by Stephanie Greenwood
The California Milk Processor Board's new ad campaign promoting milk as a cure for PMS has recently caused a stir among the media--so much so that the campaign has been pulled and apologies issued. Many people were offended at its portrayal of women as irrational, PMS-stricken creatures, and that men were the real sufferers of PMS. (See the campaign and resulting fallout here.) Borderline misogynistic undertones and marketing impact of the controversy aside, I wanted to address the actual health claims the campaign promotes.
The campaign states:
"Research has shown that a diet rich in high calcium foods, like milk, may cut the physical and emotional symptoms of PMS in half. A majority of women who consumed 1200 mg of calcium a day for three months reported being less irritable, weepy, and depressed, and suffering from fewer backaches, and less cramping and bloating."
Can milk really treat the symptoms of PMS? Let's explore the gotmilk.com website and investigate the information they use to back up these claims. First, the campaign points to a 1998 Columbia University study that found calcium supplementation relieved many symptoms of PMS. Note that the study was not about milk, but of calcium.
Another study they cite is this one that suggests, "PMS represents the clinical manifestation of a calcium deficiency state that is unmasked following the rise of ovarian steroid hormone concentrations during the menstrual cycle." So calcium deficiency caused by hormone fluctuations could be the cause of pre-menstrual symptoms. But again, the study is about calcium, not milk itself.
And finally, the campaign cites this study, which looks at calcium carbonate supplementation as a treatment for PMS. Again, the study is about calcium, not milk. (The campaign also links to pages from various website and media outlets, like WebMD, Howstuffworks, CNN, and a couple broken links, but we'll just look at the peer-reviewed medical studies today, as they're the basis for these other articles.) There have been no studies on actual milk and its effects on PMS.
The leap in logic is a big one: calcium is found to help PMS, calcium is present in milk, thus milk helps relieve PMS. It's not that simple. Perhaps if milk were just an isolated form of calcium, maybe we could make the link. But milk is not calcium alone, but a complex combination of other compounds, fats, proteins, and--importantly--hormones.
In recent years, researchers and doctors have found that Pre-Menstrual Syndrome, as well as other reproductive maladies such as endometriosis, uterine fibroids, and ovarian cysts, are likely caused by an excess of estrogen and a shortage of progesterone. (One of the cornerstones of this theory is Dr. John Lee's work.) To quote the first study linked above:
"Increasing estrogen levels would result in falling calcium concentrations with compensatory rises in parathyroid hormone preventing marked degrees of hypocalcemia. Therefore, it may be hypothesized that women with an already underlying calcium disturbance, such as those suffering with PMS (lower calcium concentrations, lower 25 hydroxyvitamin D levels and higher PTH concentrations), would be subjected to further decrements in calcium concentrations on exposure to increasing estrogen levels during the luteal phase of the menstrual cycle."
In other words, high fluctuations in estrogen were responsible for the decrease in calcium, and the calcium depletion may be the cause for the symptoms of PMS. While every woman has fluctuations in estrogen, it can be theorized that those with higher estrogen levels would have a more exaggerated rise and drop, and subsequent symptoms.
This review of estrogen's role in contributing to endometriosis notes that: "Sex steroids, estrogen and progesterone, are mainly produced in the ovaries and they regulate the growth of endometrial tissue, basically by stimulating and inhibiting cell proliferation, respectively." Breast cancer has an intricate relationship with estrogen and its metabolism. This recent review of current literature states: "[c]ell proliferation through activation of estrogen receptor (ER) by its agonist ligands and is clearly considered as one of carcinogenic mechanisms." The growth of many types of breast cancers are triggered by estrogen.
Cow's milk has long been identified as a dietary source of estrogens. (Here are a couple studies: http://www.ncbi.nlm.nih.gov/pubmed/21268636 http://www.ncbi.nlm.nih.gov/pubmed/20494161) One study on rats found that milk consumption increased uterine weights due to the hormone content of the milk. Another study even concluded that "sexual maturation of prepubertal children could be affected by the ordinary intake of cow milk." After 21 days of daily milk intake, "serum estrone (E1) and progesterone concentrations significantly increased, and serum luteinizing hormone, follicle-stimulating hormone and testosterone significantly decreased in men. Urine concentrations of E1, estradiol, estriol and pregnanediol significantly increased in all adults and children." A 26-year study that just concluded this year, found a "marginally significant overall association between dairy intake and endometrial cancer." The science is clear that milk consumption increases estrogen, and it is this increase in estrogen that depletes the body of calcium and causes the PMS.
Then there is the issue of cows treated with rBGH (recombinant bovine growth hormone). It has been found that "levels of insulin-like growth factor-1 (IGF-1) are substantially elevated and more bioactive in the milk of cows hyperstimulated with the biosynthetic bovine growth hormones rBGH, and are further increased by pasteurization." IGF-1 is a hormone that has been found to stimulate breast cancer growth and to work against anti-estrogens (thus promoting estrogen). Furthermore, the inhibition of IGF-1 has been proven a potential treatment for breast cancer. So, not only are the natural estrogens (also present in organic milk at the same levels) in milk promoters of estrogen-related disorders; the IGF-1 increase caused by rBGH dairy is a promoter as well. And milk is supposed to be a treatment for PMS?
Gotmilk.com also makes several other health claims about milk:
"Drinking three glasses of milk a day may significantly reduce your risk of bone disease and fractures. Consuming milk later in life may slow the rate of bone loss and help maintain bone density."
"The calcium in milk may help reduce cavities when it's combined with normal brushing and flossing. In addition to calcium, milk contains multiple antibacterials and proteins that promote overall oral health. For example, casein, a protein found in milk, helps prevent cavity-causing bacteria from sticking to the tooth surface."
