On a recent trip to Whole Foods, I rounded a display of quinoa macaroni, continued past a fridge stacked with local kimchee and lacto-fermented sauerkraut, ignored the child to my right who’d just shattered a bottle of sparkling matcha tea, and paused for a moment in the mouth of the dairy aisle. There before me were no fewer than 20 types of milk — the typical array of fat contents, of course, but also an entire universe removed from the cow.
Dairy and gluten have become evil twins in “elimination” diets, the holistic therapy of the moment, as people swear they feel less bloated and lethargic without them. (Not incidentally, sales of cow’s milk have essentially flattened in recent years, while nondairy alternatives, led by almond milk, are up nearly 100 percent, reaching about $2 billion in annual sales.) Best-selling authors like the integrative physician Mark Hyman maintain that, like the gluten in wheat, milk elements interact with our gut bacteria in such a way as to trigger an inflammatory response from the immune system.
But this theory, as far as gluten is concerned, has been seriously undermined: Most notable are the findings by a team of Australian researchers who suggest that at least some of the people who think they’re sensitive to gluten (and who don’t have celiac disease, the gluten-induced autoimmune disorder) really aren’t. The true culprit, they argue, may be a group of common carbohydrates lumped under the acronym fodmaps (fermentable oligo-, di-, and monosaccharides and polyols). They’re found in foods like beans, onions, and, yes, milk — lending credibility to those “dairy sensitivity” claims.
Nobody disputes that the sugar in milk, lactose, frequently causes digestive upset. As many as 15 percent of Americans seem to be genuinely lactose intolerant, and we’ll get into the why and what of it below. But for the lactose tolerant, there’s a more basic question: Should you drink milk? Or, more to the point, is it good for you?
Are You Really Lactose Intolerant?
It could be the casein talking
Joseph Hooper and Susan RinkunasWhat Happens in Your Body
As infants, healthy human beings produce an enzyme in the gut called lactase, which allows them to digest the sugar in dairy (lactose). For most of the world, the gene that controls the production of lactase begins to gradually shut down during childhood — making people what we call lactose intolerant. (Nature didn’t think it was necessary to keep the gene in the “on” position once a child was weaned from the breast.) However, when people first began dairy farming roughly 9,000 years ago, a variation of this gene was, over time, introduced into the human gene pool, most widely in Northern Europe, where drinking milk became business as usual. Descendants of these farmers inherit the gene that keeps the lactose-busting enzyme pumping for a lifetime; hence the huge disparity in rates of lactose intolerance in the U.S. by racial/ethnic group. For those who can’t handle the lactose, consuming unfermented dairy products, especially milk, causes those nasty if non-life-threatening symptoms — gas, bloating, constipation, diarrhea.
How Does Lactaid Actually Work?
Milk for people who can’t drink milk, Lactaid adds the lactase enzyme to cow’s milk to help neutralize the (gas-and-diarrhea-producing) effects of lactose. However, lactase has never been formally evaluated by the FDA — which, in fact, recommends consulting a doctor before ingesting it.
How to Get Diagnosed.
“The hydrogen breath test is a very accurate way to find out if you’re lactose intolerant,” says Dr. Sheila E. Crowe, director of gastroenterology research at the UC San Diego School of Medicine and vice-president of the American Gastroenterological Association. For people who are unable to degrade the lactose by the time it gets to their colon, this simple breath test at the doctor’s office will show a rise in the levels of hydrogen, which is being expelled as a result of their lactose intolerance.
Or Diagnose Yourself.
But there’s an even easier, cheaper way to do this at home, notes Crowe. “Drink a glass of skim milk on an empty stomach. If within a couple hours of drinking it you don’t have any GI symptoms — bloating, cramping, gas, diarrhea — you probably aren’t lactose intolerant.”
Who’s Hurting
*Data compiled from various scientific sources.
**Less common in those with Northern European ancestry, more common in those with Jewish, Arab, Italian, or Greek ancestry.
And what might be the other reasons for your milk-induced discomfort?
1.
A Milk Allergy
This is when your immune system thinks the two main proteins in milk, beta-lactoglobulin and casein, are harmful and will trigger an allergic reaction. Infants and kids can experience rashes, hives, and asthmalike wheezing as well as a range of GI symptoms. If you suspect your child has a milk allergy, he or she should be seen by an allergist for testing. If it’s confirmed, you’ll be told not to feed your child any dairy products. Most kids outgrow it by their teens.
2.
