Drink your milk.
Generations of children have heard that dictum from their mothers, doctors, and school cafeteria workers. But some studies have soured many on the drink’s nutritional value, especially for minority children.
Studies have linked milk to a variety of health problems, including anemia, allergies, and diabetes. Even so, a large proportion of the scientific community continues to stand behind milk and its benefits.
Now, the debate over the role of milk in the American diet has been taken up by the dietary-guidelines advisory committee to the U.S. departments of Agriculture and Health and Human Services. And it has spawned a lawsuit seeking to eliminate milk from the federal nutrition guidelines that prescribe what many youngsters consume in school.
“Milk is a very important component of a meal plan for children. It is a major provider of calcium in children’s diet,” said Phyllis Griffith, the president of the American School Food Service Association.
“School meals should promote grains, vegetables, fruit, and legumes, and everything else, including meats and milk, should be optional,” countered Dr. Neal Barnard, the president of the Physicians Committee for Responsible Medicine.
His Washington-based advocacy organization filed a federal suit in December against the USDA and HHS, claiming the agencies are racially biased in their dietary policies.
The federal guidelines recognize milk and its products—yogurt, cheese, and ice cream—as one of the five major food groups and recommends that Americans drink at least two glasses of milk a day.
Those recommendations extend to the schools. The national school lunch and breakfast programs reach some 93,000 schools, serving 33 million meals daily, according to the food-service association.
In order to receive reimbursement for those meals, schools must follow the USDA recommendations, which require all students who take part in the meals program to be given milk unless they have a doctor’s note.
The Physicians Committee for Responsible Medicine wants the guidelines revised to accommodate minority students, who are more likely to be lactose intolerant.
Lactose intolerance is the body’s inability to digest significant amounts of lactose, a natural sugar found in milk. People who suffer from the condition have a shortage of the enzyme that breaks it down. Consumption of dairy products can lead to gas, diarrhea, cramps, and bloating.
Researchers estimate that about 90 percent of Asian-Americans, 70 percent of African-Americans and Native Americans, and 50 percent of Hispanics have difficulty digesting lactose. Only 15 percent of whites have similar problems.
Based on those findings, “we would like milk to be optional in the guidelines,” Dr. Barnard said.
“At the very least, alternatives such as soy milk or calcium- fortified orange juice should be available,” he said. As it stands now, “schools are dumping grounds for beef and dairy products,” Dr. Barnard charged. “The changes we’re calling for are simple: We need balance in the guidelines.”
The Congressional Black Caucus and the League of United Latin American Citizens are among dozens of minority organizations and individuals that have endorsed the group’s proposals for changing the guidelines.
The lawsuit, filed in the U.S. District Court in Washington, comes as the federal guidelines are up for their five-year revision. First introduced in 1980, they provide nutritional advice for all Americans and form the basis for all federal food programs.
The dietary-guidelines committee that has discussed lactose is not scheduled to take final action until May.
Conflict of Interest?
Also at issue in the lawsuit is what the physicians’ group alleges are the committee’s conflicts of interest. Committee members were to have been appointed based on their scientific knowledge of human nutrition, according to the group. Yet, six of its 11 members have or have had in the recent past financial ties to the meat, dairy, or egg industry, the group says. Nor does the committee adequately reflect minority populations, the group contends. The committee, which is appointed by the USDA and HHS, has one African-American member and one Latino member.
“We would like to see the committee reconstituted so that there are no links to any food industry,” said Mindy Kursban, the staff lawyer for the physicians’ group.
Severing that link could prove difficult, given the long-standing and intertwined relationship between the Agriculture Department and milk producers. For example, the agency’s Agriculture Marketing Service uses its commodity-procurement programs to buy food products, particularly when surpluses exist, to help provide stable markets for producers.
The government’s position is compromised, argued Simon Chaitowitz, a spokeswoman for the physicians’ group. “Since its creation, the USDA’s role has been twofold: to educate the public about healthy eating and to promote agriculture. But the agendas haven’t always served one another.”
Milk supporters say many of the claims made by the physicians’ group are baseless. Many people with lactose intolerance can drink at least one glass of milk with a meal, nutrition experts say. Many more can eat yogurt and cheese, which are easier to digest because they have reduced lactose.
Greg Miller, the vice president of nutrition research for the National Dairy Council, decries what he sees as engagement in “race card” tactics by the physicians’ group.
