Milk, dairy, and heart disease: The early days
The history of modern medicine is full of starts, stops, and reversals in strategy for treating disease. One of the more remarkable tales in recent medical history involves peptic ulcers. This is a chronic condition in which the linings of the stomach or small intestine are eroded away causing painful internal wounds. Complications include bleeding and perforation of the gastrointestinal tract, which are potentially life threatening.
For the better half of my adult life, peptic ulcers were routinely attributed to excessive stomach acid production caused mainly by stress, or spicy foods or too much gum chewing. Even as recently as the mid 1980’s, ulcer patients were advised to take antacids, make lifestyle changes to reduce stress, cut back on spicy foods and stop chewing gum. However, as we will soon see, this advice didn’t do much to alleviate symptoms or cure the problem.
One of the more unusual ideas that surfaced to treat peptic ulcers came from an early 20th century physician, Betram Sippy (M.D.). Dr. Sippy authored an influential paper that appeared in the Journal of the American Medical Association in 1915 suggesting that peptic ulcers could be effectively treated by feeding patients milk and cream on a regular basis throughout the day.112 The good doctor’s advice became known as the “Sippy Diet” and was employed widely across the United States to care for patients with ulcers even as recently as 25-30 years ago.127
One of the downsides to the Sippy Diet, first recognized in 1960 by Dr. Hartroft and colleagues at Washington University in Saint Louis was that it noticeably increased fatal heart attacks in ulcer patients.17, 52 In Dr. Hartroft’s study three groups were examined at autopsy: 1) subjects with peptic ulcers who followed the Sippy Diet, 2) subjects with peptic ulcers who didn’t follow the Sippy Diet, and 3) subjects without peptic ulcers. The fatal heart attack rate was similar between subjects without peptic ulcers and those with peptic ulcers who hadn’t been on the Sippy Diet. However, the fatal heart attack rate in ulcer patients who had adhered to the Sippy Diet was a staggering 42%. Think about these statistics. Close to half of all ulcer patients following the Sippy Diet had succumbed from heart attacks! Thank goodness to us all that the medical community no longer recommends the Sippy Diet for peptic ulcers.
The reason that physicians no longer recommend the Sippy Diet or any other dietary regime for the treatment of ulcers is one of the most incredible and unlikely tales in all of modern medicine. For almost 100 years, peptic ulcers were looked upon as a disease of excessive stomach acid production caused by stress, spicy food – whatever. No one ever considered that this condition might be caused by an infectious organism. That is, until the publication of two revolutionary papers in 1983 and 1984 by two Australian scientists, Barry Marshall and Robin Warren, showing that 70 to 90 % of peptic ulcers resulted from infection by the bacterium Helicobacter pylori.74, 75 At first, these innovative publications were generally dismissed and discredited by the medical community. However, it didn’t take long for practicing physicians to realize that ulcers could be effectively cured simply by giving their patients a good dose of antibiotics. Unfortunately, it took about a decade for these brilliant scientists’ ideas to be accepted worldwide. Now, because of their ground-breaking insights, antibiotics are routinely used to successfully treat and cure almost all peptic ulcer cases. In 2005 Drs. Marshall and Warren were awarded the Nobel Prize in medicine for their discoveries.133
A forgotten piece of the peptic ulcer story is that milk and dairy consumption significantly increased the risk for cardiovascular disease and heart attacks. The information about Sippy Diets and heart attack risk has been buried in the scientific literature for nearly 50 years and is virtually lost to contemporary scientists. OK. Fair enough. I would no longer necessarily hang my hat upon 50 year old studies than I would drink a cup of milk. However, the knowledge, wisdom and insight of our parent’s, grandparent’s and great grandparent’s generations shouldn’t just be swept under the rug. Is it possible that they were actually on to something?
Milk, dairy, and heart disease: Contemporary science
The data from the early 1960’s studies on milk and heart attacks certainly bear further scrutiny. As we move forward from the past, numerous studies support the view that milk and dairy products may not be heart healthy and “Good for everybody”. A 1993 epidemiological study by Drs. Artaud-Wild and co-workers involving 40 countries worldwide demonstrated that milk and its components (calcium, protein and fat) had the highest relationship with cardiovascular death rates for any food or nutrient examined.7 Similar results implicating milk consumption with high mortality from heart disease were reported by Drs. Renaud and De Lorgeril in 1989,100 by Dr. Appleby and co-workers in 1999,8 by Dr. Segall,107, 108 and by Drs. Moss and Freed in 2003.78 Epidemiological studies are notorious for conflicting results. Here’s a perfect example. In a recent 2011 meta analysis,114 scientists at the Harvard School of Public Health showed that dairy food didn’t affect heart disease risk one way or another. Milk and dairy didn’t make things worse for our cardiovascular systems, but they also didn’t make them any better.114
Good scientists almost always let you know the weak points and shortcomings of their experiments because these limitations are an integral part of the scientific method which allows us all to glimpse the “truth”. The authors of this Harvard study expressed an important concern about the validity and generalizability of their experiment that you need to know. These kinds of details often get swept under the rug as milk industry lobbyists promote their products, and as governmental agencies make dietary recommendations. Let me quote the scientists who conducted this analysis:
“Conclusions from this meta-analysis only apply to the small proportion of analyzable study populations included in this work, within milk intakes of ~200-600 ml/d. Moreover, the internal validity of the different studies included in the meta-analysis (e.g., methodology and confounding factors) also determines the quality of the present meta-analysis.”
