Got Truth? Rethinking Dairy, Calcium, and Bone Health

0:00Coming up on this episode of the Dr. Hyman Show. You can develop issues with lactose and digesting dairy at any point in your life. It increases as we get older, and it often can increase after we've had, you know, some sort of infection or inflammation or antibiotics in our system. Have you been feeling stressed or tired lately? You might be low in one powerful mineral. That mineral is magnesium. Most people are, and most supplements don't fix it because they only include one or two forms. I use Magnesium Breakthrough from Bioptimizers because it has all seven forms of magnesium your body needs for sleep, stress, and recovery.

0:38It actually works. You can feel the difference. From November 23rd through December 3rd, you get 25 % off. This is the once-a-year sale you do not want to miss. Go right now to bioptimizers.com slash hymen and use code HYMAN. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day. so I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, the Hyman Hive, for live Q &As, exclusive content, and direct connection.

1:10For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at drhyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad-free with Hyman+. Just open Apple Podcasts and tap Try Free to start your seven-day free trial. Milk is something that most of the world's population doesn't tolerate. 75 % or 70 % are lactose intolerant. Most populations around the world don't consume milk on a regular basis, like China and Asia and most Asian countries, Africa.

1:46There are some exceptions, obviously, the Maasai. But I think that for the most part, it's not a staple food after weaning. and yet somehow in the West, we've come to think about it as, you know, just American as apple pie and, you know, and the American flag. And so, and in fact, you can't even get a school lunch authorized unless milk is included in the school lunch. But you really question that. I think, you know, you wrote an article a number of years ago, which was sort of a prelude to this one that was in, I think, JAMA, also with Walter Willett, where you sort of questioned the guidelines and brought up some of this data.

2:20And I wrote an article that sort of kind of derived from that called Got Proof, which essentially was a spoof on the whole Got Milk campaign, which, by the way, people don't understand that the Got Milk campaign wasn't an industry effort solely, that it was part of a government program called the Chekhov Program, which is where the United States Department of Agriculture supports industry to sell more of its products. is supposed to help with research, right? The money is tied to the government by the industry, apparently to support research, but it actually went to marketing of these ads called God Proof.

2:54And they were literally taken down by the Federal Trade Commission because there was no evidence for the claims we were making. Can you talk about that? And then how do we get to these three glasses? Right. Well, so we began by looking at the mindset, the philosophy that gave rise to these minimum recommendations And you point out that it's not just science, but it's also food politics, that the USDA, which has conventionally overseen these recommendations, has a dual message, a dual mission. One is promotion of public health, but the other is to advance the financial interests of the big food commodity producers.

3:38And dairy is absolutely very, very powerful. So you made another very important point that really cuts to the chase, that at least half of the world's population doesn't consume milk or milk products on a regular basis. And yet the children seem to be able to grow up without suffering continuous bone fractures or have short stature or other problems. So we know that milk is not required to be a healthy child or a healthy adult. And of course, before 10 ,000 years ago, when perhaps the first dairy animals were domesticated, no humans would have ever consumed any dairy product. And you wouldn't be milking a saber-toothed tiger?

4:30You know, good luck. um so so but that then so we know that milk isn't necessary uh for you know to survive to keep our keep our bones from crumbling but that doesn't mean that you know milk is inherently harmful or that we shouldn't be drinking it and a point that i'd like to continue to return to during our talk today is an interaction with diet quality that to understand the impact of a food like milk or really many other foods, because there's essentially no one, there's no one food that you have to eat in order to live. So the question is, how do these foods support health for a specific population?

5:17And to understand that, we need to think about what foods are being traded off. So for a child that's consuming junk foods all day long, you know, sugary beverages, and packaged savory snacks, cheeseburgers, and dairy products might be among the healthiest things that they eat. These are whole foods for the most part, as long as they're not loaded up with sugar, as actually does still happen in schools. So dairy products would tend to increase diet quality, displace some of these highly processed junk foods, and would be good for health. Yeah, compared to what is really the question. What are you eating instead of it?

6:00Yeah. For somebody who's got a really healthful diet based on whole foods, who's avoiding a lot of processed carbohydrates and others, just dumping in more dairy products to reach some kind of theoretical nutrient balance may miss the mark. And with regard to calcium, which is the most commonly cited. So it's amazing what you're saying. It's basically saying dairy is better than Coke is not saying much, right? Well, no, I mean, there's a lot of, you know, two thirds of what's consumed in the U.S. is highly processed poor quality. And so I think what we want to do is ask, what is the background diet we're talking about?

6:44To simply say, don't drink milk, would, I think, produce a lot of harm because there are children in the United States, and even more so in countries with borderline nutritional status, where milk provides one of the best sources of protein, of fats, of slow digesting carbohydrates, potassium, calcium, and other nutrients. So to remove milk from the diet of people, either in the United States, kids with borderline nutrition quality, or overseas in Africa or South America, where nutrient deficiency is a real problem, I think could cause great harm. But let's drill down on calcium, because that's the one that, That's the nutrient that is driving fear of low milk intake.