Dairy-Fat Sensitivity
People with irritable-bowel syndrome and other FGIDs (functional gastrointestinal disorders) like functional dyspepsia are sometimes sensitive to fat, especially animal fat. They experience symptoms similar to lactose intolerance, but really they’re reacting to the fat in milk, triacylglycerol. Switching to skim milk and other low-fat dairy products can help.
3.
Eosinophilic Esophagitis
This is an allergic disorder recognized only in the past 15 years — and found in an estimated 50 in 100,000 people, both young children and adults — that affects just the esophagus. People can be allergic to milk, wheat, soy, or eggs, and instead of having an acute response with classic allergic symptoms, their esophagus will become inflamed and narrower over time. Symptoms include difficulty swallowing, heartburn, and food getting stuck when you swallow. If your gastroenterologist determines that milk is your offending food, you’ll need to eliminate it.
What’s Causing Your Milk-Induced Stomachache?
by Susan RinkunasIt could be lactose intolerance — or a problem with your esophagus. Here, a flow chart to help find the root of your post-dairy discomfort.
What’s your primary complaint after eating dairy?
What kinds of dairy cause your intestinal chaos?
Can you drink a glass of skim milk without making your stomach upset?
Do you have irritable bowel syndrome or another functional gastrointestinal disorder?
Lactose intolerance
It sounds like you have lactose intolerance, which is extremely common. You could have a gastroenterologist test you for it or avoid cow’s milk and soft cheeses, or just take a lactase enzyme pill before eating them. You should be able to tolerate yogurt, kefir, and hard or aged cheeses since the lactose in those has already been broken down.
Dairy-fat sensitivity
People with irritable bowel syndrome and other functional gastrointestinal disorders (FGIDs) can be sensitive to the fat in dairy, known as triacylglycerol. They’ll experience symptoms similar to lactose intolerance, but not after drinking skim milk or eating low-fat cheese.
Eosinophilic esophagitis
You might have an allergic disorder that affects the esophagus. Allergies to milk, wheat, soy, or eggs or even seasonal allergens could inflame the esophagus and cause it to narrow, making swallowing harder. A gastroenterologist can help determine the cause.
Unclear
Maybe you just ate too much! ¯\_(ツ)_/¯
Timing
What Milk for What Age
by Melissa DahlThere’s little evidence that anyone other than babies actually needs milk (if one is getting key nutrients elsewhere), but the latest research helps make a case for some choices over others.
A Baby: Breast milk (but formula works, too)
There’s little evidence that anyone other than babies actually needs milk (if one is getting key nutrients elsewhere), but the latest research helps make a case for some choices over others.
A Kid: Whole milk
It’s easier to say the kind of milk that may be worst for kids: nonfat. One recent study published in the BMJ tracked preschool-age kids for two years; those who drank skim were more likely to be heavier by age 4 than the kids who drank whole, possibly because the fat keeps you fuller, staving off overeating later.
A Teenager: Whole milk
Similarly, research on early adolescents — up to age 14 — has shown a link to reduced-fat or skim-milk consumption and weight gain. Again, the easiest way to describe the best milk for teens might be to describe the worst: reduced or skim milk.
Adult Male: Whole milk
One study of middle-aged men in Sweden found that those who regularly ate high-fat dairy products were less likely to become obese than men who ate high-fat dairy products less often or who didn’t eat them at all. Another recent meta-analysis found a lower risk of obesity for adults who ate lots of high-fat dairy products.
Adult Female: Fermented milk products like kefir
A study that followed more than 60,000 women for 20 years, published in the BMJ, found that women who consumed fermented milk products were less likely to suffer bone fractures over the course of the study than women who did not consume fermented milk products.
A Woman Trying to Conceive: Whole milk
Here is one instance where it would seem that dairy is actually good for you. According to a big study published in 2007 in the journal Human Reproduction, groups that had one serving of full-fat dairy (like whole milk) per day, compared with those who had very little, reduced their risk of fertility problems by more than 25 percent.
A Retiree: No more than one glass a day
A study published in the BMJ last fall found an association between higher milk consumption and greater risk for fractures, especially hip fractures, and death, possibly owing to the high presence of inflammatory sugars in milk. In your AARP years, drink cow’s milk in moderation or switch to nondairy milk fortified with vitamin D and calcium.
The Evidence For and Against the Major Milks
Whole, skim, almond, soy: the prevailing arguments.
