Robert M. Kradjian, MD Breast Surgery Chief Division of General Surgery, Seton Medical Centre #302 - 1800 Sullivan Ave. Daly City, CA 94015 USA
"MILK"Just the word itself sounds comforting! "How about a nice cup of hot milk?" The last time you heard that question it was from someone who cared for you -- and you appreciated their effort.
The entire matter of food and especially that of milk is surrounded with emotional and cultural importance. Milk was our very first food. If we were fortunate it was our mother's milk. A loving link, given and taken. It was the only path to survival. If not mother's milk it was cow's milk or soy milk "formula" -- rarely it was goat, camel or water buffalo milk.
Now, we are a nation of milk drinkers. Nearly all of us. Infants, the young, adolescents, adults and even the aged. We drink dozens or even several hundred gallons a year and add to that many pounds of "dairy products" such as cheese, butter, and yogurt.
Can there be anything wrong with this? We see reassuring images of healthy, beautiful people on our television screens and hear messages that assure us that, "Milk is good for your body." Our dieticians insist that: "You've got to have milk, or where will you get your calcium?" School lunches always include milk and nearly every hospital meal will have milk added. And if that isn't enough, our nutritionists told us for years that dairy products make up an "essential food group." Industry spokesmen made sure that colorful charts proclaiming the necessity of milk and other essential nutrients were made available at no cost for schools. Cow's milk became "normal."
You may be surprised to learn that most of the human beings that live on planet Earth today do not drink or use cow's milk. Further, most of them can't drink milk because it makes them ill.
There are students of human nutrition who are not supportive of milk use for adults. Here is a quotation from the March/April 1991 Utne Reader:
If you really want to play it safe, you may decide to join the growing number of Americans who are eliminating dairy products from their diets altogether. Although this sounds radical to those of us weaned on milk and the five basic food groups, it is eminently viable. Indeed, of all the mammals, only humans -- and then only a minority, principally Caucasians -- continue to drink milk beyond babyhood. "Indeed, of all the mammals, only humans -- and then only a minority, principally Caucasians -- continue to drink milk beyond babyhood.
Who is right? Why the confusion? Where best to get our answers? Can we trust milk industry spokesmen? Can you trust any industry spokesmen? Are nutritionists up to date or are they simply repeating what their professors learned years ago? What about the new voices urging caution?
I believe that there are three reliable sources of information. The first, and probably the best, is a study of nature. The second is to study the history of our own species. Finally we need to look at the world’s scientific literature on the subject of milk.
Let’s look at the scientific literature first. From 1988 to 1993 there were over 2,700 articles dealing with milk recorded in the "Medicine" archives. Fifteen hundred of theses had milk as the main focus of the article. There is no lack of scientific information on this subject. I reviewed over 500 of the 1,500 articles, discarding articles that dealt exclusively with animals, esoteric research and inconclusive studies.
How would I summarize the articles? They were only slightly less than horrifying. First of all, none of the authors spoke of cow’s milk as an excellent food, free of side effects and the "perfect food" as we have been led to believe by the industry. The main focus of the published reports seems to be on intestinal colic, intestinal irritation, intestinal bleeding, anemia, allergic reactions in infants and children as well as infections such as salmonella. More ominous is the fear of viral infection with bovine leukemia virus or an AIDS-like virus as well as concern for childhood diabetes. Contamination of milk by blood and white (pus) cells as well as a variety of chemicals and insecticides was also discussed. Among children the problems were allergy, ear and tonsillar infections, bedwetting, asthma, intestinal bleeding, colic and childhood diabetes. In adults the problems seemed centered more around heart disease and arthritis, allergy, sinusitis, and the more serious questions of leukemia, lymphoma and cancer.
I think that an answer can also be found in a consideration of what occurs in nature -- what happens with free living mammals and what happens with human groups living in close to a natural state as "hunter-gatherers".