"For those suffering symptoms of insomnia, a protein naturally occurring in milk may improve sleep quality and next-day alertness."
In 2005, the FDA sent warning letters to 29 companies who were touting the anti-inflammatory and anti-oxidant powers of cherries. The FDA instructed these companies to remove the scientific information on their websites that had described the health benefits of the anthocyanins contained in cherries that reduce inflammation in the body. The FDA told the cherry growers that by citing this scientific information, they were implying that cherries treated or prevented disease, and thus they were marketing cherries as a drug. And because cherries have not been approved as a drug, they were marketing an illegal drug.
In the last year or so, FDA actions against food marketers in this fashion have accelerated. In February 2010, the FDA warned PomWonderful that they were making drug claims about pomegranate juice.
"Your POM Wonderful 100% Pomegranate Juice and POMx products are offered for
conditions that are not amenable to self-diagnosis and treatment by individuals who are not
medical practitioners; therefore, adequate directions for use cannot be written so that a
layperson can use these drugs safely for their intended purposes. Thus, your products are
misbranded under section 502(f)(1) of the Act, in that the labeling for these drugs fails to bear
adequate directions for use [21 U.S.C. 352(f)(1)]."
Later that month, the FDA warned Diamond Foods that their marketing of walnuts was illegal. Diamond was citing scientific information about omega-3 fatty acids present in walnuts and how they benefit heart health. The FDA saw this as a drug claim and shut down the company's marketing efforts. In August 2010, the FDA warned Lipton that they were making drug claims by posting scientific information about the anti-oxidants in green tea, and subsequently shut down their efforts.
If cherry-marketing companies can't get away with promoting the fruit's anti-oxidants, and if walnut companies can't promote the nut's omega-3 fatty acids, why are milk marketers allowed to promote milk as a cure for PMS, cavity-preventer, bone-density protector, and cure for insomnia? Especially when the science behind the claims is clearly weak. It's the same type of claims that these other natural food companies have made, and yet milk marketers have been allowed to do this for years.
Now let's look at Frito-Lay. Their website currently reads: "Our all-natural sunflower, canola, corn and soybean oils are considered to be healthier oils by the FDA because they contain good polyunsaturated and monounsaturated fats, which help lower total and LDL "bad" cholesterol and maintain HDL "good" cholesterol levels." Here, the FDA is allowing Frito-Lay to imply that their potato chips will help to lower cholesterol!
Maybe there was something that I was missing....
The FDA labeling requirements of health claims for foods is currently quite complicated and complex, and I don't proclaim to be a legal expert on the matter. But I do know that some minerals and vitamins like calcium and vitamin D are approved to make very particular marketing claims about their benefits for osteoporosis. However, according to the regulations, "the claim must make clear that adequate calcium or calcium and vitamin D intake throughout life in a healthful diet are essential to reducing osteoporosis risk." [Italics added.] The statement that gotmilk.com makes in regard to bone density does not include a "as part of a healthy diet" phrase as it apparently should. There are no approved statements for calcium in treating PMS, cavities, or insomnia.
In 2003 the FDA issued the Consumer Health Information for Better Nutrition Initiative that would allow some marketers to use qualified health claims. This means that companies could submit petitions to allow a particular substance to be marketed with health claims, provided that a disclaimer followed the health claim, such as: "although there is scientific evidence supporting the claim, the evidence is not conclusive." So, perhaps milk marketers have filled out this petition and are legally allowed to make these health claims.
In 2005 a petition was filled to allow calcium to be marketed, with the special disclaimer, that it could reduce the symptoms of PMS. The petition was denied.
So, why are the GotMilk campaign and Frito-Lay allowed to publish the health benefits of their products, while marketers of cherries, walnuts, green tea, and pomegranate juice are completely censored? One theory is that Frito-Lay and the California Milk Processors Board have significant lobbying power with the government because of their big bucks. But isn't Lipton Tea pretty big? And PomWonderful has plenty of cash. Another theory is that FDA is turning a blind eye to GotMilk and Frito-Lay because they're the products of US subsidies--dairy, soy, canola, and corn growers all receive government subsidies. It seems to be the same force or mentality that mandates milk (usually with added sugar and artificial flavors and colors) be served in schools, and counts French-fries as vegetables.
All marketers should be treated equal. In light of the recent actions taken against food producers in just the last year, we can see that if the FDA continues to censor food marketers at this pace, there could be complete censorship of the benefits of natural and healthful foods and supplements. Where does it end? Will natural health magazines be shut down for talking about the benefits of eating spinach because the FDA says they're giving out medical advice? Can no one discuss the benefits of blueberries? Can no one utter a word about omega-3 fatty acids, even if their benefits have been proven time after time and published in scientific peer-reviewed journals?
You can help
This spring, a bill was introduced to the US House of Representatives called the Free Speech About Science Act, HR 1364. This act would enable supplement and food companies to cite peer-reviewed scientific studies and would stop the special treatment of subsidized conglomerates. No longer would walnut farmers live in fear of legal action from the FDA. No longer would scientific information on beneficial natural substances be censored by the government. The bill also calls for a change in the way in which this information is shared. Claims would be regulated with specific verbiage and strengths of evidence. (So we don't end up with inaccurate claims like "milk treats PMS!") Support our constitutional freedom of speech and access to information and help level the playing field for the promotion of natural foods. Tell your representatives to support the Free Speech About Science Act, HR 1364, which you can do online here: https://secure3.convio.net/aahf/site/Advocacy?cmd=display&page=UserAction&id=698 The bill is currently in subcommittee, and just this month, two new co-sponsors came to the table. Time is of the essence—let's get some momentum behind this legislation. Let's get it out of committee and in to the hands of the House and Senate!