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Recently, a young mother brought her 4-year-old daughter in to help alleviate chronic constipation through diet and avoid using propylene glycol laxatives as the pediatrician had prescribed. The mother agreed to my recommendation to increase the fat in her daughter’s diet, mostly with the addition of grass-fed ghee and egg yolks. Two months later, the child came in for a follow-up and constipation was no longer a problem. But even more remarkable to me was the change in the child’s demeanor.
At her first visit, I had observed a somewhat anxious child, even to the point of hysterical crying when the mother suggested she use the bathroom. She now smiled frequently, seemed completely at ease even with the bathroom, and played quite happily on the floor. The mother shared with me that her daughter’s mood had changed for the better, and while the alleviation of her constipation could be a factor, I strongly suspect the nutrients in the ghee and egg yolks (including cholesterol) may have helped calm her nervous system (1).
Where's the evidence?
This nutritional approach would not be sanctioned by conventional medical guidelines as dairy fat is not considered a beneficial food—quite the contrary. “Clear and undisputed evidence shows that children benefit from consuming a diet rich in low- or nonfat milk and other dairy products,” asserts the Institute of Medicine committee who authored the 2011 report, Early Childhood Obesity Prevention Policies, without one single citation in support of low/nonfat dairy. Interestingly, this committee had no trouble citing studies for numerous other statements they made in their report, statements such as: “Evidence shows that young children who drink flavored milk consume more calories and more added sugars than children who drink only plain milk” (2).
If there is “undisputed evidence” that low/non-fat milk is beneficial in preventing childhood obesity, why did this IOM committee fail to cite even a single study? Could it be because none actually exist? Were they counting on the fact that no “informed” individual would dispute something widely “assumed” to be true: that the calorically-dense fat in milk and dairy makes absolutely no contribution to a healthful diet, therefore limiting it will help reduce overall energy intake and hence assist in weight management. The truth is that even the conventional medical literature has cast doubt on this widely-held assumption.
There is a growing consensus that an overall reduction of dietary fat intake does not lead to successful weight management, either in adults or in children. Yet there is one type of fat that indeed seems to be implicated in overweight and obesity – the high-omega 6 polyunsaturated vegetable oils, especially ones that are industrially processed or heat-damaged. We know that mice become overweight when fed a diet containing these oils, and it is quite probable that these oils are far from “heart-healthy” (3).
I previously cited evidence that points to a probable benefit from full-fat milk as compared to low-fat milk for maintaining a healthy weight in children (4,5) and there is evidence for a similar benefit in adults (6). However, a healthy weight should not be the only outcome we are concerned with. Ensuring children get the nutrients they need for optimal growth and development must be our first priority when making dietary recommendations. Protecting them from chronic diseases such as diabetes, heart disease, osteoporosis, and other conditions that often appear only later in life is important, but this protection should naturally follow when they receive optimal nutrition, especially during critical periods of development.
How does dairy fat provide nourishment for a child?
What can dairy fat provide for growing child? At the top of the list are the important fat soluble vitamins A, D, E, and K2, as well as beneficial fatty acids such as butyric, conjugated linoleic, and trans-palmitoleic that are not found to any appreciable extent in other foods readily eaten by children. Butyric acid is beneficial for the gut (7) and may improve insulin sensitivity (8), and trans-palmitoleic acid intake has been shown to be associated with a lower risk of diabetes in adults (9).
Dairy fat is a good source of pre-formed vitamin A, essential for growth and immune function. Decades prior to the misplaced fear of saturated fat, the USDA recommended that the whole milk sold in schools be homogenized so that all children got the same amount of the vitamin A (10). The knowledge that vitamin A protected against life-threatening infections such as measles was not lost on past generations.
The liver can make vitamin A from the carotene in orange fruits and vegetables most children eat, but this process is not as predictable or efficient as commonly thought (11). Dairy fat from grazing cows is a good source, and butter or cheese with a naturally deep yellow color will naturally contain more vitamin A than their paler counterparts. There is also vitamin D in dairy fat, but likely not enough to meet a child’s total needs year-round if they live in a northern climate. Children should be encouraged to play out of doors, wearing a non-chemical sunblock only to prevent burning when needed. Their bodies will store some of their vitamin D needs for the winter and the supplemental use of cod liver oil can provide not only additional vitamin D, but its synergistic partner, vitamin A. Like homogenized milk, cod liver oil used to be commonly recommended for children and is an excellent source of vitamins A and D. Keep in mind that the homogenization process damages some of the fat-soluble components in milk, therefore it’s best to buy full-fat, non-homogenized dairy when possible. A great source would be cheeses made from unpasteurized milk from cows allowed to graze on pasture.
