WIDLIMS podcast ep #8 – Dairy: to ditch or not to ditch?

In this week's solo podcast episode, host and final year medical student Linda takes you through some of the evidence surrounding dairy and health. 22 August is also World Plant Milk day, and coincided with earth overshoot day this year – a reminder to us all that planetary health is declining at an alarming rate, and that we must all care for our home on this Earth. This concise episode provides an overview of the topic, covering...

• what is dairy, and how does it impact human health?
• what are some known risks of dairy consumption?
• if we don’t consume dairy products – are we not risking calcium deficiency and brittle bones?
• concerns about ditching dairy: about being restrictive and triggering eating disorders, lack of accessibility, taste preferences and touching upon risks of South Asians and cultural aspects of dairy consumption.

Please note that this is really just a brief overview: I was hesitant to make this at first, as it barely touches the surface, but I hope that if you are interested in more, you take some time to check out the article I have written below as well as the linked resources throughout the post.

Happy listening!

Mentioned in the episode

Dr Shireen Kassam’s article HERE.

NEJM paper HERE – please note institutional access is needed – if you really want to access this paper (I recommend it!), get in touch with me and I can email it to you.

World plant milk day website HERE

government guidelines – dairy no longer essential, for example in Canada guidelines – interesting read HERE.

dairy and fracture risk HERE.

why we should show soya more love – and have no fear. HERE.

calcium sources that are not dairy/fortified plant alternatives. HERE.

vegetarian vs vegan diets in India. read more below in this post or HERE.

What is dairy?

Dairy can be defined as products made of the milk of mammals – essentially breast milk. When we discuss dairy, we typically mean products made of cow’s milk: cheese, yogurt, ice cream, butter and so on. Cow’s milk consumption is very normalised and prevalent, although the same goes for goat and sheep products for example.

Let me just emphasise that again: dairy products are essentially breast milk. This means, they are intended for baby mammals of a certain species to consume. The purpose of breast milk, is to nourish and feed babies for months-years – and to in a rather short space of time, encourage rapid growth. Mammalian milk is adapted to that particular species. Human breast milk is optimal for human babies. Cow’s milk is optimal for calves. In medical school, our paediatric textbook clearly stated that cow’s milk is not suitable for small children, but can be introduced at a later age (not a necessity). In the words of Dr Michael Klaper:

The purpose of cow’s milk is to turn a 65-pound calf into a 700-pound cow as rapidly as possible. Cow’s milk IS baby calf growth fluid. No matter what you do to it, that is what the stuff is. Everything in that white liquid — the hormones, the lipids, the proteins, the sodium, the growth factors like IGF-I — are all there to start that calf growing into a great big cow, or else they would not be there.

Dr Michael Klaper. Read more here.

This thought-provoking ‘social experiment’ shows how we are very willing to drink the breast milk of cows, but disgusted by the breast milk of a dog for example (but no fear, there was no dog or cow’s milk consumed in the making of this video).

So… why should we consider telling patients (and anyone else, really) to ditch dairy?

Non-health related reasons to ditch dairy

This podcast is focused on health, but let us remember that health is not solely about individuals’ physical health. Without a healthy planet with thriving eco systems, can anyone be healthy? The answer is no – and dairy is unsustainable, contributing negatively to climate change. Read more here:

• Straightforward BBC article comparing sustainability of cow’s milk and different plant milks. READ HERE.
• Slightly more comprehensive but great read by the Guardian on plant milks’ sustainability, crowning oat as the most sustainable option. READ HERE.
• Soy milk is environmentally friendly: rebuttal to false claims. READ HERE.

Apart from that, the dairy industry is unkind to our fellow creatures. Cows are freaking beautiful, and very cute and clever animals. There can be no such thing as ‘humane’ cow’s milk, because the very production of cow’s milk for human consumption involves exploitation and disruption of nature.

• What those ‘humane’ milk labels really mean. READ HERE.

Health-related reasons to ditch dairy

Dairy consumption has been linked to many disease processes, and development of conditions ranging from prostate cancer to asthma. There honestly is so much evidence out there, and I would struggle to summarise it all here. Instead, let me link some further reading. If you are short on time, definitely start by checking out this short but concise article by Dr Shireen Kassam, consultant haematologist and director of Plant-Based Health Professionals UK. There also is heaps more information collected on the World Plant Milk Day website, which you may find and click through at your own leisure here.

• swapping cow’s milk for soya milk reduces breast cancer risks. reference. consuming dairy may increase breast cancer mortality. reference.
• dairy consumption has been linked to asthma. reference.
• dairy stimulates insulin-like actions in the body, promoting metabolic syndrome and type 2 diabetes – meaning whole food plant-based diets are protective references 1, 2, 3. dairy consumption has even been explored as a risk factor for the initial autoimmune trigger in the development of type 1 diabetes – Mastering Diabetes has more information on this. more on milk & autoimmune triggers. More on ‘Western diet’ and autoimmune diseases here.
• dairy consumption has been linked to intestinal inflammation and the development of inflammatory bowel disease (IBD). reference (Dr Alan Desmond (UK-based) and Dr Will Bulsiewicz (US-based) do excellent work on gut health)
• dairy consumption has also been linked to increased risk of developing acne. reference reference 2 reference 3
• dairy is best avoided to protect against cognitive decline. reference. reference 2

There is a lot of evidence both for and against dairy. But we must ask ourselves what the quality of the studies in question are. Were there conflicting interests (i.e. any money involved from dairy industry lobbyists and so on)?

Importantly, Willett et. al pointed out in a New England Journal of Medicine review, how what really matters is what dairy is compared to in studies. If dairy is compared to consumption of soya – it is detrimental to health outcomes. If dairy is compared to sweetened beverages, or milkshakes – of course dairy will come out favourably on top. I highly recommend reading the review (institutional access is needed) HERE.

