Q+A with Alissa Hamilton

 

AL: You share the origin story of the book: A friend asking your nutrition parenting advice and whether she should feel bad she wasn’t giving her son milk. What’s your friend’s response to the book?

AH: Funny you should ask. I’m just back from Amsterdam, where my friend Maxine lives. I was there doing interviews for the Dutch translation of Got Milked? Coincidentally the Netherlands, home of all matter bovine, was the first foreign country to buy the rights to the book. While there I got to spend time with Maxine and her family. Her firstborn Oscar, who was the one she was worried about when she was visiting me back in 2012, is five now. While I witnessed Oscar’s love of broccoli when he was visiting me, this time he had the words to tell me that broccoli is his favorite vegetable. He and his younger brother, Tobias, who is almost three years old now, are both clearly thriving, and neither of them drink milk.

You’d have to ask Maxine, but I think she’s excited about the book, which is dedicated to Oscar. She is relieved to know she is not a bad parent for not giving her boys milk, and happy that her question has sparked research that others can benefit from. Just the other day my friend Ina, grandmother to toddler Alex, asked me: “Guess what Alex’s favorite food is?” Ina wasn’t asking me to guess Alex’s favorite vegetable but rather her favorite food, so I didn’t expect the answer: “Broccoli.”

It’s amazing, given the opportunity and a bit of encouragement, the good stuff kids will fill up on if they don’t start lunch with a glass of chocolate milk.

 

AL: A few years ago, a friend shared the experience of working in a summer camp in upstate New York for kids from the city. The children in her camp were nearly 100 percent black or Hispanic – and nearly all lactose-intolerant. She struggled daily, because the camp, a State program, was required to serve milk to the kids every day. From your research, why do you think these regulations are still in place even though this intolerance to lactose is well known and well documented and very widespread?

AH: Your friend’s experience is consistent with the statistics. 50-80 percent of Hispanics, 60-80 percent of African Americans and Ashkenazi Jews, and nearly 100 percent of Asians and Native Americans are lactose intolerant.

While reviewing public testimony presented to the Dietary Guidelines Advisory Committee, which advises the government on what to include in the Dietary Guidelines for Americans, a new edition of which will be released in 2015, I was struck by the comments of Dr. Milton Mills, director of the Gilead Medical Group in Annandale, Virginia. After calling attention to the prevalence of lactose intolerance among populations of color, he stated: “For the Committee to continue to encourage the consumption of foods that will necessarily make these people sick is a form of institutionalized government sponsored racism.”

Why does the government persist with its milk kick in the face of what we know about the incidence of lactose intolerance? I don’t have a satisfying explanation. It’s one of the unfortunate consequences of dairy recommendations that are not, and never have been, grounded in science. Ever since the USDA started telling us to drink milk it’s been getting it wrong. Back in 1916, USDA nutritionist Caroline Hunt wrote a guide, Food for Young Children, which advised children to drink a quart of milk per day. That’s four eight-ounce glasses of milk per day. Today pediatricians know that’s excessive and that children who drink that much milk risk becoming anemic. It’s a problem they’re frequently encountering in their clinics: toddlers who are iron deficient because they’re drinking upwards of three glasses per day of milk, which is low in iron and has been shown to deplete iron stores among children who are heavy milk drinkers.

 

AL: What are the recommendations?

AH: For dairy the USDA says everybody older than eight should be consuming three servings per day of low-fat or non-fat dairy products. Measured in milk, that amounts to three eight-ounce glasses per day.

For calcium, the recommendations reach up to 1300 mg per day, which is more than double the World Health Organization’s minimum recommendation of 500 mg per day. According to the nutrition facts on the back of the bag of soybean sprouts I have in front of me, that’s only slightly more than the 460 mg of calcium in one cup of the sprouts.

Neither the dairy nor the calcium recommendations are evidence-based.

Milk is high in calcium and calcium is essential for healthy bone development, but so are many other nutrients that don’t get the same spotlight, namely magnesium and vitamin K. We’re told to get these other nutrients from a variety of sources. Not so when it comes to calcium. The dairy food group is set up so we get virtually all of our calcium from one food: cow’s milk. It therefore creates a hierarchy of foods and nutrients, with milk and calcium at the pinnacle.

Pumpkin seeds are high in magnesium, which is an essential mineral for bone health that Americans tend to be low in. But we don’t have a pumpkin seeds food group. The analogy underscores our irrational fixation on milk and calcium for strong bones.

 

AL: I think a lot of people will be surprised by the rates of lactose intolerance you describe in the book – except those who are, of course. Can you talk briefly about why so many people are lactose intolerant?

AH: Lactose intolerance is a misnomer. The term suggests it’s a disease that needs treating. However, those who can digest the lactose in milk as adults are the unusual ones. They are among a minority who have inherited a genetic mutation that enables them to continue to produce lactase, the enzyme that breaks down the lactose in milk, beyond the years when we really need it: when we’re breastfeeding. Properly speaking this minority, the descendants of a small group of dairy farmers mostly of northern European origin, are lactase persistent. The rest of us are normal, or lactase impersistent.

