Food Groups

What foods are included in the dairy group?

All fluid milk products and many foods made from milk are considered part of this food group. Foods madefrom milk that retain their calcium content are part of the group, while foods made from milk that have littleto no calcium, such as cream cheese, cream, and butter, are not. Most milk group choices should be fat-freeor low-fat.

Some commonly eaten choices in the milk, yogurt, and cheese group are:

Milk*All fluid milk:fat-free (skim)low fat (1%)reduced fat (2%)whole milk

flavored milks:chocolatestrawberry

lactose reduced milkslactose free milks

Milk-based desserts*Puddings made with milkice milkfrozen yogurtice cream

Cheese*Hard natural cheeses:

cheddarmozzarellaSwissparmesan

soft cheesesricottacottage cheese

processed cheesesAmerican

Yogurt*All yogurt

Fat-freelow fatreduced fatwhole milk yogurt

*Selection Tips

Choose fat-free or low-fat milk, yogurt, and cheese. If you choose milk or yogurt that is not fat-free, orcheese that is not low-fat, the fat in the product counts as part of the empty calorie allowance.

If sweetened milk products are chosen (flavored milk, yogurt, drinkable yogurt, desserts), the added sugarsalso count as part of the empty calorie allowance.

For those who are lactose intolerant, lactose-free and lower-lactose products are available. These includehard cheeses and yogurt. Also, enzyme preparations can be added to milk to lower the lactose content.Calcium-fortified foods and beverages such as soy beverages or orange juice may provide calcium, but maynot provide the other nutrients found in milk and milk products.

This page was last updated on February 09, 2011 12:53 PM

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Fact SheetTop 3 Reasons Cheese Is Important in Child Nutrition ProgramsThe Dietary Guidelines, numerous health organizations and the latest science support the continued role of cheese as a core component of child nutrition programs as well as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Child and Adult Care Food Program (CACFP).

Cheese is a nutritious food that nourishes growing children• Asagoodsourceofhighquality,easilydigestibleprotein,1 cheese is considered a meat/meat alternative byNationalSchoolLunchProgram,andcanbeservedasanounce-for-ouncesubstituteformeat.2 Cheesecanalso,insomecases,besubstitutedforfluidmilkintheWICprograms.3

• Sometypesofcheeseareexcellentsourcesofcalcium,delivering27%ofthemineralintheUSfoodsupply.4Oneandahalfouncesofsomenaturalcheesecontainsapproximately300mgofcalcium,theequivalentof1cupofmilk.

Cheese is part of a healthy eating pattern • Asaresultofarestrictiveapproachinsomelocalities,somefoodsthatprovideimportantnutrients,likecheese,areatriskofbeingunintentionallyeliminated,becauseofthesaturatedfatandsodiumcontent.However,asillustratedbytheUSDA’sMyPyramid for Kids,thelong-termhealthofchildrenandadolescentscanbestbeachievedbymoderateconsumptionofavarietyofnutrient-richfoodsamongandwithinthemajorfoodgroups,includinglow-fatandfat-freedairyfoods.

• ResultsfromtwostudiesofmiddleschoolchildrenindicatedthattheadditionofcheesetovariousmenuofferingsmayhelpincreasetheconsumptionofsomeFoodGroupstoEncourage-fruit,vegetables,andwholegrains-comparedtowhencheesewasnotoffered.5

Cheese is considered a healthy snack food for school children• TheSchoolNutritionAssociationhasdevelopednutritionrecommendationsforfoodssoldoutsidereimbursablemealsandallowsupto1ounceofcheeseperserving.6 Because it provides important nutrients,cheeseisexemptfromfatandsaturatedfatstandardsanditisconsidereda“tier1”(morehealthful) food.

• TheAllianceforaHealthierGeneration(AHG)7 also has developed a voluntary set of recommendations forcompetitivefoodsinschools,andhasincludedreduced-fatandpart-skimcheese,nuts,nutbuttersandseedsaspartoftheirHealthySchoolsProgram.TheAHGalsoexemptsreduced-fatandpart-skimcheesefromsaturatedfatandsodiumlimits(asrequiredforothersnackfoods),soschoolscanofferupto1.5-ounceservingsofcheeseasaqualifiedsnackfood.

• Cheesemayhelppreventtheformationofdentalcaries8andisrecommendedasahealthfulsnackbytheAmerican Academy of Pediatric Dentistry.9

References1 Miller GD, Jarvis JK, McBean LD. Handbook of Dairy Foods and Nutrition, 3rd ed.CRC Press. 2007, Boca Raton, FL. 2 USDA National School Lunch Program. http://www.fns.usda.gov/cnd/Governance/regulations/7CFR210.pdf (Accessed November 14, 2008). 3 Committee to Review the WIC Food Packages; Food and Nutrition Board, Institute of Medicine. WIC Food Packages: Time for a Change. The National Academies Press, Washington D.C., 2006.4 http://www.ers.usda.gov/Briefing/DietQuality/Availability.htm (Accessed January 2, 2009).5 Donnelly J, et al. The Effects of Visible Cheese on Selection and Consumption of Food Groups to Encourage in Middle School Children. Presented

at School Nutrition Association annual meeting, June 2009.6 School Nutrition Association. National Nutrition Standards Recommendations, December 8, 2008.7 Alliance for a Healthier Generation Healthy School Program: Competitive Foods Guidelines. 2006. http://www.healthiergeneration.org/schools.aspx?id=76&ekmensel=1ef02451_10_114_btnlink (Accessed November 17, 2008)8 Kashket S, DePaola DP. Cheese consumption and the development and progression of dental caries. Nutr Rev 2002:60(4):97-103. 9 American Academy of Pediatric Dentistry. Diet and Dental Health. AAPD Fast Facts 1999-2000.

safeguarding the health of america’s children:The Importance of Dairy Foods in Child Nutrition Programs

july 2009

Fact SheetTop 3 Reasons Flavored Milk Is Important in Child Nutrition ProgramsThe Dietary Guidelines, numerous health organizations and the latest science support the continued role of flavored milk as a core component of child nutrition programs as well as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Child and Adult Care Food Program (CACFP).

