Whole Milk or Low Fat? The Answer's Not Clear.

Whenever the professional nutritional community discusses the use of dairy products, they always recommend using low-fat or even fat-free milk and dairy products. Courtney Helgoe argues that this advice may be totally wrong in an article for Experience Life Magazine.

Her argument is interesting, although not completely convincing. She highlights a major problem, one that I constantly complain about, that there are far too few good studies about the role of an individual food in the totality of our diets and many of the ones that exist are not as comprehensive as people make them out to be.

However, what makes her argument less than it could be is that she keeps talking about low-fat diets interchangeably with diets that use low-fat milk. There is no reason whatsoever to think that the people who take whole milk out of their diets are getting sufficient - or way too much - fat from other sources.

The entire article is interesting and well-researched and I recommend reading it with that caveat in mind.

Except. If the article were simply about the fat content of milk, I probably wouldn't bother to critique it at all. This is a blog about lactose intolerance. What jumped to my eye was a statement about the lactose in milk that I think is just plain wrong.

It's also likely that one will drink much more skim milk than whole (or eat more low-fat yogurt, fat-free sour cream, low-fat ice cream, etc.) for three reasons:

1.It generally takes larger servings of low-fat foods than full-fat foods to switch on our bodies' satiety signals.
2.There’s a psychological tendency to feel that because we're "being good" by eating these low-calorie, low-fat products, we are justified in "making up for it" by eating more of them — or more of something else.
3.Low-fat foods don’t keep us satisfied for as long and may also destabilize blood sugar, so we're likely to experience cravings to want to eat again sooner.

This last point deserves some explanation: Low- and no-fat dairy delivers more fast-absorbing lactose to the bloodstream, and more potential for corresponding insulin spikes and resultant sugar cravings. Full-fat dairy doesn’t have this effect. "The proportion of lactose decreases with every increase in milk-fat content," [Anne Mendelson in Milk: The Surprising Story of Milk Through the Ages] explains. So relative to skim milk, "heavy cream contains only minute amounts."

It's true that the lactose content of dairy products gets lower as the fat content gets higher. But the difference is hardly huge. "Minute" is the wrong word to use.

Check my Big List of Lactose Percentages. Heavy cream, which I have listed as whipping cream, has 60% of the lactose of skim milk. That's a difference, but not as significant as the quote would make out.

Lowering fats in your diet is still probably a good thing. If the only difference you make is to eat low-fat dairy products and you think that's sufficient you're wrong. Nor will taking out fats work if you devour tons of empty sugar calories. A good diet is a balance across all foods, all categories, all meals.

See table below for lactose percentages in fluid milks.

Fluid Milks	Range	Average
Regular Whole Milk	3.7-5.1%	4.8%
2% Lowfat Milk	3.7-5.3%	4.9%
1% Lowfat Milk	4.8-5.5%	5.0%
Nonfat (Skim) Milk	4.3-5.7%	5.2%
Chocolate Milk	4.1-4.9%	5.0%
Half-and-half	4.0-4.3%	4.2%
Light Cream	3.7-4.0%	3.9%
Whipping Cream	2.8-3.0%	2.9%

Milk Fat Intolerance?

Yesterday I answered the question of whether butter has lactose. Answer: not very much.

Today I'm going to look into the logical consequence, sparked by a question emailed to me.

Over the years I have not been able to get a good answer as to why I must avoid butter or subject myself to having to tolerate abdominal bloating, etc.

That's a good question. If somebody is bothered by butter and it's not the lactose, then what it is?

Assuming there is a direct connection, then the only other component to butter is the milk fat. Butter is probably 80% milk fat and 1% lactose. That would make the fat a logical culprit.

Is there such a thing as milk fat intolerance?

I don't know. The research on the subject is practically non-existent. And contradictory.

My searches have come up with a grand total of two studies in the medical literature.

The first was "Do Lipids Play a Role in Milk Intolerance?" J. P. Costet, et al., pp. 156-61 in Milk Intolerances and Rejections, J. Delmont, ed. Basel: Karger, 1983. In this limited study the authors did find that 9% of their test subjects could not tolerate milk fats. From this they concluded that the "role of lipids in milk rejection this appears moderate and of little importance."

The second study is from the European Journal of Clinical Nutrition. 1997 Sep;51(9):633-6, "Milk fat does not affect the symptoms of lactose intolerance," Vesa TH, Lember M, Korpela R.

