Whole Milk for Healthy Kids Act of 2023
Floor Speech
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Ms. FOXX. 1147.
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Ms. FOXX. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I rise in strong support of H.R. 1147. It is Christmastime across America. For many, the season brings with it the annual return of cherished Christmas traditions, such as leaving milk and cookies out for Santa Claus and his reindeer to enjoy.
As for my family, our traditional choice of dairy has always been whole milk. We want only the most nutritious option for Santa.
The nutrients in whole milk, like protein, calcium, and vitamin D, provide the fuel Santa needs to travel the whole globe in one night. Whole milk is the unsung hero of his Christmas journey.
Protein helps build and repair Santa's muscles. Hoisting heavy sacks of gifts up and down the chimney is no easy task.
Calcium is vital for strong bones. It is calcium that keeps Santa strong and sturdy as he dashes from rooftop to rooftop.
Vitamin D is essential to a strong immune system. Santa absolutely needs one as he braves the cold, wintry night. You see, it is not just the magic of the season that helps Santa deliver presents worldwide, it is also the fortifying nutrients in whole milk.
Reflecting on Christmas traditions this year begs the question: If whole milk is a good option to fuel Santa's extraordinary Christmas Eve journey, then why isn't it an option for American schoolchildren in their lunchrooms?
That is why I support Representative G.T. Thompson's Whole Milk For Healthy Kids Act, a bill allowing unflavored and flavored whole milk to be offered in school cafeterias.
Since 2012, the National School Lunch and Breakfast Program has allowed only low-fat and fat-free milk options for American schoolchildren. This means 2 percent and whole milk have been excluded from the daily diets of an entire generation of kids.
The USDA intends to finalize another rule which will further limit milk options. Anti-milk advocates advance one main argument against whole milk: that whole milk is bad for kids.
Rather, milk has 13 essential nutrients that are needed for children to live healthy lives and succeed in school. It is an essential ingredient to growth and development. Research shows that whole milk is associated with a neutral or lower risk of heart disease and obesity.
Moreover, the USDA contradicts itself by limiting milk options for young children. On one hand, it recognizes that children are at risk of underconsuming dairy, yet on the other, it creates policies that will only exacerbate the problem.
If Americans have learned anything from these past 3 years, it is that scientific authorities tend to contradict themselves. The truth is that whole milk is a significant source of vital nutrients for children's growth and development. The Federal bureaucracy should never stand between your children and a nutritious lunch.
The Whole Milk for Healthy Kids Act isn't about advocating for one type of milk over another. It is about providing parents, schools, and food service providers with the option to choose what is best for our children's nutrition.
This act does not aim to diminish the importance of other milk varieties. Rather, it seeks to restore the availability of a wholesome, natural option that has been a staple for generations. This bill is about choice. It is a chance to empower parents and schools to make informed choices about what goes into our children's diets.
Whether it is a nutritional foundation for Santa's journey or your child's math homework, let's not discount the benefits of whole milk.
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Ms. FOXX. Mr. Chair, I would just like to tell my colleague something that I think will be easy to remember about why we are doing this. Scientists/experts built the Titanic, and amateurs built the ark.
Mr. Chair, I yield 2 minutes to the gentleman from Wisconsin (Mr. Grothman).
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Ms. FOXX. Mr. Chairman, I yield myself 1 minute.
Mr. Chairman, we are very concerned about waste. One of the reasons there is so much waste is because whole milk is not allowed, and children don't like the taste of skim milk.
We are putting children first. We are not excluding soy drink. It is not milk. It is a plant-based food. It isn't milk, so you can't call it soy milk. You can call it soy drink.
It was under our first African-American President in this country that this was designed this way. The First Lady pushed through these rules and regulations to exclude whole milk, which, by the way, my colleague says has an enormous amount more fat.
The fat content of whole milk is about 3\1/2\ percent. We are foisting on children 1\1/2\ percent milk, which doesn't have a very good taste to many of them. We are excluding them from 3\1/2\ percent. We do not exclude soy drink. This is about inclusion and equity. We want people to be able to drink the kind of milk they want to drink.
Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Smucker).
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Ms. FOXX. Mr. Chairman, I yield 5 minutes to the gentleman from Pennsylvania (Mr. Thompson), the author of this legislation.
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Ms. FOXX. Mr. Chair, I yield an additional 2 minutes to the gentleman from Pennsylvania.
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Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentlewoman from Illinois (Mrs. Miller), who is the vice chair of the Education and the Workforce Committee.
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Ms. FOXX. Mr. Chair, I include in the Record two scientific articles.
[From the Friedman School of Nutrition Science and Policy] Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix Compared with Single Nutrients (By Dariush Mozaffarian) Introduction
Conventional dietary guidelines from around the globe have focused on individual nutrients to maintain and improve health and prevent disease. This is due to the historical focus, developed in the last century, on single nutrients in relation to clinical nutrient deficiency diseases. However, this reductionist approach is inappropriate for translation to chronic diseases.