By Melissa Dahl
1. Whole Milk
For: It may be high in (still controversial) saturated fat, but whole milk is also 40 percent unsaturated fat, which has been shown to improve blood cholesterol levels (thereby reducing the risk of heart disease). And whole milk keeps you feeling full longer than milk with less fat, which some recent studies suggest may help keep off the pounds. The weight control may also be due to “bioactive substances” found in milk fat, which changes the way our metabolism functions, allowing us to burn that fat for energy instead of storing it in our bodies.
Against: Whole milk has more calories — 150 per eight-ounce glass, compared with the 90 in skim. And if you’re still not convinced that saturated fat is okay, there’s that too.
2. Almond
For: It’s among the least caloric of all the milk options, even lighter than skim. Like most nondairy milks, almond milk — a purée of almonds and water — does not naturally contain as much calcium, protein, or vitamins D and A as milk. But if it’s fortified with this stuff, it can have similar nutritional benefits to those of cow’s milk.
Against: Almond milk often contains carrageenan, a food additive that’s derived from seaweed and is used as a thickener in foods. There’s some evidence that carrageenan can cause bloating and other gastrointestinal problems. Plus there’s the environmental issue: It takes 1.1 gallons of water to grow just one almond.
3. Skim
For: It’s fat-free. Even though some recent science shows saturated fat is not as harmful as we once thought it was, there’s no evidence yet to suggest that saturated fat is a health food. And if you’re a calorie counter, skim has fewer than regular milk.
Against: It’s less tasty and less filling. “We know that fat-free milk is inherently less satiating,” says Dr. David Ludwig, a professor of nutrition
at the Harvard School of Public Health. “You’re likely, after that glass of fat-free milk, to drink [or eat] something else, and that is typically processed carbohydrates.”
4. Soy
For: Nutritionally speaking, soy is the closest comparable nondairy option to whole milk, with about eight grams of protein per cup. It’s also low glycemic: the carbohydrates in unsweetened soy milk are the kinds that are very slowly digested in the body, which helps control hunger. But unlike whole milk, it’s very low in fat.
Against: Soy contains phytoestrogen, a plant-derived estrogenlike compound, which some studies have indicated promote the growth of breast-cancer cells, though other studies have disputed this. And there’s a chance that soy milk might cause more cavities than cow’s milk. Also, most soybeans grown in the U.S. are genetically modified, the long-terms effects of which are uncertain.
And How to Decipher the Alterna-Milks
Whatever your bodily wish — gut health, a little more omega-3 — there’s a kefir or nondairy beverage jostling for your attention at the specialty grocer’s.
By Katie Arnold-Ratliff
1. LiLi Pasteurized
Low-input, low-impact is a process that involves heating milk to a higher temperature and for a shorter time. So while this isn’t raw, it’s the closest you can legally get to milk in its purest form. Ole’ Mother Hubbert, of Westtown, New York, was the first American dairy to purchase a LiLi machine, in 2013.
2. Oat
The draw is the benefits of oats, like better heart health and blood-sugar levels. While a gallon at the store costs about the equivalent of three lattes, it’s also fairly easy to make at home if you’ve got oats, water, maple syrup, vanilla extract, sea salt, and five minutes (plus soaking time) to spare.
3. Hemp
Exceptionally high in nutrients, hemp milk contains folic acid, B-12, phosphorus, magnesium, zinc, and omega-3 and -6 (in addition to the usual cocktail of iron, calcium, and vitamins A and D). And, take it or leave it, Dr. Oz has said it’s his favorite alternative milk.
4. Grassmilk
Whole milk from grass-fed cows is Michael Pollan’s choice (“Fat is not the evil nutrient we thought it was,” he notes), and his preferred brand is Organic Valley. “Most cows don’t get much grass anymore,” he says, “but it does a lot for the taste, and Organic Valley insists that its farmers graze.”
5. Goat
The ubiquity of cow’s milk is an American anomaly. Owing mainly to the fact that they’re cheaper to raise, goats produce the most-consumed milk worldwide; their milk is also usually easier to digest than that of cows because it has less lactose. (Just be warned: Goat’s milk can cost a lot more than cow’s at your nearest Whole Foods.)
6. Kefir
Kefir, the kombucha of milk, is a tart drink made by fermenting milk with bacteria and yeast. It’s loaded with probiotics (three times more than yogurt, in fact), which are good for the gut.
7. Coconut
Paleo gurus tend to forbid any kind of milk (including nut milks) except coconut — so long as it doesn’t have additives and preservatives — and prefer non-refrigerator-aisle brands like Aroy-D from Thailand. This type also contains MCTs (medium chain triglycerides) that are easily metabolized and burned for energy.
