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Do you recommend dairy products made from low-fat versus whole milk? If so, what are your reasons?

Yes, as a general rule, we favor low-fat dairy products rather than products made from whole milk. We also recognize the surprising number of controversial issues that surround this basic decision about dairy products. Because we support the role of natural, whole, minimally processed foods in a diet, we believe it is especially important to be clear about our general preference for low-fat versus whole-milk dairy products. At a simple glance, all whole-milk dairy products might seem more natural and less processed than any low-fat alternatives and better choices for that reason. Yet, we do not believe they make better choices for most individuals, given the current nature of the U.S. diet and commercial milk preparation.

Calories, Fat, and Saturated Fat

The average U.S. diet features 2,157 calories, 34% fat, and 12% saturated fat. That's too many calories, too much fat, and too much saturated fat according to the American Heart Association (AHA) in its heart disease prevention recommendations and the National Academy of Sciences in their Dietary Reference Intakes. Those facts make it difficult for us to give a blanket endorsement to whole-milk dairy products, when every cup of whole milk adds about 150 calories, 8 grams of fat, and 4.5 grams of saturated fat to the diet. Approximately 25% of the calories in whole milk comes from saturated fat, and the AHA goal for our daily diets is to bring our intake to under 10%. These simple facts about the fat composition of whole milk and excessive fat intake in the average U.S. diet are one key reason for our low-fat milk recommendation.

A recent study conducted by the New York Department of Health and Mental Hygiene has shown the dramatic impact that milk choices can have on intake of calories and fat. Over a 4-year period (2006-2009), the New York City Department of Education shifted it milk purchases over from whole milk and chocolate milk made from whole-milk or low-fat milk to fat-free milk (whether unflavored or chocolate). In other words, students in 5 city boroughs (Manhattan, Queens, Brooklyn, Staten Island, and the Bronx) were only able to purchase fat-free milks in school by the end of this 5 year period. As a result, the New York Department of Education ended up purchasing and serving 4.6 billion fewer calories from milk products and 422 million less grams of fat!

In fairness to whole milk and its fat composition, there are more monounsaturated fatty acids (MUFAs) and short-chain saturated fatty acids (SCFAs) in whole milk than in 2% milk, and both of these fat types are regarded as health supportive. However, there are still very small amounts of MUFAs in whole milk in comparison to other MUFA-rich foods like extra virgin olive oil. Additionally, as human beings, most of our SCFAs aren't found in the foods we eat but rather in the by-products of those foods following breakdown by bacteria in our digestive tract. So even though whole milk has some advantages in terms of MUFAs and SCFAs, we do not believe that those advantages outweigh the disadvantages of total calories, total fat, and saturated fat since these MUFAs and SCFAs are better obtained in other ways. Still, individuals who have plenty of room in their diet for calories, total fat, and saturated fat might want to consider whole milk due to its better MUFA and SCFA composition.

Conjugated Linoleic Acid (CLA)

Conjugated linoleic acid (CLA) is one further fat-related consideration in the comparison between whole and low-fat milk. CLA is a type of fat that has been shown to have some clear health benefits, and it is found in higher concentrations in whole milk than in low-fat milk. That's a plus for whole milk, and once again, individuals who have plenty of room in their diet for calories, total fat, and saturated fat might want to consider whole milk due to its better CLA composition. However, it's also important to note that the difference in CLA concentrations between whole and 2% milk, for example, is relatively small when compared to the much more sizable amounts of CLA found in many other commonly-consumed dairy products. For example, on an ounce-for-ounce basis, there is about ten times as much CLA in cheddar cheese and cream cheese as in whole milk. Because these cheeses are so high in fat, however, potential advantages of their superior CLA content may be offset by the risks posed by their unusually high fat concentration (in cheddar, the percentage fat is 74%, and in cream cheese it's 90%). It's also worth pointing out that some of the key CLA benefits in research studies have involved immune system support, and in many of these studies, a dose level of 2-3 grams of CLA per day (achieved through dietary supplements) is required to produce these immune-system results. Since whole milk only provides about 32 milligrams of CLA per cup, it would be impossible for a person to reach this 2-3 gram level from everyday consumption of whole milk.

Vitamins and Minerals

Low-fat and whole milk are similar in terms of their vitamin and mineral content. However, in the case of milk's most widely-publicized vitamin-vitamin D-there is very little of it to be found naturally in whole, unprocessed milk. In virtually all cow's milk sold in the U.S., whether that milk be whole or low-fat, vitamin D is plentiful in the milk because it has been added into the milk at the level of 100 IU per cup during processing. For this reason, all versions of milk are very similar in vitamin D content, and there is nothing more natural about whole versus low-fat milk when it comes to vitamin D.