 

AL: You describe the disturbing recommendations of lacing milk with sugar – or chocolate – to get kids to drink it. You mentioned examples of government nutrition recommendations. Can you talk more about this and why you find it so troubling?

AH: The USDA advises parents of children who are lactose intolerant to try giving their child chocolate milk. Chocolate milk has the same amount of lactose as plain milk. The only difference is their child might like it, only to feel sick later.

More broadly, school cafeterias have removed soft drinks from the line-up but are allowed and encouraged by government-funded school meal programs to dole out flavored milk, which ounce for ounce contains almost the same amount of sugar as soda. While eight ounces of chocolate milk contains 25 grams of sugar, or the equivalent of over six teaspoons of sugar, the same amount of Coca-Cola contains 26 grams of sugar. So we’re taking sugar out of schools by the can and, with government backing, pouring it back in by the carton.

 

AL: You talk in the book about how the dairy industry frames milk as the best way to get calcium. Can you talk about that?

AH: The dairy industry repeatedly says that milk is the most palatable and convenient source of calcium. But consumption trends are showing otherwise. Sales of milk are plummeting.

Brazil’s Ministry of Health has a released a more sensible food guide than one that relies on single foods to deliver single nutrients. Theirs divides foods according to how heavily processed they are. The take-home is: opt for minimally processed foods, limit consumption of processed ones, and avoid ultra-processed products. What’s more, it cautions consumers to be wary of advertising. So whereas here the government, by promoting lucrative but not necessarily healthy agricultural commodities, is part of the problem, there the government is part of the solution.

 

AL: What are nutrients that you miss out most in not drinking milk or eating cheese and the best places to get those nutrients?

AH: The short answer is none. Not even the dairy industry disputes the fact that nobody needs dairy to get all the nutrients we need for health and wellness.

I would flip the question and ask not what you’re missing without dairy but what you’re getting from a diet built on a wide assortment of whole foods. Take turnip greens. One cup cooked contains:

• 662 percent of the DV for vitamin K;
• 220 percent of the DV for vitamin A;
• 66 percent of the DV for vitamin C;
• 42 percent of the DV for folate;
• 25 percent of the DV for manganese;
• 20 percent of the DV for calcium and fiber;
• 18 percent of the DV for copper;
• 14 percent of the DV for vitamin E;
• and 13 percent of the DV for vitamin B6.

Adding it all up, they’re a great or good source of ten essential nutrients. Yet we don’t ask what nutrients we miss out on if we don’t eat turnip greens. I doubt George H.W. Bush, the Bush who banned broccoli on Air Force One in 1990, loses sleep over the nutrients he’s missing because he doesn’t eat broccoli. We know these nutrients exist in a variety of foods. The same goes for the nutrients found in dairy products.

The dairy industry markets milk as being high in eight essential nutrients in addition to calcium. In chapter six, “Overrated,” I go through each of these nutrients to show why milk is not necessarily the best nor the only source of any of them. For instance, we’re told to drink low-fat milk because it’s a great source of vitamin D. But milk is fortified with vitamin D, which is fat-soluble. You’ve got to wonder whether low-fat or non-fat milk products are the best delivery vehicles for any fat-soluble nutrients, including vitamin A, which is also added back to milk and is on the National Dairy Council’s short list of milk’s essential nutrients. Fatty fish, which is naturally high in vitamin D, is one example of a good food source of this nutrient. The Netherlands gets it. I learned from the Dutch translator of Got Milked? that milk is not enriched with vitamin D there.

I encourage anybody who is not convinced that a diet without dairy will not leave you wanting to check out chapter six for more examples of foods outside the dairy food group that contain an impressive complement of nutrients.

 

AL: I’m a huge fan of organic dairy producers, especially those in the cooperative dairy Organic Valley. What do you say to those who argue that milk and cheese can be a highly nutritious and environmentally sound way to get protein and calcium and other nutrients that are good for our bodies?

AH: That’s a great question. You’re a huge fan of Organic Valley and I’m a huge fan of my friend and colleague Jim Goodman, a Wisconsin dairy farmer who uses sustainable and humane practices. When Jim heard Got Milked? was the May pick for #realfoodreads he emailed me asking: “So I haven’t read the book yet, but, should I be finding a different profession?” I wrote back: “No not you!!!! If only there were more yous. But most milk these days isn’t produced by you.”

To be clear I’m not saying everybody should cut dairy from his or her diet. I am saying there are many good reasons to question why we have a dairy food group that pushes three servings per day on an entire population, the majority of which can’t digest it.

