You've probably heard diet culture claims that dairy "causes acne," "is unhealthy," or even "is full of pus!" I fell for that last one when I was in 7th grade when a documentary scared me away from dairy, and I switched to almond milk. Confused by all the mixed messages about health and sustainability, I eventually went back to dairy since it tasted the best and was accessible to 13-year-old me. Back then, I didn't have access to the information or the knowledge that I do now. Everyone, including my younger self, deserves clear and reliable information to make informed food choices. Let's dive in and explore the truth about dairy together.
Does Dairy Cause Acne?
The research on whether dairy causes acne is mixed, so there's no clear answer.(1,2,3) "Dairy" includes many foods like milk, cheese, yogurt, and ice cream, each with different amounts of certain nutrients. Because of this, one general recommendation cannot be made. When it comes to acne and dairy, there seem to be two links observed regarding hormonal changes, which may lead to breakouts.
Relationship One: Dairy, Blood Sugar, and Hormones
The first relationship is with foods (not just dairy products) that cause our blood sugar to spike fast. In general, when we eat foods that raise our blood sugar (carbohydrate and protein foods), our body releases a hormone called insulin. Insulin helps move the sugar from our blood into our cells to be used for energy. With that said,
Some dairy products make blood sugar rise faster than others, such as ice cream and condensed milk, and some make blood sugar rise more slowly, such as milk (regardless of fat content or added sugar), yogurt (regardless of added sugar), kefir, and cheeses.(4)
The concern about blood sugar spikes and acne is that high blood sugar causes a lot of insulin to be released, which can also increase hormones like testosterone and IGF-1. These hormones are thought to boost oil production and may lead to breakouts. IGF-1 might also promote too many skin cells to grow, which can block pores and cause acne.(5,6,7)
A helpful strategy to prevent blood sugar from spiking is eating foods with protein, fat, or fiber along with carbs to help slow down the digestion and absorption of the food. So, if you enjoy ice cream, eating it with or after a balanced meal is a good idea to avoid quick sugar spikes. Balanced meals are not only good for preventing possible breakouts, but they also keep you full longer and provide steady energy throughout the day- A great strategy for practicing gentle nutrition.
Relationship Two: Dairy Protein and Hormones
The second relationship is how dairy may influence hormone levels due to specific milk components. Components of concern are the proteins, casein and whey, and the naturally (or artificially) occurring growth hormones as all three are thought to directly or indirectly increase IGF-1, which if we recall may increase oil production and skin cell overgrowth that can lead to breakouts.(6,8) However, these are just theories and nothing is concrete here either.
Obviously, not everyone breaks out from eating dairy. I don’t have any problems with it! The bottom line is that the evidence is mixed needing further research and improved study designs to establish clear relationships before we make any “anti-acne diet.”
Side note: I've heard that low-fat dairy might be more problematic regarding breakouts than full-fat dairy. One study from 2018 supports this idea, but another study from the same year says the opposite.(2,3) So, yeah, the research is all over the place! 😂 The theory is that the higher fat in full-fat dairy slows down how fast the body absorbs lactose, the sugar in milk, which might be why it doesn't cause as many breakouts. But with all this mixed research, it’s hard to say for sure!
If you are struggling with acne and eat a lot of dairy (Perhaps >3 servings/day), it might help to cut out dairy for a short time to see if it makes a difference. But, be careful not to accidentally include confounding variables during the dairy elimination causing unnecessary food fear and confusion. For example, switching to plant-based milks, like oat or rice milk, may not be a good idea in this scenario because they can raise blood sugar even more quickly than dairy milk, which might cause more breakouts.
Is Dairy Healthy?
Absolutely!