Our paleolithic ancestors are another crucial and interesting group to study. Here we are limited to speculation and indirect evidences, but the bony remains available for our study are remarkable. There is no doubt whatever that these skeletal remains reflect great strength, muscularity (the size of the muscular insertions show this), and total absence of advanced osteoporosis. And if you feel that these people are not important for us to study, consider that today our genes are programming our bodies in almost exactly the same way as our ancestors of 50,000 to 100,000 years ago.
What Is Milk?
Milk is a maternal lactating secretion, a short term nutrient for new-borns. Nothing more, nothing less. Invariably, the mother of any mammal will provide her milk for a short period of time immediately after birth. When the time comes for "weaning", the young offspring is introduced to the proper food for that species of mammal. A familiar example is that of a puppy. The mother nurses the pup for just a few weeks and then rejects the young animal and teaches it to eat solid food. Nursing is provided by nature only for the very youngest of mammals. Of course, it is not possible for animals living in a natural state to continue with the drinking of milk after weaning.
Is All Milk the Same?
Then there is the matter of where we get our milk. We have settled on the cow because of its docile nature, its size, and its abundant milk supply. Somehow this choice seems "normal" and blessed by nature, our culture, and our customs. But is it natural? Is it wise to drink the milk of another species of mammal?
Consider for a moment, if it was possible, to drink the milk of a mammal other than a cow, let’s say a rat. Or perhaps the milk of a dog would be more to your liking. Possibly some horse milk or cat milk. Do you get the idea? Well, I’m not serious about this, except to suggest that human milk is for human infants, dogs’ milk is for pups, cows’ milk is for calves, cats’ milk is for kittens, and so forth. Clearly, this is the way nature intends it. Just use your own good judgement on this one.
Milk is not just milk. The milk of every species of mammal is unique and specifically tailored to the requirements of that animal. For example, cows' milk is very much richer in protein than human milk. Three to four times as much. It has five to seven times the mineral content. However, it is markedly deficient in essential fatty acids when compared to human mothers' milk. Mothers' milk has six to ten times as much of the essential fatty acids, especially linoleic acid. (Incidentally, skimmed cow’s milk has no linoleic acid). It simply is not designed for humans.
Food is not just food, and milk is not just milk. It is not only the proper amount of food but the proper qualitative composition that is critical for the very best in health and growth. Biochemists and physiologists - and rarely medical doctors - are gradually learning that foods contain the crucial elements that allow a particular species to develop its unique specializations.
Clearly, our specialization is for advanced neurological development and delicate neuromuscular control. We do not have much need of massive skeletal growth or huge muscle groups as does a calf. Think of the difference between the demands make on the human hand and the demands on a cow's hoof. Human new-borns specifically need critical material for their brains, spinal cord and nerves.
Can mother’s milk increase intelligence? It seems that it can. In a remarkable study published in Lancet during 1992 (Vol. 339, p. 261-4), a group of British workers randomly placed premature infants into two groups. One group received a proper formula, the other group received human breast milk. Both fluids were given by stomach tube. These children were followed up for over 10 years. In intelligence testing, the human milk children averaged 10 IQ points higher! Well, why not? Why wouldn’t the correct building blocks for the rapidly maturing and growing brain have a positive effect?
In the American Journal of Clinical Nutrition (1982) Ralph Holman described an infant who developed profound neurological disease while being nourished by intravenous fluids only. The fluids used contained only linoleic acid - just one of the essential fatty acids. When the other, alpha linoleic acid, was added to the intravenous fluids the neurological disorders cleared.
In the same journal five years later Bjerve, Mostad and Thoresen, working in Norway found exactly the same problem in adult patients on long term gastric tube feeding.
In 1930 Dr. G.O. Burr in Minnesota working with rats found that linoleic acid deficiencies created a deficiency syndrome. Why is this mentioned? In the early 1960s pediatricians found skin lesions in children fed formulas without the same linoleic acid. Remembering the research, the addition of the acid to the formula cured the problem. Essential fatty acids are just that and cows’ milk is markedly deficient in these when compared to human milk.