I propose we get rid of the dairy food group and move dairy products that are high in protein and low in added sugar to the protein group so they become examples of foods that we can consume rather than ones that we must consume. I’m not talking about eliminating dairy as an option but as a requirement.

 

AL: Let’s talk about dairy and sustainability.

AH: This is another critical issue I discuss in the book. As you probably know, the Dietary Guidelines Advisory Committee just released its lengthy report stressing the benefits of consuming less beef, in part because we can’t sustainably eat the amount of beef we do. Yet, while one of the key steps in the Climate Action Plan that the Obama administration released in 2014 is to reduce the levels of green house gases that US dairy sector emits, we don’t hear about the need to reduce our dairy consumption. In the US, the dairy operations that are growing in number aren’t the small farms like the one that Jim Goodman runs, but the ones with 1,000 cows or more. When you consider that 200 milking cows produce as much nitrogen as the sewage of a small community, it’s not surprising that the largest dairy producing states such as Wisconsin and California are experiencing serious groundwater contamination issues due to the nitrates from dairy cow manure that are leaching into the water supply. It’s clear that we have neither reason nor the infinite resources to feed all of America three servings of dairy per day.

 

AL: What was the most interesting part of the research process for you? What surprised you the most?

AH: Researching Got Milked? has given me a whole new perspective on the relationship between diet and health. Pre-book I had bought into the USDA’s portrayal of foods as nutrient dispensers. The USDA tells us to drink milk for calcium, eat meat for protein, and consume plenty of fruits and vegetables for fiber. You’ve seen and read MyPlate’s script.

Since I was never a heavy dairy consumer I thought I better supplement my diet with calcium pills. Now I realize that as long as I continue to eat my greens, beans, and seeds, seasoned with a generous assortment of dried and fresh herbs and spices, I don’t need to worry about calcium. The shift in my thinking is fundamental. In the book I highlight the many nutrients in individual foods only to emphasize the brilliance of whole foods, which are, more than packages of nutrients, packages of nutrition, and of course pleasure.

Surprises? There are so many eye-openers. I already mentioned the fact that so many of the dietary recommendations that we rely on are not evidence based. I will add two more.

First, I am amazed at how easily and widely false claims about milk’s nutrients have spread. For instance, the National Dairy Council, regional dairy organizations, and some milk brands boast that a cup of milk contains ten percent of the DV for niacin. When I crunched the numbers I discovered that a cup of milk contains one, NOT ten, percent of the DV for niacin. Evidently we can’t even trust the FDA-regulated nutrition “facts” label on milk cartons to tell us the truth about milk.

Second, the extent to which Asian countries such as China, Vietnam and Thailand—where historically dairy has not been a staple—are embracing milk as essential to growing tall and strong is alarming, especially considering that the large majority of Asians is lactose intolerant.

 

AL: I like to ask authors about their process, the brass tacks of writing. What was your research process and in particular what did you find most helpful in the process?

AH: Bookmarks bookmarks bookmarks. I wrote the book without a printer thanks to my browser’s bookmarks feature. I have one folder, “milked,” that is like a giant Russian doll: it contains over 40 folders, each of which opens onto articles and more folders. For example, under “milked” there’s a folder, “protein,” and within that folder, a folder called “chocolate milk,” which catalogs the many articles that have been written about the latest claim that chocolate milk is a great source of protein and an ideal recovery drink for athletes.

I can’t tell you the number of articles I have nested within my “milked” folder. Zillions. While writing the book my computer crashed twice. I worried most about whether I’d be able to recover my bookmarks folders. Thankfully, I didn’t lose a single one.

 

AL: What’s been the response from the dairy industry to this book? How do you respond to critics that will paint you as a vegan evangelist?

AH: I’m not a vegan. There’s a recipe in the book for a frittata and another for herbed salmon amaranth burgers. Okay, amaranth’s part of the burger mix, but that’s a sign of my love of experimenting with all things plants. It doesn’t make me a vegan.

Nor am I an anti-dairy evangelist. I had yogurt for breakfast in Amsterdam.

My aim from day one has been to provide a resource for people like my friend Maxine so she can make her own decisions as to what’s best for her and her family. To the ire of some dairy enthusiasts, that means including credible evidence that challenges some of the virtues that have long been linked to milk. While some say the book is biased, I say it restores balance to the messaging about the wonders of milk that for years has been coming at us from all sides—from industry, from government, from health care providers.

The most frustrating reaction to the book has been from those who take my words out of context and distort the book’s premise, which is indisputable and therefore should not be controversial: milk is not an essential part of a healthy diet.

Now when I become discouraged that I’m being misunderstood, I remember what my artist friend wisely emailed me after one particularly hostile encounter: “You know whenever you put yourself out in the world people are bound to misinterpret what you are doing or saying. As an artist, writer, or anything else the best we can do is be as clear as possible, but there is still bound to be negative reaction and it is only in how we deal with that reaction that there is any control.”

Amen.