For those of you that may not completely understand this scientific admission, here’s what it means. The amount of milk in this analysis only ranged from 200 to 600 ml. This total represents a modest quantity which translates to only one to three 8 ounce glasses of milk per day. In other words the amount of milk in this study was too low to know if higher milk intakes increase heart disease risk. If we go back to the 1960s study of ulcer patients following the Sippy diet, they drank two to three times this much milk, and nearly 42 % died from heart attacks.17, 52
Milk is a lot like a moving target with more than one bull’s-eye. Scientists aren’t completely sure which element or elements may underlie its adverse effects upon our cardiovascular systems.30, 37, 73 Milk simply isn’t just a creamy white liquid that is “Good for everybody” but rather is a complex mixture of many substances suspected of causing heart disease including its high calcium content, fatty acids, lactose and certain proteins. Because milk contains so many compounds that could potentially promote heart disease, it is difficult or impossible for epidemiological studies to sort out all the facts. Let’s take a closer look at some specific elements in milk which may promote heart disease.
Decomposing milk and heart disease
Unless you haven’t watched TV or read a newspaper or magazine in the past 20 years, most people know that milk and dairy products are one of our best sources of calcium. The dairy manufacturing industry has pounded this message into our brains for decades – so much so that many women fear they will develop osteoporosis if they don’t consume dairy foods. Until just recently, the prevailing knowledge was that if a little calcium was good for us, then more certainly must be even better. Not necessarily so. If we look at the evolutionary evidence, it becomes immediately clear that it would be virtually impossible to achieve governmental recommended calcium intakes without eating dairy products. In 2002, I wrote a scientific paper covering this topic, and my analysis showed that modern day Paleo Diets provide us with only about 70% of the daily recommended calcium intake.23 Given this evolutionary clue, then it is not surprising to find that the supra-normal intakes of calcium that can be achieved by milk and dairy consumption may just cause unexpected health problems.
A recent 2010 meta analysis published in the British Journal of Medicine by Dr. Bolland and colleagues from the University of Auckland confirmed the health hazards of too much calcium. Their comprehensive analysis involving 26 separate studies and more than 20,000 subjects revealed that calcium supplementation significantly increased the risk for heart attacks and sudden death.16 High blood levels of calcium are likely involved in the artery clogging process (atherosclerosis)99 because too much calcium may promote the formation and fragility of the plaques which block our arteries.134
Interestingly, high dietary calcium also tends to cause imbalances in magnesium5, 34, 110 and this mineral is generally protective against heart disease for many reasons. As far back as 1974, Dr. Varo at the University of Finland pointed out that high dietary calcium to magnesium ratios were a better predictor of heart disease than high calcium intake alone.120 Meaning – that if you got too much calcium and not enough magnesium in your diet, it puts you at an increased risk for heart disease. Because milk’s calcium to magnesium ratio is quite high (about 12:1),128 the inclusion of dairy products in our diets can easily raise the overall calcium: magnesium ratio to about 5:1,120 thereby reducing cellular magnesium stores and promoting heart disease. Note that our studies of contemporary “Paleo”diets confirm that the dietary calcium to magnesium ratio was much lower and close to 2:1.23
Supplementation studies of magnesium show that it reduces heart disease risk via multiple mechanisms. It improves blood lipid profiles,47, 97 prevents heart beat irregularities called arrhythmias,57 improves insulin metabolism,82 and lowers markers of inflammation.82 If you decide to consume dairy products, you effectively negate these therapeutic effects of magnesium either fully or in part. If milk’s high calcium and low magnesium ratio was not bad enough, let’s consider just a few other nutritional features in milk which further promote heart disease.
In the 1950’s and early 1960’s when nutritional researchers were just beginning to understand how atherosclerosis and heart attacks developed, it was assumed to be a simple plumbing problem. Eat too much saturated fat and cholesterol, and your total blood cholesterol levels skyrocketed which clogged your arteries thereby predisposing you to a heart attack or stroke. Unfortunately, these simplistic views did not standup well to the test of time, as hundreds of studies starting in the late 1980s showed beyond a shadow of a doubt that inflammation and immune reactions were just as important or more so in the artery clogging process (atherosclerosis) than either consumption of saturated fat or cholesterol.79, 84, 135, 136
So this brings us to a larger question. What elements in diet may be responsible for causing chronic low level inflammation now known to underlie not just heart disease, but also cancer and autoimmune disease? The evolutionary template once again brings us back to foods which we never consumed in our ancestral past. Is there any possibility that these Johnnie- come-lately foods such as, milk and dairy, grains and legumes may cause chronic low level inflammation and promote immune responses that lead to heart disease?
Milk is an incredible amalgamation of nutrients, proteins and hormones that have only recently been discovered and appreciated. It certainly is not the pure white liquid, high in calcium, vitamin D and other vitamins and minerals portrayed by milk manufacturers and their lobbyists. You may not know it, but milk is essentially nothing more than filtered cow’s blood. As such, it contains almost all of the hormones, immunological factors, and body altering proteins that are found in pure cow blood.11, 64, 65 However, let’s don’t get too alarmed at this information. Most of these compounds in milk have very short half-lives and are spontaneously degraded within minutes or hours after the manufacture of modern dairy foods. Consequently, they should not enter our bloodstreams. Further, a healthy human gut lining rarely allows intact, large proteins such as those found in milk hormones to bypass its protective barrier. So why should we worry? Are there proteins or hormones in cow milk which bypass the gut barrier and eventually get into our bloodstreams to wreak havoc with our immune systems and promote atherosclerosis?
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