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Could low-fat be worse for you than whole milk?
Despite our common perceptions about low-fat milk, an increasing body of evidence seems to indicate that whole milk could be a healthier choice
As Secretary of Agriculture Tom Vilsack testified before the House Agriculture Committee this week on the upcoming 2015 Dietary Guidelines, a debate inside and outside the Capitol continues about whether the dietary benefits of low-fat milk are as significant as they have been portrayed by both major health organizations and the dairy industry. The guidelines, which are updated every five years and will be released later this calendar year by the Department of Health and Human Services and Department of Agriculture (USDA), are expected to tout vegetables, fruits, whole grains, legumes, nuts, seafood and “low- or non-fat dairy” as part of a “healthy dietary pattern”, according to an advisory report released in advance of this year’s full guidelines.
But there is little evidence that low-fat milk is a healthier dietary choice. In fact, an increasing body of evidence seems to indicate that whole fat milk could be a better choice.
Skim, low-fat and whole milks are all processed similarly in the US. The cream is separated from the whey and then added back in – or not in the case of skim milk. Low-fat milks may contain 1% or 2% fat, while whole milk contains 3.25% fat. Cup for cup, whole fat milk contains fewer carbohydrates than low-fat or skim because more of its volume is made up of fat, which does not contain lactose. It also has slightly less protein.
Several prominent nutrition researchers, including Walter Willett, who is known for his ongoing, long term health studies, and David Ludwig, who like Willett teaches at the Harvard School of Public Health, have been questioning dietary guidelines that promote low-fat and skim milk over whole milk. Often, flavorings such as chocolate and strawberry and sugars are added to low-fat and skim milk to make up for the loss of taste when the fat is removed. In those cases, the sugar content can increase by as much as 14g per cup. Studies are increasingly indicating that sugar can lead to heart disease and other health problems, even in individuals who are not overweight.
Other nutrition experts see skim milk as a less attractive option because it does not have as desirable a balance of fat to sugar to protein. “I don’t know anyone who would recommend skim,” said Suzanne Rostler, a registered dietician and co-author with Ludwig of Ending the Food Fight.
Lower fat milks gained in popularity beginning in the 1960s because of the move against saturated fats, which were believed to lead to weight gain and because saturated fat raised LDL, and LDL was tied to heart disease, according to Robert Lustig, Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco and author of Fat Chance: Beating the Odds Against Sugar, Processed Foods, Obesity, and Disease. “These two facts started the skim milk craze,” he said in an email.
Between 1975 and 2014, sales of whole fat milk have decreased by nearly 61%, while sales of 2% milk have increased nearly 106%. Sales of 1% and skim milk have increased by around 170% and 156%, respectively, according to data from the USDA.
But subsequent research has shown that because fat is more satiating, or filling, eating some higher fat foods can lead to lower calorie intake overall. Cow’s milk, including whole milk, also does not cause a significant insulin response, which is what leads to weight gain, according to Lustig. It also turns out that saturated fats in dairy can protect against certain diseases and are not associated with heart disease, as previously thought. “In any case, the entire dairy/saturated fat hypothesis has been completely debunked,” Lustig said. (See: American Journal of Clinical Nutrition and Annals of Internal Medicine.)
Lorrene Ritchie, Director of the Nutrition Policy Institute, a research organization, said by email that she believes low-fat or skim milk is still preferable to whole milk because liquid calories are not as filling as equivalent calories from solid foods and nationwide, the goal for most people should be to reduce calorie intake. “Until we decrease calorie intake on a population level, we are unlikely to see much reversal in the obesity epidemic,” she said.
However, several recent studies in the European Journal of Nutrition and Scandinavian Journal of Primary Health Care have shown that consumption of high-fat dairy foods are inversely associated with obesity.
A September report from the Credit Suisse Research Institute describes fat itself as “The New Health Paradigm”, and predicts that fat intake will grow to 31% of calorie intake from 26% by 2030, with saturated fat growing the fastest. In terms of dairy and its effect on cardiovascular disease (CVD), the report states: “Out of 18 studies published between 2010 and 2013, eight suggest that dairy lowers CVD risk, nine suggest no effect and only one points to a slight risk linked to dairy consumption.”
Consumers may decide what type of milk is best for them personally based on their preferred balance of calories to fat to protein to carbohydrates specific to their health history and their genetics. Either way, no one should be drinking enough milk for the type of that milk to make much of a difference on his or her health overall.
“In nutrition, there are no absolutes, only relative statements in the context of everything else someone eats,” said Marion Nestle, a professor of nutrition at New York University and author of What to Eat, and Food Politics.
“I don’t think the kind of milk or milk at all matters if the overall diet is reasonable. Everything in moderation.”
