woman drinking milk

Calcium, Vitamin D + the Milk Myth

Is it important to drink milk?

I get a lot of question about nutrition, specifically milk intake. We know that calcium is a critical nutrient for bone health. But is cow’s milk really the best way to get adequate amounts of calcium?

It may shock you, but I don’t think that cow’s milk is a necessary (or even healthy) part of most people’s diets. I am completely dairy-free, and my own children have never been offered milk on a regular basis, as we transitioned straight from breastfeeding to filtered water around age 2. However, I am careful to add food sources of calcium to our diets, and will be especially mindful of this as my children approach adolescence.

I find that many people don’t do well with dairy, as milk is one of the major contributors to food allergies and sensitivities.1 Beyond that, milk is high in sugar (lactose) and often offered in quantities that exceed the recommendations by the American Academy of Pediatrics (AAP).

Calcium is important for bone health

Calcium is especially important during adolescence when bone building peaks between ages 12-15 years of age.2 Adequate calcium helps prevent osteoporosis.

Calcium can also protect against lead toxicity by decreasing the absorption of lead in the gastrointestinal tract.3

It is also very important during pregnancy and breastfeeding, as adequate maternal levels protect a growing baby by preventing mobilization of lead stores from maternal bone.4

What’s not clear is if dairy products are the best source of calcium for most people. Despite aggressive marketing by the dairy industry, the verdict is still out as to whether or not milk really builds healthy bones.

What are the recommended calcium requirements?

We don’t truly understand how much calcium we need.5

Our current recommended intakes are based on short-term studies. Long-term studies are more relevant, but the few we have actually cast doubt on the need for high calcium intake that is currently recommended. Studies in other countries (India, Peru and Japan) where calcium intake is low do not show an increased rate of bone fractures, but other variables make this data hard to interpret.

Current recommendations for calcium that are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences) are6:

  • 1-3 years – 700 mg
  • 4-8 years – 1000 mg
  • 9-18 years – 1300 mg
  • 19-50 years – 1000 mg
  • 51-70+ years – 1000 to 1200 mg

The UCSF Medical Center has published the following recommendations7:

  • 1-3 years – 500 mg
  • 4-8 years – 800 mg
  • 9-18 years – 1300 mg
  • 19-50 years – 1000 mg
  • 51-70+ years – 1200 mg

Is milk good for you?

Many people do not tolerate cow’s milk. Dairy is among the 8 food groups that account for 90% of food allergies in the U.S.8

Dairy allergy or sensitivity may be due to milk proteins (casein or whey) or milk sugar (lactose), and depends on several factors including:

  • People with digestive issues and increased intestinal permeability (aka leaky gut) will tend to react more.
  • People with gluten sensitivity are often intolerant of casein as well, because its molecular structure is so similar to that of gluten. Some people do fine with sheep or goat’s milk because the casein components are different.
  • Patients with Small Intestine Bacterial Overgrowth (SIBO) don’t usually tolerate the sugars (lactose) in milk.

Consumption of cow’s milk has been associated with a number of chronic issues. In children, dairy has been linked to:

  • iron deficiency anemia9
  • recurrent ear infections, called chronic acute otitis media10
  • sleep disorders11
  • acne12
  • and even as a trigger for development of type 1 diabetes13

Also, milk has a lot of sugar! Many people think of milk as a protein source, but it’s mostly carbohydrates. Did you know that 1 cup of 2% milk has 12 grams of sugar?

Last but not least, conventional dairy factories expose us to hormones and antibiotics. Bovine growth hormone (rBGH) has long been used to increase milk production, but its use also causes mastitis and calls for increased antibiotics. Thus, both hormones and antibiotics are passed into the milk supply, which raises concern for precocious puberty14 and antibiotic-resistance.15

Remember, milk usually comes from a factory full of cows, not green pastures.

What is the difference between raw vs pasteurized milk?

For those who do tolerate milk and dairy, consuming raw vs pasteurized products is a big debate.

Proponents of raw milk say it is better tolerated and more nutritious because raw milk contains the enzymes and lactase to facilitate better digestion. At least two large studies demonstrate the protective effects of raw milk. The GABRIELA study demonstrates the protective effect of raw milk consumption on childhood asthma and atopy.16 The PASTURE study demonstrates the protective effect of raw milk from common respiratory infections.17

However, most mainstream organizations, including the FDA and the AAP, are strongly opposed to raw milk.18 This is based on a concern for food-borne illness and the premise that raw milk can have unsafe levels of bacteria like E. Coli and Listeria.