Flavored milk is a nutrient-rich beverage that’s good for kids• Offeringflavoredlow-fatorfat-freemilkisanexcellentwaytoincreasemilkconsumptionamongchildren

and make their diets more nutritious.

• Offeringflavoredmilkcanhelpincreasemilkconsumptionandboostoverallparticipationinschoolmealprograms.1Concernsaboutcalories,fatandsugarascomponentsofindividualfoodsratherthantheoveralldiethaveputnutrient-richflavoredmilkatriskofnotbeingofferedtochildren.Limitingaccesstoflavoredmilk,becauseofitsaddedsugar,mayonlyhavetheundesirableeffectoffurtherreducingintakesofessentialnutrientsprovidedbymilk.2

• Flavoredmilkprovidesthesamenineessentialnutrientsasunflavoredmilk(calcium,potassium,phosphorous,protein,vitaminsA,DandB12,riboflavinandniacin(niacinequivalents)),andcanhelpkidsmeettheircalciumrequirements.3 Kidswhoconsumeflavoredmilkmeettheircalciumrequirementswithout consuming significantly more added sugar compared to those who do not consume milk.2

• Childrenwhodrinkflavoredmilkaswellasunflavoredmilkfarebetteronavarietyofnutritionalfronts:

— Flavored milk drinkers have lower intakes of soft drinks compared to those who do not drink flavored milk.4

— Flavoredmilkdrinkersconsumemoremilkthanexclusivelyunflavoredmilkdrinkers.4

— Milk drinkers in general consume more calcium, phosphorus, magnesium, potassium and vitamin A than non milk drinkers.2

— Flavored milk drinkers do not have higher total fat or calorie intakes than non milk drinkers.4

— Childrenwhodrinkflavoredandunflavoredmilkdon’thavehigherbodymassindex(BMI)thanthose who do not drink milk.2

Kids love the taste of flavored milk• Accordingto2005USDAdata,66%ofthemilkchosenbychildreninschoolsisflavored;mostofwhichislow-fat(1%)orfat-free.5Studieshaverevealedkids’clearnutritiousbeverageofchoice:low-fatchocolatemilk,whetherornotit’slactose-free.6

• Accordingtothe2005DietaryGuidelinesforAmericans,addingasmallamountofsugartonutrient-richfoodssuchasreduced-fatmilkproductshelpsenhancetheirpalatabilityandimprovesnutrientintakewithoutaddingexcessivecalories.7

Health and nutrition experts recommend flavored milk• TheInstituteofMedicinealsorecognizesthenutritionalvalueofflavoredmilkwithmodestamountsof

sugar for school children.8

• TheAmericanAcademyofPediatricsencouragestheconsumptionoflow-fatorfat-freewhiteorflavoredmilk,waterorrealfruitorvegetablejuiceashealthfulalternativestosoftdrinks.9

safeguarding the health of america’s children:The Importance of Dairy Foods in Child Nutrition Programs

july 2009

References1 National Dairy Council and School Nutrition Association. The School Milk Pilot Test. Beverage Marketing Corporation for National Dairy Council and School Nutrition Association. 2002. http://www.nutritionexplorations.org/sfs/schoolmilk_pilottest.asp (Accessed January 4, 2009).2 Murphy MM, Douglass JS, Johnson RK, Spence LA. Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in U.S. children and adolescents. J Am Diet Assoc 2008;108:631-639.

3 Frary CD, Johnson RK, Wang MQ. Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. J Adolesc Health 2004;34(1):56-63.

4 Johnson RK, Frary C, Wang MQ,. The nutritional consequences of flavored milk consumption by school-aged children and adolescents in the United States. J Am Diet Assoc, 2002; 102(6):853-856.

5 ENVIRON International Corporation. School Milk: Fat Content Has Declined Dramatically since the Early 1990s. 2008.

6 Kids lactose-free milks product study. Prepared for Dairy Management, Inc. by Moskowitz Jacobs, Inc. July 2008.

7 United States Dept. of Health and Human Services, United States Dept. of Agriculture, and United States. Dietary Guidelines Advisory Committee, 2005 Dietary Guidelines for Americans. (6th ed. HHS publication. 2005, Washington, D.C.)

8 National Academy of Sciences, Institute of Medicine, Committee on Nutrition Standards for Foods in Schools. V.A. Stallings and A.L. Yaktine (Eds)Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth. Washington., D.C.: National Academies Press, 2007.

9 American Academy of Pediatrics, Committee on School Health. Soft drinks in schools. Pediatrics 2004;113152-154.

Top 3 Reasons Flavored Milk Is Important in Child Nutrition Programs

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The Dairy Council Digest® is available on-line.www.nationaldairycouncil.org

A N I N T E R P R E T I V E R E V I E W O F R E C E N T N U T R I T I O N R E S E A R C H

The 2005 Dietary Guidelines for Americans,the Institute of Medicine, and leading health professional organizations includingthe American Academy of Pediatrics, theAmerican Dietetic Association, and theAmerican Heart Association support the inclusion of low-fat/fat-free flavoredmilk in children’s and adolescents’ diets.

