Your bones may need calcium, but here's why it's time to moove on from milk

Because of a growing body of research, there is a dawning appreciation that allergy to the proteins in cow’s milk is behind a range of childhood illnesses.

Thanks in no small part to the efforts of the Milk Marketing Board from the 1950s onwards (do you remember “Full of natural goodness”, “Milk’s gotta lotta bottle”, or “Drinka pinta milka day”?) dairy produce enjoys an almost unassailable position in British dietary culture. Milk is seen as vital, an indispensable source of calcium and vitamin D, the foundation stone for healthy teeth and bones.

The health-care professions have been as taken in as anyone; not even evidence implicating dairy in the development of later-life problems such as heart disease has been able to undermine the belief that, for our children to get the best start, they need to be pumped full of cheese and yogurt, all washed down with a glass of nice-coldice- cold milk.

This cultural enthusiasm for dairy led the medical profession into a collective, decades-long blindness. Even today, parents who believe their child to be allergic to milk are likely to be dismissed as oddballs, clutching at improbable straws in an attempt to understand their offspring’s health problems. Dreadful eczema? That’s a skin disease. Intractable abdominal pain and digestive mayhem? There must be something wrong with the gut. Chronic cough and mucous? That’ll be the lungs.

Milk, after all, is what babies are made of. What could be wrong with such a natural, wholesome food? However, because of a growing body of research, there is a dawning appreciation that allergy to the proteins in cow’s milk is behind a range of childhood illnesses.

The journey towards this understanding has been made difficult by several confounding factors. First, there is more than one type of allergic reaction. Immediate hypersensitivity to milk, which is rarer, is easy to diagnose. Directly after exposure to cow’s milk protein, the affected individual displays a florid response, which includes swelling of the lips, face and eyes; a wheeze and breathing difficulty; and a rash called urticaria, which looks like widespread nettle stings.

Much more common in cow’s milk protein allergy (CMPA) is delayed hypersensitivity. This is tricky. There is no clear link in time between exposure and symptoms. These babies tend to have difficult-to-treat eczema, refractory respiratory problems and a range of digestive disorders such as reflux (where acid stomach contents come back into the gullet and mouth), diarrhoea or constipation, colicky pain and even bleeding into the bowel.

We still do not completely understand delayed hypersensitivity and it is likely to be more common than its currently estimated prevalence of around 5 per cent.

Even when delayed hypersensitivity is suspected, there are a number of factors that can frustrate the diagnosis. Unlike immediate hypersensitivity, there is no blood or skin-prick test that can be given. Confirmation can only come from strict exclusion diets, where one would expect symptoms to resolve over a period of between two and eight weeks.

Exclusion diets are hard to stick to. Doctors frequently advise parents to switch to soya-based products, but there is crossreactivity between cow’s milk and soya protein in around 60 per cent of cases. Failure to improve when on a soya-only diet is often mistakenly interpreted as ruling out CMPA.

Another common misconception is that breastfed babies can’t develop CMPA, yet the offending proteins in a dairy-consuming mother will cross into breast milk and provoke allergy in just the same way as with bottle-fed infants.

From an evolutionary perspective, consuming milk beyond babyhood is unnatural, yet all infants depend on milk in their first year or so. Breastfeeding mothers with allergic offspring can go dairyfree but bottle-fed babies are, figuratively speaking, up a gum tree.

Fortunately, there are now a number of formulas available to treat CMPA. In each, the protein components are hydrolysed – chemically “chopped up” into smaller units –which are less likely to provoke an allergic response. But these are very expensive and their growing use is a source of concern to those responsible for NHS prescribing budgets.

A better long-term solution is to encourage and support breastfeeding – currently fewer than a quarter of new mothers are still exclusively breastfeeding at six weeks.

This needs to be coupled with a thorough rethink of our relationship with dairy foods. Even experts in the field of CMPA remain spellbound by the belief that milk is essential for calcium and vitamin D, advising breastfeeding mothers to take artificial supplements if they are cutting out dairy.

But, in reality, milk is a relatively mediocre source of these nutrients. There are innumerable other foodstuffs that carry more calcium than milk – broccoli, figs, almonds, sesame seeds and leafy green vegetables, to name but a few.

As for vitamin D, getting ourselves and our children out into natural sunlight every day is nature’s time-honoured solution. Who knows, we might even inculcate a renewed enthusiasm for fresh air and exercise into the bargain.

Dairy might not be as good for you as you previously thought. Image: Getty

This article first appeared in the 06 November 2013 issue of the New Statesman, Are cities getting too big?

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Low fat, full fat: why the diet industry keeps changing its mind

A new report illustrates just how disillusioned the diet industry has become, at the expense of everyone else.

Another year, another wave of dietary fads. Most seem to surface in the summer, when new nutritional advice claims to provide the panacea to everyone’s health woes: “Eat clean get lean!” “The simple secret of intermittent fasting!” “The paleo way is the only way!” “Six weeks to a super you!”

However, despite the barrage of diet books, the expansion of nutrition research and the growth of education about healthy living, global obesity has more than doubled since 1980.