Milk is Nutrient-rich
Milk has 13 important nutrients that our bodies need and must get from the diet. The Food and Drug Administration (FDA) says that a “good source" provides 10-19% of our daily needs ( %DV on food labels), and a “rich source” gives more than >20% daily value. Fortified Vitamin D dairy milk is a good source of protein, Vitamin A, potassium, and Vitamin D, and a rich source of calcium! This is important because many people in the US need more Vitamin D, calcium, and potassium.(9)
Chocolate Milk is Ideal for Post-Workout Recovery
Chocolate milk is also a great option because it contains water, protein, carbohydrates (fat is variable), and electrolytes like sodium, calcium, magnesium, and potassium, making it an ideal post-workout fueling option for muscle recovery. This study even found that chocolate milk provides either similar or superior results for post-recovery compared to a placebo or other recovery drinks on the market!(10)
Dairy Protein is Convenient
Dairy is also very versatile as milk, yogurt, cheese, etc, and many are quick and convenient sources of protein that are a great way to round out any meal or snack for gentle nutrition! So yes, dairy is a healthy food and can enhance the diet if included.
Is Lactose Bad For You?
Lactose is a sugar found in milk and if you have no digestive issues with milk then you're likely okay! Some of us might not be absorbing the lactose (with no symptoms present) for our body to use for energy, but we're likely getting carbohydrates in elsewhere in our diet.
Lactose Malabsorption vs. Intolerance
Many people have trouble digesting lactose, a sugar in milk, after they grow out of infancy, this situation is called “lactose malabsorption.” About 68% of people produce less lactase, an enzyme that helps digest lactose, as they get older. Lactose is made of two sugars, glucose and galactose. Lactase splits lactose into these smaller sugars, which are then easy to absorb. Without enough lactase, lactose isn't digested.
For someone who is “lactose intolerant,” the poorly digested lactose causes symptoms of gas, diarrhea, or bloating. To be clear, not everyone with lactose malabsorption (no symptoms) is lactose intolerant (symptoms), and lactose intolerance is less common. And about a third of adults can still produce enough lactase because of their ancestors drank milk for social status or as a safe water source, which helped them keep this ability.(11)
Dairy Options for Lactose Intolerance
For those with lactose intolerance, dairy can still be an option! There are low-lactose or lactose-free products like yogurt, cheeses (especially hard cheeses), and lactose-free milk. In yogurt and cheese, safe bacteria convert lactose into lactic acid. In lactose-free milk, the lactase enzyme is added to the milk to split the lactose sugar into glucose and galactose to be easily absorbed or it may be filtered out of the milk.
Milk Protein Sensitivity?
If you believe you are lactose intolerant but still have digestion issues when consuming yogurt, hard cheese, and lactose-free milk, it could be a certain protein found in milk and not lactose. Diary milk typically contains two proteins called A1 and A2 beta-casein. The protein of concern is called A1 beta-casein. However, there is milk on the market from the A2 Milk Company that does not contain A1 beta-casein, which may be easier to digest and reduce symptoms.(12)
When in doubt, consult your doctor about appropriate tests to rule out lactose intolerance.
Is Milk Bad for Heart Health?
Many people think milk is bad because it has saturated fat, which, if consumed in high amounts, may raise your bad cholesterol level (LDL cholesterol) increasing the risk of heart disease. Dietary guidelines recommend less than 10% of your calories from saturated fat. But what if I told you that it can be more important to look at the whole food, or the milk matrix, and not just a singular nutrient?
Whole Milk and Heart Health
For example, whole milk contains 3.25% fat, but it's not just saturated fat! Milk has about 400 different types of fat. About 70% of the fat in milk is saturated, but 25% is monounsaturated, and 2.3% is polyunsaturated including omega-6 and omega-3 fatty acids, which can support your heart health.(13) When looking at whole-fat milk,
One study even suggests that drinking about a cup (200 g) of low or whole-fat milk a day wasn’t linked to the chance of dying or heart problems.(14)
Another study suggests that whole milk can raise good cholesterol levels (HDL cholesterol) without affecting total and bad cholesterol (LDL cholesterol) in people with normal cholesterol levels.(15)
For people with metabolic syndrome (a group of conditions including high blood pressure, high LDL cholesterol, and low HDL cholesterol), one study found that eating full-fat dairy didn't change their blood fat or blood pressure compared to a diet low in dairy or rich in low-fat dairy.(16)
Regarding the saturated fat content, it seems not all saturated fat is created equal either! Some research suggests odd chain saturated fats found in milk were linked to a decreased risk of developing type 2 diabetes.(17)
Milk, Calcium, and Heart Health
Moreover, milk also contains nutrients other than fat such as protein, carbohydrates, water, and many micronutrients, specifically calcium. Calcium is a key nutrient for controlling blood pressure, a primary concern regarding heart disease.(18) One cup of milk gives you 25% of the calcium you need for the day. In the U.S., it's recommended to have 3 servings of milk a day, which would give you 75% of your daily calcium!
