Three a Day Dairy Important to a Healthy Life, National Medical Association Leader Says

Transcript

Alan Bjerga: Hello and welcome to the Dairy Defined podcast. With the dietary guidelines for American Scientific Advisory Committee reviewing the science for the upcoming 2025 guidelines, better nutrition for diverse American communities is getting a lot of attention.

Our guest today, Dr. Priscilla Mpasi is on the front lines of childhood nutrition. As a population health officer and primary care pediatrician, she's a physician and an advocate seeking to expand healthcare access and equitable resources for children and families. She serves on the board of trustees for the National Medical Association and is a long-time leader in the American Academy of Pediatrics. She did her residency training at the University of Maryland Children's Hospital, completed a health policy fellowship at the University of Pennsylvania, and now lives in Philadelphia.

Thanks for joining us, Dr. Mpasi.

Dr. Priscilla Mpasi: And thanks so much for having me, Alan. Really looking forward to our conversation today.

Alan Bjerga: And it's an important conversation to have. Looking at the challenges of nutrition in America, what are some of the unique challenges of the communities you serve, especially children and families of color?

Dr. Priscilla Mpasi: This is an excellent topic for us to start our conversation. Nutrition has certainly been, I'll say a hot button topic in healthcare, though we know that nutrition is really a part of health. And I say that because there's been a lot of emphasis on food as medicine, how can food keep us healthy, but what are we doing really to make sure that we're accessing quality nutritious foods?

And so there's been a lot of emphasis around food insecurity or really food security. So that really is where I would start with some of the unique challenges is that for families and children who want to be healthy, sometimes it's not as easy to access some of these healthy foods that we initially think about: fruit, vegetables, dairy, why they may live in an area that's not near a grocery store. Or for some they may walk into a grocery store and they say, "Where do I start?"

And so we really want to make sure that really… And I love how you say the front lines and my front lines is my pediatric office sitting with a family for a well-child visit or a sick visit. And we actually are asking questions, what do you eat? How do you get these foods? And so where families and even children may know that a fruit and vegetables is a healthy snack, dairy is a snack or beverage that you can have with every meal, it's not as easy for families to get. And so we do a lot of food security screening and with that it allows us to do education and we can offer some opportunities or pathways of where they can access foods, but then also how they're eating and how they're preparing food is also an important part of nutrition.

So I really say the access and then the education part are the two areas where I think pediatricians and even our school educators are focusing for children.

Alan Bjerga: And you're also working on some of these concerns from a policy standpoint.

Dr. Priscilla Mpasi: Yeah.

Alan Bjerga: We have programs that are meant to address some of the gaps you're talking about: school meals, nutrition programs. What role do these play in closing nutrient gaps specifically for children and where do milk and dairy products fit in?

Dr. Priscilla Mpasi: Yeah, so the policy aspect is important because it's oftentimes that legislation bills are really driving opportunity or creating a barrier. And I really want to applaud many of our organizations that are really focusing on nutrition from a policy standpoint. I want to start with one of the programs because when we think about, again, children, we're starting at birth. Women and Infant Children's program, people may know that is the acronym WIC, really is an initial and frontline program. It offers children from birth to five years old, food products, and really dairy is where that starts.

So we offer, whether it's whey-based formula, cow's milk when they turn one and other dairy snacks. I don't think people realize cheese, yogurt are also available through WIC. And so that's an opportunity to really address food security head on. And then we know that children, when they start to get older, they're in daycare, but then school really spend a lot of their time.

And so children will likely have lunch at school, but many have breakfast. And so there's been a lot of work, I could name so many organizations that are really ensuring that we have quality and nutritious foods in school. So there's full breakfast programs that offer a reduced or free cost for children, same with lunch. And really the policy aspect is ensuring that we actually are offering milk and dairy. Really important, right? Kids, they're going to select from their choices. And if we're not offering milk with breakfast, they're likely not going to ask for it at lunch. Are we also still offering milk instead of soda as an opportunity as that beverage for lunch? And so school is really, really critical.

We have some great school dietetics that have been advocating for this. I've been fortunate to provide care in a school-based health center. We actually sit with our school and the cafeteria to look at what's being designed for meals. But really when you consider that children are getting two out of the three main meals at school, it's probably really the priority location that we need to focus on in addition to the home to start closing these nutrient gaps.

Alan Bjerga: It's interesting you bring up cheese and yogurt because something we should just put on the table right now because it's a challenge is lactose intolerance. Dairy has been called inequitable because a lot of communities of color have higher rate of lactose intolerance than White Americans, but it's still important.

So what approaches do you use to help encourage patients and their families who may be dealing with lactose intolerance to keep dairy in their diet and why should they even do that?

