The Great Milk Debate
New Disputes About a Mealtime Staple

Do children need milk to thrive? And with so many milk options lining the shelves at the grocery store – whole, low-fat, or skim, for example – what’s the right choice for your family? Here’s a closer look at this beverage and the issues now swirling around it.

- Lauren Katims

When 10-month-old Ellie Fahey of Newton reaches the age of 1, her parents, Kevin and Laura, plan to switch her from the formula she’s been drinking for months to whole milk.

Not a radical move, by any means. Pediatricians say the nutrients in whole milk are crucial to a toddler’s development.

Besides, milk has been a regular on family dinner tables for generations.Most parents consider it one of the healthiest beverages they can give to their children.

Ellie is currently in the 10th percentile for weight and needs the extra calories and nutrients that whole milk provides; actually, she needs even more. She’s already eating whole-milk yogurt every morning at breakfast with her formula to give her an extra protein boost.

Milk is one of the most nutrient-dense foods around, providing an excellent source of calcium, vitamin D, protein, potassium, vitamin A, vitamin B12, riboflavin, niacin and phosphorus.

It’s also widely in demand in the United States. Last year, more than 185 billion pounds of milk were produced on dairy farms nationwide, according to the U.S. Department of Agriculture. For its part, Massachusetts milk producers provide .1 percent of the beverage consumed in this country.

Yet this family mealtime staple is not without some controversy. There’s ongoing debate about whether whole, low-fat or skim milk is better for you; there’s a growing movement toward drinking raw, unpasteurized milk exclusively; and there are some who think we’ve been conditioned by the dairy industry to believe that kids need milk to grow – when actually, they claim, milk isn’t as crucial to kids’ health as many assume.

Do children need milk to thrive? And with so many milk options lining the shelves at the grocery store – whole, low-fat, or skim, for example – what’s the right choice for your family? Here’s a closer look at this beverage and the issues now swirling around it.

Whole Milk

The American Academy of Pediatrics (AAP) has long recommended that toddlers between ages 1 and 2 drink whole milk to get the fatty acids and nutrients they need for brain and central nervous system development.

Those nutrients are necessary in every toddler’s diet, not just underweight children like Ellie, and drinking whole milk is the easiest way to get them, says David Elvin, M.D., medical director of Cambridge Family Health, a division of the Cambridge Health Alliance in Cambridge, Massachusetts.

Other than sunlight, whole milk is also one of the best sources of vitamin D, which is critical to good bone health, and apparently a nutrient that many babies and toddlers aren’t getting enough of.

Researchers at Children’s Hospital Boston recently tested 380 infants and toddlers and found that 40 percent had vitamin D deficiencies. Many were African Americans and Latinos, whose darker skin can hinder the body’s ability to produce vitamin D. For the infants in that study, breast milk without a vitamin D supplement was the culprit (those who were breastfed exclusively were up to 10 times more likely to have a vitamin D deficiency, researchers found). For the toddlers, researchers found that insufficient milk consumption was to blame for the vitamin D deficiency.

Low-fat or Skim Milk

While it provides the amount of vitamin D that toddlers need, whole milk is high in fat – with 150 calories and 5 grams of saturated fat in each 8-ounce serving. A serving of 1 percent milk, by comparison, has 105 calories and 1.6 grams of saturated fat. Once a child turns 2, pediatricians generally recommend switching to low-fat or skim milk to cut out unnecessary fat.

Ironically, in response to the nation’s continuing childhood obesity epidemic, the AAP will take the unprecedented step this August of approving reduced-fat milk for 1- to 2-year-olds who are obese or who have a family history of cardiovascular disease.

That has some pediatricians and nutritionists wondering whether smaller portions of whole milk, with its full complement of vitamin D, would be a better idea. Inger Hustrulid, for example, who runs Foundations Family Nutrition in Cambridge and is president-elect of the Massachusetts Dietetic Association, suggests that if toddlers are overweight, they can still have whole milk – their parents could just cut back on the amount they give them.

The process of removing fat from milk also removes vitamin D, which is fat-soluble, notes Carine Lenders,M. D., a pediatrician, gastroenterologist and nutrition specialist at Boston Medical Center. Even though most low-fat or skim milk is fortified with vitamin D, that fortification process occurs before the fat is removed (thus, some vitamin D is still lost during fat removal), Lenders says.