A look back at the history of modern nutrition science provides important perspectives on the origins of the reductionist approach to nutrition. In 1747, the British sailor and physician James Lind tested whether citrus fruits prevented scurvy, but it was not until 1932 that vitamin C was actually isolated, synthesized, and proven to be the relevant ingredient. The period of the 1930s to 1950s was a golden era of vitamin discovery, when all the major vitamins were identified, isolated, and synthesized, and shown to be the active constituents of foods relevant for nutrient deficiency diseases such as pellagra (niacin), beriberi (thiamine), rickets (vitamin D), and night blindness (vitamin A). This scientific focus on nutrient deficiencies coincided with global geopolitics, in particular the Great Depression and World War II, which accentuated concerns about insufficient food and nutrients. For example, the birth of RDAs was at the National Nutrition Conference on Defense in 1941, which focused on identifying the individual nutrients needed to prevent nutrient deficiencies in order to have a population ready for war. Together, these scientific and historical events led to the concept of food as a delivery system for calories and specific isolated nutrients.
It was not until the 1980s that modern nutrition science began to meaningfully consider nutrition in association with chronic diseases, such as obesity, type 2 diabetes, cardiovascular disease (CVD), and cancer. Intuitively, the reductionist paradigm that had been so successful in reducing the prevalence of nutrient deficiency diseases was extended to chronic diseases. Thus, saturated fat became ``the'' cause of heart disease, whereas now, excess calories and fat are ``the'' causes of obesity.
What recent advances in nutrition science have demonstrated, however, is that although a single-nutrient focus works well for prevention of deficiency diseases, such as scurvy or beriberi, this approach generally fails for chronic diseases such as coronary artery disease (CAD), stroke, type 2 diabetes, or obesity. For such complex conditions, the focus should be on foods. Calories in/Calories out
The US obesity epidemic is a recent phenomenon, starting in the mid-1980s, and the rise of obesity globally is even more recent. The strategies to address this epidemic have not yet caught up with advances in nutrition science. Most current dietary recommendations and policies across the globe remain calorie and fat focused, recommending foods based on these reductionist metrics rather than their complex, empirically determined effects on health. For example, nearly all guidelines recommend low-fat or nonfat dairy foods to reduce calories, total fat, and saturated fat in the diet, based on the theory that this will help maintain a healthy weight and reduce the risk of CVD. This is seen, for example, in the 2015-2020 US Dietary Guidelines; National School Lunch Program, NIH Dietary Guidelines for Kids; and CDC Diabetes Prevention Program.
However, foods are not simply a collection of individual components, such as fat and calories, but complex matrices that have correspondingly complex effects on health and disease. Recommendations based on calorie or fat contents fail to consider the complex effects of different foods, independent of their calories, on the body's multiple, redundant mechanisms for weight control, from the brain to the liver, the microbiome, and hormonal and metabolic responses. This growing evidence indicates that different foods, calorie-for-calorie, have different effects on the risk of long-term weight gain and success of weight maintenance. Dairy Foods and Weight
Although dairy products contribute cents10 percent of all calories in the US diet, until recently, little direct research had evaluated the health effects of different dairy foods. The complex ingredients and matrices of different dairy foods, from milk to yogurt to cheese, appear to have varying effects on weight.
Although considerable research has focused on optimal diets for weight loss among obese individuals (secondary prevention), fewer studies have evaluated determinants of gradual weight gain (primary prevention). Among nonobese US adults, the average weight gain is centslb (0.45 kg) per year. This represents a very slow, modest increment, but when sustained over many years, this small annual weight gain drives the obesity epidemic. This gradual pace also makes it difficult, if not impossible, for individuals to identify specific causes or remedies.
To identify specific dietary factors associated with long- term weight gain, we performed prospective investigations among 3 separate cohorts that included 120,877 US men and women who were free of chronic disease and not obese at baseline. We examined weight gain every 4 y, for up to 24 y of follow-up, and its association with the increased intake of individual foods. Within each 4-y period, participants gained an average of 3.35 lb. On the basis of increased daily servings of different foods, those strongly linked to weight gain were generally carbohydrate-rich, including potato chips (per daily serving, 1.69 lb greater weight gain every 4 y), other potatoes/fries (1.28 lb), sugar-sweetened beverages (1.00 lb), sweets (0.65 lb), and refined grains (0.56 lb). Other foods were not linked to weight gain, even when then intake was increased, including cheese, low-fat milk, and whole milk. Other foods were actually related to less weight gain: the more they were consumed, the less weight was gained. This included vegetables (-0.22 lb), whole grains (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt (-0.82 lb) When sweetened vs. plain yogurt were evaluated, each was associated with relative weight loss, although when sweetened, about half the benefit was lost.
What could explain these findings? We hypothesize that different foods have varying effects on multiple redundant mechanisms for weight gain, including effects on hunger and fullness, glucose, insulin and other hormonal responses, de novo fat synthesis by the liver, gut microbiome responses; and the body's metabolic rate.