OBJECTIVE: This study investigated the role of the fat content of milk on symptoms of lactose intolerance. DESIGN: Subjects recorded intolerance symptoms using a visual analogue scale (VAS) following ingestion of three test milks for varying fat content for a two-day period. SUBJECTS/SETTING: The subjects were thirty adult volunteers, patients of two Estonian out-patient clinics with diagnosed lactose intolerance. The study milks were drunk at home or at work. All thirty subjects completed the study protocol. INTERVENTION: Each subject drank, in random order, fat-free milk (4.9% lactose), high-fat milk (8% fat, 4.9% lactose), and a lactose-free and fat-free control milk. They drank 200 ml of the milk twice a day for two days, one milk type per session, with five days between sessions. The subjects noted their gastrointestinal symptoms during the test periods and during a 5 d milk-free period at the beginning of the study. The occurrence and severity of symptoms were compared. A global measure of the severity of symptoms was defined by computing the sum of the symptoms scores. RESULTS: The sum of symptoms was higher during all milk periods than during the milk-free period (P < 0.01). There were no statistically significant differences in the occurrence or severity of symptoms during the fat-free milk period compared with the high-fat milk period. CONCLUSIONS: Even a marked difference in the fat content of milk did not affect the symptoms of lactose intolerance. Consequently, there seems to be no case for recommending full-fat milk products in the treatment of lactose intolerance.

This is again an extremely limited study, both in number and duration. Nor is it obvious that a fatty milk would produce the same results as butter.

Fats in general don't tend to produce gas in the intestines. Carbohydrates - sugars, starches, fibers - are the main gas producers. That makes it hard to blame the fat in butter just as fat.

If we're back to using logic - a slippery course whenever food is concerned - we're not left with many answers. Here are the possibilities.

1. My questioner is wrong about butter being the problem.

2. Milk fat intolerance is real but not properly identified as a problem.

It would be convenient to jump to the conclusion that the medical community has fallen down on this. On the other hand, I also just heard from somebody who wrote me that her LI symptoms went away when she changed toothpaste. That's why I never trust anecdotal information. Anecdotes make my head hurt.

Hey, Bill Gates. Have I got a study for you to fund.

Answers to Questions from Readers, part 13

Q. a. Is goat milk lactose free?
b. My mom claims to have become lactose intolerant. since a lot of my diet here is milk based, with lots of cheeses naturally, will I be going wrong by substituting goat or sheep cheeses and other milk products in my recipes?

a) Goat's milk contains almost exactly the same amount of lactose as cow's milk. For a listing of the lactose contents of dozens of different animal milks, go to my Lactose Zoo page.

b) Goat's milk cheese will have about the same amount of lactose as cow's milk cheese or sheep's milk cheese: very little. All aged cheeses are low in lactose. Substituting one for the other shouldn't make a bit of difference.

Q. I noticed that I get occasionally get LI symptoms after eating Chinese takeout, especially dishes with thick, starchy sauces. This may be a long shot, but is it possible that they contain lactose?

My guess is probably not. Usually in cooking, sauces are made thick and starchy by adding corn starch rather than milk powder. I can't guarantee this, of course, and recipes are often adapted to local customs. Some people do have corn allergies, by the way, so it may in fact be the corn that is the problem. (I hate to suggest anything so obvious that you've probably already considered it, but just to be thorough, have you tested yourself on dishes with and without MSG?)

You might also want to simply ask the next time you're in a restaurant in which you've had problems whether the dish does indeed contain any milk. Most places will be happy to check for you.

Q. Could LI over a period of time lead to osteoporosis?

Osteoporosis does not a single cause, although inadequate calcium intake, especially while young, is thought to be a major factor. So LI by itself cannot cause osteoporosis. However, since milk is leading source of calcium, someone who does not drink milk (whether because of LI or not) must ensure a substitute calcium source, either though other calcium-containing foods or by taking calcium supplements. This would be true of anyone, regardless or LI status.

Q. My mother is severely lactose intolerant, and she recently came across a new one that she hasn't seen before. It's a chocolate bar ingredient: "milk fat." What part of milk is that? Is it suitable or not for an LI person to consume?

It's the fat that is taken out of milk when lowfat or skim milk is made fat-free. Since fat makes things taste better, milk processors sell off the waste fat to other manufacturers. It should have little or no lactose, however, being pretty close to pure fat.