Another consideration when drinking milk is that some calcium sticks to the fat in your small intestine, preventing both from being absorbed into the body. This phenomenon might be why high-fat foods like dairy don’t always cause heart problems, as suggested by this study.(19) The DASH diet, which stands for Dietary Approaches to Stop Hypertension, suggests 2-3 servings of no or low-fat milk a day to get enough calcium, but with new research, perhaps whole milk will be considered!(18)
So what does this mean for you regarding dairy consumption? You get to choose your milk fat preference to support a healthy diet, though some people with existing heart concerns, like high cholesterol, should continue to follow the current recommendation of low/no fat options unless discussed otherwise with a doctor or dietitian.
Is Dairy Inflammatory?
There are quite a few journal reviews that indicate no causal relationship between dairy and inflammation.
This 2013 review looked at “overweight” and “obese” adults and found that eating dairy didn’t increase inflammation markers.(20)
Some people worry that milk protein causes inflammation. But this review found that dairy and its proteins either have no effect or a beneficial effect on inflammation makers.(21)
This 2017 review of 52 clinical trials found that milk can actually reduce inflammation in people, no matter the fat content! It also showed that milk helps lower inflammation even in people with metabolic disorders (such as gastrointestinal disorders).(22)
With this evidence, it seems dairy is not inflammatory…If anything, it’s quite the opposite!
Is Drinking Milk Sustainable?
Before I get into this, I think it's important to define “sustainability” and “sustainable nutrition” because it is not just environmental impact that is considered.
The Environmental Protection Agency (EPA) defines sustainability as “meeting today's needs without compromising the ability of future generations to meet their needs” and it has 3 pillars: Environment, economy, and societal.
Environment considers the natural elements (soil, water, air/emissions, etc).
Economy considers manufacturing, agriculture, power generation, drinking water treatment, etc that provide products and services to the public.
Societal considers the well-being of people and the community.(23, 24) Nutrition is categorized under the societal pillar (though in other frameworks, nutrition can be its own pillar).
A "sustainable diet” is defined by the Food and Agriculture Organization as “diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources.”(25)
Now let's view dairy through the pillars of sustainability:
Environment
Regarding the environment, cows' milk typically contributes more greenhouse gases and water usage than plant-based milks, except almond milk requires more water than dairy. This is important to note since dairy and almond milk are the two most popular types of milk consumers buy. Likewise, where farming is happening is also important to consider as most almonds are grown in California, which often has water shortages- This makes almond milk’s water use a bigger issue.
When considering the societal/nutrition pillar, pea milk is a good option because it has low greenhouse gas emissions, uses less water, and has as much protein as dairy milk. The problem is that pea milk isn't easy to find in stores, so it’s not as sustainable yet. Additionally, further environmental research is needed for pea, coconut, hemp, and cashew milk regarding their full effects on the environment so stay tuned for more information... (26)
Societal
Cow's milk has many health benefits to offer society, especially for kids. It helps them grow, think better, and stay healthy. This is not to say plant-based milks do not offer any health benefits, but they can vary a lot depending on the plant source and level of nutrient fortification.
For children, we need more research to understand if milk alternatives are as safe and nutritious as cow's milk since plant-based alternatives can miss out on at least 6 essential nutrients. The American Academy of Pediatrics says that fortified soy milk or cow’s milk is safe and healthy for kids up to 2 years old.