The same is not true for vitamin A, which is naturally present in whole milk but removed during the processing of low-fat milk. For this reason, fortification of low-fat milks with vitamin A at a level of at least 300 IU per cup is a requirement in the U.S.

In terms of these two important vitamins, whole and low-fat milk are therefore very similar, even though whole milk comes by its vitamin A in a natural way, and low-fat milk does not. In the case of vitamin A, however, unlike the situation with vitamin D, there are many other World's Healthiest Food sources. Even though a relatively small number of the World's Healthiest Foods contain preformed vitamin A, many of them contain beta-carotene, a preliminary form of vitamin A that can be converted into active vitamin A inside the body. Therefore, prioritizing whole milk because of its naturally occurring vitamin A content may not be necessary in the context of a diet that contained a range of fruits, vegetables, and other World's Healthiest Foods.

Calcium-the most widely publicized mineral in milk-also exists at similar levels in whole and low-fat milk. So do most of the other minerals found in milk. In fact, for many vitamins and minerals, slightly higher levels are found in low-fat versus whole milk. The reason for low-fat milk's slight advantage is simple: since some of the fat portion of the milk has been removed in low-fat milk, there is a little more room in every cup for the watery portion of the milk that contains many vitamins and minerals. This slightly higher concentration of vitamins and minerals is another reason that low-fat milk might be advantageous in the average U.S. diet.

Milk Processing

The vast majority of milk available in the U.S. marketplace comes from large-sized milk producers who have carefully regulated production techniques that apply to all forms of milk, from whole milk to non-fat milk. From a regulatory standpoint, the standard for identity of whole milk in most states is 3.25% milk fat, even though fat concentrations up to 5% are found in some whole milks. To achieve the identity standard of exactly 3.25%, however, milk manufacturers must remove the naturally occurring fat from whole milk and then add it back it at a very precise amount in order to meet a precise 3.25% concentration. The milk is then mechanically processed to split the fat globules into smaller drops that will stay dispersed in the milk rather than floating to the top. (This process is called homogenization.) Since virtually all commercially produced whole milks in the U.S. go through the processes described above, they don't qualify as whole, natural foods any more than low-fat milks do.

Smaller local dairies can offer more natural alternatives when it comes to milk. In the case of many small local dairies, whole milk may remain non-homogenized, with its fat content remaining largely unprocessed. Smaller local dairies may also feature certified organic milk as well as milk that has been obtained from grass-fed cows. We believe that many small local dairies can offer very high-quality products in the marketplace, especially when they follow all of the organic food regulations and have top-notch quality control standards. As long as your diet has plenty of room for the calorie and fat content of whole milk, and milk is a food that makes sense in your diet, we believe that certified organic whole milk from local dairies can make a very healthy addition to your food plan. The very limited availability of this milk type, however, together with the special importance of quality control in this situation, means that milk of this type is not a practical option for most U.S. consumers at this point in time.

Health Research on Dairy Products

There are three major health areas in which dairy products have been researched in some depth. These areas are: (1) breast cancer, (2) bone health, and (3) obesity. In none of these areas are whole milk dairy products significantly better risk-reducers than low-fat dairy products. However, if you have special health concerns in any of these areas, there are some further details that you may want to consider.

Low-Fat versus Whole-Milk Dairy Products and Breast Cancer

Since calcium and vitamin D can both be potentially protective against breast cancer, it is not surprising that studies in this area show some reduction of risk from both whole milk and low-fat dairy products. Both types of dairy products contribute important amounts of calcium and vitamin D to the diet.

Conjugated linoleic acid (CLA), however, has also been found to be potentially protective against breast cancer, and CLA is higher in whole milk versus 2% milk. However, as noted above, the difference in CLA concentrations between whole and 2% milk is relatively small when compared to the much more sizable amounts of CLA found in many commonly consumed cheeses. For example, on an ounce-for-ounce basis, there is about ten times as much CLA in cheddar cheese and cream cheese as in whole milk. Because these cheeses are so high in fat, however, potential advantages of their superior CLA content may be offset by the risks posed by their unusually high fat concentration (in cheddar the percentage fat is about 74% while in cream cheese it's 90%).

Because a strong immune system can be important in helping prevent the occurrence of breast cancer, it is also worth noting that the immune system benefits of CLA in research studies have often required intake of CLA supplements at a level of 2-3 grams of CLA per day. Since whole milk only provides about 32 milligrams of CLA per cup, it would be impossible for a person to reach this 2-3 gram level from any reasonable amount of whole milk consumption.