7:35It's driving milk intake. Yeah. Especially women. They want to get enough calcium to avoid milk pressures. And if you go by the calcium balance studies that were used to come up with this recommendation, you need a gram, a thousand milligrams or more calcium a day to meet new kindness. it's almost certainly flat out long these balance studies were based on very short-term studies 21 days where yes if you dump in a lot more calcium the body will absorb some of that calcium and put it into bones but what it's basically doing is filling up temporary spaces in bones They don't stay there. And so if you did longer term studies, you would see that adding more and more calcium doesn't keep building up bone.

8:28You have this short term boost in bone calcium, but then you fill up all these little temporary niches and there's no more benefits. the thing is those transient spaces don't stay there you don't have a calcium bank for life by consuming a lot of milk as a kid and we can talk more about that so yeah i mean i i was i i have to confess here i mean i hope it doesn't let it bias my opinion about milk is more hopefully medical and scientific but when i was a kid i hated milk and i just didn't like the taste of it my mother's like how are you going to grow up to be big and strong if you don't drink milk well I never drank milk and I'm six foot three and maybe I want to be an NBA player instead of a doctor.

9:12If I did drink milk, who knows? I really never did. And my bone density is great. And I think that it is a bit of a mythology about that. So we do need calcium. There's no question. Your bones are made primarily of calcium and phosphate, but how much calcium and the minimum requirement to be perfectly healthy bones, probably at most a half of what has been traditionally viewed as necessary in the United States. In the UK, their minimum calcium requirements are about a half of what they are here. And in some populations, like in South America, the adults do perfectly well getting even a third or a quarter of the amount of calcium, like 300 milligrams a day.

9:57You mentioned that. That level of calcium can be obtained from, so if you're going to get a gram or more a day of calcium, milk is sort of the obvious source. But if you accept that we don't need that much, that 500, 600 milligrams a day are probably more than sufficient, well, that's easily obtained from just a basic diet. A serving of kale is going to get you a third to a half way there. chia seeds sardines nuts seeds yeah chia seeds tahini those are my favorite i mean one of the things you said that i just want to come back to which is really important is this whole idea of calcium balance and when you look at countries like sweden that you wrote about in your paper they have the highest intakes of calcium and the highest risk of fractures and countries like indonesia and china have the lowest intakes of calcium and the lowest risk of fractures So one of the things I remember when I was a medical director at Kenny Ranch, I often talked about was osteoporosis.

10:58And it was really clear that there are a lot of things in our culture that drove calcium loss. So it's not just about how much you take in, it's how much you pee out. Right. So caffeine, alcohol, sugar, phosphoric acid from sodas, too much meat, perhaps. I don't know if that's true, but that's what it seemed to be, the high protein acid load. All these things, stress, all these things cause bone loss. And if you mitigate those, you know, otherwise you cut those out of your diet or you reduce them and you deal with stress and you deal with the fact of how you're losing calcium, that your net net may be better than if you're taking super high levels of calcium.

11:35And the other thing that's interesting to note is that, you know, cows get their calcium and have great bones. Where do they get it from? Grass, right? They're drinking milk. They're drinking three servings a day. For a little bit and then they don't. And they're getting it from grass. So why not? Why get secondhand calcium? Greenleafy vegetables are actually a very good source of calcium. You know, kale, a serving of kale has almost as much calcium as a serving of milk. And you get many fewer total calories that way. But let's go back to these ecological comparisons. Those are the comparisons where you look at different countries and see different risks.

12:14It's important to understand that there are limitations to those kinds of analyses. What they do convincingly tell us is that it's possible to be a human being, consume no milk, relatively low levels of calcium, and have low fracture risk. The problem with these studies is that they're very compounded. So when you look compared to the Swede to the Filipino, there's a big difference in height, and height is a major risk factor for bony fracture. so ironically um it it may be that milk consumption in adolescence in childhood and adolescence actually increases risk for fracture in adulthood so how could that be yeah we talked about that you don't really put away a calcium bank in childhood you don't get that benefit but the one thing that is pretty clear that milk does in childhood is accelerate growth you know it's not hugely it's not going to turn a horse racing jockey into a baseball player.

13:23But you get about an extra centimeter for every additional serving glass of milk a day. So maybe, and this is a population average, but so maybe for comparing low and high consumers, you grow an extra inch. But on a population basis, that increased height is one of the major risk factors of having a fracture. You know, simply put, the bigger they come, the harder they fall. Tom's kind of screwed. I'm like six foot three. But this is a big, you know, this is one of the first myths to go, that drinking a lot of milk as a kid is going to reduce your risk of getting a fracture in his adulthood. And if anything, it's the opposite.