Well, at Least Cow's Milk Is Pure
Or is it? Fifty years ago an average cow produced 2,000 pounds of milk per year. Today the top producers give 50,000 pounds! How was this accomplished? Drugs, antibiotics, hormones, forced feeding plans and specialized breeding; that's how.
The latest high-tech onslaught on the poor cow is bovine growth hormone or BGH. This genetically engineered drug is supposed to stimulate milk production but, according to Monsanto, the hormone's manufacturer, does not affect the milk or meat. There are three other manufacturers: Upjohn, Eli Lilly, and American Cyanamid Company. Obviously, there have been no long-term studies on the hormone's effect on the humans drinking the milk. Other countries have banned BGH because of safety concerns. One of the problems with adding molecules to a milk cows' body is that the molecules usually come out in the milk. I don't know how you feel, but I don't want to experiment with the ingestion of a growth hormone. A related problem is that it causes a marked increase (50 to 70 per cent) in mastitis. This, then, requires antibiotic therapy, and the residues of the antibiotics appear in the milk. It seems that the public is uneasy about this product and in one survey 43 per cent felt that growth hormone treated milk represented a health risk. A vice president for public policy at Monsanto was opposed to labelling for that reason, and because the labelling would create an "artificial distinction". The country is awash with milk as it is, we produce more milk than we can consume. Let’s not create storage costs and further taxpayer burdens, because the law requires the USDA to buy any surplus of butter, cheese, or non-fat dry milk at a support price set by Congress! In fiscal 1991, the USDA spent $757 million on surplus butter, and one billion dollars a year on average for price supports during the 1980s (Consumer Reports, May 1992: 330-32).
Any lactating mammal excretes toxins through her milk. This includes antibiotics, pesticides, chemicals and hormones. Also, all cows' milk contains blood! The inspectors are simply asked to keep it under certain limits. You may be horrified to learn that the USDA allows milk to contain from one to one and a half million white blood cells per milliliter. (That’s only 1/30 of an ounce). If you don’t already know this, I’m sorry to tell you that another way to describe white cells where they don’t belong would be to call them pus cells. To get to the point, is milk pure or is it a chemical, biological, and bacterial cocktail? Finally, will the Food and Drug Administration (FDA) protect you? The United States General Accounting Office (GAO) tells us that the FDA and the individual States are failing to protect the public from drug residues in milk. Authorities test for only 4 of the 82 drugs in dairy cows.
As you can imagine, the Milk Industry Foundation's spokesman claims it's perfectly safe. Jerome Kozak says, "I still think that milk is the safest product we have."
Other, perhaps less biased observers, have found the following: 38% of milk samples in 10 cities were contaminated with sulfa drugs or other antibiotics. (This from the Centre for Science in the Public Interest and The Wall Street Journal, Dec. 29, 1989).. A similar study in Washington, DC found a 20 percent contamination rate (Nutrition Action Healthletter, April 1990).
What’s going on here? When the FDA tested milk, they found few problems. However, they used very lax standards. When they used the same criteria , the FDA data showed 51 percent of the milk samples showed drug traces.
Let’s focus in on this because it’s critical to our understanding of the apparent discrepancies. The FDA uses a disk-assay method that can detect only 2 of the 30 or so drugs found in milk. Also, the test detects only at the relatively high level. A more powerful test called the "Charm II test" can detect 4o drugs down to 5 parts per billion.
One nasty subject must be discussed. It seems that cows are forever getting infections around the udder that require ointments and antibiotics. An article from France tells us that when a cow receives penicillin, that penicillin appears in the milk for from 4 to 7 milkings. Another study from the University of Nevada, Reno tells of cells in "mastic milk", milk from cows with infected udders. An elaborate analysis of the cell fragments, employing cell cultures, flow cytometric analysis , and a great deal of high tech stuff. Do you know what the conclusion was? If the cow has mastitis, there is pus in the milk. Sorry, it’s in the study, all concealed with language such as "¼macrophages containing many vacuoles and phagocytosed particles, etc."