She suggests adding yogurt or cheese to your child’s diet as a supplement to the reduced-fat milk.

Still, not enough research has been done on the 1- to 2-year-old age group to draw any definite conclusions about what kind of milk is best for toddlers, Lenders says. Because of this, physicians have been careful to follow the AAP’s recommendations.

All age groups need vitamin D and the best way to get it is through exposure to sunlight, Lenders says. But dairy and other fortified foods such as eggs, fatty fish or multivitamins are also good sources, she adds.

Raw Milk

In the midst of all this discussion about whole or lowfat milk is a growing movement that advocates raw, unpasteurized milk as a healthier alternative overall.

When milk is pasteurized, all the bacteria and pathogens are removed, including much of the good bacteria that helps with digestion. This makes the milk’s lactose harder to digest and its calcium harder to absorb, says Jill Ebbott, of Brookline, a holistic health counselor specializing in wellness through nutrition. Ebbott is also the Brookline chapter leader of the Weston A. Price Foundation, a nonprofit organization dedicated to restoring nutrient-dense foods to the human diet. She advocates for raw milk.

Despite studies that have reported the potential risk for disease associated with raw milk, Ebbott claims that if customers buy milk from small farms and if the cows are raised correctly, meaning they are held to a high standard for cleanliness and nutrition, raw milk is the healthiest option for families. She and her three children have been drinking raw milk exclusively for over three years, buying it from a local milk cooperative that transports it from the farm to communities around Boston. Its health benefits are important enough to her that she will pay $6 per gallon and buy no other kind of milk. (Learn more about the Weston Price Foundation’s “Real Milk” campaign at

Is Milk Crucial to Your Child’s Diet?

Not all experts are as convinced of the benefits of milk in a child’s – or anyone’s – diet.

The U.S. consumes the most milk in the world, yet has the highest rate of osteoporosis, says Cynthia Lair, author of several whole foods cookbooks, and a certified health and nutrition counselor who has been coordinating and teaching the whole foods cooking program at Bastyr University in Seattle since 1994.

“If you want to look at bone health, you have to look not at how much milk you are drinking or if you are getting enough calcium,” says Lair. “Not exercising, eating lots of sugar, acids in soda, lack of sunlight – these things contribute to bone loss.” Lair believes that advertising by the dairy industry has convinced the public that kids must drink milk in order to grow.

Because breastfeeding is highly recommended for a variety of nutritional benefits, people believe that some form of milk has to replace it when their child turns 1, says Dean Sloan, M.D., a family practice physician and lifestyle medicine specialist who runs Wellness Strategies in Delray Beach, Fla. But milk doesn’t have to be a major part of the diet, he says.

For teenagers, an age group associated with critical bone mass development, milk should not be considered more important than other foods, says Sloan. It can be used with other foods, like an iron-fortified cereal, but there are plenty of other foods that are just as important, such as lean protein, vegetables and whole grains.

Although Lair doesn’t advocate drinking raw milk, she agrees with Ebbott that homogenized, pasteurized milk is one of the most difficult foods for a human to digest. As a good alternative to milk, Lair, who didn’t feed her college- age daughter milk past age 1, suggests full-fat dairy in fermented and cultured forms like yogurt. In those foods, the good bacteria, such as live enzymes and vitamin C, are intact to help you digest the nutrients.

Marion Nestle, former chairperson of the Department of Nutrition, Food Studies and Public Health at New York University and author of four books on the politics of nutrition, also believes that milk isn’t necessarily essential for many American families. “What seems to be welldocumented is substantial improvement in growth among low-income children in developing countries who have meat or dairy foods added to their diets,” she says. “For well-fed Americans, drinking milk is less of an issue.” The one thing these experts do agree on? Too much milk is not good. If a child of any age becomes satiated from drinking milk all day, he may develop a deficiency in other important nutrients, such as iron, they say.

Until more concrete nutrition research is done, questions about milk and diet will continue. If you have concerns about what milk is right for your child, talk with your pediatrician. Above all, make sure your child is getting all of the nutrients she needs.

After all, Nestle says, “milk is a fine food, loaded with nutrients, but it’s neither a poison nor a panacea.”

Lauren Katims is a freelance writer in Boston, Massachusetts.

July 2008