14:06So this is the basis for our recommendations, which is you need calcium-prevented osteoporosis, and that's why our guidelines tell us to have three glasses of milk a day. Yeah, well, you do need calcium. You just don't need that much. And the amount that you need can be obtained from other sources. And so what about the idea of weight? Which again, it's not to say that milk is inherently bad or toxic. second. We talked about one situation where it could be helpful, people with borderline nutritional status, when they drink milk, they're drinking, you know, you're drinking like a glass of milk and maybe you just have two cookies after school as a kid instead of having the whole package without milk or with fat-free milk, which doesn't taste very good and isn't very satiating.

14:55Yeah, I want to get into the fat-free thing in a minute. I know that's your favorite topic, but I just want to sort of summarize here about the calcium story, because what you're saying essentially is that all the data, and there were over 100 papers you reviewed, all the data really didn't point to a benefit of increased calcium intake through supplements or through dairy, and that there was potential risks as well. And then it wasn't just a benign intervention that there may be increased risks with increased calcium intake in different situations, whether it's cancer or whether it's from perhaps the high levels of calcium causing greater growth and fracture risk.

15:31We don't know, but it's not a slam dunk. So you think based on the current data that you reviewed in the New England Journal of Medicine study, you think that the government should change its dietary guidelines? um well let me just say so you know we talked about the trade-offs um and uh milk so one downside of extra growth we talked about was fracture risk but another downside of being tall is cancer risk being the taller you are the higher your risk of cancer maybe partly it's more cell you're you're okay you're you're taking good care of yourself but first of all you've got a bigger body. But the other thing about milk is to consider how milk has evolved.

16:17The purpose of milk is to help grazing animals on the plains of Africa, the infants that are at high risk of being eaten by the local carnivores grow rapidly so they can be strong enough and fast enough to be free of predation. So that's a very strong selective, you know, fitness factors, evolutionary drive to get these baby ruminants, you know, the gazelles and the other grazing animals to grow very quickly. So that's a good thing. Except if you're consuming these foods that stimulate growth, you know, in children, but in adults, these growth factors that may be stimulating biological systems that relate to cancer.

17:07And while the data are definitely not clear yet, there seems to be evidence of cancer, of high levels of dairy consumption causing prostate cancer in men, especially aggressive forms of prostate cancer and endometrial cancer. Although, interestingly, milk intake may protect against colorectal cancer and that may be an effect of the calcium.

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18:57Now, here's the truth. Now, I wrote a book called Food Fix where I went deep into the machinations of the food industry, the collusion between government and the food industry. And by the way, you know, there's a lot of revolving doors. So people from the Dairy Council work for the government and go back to work for the Dairy Council. And it's just a it's kind of a mess. Now, big dairy is really behind the headlines that milk is good for you. It's a$47 billion a year industry. It's one of the most influential food lobbyists on Capitol Hill. According to the Center for Responsive Politics, which is a nonpartisan group that tracks money in politics, the dairy industry gave nearly$46 million to politicians between 1990 and 2016.

19:42In 2015, the Committee of Scientific Experts that shapes the dietary guidelines included two members with financial ties to big dairy. Furthermore, the dairy industry spent millions of dollars funding studies that claim that milk offers benefits like weight loss, improved health, and stronger bones. Now, I'll just tell you a quick story. Years ago, I was on Martha Stewart's television show, which no longer exists. And we were talking about optimal performance and health and I was one of the experts. Now, when you're an expert on a TV show, you don't get cue cards. You got to know your stuff. And you got to just say what you got to say when you got to say it.

20:17Now, there was a trainer that she had. I think it was her trainer that was also on the show. And when I talked to the producer, he was talking about the segment. And he said, well, we're going to talk about how dairy is this great sports drink. And I said, wait a minute. Where are you getting that information? He says, well, I said, listen, here, let me send you a bunch of papers. So I went through PubMed. I sent him all the papers showing that this is not true. And I also showed him the papers that said it was true, but they were all funded by the Dairy Council. Now, when a food industry organization or agency or a council funds a study, it's 8 to 50 times more likely to show a positive benefit.

20:56In other words, if Coca-Cola does a study on soda, it's going to find that it doesn't cause obesity. Or if the Dairy Council does a study on milk, it's going to find it's good for your bones and it's good for exercise and everything else. But actually, it's pretty frightening. So anyway, I was in this show and the trainer had these cue cards by the camera. There were these giant cue cards which had all the talking points, which were all wrong about why dairy is a perfect post-workout food. And I was like, whoa, why are you doing this? She said, well, the producer said, well, the Dairy Council is funding the segment of the show.