Based on these findings, certain foods, when consumed over the long term can have relatively neutral effects on weight, others promote weight gain, whereas still others promote weight loss.
Interestingly, although we found that cheese, low-fat milk, and whole-fat milk were each unassociated with weight change, there is evidence that dairy foods may promote healthier body composition. Consistent with our findings, a systematic review and meta-analysts of 37 randomized clinical trials with 184,802 participants, which assessed the effect of dairy consumption on weight and body composition, found that overall, dairy consumption had little effect on BMI. Body composition, however, changed significantly. Dairy consumption led to a reduction in fat mass (0.23 kg) and an increase in lean body mass (0.37 kg). Overall, high-dairy intervention increased body weight (0.01, 95 percent CI: -0.25, 0.26), and lean mass (0.37, 95 percent CI: 0.11, 0.62); decreased body fat (-0.23, 95 percent CI: -0.48, 0.02) and waist circumference (-1.37 95 percent CI: -2.28, -0.46).
In subgroup analyses, such effects appeared larger in trials also having energy restriction, but such subgroup findings should be interpreted cautiously The types and frequency of dairy products consumed varied among these trials, making it difficult to make distinctions in this meta-analysis about the effects of different types of dairy products such as low-fat or whole fat, or milk, yogurt, or cheese. When viewed in combination with our long-term observational findings, the joint results suggest that dairy foods do not promote weight gain, that dairy consumption may reduce body fat and augment muscle mass, and that the type of dairy product (milk compared with cheese compared with yogurt) may be more important for preventing long-term weight gain than the dairy fat content. Dairy Foods, Probiotics, and the Microbiome
Many pathways appear relevant to the concept that foods cannot be judged on calorie content alone for risk of obesity. Among these, the gut microbiome is particularly interesting. Substantial evidence demonstrates that the quality of the diet strongly influences the gut microbiome. Among different factors, probiotics have been studied for their effect on the microbiome; as well as potential benefits of fermented foods, which may be greater than the sum of their individual microbial, nutritive, or bioactive components.
For example, in an experimental model, mice genetically predisposed to obesity were provided control diets or a ``fast-food'' chow with and without probiotic-containing yogurt or a single probiotic (Lactobacillus reuteri) in water. Without probiotics, mice on the fast-food chow gained significant weight. However, the addition of either probiotic-containing yogurt or water prevented this weight gain. Crucially, the probiotics did not appear to reduce the amount of calories consumed; rather, the benefits appeared related to changes in microbiome function and inflammatory pathways. The results support weight benefits of probiotics and, more importantly, provide empiric evidence that challenges the widely accepted conventional wisdom that the effects of different foods on obesity depend largely on their calories.
Consistent with this animal experiment, a recent systematic review and meta-analysis of 15 randomized controlled trials examined the effects of probiotics, either in foods or as supplements, on body weight and composition in overweight and obese subjects. Administration of probiotics significantly reduced body weight percent (-0.60 kg), BMI (-0.27 kg/m\2\), and fat percentage (0.60 percent), compared with placebo. A separate meta-analysis of randomized clinical trials demonstrated that consumption of probiotics in foods or supplements significantly improves blood glucose, insulin, and insulin resistance. The trials in these two meta-analyses were neither long-term nor large--in all, a total of about 1,000 subjects were included in each meta-analysis, with trial durations ranging from 3 to 24 wk and with varying designs in terms of controls, disease conditions, and composition of probiotic preparations evaluated. Nonetheless, together with observational and experimental evidence, these studies provide compelling evidence to support weight and metabolic benefits of foods rich in probiotics. Dairy Foods, CVD, and Diabetes
Although an important risk factor for type 2 diabetes and CVD, growing research suggests that specific foods may also directly alter disease risk. In a meta-analysis of 29 prospective cohort studies including 938,465 participants who experienced 93,158 deaths, 28,419 incident CAD events, and 25,416 incident CVD events, neither total dairy nor milk consumption was significantly associated with total mortality, CAD, or CVD. Notably, findings were similar when total whole-fat dairy, or low-fat dairy were separately evaluated. In contrast, the intake of fermented dairy products (predominantly cheese, plus yogurt and fermented milk) was associated with modestly lower risk of total mortality and CVD, with about 5 percent lower risk of each per 50 g daily serving. In addition, the consumption of cheese alone, the dairy product with the highest amount of dairy fat, was associated with a significantly lower risk of both CAD and stroke.
In the Multi-Ethnic Study of Atherosclerosis cohort, including 5209US adults with Caucasian, Asian, black, and Hispanic backgrounds, different food sources of saturated fat were analyzed for their relation with subsequent CVD risk, adjusted for sociodemographics, medical history, and other dietary and lifestyle factors. A higher intake of saturated fat from dairy sources was associated with significantly lower CVD risk (per each 5 g/d, RR = 0.79, 95 percent CI = 0.68, 0.92), whereas a higher intake of saturated fat from meat sources was associated with higher CVD risk (per each 5 g/d, RR = 1.26, 95 percent CI = 1.02, 1.54). Intakes of saturated fat from other sources, such as butter and plant oils/foods, were too low to identify any associations.