Dr. Priscilla Mpasi: Yeah, so the lactose intolerance discussion, both important, but it's also really interesting. So we certainly do know that communities of color, Black Americans, Hispanic, Native American populations do have a higher rate of lactose intolerance. At the same time, we are starting to introduce the phrase a true lactose intolerance. So that means that there are symptoms related to taking in lactose, which is a protein that we tend to find in milk or dairy. And that over time these symptoms are consistent. So we think lactose intolerance, I'll use milk. That is a common dairy product. We drink milk. You may have upset stomach, some nausea, so you have some symptoms there. You can't really tolerate it because you can't break it down. That's a true lactose intolerance. Versus sometimes we see in families that a child or family member will say, "Well, I have lactose intolerance because a family member has lactose intolerance."

And so we find that in households there's no dairy because there is a concern that everyone has lactose intolerance. I think the first thing that we really want to do is have a correct diagnosis. So we will really do a food diary history and really ensure, and then if we haven't seen those symptoms, then we encourage how do we bring in dairy into the household? And so approaches that I use is that one, we actually teach about what is dairy? So milk is a dairy product, but dairy is more than just milk. So you mentioned, Alan, cheese and yogurt is one. How do we actually do that? So I say for one, you're thirsty, you can grab a glass of milk, it's great. If you are hungry, you can get a cheese stick, string cheese, which is fabulous. I have string cheese in my refrigerator.

And then how do we actually pair it with something else? So you can get carrots, you can get an apple. I'm just picking two fruit and vegetable that happens to be in my refrigerator. Take that apple, put a little peanut butter on the side, what a great snack to get you from lunch to dinner. We also talk about can you spoon it a different way? So adding milk to cereal, right? Milk to oatmeal, that's another way to take it in. Yogurt, adding fruit on top, that's another way. So you're getting a stirrer. So I actually have a schematic in my office, or actually when I am out talking to families of actually just the different types of dairy, so different cheeses. We have butter, we have yogurt, where you can them in your grocery store and it opens their opportunities right of different ways to eat that.

And then the why, it's tasty. I mean, I would say it's tasty, but really looking at the science, and I've been really fortunate to focus on the science in the last three years, particularly when we have new dietary guidelines for Americans or the DGAs come out and we anticipate the new 2025 ones coming out shortly as the year's there, we always take a look and see what are the recommendations. And the recommendations have been three servings of dairy a day, and we're hoping it stays at three servings of dairy a day. Why? Because we've seen how dairy is important to neuronal development in children. So from birth to two years old, that is the most optimal time when children's brains are developing and dairy has a lot of minerals and vitamins that support that. It's great. Bone development. How many of us know a child or you or that child that may broken a bone from playing or being outside?

But dairy is really important for bone development. We've seen improvement in skin. So teenagers, yes, if you're taking dairy, going to help your acne, can even help your mood. For those who are wanting to maintain a healthy weight, dairy's great because it makes you feel more full. We use the word satiety. You feel satiated. And that has been optimal as well. But I know I'm a pediatrician, but children live with families. There is a lot of benefit in dairy for our adults and our senior family members. We've seen that it can, more dairy, reduces the risk of some chronic diseases like diabetes and high blood pressure.

And then of course, the healthier you are, an adolescent and an adult, the greater likelihood you are going to have a lifespan into your senior life. So that's the why in dairy. I mean, the science is very clear about the health benefits from birth to our senior population. So that's a mouthful there. But that mouthful is again, a small amount of dairy a day really goes a long way and across the lifespan.

Alan Bjerga: What are some of the misconceptions that you hear and what do we need to have stronger education efforts so these families do understand the benefits and take advantage of them?

Dr. Priscilla Mpasi: That's really important as well. I'm going to start with the misinformation part because when people have some framework or understanding, that guides their decision-making. And I talked about lactose intolerance, that if one family member has a true diagnosis of lactose intolerance, there's this sense that it's genetic, it may be passed on. And then we see families are not even exposing or introducing dairy to their children. And as I mentioned, the great benefits early on, it's really important that children are getting dairy.

Some other misinformation is I'm not sure how dairy products are made. Certainly, we have a lot of regulation in the United States that not only dairy is safe, it's a health benefit. Other aspects, oh, well, I have these on my grocery list and I usually see that yogurt is really expensive. But actually if you walk in the grocery, and I'll say the dairy aisle, dairy is some of our most cost-effective foods out there.

Milk is relatively inexpensive. Cheese, yogurt, different types of yogurt. So those are usually the things that parents will say that it's easier for me to perhaps purchase a processed food versus dairy, but really understanding that not only is dairy cost-effective, the effectiveness that it will have on your nutrition and your health. So I start there with the misinformation really to provide them accurate information that's based on the science. So that's like… We'll take that breath there.

