Milk and dairy: how much do adults really need?
Nutrition
Key points
- Higher milk intake did not lower fracture risk in adults.
- A moderate amount of dairy is a reasonable choice.
- Unsweetened yogurt and other fermented dairy have better data than sweet dairy desserts.
- Other calcium sources: leafy greens like kale and bok choy, broccoli, beans, tofu and fortified plant milks.
What the review found
In 2020, Walter Willett and David Ludwig reviewed the evidence on milk and health in the New England Journal of Medicine. They concluded that recommendations for adults to drink three cups of milk a day are not well justified. Countries with high milk intake do not have fewer fractures, and in prospective studies higher milk consumption did not lower fracture risk in adults (Willett & Ludwig, 2020).
A meta-analysis of randomized trials also found that vitamin D supplements did not prevent fractures or falls in the general population (Bolland et al., 2018). Bone health depends on many factors: physical activity, protein, vitamin D, not smoking and limiting alcohol.
The EAT–Lancet Commission suggests about one serving of dairy a day as part of a healthy diet (Willett et al., 2019).
In practice
- Moderate dairy is fine for most people: plain yogurt, kefir, milk in coffee or cheese in small amounts.
- Choose unsweetened products; flavored yogurts can contain as much sugar as dessert.
- If you skip dairy, get calcium from fortified plant milks, tofu made with calcium, beans, almonds and greens such as kale and bok choy.
- Pair calcium with weight-bearing exercise for strong bones.
Frequently asked questions
Why do the Dietary Guidelines recommend 3 cups of dairy?
Mainly to help people meet calcium and vitamin D targets. Critics point out that the evidence for fracture prevention in adults is weak and that calcium can come from other foods.
Are plant milks a good substitute?
Fortified soy milk is closest nutritionally to cow’s milk. Many other plant milks are low in protein; choose unsweetened, fortified versions.
Sources
- Willett et al. (2020). Milk and Health. New England Journal of Medicine 382(7):644-654. doi:10.1056/NEJMra1903547
- Bolland et al. (2018). Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. The Lancet Diabetes & Endocrinology 6(11):847-858. doi:10.1016/S2213-8587(18)30265-1
- Willett et al. (2019). Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet 393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
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