Scientific evidence fails to support othermisperceptions such as milk consumptioncauses early puberty in girls, acne, autism,or mucus formation in the respiratory tract. Although multiple genetic and environmental factors are implicated inthese conditions, there is little, if any, scientific grounds for reducing or eliminatingmilk intake.

The perception that raw (unpasteurized)milk is more nutritious and healthful than pasteurized milk is incorrect andpotentially has serious health consequences.Consuming raw milk and raw milk products is responsible for life-threateningdisease outbreaks from harmful bacteria.Pasteurization of milk, which is widely supported by the federal government andhealth professional organizations, is themost effective means of reducing the risk of milkborne micobiological illnesses. Thereis no meaningful change in the nutritionalquality of milk as a result of pasteurization.Moreover, unlike raw milk, most pasteurizedmilk is fortified with vitamin D, which playsa beneficial role in bone health.

Health professionals can help consumersidentify and understand science-basedinformation and encourage consumption of three servings every day of low-fat andfat-free milk, cheese, or yogurt as part of a healthful diet. D

SUMMARY

Consumers’ increasing awareness of the link between nutrition and health, theirinterest in taking responsibility for improvingtheir diets, and the explosion of food andnutrition information of varied accuracyfrom many venues can contribute to misperceptions about food, including dairy foods. Low-fat and fat-free milk,cheese, and yogurt are nutrient-rich foods.Together they provide calcium, potassium,phosphorus, protein, vitamins A, D, and B12,riboflavin, and niacin (niacin equivalents).Studies show that dairy foods, when consumed as part of a healthful diet,improve overall diet quality and may help to reduce the risk of major chronic diseasessuch as osteoporosis, among others.

Misperceptions about dairy foods can result in the unnecessary elimination ofthese foods from the diet, which in turnoften leads to nutritional shortcomings and increased risk of some chronic diseases. For this reason, it is important for health professionals to understand the rationale used by people harboring misperceptions about dairy foods and effectively communicate science-basedinformation about dairy foods’ nutritionalvalue, health benefits, and quality.

A common misperception is that low-fat orfat-free flavored milk, because of its sugarcontent, is an unhealthy beverage choice for children. On the contrary, even thoughlow-fat/fat-free flavored milk contains someadded sugar, scientific studies show thatchildren who drink flavored milk consumemore milk overall, meet more of their nutrient needs, do not consume moreadded sugar or fat, and are not heavier than non-milk drinkers. Studies show thatflavored milk is the most popular milkchoice among school children.

MISPERCEPTIONSREGARDING

DAIRY FOODS:A REVIEW OF

THE EVIDENCE

Volume 81Number 1 January | February 2010

January | February 2010INTRODUCTION

Although the beneficial role of dairy foods in a healthful diet is well established by the nutrition and science community (1,2),misperceptions about these foods continueto arise. Today’s multi-media environmentincreases opportunities for misinformationleading to misperceptions about food in general to flourish (3). Consumers’increasing awareness of the link betweennutrition and health and their interest in assuming more responsibility for their eating habits can increase their vulnerability to misperceptions about foods (3). The Internet can contribute toconsumer confusion and misperceptionsabout food, including dairy foods, becausesites with science-based information co-exist with those containing questionableor inaccurate information from unqualifiedsources (3).

Misperceptions about dairy foods can result in the needless omission of thesefoods from the diet, which in turn can leadto inadequate nutrient intake, increased risk of some chronic diseases, and erosion of dairy foods’ healthful image. Dairy foodssuch as low-fat and fat-free milk, cheese,and yogurt are nutrient-rich foods, togetherproviding calcium, potassium, other minerals and vitamins, and protein essentialfor growth and development (4,5). The2005 Dietary Guidelines for Americans recognizes dairy foods as a “Food Group to Encourage” (5). Studies in children andadults indicate that consumption of dairyfoods improves the overall nutritional quality of the diet (5-8).

This Digest identifies some current misperceptions regarding dairy foods and provides findings from science-based nutrition research dispelling thesemisperceptions. Persons who unnecessarilylimit or avoid consuming dairy foodsbecause of the misperceptions discussedbelow may negatively impact the nutritionalquality of their diets and overall health.

2

Studies show that children whodrink flavored milkconsume moremilk overall, meet more of theirnutrient needs, donot consume moreadded sugar or fat,and are not heavierthan non-milkdrinkers.

DAIRY FOOD MISPERCEPTIONSVERSUS SCIENTIFIC EVIDENCE

Misperception: Flavored milk, becauseof its sugar content, is an unhealthy

beverage choice for children.

The Science: Even though flavored milk has some added sugar, studies showthat children who drink flavored milk consume more milk overall, meet more of their nutrient needs, do not consumemore added sugar or fat, and are not heavier than non-milk drinkers (9-11). Likeunflavored milk, flavored milk provides nineessential nutrients – calcium, potassium,phosphorus, protein, vitamins A, D, and B12,riboflavin, and niacin (niacin equivalents)(4). Moreover, flavored and unflavored milk supply three of the five nutrients thatfall short in children’s diets (i.e., calcium,potassium, magnesium) (4,5).

Children who drink flavored milk tend todrink more milk overall than those who donot drink flavored milk (9). Flavored milk,the majority of which is low-fat or fat-free, is the most popular milk choice amongschool children, consumed by 66% of milkdrinkers in schools during lunch (12,13). Arecent study found that removal of flavoredmilk from a school district in Connecticutresulted in a decrease in milk consumptionby 37% to 63%, depending on the gradelevel (14), which may have a consequentdeterioration in diet quality (7).

