Got Truth? Rethinking Dairy, Calcium, and Bone Health

coming up on this episode of the Dr. Hyman show. You can develop issues with lactose and digesting dairy at any point in your life. It increases as we get older and it often can increase after we've had, you know, some sort of infection or inflammation or antibiotics in our system. Have you been feeling stressed or tired lately? You might be low in one powerful mineral. That mineral is magnesium. Most people are and most supplements don't fix it because they only include one or two forms. I use magnesium breakthrough from bioptimizers because it has all seven forms of magnesium your body needs for sleep, stress and recovery. It actually works. You can feel the difference. From November 23rd through December the 3rd, you get 25% off. This is the once a year sale you do not want to miss. Go right now to bioptimizers.com slash hyman and use code hyman. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day. So I built several tools to help you take control of your health. If you're looking for guidance, education and community, check out my private membership, the hyman hive for live Q and A's exclusive content and direct connection. For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor trusted supplements and health products at doctorhyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast, ad free with hyman plus. Just open Apple podcasts and tap try free to start your seven day free trial. Milk is something that most of the world's population doesn't tolerate 75% or 70% or lactose intolerant. Most populations around the world don't consume milk on a regular basis like China and Asia and most Asian countries, Africa. There are some exceptions obviously in the side, but I think that for the most part, it's not a staple food after weaning. And yet somehow in the West, we've come to think about it as American as apple pie and the American flag. And in fact, you can't even get a school lunch authorized unless milk is included in the school lunch. But you really question that. I think you wrote an article a number of years ago, which was sort of a prelude to this one that was in, I think JAMA, also with Walter Willett, where you sort of questioned the guidelines and brought up some of this data. And I wrote an article that sort of kind of derived from that called Got Proof, which essentially was a spoof on the whole Got Milk campaign, which by the way, people don't understand that the Got Milk campaign wasn't an industry effort solely. That it was part of a government program called the Chekhov program, which is where the United States Department of Agriculture supports industry to sell more of its products. It's supposed to help with research, right? The money is tied to the government by the industry, apparently to support research, but it actually went to marketing of these ads called Got Proof. They were literally taken down by the Federal Trade Commission because there was no evidence for the claims we're making. Can you talk about that? And then how do we get to these three glasses? Right, well, so we began by looking at the mindset, the philosophy that gave rise to these minimum recommendations. And you point out that it's not just science, but it's also food politics, that the USDA, which has conventionally overseeing these recommendations, has a dual message, a dual mission. One is promotion of public health, but the other is to advance the financial interests of the big food commodity producers. And Dairy is absolutely very, very powerful. So you made another very important point that really cuts to the chase, that at least half of the world's population doesn't consume milk products on a regular basis. And yet the children seem to be able to grow up without suffering continuous bone fractures or have short stature or other problems. So we know that milk is not required to be a healthy child or a healthy adult. And of course, before 10,000 years ago, when perhaps the first dairy animals were domesticated, no humans would have ever consumed any dairy product. And you would be milking a saber-tooth tiger? You know, good luck. So, but that then, so we know that milk isn't necessary for to survive, to keep our bones from crumbling. But that doesn't mean that milk is inherently harmful or that we shouldn't be drinking it. And a point that I'd like to continue to return to during our talk today is an interaction with diet quality that to understand the impact of a food like milk or really many other foods, there's essentially no one food that you have to eat in order to live. So the question is, how do these foods support health for a specific population? And to understand that, we need to think about what foods are being traded off. So for a child that's consuming junk foods all day long, you know, sugary beverages and packaged savory snacks, going at cheeseburgers and like dairy products might be among the healthiest things that they eat. These are whole foods for the most part, as long as they're not loaded up with sugar, as actually does still happen in schools. But so dairy products would tend to increase diet quality, displace some of these highly processed junk foods and would be good for health. Yeah, compared to what is the question, what are you eating instead of it? Yeah, for somebody who's got a really healthful diet based on whole foods, who's avoiding a lot of processed carbohydrates and others, just dumping in more dairy products to reach some kind of theoretical nutrient balance may miss the mark. And with regard to calcium, which is the most commonly cited. So it's amazing what you're saying is basically saying, dairy is better than