I would argue that conventional milk factories have their own list of significant issues, like the hormones and antibiotics mentioned above.

Alternative sources of dietary calcium

In general, I recommend minimizing or avoiding cow’s milk, depending on how you (or your child) tolerate dairy. A better option might be organic goat or sheep’s milk products if they are well tolerated. As a reference, the AAP recommends 2 cups (16 oz) of milk or it’s equivalent for children ages 2-8.19

If you have a diverse diet, I think it is best to focus on calcium from non-dairy foods. The USDA provides a helpful database of foods and nutrients if you want to learn more.

There are plenty of non-dairy sources of calcium. For comparison, 1 cup of milk has about 300 mg of calcium. Some alternatives include:

  • 1 cup non-dairy fortified milk (coconut, nut, hemp, flax etc) – 200-300 mg
  • 2 oz sardines – 213 mg
  • ½ cup organic tofu – 350 mg
  • 1 oz (~2 Tb) Sesame Seeds – 280 mg
  • 1 cup collard greens, cooked – 268 mg
  • 1 cup spinach, cooked – 245 mg
  • 1 cups kale, raw – 200 mg
  • 1 cup white beans – 191 mg
  • 1 oz (~3 Tb) chia seeds – 179 mg
  • 1 cup pinto beans – 175 mg
  • 1 cup navy beans – 123 mg
  • 5 figs – 112 mg
  • ¼ cup almonds – 96 mg
  • 1 orange – 60 mg

Other nutrients that are important for bone health

We’ve established that calcium is important for bone health, but don’t stop there. Other important nutrients include vitamin D, K and magnesium. Lesser known nutrients also include silicon and boron. According to one source in The Open Orthopaedics Journal:

“Nutritional needs for bone health can be met with proper food choices. However, supplementation of the average American diet is recommended for vitamin D, calcium, magnesium, silicon, vitamin K, and boron. Regular exercise is also important for bone health. Modest amounts of zinc supplementation may be appropriate for vegetarians and for older individuals. However, routine supplementation with zinc, manganese, copper and other metals is generally unnecessary, and excessive supplementation may be harmful. Supplementation with strontium should also be questioned until long-term risks and benefits are better understood.”20

Do you want to know more about your nutrition needs?

If you want personalized guidance and advice, consider consulting with a nutritionist. Our Certified Nutritional Therapist, Jessica, consults with clients worldwide to help you understand what foods to eat (and avoid) to fuel your body’s needs and support your healing process (without starving yourself, eating weird meal replacement products, or becoming a social recluse).

Jessica utilizes a science end evidence based nutrition approach which takes into account your health goals, health history, and food preferences while using functional nutrition tools to uncover things like food sensitivities, digestive health issues, and genetic variations which directly impact nutrient levels and your current state of health.

Click here to learn more about becoming a client and to book a consultation.

 

Sources

  1. https://www.foodallergy.org/allergens
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603027
  3. http://lpi.oregonstate.edu/mic/minerals/calcium#reference84
  4. http://www.ncbi.nlm.nih.gov/pubmed/19165383
  5. https://www.hsph.harvard.edu/nutritionsource/calcium-full-story/
  6. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
  7. http://www.ucsfhealth.org/education/calcium_content_of_selected_foods/
  8. https://www.foodallergy.org/allergens
  9. http://www.ncbi.nlm.nih.gov/pubmed/22043881
  10. http://www.ncbi.nlm.nih.gov/pubmed/10728925
  11. http://pediatrics.aappublications.org/content/84/4/595
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115795/
  13. https://pubmed.ncbi.nlm.nih.gov/1797491/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038976/
  15. https://www.cdc.gov/foodsafety/challenges/antibiotic-resistance.html
  16. http://www.ncbi.nlm.nih.gov/pubmed/21875744
  17. http://www.ncbi.nlm.nih.gov/pubmed/25441645
  18. https://www.healthychildren.org/English/news/Pages/AAP-Advises-Pregnant-Women-and-Children-Not-to-Consume-Raw-Milk-Products.aspx
  19. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/default.aspx
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330619/

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I'm Dr. Christine Maren, a board-certified functional medicine physician and mother of three. I advocate for real food, healthy living, and clean beauty. I think physicians should be role models when it comes to nutrition and healthy living. This is where I share that passion. Thanks for joining me!

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