Low-fat and fat-free flavored milks have less added sugar and more nutrients thansugar sweetened soft drinks. On average, an 8-ounce serving of low-fat chocolatemilk contains about 4 teaspoons of addedsugar, while an equivalent amount of softdrinks contains about 7 teaspoons. Somenatural (mostly in the form of lactose) and added sugars, either nutritive (e.g.,sucrose, high fructose corn syrup [HFCS]) or non-nutritive depending on the brand,are found in flavored milk. The compositionof HFCS is about 55% fructose and 45%glucose, which is very similar to sucrose,commonly known as table sugar (50% glucose, 50% fructose) (15,16). Both sugarshave the same number of calories, the samesweetness, and are metabolically similar(15). Despite some allegations linking HFCSwith obesity, a scientific review conducted

January | February 2010

3

Misperceptionsregarding dairyfoods can result intheir unnecessaryelimination fromthe diet, which canlead to nutritionalshortcomings andincreased risk of some chronicdiseases.

by the American Medical Association indicates that HFCS does not appear to lead to obesity or other conditions any morethan calories from other nutritive (caloric)sweeteners (17).

Although sugar can contribute to the risk ofdental caries, several factors (e.g., amount oftime sugar remains on the teeth) influencethe degree of caries risk for a food or beverage. There is no scientific evidenceindicating that flavored milk consumptioncauses tooth decay (18). The AmericanAcademy of Pediatric Dentistry states that“chocolate milk is OK for children’s teeth”(19). Nor is there scientific evidence thatadded sugars in flavored milk cause hyperactivity, other behavioral disorders, or interfere with children’s academic performance (20-22).

The 2005 Dietary Guidelines for Americans(5), the Institute of Medicine (23), and leading health professional organizationssuch as the American Academy of Pediatrics(24,25), the American Dietetic Association(20) and the American Heart Association(AHA) (26) support the inclusion of low-fatand fat-free flavored milks in children’s andadolescents’ diets. The AHA states, “whensugars are added to otherwise nutrient-richfoods, such as sugar-sweetened dairy products like flavored milk and yogurt… the quality of children’s and adolescents’diet improves, and in the case of flavoredmilks, no adverse effects on weight statuswere found” (26).

Misperception: Milk consumptioncauses early puberty in girls.

The Science: There is no conclusive scientific evidence to support the suggestionthat consumption of milk causes earlypuberty in girls. Although recent studiessuggest a decrease in the age of onset of puberty in girls over the past severaldecades (27,28), the reason(s) behind this trend is unknown. Multiple factors –socioeconomic conditions, psychologicalfactors (e.g., stress), nutritional status,dietary quality, chronic diseases, birthweight, and early postnatal growth – havebeen examined for their effect on pubertytiming (29-32). Several studies link higherbody mass index or increased body fatnessin girls with earlier initiation or progressionof pubertal development (27,28,33-35).

There is no scientific evidence to back up the theory that hormones in milk or milk from cows treated with the synthetic hormone, recombinant bovinesomatotropin (rbST), play a role in earlyonset puberty in girls. All milk, includinghuman milk, naturally contains minuteamounts of hormones (36). Although somedairy farmers may treat cows with rbST to boost their herd’s milk production, thissynthetic hormone is not added to milk andthe composition of milk from treated anduntreated cows is the same (37). The U.S.Food and Drug Administration (37), basedon a review of the scientific evidence, statesthat milk from cows treated with rbST is safefor human consumption (37).

An observation arguing against the milk-early puberty theory is that children’smilk consumption has decreased (notincreased) in recent decades, a time coinciding with the earlier age of onset of puberty in girls (28,38). Consuming two to four servings, depending on age, of fat-free or low-fat milk or equivalent milkproducts every day is especially importantfor children and adolescents who are building peak bone mass (5,25).

Misperception: Milk intake causes acne.

The Science: According to the AmericanAcademy of Dermatology, research to datedoes not prove that diet causes acne (39).Acne is the most common skin disorder inthe United States, affecting 70 to 87% of adolescents, although it can affect all age groups (39-41). Multiple interrelatedgenetic and environmental factors (e.g., psychological stress, exposure to environmental pollutants, diet) have beenimplicated in the development of acne (40).

Some recent observational studies havefound an association between milk consumption, particularly skim milk, andincreased risk of teenage acne (42-44).These studies only suggest a correlation, not a cause-and-effect relationship (41,45).Moreover, these studies have several limitations including selection bias, failure to consider a number of confounding factors, self-reporting of acne, and, in thecase of one study (42), potentially impreciserecollection of food consumption nine yearsearlier (39,41,42,44,46). More research,

January | February 2010

4

Science-basedresearch dispels several misperceptionsrelated to dairyfoods such as those related to early puberty,acne, autism, andincreased mucusproduction in therespiratory tract.

particularly well-controlled randomized trials, is needed to confirm whether particular foods and/or dietary constituents have a direct effect on acne risk and severity (39,41,45). Individuals concerned about acne shouldconsult a dermatologist for appropriatetreatment (40). Because nutrient-richdairy foods are particularly important for adolescents’ bone and overall health,consumption of three servings of low-fator fat-free milk, cheese, or yogurt everyday should be encouraged (5).

Misperception: Children with autismshould avoid dairy foods.

The Science: To date, there is no clear scientific evidence regarding the cause or cure of autism or the effectiveness of dietary interventions (47-51). Autism (often referred to asAutism Spectrum Disorder or ASD) is a complex developmental disorder of brain function that typically appearsduring the first three years of life (47,52).Main symptoms include impaired socialinteraction, problems with verbal andnonverbal communication, and unusualor severely limited activities and interests(47,52). Once a rare condition, the number of children diagnosed withautism is increasing at a rate of10 to17 percent per year (53).