These findings suggest that saturated fat from different food sources may have varying effects on CVD risk. This may partly relate, for example, to differences in the types of saturated fatty acids in meat compared with dairy. Compared with meat, dairy has a greater proportion of short-chain and medium-chain saturated fatty acids, with correspondingly less palmitic and stearic acids. Compared with their longer chain fatty acids, growing evidence suggests that shorter and medium-chain triglycerides have different physiology, including potential benefits on metabolic risk, weight gain, obesity, and the gut microbiome.
In addition, cardiometabolic effects of different dairy foods appear to vary depending on other characteristics, such as fermentation or the presence of probiotics. The large European Investigation into Cancer and Nutrition (EPIC) cohort across 8 European countries evaluated the consumption of different dairy foods and risk of diabetes among 340,234 participants with 12,403 new cases of diabetes during follow- up. In the fully adjusted model including adjustment for estimated dietary calcium, magnesium, and vitamin D, the consumption of milk (low-fat and whole-fat) was not significantly associated with type 2 diabetes. Individuals who consumed more yogurt or thick fermented milk experienced a nonsignificant tend toward lower risk (across quintiles: RR = 0.89, 95 percent CI = 0.77, 1.03; P-trend = 0.11), whereas individuals who consumed more cheese had significantly lower risk of diabetes (RR = 0.83, 95 percent CI = 0.70, 0.98, P- trend = 0.003). A higher combined intake of fermented dairy products (cheese, yogurt, and thick fermented milk) was also associated with a lower risk of diabetes (RR = 0.85, 95 percent CI = 0.73, 0.99, P-trend = 0.02).
Similarly, in the Malmo Diet and Cancer Cohort following 26,930 participants over 14 y, different food sources of fat and saturated fat had very different associations with incidence of diabetes. Overall, low-fat dairy consumption was associated with a higher risk of diabetes (across quintiles: RR = 1.14, 95 percent CI = 1.01, 1.28; P-trend = 0.01), whereas whole-fat dairy consumption was associated with a substantially lower risk RR = 0.77, 95 percent CI = 0.68, 0.87, P-trend < 0.001). However, relations varied further by subtype. For example, nonfermented, low-fat milk was associated with higher risk; nonfermented, whole-fat milk was not associated with risk; and fermented, whole-fat milk was associated with lower risk. Cheese intake showed a nonsignificant trend toward lower risk (RR = 0.92, 95 percent CI = 0.81, 1.04; P-trend = 0.21), whereas red meat intake was associated with significantly higher risk (RR = 1.36, 95 percent CI = 1.20, 1.55; P-trend < 0.001). When estimated intakes of individual fatty acids were evaluated, intakes of saturated fatty acids with 4-10 carbons, lauric acid (12:0), and myristic acid (14:0) were associated with decreased risk (P-trend = 0.01).
In addition to the consumption of whole foods such as milk, cheese, or yogurt, significant amounts of dairy fat can be consumed as relatively ``hidden'' ingredients in creams, sauces, cooking fats, bakery desserts, and mixed dishes such as casseroles containing butter, milk, or cheese. Self- reported questionnaires may miss many of these sources, leading to inaccurate measurement of true dairy fat consumption in individuals. Biomarkers can partly reduce this mismeasurement. In a global consortium combining de novo individual-level analyses across 63,602 participants in 16 separate cohort studies, higher blood concentrations of odd- chain saturated fatty acids (15:0, 17:0) and a natural ruminant trans fatty acid (trans-16:1n-7), objective circulating biomarkers of dairy fat consumption, were evaluated in relation to onset of diabetes. Each fatty acid was associated with lower incidence of diabetes, with 20-35% lower risk across the interquintile range of blood concentrations. It is unclear whether such lower risk is related to direct health benefits of specific dairy fatty acids, or to other aspects of foods rich in dairy fat. For example, the major source of dairy fat in most diets is cheese, a fermented food rich in vitamin K2 (menoquinone) which is converted from vitamin K by the action of bacteria. Menoquinone, which cannot be separately synthesized by humans, is linked to lower risk of type 2 diabetes in prospective observational studies, with supportive experimental evidence for potential benefits on glucose control and insulin sensitivity. The biologic mechanisms that could explain metabolic and diabetes benefits of dairy foods and dairy fat have been recently reviewed.