“Minorities can benefit greatly by consuming dairy products, and there are strategies that will allow them to tolerate dairy products,” said Mr. Miller, whose organization provides education and research on dairy products.
Milk and milk products are seen as the best source for calcium because of their high calcium content. Low calcium intake is one of several factors associated with the development of osteoporosis, a debilitating condition in which bone mass is lost.
Although calcium is an essential nutrient, its intake has been low in children as well as adults in recent years, said Wahida Karmally, a spokeswoman for the American Dietetic Association.
Calcium is especially important for children, who need two to four times as much as adults. Boys and girls are urged to drink 800 milligrams of milk a day, under federal guidelines.
Other foods, such as sardines and salmon with bones, dried beans, tofu, broccoli, kale, collards, and breads and cereals, contain calcium in lower amounts. A wide variety of calcium-fortified foods are also available, including juices, fruit drinks, cereals, and carbonated beverages. In many cases, those foods are fortified with a level of calcium comparable to that in an 8-ounce serving of milk.
But Americans would have to make substantial changes in their diets to meet the recommended daily allowance for calcium without eating dairy products, nutrition experts say.
“It is more difficult, but it can be done,” said Ms. Karmally, a dietitian and an associate research scientist at Columbia University.
“We could offer other beverages, but when you begin to analyze the nutritional content of them or alternative meals, it would be a real challenge to meet the recommended daily allowances,” said Ms. Griffith of the American School Food Service Association, who is also the food-service director of the 65,000-student Columbus, Ohio, public schools.
While the lawsuit awaits trial and the dietary-guidelines committee mulls changes, the USDA has urged state agencies to work with school districts to offer such alternatives as lactose-free milk for children who are intolerant. In a letter to state child-nutrition-program directors last year, the Agriculture Department stated that offering lactose-free milk would address increasing concerns that lactose-intolerant children may risk health problems by drinking milk or by not drinking milk at all.
“Schools have a fair amount of authority to plug in alternative kinds of milk or anything they feel a demand for,” said Phil Stanholtzer, a spokesman for the USDA.
Some, but not all, districts offer alternatives, Ms. Griffith said. The cost of providing reduced- lactose milk may be prohibitive for many districts, she said.
The Sacramento, Calif., district does not offer reduced-lactose milk, but it does accommodate students who cannot drink milk. Students in need of a special diet must provide a doctor’s note. Although nearly 75 percent of the district’s 54,000 students are members of minorities, only a handful have made such requests, said Nancy Alexander, the district’s nutrition supervisor.
One reason for the small number of special diets could be the district’s “offer vs. serve” policy. Students choose three out of five items served. That policy allows a student to select food other than milk that would fulfill the USDA’s calcium requirement, Ms. Alexander said.
Students in Milwaukee’s public schools must also provide a doctor’s note in order to be considered for a special diet. But of the 65,000 student lunches served daily last school year, only five students required a milk substitute, said Mary Kelly, the head of school nutrition services. Nearly 75 percent of the students in the Wisconsin district, in America’s dairy-land, are black or Hispanic.
Mr. Miller of the National Dairy Council doubts that the physicians’ group will find success with its efforts to change dietary guidelines. But he suggests that the lawsuit may increase awareness of minority health issues.
“The right thing to do is to help people understand how they can keep this calcium-rich product in their diet,” he said. “We must do better in terms of talking to consumers, especially minority groups.”
Principal Alfred Carroll has already taken steps to make the parents of his middle school aware of potential problems.
Most of the 270 students at Sam Taylor Computer Technology Magnet School in Pine Bluff, Ark., are African-American. During his tenure, Mr. Carroll has heard a number of students complain of stomach aches or cramping following the breakfast and lunch hours. But until he learned that members of minority groups face a greater likelihood of lactose intolerance, Mr. Carroll figured many were just trying to get out of class or schoolwork.
“I may have misjudged my students,” said Mr. Carroll, who is lactose intolerant himself. His staff members now document stomach complaints.
The school will hold a public health forum this spring to inform the community about lactose intolerance and what action can be taken. And, Mr. Carroll said, if the government doesn’t provide for alternatives, the community will.
“The issues are valid whether or not the federal government sees fit to change its food guidelines,” the principal said.
A version of this article appeared in the February 09, 2000 edition of Education Week as Milk Lawsuit Leaving Some With Bad Taste