw milk. And the fascinating study that I read about it, it was done in the UK, I believe, where they looked at basically un-homogenized milk versus homogenized milk and the differential effects on blood cholesterol and lipids. And I thought that was fascinating. Yeah. Same milk, it just was differently processed. Yeah. And when it was homogenized, it really was bad and the raw milk was good.

Yeah. There are preliminary studies we don't really know yet, but there are three sort of processing when we come to, when you think about milk. One is pasteurization. So that's heating enough to kill the worst bacteria, to improve the shelf life. And we know that that reduces public health concerns, especially with industrial milk. You know, if you're getting your milk from a local dairy that has good practices, you know, it may not be, you know, as necessary, but it is necessary for industrial milk. But pasteurization also changes the proteins. If you're heating it up enough to kill the bacteria, you're going to be denaturing some proteins. changing the taste different. Second thing is homogenization, which is passing typically an electric current that breaks up the big milk globules into smaller tiny little globules and that stays suspended so you don't get fat on the top like you used to and the liquidy milk on the bottom. But that also changes the antigenic structure. These fat globules are very reactive to the immune system. And there is some evidence that that homogenization can trigger enhanced antigenicity, more of an allergic reaction to milk. And then fermentation, which I think everybody kind of thinks is a pretty good thing to do. We should be doing more of it. so.

So there's another issue, which then is, is, you know, what is the cow eating and what is the quality of the milk based on that? And I had a gentleman on the podcast recently, Fred prevens. It was a rangeland biologist, brilliant guy. And he wrote a book called nourishment, which I think you would really love, David. But he talks about this new research, which you may not be aware of, which I wasn't certainly aware of, which is you're looking at the the quality of the nutrition of grass-fed and, and wildly foraging animals. And they're finding phytonutrients in the milk and meat of these animals, especially if they're able to hunt and gather, so to speak, their own diet. In other words, if they're having a mono grass crop, probably not great. If they're having dozens of different plant species, all the different phytochemical properties, all different medicinal compounds in them. It has profound effects on the quality of their meat. One of the studies that he quoted was of goats who were foraging on sort of all kinds of wild shrubs and this and that, and they had as much catechins in the serving of goat milk as they found in green tea, which we know is so good for you. So that brings to bear the question of industrial farming and the industrial practices, even even organic milk, 'cause it may be organic milk, but it may be fed tons of grain, it may be fed other stuff that's not its natural diet. So how do you think that impacts the quality of the milk? And maybe the fact that we've had centuries of people consuming milk, it wasn't the milk we're having today.

Yep. Grass-fed, as to how gourmet the grasses happen to be for the cows, I'm gonna have to pass on that one. Certainly grass-fed cows produce somewhat different milk. It's not hugely different like in terms of the omega-3 ratio, but it is different. And there may be differences that we don't really appreciate. And it brings us back to where we started about how much milk the public should consume. If we're telling everybody to drink three servings a day and people actually do that, we're reliant on massive industrial agriculture, which is going to, you know, there's no way that can be grass-fed animals. We're going to have to be dumping in a lot of grain products. Those grain products are going to be have to be harvested in monocultures. We have to, you know, utilize a lot of petrochemicals to fertilize the monoculture and then transport the grains. If people are consuming like one serving a day, well, you know, then maybe we can revert to more traditional agricultural practices where local farmers are grazing animals in an integrated fashion. And that actually can improve the soil quality. You know, we've heard a lot about meat and milk contributing to greenhouse gases. But if the animal is grazing on grass and in an integrated agricultural system, some of those greenhouse gases are actually sort of the carbon is returned to the soil and environmental impacts are reduced. And the result is going to be a tastier product.

Yeah, and I think, you know, that's another whole issue is the environmental and climate impacts of drinking dairy in the way that we currently produce dairy. And I think those are huge and we shouldn't underestimate them. And I think the whole picture of dairy is very interesting. I mean, who doesn't love dairy products? Ice cream, cheese, butter, yogurt. I mean, those are yummy. But I think the question is how do you avoid some of the traps and how do you minimize the risks? So just to summarize a little bit for people listening, one, the recommendations that our government has are not based on good science according to the 100 plus studies that David and Dr. Walter Willett reviewed in the milk paper. It's called Milk and Health. It's the New England Journal of Medicine. You can Google it.

I think it's, is it open source? Can people download it if they want? No, but go to my Medium page. There's a blow-by-below summary. for the general public. I think you're going to put a link to that medium piece.

Yeah, absolutely. It's a great article. I read it. It's sort of digests it all. So that's one. Two is it may not increase the decrease the risk of fractures. So in fact, maybe there's an increased risk of fractures and people have more milk, especially when they're younger. It also seems to increase certain cancers like endometrial cancer, prostate cancer, although it may reduce colon cancer. It may be linked to weight gain if people are having low fat milk products because it doesn't make you feel full and satisfied and may make you eat more food, which makes you gain weight. It also seems to be linked to certain allergic disorders and clearly digestive issues for B-lactose intolerance, which is probably 70% of the world's population. And the milk we're eating isn't the milk we ate or drank. It is a very different product that's homogenized in altered in ways that to affect its health benefits. And then, of course, the industrial dairy we eat is a lot of environmental consequences. And the fact that we're having this very hormonally active food has real concerns. So I think, you know, as a functional medicine doctor in my practice, I've seen the evidence of what you're talking about. And I think it's something that I think people are, are not really aware of. And especially since the government is so strong and since the Dairy Council is so strong in the marketing efforts. We've really sort of been bamboozled to think this is nature's perfect food, which it is, but only if you're a calf. So, I think, David, is there any other final words of wisdom you want to share with our audience about milk and health?