Coke, it's not saying much, right? Well, no, I mean, there's a lot of, two thirds of what's consumed in the US is highly processed food quality. And so I think what we wanna do is ask, what is the background diet we're talking about? To simply say, don't drink milk, would I think produce a lot of home because there are children in the United States and even more so in countries with borderline nutritional status, where milk provides one of the best sources of protein, of fats, of slow digesting carbohydrates, potassium, calcium, and other nutrients. So to remove milk from the diet of people, either in the United States, kids with borderline nutrition quality, or overseas in South America, where nutrient deficiency is a real problem, I think could cause great harm. But let's drill down on calcium, because that's the one that's the nutrient that is driving fear of low milk intake. It's driving milk intake. Because especially women, they wanna get enough calcium to avoid milk pressures. And if you go by the calcium balance studies that were used to come up with this recommendation, you need a gram, a thousand milligrams or more calcium a day to meet new kinds. It's almost certainly flat out. These balance studies were based on very short-term studies, 21 days, where yes, if you dump in a lot more calcium, the body will absorb some of that calcium and put it into bones. But what it's basically doing is filling up temporary spaces in bones. They don't stay there. And so if you did longer-term studies, you would see that adding more and more calcium doesn't keep building up bone. You have this short-term boost in bone calcium. But then you fill up all these little temporary niches and there's no more benefits. The thing is that those transient spaces don't stay there. You don't have a calcium bank for life by consuming a lot of milk as a kid. And we can talk more about that. So- I had to confess here. I mean, I hope it doesn't let it bias my opinion about milk. It's more hopefully medical and scientific. But when I was a kid, I hated milk. And I just didn't like the taste of it. My mother was like, how are you gonna grow up to be big and strong if you don't drink milk? Well, I never drank milk and I'm six foot three. And maybe I would have been an NBA player instead of a doctor if I did drink milk. Who knows? I really never did and my bone density is great. And I think that it is a bit of a mythology about that. And then- So we do need calcium. There's no question. The bones are made primarily of calcium and phosphate, but how much calcium? And the minimum requirement to be perfectly healthy bones are probably at most a half of what has been traditionally viewed as necessary in the United States. In the UK, their minimum calcium requirements are about a half of what they are here. And in some populations, like in South America, the adults do perfectly well getting, even a third or a quarter of the amount of calcium, like 300 milligrams a day. So- You mentioned that level of calcium can be obtained from. So if you're gonna get a gram or more a day of calcium, milk is sort of the obvious source. But if you accept that we don't need that much, the 500, 600 milligrams a day are probably more than sufficient, well, that's easily obtained from just a basic diet. And serving of kale is gonna get you a third to an halfway there. So you're seeing- Serving of sardines, nuts, seeds. Yeah. Chia seeds, tahini, those are my favorite. I mean, one of the things you said that I just wanna come back to, which is really important, is this whole idea of calcium balance. And when you look at countries like Sweden that you wrote about in your paper, they have the highest intakes of calcium and the highest risk of fractures. And countries like Indonesia and China have the lowest intakes of calcium and the lowest risk of fractures. So one of the things that I remember when I was a medical director at Kenyansh, I often talked about was osteoporosis. And it was really clear that there are a lot of things in our culture that drove calcium loss. So it's not just about how much you take in, it's how much you pee out, right? So caffeine, alcohol, sugar, phosphoric acid from sodas, too much meat, perhaps I don't know if that's true, but that's what it seemed to be, the high protein acid load. All these things, stress, all these things cause bone loss. And if you mitigate those, in other words, you cut those out of your diet or you reduce them and you deal with stress and you deal with the fact of how you're losing calcium, that your net net may be better than if you're taking super high levels of calcium. The other thing that's interesting to note is that, cows get their calcium and have great bones. Where do they get it from? Grass, right? They're drinking milk. They're drinking three servings a day. For a little bit and then they don't. And they're getting it from grass. So why not, why get it from calcium? So green leafy vegetables are actually a very good source of calcium. Kale, a serving of kale has almost as much calcium as a serving of milk. And you get many fewer total calories that way. But let's go back to these ecological comparisons. Those are the comparisons where you look at different countries and see different risks. It's important to understand that those are, there are limitations to those kinds of analyses. What they do convincingly tell us is that you can, it's possible to be a human being, consume no milk, low, relatively low levels in calcium and have low fracture risk. The problem with these studies is that they're very conundant. So when you look compared to the Swede to the Filipino, you know, there's a big difference in