It Gets Worse
Well, at least human mothers' milk is pure! Sorry. A huge study showed that human breast milk in over 14,000 women had contamination by pesticides! Further, it seems that the sources of the pesticides are meat and -- you guessed it -- dairy products. Well, why not? These pesticides are concentrated in fat and that's what's in these products. (Of interest, a subgroup of lactating vegetarian mothers had only half the levels of contamination).
A recent report showed an increased concentration of pesticides in the breast tissue of women with breast cancer when compared to the tissue of women with fibrocystic disease. Other articles in the standard medical literature describe problems. Just scan these titles:
1."Cow’s Milk as a Cause of Infantile Colic Breast-Fed Infants. Lancet 2 (1978): 437 2."Dietary Protein-Induced Colitis in Breast- Fed Infants, J. Pediatr. I01 (1982): 906 3."The Question of the Elimination of Foreign Protein in Women’s Milk", J. Immunology 19 (1930): 15
There are many others. There are dozens of studies describing the prompt appearance of cows’ milk allergy in children being exclusively breast-fed! The cows’ milk allergens simply appear in the mother’s milk and are transmitted to the infant.
A committee on nutrition of the American Academy of Pediatrics reported on the use of whole cows’ milk in infancy (Pediatrics 1983: 72-253). They were unable to provide any cogent reason why bovine milk should be used before the first birthday yet continued to recommend its use! Doctor Frank Oski from the Upstate Medical Centre Department of Pediatrics, commenting on the recommendation , cited the problems of occult gastrointestinal blood loss in infants, the lack of iron, recurrent abdominal pain, milk-borne infections and contaminants, and said:
Why give it at all - then or ever? In the face of uncertainty about many of the potential dangers of whole bovine milk, it would seem prudent to recommend that whole milk not be started until the answers are available. Isn’t it time for these uncontrolled experiments on human nutrition to come to an end?
In the same issue of Pediatrics he further commented:
It is my thesis that whole milk should not be fed to the infant in the first year of life because of its association with iron deficiency anemia (milk is so deficient in iron that an infant would have to drink an impossible 31 quarts a day to get the RDA of 15 mg), occult gastrointestinal bleeding, and various manifestations of food allergy. I suggest that unmodified whole bovine milk should not be consumed after infancy because of the problems of lactose intolerance, its contribution to the genesis of atherosclerosis, and its possible link to other diseases.
In late 1992 Dr. Benjamin Spock, possibly the best known pediatrician in history, shocked the country when he articulated the same thoughts and specified avoidance for the first two years of life. Here is his quotation:
I want to pass on the word to parents that cows’ milk from the carton has definite faults for some babies. Human milk is the right one for babies. A study comparing the incidence of allergy and colic in the breast-fed infants of omnivorous and vegan mothers would be important. I haven’t found such a study; it would be both important and inexpensive. And it will probably never be done. There is simply no academic or economic profit involved.
Let's just mention the problems of bacterial contamination. Salmonella, E. coli, and staphylococcal infections can be traced to milk. In the old days tuberculosis was a major problem and some folks want to go back to those times by insisting on raw milk on the basis that it's "natural." This is insanity! A study from UCLA showed that over a third of all cases of salmonella infection in California, 1980-1983 were traced to raw milk. That'll be a way to revive good old brucellosis again and I would fear leukemia, too. (More about that later). In England, and Wales where raw milk is till consumed there have been outbreaks of milk-borne diseases. The Journal of the American Medical Association (251: 483, 1984) reported a multi-state series of infections caused by Yersinia enterocolitica in pasteurized whole milk. This is despite safety precautions.
