Consider a glass of milk.
Familiar, safe, evoking childhood memories of dunking cookies or cafeteria lunches with school friends. Cool, refreshing and good for you.
Maybe. While some consider milk a nutritional powerhouse, others see it as unnecessary for good health and question the rationale behind some government-related programs that try to help the marketing of milk.
"When I was growing up, drinking milk at every meal, I had a chronic upset stomach," cookbook author Mark Bittman wrote in his New York Times blog in July. As a teenager, that worsened into chronic heartburn and acid reflux, which led to a dependence on medications and a series of attempts to relieve his esophagus with other remedies.
Finally, his doctor advised him to see if eliminating certain foods from his diet would help. So, as an experiment, he tried cutting out dairy products and 24 hours later, "my heartburn was gone. Never, it seems, to return."
It has long been known that some people have trouble digesting cow's milk. The National Institutes of Health estimates about 30 million Americans have lactose intolerance, the inability to digest a type of sugar in milk. The condition is more common in people of Asian, African, Native American or Mediterranean ethnicity, and, while not dangerous, it can cause nausea, bloating, gas and diarrhea. Milk allergy, an immune system reaction that can cause hives, eczema and wheezing, as well as digestive problems, is thought to affect 2% to 5% of babies, though many outgrow it by age 3, according to the Asthma and Allergy Foundation of America.
While there are drawbacks for some, the nutritional benefits of milk are clear, says Ruth Frechman, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, formerly the American Dietetic Association. "Milk is a nutrient-dense beverage; it's relatively inexpensive and is an easy source of hydration," she says. It contains protein, calcium, vitamin D, phosphorus, potassium, vitamin B12 and other vitamins and minerals.
But its main nutrient, Frechman says, is calcium, "and most Americans are not getting the recommended amounts of calcium." Calcium is needed to build bone and teeth, help muscles to contract, and improve nerve function, she says. It plays a role in blood clotting and blood pressure.
Robert Post, deputy director of the USDA's Center for Nutrition Policy and Promotion, says of the four nutrients that are of public health concern because Americans don't get enough of them -- calcium, potassium, vitamin D and fiber -- three are in dairy foods. (There's no fiber in milk.)
Susan Levin, director of nutrition education at the Physicians Committee for Responsible Medicine, a non-profit that describes itself as promoting preventive medicine and advocates a vegetarian diet, questions the USDA's emphasis on dairy as a major food group. Levin says there's more marketing than science behind dairy promotion. She points to the dairy checkoff program (www.dairycheckoff.com), established in the 1983 Dairy Act. One of a number of similar programs funded by agricultural industries (beef, soybeans), it requires producers and importers of dairy products to pay fees that finance programs aimed at boosting sales of dairy products. It is administered by the Dairy Board, whose members are appointed by the secretary of Agriculture, and is monitored by the USDA's Agricultural Marketing Service.
By its own estimate, the program has been successful: Annual consumption of milk and milk products has risen 15%, from 541 pounds per person in 1981 to an estimated 620 pounds today, most of it fueled by increased consumption of cheese and yogurt, says Joe Bavido, program spokesman.
Consumption of liquid milk, conversely, has been on the decline, says Vivien Godfrey, CEO of the Milk Processor Education Program, MilkPEP, creators of the national Got Milk? campaign. Americans drank nearly 2 gallons of milk less per person in 2009 than they did in 2000, down from 22.4 gallons per person to 20.6 gallons. It's not that Americans are drinking less overall, she says. It's that they've switched to other beverages, primarily bottled water.
"That's concerning, because milk is important in the diet," she says. It's nutritious and "very affordable," at about a quarter per 8-ounce glass.
Now, she says, "The challenge we're faced with is to steal market share back from other beverages, like bottled water." To that end, MilkPEP is launching new advertising campaigns, one aimed at encouraging people to drink milk at breakfast and another pitching chocolate milk to adult athletes -- marathoners, triathletes and others who work out hard -- as a tasty way to refuel.
But do we need milk? "Dairy products have been touted as absolutely essential to human health," Levin says, "but there really hasn't been any scientific evidence to support that claim." Some studies raise questions about the value of dairy foods in bone or heart health, and others suggest an increased risk of health problems, such as prostate cancer in men who drink a lot of milk, she says. "To me it's irresponsible for the USDA to make it a mandatory food item served with (school) lunch," she says. "This is a beverage that could make, certainly minority kids, not feel good."
Nutritionist Gregory Miller, executive vice president of the National Dairy Council, says the preponderance of evidence is "quite good and clear in terms of the important role dairy can play in the diet to reduce chronic diseases."
He points to recommendations from the Surgeon General, the American Academy of Pediatrics and other medical authorities "all saying dairy should be part of the diet." Despite "one study here or there" that raises questions about the health benefits of dairy foods, he says, "Look at the total body of evidence out there."
The USDA's Post says that's what the agency did in developing its food guidelines. The policy is based on a thorough review of all the research, and is not influenced by marketing or pressure groups, he says. "Everything is done to review the science," he says.
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