Busting myths about milk

Photo by artemtation

Milk used to be simple. Your local dairy, say Berkeley Farms, delivered it to your doorstep.

But now we are faced with an unfathomable array: nonfat, low-fat or whole milk? Almond, soy, rice, hemp or oat milk? From goats or cows? With or without lactase? Raw or pasteurized? Plain or flavored? There’s even an ongoing controversy over which of these drinks can be called milk.

To sort through the confusion, I spoke with Stanford nutrition scientist Christopher Gardner, PhD. He is working to clear up some of the biggest misconceptions we have about milk.

Most of us grew up believing that milk is important for children to build strong bones and for the elderly to prevent osteoporosis. But milk, a good source of calcium, isn’t necessarily the most critical factor for bone health, Gardner said.

“There are countries like Japan and India where the population is predominantly lactose intolerant, where milk intake is low and hip fracture rates are also low. But many of those cultures do more weight-bearing activities than Americans,” he said. “It’s better to be physically active than drink milk as a way to strengthen your bones.”

Studies have shown that drinking milk can improve your bone density, but whether it helps prevent bone fractures is debatable, he added.

But don’t young kids need milk? According to Gardner, it depends on what kind of milk. Breast milk is incredibly important, but cow’s milk isn’t, he said.

“This myth goes way back to before the food pyramid when the National Dairy Council offered to provide nutrition material to schools for free. And in all those materials, they said that you need multiple servings of dairy every day for a healthy diet,” Gardner said. “That was never agreed on. A lot of people are lactose intolerant, and you don’t need it.”

Milk can be healthier than other options like soda. He recommended checking the nutrition panel to make sure the milk isn’t just as sugary as soda though, particularly with plant-based milks. “The popular vanilla and chocolate versions of the plant-based milks are often loaded with added sugar. Even the plain is typically sweetened, but you can get unsweetened. The lactose in milk isn’t so bad so there is no need to water it down, just avoid milks with added sugars.”

The nutrition label also allows you to compare the amount of fats, protein, carbs and vitamins in each type of milk. “For example, the plant-based milks generally don’t have saturated fat like cow’s milk so they don’t raise LDL-cholesterol as much as dairy milk, but they do have about the same amount of calcium,” he said. “And soy milk has the same amount of protein as dairy milk, but almond milk has much less protein.”

Another common misunderstanding is that 2 percent milk means that two percent of the calories are from fat — it’s really 2 percent of the weight (which is mostly water) and 35 percent of the calories, he said. “Whole milk has close to 50 percent of its calories as fat, and 1 percent milk has about 20 percent.”

However, your milk’s fat content may not affect your weight. The old belief was that drinking whole fat milk will make you fat and skim milk will help you lose weight. But this was refuted by Harvard’s Nurses’ Health Study that followed the diets of over 100,000 nurses for over 30 years, including how their diets changed.

“The Harvard study found that switching back and forth from whole fat to 2 percent to 1 percent was not associated with changes in weight,” explained Gardner.

But does drinking more milk help? Some small, short-term studies showed that people lost weight if they drank more milk. According to Gardner, this raises the always present nutrition research challenge: Was it drinking more milk or was it consuming less of something else that caused the weight loss?

And what about raw milk? Raw milk proponents argue that pasteurization kills off important healthy bacteria along with the bad listeria bacteria, but Gardner says that it’s difficult to prove any health benefits from these bacteria. Some raw milk producers also claim that it is easier to digest. However, Gardner’s study found that lactose intolerant participants had the same symptoms with raw and pasteurized milk.

And what does Gardner himself drink? He said he gave up cow’s milk for ethical reasons.

“Now, I drink unsweetened soy milk,” he admitted. ‘In our household, my wife doesn’t digest dairy milk very well, so we don’t even have it around. My four boys all drink unsweetened soy milk.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Deep brain stimulation might benefit those with severe alcoholism, preliminary studies show

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Alcoholics struggling to stay sober are faced with countless triggers that can lead to relapse — driving past a bar, getting together with former drinking buddies or even just feeling down. 

And this is a big problem. Alcoholism is a growing epidemic responsible for at least a quarter trillion dollars in US health care costs per year, as well as inestimable anguish. Current medical therapies suffer from high rates of noncompliance and variable effectiveness.

In the future, severe alcoholics with multiple failed attempts at intensive medical therapies and in-patient rehabilitation may have a different treatment option for their addiction — deep brain stimulation (DBS) — as recently reported in a review article by Stanford researchers in Neurosurgical Focus.

Currently, deep brain stimulation therapy for alcohol use disorders is not approved by the U.S. Food and Drug Administration, but it is widely used to treat Parkinson’s disease and obsessive-compulsive disorder.