It may be that this is due to the conflicting information constantly issued from the diet industry. “Eat lots of protein – it’ll speed up your metabolism!” “Too much protein will damage your kidneys – reduce your protein intake!” “Superfoods are a vital source of antioxidants!” “Superfoods aren’t so super at all!” “Don’t snack it will make you pile on the pounds!” “You should snack – it’ll stop you from binge eating!” It’s no wonder people aren’t sure what to eat.

The UK launched its first dietary guidelines in 1994, which have since been continuously revised to form the guide now known as “The Eatwell Plate”. The dietary guidelines recommend plentiful carbohydrates “such as rice, bread, pasta and potatoes”, at least five portions of fruits and vegetables, some protein, some milk, some dairy and minimal saturated fat.

However, a recent report serves to highlight the confusion consumers face when it comes to food: it claims that the official advice on low-fat diets is outright wrong, even damaging.

Led by the National Obesity Forum and the Public Health Collaboration, the report (not peer-reviewed, it’s worth noting) attacked a host of official health proposals. It claims that “eating fat does not make you fat”, and criticises Eatwell Plate’s small fat allowance. The report also stated that saturated fats have been unfairly demonised, as there is allegedly little evidence to suggest that they cause heart disease. Meanwhile sugar consumption should be dialled down to zero, apparently, and calories shouldn’t be counted, as an abundance of them won’t cause obesity. Also, forget about the exercise - apparently a bad diet can’t be outrun, according to the report.

Professor David Haslam, chairman of the National Obesity Forum, said: “As a clinician, treating patients all day every day, I quickly realised that guidelines from on high, suggesting high-carbohydrate, low-fat diets were the universal panacea, were deeply flawed. Current efforts have failed – the proof being that obesity levels are higher than they have ever been, and show no chance of reducing despite the best efforts of government and scientists.”

Dr Aseem Malhotra, consultant cardiologist and founding member of the Public Health Collaboration reinforced this by saying the guidelines were “perhaps the biggest mistake in modern medical history, resulting in devastating consequences for public health.” Under current dietary guidelines, obesity levels have indeed increased in the UK, with nearly two-thirds of men and women overweight or obese, costing the economy more than £3bn per year.

In the face of such starkly opposed sides - both backed by seemingly reputable experts who claim all their research is based on empirical evidence - what are consumers meant to do?

The vilification of fat

In 1983, it was recommended that overall dietary fat consumption should make up only 30 per cent of total daily energy intake – 10 per cent of which, at most, should come from saturated fat.

The recommendations came from a number of research papers published at the time, which suggested a link between saturated fat intake and increased levels of LDL cholesterol – the cholesterol which has been connected to increased risk of heart disease, stroke and atherosclerosis.

An even simpler reason for the suggestions boiled down to this: fat has more calories per gram than carbohydrates – nine calories per gram versus four, to be exact. This shape to future official guidelines, and gave birth to the low-fat high-carbohydrate mantra. Fat was cemented as public enemy number one.

As a result, the fat eliminated from people’s diets was to be supplemented with an increased intake of carbohydrates. Tipping the scales in favour of carbohydrates were promises of weight loss as a result of higher fibre content, elevated levels of serotonin to aid sleep and boosts in mood from feeling fuller.

But obesity levels continued to soar, and health experts shifted their focus to the next culprit: carbs.

The low-carb era

An analysis by The American Journal of Clinical Nutrition combined the results of 21 studies and found that “saturated fat was not associated with an increased risk of coronary heart disease”. Other studies demonstrated the positive effect on testosterone levels in men from increased saturated fat intake, and have noted increased levels of triglycerides (the stuff that makes you fat) from lower fat diets.

As a result, dieticians developed a deep suspicion of carbs, and sugar in particular, and diets like the Atkins regime became more and more popular.

In part, the report by the National Obesity Forum and Public Health Collaboration uses the research that propped up these low-carb high-fat diets as a means by which to attack the general consensus surrounding healthy eating. Dr Malhotra, who led the latest report, previously worked in a pressure group called Action on Sugar – a group that has tried to get the food industry to reduce the amount of sugar added to food.

The reasoning goes something like this: guidelines encouraging greater carbohydrate consumption are oblivious to the fact that sugars constitute a vast amount of refined carbohydrates. By cranking up the sugar intake we ratchet up the risk of type 2 diabetes; this in turn could spark further health problems including obesity.

The logic seems sound, and yet obesity levels have continued to soar in the face of this research. The notion that all sugar should be avoided also ignores the fact that our brains require a significant amount of glucose for optimal functioning.

Everything in moderation

In the face of an industry that can’t make up its mind about how people should eat, it’s no wonder obesity levels have grown to epidemic proportions. So what can be done?

Professor Susan Jebb, the government’s obesity adviser, believes that the current debate needs to expand beyond the battle between carbohydrates and fat. She said: “We’re eating too many calories – if we want to tackle obesity people do need to eat fewer calories and that means less fat and less sugar.” And she’s right. If decades of research have pointed to anything assertively, it’s that calories count, and paying attention to portion sizes could take us a long way.

Both fat and carbohydrates are necessary for our bodies to function. The solution? Enjoy everything in moderation. Eat fruits without fearing fructose, don’t throw away the egg yolk, get a decent amount of protein and yes, you should have your slice of cake too.