Yeah, I think you summed it up. Let me just put it, the three bullet point conclusions in our piece were that you don't need to people, the recommendation of three serving a day is not evidence-based. That's how we scientists like to say it's wrong.

That's code word for like it ain't true.

It's not. And, but we would, we would alternatively suggest zero to two servings a day. So that that means you can feel fine if you're vegan and eating a high quality diet that you don't have to feel like you have to drink milk to protect your bones. On the other hand, you know, go ahead and enjoy a serving or two of dairy products. Keep it high quality. And most importantly, avoid sugar-sweetened dairy products because that's where a lot of sugar creeps into the diet, especially with fat reduced. So enjoy the full fat versions. keep the sugar out, go for quality, and have a serving or two, feel fine about it, don't have any dairy, or try eliminating dairy and see if some of your chronic inflammatory issues improve.

Yeah, I mean, three weeks of a no dairy diet will give you a lot of clues, and there's no downside to doing that, and maybe you'll find out what's going on. I also want to to add to something there because I think, you know, quality has been your main mantra around every aspect of diet for as long as I've known you. And I think I would add the same around dairy. And so what does that mean to me? And I, I wish they had more evidence to back this up, but when I think about consuming dairy, I, I think it's important to avoid industrial dairy, both for you and the cow and the planet. Well, that's three things. But anyway, I also think that If you're going to consume dairy, try to find grass-fed cows, try to find heirloom cows. And there are ways to make it an adventure to try to source it. But there are, for example, cows now they're being raised that are A2 cows that are raised on diverse forages and grasses that probably makes them more beneficial.

Support a local dairy. Yeah.

And lastly, I think, you know, sheep and goat dairy tend to be better tolerated. are less likely to be subject to large industrial practices and have been consumed for a long time. And I know personally, just a little personal anecdote, when I have dairy, I get pimples and I get digestive issues and I get a lot of mucus and congestion. So it's not fun. But when I have sheep or goat, it doesn't really happen so much. So I think there is something to it and I'd love to see more studies on it. But I think if you want to follow the precautionary principle, and take care of yourself while enjoying dairy. I would say sheep and goat. And there's great goat and sheep yogurts and keifers also if you want to have fermented products. So that's not going to get you into trouble, right, David?

Most likely.

David keeps me honest. I have to tell you, he keeps me honest. He makes me not overstate things. And I love that about him. And I learned so much from data over the years. And if, if anybody is in his work is just a treasure trove of brilliant paper after brilliant paper. It's some of the most rigorous science and nutrition that's being done in the world today. I actually don't know very many people doing the kind of clinical trials that he's doing because they're hard, they take time, they cost a lot of money, and there's very few people funding nutrition. And I know David's been a huge advocate of raising the bar on nutrition research and raising more money to make it happen.

So, for people who want a daily hit of the latest nutrition research, follow me on Twitter. I'm David Ludwig, MD. David Ludwig, MD on Twitter. And I'd like to just post whatever is new and exciting. So we'll see you there, too.

It's how I stay smart. And also check out his website, drdavidludwig.com, that's D-R-David-Ludwig-L-U-D-W-I-G.com, check out his articles on Medium. Just so accessible and great. His book, Always Hungry, definitely get a copy. And the Always Hungry Cookbook with great recipes from his wife, Dawn. And I know they're great. Always delicious. That's- Always delicious, right? Always delicious and always hungry. Okay. So I can vouch for that because I've eaten dinner many times at David's house and it's always delicious.

And I'm never hungry. So it works.

And we're not gonna cry over spilled milk. We're not gonna, we're gonna celebrate over spilled milk. Gosh. that's where it should go on the table. Anyway, I think this has been a fantastic conversation. David has so much to say about so much and next time I have him on the podcast, we're going to go deep into the story of carbohydrates, the carbohydrate insulin hypothesis, which essentially says that all calories are not the same and that if we eat a lot of starchy, sugary calories, it affects our body and really harms wonderful ways and there's tremendous amounts of science on this. There's still a lot of controversy, a lot of debates, low fat, high fat, keto, low carb, high carb. I think it's confusing for people and I'm so excited to have you back again on the Doctor's Pharmacy to discuss this topic which has been your life's work and which really I based my entire career on and written 13 books thanks to you. Otherwise, I wouldn't have nothing to say. So, I really appreciate David, you've been a fantastic friend and mentor and teacher, and I hope everybody can discover David and learn more about what he's doing. So if you've been listening to this podcast and you love what you heard, please share with your friends and family on social media. Leave a comment. We'd love to hear from you. Subscribe wherever you get your podcast, and we'll see you next time on the Doctor's Pharmacy.