“DBS is a minimally-invasive brain surgery,” explained senior author Casey Halpern, MD, an assistant professor of neurosurgery at Stanford. “For Parkinson’s, we place deep brain stimulators to restore normal function of the region in the brain known to be dysfunctional. Patients improve immediately when a small dose of current is delivered to this area. We anticipate a similar treatment will be possible for alcoholism. At the moment, we’re performing animal studies to optimize this potential therapy and to learn its underlying mechanism of action.”

For alcohol use disorders,  researchers are targeting the nucleus accumbens, which plays a central role in the brain’s reward circuitry. They previously found that brain stimulation of this region could reduce impulsive behavior.

“The nucleus accumbens is triggered when patients anticipate a reward or prior to completing a rewarding behavior. It’s been shown to be perturbed in both addictive disorders and OCD,” said Allen Ho, MD, a Stanford neurosurgery resident working with Halpern. “By targeting this brain structure with stimulation, we hope to modulate the reward circuit in the brain to help patients resist the temptation to indulge in a binge and other addictive behaviors.”

The review article outlines extensive animal studies and pilot human subject studies have shown promising reductions in alcohol consumption and, in some cases, long-term abstinence.

According to Ho, this success is in part due to the fact that DBS doesn’t rely on patient compliance with therapy sessions, in-patient rehab, medications and abstinence. “Once the patient makes a decision to undergo treatment and the stimulator is implanted and turned on, they don’t have to make a conscious decision to pursue treatment — it is ‘on’ all the time,” said Ho.

Brain surgery may sound scary, but Ho explained that DBS is one of the safest and least invasive operations that they do as neurosurgeons. He believes alcoholics will consider the treatment since the addiction can devastate their lives, he said.

The Stanford team also hopes to apply deep brain stimulation to other addictions. “Should DBS prove effective for alcoholism, we anticipate a similar therapy could be very helpful for all addictions and even obesity,” said Halpern.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Improving domestic violence screening at Stanford: A Q&A

Photo by Kevin Lee

As part of the Clinical Observation and Medical Transcription fellowship at Stanford, Laurel Sharpless wanted to pursue a project that was personally important to her: intimate partner violence.

Her own experience with intimate personal violence during high school temporarily derailed her career plans of attending a four-year college and then medical school. So she knows how important it is to identify victims early and connect them with help.

During the fellowship — a one-year program that trains prospective health professionals to work as certified medical scribes alongside faculty physicians — Sharpless also looked at how to improve screening for intimate partner violence at Stanford clinics.

Now a San Francisco 49ers cheerleader, a clinical trials coordinator for Stanford immunology and rheumatology and a chief scribe for the COMET fellowship, Sharpless’ own dream is back on track.

I spoke with her recently about her work:

Why is it important for health care workers to screen for domestic violence?

“Intimate partner violence (IPV) is a silent epidemic affecting 1 in 3 women during their lifetime. It leads to injuries and death from physical and sexual assault, sexually transmitted infections, post-traumatic stress disorder, depression, substance abuse, suicide and many other health issues.

We need to promote intervention. This is a public health issue, and primary care and ob/gyn are the best portals for sharing that information. Otherwise, victims might not be aware of the resources they have.”

What are the barriers?

“Although the U.S. Preventive Services Task Force recommends physicians screen women of childbearing age for IPV, rates of screening in primary care settings are low. Physicians have limited time with the patient in the exam room and they have a lot to juggle when coordinating patients’ care. There is also a stigma around the topic with many patients and physicians feeling uncomfortable with the subject.”

What did you study and what did you find?

“I conducted a retrospective chart review at the five Stanford primary care clinics to understand how we were screening patients for intimate partner violence. Some clinics had medical assistants screen and others relied on the physicians alone, and I found a wide variation in screening rates.

Our study supports the national trend that medical staff should do the initial screening, and then physicians should counsel patients who screen positive and then refer them to a social worker and local victims resources.

I presented these results to the medical directors of primary care, which led to an initiative to standardize the way Stanford primary care and ob/gyn screen patients for IPV. I even got to choose the screening question we use. We now ask, ‘Because difficult relationships can cause health problems, we are asking all of our patients the following question: Does a partner, or anyone at home, hurt, hit, or threaten you?'”

What ‘s next?

 “My study results have just been accepted for publication.

I’m currently applying to medical school in hopes of becoming a physician. The COMET fellowship has really peaked my interest in primary care, but I’m going in with an open mind.

As a physician, I wish to become a champion of women’s health care, conducting research and seeing patients. I’ve seen the difference I can make in the quality of care provided to patients. I also aspire to teach the next generation of health care workers and the community at large through advocacy and education from the perspective of an academic physician.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.