Based on all the evidence, the relation of dairy foods to obesity, CVD, and diabetes does not consistently differ by fat content, but rather appears to be more specific to food type. In particular, neither low-fat nor whole milk appear strongly related to either risks or benefits, whereas cheese and yogurt (as well as other fermented dairy such as fermented milk) may each be beneficial. These findings suggest that health effects of dairy may depend on multiple complex characteristics, such as probiotics, fermentation, and processing, including homogenization and the presence or absence of milk fat globule membrane. Holistic Dietary Recommendations
Conventional dietary guidelines generally recommend 2-3 daily servings of low-fat or nonfat dairy foods, without regard of type (yogurt, cheese, milk); largely based on theorized benefits of isolated nutrients for bone health (e.g., calcium, vitamin D) and theorized harms of isolated nutrients for obesity and CAD (e.g., total fat, saturated fat, total calories). Advances in science indicate that updated dietary guidelines must incorporate the empirical evidence on health effects of different dairy products on weight, body composition, CVDs, and diabetes. These findings suggest that recommendations for milk, cheese, and yogurt should be considered separately, based on their differing relations with clinical outcomes. These findings further suggest that whole-fat dairy foods do not cause weight gain; that overall dairy consumption increases lean body mass and reduces body fat; that yogurt consumption and probiotics reduce weight gain; that fermented dairy consumption including cheese is linked to lower CVD risk; and that yogurt, cheese, and even dairy fat may protect against type 2 diabetes.
Based on the current science, dairy consumption is part of a healthy diet, and intakes of probiotic-containing yogurt and fermented dairy products such as cheese should be especially encouraged. Based on little empiric evidence that low-fat dairy products are better for health, and at least emerging research suggesting potential benefits of foods rich in dairy fat, the choice between low-fat compared with whole- fat dairy should be left to personal preference, pending further research. Such recommendations are consistent with a growing focus on and understanding of the importance of foods and overall diet patterns, rather than single isolated nutrients. ____ [From the European Journal of Clinical Nutrition, Dec. 11, 2017] Effect of Whole Milk Compared With Skimmed Milk on Fasting Blood Lipids in Healthy Adults: a 3-Week Randomized Crossover Study (By Sara Engel, Mie Elhauge, and Tine Tholstrup) Introduction
Dairy is a source of saturated fat (SFA) and dietary recommendations for choosing low-fat dairy products are mainly based on predicted effects of macronutrients, such as SFA, which are known to increase LDL cholesterol concentration in the blood. However, there is disagreement between dietary guidelines and results from meta-analysis of prospective cohort studies reporting no association between dairy and risk of cardiovascular disease (CVD) and an inverse association with type 2 diabetes (T2D). A meta-analysis including studies comparing diets of equal SFA content from cheese and butter reported a beneficial effect of cheese on LDL cholesterol. Moreover, a comparison between regular and reduced fat cheese found no difference in effect on LDL cholesterol and risk markers of the metabolic syndrome, although a significantly higher SFA content in the regular fat cheese diet. This could suggest that the expected effect on LDL cholesterol was mediated by a combination of nutrients or bioactive components in the cheese matrix. Every day, people make a choice between whole milk and skimmed milk in the super market. Thus, a comparison between these high and low-fat dairy products is a real-life practical issue for the consumer that makes it possible to further examine the effect of milk fat on health. Two studies compared milk with different fat content and found no difference in changes in LDL and HDL cholesterol; one between two control diets with semi-skimmed and skimmed milk (1.9 vs. 0.3%) and another between whole milk and skimmed milk (3.4 vs. 0.2%) but with only eight participants and therefore underpowered. Current evidence from randomized controlled trials (RCTs) indicate that milk consumption has no effect on risk of T2D in terms of fasting insulin and glucose concentrations, although not consistently. The aim of this study was to investigate the effects of whole milk compared with skimmed milk on serum total, LDL, and HDL cholesterol, and triacylglycerol concentration and secondarily on glucose and insulin concentrations in healthy subjects. We hypothesized that whole milk would increase fasting blood cholesterol concentration moderately compared to skimmed milk. Methods Subjects
