A Viva!

Health Report
By: Dr Justine Butler, Senior Health Researcher & Writer, Viva!Health
Edited by: Juliet Gellatley BSc DipDM, Founder & Director, Viva!Health £5.50
 White Lies

White Lies
By: Dr Justine Butler, Senior Health Researcher &
Writer, Viva!Health Viva!Health
Edited by: Juliet Gellatley BSc DipDM, Founder &
Director, Viva!Health & Viva! Viva!Health is the health and nutrition
Published by: Viva!, Top Suite, 8 York Court, arm of the charity, Viva! and promotes
Wilder Street, Bristol BS2 8QH human health through the promotion of
T: 0117 944 1000 a vegan diet. Viva!Health monitors and
E: [email protected] interprets research that links diet to
W: www.vivahealth.org.uk health – explaining in simple terms how
© Viva! 2014 what we eat affects us, in both positive
Registered charity 1037486 and negative ways. Viva!Health
communicates this information to the
ISBN 978-0-9571873-3-7 media, the public, health professionals,
schools and food manufacturers so
providing accurate information on which
to make informed choices.

Please note: the welfare aspects of dairy

farming are not covered here. For
information on British dairy farming and
its impact on cow welfare please see Viva!’s
referenced report The Dark Side of Dairy
(www.whitelies.org.uk T: 0117 944 1000).

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 A report

Contents
Viva!Health .........................................................2 PART TWO: DAIRY CONSUMPTION AND HEALTH 23
Foreword.............................................................4 Acne .................................................................23
Introduction ........................................................7 Allergies ..............................................................24
What is a healthy diet? ........................................8 Asthma ..........................................................25
Eczema ..........................................................26
PART ONE: THE HISTORY, GEOGRAPHY AND Hay fever........................................................26
BIOLOGY OF MILK...............................................10 Gastrointestinal bleeding ................................27
The origins of dairy farming.................................10 Arthritis ...............................................................27
Dairy farming today.............................................11 Bovine Somatotrophin (BST) ................................30
Who drinks milk? ................................................11 Cancer ................................................................31
A comparison between human milk and Breast cancer..................................................35
cow’s milk ...........................................................12 Colorectal (bowel) cancer ...............................40
Protein ...........................................................12 Ovarian cancer ...............................................44
Fat .................................................................13 Prostate cancer...............................................46
Calcium..........................................................14 Colic .................................................................50
Iron ................................................................14 Constipation........................................................53
The composition of cow’s milk.............................15 Coronary heart disease ........................................54
Water.............................................................15 Crohn’s disease....................................................61
Carbohydrate .................................................15 Diabetes ..............................................................66
Protein ...........................................................16 Dementia ............................................................71
Fat .................................................................16 Ear infection ........................................................72
Minerals and vitamins.....................................17 Food poisoning....................................................72
Fibre...............................................................17 Gallstones ...........................................................76
The undesirable components of milk and Insulin-like growth factor 1 (IGF-1).......................76
dairy products .....................................................17 Kidney disease.....................................................79
Breast is best .......................................................20 Lactose intolerance..............................................81
Infant formula .....................................................21 Migraine..............................................................83
Milk in schools.....................................................21 Multiple sclerosis and autoimmunity ....................84
Overweight and obesity.......................................86
Osteoporosis .......................................................90

CONCLUSION......................................................99

APPENDICES........................................................102
Appendix I THE SAFETY OF SOYA ........................102
Appendix II BODY MASS INDEX ...........................106

REFERENCES........................................................107

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 White Lies

Foreword
Professor T. Colin Campbell
There is hardly another controversy in health science
more contentious than the role of cow’s milk and its
products in our daily diet. Some wonder why we
would even dare to question whether there are
adverse health effects. For them, cow’s milk is
Nature’s most perfect food. It builds strong bones
and teeth and is a good source of calcium and
protein.

Besides, it represents a bucolic side of life where

gentle, lowing cows, black and white, roam in lush
green pastures. I know this, for I was raised on a
family dairy farm, milking cows and walking those
green pastures, then combining grain and putting up
hay for the winter. I drank the milk, lots of it, and we
often made our own ice-cream and butter.

Early in my research career at Massachusetts Institute

of Technology and Virginia Tech, I worked to
promote better health by eating more meat, milk
and eggs, what I believed to be ‘high-quality animal
protein’. It was an obvious sequel to my own life on
the farm and I was happy to believe that the survey of cancer mortality rates in 2,400 Chinese
American diet was the best in the world. counties that showed remarkable concentrations of
cancer in certain counties and much less so in others.
However, later I was the Campus Coordinator at We then organised an additional and unusually
Virginia Tech of a project in the Philippines working comprehensive and unique survey of diet and
with malnourished children. The primary goal of the lifestyle characteristics that might help to explain
project was to ensure that the children were getting these unusual geographic concentrations of cancer.
as much protein as possible. Personally, I was interested in the broad based
hypothesis that animal and plant-based foods, as
In this project, however, I observed something quite characterised by their nutrient profiles, have
unusual. Children who ate the highest protein diets – opposing effects on the chronic, so-called Western
and particularly animal protein – were the ones most diseases like cancer.
likely to get liver cancer. I began to review other
reports from around the world that reflected the The results from this massive study, when
findings of my research in the Philippines. considered in relation to our earlier research and
that of others, convinced me that the diet having
Although it was heretical to say that animal protein the broadest range of health benefits is one that is
wasn’t healthy, I started an in-depth study into the comprised of a variety of whole plant-based foods,
role of nutrition in the cause of cancer. but one that is also low in added fat, salt, sugar and
The research project culminated in a 20-year highly processed foods. Remarkably, relatively low
partnership of Cornell University, Oxford University, intakes of animal-based foods (such as dairy
and the Chinese Academy of Preventive Medicine, a products and meat) in rural China were associated
survey of diseases and lifestyle factors in rural China with biological conditions that favour the
and Taiwan. More commonly known as the China occurrence of the chronic diseases typically found in
Study, this project eventually produced more than Western industrialised countries.
8,000 statistically significant associations between
various dietary factors and disease. Then it was on to discovering how broad might be
this dietary effect. My son, Tom, and I turned our
This opportunity arose from a Chinese government attention to the research investigations of others.

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 A report

The published literature of these investigations is report which is timely, broad in scope and profound
unimaginably huge. Moreover, the breadth of the in its consistency.
health benefits of a plant-based diet is even far
greater than our own research had indicated, with it And finally, two other observations need attention.
reducing the risk of additional cancers, various First, it is likely that the adverse dairy effects
cardiovascular diseases, diabetes (types I and II), observed in many studies are underestimated
multiple autoimmune diseases, osteoporosis, psycho- because they have been observed in humans where
neural diseases (eg attention deficit disorder, clinical the dairy-like nutritional effect already has been
depression, Alzheimer’s, cognitive dysfunction), eye maximised by other animal-based foods. Second,
disorders, kidney diseases, skin ailments and obesity imprecise measurement of risk factors and outcomes
amongst others. will mathematically attenuate the real effect.

Importantly, animal-based foods, as a group, have It is not that these various dairy effects are
substantially different nutritional characteristics from independently proven to be true beyond doubt, any
plant-based foods and it is these nutritional more than tobacco use is independently proven to
characteristics, highly integrated at the metabolic cause lung cancer and heart disease. Rather, it is the
level, that are chiefly responsible for the opposing weight and breadth of the evidence, along with its
effects of plant and animal-based foods on health biological plausibility, that should determine the
and disease. Moreover, these effects involve reliability of the evidence. Using these criteria, there
countless food chemicals and exist throughout the is no doubt that this evidence on dairy is sufficient,
range of consumption of these foods. at a minimum, to question the rather specious claims
of health for cow’s milk that have been made by the
Of course, dairy foods have nutritional characteristics industry and its supporters and apologists.
and disease associations that are consistent with
other animal-based foods. Indeed, if anything, cow’s I know well that this information deeply troubles
milk and its products appear to be even more many people, as it did me. But, at some point, we
problematic than other animal-based foods. must give public voice to these observations and, if
necessary, to sponsor discourse that is candid, openly
Unfortunately the scientific literature on the transparent and, as much as possible, free of
characteristics and associations of dairy with health commercial bias.
and disease seem to have been more obscured from
public view than is the case for other animal-based T. Colin Campbell, PhD
foods. For example, research 40-60 years ago had Jacob Gould Schurman Professor Emeritus of
shown that cow’s milk proteins (casein and Nutritional Biochemistry
lactalbumin) markedly elevated blood cholesterol Cornell University, Ithaca, NY
and its parallel formation of atherosclerotic plaques. February 2014
More recently, much more evidence on the adverse
health effects of cow’s milk have accumulated, and
much of it has been ably reviewed in this excellent

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 White Lies

Foreword
Professor Jane Plant CBE (DSc) Prostate Cancer, Osteoporosis (yes – there is even a
compelling case against dairy produce, especially
I was delighted to cheese, in the development of this crippling bone
be asked to write disease) and Eating for Better Health. This new
a foreword for report takes the evidence on the adverse human
this excellent and health impacts of dairy further.
well-researched
report into the What I had not appreciated until I attended the
adverse health excellent and thought-provoking lecture given by
impacts of dairy Juliet Gellatley of Viva! at the Incredible Veggie
consumption on Show in London in 2005 was the true nature of the
human health. My modern dairy industry. It is hard to forget some of
book, Your Life in the images of cruelty that she presented then. This
Your Hands, report exposes the nature of the modern
describes how industrialised dairy industry and the serious
giving up dairy implications that this has for our health. I do hope
produce has that White Lies receives the recognition it deserves
helped me and other women to overcome metastatic and that this will embolden politicians to take a
breast cancer. When it was first published in 2000, I stand against the dairy industry. To do so would
faced a barrage of criticism from orthodox doctors, improve human health, improve the environment,
charities and nutritionists. All of them, for whatever address serious issues of animal welfare and save the
reason, poured scorn on the idea that consuming taxpayer a great deal of money spent in subsidising
dairy could be bad for health. This may have been an industry that was the centre of the BSE crisis, the
because, as Dr Justine Butler shows in this report, we foot and mouth disease disaster and now the bovine
have all been subjected to relentless publicity from tuberculosis problem.
the industry that tries to persuade us that dairy is
wholesome, natural and good for our health. It is a Cow’s milk is a perfect food for a rapidly growing
measure of how far medical opinion has changed calf but that doesn’t mean it is good for human
that in 2005 I was awarded a life fellowship of the babies – or adults! If you want to improve your
Royal Society of Medicine in recognition of my health by making just one change to your diet, I
contribution to science through my books. We have recommend you eliminate all dairy from the diet.
a long way to go, however, until the truth about
dairy is generally accepted, so this report is both Professor Jane Plant CBE (DSc, CEng)
timely and very welcome. Life Fellow of the Royal Society of Medicine
Professor of Applied Geochemistry
When I was carrying out the research for Your Life in Imperial College, London
Your Hands, which includes more than 500 February 2014
references from the peer reviewed scientific
literature, I was astonished at just how much
information was available on the role of dairy
produce in promoting disease – not only breast,
prostate, ovarian and other cancers but also other
conditions ranging from eczema and other allergic
conditions to heart disease and diabetes. Despite all
the criticism of my books, no one has presented a
single scientific fact that persuades me to change
one sentence of what I wrote in 2000 – and as a
trained scientist I would have done that had I been
given convincing evidence that I was wrong or had
misunderstood some issue. Instead, the evidence
against consuming dairy produce has continued to
mount, as I detailed in the second and third editions
of Your Life in Your Hands, and in my other books,

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Introduction
The foods we consume are of immense importance The aim of this report is to redress the balance by
to our health and well-being. The recent increase in presenting and reviewing the research on the health
television and media coverage of food and health effects of cow’s milk and dairy products.
issues has improved our understanding of the links
that exist between diet and health. The types of food
that we eat are strongly linked to our culture and
food issues can cause emotional responses. In the
UK and other northern European countries as well as
North America, we have developed a strong
emotional attachment to the idea that milk is a
natural and healthy drink for us, even as adults.

Milk is the first food that we consume, our mother’s

breast milk if we are fortunate, if not then specially
formulated substitutes based on cow’s or soya milk
are generally used in the UK. We associate milk with
comfort and nurturing and consider milk to be a
wholesome nutrient-rich component of the diet that
is essential for normal growth and development,
which for a baby it is. However, all other mammals
on the planet are weaned off milk at an early age,
whereas some humans continue drinking milk into
adulthood. Not only that, we drink the milk of
another species, something no other mammal does.
To be fair, contrary to popular belief, most people in
the world do not drink milk; it would make many of
us ill. But in the UK, we are a nation of milk drinkers,
along with most other northern European countries
and North America. Infants, the young, adolescents,
adults and the aged all consume large quantities of
milk, cheese, butter and yogurt every year. But why
are we so convinced that milk is some kind of
wonder food?

Milk, it seems, can help you lose weight; it can also

make you gain weight. Milk promotes healthy skin; it
may also cause acne. You need milk for good bone
health, but the incidence of osteoporosis is highest in
countries that consume the most milk. These
conflicting reports leave us confused and unsure
who to believe. The dairy industry invests millions in
milk advertising and promotion. It could be argued
that they present a biased view motivated by
financial interest. An increasing amount of scientific
evidence now shows that cow’s milk is not the
wonder food the dairy industry would have us
believe. This research goes further in linking the
consumption of cow’s milk to a wide range of health
problems. Many people, even health professionals,
may find it hard to be objective about the
detrimental impact of dairy products on health
described in this report because of the emotional
attachment many of us have to the idea that milk is
natural and healthy.

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 White Lies

What is a healthy diet?

A healthy diet contains a wide range of fresh fruit
and vegetables, whole grains, pulses, nuts and seeds. Table 1 Government guidelines on
It is rich in important fibre and disease-busting fat content
antioxidants that protect against a number of
illnesses and diseases including certain cancers and Total fat
cardiovascular disease (Genkinger et al., 2004; He et More than 17.5g of fat per 100g High
al., 2007; Rautiainen et al., 2012). It has been 3g of fat or less per 100g Low
suggested that the high concentration of antioxidants
in blood may be one of the reasons for the lower Saturated fat
incidence of chronic diseases in people consuming a More than 5g of saturated fat per 100g High
plant-based diet rich in fruit and vegetables 1.5g of saturated fat or less per 100g Low
(Waldman et al., 2005). A healthy diet provides
plenty of fibre protecting against a range of diseases Source: NHS Choices, 2013.
including colorectal cancer (Murphy et al. 2012). It is
rich in vitamins and minerals, again protecting health.
A healthy diet should contain a good source of plant- Saturated fats from animal foods such as whole milk,
based essential polyunsaturated fatty acids including cream and butter increase the amount of cholesterol
the omega-3 fatty acids known to protect heart in the blood which in turn increases the risk of heart
health (Pan et al., 2012). disease and diabetes. Research shows that a plant-
based diet contains significantly less saturated fat.
On the other hand, a healthy diet should be low in The extensive EPIC Oxford study comprising 33,883
saturated fat, animal protein and cholesterol for meat-eaters, 10,110 fish-eaters, 18,840 vegetarians
which we have no dietary requirement. Too much and 2,596 vegans showed that while the total fat
saturated fat can increase the amount of cholesterol intake was highest in the meat-eaters and lowest in
in the blood, which increases your risk of developing vegans, the difference between the groups was
heart disease. Saturated fat is found in many foods, relatively small. However, the percentage of energy
such as hard cheese, cakes, biscuits, sausages, cream, from saturated fat was strikingly different across the
butter, lard and pies. The government recommends four diet groups: saturated fat intake was highest in
that we eat less of these types of food and choose meat-eaters, almost identical in fish-eaters and
foods that contain unsaturated rather than saturated vegetarians and significantly lowest among the
fats (NHS Choices, 2012). This means eating more vegans (Davey et al., 2003). So significant is the
avocados, nuts and seeds and plant-based oils and lower saturated fat content of a plant-based diet
spreads such as flax seed oil and soya spread. that it can be used to control weight without
worrying about calorie counting. In one clinical trial,
Cow’s milk, cheese, butter, cream, ice-cream and milk adoption of a low-fat vegan diet was shown to help
chocolate all contain the unhealthy saturated kind of weight loss despite the absence of prescribed limits
fat associated with an increased risk of heart disease. on portion size or energy intake (Barnard et al.,
Some of these foods contain considerable amounts 2005). Other research confirming that vegetarians
of saturated fat. For example, Cheddar cheese and vegans have a lower risk of overweight and
contains around 35 per cent fat, of which over 60 per obesity than meat-eaters shows that consuming
cent is saturated. Similarly, butter contains over 80 more plant foods and less animal products may help
per cent fat, of which over 60 per cent is saturated individuals control their weight (Newby, et al., 2005).
(FSA, 2002). This means that a 10 gram serving of Being overweight or obese increases the risk of many
butter contains over five grams of saturated fat! The health problems including type 2 diabetes, heart
Government provide guidelines to tell you if a food is disease, asthma, infertility, high blood pressure and
high or low in total and saturated fat (see Table 1). many cancers.

So the five grams of saturated fat contained in just Milk and other dairy products contain many
10 grams of butter makes this food remarkably biologically active molecules including hormones and
unhealthy. Plant-based polyunsaturated fat spreads growth factors. Cow’s milk has been shown to
contain less total fat (around 60 per cent) of which contain over 35 different hormones and 11 growth
less than 20 per cent is saturated. They tend to factors (Grosvenor et al., 1992). Some researchers
contain more of the valuable polyunsaturated fatty are particularly concerned about the oestrogen
acids and so provide a much healthier option. content of cow’s milk (Ganmaa and Sato, 2005),

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suggesting that cow’s milk is one of the important Interestingly, one study observed a 10 per cent
routes of human exposure to oestrogens. The milk increase in blood serum levels of IGF-1 in subjects
consumed now is very different to the milk who increased their intake of non-fat milk (Heaney,
consumed a century ago. Unlike their pasture-fed 1999) while another study noted that vegan men
counterparts of old, modern dairy cows are usually had a nine per cent lower serum IGF-1 level than
pregnant and continue to lactate during the latter meat-eaters and vegetarians (Allen et al., 2000).
half of pregnancy, when the concentration of Whether the consumption of cow’s milk and dairy
oestrogens in blood, and hence in the milk, products raises IGF-1 levels directly (by crossing the
increases. Although there is a paucity of research in gut wall), or indirectly (by triggering an increased
this field, early evidence suggests the increase in production of human IGF-1 in the body), evidence
exposure to cow’s oestrogen may be linked to an suggests that some component of milk causes an
increased incidence of certain cancers. In one study, increase in blood serum levels of IGF-1. It has even
cancer incidence was correlated with food intake in been suggested that IGF-1 may be used as a
40 countries (Ganmaa and Sato, 2005). Results predictor of certain cancers, in much the same way
showed that both cow’s milk and cheese that cholesterol is a predictor of heart disease
increased the risk of hormone- (Campbell and Campbell, 2005).
dependent cancers such as
breast and ovarian In summary, a diet
cancer. Among the containing
dietary risk factors saturated fat,
identified, these cholesterol,
researchers were animal protein,
most concerned hormones and
with milk and dairy growth factors is
products because, not a healthy
as already stated, diet. Cow’s milk,
the milk drunk butter, cheese,
today tends to cream, ice-cream
come from and other dairy
pregnant cows products contain
among whom all these unhealthy
oestrogen and components
progesterone levels are whereas substantial
markedly elevated. evidence shows that a
plant-based diet rich in
Another bioactive fruit and vegetables, whole
component of cow’s milk grains and unsaturated fats
receiving an increasing amount (including omega-3 fatty acids)
of attention is the growth factor offers significant health benefits.
called insulin-like growth factor 1 By adopting a healthy diet, together
(IGF-1). The amount of IGF-1 present is with regular physical exercise, avoiding
higher in milk produced by pregnant cows. smoking and drinking (alcohol) only
The concern is that because IGF-1 in cows is moderately, many of the so-called modern Western
identical to human IGF-1, this growth factor could diseases can be prevented. As part of its global
cross the gut wall and trigger an abnormal response, strategy on diet, physical activity and health, the
for example increasing the risk of certain cancers. It World Health Organisation (WHO) claims that up to
may be that IGF-1 does not cross the gut wall but 80 per cent of cases of coronary heart disease, 90
that other bioactive components in milk boost IGF-1 per cent of type 2 diabetes cases and one-third of
production in the liver (see IGF-1). Either way, over cancers can be avoided by changing to a healthier
the last decade IGF-1 has been linked to an diet, increasing physical activity and stopping
increased risk of childhood cancers, breast cancer, smoking (WHO, 2003).
lung cancer, melanoma and cancers of the pancreas
and prostate (LeRoith et al., 1995; Chan et al., 1998)
and gastrointestinal cancers (Epstein, 1996).

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 White Lies

Part one:
The History, Geography and Biology of Milk
The Origins of Dairy Farming The ability to digest lactose (the sugar in milk)
evolved as a result of a genetic mutation among
Although sheep, cattle and goats are thought to people in the Balkans and central Europe (amongst
have been domesticated in parts of the Middle East some other places) around 7,500 years ago.
and central Asia over 9,000 years ago there is no Descendants of these people are able to consume
direct evidence that these animals were used to dairy milk today without suffering the symptoms of
supply milk. Written texts, paintings and drawings lactose intolerance (bloating, wind, discomfort etc).
from around 6,000 years ago provide evidence of Cheese-making would have allowed the lactose-
dairy farming from then (Pringle, 1998). However, intolerant Neolithic farming communities to
analysis of dairy fat residues on pottery fragments consume milk without becoming ill, as processing
suggests that the exploitation of animals for milk milk into cheese reduces the lactose content.
was already an established practice in Britain when
farming began in the fifth millennium BC (Copley et Although this all sounds like a long time ago, in
al., 2003). More recent research show that humans evolutionary terms it is very recent history and early
in north-west Anatolia (Asia Minor or Turkey) were dairy farming would have been practised on a
using milk 8,000 years ago (Evershed et al., 2008). relatively small scale. Hominid (modern humans and
Analysis of fat residues on sieve-like pottery our forerunners) fossils date back to nearly seven
structures indicates that cheese manufacture may million years ago (Cela-Conde and Ayala, 2003). If
have been practiced by Neolithic people 7,500 years seven million years were represented as a twelve-hour
ago (Salque et al., 2013). clock, starting at midday, humans would have started
dairy farming less than one minute before midnight.

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Dairy farming today about five years – that is after three or four lactations,
when naturally she may live for 20 to 30 years.
Milk production today is big business. The total value
of the production of milk in the UK is estimated to
be £3.8 billion (Defra, 2012). This is more than the Who drinks milk?
value of production of beef, lamb, pig, poultry meat,
eggs and around three times the value of the Since 1960, global milk production has nearly doubled
production of fresh vegetables (Defra, 2012). (Speedy, 2003). The most substantial growth has
occurred in developing countries; the consumption of
There are now 1.81 million dairy cows in the UK milk per person in China has increased tenfold since
dairy herd (Dairy Co, 2013). Although the numbers 1980 (FAO, 2009). These changes in diet have had an
of dairy cows are falling year by year (down 7.3 per impact on the global demand for agricultural products
cent or 142,000 dairy cows in the last five years), the and will continue to do so.
milk yield has increased. Defra states that the
increase in milk yield far offsets the fall in the Around three-quarters of the world’s population
number of dairy cattle (Dairy Co, 2013a). The latest do not drink milk, but among those who do, the
figures from Defra show that the total level of milk pattern of consumption varies widely between countries.
produced in the UK from 2011 to 2012 increased by Data collected by the Food and Agriculture Organisation
163 million litres to 13.8 billion litres (Dairy Co, of the United Nations (FAO) provides figures for the
2013a). There is a clear trend; fewer cows are being consumption of milk (excluding butter) in kilograms per
forced to produce more milk. capita per year for over 170 countries (FAOSTAT, 2013).

Excluding suckled milk, each cow now produces over As shown in Figure 1.0 the level of milk and dairy
20 litres of milk per day, which equates to 7,617 litres product consumption varies widely between
of milk yearly (Dairy Co, 2013a). Over the last 10 years, countries. The highest levels of consumption are seen
selective breeding and high protein feed has increased in Europe. In Finland for example, a massive 375.4kg
the average yield per cow from 17.7 litres per day to was consumed per person in 2009, with Sweden
20.9 litres per day. That is 3.2 litres additional milk close behind at 357.4kg, then the Netherlands
being produced by dairy cows, every day! (357.3.7kg), Albania (282kg), Germany (264kg) and
Norway (262.6kg). Between 2002 and 2009, US
A common misconception is
that it is natural for cows to Figure 1.0 Consumption of milk (excluding butter) in selected
produce milk constantly. This countries compared to world consumption.
is not the case; just like us, 400
cows only produce milk after
a nine-month pregnancy and 350
giving birth. Today’s large- 2002
scale intensive dairy farming 300
2009
employs a highly regulated
kg/capita/year

250
regime of cycling pregnancy
and lactation concurrently, 200
meaning that cows are both
pregnant and being milked 150
at the same time for most of
each year. This intensive 100
physical demand puts a
tremendous strain on the 50
dairy cow and, as she gets
older, infertility and severe 0
South Africa

Congo
Mozambique
China
Albania

Australia
Sweden

USA

Thailand
Netherlands

Kenya
Spain

Mexico
Finland

Vietnam
Germany

Brazil
France
Norway

UK

Liberia
Ireland

India
Portugal

World

infections causing mastitis

and lameness cuts short her
economic and productive life.
The average lifespan of a
modern dairy cow is only Data from FAOSTAT, 2013.

11
 White Lies

consumption dropped from 264.6kg to 255.6kg and

UK consumption increased from 233.3kg to 248.5kg A comparison between
so the gap between the two has largely been closed.
The average amount of milk and dairy products human milk and cow’s milk
consumed per person per year on a global scale is just
87.3kg (up from 79.8kg in 2002). It should be noted The composition of milk varies according to the
that while overall dairy consumption in the UK may animal from which it comes, providing the correct
have increased, the consumption of milk in 2009 was rate of growth and development for the young of
reduced according to the 2008/2009 National Diet that species, thus for human infants, human milk is
and Nutrition Survey. For example, consumption for obviously more suitable than cow’s milk. Indeed, the
girls aged 11-18 years was 136 grams per day on popular consensus among health care professionals
average in 1997 and 107grams per day in 2009; is that ordinary cow’s milk, goat’s milk, condensed
consumption for boys of the same age was 208 milk, dried milk, evaporated milk, or any other type
grams per day in 1997 and 172 grams per day in of milk should not be given to a child under the age
2009. For adults, even larger decreases were seen, for of one. This is because of differences in the
women from 195 grams per day in 2000/2001 to 120 composition of milk that have been revealed by
grams per day in 2009 and for men, from 225 grams research over the last decade or so. While cow’s milk
per day to 165 grams per day (Bates et al., 2010). and human milk contain a similar percentage of
water, the relative amounts of carbohydrate, protein,
The lowest levels of consumption are seen in Africa fat, vitamins and minerals vary widely.
and Asia. In Liberia a mere 2.5kg was consumed per
person in 2009. Other countries consuming small Figure 2.0 A comparison of the carbohydrate,
amounts include the Congo (3.7kg), Mozambique protein and fat components of whole cow’s milk
(4.1kg), the Democratic People's Republic of Korea and human milk.
(4.5kg), Viet Nam (11.5kg) and Thailand (21.8kg).
With levels this low, it is reasonable to assume that 8
many people in these countries and others do not
7
consume any milk or milk products at all. Whole cow’s milk Human milk
6
Grams per 100g

5
While some European countries are consuming less
4
(Sweden, France, Norway, Ireland, Portugal and
3
Spain), consumption in developing countries is
2
increasing (Brazil, Kenya, South Africa, India and
1
China). In 2002 the amount consumed per person in
0
China was 13.2kg, by 2009 this figured has risen to
Carbohydrate Protein Fat
29.8kg. Although the amount consumed per person
in China is still relatively low compared to that in the
West, it should be remembered that China has a Source: FSA, 2002.
population of 1.35 billion so this increase amounts to
a significantly higher demand. Protein
The carbohydrate, protein and fat content of milk
It could be argued that the lower level of consumption from one species is finely tuned to meet the
seen in some developing countries just reflects the fact nutritional requirements of that particular animal
that people cannot afford to buy milk products. whether human, elephant, buffalo, camel or dog.
However, in Japan for example (not a developing Figure 2.0 shows that the protein content in 100g of
country), consumption is very low at only 73.9kg. Most whole cow’s milk (3.3g) is more than double that of
people in the world do not drink milk; their reasons human milk (1.3g); this is because the amount of
may be cultural, economic, historical or biological. For protein in milk is linked to the amount of time it
example, most of the world’s population are lactose takes that particular species of animal to grow in
intolerant (see Lactose intolerance). But many of us size. Growing calves need more protein to enable
think of milk as a fundamental component of a them to grow quickly. Human infants on the other
healthy diet. Why is this? Is milk the only source of hand need less protein and more fat as their energies
some obscure essential nutrient? Or is milk unique in are expended primarily in the development of the
that it contains all the nutrients that we require? brain, spinal cord and nerves.

12
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Figure 3.0 The fatty acid composition of whole cow’s milk and
human milk.
3

2.5
Whole Cow’s milk
Species with the highest Human milk

Grams per 100g

2
milk protein concentration
exhibit the most rapid
growth rate. Leucine is a
unique amino acid in that 1.5
it stimulates muscle
protein synthesis. The
higher the protein plus 1
leucine content of milk,
the quicker the neonate
doubles its birth weight. 0.5
For instance, the leucine
content of rat’s milk is 11
grams per litre and the rat 0
doubles its birth weight in Saturated Mono-unsaturated Poly-unsaturated
just four days. Cat’s milk
contains 8.9 grams per Fatty acids
Source: FSA, 2002.
litre and the cat takes 10
days to double its birth weight. Cow’s milk contains contains around four per cent fat whereas milk from
3.3 grams per litre and the calf doubles its birth the grey seal contains over 50 per cent fat (Baker,
weight after 40 days. Human milk contains 0.9 1990); this is because baby seals need more body fat
grams per litre and the human infant, the mammal to survive in cold water. Figure 2.0 shows that 100g
with the slowest growth rate, doubles its birth of whole cow’s milk and human milk contain similar
weight after 180 days. The weight gain of calves amounts of fat (3.9g and 4.1g respectively). While
during the first year (0.7-0.8 kg per day) is nearly 40 these values are close, the types of fat vary. Figure
times higher than that of breastfed human infants 3.0 shows that cow’s milk contains more saturated
(0.02 kg per day). It has been demonstrated that fat while human milk contains more unsaturated fat.
cow’s milk-based infant formula feeding significantly
increases serum concentrations of leucine, insulin Figure 3.0 shows that 100g of whole cow’s milk
and IGF-1 in comparison to breast-feeding (Melnik contains 2.5g saturated fat, 1.0g monounsaturated
et al., 2012). This may be one of the mechanisms and 0.1g polyunsaturated fat, while human milk
linking formula feeding to overweight and obesity contains 1.8g saturated fat, 1.6g monounsaturated
(see Breast Is Best below). fat and 0.5g polyunsaturated fat (FSA, 2002). These
figures demonstrate the higher level of saturated fat
The proteins in milk can be divided into two in cow’s milk compared to human milk, and the
categories: caseins and whey proteins. Human milk higher level of unsaturated fat in human milk
contains these in a ratio of 40:60 respectively; while compared to cow’s milk. This imbalance contributes
in cow’s milk the ratio of casein to whey proteins is to the unsuitability of cow’s milk for human infants.
80:20. Given that the amount of total protein in
cow’s milk is more than double that of human milk, The higher level of unsaturated fatty acids in human
cow’s milk clearly contains considerably more casein milk reflects the important role of these fats in brain
than human milk. Casein can be difficult to digest, in development. In humans the brain develops rapidly
fact it is used as the basis of some glues! Infant milks during the first year of life, growing faster than the
are formulated to contain more whey than casein body and tripling in size by the age of one. The brain
(the ratio of whey to casein in these milks is similar is largely composed of fat and early brain
to that of human milk), and this is why it is thought development and function in humans requires a
to be easier for new babies to digest. Casein has sufficient supply of polyunsaturated essential fatty
been linked to a range of diseases and allergies, acids. The omega-6 fatty acid arachidonic acid (AA)
including type 1 diabetes (see Diabetes). and the omega-3 fatty acid docosahexaenoic acid
(DHA) are both essential for brain development and
Fat functioning. Both are supplied in human milk but not
The amount and type of fat present in the milk in cow’s milk (currently AA and DHA-enhanced infant
similarly reflects the requirements of the species of formulas are available, although not mandatory,
animal producing that milk. Whole milk from a cow throughout most of Europe). Cow’s milk does contain

13
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Table 2.0 Comparison of the mineral and vitamin

components of cow’s milk and human milk.

Cow’s Milk (semi-skimmed, Human Milk (mature)

pasteurised) per 100g per 100g

Sodium (mg) 43 15
the shorter chain omega-6 Potassium (mg) 156 58
linoleic acid (LNA) and the Calcium (mg) 120 34
omega-3 α-linolenic acid Magnesium (mg) 11 3
(ALA) but these have to be Phosphorus (mg) 94 15
converted in the body into Iron (mg) 0.02 0.07
the longer chain versions Copper (mg) Trace 0.04
mentioned above. Zinc (mg) 0.4 0.3
Chloride (mg) 87 42
A review of 20 studies of Manganese (mg) Trace Trace
cognitive function of breast Selenium ( g) 1 1
fed infants compared to Iodine ( g) 30 7
that of formula fed infants Retinol ( g) 19 58
concluded that the Carotene ( g) 9 (24)
nutrients in breast milk may Vitamin D ( g) Trace Trace
have a significant effect on Vitamin E (mg) 0.04 0.34
neurological development Thiamin (mg) 0.03 0.02
in infants (Anderson et al., Riboflavin (mg) 0.24 0.03
1999). More recent work Niacin (mg) 0.1 0.2
indicates that compared to Vitamin B6 (mg) 0.06 0.01
formula milk, nutrients in Vitamin B12 ( g) 0.9 Trace
breast milk may confer Folate ( g) 9 5
better cognitive and motor Pantothenate (mg) 0.68 0.25
development in infants Biotin ( g) 3.0 0.7
(Bernard et al., 2013) which Vitamin C (mg) 2 4
may extend into
intelligence in adulthood ( ) = estimated value. Source: FSA, 2002.
(Mortensen et al., 2003).

Cow’s milk tends to be low in the types of fat calves grow much more quickly and have a larger
essential for human brain development; a rapid skeleton than human babies and therefore need
increase in body size is more of an imperative for much more calcium (FAO, 1997). Cow’s milk is
cows than rapid brain development, so cows specifically designed to meet this high demand which
produce milk that is high in body-building saturated is why whole cow’s milk is not recommended for
fats to help their calves grow rapidly in size. infants under 12 months. Although human milk
contains less calcium, it is more easily absorbed than
Similarly, the fatty acid composition of cow’s milk is that found in cow’s milk. According to the American
more suited to a calf than to a person. Attempts to Academy of Pediatrics Committee on Nutrition, the
alter the fatty acid composition of cow’s milk, and so available data demonstrate that the bioavailability of
increase the nutritional value of cow’s milk to calcium from human milk is greater than that from
humans, have involved experiments feeding cows fish infant formulas (58 per cent and 38 per cent
meal and soya beans (AbuGhazaleh et al., 2004) and respectively) (Greer and Krebs, 2006). In an effort to
flax seed (Petit, 2002). Feeding flax seed resulted in a address this discrepancy, the concentration of calcium
lower omega-6 to omega-3 fatty acid ratio, which is in infant formulas is generally higher than that in
thought might improve the nutritional value of milk human milk. So although human milk contains less
from a human health point of view by reducing the calcium than cow’s milk, the calcium in human milk is
potential risk of disease. Of course you could just eat better absorbed into the body than the calcium in
the flax seed oil yourself to improve the balance of cow’s milk, again illustrating why human milk is the
omega-3 and omega-6 oils in your diet while best source of nutrition during the first year of life.
avoiding the undesirable components of milk.
Iron
Calcium Cow’s milk contains very little iron (FSA, 2002) which
The calcium content of cow’s milk (120mg per is another reason why cow’s milk is deemed to be
100ml) is nearly four times that of human milk (34mg unsuitable for infants under the age of 12 months.
per 100ml). This discrepancy occurs for good reason; Indeed a one-year-old attempting to meet the

14
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reference nutrient intake

(RNI) of 5.3mg of iron
would have to drink over
30 pints of cow’s milk per
day if it were to be used to
meet their iron
requirement. Furthermore,
cow’s milk is low in vitamin
C and vitamin D
(Department of Health,
1994), and contains less
vitamin A than human milk.

The high protein, sodium,

potassium, phosphorus
and chloride content of
cow’s milk present what is
called a high renal solute
load; this means that the
unabsorbed solutes from
the diet must be excreted
via the kidneys. This can
place a strain on immature
kidneys forcing them to
draw water from the body
thus increasing the risk of
dehydration. The renal
solute load of infants fed
cow’s milk has been shown to be twice as high as
that of formula fed infants (Martinez et al., 1985) The composition of cow’s milk
and three times that of human milk (Ziegler, 2011).
Cow’s milk composition can vary widely between
Allergic reactions to the proteins in cow’s milk are different breeds and during different stages of
common among infants, and cow’s milk-induced lactation. In the first few days after birth, a special
intestinal bleeding as an allergic response is a well- type of milk called colostrum is excreted which is rich
recognised cause of rectal bleeding in infancy in fats and protein. Colostrum also contains
(Willetts et al., 1999). This blood loss can affect the important infection-fighting antibodies which
iron nutritional status of the infant (Ziegler et al., strengthen the immune system of the young
2011) and in many cases may lead to anaemia. This mammal. The transition from colostrum to true milk
condition will deteriorate if iron-rich foods are occurs within a few days following birth.
excluded by the continued consumption of milk,
a food very low in iron (see Allergies – Water
Gastrointestinal bleeding). All milk produced by animals contains carbohydrate,
protein, fat, minerals and vitamins but the major
The health problems caused by the early component is water. Water dilutes the milk allowing
consumption of ‘normal’ off-the-shelf cow’s milk are its secretion from the body; without water it would
so well documented that for some time now, parents be impossible to express milk. Additionally, the water
and caregivers have been advised not to introduce in milk is essential to the newborn for hydration.
cow’s milk before the age of 12 months in the UK Cow’s milk contains a similar amount of water to
(Department of Health, 1994), the US (American human milk – around 87 per cent.
Academy of Pediatrics, 1992), Denmark (The National
Board of Health, Denmark, 1998) Canada (Canadian Carbohydrate
Paediatric Society, 1998), Sweden (Axelsson et al., The major carbohydrate in mammalian milk is a
1999) and New Zealand (Soh et al., 2004). disaccharide (or sugar) called lactose. For lactose to

15
 White Lies

be digested, it must be broken down in the intestine Protein

by the enzyme lactase to its component Protein provides energy and is required for the
monosaccharides glucose and galactose. Glucose can growth and repair of tissue such as skin and muscle.
then supply energy to the young animal. Many Caseins are the primary group of proteins in cow’s
people are unable to consume cow’s milk and dairy milk, making up around 80 per cent of the total
products because they are unable to digest lactose protein content. The remaining portion is made up
after weaning. Most infants possess the enzyme from whey proteins. There are four types of casein
lactase and can therefore digest lactose, but this (alphaS1, alphaS2, beta and kappa casein) that
ability is lost in many people after weaning combine to make up a structure known as a casein
(commonly after the age of two). In global terms micelle. The micellar structure of casein is important
lactose intolerance is very common, occurring in in the production of cheese; it also plays a significant
around 90-100 per cent of Asians, 65-70 per cent of role in cow’s milk allergies (see Allergies).
Africans, but just 10 per cent of Caucasians (Robbins,
2001). Therefore most of the world’s population Fat
are unable to digest milk after weaning. The principal fat in milk is a complex combination of
lipids called triglycerols
(esters of three fatty acids
with one molecule of
glycerol). There are more
than 400 fatty acids in
cow’s milk ranging in
carbon atom chain length.
Fatty acids are described as
saturated or unsaturated
depending on the amount
of hydrogen in the carbon
chain of the molecule; milk
contains both saturated
and unsaturated fatty
acids. Unsaturated fatty
acids may be further
classified as
monounsaturated or
polyunsaturated
(depending on the number
of double bonds in the
carbon chain of the fatty
acid molecule). Most of the
fat in whole cow’s milk
(around 65 per cent) is the
saturated type. Around 30
per cent is
monounsaturated and just
five per cent
polyunsaturated. Saturated
fatty acids are associated
with high blood cholesterol
and heart disease.

Polyunsaturated fats
include fatty acids called
the omega-6 and omega-3
fatty acids, (these names
refer to the position of the

16
 A report

double bond in the carbon chain of the fatty acid having to change their eating habits (Shingfield et
molecule). Milk contains the omega-6 essential fatty al., 2013). This brave new world approach to how
acid linoleic acid and the omega-3 fatty acid linolenic we eat is called nutrigenomics. The simpler
acid. These are called essential fatty acids because alternative would be to just eat healthier food!
they are essential to health but cannot be made
within the body and so must be obtained from the In addition to the fatty acids discussed there are
diet. While milk does contain linoleic acid and small amounts of phospholipids and other fats
linolenic acid (both with chains of 18 carbon atoms) present in milk including fat soluble vitamins.
it does so at relatively low levels.
Minerals and vitamins
There has been much excitement over the last ten Minerals found in cow’s milk include sodium,
years about conjugated linoleic acids (CLAs) in cow’s potassium, calcium, magnesium, phosphorus and
milk. The term ‘conjugated’ refers to the molecular chloride, zinc, iron (although at extremely low levels),
arrangement of the molecule. CLAs are described as selenium, iodine and trace amounts of copper and
positional and geometric isomers of linoleic acid; this manganese (FSA, 2002). Vitamins in cow’s milk
means that CLAs are made up of exactly the same include retinol, carotene, vitamin E, thiamin,
components as normal linoleic acid, just in a riboflavin, niacin, vitamin B6, vitamin B12, folate,
different arrangement. It has been suggested that pantothenate, biotin, vitamin C and trace amounts
some forms of CLA may confer a range of potential of vitamin D (FSA, 2002). In the US, milk is fortified
human health benefits (McGuire and McGuire, 2000, with additional vitamin D; this has important
Whigham et al., 2007). However, the majority of implications as we shall see later (see Osteoporosis).
studies on weight loss, cancer, cardiovascular
disease, insulin sensitivity and diabetes and immune Although cow’s milk contains all these nutrients it is
function have been conducted on animals (or in important to note that these vitamins are contained
vitro) and it has been acknowledged that variations at very low levels. Furthermore, the mineral content
exist between different animals’ responses to CLAs. is so out of balance with human biochemistry that it
Human studies have produced mixed results; a is difficult for us to absorb the optimum amounts
review of 17 studies on humans concluded that CLA required for health.
does not affect body weight or body composition
and has a limited effect on immune function (Tricon Fibre
et al., 2005). Furthermore some detrimental effects Milk contains no dietary fibre.
of CLA have been observed in mice and some
reports suggest that CLAs can elicit pro-carcinogenic
effects (Wahle et al., 2004). One form of CLA is The undesirable components
suspected of having pro-diabetic effects in
individuals who are already at risk of developing of milk and dairy products
diabetes (McCrorie et al., 2011).
Whole milk, cheese, butter and many other dairy
In summary, there is no substantive evidence of a products contain high levels of saturated fat,
consistent benefit of CLA on any human health cholesterol and animal protein all of which are not
conditions and evidence regarding effectiveness of required in the diet and have been linked to a wide
CLA in humans is inconclusive (Silveira et al., 2007). range of illnesses and diseases. For example, excess
Despite warnings from researchers that until we saturated fat and cholesterol in the diet is associated
know more, CLA supplementation in humans should with an increased risk of heart disease and stroke.
be considered with caution, the dairy industry sees Cross cultural studies show that as the consumption
this molecule as a new marketing opportunity and of saturated fat, cholesterol and animal protein
research into producing CLA-enriched milk, by increases from country to country, so does the
manipulating the diet of dairy cows, began over a incidence of the so-called diseases of affluence such
decade ago (Lock and Garnsworthy, 2002). As stated as obesity, heart disease, diabetes, osteoporosis and
above, cow’s milk and dairy products are significant certain cancers. It has been suggested that this is
source of saturated fat in the human diet. Altering because of genetic differences between different
the fatty acid composition of dairy foods would races. However, when people migrate from an area
mean that people could comply with government of low incidence of the so-called affluent diseases to
health recommendations on fat intake without an area of high incidence, they soon acquire the

17
 White Lies

same high incidence shared by the population into • Milk thrown away due to contamination by
which they have moved. This correlation must then medication or being unfit to drink
be attributed, at least in part, to environmental • A reduction in yields due to illness and any
factors such as diet and lifestyle. So if you can permanent damage to udder tissue
increase the risk of disease by changing your diet • The extra labour required to tend to mastitic
and lifestyle, it stands to reason that you can reduce cows
the risk of disease by changing your diet and • The costs of veterinary care and medicines
lifestyle. The World Health Organisation (WHO) state • The cost of reduced longevity due to premature
that there are major health benefits in eating more culling
fruit and vegetables, as well as nuts and whole
grains and moving from saturated animal fats to Source: Dairy Co, 2013b.
unsaturated vegetable oil-based fats (WHO, 2003).
The number of somatic cells in the milk (the somatic
In addition to saturated fat, cholesterol and animal cell count) provides an indication of the level of
protein, a wide range of undesirable components infection present. These measurements are taken
occur in cow’s milk and dairy products. The modern from the milk bulk tank and not from individual
dairy cow is prone to both stress and disease. In the cows, so milk from a diseased cow is diluted,
UK, cows suffer from a range of infectious diseases especially in larger herds. The somatic cell count
including brucellosis, bovine tuberculosis, foot and usually forms part of a payment structure to farmers
mouth disease, viral pneumonia and Johne’s disease. with defined thresholds of concentration determining
As a result of an infectious disease a wide range of the qualification for bonus payments or penalty
contaminants can occur in milk. Mastitis charges. Indeed, milk contracts often define several
(inflammation of the mammary gland) is a somatic cell count thresholds and any respective
widespread condition affecting cattle in the UK in bonus for attaining them (Dairy Co 2013c). In most
which all or part of the udder suffers from an developed dairy industries various regulatory limits
infection caused by bacteria entering through the are applied to milk for human consumption. In the
teat (Dairy Co, 2013b). Mastitis may be referred to as European Union the somatic cell limit is a maximum
subclinical (no symptoms) or clinical whereby of 400,000 cells per ml in bulk milk (Dairy Products
symptoms include swelling, pain, hardness, milk clots (Hygiene) Regulations 1995). This means that milk
or discoloured milk. The cow responds to the containing 400 million pus cells per litre can be
infection by generating white blood cells (somatic sold legally for human consumption. So one
cells) which migrate to the affected area teaspoonful of milk could contain up to two
in an effort to combat the million pus cells! It could be even
infection. These cells, along with worse, as concerns have been raised
cellular debris and necrotic about the efficiency of cell counting
(dead) tissue, are a component techniques (Berry et al., 2003).
of pus and are excreted into the
milk. Mastitis treatment and Goat’s milk is no better. According to
control is one of the largest the Universities Federation for Animal
costs to the dairy industry in the Welfare (UFAW), 65 per cent of goat
UK. Financial losses arise from: milk samples will have a cell count
greater than 1,000 million cells per litre
(Mowlem, 2011).

18
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Mastitis effects the quality of milk in many ways; the molecules). The concern here is that these signalling
total protein content is decreased, the amounts of molecules that have evolved to direct the rapid
calcium, phosphorus and potassium content are growth of the offspring for which they were
decreased, the taste deteriorates (becomes bitter), intended. So, cow’s milk, ‘designed’ to turn a calf
and the levels of undesirable components rise. These into a cow, may initiate inappropriate signalling
include enzymes such as plasmin and lipase, and pathways in the human body that may lead to
immunoglobulins (Blowey and Edmondson, 2000). illnesses and diseases such as cancer.
Mastitis is treated with antibiotics delivered directly
into the udder. These drugs can also end up in the All milk produced by mammals is a medium for
milk, so milk from treated cows must not be transporting hundreds of different chemical
marketed until the recommended withholding period messengers. Human breast milk is a dynamic,
has elapsed. Mastitis occurs in around 50 per cent of multifaceted infant food containing a wide range of
cows in the UK (Blowey and Edmondson, 2000). nutrients and bioactive factors needed for human
infant health and development: macrophages, stem
Recent studies show that the value of mammalian cells, immunoglobulins, cytokines, chemokines,
milk is not just nutritional but that it contains a growth factors, hormones, oligosaccharides, glycans
variety of factors (biologically active molecules) with and glycosaminoglycans (Ballard and Morrow, 2013).
additional qualities that have a profound role in the While many studies of human milk composition have
survival and health of the offspring consuming it. been conducted, components of human milk are still
These biologically active molecules include enzymes, being identified. Mammalian milk ‘communicates’
hormones and growth factors. In 1992, Pennsylvania between the maternal mammary epithelia and the
State University endocrinologist Clark Grosvenor infant’s intestinal system directing and educating the
published an extensive review of some of the known immune, metabolic and microflora systems within
bioactive hormones and growth factors found in a the infant (German et al., 1992). Indeed, research
typical glass of cow’s milk in the US. The list included indicates that many of these molecules survive the
seven pituitary (an endocrine gland in the brain) environment of the infant’s gut and are absorbed
hormones, seven steroid hormones, seven into the circulation where they may exert an
hypothalamic (another brain endocrine gland) influence on the infant’s immune system, intestinal
hormones, eight gastrointestinal peptides tract, neuroendocrine system, or take some other
(chains of two or more amino acids), six effect. This has evolved as a useful mechanism
thyroid and parathyroid hormones, 11 between mothers and infants
growth factors, and nine other of the same species, but
biologically active compounds the effects of bioactive
(Grosvenor et al., 1992). substances in milk taken
from one species and
Other consumed by another are
biologically largely unknown. The concern
important is that the bioactive molecules in
proteins and cow’s milk may direct undesirable
peptides in milk regulation, growth and
include differentiation of various tissues in the
immunoglobulins, human infant. Of particular concern
allergens, enzymes, for example is the insulin-like growth
casomorphins (casein peptide factor 1 (IGF-1) which occurs naturally
fragments) and cyclic in milk and has been linked to several
nucleotides (signalling cancers in humans (see IGF-1).

19
 White Lies

Breast is Best depression (UNICEF, 2013). On the other hand,

artificially fed babies are at greater risk of: gastro-
A substantial body of evidence shows that intestinal infection, respiratory infections, necrotising
breastfeeding has important advantages for both enterocolitis, urinary tract infections, ear infections,
infant and mother. Babies receive an important boost allergies (eczema and wheezing), type 1 and type 2
to their immune system in the first few days of diabetes, sudden infant death syndrome and
breastfeeding as important antibodies are passed childhood leukaemia (UNICEF, 2013).
from the mother to the infant in the colostrum (the
fluid expressed before the so-called true milk). These UNICEF state that:
antibodies protect the baby from infection. But that is
just the start of it; breastfed babies may have better Formula is not an acceptable substitute for
neurological development than artificially fed infants. breast milk because formula, at its best, only
They may have better cholesterol and blood pressure replaces most of the nutritional components
levels. More research is needed, but breastfeeding of breast milk: it is just a food, whereas breast
may also provide protection against: multiple milk is a complex living nutritional fluid
sclerosis, acute appendicitis and tonsillectomy. containing anti-bodies, enzymes, long chain
Numerous studies show that the risk of obesity in fatty acids and hormones, many of which
later life is reduced in people who breastfed as simply cannot be included in formula.
infants (Harder et al., 2005; Arenz et al., 2004; Owen Furthermore, in the first few months, it is
et al., 2005). Women who were breastfed as infants hard for the baby’s gut to absorb anything
are at lower risk of: breast cancer, ovarian cancer, hip other than breast milk. Even one feeding of
fractures and reduced bone density. Mothers who formula or other foods can cause injuries to
breastfeed their infants may have a lower risk of the gut, taking weeks for the baby to recover
rheumatoid arthritis, type 2 diabetes and postnatal (UNICEF, 2005).

20
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Furthermore, breastfeeding is free. You do not need comply with strict UK and EC legislation which
to wash and sterilise an endless number of bottles. specifies the nutritional composition of the feeds.
You will not be up in the night mixing and testing Soya-based infant formulas provide a safe feeding
the milk to see if it is cool enough; breast milk comes option for most infants that meet all the nutritional
ready mixed at the perfect temperature. The act of requirements of the infant with none of the
breastfeeding is also important for bonding the detrimental effects associated with the consumption
mother and baby relationship. of cow’s milk formulas. Under no circumstances
should a child under 12 months be given ‘normal’
In 2013, figures from the Department of Health cow’s, goat’s, soya or any other milk that is not
revealed that the number of new mothers specifically formulated for an infant (for a review on
attempting to breastfeed fell in England for the first the safety of soya see Appendix I).
time since it began collecting the statistics in 2004.
The figures showed that 5,700 fewer women
initiated breastfeeding with their child in 2012- Milk in Schools
2013 than did the year before. During this period,
327,048 women (just under half of all In 1924, local education authorities (LEAs) in the
maternities) were not breastfeeding their baby UK were permitted to provide children with free
at all by the time of their eight week check- milk. This was the start of the movement to
up (Royal College of Paediatrics and introduce milk to school-aged children that
Health, 2013). This prompted the Royal would continue to this day. In 2005, in a
College of Midwives to express concern paper published in the Economic History
over a lack of promotion of breastfeeding Review, Dr Peter Atkins of Durham
under the current Government, which University reviewed the motivations behind
scrapped funding for National the introduction of cow’s milk in schools
Breastfeeding Awareness Week in 2011. during the first half of the twentieth
The Royal College of Midwives said century (Atkins, 2005). Atkins stated that
there is a shortage of 5,000 midwives the nutritional benefits of school milk were
and criticised the scrapping of infant debatable, possibly even negative in those
feeding coordinators, who encouraged areas where it replaced other foods, but
breastfeeding in parts of the country noted that the dairy industry did well,
with the lowest uptake. creating new markets at a time of
depression (Atkins, 2005).
UNICEF states that the major problems
are the societal and commercial In 1946, the School Milk Act provided free
pressure to stop breastfeeding, milk to all school children. A third of a pint
including aggressive marketing and of milk was provided to all children under
promotion by formula producers (UNICEF, the age of 18 years until 1968 when
2013a). In addition, many mothers have to Harold Wilson’s Government withdrew free milk
return to work soon after giving birth and they face from secondary schools. This policy was extended in
a number of challenges and pressures which often 1971 when Margaret Thatcher (then secretary of
lead them to stop exclusive breastfeeding early. state for education) withdrew free school milk from
Clearly, mothers (including working mothers) need children over seven. This was an economic decision,
support, including legislative measures, to enable not one based on a nutritional assessment of the
them to continue breastfeeding. Strategies to value of milk, and for this she earned the nickname
promote breastfeeding could confer important and ‘Thatcher, Thatcher, milk snatcher’ – although many
widespread health benefits. children were delighted at not having to drink the
warm sickly odorous milk at school anymore!