Although there is no known single cause of autism, both genetic and environmental factors are thought to play a role in its etiology (47,52). Treatment for specific symptoms usuallyconsists of educational/behavioral andmedical interventions (47,49,50). One of the most popular, yet unproven, nutritional strategies for autism is thegluten-free, casein-free (GFCF) diet. It is hypothesized that some autisticsymptoms may be the result of opioidpeptides formed from the incompletebreakdown of foods containing gluten(wheat, rye, barley) and casein (in dairyfoods) (49,50).

Although some proponents believe that a GFCF diet improves symptoms of autism, there is little, if any, scientificproof of the efficacy of this dietary

intervention (48,49,51). A recent randomized, double-blind clinical trial in13 children with autism found no significant differences in behavioral data or urinary peptide levels betweenchildren treated with a GFCF diet and acontrol group (49). Moreover, there canbe drawbacks of the GFCF diet, especiallyif self-prescribed (48,54,55). Some datasuggest that children following this dietmay be at risk of essential amino aciddeficiencies (54) and bone loss (55).Removing foods from two major foodgroups (i.e., grain and dairy) makes it difficult to achieve a nutritionally balanced diet, particularly for autisticchildren, many of whom already consume self-restricted diets because of their aversion to texture, temperature,or other characteristics of food (56).

A recent multidisciplinary expert panelconcluded that available data do not support the use of special diets such as acasein-free diet, a gluten-free diet, or theGFCF diet for patients with autism (51).Because many autistic children are at riskfor nutritional deficiencies due to dietaryaversions and/or intake of controversial,restrictive therapeutic diets (57), healthprofessionals, especially registered dietitians, have an important role to play in helping to ensure the nutritionalhealth of those with autism (50,51,58).

Misperception: Consuming milkincreases mucus formation in the

respiratory tract.

The Science: According to a recentreview, there is no conclusive evidencefor the belief that consuming milkincreases mucus production and aggravates the congestion of colds, allergies, or asthma (a chronic inflammatory disease of the lower respiratory tract) (59). However, the milk-mucus believers were more likelythan non-believers to report sensory perceptions related to mucus followingmilk intake. A likely explanation for this perception is that it is an acute phenomenon with the milk emulsiontemporarily adhering to the thin layer of mucus always coating the throatmucous membrane.

January | February 2010 Association, the American VeterinaryMedical Association, the U.S. Department of Agriculture, the International Association for Food Protection, and the World Health Organization, among others (60).

In the U.S., it is illegal to sell raw milkpackaged for consumer use across state lines (60,61). However, the sale of raw milk by some means (e.g., direct purchase, cow-share, or leasingprograms) within states is allowed.Despite the documented health hazardsof consuming raw milk or raw milk products, 29 states allow the sale of these foods (60). Therefore, it is important to increase public awareness of the microbiological safety hazards of raw milk and certain dairy products manufactured using raw milk and recommend that only pasteurized milk be consumed (60). Strict governmentregulations and the dairy industry’s commitment to providing safe, high quality milk helps to assure that pasteurized milk and milk products are safe and nutritious. Visit www.dairyfarmingtoday.org formore information about the steps America’s dairy farmers and milk processors take to protect the safety and quality of cow’s milk and other dairy foods.

CONCLUSION

Misperceptions regarding dairy foods can lead to their unnecessary eliminationfrom the diet, which almost always lowers the total dietary intake of milk’sessential nutrients, such as calcium, andpotentially jeopardizes health. Healthprofessionals can positively shape theirclients’ food choices by understandingthe rationale used by people who harbormisperceptions regarding dairy foods andeffectively communicating science-basedinformation about dairy foods’ nutritionalvalue, health benefits, and quality. TheAmerican Dietetic Association (3) haslisted strategies for communicating accurate nutrition information to consumers and questions to ask whenevaluating research reports and the credibility of nutrition information on websites.

5

Unpasteurized (raw) milk isresponsible for life-threatening illnesses caused byharmful bacteria.For this reason,numerous healthprofessional and government organizations recommend thatonly pasteurizedmilk be consumed.

D

Misperception: Raw (unpasteurized)milk is a more nutritious and healthful

beverage than pasteurized milk.

The Science: Raw milk consumption isresponsible for life-threatening illnessescaused by harmful bacteria such as E.coli0157:H7, Salmonella, Campylobacterspp, and L. monocytogenes (60-62).Although proponents of raw (unpasteurized) milk and raw milk products believe that these products possess enhanced nutritional qualities,taste, and health benefits, science-baseddata do not substantiate these beliefs(60-62). In fact, consuming raw milk andraw milk products is a continued publichealth threat.

Pasteurization of milk is the most effective means of reducing the risk of microbiological hazard (60,61,63). Pasteurization involves heating raw milkfor a very brief time at a predeterminedtemperature as defined in the Food andDrug Administration’s Pasteurized MilkOrdinance (63). Lower morbidity andmortality associated with consumption of pasteurized milk attest to the benefit of pasteurizing raw milk (60).During pasteurization, there is no meaningful change in the nutritionalquality of milk (61). Moreover, unlike rawmilk, most pasteurized milk as marketedis fortified with vitamin D, a nutrientwhich enhances the intestinal absorptionof calcium and phosphorus and plays abeneficial role in bone health (64). Theaddition of vitamin D makes pasteurizedmilk an excellent source of this nutrient,providing 25% of the Daily Value in one8-ounce serving. Vitamin D insufficiencyand deficiency is common among manyU.S. children and adults, especially thoseof Hispanic and African Americandescent (65-67).