Subjects were recruited through postings on the Internet and around university campus area in Copenhagen. A total of 25 subjects were screened through telephone calls, 19 were assessed for eligibility, 18 were enrolled in the study, and 1 subject dropped out after randomization. Exclusion criteria were: previous or current CVD, diabetes, or other severe chronic disease: BMI (in kg/m\2\) <18.5 and >30; age <20 years and >70 years; pregnancy or planning of pregnancy during study period; excessive physical activity (>10 h/wk); milk allergy or lactose intolerance; blood donation <1 mo prior to and during study period; use of supplements, lipid- lowering medication, as well as medicine that might affect study outcomes; known or suspected abuse of alcohol, medication, or drugs; blood pressure >140/90 mmHg; and inability to follow study protocol. After receiving oral and written information about the study all subjects gave their informed consent in writing and completed a lifestyle questionnaire including questions about current and previous disease. Study design
The study was a crossover RCT. The two intervention periods of whole milk and skimmed milk (in random order) were 3 weeks long with no wash-out period, as the lipids in the blood are known to adjust after 2 weeks. The study was not blinded as the appearance of the test beverages could not be concealed. However, analyses of blood samples as well as statistics were done blinded. Sample size was based on a previous study on dairy fat in which butter significantly increased LDL cholesterol compared with olive oil (control) (difference in concentration 0.17 mmol/L). Thus with a standard deviation (SD) of 0.19 mmol/L, a total of 12 subjects had to be included in order to detect a similar difference (assuming a significance level of 5 and 80% power). The study was carried out at the Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark from 3 October to 17 December 2015. The study was approved by the Municipal Ethical Committee of Copenhagen (Report H-15011908) and conducted according to the Helsinki Declaration. Intervention
The test foods were provided to the study subjects, consisting of 0.5 L conventional skimmed milk (0.1%, Arla Foods, Denmark) and whole milk (3.5%, Arla Foods, Denmark) from cows and from the same season. The energy content and macronutrient composition of the milks are shown in Table 1. Subjects were instructed not to consume yogurt, ice-cream, or milk besides the test milk. For other dairy products such as cheese and butter and for cooking oils subjects were instructed to keep the same dietary pattern throughout the intervention. Apart from the test foods and restrictions in dairy intake the remaining diet was self-selected and study subjects were asked to maintain their usual diets and their regular level of physical activity throughout the intervention periods. Subjects were instructed in how to substitute the test foods for food items from their habitual diets (usually the milk they normally drank). Weekly subjects visited the department to collect the milk and for weighing and follow-up making sure they adhered to the test diet and kept a stable body weight during intervention periods. Compliance was measured as a percentage of milk consumed according to a diary kept throughout the intervention compared with the milk handed out. Subjects completed 3-d dietary records the last week of each period and were instructed to include 1 weekend day and 2 weekdays to take account of differences in nutrient intake. Dietary intake was assessed using Dankost Pro dietary assessment software (Dankost). Clinical investigations
Fasting blood samples were taken at baseline, after 3 weeks and after 6 weeks. Prior to the blood sampling subjects fasted (12 h) and were asked to refrain from smoking (12 h), extreme sports (36 h), alcohol or medicine (24 h). Blood samples were drawn for assessment of following: serum lipids (total, LDL, and HDL cholesterol and triacylglycerol), insulin, and plasma glucose. Samples for assessment of blood lipids and insulin were collected into dry tubes, and samples for glucose were collected into tubes with a 1 3 mL-fluoride citrate mixture. To coagulate blood samples were stored at room temperature for 30 min. Further, blood samples for assessment of blood lipid and insulin concentrations were centrifuged at 2754 g for 10 min at 4 deg.C and stored at -80 deg.C until the concentration was analyzed. For glucose, samples were centrifuged at 2754 g for 10 min at 20 deg.C and stored at -80 deg.C until the concentration was analyzed. LDL and HDL cholesterol concentrations were assessed by enzymatic colorimetric procedure (ABX Pentra LDL Direct CP and ABX Pentra HDL Direct CP, respectively; Horiba ABX). Concentration of total cholesterol was assessed by enzymatic photometric test (CHOD-PAP from ABX Pentra Cholesterol CP). Triacylglycerol and glucose concentrations were assessed by enzymatic colorimetric procedure (ABX Pentra Triglycerides CP and ABX Pentra Glucose HK CP; Horiba ABX, respectively). Blood lipid concentration was analyzed on an ABX Pentra 400 Chemistry Analyzer (Horiba ABX). Interassay CVs for total, LDL and HDL cholesterol, triacylglycerol, and glucose were 2.2, 2.7, 2.0, 2.6, and 2.5%, respectively. Intra-assay CVs for total, LDL and HDL cholesterol, triacylglycerol, and glucose were 0.9, 0.7, 1.2, 3.8, and 1.1%, respectively. Insulin concentrations were assessed by the solid-phase enzyme-labeled chemiluminescent immunometric assay with an Immunlite 2000 XPi (Siemens Medical Solutions Diagnostics). Interassay and intra-assay CVs for insulin were 3.5 and 4.2%, respectively.