Low-Fat versus Whole-Milk Dairy Products and Bone Health

When it comes to dairy products and bone health, there seems to be a split between some helpful aspects of dairy nutrients and some unhelpful ones. The calcium and potassium in both whole milk and low-fat dairy products have been repeatedly shown to help support bone mass. However, the sodium and protein levels in some of these dairy products have been shown to take a potential toll on our bones. This mixture of helpful and non-helpful dairy components has led to some controversy in the research over the role of dairy in bone health.

The differences between whole milk and low-fat dairy products do not seem to be as important in determining bone health as other differences in dairy. For example, acid-curd cheeses like cottage cheese can have particularly high amounts of sodium in comparison to both calcium and potassium, while also containing large amounts of protein. This combination of factors makes them particularly problematic for bone health if our kidneys have difficulty keeping proper amounts of calcium and potassium and other minerals in our bloodstream while simultaneously getting rid of excess sodium and acids. A special term called Potential Renal Acid Load, or PRAL, has been developed to describe the challenge faced by the kidneys in processing very high protein foods, including cottage cheese and other cheeses, which have a large number of amino acids and would cause the urine to become too acidic without the help of buffers to help lower acidity. Since potassium, calcium, and magnesium are commonly used buffers, acid-curd cheeses like cottage cheese can have high PRAL values that end up robbing the body of key bone-support nutrients. It appears to be the high-protein and high-sodium nature of certain cheeses that most contributes to these bone-compromising processes rather than the whole versus low-fat aspect of dairy products. For this reason, limited intake of both whole milk and low-fat cheeses that are high in protein and sodium, together with limited intake of all acid-curd cheeses (including cottage cheese and ricotta cheese), might be helpful in lowering risk of bone mass problems in individuals who have special concerns in this area. Whole milk and low-fat milk would both be considered safer in this regard since both score lower on the PRAL scale than most cheeses. (Milks have a score near the 1.0 PRAL level while cheeses score much closer to an 8.0 PRAL.)

Low-Fat versus Whole-Milk Dairy Products and Obesity

Excessive food intake, including excessive intake of calories and high-fat foods, has repeatedly been linked to weight gain and obesity. These relationships hold true for dairy products as well. We're only aware of one large-scale study in which whole milk products fared better than low-fat dairy in protection against obesity, and the authors of that study, called the Hoorn Study, did not draw the same conclusions that many popular press writers have drawn in publicizing the study results.

In the Hoorn Study, carried out on 2,000 men and women in the Netherlands by researchers at the Vrije University Medical Center, total consumption of dairy was not found to be associated with body weight or obesity, although consumption of high-fat dairy was associated with lower body mass index (BMI) while intake of low-fat dairy was associated with higher BMI. Interestingly, however, the authors of the study did not conclude that it was the low-fat dairy per se that accounted for the lower BMI, that there was a general and direct cause and effect relationship. Instead, they speculated that the low-fat dairy may only have been helpful at certain times of day, and particularly when consumed after a main meal. The authors further speculated that the higher concentrations of saturated fat in high-fat dairy (milks greater than 2% fat) may have triggered more secretion of a hormone in the body called glucagon-like peptide 1 (or GLP-1), which in turn delayed emptying of food contents from the stomach to the intestines, delaying digestion and maintaining a feeling of fullness and subsequently causing a person to eat fewer snacks in between meals. Of course, the authors offered this explanation only as conjecture, pointing out that there was no way for them to tell whether their speculation was correct without further study. Interestingly, even though many writers have publicized this study as demonstrating the added benefits of high-fat versus low-fat dairy, the authors themselves believed that the benefits of high-fat dairy ultimately came down to less snacking and less food consumption.

Neither low-fat milk nor whole milk will automatically make you obese or help you maintain your normal weight or cause you to lose or gain weight. In this sense, both types of milk are reasonable options in a weight-management diet. However, if you are only able to consume a moderate amount of calories each day to maintain a healthy weight (or lose excess weight), your chances of doing so will be greater if that milk uses up as few calories and grams of fat in your diet as possible. On a 1,500-calorie diet that features 30% of calories from fat, one cup of whole milk will take up about 10% of your available calories (150 out of 1,500) and 16% of your available fat allowance (8 out of 50 grams). Two cups will take up 20% of your calories and 32% of your fat allowance. In contrast, two cups of low-fat 2% milk would take up 16% of your calories and 20% of your fat, and non-fat milk will take up about 10% of your calories and virtually none of your fat. As you can see, with lower fat milk, there is more room for you to maneuver during the rest of the day with other potentially high-fat foods in your diet that you will want to include such as high-quality nuts and seeds, fattier omega-3 rich fish like salmon, and extra virgin olive oil.

