Whole Milk and the Kartini Meal Plan

I can’t tell you how often a look of horror and surprise crosses parents’ faces when I explain to them that Kartini Clinic’s Meal Plan, in our spirit of real, undoctored (no pun intended) food, uses only full fat dairy products: whole milk, whole milk yogurt, whole milk cottage cheese, etc. “But doctor,” more than one father has said, “I have high cholesterol!”  

“How high?”, I ask. Usually they don’t know, but sometimes say that their doctor told them their cholesterol was “kind of on the high side” and they should “watch their fat intake”. Or sometimes they are actually on statins  (a whole different controversy). My assurances that Kartini Clinic’s Meal Plan is balanced for fat and protein and carbohydrates and is emphatically not a “high fat” diet fall on deaf ears at the seemingly scary thought of whole milk!

The science behind recommendations for reduced fat or skim milk (including from the American Academy of Pediatrics) has long been on shaky ground.  Despite this, old prejudices seem to die hard and dieticians and eating disorder treatment centers have continued to tolerate and even advocate skim milk products to patients who are struggling with weight restoration (fat free Greek yogurt anyone?).  And dieticians and primary care doctors continue to tell the rest of us to limit our intake of dairy products and use low- and reduced-fat items if we feel we must have dairy, to say nothing of the everyone-is-lactose-intolerant and milk-protein-intolerant fads that have resulted in an explosion of non-dairy rice milks and almond milks, etc.

Did I mention Consumer Reports recently came out with an analysis of the drawbacks and even potential dangers of a gluten free diet, which mainly substitutes rice for wheat products and thereby may greatly increase a person’s intake of arsenic? I wonder if anyone has analyzed rice milk?

Now comes an article in the Washington Post, in language everyone can understand, summarizing the latest evidence related to whole milk specifically and saturated fats in general, using such strong language as: “Scientists who tallied diet and health records for several thousand patients over ten years found, for example, that contrary to the government advice, people who consumed more milk fat had lower incidence of heart disease.”  The article continues: “ ‘By warning people against full-fat dairy foods, the United States is losing a huge opportunity for the prevention of disease’, said Marcia Otto, an assistant professor of epidemiology at the University of Texas and the lead author of large studies published in 2012 and 2013, which were funded by government and academic institutions, not the industry.”

The article goes on to discuss how work by Ancel Keys (of Human Starvation fame) supported the belief that saturated fats caused heart disease, a classic case of correlation being mistaken for causation if ever there was one.

A major review by the highly respected British Medical Journal in July found that there exists “no clear association between higher intake of saturated fats and all cause mortality, CHD, CHD mortality, ischemic stroke, or type 2 diabetes among apparently healthy adults. Consumption of trans unsaturated fatty acids, however, was associated with a 34% increase in all cause mortality, a 28% increased risk of CHD mortality, and a 21% increase in the risk of CHD. Further, these data suggest that industrial trans fats confer a 30% increase in the risk of CHD events and an 18% increase in the risk of CHD mortality. ”

Please do take a moment to read this important article.  Defend yourselves against poor advice, know what the evidence shows and draw your own conclusions.

Once, when discussing a mutual patient who was on Kartini’s Meal Plan with the head of a prominent residential treatment center and his lead dieticians, I was told “we offer our patients a choice between ‘red-top’ and ‘blue-top’ milk”.  

“You mean regular or low fat?” I asked.  “Why?”

He turned to his dieticians in surprise, “Actually I don’t know.  Why is it we do that, exactly?”

I mean, I ask you, who among eating disordered patients, precisely the folks who need to gain weight, will choose “red top”? And in their defense, they are not just avoiding calories, they probably sincerely believe, as many do, that low-fat is “healthier”.  So that explains them, but good grief, what explains all those providers who should know better!?

Time to update the proverbial database, folks.  Especially those of us who give dietary advice to others.