All parents dread juvenile diabetes for their children. A Canadian study reported in the American Journal of Clinical Nutrition, Mar. 1990, describes a "...significant positive correlation between consumption of unfermented milk protein and incidence of insulin dependent diabetes mellitus in data from various countries. Conversely a possible negative relationship is observed between breast-feeding at age 3 months and diabetes risk.".
Another study from Finland found that diabetic children had higher levels of serum antibodies to cows’ milk (Diabetes Research 7(3): 137-140 March 1988). Here is a quotation from this study:
We infer that either the pattern of cows’ milk consumption is altered in children who will have insulin dependent diabetes mellitus or, their immunological reactivity to proteins in cows’ milk is enhanced, or the permeability of their intestines to cows’ milk protein is higher than normal.
The April 18, 1992 British Medical Journal has a fascinating study contrasting the difference in incidence of juvenile insulin dependent diabetes in Pakistani children who have migrated to England. The incidence is roughly 10 times greater in the English group compared to children remaining in Pakistan! What caused this highly significant increase? The authors said that "the diet was unchanged in Great Britain. Do you believe that? Do you think that the availability of milk, sugar and fat is the same in Pakistan as it is in England? That a grocery store in England has the same products as food sources in Pakistan? I don’t believe that for a minute. Remember, we’re not talking here about adult onset, type II diabetes which all workers agree is strongly linked to diet as well as to a genetic predisposition. This study is a major blow to the "it’s all in your genes" crowd. Type I diabetes was always considered to be genetic or possibly viral, but now this? So resistant are we to consider diet as causation that the authors of the last article concluded that the cooler climate in England altered viruses and caused the very real increase in diabetes! The first two authors had the same reluctance top admit the obvious. The milk just may have had something to do with the disease.
The latest in this remarkable list of reports, a New England Journal of Medicine article (July 30, 1992), also reported in the Los Angeles Times. This study comes from the Hospital for Sick Children in Toronto and from Finnish researchers. In Finland there is "...the world's highest rate of dairy product consumption and the world's highest rate of insulin dependent diabetes. The disease strikes about 40 children out of every 1,000 there contrasted with six to eight per 1,000 in the United States.... Antibodies produced against the milk protein during the first year of life, the researchers speculate, also attack and destroy the pancreas in a so-called auto-immune reaction, producing diabetes in people whose genetic makeup leaves them vulnerable." "...142 Finnish children with newly diagnosed diabetes. They found that every one had at least eight times as many antibodies against the milk protein as did healthy children, clear evidence that the children had a raging auto immune disorder." The team has now expanded the study to 400 children and is starting a trial where 3,000 children will receive no dairy products during the first nine months of life. "The study may take 10 years, but we'll get a definitive answer one way or the other," according to one of the researchers. I would caution them to be certain that the breast feeding mothers use on cows' milk in their diets or the results will be confounded by the transmission of the cows' milk protein in the mother's breast milk.... Now what was the reaction from the diabetes association? This is very interesting! Dr. F. Xavier Pi-Sunyer, the president of the association says: "It does not mean that children should stop drinking milk or that parents of diabetics should withdraw dairy products. These are rich sources of good protein." (Emphasis added) My God, it's the "good protein" that causes the problem! Do you suspect that the dairy industry may have helped the American Diabetes Association in the past?
Leukemia? Lymphoma? This May Be the Worst -- Brace Yourself!
I hate to tell you this, but the bovine leukemia virus is found in more than three of five dairy cows in the United States! This involves about 80% of dairy herds. Unfortunately, when the milk is pooled, a very large percentage of all milk produced is contaminated (90 to 95 per cent). Of course the virus is killed in pasteurization -- if the pasteurization was done correctly. What if the milk is raw? In a study of randomly collected raw milk samples the bovine leukemia virus was recovered from two-thirds. I sincerely hope that the raw milk dairy herds are carefully monitored when compared to the regular herds. (Science 1981; 213:1014).