21:34And I was just flabbergasted. So we think we're getting straight up information. We're just not. First of all, we need to know this. The whole Got Milk campaign, you know, the mustache thing where you had all the health and human services secretary, all the athletes, all the celebrities, you know, wearing the milk mustache. That was funded in part by the government, something called the Checkout Program and the Dairy Council. And it was promoting all these claims like it's great for your bones and it's great for this and it's great for that. But it's not. And so the Federal Trade Commission actually made them take the ads off the air and out of magazines.

22:15That's why you don't see them anymore because there was no scientific basis for the claims. And it was false advertising. So this is a government literally funding millions of dollars to tell us stuff that wasn't scientifically true. So anyway, the bottom line here is that milk is not good for your bones. And you don't need milk for strong bones. Everybody knows we need stronger bones, right? That's what we're taught. Drink your milk, grow big and strong and tall. You need calcium. And without it, children won't grow to be big and strong. Adults will get hip fractures, and most people would be getting osteoporosis, and their bones will crumble to dust as they age.

22:50But there's absolutely no evidence that we need milk to strengthen our bones. And, for example, countries with the lowest milk consumption have the lowest rates of osteoporosis and fractures. Well, those with the highest dairy consumption and calcium have the highest rates of fractures. How do you make sense of that? In fact, in one study, they found that those who drank more milk had higher risk of fractures. So that's a bit concerning to me.

23:16Also, it's good for kids, right? I mean, we now force kids to have milk. If you want to have a school lunch program, you have to serve milk. And most of it's sugary milk, which is basically like a soda and milk together. And it's mandated by the government that in public schools, we have to have milk. But, you know, kids can't get their federal school lunch money unless they give, I'm sorry, the schools can't get their federal school lunch money unless they give every kid milk. But there's no evidence that it's true. In fact, they're also giving them low-fat milk, which is even worse because low-fat milk actually causes them to gain more weight because it makes them not feel satisfied or full from the fat.

23:59Also, milk is a lousy source of calcium. The studies are pretty clear on this. There's nothing special about dairy and bone health. In fact, vitamin D that you get with milk, that's added to the milk. It's not actually naturally in milk, believe it or not. They put it in there to prevent rickets, which is a good thing, but still, it's not where we get vitamin D. The amount of calcium everybody needs is actually far less than the levels recommended in the United States. It's not actually the total calcium intake that matters, but how much you actually keep. For example, in Africa, they might have 300 milligrams of calcium intake in their diet, but they have very good bones and strong health, but they only lose maybe 200 milligrams of calcium.

24:40So their net is 100 milligrams of calcium a day. Whereas in America, we might take in 1 ,500 milligrams, but we might lose 1 ,600 or 1 ,700 milligrams because of all of our bad habits. For example, if you smoke cigarettes, if you eat sugar, if you drink soda, which has phosphoric acid, it's like leeches out your bones. Actually, oh my God. I was buying some ribs for a barbecue and having the other day at my local butcher. And I said, well, how do you kind of make them? What do you do? He says, well, first you want to soak the ribs in Coca-Cola. And I'm like, what? it? He's like, yeah, because it helps dissolve the fibers and soffit up the meat and get it off the bone.

25:22I'm like, wow, okay. I don't think I want to do that. Also stress causes you to lose calcium, caffeine, alcohol, excess salt, all cause us to lose calcium. We're doing a lot of things, plus being sedentary causes us to lose calcium. So we live a lifestyle that causes calcium loss. We got to stop that. So we need to also think about not just how much we're taking in, but how much we're losing. Next, we need to think about where can we get calcium from in our diet besides milk? And in fact, actually, you can get a lot of calcium from things that don't have hormones, that don't have allergens, that don't have all kinds of antibiotics in them and all kinds of crap.

25:57So let's talk about, for example, how some common foods stack up to about four ounces of cow's milk, which is about 138 milligrams of calcium. First of all, sesame seeds, a quarter cup of sesame seeds, tahini is an amazing thing. You can make dressing out of it. I make like miso tahini dressing I put on my vegetables. There's lots of ways to include tahini and sesame seeds, but a quarter cup has 351 milligrams, which is almost, I'm not good with math, but more than twice the amount that milk has. Sardines, a little can of sardines has, with the bones, which sounds weird, but you can actually eat the bones, has 350 milligrams of calcium.

26:35Tofu, which is three in a thousand, has 350 milligrams of calcium. Yogurt, which is obviously dairy, but you can get it from sheep or goat, has 256 milligrams. Collard greens, which by the way, these may be better utilized and absorbed by the body, has about 268 milligrams. Spinach has 245 milligrams in a cup. Cheese, which is another dairy product, has a little less, 204. Sockeye salmon, three ounces with the bones in them, 188 milligrams. Almonds, dry roasted, two ounces have about 150. So basically from two ounces of almonds, you get more calcium than you will from milk. Also, chia seeds are another great source of calcium and have way more calcium than milk than you can get from milk.