height. And height is a major risk factor for bone infrasher. So ironically, it may be that milk consumption in adolescents and childhood and adolescence, actually increases risk for fracture in adulthood. So how could that be? Well, we've talked about that you don't really put away a calcium bank in childhood. You don't get that benefit. But the one thing that is pretty clear that milk does in childhood is accelerate growth. It's not hugely, it's not gonna turn a, you know, a horse racing jockey into a baseball player. The baseball player, but you get about an extra centimeter for every additional survey glass of milk a day. So maybe, and this is a population average, but so maybe for comparing low and high consumers, you grow an extra inch. But on a population basis, that increased height is one of the major risk factors of having a fracture. You know, simply put the bigger they come, the harder they fall. I'm kind of screwed. I'm like six foot three. But this is a big, you know, this is one of the first myths to go. The drinking a lot of milk as a kid is gonna reduce your risk of getting a fracture in his adulthood. And if anything, it's the opposite. So these are the basis of the basis for our recommendations, which is you need calcium provenoste process. And that's why our guidelines tell us to have three glasses of milk a day. Yeah, well, you do need calcium. You just don't need that much. And the amount that you need can be obtained from other sources. And so what about the idea of weight? Because again, it's not to say that milk is inherently bad or toxic. I mean, we talked about one situation where it could be helpful. People with borderline nutritional status, when they drink milk, they're drinking, you know, you're drinking like a glass of milk. And maybe you just have two cookies after school as a kid, instead of having the whole package without milk or with fat-free milk, which doesn't taste very good and isn't very satiating. Yeah, I wanna get into the fat-free thing in a minute. I know that's your favorite topic, but I just wanna sort of summarize here about the calcium story. Because you're saying essentially is that all the data, and there were over 100 papers you reviewed, all the data really didn't point to a benefit of increased calcium intake through supplements or through dairy, and that there was potential risks as well. And then it wasn't just a benign intervention, that there may be increased risks with increased calcium intake in different situations, whether it's cancer or whether it's from perhaps the high levels of calcium causing greater growth and fracture risk, we don't know, but it's not a slam dunk. So you think based on the current data that you reviewed that in the New England Journal of Medicine's tell you, you think that the government should change its dietary guidelines? Let me just say, so we talked about the trade-offs, and milk, so one downside of extra growth, we talked about was fracture risk, but another downside of being tall is cancer risk. Being tall you are, the higher your risk of cancer. Maybe partly it's more self, you're okay, you're taking good care of yourself. But first of all, you've got a bigger body, but the other thing about milk is to think, to consider why, how milk has evolved. I mean milk, the purpose of milk is to help grazing animals, like clans of Africa, but the infants that are at high risk of being eaten by the local carnivores, grow rapidly so they can be strong enough and fast enough to be free of predation. So that's a very strong selective, fitness factors, evolutionary drive to get these baby womanins, the gazelles and the other grazing animals to grow very quickly. So that's a good thing, except if you're consuming these foods that stimulate growth in children, but in adults, these growth factors that may be stimulating biological systems that relate to cancer. And while the data are definitely not clear yet, there seems to be evidence of cancer, of high levels of dairy consumption, causing prostate cancer in men, especially aggressive forms of prostate cancer and endometrial cancer. Although interestingly, milk intake may protect against colorectal cancer, and that may be an effect of the calcium. 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From November 23rd through December 3rd, you get 25% off. This is the once-a-year sale you do not want to miss. Plus, this part is exclusive to my audience and only at bioptimizers.com slash hyman. You'll not only get an amazing discount, but also free gifts with select purchases. Go right now to bioptimizers.com slash hyman, use code hyman and grab your favorites before the steal disappears. After December 3rd, it's gone. Don't miss it. Now here's the truth. Now I wrote a book called Food Fix where I went deep into the machinations of the food industry, the collusion between government and the food industry. And by the way, there's a lot of revolving doors. So people from the dairy council work for the government and go back to work for the dairy council. And it's just a mess. Now, big dairy is really behind the headlines that milk is good for you. It's a $47 billion dollar a year industry. It's one of the most influential food lobbyists on Capitol Hill. According to the Center for Responsive Politics, it's a nonpartisan group that tracks money in politics. The dairy industry gave nearly $46 million to politicians between 1990 and 2016. In 2015, the committee of scientific experts that shapes the dietary guidelines included two members with financial ties to big dairy. Furthermore, the dairy industry spent millions of dollars funding studies that claim that milk offers benefits like weight