This is a world-wide problem. One lengthy study from Germany deplored the problem and admitted the impossibility of keeping the virus from infected cows' milk from the rest of the milk. Several European countries, including Germany and Switzerland, have attempted to "cull" the infected cows from their herds. Certainly the United States must be the leader in the fight against leukemic dairy cows, right? Wrong! We are the worst in the world with the former exception of Venezuela according to Virgil Hulse MD, a milk specialist who also has a B.S. in Dairy Manufacturing as well as a Master's degree in Public Health.
As mentioned, the leukemia virus is rendered inactive by pasteurization. Of course. However, there can be Chernobyl like accidents. One of these occurred in the Chicago area in April, 1985. At a modern, large, milk processing plant an accidental "cross connection" between raw and pasteurized milk occurred. A violent salmonella outbreak followed, killing 4 and making an estimated 150,000 ill. Now the question I would pose to the dairy industry people is this: "How can you assure the people who drank this milk that they were not exposed to the ingestion of raw, unkilled, bully active bovine leukemia viruses?" Further, it would be fascinating to know if a "cluster" of leukemia cases blossoms in that area in 1 to 3 decades. There are reports of "leukemia clusters" elsewhere, one of them mentioned in the June 10, 1990 San Francisco Chronicle involving No. California.
What happens to other species of mammals when they are exposed to the bovine leukemia virus? It’s a fair question and the answer is not reassuring. Virtually all animals exposed to the virus develop leukemia. This includes sheep, goats, and even primates such as rhesus monkeys and chimpanzees. The route of transmission includes ingestion (both intravenous and intramuscular) and cells present in milk. There are obviously no instances of transfer attempts to human beings, but we know that the virus can infect human cells in vitro. There is evidence of human antibody formation to the bovine leukemia virus; this is disturbing. How did the bovine leukemia virus particles gain access to humans and become antigens? Was it as small, denatured particles?
If the bovine leukemia viruses causes human leukemia, we could expect the dairy states with known leukemic herds to have a higher incidence of human leukemia. Is this so? Unfortunately, it seems to be the case! Iowa, Nebraska, South Dakota, Minnesota and Wisconsin have statistically higher incidence of leukemia than the national average. In Russia and in Sweden, areas with uncontrolled bovine leukemia virus have been linked with increases in human leukemia. I am also told that veterinarians have higher rates of leukemia than the general public. Dairy farmers have significantly elevated leukemia rates. Recent research shows lymphocytes from milk fed to neonatal mammals gains access to bodily tissues by passing directly through the intestinal wall.
An optimistic note from the University of Illinois, Ubana from the Department of Animal Sciences shows the importance of one’s perspective. Since they are concerned with the economics of milk and not primarily the health aspects, they noted that the production of milk was greater in the cows with the bovine leukemia virus. However when the leukemia produced a persistent and significant lymphocytosis (increased white blood cell count), the production fell off. They suggested "¼a need to re-evaluate the economic impact of bovine leukemia virus infection on the dairy industry". Does this mean that leukemia is good for profits only if we can keep it under control? You can get the details on this business concern from Proc. Nat. Acad. Sciences, U.S. Feb. 1989. I added emphasis and am insulted that a university department feels that this is an economic and not a human health issue. Do not expect help from the Department of Agriculture or the universities. The money stakes and the political pressures are too great. You’re on you own.
What does this all mean? We know that virus is capable of producing leukemia in other animals. Is it proven that it can contribute to human leukemia (or lymphoma, a related cancer)? Several articles tackle this one:
1."Epidemiologic Relationships of the Bovine Population and Human Leukemia in Iowa". Am Journal of Epidemiology 112 (1980): 80 2."Milk of Dairy Cows Frequently Contains a Leukemogenic Virus". Science 213 (1981): 1014 3."Beware of the Cow". (Editorial) Lancet 2 (1974):30 4."Is Bovine Milk A Health Hazard?". Pediatrics; Suppl. Feeding the Normal Infant. 75:182-186; 1985