In an effort to protect human health, anumber of organizations have publishedguidelines and statements supporting the pasteurization of milk and restrictionof raw milk and milk products made fromraw milk (60,61). These organizations include the U.S. Food and Drug Administration, the U.S. Centers for Disease Control, the American MedicalAssociation, the American Academy ofPediatrics, the American Public Health

January | February 2010

30. Semiz, S., F. Kurt, D.T. Kurt, et al. Turk. J. Pediatr. 51:49, 2009.

31. Karaolis-Danckert, N., A.E. Buyken, A. Sonntag, et al. Am. J. Clin. Nutr. 90: 1559, 2009.

32. Cheng, G., S. Gerlach, L. Libuda, et al. J. Nutr. 140:95, 2010.

33. Lee, J.M., D. Appugliese, N. Kaciroti, et al. Pediatrics119: e624, 2007.

34. DiVall, S.A., and S. Radovick. Curr. Opin.Endocrinol. Diabetes Obes. 16: 1, 2009.

35. Buyken, A.E., N. Karaolis-Danckert, and T. Remer.Am. J. Clin. Nutr. 89: 221, 2009.

36. Vicini, J., T. Etherton, P. Kris-Etherton, et al. J. Am. Diet. Assoc. 108: 1198, 2008.

37. U.S. Food and Drug Administration. Report of the Food and Drug Administration’sReview of the Safety of Recombinant Bovine Somatotropin. April 23, 2009.www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm130321.htm.

38. Nielsen, S.J., and B.M. Popkin. Am. J. Prev. Med.27: 205, 2004.

39. American Academy of Dermatology. Food does not cause acne. AcneNet. Updated 1/14/09.www.skincarephysicians.com/acnenet/acne_and_diet.html.

40. American Academy of Dermatology. Acne. 2009.www.aad.org/media/background/factsheets/fact_acne.html.

41. Tom, W.L., and V.R. Barrio. Curr. Opin. Pediatr. 20:436, 2008.

42. Adebamowo, C.A., D. Spiegelman, F.W. Danby, et al. J. Am. Acad. Dermatol. 52: 207, 2005.

43. Adebamowo, G., D. Spiegelman, C.S. Berkey, et al.Dermatol. Online 12: 1, 2006.

44. Adebamowo, C.A., D. Spiegelman, C.S. Berkey, et al. J. Am. Acad. Dermatol. 10: 1, 2008.

45. Marcason, W. J. Am. Diet. Assoc. 110: 152, 2010.46. Webster, G.F. J. Am. Acad. Dermatol. 58:

794, 2008.47. National Institute of Neurological Disorders

and Stroke. Autism Fact Sheet. NIH Publication No. 09-1877. September 2009. www.ninds.nih.gov/disorders/autism/detail_autism.htm.

48. Millward, C., M. Ferriter, S. Calver, et al. CochraneDatabase Syst. Rev. 2: CD003498, 2008.

49. Elder, J.H. Nutr. Clin. Pract. 23: 583, 2008.50. Marcason, W. J. Am. Diet. Assoc. 109: 572, 2009.51. Buie, T., D.B. Campbell, G.J. Fuchs, III, et al.

Pediatrics 125: 1s, 2010.52. Autism Society of America. About Autism. 2008.

www.autism-society.org.53. The American Dietetic Association.

Autism and diet. www.eatright.org/Public/content.aspx?id=6815.

54. Arnold, G.L., S.L. Hyman, R.A. Mooney, et al. J. Autism Dev. Disord. 33: 449, 2003.

55. Hediger, M.L., L.J. England, C.A. Molloy, et al. J. Autism Dev. Disord. 38: 848, 2008.

56. Goday, P. Nutr. Clin. Practice 23: 581, 2008.57. Herndon, A.C., C. DiGuiseppi, S.L. Johnson, et al.

J. Autism Dev. Disord. 39: 212, 2009.58. Peregrin, T. J. Am. Diet. Assoc. 107: 727, 2007.59. Wuthrich, B., A. Schmid, B. Walther, et al.

J. Am. Coll. Nutr. 24: 547s, 2005.60. Oliver, S.P., K.J. Boor, S.C. Murphy, et al.

Foodborne Pathogens and Disease 6(7): 793, 2009.61. LeJeune, J.T., and P.J. Rajala-Schultz.

Clin. Infect. Dis. 48: 93, 2009.62. U.S. Food and Drug Administration, U.S.

Department of Health and Human Services. The Dangers of Raw Milk: Unpasteurized Milk Can Pose A Serious Health Risk. November 2009.www.fda.gov/Food/ResourcesForYou/Consumers/ucm079516.htm.

63. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration. Grade “A” Pasteurized Milk Ordinance. 2007 Revision. Washington, DC:USDHHS, PHS, FDA, 2007.

64. Food and Nutrition Board, Institute of Medicine,National Academy of Sciences. Dietary ReferenceIntakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: NationalAcademy Press, 1997.

65. Holick, M.F., and T.C. Chen. Am. J. Clin. Nutr. 87(s):1080s, 2008.

66. Mansbach, J.M., A.A. Ginde, and C.A. Camargo, Jr.Pediatrics 124: 1404, 2009.

67. Ginde, A.A., M.C. Liu, and C.A. Camargo, Jr. Arch. Intern. Med. 169: 626, 2009.

REFERENCES

1. Huth, P.J., V.L. Fulgoni, III, D.B. DiRienzo, et al. Nutr. Today 43: 226, 2008.

2. Nicklas, T.A., and M. Van Loan. J. Am. Coll. Nutr.28(s): 69s, 2009.

3. The American Dietetic Association. J. Am. Diet.Assoc. 106: 601, 2006.

4. U.S. Department of Agriculture, AgriculturalResearch Service. USDA National Nutrient Databasefor Standard Reference. Release 22, 2009.www.ars.usda.gov/ba/bhnrc/ndl.

5. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. Washington, DC:U.S. Government Printing Office, 2005.www.healthierus.gov/dietaryguidelines.

6. Rajeshwari, R., T.A. Nicklas, S.-J. Yang, et al. J. Am. Diet. Assoc. 105: 1391, 2005.

7. Murphy, M.M., J.S. Douglass, R.K. Johnson, et al. J. Am. Diet. Assoc. 108: 631, 2008.

8. Poddar, K.H., K.W. Hosig, S.M. Nickols-Richardson,et al. J. Am. Diet. Assoc. 109: 1433, 2009.

9. Johnson, R.K., C. Frary, and M.Q. Wang. J. Am. Diet. Assoc. 102: 853, 2002.

10. Frary, C.D., R.K. Johnson, and M.Q. Wang. J. Adol. Health 34: 56, 2004.

11. Murphy, M.M., J.S. Douglass, R.K. Johnson, et al. J. Am. Diet. Assoc. 108: 631, 2008.

12. U.S. Department of Agriculture, Food and NutritionService. School Nutrition Dietary Assessment Study – III. Alexandria, VA: Food and Nutrition Service, USDA, November 2007. www.fns.usda.gov(under Research, Child Nutrition Studies).

13. ENVIRON International Corporation. School Milk:Fat Content Has Declined Dramatically Since theEarly 1990s. 2008. www.nationaldairycouncil.org.

14. Patterson, J., and M. Saidel. J. Am. Diet. Assoc.109: A97, 2009.

15. Fulgoni, V., III. Am. J. Clin. Nutr. 88(s): 1715s, 2008.16. International Food Information Council Foundation.

What science says about fructose. Food InsightJuly/August: 2, 2008. www.foodinsight.org.

17. American Medical Association, Council on Scienceand Public Health. The Health Effects of High Fructose Syrup. Report 3 of the Council on Scienceand Public Health (A-08). June 19, 2008.www.ama-assn.org/.

18. Levine, R.S. Br. Dent. J. 191: 20, 2001.19. American Academy of Pediatric Dentistry.

AAPD Fast Facts. Diet and Dental Health. 2009.www.aapd.org/media/fastfacts08.pdf.

20. American Dietetic Association. J. Am. Diet. Assoc.104: 255, 2004.

21. White, J.W., and W. Wolraich. Am. J. Clin. Nutr.62(s): 242s, 1995.

22. Wolraich, M.L., D.B. Wilson, and J.D. White. JAMA 274: 1617, 1995.

23. National Academy of Sciences, Institute of Medicine, Committee on Nutrition Standards forFoods in Schools. V.A. Stallings and A.L. Yaktine(Eds). Nutrition Standards for Foods in Schools:Leading the Way Toward Healthier Youth.Washington, DC: National Academies Press, 2007.

24. American Academy of Pediatrics, Committee onSchool Health. Pediatrics 113: 152, 2004.

25. Greer, F.R., and N.R. Krebs for the American Academy of Pediatrics Committee on Nutrition.Pediatrics 117: 578, 2006.

26. Johnson, R.K., J.A. Lawrence, A.M. Brands, et al.Circulation 120: 1011, 2009.

27. Kaplowitz, P. Curr. Opin. Obstet. Gynecol.18: 487, 2006.

28. Kaplowitz, P.B. Pediatrics 121(suppl 3): 208s, 2008.29. Ellis, B.J., and M.J. Essex. Child Develop. 78: 1799,

2007.

ISSN 0011-55686

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DIETARY PROTEIN’SROLE IN

HEALTHY AGING

ACKNOWLEDGMENTS

National Dairy Council® assumes the responsibilityfor this publication. However, we would like toacknowledge the help and suggestions of the following reviewers in its preparation:■ Connie Diekman, M.Ed., RD, LD, FADA

Director of University NutritionWashington University in St. LouisSt. Louis, MO

■ Robert P. Heaney, MDJohn A. Creighton University ProfessorCreighton UniversityOmaha, NE

The Dairy Council Digest® is written and edited byLois D. McBean, MS, RD.

COPYRIGHT NOTICECopyright © 2010, NATIONAL DAIRY COUNCIL,®

O’Hare International Center, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616.

RELATED RESOURCES

www.nationaldairycouncil.org■ Modern Dairy Farming Practices and Milk

Quality: Myths and Facts. Dairy Council Digest78(3), 2007 (under Research, Dairy CouncilDigest Archives).

■ Flavored Milk: Questions & Answers. DairyCouncil Digest 76(6), 2008.

■ Flavored Milk in Perspective. 2009 (under ChildNutrition, General Nutrition & Health).

www.raiseyourhand4milk.com

www.dairyfarmingtoday.org/DairyFarmingToday/Learn-More/Media-Center/#Fact-Sheets

D

Food myths can lead to needless dietary omissions as well as to nutritional deficiencies. According to a 2006 report by the American Dietetic Association (ADA), dietary myths can have harmful effects on consumers’ health and well-being. As with many other foods, misinformation about milk and milk products has subsisted for centuries.

