Two Harvard professors question whether replacing whole milk with reduced-fat milk accomplishes its weight-management and disease-prevention goals.
In a "Viewpoint" editorial in the journal JAMA Pediatrics, Dr. David S. Ludwig of Boston Children’s Hospital and Harvard Medical School, and Dr. Walter C. Willett of the Harvard School of Public Health and Harvard Medical School, suggest that the recommendation may be harmful because of substitutions made for the fat, such as sugar.
"One cup of 2-percent milk contains 12.3 grams of sugar, more than a Reeses Peanut Butter Cup and almost as much as a chocolate chip cookie. Consider that the recommendations for sugar intake call for just 12 grams a day (three teaspoons, at 4 grams each) for children. So one serving of milk a day would put a child over the limit, two cups a day would top a woman’s limit of 5 teaspoons, and three cups a day would top a man’s limit of 8-9 teaspoons," wrote Forbes' Melanie Haiken of the question the two raised.
Guidelines from the U.S. Department of Agriculture and the American Academy of Pediatrics recommend limiting consumption of calorie-containing liquids, with the exception of reduced-fat milk. People in most age groups are encouraged to drink three cups a day.
Ludwig, who is a proponent of a low-sugar approach rather than a low-fat approach to dieting, believes milk consumption isn't needed at all. He has said a healthy diet provides enough calcium.
“Primary focus on reducing fat intake does not facilitate weight loss compared with other dietary strategies,” the two doctors wrote in the editorial. They recommend more studies. Until then, they suggest a guideline range that starts at zero and tops out at three cups of milk, that does not recommend low-fat over whole milk and that targets flavored drinks.
"One problem, they say, is that there have been few randomized trials of the effects on weight gain of reduced-fat milk compared with whole milk and that current guidelines presume the lower-fat milks will decrease total calorie intake," wrote Los Angeles Times writer Mary MacVean.
She later updated it with a note that Ludwig sent her suggesting 2-percent milk is "probably a reasonable compromise" between whole and 1-percent or nonfat milk.
"The issue is not to focus single-mindedly on fat reduction, and then condone lots of added sugars, as in chocolate milk," he wrote. "The bottom line is that reducing fat has not proven to be an effective approach to obesity, whereas there is very good evidence for the adverse effects of added sugars," especially for children.
The editorial drew a swift response from Greg Miller, executive vice president of the National Dairy Council, who said milk is vital to helping children get the vital nutrients they need.
“The nation's leading health and nutrition organizations recognize the valuable role that milk, including flavored milk, can play in meeting daily nutrient needs. In addition, the 2010 Dietary Guidelines recognize that a small amount of added sugars can be used to increase the palatability and appeal of nutrient-dense foods, such as fat-free chocolate milk," he said.
Miller pointed to another study that said removing or limiting flavored milk from schools had negative impact on children's nutrient intake. "In the 49 elementary schools examined, there was a 37 percent average decrease in milk consumption, resulting from a 26 percent decline in milk purchased and an 11 percent increase in milk discarded. To replace the nutrients from less milk intake in a school district, it would require three to four additional foods, resulting in more calories and fat, and a cost increase of up to $4,600 per 100 students,” Miller said.
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