The bottom line is that dairy almost certainly or most likely has negative impacts on our cardiovascular health (and thereby many disease processes where endothelial inflammation and damage are implicated), hormonal health, cancer risk, metabolic health, gut health, skin health and autoimmune conditions.

It is not a special health food we absolutely require.

Anything seemingly beneficial that dairy products contain, can be obtained from lower risk sources.

Concerns about dropping dairy?

Calcium together with vitamin D are required for maintaining bone strength, preventing osteoporosis and fractures as we get older. A main argument for the consumption of dairy, is usually how it is a good source of calcium. While dairy products do contain a good amount of calcium, this calcium comes at the cost of consuming saturated fat, cholesterol, antibiotics, hormones and so on (remember, cow’s milk is calorically dense baby calf growth fluid). Research has also shown that higher dairy consumption is not protective against future risk of hip fractures.

Plant milks nowadays contain the same amount of vitamin D and calcium as do cow’s milk products. The same goes for most dairy alternatives to yogurts, cheeses and so on. Fortified plant milks are nutritionally equivalent to milk in most cases, without all that cholesterol (and cholesterol and saturated fat are detrimental to heart health – it has been proven, and the more recent pro-fat claims debunked).

I would say here, though, that the best plant milk to consume, is soya milk. It has a good amount of protein (more than any other plant milk), and soya has been shown to be protective against some cancers, such as breast cancer and prostate cancer. There is absolutely no reason to fear soya, and I will be sure to return to this topic in the future. It will not give you man-boobs, or cancer (which seems to be among the FAQs). Here’s a great summary of the role soya plays in health, by obgyn Nitu Bajekal.

While dairy, and fortified dairy alternatives, can produce a lot of calcium, please remember that you should be eating other sources of calcium. Dietician Brenda Davis has written a useful summary of such foods, which you can read here. Some calcium-rich foods to consume regularly include:

• leafy green vegetables, such as pak choi, broccoli and kale.
• calcium-set tofu products.
• beans and lentils.
• almonds, almond butter, sesame seeds, tahini.

Reasons not to ditch dairy?

Of course, we can always say that ‘dairy products taste nice’. Sure, but just because some people think cocaine is great, should we be encouraging that?

A bit drastic of a comparison perhaps, but we cannot use pleasure as justification. I grew up drinking more milk than water (true story from your Scandinavian gal), so trust me when I say I understand how it is possible to obtain pleasure from dairy consumption. However, it really was not hard to give up when I started using plant alternatives, and I can hands down say I do not miss it at all. Educating myself has also taken away any appeal it had.

There are alternatives to most dairy products on the market, including milks, ice creams, yogurts and cheeses. Cheese can be the hardest one, but I have found ones that I like and will turn to. I make a mean mac n’ cheese, and some tasty toasties when the craving hits me. I have written more about vegan food alternatives in my veganuary guide here, including a section on my favourite dairy alternatives in the UK and globally.

I want to remind us all to also not be culturally blind here. I have been informed about the cultural role dairy plays in for example South Asian communities. Thera are many plant-based South Asians, who I would strongly suggest you follow, such as @rohinibajekal on IG or @veganricha. One PBHP member commented on a post I had made “culturally ghee is irreplaceable but having said that Nutiva has a plant based ghee which is supposed to be very close. I am a South Indian and 85% of the Tamil lacto-vegetarian diet is inherently vegan but the 15% includes all the desserts and yoghurt based dishes. Replicating that is challenging but not impossible. Peanut curd is very close to dairy curd when mixed with rice.” which was very interesting to read. We also know that South Asians are at higher risk of cardiovascular disease and type 2 diabetes, and it would seem vegetarians are at higher risk; this might be due to the high dairy consumption – however it would be unjust to put this down purely to dairy consumption. Again, Rohini Bajekal wrote a great post about it here, and is certainly better placed than myself to comment on this.

Somebody reached out to me, concerned about how excluding a food group such as dairy would be triggering for eating disorders. And with this, I also sympathise. I think it is possible for some to not be able to transition to vegan at any point in time. However, for me, I do not feel like I am restricting anything or depriving myself. Not consuming dairy, only means that I instead consume dairy alternatives instead. I have not banned milk, yogurt, cheese and ice cream from my diet. I only have plant-based versions instead (that are equally indulgent and delicious!)

In conclusion…

Keeping a little bit of dairy is unlikely to cause harm.. but it is not a necessity. I highly recommend checking out Dr David Katz’ ‘Milk Manifesto’ here, where he goes through some of the common questions and claims. Ultimately – dairy is not needed for human health. So… why keep it in your diet?

Having said that, if you feel you would struggle to completely stop consuming dairy – nobody is forcing you! I just want you to be aware of the alternatives. If you really want some cow’s milk in your tea, but are fine to use oat milk when making your porridge, or grate some vegan cheddar on top of a pasta bake – then keep some dairy in. Replace what you can.

Are you ready?

My main motive with this episode, was to highlight to you some of the evidence and research we have access to, in terms of dairy consumption. I want you to know what risks you and your patients/clients are taking by continuing to consume dairy products. Dairy is not necessary at all for human health, and there are sooo many products on the market that are cruelty free and without health risks!

I do know that some of these can be expensive, and it is privileged to assume absolutely anyone can make the swap. I do know, however, that whoever is reading this is pretty likely to be able to make the switch most of the time, if not for good. I am a student myself, and the cheapest products I get is the unsweetened long-life soya milks from Aldi, Lidl or Tesco (all under £1).

Check out the ultimate guide to dairy alternatives here, and maybe even sign up to try 7 days without dairy here!

As always, I am super happy to chat further and answer any questions.