Insulin resistance was evaluated by using homeostasis model assessment--insulin resistance (HOMA-IR) with the following formula: HOMA-IR = Fasting serum insulin (
Fasting body weight was measured at baseline, 3 and 6 weeks to the nearest 0.1 kg wearing light clothing and having emptied their bladder in advance. Height, body weight for BMI calculation, and waist circumference were also measured at screening. Height was measured without shoes to the nearest 0.5 cm with a wall-mounted stadiometer (Seca) and waist circumference was measured horizontally at the midpoint between the bottom rib and the top of the hip bone. Statistical analysis
Statistical differences for outcome measures were analyzed with linear mixed models that incorporated systematic effects of period and treatment and their interaction. Approximate F- tests were used to evaluate the interaction between time and treatment and if non-significant to evaluate a time- independent treatment effect. Baseline values and relevant covariates: sex, age, waist circumference, and baseline-BMI were included. Subject-specific random effects were included to account for inter-subject variability and to adjust for non-specific differences that could not be explained by the explanatory variables included. For dietary records statistical differences were based on paired t-test or Wilcoxon Signed Rank test for non-parametric variables. Treatment differences were reported in terms of unadjusted mean levels with corresponding standard errors. All models were validated by graphical assessment of normal quantile plots and residual vs. fitted plots. When departure was detected logarithmic transformation of the variables were made. Variance homogeneity was visually inspected and showed similar variance. Concentration of glucose and insulin were correlated to blood lipid responses using Pearson correlation test or Spearman correlation test for non-parametric variables. A two-tailed P-value < 0.05 was considered significant. The statistical software R version 3.1.3 2015 was used for all statistical evaluations. Results Subjects
Of the 18 recruited subjects, 1 dropped out in the first period because of inability to follow study protocol. Baseline characteristics of the 17 subjects who completed the study are outlined in Table 2. No difference was observed in body weight during the intervention between whole milk and skimmed milk periods (P = 0.59). The compliance for intake of milk during the first and second period was 99.7 and 98.5%, respectively. Blood lipids
Results from fasting blood lipid measurements at the end of each period are listed in Table 3. HDL cholesterol was significantly higher with whole milk than with skimmed milk (P < 0.05). There were no significant differences between the periods for any of the other blood lipids. For total cholesterol there was a tendency for a higher concentration with whole milk than with skimmed milk (P = 0.06). Insulin and glucose
Results of glucose and insulin concentrations measured at the end of each period as well as calculated HOMA values are listed in Table 3. There were no significant differences between the periods for any of these outcomes. However, correlation analysis with skimmed milk showed that insulin and LDL cholesterol were moderately positively correlated (r = 0.54, P < 0.05) and with whole milk that glucose and HDL cholesterol were moderately negatively correlated (r = 0.52, P < 0.05). Dietary intake
Total energy intake was significantly higher with whole milk than with skimmed milk (P < 0.05). Fat intake (in grams and percentage of energy) was significantly higher with whole milk than with skimmed milk (P < 0.001). Also, the intake of saturated, monounsaturated, and polyunsaturated fat was significantly higher with whole milk than with skimmed milk (P<0.001, P<0.05, and P<0.05, respectively). Intake of carbohydrate was significantly higher with skimmed milk than with whole milk (P<0.01). There were no differences between the periods for intake of protein, calcium, alcohol, and dietary fiber. Discussion
In the present study we showed that a daily intake of 0.5 L whole milk for 3 weeks did not increase LDL cholesterol compared to an equal intake of skimmed milk in healthy subjects. Moreover, although small, a significant increase in HDL cholesterol concentration was shown with whole milk compared to skimmed milk, which was significantly, moderately, and negatively correlated with glucose concentration. None of the other outcome measurements showed a difference between the periods. The increase in HDL cholesterol following intake of whole milk was expected due to the higher content of SPAs known to increase HDL and LDL cholesterol concentrations. The Nordic Nutrition Recommendations as well as the American Dietary Guidelines advice that SFA should be limited to less than 10E%, due to the predicted effect on LDL cholesterol. In comparison, the amount of SFAs in the whole milk diet was almost 5 E% above and in the skimmed milk diet close to recommendation (14.4 and 11.3 E%, respectively), according to the dietary records. Thus, the result of no difference in LDL cholesterol was unexpected and opposite to the dietary guidelines and our hypothesis, despite of the dominating macronutrient content of SFA with whole milk. Studies of the association between HDL cholesterol concentration and CVD has shown that HDL is protective. However, it is necessary to be cautious when interpreting low concentration of HDL cholesterol as a CVD risk factor. Mendelian randomization studies have shown that genetically decreased HDL cholesterol was not associated with increased risk of myocardial infarction, questioning the causality of an association between low HDL concentration and CVD. Still, HDL cholesterol concentration, as a marker of cardiovascular health, should be taken into consideration when interpreting the effect of dairy or SFAs in the diet.
Our results are in line with two previous intervention studies from 2009 and 1994 comparing milk of different fat content that also showed no effect on total and LDL cholesterol concentration after 12 months and 6 weeks with similar milk intake (500 and 660 ml/d, respectively); however, contrary to our results also no effect on HDL cholesterol. Fonolla et al. compared semi-skimmed milk and skimmed milk and therefore a smaller difference in milk fat (1.9 vs. 0.3%), which could explain the lack of difference in HDL cholesterol compared to the present study. Steinmetz et al., the more comparable study and of good quality, also compared skimmed milk with whole milk in a crossover design, but in a background diet designed to meet the AHA recommendations. Steinmetz et al. reported a significantly higher concentration of total and LDL cholesterol with whole milk compared to skimmed milk. However, the statistical analysis was not adjusted for baseline measurements, and thus not adjusted for differences between periods, and in addition the sample size was small (n = 8). Still, the analysis of difference in change from baseline between the two diets was also reported which showed no difference between total and LDL cholesterol, in line with our results. Nevertheless, the study reported higher Apolipoprotein B concentrations with whole milk compared to skimmed milk known to be a predictor of cardio metabolic risk.