When it comes to saturated fat, whole milk may be even more difficult to weave into your daily diet. Since the American Heart Association suggests that we keep our calories from saturated fat under 10% of total calories for the day, and two cups of whole milk contains about 9 grams of saturated fat, we're talking about 81 calories' worth of saturated fat or 5% of a 1,500 calorie diet. That amount may not leave enough room for saturated fat from all of the other day's foods. However, if whole milk still makes more sense to you, and you prefer it to low-fat products, there is still room for you to create a healthy weight loss or weight management diet that includes whole milk, but it may take more planning and effort to make sure that your diet meets all of your nutrient and health goals.

Whey Proteins and Type of Milk

Both whole milk and low-fat milk contain whey proteins and should be considered as fairly comparable in this regard. Whey proteins may be helpful in immune-system support, and they may also be helpful in blood-sugar regulation. They can also help promote muscle building, especially following resistance exercises like weight lifting. In this muscle-support area, it may be the branched chain amino acids, or BCAAs (which include leucine, isoleucine, and valine), especially available from when proteins, which play a primary role in muscle building. On a calorie-for-calorie basis, you'll find that low-fat milks are slightly higher in BCAAs than whole milk.

Alongside of these whey protein benefits that can be obtained from either whole or low-fat milk, there are also individuals who experience an allergic reaction to whey proteins. In this case, both low-fat and whole-milk milk would be a problem since both contain when proteins.

Beneficial Bacteria and Type of Milk

Since virtually all commercially produced milk products have been pasteurized for safety reasons, you will not find them containing large amounts of beneficial bacteria unless those bacteria have been added to the product. This rule holds true for low-fat as well as whole-milk products. In the U.S., about half of the states have laws against the sale of raw, unpasteurized milk. In states that do allow the sale of unpasteurized milk, some smaller local dairies make available raw milk products that have not been pasteurized and that naturally contain larger amounts of bacteria. Some of these small dairies will also be selling whole milk products that are certified organic and obtained from grass-fed cows. We believe these products can make important contributions to a healthy diet, but we also know that unpasteurized products may contain unwanted bacteria like E. coli, Listeria or Salmonella and that special efforts are needed on the consumer's part to make sure that these products and the underlying dairy practices are of the highest quality. These special efforts may include calls to the small local dairies, calls to local health department inspection divisions that monitor their quality control, or even a trip out to the dairy itself to talk to the owners or staff about their product sampling methods and results. More readily available for most individuals will be certified organic dairy products to which beneficial bacteria (sometimes called "probiotics") have been added. Live-culture yogurts would be the best example of these types of products, and it can be easy for you to get the benefits of low-fat dairy together with probiotic benefits by including certified organic, live-culture, low-fat yogurts in your diet.

Food Allergy and Type of Milk

Both low-fat and whole milk products typically contain lactose, casein proteins, and whey proteins, and these three dairy components account for most of the adverse reactions to milk. Cow's milk allergy is among the most common of all food allergies, with people reporting allergies to cow's milk about 10 times more often than these allergies can be proven in clinical research studies. If you experience an adverse reaction to milk, you are not going to be able to address this problem by choosing either low-fat or whole milk. Instead, you will need to determine what part of the milk is causing a reaction and then take steps accordingly. (The help of a healthcare practitioner may be needed to help make this determination since blood tests for protein antibodies are often involved.)

The most common of milk reactions involves intolerance to lactose, or milk sugar. Both low-fat and whole milks are available in reduced-lactose versions, and it is also possible to add lactase enzyme drops to both whole milk and low-fat milk and come up with a version of either milk that is very low in lactose. Selecting these products, or taking these steps with lactaseenzyme drops, can be a good solution if you are lactose intolerant and still want to include either low-fat or whole milk in your diet.

Since it is not possible to eliminate all of the casein or whey proteins in either low-fat or whole milk, individuals with protein-based allergies to milk will not solve their allergy problems by choosing either low-fat or whole milk. Unlike lactose problems, where you can find reduced lactose products or use liquid drops to reduce the lactose yourself, there are no dairy products available with their reaction-producing proteins removed. For this reason, restriction or elimination of milk from your diet will typically be required in the case of a protein-based milk allergy, and once again, the help of a healthcare practitioner may be needed to help you determine the best course of action.

Practical Tip

Some people do well on dairy products, and some do not. If you're a person who doesn't, there is no absolute requirement for you to include milk or dairy products in your diet, but you'll want to make sure that the key nutrients provided by most dairy products-especially calcium vitamin D, and vitamin A-are plentiful in your diet as a result of your overall food choices. If you think you'll have trouble making space for the added fat content (especially the saturated fat content) of whole milk and whole-milk products, you'll want to stick with low-fat dairy products. For most individuals who enjoy dairy products and do not experience any adverse reactions to them, including dairy products 3-4 times per week makes sense to us as a general guideline for dairy consumption.

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