I was delighted to join my friend Dr. Oz today to tape a segment for his show about the recent studies of dairy, weight, and diabetes. I believe the exchange Mehmet and I had blenderized our perspectives well, and should prove genuinely informative -- albeit brief, punchy, and, inevitably, of that made-for-TV style when it airs. As for my personal and unpasteurized views on the topic, I have already shared those, both recently, and in an older vintage of very similar stock.
Limiting commentary here to the cream suitable for skimming, the place for dairy in any healthful diet is small. One compelling reason is that dairy occupies a very small place in almost all of the diets that contend reasonably for "best diet" laurels. Dietary patterns most decisively associated with both longevity and vitality around the globe typically include little to no dairy, and that dairy is more often from sheep and goats than from cows. If the place for dairy were larger, it would displace foods known to promote overall health far more convincingly: vegetables, fruits, whole grains, beans, lentils, nuts, seeds, and water when thirsty. To paraphrase the Facebook post of a colleague from yesterday: while debating the place for dairy in your diet, drink a glass of water and have a spinach salad.
The other reason for dairy at modest levels is the planet, a golden-egg-laying goose if ever there was one, and one we are clearly cooking. The environmental impact of animal foods is consistently higher than that of plant foods, and that argues for keeping dairy confined to those ecological niches where it contributes more to food security than it costs in environmental degradation. One potential way to have some yogurt and eat it, too, is to use dairy, a good protein source, as a partial replacement for meat in our diets. While the environmental costs of milk from cattle are high, they are considerably lower than those attached to eating the cattle. A bit more dairy, and less meat, could work for those inclined.
As for dairy fat, it's worth noting -- without revisiting the recent studies, addressed at the links above -- that the one dietary pattern that does emphasize dairy, and also shows up on short lists of health-promoting diets, is DASH. The DASH diet explicitly emphasizes low and no-fat dairy. An even stronger case has been made by one of the most decisive, population-wide lifestyle interventions of all time. The North Karelia Project, which has dramatically increased life expectancy, and slashed cardiovascular disease rates by over 80% at the population level, has included a reduction in dairy fat intake among its key priorities from the start.
Moving on from the topic to the venue, I wanted to say a few words about the taping. I have been on the Dr. Oz Show many times, but it has been a while. This may have been my first appearance since the turbulence of last year.
There have been important changes.
Content is now overseen by a dedicated unit run by a physician with experience in both clinical care, and consumer protection. My segment was put together by another, young physician, with evident passion for advancing public health through education and effective communication.
The three of us had a brief hallway meeting after my segment was shot, talking about the production changes and the challenges of television. Medicine and the media have always made a volatile mix, and there is no definitive solution for that. The best medical information tends to be cautious and qualified; the most compelling television tends to be dramatic and decisive. The docs handling production duties for the show now are doing all they can to reconcile these, as, indeed, is Mehmet himself.
One issue that I know tends to be off-putting for my colleagues is the "tease." On a medical show, the tease might be along the lines of: "is _________ the miraculous cure for weight gain we've all been waiting for? Find out after the break..." For today's segment, it might be: "is the best defense against diabetes in a cup of whole milk? Find out..."
I very much doubt television, any kind of television, will abandon the tease any time soon. It's ubiquitous. Every serial program on television touts the "episode you can't miss," and the "shock that all of America will be talking about." The evening news is replete with teases, as are all the morning shows. Frankly, one of the most teased items in all of media is the weather. We routinely get: "today was beautiful, but are BIG changes coming? Tune in at 11..." Yet, I don't hear collective outrage about this unprofessional handling of meteorology. Everyone seems to understand it's just how television is done.
Maybe medicine should be held to a different standard altogether, but the simple fact is, if medicine is to work on television, it will have to be made for television. This is a particular case, I suppose, of the generic: "when in Rome..."
The opportunity for balance and the delivery of genuinely useful information is never in the tease -- but in the conclusion. Regarding my examples above, the conclusions might well be: no, this is not the miracle weight loss cure; no, it's not obviously time to rely on full-fat milk to prevent diabetes; and no, the weather isn't about to change. The tease is the question; not the answer. Since, I presume, very few of my colleagues watch daytime television -- and for that matter, nor do I -- I also presume that their only exposure to medical television is apt to be the teases that show up in marketing and other media.
Medicine and the media are in some ways like a celebrity marriage: of widespread, seemingly irresistible interest; and routinely on the brink of disaster. Neither union, nor the prevailing fascination with it, is apt to go away soon.
Nor is the tease. But I can say that there are good people doing all they can to play by the rules of television, and tease out some genuinely useful information just the same. To get it, you'll have to stick around for the punch line. A glass of milk, of whatever variety, while waiting for it is strictly optional.
Of course, there is the alternative. Google it later; watch less television -- and go for a walk. Please don't tell my friends at the Oz Show I said so.
-fin
Director, Yale University Prevention Research Center; Griffin Hospital
President, American College of Lifestyle Medicine
Founder, The True Health Initiative