Infant Formula The school milk scheme was introduced in 1977 by

the European Union (EU) to encourage the
Some mothers are unable to, or choose not to, consumption of milk in schools. The scheme required
breastfeed and in these circumstances infant formula member states to make subsidised milk available to
milk is used. Formula milk is designed to meet the primary and nursery schools wishing to take part,
nutritional requirements of the infant and must but participation was entirely a matter for the school

21
 White Lies

or LEA. The European Commission had originally commenced on 10th October 2005. Previous school
indicated that it wished to abolish the subsidy milk weeks have generated over 6,000 new school
because the scheme was not providing value for milk drinkers or as Dairy UK put it “over one million
money. The UK did not accept these conclusions and new serving opportunities per annum”.
fought hard to retain the scheme. A compromise
was secured whereby in 2001 the subsidy rate was In 2008, the MDC was replaced by DairyCo
reduced from 95 to 75 per cent. The UK following a fundamental review of agricultural levy
Government topped up the subsidy to its original boards by Defra. The five existing levy boards
level in England, up to a maximum total expenditure (including the MDC) were replaced by one statutory
of £1.5 million each year. In the academic year 2003 levy board, the Agriculture and Horticulture
to 2004, around one million school children in Development Board (AHDB). Its statutory purpose is
England drank 34.9 million litres of subsidised milk to improve UK farm business efficiency and
at a cost of around £7 million. competitiveness. In 2010 DairyCo conducted a full
review of in school activities and re-launched its
The move to increase milk consumption in schools Schools and Education programme in January 2011
gathered momentum; the School Milk Project, was which replaced The School Milk Project. DairyCo
set up in 1998 by the Women’s Food and Farming works alongside the British Nutrition Foundation
Union, aiming to increase the uptake of milk in (another industry-funded body) to promote milk in
primary schools. It received funding from the Milk schools using a range of tools including web-based
Development Council (MDC) which was established education resources promoting dairy products. To
following the re-organisation of the milk industry in this end, DairyCo offers free resources and advice to
1994. The MDC was funded by a statutory levy on local authorities and schools about milk production
all milk sold off farms in Great Britain; the annual and dairy farming and how to introduce or increase
income from the levy was over £7 million. Primarily milk provision in their schools.
the MDC funded research and development into
milk production methods, it also funded the School This sophisticated and aggressive marketing is of real
Milk Project which employed ‘facilitators’ to promote value to the dairy industry in establishing milk as a
the uptake of school milk through direct contact ‘normal’ commodity for regular family consumption
with LEAs, schools and dairy suppliers. now and in the future. The policy of introducing
school milk begs the question, are the dairy industry
The charity Milk For Schools (MFS) was founded in nurturing our children? Or simply nurturing a
1994. Set up to educate the public in the field of future loyal adult consumer base?
school based nutrition, MFS is a registered
member of the United Nations Food and
Agriculture Organisation (UNFAO) School
Milk Network, which initiated the first
World School Milk Day on 27th
September 2000. In October 2004 Dairy
UK was established as a cross-industry
body representing processors and
distributors of liquid milk and dairy
products, as well as milk producer
co-operatives. In 2005 the
European Union (EU) and Dairy
UK joined forces with the MDC
to promote milk
consumption in primary
schools. Schools were
targeted with
‘Teacher’s Guides
to Health and
Fitness’ and
School Milk
Week

22
 A report

Part two:
Dairy Consumption and Health
The suggestion that the consumption of cow’s milk Furthermore, given that around 70 per cent of
can lead to a wide range of health problems, people in the world do not drink milk, just how
illnesses and diseases strikes at the core of many essential can it be? The list of illnesses and diseases
people’s thinking. How can such a natural food be associated with the consumption of milk and dairy
unhealthy? Well the answer lies in the fact that milk products is quite extensive. These health problems
is not a natural drink for adults. Furthermore, cow’s tend to occur at levels that relate directly to how
milk is not a natural drink for humans. In nature, much milk is drunk in a particular region or country.
milk is consumed from a mother up until weaning, Furthermore, as milk consumption spreads to areas
which is when the mother normally stops producing where previously it was not drunk, these diseases
milk. Consuming milk from a pregnant mother is not follow. Some of these problems are discussed in
the normal course of events. Furthermore, in nature, detail below.
mammals consume the milk of their own species,
not that of another. In a commentary published in
the Journal of the American Academy of Acne
Dermatology, New Hampshire dermatologist Dr F.W.
Danby states that the human consumption of large Acne is a skin condition that affects many teenagers
volumes of another species’ milk, especially when and in a small number of cases it may occur in
that milk comes from pregnant cows during the adulthood. About 80 per cent of people between
human’s normally post-weaned years, is essentially the ages of 11 and 30 will be affected by acne. It is
unnatural (Danby, 2005). most common between the ages of 14 and 17 in
girls, and between 16 and 19 in boys. Acne can
As previously stated, cow’s milk is designed to help a continue into adult life; about five per cent of
small calf grow into a big cow in less than a year. In women and one per cent of men have acne over the
order to sustain this rapid physical growth, the age of 25 (NHS Choices, 2012a).
composition of cow’s milk has evolved to contain the
specific types of nutrients required, at the specific Acne can cause physical scarring but it can also
levels required. These are not necessarily natural or cause distress, anxiety and depression in some
healthy for humans. For example, whole milk and sufferers who report feeling suicidal because of
certain dairy products such as butter and cheese, bullying or lack of self-confidence.
contain considerable amounts of saturated fat,
cholesterol and animal protein, the detrimental Acne is caused by a combination of factors.
health effects of which are now well-documented. In Hormonal changes can increase the secretion of an
addition to this, the vitamin and mineral content of oily substance called sebum from the skin’s
cow’s milk is not well-suited to human requirements, sebaceous glands which are frequently located
especially those of the human infant. To meet the adjacent to hair follicles. If skin cells build up and
rapid skeletal growth requirements of a calf, cow’s block the opening of hair follicles, subsequent
milk contains four times the amount of calcium as clogging of the sebaceous gland can contribute
human milk. This does not mean that cow’s milk is a further to the development of acne. The problem is
good source of calcium for the human infant, far often made even worse by the colonisation of the
from it; this level of calcium coupled to the high skin by the bacterium Propionibacterium acnes
levels of other minerals in cow’s milk represents what which can become trapped in the hair follicles.
is called a high renal solute load which means that Inflammation then may lead to the eruption of large
the young human infant’s kidneys cannot cope with pus-filled spots characteristic of acne. Despite the
‘off the shelf’ cow’s milk. wholesale dismissal of diet as a potential
environmental factor underlying the development of
In addition to the unsuitable nutritional composition acne, a large body of evidence now exists that
of cow’s milk, there are many other reasons why demonstrates how certain foods and food
cow’s milk and dairy products are not natural foods substances (especially cow’s milk) may adversely
for humans, for example, the increasing body of influence hormones and cytokines that influence the
evidence linking bioactive molecules in milk causes of acne (Cordain, 2005).
(hormones and growth factors) to disease. While the
dairy industry would have us believe that milk is an A large-scale study from Harvard’s School of Public
essential part of the diet, much of the research used Health linked the intake of milk during adolescence
to promote this view is industry-sponsored. with the incidence of acne in 47,355 nurses who

23
 White Lies

completed questionnaires
on high school diet and
teenage acne
(Adebamowo et al., 2005).
The link between teenage
acne and milk
consumption was strongest
for skimmed milk, so it
would seem that the
saturated fat content of
milk is not the causal
factor. The authors
hypothesised that the
hormonal content of milk
may be responsible for
causing acne in teenagers. Cow’s milk contains the recommends that use of whey protein supplements
hormones oestrogen and progesterone along with should be screened for when taking history from
certain hormone precursors (androstenedione, teenage males suffering with acne.
dehydroepiandrosterone-sulphate, and 5 -reduced
steroids like 5 -androstanedione, 5 -pregnanedione Milk also contains many bioactive molecules that act
and dihydrotestosterone), some of which have been on the sebaceous glands and hair follicles (such as
implicated in the development of acne. glucocorticoids, IGF-1, transforming growth factor-β
(TGF-β), neutral thyrotropin-releasing hormone-like
The levels of these hormones in cow’s milk vary peptides and opiate-like compounds), some of which
depending on whether the cow is pregnant or not, survive pasteurisation. The bioavailability of the
and if so at what stage of the pregnancy she is. At factors involved may be altered during pasteurisation.
least two-thirds of cow’s milk in the UK is taken from In other words, heat-induced changes in the shape or
pregnant cows (Danby, 2005). The same team of structure of the molecule may alter the way it
researchers have produced two subsequent articles behaves in the body and, until we know more, it is
based on the nurses’ sons and daughters. In these difficult to say exactly what role these bioactive
groups too, a positive association was observed molecules play in causing acne and other health
between dairy products (particularly skimmed milk) problems. However, the current literature leaves no
and acne (Adebamowo et al., 2006; Adebamowo et room for doubt that dairy products increase the risk
al., 2008). Again, this suggests that it is some of acne. In summary, to help eliminate or avoid acne,
component in cow’s milk other than saturated fat eat more fruit and vegetables and stay away from
that causes acne. cow’s milk and dairy products.

Body builders who use steroid hormones to stimulate

muscle growth and strength are more prone to acne Allergies
as many of the side effects of steroids are manifested
in the skin. This also applies to athletes who use The body’s immune system has to constantly
whey-based supplements for weight gain as these discriminate between many different unfamiliar
protein powders increase IGF-1 and insulin levels, molecules, some of which may be toxic substances
both of which are linked to acne. A number of while others are harmless components of food. An
recent studies have revealed a link between whey allergy results from an inappropriate immune
protein and acne. One case study showed that response to such a substance (or allergen) such as
healthy male adults developed acne after the dust, pollen or a component of food. An allergic
consumption of whey protein (Simonart, 2012). reaction occurs as the body attempts to launch an
Another found that benzoyl peroxide cream or oral attack against the foreign ‘invader’ perceived to be a
antibiotics had little effect on treating the serious threat to health. In such an attack, the body releases
acne affecting five young men who used whey a substance called histamine, which dilates and
supplements. However, when they stopped using increases the permeability of the small blood vessels.
whey, their acne became less severe and was This results in a range of symptoms including local
treatable (Silverberg, 2012). The author of this study inflammation, sneezing, runny nose, itchy eyes and

24
 A report

so on. These types of reactions may give rise to the resulting in a runny nose and blocked ears. More
so-called classic allergies: asthma, eczema, hay fever serious symptoms include asthma, eczema, colic,
and urticaria (skin rash). These responses are called diarrhoea and vomiting.
anaphylactic reactions and they vary widely in their
severity. The most severe type of reaction Asthma
(anaphylactic shock) may involve difficulty in Asthma is a chronic, inflammatory lung disease
breathing, a drop in blood pressure and ultimately characterised by recurrent breathing problems.
heart failure and death. Asthma is a common condition in the UK; 5.4 million
people are currently receiving treatment for asthma
Initial sensitisation to the allergen precedes an (NHS Choices, 2012b). That is one in every 12 adults
allergic reaction and this first exposure may not and one in every 11 children. The number of children
generate any perceivable symptoms. In fact initial with asthma has risen steeply since the 1970s when
sensitisation may result not from the direct exposure just one in 50 children had asthma. Asthma
to an allergen but from exposure to dietary allergens prevalence is thought to have plateaued since the
during breastfeeding. Evidence suggests that this late 1990s, although the UK still has some of the
process, known as atopic sensitisation, can occur in highest rates in Europe and on average three people
exclusively breastfed infants whose mother’s breast a day die from asthma (Asthma UK, 2013).
milk contains dietary allergens. For example, a
Finnish study reported that a maternal diet rich in During an asthma attack, the lining of the airways
saturated fat during breastfeeding might be a risk becomes inflamed and the airways become narrower
factor underlying the later development of allergies causing the characteristic symptoms of asthma:
(Hoppu et al., 2000). The same research group later coughing, wheezing, difficulty in breathing and
reported that breast milk rich in saturated fat and tightness across the chest. Asthma can start at any
low in omega-3 fatty acids might be a risk factor for age and the causes are thought to include a
eczema (Hoppu et al., 2005). While numerous combination of factors including a genetic
studies now show that breastfeeding predisposition (asthma in the family), diet and
can protect against the environmental triggers such as cigarette smoke,
development of allergies, and chemicals and dust mites.
the majority of studies are
strongly in favour of As stated previously, allergies tend to run in
breastfeeding, it may be prudent families, so asthma, eczema or hay
to avoid suspected allergens in fever in some family members
the diet while breastfeeding may increase the risk of
especially if allergies such as others developing the
asthma, eczema and hay fever same or another allergy.
run in the family. But a genetic
predisposition is not the
Allergies are now so common in the UK, only cause, as stated
affecting around one in three people, that the asthma is caused by a
increasing occurrence is referred to by some as an combination of factors. In the
epidemic (Royal College of Physicians, 2003). The UK past, the rise in childhood asthma has been
is one of the top countries in the world for the attributed to an increase in air pollution. However,
highest incidence of allergy, especially asthma. this seems unlikely as many of the most polluted
Millions of adults in the UK are affected by at least countries in the world, such as China, have low rates
one allergy and numbers continue to rise (Allergy of asthma, whereas countries with very good air
UK, 2013). Each year the number of allergy sufferers quality, such as New Zealand, have high rates of
increases by five per cent, half of all affected being asthma (ISAAC, 1998). The ‘hygiene hypothesis’ has
children, and by 2015, 50 per cent Europeans will gained popularity as a causal factor for the increase
suffer from an allergy (EFA, 2011). in asthma. This hypothesis blames the increasing
asthma rates on the extreme levels of cleanliness
Food allergy is increasingly widespread and the most found in many homes. Increased hygiene means that
common of these is cow’s milk allergy, affecting our immune systems are being challenged less and
around two per cent of all infants under the age of less. It has been suggested that this causes us to
one. Symptoms include excessive mucus production overreact to allergens such as dust mites.

25
 White Lies

Food allergy is frequently underestimated in Eczema can vary in severity and most people are only
association with asthma despite the fact that food mildly affected but severe symptoms can include
allergy and asthma frequently co-exist. Children with cracked, sore and bleeding skin. Severe eczema can
food allergy are more than two to four times as likely have a significant impact on daily life. The number of
to have other atopic conditions such as asthma, people diagnosed with atopic eczema has increased in
eczema or respiratory allergy compared to children recent years and currently, about one in five children
without food allergies (Kewalramani and Bollinger, and one in 12 adults in the UK have eczema (NHS
2010). Furthermore, food allergy has been shown to Choices, 2012b; National Eczema Society 2013).
trigger or exacerbate broncho-obstruction in two to
8.5 per cent of children with asthma (Baena-Cagnani Cow’s milk allergy is a risk factor for many allergic
and Teijeiro, 2001). Food allergies may be responsible conditions including asthma and eczema (Saarinen,
for around five per cent of all asthma cases (James et 2005). There is an increasing amount of interest in
al., 1994) and as cow’s milk is a primary cause of the role of the diet in the development of eczema. In
food allergies, it may therefore be useful to consider recent years, the links between certain foods and
the possibility of cow’s milk allergy in the treatment eczema has become better understood. Eczema can
of asthma. be caused by several environmental factors including
dust mites, grasses and pollens, stress and certain
Eczema foods. Eczema usually starts when a baby is around
Eczema (also known as atopic dermatitis) is a six months old and in about 10 per cent of cases it is
condition that causes the skin to become itchy, red, triggered by foods including milk, eggs, citrus fruit,
dry and cracked. It is a long-term, chronic condition. chocolate, peanuts and colourings (NHS Choices,
2013c). The most common food triggers are cow’s
milk and eggs, but many other foods including soya,
wheat, fish and nuts can act as triggers (National
Eczema Society 2013a). So, when treating eczema,
cow’s milk allergy should be considered.

Hay fever
Hay fever (seasonal allergic rhinitis) is an allergic
reaction to grass or hay pollens. A minority of cases
may be caused by later flowering weeds or fungal
spores, and some research suggests pollution can
worsen symptoms. In response to exposure to pollen,
the immune system releases histamine which gives
rise to a range of symptoms including a runny nose,
sneezing and itchy eyes and throat. Hay fever is
often regarded as a trivial problem but it can severely
affect people's quality of life, disturbing sleep,
impairing daytime concentration, it causes people to
miss work or school and has been shown to affect
school exam results (Allergy UK, 2012).

Hay fever is one of the most common allergic

conditions that affects up to one in five people at
some point in their life. Hay fever is more likely if there
is a family history of allergies, particularly asthma or
eczema (NHS Choices, 2011). Some evidence suggests
that altering the diet can help some people with
asthma and allergic rhinitis (Ogle and Bullock, 1980).
However, the effects of diet on hay fever symptoms
have not yet been well studied. As cow’s milk allergy
is linked to other allergic reactions (see above) it may
be sensible to consider avoiding all dairy in order to
combat hay fever symptoms.

26
 A report

Gastrointestinal bleeding Arthritis

As stated above, cow’s milk-induced gastrointestinal
bleeding as an allergic response is a well-recognised Millions of people in the UK experience some form
cause of rectal bleeding in infancy (Willetts et al., of musculoskeletal problem each year. Around nine
1999). One of the main causes of gastrointestinal million people seek help from their GP each year, of
bleeding is dietary protein allergy, the most common these, more than two million have osteoarthritis and
cause of which is cow’s milk protein (casein). more than 350,000 have rheumatoid arthritis. About
Gastrointestinal bleeding from cow’s milk allergy often 15,000 children and adolescents suffer from juvenile
occurs in such small quantities that the blood loss is forms of arthritis (Arthritis Research UK, 2013).
not detected visually, but over prolonged time these
losses can cause iron-deficiency anaemia in children. Osteoarthritis, the most common form of arthritis in
Intestinal blood loss associated with cow’s milk the UK, affects an estimated 8.5 million people and
consumption during infancy affects about 40 per cent often develops in people who are over 50 years of
of otherwise healthy infants (Ziegler et al., 2011). In age (NHS Choices, 2012d). Osteoarthritis is a
one trial of 52 infants, 31 of whom had been degenerative disease where articular cartilage
breastfed, and 21 fed formulas up to the age of 168 gradually becomes thinner as its renewal does not
days of age, the introduction of cow’s milk (rather keep pace with its breakdown. Eventually the bony
than formula milk) was associated with an increased articular surfaces come into contact and the bones
blood loss from the intestinal tract and a nutritionally begin to degenerate. Osteoarthritis can develop after
important loss of iron (Ziegler et al., 1990). an injury to a joint; this can happen months or even
years after the injury. The most frequently affected
Frank Oski, former paediatrics director at Johns joints are in the hands, knees, feet, hips and spine.
Hopkins School of Medicine, estimates that half the
iron-deficiency in infants in the US results from cow’s The next most common type of arthritis is
milk-induced gastrointestinal bleeding (Oski, 1996). rheumatoid arthritis, a chronic inflammatory disease
This represents a staggering figure since more than of the joints. In the UK, rheumatoid arthritis affects
15 per cent of US infants under the age of two around 400,000 people and often starts in people
suffer from iron-deficiency anaemia. between the ages of 40 and 50 years old. Women
are three times more likely to be affected by the
The only reliable treatment for cow’s milk allergy is to condition than men. (NHS Choices, 2012d).
avoid all cow’s milk and dairy products including: milk, Rheumatoid arthritis is a chronic condition
milk powder, milk drinks, cheese, butter, margarine, characterised by hot painful swelling in the joints. In
yogurt, cream and ice cream. Also products with many diseases inflammation can help towards
hidden milk content should be avoided. Food labels healing but in rheumatoid arthritis it tends to cause
that list any of the following ingredients also contain damage. For some people the pain and discomfort
some cow’s milk or products in them: casein, caused by this condition has a serious impact on
caseinates, hydrolysed casein, skimmed milk, skimmed their lives. Rheumatoid arthritis is thought to be an
milk powder, milk solids, non-fat milk, whey, whey autoimmune disease, caused by a fault in the
syrup sweetener, milk sugar solids. These ingredients immune system that causes the body to attack its
can be difficult to avoid as they are commonly used in own tissues. This condition usually starts in the
the production of bread, processed cereals, instant wrists, hands and feet but can spread to other joints
soups, margarine, salad dressings, sweets, cake mix in the body.
and even crisps. It can seem a daunting prospect
having to read the ingredients labels but most Other forms of arthritis include: ankylosing
supermarkets now produce ‘free-from’ lists of spondylitis, cervical spondylitis, fibromyalgia, lupus,
products and many supermarkets also have their own- gout, psoriatic arthritis, reactive arthritis, secondary
label free-from range. There are even iPhone apps arthritis and polymyalgia rheumatica (NHS Choices,
available now to help you identify ingredients by 2012d). In the UK, about 12,000 children under 16
scanning the product bar code. Soya ice creams, years of age have arthritis. Most types of childhood
spreads and yoghurts and dairy-free cheeses are just arthritis are referred to as juvenile idiopathic arthritis
some examples. Calcium-enriched soya, rice and oat and although the exact causes are unknown, the
milks can be used as alternatives to cow’s milk. (For symptoms often improve as a child gets older,
other gastrointestinal problems associated with cow’s allowing them to lead a normal life (NHS Choices,
milk see Lactose intolerance.) 2012d).

27
 White Lies

There has been a general

reluctance to acknowledge
the links between diet and
arthritis with a tendency to
dismiss anecdotal evidence.
However, studies show that
people who eat a lot of red
meat may have a higher
risk of developing
inflammatory types of
arthritis. It has also been
suggested that dairy may
trigger an inappropriate
autoimmune response in
some people who may
then go on to develop
rheumatoid arthritis via a
mechanism called
molecular mimicry. This
may occur when antibodies
react to a protein in cow’s
milk called bovine serum
albumin, mistaking it for an
antigen or foreign protein.

Some studies have looked at the effects of a vegan avoided by opting for plant-based sources of omega-
diet on the symptoms of arthritis. A single-blind 3s.) It is important for people with arthritis to maintain
dietary intervention study investigated the effects of a a healthy well-balanced diet. Arthritis Care (the UK’s
very low-fat, vegan diet on patients with rheumatoid largest voluntary organisation working with and for
arthritis (McDougall et al., 2002). This study people with arthritis) suggest a diet high in fruit,
evaluated the influence of a four-week, low-fat, vegetables, starch and fibre and low in fatty foods, salt
vegan diet on 24 people with rheumatoid arthritis. and added sugars can help (Arthritis Care, 2011).
The results showed a significant decrease in
symptoms. The degree of pain dramatically reduced; Some research suggests a high intake of fruit and
limitation in ability to function improved, joint vegetables may prevent or slow down osteoarthritis.
tenderness and joint swelling significantly decreased. Sulforaphane, a chemical found in vegetables such
The severity of morning stiffness improved, the only as broccoli, has been reported to have anti-
thing not to improve was the duration of the inflammatory properties, may protect against a form
morning stiffness. The researchers concluded that of inflammatory arthritis and reduce the production
patients with moderate-to-severe rheumatoid of enzymes that contribute to the breakdown of
arthritis, who switch to a very low-fat, vegan diet can cartilage. Indeed a recent study from the University
experience significant reductions in their symptoms. of East Anglia looked at human cartilage cells
treated with cytokines and found that sulforaphane
It is now accepted that the Mediterranean diet can reduced the production of enzymes involved in
help people with arthritis as well as a number of other cartilage damage (Davidson et al., 2013). This
conditions. This diet includes plenty of fruit and suggests that sulforaphane could help reduce
vegetables, fish, grains and pulses and a moderate cartilage damage and prevent or slow the
amount of red meat. Foods rich in omega-3 are progression of arthritis. Most people could benefit
believed to have an anti-inflammatory effect, which from eating more fruit and vegetables, complex
may reduce the pain associated with inflamed joints. carbohydrates, fibre, vitamins and minerals and less
Omega-3 is found in nuts and seeds (particularly sugar and saturated fat.
linseed or flax seed) and is regularly used to fortify
margarines. (It is also found in oily fish but oily fish also If you suffer from arthritis it is important to keep as
contains PCBs, dioxins and other toxins that are best healthy as possible by ensuring that the diet provides

28
 A report

all the important nutrients including minerals such as essential fatty acids (EFAs) have been shown to help
calcium and iron. Some people are concerned that some people with arthritis. These polyunsaturated
their calcium intake may drop if they cut out dairy fatty acids are divided into two main groups: omega-
foods. Arthritis Care state that dairy products are not 3 and omega-6. Omega-3 fatty acids are thought to
the only sources of calcium and that you can reach be of most benefit in inflammatory arthritis (Arthritis
the recommended daily amount by eating a variety Research UK, 2013a).
of calcium-rich foods (Arthritis Care, 2010). They list
several non-dairy sources of calcium including When trying to lose weight, it is important to
watercress, tofu, figs, Brazil nuts, bread and baked maintain a good intake of vitamins and minerals.
beans. Be careful not to have too much salt or This means consuming plenty of fruit and
caffeine as excessive quantities of these can reduce vegetables. A healthy balanced diet containing
the body’s ability to absorb or retain calcium. plenty of fruit and vegetables, pulses and whole
grain carbohydrate foods (such as wholemeal bread,
Others are worried about iron, particularly people brown rice and whole wheat pasta) provides a good
who have recently stopped eating red meat. This supply of vitamins, minerals and fibre. A diet lacking
should not be a concern as vegetarians and vegans in fruit and vegetables, and containing processed
are no more likely to become iron deficient than carbohydrates (such as white bread, white rice and
meat-eaters. Indeed one of the largest studies of white pasta) does not provide such a good source of
vegetarians and vegans in the world (the EPIC these essential nutrients and can have a deleterious
Oxford cohort study) looked at over 33,883 meat- effect on health. Whereas a good diet may help even
eaters, 18,840 vegetarians and 2,596 vegans and if strong drugs are being taken to treat arthritis.
found that the vegans had the highest intake of iron,
followed by the vegetarians then the meat-eaters The subject of food allergy and arthritis is quite
(Davey et al., 2003). It should be stressed that milk controversial. However, research has shown that, in
and milk products are an extremely poor source of some people, rheumatoid arthritis can be made
iron, whereas pulses, dried fruits and dark leafy worse by certain foods including milk products and
vegetables are good sources. food colouring (Laar and Korst, 1992). In 2001,
Swedish researchers reported that nine out of 22
The Arthritis Research Campaign (now Arthritis patients with rheumatoid arthritis showed significant
Research UK) founded in 1936, raises funds to improvements in their condition compared to one
promote medical research into the cause, treatment patient out of 25 after following a gluten-free, vegan
and cure of arthritic conditions. They have produced diet (Hafstrom et al., 2001). Of course it is difficult to
dietary guidelines for people with arthritis and they say whether eliminating milk was the reason these
suggest that one of the most important links patients improved as they eliminated all animal foods
between diet and arthritis is being overweight. The and gluten from the diet. However, this work
extra burden on the joints can make symptoms provides evidence that dietary modification can
considerably worse. Losing weight can have a benefit arthritis patients. Diet is not the only factor
dramatic effect in improving the condition. In order to cause and aggravate rheumatoid arthritis, nor is a
to lose weight, you need to use more energy than vegan diet the only way to reduce or eliminate the
you consume in the diet. Research shows that pain and damage caused by this disease. However,
vegetarians and vegans weigh less than meat-eaters research shows that a low fat vegan diet can be a
and Arthritis Research UK suggests that vegetarian powerful and positive, drug free way of limiting the
diets have been shown to be helpful in the long term painful symptoms caused by this disease.
for some people with rheumatoid arthritis. A vegan
diet, which doesn’t include any meat, fish or other
animal products, may also be helpful, possibly
because of the types of polyunsaturated fatty acids
included in the diet (Arthritis Research UK, 2013a).
Cutting down on sugar and taking regular (even
gentle) exercise will help control weight as well.

Saturated fats are the most important kind of fat to

cut down on. The body does not require saturated
fats and they may aggravate arthritis whereas

29
 White Lies

Bovine Somatotrophin (BST) discriminating against imports from the US. The
sensible option is to avoid all dairy products.
In cows, milk production is influenced by the
complex interaction of a range of hormones. Bovine Concern has been expressed over several health issues
somatotrophin (BST) is a natural growth hormone associated with the use of rBST. The increased
that occurs in cattle and controls the amount of milk incidence of lameness and mastitis in rBST-treated
that they produce. In 1994 Monsanto began cows inevitably leads to an increased use of antibiotics
marketing a synthetic version of BST, known as to treat these and other infections. Because of their
recombinant BST (rBST), which was sold as Posilac efficacy in treating and preventing disease and the
and fast became the largest selling dairy animal fact that they can promote growth in some animals
pharmaceutical product in the US. In 2008, when used at sub-therapeutic levels, antibiotics have
Monsanto sold the Posilac business to Eli Lilly and been widely used for many years. Over half of the
Company for $300 million. From 2000-2005 the antibiotics that are produced in the US are used for
USDA National Agricultural Statistics Service survey agricultural purposes (Mellon et al., 2001).
of dairy producers found that about 17 per cent of
dairy milk producers used rBST. Injecting dairy cows Antibiotic use is known to promote the development
with rBST alters the metabolism to increase milk of antibiotic resistance. Thus the widespread use of
production by up to 15 per cent. Monsanto claims these drugs has contributed to the high frequency of
that this ‘allows’ the cow to produce more milk. resistant bacteria in the intestinal flora of farmed
They also argue that the increased production lowers animals (Lipsitch et al., 2002). This raises concerns
the cost of milk, making it more affordable, and the about the development of antibiotic resistant
number of cows needed to keep current milk infections in humans. A study in the New England
production levels is decreased thus saving natural Journal of Medicine in 2000 reported that the
recourses (Monsanto, 2009). emergence of antibiotic-resistant strains of
Salmonella is associated with the use of antibiotics in
However, there is a cost associated with the use of cattle. This study described how a new antibiotic-
rBST; its use is associated with severe welfare resistant strain of Salmonella was isolated from a 12-
problems, for example increasing the incidence of year-old boy admitted to hospital with abdominal
lameness and mastitis. While the US Food and Drug pain, vomiting and diarrhoea. The boy lived on a
Administration (FDA) permit the use of rBST, for ranch in Nebraska and subsequent investigation
reasons of animal health and welfare, the use of revealed the presence of the identical strain of
rBST in the EU was prohibited in 2000. Indeed bacteria, resistant to the antibiotic ceftriaxone,
Canada, Japan and many other countries have also among cattle on his family’s ranch and nearby
banned the use of rBST because of its effects on ranches that had suffered outbreaks of salmonellosis.
animal health and welfare. However, there are no The cattle had been treated with ceftriaxone. This
restrictions on the import of rBST dairy products to evidence suggests that the boy’s gastrointestinal
the UK, or any requirement to label them. infection was acquired from cattle (Fey et al., 2000).

The Government’s Veterinary Medicines Directorate The use of antibiotics in animals is so widespread
does not carry out any testing of imported milk for now that it may exceed their use in human medicine.
rBST (Defra, 2013). Furthermore, Defra confirmed in As stated, drug-resistance in bacteria is driven by this
correspondence with the Viva!Health, that since the selective pressure and can spread to humans either
EU is a single market once a product has entered, if by the food supply (meat, fish, eggs and dairy
it is transported on to another country within the EU, products), direct contact with animals or more
then the origin of the product will be the EU country indirectly through environmental pathways (da Costa
rather than the originating country (Defra, 2013). et al., 2013). This may shorten the time that these
Over the last decade imports of dairy foods have valuable antimicrobial agents will be available for
fallen from around 6,000 tonnes (mainly ice cream) effective treatment of infections in humans
per year to around 1,000. There was a steep rise in (Hammerum and Heuer, 2009). The obvious concern
2007 when nearly 4,000 tonnes were imported, and here is that the widespread use of antibiotics in
in the last year imports of yoghurt have increased cattle can lead to an increase in antibiotic-resistant
significantly (Defra, 2013a). Although these figures strains that may subsequently transmit to humans.
have declined, they still remain a concern, especially This is a public health concern and the question must
as the consumer has a limited chance of be asked: how much evidence of harm do we need

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before we much further

restrict the use of
antibiotics in farm
animals?

Milk production
increases in cows
treated with rBST
because it promotes
the production of the
naturally occurring
growth hormone
insulin-like growth
factor 1 (IGF-1) which
then stimulates the glands
in the cow’s udders to produce
more milk. Research shows that
rBST use on dairy cows can substantially
increase the levels of IGF-1 in their milk (Prosser et al.,
1989). IGF-1 in milk is not denatured (inactivated) by
pasteurisation. This raises concerns about the
potential biological action of IGF-1 from cow’s milk in Cancer
humans especially because IGF-1 from cows is
identical to human IGF-1. Professor Samuel Epstein, More than one in three people in the UK will develop
an international leading authority on the causes and some form of cancer during their lifetime (NHS
prevention of cancer, warns that converging lines of Choices, 2012u). Around 325,000 people were
evidence incriminate IGF-1 in rBST milk as a potential diagnosed with cancer in 2010 in the UK, that’s
risk factor for both breast and gastrointestinal cancers around 890 people every day. Cancer causes more
(Epstein, 1996). However, the extent to which intact, than one in four of all deaths in the UK. In 2010
active IGF-1 is absorbed through the human digestive around 430 people died from cancer every day; that
tract remains uncertain (see IGF-1). is one person every four minutes (Cancer Research
UK, 2013). The four most common cancers in the UK
So why should this concern us if we do not allow the are breast, prostate, lung and colorectal (bowel)
use of rBST in the UK? Well in terms of human cancer. The data shows that while incidence rates
health, the concern is that milk and milk products have increased over previous years, mortality rates
imported from countries that permit the use of rBST have fallen. So more people are getting cancer, but
may lead to the consumption of foods that promote less are dying from it. The net result is that mortality
increased levels of IGF-1 in humans. In 1999, the from cancer over the last 50 years has remained
minister of state, Baroness Hayman, referred to a fairly constant. This is very worrying when you
report from the Veterinary Products Committee consider the vast improvement in both cancer
(VPC) which stated that while the use of rBST does diagnosis techniques and cancer treatment methods.
not increase the level of BST found naturally in cow’s It means that as even more people are getting
milk, there is a two-to-five fold increase the level of cancer, the medical profession are running, just to
IGF-1 in the milk, which she acknowledged may be stand still. It is predicted that by 2020 almost one in
implicated in the occurrence of colonic cancer. two people (47 per cent) will get cancer in their
However, Hayman reiterated the VPC’s view that the lifetime (Macmillan Cancer Support, 2013). This
risk to human health was likely to be extremely poses a huge challenge for the NHS and for society.
small. Hayman also suggested that just 0.3 per cent
of total milk and milk products imported into the UK Up to 40 per cent of cancers in the UK could be
come from the US where rBST is authorised for use prevented by lifestyle changes (Parkin et al., 2010).
(UK Parliament, 1999). While it is not proven that Most people now recognise that smoking is the
milk produced using rBST increases IGF-1 levels and biggest single preventable risk factor for cancer.
the risk of cancer in humans, you can avoid these Lung cancer is the UK’s biggest cancer killer, causing
potential risks by avoiding all dairy products. one in four of all deaths from cancer. Nearly 35,000

31
 White Lies

people die from lung cancer in the UK every year specified the beneficial effects of fibre, fruits,
(NHS Choices, 2013a). Smoking also increases the vegetables, beans, peas and pulses (including soya
risk of many other types of cancer, including cancers foods) and whole grains Their recommendation was
of the: mouth, pharynx (behind the nose), larynx as follows: To reduce your cancer risk, eat no more
(voice box), oesophagus, stomach, pancreas, liver, than 500 grams (cooked weight) per week of red
cervix, kidney and bladder. Stopping smoking, even meat, like beef, pork and lamb, and avoid processed
when middle-aged, can dramatically reduce the risk meats such as ham, bacon, salami, hot dogs and
of developing cancer. some sausages. This was headline news; telling
people to avoid all processed meats. The link
However, it is less well known that a poor diet is the between red and processed meat and cancer was
second largest preventable risk factor for cancer, further supported by a large scale study of over half
coming close behind smoking. Research shows that a million people aged 50 to 71 years who were
nutrition plays a major role in cancer (Donaldson, followed for 10 years (Sinha et al., 2009). They too
2004). Indeed a poor diet may be responsible for up found that red and processed meat intakes were
to a third of all cancer deaths. Evidence from associated with an increased risk of death from
migration studies from the 1980’s shows that plant- cancer (as well as cardiovascular disease).
based diets can protect against cancer, while typical
Western diets, rich in animal foods, sugar and highly The European Prospective Investigation into Cancer
processed food products, can increase the risk. and Nutrition (EPIC) study is a Europe-wide prospective
Indeed, a significant body of evidence now shows cohort study of the relationships between diet and
that a plant-based diet, containing less saturated cancer. With over half a million participants, it is the
animal fats, cholesterol, animal protein, sugar, salt largest study of diet and disease to be undertaken.
and processed foods can lower the risk of some EPIC is coordinated by the International Agency for
cancers and that a diet rich in saturated animal fats, Research on Cancer (IARC), part of the World Health
cholesterol, animal protein, sugar, salt and processed Organization (WHO). 521,457 healthy adults (mostly
foods can increase the risk of certain cancers. Diet aged 35-70), were recruited from 23 centres in 10
has now been linked to numerous types of cancer European countries: Denmark, France, Germany,
including cancer of the: bowel, stomach, breast, Greece, Italy, The Netherlands, Norway, Spain, Sweden
lung, prostate, pancreas, oesophagus and bladder and the UK. One UK centre (Oxford) recruited 27,000
(Cancer Research UK, 2011). vegetarians and vegans; this subgroup forms the
largest study of this dietary group.
The link between red and processed meat and
cancer is now well-established. In 2007, a review by Strong evidence that vegetarian diets are associated
a team of experts convened by the World Cancer with reduced cancer risk was provided by a recent
Research Fund (WCRF) and the American Institute for large scale study from the Oxford Vegetarian Study
Cancer Research (AICR) concluded that red and and the EPIC-Oxford group. Prospective studies follow
processed meats increase the risk of some cancers groups of people over time. Generally these people
and that diets rich in plant foods decrease the risk of are alike in many but not all ways (for example, young
many types of cancer (WCRF/AICR, 2007). They women who smoke and young women who do not).

32
 A report

The prospective cohort study will then look for a link (coupled to the ‘health conscious’ character of the
between their behaviour and a particular outcome meat-eaters in the EPIC group) may account for why
(such as lung cancer). In this study, 61,566 British a review of five prospective studies showed no large
adults were separated into three diet groups: meat- differences in cancer mortality between vegetarians
eaters (32,403), fish-eaters (8,562) and vegetarians and non-vegetarians (Key et al., 1999). In another
(20,601). After 12 years, 3,350 had been diagnosed example from the EPIC group, they found that British
with cancer (2,204 meat-eaters, 317 fish-eaters and vegetarians had a similar risk of colorectal cancer as
829 vegetarians). Total cancer incidence was non-vegetarians (Fraser et al., 2009). Whereas other
significantly lower among both fish-eaters and studies provide convincing evidence that plant-based
vegetarians (18 and 12 per cent lower respectively) diets are protective against colorectal cancer
than among meat-eaters. Interestingly, there were (WCRF/AICR, 2007). It is likely that using ‘vegetarian’
vegans in this cohort, but there were too few to be as a single dietary label in research is probably
informative (Key et al., 2009). However, in a follow-on inadequate and this group needs to be divided into
study, they determined a significant statistic for the more descriptive subtypes to include vegans.
vegan group; total cancer incidence was again lower However, taken together, the evidence suggests that
in fish-eaters and vegetarians (12 and 11 per cent vegetarian diets are a useful strategy for reducing
respectively) but was 19 per cent lower in vegans cancer risk (Lanou and Svenson, 2010).
compared with meat-eaters (Key et al., 2014).
It has been suggested that animal protein increases
Another large scale study (over 500,000 participants) the risk of cancer. In Professor T. Colin Campbell’s
from the EPIC group found that increasing the intake extensive China Study (one of the largest studies in
of fruit and vegetables by 200 grams per day the world on the effects of diet on health) a startling
lowered the risk of cancer (albeit by a few per cent). observation was made. Based on previous work and
The authors cautioned against over interpreting his own studies, Campbell saw a direct link between
these results when making dietary recommendations dietary protein intake and cancer; the more protein
for cancer risk reduction because the magnitude of in the diet, the higher the risk of certain cancers,
the effect was relatively small (Boffetta et al., 2010). such as liver cancer. But this was not all protein, just
Both the vegetarian and non-vegetarian people in animal protein. Campbell decided to look at the
the EPIC-Oxford Study were shown to have overall relationships between animal protein intake and the
lower cancer rates than the general population of incidence of cancer in different cultures.
the UK. It was noted that the meat intake of the
meat-eaters group was lower than intakes reported Colorectal cancer is the fourth most common cancer
in the National Diet and Nutrition Survey for the UK in the world; it is the second most common in the US.
(Key et al., 2009a). It seems likely that the meat- Campbell noted that while North America, Europe,
eaters in this health conscious study group are not Australia and wealthier Asian countries (such as Japan
typical of the wider meat-eating population. If you and Singapore) had relatively high rates of colorectal
compared cancer rates between the average UK cancer, Africa, Asia and most of Central and South
meat-eater with vegetarians and vegans, the America had much lower rates. For example,
difference between the two may be even greater. Campbell noted that the Czech Republic had a death
rate of 34.19 per 100,000 males, while in Bangladesh
The extent to which a vegetarian diet lowers the risk the figure was just 0.63 per 100,000 males (Campbell
of cancer depends largely on what is in the diet. The and Campbell, 2005). Campbell is not alone in
diets of some Western vegetarians may have a revealing the enormous differences in the incidences
similar macronutrient and micronutrient profile to of certain cancers between countries. The
that of a typical Western style diet. In other words, a International Agency for Research on Cancer (IARC)
vegetarian junk food diet! A wide variation exists in provides startling figures comparing the incidence of
what Western vegetarians eat. The diet may include breast cancer and prostate cancer in England and
very large or very small amounts of: whole grain Wales to that in rural China. In 1997, in England and
foods, raw foods, highly processed foods, sugary Wales, the IARC reported the incidence rate of breast
sweet foods, fatty foods and crucially may vary cancer in women was 68.8 per 100,000 compared to
widely with respect to eggs, cheese, cream, butter just 11.2 per 100,000 in rural China. Similarly the
and other dairy products. This may go some way to incidence of prostate cancer in men in England and
explain why there are discrepancies in the results of Wales was 28.0 per 100,000 compared to just 0.5 per
some studies looking at cancer and diet. This 100,000 in rural China (IARC, 1997).

33
 White Lies

Figure 4.0 A comparison of animal proteins contain less of the essential amino acids
protein intake in the US, UK and rural methionine and lysine than animal protein and more
China. of the non-essential amino acids arginine, glycine,
alanine and serine. It has been suggested that
100
consuming mostly a plant-based diet has a knock-on
90
effect of limiting the biological activity of certain
Plant protein
chemical substances involved in cancer development
Percentage of total protein

80
Animal protein
70 and that a sufficient consumption of plant proteins
60 has a protective role against cancer (Krajcovicova-
50 Kudlackova, 2005). So a vegetarian diet is a healthier
40 option, not just because it excludes meat and other
30 animal foods but because of the range of beneficial,
20 protective factors present. Vegetarian diets contain
10 less saturated fats and more of the good fats (omega-
0 3 and omega-6 unsaturated fatty acids), more
US UK Rural China complex carbohydrates, more fibre and more
vitamins, minerals and antioxidants. These factors help
Source: Campbell and Campbell, 2005; Henderson et al., 2003. to explain the reduced risk of cancer in vegetarians.

It is widely acknowledged that the incidence of certain Increasing your fruit and vegetable consumption is
cancers is much greater in some countries than considered the second most effective strategy to reduce
others, what intrigued Campbell was the relationship the risk of cancer (after stopping smoking). Indeed, one
between these cancers and dietary animal protein. of the most important messages of modern nutrition
Figure 4.0 shows the differences in animal protein research is that a diet rich in fruits and vegetables
intake between the US, the UK and rural China. In the protects not only against cancer, but against many
US, over 15 per cent of total energy intake comes other diseases too including heart disease and diabetes
from protein of which 70 per cent is animal protein (Donaldson, 2004). In 2003 the UK Department of
(Campbell and Campbell, 2005). In the UK, over 16 Health launched its 5-a-day campaign, encouraging
per cent of food energy comes from protein, and of people to eat more fruit and vegetables. The campaign
this, 62 per cent comes from animal foods (Henderson is based on advice from the World Health Organization,
et al., 2003). While in rural China, the figures are which recommends eating a minimum of 400g of fruit
quite different; nine to 10 per cent of total energy and vegetables a day to lower the risk of serious health
comes from protein and only 10 per cent of that is problems, such as heart disease, stroke, type 2 diabetes
from animal protein (Campbell and Campbell, 2005). and obesity. In 2012 the National Diet and Nutrition
Survey showed that despite the campaign, adults are
It could be argued that the difference in cancer still only eating four portions a day and children are
incidence between cultures reflects genetic differences eating just three or less.
between ethnic groups rather than environmental
(dietary) effects. However, as stated above, migrant Further to this, there is an increasing body of
studies have shown that as people move from a low- evidence linking the consumption of cow’s milk to
cancer risk area to a high-cancer risk area, they assume certain cancers. One of the reasons for this may be
an increased risk within two generations (WCRF/AICR, the increasing levels of hormones and other
1997). Therefore these vast differences in cancer rates bioactive compounds present in the milk that result
must be largely attributable to environmental factors from intensive farming practices (taking milk from
such as diet and lifestyle. Campbell concluded that pregnant cows). In other words, in an effort to
animal-based foods are linked to an increased cancer increase milk production, the dairy industry has
risk whereas a whole grain plant-based diet including intensified farming techniques to such a high level
fibre and antioxidants is linked to lower rates of cancer that between 75 per cent and 90 per cent of
(Campbell and Campbell, 2005). One possible marketed milk and milk products are derived from
mechanism for this may be the different composition pregnant cows (Danby, 2005). (See The undesirable
of animal and plant proteins. components of milk and dairy products).

Plant proteins contain a different balance of amino There are a number of other important factors that
acids than animal proteins. More specifically, plant can contribute to the development of cancer, including

34
 A report

obesity (breast and endometrial cancer), alcohol woman's risk of breast cancer, they are called TP53
(mouth, throat, liver and breast cancer), sunlight (skin and PTEN. Researchers have found other genes that
cancer), radon (lung cancer) and physical activity can can slightly increase a woman's risk of developing
protect against some cancers (colorectal). breast cancer, they include: CASP8, FGFR2, TNRCP,
MAP3K1, rs4973768, LSP1 and some rare genes that
There are more than 200 different types of cancer, but can also increase breast cancer risk slightly include:
just four of them (breast, lung, colorectal and CHEK2, ATM (ataxia telangiectasia mutated), BRIP1
prostate) account for over half (54 per cent) of all new and PALB2 (MacMillan Cancer Support, 2011).
cases (Cancer Research UK, 2012). The role of cow’s
milk and dairy products in breast, colorectal, ovarian These discoveries linking genetics to cancer has given
and prostate cancer is discussed in more detail. rise to a certain degree of genetic fatalism. However,
as stated current estimates are that only around five
Breast cancer to ten per cent of breast cancers are due to
Breast cancer is the most common cancer in the UK. abnormal genes. This means that the vast majority of
When this report was first published in 2006, the cancers (90-95 per cent) are not caused by abnormal
lifetime risk of being diagnosed with breast cancer genes. Secondly, it is important to remember that
was one in nine for UK women. In 2014, the figure is having an abnormal gene does not mean that a
one in eight. That means one in every eight women person will definitely develop breast cancer, but does
in the UK will develop breast cancer at some point in mean they are considerably more at risk of
their lives. In the UK in 2010 more than 49,500 developing the condition than someone who does
women and around 400 men were diagnosed with not have one of the abnormal genes.
breast cancer, that’s around 136 women per day and
at least one man per day. Female breast cancer Lifestyle and environmental factors that can increase
incidence rates in Britain have increased by almost breast cancer risk include: age (the risk increases
70 per cent since the mid-1970s. Just in the last ten significantly as you get older), alcohol, obesity, early
years they have gone up by six per cent. puberty, late menopause (women who have
undergone the menopause have a lower risk of
Figure 5.0 shows that while the incidence of breast breast cancer than premenopausal women of the
cancer has risen sharply,
mortality from breast cancer
has fallen (albeit relatively Figure 5.0 Incidence of and mortality from breast cancer in
modestly) over the same England and Wales between 1971 and 2009.
period thanks largely to
140.0
improved diagnostic methods
and more efficient treatment.
120.0

Much has been made of the

Rate per 100.000

100.0
link between genes and
breast cancer. However, only Incidence
80.0
five to ten per cent of all Mortality
breast cancers are thought to
60.0
be linked to an inherited
breast cancer gene. The
40.0
genes BRCA1 and BRCA2
have received the most
20.0
attention since they were first
discovered in 1994 and 1995
0.0
respectively. Between 45 and
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009

90 out of every 100 women

carrying BRCA genes will get
breast cancer at some point Year
in their lives. We now know
of other genes that Source: National Statistics, 2010.
significantly increase a

35
 White Lies

same age), late age at first childbirth, hormone

replacement therapy (HRT) and the contraceptive pill.
Factors that may decrease the risk include: younger
age at first pregnancy (the younger the woman is
when she begins childbearing, the lower her risk of
breast cancer), breastfeeding, late puberty, early
menopause and physical activity. The contribution of
various environmental and lifestyle factors (excluding
reproductive factors) to breast cancer risk has was
calculated by a group from Harvard School of Public
Health (Danaei et al., 2005). They conclude that 21
per cent of all breast cancer deaths worldwide are
attributable to alcohol use, being overweight or
obese and physical inactivity. This proportion is even
higher (27 per cent) in high-income countries. That’s
nearly a third of all breast cancer cases being
attributed to avoidable risk factors.

Breast cancer incidence rates vary greatly worldwide,

with age standardised rates as high as 99.4 per
100,000 in North America. Eastern Europe, South
America, Southern Africa and Western Asia have
moderate incidence rates, but these are increasing.
The lowest rates are found in most African countries
but here breast cancer incidence rates are also
increasing (WHO, 2013a). Migration studies show us
that this variation is not due to genetic factors and
that environmental and lifestyle factors must be
involved. Because of this, an increasing amount of likely to be vegetarian and therefore had more fibre
attention has focused on the links between diet and in their diet due to their higher intake of fruit and
breast cancer, particularly the relationship between vegetables (McCormack et al., 2004). More recently,
the consumption of cow’s milk and dairy products a prospective cohort study looked at the associations
and breast cancer. between plant foods, fibre and risk of breast cancer
in 11,726 postmenopausal women in the Malmö
Studying cancer incidence among particular groups Diet and Cancer cohort in Sweden among whom
of people can provide useful insights into the links 342 incident cases of breast cancer were recorded.
between diet and disease. Researchers from the They found that a dietary pattern characterised by
London School of Hygiene and Tropical Medicine high fibre and low fat intakes was associated with a
recently reported breast cancer incidence is lower risk of postmenopausal breast cancer
substantially lower, and survival rates higher, in South (Mattisson et al., 2009). There are several
Asians living in the UK than other women (Farooq mechanisms by which fibre in the diet might
and Coleman, 2005). No data on diet was collected influence breast cancer risk. One possible mechanism
but the authors of this study suggested that is through an effect on hormones: increasing the
differences in diet and lifestyle could explain the amount of fibre in the diet may reduce breast cancer
different rates observed. Earlier research published in risk by altering the levels of female hormones
the British Journal of Cancer also showed that South (oestrogens) circulating in the blood (Gerber, 1998).
Asian women living in the UK are less likely to be
diagnosed with breast cancer than other women, A number of studies show that women with breast
but found that the risk varied according to their cancer tend to have higher levels of circulating
specific ethnic subgroup. This research showed that oestrogens. A recent review of 13 studies concluded
Muslim women from India and Pakistan are almost that circulating sex hormone concentrations in
twice as likely to develop breast cancer as Gujarati postmenopausal women are strongly associated with
Hindu women. This study did examine the diet and several established or suspected risk factors for
found that the Gujarati Hindu women were more breast cancer and may mediate the effects of these

36
 A report

factors on breast cancer risk (Key et al., 2011). In dietary patterns in a large French cohort study. The
other words, some environmental or lifestyle factors ‘alcohol/Western’ diet included processed meat and
(for example, obesity or alcohol consumption) may meat products, ham, offal, French fries, appetisers,
increase the levels of hormones circulating in the sandwiches, rice/pasta, potatoes, pulses, pizza/pies,
body and this may lead to breast cancer in some canned fish, eggs, crustaceans, alcoholic beverages,
people. cakes, mayonnaise, butter and cream and the
‘healthy Mediterranean’ diet was made up of a high
A prospective study conducted on the island of intake of vegetables and fruits, fish and crustaceans,
Guernsey examined serum levels of the oestrogen olives and sunflower oil. Results showed those eating
hormone oestradiol in samples taken from 61 the Western diet had a 20 per cent increased risk of
postmenopausal women who developed breast breast cancer while those consuming the
cancer an average of 7.8 years after blood collection. Mediterranean diet had a 15 per cent lower risk
Compared to 179 age-matched controls, oestradiol (Cottet et al., 2009).
levels were 29 per cent higher in women who later
developed breast cancer (Thomas et al., 1997). Identifying the type of diet that can increase or
Another prospective study (this time from the US), reduce the risk of cancer is just part of the puzzle.
compared oestrogen levels in 156 postmenopausal Identifying which components of that diet are
women who developed breast cancer, after blood responsible is another matter of considerable
collection, with two age-matched controls for each complexity. While some research has identified
cancer patient. Results showed increased levels of dietary factors that reduce the risk of breast cancer,
the hormones oestradiol, oestrone, oestrone such as fibre, other studies have attempted to
sulphate and dehydroepiandrosterone sulphate in identify dietary factors that increase the risk, such as
women who subsequently developed breast cancer dietary fat. Case-control studies use a group of
thus providing strong evidence for a causal people with a particular characteristic (for example
relationship between postmenopausal oestrogen older women with lung cancer). This particular group
levels and the risk of breast cancer (Hankinson et al., is selected and information collected (for example,
1998). A review of studies carried out over a 10 year history of smoking), then a control group is selected
period in the Department of Clinical Chemistry at the from a similar population (older women without lung
University of Helsinki in Finland suggested that the cancer) to see if they smoked or not, then a
Western diet (characterised by milk and meat conclusion is drawn (smoking does or does not
products) increases levels of these types of hormones increase risk of lung cancer). A combined analysis of
and concluded that the hormone pattern found in 12 case-control studies designed to examine diet and
connection with a Western-type diet is prevailing in breast cancer risk found a positive association
breast cancer patients (Adlercreutz, 1990). between fat intake and this disease. The reviewers
estimated that the percentage of breast cancers that
Researchers at the Department of Preventive might be prevented by dietary modification in the
Medicine at the University of Southern California North American population was 24 per cent for
Medical School in Los Angeles published a review of postmenopausal women and 16 per cent for
13 dietary fat intervention studies that were premenopausal women (Howe et al., 1990). This is a
conducted to investigate the effect of fat intake on significant number of cancers that could be
oestrogen levels. The results showed decreasing prevented simply by changing the diet.
dietary fat intake (to between 10 and 25 per cent of
the total energy intake) reduced serum oestradiol In a prospective cohort study involving over 90,000
levels by between 2.7 and 10.3 per cent. It was premenopausal women, researchers from Harvard
concluded that dietary fat reduction can result in a Medical School also found that animal fat intake was
lowering of serum oestradiol levels and that such a associated with an elevated risk of breast cancer. Red
dietary modification may offer an approach to breast meat and high-fat dairy foods such as whole milk,
cancer prevention (Wu et al., 1999). As stated, cow’s cream, ice-cream, butter, cream cheese and cheese
milk and dairy products are a major source of dietary were the major contributors of animal fat in this
saturated fat. cohort of relatively young women. Interestingly, this
research did not find any clear association between
These early reports are supported by more recent vegetable fat and breast cancer risk; the increased
research that examined postmenopausal breast risk was only associated with animal fat intake. It has
cancer risk in women consuming two different been suggested that a high-fat diet increases the risk

37
 White Lies

of breast cancer by elevating concentrations of precursor) content of milk varies widely. It is the high
oestrogen. However, the author of this study, Dr levels of hormones in milk that have been linked to
Eunyoung Cho, suggests that if this were true a diet the development of hormone-dependent cancers
high in animal fat and a diet high in vegetable fat such as ovarian and breast cancer.
should both lead to higher rates of cancer, and that
was not the case in this study. Cho suspects that In a review of the relationship between breast cancer
some other component such as the hormones in incidence and food intake among the populations of
cow’s milk might play a role in increasing the risk of 40 different countries, a positive correlation was
breast cancer (Cho et al., 2003). A subsequent meta- seen between the consumption of meat, milk and
analysis of all papers published up to July 2003 that cheese and the incidence of breast (and ovarian)
examined the association of dietary fat with risk of cancer. Meat was most closely correlated with breast
breast cancer also found a positive association cancer incidence, followed by cow’s milk and cheese.
between higher intakes of fat and an increased risk By contrast, cereals and pulses were negatively
of breast cancer (Boyd et al., 2003). correlated with the incidence of breast cancer. This
review concluded that the increased consumption of
However, other studies of fat intake and the animal foods may have adverse effects on the
incidence of breast cancer have yielded conflicting development of hormone-dependent cancers.
results. The discrepancy in results may reflect the Among dietary risk factors of particular concern
difficulties of accurately recording fat intake. Dr were milk and dairy products, because so much of
Sheila Bingham of the Dunn Human Nutrition Unit in the milk we drink today is taken from pregnant
Cambridge developed a data-collection method to cows, in which oestrogen and progesterone levels
overcome these problems. Bingham used food are markedly elevated (Ganmaa and Sato, 2005).
frequency questionnaire methods with a detailed Commercial milk products have been shown to
seven-day food diary in over 13,000 women contain considerable levels of oestrogen metabolites
between 1993 and 1997. The study concluded that (Farlow et al., 2009). This raises concerns that the
those who ate the most animal saturated fat (found high levels of oestrogen metabolites and other
mainly in whole milk, butter, meat, cakes and bioactive molecules in milk may influence cancer risk.
biscuits) were almost twice as likely to develop breast
cancer as those who ate the least. It was also In a review of the evidence linking dairy
concluded that previous studies may have failed to consumption to breast cancer risk, researchers from
establish this link because of imprecise methods Princeton University in New Jersey concluded that
(Bingham et al., 2003). That said, a recent study milk may promote breast cancer by the action of the
using data from four prospective cohort studies in growth factor IGF-1, which has been shown to
the United Kingdom (EPIC-Norfolk , EPIC-Oxford, the stimulate the growth of human breast cancer cells in
UKWCS and Whitehall II study) found no association the laboratory (Outwater et al., 1997). In another
between dietary fat and breast cancer (Key et al., review, examining the role of IGF-1 in cancer
2011a). These researchers were aware of the development, Yu and Rohan state that IGFs play a
methodology problems identified by Bingham and critical role in regulating cell growth and death. This
could not identify any reason why their results were function has led to speculation about their
different from those of Bingham’s group. More involvement in cancer development. Laboratory
research is needed to clarify the role of total fat and experiments demonstrate the ability of IGFs to
saturated fat in breast cancer. stimulate growth of a wide range of cancer cells and
to suppress cell death or apoptosis (Yu and Rohan,
Some research groups are more interested in the 2000). The concern here is that if IGF-1 can cause
endogenous hormonal content of milk (hormones human cancer cells to grow in a Petri dish in the
produced by the cow and excreted in the milk), laboratory, they might have a cancer-inducing effect
which has not been widely discussed. The milk when consumed in the diet. Furthermore, cow’s milk
produced now is very different from that produced is known to increase IGF-1 levels in the blood by
100 years ago; modern dairy cows are impregnated driving up IGF-1 production by the liver.
while still producing milk (Webster, 2005). Two-
thirds of milk in the UK is taken from pregnant IGF-1 is present in all milk and is not destroyed
cows with the remainder coming from cows that during pasteurisation. Dr J.L. Outwater of the
have recently given birth. This means that the Physicians Committee For Responsible Medicine
hormone (oestrogen, progesterone and androgen (PCRM) in Washington, DC, warns that IGF-1 may be

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absorbed across the gut and cautions that regular researching breast cancer in other cultures and found
milk ingestion after weaning may produce enough a much lower incidence in China. The data showed
IGF-1 in mammary tissue to encourage cell division that in rural China breast cancer affects just one in
thus increasing the risk of cancer (Outwater et al., 10,000 women compared to one in 10 British
1997). However, other scientists contest this view women (now one in eight). However, Plant observed
and say that IGF-1 could not cross the gut wall at that among wealthy Chinese women with a more
sufficient levels to alter systemic levels already Western lifestyle (for example in Malaysia and
circulating but do say that there are many small Singapore), the rate of breast cancer is similar to that
peptides and amino acids that are present in milk in the West. Furthermore, epidemiological evidence
that potently stimulate hepatic IGF-1 expression and shows that when Chinese women move to the West,
pituitary growth hormone release (Holly, 2013). In within one or two generations their rates of breast
either scenario, the net effect is the same; cow’s milk cancer incidence and mortality increase to match
consumption raises IGF-1 levels in humans and those of their host country. This suggested that diet
higher IGF-1 levels are linked to cancers of the colon, and lifestyle (rather than genetics) must be a major
prostate and breast. determinant of cancer risk.