loss, improved health, and stronger bones. Now, let's tell you a quick story. Years ago, I was on Martha Stewart's television show, which no longer exists. And we were talking about optimal performance and health and I was one of the experts. Now, when you're an expert on a TV show, you don't get cue cards. You got to know your stuff. And you got to just say what you got to say when you got to say it. Now, there was a trainer that she had, I think it was her trainer, that was also on the show. And when I talked to the producer, he was talking about the segment and he said, well, we're going to talk about how dairy is this great sports drink. And I said, wait a minute, where are you getting that information? He says, well, I said, listen, here let me send you a bunch of papers. So I went through PubMed and I sent him all the papers showing that this is not true. And I also showed him the papers that said it was true, but they were all funded by the dairy council. Now, when a food industry organization or agency or a council funds a study, it's eight to 50 times more likely to show a positive benefit. In other words, if Coca-Cola does a study on soda, that's going to find that it doesn't cause obesity. Or if the dairy council does a study on milk, it's going to find it's good for your bones and it's good for exercise and everything else. But actually, it's pretty frightening. So anyway, I was in this show and the trainer had these cue cards by the camera. There were these giant cue cards which had all the talking points, which were all wrong about why dairy is a perfect post-workout food. And I was like, well, why are you doing this? The producer said, well, the dairy council is funding the segment of the show. And I was just flabbergasted. So we think we're getting straight up information, we're just not. First of all, we need to know this. The whole Got Milk campaign, the mustache thing, where you had all the health and human services secretary, all the athletes, all the celebrities, wearing the milk mustache, that was funded in part by the government, something called the checkout program, and the dairy council. And it was promoting all these claims, like it's great for your bones and it's great for this and it's great for that, but it's not. And so the federal trade commission actually made them take the ads off the air and out of magazines. That's why you don't see them anymore because there was no scientific basis for the claims. And it was false advertising. So this is like government, let me find millions of dollars to tell us stuff that wasn't scientifically true. So anyway, the bottom line here is that milk is not good for your bones and you don't need milk for strong bones. Everybody knows we need milk for stronger bones, right? That's what we're taught, drink your milk, go big and strong and tall, you need calcium. And without a children, won't grow up to be big and strong. Adults will get hip fractures and most people would be getting osteoporosis and their bones will crumble to dust as they age, but there's absolutely no evidence that we need milk to strengthen our bones. And for example, countries with the lowest milk consumption have the lowest rates of osteoporosis and fractures. Well, those with the highest dairy consumption and calcium have the highest rates of fractures. How do you make sense of that? In fact, in one study they found that those who drank more milk had higher risk of fractures. So that's a bit concerning to me. Also, it's good for kids, right? I mean, we now force kids to have milk. If you wanna have a school lunch program, you have to serve milk. And most of it's sugary milk, which is basically like a soda and milk together. And it's mandated by the government that in public schools, we have to have milk. But kids can't get their federal school lunch money unless they give, I'm sorry, the schools can't get their federal school lunch money unless they give every kid milk. But there's no evidence that it's true. In fact, they're also giving them low fat milk, which is even worse because low fat milk actually causes them to gain more weight because it makes them not feel satisfied or full from the fat. Also, milk is a lousy source of calcium. The studies are pretty clear on this. There's nothing special about dairy and bone health. In fact, vitamin D that we get with milk, that's added to the milk. It's not actually naturally in milk, believe it or not. They put it in there to prevent rickets, which is a good thing, but still it's not where we get vitamin D. The amount of calcium everybody needs is actually far less than the levels recommended in the United States. It's not actually the total calcium intake that matters, but how much you actually keep. For example, in Africa, they might have 300 milligrams of calcium intake in their diet, but they have very good bones and strong health, but they only lose maybe 200 milligrams of calcium. So their net is 100 milligrams of calcium a day. Whereas in America, we might take in 1500 milligrams, but we might lose 16 or 1700 milligrams because of all of our bad habits. For example, if you smoke cigarettes, if you eat sugar, if you drink soda, which has force-fork acids, like leeches out your bones, actually. Oh my God. I was buying some ribs for a barbecue having the other day at my local butcher. And I said, well, how do you kind of make them? What do you do? He says, well, first you wanna soak the ribs in Coca-Cola. And I'm like, what? He's like, yeah, because it helps dissolve the fibers and stuff it up the meat and get it off the bone. I'm like, wow, okay. I don't think I wanna do that. Also stress, cause you to lose