When I finished studying nutrition, I started clinical practice with the idealism of any 20 something professional armed with nothing other than a shiny new degree and lots of energy. It was with this enthusiasm that I preached the benefits of eating more vegetables, more dietary fibre and the crucial importance of making the change to skim milk.
I have to be honest, now more than 10 years later I am much more open minded in my approach to nutrition, particularly when it comes to the full cream versus skim milk debate. In fact, in many of my client examples on a daily basis, I would argue in many cases there are far worse dietary habits to change than swapping from full cream to skim milk.
The focus on low fat dairy foods emerged largely in the 1980’s after the links between a high intake of saturated fat and heart disease was noted in the scientific literature. Based on this it was reasoned that as Australians were consuming a significant proportion of their saturated fat via meat and dairy foods that recommending low fat dairy foods was a powerful way to reduce our intake of saturated fat as a population and hence help reduce the incidence of heart disease. To some extent, it makes sense. A single glass of full cream milk contains 10g of total fat, 6 of which is saturated fat and since we ideally need to cut back out saturated fat intake to just <20g a day in total to support heart health, choosing low fat dairy, milk in particular makes sense.
The issue with this approach is that while it may sound optimistic from a public health perspective, when it comes down to an individual dietary prescription it makes less sense. Sure you can cut the fat out of your milk, but if you continue to eat fatty meat, fried food and refined carbohydrates, your risk of heart disease is not likely to be any lower, if anything probably worse, all the while you are feeling as if you are ticking the right nutritional boxes with your low fat, skim style diet. The same can be said for the diets of individuals which are already reasonably ‘healthy’ – if you make a concerted effort to eat a low fat diet with lean meat, limit your treats and high fat foods and exercise regularly, if your fat intake is already low, is skim milk in place of a more nutrient rich milk really be a better choice?
Milk, like bread has been a dietary staple for hundreds of years, and yet it seems modern life and the impact it has on our weight and health is more the issue than any one food. Sure, if you polish off 500ml of full cream milk a day, swapping to light or skim milk will save you 12-18 grams of fat but if your milk is more likely consumed via a cup of coffee once a day, it is likely that you feel that the extra 5-6grams of fat is worth it for flavour and taste alone. Then there is the school of thought who argue that full cream milk, or even light, reduced fat milks are more satiating, and hence help us all to ultimately eat less – the number one thing we can all do for weight control.
It should be said that there are a couple of common misconceptions when it comes to both skim and full cream milk. Skim milk has not had sugar added in processing, nor does full cream milk have a better nutrient profile than low fat milk. If anything, low fat milk tends to have better nutritional properties with higher levels of calcium, protein and essential nutrients, which have often been added to the milk to improve the entire nutrient profile – the only thing that full cream milk offers is extra fat.
So, what do I tell my clients based on both the science and from an individual, whole diet perspective? Usually I hedge my bets and recommend reduced fat or light style milk – it still tastes creamy, cuts out 5-6 grams of fat, 3-4 of which are saturated and seems to be a nice balance between full cream and skim. If though, I find that one of my clients enjoys full cream milk sparingly via a coffee once a day or a little with their oats, and the rest of their diet is looking pretty good, very rarely would I suggest that they make the change. If anything, the recent media reports of our biggest dairy suppliers using permeate – the byproduct from cheese production as a ‘filler’ in our milk makes me think that when it comes to any of our processed foods we have more important things to take into account when choosing different brands than whether the milk is full cream or not.
And then let’s not forget individual choice. Like many of you, I actually do not like the taste of full cream milk, having been programmed throughout my childhood to drink reduced fat milk. Perhaps though, like many for you also, I tend to make up my saturated fat intake via good quality cheese, which clearly a food type that is simply not meant to be consumed in a low fat style. Such a decision and example of the different food mixes that can achieve a sound dietary balance again emphasizes why dietary prescription should always be made based on an individual’s food preferences and choice, there is simply not one approach that is best for all of us.