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October 1999
The Satya Interview

Milton Mills on Ethnicity, Milk, and Intolerance By Angela Starks



Milton Mills, M.D. is associate director of preventative medicine at the Physicians Committee for Responsible Medicine (PCRM). He has been instrumental in PCRM’s campaign to highlight the dairy bias in the U.S.’s Dietary Guidelines [see sidebar], particularly in the context of lactose intolerance and racial differences.

Q: How did you become aware of the issue of lactose intolerance and ethnicity, and why did you feel it was important to raise awareness of this issue?
It grew out of both my personal experience and my experience as a clinician. In my early 20s I became profoundly lactose intolerant. Within one to two hours of eating a frozen yogurt I would be very sick—not just uncomfortable. I mean severe cramps, lots of gas and bloating, followed by diarrhea. When this first started happening, it was quite scary as I thought something was wrong with me. I talked to my mother and she said, “You probably just can’t tolerate milk...many blacks can’t.” That was my introduction to the fact that there were some major differences based on ethnicity with respect to the ability to tolerate dairy foods.

After I became a physician, not infrequently I would get patients complaining of gastrointestinal distress. On questioning, it was clear that they were still consuming dairy foods, so I’d ask them to do an experiment where they would avoid all dairy for two weeks and see if the problem resolved. In 70 to 80 percent of the cases the problem was resolved. That told me there are a lot of people experiencing needless illness, and who are carrying diagnoses that are completely inaccurate and are probably medicating themselves for problems that are entirely avoidable.

It was at that point that I approached PCRM, telling them what a major problem this is, that it’s a problem for specific groups, and it’s entirely inappropriate for the Dietary Guidelines to be recommending that dairy be a regular part of the American diet, since it’s clearly not appropriate for a large number of individuals.

Q: Perhaps the phrase “lactose intolerance” is a misnomer. Is lactose intolerance actually the norm?
A: Absolutely. Worldwide, the majority of humans lose the ability to digest lactose after they become adults, which is actually natural for all mammals. Only a small proportion of humans have retained the ability to digest lactose throughout their lifetime and that is presumably an adaptation to a culture that included dairy foods. It is most noticeable in people of northern European ancestry. So yes, it [lactose intolerance] is a misnomer. In fact, some recent scientific papers use the term “lactose non-persisters” to point out that the ability to continue digesting lactose is the exception rather than the rule.

Q: Some people think that if they keep drinking milk they will develop the ability to digest lactose. Can this be true?
I don’t know where that idea came from, but it’s ridiculous. That’s like saying if you jump off a building enough times, flapping your arms, you are going to develop wings. The ability to digest lactose is governed by your genes, and if your genes decide you will no longer make the enzymes, you are not going to. So, no, that is not true.

Q: Because of all the advertising and conditioning, might lactose intolerant individuals, especially those at risk of osteoporosis, be reluctant to avoid milk for fear of becoming calcium deficient?

First, we have to get over this idea that dairy foods are the best source of calcium. The inclusion of dairy in the human diet is a very recent development from an evolutionary standpoint. We do not need dairy foods. Human beings evolved eating plant foods from which they can, and continue to obtain, more than adequate amounts of calcium.

Dairy foods have never been shown to prevent osteoporosis. In fact, worldwide, the incidence of osteoporosis correlates closely with per capita dairy intake. Part of the problem stems from the fact that the high protein content of dairy foods ends up causing more calcium to be lost in the urine than they supply.

Furthermore, dairy foods can be very high in fat unless they are the artificially produced ones that have all the fat and crap removed. That ought to make some bells go off. Clearly this is not natural, and if it’s not natural it is not necessary. So the idea that people have to or ought to eat these foods is absurd. Worldwide, the majority of humans get all the calcium they need from plant foods.

Q: One reason given for the high profile of dairy in the Food Pyramid is the idea that people won’t eat more leafy green vegetables as an alternative calcium source.
A: That points out another major problem with the Dietary Guidelines Advisory Committee (DGAC), which is that the committee is woefully short on minority representation. Kale and other dark green leafy foods are an integral part of the diet of many minority populations. Included in the Asian diet are seaweed and other leafy greens, and traditionally no dairy. The U.S. has attempted to export dairy to Asia but it has had very limited success; yet we are pushing these foods on Asian-Americans.