calcium, caffeine, alcohol, excess salt, all cause us to lose calcium. We're doing a lot of things, plus being sedentary causes us to lose calcium. So we're living a lifestyle that causes calcium loss. We gotta stop that. So we need to also think about not just how much we're taking in, but how much we're losing. Next, we need to think about where can we get calcium from in our diet besides milk? And in fact, actually you can get a lot of calcium from things that don't have hormones, that don't have allergens, that don't have all kinds of antibiotics in them, and all kinds of crap. So let's talk about, for example, how some common foods stack up to about four ounces of cow's milk, which is about 138 milligrams of calcium. First of all, sesame seeds, a quarter cup of sesame seeds, tahini, is an amazing thing. You can make dressing out of it. I make like miso tahini dressing. I put on my vegetables. There's lots of ways to include tahini and sesame seeds, but a quarter cup has 351 milligrams, which is almost, I'm not good with math, but more than twice the amount that milk has. Sardines, a little can of sardines has, with the bones, which sounds weird, but you can actually eat the bones, has 350 milligrams of calcium. Tofu, which is 300,000, has 350 milligrams of calcium. Yogurt, which is obviously dairy, but you can get it from sheep or goat, has 256 milligrams. Collard greens, which, by the way, these may be better utilized and absorbed by the body, has about 268 milligrams. Spinach has 245 milligrams in a cup. Cheese, which is another dairy product, has a little less, 204. Sake salmon, three ounces with the bones in them. 188 milligrams. Almonds, dry roasted have a, two ounces have about 150. So basically, from two ounces of almonds, you get more calcium than you will from milk. Also chia seeds are another great source of calcium, and have way more calcium than milk that you can get from milk. And by the way, it turns out that it's vitamin D that's the most important for actually helping our bones, not so much calcium. Milk also may increase your risk of cancer. Now, in a very important editorial in JAMA Pediatrics in 2013, two of the leading nutrition scientists in the world from Harvard, David Liddy and Walter Willett, called out the federal government for advising three cups daily of low-fat milk for most Americans. And these are not kind of radical vegans. These are people who work at the top levels of academia who've done extraordinary amounts of research and basically are saying, hey, we got it all wrong about dairy. As we talked about earlier, milk doesn't promote bone health. Dr. Willett and Dr. Ludwig noted that it actually may promote cancer. That's because milk contains a witch's brew of hormones that may act like miracle growth for cancer cells. For example, the average glass of milk contains 60 different hormones. Now, these are not necessarily hormones that are added to the milk, but think about what is milk? It's basically a growth food. It's designed to grow babies and grow cows, and it's got all these growth factors and growth hormones in it, anabolic hormones, but it also doesn't just cause your body to grow in your little, it actually causes cancer cells to grow. So it's kind of bad news. It also increases something called IGF-1, which is a known cancer promoter, insulin growth factor one. It's also associated with kidney disease, diabetes, heart disease, and lower levels of people with IGF-1 actually live longer and at lower rates of cancer, but milk pushes your levels of IGF-1 in the wrong direction. So may have cancer links, maybe increased to prostate cancer and other cancers as well. Also, dairy fat may not be the issue, right? The fat from dairy is an issue. It's the casein and the other hormonal compounds in the milk. The government guidelines basically say that we shouldn't really tell people to drink milk, but they specifically recommend low fat or fat-free versions because of a longstanding misguided view that saturated fat is the boogeyman for heart disease. Now, saturated fat actually may be really good for some people, although maybe not others, but for most people, it's actually okay, particularly people with metabolic issues, diabetes, and so forth. Trove's a research that showed that it's not the boogeyman we thought it was. And actually, the dairy fat may be better. In fact, there was an article called Butter is Back in one of the major medical journal, Latin American journal of cardiology where they actually, and I'll get into that in a minute, show that it was actually quite helpful for people with diabetes and prevention and so forth. But there was a big review of saturated fat, and I wrote a lot about this in my book, Eat Fat, Get Thin. So if you wanna learn more about it, you can go ahead and read that book. But there was a huge landmark review published in the end of internal medicine, one of the major medical journals in 2014, that looked at 72 of the most rigorous studies on dietary fat and heart disease, including two dozen randomized controlled trials, which are hard to do, and also population studies, blood studies, and they found that saturated fat and total fat consumption have very little effect and no effect on heart disease. They found that actually, trans fat was a bad one, but that was for sure bad, so we don't want trans fat. But they found that actually people having the fats from dairy actually had lower cardiovascular risk. Also, other studies have shown this as well for diabetes. Those with higher levels of the saturated fat from dairy, which is a different kind of saturated fat, actually have lower risk of diabetes. So, butters had a terrible reputation because it's basically just animal fat. Most of it's saturated, not all of it, by the way, that most foods are mixed fats. So, panamono is saturated, polyunsaturated, saturated. And the government tells us not to eat butter, right? But about 60% of the fats are saturated fat, 20% mono saturated in the rest of your poly. But I think butter is not the enemy number one, like we thought it was. It doesn't usually eat butter as much as you want. It's fine to eat it like a grandparents did, have a little butter, have grass-fed butter, it's fine. It has better fats, it has antioxidants, it has more carotenoids, it has a higher source of CLA, which is an important conjugated linoleic acid, which boosts your metabolism and may help prevent cancer and heart disease. So, have a little butter, enjoy it, track your numbers, but some people are super responders to saturated fat. I'm maybe one of them. So, there are people who are thin, lean athletes tend to get more saturated fat response for some reason. I think it's genetic. You're gonna have it on your veggies. Also, be aware that saturated fat plus sugar and starch are bad combos. So, butter on your veggies, put on your fish, protein, no problem. Mixing it with carbs and sugar, not a good idea. So, butter and bread, bad idea. Lactose intolerance is so common. It's at least 65% of the world population, and it increases as we get older. It's not, what lactose intolerance means is the inability to digest the lactose in dairy products, that carbohydrate in dairy products. And it really does vary amongst different racial groups and ethnic groups. So, it's more common in Lysine and Africa and South America and Asia. It's less common in Europe, but it is throughout the whole world, we see lactose intolerance. And as people get older, we see more and more lactose intolerance. In fact, some people think that by once we reach age 99, everybody has some degree of lactose intolerance. As I mentioned, it's uncommon in younger kids, but there are young kids who have lactose intolerance. And anything that damages the intestines, if you damage the villi in the intestines, so if you get a gastroenteritis, so if you get an infection in the, an inflammation in the intestines, sometimes if people take antibiotics or have chemotherapy or have inflammation in their intestines, that can result in lactose intolerance starting. So people will always say to me, well, I used to have no problem with dairy, but now I'm having trouble with dairy. And it's because that can happen after a round of antibiotics or after an infection, or we just, as we get older. The other thing to recognize about lactose intolerance is it's dose dependent. So that's what sort of throws people off sometimes, is that they may have a little bit of dairy and be fine, but at some amount of dairy, then they start to have a problem. So it is, we have this enzyme in our intestines called lactase and it digests our lactose. And if we don't have enough lactase or if we eat too much lactose, then we get problems with lactose intolerance. Okay, so I don't know why they call it lactose intolerance because the fact is that most of the world is intolerant to dairy and lactose. And the abnormal situation is being able to consume it and tolerate it. And also, there's an ethic component to this. If you're African, South American, Asian, you're more likely to be lactose intolerant if you're European descent, you're actually Northern European, you're certainly better. But we don't really think about the fact that most of the world's population doesn't really do well with dairy. And also, the dairy we're eating is not the greatest dairy. I've talked a lot about that in previous podcasts in my book, The Peek and Dye, as well as Food, What the Heck Should I Eat? And the other factors that are causing it to be more common are things that you said, such as damage to our gut from antibiotics and bad diet and bacterial overgrowth and all these other problems. So how do we begin to think about helping people diagnose it and then treating it? Absolutely. So one of the things is we start to pay attention to what symptoms somebody has. So when somebody comes in and they complain of abdominal pain, maybe they get fullness or bloating after they eat, maybe they have diarrhea after they consume, or just diarrhea during the day, and they may feel nauseous or have excess gas. And so then you get a good detailed history of what they're eating. Sometimes people, it throws somebody off because they may not have had problems with dairy prior to when they, at a younger age, and then they developed. And so they're confused as to why they have started to have problems now. But as I mentioned, you can develop problems with lactose, issues with lactose and digesting dairy at any point in your life. It increases as we get older, and it often can increase after we've had some sort of infection or inflammation or antibiotics in our system. And so you wanna just figure out what is somebody dealing with with the abdominal pain, the bloating, and gas. And then you wanna say, okay, when do your symptoms occur? Because typically when there's problems with lactose, it's half an hour to two hours after you consume the lactose-containing food, so the dairy. And the symptoms usually resolve five to seven days after you've removed the dairy from the diet. And what's happening is there's low levels of this lactase enzyme in the small intestine than the carbohydrate component of dairy, the lactose, does not get broken down. And when it's not absorbed as it should be, it goes into the colon. And in the colon, it gets consumed, the bacteria in the colon eat it and produce a lot of gas and a lot of water goes into the colon to deal with these food particles that are too large. And as a result, you get a lot of gas and bloating and diarrhea. So it is a very hard food to digest and absorb. We see it all the time. And so it's the reason we wanted to talk about it and do this podcast is because it's so common. And patients are really struggling with it all the time. And even though, to you and I, it's like, okay, we see, of course, go off dairy. People often come in in denial. They're like, oh no, it's not the dairy. You know, and I'm like, yeah, you gotta give it a try. You know, one of the things that's often people wonder about is what about black taste free milk or what about yogurt or what about cow or sheep or what about A2 versus A1 casing? How do we figure all that out? And how do we determine, you know, what people should be doing if they wanna include dairy? Because I know, for example, if I eat regular milk, I'll be in trouble. But if I have goat or sheep yogurt, I seem to do okay. So I wonder, you know, how does that work? And can you explain a little bit about that? It's such a great question. I mean, what we often start with is pulling away all dairy for somebody because that's how we can see, okay, how much is this gonna improve your symptoms? But you're correct. There are some better quality dairies like the A2 milk that people tolerate better. If the dairy is fermented like yogurt, it's broken down. And so many times people can tolerate some plain, whole fat yogurt and without problem, but they couldn't drink a glass of milk, for example. And because that fermenting process breaks it down. For other people, they can't tolerate anything. So they can't, some people even have to be a little, they have to watch even butter intake and they have to go with something like a ghee instead. So there's many ways you can react to dairy. So we're talking about reacting to the lactose in dairy, which is the carbohydrate component of dairy. That's what we're talking about here. But people also react to the proteins in dairy and they can have food sensitivities or food allergies to that dairy as well. So there's multiple ways people can react to dairy. But so we always start with pulling it all out and then maybe adding back in some easier to digest dairy if somebody really wants it and they don't have a problem with it, such as a full fat, you know, non-sweetened yogurt. And so what about people taking enzymes like lactase? Or is that a good idea? Should people just avoid dairy? Are there other issues that happen? And one of the consequences of sort of consuming dairy if you are lactose intolerant? You know, that's a great question. So the enzymes that are in, that like the lactase enzyme is, the enzyme in lactate is a beta-galactosidase. And that can help people break down their dairy and tolerate it better. But that's a good question. Like I typically recommend that people don't consume a lot of these enzymes if they're having problems and just avoid the food. But some people choose to have some of these digestive aids and then have a little bit of the dairy from time to time. Yeah, as I'm just cheating and eat ice cream and then of course I pay for it later. Yeah, right? Yeah, yeah. So, you know, it's, you know, I think that these enzymes may be helpful for some people, but I think the reason that we're so focused on dairy is, you know, everybody was like, you gotta get your calcium, you gotta get your calcium. It was a huge marketing campaign to promote the amount of dairy that we needed to consume. And so it's really important to remind people that there's so many other ways to get their calcium. You know, almonds, almond butter, great sources of calcium. Sardines, great source of calcium. Salmon in a can has bones in it, great source of calcium. Broccoli and your greens are a good source of calcium. And so there's lots of ways you can get good calcium in your diet and you don't have to feel like you need to be getting it from dairy products. Yeah, and I would just underscore that anybody listening who's wants to hear about dairy should listen to the podcast I did with David Ludwig, where he dug into the article that he wrote with Walter Willett, who's one of the leading scientists at Harvard, called Milk and Health. And if you wanna Google it, it's New England Journal of Medicine, Milk and Health. We'll put it in the show notes, but there's also a great medium article he wrote about it as well. Bottom line is that, you know, all the propaganda about milk needing for your bones, it actually increases fractures. It's, you know, it doesn't do a lot of things that it was promoted to do by the dairy council and they've got milk ads. It's not a great sports drink. It's not great for weight loss. It's not great for osteoporosis and vagamate cause osteoporosis. It may cause allergies, digestivations, as we mentioned, even autoimmune diseases, cancer. So I think there's a lot of reasons to be cautious about dairy. And again, I think just underscore the fact that when we're talking about dairy, we're talking about sort of modern cow dairy. Sometimes heirloom cows have different, you know, grass finished cows have different properties and better tolerated to my sheep and goat is better tolerated. So it really depends on sort of you and a personal decision, but it's not nature's perfect food unless you're a calf. And it's also, you know, problematic in many, many ways. Absolutely. As we see here with some of these cases, like this first one here was a 25 year old gentleman who came to see me and, you know, he was, he was relatively, he was really healthy actually. And he was doing well until about a year ago and he had like a stomach bug. He was traveling and he got some stomach bug. He didn't really think much of it. He recovered from it. He had, but at the time he had like a fever and some diarrhea. He recovered from the bug, but then since that point in time, he still had episodes where he was rushing to the bathroom and had diarrhea and bloating and gas production. And he really couldn't figure out what foods were involved at all and he didn't think any food was involved. And he was, you know, so he wanted to figure it out. So based on his timeline of symptoms and, you know, that we gathered from him, we said, you know, even without any testing, we said, let's just do a trial off a dairy and see what happens. And within a week, his symptoms got all better. And he thought, I, you know, this just, you know, did a wonderful job. He was like, you know, right? I fixed his diarrhea and gas and bloating. And, you know, he's, he just avoids really most dairy because he feels better at this point in his life. So it's, you know, it's, it's sometimes, can make a huge difference in something that we really encourage a lot of people to give a trial for. Yeah, I think, you know, we've all been sort of brainwashed that we can't live without milk and dairy. And then it's, it's important for all these reasons, which turns out not to be, I would say that, you know, clinically practicing functional medicine for plus 30 years and you also, you know, is one of those foods that is really problematic for a lot of people, not just lactose intolerance, but eczema, asthma, just general digestive discomfort, acne, autoimmune diseases, all kinds of problems clear up when you stop dairy. So if you've never done it, I would encourage people to think about just taking a holiday for three or four weeks and just then adding it back and seeing what happens. You'll know, your body will tell you very quickly whether or not you are intolerant of dairy. I mean, cause it may not cause lactose intolerance, but you can get other reactions like congestion, sinus infections, you know, all kinds of skin issues, eczema and so forth. And we did a, we did a Pigen diet challenge with Katie Kirk and she has eczema and she's like an arthritis and she got off all that junk and it got better. Oh, good for her. Good for her. You know, it is amazing. Like you were mentioning, you can, you can have a hard time digesting the carbohydrate in the dairy and have the lactose intolerance. And you can also have a sensitivity to the proteins in the dairy. And, and with a sensitivity with the proteins, a lot of times that will cause acne or it'll cause the eczema or asthma or inflammation in the skin. And of course you can have an immediate reaction to dairy too. You can have an, an IGE allergy. So you can have an allergy, a sensitivity or a lactose intolerance. There's so many ways that people react to, to dairy. And in my second case here, it was a 20 year old woman who came in and she got bloated every time she ate. She felt full and she sometimes had diarrhea and stomach pains. So she was just really struggling with her digestion. It would sometimes be constipated, but then sometimes diarrhea, sometimes rushing to the bathroom, really feeling bloated a lot. And when we got her history, we realized that she had this long history of acne. Well, she's only 20, so it wasn't that long, but a few, you know, a history of acne. And so she was placed on antibiotics for the acne at age 18 and she had been on antibiotics for a couple of years. And what we know is that even though those antibiotics may clear up the acne for, you know, immediately at that time, long-term, that's a huge concern because it's getting rid of all the good bacteria on our skin that prevents acne in the future. And it's also getting rid of all the good bacteria in our digestive system that is keeping our digestive system working well. And so that can really mess up the microbiome and result in lots of issues. And for her, you know, over time, she started to have a lot more issues being on those antibiotics with her digestion. So, you know, for her, we did a dairy-free trial just for both her skin and her digestion. And, you know, we saw a good improvement in her digestion and her skin, like her digestion got about 50% better. Her skin got 60 to 70% better, but she was not 100% better. So then we need to do more testing. We did testing for small intestinal bacterial overgrowth. We did stool testing and we found that she had this small intestinal bacterial overgrowth that we needed to treat. And so, you know, I think a lot of times those long-term antibiotics like that can result in this overgrowth of bacteria that then, you know, that then then just snowballs into more and more problems. And so we needed to treat that with an herbal approach. And it was at that point, when we kept her off of the dairy, treated her bacterial overgrowth that she, you know, started to get much better in terms of her digestion. Her skin improved, her digestion improved, and her pain and her belly improved significantly as well. And, you know what, she sometimes at this point sheets with a little bit of, you know, healthy yogurt, but she mostly stays off of all dairy and is doing much better. Well, I mean, you know, basically the messenger thing is when in doubt, cut it out, right? Yeah. And I think everybody should think about just a trial of no dairy because of the challenges we often see. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out, I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guest's opinions, neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. 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