In her book Your Life in Your Hands, Professor Jane Plant decided to investigate the role of diet in breast
Plant CBE, the chief scientist of the British Geological cancer risk. She examined the results of the China-
Survey, describes a very personal and moving story of Cornell-Oxford project on nutrition, environment and
how she overcame breast cancer by excluding all health (Campbell and Junshi, 1994). This project was
dairy products from her diet (Plant, 2007). Plant was based on national surveys conducted between 1983
diagnosed with breast cancer in 1987. She had five and 1984 in China. The project was a collaboration
recurrences of the disease and by 1993 the cancer between T. Colin Campbell at Cornell University in
had spread to her lymphatic system. She could feel the US, Chen Junshi from the Chinese Academy of
the lump on her neck, and was told that she had just Preventative Medicine, in Beijing, China, Li Junyao at
three months to live, six if she was lucky. However, the Chinese Academy of Medical Sciences, Beijing,
Plant was determined to use her scientific training to and Richard Peto from Oxford University in the UK.
find a solution to this ‘problem’. She began The project revealed some surprising insights into

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 White Lies

diet and health. For example, it showed that people specialist that it was the change in diet that saved
in China tend to consume more calories per day that her life, he now refers to cancer mortality maps in his
people in the US, but only 14 per cent of these lectures and recommends a dairy-free diet to his
calories come from fat compared to a massive 36 per breast cancer patients.
cent in the West. This coupled to the fact that
Chinese people tend to be more physically active Plant eventually defeated cancer by eliminating dairy
than people in the West, is why obesity affects far products from her diet, replacing them with healthy
more people in the West than in China. However, alternatives and making some lifestyle changes. At
Plant’s diet had not been particularly high in fat; the time of writing (2007) Plant had been cancer-free
indeed she describes it as very low in fat and high in for 14 years and now advises that if you do only one
fibre. Then Plant had a revelation: the Chinese don’t thing to cut your risk of breast cancer, make the
eat dairy produce. Plant had been eating yogurt and change from dairy to soya (Plant, 2007).
skimmed organic milk up until this time, but within
days of ceasing all dairy, the lump on her neck began A meta-analysis of the effects of soya on breast
to shrink. The tumour decreased and eventually cancer found a mildly protective rather than
disappeared, leading her to the conviction that there deleterious effect in premenopausal women (Trock et
is a causal link between the consumption of dairy al., 2006) and more recently a paper from the
products and breast cancer. Although Plant received Shanghai Breast Cancer study also indicated
chemotherapy during this time, it did not appear to somewhat better outcomes related to soya
be working and so convinced was her cancer consumption in woman with established breast
cancer Shu et al., 2009). Providing breast cancer
patients with sound dietary advice could greatly
increase survival rates. Taken together, these
observations show that a dairy-free plant-based diet
can reduce many of the risk factors associated with
breast cancer and may help those who have been
diagnosed with the disease.

Colorectal (bowel) cancer

Colorectal cancer is the second most common
cancer in England and the third most common cause
of cancer death (after lung and prostate cancer in
men, and lung and breast cancer in women).
Between 1971 and 2009 the incidence of colorectal
cancer increased by 33 per cent for men and 14 per
cent for women. In 2009 there were 18,538 new
cases for men and 15,066 for women. While the
incidence of colorectal cancer has increased,
mortality rates have halved for women between
1971 and 2010 and have decreased by 38 per cent
for men during this time. In 2010, there were 15,708
deaths from bowel cancer in the UK: 8,574 (55 per
cent) in men and 7,134 (45 per cent) in women
(Office for National Statistics, 2012). Colorectal
cancer occurs when the process of cell renewal in
the bowel goes wrong. Abnormal cells can
form polyps (small growths) which may
develop into cancer. Risk factors for
colorectal cancer include obesity,
alcohol, smoking and poor diet.

A large body of evidence suggests

a diet high in red and processed
meat (such as smoked meat, ham,

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bacon, sausages, pâté and tinned meat) can increase evidence that a diet high in fibre and low in saturated
the risk of colorectal cancer. In 2005, a large fat can help reduce the risk (NHS Choices, 2012e).
prospective study from the EPIC group investigated Several mechanisms by which fibre may offer a
the role of diet in colorectal cancer. They followed protective effect have been suggested: the formation
478,040 men and women from 10 European of short-chain fatty acids from fermentation by
countries between 1992 and 1998. Information on colonic bacteria; the reduction of secondary bile acid
diet and lifestyle was collected and after nearly five production; the reduction in intestinal transit time
years, 1,329 cases of colorectal cancer were recorded. and increase of faecal bulk; and a reduction in insulin
Results showed that colorectal cancer risk is linked to resistance (Murphy et al., 2012).
a high consumption of red and processed meat (Norat
et al., 2005). Several mechanisms by which red and The protective role of a whole grain plant-based diet
processed meat may cause colorectal cancer have containing plenty of fruit and vegetables (and
been suggested. The type of iron (haem iron) found in therefore fibre) is well-documented. Two large-scale
meat, but not plant foods, may cause changes in cells studies (both published in the Lancet) examined the
that lead to cancer (Tapel et al., 2007). Other relationship between diet and colorectal cancer; both
compounds found in red and processed meats called confirmed that as dietary fibre intake increases, the
N-nitroso compounds, heterocyclic amines and risk of colorectal cancer decreases. In the first of
polycyclic aromatic hydrocarbons may be responsible these two studies, a research team from the National
for the link with cancer (Lewin et al., 2006; Cross et Cancer Institute in the US compared fibre intake of
al., 2007; Genkinger and Koushik, 2007). 3,591 people with at least one bowel adenoma or
polyp (a benign growth that may or may not
In November 2007, The World Cancer Research Fund transform to cancer), with that of 33,971 people
launched the report Food, Nutrition, Physical Activity, without polyps. They found that the participants in
and the Prevention of Cancer: a Global Perspective. It the top 20 per cent for dietary fibre intake had 27
was the most comprehensive report to date ever per cent lower risk of adenoma than people in the
published on the link between cancer and lifestyle lowest 20 per cent (representing a difference in fibre
(WCRF/AICR, 2007). Their recommendation to eat intake of 24 grams per day). It was concluded that
less red meat (such as beef, pork and lamb) and dietary fibre, particularly from grains, cereals and
avoid processed meat became headline news on a fruits, was associated with a decreased risk of
global scale. In more detail, they said: To reduce your colorectal adenoma (Peters et al., 2003). In the
cancer risk, eat no more than 500 grams (cooked second study, (the largest prospective study published
weight) per week of red meat, like beef, pork and at that time on fibre in colorectal cancer prevention)
lamb, and avoid processed meats such as ham, researchers from the EPIC group prospectively
bacon, salami, hot dogs and some sausages. The examined the association between dietary fibre
report warned that eating 150 grams of processed intake and incidence of colorectal cancer in 519,978
meat a day (the equivalent of two sausages and individuals aged between 25 and 70 years-old,
three rashers of bacon) increases bowel cancer risk recruited from 10 different European countries.
by 63 per cent and that 50 grams a day (one Participants completed a dietary questionnaire
sausage) increases the risk by about 20 per cent. The between 1992 and 1998 and were followed up for
evidence that processed meat is a cause of bowel cancer incidence on average 4.5 years later. From this
cancer is so strong that the WCRF recommends that group, 1,065 cases of colorectal cancer were
people should avoid eating it altogether. However, reported. Again, people with the highest fibre intake
less than a third of people in Britain are aware that (35 grams per day) had a 40 per cent lower risk of
eating processed meat such as bacon and ham colorectal cancer compared to those with the lowest
increases risk of cancer (WCRF, 2009). 10 per cent of intake (15 grams per day). They concluded that in
bowel cancers cases in the UK could be prevented populations with low average intake of dietary fibre,
through reducing the amount of processed meat we an approximate doubling of total fibre intake from
eat. The Department of Health advises people who foods could reduce the risk of colorectal cancer by 40
eat more than 90 grams (cooked weight) of red and per cent (Bingham et al., 2003a). These studies
processed meat per day to cut down on their intake provide convincing evidence that increasing the
(NHS Choices, 2012e). amount of whole grains and fruit and vegetables in
the diet reduces the risk of colorectal cancer. A
While red and processed meat is linked to an further EPIC report, in which an even larger number
increased risk of colorectal cancer, there is good of cases (1,721 cases) were included, confirmed the

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original results showing an even stronger protective National Institutes of Health (NIH)-AARP (formerly
association between fibre intake in food and risk of known as the American Association of Retired
colorectal cancer (Bingham et al., 2005). In the most Persons) Diet and Health Study found that during an
recent EPIC study, 4,517 colorectal cancer cases were average of seven years of follow-up, dairy food and
documented amongst the 477,312 participants calcium intakes were inversely associated with
(Murphy et al., 2012). After 11 years of follow-up, cancers of the digestive system. A decreased risk was
this analysis of EPIC data also confirmed the particularly pronounced in colorectal cancer.
protective role of dietary fibre in colorectal cancer. Interestingly in this study, supplemental calcium
intake was also inversely associated with colorectal
Not all studies report a positive effect of fibre; some cancer risk. They concluded that calcium intake is
have found that fibre has little or no effect on associated with a lower risk of total cancer and
colorectal cancer risk (Pietinen et al., 1999; Fuchs, et cancers of the digestive system, especially colorectal
al., 1999; Terry et al., 2001). It should be noted that cancer (Park et al., 2009). A meta-analysis of 60
these studies only looked at populations from single epidemiological studies including 26,335 colorectal
countries and may have looked at ranges of fibre cases also found that the risk reduction associated
that were too low. For example, Americans eat very with calcium was similar for dietary and
little fibre on average. So a large study that focused supplemental sources (Huncharek et al., 2009). So in
on Americans would not be able to see the benefits these studies, it would appear to be the calcium
of the high levels of fibre that, for example, an Italian rather than some unidentified component of dairy
person would eat (Cancer Research UK, 2009). Taken that lowered the risk.
together, the WCRF and EPIC research (which looks
at multiple countries) and numerous other studies However, the EPIC group found that their inverse
(Jacobs et al., 1998; Peters et al., 2003; Nomura et associations were limited to dairy sources of calcium.
al., 2007; Wakai et al., 2007) confirm the protective They investigated intakes of milk (whole-fat, semi-
role of dietary fibre intake in colorectal cancer. These skimmed and skimmed), yoghurt, cheese and dietary
results strengthen the evidence for the calcium with colorectal cancer risk amongst 477,122
recommendation of increasing the consumption of men and women. During 11 years of follow-up, 4,513
fibre rich foods for colorectal cancer prevention. incident cases of colorectal cancer occurred. Results
showed that higher intakes of all dairy products and
Studies looking at the links between dairy foods and dietary calcium (from dairy sources only) were
colorectal cancer have produced mixed results. Some associated with a modest (seven per cent) reduction in
prospective studies have reported a lower colorectal colorectal cancer risk (Murphy et al., 2013). They
cancer risk associated with dairy products and suggest that a possible explanation for the lack of a
calcium. In 2004, a pooled analysis of 10 cohort protective effect of non-dairy calcium could be that
studies from North America and Europe concluded plant sources of calcium (the main contributors to non-
that the consumption of dairy milk (but not other dairy calcium intake amongst EPIC participants)
dairy foods) and calcium were related to a lower risk contain oxalate and phytate (phytic acid) which inhibit
of colorectal cancer (Cho et al., 2004). The inverse calcium absorption. Furthermore, it should be noted
association between calcium intake and colorectal that dietary calcium has been consistently associated
cancer was only statistically significant among those with an increased risk of prostate cancer risk. Within
with the highest vitamin D intake. This may be either EPIC, a 300 mg per day intake of dietary calcium was
because vitamin D enhances calcium absorption, or previously associated with a nine per cent increased
because vitamin D itself may decrease colorectal risk of prostate cancer (Allen et al., 2008) and the
cancer risk (Garland, 1999). More recently, an WCRF/AICR 2007 report judged it a probable cause of
updated meta-analysis from the WCRF Continuous the disease (WCRF/AICR, 2007). So it would seem
Update Project also found that milk and total dairy clear that recommending dairy to men to lower their
products (but not cheese or other dairy products), risk of colorectal cancer would not be a sensible
are associated with a reduction in colorectal cancer option. Indeed, obtaining a good supply of calcium
risk (Aune et al., 2012). from non-oxalate vegetables and other plant-based
foods (see below) is the healthier option for all people.
The principal anti-carcinogenic component in cow’s
milk and dairy products is believed to be calcium It has been suggested that the high-fat content of
(Murphy et al., 2013). One study looking at dairy some dairy products may negate their protective
foods and calcium intakes in relation to cancer in the effect against certain cancers. However the EPIC

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Calcium-rich foods

Almonds Amaranth grain Asparagus Apricots (dried)

Artichokes Baked beans (haricot) Blackberries Blackstrap molasses

Blackcurrants Bok choy Brazil nuts Bread (wholemeal)

Broccoli Chickpeas Cinnamon Edamame (soya beans)

Fennel Kale Kidney beans Olives

Sesame seeds
Oranges (and other seeds ) Soya milk (fortified) Spring greens

Tofu Swede Walnuts Watercress

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 White Lies

study found no difference in how high or low-fat Ovarian cancer

dairy products affected colorectal cancer risk (Murphy The ovaries are two almond shaped organs located
et al, 2013). Other constituents of dairy products may on either side of the uterus. They produce eggs and
contribute to the protective role observed. For the reproductive hormones (oestrogen and
example lactoferrin, vitamin D in fortified dairy progesterone). Ovarian cancer affects more than
products and certain fatty acids, such as butyric acid, 6,500 women in the UK each year. It is the fifth most
have been linked with having possible beneficial roles common cancer among women after breast cancer,
against colorectal cancer (Murphy et al., 2013). Also bowel cancer, lung cancer and cancer of the uterus
it should be noted that in the EPIC cohort the lowest (NHS Choices, 2012f).
dairy consumers had the highest proportion of
smokers and the highest dairy consumers were more Several possible risk factors for ovarian cancer have
physically active, had lower BMIs, had lower intakes been identified. Most ovarian cancers are due to
of alcohol, higher intakes of fibre and had achieved a gene changes that develop during a woman’s life but
higher level of education. Because we have been led about one in 10 ovarian cancers are caused by an
to believe that milk is a health food, it may be that inherited faulty gene. Faulty inherited genes that
people who use dairy may be doing other 'healthy' increase the risk of ovarian cancer include BRCA1
activities which could be masking the negative effects and BRCA2; these genes also increase the risk of
of their dairy consumption, even making it look breast cancer (Cancer Research UK, 2012a). As with
positively healthy. More work is required to tease out most cancers, the risk of developing ovarian cancer
these complex relationships. increases as you get older. Most cases are in women
who have had their menopause.
As with breast cancer, there are growing concerns
that the consumption of cow’s milk raises levels of Apart from getting older, the risk of ovarian cancer
IGF-1 in the blood (either directly or indirectly) and may be increased by a range of actors including:
higher IGF-1 levels are a risk factor for colorectal
cancer. In fact, circulating IGF-1 levels are not just • A family history of cancer
related to future colorectal cancer risk but may also • Having breast cancer
predict cancer progression (Renehan et al., 2001). In • Being infertile or having fertility treatment
a study of 204 healthy men and women aged 55 to • Using a coil (intra uterine device – IUD)
85 years, three servings of non-fat milk per day over • Using hormone replacement therapy (HRT)
12 weeks increased blood serum levels of IGF-1 by • Being overweight or tall
10 per cent (Heaney, 1999). Because elevated levels • Having endometriosis
of IGF-1 are associated with increased risk of • Using talcum powder
colorectal cancer (Ma et al., 1999; Giovannucci et al., • Smoking
2000; Kaaks et al., 2000), an increase in IGF-1 • Diet factors
attributable to the consumption of milk could
potentially counter any protective effect conferred by Source: Cancer Research UK, 2012a.
dietary calcium (and vitamin D in US fortified milk).
It has been suggested that the milk sugar lactose is a
Taken together, the research suggests that plant foods risk factor for ovarian cancer. A positive relationship
provide a safer and healthier source of calcium than between ovarian cancer and dairy products was first
dairy products. Plant-based sources of calcium, including reported in the Lancet in 1989 when it was
non-oxalate dark green leafy vegetables, dried fruits, suggested that lactose consumption may be a
nuts, seeds and pulses as well as fortified foods such as dietary risk factor for ovarian cancer (Cramer et al.,
calcium-set tofu (soya bean curd) and calcium-enriched 1989). In 2004, data collected from the Harvard
soya milk, provide a safer source of calcium. Vitamin D Nurses’ Health Study was used to assess the lactose,
can be either obtained from the diet or synthesised in milk and milk product consumption in relation to
the skin following exposure to sunlight. ovarian cancer risk in over 80,000 women. Over 16
years of follow-up, 301 cases of one particular type
To lower your risk of colorectal cancer it is important of ovarian cancer were confirmed in this study
to eat a healthy plant-based diet rich in fibre and low group. Results showed that women who consumed
in fat, take regular physical exercise, maintain a the most lactose had twice the risk of this type of
healthy weight and avoid excessive alcohol ovarian cancer than women who drank the least
consumption and avoid smoking. lactose. It was suggested that galactose (a

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component of lactose) may damage ovarian cells between the intake of total dairy foods, low-fat milk
making them more susceptible to cancer (Fairfield et and lactose and the risk of ovarian cancer. In
al., 2004). contrast, the data from the 18 case-control studies
produced mixed results and (except for whole milk,
In the same year, Susanna Larsson and colleagues of which was consistently linked to an increased risk of
the Karolinska Institute in Stockholm, Sweden, ovarian cancer) these studies did not provide
published a study in the American Journal of Clinical evidence of a positive association between dairy
Nutrition that examined the association between food and lactose intake with ovarian cancer (Larsson
intakes of dairy products and lactose and the risk of et al., 2006). The differences between the findings of
ovarian cancer. In this study of 61,084 women aged the cohort and case-control studies might be
38 to 76 years, the diet was assessed over three explained by a number of factors including selection
years and after 13.5 years 266 participants had been bias (choosing individuals that are not representative
diagnosed with ovarian cancer. Results showed that of the norm) or changes in the diet following cancer
women consuming four or more servings of dairy a diagnosis. Alternatively, the differences between the
day had double the risk of ovarian cancer compared findings may be due to the time interval between
to low or non-dairy consumers. Milk was the dairy diet assessment and cancer diagnosis. Cohort studies
product with the strongest positive association with frequently record dietary practices many years before
ovarian cancer. The authors of this study observed a illness occurs, which may make the data more likely
positive association between lactose intake and to be accurate compared to data collected in case-
ovarian cancer risk and concluded that high intakes control studies which tends to be collected at the
of lactose and dairy products, particularly milk, are time of diagnosis.
associated with an increased risk of ovarian cancer
(Larsson et al., 2004). In another study examining the link between diet
and ovarian cancer, ovarian cancer incidence
Larsson subsequently compared two groups of between 1993 and 1997 in different geographical
studies: three prospective cohort studies and 18 locations was coupled to food consumption data
case-control studies. The results of the three from FAOSTAT Database Collections. The food items
prospective cohort studies showed a strong link used for this study were animal fats, meat (beef,

45
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pork, poultry, mutton and goat meat), eggs, butter, Prostate cancer
milk, cereals, pulses, beans, soya beans, peas, fruits, Prostate cancer is the most common cancer in men
vegetables, coffee, tea and alcoholic beverages. in the UK, with over 40,000 new cases diagnosed
Results showed that Iceland had the highest rates of every year (NHS Choices, 2012g). It is the second
ovarian cancer affecting 16.2 women per 100,000, most common cause of cancer death in UK men,
followed by 15.2 in Sweden and 13.7 in the UK. The after lung cancer (Cancer Research UK, 2012b). In
lowest rate per 100,000 was 1.6 for Korea, followed the UK, about one in nine men will get prostate
by 2.1 in Mali and 4.0 in both China and Brazil. cancer at some point in their lives. This lifetime risk
Again, results showed a strong link between dairy includes men who get prostate cancer at any age
foods and cancer: milk was most closely correlated and more than half of all cases are diagnosed in men
with the incidence of ovarian cancer, followed by over 70, prostate cancer is quite rare in men under
animal fats and cheese. Conversely, pulses were 50 (Cancer Research UK, 2012c).
negatively correlated with the incidence of this
cancer (Ganmaa and Sato, 2005). This provides yet Prostate cancer develops from cells within the
more evidence that animal-based foods tend to prostate gland which is the size of a walnut and lies
increase the risk of disease while whole grain plant- directly under the bladder. The prostate produces a
based diets reduce the risk. protein called prostate-specific antigen (PSA) which
turns semen into liquid form. The majority of
While several other studies have shown that dairy prostate cancers are slow growing and it may be
intake increases ovarian cancer risk, other studies some time before any symptoms are noticed, which
have found no evidence of an association. A number can make this disease less treatable. Symptoms
of epidemiological studies have also examined the include: needing to urinate often, especially at night;
influence of specific nutrients from dairy products, difficulty starting to urinate; straining to urinate or
including lactose, calcium and fat in the taking a long time to finish and pain when urinating
development of ovarian cancer. However, results or during sex. Other less common symptoms include:
from these studies are also mixed. In an effort to pain in the lower back and blood in the urine.
resolve this uncertainty, scientists from The Danish
Cancer Society Research Center investigated the Cancer is not usually inherited, but some types
association between intake of specific dairy products (breast, ovarian and prostate cancer) can be
and related nutrients (lactose and calcium) and influenced by genes and can run in families. Having
ovarian cancer risk in a large population-based case- a close male relative (such as a brother, father or
control study among Danish women. They found uncle) who has had prostate cancer can be linked to
that the intake of dairy products (particularly milk, an increased risk. Men who have relatives with
soured milk products and yoghurt), was associated breast cancer (especially under the age of 60) may
with an increased overall ovarian cancer risk. A also have a higher risk of prostate cancer. This
similar association was found between lactose intake increased risk may be caused by inherited faulty
and overall ovarian cancer risk (Faber et al., 2012). genes BRCA1 and BRCA2. Men who carry a faulty
BRCA1 gene may have a slightly higher risk (one per
In conclusion, the consumption of animal-based cent) of male breast cancer. Some studies suggest
foods is associated with an increased risk of certain there may be a slight increase in the risk of prostate
hormone-dependent cancers. Milk and dairy cancer. Men who carry a faulty BRCA2 gene have a
products are of particular concern: as already stated, seven per cent higher chance of getting breast
most milk drunk today is produced from pregnant cancer and a 20-25 per cent higher lifetime risk of
cows, in which oestrogen and progesterone levels developing prostate cancer. Most of these prostate
are markedly elevated (Ganmaa and Sato, 2005). cancers occur over the age of 45 (Oxford University
While there are several candidate components of Hospitals NHS Trust, 2011).
milk that may increase the risk of ovarian and other
hormone-dependent cancers, the precise There are many different factors that influence the
mechanisms underlying their action remain unclear. development of prostate cancer Experts think that
However, as milk and dairy products have been just five to 15 per cent of prostate cancers are linked
identified as a risk factor for ovarian cancer, it stands to inherited genes (Macmillan Cancer Support,
to reason that this particular risk can be reduced by 2013a). That means that 85 per cent or more of
switching to a plant-based diet that excludes all prostate cancers are caused by environmental and/or
dairy products. lifestyle factors. Research suggests there may be a

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link between obesity and prostate cancer and It is now well-documented that diets high
that men who regularly exercise have a lower in calcium and dairy protein can increase
risk of developing the disease. Some evidence the risk of prostate cancer (Cancer Research
suggests that diet can affect your risk of UK, 2012c). One of the earliest reports
developing prostate cancer. Current linking dairy consumption to prostate cancer was
thinking suggests that a diet high in published in the 1980s when a study of over
animal fats may increase your risk of 27,000 Californian Seventh-Day Adventists who
developing prostate cancer. In had completed dietary questionnaires 20 years
particular, red meat (such as beef, earlier concluded that milk consumption was
lamb and pork), eggs and dairy positively associated with prostate cancer
produce (including butter, whole mortality (Snowdon, 1988). Since then many
milk, cheese and cream) contain a lot more reports have confirmed an increased risk from
of saturated fat (Macmillan Cancer Support, the consumption of dairy foods.
2013a). As we see with other hormone-dependent
cancers (for example, breast cancer), the highest One possible mechanism for the action of milk in
incidence rates of prostate cancer occur in the increasing prostate cancer risk may involve the calcium
developed world and the lowest rates are seen in in milk. Researchers from Harvard Medical School have
Africa and Asia. However, African-American men are shown that high consumption of calcium is linked to
more affected than white American men. This advanced prostate cancer (Giovannucci et al., 1998). It
suggests that prostate cancer risk is influenced by has been suggested that calcium increases prostate
dietary and lifestyle factors. cancer risk by suppressing circulating vitamin D
(Giovannucci, 1998). In a study of 3,612 men observed
Figure 6.0 shows how the incidence of prostate between 1982 and 1992, 131 prostate cancer cases
cancer varies widely around the world. Incidence were identified and dietary intake analysed (Tseng et
rates are highest in Australia, New Zealand and al., 2005). Results confirmed that dietary calcium was
Western Europe (104 and 93 per 100,000 in 2008 associated with an increased risk whereas vitamin D
respectively), where prostate cancer screening and was not associated. The researchers concluded that
PSA testing is common. The lowest rates are seen in dairy consumption may increase prostate cancer risk
South-Central Asia; four per 100,000 (Cancer through a calcium-related pathway.
Research UK, 2012d).

Research shows that prostate Figure 6.0 Incidence and mortality rates for prostate cancer
cancer rates are lower in in selected countries in 2008.
countries with low
120
consumption rates of typical
Western foods such as meat
100
Rate per 100,000 popula on

and dairy. However, advice

from the NHS on the links Incidence
80
between diet and prostate Mortality
cancer is fairly sparse. They 60
say that there is evidence that
a diet high in calcium is 40
linked to an increased risk of
developing prostate cancer 20
and that some research has
shown prostate cancer rates 0
appear lower in men who eat
rth n E nd

es W e
n rica
S o C ar o p e
n ica

ut Am ca
l a n Eu a
Ea l A pe
So ern an

So We Af a

ra a
No ste Asia

si a
M n A ld

ut er sia
a
st sia
rth m e

Ea e A a

foods containing certain

p
ra Ce ern eric

rn ic

nt ric
ut ste ric
te or
No ern rop

id fric
So th Afri

ro
No ster eala

h be

nd tra ro
er er

ste fr

lA
So rth rn A
Ea rn A
st me

Ce f
r

h nA
Eu
Eu

Ea rn
ut ib
u

nutrients including lycopene,

e Z

e
dl
r
W ew

er
u
h
/N

found in tomatoes and other

W

h
l ia
tra

red fruit, and selenium, found

s
Au

in Brazil nuts (NHS Choices,

nt
Ce

2012h).
Source: Cancer Research UK, 2012d.

47
 White Lies

More recently an EPIC study found that a 35g per consumption as a major dietary risk factor for the
day increase in consumption of dairy protein was development of prostate cancer. This study reported
associated with a 32 per cent increase in the risk of how bioactive molecules in cow’s milk initiate a
prostate cancer. They also found that calcium from signalling pathway (protein-mediated mTORC1
dairy products was positively associated with risk, but signalling) and that this, along with constant
not calcium from other foods. These results support exposure to commercial cow’s milk oestrogens
the hypothesis that a high intake of protein or derived from pregnant cows, may explain the
calcium from dairy products may increase the risk for observed association between high dairy
prostate cancer (Allen et al., 2008). Given that consumption and increased risk of prostate cancer in
calcium and low-fat milk are vigorously promoted to Westernised societies. Normally, only infants
reduce risk of osteoporosis (and colon cancer), the consume milk up until weaning, so milk-mediated
mechanisms by which dairy and calcium might mTORC1 signalling is restricted to the postnatal
increase prostate cancer risk should be clarified and growth phase of the vast majority of mammals – this
confirmed (Tseng et al., 2005). is the natural state. Only milk proteins (compared to
meat and fish) have the unique ability to
Another study considered the oestrogen content of preferentially increase both the insulin/IGF-1 and
milk as a causal factor, having noted that the typical leucine signalling pathways necessary for maximal
Western diet (characterised by milk and meat mTORC1 activation. In other words, the persistent
products) contains higher levels of oestrogen than consumption of cow’s milk in humans provides a
the foods eaten by Asian men who suffer much less unique combination of factors that can lead to
from prostate cancer. This study measured the prostate cancer. The author suggests that a
hormone contents of two kinds of commercial milks contemporary Palaeolithic diet and restriction of
(from Holstein and Jersey cows) and found that levels dairy protein intake may offer protection from the
were markedly higher than they were 20 years ago. most common dairy-promoted cancer in men of
This was attributed to modern dairy farming Western societies (Melnik, et al., 2012).
methods whereby around 75 per cent of commercial
milk comes from pregnant cows (Qin et al., 2004). Numerous studies now indicate that the growth
factor IGF-1 is associated with an increased risk of
In a more recent study looking at the effects of prostate cancer. In an early Swedish study, levels of
persistent milk consumption beyond weaning (adults IGF-1 were measured in blood samples from over
drinking milk) it was stated that epidemiological 800 men, 281 of whom were later diagnosed as
evidence points to increased dairy protein having prostate cancer. A strong correlation between

48
 A report

IGF-1 and prostate cancer was observed and it was Perhaps of greater significance though is the fact
concluded that circulating IGF-1 levels are associated that recent evidence from population studies of
with an increased risk for this disease (Stattin et al., prostate cancer suggests that the association with
2004). In a pooled reanalysis of worldwide IGF-1 is not so much of an effect on cancer initiation,
prospective data based on 3,700 men with prostate but reflects an effect on the risk of progression to
cancer and 5,200 controls, researchers also clinically relevant disease (Holly 2013a). As mitogens
concluded that high circulating IGF-1 concentrations (substances that encourage cell division), and
are associated with a moderately increased risk for antiapoptotic agents (substances that prevent
prostate cancer (Roddam et al., 2008). apoptosis or cell death) IGF-1 may be important in
carcinogenesis, possibly by increasing the risk of
In 2007, an EPIC study (based on 630 cases and 630 cellular transformation by enhancing cell turnover
controls), found a marginally increased prostate (Kucuk et al., 2001). In other words, many men
cancer risk for men with the highest IGF-1 levels develop prostate cancer (or benign tumours) but IGF-
(Allen et al., 2007). In an extension of this work (this 1 may transform the tumours into a more aggressive
time based on 1,542 prostate cancer cases matched form of cancer (Holly et al., 2013a). Either way, IGF-
to 1,542 controls) IGF-1 concentration was 1, from cow’s milk, appears to be a risk factor that
significantly associated with an increased risk of could easily be avoided by eliminating dairy foods
prostate cancer. It was concluded that these results from the diet.
suggest that circulating concentrations of IGF-1 in
middle to late adulthood are strongly associated with It has been suggested that men with prostate cancer
subsequent prostate cancer risk over the relatively who increase consumption of plant-based foods and
long term (Price et al., 2012). Campbell suggests avoid dairy products and meat may significantly
that IGF-1 is turning out to be a predictor of certain increase their chances of survival. Researchers from
cancers, including prostate cancer, in much the same the Physicians Committee for Responsible Medicine
way that cholesterol is a predictor of heart disease (PCRM) reviewed eight observational studies and 17
(Campbell and Campbell, 2005). intervention studies on the effect of a plant-based
diet on prostate cancer results and found that a
As stated previously the diet can influence IGF-1 plant-based diet may slow prostate cancer
levels in the blood and dairy products have been progression and improve prognosis (Berkow et al.,
shown to increase the level of circulating IGF-1 2007). They found that diets high in saturated fat are
(Young et al., 2012). In a group of healthy, middle- associated with a threefold higher risk of cancer
aged men, dairy products, milk and calcium were all progression and death, compared with a diet low in
associated with raised IGF-1 levels (Gunnell et al., saturated fat. In addition, specific plant foods,
2003). In the same study, high intakes of vegetables including flaxseeds and lycopene-rich tomatoes, may
and tomatoes, or tomato-containing products, were help slow prostate cancer progression.
associated with lower levels of IGF-1. Furthermore, a
study published in the British Journal of Cancer Possible mechanisms of action for lycopene, the
noted that vegan men had a nine per cent lower major carotenoid in tomatoes, include the following:
serum IGF-1 level than meat-eaters and vegetarians
(Allen et al., 2000). So again it is shown that milk • inhibition of growth in cancer cells by modulating
increases IGF-1 and raised IGF-1 is linked to the expression of cell cycle regulatory proteins
increased risk of cancer. • modulation of the IGF-1/IGFBP-3 system (IGF
signalling is thought to affect tissue growth and
Research has clearly established that IGF-1 has a very development with IGF-1 and IGF binding protein-
important role in the development and progression 3 (IGFBP-3) having putative pro- and anti-
of certain cancers, including prostate (Meinbach and carcinogenic properties respectively)
Lokeshwar, 2006). Recent prospective • up-regulation of tumor suppressor proteins and
epidemiological studies have also consistently shown increased gap junctional intercellular
strong associations between circulating IGF-1 levels communication
and the subsequent risk of developing prostate • modulation of redox signaling
cancer (Roddam et al., 2008). Individuals with • prevention of oxidative DNA damage
circulating IGF-1 levels at the upper end of the • modulation of carcinogen metabolising enzymes
normal range are at significantly increased risk of
subsequently developing prostate cancer years later. Source: Kucuk et al., 2001.

49
 White Lies

While the precise molecular mechanisms underlying observed that while meat and dairy are associated
the development of prostate cancer are still being with an increased risk, the consumption of tomato
teased out, the effects of changing the diet have products (which contain the antioxidant lycopene),
produced positive results. Researchers at the vitamin E and selenium supplements have all been
Preventative Medicine Research Institute in California shown to decrease risk. Tomato ketchup is a source
evaluated the effects of dietary changes in 93 of lycopene and organic brands may contain up to
volunteers who had chosen not to undergo three times as much lycopene as non-organic (Ishida
conventional treatment for early prostate cancer. This and Chapman, 2004). A high level of physical activity
was a unique opportunity to observe the effects of was also identified as a factor decreasing the risk of
diet and lifestyle changes without the confounding prostate cancer (Wolk, 2005).
effects of radiation or surgery. Participants in the
lifestyle-change group were placed on a vegan diet Studies have shown that the consumption of soya
consisting primarily of fruits, vegetables, whole grains foods may be associated with a reduction in cancer
and pulses supplemented with soya, vitamins and risk in humans. In a meta-analysis of 15
minerals. Two standard tests were used to assess epidemiologic studies on soya consumption and nine
disease status. The first was a routine blood test on isoflavones (the plant hormones in soya foods) in
measuring PSA levels; this protein produced by the association with prostate cancer risk, results showed
prostate gland can be used to assess disease that soya foods are associated with a reduction in
progression. The second test relied on differences in prostate cancer risk. This protection may be
the growth rates of a human prostate cancer cells associated with the type and quantity of soy foods
(LNCaP) treated with patient serum. This is a standard consumed (Yan and Spitznagel, 2009).
laboratory test used for evaluating the effects of
conventional treatments of prostate cancer. In summary, the data linking the consumption of
cow’s milk and dairy products to numerous different
While none of the experimental (vegan) patients types of cancer provides a convincing argument for
underwent conventional treatment during the study, eliminating all animal foods from the diet while
six control patients underwent treatment due to an increasing the intake of whole grains, pulses
increase in PSA and/or progression of the disease on (including soya), fruit and vegetables.
magnetic resonance imaging. PSA decreased four per
cent in the experimental group but increased six per
cent in the control group. Although the magnitude of Colic
these changes was relatively modest, the direction of
change may be clinically significant since an increase Colic was first mentioned in recorded history by the
in PSA predicts clinical progression in the majority of ancient Greeks (Cirgin Ellett, 2003), yet in 2013 the
men with prostate cancer. In the second test, the cause remains somewhat undetermined. Colic is the
growth of LNCaP prostate cancer cells was inhibited medical term for excessive, frequent crying in a baby
almost eight times more by serum from the who appears to be otherwise healthy and well fed. It
experimental than from the control group. Changes is a poorly understood yet common condition that
in serum PSA and also in LNCaP cell growth were affects around one in five babies. However, the
significantly associated with the degree of change in condition is not harmful and babies with colic
diet and lifestyle. It was concluded that intensive continue to feed and gain weight normally. There is
lifestyle changes may affect the progression of early, no evidence that colic has any long-term effects on a
low grade prostate cancer (Ornish et al., 2005). baby’s health (NHS Choices, 2012i). A baby with
colic may have several crying outbursts a day and
In the late 1980s, increasing the consumption of this may occur a few times a week. The crying
beans, lentils, peas, tomatoes, raisins, dates and pattern usually begins within the first few weeks of
other dried fruit was found to be associated with a life but often stops by the time the baby is four
significantly decreased risk of prostate cancer (Mills months old, by six months at the latest. Typically, a
et al., 1989). A decade later, a study of over 47,000 baby with colic will scream and draw up their legs,
men confirmed an inverse link between fructose and and may refuse to be comforted. It can be very
prostate cancer indicating that eating fruit offers distressing for parents, especially as the cause of
some protection against prostate cancer colic remains largely unknown.
(Giovannucci et al., 1998a). More recently, in a
review of diet, lifestyle and prostate cancer it was While the exact cause is unknown several factors are

50
 A report

thought to contribute
including poor digestion,
lactose intolerance and/or
a reaction to cow’s milk
proteins. Since the 1970s,
numerous studies have
indicated that certain
components of cow’s milk
may lead to colic. In a
clinical trial to investigate
the effects of cow’s milk
whey proteins, 24 out of
27 infants with colic
showed no symptoms of
colic after whey protein
was removed from their
diet. In fact crying hours
per day dropped from 5.6
hours to 0.7 hours (Lothe
and Lindberg, 1989). In
order to alleviate the
negative effects of cow’s
milk whey proteins (and
other milk proteins thought
to cause colic) some infant
formulas are hydrolysed,
this means the proteins are
broken up. These
hydrolysed formulas are
called hypoallergenic and
have been shown to be
effective in the treatment of colic in some infants palmitic acid is predominantly in the central or beta-
(Lindberg, 1999; Jakobsson et al., 2000; Lucassen et position, whereas in cow’s milk and infant formulas, it
al., 1998; Lucassen et al., 2000). is mainly in the first and third position and may form
calcium-fatty acid complexes which are poorly
Some differences in intestinal flora (the bacteria that absorbed in the gut (Savino, 2006). In a previous
inhabit the gut) have been identified in infants with observational study, within two weeks of feeding with
colic (Lehtonen et al., 1994; Savino et al., 2004). this formula, a significant decrease in the number of
Research suggests that altering intestinal flora might colic episodes was observed in the majority of infants
help prevent colic in formula-fed infants, who have tested (Savino et al., 2003). This study was performed
well-known differences in gut flora compared to to confirm the role of this new formula in infants with
breast-fed infants (Newburg, 2000). Other reports colic in a randomised prospective trial. Results showed
that oligosaccharide (prebiotic) supplements in infant that infants fed with the formula had a significant
formulas may promote gastrointestinal health are decrease in colic episodes after just one week of
inconclusive (Savino et al., 2006). However, a formula treatment compared to infants from the control
specifically developed to simulate the beneficial effects group. The difference in crying time was even more
of human breast milk and to reduce some of the significant after two weeks of treatment. This study
common feeding problems of cow’s milk formula-fed provides compelling evidences for the relation
infants was tested in infants with colic. It contained between colic and type of feeding. However, the
partially hydrolysed whey proteins, a mixture of increasingly expensive and elaborate attempts to
oligosaccharides (90 per cent galacto-oligosaccharides simulate human breast milk beg the question, why
and 10 per cent fructo-oligosaccharides), low lactose, don’t we put a more concerted effort into simply
modified vegetable oil with 41 per cent of the palmitic promoting breastfeeding?
acid in the beta-position and starch. In human milk,

51
 White Lies

In transient lactose intolerance, the enzyme lactase is interventions for infantile colic from 1980 to 2009
not produced while there is illness in the gut, but is found some scientific evidence to support the use of
manufactured again once the gut has recovered. In a a casein hydrolysate formula in formula-fed infants
review investigating transient lactose intolerance as a and a low-allergen maternal diet in breastfed infants
cause of colic, a range of studies showed that crying with colic. However, they found little scientific
time was reduced when formula or breast milk was evidence to support the use of lactase, additional
incubated with the enzyme lactase (Buckley, 2000). It fibre or behavioural interventions. They suggested
has been suggested that infant colic has a multiple that further research on low-allergenic formulas and
aetiology; in other words, colic may be caused by a maternal diets would be useful (Hall et al., 2012).
number of different factors including whey proteins,
lactose and others. In a substantial review of 27 controlled trials
published in the British Medical Journal, the
The fact that the incidence of colic is similar in elimination of cow’s milk protein was deemed to be
formula fed and breastfed infants has led scientists a highly effective treatment for infantile colic. The
to investigate the role of the maternal diet in this reviewers remained uncertain about the effectiveness
condition and many reports now link the maternal of low lactose formula milks and the effectiveness of
intake of cow’s milk to the occurrence of colic in substitution with soya-based formula milks (although
exclusively breastfed infants. The breast milk of no adverse events were reported) while supporting
mothers who consume cow’s milk and milk products the substitution of normal cow’s milk formula for
has been shown to contain intact proteins from whey or casein protein hydrolysate (hypoallergenic)
these foods. To test the possible role of cow’s milk formulas, in which the milk protein is partially broken
proteins in breast milk, researchers have investigated down to ease digestion (Lucassen, 1998).
the effects of eliminating all dairy products from the
mothers’ diet. An early report linking cow’s milk Interestingly, Dr Benjamin Spock, author of the
proteins in human breast milk to infantile colic date hugely popular book Baby and Child (over 50 million
back to a letter published in the Lancet in the late copies sold worldwide) warns that the proteins in
1970s (Jakobsson and Lindberg, 1978). The letter cow’s milk formulas can cause colic (Spock and
described how the symptoms of colic disappeared in Parker, 1998). Spock acknowledges that some
13 out of 19 infants whose mothers eliminated infants that are allergic to cow’s milk formula may be
cow’s milk from their diet. In a subsequent clinical allergic to soya-based infant formula as well and that
trial designed by the same researchers, 66 these infants are often given expensive hydrolysate
breastfeeding mothers of infants with colic were put formulas. However, he states that soya formulas
on a diet free from cow’s milk. The colic disappeared have an important advantage over cow’s milk
in 35 of the infants and subsequently reappeared in formulas in that they contain none of the animal
23 of them when cow’s milk protein was proteins linked with colic (and type 1 diabetes) and
reintroduced to the mothers’ diet (Jakobsson and are free of lactose.
Lindberg, 1983). The authors suggest that a diet free
of cow’s milk may be useful as a first trial of This said, it should be emphasised to parents who
treatment of infantile colic in breastfed infants. breastfeed, it is a good idea to continue
breastfeeding as weaning on to formula milk may
Researchers at the Washington School of Medicine in make the colic worse. If eliminating cow’s milk and
Missouri US found that mothers of infants with colic milk products from the maternal diet does not help,
had significantly higher levels of the cow’s milk cutting out other foods may help. Researchers at the
antibody immunoglobulin G (IgG) in their breast milk University of Minnesota tested a range of foods
than mothers of infants without colic (Clyne and including cruciferous vegetables (cabbage,
Kulczycki, 1991). The authors of this study suggest cauliflower, sprouts and broccoli) in an elimination
that bovine IgG present in breast milk may be diet in mothers of babies with colic. While the results
involved in the development of colic. This link was showed that cow’s milk had the strongest
confirmed more recently and again it was suggested association with colic, other foods more weakly
that the maternal avoidance of milk and dairy associated included: onions, chocolate, cabbage,
products may be an effective treatment for colic in broccoli and cauliflower (Lust et al., 1996).
some breastfed infants (Estep and Kulczycki, 2000).
A systematic review of nineteen studies and two In conclusion, colic is a common cause of maternal
literature reviews on medical and conventional distress and family disturbance and more research is

52
 A report

needed to develop solid evidence-based diet, pregnancy, an excessive intake of tea or coffee
recommendations for successful treatment. (this increases urine production and so decreases the
However, eliminating cow’s milk from the maternal amount of fluid in the bowel). Other factors include
diet (if breastfeeding) and avoiding cow’s milk surgery, haemorrhoids (piles) and psychological
formula may help. problems such as anxiety. Constipation may be a
symptom of another medical condition such as
irritable bowel syndrome (IBS).
Constipation
The link between constipation and cow’s milk
Constipation is a condition in which bowel intolerance was first made in medical literature in the
movements are infrequent or incomplete. While it is 1950s (Clein, 1954). Since then, there have been
normal for some people to go to the toilet several numerous studies published confirming that this link
times a day, others go less frequently. A change in exits. Researchers at the University of Palermo in Italy
the normal frequency of trips to the toilet can be an studied 65 children (aged from 11 to 72 months)
indicator of constipation. Similarly if you are going suffering from chronic constipation (Iacono et al.,
as frequently but having trouble passing stools, 1998). All of these children had been treated with
having to strain, this too may indicate constipation. laxatives without success. After 15 days of
Common symptoms include stomach ache and observations (in a double-blind crossover study) each
cramps, feeling bloated, nausea, a sense of child received either cow’s milk or soya milk for two
fullness, headache, loss of appetite, fatigue weeks, and then had a week off when they could
and depression. eat and drink anything they wanted. Then the
feeding order was reversed, so that the group
There are a number of factors that increase that had previously drunk cow’s milk
the risk of constipation, including: switched to soya and vice versa. The
researchers (and children) were unaware of
• not eating enough fibre, such as fruit, the order of treatment. Careful recordings
vegetables and cereals of the bowel habits were made and a
• a change in your routine or lifestyle, such response to the treatment was defined as
as a change in your eating habits eight or more bowel movements during
• ignoring the urge to pass stools the two week treatment period.
• side effects of certain medication Results showed that 44 of the 65
• not drinking enough fluids children (68 per cent) had a
• anxiety or depression response while receiving soya
• In children, poor diet, fear about milk compared to none of the
using the toilet and poor toilet children receiving cow’s milk.
training can all be responsible The results were most
dramatic in children who had
Source NHS Direct, 2012j. frequent runny noses,
eczema or wheezing,
In more detail, constipation may which may have been a
be caused by a range of factors symptom of milk allergy in
including insufficient fluid in the these children. Sometimes
diet, lack of fibre (fruit, however, constipation can be
vegetables and cereals) in the only symptom of cow’s milk
the diet, lack of intolerance (or
physical exercise, allergy).
certain drugs
(diuretics or In addition to
painkillers, cow’s milk
antidepressants and intolerance,
antacids that contain cow’s milk allergy in
iron, calcium or children can also cause
aluminium), too much chronic constipation.
calcium or iron in the Some small-scale

53
 White Lies

studies have observed how a cow’s milk protein-free modes of action: cow’s milk intolerance or cow’s milk
diet can alleviate constipation in children with cow’s allergy. In either case, studies suggest that cow’s milk
milk allergy (Daher et al.; 2001; Turunen, 2004). A intolerance or allergy should be considered as a
larger randomised clinical study investigating the role cause of constipation although the underlying
of cow’s milk allergy as a cause of chronic mechanism still requires further investigation. In
constipation in two groups of 70 children (aged 1- general it should be noted that dairy products supply
13) with chronic constipation compared the effects children with unnecessary saturated fat while
of a cow’s milk free diet with cow's milk diet. All providing no dietary fibre whatsoever. Fibre is
children had previously been treated with laxatives essential in the diet to maintain good bowel health
for at least three months without success. The test through regular movements.
group received the cow’s milk-free diet for four
weeks. After that they received a cow’s milk diet for
two weeks. The control group received a cow’s milk Coronary heart disease
diet for the whole six weeks. After four weeks, 56
patients (80 per cent) of the test group had Diseases of the heart and circulatory system are
responded in comparison to 33 (47.1 per cent) collectively called cardiovascular disease (CVD) and
patients in the control group. In the test group after are a leading cause of death in the UK. Coronary
two weeks challenge, 24 out of 56 responders (42.8 heart disease (CHD) is one of the two main forms of
per cent) developed constipation again. 80 per cent CVD along with stroke. Over 1.6 million men and
of the constipated children tested positive for cow’s over one million women are affected by CHD. It is
milk allergy. The authors concluded that, in children, responsible for more than 88,000 deaths in the UK
chronic constipation can be a symptom of cow’s milk each year, an average of 224 people each day or one
allergy and suggest that an elimination diet is death every six minutes. Around one in six men and
advisable in all children with constipation one in nine women die from CHD (BHF, 2013). Most
unresponsive to laxative treatment (Dehghani et deaths from CHD are caused by heart attacks. In the
al., 2012). UK, there are about 124,000 heart attacks each year.
There are also around 152,000 strokes in the UK
Cow’s milk protein-induced constipation in children each year, resulting in over 43,000 deaths (NHS
is often associated with anal fissures (tears or ulcers Choices, 2012k).
that develops in the lining of the rectum or anus)
and rectal eosinophilia (a condition in which CHD occurs when there is a build-up of fatty
abnormally high amounts of white blood cells deposits (plaques) along the walls of the arteries that
called eosinophils are found in the gut lining. supply the heart with oxygenated blood. These
Eosinophilia occurs in a wide range of conditions plaques build up and clog the arteries making them
including allergies such as asthma and cow’s milk narrower and restricting the blood flow. Blood clots
allergy). In children with cow’s milk allergy, cow’s can form at the site of a plaque in the coronary
milk may lead to painful defecation, perianal artery and cut off the blood supply to the heart. This
erythema or eczema and anal fissures with possible can result in heart attack and sudden death. Like the
painful faecal retention, thus aggravating heart (and other organs), the brain needs the oxygen
constipation (Andiran et al., 2003). For this provided by blood to function properly. If the supply
particular symptom (constipation), it has been of blood is restricted or stopped, a stroke may occur
reported that tolerance of cow’s milk may be and brain cells could begin to die, it can lead to brain
achieved after an average of 12 months of strict damage and possibly death. The plaques that block
avoidance (El-Hodhod et al., 2010). In other words, the arteries are made up of a fatty substance that
in children with cow’s milk allergy-induced contains cholesterol. Cholesterol is essential for cells
constipation, reintroducing cow’s milk into the diet but too much can lead to CHD and stroke.
can trigger the constipation for an average time of Lipoproteins carry cholesterol to and from the cells in
up to one year. It is interesting that there is a the blood. Low-density lipoprotein (LDL) takes
persistent insistence on including a food in the diet cholesterol from the liver to the cells, and high-
that can cause such unpleasant and distressing density lipoprotein (HDL) carries excess cholesterol
symptoms when dairy food is not an essential back to the liver for excretion. HDL is known as the
component of the human diet. ‘good fat’ while LDL (‘bad fat’) tends to build up on
the walls of the arteries increasing the risk of CHD
Cow’s milk may lead to constipation by two distinct and stroke.

54
 A report

There are several well-documented risk factors for five boys and girls aged five to 15 consume the
CVD including: recommended amount

• Smoking – significantly increases the risk of CHD Source: BHF, 2013

• Obesity – more than a quarter of adults in
England are obese and around 30 per cent of Some risk factors put you at greater risk of CHD and
boys and girls aged two to 15 in England and stroke than others but the more risk factors you do
Scotland are overweight or obese have, the greater your chance of developing CVD.
• Alcohol – more than a third of men and over a However, having a risk factor does not necessarily
quarter of women regularly exceed the mean you will develop CVD, it just means it is more
government recommended level of alcohol intake likely. So, limiting your risk factors reduces your risk.
• Blood pressure – around one in three adults in
England and Scotland
have high blood pressure
and nearly half of them Figure 7.0 Death rates from CHD for people aged 35-75
are not receiving from 1968 to 2010.
treatment for it 4500
• Cholesterol – around six
Deaths per 100,000 population

4000
in 10 adults in England
have cholesterol levels of 3500
5mmol/l or above (you 3000
should aim to have a 2500
cholesterol level under 2000
4mmol/l)
1500
• Poor diet – less than one
third of men and women 1000
currently eat the 500
recommended five 0
portions of fruit and
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010

vegetables per day in

Britain, only around one in Source: BHF, 2012.

55
 White Lies

Figure 7.0 shows how the number of deaths from Researchers from the Department of Applied Health
CHD has fallen markedly since the late 1960s. This is Research, at the University College London used a
because of a combination of factors including well-known, tried and tested epidemiological model
improvements in medical treatment and lifestyle (IMPACT) to analyse the total population of England
changes. For example a vast improvement has been aged 25 and older in 2000 and 2007 (Bajekal et al.,
made in the speed at which so-called clot-busting 2012). They included all the major risk factors for CHD
drugs are applied, which has had a huge impact in plus 45 current medical and surgical treatments in
preventing death. Furthermore, nearly two million their model. They found that half (52 per cent) of the
people receive drugs called statins that lower recent CHD mortality fall in England was attributable
cholesterol levels and reduce the risk of heart to improved treatment uptake. However, opposing
disease. Research suggests that statins may prevent trends in major lifestyle risk factors meant that the net
cardiovascular events and reduce subsequent contribution of these interventions amounted to only
mortality by up to 60 per cent (Mills et al., 2008). just over a third of the CHD deaths averted. In other
words, despite the medical advances of the last ten
Many people have quit smoking, which has had a years, plus the large drop in the number of smokers in
significant effect on lowering their risk of heart the UK, we are not reaping the benefits as much as
disease. Figures from the UK’s Office of National we could because of poor lifestyle and dietary choices.
Statistics’ Opinions and Lifestyle Survey show that 45 You could say it is a case of ‘two steps forward and
per cent of adults smoked in 1974 compared with one step back’. Furthermore, concerns are that the
20 per cent in 2012. This has contributed to the decline in deaths from heart disease may be short
decline in smoking-related heart disease and lived due to the increasing levels of inactivity, the rise
subsequent mortality. The risk of CVD dramatically in obesity, the increase in cholesterol levels and the
decreases when a person quits smoking and rise of type 2 diabetes.
continues to fall rapidly for the first year and after
five years the risk of CVD returns to the level of that The quest to identify dietary and lifestyle risk factors
of a non-smoker (Glantz and Gonzalez, 2012). UK for CHD dates back over five decades. In 1946 Los
Government initiatives encouraging people to reduce Angeles physician Dr Lester Morrison began a study
their salt intake (linked to high blood pressure) are to determine the relationship of dietary fat intake to
also likely to have contributed to the decline in high the incidence of CHD (Morrison, 1960). He reduced
blood pressure-related mortality (Office for National the dietary fat intake of 50 heart attack survivors
Statistics, 2013). and compared their health to 50 other heart attack
survivors whose fat intake was left unchanged. After
However, while fewer people are dying from CVD, eight years, 38 of the control group had died
the number of people living with it has remained compared to 22 of the low-fat group. After 12
relatively constant over the
last decade. Figure 8.0 shows
that from 2000 to 2010, the Figure 8.0 Prevalence of CVD in people aged over 16 in
percentage of men and Great Britain, 2000-2010.
women (aged over 16 years) 14
with CVD in Great Britain
varied moderately, remaining 12
between nine and 12 per
10
cent (falling no lower than
9.4 and rising no higher than 8
11.9). The benefits we should
Per cent

Men
be seeing, due to the 6
Women
advances in medical
treatment and the reduction 4
in smoking, are being 2
negated by an increase in
deaths attributable to rises in 0
body mass index and 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
diabetes.
Source: BHF, 2012.

56
 A report

years, the entire control group had died but 19 of factors are modest, breastfeeding rates are
the low-fat diet group were still alive. Around the suboptimal in many countries and strategies to
same time, the residents of Framingham, just promote breastfeeding could therefore confer
outside Boston Massachusetts in the US, took part important benefits for cardiovascular health at a
in a study to investigate the role of diet and lifestyle population level (Robinson and Hall, 2012). The
in CHD. The study began in 1948, and by observing authors concluded that there is a growing
who suffered from CHD and who did not, the recognition of the need for a life course approach to
Framingham Study established the concept of risk understanding how adult diseases, such as CVD,
factors such as cholesterol, high blood pressure develop and there is now significant evidence that
(hypertension), lack of physical exercise, smoking links patterns of infant feeding to different health
and obesity (Kannal et al., 1961). outcomes both in the short and longer term.

It is important to note that dietary risk factors for As stated, a number of risk factors are now firmly
CVD do not just apply to adults. Various studies associated with CHD including high cholesterol levels,
warn of the increased risk of CVD (later in life) high blood pressure, family history of heart disease,
associated with the consumption of cow’s milk and diabetes, obesity and smoking. Additionally, there is
cow’s milk infant formula in young children. A much evidence linking CHD to poor dietary practices,
review on infant feeding practices published in the including the high consumption of saturated fats, salt
US journal Pediatrics suggests that the consumption and refined carbohydrates, and the low consumption
of whole milk should be discouraged in infants of fruits and vegetables (WHO/FAO, 2002).
because of its potential role in atherosclerotic heart
disease (Oski, 1985). A certain amount of cholesterol is essential for good
health, but high cholesterol levels in the blood are
In 2002, a substantial report of a joint WHO/FAO associated with an increased risk of CHD and stroke.
expert consultation review of the evidence on the This is because cholesterol contributes towards the
effects of diet and nutrition on chronic diseases build-up of fatty plaques on the artery walls which
stated that: results in the narrowing of the arteries and can lead
to a blockage and subsequent failure or death of the
“Data from most, but not all, observational organ that the artery provides blood to. The organs
studies of term infants have generally affected often include the heart (heart attack) and
suggested adverse effects of formula brain (stroke), but may affect other organs such as
consumption on the other risk factors for the kidneys (kidney failure). But what determines
cardiovascular disease (as well as blood blood cholesterol levels? Contrary to popular belief,
pressure), but little information to support this most of our cholesterol does not come from the diet
finding is available from controlled clinical but is produced within the body by the liver. Only a
trials. Nevertheless, the weight of current small amount of our cholesterol (estimates vary from
evidence indicates adverse effects of formula 15 to 20 per cent) comes from the diet. Cholesterol
milk on cardiovascular disease risk factors; this is found only in animal foods and is particularly
is consistent with the observations of concentrated in eggs and organ meats. Even high-fat
increased mortality among older adults who plant foods, such as avocados, nuts and seeds,
were fed formula as infants. The risk for contain no cholesterol whatsoever, so a plant-based
several chronic diseases of childhood and vegan diet is cholesterol-free. We have no actual
adolescence (e.g. type 1 diabetes, coeliac dietary requirement for cholesterol, in other words
disease, some childhood cancers, inflammatory we do not need to eat foods that contain cholesterol
bowel disease) have also been associated with as the liver can manufacture as much as is required.
infant feeding on breast-milk substitutes and However, there is no mechanism limiting the amount
short-term breastfeeding” (WHO/FAO, 2002). of cholesterol produced by the liver and cholesterol
production can rise to unhealthy levels.
A more recent review of the current literature
concurred that being breastfed as an infant (as So what causes high cholesterol production in the
opposed to cow’s milk formula-feeding) is associated liver? The answer lies in the types of foods we eat:
with a reduction in blood pressure, cholesterol and a diets high in animal protein and saturated animal fats
lower risk of obesity and diabetes in adult life. The have been shown to increase cholesterol. The
authors stated that although the effects on CVD risk cholesterol-raising effects of saturated fat are well-

57
 White Lies

documented. In a review of the literature, researchers total fat consumption. Studies on the protective
from the Department of Nutrition at the Harvard effect of seafood polyunsaturated omega-3 fatty
School of Public Health in Boston, Massachusetts, acids (EPA and DHA) have produced mixed results
found compelling evidence that the types of fat are because of the relatively high levels of pollutants
more important than total amount of fat in found in oily fish. A 2012 meta-analysis published in
determining the risk of CHD (Hu et al., 2001). Here the Journal of the American Medical Association of
the culprit is saturated fat, and controlled clinical trials 20 studies and 68,680 patients found that fish oil
have shown that replacing this type of fat with supplementation did not reduce the chance of
polyunsaturated fat is more effective in lowering death, cardiac death, heart attack or stroke (Rizos et
cholesterol and reducing the risk of CHD than al., 2012). Furthermore, some positive results have
reducing total fat consumption. In 1985, research been wildly exaggerated (NHS Choices, 2012l). In a
published in the Journal of the American Medical meta-analysis of studies looking at the plant-based
Association suggested that dairy products are a major omega-3 fatty acid ALA (found in soya beans,
source of dietary saturated fat and cholesterol and walnuts and canola/rapeseed oil) it was found that
that ingestion of high-fat dairy products raises both each gram per day increment of ALA intake was
total and LDL ‘bad’ cholesterol levels (Sacks et al., associated with a 10 per cent lower risk of CHD
1985). It is now widely
accepted that diets high in
animal fats are unhealthy and
that reducing the saturated
fat intake is very important for
reducing the risk of CHD. The
UK Government recommends
avoiding or cutting down on
fatty foods. Foods high in
saturated fat include: meat
pies, sausages and fatty cuts
of meat, butter, ghee, lard,
cream, hard cheese, cakes and
biscuits and foods containing
coconut or palm oil (NHS
Choices, 2013c). Like
saturated fats, trans fats can
also raise cholesterol levels.
Trans fats are found naturally
at low levels in meat and dairy
products and foods containing
hydrogenated vegetable oil,
including processed foods
such as biscuits, cakes, fast
food, pastry, margarines and
spreads. However, most
people in the UK don’t eat a
lot of trans fats as many
supermarkets in the UK have
removed hydrogenated
vegetable oil from their
products.

As stated, replacing saturated

fat with polyunsaturated fat
is more effective in lowering
cholesterol and reducing the
risk of CHD than reducing

58
 A report

death (Pan et al., 2012). The authors state that around 4.3 per cent in LDL cholesterol with a
compared with seafood omega-3 fatty acids, ALA potential additional reduction of 3.6-6.0 per cent
from plant sources is more affordable and widely due to displacement of saturated fat and cholesterol
available globally. Thus, whether ALA can reduce the depending on the diet and the foods displaced.
risk of CVD is of considerable public health Based on these assumptions, the authors concluded
importance. It should be noted that algal sources of that soya foods have the potential to lower LDL
EPA and DHA are now available in supplement form cholesterol by as much as 10.3 per cent. The authors
for people concerned about their omega-3 intake. state that the displacement value may be unique to
soya, because other cholesterol-lowering foods are
In The China Study, Campbell observes that animal added to the diet rather than exchanged for
protein intake correlates directly with heart disease suboptimal (meat and dairy) foods. They say that this
incidence, which he attributes to the cholesterol- makes soya a particularly valuable tool in the dietary
raising effect of animal protein. Conversely, armamentarium to reduce serum cholesterol. In
Campbell notes that eating plant protein lowers addition, many soya products could be beneficial to
cholesterol (Campbell and Campbell, 2005). Studies cardiovascular and overall health because of their
have shown that replacing animal milk protein high content of polyunsaturated fats, fibre, vitamins
(casein) with soya protein reduces blood cholesterol, and minerals and low content of saturated fat.
even when the fat intake remains unchanged (Lovati Replacing cheese, meat and other animal foods with
et al., 1987; Sirtori et al., 1999). Exactly how soya soya can mean using tofu, soya beans (edamame) or
protein lowers cholesterol is uncertain, although a soya milk (in a white sauce). Soya-based faux meats
range of theories have been proposed. One (such as soya mince) can be used although the
hypothesis suggests that the amino acid composition amount of processed food in the diet should be
of soya protein causes changes in cholesterol limited as they can contain relatively high levels of
metabolism (possibly via the endocrine system). saturated fat and salt, but still remain a healthier
Others propose that non-protein components (such option than meat and dairy.
as saponins, fibre, phytic acid, minerals and
isoflavones) associated with soya protein affect Many other plant foods (and components of them)
cholesterol metabolism either directly or indirectly are known to possess cholesterol-lowering properties
(Potter, 1995). The most popular theory currently including nuts, plant sterols and viscous (soluble)
accepted is that soya protein reduces cholesterol fibres. Individually, these plant food components can
metabolism in the liver by increasing the removal of be expected to lower LDL cholesterol in the range of
LDL ‘bad’ cholesterol. The precise mechanism is 3-10 per cent, far less than the 40-60 per cent
thought to involve enhanced LDL-degradation by reductions achievable with statins. However,
increased binding of LDL to receptors (Sirtori et al., collectively they could reduce LDL cholesterol by up
1977; Lovati et al., 2000). to 30 per cent, which would have a considerable
impact on preventing CHD (Jenkins et al., 2010).
A cross-sectional study of 1,033 pre- and
postmenopausal women selected from the Oxford Eating a diet that contains plenty of soluble fibre can
arm of the EPIC study (including 361 non- help to reduce the amount of cholesterol in the blood
vegetarians, 570 vegetarians and 102 vegans) found and so reduce the risk of CHD. Good sources of
that soya protein intake was inversely associated soluble fibre include oats, beans, peas, lentils, chick
with total and LDL cholesterol levels. LDL (‘bad’) peas, fruit and vegetables (NHS Choices, 2013c).
cholesterol in women with a soya protein intake of Increased consumption of fruit and vegetables is
at least six grams per day was 12.4 per cent lower associated with a reduced risk of CHD. A meta-analysis
than that in women who consumed less than 0.5 of twelve cohort studies including 278,459 individuals
grams per day (Rosell et al., 2004). (9,143 CHD events) with an average follow-up of 11
years found that, increasing consumption of fruit and
More recently, a meta-analysis of studies examining vegetables from less than three to more than five
the extent to which soya foods could reduce LDL servings per day reduced CHD risk by 17 per cent. The
cholesterol found that replacing meat or dairy authors state that these results provide strong support
protein with 13 grams of soya protein resulted in a for the recommendations to consume more than five
LDL cholesterol reduction of 0.15mmol/l, 50 grams servings of fruit and vegetables a day (He et al., 2007).
of soya protein reduced the level by 0.25mmol/l The government recommend that we eat at least five
(Jenkins et al., 2010). This represents a reduction of portions of fruit and vegetables each day.

59
 White Lies

Dr Dean Ornish, best known for his Lifestyle Heart cholesterol levels above 3.2mmol/l (WHO, 2003). It
Trial, investigated the role of a low-fat, high-fibre diet could be argued that genetic differences between
coupled to lifestyle changes in heart disease patients. races may affect the risk factors for CHD and other
Ornish treated 28 heart disease patients with diet and diseases. However, Campbell’s observations that
lifestyle changes alone. They followed a low-fat Japanese men in Hawaii and California have much
plant-based diet including unrestricted amounts of higher levels of blood cholesterol and incidence of
fruits, vegetables and grains. They also practised CHD than Japanese men in Japan confirms that
stress management techniques and exercised some risk factors are environmental rather than
regularly. After one year 82 per cent of the test group genetic. In other words, the choices we make about
experienced regression of their heart disease, the food we eat and how we live can have a
including a 91 per cent reduction in the frequency of significant impact on heart health.
heart pain compared to 165 per cent increase in the
control group (Ornish et al., 1990). No conventional Since the early 1990s the amino acid homocysteine
drug or surgery related therapies compare with these has become the subject of much interest among the
results (Campbell and Campbell, 2005). scientific community. Evidence suggests that
homocysteine damages the lining of blood vessels
A study published in the Journal of the American and enhances blood clotting. Elevated
College of Nutrition investigating the risk factors concentrations of homocysteine in the blood have
associated with CHD found that African-American been linked to an increased risk for both heart
vegans exhibit a more favourable serum lipid profile disease and stroke. Homocysteine is converted into
(a healthier balance of fats in the blood) compared the amino acid methionine in the presence of
to vegetarians who ate milk, milk products and eggs vitamin B12. In the same reaction,
(Toohey et al., 1998). This means that the vegans methyltetrahydrofolate is converted to folate which
had healthier levels of total cholesterol, LDL and HDL is used in the synthesis of DNA. This entire reaction
in their blood compared to the vegetarians. The relies on sufficient supplies of vitamins B6, B12 and
major factors contributing to this result were folate. In B12 deficiency, the amount of
thought to be the lower saturated fat intake and homocysteine in the body can escalate to potentially
higher fibre intake of vegans. dangerous levels and has been linked to a range of
disorders including depression, dementia, damage to
Examining the incidence of CHD in other cultures the inner lining of the artery walls and may be a
allows us to draw conclusions about the role of diet trigger for CHD. While increased homocysteine levels
in disease. Several studies have shown that certified have been observed in some vegetarians and vegans
death rates from CHD are linked country-by-country they do not occur in those ensuring an adequate
with milk consumption (Moss and Freed, 2003). B12 intake of three micrograms per day, whereas
In The China Study, Campbell was astonished at the elevated homocysteine levels are not uncommon
low rates of CHD in the southwest Chinese provinces among meat-eaters due to a low folate intake
of Sichuan and Guizhou; between 1973 and 1975 (Walsh, 2003). Additionally, elevated serum
not one single person died of CHD before the age of homocysteine levels tend to increase in the elderly as
64 among 246,000 men and 181,000 women incidence of B12 deficiency occurs more frequently.
(Campbell and Campbell, 2005). Campbell suggests Interestingly, a recent study showed how a daily
these figures reflect the important protective role of serving of breakfast cereal fortified with folic acid, B6
low blood cholesterol levels observed in rural China. and B12 not only contributed to the plasma status of
these vitamins but significantly reduced
A joint report between the Medical Research Council homocysteine concentrations in a randomly selected
and the British Heart Foundation states that the group of relatively healthy 50-85 year olds (Tucker et
average blood total cholesterol level for people aged al., 2004).
16 and above in the UK is about 5.5mmol/l. In China
(where there is much less heart disease), mean total The role of a vegetarian and vegan diet in nutrition
cholesterol levels in the cities are about 4.5mmol/l and health was examined among a large group of
for men and women aged 35-64, and levels in the vegetarians in the Oxford Vegetarian Study (Appleby
countryside are even lower (MRC/BHF, 2006). et al., 1999). This was a prospective study of 6,000
According to the WHO, almost a fifth (18 per cent) vegetarians and 5,000 non-vegetarian controlled
of global stroke events and about 56 per cent of subjects recruited in the UK between 1980 and
global heart disease is attributable to total 1984. In this study vegans had lower cholesterol

60
 A report

levels than meat-eaters (vegetarians and fish-eaters higher their risk. In summary, animal protein and
had intermediate or similar values). Meat and cheese saturated animals fats increase blood cholesterol and
consumption were positively associated, and dietary the risk of CHD while plant protein and fibre lowers
fibre intake was inversely associated, with cholesterol cholesterol and reduces the risk. Therefore, to reduce
levels. After 12 years of follow-up, mortality from the risk of CHD we should reduce the amount of
heart disease was positively associated with animal foods in the diet and eat more wholegrain,
estimated intakes of total animal fat, saturated plant-based foods.
animal fat and dietary cholesterol. A subsequent
review of the literature comparing the health of There are of course other factors that can contribute
Western vegetarians to non-vegetarians found that to the risk of CHD. Exercise is extremely important as
vegetarians had lower cholesterol levels (by about it increases HDL cholesterol levels, which in turn helps
0.5mmol/l) and a lower mortality from heart disease keep LDL cholesterol levels down. Exercise also helps
(by about 25 per cent). It was suggested that the control weight. As stated, smoking is a major risk
widespread adoption of a vegetarian diet could factor of CHD as it hardens the arteries, causing them
prevent approximately 40,000 deaths from heart to narrow. Alcohol consumption can increase the risk
disease in Britain each year (Key et al., 1999). so it should be limited and binge drinking avoided.

Taken together, the evidence shows that a plant-

based diet reduces the risk of CHD. This may be for a Crohn’s disease
range of reasons including the cholesterol-lowering
effect of fibre. It has been suggested that the Crohn’s disease is a chronic inflammatory bowel
antioxidants (beta-carotene and vitamins C and E) disease (IBD). It is a long-term condition that causes
contained in fruit and vegetables and cereals prevent inflammation of the lining of the digestive system.
saturated fats from being converted into cholesterol The symptoms are similar to other bowel conditions
in your body. Whatever the precise mechanism, the such as irritable bowel syndrome (IBS) and another
evidence is clear: a plant-based diet containing IBD ulcerative colitis. Crohn’s disease commonly
plenty of fruits and vegetables and whole grains occurs in the ileum (the lower part of the small
reduces the risk of CHD. There is much speculation intestine), but it can affect any part of the bowel. In
about how the consumption of animal foods fact it can occur anywhere along the entire
increases the risk of CHD. Again, the precise alimentary tract from the mouth to the anus. In most
mechanisms involved may be unresolved, but it is cases though, Crohn’s disease occurs in sections of
clear that the more animal foods a person eats, the the bowel which become inflamed, ulcerated and

61
 White Lies

thickened. Symptoms can include diarrhoea, offered to induce remission and azathioprine or
abdominal pain, fatigue (extreme tiredness), mercaptopurine can be offered as maintenance
unintended weight loss and blood and mucus in the treatment (NICE, 2012). The National Institute for
faeces (NHS Choices, 2013d). There may be long Health and Care Excellence (NICE) guidance suggests
periods lasting for weeks or months where there are that the first treatment offered to reduce symptoms
mild or even no symptoms, this is known as is usually corticosteroids (steroid medication). If this
remission. Remission may be followed by periods doesn’t help, immunosuppressants (medication to
where symptoms are particularly disruptive and/or suppress the immune system) and medication to
distressing, these are known as flare-ups. reduce inflammation may be used. In some cases,
surgery may be required to remove the inflamed
According to the National Association for Colitis and section of the intestine. Once the symptoms under
Crohn’s Disease, the disease affects about one in control, further medication may be used to help
every 1,000 people in the UK (NACC, 2010). There maintain remission.
are currently at least 115,000 people living with
Crohn’s disease in the UK. It can affect people of all Although the exact cause of Crohn’s disease remains
ages, including children but most cases first develop unclear, research suggests that a combination of
between the ages of 16 and 30. A large number of factors may be responsible including:
cases also develop between the ages of 60 and 80. It
affects slightly more women than men, but in • Genetics – genes that you inherit from your
children more boys are affected than girls. Crohn’s parents may increase your risk of developing
disease is more common in white people than in Crohn’s disease
black or Asian people. It is
most prevalent among Jewish
people of European descent
(NHS Choices, 2013e). Over
time, inflammation may
damage parts of the digestive
system, resulting in additional
complications, such as
stricture (narrowing of the
intestine) and fistula (a
channel that develops
between the anal canal and
the skin near the anus). These
problems usually require
surgical treatment. The
condition can lead to delay of
growth and puberty in
children, as well as affecting
fertility and sexual
relationships in adults
(NICE, 2012).

There is currently no cure for

Crohn’s disease so the aims
of treatment are to stop
inflammation, relieve
symptoms, induce and
maintain remission and avoid
surgery wherever possible. In
the last decade, there have
been a number of new drugs
licensed for the condition;
glucocorticosteroids can be

62
 A report

• The immune system – the inflammation may be present in around 20 per cent of Crohn’s patients
caused by a problem with the immune system compared to less than seven per cent of controls
(the body’s defence against infection and illness) (without Crohn’s). Although these results did not
that causes it to attack healthy bacteria in the gut provide the substantive evidence initially anticipated
• Previous infection – a previous infection may the researchers concluded that MAP (or some similar
trigger an abnormal response from the immune species) infects a subset of IBD patients (Collins et
system al., 2000). In another study, Professor John Hermon-
• Smoking – smokers with Crohn’s disease usually Taylor and colleagues at St George’s Hospital
have more severe symptoms than non-smokers Medical School in London tested a group of patients
• Environmental factors – Crohn’s disease is most with and without Crohn’s disease for MAP. Using
common in westernised countries, such as the UK, improved molecular biology techniques that
and least common in poorer parts of the world, increased the sensitivity of the tests, this time 92 per
such as Africa, which suggests the environment cent of patients with Crohn’s disease tested positive
(particularly sanitation) has a part to play compared to 26 per cent of the controls. These
patients were from the UK, Ireland, US, Germany
Source: NHS Choices, 2013d. and United Arab Emirates, suggesting exposure to
this pathogen occurs on an international basis. They
It has been proposed that an environmental factor concluded that the discovery that MAP is present in
leading to Crohn’s disease is a pathogenic bacterium. the majority of Crohn’s patients would suggest a
The most popular candidate is the infectious causal link between this bacterium and the
bacterium Mycobacterium avium subspecies condition (Bull et al., 2003). Since then, additional
paratuberculosis (MAP). MAP infection is widespread reports have confirmed MAP as a predominant
in domestic livestock and is present in retail feature of Crohn’s disease (Autschbach et al., 2005;
pasteurised cow’s milk in the UK and potentially Sechi et al., 2005). MAP can be notoriously difficult
elsewhere and water supplies are also at risk (Bull et to detect in humans but when validated
al., 2003). The overall prevalence of MAP infection in methodologies have been used, most people with
US dairy herds was reported by a USDA survey Crohn’s disease have been found to be infected with
(1991-2007) to be 68.1 per cent and it is suggested MAP (Hermon-Taylor et al., 2009).
that MAP infection in farmed animals is also
widespread in many areas of Western Europe and But how does MAP infection occur? The answer
elsewhere (Hermon-Taylor, 2009). As MAP may lie under our very noses, depending on what
contaminates and persists in natural watercourses we are drinking. MAP can survive the pasteurisation
and the environment, it is found in dairy products, it process, indeed an FSA-commissioned survey in
can survive milk pasteurisation and it is present in 2002 found MAP in two per cent of pasteurised
meat from infected animals and there are concerns milk on sale in the UK (FSA, 2002a). However,
that water supplies may be contaminated, it is researchers from the Department of Surgery at St
inevitable that human populations are widely George’s Hospital Medical School in London
exposed. MAP is a robust and versatile pathogen detected MAP in 22 of 312 (seven per cent) of
which has been shown to cause chronic samples of whole pasteurised cow’s milk obtained
inflammation in the intestines of many species of from retail outlets throughout central and southern
animal, including primates. MAP causes a chronic England from September 1991 to March 1993.
gastrointestinal infection called Johne’s disease in Alarmingly this study revealed the presence of peak
cattle and other ruminants. The rising incidence of periods in January to March and in September to
Crohn’s disease reported from several former low November, when up to 25 per cent of samples
incidence countries in Asia shows that, as with tested positive for MAP (Millar et al., 1996). Taken
Johne’s disease, Crohn’s disease is spreading together with data on the prevalence of MAP
worldwide (Hermon-Taylor et al., 2009). infection in herds in the UK, the known secretion of
MAP in milk from infected animals and the inability
A substantial body of evidence supports the causal of laboratory conditions simulating pasteurisation to
link between MAP and Crohn’s disease. Researchers ensure the killing of all these slow-growing
at the University of Wisconsin used a range of organisms, the authors of this study concluded that
modern molecular techniques to search for and there is a high risk, particularly at peak times, that
confirm the presence of MAP in patients with IBDs residual MAP will be present in retail pasteurised
including Crohn’s. The results showed MAP was cow’s milk in England.

63
 White Lies

In response to concerns about the presence of MAP agricultural river catchments of the US Midwest,
in retail milk, the FSA devised a strategy to control meeting those from the provinces of Manitoba,
MAP in milk at all stages of the food chain (FSA, Saskatchewan and Alberta (Hermon-Taylor, 2009).
2003). This strategy aims to ensure hygienic milking Avoiding dairy products alone may not be enough to
practices and effective pasteurisation of milk and ensure avoiding exposure to MAP, although if
reduce the level of MAP in dairy herds. Of course the everyone reduced their intake of animal products
overall aim is to reduce the likelihood of consumers there would be fewer cattle and therefore less MAP
being exposed to MAP. However, this strategy does present in the environment.
not consider alternative routes of exposure. In 2006
the strategy was reviewed and FSA Board Members Some evidence from clinical trials suggests that anti-
were informed of progress, provided with an update MAP treatment may be able to heal Crohn’s disease
on developments and told that no action was in some people. When anti-MAP treatment works in
required. The report concluded “the Agency is not so-called ‘responders’ receiving treatment with drug
aware of any developments to suggest that its combinations (including rifabutin and clarithromycin)
current advice on the drinking of milk needs the clinical and pathological improvements can be
updating at this time. The Agency and DH [The dramatic. Furthermore, some of the clinical benefit
Department of Health], together with their expert resulting from treatment with immunosuppressants
committees, continue to keep evidence on the (such as mercaptopurine or methotrexate) may
possible link between MAP and Crohn’s disease actually be a consequence of their anti-MAP action.
under review” (FSA, 2006). However, MAP infections are difficult to eradicate,
the organisms are generally resistant to drugs
MAP is a robust organism which can survive for conventionally used in the treatment of tuberculosis
months or even years in the environment which is a (Hermon-Taylor, 2009).
cause of much concern as infected animals excrete
huge numbers of MAP in their faeces. In South The hypothesis that MAP causes Crohn’s disease
Wales, researchers sampled river water from the Taff remains controversial and is disputed by some.
which runs off the hills and through the city of Professor Ryan Balfour Sartor, from the Department
Cardiff and detected MAP in 32.3 per cent of the of Medicine at the University of North Carolina in the
samples (Pickup et al., 2005). The hills are grazed by US says that we must determine whether MAP
livestock in which MAP is endemic. Previous research infection causes human disease or whether this
in Cardiff has shown a steep increase in the environmental contaminant innocently lodges in
incidence of Crohn’s disease. Given that inhalation is ulcerated mucosa. He asks if MAP might be
a probable route of MAP infection in cattle, it was analogous to Helicobacter pylori in peptic ulcer
suggested that the pattern of clustering of Crohn’s disease, gastritis and gastric cancer, where host
disease in Cardiff may be due to people inhaling genetics and microbial virulence factors determine
aerosols carrying MAP from the river. Other locations immune responses that mediate clinical disease in a
around the world, with similar geographic small minority of patients exposed to a widespread
characteristics to the landscape in Cardiff, have since infectious agent. He says that this controversy has
been identified as having higher rates of Crohn’s persisted far too long and needs to be resolved
disease. In New Zealand, a high incidence of Crohn’s (Sartor, 2005).
disease has been reported in the Canterbury region
of South Island where Christchurch is the principal For patients that have developed Crohn’s disease
city. Rivers run from the mountains in the northwest avoiding foods that precipitate the symptoms has
across rich agricultural pastures and then around proved to be a successful way of avoiding drug
either side of Christchurch before entering the sea. A (corticosteroid) therapy. In the Lancet in 1993,
small river meanders through the city itself. As researchers from a Cambridge hospital reported that
stated, these features resemble the situation in altering the diet was as effective in producing
Cardiff. Similarly, a higher incidence of Crohn’s remission of Crohn’s disease as corticosteroid
disease has been observed in the US, in Winnipeg, treatment thus providing an alternative therapeutic
Minnesota. The city straddles the junction of two strategy to treating Crohn’s. The research showed
large rivers; the Red River and the Assiniboine River. that the food intolerances were predominantly to
The 'hot spot' of Crohn’s disease in Winnipeg is cereals, dairy products and yeast (Riordan et al.,
probably due to local exposure to high levels of 1993). The foods that trigger symptoms differ for
waterborne MAP brought down from the each person with Crohn’s disease and no single diet

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has been established to alleviate the symptoms. practice guidelines’ that will consolidate the existing
Types of food and drink that have been associated information regarding diet and IBD. They include
with worsening symptoms include: nutritional deficiency screening, avoiding foods that
worsen symptoms, eating smaller meals at more
• Milk and dairy products frequent intervals, drinking adequate fluids, avoiding
• Alcohol caffeine and alcohol, taking vitamin/mineral
• Spicy foods supplements, eliminating dairy if lactose intolerant,
• Fatty foods limiting excess fat, reducing carbohydrates and
• High-fibre foods reducing high-fibre foods during flare ups. They say
that mixed advice exists regarding probiotics and
Source: NHS Direct Wales, 2013. note that enteral nutrition (the delivery of
nutritionally complete food directly into the stomach)
Not all patients respond equally to dietary changes, is recommended for Crohn’s disease patients in
many simply remove symptom-provoking foods that Japan, which differs from practices in the USA and
affect them, such as dairy, wheat, corn and certain UK (Brown et al., 2011). Manipulating the diet rather
fruits and vegetables (Brown and Roy, 2010). In a than relying on drug therapy may be particularly
review of the evidence coupled to existing dietary important as corticosteroid treatment in patients
information provided patient-centred IBD-related with Crohn’s disease has been linked to osteoporosis
organisations, scientists from the Department of (Dear et al., 2001).
Complementary and Alternative Medicine at John A
Burns School of Medicine at the University of Hawaii Stress and smoking can also influence the course of
in Manoa are attempting to create new ‘global Crohn’s disease.

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Diabetes factors and environmental triggers. Type 1 diabetes is

usually treated with regular injections of insulin to
Diabetes mellitus is a chronic disease caused by too regulate blood sugar levels.
much sugar (glucose) in the blood. Blood sugar levels
rise when there is not enough insulin in the blood, or Type 2 diabetes occurs either when the body does
the insulin that is in the blood does not work not produce enough insulin or when it cannot use
properly. Insulin is an important hormone secreted by the insulin produced. This type of diabetes is linked
the beta cells of the islets of Langerhans in the with obesity. If you are overweight or obese
pancreas. It regulates blood sugar levels by, for (you have a body mass index of 30 or more),
example, promoting the uptake of glucose into you are at greater risk of developing type 2
the cells. When things go wrong, high levels of diabetes. In particular, fat around your
glucose in the blood can cause damage to the abdomen (tummy) puts you at increased
nerves and blood vessels. Without treatment risk because it releases chemicals that can
diabetes can lead to long-term health problems upset the body’s cardiovascular and
including kidney failure, gangrene, metabolic systems (NHS Choices, 2012m).
sensory loss, ulceration, blindness, Type 2 diabetes occurs mostly in
cardiovascular disease and stroke. people over the age of 40, but is now
increasingly affecting people at a
There are two main types of much younger age.
diabetes; type 1 and type 2. A third
type of diabetes, gestational The main symptoms are common to
diabetes, develops in some women both types of diabetes: feeling very
during pregnancy but usually thirsty, urinating frequently,
disappears after giving birth. particularly at night, feeling very
tired and weight loss with loss of
Type 1 (insulin-dependent muscle bulk. Other symptoms of
diabetes) occurs when the body type 2 diabetes include: itchiness
produces little or no insulin. around the vagina or penis, or
People who have type 1 regular bouts of thrush (a yeast
diabetes must check the infection), blurred vision that is
levels of glucose in their caused by the lens of your
blood regularly and will eye becoming very dry,
need treatment for the cramps, constipation and
rest of their lives. Type 1 skin infections. Not all
diabetes is sometimes symptoms occur and
called juvenile-onset those that do might be
diabetes because it tends to subtle and may go unnoticed
develop before the age of 40, often in for years. Blood sugar levels in type 2
the teenage years. The peak age for diabetes can be controlled by lifestyle
diagnosis in the UK is between 10 and 14 changes including regular exercise coupled
years but is becoming younger with a steep to diet control and weight loss.
rise in the under-fives (Williams and Pickup,
2004). Over the past 60 years, the Type 1 diabetes is an autoimmune disease
worldwide incidence of type 1 diabetes where the immune system’s ‘soldiers’,
has been increasing by 3-5 per cent per known as T-cells, destroy the body’s own
year, doubling approximately every 20 insulin-producing beta cells in the
years with a rapid increase in the number pancreas. This type of response is thought
of very young children affected (TEDDY to involve a genetic predisposition
Study Group, 2008). Symptoms include a (diabetes in the family) coupled to an
frequent urge to urinate, extreme thirst environmental trigger.
and hunger, weight loss, fatigue, irritability
and nausea. The cause of type 1 diabetes is In the UK, about 90 per cent of all adults
poorly understood, but evidence suggests it with diabetes have type 2 diabetes. While
involves a combination of genetic rising obesity levels have contributed to

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the increase in the incidence of type 2 diabetes, the some parts of the world, principally in developed
increase in obesity does not explain the huge countries. Diabetes tends to occur more in cultures
increase in the number of cases of type 1 diabetes consuming diets high in animal fats and less in
seen over the last few decades. The number of cultures consuming diets high in complex
under-fives with Type 1 diabetes has increased five- carbohydrates. As carbohydrate intake increases and
fold over 20 years (Gillespie et al., 2004). saturated animal fat intake decreases from country
Furthermore, new research shows that the UK now to country, the number of deaths from type 2
ranks fifth out of 88 countries in the incidence of diabetes plummets from 20.4 to 2.9 people per
type 1 diabetes in children. A league table compiled 100,000 (Campbell and Campbell, 2005).
by the charity Diabetes UK from data from the
International Diabetes Federation shows that Finland In England and Wales, the rates of diabetes fell
tops the international league table with a rate of markedly between 1940 and 1950. This is because
57.6 per 100,000 children in 2011. Sweden is next during the Second World War, and in the period
with a rate of 43.1, then Saudi Arabia 31.4, and following it, people tended to eat less fat and sugar
Norway 27.9 and then the UK with 24.5 children in and more plant foods, and therefore more fibre,
every 100,000 diagnosed (Iacobucci, 2013). Type 1 antioxidants, complex carbohydrates, vitamins and
diabetes is the most common form of the disease in minerals (Trowell, 1974). All available land was used;
children; over 90 per cent of children under the age many people grew their own vegetables and
of 16 with diabetes have type 1. However, type 2 vegetable patches were cultivated all over the
diabetes (normally affecting adults in the post 40 age country. Gardens, flowerbeds and parks were dug up
group) now seems to be emerging in young adults and planted with vegetables; even the moat around
too at the level of a global epidemic driven by the the Tower of London (drained in 1843) was used for
increasing burden of obesity (Wilmot et al., 2010; growing vegetables. Then as rationing came to an
Song, 2012). This raises the possibility of a serious end and people moved away from whole grains
public health challenge in the next few decades. towards a more processed diet, rates of diabetes
increased again (Trowell, 1974). The conclusion must
Between 1996 and 2011, the number of people be that a high-carbohydrate, low-fat plant-based
diagnosed with diabetes rose from 1.4 to 2.9 million in diet offers some protection against type 2 diabetes.
the UK. An estimated 850,000 people are thought to
have the disease but not yet know it. If current trends The risk factors for type 2 diabetes (obesity, poor diet
continue by 2025 it is estimated that five million people and lack of exercise) are well-documented and there
in the UK will have diabetes (Diabetes UK, 2012). A are many steps people can take to limit their chances
report published in the journal Diabetic Medicine of developing type 2 diabetes. One obvious step is to
projects that the NHS’s annual spending on diabetes reduce the amount of saturated fat in the diet, this
will increase from £9.8 billion to £16.9 billion over the means cutting down on meat and dairy and
next 25 years, this rise means that in 2035, the NHS increasing the intake of fruit, vegetables, whole
could be spending 17 per cent of its entire budget grains, pulses, nuts and seeds. Simple lifestyle
on treating diabetes (Hex et al., 2012). measures have been shown to be effective in
preventing or delaying the onset of type 2 diabetes.
The global rise in diabetes is epidemic. In 1985 an
estimated 30 million people worldwide had diabetes; To help prevent type 2 diabetes and its
a decade later this figure had increased to 135 complications, the WHO recommends the following:
million and by 2000 an estimated 171 million people
had diabetes. In 2011, 347 million people worldwide • Achieve and maintain healthy body weight
were affected and the WHO projects that diabetes • Be physically active – at least 30 minutes of
will be the seventh leading cause of death in 2030 regular, moderate-intensity activity on most days
(WHO, 2013b). The increase in diabetes is attributed (more activity is required for weight control)
to a range of factors including population growth, • Eat a healthy diet of between three and five
ageing, unhealthy diets that are high in saturated fat servings of fruit and vegetables a day and reduce
and cholesterol, obesity and lack of physical exercise. sugar and saturated fats intake
• Avoid tobacco use – smoking increases the risk of
Diabetes has become one of the major causes of cardiovascular diseases
premature illness and death in many, but not all,
countries. Indeed, diabetes occurs much more in (WHO, 2013b).

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Prevention of diabetes is crucial to lowering disease changes, the low-fat vegan diet was found to
incidence and minimising the public health burden. improve glycaemia and plasma lipids more than the
There is a large body of evidence showing that plant- conventional diabetes diet. In other words, the vegan
based diets can lower the risk of diabetes. A study of diet offered significantly more benefits.
the relationship between diet and chronic disease in a
cohort of 34,192 California Seventh-day Adventists A further review of the literature revealed how
revealed that the vegetarian Adventists were much observational studies show that vegetarians are about
healthier than their meat-eating counterparts: the half as likely to develop diabetes compared with non-
meat-eaters were twice as likely as the vegetarians to vegetarians. They also describe how in clinical trials in
suffer from diabetes (Fraser, 1999). This study also individuals with type 2 diabetes, low-fat vegan diets
revealed that obesity increased as meat consumption improve glycaemic control to a greater extent than
increased; the difference between vegetarian and conventional diabetes diets. This beneficial effect is
non-vegetarian men and women was 6.4kg and largely due to weight loss but may also be partly
5.5kg respectively (Fraser, 1999). More recently, a attributable to the reduced intake of saturated fats
meta-analysis of studies examining the role of diet and high-glycaemic-index foods coupled to the
and lifestyle in diabetes prevention found that diets increased intake of dietary fibre and vegetable
rich in whole-grain, high-fibre cereal products and protein. Vegetarian and vegan diets also improve
non-oil-seed pulses (chick peas, beans, peas and plasma lipid concentrations and have been shown to
lentils) are beneficial, whereas, frequent meat reverse atherosclerosis progression, thus lowering the
consumption was found to increase the risk risk of heart disease (Barnard et al., 2009a).
(Psaltopoulou et al., 2010). They also found that four
cups per day of filtered coffee or tea reduced Further studies confirm the beneficial role of plant-
diabetes risk but that alcoholic beverages should not based diets in the prevention and treatment of
exceed 1-3 drinks per day. They concluded that diabetes. A review of both observational studies and
obesity is the most important factor accounting for intervention trials concluded that a low-fat, plant-
more than half of new diabetes cases; even modest based diet can improve control of weight, glycaemia
weight loss has a favourable effect in preventing and cardiovascular risk. The authors of this review
diabetes and physical exercise, with or without diet, concluded that vegetarian and vegan diets present
contributes to a healthier lifestyle and lowers the risk. potential advantages in managing type 2 diabetes
that merit the attention of individuals with diabetes
Vegetarian and vegan diets offer significant benefits and their caregivers (Trapp and Barnard, 2010). In
for diabetes management. One study compared the summary, the current literature indicates that
effects of a low-fat vegan diet with that of a vegetarian and vegan diets present huge potential
conventional diabetes diet on glycaemia, weight and advantages for the management of type 2 diabetes.
plasma lipids in a clinical trial (Barnard et al., 2009).
Type 2 diabetics were randomly assigned either a The importance of high-fibre diets in diabetes has
low-fat vegan diet or a diet following American been studied extensively since the 1970s by James
Diabetes Association guidelines. Their weight and Anderson, Professor of Medicine at the University of
plasma lipids were measured at the start, middle and Kentucky. Anderson used a high-fibre, high-
end of the 74-week trial. Both groups lost weight carbohydrate low-fat diet to treat 25 type 1 and 25
but those on the conventional diet had restricted type 2 diabetics (Anderson, 1986). The experimental
calorie intake whilst the vegan group did not. Both diet consisted mostly of whole plant foods (although
diets were associated with a sustained drop in it did contain a small amount of meat). After three
plasma lipid concentrations. The reduction in weeks, Anderson measured blood sugar levels,
triglycerides (fats in blood) in the vegan group was weight and cholesterol levels and calculated their
substantial as was the decrease in cholesterol levels medication requirements. The results were
(the total cholesterol level fell by 0.53mmol/L and astounding. Remember in type 1 diabetes no insulin
0.18mmol/L in the vegan and conventional diet is produced so it seems unlikely that a change in diet
groups respectively). Around six in 10 adults in would help. However, Anderson’s patients required
England have cholesterol levels of 5mmol/l or above, 40 per cent less insulin medication than they had
you should aim to have a cholesterol level under needed before the trial. In addition to this, their
4mmol/l (BHF, 2013). So a reduction of 0.5mmol/L cholesterol levels dropped by an average of 30 per
could be significant in reducing the risk of heart cent too. This is just as important in lowering the risk
disease. In an analysis controlling for medication factors for secondary outcomes of diabetes such as

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heart disease and stroke. Type 2 diabetes is generally high proportion of the high risk genes are referred to
more treatable and the results among the type 2 as having a ‘high-risk HLA genotype’. Researchers
patients were even more impressive: 24 out of the from the Diabetes and Metabolism Division of
25 participants consuming the high-fibre, low-fat Medicine at the University of Bristol looked at the
diet were able to stop taking their insulin medication frequency of these high risk genes in a group of 194
completely! These benefits were not of a temporary patients who were diagnosed with type 1 diabetes
nature, indeed they were sustained over time in a as children over 50 years ago (between 1922 and
group of 14 diabetic men continuing on the high- 1946). They compared them to a group of 582 age-
carbohydrate, high-fibre diet for four years (Story et matched and sex-matched individuals diagnosed
al., 1985). between 1985 and 2002. Results showed that the
frequency of the high-risk genotype was 12 per cent
The evidence is overwhelming: a high-carbohydrate, lower in the individuals diagnosed recently compared
high-fibre diet provides effective, positive and safe with the older group (Gillespie et al., 2004). Other
treatment for diabetes and lowers the associated risk studies from Finland and the US have found a similar
for coronary artery disease (Anderson et al., 1990). disparity (Hermann et al., 2003; Vehik et al., 2008).
More recent studies have shown increasing dietary
fibre in the diet of patients with type 2 diabetes is So, what does this all mean? The important point
beneficial and should be encouraged as a disease here is that increasing environmental exposure is
management strategy (Anderson et al., 2004; now able to trigger type 1 diabetes in people who
Barnard et al., 2009; Post et al., 2012). Of course it are less genetically susceptible than the generation
should be noted that this is not a special diet for above them. In other words, the rapid rise of type 1
diabetics; most people would benefit from increasing diabetes must be due to a major environmental
their fibre intake while reducing the amount of factor rather than genes.
dietary fat they consume.
But what is this elusive environmental trigger? A
As stated, it is thought that type 1 diabetes involves growing body of evidence suggests it may be a
a genetic susceptibility coupled to an environmental component of the diet. In 2000 an extensive study of
trigger. It has been suggested that an increased children from 40 different countries confirmed a link
environmental pressure may reduce the need for a between diet and incidence of type 1 diabetes
strong genetic susceptibility in order for type 1 (Muntoni et al., 2000). The study set out to examine
diabetes to develop (Vehik et al., 2008). Modern the relationship between dietary energy from major
molecular genetics has enabled scientists to identify food groups and incidence of type 1 diabetes. The
genes linked to type 1 diabetes and develop a total energy intake was not associated with type 1
hierarchy of susceptibility based on the number of diabetes incidence. However, energy from animal
these genes that a person carries. People carrying a sources (meat and dairy foods) was associated and

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energy from plant sources was inversely associated diabetes are more likely to have been breastfed for
with diabetes. This means that the more meat and less than three months and to have been exposed to
milk in the diet, the higher the incidence of diabetes cow’s milk protein before four months of age
and the more plant-based food in the diet, the lower (Gerstein et al., 1994). The avoidance of cow’s milk
the incidence. during the first few months of life may reduce the
risk of type 1 diabetes. Infants who cannot
As stated, type 1 diabetes is thought to involve both breastfeed from their mothers may benefit more
a genetic predisposition and an environmental from taking a plant-based formula such as soya-
trigger. The trigger may be a virus or some based formula rather than one based on cow’s milk.
component of food. In the early 1990s a Canadian Other studies support the finding that both early and
research group suggested that cow’s milk proteins adolescent exposure to cow’s milk may be a trigger
might be an important environmental trigger for type 1 diabetes (Kimpimaki et al., 2001;
providing specific peptides that share antigenic Thorsdottir and Ramel, 2003).
epitopes with host cell proteins (Martin et al., 1991).
This means that the proteins in cow’s milk look the Further evidence suggesting that the early exposure
same as proteins in our own bodies; these similarities to cow’s milk in infancy (including cow’s milk infant
can confuse our immune system and initiate an formula) may be a trigger for type 1 diabetes in
inappropriate (autoimmune) response that can lead some children was provided in a substantial review
to diabetes. of 27 case-control studies and one prospective
cohort study looking at the associations of
The milk protein casein is similar in shape to the breastfeeding and/or the early introduction of cow’s
insulin-producing cells in the pancreas. Because the milk and formula with the development of type 1
body may perceive casein as a foreign invader and diabetes. Eight of the studies showed that
attack it, it may also start to attack the pancreas cells breastfeeding can protect against type 1 diabetes
having confused them for casein, again leading to while seven additional studies emphasised that a
diabetes (Cavallo et al., 1996). Some studies have short period or absence of breastfeeding could be a
suggested that bovine serum albumin (BSA) is the risk factor for type 1 diabetes. The authors
milk protein responsible. In a study of 142 children concluded that a short duration and/or a lack of
with type 1 diabetes, all the diabetic patients had breastfeeding may constitute a risk factor for the
higher serum concentrations of anti-BSA antibodies development of type 1 diabetes later in life
compared to 79 healthy children (Karjalainen et al., (Patelarou et al., 2012).
1992). These antibodies may react with proteins on
the surface of the beta cells of the pancreas and so The hunt for the elusive environmental trigger
interfere with insulin production. responsible for the global rise in the incidence of
type 1 diabetes continues. Theories include: the
Other studies suggest it is the cow’s insulin present in hygiene hypothesis (a lack of early childhood
formula milk that increases the risk of type 1 exposure to infectious agents and parasites weakens
diabetes in infants (Vaarala et al., 1999). Research immunity and increases susceptibility to allergic and
shows that some infants may be more vulnerable to autoimmune diseases), a viral agent, vitamin D
type 1 diabetes later in life if exposed to cow’s milk deficiency and the breast milk versus cow’s milk
formula while very young. A Finnish study of children argument. It may be that no single factor is
(with at least one close relative with type 1 diabetes) responsible for the increase in the incidence of
examined whether early exposure to insulin in cow’s diabetes all over the world, a multi-factorial process
milk formula increased the risk of type 1 diabetes. might be involved and there may be some overlap
Results showed that infants given cow’s milk formula between the various hypotheses (Ergo, 2013).
at three-months-old had immune systems which However, taken together, the evidence suggests that
reacted far more strongly to cow’s insulin (Paronen et avoiding milk and milk products may offer protection
al., 2000). This raises concerns that exposure to from diabetes (types 1 and 2).
cow’s insulin plays a role in the autoimmune process
leading to type 1 diabetes. For more information see Viva!Health’s fully-
referenced scientific report The Big-D: Defeating
A review of the clinical evidence suggests that the Diabetes through Diet and easy-to-read guide
incidence of type 1 diabetes is related to the early The Big-D: defeating diabetes with the D-Diet at
consumption of cow’s milk; children with type 1 www.vegetarian.org.uk/campaigns/diabetes.

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Dementia dementia found that, compared to normal weight,

being overweight or obese in midlife, increases the risk
Obesity is epidemic in Western societies and of dementia later in life by 34 and 91 per cent
constitutes a major public health concern. A study respectively. It was predicted that dementia levels in
published in the British Journal of Medicine reports the US and China would be nine and 19 per cent
that being obese during middle-age can increase the higher respectively than previously forecast (Loef et al.,
risk of developing dementia later in life (Whitmer et 2013). The authors of this review conclude that the
al., 2005). The research is based on data collected increase in midlife obesity levels will contribute
from detailed health checks made on 10,276 men significantly to the future prevalence of dementia and
and women between 1964 and 1973 (when they suggest that public health measures to reduce midlife
were aged 40 to 45). Dementia was diagnosed in obesity should be regarded as also being primary
seven per cent of participants between 1994 and prevention measures to reduce the risk of dementia.
2003. Results showed that being obese increased This raises very real concerns that the current obesity
the risk of dementia by a whopping 74 per cent epidemic could lead to a steep rise in the numbers of
while being overweight increased it by 35 per cent. people suffering from dementia in the future. The
The link between obesity and dementia in women evidence suggests that eating a healthy plant-based
was stronger than that in men. diet and leading a healthy lifestyle could help to reduce
the risk of dementia (See Overweight and obesity).
This is in agreement with a
Swedish study which found
that the higher a woman’s
body mass index (BMI), the
greater the risk of
dementia (Gustafson et al.,
2003). In this study the
relationship between BMI
and dementia risk was
investigated in 392
Swedish adults who were
assessed between the ages
of 70 and 88. During the
18-year study, 93
participants were
diagnosed as having
dementia. Women who
developed dementia had a
higher average BMI
compared to women
without dementia. For
every one unit increase in
BMI at age 70 years, the
risk of dementia increased
by 36 per cent.

A substantial body of
evidence now shows that
obesity is a risk factor for
dementia. However, it has
been argued that current
forecasts of dementia fail to
take the rising obesity levels
into account. A review of
studies on the association
between midlife obesity and

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Ear Infection 27 per cent of those with the allergy suffered from
recurrent ear infections compared to just 12 per cent
The most common type of ear infection (otitis media) of those who did not have the allergy (Juntti et al.,
affects the middle ear, the space between the 1999). It was concluded that children with cow’s milk
eardrum and the inner ear. The middle ear is usually allergy experience significantly more ear infections.
filled with air but it can fill up with fluid (during a
cold for example) and ear infections happen when Dr John James of the Colorado Allergy and Asthma
bacteria, viruses or fungi infect the fluid and cause Centres in the US suggests that food allergies can
swelling in the ear. Ear infections are common in cause inflammation in the nasal passages and lead to
childhood and can be extremely painful causing a the build-up of fluid in the middle ear, but he
considerable amount of distress. Chronic otitis media acknowledges that the link between food allergy and
is when ear infections keep recurring, for example ear infection may be hard to prove (James, 2004). A
glue ear is a type of chronic otitis media. Otitis media recent review stated how a large body of
usually reoccurs several times during childhood epidemiologic evidence now supports a role for
years. One third of children will have six or more allergic rhinitis (allergic inflammation of the nasal
episodes of otitis media by the time they are seven airways) as a possible cause of otitis media. Evidence
years old. The condition occurs less often as the child also supports a role for histamine (a compound that
gets older. It would be unusual for children over the triggers the inflammatory response) in both
age of seven to be affected by further episodes (NHS conditions (Skoner et al., 2009). The authors of this
Choices, 2012m). Complications of middle ear study say that given the strong likelihood of allergy as
infection are now less common than they were in a risk factor for otitis media, allergic rhinitis patients
the past. However, it can be a serious problem; otitis should be evaluated for otitis media and vice versa.
media with effusion (glue ear) is the most common
cause of hearing impairment in childhood (NICE, In 2009 the American Dietetic Association reported
2011). Symptoms vary with time and age, hearing that for infants, breastfeeding is associated with a
loss usually resolves over several weeks or months, reduced risk of otitis media (along with a reduced
but may be more persistent if in both ears, may lead risk of gastroenteritis, respiratory illness, sudden
to educational, language and behavioural problems. infant death syndrome, necrotising enterocolitis,
obesity and hypertension. They say that exclusive
Ear infections are often linked to colds or other breastfeeding provides optimal nutrition and health
problems of the respiratory system. However, some protection for the first six months of life and
reports link ear infections to food allergies (Hurst, breastfeeding with complementary foods from six
1998; Aydogan et al., 2004; Doner et al., 2004). months until at least 12 months of age is the ideal
Researchers from Georgetown University in the US feeding pattern for infants (James et al., 2009). More
examined the role of food allergy in ear infection in studies are needed to examine the relationship
104 children with recurrent ear problems (Nsouli et between food allergy and ear infection but the
al., 1994). The children were tested for food allergies possibility of cow’s milk allergy should be considered
and those who tested positive excluded that in all cases of ear infection, particularly in children.
particular food for 16 weeks, then reintroduced it.
Results showed that 78 per cent of the children with
ear problems also had food allergies, the most Food Poisoning
common allergenic foods were cow’s milk (38 per
cent), wheat (33 per cent), egg white (25 per cent), Food poisoning is a common, often mild, but
peanut (20 per cent) and soya (17 per cent). 86 per sometimes deadly illness. It is caused by the
cent of these children responded well to eliminating consumption of food or drink that is contaminated
the offending food, and of these, 94 per cent with bacteria, parasites or viruses. Most cases result
suffered a recurrence of ear problems on from bacterial contamination. Food poisoning
reintroducing the offending food. happens in one of two ways: either in the food (for
example in undercooked meat or unpasteurised
A different approach was taken in a Finnish study of milk), or on the food (if it is prepared by someone
56 children with cow’s milk allergy and 204 children who has not washed their hands). The length of the
without cow’s milk allergy. These researchers incubation period (the time between swallowing the
examined the occurrence of ear infection in children bacteria and symptoms appearing) varies from hours
known to have cow’s milk allergy. Results showed that to days, depending on the type of bacteria and how

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many were swallowed. The most common symptoms caused illness and deaths (especially among children)
of food poisoning are sickness, vomiting, abdominal owing to its presence (in several countries) in minced
pain and diarrhoea. It’s difficult to know exactly how beef, unpasteurised cider, cow’s milk, manure-
many people get food poisoning because mild cases contaminated lettuce and alfalfa and manure-
often go unreported but the Food Standards Agency contaminated drinking-water (WHO, 2013c). The
estimates that food poisoning affects up to 5.5 potential sources of E. coli contamination of fruit
million people in the UK each year (NHS Choices, (cider apples) are numerous. One possible source
2013f). It usually lasts for less than three days, but may be bird droppings; birds have been shown to
can continue for up to a week. The greatest danger spread various food-borne pathogens including
lies in the loss of fluids and salts from prolonged Campylobacter, Salmonella, Vibrio cholerae and
diarrhoea. The results can be deadly in infants and Listeria species. Another possibility is windfall apples
over 60s. Also, in these patients, the bacteria may being exposed to animal faeces. The contamination
enter the bloodstream infecting other parts of the of damaged apples with E. coli O157:H7 can also be
body and may cause death unless the person is spread by fruit flies and then fruit-to-fruit
treated promptly with antibiotics. transmission by fruit flies ensures the infection
spreads (Janisiewicz et al., 1999). Indeed research
Some toxins can cause food poisoning within a shows that flies can transmit foodborne pathogens
much shorter time than described above. In these and that the areas of higher risk are those in closer
cases, vomiting is the main symptom. Foods proximity to animal production sites (Barreiro et al.,
particularly susceptible to contamination if not 2013). In a joint report between the FSA
handled, stored or cooked properly include: Scotland and the Scottish Executive it
was noted that the main source of E.
• Raw meat and poultry coli O157 is from cattle and sheep,
• Raw eggs but that more cases of E. coli O157
• Raw shellfish are now associated with
• Unpasteurised milk environmental contamination,
• 'Ready to eat' foods, such as cooked including contact with animal faeces
sliced meats, pâté, soft cheeses and pre- or contamination by faeces of water
packed sandwiches supplies, than with food (FSA/SE,
2001). If plants do cause food
Source: NHS Choices, 2013e. poisoning it is generally because
they have been
Most cases of food poisoning contaminated with
are related to the animal excreta, human
consumption of animal sewerage or handled
products (meat, poultry, with dirty hands
eggs, fish and dairy) as during preparation.
plants tend not to harbour Safe disposal of
the types of bacteria manure from large-
capable of causing food scale animal and
poisoning in humans. poultry production
Intensive animal facilities is a
husbandry growing food
technologies, safety problem in
introduced to minimise much of the world
production costs, have (WHO, 2013c).
led to the emergence of
new zoonotic diseases; Food can become
animal diseases that can contaminated at any
be transmitted to humans stage during
(WHO, 2013c). Escherichia production, processing or
coli (E. coli) O157 was cooking, for example,
identified for the first time food poisoning can be
in 1979 and has since caused by:

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 White Lies

• Not cooking food

thoroughly (particularly
poultry, pork, burgers,
sausages and kebabs)
• Not storing food that
needs to be chilled at
below 5°C correctly
• Leaving cooked food
for too long at warm
temperatures
• Someone who is ill or
who has dirty hands
touching the food
• Eating food that has
passed its ‘use by’ date
• Cross-contamination
(the spread of bacteria, such as E.coli, from cooked shellfish to reduce their risk of food
contaminated foods) poisoning (NHS Choices, 2013f).

Source: NHS Choices, 2013e. In the Food Standards Agency’s Annual Report to the
Chief Scientist 2012-2013, it was reported that of
The most common cause of food poisoning in the the five major pathogens monitored by the Agency
UK is the bacterium Campylobacter, which are (campylobacter, Listeria monocytogenes, norovirus,
usually found on raw or undercooked meat E. coli O157 and salmonella), campylobacter remains
(particularly poultry), unpasteurised milk and the most frequently reported cause of foodborne
untreated water. Undercooked chicken liver and liver disease accounting for 60 per cent of reported cases
pâté are also common sources. The next most in England and Wales and the highest proportion of
common cause is Salmonella, which are often found hospitalisations (92 per cent). Although foodborne
in raw meat and poultry, they can also be passed illness due to Listeria monocytogenes is relatively rare
into eggs and unpasteurised milk. Listeria bacteria (less than one per cent), it is associated with the
may be found in a range of chilled, ready-to-eat highest mortality at 30 per cent (FSA, 2013a).
food, including: pre-packed sandwiches, pâté,
butter, soft cheeses (such as brie, camembert or The Food Standards Agency’s current best estimate
others with a similar rind), soft blue cheese, cooked suggests that there are around one million cases of
sliced meats and smoked salmon. E. coli are found in foodborne illness in the UK each year, resulting in
the digestive systems of many animals, including 20,000 hospital admissions and contributing to
humans. Most strains are harmless but some strains around 500 deaths. However, many illnesses go
can cause serious illness. Most cases of E. coli food unreported and their report states that around 25
poisoning occur after eating undercooked beef per cent of the population suffer from an episode of
(particularly mince, burgers and meatballs) or intestinal infectious disease each year; equivalent to
drinking unpasteurised milk (NHS Choices, 2013f). 17 million cases annually. The public health impact of
gastrointestinal infection continues to be significant;
The virus most commonly linked to gastrointestinal the estimated cost for England and Wales in 2011
illness is the norovirus (also known as the vomiting was £1.6 billion (FSA, 2013a).
bug). It is easily transmitted from person to person,
from contaminated food or water. Raw shellfish, Listeria is an opportunistic pathogen that can cause
particularly oysters can be a source of viral severe illness (listeriosis) in vulnerable groups such as
contamination. A study funded by the Foods pregnant women, babies, the elderly and people with
Standards Agency found that three-quarters of reduced immunity. The Government advises pregnant
oysters sampled from harvesting beds within UK women to avoid soft mould-ripened cheese, such as
waters contained norovirus (albeit at low levels in Camembert and Brie, blue cheese and all types of
half the samples). The FSA advises that older people, meat pâté. Other bacteria that can cause food
pregnant women, very young children and people poisoning include species of Staphylococcus and
who are unwell should avoid eating raw or lightly Clostridium. Certain strains of otherwise normal

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intestinal bacteria can cause food poisoning. For found that a Mexican-style soft cheese had been
example, E. coli is usually harmless but the strain E. contaminated with unpasteurised milk.
coli O157 can cause kidney failure and death.
Bacteria are too small to see and they do not taste or
The majority of food poisoning cases in the UK are smell of anything so it is difficult to detect their
caused by consuming contaminated meat or dairy presence. The risk of food poisoning can be
products. For example, of the Staphylococcal food minimised by following some basic hygiene rules.
poisonings reported in the UK between 1969 and This means washing hands before handling food,
1990, 53 per cent were due to meat products washing salads thoroughly (to remove contaminating
(especially ham), 22 per cent were due to poultry, bacteria from manure for example), making sure all
eight per cent were due to milk products, seven per food is covered and chilled. If meat is to be
cent to fish and shellfish and 3.5 per cent to eggs consumed it must be thawed and cooked properly to
(Wieneke et al., 1993). While most cases of food kill harmful bacteria. It is important to keep raw
poisoning are associated with meat and poultry, the meat (and its juices) away from other foods.
link between milk products and food poisoning
should not be discounted: 20 separate outbreaks of The Centers for Disease Control and Prevention (CDC)
food poisoning in England and Wales associated in Atlanta, US is a national public health institute that
with the consumption of milk and dairy products focuses on disease control and prevention. The CDC
were reported to the Public Health Laboratory state that raw (unpasteurised) milk can carry harmful
Service Communicable Disease Surveillance Centre bacteria and other germs and that while it is possible
between 1992 and 1996 (Djuretic et al., 1997). 600 to get foodborne illnesses from many different foods,
people were affected and over 45 were admitted to they say that raw milk is one of the riskiest of all.
hospital. Salmonella species were responsible for 11 Bacteria such as E. coli, Campylobacter and
of the outbreaks, Campylobacter species for five, E. Salmonella can contaminate milk from cows, sheep
coli O157 for three and Cryptosporidium parvum for and goats. Animals that carry these germs usually
one. Outbreaks were associated with hotels, a appear healthy. Getting sick from raw milk can mean
psychogeriatric hospital, schools, a Royal Air Force many days of diarrhoea, stomach cramping, and
base, a farm visit, an outdoor festival and milk vomiting. Less commonly, it can mean kidney failure,
supplied directly from farms. Milk was implicated in paralysis, chronic disorders and even death. A person
16 of the outbreaks, 10 of which were associated can develop severe or even life-threatening diseases,
with unpasteurised milk. Two outbreaks were such as Guillain-Barré syndrome, which can cause
associated with eating contaminated ice-cream and paralysis and haemolytic uremic syndrome, which can
two with eating contaminated cheese. result in kidney failure and stroke (CDC, 2013).

In 2010, it was reported that since 2001, an increase Milk contamination may occur from:
in the number of listeriosis cases has been observed
in several EU countries, including England and Wales, • Cow faeces coming into direct contact with
predominantly in the over-60s population (Little et the milk
al., 2010). The main culprits for the overall • Infection of the cow’s udder (mastitis)
population and over 60’s were given as follows: • Cow diseases (eg bovine tuberculosis)
mixed sandwiches and pre-packed salads (23.1 and • Bacteria that live on the skin of cows
22 per cent respectively); finfish (16.8 and 14.7 per • Environmental contamination (eg faeces, dirt,
cent) and beef (15.3 and 11.2 per cent). For processing equipment)
pregnancy-associated cases, beef (12.3 per cent), • Insects, rodents and other animal vectors
milk and milk products (11.8 per cent), and finfish • Humans (eg by cross-contamination from soiled
(11.2 per cent) were more important sources of clothing or boots)
infection. Food poisoning may result from milk and
milk products if they have not been properly heated Source: CDC, 2013.
(pasteurised) or if they have become contaminated
following pasteurisation. A report published in the Good hygienic practices during milking may reduce,
New England Journal of Medicine reported how 142 but not eliminate, the risk of milk contamination.
cases of listeriosis in Los Angeles in 1985 led to 48 However, as the CDC state, dairy farms are a
deaths (Linnan, 1988). An extensive investigation reservoir for illness-causing bacteria. No matter what
traced the source to a cheese factory where it was precautions farmers take and even if their raw milk

75
 White Lies

tests come back negative, they cannot guarantee along the bile duct to the duodenum can be
that the milk, or the products made from their milk, extremely painful.
are free of harmful germs (CDC, 2013).
Obesity is a major risk factor for gallstones,
Distribution of raw milk is illegal in Scotland. In especially in women, who are two to three times as
England it is illegal to sell it from shops or likely as men to develop gallstones. Risk also
supermarkets but a number of registered producers increases with age; people over 40 are at a higher
can sell raw or ‘green top’ milk, directly to consumers, risk. Diet is also a causal factor. A study published in
either from a farm or at a farmers’ market or through the British Medical Journal in 1985 reported that
a delivery service. The number of registered raw cow’s meat-eaters are twice as likely to develop gallstones
drinking milk producers in England and Wales fell from as vegetarians (Pixley et al., 1985). Since then the
around 570 in 1997 to 102 in 2009 (FSA, 2009). They low incidence of gallstones in vegetarians compared
must display the warning "this product has not been to meat-eaters has been reported (Key et al., 1999).
heat-treated and may contain organisms harmful to Indeed vegetarian diets have been shown to be
health" and the dairy must conform to higher hygiene beneficial for both the prevention and treatment of
standards than dairies producing only pasteurised milk. gallstones (Leitzmann, 2005). The main risk factors
Avoiding unpasteurised milk, raw eggs and appear to be low fibre intake, high saturated fat and
undercooked meat further reduces the risk of food cholesterol intake and obesity. An Australian study
poisoning. Of course the safest option is to follow a reported an inverse association between dietary
plant-based diet free of red meat, poultry, fish, milk fibre and gallstones (Segasothy and Phillips, 2000).
and eggs. Excluding animal foods from the diet will In other words, the more fibre in the diet, the lower
dramatically decrease the risk of food poisoning. the risk of gallstones. Polish researchers examined
the diets of patients suffering from gallstones and
found that they were characterised by their low
Gallstones fibre diet (Ostrowska et al., 2005). Patients with
gallstones ate less wholemeal products, fruit and
Gallstones are solid pieces of stone-like material vegetables and pulses. Furthermore, obese women
usually made of cholesterol that form in the gall with gallstones ate significantly more milk, yogurt,
bladder, which is a small organ on the right hand meat and meat products.
side of the body, below the liver. It stores a green
liquid called bile, which is produced by the liver to Due to the role that cholesterol appears to play in
help the body digest fats. As we eat, bile is released the formation of gallstones, the UK government
from the gall bladder into the intestines through a recommends that the following fatty foods with high
thin tube called the bile duct. Gallstones are formed cholesterol content are avoided: meat pies, sausages
when some of the chemicals stored in the gall and fatty cuts of meat, butter and lard, and cakes
bladder harden into a solid mass. They may be as and biscuits. They recommend a low-fat, high-fibre
small as a grain of sand or as large as a golf ball. diet including plenty of fresh fruit and vegetables (at
Some people may have one large stone while others least five portions a day) and wholegrain foods (NHS
may have many small ones. Gallstones are the most Choices, 2012p). They also say that there is evidence
common cause of emergency hospital admission for that regularly eating nuts (such as peanuts or
people with abdominal pain. About eight per cent of cashews), can help reduce the risk of developing
the adult population has gallstones and 50,000 gallstones. Cutting down your drinking to no more
people a year have an operation to remove their than 3-4 units a day for men and 2-3 units a day for
gallbladder (NHS Choices, 2012o). women may also reduce the risk.

Gallstones are made up from a mixture of water,

cholesterol and other fats, bile salts and the pigment Insulin-like growth factor
bilirubin. They occur when the composition of the
bile is abnormal, the outlet from the gall bladder is 1 (IGF-1)
blocked (perhaps by infection), or if there is a family
history of gallstones. Gallstones can cause Insulin-like growth factor 1 (IGF-1) is a hormone
inflammation of the gall bladder (cholecystitis), produced in the liver and body tissues of mammals.
which may then block the bile duct leading to One important role for IGF-1 is to promote cell growth
obstructive jaundice. The passage of a gallstone and division, this is important for normal growth and

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development. It plays an important role in childhood Bristol says that although bovine IGF-1 is identical to
growth and continues to have anabolic effects (the human IGF-1 and in theory some of the IGF-1 that is
building up of organs and tissues) in adults. present in ingested milk may be absorbed un-
degraded, it is implausible that this would affect the
IGF-1 from cows is identical to human IGF-1 in that systemic levels of IGF-1 in humans. Holly states that
the amino acid sequence of both molecules is the the dynamics of the IGF-1 system (with a huge
same (Honegger and Humbel, 1986). Amino acids circulating reservoir and a large flux primarily due to
are the building blocks of proteins and there are 20 production from the liver) means that even assuming
different amino acids. All proteins consist of amino the extreme estimates of what could be absorbed
acids joined together like beads on a string and the and not metabolised it would still require
nature of the protein (how it behaves) is determined consumption of something like 60 litres of milk a day
by the order in which the amino acids occur along to increase serum levels by the least amount that
the string. In both human and bovine IGF-1 the same could be measurable. However, he goes on to say
70 amino acids occur in exactly the same order, that there are many small peptides and amino acids
which may or may not have a significant impact on that are present in milk that potently stimulate
human health (see below). As previously stated, the hepatic IGF-1 expression and pituitary growth
use of recombinant bovine somatotrophin (rBST) in hormone release (Holly, 2013). In other words,
cows increases levels of IGF-1 in their milk, however, drinking milk increases IGF-1 production from the
it should be noted that cow’s milk from cows that liver which in turn leads to an increase in the levels
are not treated with rBST also contains IGF-1. Again, present in the blood.
the significance of this is discussed below.
Milk is designed as the only food between birth and
It has been suggested that IGF-1 is not destroyed weaning and is designed to sustain the rapid growth
during pasteurisation. Furthermore it has also been that occurs at this stage of life. Holly states that his
suggested that it is not completely broken down in studies and those of others have consistently found
the gut and that it may cross the intestinal wall in that, of all the components of human diet, milk and
the same way that another dairy products have the greatest effects on IGF-1
hormone, epidermal growth levels. So it is not the presence of IGF-1 in milk that
factor (EGF), has been matters but rather the impact of milk on stimulating
shown to do. EGF is human IGF-1 production within individuals who
protected from being consume milk and dairy products. He also points
broken down when out that there is similar confusion over
food proteins (such as dairy cows treated with rBST (in the
the milk protein casein) US), the milk from such cows has
block the active sites of higher levels of bovine growth hormone
the digestive enzymes and bovine IGF-1 but neither are likely
(Playford et al., 1993). to alter the effects on humans
This allows the molecule consuming such milk.
to stay intact and cross the
intestinal wall and enter the Whether cow’s milk
blood. This raises a ingestion increases IGF-
theoretical concern that 1 levels in humans by
IGF-1 from cow’s milk bovine IGF-1 crossing
could increase normal the gut wall, or (as
blood IGF-1 levels and seems more likely)
so increase the risk of other components in
certain cancers linked milk initiating a rapid
to IGF-1. rise in human IGF-1
production from the
However, Professor liver, the net effect is the
Jeffrey Holly, same; if you drink cow’s
Professor of milk, you end up with
Clinical Sciences at higher levels of IGF-1 in
the University of your blood (see below).

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As stated, IGF-1 regulates cell growth, development colorectal cancer. Analysis of IGF-1 levels in samples
and division; it can stimulate growth in both normal taken from these men and 318 controls revealed an
and cancerous cells. Even small increases in serum increased risk for colorectal cancer among the men
levels of IGF-1 in humans are associated with increased who had the highest levels of circulating IGF-1 and it
risk for several common cancers including cancers of was concluded that circulating IGF-1 is related to
the breast, prostate, lung and colon (Wu et al., 2002). future risk of colorectal cancer (Ma et al., 1999).
The link between IGF-1 and cancer is becoming
increasingly apparent in the scientific literature. In summary, the literature strongly supports a link
between high circulating IGF-1 levels and cancer, but
In the first prospective study to investigate the what has this to do with the consumption of cow’s
relationship between the risk of breast cancer and milk and dairy products? The answer is a lot:
circulating IGF-1 levels, researchers at Harvard circulating IGF-1 levels are higher in people who
Medical School analysed blood samples originally consume milk and dairy products. Researchers at
collected from 32,826 women aged between 43 and Bristol University investigating the association of diet
69 years during 1989 and 1990. From this group, with IGF-1 in 344 disease-free men found that raised
397 women were later diagnosed with breast cancer. levels of IGF-1 were associated with higher intakes of
Analysis of IGF-1 levels in samples collected from milk, dairy products and calcium while lower levels of
these women compared to samples from 620 IGF-1 were associated with high vegetable
controls (without breast cancer) revealed a positive consumption, particularly tomatoes. In their study,
relationship between circulating IGF-1 levels and the published in the British Journal of Cancer, it was
risk of breast cancer among premenopausal (but not concluded that IGF-1 may mediate some diet-cancer
postmenopausal) women. It was concluded that associations (Gunnell et al., 2003).
plasma IGF-1 concentrations may be useful in the
identification of premenopausal women at high risk US researchers from Harvard Medical School and
of breast cancer (Hankinson et al., 1998a). Bringham and Women’s Hospital in Boston also
investigated the link between IGF-1 levels and diet.
To investigate the link between prostate cancer risk They examined circulating IGF-1 levels in 1,037
and plasma IGF-1 levels, a study was conducted on healthy women. The most consistent finding was a
152 men with prostate cancer and 152 men without positive association between circulating IGF-1 and
the disease. Analysis revealed a strong positive protein intake; this was largely attributable to cow’s
association between IGF-1 levels and prostate cancer milk intake (Holmes et al., 2002). In another study,
risk (Chan et al., 1998). In agreement, a Swedish researchers at the Fred Hutchinson Cancer Research
study compared IGF-1 levels in 210 prostate cancer Centre in Washington investigated the link between
patients with those in 224 men without the disease plasma levels of IGF-1 and lifestyle factors in 333
and found that there was a strong positive people thought to be representative of the general
correlation between the risk of prostate cancer and population. They too found that milk consumption
raised serum levels of IGF-1. It was concluded that was linked to IGF-1 levels (Morimoto et al., 2005).
high levels of IGF-1 may be an important predictor One study actually quantified the effect of cow’s milk
for risk of prostate cancer (Wolk et al., 1998). on circulating IGF-1 levels in 54 Danish boys aged
2.5 years. In this study an increase in cow’s milk
In a study into the link between the risk of lung intake from 200 to 600ml per day corresponded to a
cancer and IGF-1, serum IGF-1 levels were measured massive 30 per cent increase in circulating IGF-1. In
in 204 lung cancer patients registered at the agreement with Holly’s research, it was concluded
University of Texas M.D. Anderson Cancer Centre that milk contains certain compounds that stimulate
and compared to those in 218 people without lung IGF-1 concentrations (Hoppe et al., 2004). An even
cancer. Results showed that high levels of IGF-1 were earlier study concurred that cow’s milk contains
associated with an increased risk of lung cancer (Yu many bioactive compounds such as hormones and
et al., 1999). cytokines, growth factors, and many bioactive
peptides (Playford et al., 2000), which may also
In order to assess colorectal cancer risk in relation to affect IGF-1 levels.
IGF-1, a research group at Harvard Medical School
analysed blood plasma samples originally collected In conclusion, the research shows that nutrition has
from a pool of 14,916 men. In a 14-year follow-up an important role in determining serum IGF-1 levels
of these men, 193 had been diagnosed with (Yaker et al., 2005). Whether the increase in IGF-1

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caused by cow’s milk occurs directly (by IGF-1 Normally protein is filtered out by the kidneys and no
crossing the gut wall), or indirectly (as a result of the protein is excreted into the urine. However, when the
action of other factors), the research is clear. The kidneys are damaged, protein may pass into the
consumption of cow’s milk and milk products is urine. Other symptoms include retention of water in
linked to increased levels of IGF-1, which in turn are the body, called nephrotic syndrome. In some cases
linked to various cancers. In time, the molecular the damage to the kidney can be so severe that it
mechanisms underlying these links will inevitably be leads to a build-up of waste in the body and
teased out. ultimately kidney failure. The symptoms of kidney
failure include tiredness, sickness and vomiting.

Kidney Disease Certain kidney disorders can lead to the formation of

a kidney stone (renal calculi), a small hard mass in
The kidneys are two bean-shaped organs located in the kidney that forms from mineral deposits in the
the lower back. Kidneys filter the blood to remove urine. Stones may form when there is a high level of
unwanted waste products broken down from calcium, oxalate or uric acid in the urine; a
our food and drink. They also remove lack of citrate in the urine; or
excess liquid to help maintain correct insufficient water in the kidneys
fluid balance in the body. to dissolve waste products.

There are many diseases and Traditionally, a low-calcium

conditions that can affect the diet has been
kidney function: kidney recommended to reduce
inflammation the strain on the kidneys
(glomerulonephritis); in kidney stone patients.
kidney infection (such as However, over time a low-
pyelonephritis); genetic calcium diet can cause
disorders (such as problems in terms of bone
polycystic kidney health. In the last decade,
disease); hardening of attention has switched to the
the kidney due to a effects of animal protein on
disease of the arteries kidney stone formation. Several
(nephrosclerosis); kidney studies now suggest that a diet
failure due to characterised by normal-calcium,
atherosclerosis (plaques low-animal protein and low-salt
forming in the arteries levels is more effective than the
supplying the kidneys); traditional low-calcium diet for
autoimmune diseases (such as the prevention of kidney stones
systemic lupus erythematosus); in some people.
malaria; yellow fever; certain
medicines; mechanical blockages The relationship between an animal
(kidney stones) and physical injury. protein-rich diet and kidney stone formation
was investigated by researchers at the Centre in
Surveys have revealed that mild forms of kidney Mineral Metabolism and Clinical Research at the
disease are surprisingly common among the general Department of Internal Medicine in Dallas, Texas
population. The global epidemic of type 2 diabetes (Breslau, 1988). In this study, 15 young healthy
has led to an alarming increase in the number of participants were studied for three 12-day dietary
people with chronic kidney disease. The prevalence periods during which their diet contained vegetable
of chronic kidney disease is estimated to be eight to protein, vegetable and egg protein, or animal protein.
16 per cent worldwide (Jha et al., 2013). There may While all three diets were constant with respect to
be no apparent symptoms, although small amounts sodium, potassium, calcium, phosphorus, magnesium
of blood or protein may pass through the damaged and the total quantity of protein, they had progressively
filters in the kidneys into the urine. Such small higher sulphur contents (due to the increased sulphur
amounts of blood and protein in the urine are not content of animal proteins compared to that of plant
visible but can be detected by certain medical tests. proteins). As the sulphur content of the diet increased,

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urinary calcium excretion increased from 103mg per A report published in the Lancet in 1992 suggested
day on the vegetarian diet to 150mg per day on the that soya products may be beneficial in kidney
animal protein diet. The animal protein-rich diet was disease. Kidney disease patients with protein in the
associated with the highest excretion of uric acid and urine and high cholesterol levels were placed on a
therefore conferred an increased risk for uric acid cholesterol-free, low-protein, low-fat, high-fibre
stones (but not for calcium oxalate stones). The link vegetarian (vegan) diet containing soya products.
between animal protein and kidney stone formation The amount of protein excreted in the urine dropped
has since been demonstrated in both men (Curhan et considerably as did their blood cholesterol levels
al., 1993; Taylor et al., 2004) and women (Curhan et (D’Amico et al., 1992). It was uncertain whether
al., 1997). these results reflected the reduction in dietary
protein and fat or if the favourable results arose from
More recently, the Researchers from Harvard Medical a change in the nature of the food consumed. Either
School prospectively examined the relationship way, switching from a diet containing meat and dairy
between a Dietary Approaches to Stop Hypertension products to a plant-based diet containing less fat and
(DASH) style diet and the incident of kidney stones in protein and more fibre was beneficial to patients
three large cohorts: The Health Professionals Follow-up with kidney disease.
Study (45,821 men with 18 years of follow-up), The
Nurses’ Health Study I (94,108 older women and 18 In addition to avoiding animal protein in the diet,
years of follow-up), and The Nurses’ Health Study II increasing the potassium intake has been shown to
(101,837 younger women with 14 years of follow-up). yield benefits as potassium reduces calcium
The DASH diet is high in fruits and vegetables, excretion, which can decrease the risk of stone
moderate in low-fat dairy products and low in animal formation. Additionally, the beneficial effect of
protein (but with a substantial amount of plant protein increasing the fluid intake and the subsequent
from pulses and nuts). Over a combined 50 years of dilution of urine is well known (Curhan et al., 1993).
follow-up, they documented
5,645 kidney stones in the
three cohorts. Results
showed that the
consumption of a DASH-
style diet was associated
with a marked decrease in
the risk of incident kidney
stones (Taylor et al., 2009).
Dr Neil Barnard, president of
the PCRM, states that
animal protein is the worst
kind of enemy of people
with a tendency towards
kidney stones or any kidney
disease (Barnard, 1998). The
animal protein in red meat,
poultry, fish, eggs and milk
tend to overwork the
kidneys causing their
filtering abilities to decline.
This may make matters
worse in a person who
already has kidney disease.
Additionally, animal protein
causes calcium to be
leached from the bones and
excreted in the urine, adding
further to the burden on the
overworked kidney.

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Lactose Intolerance mild symptoms, whereas a person producing very

little or no lactase will suffer more severe symptoms.
In 1836, after returning from the Beagle, Charles Even more worrying is that bacterial toxins may play
Darwin wrote “I have had a bad spell. Vomiting a key role in several other diseases, such as diabetes,
every day for eleven days, and some days after every rheumatoid arthritis, multiple sclerosis and some
meal.” Darwin suffered for over 40 years from long cancers (Campbell et al., 2009).
bouts of vomiting, stomach cramps, headaches,
severe tiredness, skin problems and depression. A There are three types of lactase deficiency:
number of researchers now suggest that he suffered
from lactose intolerance (Campbell and Matthews, • Primary lactase deficiency (adult-type hypolactasia)
2005). His case is a good example of how easily is the most common form. In most mammals,
lactose intolerance can be missed. lactase activity naturally declines at variable rates
following weaning until it reaches undetectable
Lactose is a disaccharide made up from glucose and levels (Lomer, 2008). Generally the age of onset
galactose. It is the primary carbohydrate (sugar) ranges from 1-20 years (Rasinperä et al., 2004).
found exclusively in mammalian milk (Heyman, However, it is not unknown for lactose intolerance
2006). To obtain energy from lactose, it must be to develop in people over 20 (Seppo et al., 2008).
broken down to glucose and galactose by the • Secondary (acquired) lactase deficiency is caused
enzyme lactase. This enzyme is found in the small by illness, injury or medication. It can result from
intestine on the tips of the villi. Glucose and digestive diseases of the small intestine (such as
galactose are then readily absorbed into the ulcerative colitis and Crohn’s disease), or intestinal
bloodstream to provide energy. Lactose intolerance damage caused by infections (such rotavirus and
occurs when the body produces little or no lactase, Giardia) (Matthews, 2005). Chemotherapy and
or when the lactase it produces doesn’t work. In the long courses of antibiotics can cause lactose
absence of lactase, lactose is fermented by bacteria intolerance too. This may be temporary, but if
in the large intestine. These bacteria produce caused by a long-term condition, could be
hydrogen and a wide range of potential toxins permanent.
(Matthews et al., 2005). • Congenital lactase deficiency is an extremely rare
disorder of new-borns associated with a complete
Lactose intolerance and cow’s milk allergy are often absence of lactase. Affected infants present with
mistakenly confused. Lactose intolerance is caused intractable diarrhoea as soon as human milk or
by a lack of lactase, cow’s milk allergy is an adverse lactose-containing formula is introduced. Infants
immune reaction to proteins found in milk. with this condition would not be expected to
survive before the 20th century, as no suitable
Hippocrates first described lactose intolerance lactose-free formula was available (Heyman, 2006).
around 400 years BC but the clinical symptoms have
become recognised only in the last 50 years (Lomer For some years, it was thought that lactase
et al., 2008). Symptoms include diarrhoea, bloated persistence in humans was the ‘wild-type’ pattern. It
and painful stomach and on some occasions nausea is now widely accepted that in adulthood, lactase
and vomiting. Typically lactose intolerance causes deficiency is the normal state for most people (Lomer
diarrhoea via an osmotic mechanism. However, et al., 2008). A staggering 4,000 million people
persistent lactose-induced diarrhoea that lasts long cannot digest lactose properly (Campbell et al.,
after the lactose has gone may be caused by a 2009). In fact, around 70 per cent of the world’s
signalling mechanism analogous to cholera or population has primary lactase deficiency (Heyman,
enterotoxin (Matthews et al., 2005). 2006; Lomer et al., 2008). It is most prevalent in
Asian and African countries with 80-100 per cent
Other symptoms may include muscle and joint pain, frequency. In Northern Europe, prevalence varies
headaches, dizziness, lethargy, difficulty with short- between one and 18 per cent (Rasinperä, 2004). The
term memory, mouth ulcers, allergies (eczema, age of onset varies among different ethnic
rhinitis, sinusitis and asthma) cardiac arrhythmia, sore populations. Around 20 per cent of Hispanic, Asian
throat, increased frequency of urination, acne and and black children under five show some evidence of
depression (Lomer et al., 2008). The severity of lactase deficiency (Heyman, 2006), while low lactase
symptoms depends on the level of lactase produced; levels are rarely seen in white children under five
someone producing moderate levels may experience (Rasinperä, 2004.

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 White Lies

The widespread prevalence of lactose intolerance processed meats (sausages and burgers) and even
suggests that lactase deficiency is the normal or injected into some chicken meat. It is also added to
natural state and that the ability to continue to some soft drinks and lagers. Breakfast drinks,
digest lactose after weaning originates from a powders and slimming products can contain as
genetic mutation that provided a selective advantage much lactose as cow’s milk and it is often used in
to populations using dairy products (Swagerty et al., sauces supplied to butchers and restaurants
2002). This idea is supported by William Durham in (Matthews et al., 2005). Since 25 November 2005,
his book Coevolution (Durham, 1991). Durham all pre-packed foods sold in the UK have to show
describes milk as baby food not ‘intended’ for adult clearly on the label if they contain milk or any of the
consumption. He describes how the ability to digest ingredients of milk.
lactose is the exception to the norm and can
originally be traced back to a minority of pastoral Treatment depends on how sensitive the patient is to
tribes: the Tutsi and Hutu of Rwanda; the Fulani of lactose. If they are mildly intolerant, they may be
West Africa; the Sindhi of North India; the Tuareg of able to tolerate small amounts of some dairy foods.
West Africa and some European tribes. People who Fermented dairy foods (such as probiotic yoghurt
have retained the normal intolerance of lactose and milk, sour cream, cottage cheese and hard
include: Chinese, Japanese, Inuit, native Americans, cheeses, such as Edam and Cheddar) contain less
Australian Aborigines, Iranians, Lebanese and many lactose than fresh dairy products. Alternatively
African tribes including the Zulus, Xhosas and lactase may be taken in liquid form or capsules
Swazis. These people, generally, do not have a before a meal or added to cow’s milk. Low lactose
history of pastoralism. As stated in Part One (The milk is also available in supermarkets but is quite
Origins of Dairy Farming) lactase persistence only sweet as it contains galactose and glucose from
developed around 8,000 years ago. In evolutionary degraded lactose. Other animal milks (such as goat’s
terms, this is very recent history. milk), are not lactose-free. In fact, the lactose
content of goat’s and cow’s milk are very similar;
A range of tests can be used to diagnose lactose goat’s milk contains 4.4g of lactose per 100g and
intolerance. The breath hydrogen test is currently whole milk contains 4.5g per 100g and semi-
considered to be the most cost-effective, non- skimmed contains 4.7g per 100g (FSA, 2002). Of
invasive reliable test (Lomer et al., 2006). However, it course, non-dairy products (such as soya, rice and
involves drinking a lactose solution and can cause oat milk) are excellent alternatives that do not
severe symptoms, sometimes lasting for days require any monitoring at all.
(Matthews, 2005). In rare cases a small bowel biopsy
may be used to measure lactase levels. However, this Avoiding all lactose means cutting out all dairy foods
invasive technique is usually used to determine and checking labels for lactose in bread, chocolate
whether the symptoms are caused by another and other processed foods including meats. In
condition, such as coeliac disease. A stool acidity test addition, lactose is used in some types of medication
may be used to check infants for lactose intolerance. so the patient should check with their GP or
This is because large doses of lactose, such as those pharmacist (although symptoms of lactose
given in the breath hydrogen test, are dangerous for intolerance rarely occur as a result of taking
young children. Also, infants are more likely to medication containing it).
develop dehydration caused by diarrhoea. DNA
analysis of blood samples could offer a quick and Although there is no evidence of calcium deficiency
easy to way to diagnose lactose intolerance and may in people eating a Chinese or Japanese diet with no
help to differentiate patients with primary and lactose (Matthews, 2005), patients cutting out dairy
secondary lactase deficiency (Lomer et al., 2008). foods may need some help and advice on how to
However, this test is not yet routinely available. ensure they still get plenty of calcium. This may be
important for young children who need calcium for
When a dairy exclusion diet appears to fail, lactose healthy growth and development. There are many
intolerance is often mistakenly ruled out (Matthews excellent non-dairy sources of calcium including
et al., 2005). This is because lactose is added to non-oxalate dark green leafy vegetables (broccoli,
many unexpected (non-dairy) foods and may kale, spring greens, cabbage, bok choy and
continue producing symptoms in a patient convinced watercress), dried fruits (figs and dates), nuts
they are on a lactose-free diet. Lactose is used as a (almonds and Brazil nuts) and seeds (sesame seeds
browning agent in bread and cakes, it is added to and tahini, which contains a massive 680 milligrams

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of calcium per 100 grams) (FSA, 2002). The dairy Migraine

industry frequently cites the poor absorption of
calcium from spinach as an example of how A migraine is much more than a bad headache; unless
‘superior’ cow’s milk is as a source of calcium. you suffer from them it is difficult to appreciate just
However, spinach is an unusually poor source of how debilitating a migraine can be. Often people with
calcium compared to other plant foods as it contains a migraine can do nothing but lie quietly in a
higher levels of oxalate which binds calcium and darkened room waiting for the pain to pass. The pain
lowers its availability. Pulses (soya beans, kidney is excruciating, often accompanied by nausea,
beans, chick peas, baked beans, broad beans, vomiting and an increased sensitivity to light and
lentils, peas and calcium-set tofu) also provide a sound. A migraine can last for a few hours or a few
good source, as does calcium-fortified soya milk. days. Migraines occur more commonly in women
than men (one in four women and one in 12 men) in
Although rarely life-threatening, the symptoms of the UK. and usually affect people in their teenage
lactose intolerance can lead to significant discomfort, years up to around 40 years of age, although they do
disrupted quality of life, loss of school attendance sometimes occur in children. Migraine affects about
and leisure and sports activities and work time, all at 15 per cent of adults in the UK (NHS Choices, 2012q).
a cost to individuals,
families and society
(Heyman, 2006). The
terminology relating to
lactose intolerance (as
opposed to milk protein
allergy) can be confusing. It
is therefore crucial to
ensure that these
problematic terms do not
cause diagnostic mistakes
and inappropriate
treatment (Harrington and
Mayberry, 2008).

In conclusion, drinking
cow’s milk is neither
normal nor natural. The
health implications of
being the only mammal to
consume milk as adults
(and not just that, milk
from another species too)
are becoming clearer in the
scientific literature as levels
of the so-called diseases of
affluence soar. The
treatment for lactose
intolerance is
straightforward: avoid
lactose. This means cutting
out all dairy foods and
checking labels for lactose
in bread, chocolate and
other processed foods.

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 White Lies

A range of common factors that can cause migraines had initially developed a migraine in response to
in some people have been identified. Some scientists factors other than food (for example flashing lights
suggest that fluctuating levels of hormones may be or exercise) no longer responded to these triggers
linked to the causes of migraines (hence the higher while on the special elimination diet.
number of women affected). Other factors include:
emotional, physical, environmental, medicinal and The relationship between food allergy or intolerance
dietary factors. Foods are frequently identified as and migraine is difficult to prove and, despite the
triggers and the most common culprits include dairy evidence, remains a controversial subject. However,
products (particularly cheese), chocolate, alcohol the possibility of cow’s milk allergy or intolerance
(particularly red wine), caffeine, citrus fruits, nuts, should be considered in all cases of migraine.
fried foods and foods containing monosodium
glutamate (MSG) such as some Chinese food,
processed meats and frozen pizzas. Other triggers Multiple sclerosis and
include cigarette smoke, bright lights, hunger,
certain drugs (such as sleeping tablets, HRT and the autoimmunity
combined oral contraceptive pill), loud noises, strong
smells, neck and back pain, stress and tiredness. All Multiple sclerosis (MS) is the most common disease
these factors and others can lead to a migraine, and of the central nervous system (the brain and spinal
some people may experience a migraine following cord) affecting young adults in the UK. It is estimated
any one or a combination of these factors. that there are currently around 100,000 people with
MS in the UK. Symptoms usually first develop
One study looked at a range of 36 possible between the ages of 15 and 45, with the average
(hormonal, environmental and dietary) triggering age of diagnosis being about 30. For reasons that
factors that may precipitate a migraine in a group of are unclear, MS is twice as common in women than
123 migraine sufferers. The dietary factors included: men and more common in white people than black
chocolate, cheese, citrus fruits, alcohol, aspartame, and Asian people (NHS Choices, 2012r).
MSG, a fat-rich diet, dairy products and caffeine as
well as skipped meals or fasting and deprivation or Sclerosis means scarring and multiple refers to the
insufficient intake of water. Out of all the patients different sites at which the scarring can occur
tested, only 2.4 per cent did not complain about any throughout the brain and spinal cord. In MS the
dietary factor (Camboim Rockett et al., 2012). The protective sheath (myelin) that surrounds the nerve
national medical charity Allergy UK lists cheese fibres of the central nervous system becomes
(particularly Stilton, Brie, Camembert and damaged. When myelin is damaged (demyelination)
Emmenthal) as the third commonest cause of food- the messages between the brain and other parts of
induced migraine after alcohol and chocolate. They the body become disrupted. Myelin protects the
suggest that 29 per cent of food-induced migraines nerve fibres in much the same way that household
are caused by alcohol, 19 per cent by chocolate, 18 electrical wires are protected by an insulating cover.
per cent by cheese and 11 per cent by citrus foods. If this cover becomes damaged the normal signalling
Other foods thought to trigger migraine include fried route becomes disrupted and may result in a short-
and fatty foods, onions, pork, pickled herring and circuit. The severity of the symptoms depends on
yeast extract (Allergy UK, 2005). how much damage has occurred to the central
nervous system. More severe symptoms include
In a study at Great Ormond Street Children’s Hospital blurred vision, paralysis, slurred speech, lack of
in London, 88 children with severe and frequent coordination and incontinence.
migraines were treated with a diet that eliminated
many foods linked to migraine, 93 per cent of the Around eight out of 10 people with MS will have a
children responded well to the diet and were free of type of MS called ‘relapsing-remitting’. This means
headaches (Egger et al., 1983). Foods were gradually they will have periods of remission (that can last for
reintroduced to identify those most likely to provoke days, weeks or even months) where symptoms are
a migraine. Top of the list was cow’s milk, followed mild or disappear altogether. Remission is followed
by chocolate (containing cow’s milk), the food by a flare-up of symptoms, known as a relapse,
preservative benzoic acid, eggs, the synthetic yellow which can last from a few weeks to few months.
food colouring agent tartrazine, wheat, cheese, Usually after around 10 years, around half of people
citrus, coffee and fish. Interestingly, children who with relapsing-remitting MS go on to develop

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secondary progressive MS whereby symptoms 2005). Interestingly, in the 1970s a correlation

gradually worsen and there are fewer or no periods between the world distribution of dairy production
of remission. The least common form of MS is and consumption and the incidence of multiple
primary progressive MS in which symptoms gradually sclerosis was noted (Butcher, 1976). It was suggested
get worse over time and there are no periods of then that dairy may be a contributing factor.
remission (NHS Choices, 2012r). A subgroup of
patients with relapsing-remitting MS exhibits a The research investigating the links between diet and
benign course with no disease progression and MS dates back over 50 years to Dr Roy Swank’s work
minimal disability decades after the first first at the Montreal Neurological Institute in Norway,
manifestations. Eventually, these patients may switch then at the Division of Neurology at the University of
to a progressive state (Ramsaransing et al., 2009). Oregon Medical School in the US. Swank was
intrigued by the geographical distribution of MS and
MS is an autoimmune disease whereby the body’s thought it may be due to dietary practices. Swank
immune system attacks its own tissues. As with other suspected animal foods high in saturated fats may be
autoimmune diseases, it is thought responsible as MS seemed to occur most among
that a combination of genetic inland dairy-consuming populations and
factors and less among coastal fish-eating
environmental populations. Perhaps his best
triggers cause the known trial was that
disease. Recent published in the Lancet in
research shows 1990. In this study
that an Swank followed 144
important MS patients for a
environmental total of 34 years.
factor is diet Swank prescribed a
(Ramsaransing low-saturated fat
et al., 2009). diet to all the
Other participants but
environmental the degree of
triggers may include adherence to the
viruses or emotional factors diet varied widely.
such as stress. Interestingly, He observed how
the incidence of MS increases their conditions
the further you get from the progressed. Results
equator, whether going north or showed that for the group
south. For example, MS is relatively of patients who began the
common in the UK, North low-saturated fat diet (less than
America and Scandinavia, but rare in 20g per day saturated fat) during the earlier
Malaysia or Ecuador. Campbell suggests that MS stages of MS, 95 per cent survived and
is over 100 times more prevalent in the far north than remained physically active for approximately
at the equator (Campbell and Campbell, 2005). In 30 years. Even those with significant disability
Australia the incidence of MS decreases seven-fold as were shown to markedly slow the progression of the
you move towards the equator from the south to disease if they could stick to the low-saturated fat
the north (Campbell and Campbell, 2005). This diet. In contrast, 80 per cent of the patients with
geographical distribution pattern applies to other early-stage MS who did not adhere to the diet died of
autoimmune diseases including type 1 diabetes and MS (Swank and Dugan, 1990). It was concluded that
rheumatoid arthritis (Campbell and Campbell, 2005). saturated animal fats increase the risk of MS.
Indeed, this phenomenon has been noted since 1922
(Davenport, 1922). Campbell suggests in his book Other studies have extended Swank’s findings and
The China Study that autoimmune diseases should be revealed a positive correlation between the
considered as a group rather than as individual consumption of cow’s milk and the incidence of MS.
diseases as they share similar clinical backgrounds This later research suggests that there could be a
and sometimes occur in the same person or among combination of predisposing or precipitating factors
the same populations (Campbell and Campbell, involved in the aetiology of MS, and that

85
 White Lies

environmental factors, such as the consumption of As the incidence of most autoimmune diseases
cow’s milk, play a part (Agranoff et al., 1974; Butcher, correlates directly to the consumption of animal
1976). These and other studies suggest that cow’s milk foods, this approach could help prevent other
may contain some component other than saturated fat autoimmune conditions that occur increasingly
that influences the incidence of MS. For example, it among populations that consume high levels of dairy
has been suggested that this factor or environmental and meat products.
trigger may be a virus (Malosse et al., 1992).

You are more likely to get MS if other people in your Overweight and obesity
family have it (especially a brother or sister). This
shows that there is an element of genetic Most people know what the term obesity means: an
predisposition in this disease. However, twin studies increased body weight caused by the excessive
have shown that only about a quarter of identical accumulation of fat. Overweight and obesity occur
twins with MS have a twin with the disease (Willer et when more calories are taken into the body than are
al., 2003). In other words for every four genetically burnt up over time. In other words, if you don’t burn
identical sets of twins (one of whom has MS) one up the energy you consume it will be stored as fat,
other twin will have the disease and three will not. If and over time this may lead to excessive weight gain
genes were solely responsible for MS, the genes that and obesity. So someone who works in a very
cause MS in one twin would also cause it in the physically demanding job, such as a building-site
other. When considering the role of genetics in a labourer, may need between 4,000 and 5,000
disease, it is also useful to look at what happens to calories per day to maintain their normal weight.
the risk of that disease in migrating populations. As Whereas an office worker, who drives to work and
for cancer, heart disease and type 2 diabetes, people does not take any exercise, may only need 1,500
tend to acquire the MS risk of the population to calories per day.
which they move, especially if they move early in life.
This shows that MS is more strongly related to Another way of defining obesity is to measure your
environmental factors and diet than genes. body mass index (BMI). This is your weight in
kilograms divided by the square of your height in
While the benefits of excluding milk from the diet metres. There are many websites that can do
may not have been directly proven for MS sufferers, conversions and calculations for you (see Appendix
there is evidence that a high intake of saturated fat II). In England, people with a body mass index
increases the incidence and severity of this disease. between 25 and 29 are categorised as overweight,
Others studies suggest that increasing the intake of and those with an index of 30 or above are
unsaturated fatty acids (such as linoleic acid), vitamin categorised as obese. If your BMI is over 40, you
D and antioxidants may be helpful (Schwartz et al., would be described as morbidly obese (NHS Choices,
2005). Recent studies concur that limiting the 2012s). The UK government describes 18.5 to 25 as
consumption of saturated fatty acid intake and healthy and suggests that a BMI of less than 18.5 is
supplementing with unsaturated fatty acids in underweight. Alternatively, another useful method is
combination with more vegetables can favour to measure around your waist. People with very fat
prognosis in relapsing-remitting MS (Ramsaransing et waists (94cm or more in men and 80cm or more in
al., 2009). This may be related to the anti- women) are more likely to develop obesity-related
inflammatory properties of omega-3-fatty acids. This health problems (NHS Choices, 2012s).
study also found that, compared to the daily
recommended allowance, the MS patients studied Abdominal fat (also known as internal or visceral fat)
had a lower than recommended intake of folic acid, is of particular concern because it’s a key player in a
magnesium, zinc and selenium. The overall message variety of health problems including high blood
is clear: a plant-based diet low in fat, salt and sugar pressure and cholesterol (which can lead to heart
(and processed foods) and high in fresh fruits, disease), diabetes and some cancers. You don’t have
vegetables, whole grains, pulses, nuts and seeds can to be overweight or obese to have high levels of this
provide all the vitamins, minerals and other nutrients type of fat. Some slim people, who do little or no
required for good health and reduce some of the risk exercise, can have elevated levels of visceral fat. Unlike
factors for MS or prevent making an already existing subcutaneous fat (the kind you can grasp with your
condition worse. hand), visceral fat lies deep within the abdominal
region, hidden in the white fat that surrounds the vital

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organs, streaked through underused muscles and amount of physical activity they undertake. This is
wrapped around the heart. An MRI scan will reveal very worrying as early childhood obesity tends to
how much visceral fat a person has but from the indicate adult obesity which can lead to serious
outside it is impossible to tell. Hence the term ‘tofi’ – health risks later in life. Obesity is a known risk factor
thin on the outside, fat on the inside. Such people are for many illnesses including type 2 diabetes, heart
less likely to think they need to change their lifestyle disease, high blood pressure, stroke, gall bladder
and could unwittingly be at risk of serious health disease and certain forms of cancer especially the
consequences. Research suggests that diet and hormonally related and large-bowel cancers.
exercise can be very effective in helping reduce Childhood obesity is associated with a higher chance
visceral fat. Complex carbohydrates (fruits, vegetables of obesity, premature death and disability in
and whole grains) and limiting the intake of simple adulthood. But in addition to increased future risks,
carbohydrates such as white bread, white pasta and obese children experience breathing difficulties,
sugary drinks can help. Replacing saturated fats with increased risk of fractures, high blood pressure, early
polyunsaturated fats can also help. markers of CVD, insulin resistance and psychological
effects (WHO, 2013e).
In 2008, over a third (35 per cent) of all adults in the
world were overweight, and more than one in ten As populations become more urban and incomes
(11 per cent) was obese. From 1980-2008, the rise, diets high in sugar, fat and animal products
worldwide prevalence of obesity nearly doubled with replace more traditional diets that were high in
an estimated half a billion adults worldwide being complex carbohydrates and fibre. Ethnic cuisine and
described as obese. The highest levels of overweight unique traditional food habits are being replaced by
and obesity occur in Canada, North and South westernised fast foods, soft drinks and increased
America with 62 per cent overweight and 26 per cent meat consumption. Homogenisation and
obese. The lowest figures are seen in South East Asia westernisation of the global diet has increased the
(14 per cent overweight three per cent obese). In energy density and this is particularly
Europe, the Eastern Mediterranean and the Americas, a problem for the poor in all
over 50 per cent of women are overweight. For all countries who are at risk of both
three of these regions, roughly half of overweight obesity and micronutrient
women are obese (WHO, 2013d). deficiencies (Swinburn et al.,
2004). This combined with a
The main causes of obesity include an excessive shift towards less physically
intake of food coupled to a lack of exercise and a demanding work, an increasing
sedentary lifestyle. Other much less frequent causes use of automated transport,
include a genetic predisposition or an underlying technology in the home and
illness (such as hypothyroidism). The British Medical
Association (BMA) warns that
childhood obesity levels
have soared in the UK
over recent years. They
say that just over a
quarter of adults in
England are obese
and three out of 10
children aged 2-15
in England are
overweight or obese.
They warn that by
2050, it is estimated
that half of the
population in England will be
obese (BMA, 2013).

The BMA attribute this rise to the fact that

children are eating too much for the

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 White Lies

more passive leisure pursuits means that people are intake of saturated fat were relatively small (1-3g per
less active than their parents and grandparents. day). Clearly we are failing to heed the advice to
reduce our intake of saturated fat.
The WHO suggests several ways to lose weight
including eating more fruit, vegetables, nuts and Milk and dairy foods make a significant impact on
whole grains; engaging in daily moderate physical saturated fat in the diet. Most saturated fat in the
activity (60 minutes a day for children and 150 average UK diet comes from: milk, cheese, ice-
minutes per week for adults); cutting the amount of cream, butter, margarine and fat-based spreads
fatty, sugary foods in the diet and moving from along with meat, pastry products (pies, tarts etc),
saturated animal-based fats to unsaturated bakery products (buns, biscuits, cakes), chocolate
vegetable-oil based fats. Whole milk, cheese, cream, and chocolate confectionery and snacks.
butter, ice-cream and most other dairy products, Approximately 65 per cent of the fat in milk is
apart from skimmed and non-fat products, contain saturated and about three per cent of food energy is
significant amounts of saturated fat and cholesterol. from dairy products making this a major target
While we do need a certain amount of fat in the diet (Talbot, 2006).
there is no nutritional requirement for saturated fat.
Cow’s milk is high in the unhealthy saturated fats A number of small-scale studies (of less than 35
and low in the healthy polyunsaturated essential obese adults) have suggested that the consumption
fatty acids, which are required in the diet for good of dairy products may actually help people lose
health. Most people eat much more fat than they weight (Zemel et al., 2004; Zemel et al., 2005). In
need, and making minor changes to the diet (cutting these studies Professor Zemel, who has received a
down on fat) can make a big difference over time. considerable amount of funding from the National
Dairy Council, suggested that diets containing
The Department of Health recommends that calcium from dairy foods might affect fat cell
saturated fat should contribute no more than 11 per metabolism in such a way that greater weight loss
cent of the total energy that we get from food can occur despite an identical calorie intake with a
(Department of Health, 1991). Most people consume control group not consuming so much dairy.
more than that. The 2012 National Diet and
Nutrition Survey found that on average, saturated fat The US National Dairy Council (who funded Zemel’s
made up 12.8-13.6 per cent of food energy in all research) is overseen by Dairy Management
groups aged between four and 64 (Pot et al., 2012). Incorporated, a non-profit corporation that defines
Compared with previous surveys, saturated fat its mission as increasing sales and demand for dairy
intakes were somewhat lower in this study but, for products. Not dissimilar to the UK’s dairy industry-
adults, no statistically significant changes were funded DairyCo, Dairy Management Incorporated is
observed. In general, the differences in absolute funded by America’s dairy farmers via a government-

88
 A report

mandated fee. In 2009 they also received $5.3 of already. A small amount of good-flavoured cheese
million from the Agriculture Department to promote can be compatible with a healthy diet, but
dairy sales overseas. In 2010, Dairy Management’s consumption in the U.S. is enormous and way
annual budget approached a staggering $140 beyond what is optimally healthy”.
million. By comparison, the Center for Nutrition
Policy and Promotion, which promotes healthy diets, The dairy industry’s national advertising campaign
had a total budget of just $6.5 million. promoting the notion that people could lose weight
by consuming more dairy products went on for a
Dairy Management Incorporated has relentlessly total of four years finally ending in 2007 when the
marketed cheese despite the fact that Agriculture Federal Trade Commission acted on the two-year-old
Department data show that cheese is a major reason petition by the PCRM. The Agriculture Department
the average US diet contains too much saturated fat. and dairy officials agreed to halt the campaign
They employed a whole new marketing strategy with pending further research. Dairy Management
a weight-loss campaign based on Zemel’s research. Incorporated moved on to promoting milk and dairy
However, a subsequent study (by a research group foods in other areas such as promoting chocolate
including Zemel but not as the first named author) milk in schools and encouraging companies like
found no evidence that a diet high in dairy products Domino’s pizza to use even more cheese in its pizzas
enhances weight loss (Thompson et al., 2005). (Domino’s Wisconsin pizza now has six cheeses on
Furthermore, research that they also hoped would top and two more in the crust). In an article in the
support Zemel’s work found no evidence of dairy- New York Times, Dr Neal D. Barnard, president of
related weight loss (Harvey-Berino et al., 2005). Dairy the PCRM said: “If you want to look at why people
Management Incorporated pressed on with its are fat today, it’s pretty hard to identify a contributor
advertising campaign regardless. more significant than this meteoric rise in cheese
consumption” (Moss, 2010). This may seem little to
Dr Amy Lanou, the nutrition director of the PCRM, do with overweight and obesity problems in the UK,
warned that care should be taken when interpreting but these issues are mirrored here and trends show
the findings from Zemel’s trials. Furthermore, Lanou that we are not that far behind the extreme levels of
suggested that the US National Dairy Council’s claims obesity seen in the US.
promoting dairy consumption for weight loss went
well beyond Zemel’s findings. Lanou suggests that it Despite the dairy industry’s claims outlined above,
was likely that calorie restriction, not dairy scientific studies show that adding dairy products to
consumption, caused the weight loss reported in the diet does not help control weight; in fact the
these studies (Lanou, 2005). research confirms that in many cases the reverse is
true, consuming milk and dairy foods can lead to
In June 2005 the PCRM decided enough was weight gain. Some studies designed to test the
enough and filed two separate lawsuits to stop the effects of dairy consumption on weight found no
multimillion-dollar advertising campaign claiming difference in weight between groups consuming
that milk facilitates weight loss. They filed one relatively large amounts of dairy foods compared to
lawsuit to the US Food and Drugs Administration groups consuming little (Lappe et al., 2004; Gunther
and the other to the US Federal Trade Commission. et al., 2005). Another study, this time of the effects
In the lawsuit the PCRM charged the National Dairy of just calcium supplementation on weight loss in
Council, the International Dairy Foods Association, women who had recently given birth, found no
Dairy Management Incorporated, Dannon Company, relationship between calcium supplementation and
Kraft Foods and other dairy manufacturers with weight loss (Wosje, 2004). Researchers at the
purposefully misleading customers (PCRM, 2005). University of British Columbia in Vancouver, Canada,
Astonishingly, government lawyers defended the who reviewed the scientific literature on the effects
campaign, saying that the Agriculture Department of dairy products or calcium supplements on body
reviewed, approved and continually oversaw the weight found that out of nine studies on dairy
effort. Dr Walter C. Willett, chairman of the nutrition products, seven showed no significant difference
department at the Harvard School of Public Health while two studies linked weight gain to dairy
and a former member of the federal government’s consumption (Barr et al., 2003). Furthermore, out of
nutrition advisory committee, said: “The USDA 17 studies on calcium supplementation, just one
should not be involved in these programs that are reported weight loss. The authors state that
promoting foods that we are consuming too much interpreting such findings is limited by the inability to

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 White Lies

accurately determine the extent of compensation for commonly occur in the spine, wrist and hips (NHS
the energy intake from the added dairy products. In Choices, 2012t). Osteoporosis is sometimes called
other words, people who increased their dairy intake the silent disease as there are often no symptoms
may have maintained the same energy intake (and until a fracture occurs.
so not gained weight) by reducing other foods. For
example, the authors of one of the studies reviewed Bones consist of a thick outer shell and a strong
noted that the dairy product group in their study inner mesh filled with a protein called collagen,
may have reduced their consumption of baked calcium salts and other minerals. Osteoporosis occurs
goods to compensate for the additional intake of when calcium is lost from the bones and they
dairy foods. Furthermore serious questions have become more fragile and prone to fracture. This
arisen regarding the ability of diet records to reflect debilitating condition tends to occur mostly in
actual energy intake. postmenopausal women between 51 and 75 due to
a lack of the hormone oestrogen, which helps to
Another large scale study that followed over 12,000 regulate the incorporation of calcium into the bones.
children for three years concluded that the children It can occur earlier or later and not all women are at
who drank the most milk gained the most weight equal risk of developing osteoporosis. Around three
(Berkey et al., 2005). The analyses showed that out million people in the UK are thought to have
of milk, calcium, dairy fat and total energy intake, it osteoporosis and there are over 250,000 fractures
was energy intake that was the most important every year as a result. Although commonly
predictor of weight gain. The authors attribute this associated with post-menopausal women,
weight to… you’ve guessed it, the added calories! osteoporosis can also affect men, younger women
and children (NHS Choices, 2012t). In the UK, one in
On the other hand, numerous studies show that a two women and one in five men over the age of 50
low-fat plant-based diet can be very effective in will break a bone mainly because of poor bone
helping lose and maintain a healthy weight (Turner- health (National Osteoporosis Society, 2013).
McGrievy et al, 2007; Barnard et al., 2009). A recent
study looked at the effects of eating a low-fat plant- Osteoporosis has been called the silent epidemic as
based diet for 18 weeks on body weight and CVD the first sign some people experience is a fracture. In
risk in people with a BMI of 25 or higher and/or a 2006, the dairy industry responded to this health
previous diagnosis of type 2 diabetes. Results scare by promoting milk, cheese and yogurt directly
showed the average weight loss was 2.9 kg to teenage girls in an advertising campaign called
(compared to 0.06 kg in the control group). Total and Naturally Beautiful, run by the Milk Development
LDL (‘bad’) cholesterol also fell in the test group. It Council with the support from the European
was concluded that dietary intervention using a low- Commission (MDC, 2005a). Since then, the
fat plant-based diet improves body weight, plasma promoting of cow’s milk and cheese to teenage girls
lipids and in individuals with diabetes, it can also for bone health has decreased. DairyCo now tends
help control blood sugar levels (Mishra et al., 2013). to focus more on promoting milk in schools by
providing ‘educational resources’ and website
To most people it is just common sense, a calorie is a material for schools as well as promoting dairy
calorie and weight gain or weight loss is a case of farming actively to the public through their
mathematics. If you take in more energy (calories) consumer facing website as well as talking to the
than you use, you will gain weight. If you use up media (Dairy Co, 2013d). Most people know about
more energy than you consume, you will lose osteoporosis and it is commonly assumed that dairy
weight. There is no magic bullet, and if there were it products can help protect against it. Indeed it is
seems very unlikely that it would be cow’s milk, deeply entrenched in the British psyche that calcium
butter or cheese. from dairy sources is essential for good bone health.
However, this association is more to do with
successful marketing than scientific evidence.
Osteoporosis
In 2012, researchers from The WHO Collaborating
Osteoporosis (meaning porous bones) is a condition Centre for Metabolic Bone Diseases, at the University
that affects the bones, causing them to become of Sheffield Medical School in the UK published a
weak and more likely to fracture. Although the review of hip fracture incidence and probability of
whole skeleton is usually affected, fractures most fracture worldwide. Figure 9.0 shows the hip fracture

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Figure 9.0 World age-standardised hip fracture rates for

women per 100,000 in selected countries.
600
Women per 100,000 population

500

400

300

200

100

0
Hong Kong

Saudi Arabia
New Zealand

Columbia
Czech

Canada

S Africa
China
Croatia
Germany

Morocco
Denmark

Australia
Switzerland

Thailand
Austria

Japan

Netherlands

Spain
UK

Mexico

Nigeria
Brazil
Serbia
France

Russia
Ireland

India
US

Poland
Italy
Sweden

Turkey
Taiwan

Tunisia
Source: Kanis et al., 2012.

rates for women per 100,000 from a range of changes in risk in immigrant populations. For
countries. The pattern for men was broadly similar to example, black Americans have a lower fracture risk
that for women. The authors of this review observed a than Caucasians in the US, but a much higher risk
greater than 10-fold variation in hip fracture risk than black Africans. A similar scenario is seen among
between countries (Kanis et al., 2012). The high-risk the Japanese population of Hawaii compared to
countries extended from North Western Europe those in Japan and Chinese people living in Singapore
(Iceland, UK, Ireland, Denmark, Sweden and Norway) compared with mainland China (Kanis et al., 2012).
through central Europe (Belgium, Germany, Austria,
Czech Republic, Slovakia, Hungary, Switzerland and Many risk factors for osteoporosis have been
Italy) to the south east (Greece, Slovenia) and onwards identified including a low body mass index (BMI),
(to the Lebanon, Oman and Iran). Other high-risk low bone mineral density, reduced sunlight exposure
countries for women were Hong Kong, Singapore, (crucial for vitamin D production in the skin), early
Malta and Taiwan. Notably, if ethnic-specific rates menopause, smoking, alcohol consumption and low
were considered in the US, then Hispanic, Asian and physical activity levels. In addition, somewhat
Black populations (often lactose intolerant and so unexpectedly, obesity has been identified as a risk
non-milk consumers) would be described as low risk factor; so being underweight or overweight can
but Caucasian women were deemed to be at a high increase the risk. Migration status obesity (whereby
risk (this is why the US appears in the middle of the obesity levels among migrants are significantly
graph). Regions of moderate risk included Oceania (a higher compared with the native population as a
region centred on the islands of the tropical Pacific result of increased availability of poor quality food
Ocean), the Russian Federation, the southern and/or increased exposure to aggressive marketing
countries of Latin America and the countries of North of fast food), is also a risk factor (Kanis et al., 2012).
America. Low-risk regions included the northern Numerous dietary factors are thought to influence
regions of Latin America, Africa, Jordan and Saudi bone health and fracture risk, including: calcium,
Arabia, India, China, Indonesia and the Philippines. In vitamin D, protein (including the ratio of plant to
Europe, the majority of countries were categorised at animal protein), potassium, sodium and fruit and
high or moderate risk with the exceptions of Croatia vegetables (Appleby et al., 2007). Assessing the
and Romania (Kanis et al., 2012). relative contribution of each of these is difficult as
nutrients are not consumed in isolation and may
In summary, fracture rates are highest in Caucasian work together or be influenced by other factors.
women living in temperate climates and are Furthermore the experimental data is somewhat
somewhat lower in women from Mediterranean and inconsistent with conflicting findings.
Asian countries and are lowest among women in
Africa. Countries in economic transition, such as Figure 9.0 supports earlier research that shows how
Hong Kong, have seen significant increases in Western style diets accompany hip fracture rates
fracture rates in recent decades (WHO, 2003a). This around the world. There are a number of theories as
indicates that environmental factors, such as diet, to why this could be. One of the most popular - and
may be responsible. This view is supported by controversial - is the acid-alkaline hypothesis.

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The acid-alkaline hypothesis A substantial body of evidence links animal protein

The hypothesis that a high animal protein diet could to a decrease in bone mineral density. A study,
be a risk factor for osteoporosis dates back to looking at hip fracture incidence in 33 different
research conducted more than 40 years ago (Barzel countries in relation to consumption of plant and
and Jowsey, 1969). The hypothesis proposes that as animal protein, found that the countries with the
food is digested, acids are released into the blood, lowest fracture rates also had the lowest intakes of
and the body attempts to neutralise the acid by animal protein. Conversely, in 10 of the 11 countries
drawing calcium from the bones. This calcium is then with the highest fracture rates, animal protein intake
excreted in the urine (the calciuric response). Animal exceeded plant protein intake. The authors said that
proteins, from cow’s milk and dairy products, meat, hip fracture incidence is directly related to animal
fish and eggs, are said to have a particularly bad protein intake and suggested that bone integrity is
effect because of the greater amount of sulphur- compromised by acid that results from the
containing amino acids they contain compared to metabolism of animal proteins. They suggested that
most plant proteins. Sulphur-containing amino acids the moderation of animal food intake, coupled to an
give rise to sulphuric acid when they are broken increased ratio of vegetable to animal food
down in metabolism. consumption, may confer a protective effect
(Frassetto et al., 2000). Another study of 1,035
Modern diets in industrialised countries are elderly women found that women
considerably more acid-forming than the more with a high ratio of animal to
alkalising foods that would have been consumed vegetable protein intake had a
throughout the vast majority of human evolution. greater risk of hip fracture than
Just consider a beef-burger in a white bun with fries those with a low ratio (Sellmeyer et
and a fizzy drink compared to nuts, seeds, fruit, al., 2001). A further study of 757
leaves and water with the occasional piece of meat young girls in urban Beijing in
and/or fish… Consequently, it is suggested that China, compared the effects
humans may be poorly adapted to the of protein intakes from
contemporary acid-forming diets and that this animal and plant sources on
may contribute to modern epidemics of chronic bone mass accrual over five
disease (Scialla and Anderson, 2013). years. Results showed that
protein from animal foods,
Until relatively recently, the acid-alkaline particularly meat, had
hypothesis has been widely accepted; in negative effects on bone
2003, in their recommendations for mineral content. It was
preventing osteoporosis, the WHO concluded that higher
stated that: protein intake,
especially from animal
“With regard to calcium intakes foods, has a
to prevent osteoporosis, the significant negative
Consultation referred to the effect on bone
recommendations of the Joint mass accrual in
FAO/WHO Expert Consultation on pre-pubertal girls
Vitamin and Mineral Requirements in (Zhang et al., 2010).
Human Nutrition which highlighted the
calcium paradox. The paradox (that hip Another study compared the effects
fracture rates are higher in of animal and plant protein in the
developed countries where calcium diets of overweight and obese post-
intake is higher than in developing countries menopausal women dieting. They
where calcium intake is lower) clearly calls for found that the energy-restricted diet
an explanation. To date, the accumulated data with protein from meat sources
indicate that the adverse effect of protein, in promoted bone loss compared with an
particular animal (but not vegetable) protein, energy-restricted diet without meat.
might outweigh the positive effect of calcium They concluded that for post-
intake on calcium balance.” WHO, 2003a. menopausal women, choosing a
diet containing meat may decrease

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bone mineral density and increase the risk of increasing milk consumption did not confer a
osteoporosis (Campbell and Tang, 2010). This protective effect against hip or forearm fracture. In
extends the findings of an earlier study which fact the 1997 study found that an increased calcium
examined the levels of bone loss in 1,600 older intake from dairy foods was associated with a higher
women and found that vegetarians had lost only 18 risk of fracture. They concluded that their results do
per cent bone mineral compared to omnivores who not support the hypothesis that higher consumption
had lost 35 per cent bone mineral by the age of 80 of milk or other food sources of calcium by adult
(Marsh et al., 1988). women protects against hip or forearm fractures
(Feskanich et al., 1997). In a 2003 follow-up of the
Cross-cultural studies summarising data on protein Nurses’ Health Study, the increased risk associated
intake and fracture rates from 16 countries with dairy was not reported but they still found that
compared industrialised and non-industrialised higher daily intakes of cow’s milk did not reduce the
lifestyles and revealed strong links between a high risk of hip fracture. In other words, there was still no
animal protein diet, bone degeneration and the evidence of a protective effect of dairy against
occurrence of hip fractures (Abelow et al., 1992). In fracture risk (Feskanich et al., 2003). Interestingly, a
the book The China Study, Campbell observed that lower risk of hip fracture was found among those
in rural communities where animal protein made up with higher vitamin D intakes.
just 10 per cent of the total protein intake (the other
90 per cent coming from plant-based sources) the In a more recent extensive review of studies looking
bone fracture rate was one-fifth of that in the US at total calcium intake and hip fracture risk, results
where 50 per cent or more of total protein is made showed that in prospective cohort studies, calcium
up of animal protein (Campbell and Campbell, intake was not significantly associated with hip
2005), again indicating a link between animal fracture risk in women or men. The pooled results
protein and bone degeneration. The traditional Inuit from randomised controlled trials not only found no
(or Eskimo) diet is made up almost entirely of animal reduction in hip fracture risk with calcium
protein. Inuits potentially have one of the highest supplementation but suggested an increased risk
calcium intakes in the world (up to 2,500 milligrams with calcium supplementation among men and
per day) depending on whether they eat whole fish, women (Bischoff-Ferrari et al., 2007).
including the bones, or not. They also have a high
rate of osteoporosis, even higher than white So, for children and adolescents, while an adequate
Americans (Mazess et al., 1974; Mazess et al., 1975; intake of protein is necessary for good bone
Pratt and Holloway, 2001). development and stability, some research suggests
that large intakes of animal protein may counter this
A substantial body of evidence supports a positive link positive effect. In a study looking at long-term dietary
between fruit and vegetables and bone health. A protein intake, dietary acid load and bone status in
review of the role of protein, calcium and bone health children, it was concluded that the positive effect of
in women in the EPIC-Potsdam cohort in Germany protein could be negated, at least partly, by a high
found that vegetable protein played a positive role in renal acid load. The authors say that their findings
maintaining good bone health (Weikhert et al., 2005). support the health benefit of a diet rich in alkali-
Indeed, vegetable consumption was found to be an yielding fruit and vegetables (which is in accordance
independent negative predictor for the worldwide with the 5-a-day campaign) and recommend an
incidence of hip fracture and high consumption of integrative approach saying that focusing on single
fruit and vegetables was positively associated with nutrients is not sufficient (Alexy et al., 2005). Such
bone mineral density in both women and men evidence, plus other studies showing that an animal
(Weikhert et al., 2005). The research showing that protein-based diet (with the same total quantity of
plant proteins confer a beneficial effect on bone protein as a vegetarian diet) confers an increased risk
health is consistent. for uric acid stones (Breslau et al., 1988) have led
some to suggest that the high calcium losses in the
Other studies have investigated the effects of cow’s urine caused by animal protein may be a risk factor
milk and calcium in relation to bone health. The for the development of osteoporosis.
Harvard Nurses’ Health study examined whether
higher intakes of milk can reduce the risk of A number of studies, including observational
osteoporotic fractures. The study observed over epidemiology and some small clinical trials, have
75,000 women for 12 years and concluded that examined the role of the dietary acid load in people

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with chronic kidney disease. It has been suggested that

the evidence largely supports the hypothesis of a direct
relationship between a higher dietary acid load and
chronic kidney disease progression, bone loss and
sarcopenia (loss of skeletal muscle). However, due to a

Image©2012 Midlands Technical College

wide variety of techniques and terminology used to
quantify the dietary acid load, this theory is not widely
appreciated by nephrologists (Scialla and Anderson,
2013). A number of critical reviews of the acid-alkaline
hypothesis have been published (Darling et al., 2009;
Fenton et al., 2009; Fenton et al., 2011). These reviews
argue that a causal association between dietary acid
load and osteoporosis is not supported by the research
and say that there is no evidence that an alkaline diet
can protect bone health (Fenton et al., 2011).

One of the main criticisms is that if bone is the

primary source of calcium from which diet-related acid
is buffered, it is suggested that all the bone in the skeleton, which provides the buffer needed to
body would be dissolved in just a few years (Bonjour, maintain blood pH and plasma bicarbonate
2005). It is also argued that homeostatic mechanisms concentrations (Pizzorno et al., 2010). While kidney
(including renal acid excretion) would not permit a metabolism represents a major mechanism by which
steady-state low-grade metabolic acidosis caused by a metabolic acid loads are handled by the body, if the
typical Western diet. In other words, the body has kidneys are overwhelmed or compromised (kidney
ways of redressing the balance when, for example, function declines with age), calcium from the bones
the diet increases the acid levels in the blood, and may be called on to compensate for the increasingly
even small increases in acidity are countered by these acidic environment and an alkalising diet could help
mechanisms – that is the theory anyway. However, it redress the balance (Dargent-Molina et al., 2008;
has been demonstrated that a high dietary acid load, Frassetto and Sebastian, 2013). So, under certain
which lies within the ranges seen in a typical conditions, the acid-alkaline hypothesis may provide
American or European diet, can increase the acidity of a plausible mechanism in which a plant-based diet,
blood to detectable levels (Frassetto and Sebastian, rich in fruit and vegetables, could help promote and
2013). So, on the one hand we are told that we can preserve bone health. This may go some way in
compensate for the acidifying effects of a high-protein explaining the apparently contradictory evidence
diet, while on the other hand, the research shows that concerning animal protein and bone health.
we may not be able to balance it out completely. It
may be that the truth lies somewhere between these The acid-alkaline hypothesis has also been
two apparently irreconcilable arguments. challenged on the basis of a series of short-term
experimental studies that suggest that high-protein
Buffers are chemical substances that can minimise diets are not harmful to bone health and might
changes in a liquid when it becomes more acidic or actually be beneficial by improving calcium
alkaline. To maintain equilibrium whilst there is an absorption (Kerstetter et al., 2003). However, while
increased amount of acid in the body, at least three high-protein diets may increase calcium absorption,
compensatory physiological responses are activated: they also increase calcium excretion in the urine.
buffering from the bone (and so some degree Therefore, the positive effects of protein intake on
skeletal muscle), increased ventilation to eliminate bone health may only be beneficial under conditions
carbon dioxide, and in the kidney, bicarbonate is of adequate calcium intake (Mangano et al., 2014).
generated and reabsorbed into the blood while Indeed, growing evidence suggests that calcium and
excess hydrogen ions are secreted into the urine. In protein may interact in terms of bone health and
healthy people, these buffering systems all have a that the potential harmful effect of a high-protein
tremendous capacity to maintain the blood pH (acid- intake may be compensated for by an adequate
alkali balance) within a very narrow margin calcium intake (Weikert et al., 2005). If there is
(Kerstetter, 2009). However, the major reservoir of insufficient calcium in the diet to counter the
alkali (in the form of alkaline salts of calcium) is the calciuric effect, calcium may be lost from the bone.

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The generally accepted daily protein dietary Table 3.0 Potential acid as sulphate
allowance is 0.8g per kg of body weight. One study from sulphur-containing amino acids.
(of just 13 participants) compared a moderate animal
protein intake to a high animal protein intake diet Food mEq per g of protein
(1.0g per kg body weight compared to 2.1g per kg) Oatmeal 0.82
and found with 800mg of calcium per day, all Egg 0.80
participants ended up in negative calcium balance Walnuts 0.74
(Kerstetter et al., 2005). This was not anticipated and Pork 0.73
the authors suggested that the level of dietary Whole wheat 0.69
calcium was not enough to maintain calcium White rice 0.68
balance. However, because the extra urinary calcium Barley 0.68
lost in the high-protein diet was found to come from Tuna 0.65
the diet (as opposed to the bone), the authors Chicken 0.65
concluded that, at least in the short term, high- Corn 0.61
protein diets are not detrimental to bone. While, the Beef 0.59
increased urinary calcium produced by the high Cow’s milk 0.55
protein diet may reflect enhanced calcium absorption Cheddar 0.46
and not bone resorption, under both the moderate Soya 0.40
and high protein diets tested, the vast majority (over Peanuts 0.40
90 per cent) of the calcium found in the urine still Millet 0.31
came from the bones. Adult bones constantly Almonds 0.23
undergo remodelling through bone resorption by Potato 0.23
osteoclasts and bone formation by osteoblasts. In
adults, almost the entire human skeleton may be Source: Hoffman and Falvo, 2004.
remodelled over a 10-year cycle. While this study
suggests that higher protein intakes may not be
harmful in the short term, it should be remembered higher protein and some studies identify proteins
that they can lead to kidney problems and increased from animal sources as the key factor increasing
levels of IGF-1 which are linked to certain cancers fracture risk.
(see below). The long-term impact of high-protein
diets on bone health is still unclear and the relative A further possible confounding factor is that it is
contribution of calcium from the bone and/or diet to commonly assumed that all animal proteins have a
protein-induced calciuria remains controversial higher content of sulphur-containing amino acids
(Heaney, 2002). than all plant proteins. However, this may not be
entirely correct, some plant proteins (certain grains)
Other studies suggest that high-protein diets may may have a greater potential to produce more
increase calcium absorption and help preserve bone sulphuric acid than animal proteins (Massey, 2003).
mass by stimulating IGF-1, a potent bone growth Medical professionals use milliequivalents (mEq) to
stimulator (Tang, 2014; Mangano et al., 2014). measure electrolyte levels in body fluids. Table 3.0
However, as stated, increased IGF-1 levels are linked shows the mEq of selected animal and plant foods
to an increased risk of certain cancers so high animal and shows how some plant proteins may have a
protein diets are therefore not desirable and should greater potential to produce more mEq of sulphuric
not be recommended (see IGF-1). acid per gram of protein than some animal proteins.
For example, if protein comes from white rice it
Results of observational epidemiological studies have would have a mEq of 0.68 per gram of protein while
not helped to clarify the nature of the effect of high- protein from milk contains 0.55 mEq per gram of
protein intakes on the skeleton (Dargent-Molina et protein (Hoffman and Falvo, 2004).
al., 2008). Some studies show a positive association
with bone mass, some show no association and As stated, this is a complex issue with a wide range
some show a negative association. Even fewer of factors involved, not least the role of the kidney. It
studies have investigated the effect of protein intake should be noted that people who consume a high-
on fracture risk. These too have yielded mixed results animal protein diet have an increased risk of kidney
including a decreased risk of fracture with higher disease and continuing to consume high levels of
protein intake, and increased risk of fracture with meat, eggs and dairy foods may present a burden on

95
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an already overworked kidney (see Kidney Disease). It for calcium for adults is 700mg per day. The 2003
seems logical that the harder you make the kidneys UK National Diet and Nutrition Survey found that the
work, the more likely they are to struggle to meet the average calcium intake for men and women was
challenge. There appears to be some consensus that 1,007mg and 777mg per day respectively (144 and
in people with kidney disease or poor kidney function 111 per cent of the RNI respectively). Younger adults
(resulting from aging), a high dietary acid load may tended to have lower intakes but these were still
result in acidosis which may then lead to bone and above the EAR of 525mg per day). Overall, men and
muscle loss. In a recent study looking at the effects of women had significantly higher average daily intakes
dietary acid load in chronic kidney disease it was of calcium in the 2003 survey than in the 1986/87
concluded that in the setting of chronic kidney Adults Survey (Henderson et al., 2003a). So while a
disease and aging, a higher dietary acid load relatively small number of people had intakes on the
(determined by the balance of acid-inducing foods low side, generally, the level of calcium intake in the
such as meats, eggs, cheese and cereal grains against UK was good. If you are already getting enough
alkali-inducing foods such as fruits and vegetables) calcium, just adding more isn’t going to be helpful. It
may result in low-grade, subclinical acidosis (Scialla could be that getting sufficient calcium isn’t the
and Anderson, 2013). The authors went on to say problem, but that holding on to it is. As stated, there
that in these circumstances, efforts to maintain stable are genetic and lifestyle factors that can cause
blood pH and boost acid excretion from the kidney calcium to be lost from the body.
may lead to bone and muscle loss and further decline
in kidney function, but that this may be mitigated by It should be stated that very low calcium intakes
alkali. In summary, they say that studies with hard have been linked to poor bone health. A large-scale
outcomes are needed to determine the degree of EPIC-Oxford study found that women with a low
benefits of a foods-based approach to reducing the calcium intake (less than 525mg per day) had an
dietary acid load in patients with early to moderate increased risk of bone fracture compared with
chronic kidney disease. women with a calcium intake of at least 1,200mg
per day (Key et al., 2007). Another EPIC-Oxford
The acid-alkaline hypothesis is a controversial area of study found that a higher fracture rate among
research. Currently, data that support both the vegans compared with meat-eaters was halved in
proponents and opponents of the acid-alkaline magnitude by adjustment for energy and calcium
hypothesis exist (Frassetto and Sebastian, 2013). The intake and disappeared altogether when the analysis
pattern of incidence of osteoporosis around the was restricted to subjects who consumed at least
world certainly suggests that some aspect of the 525mg per day of calcium. In other words, there is
typical Western lifestyle could be a significant no reason to believe that vegans who consume an
contributing factor to bone loss. Furthermore, the adequate amount of calcium would have different
evidence shows that animal protein can be harmful bone fracture rates to vegetarians or meat-eaters.
to bone health but clearly more research is required. The authors concluded that an adequate calcium
In the meantime, it seems prudent to observe how intake is essential for bone health, irrespective of
the Western diet is accompanied by the so-called dietary preferences (Appleby et al., 2007). In a more
Western diseases including osteoporosis and limit, if recent study, the average intake of calcium among a
not eliminate, all animal protein from the diet. group of UK vegans was higher than in Appleby’s
2007 study; 456 mg per day compared to 232 mg
Calcium matters per day for men and 226 mg per day for women
If simply consuming sufficient levels of calcium was (Clarys et al., 2014). So, some people are not getting
the answer to preventing bone loss, then Northwest enough calcium in the diet and more care needs to
European countries like Denmark, Sweden and the be taken. This does not mean we should consume
UK, and the US would have the lowest fracture rates dairy products, far from it, the healthiest sources of
in the world. This is simply not the case; in fact they calcium are plant-based foods that do not contain
have the highest rates, a fact that is often the harmful components found in cow’s milk and
overlooked by health professionals. In the UK, the dairy products. Furthermore, care should be taken
estimated average requirement (EAR) for calcium, not to consume too much calcium as high intakes
whereby 50 per cent of the population’s requirement may be linked to an increased risk of heart attack or
is met, is set at 525mg per day. The recommended stroke (Daly and Ebeling, 2010). The UK NHS
amount or reference nutrient intake (RNI), whereby suggests that taking 1,500mg or less a day is unlikely
97.5 per cent of the population’s requirement is met, to cause any harm (NHS, 2012v).

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The role calcium plays in bone health is the hook the fracture was actually increased in those with high
dairy industry uses to encourage parents to feed dietary calcium intakes (Warensjö et al., 2011).
their children increasing amounts of dairy products.
We have been repeatedly sold the line that cow’s Exercise
milk and dairy foods are the best source of calcium. There are many factors linked to bone health that
However, while calcium remains important for bone may be more important than calcium. For example,
health, it could be that focusing on achieving high some studies show that exercise is the predominant
levels of calcium (above recommended intakes) has lifestyle determinant of bone strength. When the
little benefit and may even cause us to neglect other bone density of 80 young women was monitored
lifestyle factors that could offer greater benefits. A over a 10-year period, it showed that exercise was
2005 review on dairy products and bone health more important than calcium intake (Lloyd et al.,
published in the official journal of the American 2004). In a group of older people, a 15-year
Academy of Pediatrics concluded that there is very investigation into whether low calcium intake was a
little evidence to support increasing the consumption risk factor for hip fractures concluded that cutting
of dairy products in children and young adults in back on dairy did not increase the risk and that
order to promote bone health. This review examined physical activity provided better protection (Wickham
the effects of dairy products and total dietary et al., 1989). The discovery of 18th-century human
calcium on bone integrity in children and young bones under a London church revealed that today’s
adults and found that out of 37 studies, 27 showed women lose far more calcium than our ancestors
no relationship between dairy or dietary calcium (Lees et al., 1993). This may be attributed to the
intake and measures of bone health. In the lower degree of physical activity undertaken today.
remaining studies the effects on bone health were This research supports an increasing amount of
either small or results were confounded by the evidence that physical activity is a key factor in
fortification of milk with vitamin D (Lanou et al., reducing osteoporosis risk.
2005). Another meta-analysis of 19 studies involving
2,859 children, published in the British Medical Salt
Journal found that calcium supplementation in Other studies suggest a detrimental effect
children was unlikely to decrease the risk of fracture of dietary salt (sodium chloride) on bone
in childhood or in later life (Winzenberg et al., 2006). health. One study describes how a typical
In this analysis, there were American diet contains amounts of sodium
few studies involving children chloride far above evolutionary norms and
with low intakes. It may be potassium levels far below. This
that, providing we get imbalance is thought to
adequate calcium, contribute to the acid
supplementing the diet offers no producing effects of a typical
benefit and may actually be Western diet. This may
detrimental. contribute to development
of osteoporosis, kidney
This research strengthens previous stones and other health
evidence that extra calcium or and/or dairy problems. The authors
products do not have a clinically relevant impact on point out how, after
bone health in youth. More recently, a prospective seven million years of
study involving 61,433 Swedish women followed hominid evolution,
over 19 years, investigated associations between the humans remain genetically adapted
long-term dietary intake of calcium and to the potassium-rich, sodium-
risk of fracture and osteoporosis. The chloride-poor, alkali-producing
findings did show an association diet of our ancestral hunter-
between very low dietary calcium gatherers. In other words, our
intake and an increased risk of bodies are not well-suited to
fractures but above the base level of an acid-producing diet. The
750mg, increased intakes of calcium
were not associated with a reduction
in risk of fracture or osteoporosis. In
addition to that, the rate of hip

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shift to the contemporary diet occurred too recently and calcium-set tofu (soya bean curd) provide a good
for evolutionary forces to have had the opportunity to source of calcium. A good additional source is
make any changes in our metabolic machinery. calcium-enriched soya milk. Interestingly, the calcium
However, they suggest that decreasing salt intake and in dairy products is not as well absorbed as that in
increasing the intake of plant foods may not just help many dark green leafy vegetables, for example, in
the aging skeleton but provide other potential health one study, calcium absorbability from kale was
benefits as well (Frassetto et al., 2008). demonstrated to be considerably higher than that
from cow’s milk (Heaney and Weaver, 1990).
Vitamin K
Other studies suggest a positive role in bone health The interaction between calcium intake and physical
for vitamin K. A review of projects funded by the UK activity, sun exposure/vitamin D, intake of vitamin K,
Food Standards Agency examined the potential sodium, protein and protective phytonutrients (soya
benefits of fruit and vegetables, vitamin K, early-life compounds), needs to be considered before
nutrition and vitamin D on bone health. They reached recommending increased calcium intake in countries
two conclusions; firstly that a diet rich in fruit and with low fracture incidence (WHO, 2003a). In a
vegetables might be beneficial to bone health and paper in the British Medical Journal, Dr Amy Lanou
secondly that an increased consumption of vitamin K suggests that it is time to revise our calcium
may also contribute to bone health. A major research recommendations for young people and change our
gap they identified was the need to investigate assumptions about the role of calcium, milk and
vitamin D status in relation to bone health in different other dairy products in the bone health of children
groups (Ashwell et al., 2008). A higher calcium intake and adolescents. Lanou argues that while the policy
is still the primary recommendation for the prevention experts work on revising recommendations, doctors
of osteoporosis, and vitamin D deficiency is often and other health professionals should encourage
overlooked. In a study of US adults, a large children to spend time in active play or sports and to
proportion of younger and older adults were found consume a nutritious diet built from whole foods
to be below the desirable vitamin D threshold, from plant sources to achieve and maintain a healthy
whereas calcium intakes seemed to be adequate in weight and provide an environment conducive to
the majority of individuals. The authors concluded building strong bones (Lanou, 2006).
that the correction of vitamin D status is more
important than increasing dietary calcium intake In summary, we know that high-protein diets increase
(Bischoff-Ferrari et al., 2009). calcium excretion but the effect of high-protein diets
on calcium absorption is still unclear. High acid-
The idea that humans must suckle from cows for forming diets tend to increase calcium excretion,
their entire lives in order to meet their calcium needs whereas a more alkaline-forming diet (rich in fruit and
is clearly absurd. An increasing amount of evidence vegetables) decreases calcium excretion. Therefore, if
now shows that milk is not the best source of calcium you eat a high-protein diet but do not have sufficient
at all and suggests that our bone health would calcium, it stands to reason that, over time, you may
benefit enormously if we switched to plant-based lose calcium from your bones. You may be able to
sources. Interestingly, the 2003 National Diet and limit this loss by increasing the amount of alkaline-
Nutrition Survey showed that a large share of the forming foods (fruit and vegetables) in the diet and
calcium in our diets (over 50 per cent) comes from limiting, or eliminating all animal protein.
sources other than dairy foods (Henderson et al., Furthermore, research suggests that physical
2003a). This is not surprising as most people in the (especially weight-bearing) exercise is the most critical
world (over 70 per cent) obtain their calcium from factor for maintaining healthy bones, followed by
plant-based sources rather than dairy products. Good improving diet and lifestyle; this means eating plenty
plant-based sources of calcium include non-oxalate of fresh fruit and vegetables, and cutting down on
dark green leafy vegetables such as broccoli, kale, caffeine and avoiding alcohol and smoking.
spring greens, cabbage, bok choy and watercress.
Also rich in calcium are dried fruits, such as figs and For more information see Viva!Health’s fully-
dates, nuts, particularly almonds and Brazil nuts, and referenced scientific report Break Free – How to
seeds including sesame seeds and tahini (sesame seed Build Healthy Bones and What Really Matters in
paste) which contains a massive 680mg of calcium the Prevention of Osteoporosis and easy-to-read
per 100g. Pulses including soya beans, kidney beans, guide Building Bones for Life at:
chick peas, baked beans, broad beans, lentils, peas www.vegetarian.org.uk/campaigns/bones.

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Conclusion
The realisation is growing that changing our diet can they cannot because their bodies will not tolerate it.
have an enormous impact on health – for better or Up to 100 per cent of some ethnic groups are
worse. But what constitutes healthy food – and lactose intolerant. It’s obvious that the claims made
unhealthy – is not universally agreed and seems to for milk ignore the research and owe more to
change on a weekly basis. Cow’s milk is vigorously marketing hype than science.
defended by the dairy industry and they have
managed to turn it into a national icon. Woe-betide The dairy industry has spent many years and many
anyone who challenges their sacred cow. Not millions promoting the notion that cow’s milk is
surprisingly, the resulting controversy is confusing. good for us through expensive advertising
On the one hand consumers are told that milk is campaigns such as the ‘White Stuff’ – fronted by the
essential for good bone health while on the other, milk-moustachioed celebrity, Nell McAndrew. Now,
that it causes allergies, illness and disease. because of an increasing body of evidence, there are
signs of a growing realisation that milk is neither
Of course we need calcium for bones and teeth as natural nor healthy.
well as blood clotting, muscle function and regulating
the heart’s rhythm. But no matter how loudly the The very people who are most aggressively targeted
dairy industry shouts, an increasing body of evidence by the dairy industry – the young – are those most at
begs the question: is cow’s milk really the best source risk of being damaged by milk. It is not just the few
of calcium? It certainly is not for most of the world’s per cent under the age of one who will develop
people. Claims that dairy is best carry strong allergies but those likely to develop type 1 diabetes
overtones of cultural imperialism and simply ignore from cow’s milk infant formula. The evidence is
the 70 per cent of the global population who obtain convincing even though the mechanism may not yet
their calcium from other sources – people such as the be fully understood. This is not the time to be
Japanese who traditionally have consumed no dairy withdrawing support from the midwives and infant
yet have far better health than British people and live feeding coordinators, who encourage breastfeeding
considerably longer. in parts of the country with the lowest uptake.

Milk has been part of the human diet for less than Author of the world-famous book, Baby and Child
8,000 years – this is very recent in evolutionary Care, Dr Benjamin Spock, withdrew his support for
terms. It is not just that most people don’t drink it – cow’s milk in 1998. In 1999, a study published in the

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Journal of Pediatric Surgery reported that A point that is consistently overlooked is that two-
gastrointestinal bleeding caused by an allergic thirds of the UK’s milk comes from pregnant cows
response to milk was a major cause of rectal bleeding and as every mum knows, hormone levels during
in infancy, leading to iron-deficiency anaemia. This is pregnancy can rise dramatically. This is no laughing
now universally accepted. The World Health matter as prostate, ovarian and colorectal cancer are
Organisation recommends that infants should be all implicated. These cancers and the so-called
exclusively breastfed for the first six months of life in diseases of affluence, such as diabetes, obesity, heart
preference to being given cow’s milk or soya formulas. disease and even osteoporosis, occur increasingly in
the countries that consume the most dairy products.
But it’s not all about infants; cow’s milk was linked to It is not rocket science… cow’s milk and dairy
teenage acne in a study published in the Journal of products cause disease.
the American Academy of Dermatology. In the same
year, the journal Pediatrics published a review article The conclusions of this report are drawn from a huge
concluding that there is scant evidence that body of peer-reviewed research from academic
consuming more milk and dairy products promotes institutions all around the world. While the majority
better bone health in either children or adolescents. was done in an academic environment involving
Since then, more evidence has built on these findings. clinical trials or statistical analysis, some is of a more
personal nature. Professor Jane Plant’s spirit and
T. Colin Campbell, professor emeritus of nutritional courage in overcoming breast cancer through the
biochemistry at Cornell University, culminated a lifetime elimination of all dairy could not fail to inspire the
of research with The China Study, one of the most increasing number of women who are affected by
comprehensive nutritional studies ever undertaken. this type of cancer.
Campbell agrees there is little evidence to show that
increasing calcium intake will prevent fractures. In fact, Plant did not set out to promote one type of diet
research is moving in the opposite direction, showing above another but as a scientist (geochemist) she
that the more dairy and animal protein that is took an analytical approach to the problem of cancer
consumed, the higher the incidence of osteoporosis. and ultimately found the solution: a dairy-free diet.
Similarly, what initiated Campbell’s extensive China
Cow’s milk is clearly implicated in disease in both the study was not an attempt to justify or promote
young and old. Both UK arthritis charities, Arthritis vegetarianism. In fact, Campbell grew up on a farm
Care and the Arthritis Research UK, agree that in northern Virginia and for much of his life ate the
moving away from fatty foods such as meat and typical North American diet high in meat, eggs,
dairy and towards a diet rich in fruit, vegetables, and whole milk and butter. He began his academic life
whole grains can help people with arthritis. trying to increase animal protein production. It was
evidence from his own laboratory research that
The rate at which some cancers are increasing is also pointed an accusing finger at animal protein as a
a matter of concern. When Professor Jane Plant trigger for many diseases and he set out to confirm it
wrote Your Life in Your Hands, an account of how through epidemiological research. For health
she overcame breast cancer by eliminating dairy, one reasons, he and his family now eat a vegan diet.
in 10 UK women were affected by the disease. That
was in 2000. When this report was first written in The World Health Organisation believes that the only
2006, the figure had gone up to one in nine women. way people can improve their health is through
Now in 2014, a shocking one in eight women will informed opinion and their own, active co-operation.
develop breast cancer at some point in their lives! We agree! As a science-based health charity,
Viva!Health provides unbiased information on which
Female breast cancer incidence rates in Britain have people can make informed choices. We monitor and
increased by almost 70 per cent since the mid-1970s. interpret scientific research on diet and health and
Just in the last ten years they have gone up by six per communicate those findings to the public, health
cent. In rural China, on the other hand, where very little professionals, schools and food manufacturers.
if any dairy is consumed, just one in 10,000 women Importantly, we have no commercial or vested interests
gets breast cancer. These figures should be shouted and offer a vital – and what sometimes feels like a
from the rooftops as a basis for action. Plant and solitary – source of accurate and unbiased information.
Campbell – and many others for that matter – are in no
doubt that cow’s milk and dairy foods are responsible. This report combines the findings of over 400

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scientific papers from reputable peer-reviewed

journals such as the British Medical Journal and the
Lancet. The research is clear – the consumption of
cow’s milk and dairy products is linked to the
development of teenage acne, allergies, arthritis,
some cancers, colic, constipation, coronary heart
disease, Crohn’s disease, diabetes, dementia, ear
infection, food poisoning, gallstones, kidney disease,
migraine, autoimmune conditions, including multiple
sclerosis, overweight, obesity and osteoporosis.

As a species, we do not need saturated animal fat,

animal protein or cholesterol. We do not need the
trans fatty acids in processed foods. We do not need
salt and sugar in their current quantities. We do
need to move towards a plant-based, whole grain
diet containing a wide range of fruits, vegetables,
grains, pulses, nuts and seeds for the nutrients that
will promote a long and healthy life.

These, of course, are the same foods which contain

protection against disease in the form of antioxidants
and fibre. What is killing the Western world are the
degenerative diseases associated with affluence. It is
clear that the same diet that is good for preventing
cancer is also good for preventing heart disease,
obesity, diabetes and so on.

The official approach to the causes of all these

diseases remains extremely equivocal and dietary
advice seems to be based far more on not upsetting
particular vested interests than improving the public’s
health. As a consequence, no matter how much
money is thrown at the NHS, the incidence of all
these diseases goes on increasing remorselessly
because public health policy is geared almost
exclusively towards cure rather than prevention. It is
predicted that by 2020 almost one in two people (47
per cent) will get cancer in their lifetime and that by
2035 the NHS will be spending 17 per cent of its
entire budget on treating diabetes alone. This is
clearly unsustainable and we need to start looking
for preventative measures.

Only when prevention assumes the pre-eminence it

should have will the avoidance of dairy and other
animal products be seen as central to improving
public health. Meanwhile, it is left to individuals to
discover what they can about diet and heath while
Government health policy continues to kill us and
sows the seeds for the destruction of our own
children’s health, most of which will germinate in
early adulthood. It is a national disgrace and an
evolutionary disaster.

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Appendix I
The Safety of Soya collective data suggests that diets rich in
phytoestrogens have bone-sparing effects in the long
Soya milk, made from soya beans, contains the same term, in other words the data indicates that
amount of protein as dairy milk. It also provides all phytoestrogens may be beneficial to bone health
eight of the essential amino acids which the human (Setchell and Lydeking-Olsen, 2003).
body requires. Soya milk is rich in polyunsaturated
fatty acids including omega-3, and is free of Conversely, research focusing on the hormonal
cholesterol. Compared to cow’s milk, soya milk content of cow’s milk has not been widely discussed
contains lower levels of saturated fat and higher levels and surprisingly very little research has been
of unsaturated essential fatty acids which can lower published on this topic. Cow’s milk contains the
cholesterol levels in the body. Soya products provide hormones oestrogen, progesterone and a range of
an excellent source of B vitamins, calcium, iron and hormone precursors (androstenedione,
zinc. Soya also contains fibre which is important for dehydroepiandrosterone-sulphate, and 5 -reduced
good bowel health and can also lower cholesterol. steroids like 5 -androstanedione, 5 -pregnanedione,
and dihydrotestosterone). Some researchers are
In recent years, soya milk and soya-based products particularly concerned about the oestrogen content
have received much attention because of the of cow’s milk (Ganmaa and Sato, 2005), suggesting
phytoestrogens that they contain. Phytoestrogens that cow’s milk is one of the important routes of
are plant-made substances that can act in a similar human exposure to oestrogens. What concerns them
way to the hormone oestrogen, although they are is that the nature of cow’s milk has changed
far less potent (Coldham et al., 1997). They are drastically over the last hundred years, in that for
found in many fruits, vegetables, dried beans, peas, most of the time that a cow is milked, she is also
and whole grains. Isoflavones are a type of pregnant and therefore secreting hormones into the
phytoestrogen found in soya beans and include milk. The levels of these hormones in cow’s milk
genistein and daidzein. In general, much of the data increases markedly during pregnancy and has been
indicates that isoflavones are beneficial to health. For linked to a wide range of illnesses and diseases
example, isoflavones may have a protective role including certain hormone-dependent cancers such
against heart disease. Extensive research has shown as ovarian and breast cancer.
that soya protein can lower blood cholesterol levels.
The American Food and Drug Administration and the Consistent levels of soya isoflavones have been a
UK Joint Health Claim Initiative approved following component of the diet of many populations for
health claim: the inclusion of at least 25g of soya centuries and the consumption of soya is generally
protein per day, as part of a diet low in saturated fat, regarded as beneficial for health with a potentially
can help reduce blood cholesterol levels (FDA, 1999; protective effect against a number of chronic
JHCI, 2002). In a recent review of soya research it diseases because of their oestrogenic activity. A 2003
was reported that soya protein could lower LDL review concluded that when viewed in its entirety,
(‘bad’) cholesterol by 3-5 per cent, which is similar to the literature supports the safety of isoflavones as
the effects of soluble fibre. The author if this review typically consumed in diets based on soya or
says that even this modest reduction is meaningful, containing soya products (Munro et al., 2003). More
because in theory, over time, each one per cent recently, a review of 20 years of soya research
decrease in LDL cholesterol reduces heart disease risk concluded that, other than allergic reactions, there is
and/or mortality by as much as 2-5 per cent almost no credible evidence to suggest traditional
(Messina, 2010). soya foods exert clinically relevant adverse effects in
healthy individuals when consumed in amounts
In addition to the benefits to heart health, consistent with Asian intake (Messina, 2010).
isoflavones have been shown to offer other health
benefits. For example, they may have a role in
reducing menopausal symptoms; dietary soya
supplementation has been shown to substantially
reduce the frequency of hot flushes in some
postmenopausal women (Albertazzi et al, 1998).
While only a few clinical studies have examined the
influence of phytoestrogens on bone health, a
review of the current research states that the

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Soya-based Infant Formula Nutritional adequacy

Soya-based infant formulas are formulated to meet
Because soya-based infant formula is such a popular all of the nutrient requirements of the growing
alternative to cow’s milk formula, it was decided to infant. A number of studies have documented
include a separate section on it here. Soya protein- normal growth and development in infants fed soya-
based nutrition during infancy has a long history of based infant formulas. One study compared weight,
safe use around the world dating back centuries. The length and head circumference of healthy term
first report of soya-based infant formula in the West infants to one year of age, fed either soya-based
was recorded in 1909 (Ruhrah, 1909) and soya-based formula, or exclusively breastfed for at least two
infant formula was used in cases of infantile eczema months then weaned on to cow’s milk formula.
as early as in the 1920s (Hill and Stuart, 1929). Since Results demonstrated similar growth in the first year
these early days soya-based infant formula has come of life between groups (Lasekan et al., 1999).
a long way; it now contains all the nutrients needed Another, more recent study compared the nutritional
by an infant and can be used as a safe alternative or status and growth of 168 infants who were allergic
supplement to breast milk if necessary. to cow’s milk and were fed either soya-based infant
formula or extensively hydrolysed whey formula.
Soya-based infant formulas have been widely used Results showed that in both groups, nutrient intake
since the 1960s. In the US, the prevalence of and growth were within reference values confirming
feeding with soya-based infant formula can be as the safety and effectiveness of the soya-based
high as 36 per cent (Merritt and Jenks, 2004). In formula (Seppo et al., 2005). Current evidence
contrast, in most European countries, feeding with indicates that soya-based infant formulas ensure
soya-based infant formula is largely restricted to normal growth and development in healthy term
infants who are allergic to or intolerant of cow’s infants (Turck, 2007).
milk formula. The prevalence of soya-based infant
formula feeding in the UK tends to be less than two Unfortunately there is currently no infant formula
per cent (COT, 2003). In 2000, a survey conducted available in the UK which is suitable for vegans since
on behalf of the Department of Health, the Scottish Heinz discontinued their Nurture Soya (formerly
Executive, the National Assembly for Wales and the Farley’s Soya Formula) in 2010. There are soya
Department of Health, Social Services and Public formulas available (such as SMA’s Wysoy and Cow
Safety in Northern Ireland reported that soya and Gate’s Infasoy), but these are not suitable for
formula was fed to approximately one per cent of vegans as they are fortified with vitamin D3, which is
non-breastfed infants aged four to 10 weeks rising made from lanolin (a soft waxy substance secreted
to approximately two per cent of infants aged 10-14 by the sebaceous glands of sheep).
weeks (Hamlyn et al., 2002).
Phytoestrogens
The UK government currently advises that you The role of phytoestrogens in the diet has become a
shouldn’t give your baby soya-based infant formula somewhat controversial area with warnings focusing
unless your GP or health visitor advises you to (NHS particularly on the safety of soya-based infant
Choices, 2013g). They also state that in almost all formulas. Various animal experiments (primarily
cases, breastfeeding or another type of formula will using rodents and primates) have suggested that
be a better choice, and suggest that if you are giving phytoestrogens can elicit oestrogenic effects with
your baby soya-based infant formula at the moment, respect to sexual development and reproductive
you should talk to your GP or health visitor about function. However, it is widely acknowledged that
changing to a different formula. This reflects the results of animal experiments should not form
concerns about the use of soya-based infant the basis of a public health policy as significant
formulas. Based largely on anecdotal and animal- differences in biological function between rodents,
based experimental evidence, these concerns have primates and humans make the interpretation of
focused on the nutritional adequacy of soya-based these types of experimental studies extremely
infant formula, the effect of phytoestrogens, difficult. Just one single human study has specifically
genetically modified soya and the effects of glucose examined the effect of soya formula feeding on
syrup (which is used in place of lactose). These sexual development and fertility (Strom et al., 2001).
concerns are addressed below. This study examined the association between
exposure to soya formula in infancy and reproductive
health in adulthood. The results provided no

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evidence of adverse clinical effects on sexual the health of infants. However, they said that the
development or reproductive health of males and findings did provide evidence of potential risks. For
females. Indeed the authors of this study stated that this reason, the Scientific Advisory Committee on
their findings were reassuring about the safety of Nutrition (SACN) considered there to be no
infant soya formula. substantive medical need for, nor health benefit
arising from, the use of soya-based infant formulas
In 1998, a review on isoflavones, soya-based infant and together with the COT recommended that the
formulas and hormone function reported that Department of Health reviewed current advice on
growth was normal and no changes in timing of the use of soya-based infant formulas.
puberty or in infertility rates were reported in
humans who consumed soya formulas as infants The report did acknowledge that there is no
(Klein, 1998). The author concluded that soya-based evidence that populations which habitually ingest
infant formulas continue to be a safe, nutritionally high quantities of soya (such as the Chinese or
complete feeding option for most infants. Japanese) have impaired fertility or altered sexual
development. Despite this, they recommended that
However in 2003, in response to concerns about the research should be undertaken as a matter of high
oestrogenic properties of phytoestrogens the UK priority to determine whether ingestion of soya-
Department of Health’s committee of independent based formulas can affect infant reproductive
experts, the Committee on Toxicity of Chemicals in development in any way. Interestingly, the United
Food, Consumer Products and the Environment Kingdom and New Zealand are the only countries to
(COT) reviewed the health aspects of phytoestrogens have issued such advice with specific reference to
as part of an ongoing programme of reviews on phytoestrogens and soya-based infant formulas.
naturally-occurring chemicals (COT, 2003). This
report attempted to assess, on the basis of current This is a controversial issue which has yet to be
evidence, if ingestion of soya-based infant formulas resolved. The FSA advise that, until a full review of
poses any risk for human infants. the evidence both supporting and opposing soya
formula has been completed, there is no reason to
The report compared estimated dietary isoflavone stop your baby having a soya formula if it has been
intakes in Western and Eastern populations and suggested by a health professional. This it would
found that Eastern populations have a significantly seem is erring of the side of extreme caution given
higher intake of phytoestrogens. While in the UK, the that thousands of babies have been raised on soya-
US, Australia and New Zealand isoflavone intakes based infant formula.
tended to range from around 0.8 milligrams per day
to 17.0 milligrams per day, intakes in Japan, China Genetically modified soya
and Korea ranged from 18.0 milligrams per day to It is relatively recently that the genetic modification
200 milligrams per day. These figures did not include (GM) of organisms (plants and animals) has developed
data collected from one group of vegans in New as a technology. However, GM technology has not
Zealand whose intake was found to be 140.0 been welcomed by the British public; many people are
milligrams per day (COT, 2003). The COT estimated deeply suspicious and mistrustful of the science. We
that the daily isoflavone intake of a soya formula fed have been reassured in the past that certain foods are
infant was approximately 40 milligrams per day (COT, quite safe to eat only to find that they are not. Many
2003), above the average Western intake but well of us will remember in 1990, just before the bovine
within the range of intakes seen in Eastern countries. spongiform encephalopathy (BSE) crisis, John
Gummer feeding his daughter a beef burger and
In a cautionary statement the COT warned that saying that beef was perfectly safe, it was not.
isoflavones may lower free thyroxine concentrations
and advised that physicians and other health care The mistrust remains and many questions have gone
workers be aware of possible interactions between unanswered. For example, have the transgenic plants
isoflavones in soya-based infant formulas and thyroid grown so far met expectations? Evidence suggests
function, particularly in infants with congenital that in many cases they have not met the high yields
hypothyroidism. That said, the report concluded that expected. What is the real risk of transgenic
the findings from a wide range of studies did not contamination between genetically modified (GM)
provide direct evidence that phytoestrogens present and unmodified plants? This question refers to the
in soya-based infant formulas can adversely affect contamination of an unmodified crop with pollen

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from a GM plant. The pollen of the GM plant will as glucose or syrup. It is mainly made up of beneficial
carry copies of the foreign genes that were used complex carbohydrates (starches) rather than simple
confer some additional characteristic to the plant. carbohydrates (sugars) which are known to be
These may encode pesticide resistance for example harmful to teeth. Research has shown that soya
along with antibiotic resistance marker genes that infant formulas are no more likely to cause tooth
were used to identify the successfully modified plants decay than other infant formulas (Moynihan, 1996).
when they were first produced. The question of
contamination is difficult to answer as it may be Tooth decay can be the result of many factors, not
years or even decades before we can assess the full only the presence of sugars in a food and drink but
extent of transgenic contamination, but so far how they are consumed. It has been shown that
evidence suggests widespread contamination has prolonged contact of sugary foods and drinks with
occurred in some parts of the world. teeth increases the risk of tooth decay significantly.
Children should be encouraged to drink water if they
Another concern is that the genetic material (DNA or are thirsty as it quenches the thirst, maintains body
genes) may be transferred from GM foods to fluid levels, does not spoil the appetite and is safe for
bacteria in the human gut and from there into teeth. Fresh fruit juice provides a good source of
human tissue. There is experimental evidence that vitamin C and can be given with meals to help the
DNA from GM soya has been taken up by bacteria in absorption of iron. However, fresh fruit juices are
the small intestines of human volunteers acidic so may be harmful to teeth and should be
(Netherwood et al., 2004). This raises concerns that diluted with water. Furthermore, juice should be
bacteria in the gut (for example Lactobacillus) might served in a cup rather than a bottle to minimise the
then transfer that DNA into our intestinal epithelial risk of tooth decay. Children should be discouraged
cells. What effect this may have on human health from consuming sugary carbonated drinks and
will largely depend on what the gene does; it may squashes as these contribute to dental problems, are
do nothing but is that a risk worth taking? Finally, as a poor source of nutrients and tend to displace other
a result of a lack of funding, scientists are sometimes more nutritious foods. If normal weaning practices
forced to adopt the corporate agenda, which is not are adopted, soya infant formulas should not cause
necessarily the same as the public good. For harm to teeth (Moynihan, 1996).
example, Monsanto has used genetic engineering to
produce herbicide resistance crops thus increasing In summary, soya-based infant formulas continue to
sales of its herbicide Roundup. provide a safe feeding option for most infants. They
meet all the nutritional requirements of the infant
GM products, especially soya and maize, are now in with none of the detrimental
so many foods, including baby milks, that it can be effects associated with
difficult to avoid them. We do not yet know enough the consumption of
about this technology to confidently say what the cow’s milk
long term effects of it will be but consumers appear formulas.
to be voting with their shopping baskets by avoiding
GM foods as far as possible. SMA Nutrition and Cow
and Gate state that no GM soya is used in their soya-
based infant formulas (SMA Careline, 2014; Cow
and Gate, 2014).

Glucose syrup and tooth decay

Another concern with infant soya formula is that the
glucose syrup content may harm teeth. All infant
formulas must comply with standards laid down by
UK regulations which specify minimum and
maximum amounts of carbohydrate (the body’s main
form of energy). The carbohydrate in cow’s milk is the
sugar lactose, in soya-based infant formula an
alternative carbohydrate is used: glucose syrup.
Glucose syrup is often confused with sugars but in
fact is derived from corn starch and is not the same

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Appendix II
Body Mass Index
Table 1. Body mass index (BMI) table in imperial units. Find the nearest height in feet and inches on the top
row. Read down that column to find the nearest weight in stones and pounds. Then find your BMI in the left
hand column.

BMI 4FT10IN 4FT11IN 5FT 0IN 5FT 1IN 5FT 2IN 5FT 3IN 5FT 4IN

17.0 5st11lb 6st0lb 6st3lb 6st5lb 6st8lb 6st11lb 7st1lb

18.5 6st4lb 6st7lb 6st10lb 6st13lb 7st3lb 7st6lb 7st9lb
20.0 6st11lb 7st1lb 7st4lb 7st7lb 7st11lb 8st0lb 8st4lb
22.5 7st9lb 7st13b 8st3lb 8st7lb 8st11lb 9st1lb 9st5lb
25.0 8st7lb 8st11lb 9st2lb 9st6lb 9st10lb 10st1lb 10st5lb
27.5 9st5lb 9st10lb 10st0lb 10st5lb 10lb10lb 11st1lb 11st6lb
30.0 10st3lb 10st8lb 10st13lb 11st4lb 11st10lb 12st1lb 12st6lb
32.5 11st1lb 11st6lb 11st12lb 12st4lb 12st9lb 13st1lb 13st7lb
35.0 11st13lb 12st5lb 12st11lb 13st3lb 13st9lb 14st1lb 14st7lb

BMI 5FT 5IN 5FT 6IN 5FT 7IN 5FT 8IN 5FT 9IN 5FT10IN 5FT11IN

17.0 7st4lb 7st7lb 7st10lb 7st13lb 8st3lb 8st6lb 8st9lb

18.5 7st13lb 8st2lb 8st6lb 8st9lb 8st13lb 9st2lb 9st6lb
20.0 8st8lb 8st11lb 9st1lb 9st5lb 9st9lb 9st13lb 10st3lb
22.5 9st9lb 9st13lb 10st3lb 10st7lb 10st12lb 11st2lb 11st7lb
25.0 10st10lb 11st0lb 11st5lb 11st10lb 12st1lb 12st6lb 12st11lb
27.5 11st11lb 12st2lb 12st7lb 12st12lb 13st4lb 13st0lb 14st1lb
30.0 12st12lb 13st3lb 13st9lb 14st1lb 14st7lb 14st13lb 15st5lb
32.5 13st13lb 14st5lb 14st11lb 15st3lb 15st10lb 16st2lb 16st9lb
35.0 15st0lb 15st6lb 15st13lb 16st6lb 16st13lb 17st5lb 17st12lb

BMI 6FT 0IN 6FT 1IN 6FT 2IN 6FT 3IN 6FT 4IN 6FT 5IN

17.0 8st13lb 9st2lb 9st6lb 9st10lb 9st13lb 10st3lb

18.5 9st10lb 10st0lb 10st4lb 10st8lb 10st11lb 11st2lb
20.0 10st7lb 10st11lb 11st1lb 11st6lb 11st10lb 12st0lb
22.5 11st11lb 12st2lb 12st7lb 12st12lb 13st2lb 13st7lb
25.0 13st2lb 13st7lb 13st12lb 14st4lb 14st9lb 15st0lb
27.5 14st6lb 14st12lb 15st4lb 15st10lb 16st1lb 16st7lb
30.0 15st11lb 16st3lb 16st9lb 17st2lb 17st8lb 18st1lb
32.5 17st1lb 17st8lb 18st1lb 18st8lb 19st1lb 19st8lb
35.0 18st6lb 18st13lb 19st6lb 20st0lb 20st7lb 21st8lb

106
 A report

References
Abelow BJ, Holford TR, and Insogna KL. 1992. Cross-cultural American Academy of Pediatrics, Committee on Nutrition. 1992.
association between dietary animal protein and hip fracture: a The use of whole cows’ milk in infancy. Pediatrics. 89, 1105-1109.
hypothesis. Calcified Tissue International. 50 (1) 14-18. Anderson JW, Johnstone BM and Remley DT. 1999. Breast-feeding
Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett and cognitive development: a meta-analysis. American Journal of
WC and Holmes MD. 2005. High school dietary dairy intake and Clinical Nutrition. 70 (4) 525-535.
teenage acne. Journal of the American Academy of Dermatology. Anderson JW. 1986. Dietary fiber in nutrition management of
52 (2) 207-214. diabetes. In: G. Vahouny, V. and D. Kritchevsky (eds.), Dietary
Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett fiber: Basic and Clinical Aspects. New York: Plenum Press.
HH, Colditz GA, Willett WC and Holmes MD. 2006. Milk Anderson JW, Smith BM and Geil PB. 1990. High-fiber diet for
consumption and acne in adolescent girls. Dermatology Online diabetes. Safe and effective treatment. Postgraduate Medicine. 88
Journal. 12 (4) 1. (2) 157-161, 164, 167-168.
Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett Anderson JW, Randles KM, Kendall CW and Jenkins DJ. 2004.
HH, Colditz GA, Willett WC and Holmes MD. 2008. Milk Carbohydrate and fiber recommendations for individuals with
consumption and acne in teenaged boys. Journal of the American diabetes: a quantitative assessment and meta-analysis of the
Academy of Dermatology. 58 (5) 787-793. evidence. Journal of the American College of Nutrition. 23 (1) 5-
AbuGhazaleh AA, Schingoethe DJ, Hippen AR, and Kalscheur KF. 17.
2004. Conjugated linoleic acid increases in milk when cows fed Andiran F, Dayi S, and Mete E. 2003. Cow’s milk consumption in
fish meal and extruded soybeans for an extended period of time. constipation and anal fissure in infants and young children.
Journal of Dairy Science. 87 (6) 1758-1766. Journal of Paediatrics and Child Health. 39 (5) 329-331.
Agranoff BW and Goldberg D. 1974. Diet and the geographical Appleby PN, Thorogood M, Mann JI and Key TJ. 1999. The Oxford
distribution of multiple sclerosis. The Lancet. 2 (7888) 1061-1066. Vegetarian Study: an overview. American Journal of Clinical
Adlercreutz H. 1990. Western diet and Western diseases: some Nutrition. 70 (3 Suppl) 525S-531S.
hormonal and biochemical mechanisms and associations. Appleby P, Roddam A, Allen N, Key T. 2007. Comparative fracture
Scandinavian Journal of Clinical Laboratory Investigation risk in vegetarians and nonvegetarians in EPIC-Oxford. European
Supplementum. 201, 3-23. Journal of Clinical Nutrition. 61 (12) 1400-1406.
Albertazzi, P., Pansini, F., Bonaccorsi, G., Zanotti, L., Forini, E. and Arenz S, Rückerl R, Koletzko B and von Kries R. (2004)
De Aloysio, D. 1998. The effect of dietary soy supplementation on Breastfeeding and Childhood obesity: a systematic review.
hot flushes. Obstetrics and Gynecology. 91 (1) 6-11. International Journal of Obesity Related Metabolic Disorders. 28:
Alexy U, Remer T, Manz F, Neu CM and Schoenau E. 2005. Long- 1247-1256.
term protein intake and dietary potential renal acid load are Arthritis Research UK, 2013. Who gets arthritis? [online]. Available
associated with bone modeling and remodeling at the proximal from: www.arthritisresearchuk.org/arthritis-
radius in healthy children. American Journal of Clinical Nutrition. information/conditions/arthritis/who-gets-it.aspx [Accessed 17
82 (5) 1107-1114. September 2013].
Allen NE, Appleby PN, Davey GK and Key TJ. 2000. Hormones and Arthritis Research UK, 2013a. Do vegetarian or vegan diets help?
diet: low insulin-like growth factor-I but normal bioavailable [online]. Available from: www.arthritisresearchuk.org/arthritis-
androgens in vegan men. British Journal of Cancer. 83 (1) 95-97. information/arthritis-and-daily-life/diet-and-arthritis/do-vegetarian-
Allen NE, Key TJ, Appleby PN, Travis RC, Roddam AW, Rinaldi S, or-vegan-diets-help.aspx [Accessed 17 September 2013].
Egevad L, Rohrmann S, Linseisen J, Pischon T, Boeing H, Johnsen Arthritis Research UK, 2013b. Who Foods and supplements that
NF, Tjønneland A, Grønbaek H, Overvad K, Kiemeney L, Bueno-de- might help [online]. Available from:
Mesquita HB, Bingham S, Khaw KT, Tumino R, Berrino F, Mattiello www.arthritisresearchuk.org/arthritis-information/arthritis-and-
A, Sacerdote C, Palli D, Quirós JR, Ardanaz E, Navarro C, daily-life/diet-and-arthritis/foods-and-supplements-that-might-
Larrañaga N, Gonzalez C, Sanchez MJ, Trichopoulou A, Travezea help.aspx [Accessed 17 September 2013].
C, Trichopoulos D, Jenab M, Ferrari P, Riboli E and Kaaks R. 2007.
Arthritis Care, 2010. Calcium Fact Sheet [online] Available from:
Serum insulin-like growth factor (IGF)-I and IGF-binding protein-3
www.arthritiscare.org.uk/PublicationsandResources/Listedbytype/F
concentrations and prostate cancer risk: results from the European
actsheets/main_content/CalciumFactsheetMay10.pdf [Accessed 17
Prospective Investigation into Cancer and Nutrition. Cancer
September 2013].
Epidemiology Biomarkers and Prevention. 16 (6) 1121-1127.
Arthritis Care, 2011. Eating well [online] Available from:
Allen NE, Key TJ, Appleby PN, Travis RC, Roddam AW, Tjønneland
www.arthritiscare.org.uk/LivingwithArthritis/Self-
A, Johnsen NF, Overvad K, Linseisen J, Rohrmann S, Boeing H,
management/Eatingwell [Accessed 17 September 2013].
Pischon T, Bueno-de-Mesquita HB, Kiemeney L, Tagliabue G, Palli
D, Vineis P, Tumino R, Trichopoulou A, Kassapa C, Trichopoulos D, Ashwell M, Stone E, Mathers J, Barnes S, Compston J, Francis RM,
Ardanaz E, Larrañaga N, Tormo MJ, González CA, Quirós JR, Key T, Cashman KD, Cooper C, Khaw KT, Lanham-New S,
Sánchez MJ, Bingham S, Khaw KT, Manjer J, Berglund G, Stattin P, Macdonald H, Prentice A, Shearer M and Stephen A. 2008.
Hallmans G, Slimani N, Ferrari P, Rinaldi S and Riboli E. 2008. Nutrition and bone health projects funded by the UK Food
Animal foods, protein, calcium and prostate cancer risk: the Standards Agency: have they helped to inform public health
European Prospective Investigation into Cancer and Nutrition. policy? British Journal of Nutrition. 99 (1) 198-205.
British Journal of Cancer. 98 (9) 1574-1581. Atkins PJ. 2005. Fattening Children or Fattening Farmers? School
Allergy UK, 2005. Migraine. (Fact sheet) London: Allergy UK. Milk in Britain, 1921-1941. Economic History Review. 58 (1) 57-78.
Allergy UK, 2012. Hay Fever and Allergic Rhinitis [online]. Available Aune D, Lau R, Chan DS, Vieira R, Greenwood DC, Kampman E
from: www.allergyuk.org/hayfever-and-allergic-rhinitis/hay-fever- and Norat T. 2012. Dairy products and colorectal cancer risk: a
and-allergic-rhinitis [Accessed 17 September 2013]. systematic review and meta-analysis of cohort studies. Annals of
Oncology. 23 (1) 37-45.

107
 White Lies

Autschbach F, Eisold S, Hinz U, Zinser S, Linnebacher M, Giese T, Bernard JY, De Agostini M, Forhan A, Alfaiate T, Bonet M,
Loffler T, Buchler MW and Schmidt J. 2005. High prevalence of Champion V, Kaminski M, de Lauzon-Guillain B, Charles MA and
Mycobacterium avium subspecies paratuberculosis IS900 DNA in Heude B; EDEN Mother-Child Cohort Study Group. 2013.
gut tissues from individuals with Crohn’s disease. Gut. 54 (7) Breastfeeding duration and cognitive development at 2 and 3
944-949. years of age in the EDEN mother-child cohort. Journal of
Axelsson I, Gebre-Medhin M, Hernell O, Jakobsonn I, Michaelsen Pediatrics. 163 (1) 36-42.
KF and Samuelson G. 1999. Recommendations for prevention of Bernstein, J.M. 1993. The role of IgE-mediated hypersensitivity in
iron deficiency. Delay cow’s milk intake as a beverage to infants the development of otitis media with effusion: a review.
until 10-12 months of age. Läkartidningen. 96, 2206-2208. Otolaryngology and Head and Neck Surgery. 109 (3 Pt 2) 611-620.
Aydogan B, Kiroglu M, Altintas D, Yilmaz M, Yorgancilar E and Berry, E., Middleton, N., Gravenor, M. and Hillerton, E. 2003.
Tuncer U. 2004. The role of food allergy in otitis media with Science (or art) of cell counting. Proceedings of the British Mastitis
effusion. Otolaryngology and Head and Neck Surgery. 130 (6) Conference (2003) Garstang. 73-83 [online]. Available from:
747-750. www.britishmastitisconference.org.uk/BMC2003Proceedings.pdf
Bajekal M, Scholes S, Love H, Hawkins N, O'Flaherty M, Raine R [Accessed 9 September 2013].
and Capewell S. 2012. Analysing recent socioeconomic trends in BHF, 2012. British Heart Foundation. Coronary heart disease
coronary heart disease mortality in England, 2000-2007: a statistics. A compendium of health statistics [online] Available
population modelling study. PLoS Medicine. 9 (6) e1001237. from: www.bhf.org.uk/publications/view-
Baker JR. 1990. Grey seal (Halichoerus grypus) milk composition publication.aspx?ps=1002097 [Accessed 14 October 2013].
and its variation over lactation. The British Veterinary Journal, 146 BHF, 2013. British Heart Foundation. Cardiovascular disease
(3) 233-238. statistics. [online] Available from:
Ballard O and Morrow AL. 2013. Human milk composition: www.bhf.org.uk/heart%20health/facts%20and%20statistics.aspx
nutrients and bioactive factors. Pediatric Clinics of North America. [Accessed 14 October 2013].
60 (1) 49-74. Bingham SA, Luben R, Welch A, Wareham N, Khaw KT and Day N.
Barnard N. 1998. Foods that fight pain. New York, US: Three 2003. Are imprecise methods obscuring a relation between fat
Rivers Press. and breast cancer? The Lancet. 362 (9379) 212-214.
Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ and Glass J. Bingham SA, Day NE, Luben R, Ferrari P, Slimani N, Norat T, Clavel-
2005. The effects of a low-fat, plant-based dietary intervention on Chapelon F, Kesse E, Nieters A, Boeing H, Tjonneland A, Overvad
body weight, metabolism, and insulin sensitivity. The American K, Martinez C, Dorronsoro M, Gonzalez CA, Key TJ, Trichopoulou
Journal of Medicine. 118 (9) 991-997. A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita HB,
Peeters PH, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks R and
Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L,
Riboli E; European Prospective Investigation into Cancer and
Green A and Ferdowsian H. 2009. A low-fat vegan diet and a
Nutrition. 2003a. Dietary fibre in food and protection against
conventional diabetes diet in the treatment of type 2 diabetes: a
colorectal cancer in the European Prospective Investigation into
randomized, controlled, 74-wk clinical trial. American Journal of
Cancer and Nutrition (EPIC): an observational study. The Lancet.
Clinical Nutrition. 89 (5) 1588S-1596S.
361 (9368) 1496-1501.
Barnard ND, Katcher HI, Jenkins DJ, Cohen J and Turner-McGrievy
Bingham SA, Norat T, Moskal A, Ferrari P, Slimani N, Clavel-
G. Vegetarian and vegan diets in type 2 diabetes management.
Chapelon F, Kesse E, Nieters A, Boeing H, Tjønneland A, Overvad
2009a. Nutrition Reviews. 67 (5) 255-263.
K, Martinez C, Dorronsoro M, González CA, Ardanaz E, Navarro
Barr SI. 2003. Increased dairy product or calcium intake: is body C, Quirós JR, Key TJ, Day NE, Trichopoulou A, Naska A, Krogh V,
weight or composition affected in humans? Journal of Nutrition. Tumino R, Palli D, Panico S, Vineis P, Bueno-de-Mesquita HB, Ocké
133 (1) 245S-248S. MC, Peeters PH, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks
Barreiro C, Albano H, Silva J and Teixeira P. 2013. Role of flies as R and Riboli E. 2005. Is the association with fiber from foods in
vectors of foodborne pathogens in rural areas. ISRN Microbiology. colorectal cancer confounded by folate intake? Cancer
2013:718780. Epidemiology Biomarkers and Prevention. 14 (6) 1552-1556.
Barzel US and Jowsey J. 1969. The effects of chronic acid and Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li
alkali administration on bone turnover. Clinical Science. 36. 517- R, Spiegelman D, Specker B, Orav JE, Wong JB, Staehelin HB,
524. O'Reilly E, Kiel DP and Willett WC. 2007. Calcium intake and hip
fracture risk in men and women: a meta-analysis of prospective
Bates B, Lennox A and Swan G. 2010. NDNS Headline results from
cohort studies and randomized controlled trials. American Journal
Year 1 of the Rolling Programme (2008/2009) [online].
of Clinical Nutrition. 86 (6) 1780-1790.
www.food.gov.uk/multimedia/pdfs/publication/ndnsreport0809.pd
f [Accessed 23 October 2013]. Bischoff-Ferrari HA, Kiel DP, Dawson-Hughes B, Orav JE, Li R,
Spiegelman D, Dietrich T and Willett WC. 2009. Dietary calcium
Berkey CS, Rockett HR, Willett WC and Colditz GA. 2005. Milk,
and serum 25-hydroxyvitamin D status in relation to BMD among
dairy fat, dietary calcium, and weight gain: a longitudinal study of
U.S. adults. Journal of Bone and Mineral Research. 24 (5) 935-
adolescents. Archives of Pediatric and Adolescent Medicine. 159
942.
(6) 543-550.
Blowey R and Edmondson P. 2000. Mastitis Control in Dairy Herds.
Berkow SE, Barnard ND, Saxe GA and Ankerberg-Nobis T. 2007.
UK: Farming Press Books.
Diet and survival after prostate cancer diagnosis. Nutrition
Reviews. 65 (9) 391-403. BMA, 2013. British Medical Association. Obesity, policy and facts
[online]. Available from: http://bma.org.uk/working-for-
change/improving-and-protecting-health/obesity/obesity-policy-
and-facts [Accessed 22 October 2013].

108
 A report

Boffetta P, Couto E, Wichmann J, Ferrari P, Trichopoulos D, Bueno- Cancer Research UK, 2009. Diet and cancer: the evidence [online].
de-Mesquita HB, van Duijnhoven FJ, Büchner FL, Key T, Boeing H, Available from:www.cancerresearchuk.org/cancer-
Nöthlings U, Linseisen J, Gonzalez CA, Overvad K, Nielsen MR, info/healthyliving/dietandhealthyeating/howdoweknow/diet-and-
Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault MC, cancer-the-evidence [Accessed 27 September 2013].
Morois S, Lagiou P, Naska A, Benetou V, Kaaks R, Rohrmann S, Cancer Research UK, 2011. Preventing Cancer [online]. Available
Panico S, Sieri S, Vineis P, Palli D, van Gils CH, Peeters PH, Lund E, from: www.cancerresearchuk.org/cancer-help/about-
Brustad M, Engeset D, Huerta JM, Rodríguez L, Sánchez MJ, cancer/causes-symptoms/preventing-cancer [Accessed 23
Dorronsoro M, Barricarte A, Hallmans G, Johansson I, Manjer J, September 2013].
Sonestedt E, Allen NE, Bingham S, Khaw KT, Slimani N, Jenab M,
Cancer Research UK, 2012. 20 Most Common Cancers [online].
Mouw T, Norat T, Riboli E and Trichopoulou A. 2010. Fruit and
Available from: www.cancerresearchuk.org/cancer-
vegetable intake and overall cancer risk in the European
info/cancerstats/incidence/commoncancers/uk-cancer-incidence-
Prospective Investigation Into Cancer and Nutrition (EPIC). Journal
statistics-for-common-cancers#Twenty [Accessed 25 September
of the National Cancer Institute. 102 (8) 529-537.
2013].
Bonjour JP. 2005. Dietary protein: an essential nutrient for bone
Cancer Research UK, 2012a. Ovarian cancer, Causes and Risks
health. Journal of the American College of Nutrition. 24. 526S-
[online]. Available from: www.cancerresearchuk.org/cancer-
536S.
help/type/ovarian-cancer/about/ovarian-cancer-risks-and-causes
Boyd NF, Stone J, Vogt KN, Connelly BS, Martin LJ and Minkin S. [Accessed 7 October 2013].
2003. Dietary fat and breast cancer risk revisited: a meta-analysis
Cancer Research UK, 2012b. Prostate cancer mortality statistics
of the published literature. British Journal of Cancer. 89 (9) 1672-
[online]. Available from: www.cancerresearchuk.org/cancer-
1685.
info/cancerstats/types/prostate/mortality/uk-prostate-cancer-
Breslau, N.A., Brinkley, L., Hill, K.D. and Pak C.Y. 1988. mortality-statistics [Accessed 9 October 2013].
Relationship of animal protein-rich diet to kidney stone formation
Cancer Research UK, 2012c. Prostate cancer risks and causes
and calcium metabolism. The Journal of Clinical Endocrinology
[online]. Available from: www.cancerresearchuk.org/cancer-
and Metabolism. 66 (1) 140-146.
help/type/prostate-cancer/about/prostate-cancer-risks-and-causes
Brown AC and Roy M. 2010 Does evidence exist to include dietary [Accessed 9 October 2013].
therapy in the treatment of Crohn’s disease? Expert Review of
Cancer Research UK, 2012d. Prostate cancer: incidence and
Gastroenterology and Hepatology. 4 (2) 191-215.
mortality statistics for prostate cancer worldwide. [online].
Brown AC, Rampertab SD and Mullin GE. 2011 Existing dietary Available from: www.cancerresearchuk.org/cancer-
guidelines for Crohn's disease and ulcerative colitis. Expert Review info/cancerstats/world/prostate-cancer-world/ [Accessed 9 October
of Gastroenterology and Hepatology. 5 (3) 411-425. 2013].
Buckley, M. 2000. Some new and important clues to the causes of Cancer Research UK, 2013. All Cancers Combined [online].
colic. British Journal of Community Nursing. 5 (9) 462, 464-465. Available from: http://publications.cancerresearchuk.org/
Bull TJ, McMinn EJ, Sidi-Boumedine K, Skull A, Durkin D, Neild P, downloads/Product/CS_KF_ALLCANCERS.pdf [Accessed
Rhodes G, Pickup R. and Hermon-Taylor J. 2003. Detection and September 23 2013].
verification of Mycobacterium avium subsp. paratuberculosis in Cavallo MG, Fava D, Monetini L, Barone F and Pozzilli P. 1996.
fresh ileocolonic mucosal biopsy specimens from individuals with Cell-mediated immune response to beta casein in recent-onset
and without Crohn’s disease. Journal of Clinical Microbiology. 41 insulin-dependent diabetes: implications for disease pathogenesis.
(7) 2915-2923. The Lancet. 348 (9032) 926-928.
Butcher, J. 1976. The distribution of multiple sclerosis in relation to CDC, 2013. Raw (Unpasteurized) Milk [online]. Available from:
the dairy industry and milk consumption. New Zealand Medical www.cdc.gov/features/rawmilk [Accessed 14 January 2014].
Journal. 83 (566) 427-430.
Cela-Conde CJ and Ayala FJ. 2003. Genera of the human lineage.
Camboim Rockett F, Castro K, Rossoni de Oliveira V, da Silveira Proceedings of the National Academy of Sciences, 100 (13) 7684-
Perla A, Fagundes Chaves ML and Schweigert Perry ID. 2012. 7689.
Perceived migraine triggers: do dietary factors play a role?
Chan JM, Stampfer MJ, Giovannucci E, Gann PH, Ma J, Wilkinson
Nutrición hospitalaria. 27 (2) 483-489.
P, Hennekens C and Pollak M. 1998. Plasma insulin-like growth
Campbell TC and Campbell TM II. 2005. The China Study. Dallas, factor-I and prostate cancer risk: a prospective study. Science. 279
Texas, USA: BenBella Books. (5350) 563-566.
Campbell TC and Junshi C. 1994. Diet and chronic degenerative Cho E, Spiegelman D, Hunter DJ, Chenm WY, Stampfer MJ,
diseases: perspectives from China. American Journal of Clinical Colditz GA and Willett WC. 2003. Premenopausal fat intake and
Nutrition. 59 (5 Suppl) 1153S-1161S. risk of breast cancer. Journal of the National Cancer Institute. 95
Campbell AK and Matthews SB. 2005. Darwin’s illness revealed. (14) 1079-1085.
Postgraduate Medical Journal. 81(954) 248-251. Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den
Campbell AK, Waud JP and Matthews SB. 2009. The molecular Brandt PA, Colditz GA, Folsom AR, Fraser GE, Freudenheim JL,
basis of lactose intolerance. Science Progress. 92 (Pt 3-4) 241-287. Giovannucci E, Goldbohm RA, Graham S, Miller AB, Pietinen P,
Campbell WW and Tang M. 2010. Protein intake, weight loss, and Potter JD, Rohan TE, Terry P, Toniolo P, Virtanen MJ, Willett WC,
bone mineral density in postmenopausal women. Journals of Wolk A, Wu K, Yaun SS, Zeleniuch-Jacquotte A and Hunter DJ.
Gerontology. Series A Biological Sciences and Medical Sciences. 65 2004. Dairy foods, calcium, and colorectal cancer: a pooled
(10) 1115-1122. analysis of 10 cohort studies. Journal of the National Cancer
Institute. 96 (13) 1015-1022.
Cirgin Ellett ML. 2003. What is known about infant colic?
Gastroenterology Nursing. 26 (2) 60-65.

109
 White Lies

Clarys P, Deliens T, Huybrechts I, Deriemaeker P, Vanaelst B, De Dairy Co, 2013a. Average Milk Yield [online]
Keyzer W, Hebbelinck M and Mullie P. 2014. Comparison of www.dairyco.org.uk/market-information/farming-data/milk-
nutritional quality of the vegan, vegetarian, semi-vegetarian, yield/average-milk-yield/ [Accessed 6 September 2013].
pesco-vegetarian and omnivorous diet. Nutrients. 6 (3) 1318- Dairy Co, 2013b. Mastitis in Dairy Cows [online]
1332. www.dairyco.org.uk/technical-information/animal-health-
Clein NW. 1954. Cow’s milk allergy in infants. Pediatric Clinics of welfare/mastitis/ [Accessed 9 September 2013].
North America. 25, 949-962. Dairy Co, 2013c. Somatic Cell Count – Milk Quality Indicator
Clyne PS and Kulczycki A Jr. 1991. Human breast milk contains [online] www.dairyco.org.uk/technical-information/animal-health-
bovine IgG. Relationship to infant colic? Pediatrics. 87 (4) 439- welfare/mastitis/symptoms-of-mastitis/somatic-cell-count-milk-
444. quality-indicator/ [Accessed 9 September 2013].
Coldham NG, Dave M, Sivapathasundaram S, McDonnell DP, Dairy Co, 2013d. Talking to the public [online]
Connor C. and Sauer MJ. 1997. Evaluation of a recombinant yeast www.dairyco.org.uk/talking-to-the-public/#.UmkdYVOJJEM
cell estrogen screening assay. Environmental Health Perspectives. [Accessed October 24 2013].
105 (7) 734-742. Dairy Products (Hygiene) Regulations 1995. Statutory Instrument
Collins MT, Lisby G, Moser C, Chicks D, Christensen S, 1995 No. 1086, London, HMSO.
Reichelderfer M, Hoiby N, Harms BA, Thomsen OO, Skibsted U D’Amico G, Gentile MG, Manna G, Fellin G, Ciceri R, Cofano F,
and Binder V. 2000. Results of multiple diagnostic tests for Petrini C, Lavarda F, Perolini S and Porrini M. 1992. Effect of
Mycobacterium avium subsp. paratuberculosis in patients with vegetarian soy diet on hyperlipidaemia in nephrotic syndrome. The
inflammatory bowel disease and in controls. Journal of Clinical Lancet. 339 (8802) 1131-1134.
Microbiology. 38 (12) 4373-4381.
Daly RM, Ebeling PR. 2010. Is excess calcium harmful to health?
Copley, MS, Berstan, R, Dudd, SN, Docherty, G, Mukherjee, AJ, Nutrients. 2 (5) 505-522.
Straker, V, Payne, S. and Evershed, RP. 2003. Direct chemical
Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M;
evidence for widespread dairying in prehistoric Britain.
Comparative Risk Assessment collaborating group (Cancers).
Proceedings of the National Academy of Sciences, 100 (4)1524-9.
2005. Causes of cancer in the world: comparative risk assessment
Cordain, L. 2005. Implications for the role of diet in acne. of nine behavioural and environmental risk factors. The Lancet.
Seminars in Cutaneous Medicine and Surgery. 24 (2) 84-91. 366 (9499) 1784-1793.
da Costa PM, Loureiro L and Matos AJ. 2013. Transfer of Danby FW. 2005. Acne and milk, the diet myth, and beyond.
multidrug-resistant bacteria between intermingled ecological Journal of the American Academy of Dermatology. 52 (2) 360-362.
niches: the interface between humans, animals and the
Dargent-Molina P, Sabia S, Touvier M, Kesse E, Bréart G, Clavel-
environment. International Journal of Environmental Research and
Chapelon F, Boutron-Ruault MC. 2008. Proteins, dietary acid load,
Public Health. 10 (1) 278-294.
and calcium and risk of postmenopausal fractures in the E3N
COT, 2003. Committee on Toxicity of Chemicals in Food, French women prospective study. Journal of Bone and Mineral
Consumer Products and the Environment. Phytoestrogens and Research. 23 (12) 1915-1922.
Health. London: The Food Standards Agency, FSA/0826/0503.
Darling AL, Millward DJ, Torgerson DJ, Hewitt CE, Lanham-New
Cottet V, Touvier M, Fournier A, Touillaud MS, Lafay L, Clavel- SA. 2009. Dietary protein and bone health: a systematic review
Chapelon F and Boutron-Ruault MC. 2009. Postmenopausal and meta-analysis. American Journal of Clinical Nutrition.
breast cancer risk and dietary patterns in the E3N-EPIC prospective 90.1674-1692.
cohort study. American Journal of Epidemiology. 170 (10) 1257-
Davenport CB. 1922. Multiple sclerosis from the standpoint of
1267.
geographical distribution and race. Archives of Neurological
Cow and Gate ([email protected]). February 11 2014. Psychiatry. 8, 51-58.
Re: Reply from Cow and Gate. E-mail to J. Butler
Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH and Key
([email protected]).
TJ. 2003. EPIC-Oxford: lifestyle characteristics and nutrient intakes
Cramer DW, Harlow BL, Willett WC, Welch WR, Bell DA, Scully RE, in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in
Ng WG and Knapp RC. 1989. Galactose consumption and the UK. Public Health Nutrition. 6 (3) 259-269.
metabolism in relation to the risk of ovarian cancer. The Lancet. 2
Davidson RK, Jupp O, de Ferrars R, Kay CD, Culley KL, Norton R,
(8654) 66-71.
Driscoll C, Vincent TL, Donell ST, Bao Y and Clark IM. 2013.
Curhan GC, Willett WC, Speizer FE, Spiegelman D and Stampfer Sulforaphane represses matrix-degrading proteases and protects
MJ. 1997. Comparison of dietary calcium with supplemental cartilage from destruction in vitro and in vivo. Arthritis and
calcium and other nutrients as factors affecting the risk for kidney Rheumatism. 65 (12) 130-140.
stones in women. Annals of Internal Medicine. 126 (7) 497-504.
Dear KL, Compston JE and Hunter JO. 2001. Treatments for
Curhan GC, Willett WC, Rimm EB and Stampfer MJ. 1993. A Crohn’s disease that minimise steroid doses are associated with a
prospective study of dietary calcium and other nutrients and the reduced risk of osteoporosis. Clinical Nutrition.20 (6) 541-546.
risk of symptomatic kidney stones. New England Journal of
Defra, 2012. Agriculture in the United Kingdom 2012 [online]
Medicine. 328 (12) 833-838.
Available at: www.gov.uk/government/uploads/system/
Daher S, Tahan S, Sole D, Naspitz CK, Da Silva, Patricio FR, Neto uploads/attachment_data/file/208436/auk-2012-25jun13.pdf
UF and De Morais MB. 2001. Cow’s milk protein intolerance and [Accessed 6 September 2013].
chronic constipation in children. Pediatric Allergy and
Defra, 2013. S. Russell, Veterinary Medicines Directorate, Defra.
Immunology. 12 (6) 339-342.
([email protected]) September 19 2013. rBST query.
Dairy Co, 2013. UK Cow Numbers [online] E-mail to J. Butler ([email protected]).
www.dairyco.org.uk/market-information/farming-data/cow-
numbers/uk-cow-numbers/ [Accessed 6 September 2013].

110
 A report

Defra, 2013a. Defra. ([email protected]) September FAO, 1997. Latham, M.C. Human nutrition in the developing
30 2013. US dairy imports query. E-mail to J. Butler world. Rome: FAO Food and Nutrition Series No. 29. Cornell
([email protected]). University Ithaca, New York, USA.
Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh FAO, 2009. The State of Food and Agriculture [online]. Available
MH and Soleimani M. 2012. The Role of Cow's Milk Allergy in from: www.fao.org/docrep/012/i0680e/i0680e.pdf [Accessed 9
Pediatric Chronic Constipation: A Randomized Clinical Trial. September 2012].
Iranian Journal of Pediatrics. 22 (4) 468-474. FAOSTAT, 2013. Food Supply [online] Available at:
Department of Health, 1991. Dietary Reference Values for Food http://faostat.fao.org/site/610/DesktopDefault.aspx?PageID=610#
Energy and Nutrients for the United Kingdom. London. ancor [Accessed 6 September 2013].
Department of Health, 1994. Weaning and the weaning diet. Farlow DW, Xu X and Veenstra TD. 2009. Quantitative
Report of the Working Group on the Weaning Diet of the measurement of endogenous estrogen metabolites, risk-factors
Committee on Medical Aspects of Food Policy. London: HMSO. for development of breast cancer, in commercial milk products by
Report on Health and Social Subjects No 45. LC-MS/MS. Journal of Chromatography. B Analytical Technologies
Diabetes UK, 2012. Diabetes in the UK 2012. Key statistics on in the Biomedical and Life Sciences. 877 (13) 1327-1334.
diabetes [online]. Available from: www.diabetes.org.uk/About_us/ Farooq S and Coleman MP. 2005. Breast cancer survival in South
What-we-say/Statistics/Diabetes-in-the-UK-2012/ [Accessed 17 Asian women in England and Wales. Journal of Epidemiology and
October 2013]. Community Health. 59 (5) 402-406.
Djuretic T, Wall PG and Nichols G. 1997. General outbreaks of Feskanich D, Willett WC, Stampfer MJ and Colditz GA. 1997.
infectious intestinal disease associated with milk and dairy Milk, dietary calcium, and bone fractures in women: a 12-year
products in England and Wales: 1992 to 1996. Communicable prospective study. The American Journal of Public Health. 87 (6)
Disease Report. 7 (3) R41-45. 992-997.
Donaldson MS. 2004. Nutrition and cancer: a review of the Fey PD, Safranek TJ, Rupp ME, Dunne EF, Ribot E, Iwen PC,
evidence for an anti-cancer diet. Nutrition Journal. 3, 19. Bradford PA, Angulo FJ. and Hinrichs SH. 2000. Ceftriaxone-
Doner F, Yariktas M and Demirci M. 2004. The role of allergy in resistant salmonella infection acquired by a child from cattle. New
recurrent otitis media with effusion. Journal of investigational England Journal of Medicine 342 (17) 1242-1249.
allergology and clinical immunology. 14 (2) 154-158. FDA, 1999. Food labeling health claims: soy protein and coronary
Durham WH. 1991. Co-evolution: Genes, Culture and Human heart disease. Food and Drug Administration, HHS. Final rule.
Diversity. Stanford: Stanford University Press. Federal Register. 64, 57700-57733.
Egger J, Carter CM, Wilson J, Turner MW and Soothill JF. 1983. Is Fenton TR, Lyon AW, Eliasziw M, Tough SC and Hanley DA. 2009.
migraine food allergy? A double-blind controlled trial of Meta-analysis of the effect of the acid-ash hypothesis of
oligoantigenic diet treatment. The Lancet. 2 (8355) 865-869. osteoporosis on calcium balance. Journal of Bone and Mineral
Research. 24 (11) 1835-1840.
Epstein SS. 1996. Unlabeled milk from cows treated with
biosynthetic growth hormones: a case of regulatory abdication. Fenton TR, Tough SC, Lyon AW, Eliasziw M and Hanley DA.
International Journal of Health Services. 26 (1) 173-185. 20011. Causal assessment of dietary acid load and bone disease:
a systematic review & meta-analysis applying Hill's
Egro FM. 2013. Why is type 1 diabetes increasing? Journal of
epidemiologic criteria for causality. Nutrition Journal. 10:41.
Molecular Endocrinology. 51 (1) R1-13.
Fraser GE. 1999. Associations between diet and cancer, ischemic
El-Hodhod MA, Younis NT, Zaitoun YA and Daoud SD. 2010.
heart disease, and all-cause mortality in non-Hispanic white
Cow’s milk allergy related pediatric constipation: appropriate time
California Seventh-day Adventists. American Journal of Clinical
of milk tolerance. Pediatric Allergy and Immunology. 21 (2 Pt 2)
Nutrition. 70 (3 Supplement) 532S-538S.
e407-412.
Fraser GE. 2009. Vegetarian diets: what do we know of their
Estep DC and Kulczycki A Jr. 2000. Colic in breast-milk-fed
effects on common chronic diseases? American Journal of Clinical
infants: treatment by temporary substitution of neocate infant
Nutrition. 89 (Suppl) 1607S-1612S.
formula. Acta Paediatrica. 89 (7) 795-802.
Frassetto LA, Todd KM, Morris RC Jr and Sebastian A. 2000.
Evershed RP, Payne S, Sherratt AG, Copley MS, Coolidge J, Urem-
Worldwide incidence of hip fracture in elderly women: relation to
Kotsu D, Kotsakis K, Ozdoğan M, Ozdoğan AE, Nieuwenhuyse O,
consumption of animal and vegetable foods. The Journals of
Akkermans PM, Bailey D, Andeescu RR, Campbell S, Farid S,
Gerontology. Series A, Biological Sciences and Medical Sciences.
Hodder I, Yalman N, Ozbaşaran M, Biçakci E, Garfinkel Y, Levy T
55 (10) M585-592.
and Burton MM. 2008. Earliest date for milk use in the Near East
and southeastern Europe linked to cattle herding. Nature. 455 Frassetto LA, Morris RC Jr, Sellmeyer DE and Sebastian A. 2008.
(7212) 528-531. Adverse effects of sodium chloride on bone in the aging human
population resulting from habitual consumption of typical
Faber MT, Jensen A, Søgaard M, Høgdall E, Høgdall C, Blaakaer J
American diets. Journal of Nutrition. 138 (2) 419S-422S.
and Kjaer SK. 2012. Use of dairy products, lactose, and calcium
and risk of ovarian cancer - results from a Danish case-control Frassetto LA and Sebastian A. 2013. Commentary to accompany
study. Acta Oncologica. 51 (4) 454-464. the paper entitled 'nutritional disturbance in acid-base balance
and osteoporosis: a hypothesis that disregards the essential
Fairfield KM, Hunter DJ, Colditz GA, Fuchs CS, Cramer DW,
homeostatic role of the kidney', by Jean-Philippe Bonjour. British
Speizer FE, Willett WC and Hankinson SE. 2004. A prospective
Journal of Nutrition. 110 (11) 1935-1937.
study of dietary lactose and ovarian cancer. International Journal
of Cancer. 110 (2) 271-277. Frye JG and Jackson CR. 2013. Genetic mechanisms of
antimicrobial resistance identified in Salmonella enterica,
Escherichia coli, and Enteroccocus spp. isolated from U.S. food
animals. Frontiers in Microbiology. 4:135.

111
 White Lies

FSA/SE, 2001. Task force on E. coli O157 [online] Available at: Giovannucci E. 1998. Dietary influences of 1,25(OH)2 vitamin D in
www.food.gov.uk/multimedia/pdfs/ecolitaskfinreport.pdf relation to prostate cancer: a hypothesis. Cancer Causes Control. 9
[Accessed 15 October 2013]. (6) 567-582.
FSA, 2002. McCance and Widdowson’s The Composition of Giovanucci E, Rimm EB, Wolk A, Ascherio A, Stampfer MJ, Colditz
Foods, 6th summary edition. Cambridge, England, Royal Society GA and Willett WC. 1998a. Calcium and fructose in relation to
of Chemistry. risk of prostate cancer. Cancer Research. 58 (3) 442- 447.
FSA, 2002a. A review of the evidence for a link between exposure Giovannucci E, Pollak MN, Platz EA, Willett WC, Stampfer MJ,
to Mycobacterium paratuberculosis (MAP) and Crohn’s disease Majeed N, Colditz GA, Speizer FE and Hankinson SE. 2000. A
(CD) in humans. A report for the Food Standards Agency January prospective study of plasma insulin-like growth factor-1 and
2002. [online] Available from: binding protein-3 and risk of colorectal neoplasia in women.
www.food.gov.uk/multimedia/pdfs/mapcrohnreport.pdf [Accessed Cancer Epidemiology, Biomarkers and Prevention: a publication of
16 October 2013]. the American Association for Cancer Research, cosponsored by
FSA, 2003. Strategy for the control of Mycobacterium avium the American Society of Preventive Oncology. 9 (4) 345-349.
subspecies paratuberculosis (MAP) in cow’s milk. [online] Available Glantz, S and Gonzalez, M. 2012. Effective tobacco control is key
from: www.food.gov.uk/multimedia/pdfs/map_strategy.pdf to rapid progress in reduction of non-communicable diseases.
[Accessed 16 October 2013]. Lancet. 379 (9822) 1269-1271.
FSA, 2006. Second progress report on strategy for the control of Greer FR and Krebs NF; American Academy of Pediatrics
mycobacterium avium subspecies paratuberculosis (MAP) in cows' Committee on Nutrition. Optimizing bone health and calcium
milk [online]. http://tna.europarchive.org/20130814101929/ intakes of infants, children, and adolescents. 2006. Pediatrics. 117
http://www.food.gov.uk/multimedia/pdfs/int060311rev1.pdf (2) 578-585.
[Accessed 15 October 2013]. Grosvenor CE, Picciano MF and Baumrucker CR. 1992. Hormones
FSA, 2009. Raw drinking milk and raw cream control and growth factors in milk. Endocrine Reviews. 14 (6) 710-728.
requirements in the different countries of the UK [online]. Gunnell D, Oliver SE, Peters TJ, Donovan JL, Persad R, Maynard M,
www.food.gov.uk/business-industry/guidancenotes/dairy- Gillatt D, Pearce A, Hamdy FC, Neal DE and Holly JM. 2003. Are
guidance/rawmilkcream [Accessed 14 January 2014]. diet-prostate cancer associations mediated by the IGF axis? A
FSA, 2013. Measuring foodborne illness levels [online]. cross-sectional analysis of diet, IGF-I and IGFBP-3 in healthy
www.food.gov.uk/policy-advice/microbiology/fds/ middle-aged men. British Journal of Cancer. 88 (11) 1682-6.
58736#.UmRT4VOJJEM [Accessed 15 October 2013]. Gunther CW, Legowski PA, Lyle RM, McCabe GP, Eagan MS,
FSA, 2013a. Annual Report of the Chief Scientist 2012/13 [online]. Peacock M and Teegarden D. 2005. Dairy products do not lead to
www.food.gov.uk/multimedia/pdfs/publication/cstar_2013.pdf alterations in body weight or fat mass in young women in a 1-y
[Accessed 20 October 2013]. intervention. American Journal of Clinical Nutrition. 81 (4) 751-
Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Stampfer MJ, 756.
Rosner B, Speizer FE and Willett WC. 1999. Dietary fiber and the Gustafson D, Rothenberg E, Blennow K, Steen B and Skoog I.
risk of colorectal cancer and adenoma in women. New England 2003. An 18-year follow-up of overweight and risk of Alzheimer’s
Journal of Medicine. 340 (3) 169-176. disease. Archives of Internal Medicine. 163 (13) 1524-1528.
Ganmaa D and Sato A. 2005. The possible role of female sex Hafstrom I, Ringertz B, Spangberg A, von Zweigbergk L,
hormones in milk from pregnant cows in the development of Brannemark S, Nylander I, Ronnelid J, Laasonen L and Klareskog L.
breast, ovarian and corpus uteri cancers. Medical Hypotheses. 65 2001. A vegan diet free of gluten improves the signs and
(6) 1028-1037. symptoms of rheumatoid arthritis: the effects on arthritis correlate
Garland CF, Garland FC and Gorham ED. 1999. Calcium and with a reduction in antibodies to food antigens. Rheumatology
vitamin D. Their potential roles in colon and breast cancer (Oxford). 40 (10) 1175-1179.
prevention. Annals of the New York Academy of Sciences. 889, Hall B, Chesters J and Robinson A. 2012. Infantile colic: a
107-119. systematic review of medical and conventional therapies.
Genkinger JM, Platz EA, Hoffman SC, Comstock GW and Paediatric Child Health. 48 (2) 128-137.
Helzlsouer KJ. 2004. Fruit, vegetable, and antioxidant intake and Hamlyn B, Brooker S, Oleinikova K and Wands S. 2002. Infant
all-cause, cancer, and cardiovascular disease mortality in a Feeding 2000. The Stationery Office. London, UK.
community-dwelling population in Washington County, Maryland. Hammerum AM and Heuer OE. 2009. Human health hazards from
American Journal of Epidemiology. 160 (12) 1223-1233. antimicrobial-resistant Escherichia coli of animal origin. Clinical
Gerber M. 1998. Fibre and breast cancer. European Journal of Infectious Diseases. 48(7):916-21
Cancer Prevention. 7 Supplement 2, S63-67. Hankinson SE, Willett WC, Manson JE, Colditz GA, Hunter DJ,
German JB, Dillard CJ and Ward RE. 2002. Bioactive components Spiegelman D, Barbieri RL and Speizer FE. 1998. Plasma sex
in milk. Current Opinion in Clinical Nutrition and Metabolic Care. steroid hormone levels and risk of breast cancer in
5 (6) 653-658. postmenopausal women. Journal of the National Cancer Institute.
Gerstein HC. 1994. Cow’s milk exposure and type I diabetes 90 (17) 1292-1299.
mellitus. A critical overview of the clinical literature. Diabetes Care. Hankinson SE, Willett WC, Colditz GA, Hunter DJ, Michaud DS,
17 (1) 13-9. Deroo B, Rosner B, Speizer FE and Pollak M. 1998a. Circulating
Gillespie KM, Bain SC, Barnett AH, Bingley PJ, Christie MR, Gill GV concentrations of insulin-like growth factor-I and risk of breast
and Gale EA. 2004. The rising incidence of childhood type 1 cancer. The Lancet. 351, 1393-1396.
diabetes and reduced contribution of high-risk HLA haplotypes.
Lancet. 364 (9446) 1699-700.

112
 A report

Harder T, Bergmann R, Kallischnigg G and Plagemann A. 2005. Honegger A and Humbel RE. 1986. Insulin-like growth factors I
Duration of breastfeeding and risk of overweight: a meta-analysis. and II in fetal and adult bovine serum. Purification, primary
American Journal of Epidemiology. 162, 397-403. structures, and immunological cross-reactivities. Journal of
Harrington LK and Mayberry JF. 2008. A re-appraisal of lactose Biological Chemistry. 26, 569-575.
intolerance. International Journal of Clinical Practice. 62 (10) Hoppe C, Udam TR, Lauritzen L, Molgaard C, Juul A and
1541-1546. Michaelsen KF. 2004. Animal protein intake, serum insulin-like
Harvey-Berino J, Gold BC, Lauber R and Starinski A. 2005. The growth factor I, and growth in healthy 2.5-y-old Danish children.
impact of calcium and dairy product consumption on weight loss. American Journal of Clinical Nutrition. 80 (2) 447-452.
Obesity Research. 13 (10) 1720-1726. Hoppu U, Kalliomaki M and Isolauri E. 2000. Maternal diet rich in
He FJ, Nowson CA, Lucas M and MacGregor GA. 2007. Increased saturated fat during breastfeeding is associated with atopic
consumption of fruit and vegetables is related to a reduced risk of sensitization of the infant. European Journal of Clinical Nutrition.
coronary heart disease: meta-analysis of cohort studies. Journal of 54 (9) 702-705.
Human Hypertension. 21 (9) 717-728. Hoppu U, Rinne M, Lampi AM and Isolauri E. 2005. Breast milk
Heaney RP, McCarron DA, Dawson-Hughes B, Oparil S, Berga SL, fatty acid composition is associated with development of atopic
Stern JS, Barr SI and Rosen CJ. 1999. Dietary changes favourably dermatitis in the infant. Journal of Pediatric Gastroenterology and
affect bone remodelling in older adults. Journal of the American Nutrition. 41 (3) 335-338.
Dietetic Association. 99 (10) 1228-1233. Howe GR, Hirohata T, Hislop TG, Iscovich JM, Yuan JM,
Heaney RP and Weaver CM. 1990. Calcium absorption from kale. Katsouyanni K, Lubin F, Marubini E, Modan B, Rohan T, Toniolo P
American Journal of Clinical Nutrition. 51 (4) 656-657. and Shunxhang Y. 1990. Dietary factors and risk of breast cancer:
combined analysis of 12 case-control studies. Journal of the
Heaney RP. 2002. Protein and calcium: antagonists or synergists?
National Cancer Institute. 82 (7) 561-569.
American Journal of Clinical Nutrition. 75 (4) 609-610.
Hu FB, Manson JE and Willett WC 2001. Types of dietary fat and
Henderson L, Gregory J, Irving K, and Swan G. 2003. National Diet
risk of coronary heart disease: a critical review. Journal of the
and Nutrition Survey: adults aged 19 to 64 years: Energy, protein,
American College of Nutrition. 20 (1) 5-19.
carbohydrate, fat and alcohol intake. London: TSO. Volume 2.
Huncharek M, Muscat J and Kupelnick B. 2009. Colorectal cancer
Henderson L, Irving K, Gregory J, Bates CJ, Prentice A, Perks J,
risk and dietary intake of calcium, vitamin D, and dairy products: a
Swan G and Farron, M. 2003a. National Diet and Nutrition Survey:
meta-analysis of 26,335 cases from 60 observational studies.
adults aged 19 to 64 years: Vitamin and mineral intake and
Nutrition and Cancer. 61 (1) 47-69.
urinary analytes. London: TSO. Volume 3.
Hurst DS. 1998. The relation of allergy to otitis media with
Hermann R, Knip M, Veijola R, Simell O, Laine AP, Akerblom HK,
effusion: clinical and histochemical studies. Uppsala University,
Groop PH, Forsblom C, Pettersson-Fernholm K, Ilonen J; FinnDiane
Sweden: Acta Universitatis Upsaliensis.
Study Group. 2003. Temporal changes in the frequencies of HLA
genotypes in patients with Type 1 diabetes--indication of an Iacobucci G. 2013. UK has fifth highest rate of type 1 diabetes in
increased environmental pressure? Diabetologia. 46 (3) 420-425. children, new figures show. British Medical Journal. 3; 346: f22.
Hermon-Taylor J. 2009. Mycobacterium avium subspecies IARC, 1997. Cancer incidence in five continents. Volume VII.
paratuberculosis, Crohn’s disease and the Doomsday scenario. Gut International Agency for Research on Cancer (IARC) Scientific
Pathology. 1 (1) 15. Publications. 143: i-xxxiv, 1-1240.
Hex N, Bartlett C, Wright D, Taylor M and Varley D. 2012. Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M,
Estimating the current and future costs of Type 1 and Type 2 Soresi M, Notarbartolo A and Carroccio A. 1998. Intolerance of
diabetes in the UK, including direct health costs and indirect cow’s milk and chronic constipation in children. New England
societal and productivity costs. Diabetic Medicine. 29 (7) 855-862. Journal of Medicine. 339 (16) 1100-1104.
Heyman MB. 2006. Lactose intolerance in infants, children, and ISAAC. 1998. The International Study of Asthma and Allergies in
adolescents. Pediatrics. 118 (3) 1279-1286. Childhood (ISAAC) Steering Committee. Worldwide variation in
prevalence of symptoms of asthma, allergic rhinoconjunctivitis,
Hill, LW and Stuart HC. 1929. A soya bean food preparation for
and atopic eczema. The Lancet. 351, 1225-1232.
feeding infants with milk idiosyncrasy. Journal of the American
Medical Association. 93, 985-987. Ishida BK and Chapman MH. 2004. A comparison of carotenoid
content and total antioxidant activity in catsup from several
Hoffman JR and Falvo MJ. 2004. Protein – Which is Best? Journal
commercial sources in the United States. Journal of Agricultural
of Sports Science and Medicine. (3) 118-130.
and Food Chemistry. 52 (26) 8017-8020.
Holly, 2013. Professor Jeff Holly ([email protected])
Jacobs DR Jr, Marquart L, Slavin J and Kushi LH. 1998. Whole-
September 2 2013. IGF-1 and dairy consumption. E-mail to
grain intake and cancer: an expanded review and meta-analysis.
J. Butler ([email protected]).
Nutrition and Cancer. 30 (2) 85-96.
Holly JM, Zeng L and Perks CM. 2013. Epithelial cancers in the
Jakobsson I and Lindberg T. 1978. Cow’s milk as a cause of
post-genomic era: should we reconsider our lifestyle? Cancer
infantile colic in breast-fed infants. The Lancet. 2 (8092 Pt 1) 734.
Metastasis Reviews. Aug 2. [Epub ahead of print]
Jakobsson I and Lindberg T. 1983. Cow’s milk proteins cause
Holmes MD, Pollak MN, Willett WC and Hankinson SE. 2002.
infantile colic in breast-fed infants: a double-blind crossover study.
Dietary correlates of plasma insulin-like growth factor 1 and
Pediatrics. 71 (2) 268-271.
insulin-like growth factor binding protein 3 concentrations. Cancer
Epidemiology Biomarkers and Prevention. 11 (9) 852-861. Jakobsson I, Lothe L, Ley D and Borschel MW. 2000. Effectiveness
of casein hydrolysate feedings in infants with colic. Acta
Paediatrica. 89 (1) 18-21.

113
 White Lies

James JM, Bernhisel-Broadbent J and Sampson HA. 1994. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G,
Respiratory reactions provoked by double-blind food challenges in Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J
children. American Journal of Respiratory and Critical Care and McPherson K. 1999. Mortality in vegetarians and
Medicine. 149, 59-64. nonvegetarians: detailed findings from a collaborative analysis of 5
James JM. 2004. Common respiratory manifestations of food prospective studies. American Journal of Clinical Nutrition. 70
allergy: a critical focus on otitis media. Current Allergy and (Suppl) 516S-524S.
Asthma Reports. 4 (4) 294-301. Key TJ, Appleby PN, Spencer EA, Roddam AW, Neale RE and Allen
James DC and Lessen R; American Dietetic Association. 2009. NE. 2007. Calcium, diet and fracture risk: a prospective study of
Position of the American Dietetic Association: promoting and 1,898 incident fractures among 34,696 British women and men.
supporting breastfeeding. Journal of the American Dietetic Public Health Nutrition. 10 (11) 1314-1320.
Association. 109 (11) 1926-1942. Key TJ, Appleby PN, Spencer EA, Travis RC, Allen NE, Thorogood
Janisiewicz WJ, Conway WS, Brown MW, Sapers GM, Fratamico P M and Mann JI. 2009. Cancer incidence in British vegetarians.
and Buchanan RL. 1999. Fate of Escherichia coli O157:H7 on British Journal of Cancer. 101:192–197.
fresh-cut apple tissue and its potential for transmission by fruit Key TJ, Appleby PH, Spencer EA, Travis RC, Roddam AW and Allen
flies. Applied Environmental Microbiology. 65 (1) 1-5. NE. 2009a. Cancer incidence in vegetarians: results from the
Jenkins DJ, Mirrahimi A, Srichaikul K, Berryman CE, Wang L, European Prospective Investigation in Cancer and Nutrition (EPIC-
Carleton A, Abdulnour S, Sievenpiper JL, Kendall CW and Kris- Oxford). American Journal of Clinical Nutrition. 89 (Suppl) :1620S-
Etherton PM. 2010. Soy protein reduces serum cholesterol by both 1626S.
intrinsic and food displacement mechanisms. Journal of Nutrition. Key TJ, Appleby PN, Reeves GK, Roddam AW, Helzlsouer KJ,
140 (12) 2302S-2311S. Alberg AJ, Rollison DE, Dorgan JF, Brinton LA, Overvad K, Kaaks R,
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Trichopoulou A, Clavel-Chapelon F, Panico S, Duell EJ, Peeters PH,
Wang AY and Yang CW. 2013. Chronic kidney disease: global Rinaldi S, Fentiman IS, Dowsett M, Manjer J, Lenner P, Hallmans G,
dimension and perspectives. Lancet. 382 (9888) 260-272. Baglietto L, English DR, Giles GG, Hopper JL, Severi G, Morris HA,
Hankinson SE, Tworoger SS, Koenig K, Zeleniuch-Jacquotte A,
JHCI, 2002. Joint Health Claims Initiative. [online] Available from:
Arslan AA, Toniolo P, Shore RE, Krogh V, Micheli A, Berrino F,
http://webarchive.nationalarchives.gov.uk/nobanner/2013040413
Barrett-Connor E, Laughlin GA, Kabuto M, Akiba S, Stevens RG,
5254/http://www.jhci.org.uk/approv/schol2.htm [Accessed 11
Neriishi K, Land CE, Cauley JA, Lui LY, Cummings SR, Gunter MJ,
February 2014).
Rohan TE and Strickler HD. Endogenous Hormones and Breast
Juntti H, Tikkanen S, Kokkonen J, Alho OP and Niinimaki A. 1999. Cancer Collaborative Group. 2011. Circulating sex hormones and
Cow’s milk allergy is associated with recurrent otitis media during breast cancer risk factors in postmenopausal women: reanalysis of
childhood. Acta Oto-laryngologica. 119 (8) 867-873. 13 studies. British Journal of Cancer. 105 (5) 709-722.
Kaaks R, Toniolo P, Akhmedkhanov A, Lukanova A, Biessy C, Key TJ, Appleby PN, Cairns BJ, Luben R, Dahm CC, Akbaraly T,
Dechaud H, Rinaldi S, Zeleniuch-Jacquotte A, Shore RE and Riboli Brunner EJ, Burley V, Cade JE, Greenwood DC, Stephen AM,
E. 2000. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF- Mishra G, Kuh D, Keogh RH, White IR, Bhaniani A, Borgulya G,
binding proteins, and colorectal cancer risk in women. Journal of Mulligan AA and Khaw KT. 2011a. Dietary fat and breast cancer:
the National Cancer Institute. 92 (19) 1592-1600. comparison of results from food diaries and food-frequency
Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA and questionnaires in the UK Dietary Cohort Consortium. American
Cooper C; IOF Working Group on Epidemiology and Quality of Journal of Clinical Nutrition. 94 (4) 1043-1052.
Life. 2012. A systematic review of hip fracture incidence and Key TJ, Appleby PN, Crowe FL, Bradbury KE, Schmidt JA andTravis
probability of fracture worldwide. Osteoporosis International. 23 RC. 2014. Cancer in British vegetarians: updated analyses of 4998
(9) 2239-2256. incident cancers in a cohort of 32,491 meat eaters, 8612 fish
Kannel WB, Dawber TR, Kagan A, Revotskiw N and Stokes J 3rd. eaters, 18,298 vegetarians, and 2246 vegans. American Journal of
1961. Factors of risk in the development of coronary heart Clinical Nutrition. June 4; 100 (Supplement 1) :378S-385S.
disease--six year follow-up experience. The Framingham Study. Kimpimaki T, Erkkola M, Korhonen S, Kupila A, Virtanen SM.,
Annals of Internal Medicine. 55, 33-50. Ilonen J, Simell O and Knip M. 2001. Short-term exclusive
Karjalainen J, Martin JM, Knip M, Ilonen J, Robinson BH, Savilahti breastfeeding predisposes young children with increased genetic
E, Akerblom HK and Dosch HM. 1992. A bovine albumin peptide risk of Type I diabetes to progressive beta-cell autoimmunity.
as a possible trigger of insulin-dependent diabetes mellitus. New Diabetologia. 44 (1) 63-69.
England Journal of Medicine. 327 (5) 302-307. Klein KO. 1998. Isoflavones, soy-based infant formulas, and
Kerstetter JE, O’Brien KO and Insogna KL. 2003. Dietary protein, relevance to endocrine function. Nutrition Review. 56 (7) 193-204.
calcium metabolism, and skeletal homeostasis revisited. American Krajcovicova-Kudlackova M, Babinska K and Valachovicova M.
Journal of Clinical Nutrition. 78 (3 Suppl) 584S-592S. 2005. Health benefits and risks of plant proteins. Bratislavske
Kerstetter JE, O'Brien KO, Caseria DM, Wall DE, Insogna KL. 2005. Lekarske Listy. 106 (6-7) 231-234.
The impact of dietary protein on calcium absorption and kinetic Kucuk O, Sarkar FH, Sakr W, Djuric Z, Pollak MN, Khachik F, Li YW,
measures of bone turnover in women. The Journal of Clinical Banerjee M, Grignon D, Bertram JS, Crissman JD, Pontes EJ and
Endocrinology and Metabolism. 90 (1) 26-31. Wood DP Jr. 2001. Phase II randomized clinical trial of lycopene
Key TJ, Davey GK and Appleby PN. 1999. Health benefits of a supplementation before radical prostatectomy. Cancer
vegetarian diet. Proceedings of the Nutrition Society. 58 (2) 271- Epidemiology Biomarkers and Prevention. 10 (8) 861-868.
275. Lanou AJ. 2005. Data do not support recommending dairy
products for weight loss. Obesity Research. 13 (1) 191.

