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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What’s the secret of the world’s best-paid sports manager? Ask the Chicago Cubs

Theo Epstein is a star because he values the person as much as the player.

As I write, the Chicago Cubs, perennial underachievers, are three wins away from reaching baseball’s World Series for the first time since 1945. By the time you read this they may have crashed out. Besides, baseball – like cricket – is a language that asks a lot of its translators. So, in writing about the Cubs, I’ll skip the baseball bits. Fortunately, the lessons of the Cubs’ success (they were the outstanding team of 2016, even if they don’t win the World Series) transcend baseball.

To understand the future of sport – and perhaps employment – I recommend a pair of profiles of Theo Epstein, the president of baseball operations for the Cubs, one published in the New York Times and the other written by David Axelrod (Barack Obama’s strategist) for the New Yorker.

Epstein, 42, has just agreed a contract extension worth $50m over five years, making him the highest-paid non-player in professional sport. There is plenty in the profiles on his whizzy use of data analytics; his algorithmic tests that measure players’ co-ordination (essentially using neuroscience to measure talent); as well as the Cubs’ coaching programme dedicated to mental health and managing stress. Most timely and important of all is Epstein’s emphasis on character. He talks about “scouting the person more than the player”. He wants the right kind of people on the field.

“In the draft room [where the team decides which players to sign], we will always spend more than half the time talking about the person rather than the player,” he has said. “We ask our scouts to provide three detailed examples of how these young players faced adversity on the field and responded to it, and three examples of how they faced adversity off the field.”

Epstein is well known for empowering a “geek department” inside his baseball teams. Yet instead of perceiving a conflict between science and the human realm, he sees the two as part of the same big picture. He craves players with character who can benefit from the insights of science.

“Character” is a vexed subject inside sport. It sets off uncomfortable associations. Talking too much about character – building it, or even just valuing it – sounds dangerously close to endorsing an amateur ethos. Victorian public schools often celebrated sport explicitly in opposition to intelligence, even achievement. H H Almond, the headmaster of Loretto from 1862, got an A for candour (if nothing else) when he ranked his school’s priorities: “First – Character. Second – Physique. Third – Intelligence.”

The Victorian notion of games cast a long shadow over sport and society in the 20th century. The first phase of ultra-professionalism, in the office as well as on the sports field, was a reaction to Almond’s set of values. The concept of character was recast as a consolation prize, doled out to the class dunce or the twelfth man. Crucially, reformers and nostalgics alike bought in to the historical perception of a separation or conflict between character, intellectual life and sporting achievement.

The Cubs, however, know better. To adapt Almond’s clumsy saying: intelligence and physical skills derive, significantly though not entirely, from character. Character is now being understood not as the destination, but the foundation, even the process.

This is an overdue reassessment. In the loosest terms, I would identify three phases in the development of professional sport. Phase one optimised the body. Sadly, though we are still inching forward, the human body is now reaching the outer wall of virtuosity. All sports will tail off in speed of progress, in terms of pure physicality.

Phase two of modern sport turned to psychology. Realising how hard it is to gain an edge through physical conditioning, everyone suddenly started talking about the mind: the inner game of this, the mental game of that. However, reconfiguring the mental approach of elite athletes – already in their twenties and thirties, with deeply ingrained habits and highly evolved psychological software – is also exceptionally difficult. That is why many top athletes recoil from conventional “sports psychology”; the discipline is oversold and under-sceptical.

We are now entering phase three: the whole person. Sustained high achievement relies on something much deeper than a few sessions with a sports psychologist. So you need the right people in the room.

Coaches in future will be numerate and intellectually unthreatened by the scientific advances that illuminate sport. But the best coaches will never lose sight of a parallel truth: that although science can help us to understand what happens on the sports field, and sometimes how to do it better, it cannot conveniently convert athletes into inert particles, as though it were a ­physical science. Coaching can benefit from ­science but remains an art – one that revolves around understanding and helping people.

In most sports, players and coaches are really in the business of decision-making. The winning team, as Pep Guardiola says, makes more good decisions. Sport, in other words, advances when it trains people to make better decisions. There are now highly evolved analytical techniques for understanding how those decisions influence results. However, the athletes themselves are still people, imperfect and imperfectible. If you want machines, you get dummies.

This month, I was asked to found a new institute of advanced sports studies at the University of Buckingham. The mission is to create undergraduate and postgraduate courses that attend to the entire mindset – critical thinking, ethics and leadership, as well as data analytics and sports science: a kind of “PPE of sport”. After a misleading triple fissure – character, body, mind – sport is starting to put the pieces back together again. That’s why, this month, I’m rooting for Epstein’s Cubs.

Ed Smith is a journalist and author, most recently of Luck. He is a former professional cricketer and played for both Middlesex and England.

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood