Is milk necessary for a healthy diet?

Once people began preparing to quarantine for COVID-19, they started “panic buying” staples like milk, making them harder to get. But is milk a necessity? The debate about whether or not milk is a crucial part of a balanced diet has swirled for years. Social distancing — plus a  review article from the New England Journal of Medicine — spurred us to revisit the question of the necessity of cow’s milk.

What’s wrong with milk?

In 2014, the The American Journal of Clinical Nutrition published an article by Connie M Weaver, emeritus professor and former Head of the Department of Nutrition Science at Purdue University in West Lafayette, IN. In it, Dr. Weaver expressed the concern that there had not been enough randomized controlled trials to provide evidence of milk’s health benefits. She discussed how our culture’s reliance on milk began back in the industrial revolution, when the changing diet of Americans led to milk becoming the major source of dietary calcium.

Since then, some studies have been conducted regarding milk’s effectiveness in health, which Dr. Walter C. Willett and Dr. David S. Ludwig reviewed in their New England Journal of Medicine article. Milk has come to be seen as helpful for bone health, but Dr. Willett and Dr. Ludwig cited a 2014 JAMA study which found that higher milk consumption during one’s teenage years led to an increased risk of hip fractures later in life. There’s also no evidence that milk helps with weight management, blood pressure, or cholesterol. Some studies point to milk lowering the risk of certain cancers, while others show milk increasing the risk. To top it off, milk consumption has a huge environmental impact. “If everyone consumed 3 glasses per day, this would make avoiding extreme global warming very difficult,” said Dr. Willett.

Should we stop drinking milk completely?

There’s no solid answer as to whether or not we should drink milk. Despite the previously mentioned risks, milk can help reduce heart disease in those with high-starch diets, providing good nutritional value. As Dr. Willett explains, “If someone is consuming a poor-quality diet high in refined starch and sugar, as is common in many [low-income] populations around the world, milk can fill in some important nutritional gaps. However, if diet quality is otherwise good, the added nutritional benefits of milk will be much less.” Both Dr. Willett and Dr. Ludwig point out that too much or too little of anything, including milk, can have detrimental effects.

Although dairy is not necessary for a healthful diet, milk is still full of nutrients such as protein, calcium, and vitamin D, and is easy to obtain. However, these nutrients can be found abundantly in other foods, and both doctors believe that the United States Dietary Guidelines’ recommendation of 3 cups of dairy a day is too high. They suggest consuming 0–2 cups a day instead, and recommend keeping it to 1 cup a day on average for environmental reasons. Since the average American consumes 1.6 cups a day already, your patients likely don’t need to change their dairy consumption habits. So let them know not to panic if their grocery store is out of milk: As long as they’re eating healthy in other respects, it’s fine if they don’t or can’t consume dairy.

Our comparison chart of milk types — almond milk, oat milk, and more

If your patients are wondering about different varieties of milk now that their preferred kind may be unavailable, we’ve made a chart describing the nutritional differences between seven kinds of milk, three of which are types of cow’s milk and four of which are plant-based alternatives:

Milk varieties comparison chart. Information from Woman's Day, Live Science, and Bucket List Tummy.