For certain health conditions, some plant-based milks can cause a quick rise in blood sugar, unlike cow's milk. Likewise, many plant-based milks have added sugar, which according to the Dietary Guidelines for Americans 2020-2025, it's best to keep added sugars to less than 10% of your daily calories.
In short, while plant-based milks can be nutritious, cow’s milk has unique benefits, especially for growing children.(26)
Economy
Economically, plant-based milks are generally more expensive than cow's milk. They cost about 20% more, making them harder for people with less money to afford and therefore not as sustainable. Additionally, cow’s milk is the top seller in stores, bringing in a lot of money and supporting the economy more than plant-based milks.
In combination with the societal/nutrition pillar, the cost of nutrients is important to consider. Cow's milk is one of the cheapest ways to get important nutrients like calcium, vitamin D, magnesium, potassium, and vitamin A. It costs less than other foods that provide these nutrients, like grains, fruits, and vegetables.
In combination with the environmental pillar, grass-fed dairy milk can be cheaper to produce because farmers don’t have to buy feed and their farming uses rainfall. However, grass-fed cows produce less milk, which can increase greenhouse gas emissions in order to produce as much milk as conventionally fed dairy cattle.(26, 27)
If you're feeling stuck when weighing the pros and cons of including dairy, it doesn't have to be all or nothing- You can incorporate dairy AND plant-based! For example, if you are currently drinking dairy milk exclusively, you could mix in plant-based milk half the time and potentially cut your dairy-related environmental impact by half doing so. Moreover, it's also important to remember that big changes come from larger systems, not just individuals. Farmers are aware of their environmental impact and are continuously working to adopt greener practices because without a healthy environment then there will be no farms!!
Should I Drink Raw Milk?
Short and sweet, the answer is NO. So then what's all the buzz about drinking raw milk?
Raw Milk has Harmful Bacteria
Some people say raw milk has probiotics (good bacteria for your gut), but the FDA has not found that true.(28) Raw milk can have harmful bacteria present such as campylobacter, cryptosporidium, E. coli, listeria, brucella, and salmonella, that can make you very sick, causing diarrhea, stomach cramps, vomiting, and severe outcomes of Gullain-Barre syndrome and hemolytic uremic syndrome, which can lead to paralysis, kidney failure, stroke, and death. That's why pasteurized milk, which is heated to kill these bacteria, is safer and still nutritious.(29)
Pasteurized Milk is as Nutritious as Raw Milk (and is safe to drink)
Some people also claim pasteurized milk has no nutrients compared to raw milk, but that's not true. Both raw and pasteurized milk have similar nutrition and research supports the process of pasteurization having minimal impact on the nutritional value of milk.(30) To shut this rumor down further, if the claim that pasteurized milk has no nutritional value was true, then we would not have research showing that pasteurized milk is related to good health such as lowered risk of heart disease, stroke and other health problems.(31)
All I have to say is thank you, Louis Pasteur, for such a great innovation that has saved and supported the lives of so many!
Is Milk Full of Pus?
Milk comes from cows, which, like other living things, have various types of cells. Some of these cells are called “somatic cells,” which are live white blood cells that help fight infections. Some people mistakenly think these cells are “pus,” but that’s false. Pus is a mix of dead skin cells, bacteria, and dead white blood cells caused by fighting infection, while somatic cells are living cells that are continuously present to monitor for threats and promptly act when a threat is identified to launch an immune attack.
On dairy farms, milk is tested for the number of somatic cells, called the “somatic cell count” (SCC). If the SCC is too high, the milk is rejected because it indicates that the cow might be fighting an infection. When this happens, farmers can take the cow out of the herd so that she receives treatment and care.
Farmers benefit from keeping SCC low as it means the milk is of high quality with a long shelf-life and better taste allowing them to charge more for it. Plus, healthier cows mean lower costs, fewer medical treatments, and higher milk production. So, farmers have many reasons to keep their cows healthy and produce the best milk possible.(32)
So, did I answer all of your dairy questions? I hope now with the information provided here, you can now make a confident decision on whether to include dairy in your diet and finally block out the diet culture noise surrounding dairy. I would love to hear your decision or something new you learned-Comment below!
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