Full-fat dairy is one of the best sources of vitamin K2, especially from the type of cheese described above. Vitamin K2 may prove to be the most important vitamin a majority of children are falling short on. Vitamin K2 plays a role in directing calcium into bones and away from soft tissues (including the arteries) ensuring a child will form well-mineralized, strong bones and teeth and helping prevent both osteoporosis and heart disease later in life. Vitamins A, D, and K2 work in concert together, so the fact that full-fat dairy contains all three is not surprising. Nature has a peculiar way of doing that! (12).
But what about heart disease?
But do fatty foods like butter increase the risk for heart disease, even starting in childhood? Dairy fat is about 65% saturated, termed “artery-clogging” because it is thought to contribute to the build-up atherosclerotic plaque in the blood vessels supplying the heart and other vital organs. This common understanding of heart disease is grossly oversimplified – chiefly because plaque does not build-up on the surface of the blood vessels and is nothing like a “clog” in a drainpipe that it is often compared to. The forces behind plaque formation are now widely understood to be inflammation, infection, and oxidative stress; many would add subclinical malnutrition (or malnutrition not apparent to the average clinician). Poor intake of the fat soluble vitamins due to avoidance of foods like full-fat dairy may contribute to the development of atherosclerosis (13).
You may have heard that very young children begin to develop fatty streaks in their arteries, but these streaks appear to be a normal physiological process and are not associated with a higher risk for heart disease later in life. From birth to 15 years, humans are resistant to plaque formation (14). So it seems in any case, limiting the amount of dairy fat and other fats in children’s diets is at best totally unnecessary, and at worst actually counterproductive to the goal of promoting health and preventing obesity and chronic disease.
1. Aneja A, Tierney E. Autism: The role of cholesterol in treatment. Int Rev Psych. 2008;20(2): 165-170. This article discusses the high prevalence of autism in children diagnosed with Smith-Lemli-Optiz syndrome that causes an abnormal cholesterol metabolism, citing potential reasons for behavioral changes such as disruption in oxytocin receptor functioning and serotonin transport.
2. Institute of Medicine (IOM). 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press.
3. See the blogs of Paul Jaminet http://perfecthealthdiet.com/category/toxins-and-toxicity/vegetable-oil… and Michael Eades http://www.proteinpower.com/drmike/lipids/dining-out-and-bad-fats/ for provocative discussions on this.
4. Berkey CS et al. Milk, Dairy Fat, Dietary Calcium, and Weight Gain: A Longitudinal Study of Adolescents. Arch Pediatr Adolesc Med. 2005;159:543-550.
5. Scharf RJ, Demmer RT, DeBoer MD. Longitudinal evaluation of milk type consumed and weight status in preschoolers. Arch Dis Child.2013;98:335-340.
6. Kratz M, Baars T, Guynet ST. The relationship between high fat dairy consumption and obesity, diabetes, and cardiovascular disease. Eur J Nutr. 2013;52(1):1-24.
7. Canani RB et al. Potential benefits of butyrate in intestinal and extraintestinal disease. World J Gastroenterol. 2011;17(12):1519-28. Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070119/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070119/table/T2/
8. Gao Z, Yin J, Zhang J, Ward RE, Martin RJ, Lefevre M, Cefalu WT, Ye J. Butyrate improves insulin sensitivity and increases energy expenditure in mice. Diabetes. 2009;58:1509–1517. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699871/
9. Mozzaffarian D et al. Trans-palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults: a cohort study. Ann Intern Med. 2010;153(12):790-9.
10. U.S. Department of Agriculture Miscellaneous Publication No.246. Menus and Recipes for Lunches at School. Available at: https://archive.org/details/menusrecipesforl246carp.
11. Haskell MJ. The challenge to reach nutritional adequacy for vitamin A: β-carotene bioavailability and conversion--evidence in humans. Am J Clin Nutr. 2012;96(5):1193S-203S.
12. Masterjohn C. Beyond Good and Evil. Available at: http://www.westonaprice.org/vitamins-and-minerals/beyond-good-and-evil .
13. A detailed and user-friendly explanation of the etiology of heart disease has been provided by Chris Masterjohn: http://www.fleetwoodonsite.com/product_info.php?cPath=40_366&products_i…
14. “The prevalence of fatty streaks in childhood bears little relationship to the prevalence of atheromatous plaques in adulthood. These fatty streaks are universally present in infants and children, independent of gender, race, diet, or national origin.” Olson RE. Is it wise to restrict fat in the diets of children? J Am Diet Assoc. 2000 Jan;100(1):28-32. (Note that this is the same journal where the 2013 poster abstracts I described in part 1 of this series were published, now renamed the Journal of the Academy of Nutrition and Dietetics. )