114
 A report

Lanou AJ, Berkow SE and Barnard ND. 2005. Calcium, Dairy Lock AL and Garnsworthy PC. 2002. Independent effects of
Products, and Bone Health in Children and Young Adults: A Re- dietary linoleic and linolenic fatty acids on the conjugated linoleic
evaluation of the Evidence. Pediatrics. 115 (3) 736-743. acid content of cows’ milk. Animal Science. 74, 63-176.
Lanou AJ. 2006 Oct Bone health in children. The British Medical Loef M and Walach H. 2013. Midlife obesity and dementia: meta-
Journal. 14; 333 (7572) 763-764. analysis and adjusted forecast of dementia prevalence in the
Lanou AJ and Svenson B. 2010. Reduced cancer risk in United States and China. Obesity (Silver Spring). 21 (1) E51-55.
vegetarians: an analysis of recent reports. Cancer Management Lomer MC, Parkes GC and Sanderson JD. 2008. Review article:
and Research. 3:1-8. lactose intolerance in clinical practice--myths and realities.
Lappe JM, Rafferty KA, Davies KM and Lypaczewski G. 2004 . Alimentary Pharmacology and Therapeutics. 27 (2) 193-103.
Girls on a high-calcium diet gain weight at the same rate as girls Lothe L and Lindberg T. 1989. Cow’s milk whey protein elicits
on a normal diet: a pilot study. Journal of the American Dietetic symptoms of infantile colic in colicky formula-fed infants: a
Association. 104 (9) 1361-1367. double-blind crossover study. Pediatrics. 83 (2) 262-266.
van de Laar MA and van der Korst JK. 1992. Food intolerance in Lovati MR, Manzoni C, Canavesi A, Sirtori M, Vaccarino V, Marchi
rheumatoid arthritis. I. A double blind, controlled trial of the M, Gaddi G and Sirtori, CR. 1987. Soybean protein diet increases
clinical effects of elimination of milk allergens and azo dyes. low density lipoprotein receptor activity in mononuclear cells from
Annals of the Rheumatic Diseases. 51 (3) 298-302. hypercholesterolemic patients. The Journal of Clinical
Larsson SC, Bergkvist L and Wolk A. 2004. Milk and lactose Investigation. 80 (5) 1498-1502.
intakes and ovarian cancer risk in the Swedish Mammography Lovati MR, Manzoni C, Gianazza E, Arnoldi A, Kurowska E, Carroll
Cohort. American Journal of Clinical Nutrition. 80 (5) 1353-1357. KK and Sirtori CR. 2000. Soy protein peptides regulate cholesterol
Larsson SC, Orsini N and Wolk A. 2006. 2006. Milk, milk products homeostasis in Hep G2 cells. Journal of Nutrition. 130 (10) 2543-
and lactose intake and ovarian cancer risk: a meta-analysis of 2549.
epidemiological studies. International Journal of Cancer. 118 (2) Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop
431-441. WJ and Neven AK. 1998. Effectiveness of treatments for infantile
Lasekan JB, Ostrom KM, Jacobs JR, Blatter MM, Ndife LI, Gooch colic: systematic review. British Medical Journal. 316 (7144) 1563-
WM 3rd and Cho S. 1999. Growth of newborn, term infants fed 1569.
soy formulas for one year. Clinical Pediatrics. 38 (10) 563-571. Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT and Douwes
Lees B, Molleson T, Arnett TR and Stevenson JC. 1993. Differences AC. 2000. Infantile colic: crying time reduction with a whey
in proximal femur bone density over two centuries. The Lancet. hydrolysate: A double-blind, randomized, placebo-controlled trial.
13, 341 (8846) 673-675. Pediatrics. 106 (6) 1349-1354.
Lehtonen L, Korvenranta H and Eerola E. 1994. Intestinal Lust KD, Brown E and Thomas W. 1996. Maternal intake of
microflora in colicky and noncolicky infants: bacterial cultures and cruciferous vegetables and other foods and colic symptoms in
gas-liquid chromatography. Journal of Pediatric Gastroenterology exclusively breast-fed infants. Journal of the American Dietetic
and Nutrition. 19 (3) 310-314. Association. 96 (1) 46-48.
Leitzmann C. 2005. Vegetarian diets: what are the advantages? Ma J, Pollak MN, Giovannucci E, Chan JM, Tao Y, Hennekens CH.
Forum of Nutrition. (57) 147-56. and Stampfer M.J. 1999. Prospective study of colorectal cancer
risk in men and plasma levels of insulin-like growth factor (IGF)-I
LeRoith D, Werner H, Neuenschwander S, Kalebic T and Helman LJ.
and IGF-binding protein-3. Journal of the National Cancer
1995. The role of the insulin-like growth factor-I receptor in cancer.
Institute. 91 (7) 620-625.
Annals of the New York Academy of Sciences. 766, 402-408.
Macmillan Cancer Support, 2011. Breast cancer risk factors and
Lewin MH, Bailey N, Bandaletova T, Bowman R, Cross AJ, Pollock
causes [online]. Available from: www.macmillan.org.uk/
J, Shuker DE and Bingham SA. 2006. Red meat enhances the
Cancerinformation/Cancertypes/Breast/Aboutbreastcancer/Causes.
colonic formation of the DNA adduct O6-carboxymethyl guanine:
aspx#DynamicJumpMenuManager_5_Anchor_5 [Accessed 25
implications for colorectal cancer risk. Cancer Research. 66 (3)
September 2013].
1859-1865.
Macmillan Cancer Support, 2013. By 2020 almost half of Britons
Lindberg T. 1999. Infantile colic and small intestinal function: a
will get cancer in their lifetime – but 38% will not die from the
nutritional problem? Acta Paediatrica Suppl. 88 (430) 58-60.
disease [online]. Available from: www.macmillan.org.uk/Aboutus/
Linnan MJ, Mascola L, Lou XD, Goulet V, May S, Salminen C, Hird News/Latest_News/By2020almosthalfofBritonswillgetcancerintheirl
DW, Yonekura ML, Hayes P and Weaver R. 1988. Epidemic ifetime%E2%80%93but38willnotdiefromthedisease.aspx
listeriosis associated with Mexican-style cheese. New England [Accessed 23 September 2013].
Journal of Medicine. 29, 319 (13) 823-828.
Macmillan Cancer Support, 2013a. Cancer genetics - prostate
Lipsitch M, Singer RS and Levin BR 2002. Antibiotics in agriculture: cancer [online]. Available from: www.macmillan.org.uk/
When is it time to close the barn door? Proceedings of the Cancerinformation/Causesriskfactors/Genetics/Cancergenetics/Spe
National Academy of Sciences. 99, 5752-5754. cificconditions/Prostatecancer.aspx [Accessed 10 October 2013].
Little CL, Pires SM, Gillespie IA, Grant K and Nichols GL. 2010. Malosse D, Perron H, Sasco A and Seigneurin JM. 1992.
Attribution of human Listeria monocytogenes infections in Correlation between milk and dairy product consumption and
England and Wales to ready-to-eat food sources placed on the multiple sclerosis prevalence: a worldwide study.
market: adaptation of the Hald Salmonella source attribution Neuroepidemiology. 11 (4-6) 304-312.
model. Foodborne Pathogenic Diseases. 7 (7) 749-756.
Marsh AG, Sanchez TV, Michelsen O, Chaffee FL and Fagal SM.
Lloyd T, Petit MA, Lin HM and Beck TJ. 2004. Lifestyle factors and 1988. Vegetarian lifestyle and bone mineral density. American
the development of bone mass and bone strength in young Journal of Clinical Nutrition. 48 (3 Supplement) 837-841.
women. The Journal of Pediatrics. 144 (6) 776-782.

115
 White Lies

Martin JM, Trink B, Daneman D, Dosch HM and Robinson B. 1991. Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P and Perri D. 2008.
Milk proteins in the etiology of insulin-dependent diabetes Primary prevention of cardiovascular mortality and events with
mellitus (IDDM). Annals of Medicine. 23 (4) 447-452. statin treatments: a network meta-analysis involving more than
Martinez GA, Ryan AS and Malec DJ. 1985. Nutrient intakes of 65,000 patients. Journal of the American College of Cardiologists.
American infants and children fed cow's milk or infant formula. 52 (22) 1769-1781.
American Journal of Diseases in Children. 139 (10) 1010-1018. Mishra S, Xu J, Agarwal U, Gonzales J, Levin S and Barnard ND.
Massey LK. 2003. Dietary animal and plant protein and human 2013. A multicenter randomized controlled trial of a plant-based
bone health: a whole foods approach. Journal of Nutrition. 133 nutrition program to reduce body weight and cardiovascular risk
(3) 862S-865S. in the corporate setting: the GEICO study. European Journal of
Clinical Nutrition. 67 (7) 718-724.
Matthews SB, Waud JP, Roberts AG and Campbell AK. 2005.
Systemic lactose intolerance: a new perspective on an old Moss, M. 2010. While Warning About Fat, U.S. Pushes Cheese
problem. Postgraduate Medical Journal. 81 (953) 167-173. Sales. New York Times, 6 November, 2010. Available from:
www.nytimes.com/2010/11/07/us/07fat.html?pagewanted=all&_r
Mattisson I, Wirfält E, Johansson U, Gullberg B, Olsson H,
=0 [Accessed 22 October 2013].
Berglund G. 2004. Intakes of plant foods, fibre and fat and risk of
breast cancer--a prospective study in the Malmö Diet and Cancer Monsanto, 2009. rBST: a Safety Assessment [online]. Available
cohort. British Journal of Cancer. 90 (1) 122-127. from: www.monsanto.com/newsviews/Documents/
rbst_safety_assessment_071409.pdf [Accessed 18 September
Mazess RB and Mather WE. 1974. Bone mineral content of North
2013].
Alaskan Eskimos. American Journal of Clinical Nutrition. 27 (9) 916-25.
Morimoto LM, Newcomb PA, White E, Bigler J and Potter JD.
Mazess RB and Mather WE. 1975. Bone mineral content in
2005. Variation in plasma insulin-like growth factor-1 and insulin-
Canadian Eskimos. Human Biology. 47 (1) 44-63.
like growth factor binding protein-3: personal and lifestyle factors
McCormack VA, Mangtani P, Bhakta D, McMichael AJ and dos (United States). Cancer Causes Control. 16 (8) 917-927.
Santos Silva I. 2004. Heterogeneity of breast cancer risk within the
Morrison LM. 1960. Diet in coronary atherosclerosis. The Journal
South Asian female population in England: a population-based
of the American Medical Association. 25, 173, 884-888.
case-control study of first-generation migrants. British Journal of
Cancer. 90 (1) 160-166. Mortensen EL, Michaelsen KF, Sanders SA and Reinisch JM. 2003.
Breast feeding and intelligence. Ugeskrift Laeger. 165 (13) 1361-
McGuire MA and McGuire MK. 2000. Conjugated linoleic acid
1366.
(CLA): A ruminant fatty acid with beneficial effects on human
health. (Invited Review). Proceedings of the American Society of Moss M and Freed D. 2003. The cow and the coronary:
Animal Science. [online] Available from: epidemiology, biochemistry and immunology. International Journal
www.asas.org/jas/symposia/proceedings/0938.pdf [Accessed 6 of Cardiology. 87 (2-3) 203-216.
March 2006]. Mowlem A. 2011. Goats. In: John Webster, 2011. Management
McCrorie TA, Keaveney EM, Wallace JM, Binns N and Livingstone and Welfare of Farmed Animals. The UFAW Farm Handbook.
MB. 2011 Human health effects of conjugated linoleic acid from Universities Federation for Animal Welfare. Wiley Blackwell, p388.
milk and supplements. Nutrition Research Reviews. 24 (2) 206-227. Moynihan PJ, Wright WG and Walton AG. 1996. A comparison of
McDougall J, Bruce B, Spiller G, Westerdahl J and McDougall M. the relative acidogenic potential of infant milk and soya infant
2002. Effects of a very low-fat, vegan diet in subjects with formula: a plaque pH study. International Journal of Paediatric
rheumatoid arthritis. Journal of Alternative Complementary Dentistry. 6 (3) 177-181.
Medicine. 8 (1) 71-75. MRC/BHF, 2006. MRC/BHF Heart Protection Study, questions and
Meinbach DS and Lokeshwar BL. 2006. Insulin-like growth factors answers about cholesterol. [online] Available at:
and their binding proteins in prostate cancer: cause or www.ctsu.ox.ac.uk/~hps/fact_chol.shtml [Accessed 15
consequence? Urologic Oncology. 24 (4) 294-306. October 2013].
Melnik BC, John SM, Carrera-Bastos P and Cordain L. 2012. The Munro IC, Harwood M, Hlywka JJ, Stephen AM, Doull J, Flamm
impact of cow's milk-mediated mTORC1-signaling in the initiation and WG and Adlercreutz H. 2003. Soy isoflavones: a safety review.
progression of prostate cancer. Nutrition and Metabolism. 9 (1) 74. Nutrition Review. 61 (1) 1-33.
Mellon M, Benbrook C and Benbrook KL. 2001. Hogging It: Muntoni S, Cocco P, Aru G and Cucca F. 2000. Nutritional factors
Estimates of Antimicrobial Abuse in Livestock. Washington DC: and worldwide incidence of childhood type 1 diabetes. American
Union of Concerned Scientists. Journal of Clinical Nutrition. 71 (6) 1525-9.
Merritt RJ and Jenks BH. 2004. Safety of soy-based infant Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B,
formulas containing isoflavones: the clinical evidence. The Journal Skeie G, Dahm CC, Overvad K, Olsen A, Tjønneland A, Clavel-
of Nutrition. 134 (5) 1220S-1224S. Chapelon F, Boutron-Ruault MC, Racine A, Kaaks R, Teucher B,
Boeing H, Bergmann MM, Trichopoulou A, Trichopoulos D, Lagiou
Messina M. 2010. Insights gained from 20 years of soy research.
P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Siersema P, van
The Journal of Nutrition. 140 (12) 2289S-2295S.
Duijnhoven F, Peeters PH, Hjartaker A, Engeset D, González CA,
Millar D, Ford J, Sanderson J, Withey S, Tizard M, Doran T and Sánchez MJ, Dorronsoro M, Navarro C, Ardanaz E, Quirós JR,
Hermon-Taylor J. 1996. IS900 PCR to detect Mycobacterium Sonestedt E, Ericson U, Nilsson L, Palmqvist R, Khaw KT, Wareham
paratuberculosis in retail supplies of whole pasteurized cows' milk N, Key TJ, Crowe FL, Fedirko V, Wark PA, Chuang SC and Riboli E.
in England and Wales. Applied and Environmental Microbiology. 2012. Dietary fibre intake and risks of cancers of the colon and
62 (9) 3446-3452. rectum in the European prospective investigation into cancer and
Mills PK, Beeson WL, Philips RL and Fraser GE. 1989. Cohort study nutrition (EPIC). PLoS One. 7 (6) :e39361.
of diet, lifestyle, and prostate cancer in Adventist men. Cancer. 64
(3) 598-604.

116
 A report

Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie NHS Choices, 2012f. Ovarian cancer [online] Available from:
G, Olsen A, Tjønneland A, Dahm CC, Overvad K, Boutron-Ruault www.nhs.uk/Conditions/Cancer-of-the-
MC, Clavel-Chapelon F, Nailler L, Kaaks R, Teucher B, Boeing H, ovary/Pages/Introduction.aspx [Accessed 7 October 2013].
Bergmann MM, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, NHS Choices, 2012g. Prostate cancer [online] Available from:
Pala V, Tumino R, Vineis P, Panico S, Peeters PH, Dik VK, Weiderpass www.nhs.uk/Conditions/Cancer-of-the-
E, Lund E, Garcia JR, Zamora-Ros R, Pérez MJ, Dorronsoro M, prostate/Pages/Introduction.aspx [Accessed 9 October 2013].
Navarro C, Ardanaz E, Manjer J, Almquist M, Johansson I, Palmqvist
NHS Choices, 2012h. Causes of prostate cancer [online] Available
R, Khaw KT, Wareham N, Key TJ, Crowe FL, Fedirko V, Gunter MJ
from: www.nhs.uk/Conditions/Cancer-of-the-
and Riboli E. 2013. Consumption of Dairy Products and Colorectal
prostate/Pages/Causes.aspx [Accessed 9 October 2013].
Cancer in the European Prospective Investigation into Cancer and
Nutrition (EPIC). PLoS One. 8 (9) :e72715. NHS Choices, 2012i. Colic [online] Available from:
www.nhs.uk/conditions/colic/Pages/Introduction.aspx [Accessed
NACC, 2010. Crohn’s Disease [online]. Available from:
10 October 2013].
www.crohnsandcolitis.org.uk/Resources/CrohnsAndColitisUK/Doc
uments/Publications/Booklets/Crohns Disease.pdf [Accessed 15 NHS Choices, 2012j. Constipation [online] Available from:
October 2013]. www.nhs.uk/Conditions/Constipation/Pages/Introduction.aspx
[Accessed 12 October 2013].
The National Board of Health (Denmark), 1998. Recommendations
for the nutrition of infants; recommendations for health personnel NHS Choices, 2012k. Cardiovascular Disease [online] Available
[in Danish]. Copenhagen, Denmark: The National Board of Health from: www.nhs.uk/Conditions/cardiovascular-
(Denmark). disease/Pages/Introduction.aspx [Accessed 14 October 2013].
National Eczema Society, 2013. What is eczema? [online]. NHS Choices, 2012l. Can fish oil prevent heart attack deaths?
Available from: www.eczema.org/what-is-eczema [Accessed 17 [online] Available from:
September 2013]. www.nhs.uk/news/2012/10October/Pages/Fish-oil-could-save-
thousands-of-women-from-heart-attacks-deaths.aspx [Accessed
National Eczema Society, 2013a. Atopic eczema [online]. Available
14 October 2013].
from: www.eczema.org/atopic-eczema [Accessed 17 September
2013]. NHS Choices, 2012m. Diabetes, Type 2, causes [online] Available
from: www.nhs.uk/Conditions/Diabetes-type2/Pages/Causes.aspx
National Osteoporosis Society, 2013. Key Facts & Figures [online]
[Accessed 17 October 2013].
Available from:www.nos.org.uk/page.aspx?pid=328 [Accessed 24
October 2005]. NHS Choices, 2012n. Middle ear infection (otitis media) -
Symptoms [online] Available from: www.nhs.uk/Conditions/Otitis-
Newby PK, Tucker KL and Wolk A. 2005. Risk of overweight and
media/Pages/Symptoms.aspx [Accessed 19 October 2013].
obesity among semivegetarian, lactovegetarian, and vegan
women. American Journal of Clinical Nutrition. 81 (6) 1267-1274. NHS Choices, 2012o. Gallstones [online] Available from:
www.nhs.uk/Conditions/gallstones/Pages/introduction.aspx
Netherwood T, Martin-Orue SM, O’Donnell AG, Gockling S,
[Accessed 19 October 2013].
Graham J, Mathers JC and Gilbert HJ. 2004. Assessing the survival
of transgenic plant DNA in the human gastrointestinal tract. NHS Choices, 2012p. Gallstones – prevention [online] Available
Nature Biotechnology. 22 (2) 204-209. from: www.nhs.uk/Conditions/Gallstones/Pages/Prevention.aspx
[Accessed 19 October 2013].
Newburg DS. 2000. Oligosaccharides in human milk and bacterial
colonization. Journal of Pediatric Gastroenterology and Nutrition. NHS Choices, 2012q. Migraine [online] Available from:
30 Suppl 2: S8-17. www.nhs.uk/conditions/migraine/pages/introduction.aspx
[Accessed October 21 2013].
NHS Choices, 2011. Hay fever [online] Available at:
www.nhs.uk/conditions/hay-fever/pages/introduction.aspx NHS Choices, 2012r. Multiple sclerosis [online] Available from:
[Accessed 17 September 2013]. www.nhs.uk/conditions/multiple-sclerosis/pages/introduction.aspx
[Accessed 21 October 2013].
NHS Choices, 2012. Eight tips for healthy eating [online] Available
at: www.nhs.uk/Livewell/Goodfood/Pages/eight-tips-healthy- NHS Choices, 2012s. Obesity [online] Available from:
eating.aspx [Accessed 2 September 2013]. www.nhs.uk/conditions/obesity/pages/introduction.aspx [Accessed
22 October 2013].
NHS Choices, 2012a. Acne. [online] Available from:
www.nhs.uk/Conditions/Acne/Pages/Introduction.aspx [Accessed NHS Choices, 2012t. Osteoporosis [online] Available from:
13 September 2013]. www.nhs.uk/Conditions/osteoporosis/Pages/Introduction.aspx
[Accessed 24 October 2013].
NHS Choices, 2012b. Atopic eczema [online] Available from:
www.nhs.uk/conditions/Eczema-%28atopic%29/ NHS Choices, 2012u. Cancer [online] Available from:
Pages/Introduction.aspx [Accessed 17 September 2013]. www.nhs.uk/conditions/Cancer/Pages/Introduction.aspx [Accessed
7 January 2014].
NHS Choices, 2012c. Eczema: 7 tips to stop the itch. [online]
Available from: NHS, 2012v. Vitamins and minerals – Calcium [online]. Available
www.nhs.uk/Livewell/Allergies/Pages/Stopthescratching.aspx from: http://www.nhs.uk/Conditions/vitamins-
[Accessed 17 September 2013]. minerals/Pages/Calcium.aspx [Accessed May 8 2014].
NHS Choices, 2012d. Arthritis. [online] Available from: NHS Choices, 2013. Food Labels [online] Available from:
www.nhs.uk/conditions/arthritis/Pages/Introduction.aspx [Accessed www.nhs.uk/livewell/goodfood/pages/food-labelling.aspx
17 September 2013]. [Accessed 17 September 2013].
NHS Choices, 2012e. Lung cancer myths and facts [online] NHS Choices, 2013a. Lung cancer myths and facts [online]
Available from: www.nhs.uk/Conditions/Cancer-of-the-colon- Available from: www.nhs.uk/Livewell/Lungcancer/
rectum-or-bowel/Pages/Causes.aspx [Accessed 23 September Pages/Lungcancermythsandfacts.aspx [Accessed 23 September
2013]. 2013].

117
 White Lies

NHS Choices, 2013b. Eat less saturated fat [online] Available from: Ogle KA and Bullock JD. 1980. Children with allergic rhinitis
www.nhs.uk/livewell/goodfood/pages/eat-less-saturated-fat.aspx and/or bronchial asthma treated with elimination diet: a five-year
[Accessed 14 October 2013]. follow-up. Annals of Allergy. 44 (5) 273.
NHS Choices, 2013c. Lower your cholesterol [online] Available Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT,
from: www.nhs.uk/Livewell/Healthyhearts/Pages/Cholesterol.aspx Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ and Gould KL.
[Accessed 14 October 2013]. 1990. Can lifestyle changes reverse coronary heart disease? The
NHS Choices, 2013d. Crohn’s Disease [online] Available from: Lifestyle Heart Trial. The Lancet. 336 (8708) 129-133.
www.nhs.uk/Conditions/Crohns-disease/Pages/Introduction.aspx Ornish D, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisin CJ,
[Accessed 15 October 2013]. Dunn-Emke S, Crutchfield L, Jacobs FN, Barnard RJ, Aronson WJ,
NHS Choices, 2013e. Food poisoning [online] Available from: McCormac P, McKnight DJ, Fein JD, Dnistrian AM, Weinstein J,
www.nhs.uk/conditions/Food-poisoning/Pages/Introduction.aspx Ngo TH, Mendell NR and Carroll PR. 2005. Intensive lifestyle
[Accessed 20 October 2013]. changes may affect the progression of prostate cancer. Journal of
Urology. 174 (3) 1065-1069.
NHS Choices, 2013f. Food poisoning -Causes [online] Available
from: www.nhs.uk/Conditions/Food-poisoning/Pages/Causes.aspx Oski FA. 1985. Is bovine milk a health hazard? Pediatrics. 75 (1 Pt
[Accessed 20 October 2013]. 2) 182-186.
NHS Choices, 2013g. Can I give my baby soya-based infant Oski FA. 1996. Don’t Drink Your Milk. New York: TEACH Services
formula? [online] Available from: www.nhs.uk/chq/Pages/can-I- Inc.
give-my-baby-soya-based-infant- Ostrowska L, Czapska D, Stefanska E, Karczewski J and Wyszynska
formula.aspx?CategoryID=62&SubCategoryID=63 [Accessed 10 U. 2005. Risk factors for cholecystolithiasis in obesity and at
February 2014]. normal weight. Roczniki Panstwowego Zakladu Higieny. 56 (1)
NHS Direct Wales, 2013. Crohn’s Disease [online] Available from: 67-76.
www.nhsdirect.wales.nhs.uk/encyclopaedia/c/article/crohnsdisease Outwater JL, Nicholson A and Barnard N. 1997. Dairy products
/ [Accessed 15 October 2013]. and breast cancer: the IGF-I, estrogen, and bGH hypothesis.
NICE, 2011. Otitis media with effusion [online] Available from: Medical Hypotheses. 1997 48 (6) 453-461.
http://cks.nice.org.uk/otitis-media-with-effusion#!topicsummary Oxford University Hospitals NHS Trust, 2011. BRCA1 and BRCA2
[Accessed 20 October 2013]. for men. Information for men from families with a known
NICE, 2012. NICE publishes new guideline on Crohn’s disease alteration in the BRCA1/2 gene [online]. Available from:
[online] Available from: www.nice.org.uk/newsroom/pressreleases/ www.ouh.nhs.uk/patient-
CrohnsDiseaseGuideline.jsp [Accessed 15 October 2013]. guide/leaflets/files%5C120417brca1brca2.pdf [Accessed 10
October 2013].
Nomura AM, Hankin JH, Henderson BE, Wilkens LR, Murphy SP,
Pike MC, Le Marchand L, Stram DO, Monroe KR and Kolonel LN. Owen CG, Martin RM, Whincup PH, Davey-Smith G, Gillman MW
2007. Dietary fiber and colorectal cancer risk: the multiethnic and Cook DG. 2005. The effect of breastfeeding on mean body
cohort study. Cancer Causes Control. 18 (7) 753-764. mass index throughout life: a quantitative review of published and
unpublished observational evidence. American Journal of Clinical
Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M,
Nutrition. 82: 1298-1307.
Overvad K, Olsen A, Tjonneland A, Clavel F, Boutron-Ruault MC,
Kesse E, Boeing H, Bergmann MM, Nieters A, Linseisen J, Pan A, Chen M, Chowdhury R, Wu JH, Sun Q, Campos H,
Trichopoulou A, Trichopoulos D, Tountas Y, Berrino F, Palli D, Panico Mozaffarian D and Hu FB. 2012. α-Linolenic acid and risk of
S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Engeset cardiovascular disease: a systematic review and meta-analysis.
D, Lund E, Skeie G, Ardanaz E, Gonzalez C, Navarro C, Quiros JR, American Journal of Clinical Nutrition. 96 (6) 1262-1273.
Sanchez MJ, Berglund G, Mattisson I. Hallmans G. Palmqvist R. Day Park Y, Leitzmann MF, Subar AF, Hollenbeck A, Schatzkin A. 2009.
NE Khaw KT, Key TJ, San Joaquin M, Hemon B, Saracci R, Kaaks R Dairy food, calcium, and risk of cancer in the NIH-AARP Diet and
and Riboli E. 2005. Meat, fish, and colorectal cancer risk: the Health Study. Archives of Internal Medicine. 2009. 169 (4) 391-401.
European Prospective Investigation into cancer and nutrition. Parkin DM, Boyd L and Walker LC. 2010. Chapter 16. The fraction
Journal of the National Cancer Institute. 97 (12) 906-916. of cancer attributable to lifestyle and environmental factors in the
Nsouli TM, Nsouli SM, Linde RE, O’Mara F, Scanlon RT and Bellanti UK in 2010. British Journal of Cancer. 105 Suppl 2: S77-81.
JA. 1994. Role of food allergy in serous otitis media. Annals of Paronen J, Knip M, Savilahti E, Virtanen SM, Ilonen J, Akerblom
Allergy. 73 (3) 215-219. HK and Vaarala O. 2000. Effect of cow’s milk exposure and
Office for National Statistics, 2009. Colorectal Cancer England maternal type 1 diabetes on cellular and humoral immunization to
2009 [online]. Available from: www.ons.gov.uk/ons/rel/cancer- dietary insulin in infants at genetic risk for type 1 diabetes. Finnish
unit/bowel-cancer-in-england/2009/sum-colorectal.html [Accessed Trial to Reduce IDDM in the Genetically at Risk Study Group.
25 September 2013]. Diabetes. 49 (10) 1657-65.
Office for National Statistics, 2010. Breast Cancer: Incidence, Patelarou E, Girvalaki C, Brokalaki H, Patelarou A, Androulaki Z
Mortality and Survival, 2010 [online]. Available from: and Vardavas C. 2012. Current evidence on the associations of
www.ons.gov.uk/ons/rel/cancer-unit/breast-cancer-in- breastfeeding, infant formula, and cow's milk introduction with
england/2010/sum-1.html [Accessed 25 September 2013]. type 1 diabetes mellitus: a systematic review. Nutrition Reviews.
Office for National Statistics, 2013. Avoidable deaths from 70 (9) 509-519.
cardiovascular disease fell sharply between 2001 and 2011 in
England and Wales [online]. www.ons.gov.uk/ons/rel/subnational-
health4/avoidable-mortality-in-england-and-wales/2011/sty-
avoidable-mortality.html Available from: [Accessed 14
October 2013].

118
 A report

PCRM, 2005. Doctors Group Files Suit against Kraft, General Mills, Price AJ, Allen NE, Appleby PN, Crowe FL, Travis RC, Tipper SJ,
Dannon, and Dairy Trade Groups for False Dairy Weight-Loss Overvad K, Grønbæk H, Tjønneland A, Johnsen NF, Rinaldi S,
Claims [online] Available from: http://pcrm.org/media/news/ Kaaks R, Lukanova A, Boeing H, Aleksandrova K, Trichopoulou A,
doctors-group-files-suit-against-kraft-general [Accessed 22 Trichopoulos D, Andarakis G, Palli D, Krogh V, Tumino R,
October 2013]. Sacerdote C, Bueno-de-Mesquita HB, Argüelles MV, Sánchez MJ,
Peters U, Sinha R, Chatterjee N, Subar AF, Ziegler RG, Kulldorff M, Chirlaque MD, Barricarte A, Larrañaga N, González CA, Stattin P,
Bresalier R, Weissfeld JL, Flood A, Schatzkin A and Hayes RB; Johansson M, Khaw KT, Wareham N, Gunter M, Riboli E and Key
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial T. 2012. Insulin-like growth factor-I concentration and risk of
Project Team. 2003. Dietary fibre and colorectal adenoma in a prostate cancer: results from the European Prospective
colorectal cancer early detection programme. The Lancet. Investigation into Cancer and Nutrition. Cancer Epidemiology
361(9368):1491-1495. Biomarkers Previews. 21 (9) 1531-1541.
Petit HV. 2002. Digestion, milk production, milk composition, and Pringle H. 1998. Neolithic Agriculture: Reading the Signs of
blood composition of dairy cows fed whole flax seed. Journal of Ancient Animal Domestication. Science. 282, 1448.
Dairy Science. 85 (6) 1482-1490. Prosser CG, Fleet IR and Corps AN. 1989. Increased secretion of
Pickup RW, Rhodes G, Arnott S, Sidi-Boumedine K, Bull TJ, insulin-like growth factor I into milk of cows treated with
Weightman A, Hurley M and Hermon-Taylor J. 2005. recombinantly derived bovine growth hormone. The Journal of
Mycobacterium avium subsp. paratuberculosis in the catchment Dairy Research. 56 (1) 17-26.
area and water of the River Taff in South Wales, United Kingdom, Psaltopoulou T, Ilias I and Alevizaki M. 2010. The role of diet and
and its potential relationship to clustering of Crohn’s disease cases lifestyle in primary, secondary, and tertiary diabetes prevention: a
in the city of Cardiff. Applied and Environmental Microbiology. 71 review of meta-analyses. Review of Diabetic Studies. 7 (1) 26-35.
(4) 2130-2139. Qin LQ, Wanf PY, Kaneko T, Hoshi K and Sato A. 2004. Estrogen:
Pietinen P, Malila N, Virtanen M, Hartman TJ, Tangrea JA, Albanes one of the risk factors in milk for prostate cancer. Medical
D and Virtamo J. 1999. Diet and risk of colorectal cancer in a Hypotheses. 62 (1) 133-142.
cohort of Finnish men. Cancer Causes and Control. 10 (5) 387- Ramsaransing GS, Mellema SA and De Keyser J. 2009. Dietary
396. patterns in clinical subtypes of multiple sclerosis: an exploratory
Pixley F, Wilson D, McPherson K and Mann J. 1985. Effect of study. Nutrition Journal. 8, 36.
vegetarianism on development of gall stones in women. British Rasinperä H, Savilahti E, Enattah NS, Kuokkanen M, Tötterman N,
Medical Journal. 291 (6487) 11-12. Lindahl H, Järvelä I and Kolho KL. 2004. A genetic test which can
Pizzorno J, Frassetto LA, and Katzinger J. 2010. Diet-induced be used to diagnose adult-type hypolactasia in children. Gut. 53
acidosis: is it real and clinically relevant? British Journal of (11) 1571-1576.
Nutrition. 103 (8) 1185-1194. Rautiainen S, Levitan EB, Orsini N, Åkesson A, Morgenstern R,
Plant J. 2007. Your life in your hands, understanding, preventing Mittleman MA and Wolk A. 2012. Total antioxidant capacity from
and overcoming breast cancer. London: Virgin Publishing Limited. diet and risk of myocardial infarction: a prospective cohort of
Playford RJ, Woodman AC, Clark P, Watanapa P, Vesey D, Deprez women. American Journal of Medicine. 125 (10) 974-980.
PH, Williamson RC and Calam J. 1993. Effect of luminal growth Robinson S and Fall C. 2012. Infant nutrition and later health: a
factor preservation on intestinal growth. Lancet. 341 (8849) 843- review of current evidence. Nutrients. 4 (8) 859-874.
848. Roddam AW, Allen NE, Appleby P, Key TJ, Ferrucci L, Carter HB,
Playford RJ Macdonald CE and Johnson WS. 2000. Colostrum and Metter EJ, Chen C, Weiss NS, Fitzpatrick A, Hsing AW, Lacey JV Jr,
milk-derived peptide growth factors for the treatment of Helzlsouer K, Rinaldi S, Riboli E, Kaaks R, Janssen JA, Wildhagen
gastrointestinal disorders. American Journal of Clinical Nutrition. MF, Schröder FH, Platz EA, Pollak M, Giovannucci E, Schaefer C,
72, 5-14. Quesenberry CP Jr, Vogelman JH, Severi G, English DR, Giles GG,
Post RE, Mainous AG 3rd, King DE and Simpson KN. 2012. Dietary Stattin P, Hallmans G, Johansson M, Chan JM, Gann P, Oliver SE,
fiber for the treatment of type 2 diabetes mellitus: a meta- Holly JM, Donovan J, Meyer F, Bairati I and Galan P. 2008. Insulin-
analysis. Journal of the American Board of Family Medicine 25 (1) like growth factors, their binding proteins, and prostate cancer
16-23. risk: analysis of individual patient data from 12 prospective
studies. Annals of Internal Medicine. 149 (7) 461-471.
Pot GK, Prynne CJ, Roberts C, Olson A, Nicholson SK, Whitton C,
Teucher B, Bates B, Henderson H, Pigott S, Swan G and Stephen Royal College of Paediatrics and Health, 2013. Breastfeeding
AM. 2012. National Diet and Nutrition Survey: fat and fatty acid figures fall as NHS budget is cut. [online] Available from
intake from the first year of the rolling programme and www.rcpch.ac.uk/news/breastfeeding-figures-fall-nhs-budget-cut
comparison with previous surveys. British Journal of Nutrition. 107 [Accessed 12 September 2013].
(3) 405-415. Renehan AG, Painter JE, Atkin WS, Potten CS, Shalet SM and
Potter SM. 1995. Overview of proposed mechanisms for the O’Dwyer ST. 2001, High-risk colorectal adenomas and serum insulin-
hypocholesterolemic effect of soy. The Journal of Nutrition. 125 (3 like growth factors. The British Journal of Surgery. 88, 107-113.
Suppl) 606S-611S. Riordan AM, Hunter JO, Cowan RE, Crampton JR, Davidson AR,
Pratt WB and Holloway JM. 2001. Incidence of hip fracture in Dickinson RJ, Dronfield MW, Fellows IW, Hishon S and Kerrigan
Alaska Inuit people: 1979-89 and 1996-99. Alaska Medicine. 43 GN. 1993. Treatment of active Crohn’s disease by exclusion diet:
(1) 2-5. East Anglian multicentre controlled trial. The Lancet. 342 (8880)
1131-1134.

119
 White Lies

Rizos EC, Ntzani EE, Bika E, Kostapanos MS and Elisaf MS. 2012. Sellmeyer DE, Stone KL, Sebastian A and Cummings SR. 2001. A
Association between omega-3 fatty acid supplementation and risk high ratio of dietary animal to vegetable protein increases the rate
of major cardiovascular disease events: a systematic review and of bone loss and the risk of fracture in postmenopausal women.
meta-analysis. Journal of the American Medical Association. 308 American Journal of Clinical Nutrition. 73 (1) 118-122.
(10) 1024-1033. Seppo L, Korpela R, Lonnerdal B, Metsaniitty L, Juntunen-
Robbins, J. 2001. The Food Revolution, how your diet can help save Backman K, Klemola T, Paganus, A and Vanto T. 2005. A follow-
your life and the world. Berkeley, California, USA. Conari Press. up study of nutrient intake, nutritional status, and growth in
Rosell MS, Appleby PN, Spencer EA and Key TJ. 2004. Soy intake infants with cow milk allergy fed either a soy formula or an
and blood cholesterol concentrations: a cross-sectional study of extensively hydrolyzed whey formula. American Journal of Clinical
1033 pre- and postmenopausal women in the Oxford arm of the Nutrition. 82 (1) 140-145.
European Prospective Investigation into Cancer and Nutrition. Seppo L, Tuure T, Korpela R, Järvelä I, Rasinperä H and Sahi T.
American Journal of Clinical Nutrition. 80 (5) 1391-1396. 2008. Can primary hypolactasia manifest itself after the age of 20
Royal College of Physicians, 2003. Containing the Allergy years? A two-decade follow-up study. Scandinavian Journal of
Epidemic. London: Royal College of Physicians. Gastroenterology. 43 (9) 1082-1087.
Ruhrah, J. 1909. The soy bean in infant feeding: preliminary Setchell KD and Lydeking-Olsen E. 2003. Dietary phytoestrogens
report. Archives of Pediatrics. 26, 496-501. and their effect on bone: evidence from in vitro and in vivo,
human observational, and dietary intervention studies. American
Saarinen KM, Pelkonen AS, Makela MJ and Savilahti E. 2005.
Journal of Clinical Nutrition. 78 (3 Suppl) 593S-609S.
Clinical course and prognosis of cow’s milk allergy are dependent
on milk-specific IgE status. Journal of Allergy and Clinical Shingfield KJ, Bonnet M and Scollan ND. 2013. Recent
Immunology. 116 (4) 869-875. developments in altering the fatty acid composition of ruminant-
derived foods. Animal. 7 Suppl 1:132-62.
Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP and Kass
EH. 1985. Plasma lipoprotein levels in vegetarians. The effect of Shu XO, Zheng Y, Cai H, Gu K, Chen Z, Zheng W and Lu W. 2009.
ingestion of fats from dairy products. Journal of the American Soy food intake and breast cancer survival. Journal of the
Medical Association. 254 (10) 1337-1341. American Medical Association. 302 (22) 2437-2443.
Salque M, Bogucki PI, Pyzel J, Sobkowiak-Tabaka I, Grygiel R, Simonart T. 2012. Acne and whey protein supplementation
Szmyt M and Evershed RP. 2013. Earliest evidence for cheese among bodybuilders. Dermatology. 225 (3) 256-258.
making in the sixth millennium BC in northern Europe. Nature. Silveira MB, Carraro R, Monereo S and Tébar J. 2007. Conjugated
493 (7433) 522-525. linoleic acid (CLA) and obesity. Public Health and Nutrition. 10
Sartor RB. 2005 Does Mycobacterium avium subspecies (10A) 1181-1186.
paratuberculosis cause Crohn's disease? Gut. 54 (7) 896-898. Silverberg NB. 2012. Whey protein precipitating moderate to
Savino F, Cresi F, Maccario S, Cavallo F, Dalmasso P, Fanaro S, severe acne flares in 5 teenaged athletes. Cutis. 90 (2) 70-72.
Oggero R, Vigi V and Silvestro L. 2003. "Minor" feeding problems Sinha R, Cross AJ, Graubard BI, Leitzmann MF and Schatzkin A.
during the first months of life: effect of a partially hydrolysed milk 2009. Meat intake and mortality: a prospective study of over a half
formula containing fructo- and galacto-oligosaccharides. Acta a million people. Archives of Internal Medicine. 169 (6) 562-571.
Paediatrica Suppl. 91 (441) 86-90. Sirtori CR, Agradi E, Conti F, Mantero O and Gatti E. 1977.
Savino F, Cresi F, Pautasso S, Palumeri E, Tullio V, Roana J, Silvestro Soybean-protein diet in the treatment of type-II
L and Oggero R. 2004. Intestinal microflora in breastfed colicky hyperlipoproteinaemia. Lancet. 1 (8006) 275-277.
and non-colicky infants. Acta Paediatrica. 93 (6) 825-829. Sirtori CR, Pazzucconi F, Colombo L, Battistin P, Bondioli A and
Savino F, Palumeri E, Castagno E, Cresi F, Dalmasso P, Cavallo F, Descheemaeker K. 1999. Double-blind study of the addition of
Oggero R. 2006. Reduction of crying episodes owing to infantile high-protein soya milk v. cows' milk to the diet of patients with
colic: A randomized controlled study on the efficacy of a new severe hypercholesterolaemia and resistance to or intolerance of
infant formula. European Journal of Clinical Nutrition. 60 (11) statins. British Journal of Nutrition. 82 (2) 91-96.
1304-1310. Skoner AR, Skoner KR and Skoner DP. 2009 Allergic rhinitis,
Schwarz S and Leweling H. 2005. Multiple sclerosis and nutrition. histamine, and otitis media. Allergy and Asthma Proceedings. 30
Multiple Sclerosis. 11 (1) 24-32. (5) 470-481.
Scialla JJ and Anderson CA. 2013. Dietary acid load: a novel SMA Careline. ([email protected]) February 11
nutritional target in chronic kidney disease? Advances in Chronic 2014. Re: Reply from SMA Careline. E-mail to J. Butler
Kidney Disease. 20 (2) 141-149. ([email protected]).
Sechi LA, Scanu AM, Molicotti P, Cannas S, Mura M, Dettori G, Snowdon DA. 1988. Animal product consumption and mortality
Fadda G and Zanetti S. 2005. Detection and Isolation of because of all causes combined, coronary heart disease, stroke,
Mycobacterium avium subspecies paratuberculosis from intestinal diabetes, and cancer in Seventh-day Adventists. American Journal
mucosal biopsies of patients with and without Crohn’s disease in of Clinical Nutrition. 48 (3) 739-748.
Sardinia. The American Journal of Gastroenterology. 100 (7) Soh P, Ferguson EL, McKenzie JE, Homs MY and Gibson RS. 2004.
1529-1536. Iron deficiency and risk factors for lower iron stores in 6-24-
Segasothy M and Phillips PA. 1999. Vegetarian diet: panacea for month-old New Zealanders. European Journal of Clinical Nutrition.
modern lifestyle diseases? QJM: Monthly Journal of the 58 (1) 71-79.
Association of Physicians. 92 (9) 531-544. Song SH. 2012. Emerging type 2 diabetes in young adults.
Advances in Experimental Medical Biology. 771: 51-61.

120
 A report

Speedy AW. 2003. Global production and consumption of animal Thorsdottir I and Ramel A. 2003. Dietary intake of 10- to 16-year-
source foods. The Journal of Nutrition. 133 (11 Supplement 2) old children and adolescents in central and northern Europe and
4048S-4053S. association with the incidence of type 1 diabetes. Annals of
Spock B and Parker SJ. 1998. Baby and Child Care, the one Nutrition and Metabolism. 47 (6) 267-275.
essential parenting book. London: Simon and Schuster UK Limited. Toohey ML, Harris MA, DeWitt W, Foster G, Schmidt WD and
Stattin P, Rinaldi S, Biessy C, Stenman UH, Hallmans G and Kaaks Melby CL. 1998. Cardiovascular disease risk factors are lower in
R. 2004. High levels of circulating insulin-like growth factor-I African-American vegans compared to lacto-ovo-vegetarians.
increase prostate cancer risk: a prospective study in a population- Journal of the American College of Nutrition. 17 (5) 425-434.
based non-screened cohort. Journal of Clinical Oncology. 22 (15) Trapp CB and Barnard ND. 2010. Usefulness of vegetarian and
3104-3112. vegan diets for treating type 2 diabetes. Current Diabetes Reports.
Story L, Anderson JW, Chen WJ, Karounos D and Jefferson B. 10 (2) 152-158.
1985. Adherence to high-carbohydrate, high-fiber diets: long- Tricon S, Burdge GC, Williams CM, Calder PC and Yaqoob P.
term studies of non-obese diabetic men. Journal of the American 2005. The effects of conjugated linoleic acid on human health-
Dietetic Association. 85 (9) 1105-1110. related outcomes. Proceedings of the Nutrition Society. 64 (2)
Strom BL, Schinnar R, Ziegler EE, Barnhart KT, Sammel MD, 171-182.
Macones, GA, Stallings VA, Drulis JM, Nelson SE and Hanson SA Trock BJ, Hilakivi-Clarke L and Clarke R. 2006. Meta-analysis of
2001. Exposure to soy-based formula in infancy and soy intake and breast cancer risk. Journal of the National Cancer
endocrinological and reproductive outcomes in young adulthood. Institute. 98 (7) 459-471.
Journal of the Medical Association. 286 (7) 807-814. Trowell H. 1974. Diabetes mellitus death-rates in England and
Swagerty DL Jr, Walling AD and Klein RM. 2002. Lactose Wales 1920-70 and food supplies. The Lancet. 2 (7887) 998-
intolerance. American Family Physician. 65 (9) 1845-1850. 1002.
Swank RL and Dugan BB. 1990. Effect of low saturated fat diet in Tseng M, Breslow RA, Graubard BI and Ziegler RG. 2005. Dairy,
early and late cases of multiple sclerosis. Lancet. 336 (8706) 37- calcium, and vitamin D intakes and prostate cancer risk in the
39. national health and nutrition examination epidemiological follow-
Swinburn BA, Caterson I, Seidell JC and James WP. 2004. Diet, up study cohort. American Journal of Clinical Nutrition. 81 (5)
nutrition and the prevention of excess weight gain and obesity. 1147-1154.
Public Health Nutrition. 7 (1A) 123-146. Tucker KL, Olson B, Bakun P, Dallal GE, Selhub J and Rosenberg IH.
Talbot G. 2006. Independent advice on possible reductions for 2004. Breakfast cereal fortified with folic acid, vitamin B-6, and
saturated fat in products that contribute to consumer intakes. vitamin B-12 increases vitamin concentrations and reduces
Summary Report Prepared for Food Standards Agency [online]. homocysteine concentrations: a randomized trial. American
Available from: www.food.gov.uk/multimedia/pdfs/reductions.pdf Journal of Clinical Nutrition. 79 (5) 805-811.
Tappel A. 2007. Heme of consumed red meat can act as a catalyst Turck D. 2007. Soy protein for infant feeding: what do we know?
of oxidative damage and could initiate colon, breast and prostate Current Opinion in Clinical Nutrional Metabolic Care. 10 (3) 360-
cancers, heart disease and other diseases. Medical Hypotheses. 68 365.
(3) 562-564. Turner-McGrievy GM, Barnard ND and Scialli AR. 2007. A two-
Taylor EN, Stampfer MJ and Curhan GC. 2004. Dietary factors and year randomized weight loss trial comparing a vegan diet to a
the risk of incident kidney stones in men: new insights after 14 more moderate low-fat diet. Obesity (Silver Spring). 15 (9) 2276-
years of follow-up. Journal of the American Society of 2281.
Nephrology. 15 (12) 3225-3232. Turunen S, Karttunen TJ and Kokkonen J. 2004. Lymphoid nodular
Taylor EN, Fung TT, Curhan GC. 2009. DASH-style diet associates hyperplasia and cow’s milk hypersensitivity in children with chronic
with reduced risk for kidney stones. Journal of the American constipation. The Journal of Pediatrics. 145 (5) 606-611.
Society of Nephrology. 20 (10) 2253-2259. UK Parliament, 1999. Select Committee on European Scrutiny
TEDDY Study Group. 2008. The Environmental Determinants of Third and Fourth report, Use of Bovine Somatotropin (BST).
Diabetes in the Young (TEDDY) Study. Annals of the New York [online] Available from: www.publications.parliament.uk/
Academy of Sciences. 1150, 1-13. pa/cm199900/cmselect/cmeuleg/23-iii/2319.htm#n42 [Accessed
24 October 2013].
Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H,
Holmberg L and Wolk A. 2001. Fruit, vegetables, dietary fiber, and UNICEF, 2005. Breastfeeding. [online] Available from
risk of colorectal cancer. Journal of the National Cancer Institute. www.unicef.org/nutrition/index_24824.html [Accessed 12
93 (7) 525-533. September 2013].
Thomas HV, Key TJ, Allen DS, Moore JW, Dowsett M, Fentiman IS UNICEF, 2013. The UNICEF UK Baby Friendly Initiative – The health
and Wang DY. 1997. A prospective study of endogenous serum Benefits of breastfeeding. [online] Available from
hormone concentrations and breast cancer risk in post- www.unicef.org.uk/BabyFriendly/About-Baby-
menopausal women on the island of Guernsey. British Journal of Friendly/Breastfeeding-in-the-UK/Health-benefits/ [Accessed 9
Cancer. 76 (3) 401-405. September 2013].
Thompson WG, Rostad Holdman, N, Janzow DJ, Slezak JM, Morris UNICEF, 2013a. Breastfeeding – Impact on child survival and
KL and Zemel MB. 2005. Effect of energy-reduced diets high in global situation. [online] Available from
dairy products and fiber on weight loss in obese adults. Obesity www.unicef.org/nutrition/index_24824.html [Accessed 9
Research. 13 (8) 1344-1353. September 2013].

121
 White Lies

Vaarala O, Knip M, Paronen J, Hamalainen AM, Muona P, Vaatainen WHO/FAO, 2002. Diet, nutrition and the prevention of chronic
M, Ilonen J, Simell O and Akerblom HK. 1999. Cow’s milk formula diseases: Infancy 4.4.4. [online] Available from:
feeding induces primary immunization to insulin in infants at www.who.int/nutrition/topics/4_dietnutrition_prevention/en/index
genetic risk for type 1 diabetes. Diabetes. 48 (7) 1389-1394. 1.html [Accessed 14 October 2013].
Vehik K, Hamman RF, Lezotte D, Norris JM, Klingensmith GJ, WHO, 2005b. Obesity and overweight. [online] Available from:
Rewers M and Dabelea D. 2008. Trends in high-risk HLA www.who.int/dietphysicalactivity/publications/facts/obesity/en/
susceptibility genes among Colorado youth with type 1 diabetes. [Accessed 31 October 2005].
Diabetes Care. 31 (7) 1392-1396. WHO, 2013. Infant and young child feeding - Fact sheet N°342.
Wahle KW, Heys, SD and Rotondo D. 2004. Conjugated linoleic [online] Available at: www.who.int/mediacentre/factsheets/
acids: are they beneficial or detrimental to health? Progress in fs342/en/index.html [Accessed 9 September 2013].
Lipid Research. 43 (6) 553-587. WHO, 2013a. Breast cancer: prevention and control [online]
Wakai K, Date C, Fukui M, Tamakoshi K, Watanabe Y, Hayakawa Available at: www.who.int/cancer/detection/breastcancer/
N, Kojima M, Kawado M, Suzuki K, Hashimoto S, Tokudome S, en/index1.html [Accessed 25 September 2013].
Ozasa K, Suzuki S, Toyoshima H, Ito Y and Tamakoshi A; JACC WHO, 2013b. Diabetes Fact sheet N°312 [online] Available from:
Study Group. 2007. Dietary fiber and risk of colorectal cancer in www.who.int/mediacentre/factsheets/fs312/en/index.html
the Japan collaborative cohort study. Cancer Epidemiology and [Accessed October 17 2013].
Biomarkers Prevention. 16 (4) 668-675.
WHO, 2013c. General information related to microbiological risks
Waldmann A, Koschizke JW, Leitzmann C and Hahn A. 2005. in food. [online] Available from: www.who.int/foodsafety/micro/
Dietary intakes and blood concentrations of antioxidant vitamins general/en/print.html [Accessed 20 October 2013].
in German vegans. International Journal for Vitamin and Nutrition
WHO, 2013d. Mean Body Mass Index (BMI) [online] Available
Research. 75 (1) 28-36.
from: www.who.int/gho/ncd/risk_factors/bmi_text/en/ [Accessed
Walsh, S. 2003. Plant Based Nutrition and Health. St. Leonard’s- 22 October 2013].
on-Sea, East Sussex. The Vegan Society.
WHO, 2013e. Overweight and obesity. Fact sheet N°311 [online]
Warensjö E, Byberg L, Melhus H, Gedeborg R, Mallmin H, Wolk A Available from: www.who.int/mediacentre/factsheets/fs311/
and Michaëlsson K. 2011. Dietary calcium intake and risk of en/index.html [Accessed 22 October 2013].
fracture and osteoporosis: prospective longitudinal cohort study.
Wickham CA, Walsh K, Cooper C, Barker DJ, Margetts BM, Morris
British Medical Journal. 342: d1473.
J and Bruce SA. 1989. Dietary calcium, physical activity, and risk of
WCRF/AICR, 2007. Food, nutrition, physical activity, and the hip fracture: a prospective study. British Medical Journal. 299
prevention of cancer: a global perspective [online]. Available from: (6704) 889-892.
www.dietandcancerreport.org/cancer_resource_center/downloads
Wieneke AA, Roberts D and Gilbert RJ. 1993. Staphylococcal food
/summary/english.pdf [Accessed: 27 September 2013].
poisoning in the United Kingdom, 1969-90. Epidemiology and
WCRF, 2009. Less than a third aware of processed meat cancer Infection. 110, 519-531.
link. [online] Available from: www.wcrf-
Willer CJ, Dyment DA, Risch NJ, Sadovnick AD and Ebers GC;
uk.org/about_us/media/press_release.php?recid=64 [Accessed 7
Canadian Collaborative Study Group. 2003. Twin concordance
January 2014].
and sibling recurrence rates in multiple sclerosis. Proceedings of
Webster J. 2005. Animal welfare; limping towards Eden. Oxford: the National Academy of Sciences. 100 (22) 12877-12882.
Blackwell Publishing Limited.
Willetts IE, Dalzell M, Puntis JW and Stringer MD. 1999. Cow’s
Weikert C, Walter D, Hoffmann K, Kroke A, Bergmann MM and milk enteropathy: surgical pitfalls. Journal of Pediatric Surgery. 34
Boeing H. 2005. The relation between dietary protein, calcium (10) 1486-1488.
and bone health in women: results from the EPIC-Potsdam cohort.
Williams G and Pickup J. 2004. Handbook of Diabetes.
Annals of Nutrition and Metabolism. 49 (5) 312-318.
Massachusetts, US: Blackwell Publishing.
Whigham LD, Watras AC and Schoeller DA. 2007. Efficacy of
Wilmot EG, Davies MJ, Yates T, Benhalima K, Lawrence IG and
conjugated linoleic acid for reducing fat mass: a meta-analysis in
Khunti K. 2010. Type 2 diabetes in younger adults: the emerging
humans. American Journal of Clinical Nutrition. 85 (5) 1203-1211.
UK epidemic. Postgraduate Medical Journal. 86 (1022): 711-718.
Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr
Winzenberg T, Shaw K, Fryer J and Jones G. 2006. Effects of
and Yaffe K. 2005. Obesity in middle age and future risk of
calcium supplementation on bone density in healthy children:
dementia: a 27 year longitudinal population based study. British
meta-analysis of randomised controlled trials. British Medical
Medical Journal. 330 (7504) 1360.
Journal. 333 (7572) 775.
WHO, 2003. Global strategy on diet, physical activity and health.
Wolk A, Mantzoros CS, Andersson SO, Bergstrom R, Signorello LB,
[online] Available from: www.who.int/dietphysicalactivity/media/
Lagiou P, Adami HO and Trichopoulos D. 1998. Insulin-like growth
en/gsfs_general.pdf [Accessed 5 September 2013].
factor 1 and prostate cancer risk: a population- based case-control
WHO, 2003a. Recommendations for preventing osteoporosis study. Journal Of The National Cancer Institute. 90, 911-915.
[online] Available from: www.who.int/nutrition/topics/
Wolk A. 2005. Diet, lifestyle and risk of prostate cancer. Acta
5_population_nutrient/en/index25.html [Accessed 24 October
Oncologica. 44 (3) 277-281.
2013].
Wosje KS and Kalkwarf HJ. 2004. Lactation, weaning, and calcium
WHO, 2006. Chronic Disease, key risk factors include, high blood
supplementation: effects on body composition in postpartum
pressure, low fruit and vegetable intake. [online] Available from:
women. American Journal of Clinical Nutrition. 80 (2) 423-429.
www.who.int/dietphysicalactivity/media/en/gsfs_chronic_disease.p
df [Accessed 14 October 2013]. Wu AH, Pike MC and Stram DO. 1999. Meta-analysis: dietary fat
intake, serum estrogen levels, and the risk of breast cancer.
Journal of the National Cancer Institute. 91 (6) 529-534.

122
 A report

Wu Y, Yakar S, Zhao L, Hennighausen L and LeRoith D. 2002. Zhang Q, Ma G, Greenfield H, Zhu K, Du X, Foo LH, Hu X and
Circulating insulin-like growth factor-I levels regulate colon cancer Fraser DR. 2010. The association between dietary protein intake
growth and metastasis. Cancer Research. 62 (4) 1030-1035. and bone mass accretion in pubertal girls with low calcium
Yakar S, LeRoith D and Brodt P. 2005. The role of the growth intakes. British Journal of Nutrition. 103 (5) 714-723.
hormone/insulin-like growth factor axis in tumor growth and Ziegler EE, Fomon SJ, Nelson SE, Rebouche CJ, Edwards BB,
progression: Lessons from animal models. Cytokine and Growth Rogers RR and Lehman LJ. 1990. Cow milk feeding in infancy:
Factor Reviews. 16 (4-5) 407-420. further observations on blood loss from the gastrointestinal tract.
Yan L and Spitznagel EL. 2009.Soy consumption and prostate The Journal of Pediatrics. 116 (1) 11-8.
cancer risk in men: a revisit of a meta-analysis. American Journal Ziegler EE. 2011. Consumption of cow’s milk as a cause of iron
of Clinical Nutrition. 89 (4) 1155-1163. deficiency in infants and toddlers. Nutrition Reviews. 69
Young NJ, Metcalfe C, Gunnell D, Rowlands MA, Lane JA, Gilbert Supplement 1:S37-S42.
R, Avery KN, Davis M, Neal DE, Hamdy FC, Donovan J, Martin RM Zemel MB, Thompson W, Milstead A, Morris K and Campbell P.
and Holly JM. 2012. A cross-sectional analysis of the association 2004. Calcium and dairy acceleration of weight and fat loss
between diet and insulin-like growth factor (IGF)-I, IGF-II, IGF- during energy restriction in obese adults. Obesity Research. 12 (4)
binding protein (IGFBP)-2, and IGFBP-3 in men in the United 582-590.
Kingdom. Cancer Causes Control. 23 (6) 907-917. Zemel MB, Richards J, Russel J, Milstead A, Gehardt L and Silva E.
Yu H and Rohan T. 2000. Role of the insulin-like growth factor 2005. Dairy augmentation of total and central fat loss in obese
family in cancer development and progression. Journal of the subjects. International Journal of Obesity. 29 (4) 341-347.
National Cancer Institute. 92 (18) 1472-1489.
Yu H, Spitz MR, Mistry J, Gu J, Hong WK and Wu X. 1999.
Plasma levels of insulin-like growth factor-I and lung cancer risk: a
case-control analysis. Journal of the National Cancer Institute. 91,
151-156.

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