Importance of Dairy Foods in the DietMilk, cheese and yogurt are naturally nutrient-rich foods providing calcium, potassium, other minerals and vitamins, and protein essential for human growth and development. Milk is also an excellent source of vitamin D and calcium. As a result, the 2005 Dietary Guidelines for Americans recommends three servings of low-fat and fat-free milk and milk products each day to help provide adequate calcium, potassium, vitamin A and magnesium – vital minerals that were identified as “nutrients of concern” for adults because of widespread under-consumption. Based on research, the Dietary Guidelines determined that people who consume more dairy foods - milk, cheese and yogurt - have better overall diets and see improved bone health, which is why, ultimately, low-fat milk and milk products were included as one of the “food groups to encourage” - low-fat milk and milk products, fruits, vegetables and whole grains.1

Myths about Dairy Food

MYTH #1: People who are sensitive to lactose should avoid milk and other dairy foods FACTS:

• African-Americansshouldget3-4servingsofdairyfoodsaday to reduce the risk of calcium-related chronic diseases for which they are at the greatest risk.2

• Whenconsideringmilkalternatives,the2005DietaryGuidelines for Americans recommends lactose-free milk or yogurt with live, active cultures for those with lactose sensitivity to get dairy’s nutrient-rich health benefits in a form that may be better tolerated.

• TheNMAConsensusReportalsostatesthatlactoseintolerance doesn’t mean dairy intolerance. Some people with lactose intolerance can drink up to one cup of milk with a meal without developing symptoms.

MYTH #2: Hormones in milk cause early puberty in girls FACTS:

• Accordingtogovernmentandpediatrichealthexperts,thereis no scientific evidence to support the notion that rBGH,

a hormone supplement some farmers administer to cows, affects human growth and development.

• Theconcentrationofhormonesincow’smilkisveryminimalrelative to the level of normal human hormone production and, therefore, is of little physiological significance.

MYTH #3: Organic milk is healthier than regular milk FACTS:

• Thereisnoconclusivescientificevidencethatorganicfood,including milk, is superior with regard to food safety or nutrition. Organic and regular milk contain the same unique package of nine essential nutrients, including calcium, vitamin D, and potassium, that make dairy products an important part of a healthy diet.

• Allmilkistestedforantibioticstoensureitmeetsthegovernment’s stringent quality and safety standards.

• Certifiedorganicproductsprovideanotheroptionalongwith low-fat, lactose-free and flavored milk so it is easier for the consumer to meet the federal government’s dietary recommendations for three servings of milk and milk products each day based on their preferences

NationalMedicalAssociation1012TenthStreet,NWWashington,DC20001www.NMAnet.org202.347.1895Phone202.898.2510Fax

Pervasive Dairy Food Myths & Persuasive Dairy Food Facts

Fact Sheet

MYTH#4: Consuming dairy products can lead to weight gain

FACTS:• Despitepopularbeliefthatdairyfoodscanbe“fattening,”

a study showed no difference in weight gain for adolescent girls on a high-calcium diet versus girls on a normal diet.

• Increasedconsumptionofdairyfoodsaspartofareduced-caloriedietmayenhanceweightloss.Ina24-weekstudy of obese adults, those who consumed a reduced-calorie diet with3to4servingsofdairyfoodslostagreaterpercentageof body weight than those taking calcium supplements and those in a low-dairy or low-calcium group.

• Thevarietyofchoicesnowavailableinthedairycase,including low-fat, fat-free, flavored, organic and lactose-free products, make dairy foods a convenient, and reliable nutrition source that should not be avoided due to misinformation. Dispelling myths that surround dairy is an important step in encouraging healthy eating as defined by the Dietary Guidelines.

MYTH #5: Soy beverages are a good replacement for milk

FACTS: • Whilesoybeveragesareagoodsourceofplantprotein,

they do not deliver the same bioavailability or nutrient package (calcium, potassium, phosphorus, protein, vitamins A, D and B12, riboflavin and niacin) found in milk.

•Infantsdonotneedsoyinfantformulasovermilk-based formulas unless the infant has a

documented cow’s-milk-protein allergy, a metabolic disease or the parents choose a vegan diet for the child. Milk allergies requiring soy infant formula/beverages are rare.

MYTH #6: Supplements are an acceptable method to get essential nutrients found in dairy foods

FACTS: • Supplements do not offer the benefit of other associated

nutrients found in dairy foods, and compliance can be a problem.

• DailyvitaminandmineralsupplementsatorbelowtheRecommendedDietaryAllowancesareconsideredsafebut are rarely needed by people who eat a variety of foods asrecommendedintheFoodGuidePyramid,howeversupplements are sometimes needed to meet specific nutrient requirements.6

For a complete list of references and additional information on the health benefits of dairy foods, visit the National Dairy Council Web site at www.nationaldairycouncil.org.

For additional information on animal and farm practices on dairy farms, visit the Dairy Farming Today Web site at www.dairyfarmingtoday.org.

Reviewed By:Jatinder Bhatia, MD, FAAPMedical College of Georgia, Augusta, GA Connie Diekman, MEd, RD, LD, FADAWashington University, St. Louis, MissouriChristina Economos, PhDGerard J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MassachusettsRobert Heaney, MD, FACP, FASNSCreighton University, Omaha, NebraskaMichelle May, MD“Am I Hungry?”, P.L.L.C, Phoenix, ArizonaWilma Wooten, MD, MPHUniversity of California, San Diego, San Diego, CaliforniaKathleen Zelman, MPH, RD, LDWebMD, Marietta, Georgia

National Medical Association Staff Washington, DC

Endnotes1 U.S. Department of Agriculture and U.S. Department of Health and Human

Services. (January 2005). Dietary Guidelines for Americans, 2005. 6th ed

2 NationalMedicalAssociation.(December2004).TheRoleofDairyandDairyNutrientsintheDietofAfricanAmericans.

Myths about Dairy Food