Traditional West African diets don’t include dairy either, yet we have no qualms about painting a milk mustache on every famous black person we can find to convince black people they ought to drink milk. In my household if you didn’t eat greens you weren’t considered black. These foods are a traditional part of African-American diets and are quite common in the diets of other people of color, so it is a sign of reprehensible ethnocentrism to say, “Well, no one is going to eat them.”

Q: Why then does the DGAC continue to recommend that dairy be included in the nation’s Dietary Guidelines?
The problem is that the DGAC is a joint venture between the Department of Health and Human Services (DHHS) and the Department of Agriculture (USDA). This represents an intrinsic conflict of interest because while the DHHS is meant to promote the health of all Americans, the USDA’s Congressional charge is to find a market for agricultural output, which in my opinion ought to have nothing to do with guidelines to promote Americans’ health. One might argue that most of the political clout of the DGAC comes from people appointed by the USDA who are beholden to the agricultural industry, and as a result they push for foods to be included that in essence will help agribusiness. The dairy industry is one of the most powerful lobbies and largest of the agribusiness industries, and that’s quite unfortunate because it is harming the health of America, without question.

Q: Are resources emerging within African-American communities to promote a plant-based diet?
There’s a slowly emerging consciousness, but, unfortunately, in a population with a significant amount of poverty and people trying to climb their way up, people assume that what they see in the majority culture is what’s best and they seek to copy that. This includes what they eat. However, within the communities, there are now more people of color who become educated about nutrition and disease, who are starting to sound the alarm about what we are doing to ourselves via our diet. Noteworthy is the role of the Seventh Day Adventist church, which has a significant number of African-American members, and has traditionally encouraged its members to adopt a plant-based diet.

I am trying to target media that service and reach communities of color so we can get the message out, as it’s particularly tragic for more recent immigrants, specifically Hispanics and Asians. They come to this country with a basically good diet but then start to abandon it for the Western diet, which then causes their disease profile to skyrocket.

With respect to African-Americans, I would encourage them to question what I call the plantation diet. When they were brought over here as slaves they were essentially fed the garbage of the plantation, and unfortunately when we were emancipated from slavery we embraced that diet and called it soul food. We need to look back at what the traditional West African diet is because studies have shown that diets that are similar in composition will promote health.

Q: Dairy products also exacerbate a range of diseases, don’t they?
Indeed, such as diabetes and obesity because of the fat content. Also, if someone is at all predisposed to developing kidney trouble or already has some kidney dysfunction, the excessively high animal protein content of dairy foods will tend to worsen it; multiple studies confirm this. Also, if someone has heart disease, the very high fat and saturated fat content of dairy foods is going to exacerbate it.

Q: Do you think people take the Dietary Guidelines seriously?
Yes, I hear many women say, “I’ve got to have dairy because I need calcium.” The dairy industry has been successful in making people think that its products are the best source of calcium. Also, one of the first questions people ask me when they find out I am vegetarian is, “Where do you get your protein?” I respond, “The same place elephants get theirs”—just to make people aware that you can be big, strong and powerful and never eat meat. You do not need meat for protein but most people think you do because of the way the Dietary Guidelines are constructed and because of the sort of popular education people receive about nutrition.

Q: Might this campaign go on to challenge meat and dairy?
We need to get the issue of dairy foods dealt with for now, but as far as the Dietary Guidelines are concerned, it’s part and parcel of our concern. It’s impossible to discuss one without the other. A PCRM article entitled “Racial Bias in Federal Nutrition Policy” deals specifically with the lactose issue but then goes on to discuss the issues of chronic disease. That’s where you get into the issues of meat, because it increases the incidence of chronic disease.

Q: What do you hope will be the outcome of this campaign?
I hope that the government says very emphatically and clearly that dairy foods are an option and not a requirement or a recommendation. I hope they highlight other sources of dietary calcium such as dark green leafy vegetables, and state that dairy products may not be appropriate for people with particular ethnic backgrounds because of widespread lactose intolerance. In other words, the truth.

For more information, visit PCRM’s web site.


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