Milk, the elixir of life in childhood, holds a nuanced and complex position in the western hemisphere. Its consumption patterns, economic drivers and health implications weave a tale that transcends mere nutrition, delving into historical legacy, socioeconomic landscape and evolving science.

Statistics from across the world reveal that 75 per cent to 90 per cent of children consume milk, driven by its perceived role in growth, bone development and overall health.

Beyond childhood, one in two Americans above the age of 18 years is reported to drink milk regularly, in contrast to what is believed to be less than 10 per cent of adults in the eastern hemisphere. These figures prompt the question: is milk truly essential in mature age?

The Western dairy industry is a behemoth, rooted in historical circumstances. European settlement brought cattle and dairy practices to the Americas, laying the foundation for a booming industry. Technological advancements in refrigeration, homogenisation and transportation further spurred its growth, creating a readily available and seemingly indispensable source of nutrition.

In stark divergence from the Western paradigm, milk consumption in many Eastern and near-Eastern societies takes a back seat after childhood. For one thing, lactose intolerance is more prevalent in Asian and Middle Eastern populations, leading to a natural disinclination towards milk usage. Additionally, cultural factors play a role, with soy milk, nuts, plant-based proteins and fermented products often holding a more prominent place in these diets.

Necessity or nostalgia?

While milk boasts undeniable nutritional benefits, particularly for children, the science surrounding its necessity for adults is less clear-cut.

Calcium, often cited as a primary driver of milk consumption, can be adequately obtained through other dietary sources such as leafy greens and tofu.

Some studies show that the fat content present in milk may pose heart problems for some adult patients, especially with high and regular milk use, and more so in individuals with other cardiovascular risk factors.

The protein debate adds further complexity. While casein, the major protein in milk, contains all nine essential amino acids for muscle growth and tissue maintenance, it has been linked in some small studies to negative health outcomes, including risk of diabetes, allergies, gastrointestinal inflammation and respiratory congestion. However, there are no conclusive data, yet, to substantiate such claims.

What is lactose intolerance?

Lactose is the natural sugar found in milk. Individuals with lactose intolerance lack the enzyme needed to digest lactose, which can lead to digestive symptoms such as bloating, gas and diarrhoea. The lactose content in different dairy products varies:

• Milk, ice cream, pudding and other liquid dairy products generally have the highest lactose content

• Yoghurt typically contains less lactose than milk owing to bacterial fermentation that breaks it down partially

• Hard cheeses and aged cheeses have very low lactose content owing to natural breakdown during the ageing process. They are often well stomached by lactose-intolerant people

“Got Milk”?

The dairy industry supports the livelihoods of millions of farmers, processors and distributors, contributing to rural economies and providing employment opportunities. In addition, dairy organisations often collaborate with public health agencies to promote milk consumption as part of balanced diets, particularly for vulnerable populations such as children and pregnant women.

On the other hand, milk marketing campaigns frequently target adults, utilising persuasive techniques such as celebrity endorsements, emotional appeals and at times misleading health claims. This can potentially influence consumer choices beyond nutritional requirements.

Overselling benefits: marketing messages often overemphasise the benefits of milk for adults, ignoring the lack of strong scientific evidence supporting its necessity beyond childhood. This can create unrealistic expectations from dairy consumption

Ignoring alternatives: the focus on milk can overshadow the growing availability and comparable nutritional value of plant-based milk alternatives

Environmental impact: large-scale dairy production contributes significantly to greenhouse gas emissions, deforestation and water pollution

What are the different types of milk?

A. Whole milk:

• Fat content: 3.25 per cent

• Description: it retains all the fat naturally present in cow's milk

• Colour code: red cap or label

• Benefits: highest in calories, making it a good source of energy, and rich in fat-soluble vitamins such as A and D

• Drawbacks: same, ie, higher in saturated fat than other milk options, making it unsuitable for most adults

B. 2 per cent milk:

• Fat content: 2 per cent

• Description: offers reduced fat content compared with whole milk

• Colour code: blue or light blue cap or label

• Lower in calories and fat than whole milk while still providing a good source of calcium and other nutrients

C. 1 per cent milk:

• Fat content: 1 per cent

• Colour code: green cap or label

• Benefits: low in fat and calories

• Drawbacks: thinner texture may not be enjoyable for everyone and potentially lower in fat-soluble vitamins such as A and D

D. Skimmed milk:

• Fat content: less than 0.5 per cent

• Description: the thinnest and most calorie-free milk option, with almost all the fat removed

• Colour code: purple cap or label

• Benefits: very low in calories and fat, making it suitable for strict low-fat or weight-loss diets

• Drawbacks: lacks the creamy texture and flavour of other milk options, and potentially lower in fat-soluble vitamins such as A and D

E. Lactaid milk:

• Fat content: varies depending on the chosen fat option (whole, 2 per cent, 1 per cent, or skimmed)

• Description: contains the enzyme lactase, which predigests lactose, making it suitable for individuals with lactose intolerance

• Colour code: varies depending on the chosen fat option, but with an additional "Lactaid" label

• Benefits: allows individuals with lactose intolerance to enjoy the taste and nutritional benefits of milk without digestive discomfort

Drawbacks: slightly sweeter taste owing to the added lactase, and often slightly more expensive

F. Plant-based milk alternatives:

• Fat content: varies depending on the type of plant milk, but generally lower than cow's milk

• Description: made from various plant sources such as soy, almond, oat, coconut, etc, offering dairy-free and often lactose-free alternatives

• Benefits: suitable for individuals with dairy allergies and lactose intolerance, or who are vegan

• Drawbacks: can vary in protein content and nutrient profile compared with cow's milk. Some types may need fortification with calcium and vitamin D

• Joe Yammine, MD, is a consultant cardiologist at the Bermuda Hospitals Board. The information here is not intended as medical advice or as a substitute for professional medical opinion. Always seek the advice of your physician.