Although the dietary records showed a significantly higher energy intake with whole milk compared to skimmed milk, it seems that the study subjects compensated for the extra energy with whole milk by lowering their intake of carbohydrate which was significantly lower compared to skimmed milk. The content of calcium and protein were similar in the two milk types, but whole milk has a higher content of milk fat globule membranes (MFGM), which encloses the fat. A possible matrix effect of MFGMs was suggested in a recent study showing an impaired lipoprotein profile after a butter oil diet, low in MFGMs, compared with a whipping cream diet, high in MFGMs. One proposed mechanism, based on a mice study, is through lowering of cholesterol absorption by inhibition of cholesterol micellar solubility possibly due to presence of sphingomyelin in MFGM fragments. Thus, one could speculate that an expected higher LDL cholesterol concentration after whole milk may be modified by a dairy matrix effect of MFGM.
The strength of the present RCT was the imitation of real- life settings by not matching the diets for energy content or macronutrient composition, which made it possible to directly compare whole milk and skimmed milk as whole foods. The free- living design of the study was a limitation, thus allowing the presence of potential confounding by other lifestyle and dietary factors. However, the crossover design minimizes this potential confounding as study subjects were their own control,
In conclusion, the results indicate that intake of 0.5 L/d of whole milk does not adversely affect fasting blood lipids, glucose, or insulin compared to skimmed milk in healthy adults. Moreover, intake of whole milk increased HDL cholesterol concentration compared to skimmed milk. These findings suggest that if the higher energy content is taken into account, whole milk can be considered as part of a healthy diet among the normocholesterolemic population.
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Ms. FOXX. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Tennessee (Mr. Rose).
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Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from Pennsylvania (Mr. Joyce).
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Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from Wisconsin (Mr. Van Orden).
Mr. VAN ORDEN. Mr. Chair, I thank the gentleman from Louisiana for painting a vivid and completely disingenuous picture of junior high school students being held down and having milk forced down their throats in a school cafeteria.
I will also take the opportunity--I can't believe I am doing this-- the milk fat content of whole milk is actually 3.25 percent making it 96.7 percent fat-free.
So when we look at the science, we read this definition: Milk means the lacteal secretion practically free from colostrum obtained by the complete milking of one or more healthy cows.
The reason soy milk is not in there is because it is not milk. Neither is almond milk. Milk comes from a mammal.
Mr. Chair, I strongly support this bill, and I am looking forward to having our children have healthy and nutritious choices in their schools.
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Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from New York (Mr. Molinaro).
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Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentleman from California (Mr. Costa), who is my classmate.
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Ms. FOXX. Mr. Chair, I yield an additional 1 minute to the gentleman from California.
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Ms. FOXX. Mr. Chair, we are waiting for one more speaker to come, so I will yield myself 1 minute.
Mr. Chairman, I want to reiterate some points that were made before. We are not being driven by any special interest group lobby. We are being driven by the special interest group of children. We want children in school to have access to whole milk, which, as my colleagues have pointed out, is 96.75 percent fat-free, but it provides one of the most nutritious meals that children can have.
We are seeing tremendous waste in the schools. We are not excluding soy drink. The policy that we are trying to overcome here by providing whole milk to children was a policy passed under the Obama administration. We are not trying to harm minorities in any way whatsoever. We want everybody to have the choice to drink a soy drink, whole milk, skim milk, 1 percent milk, whatever.
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Ms. FOXX. Mr. Chair, I yield an additional 15 seconds to myself.
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Ms. FOXX. Mr. Chairman, this bill has been terribly mischaracterized by our colleagues on the other side of the aisle. It is about healthy choices for children.
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Ms. FOXX. Mr. Chair, I yield 1 minute to the gentleman from Pennsylvania (Mr. Meuser).
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Ms. FOXX. Mr. Chair, I yield myself the balance of my time.
Mr. Chair, I have seen a lot of bills mischaracterized on this floor in my time here, but I think this is one of the worst.
Passing the Whole Milk for Healthy Kids Act would be a critical step toward empowering parents and securing our children's well-being. Whole milk isn't just a beverage; it is a vital source of nutrients essential for children's growth. Denying access to its calcium, vitamin D, and protein threatens to inhibit their development.
To the anti-milk advocates, I have one thing to ask of you: What do you have against milk?
If you scrutinize them closely, you might be convinced that Democrats are waging a war on dairy. The Democrat administration has presided over a 15 percent milk price increase in the grocery store.
A Democrat proposal, the Green New Deal, calls for the elimination of cows for their so-called greenhouse gas emissions.
A Democrat policy is slashing the milk available to newborns through the Special Supplemental Nutrition Program for women, infants, and children by four quarts.
A Democrat interest group, PETA, has called milk a so-called white supremacist symbol. How patently absurd.
Let's end the war on milk and pass the bill.
Together, we can ensure that our children have access to the nutritional foundation they need to thrive and become the healthy, vibrant leaders of tomorrow.
Mr. Chair, I urge all my colleagues to vote ``yes'' on this bill, and I yield back the balance of my time.
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Ms. FOXX. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
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