8. Dry Milk
This became the hot baking ingredient when it was revealed to be part of the recipes for Milk Bar’s cookies. As for her preferred brand, says Christina Tosi, founder and owner of Milk Bar, “Redi Lac has the perfect balance and depth of flavor, while the granules are still large and soluble enough to hold shape for our ‘Milk Crumbs.’ ”
9. Cashew
Nutritionally similar to almond milk but a lot creamier and sweeter. Also, from an environmental standpoint, you’d be saving a few almonds. Darleen Scherer, owner of the forthcoming Bushwick café Supercrown, has a recipe to make it at home so you get none of the additives of the store-bought brands: Combine 1 1/2 cups raw cashews, 1/3 cup pitted dates, and 1/4 teaspoon of sea salt in a large lidded container. Add four cups of filtered warm water, cover, and let soak at room temperature for at least 12 hours. Using a blender set to the highest speed, mix for 3 to 4 minutes or until smooth and creamy. Strain the mixture through a cloth napkin, squeezing until only solids remain, and enjoy.
Get Ready for Peanut Milk
This year, a century after the first patent was filed, a commercial peanut milk is finally in the works. Bob Parker, president and CEO of the National Peanut Board, has confirmed that the group has been quietly working with an undisclosed industry partner on a peanut milk set to be released as soon as next year. So what took so long? For decades, the major issues scientists faced were mouthfeel and overpowering peanut flavor. But if the forthcoming milk has overcome taste and texture (the product is based on a new formula patented in 2010), there is one barrier today that no amount of stabilizers could fix: allergies. Kaitlin Walter, director of marketing for alt-milk brand Califia Farms, cited the “peanut-free table” as a reason the company hasn’t developed a peanut milk to join its almond varietals. The secrecy surrounding the Peanut Board’s project suggests some touchiness on the part of the industry, which has ceded the peanut’s comfy spot as “America’s Favorite Nut” to almonds and seems none too pleased about it. For what it’s worth, Parker promises his peanut milk won’t taste anything like peanut butter. By Belle Cushing
Was milk a simpler nutritional proposition in this country in the days before industrialized farming? Not exactly. Settlers brought the first dairy cows to North America in the early 1600s, and while milk was regarded as a useful source of fuel, milk-borne pathogens like listeria had laid people low before pasteurization became routine in the 1920s. After vitamin D was added to cow’s milk in the ’30s, the beverage became a one-stop-shopping solution for healthy bone growth and the vitamin-deficiency disease rickets. “Our relationship to dairy was one of reverence,” says Dr. David Katz, the director of Yale’s Prevention Research Center.
And naturally, the dairy industry has wanted to maintain that relationship. (Think of the “Milk. It does a body good” commercials.) But as it turns out — and here’s a recent development where there does seem to be some consensus — regardless of what you learned growing up, you don’t need milk (or any dairy) to enjoy a healthy diet after the age of 2. Authorities like Katz and Willett — and indeed most nutrition scientists, even those whose research is subsidized by the still-powerful National Dairy Council — agree that you can get enough calcium and potassium by eating whole grains and leafy green cruciferous vegetables like kale, arugula, and broccoli. (Of course, for families in neighborhoods with inadequate supermarkets, milk might be the easier choice.) Two recent studies published in the BMJ show no connection between calcium consumption and bone breaks in those over 50. Plus, there are the environmental implications: all the methane emissions and water consumption associated with raising enough livestock for people to consume the USDA-recommended three glasses of milk a day. If we actually followed those current “MyPlate” standards, we’d be doubling dairy consumption in the U.S.— what Willett calls a “radical” position.
Ultimately, then, milk is a consumer product, not a medicine. Many of us have no intention of giving up more modest amounts of the stuff that goes so well with coffee, or a bowl of Cheerios, or a superfood smoothie — because we enjoy it. In which case, perhaps the sensible approach to the modern dairy aisle is with your specific needs — and wants — in mind. Each type of milk competing for your attention offers an experience, a health claim, and a projected lifestyle all its own. People going Paleo can turn to additive-free coconut milk. Some might like the silky consistency of soy milk. Others might have taken to vanilla almond milk ever since their local third-wave coffee shop started offering it (perhaps not noticing all the extra sugars and thickening gums in the ingredients). For those of us who don’t shun dairy, there’s whole milk from grass-fed cows, which, according to Michael Pollan, might be the greatest-tasting milk of all.
By Joseph Hooper
*This article appears in the November 16, 2015 issue of New York Magazine.