And then, Alan, going back to why about the parents? Because kids live with their parents or caregiver or an adult. And oftentimes kids are not making the food choices early on as children. They eat what they are served or what they see on the table or what's in their refrigerator. And so it's really important for the adults in the household to be buying these nutritious foods and making sure that children are exposed. And if we're able to create that foundation early on, 3, 4, 5, then when they're 13, 14, 15, they're now able to make the nutritious choices or selection in adolescence and that carries on with them. So really where it's… Again, I am treating the child, it's really an education of the family. And when we see families transition and adopt more nutritious and healthy foods in the household, that translates to the children.

Alan Bjerga: Let's take a moment and talk about something related, which is plant-based beverages. Studies show this that there is confusion between the nutritional value of plant-based beverages relative to dairy. When you see families bring in their kids and you're asking their questions, what is the difference that you might commonly see between a family that our kids are consuming milk and drinking dairy versus ones that may be saying, for whatever reasons, we've decided to switch to a plant-based beverage?

Dr. Priscilla Mpasi: This is important to navigate. And when we have our grocery store partners, we're going to see dairy, we're going to see milk as a promoted item. And I'm glad that we're using the term plant-based beverage because if it's plant-based, it's actually not milk. It's using, some people will say an alternative in that regard. And so it's really important, first I ask the why. And some families will say, "Well, we're really trying to be healthy." So that means there's something in their informational gathering that translated that milk is not healthy or a plant-based beverage is healthier than milk. And some will say there's too much sugar and people use the term sugar. But if you actually look at the nutritional facts, the amount of carbohydrates in milk is relatively low, it's appropriate. Some might say, again, I can't tolerate lactose. Okay, so we'll start there. So that's why parents switch their kids.

So think about it, if you're a parent, you have three kids in the house and you may need to have a plant-based beverage because of your health, who wants to buy two or three different types of milk in the house? If you buy one milk, everyone drinks that milk. That's the really important part of education is that your health may require plant-based beverage of lactose intolerance. What are the other opportunities for the kids? Milk, we could do a lactose-free milk. It's right next to the milk. Let's start there. They're still getting all the dairy nutrients. The lactose is removed so it's easier to process. But from children's zero to five, we really need to be providing cows milk. What are opportunities to get that? Maybe not buying a full gallon in the house if it's not going to be fully consumed. We can do pint, we can do quart, half gallon, right? There's those other options there.

But I think what's really, really telling for families is when you compare the nutrition facts, and I think that's like the… Right? And so what is actually in milk, as we look at the fat, we look at the carbohydrates and we look at the protein is our macros and then all the different minerals and vitamins such as calcium that's in there. When you compare them, there's a vast, vast difference, Alan, when I say vast, vast. So what we really look at is the fat and protein. There are good fats. People say, "Oh, there's good fats, fish, oil, avocado." The fat in milk is one of those good fats, guys. Put that on your list, it's good fat. But when we start to get to plant-based beverages, we actually have a decrease in that fat content and we have a significant decrease in protein content as well.

And then we actually see in the reverse is that we will see an increase in carbohydrate content as well. So we have to really know what's in our beverages. And it's really simple. You can look at the back, compare the two and see. And so I often put them side by side. Now, Alan, there are going to be families where again, we do have a true lactose intolerance. So what would we recommend? We like lactose-free milk first and if we need to, the equivalent that we recommend is soy. We still see some of the protein content and fat content in soy. That is really the only alternative if a cow milk or lactose-free milk is not an option.

So the encouragement is not only the health benefit, but really looking at the nutritional facts. Sometimes you can't just tell people, they need to see it. When they're looking at the numbers, it's very clear where the best nutrient option is with milk versus our plant-based beverages.

Alan Bjerga: It's always a pleasure, Dr. Mpasi, to talk to someone who has such evident passion and knowledge on the topic, but it's also easy to get caught up in the conversation and miss something important. So if we've missed something here, is there anything you'd like to add?

Dr. Priscilla Mpasi: Yeah, if I could, I always tell… I say people, may not be a patient, may not be a family of a patient, is that the first thing is to ask, I have a question about nutrition, who can I ask? Physician is a great start. I would also say registered dietitian, nutritionist. These are actually who I turn to, where other physician colleagues turn to really to be that expert about nutrition and provide up-to-date information and the science. And so that collaboration I think really has been pivotal where we've seen just positive improvement in nutrition education and uptake in dairy milk.

So I always encourage, is there an opportunity for a registered dietitian to be available? Are we including school dietetics or dietetics in our school nutrition programs? That's the first thing that I would add is ask those that are the experts. Then I think second is remembering again that when we say you are what you eat, there is a lot of truth in that.

And so I would encourage us to really be mindful that we're eating foods that are going to provide us energy, that are going to provide us nutrients, that are going to maintain us throughout our lifespan. And so where this conversation is focused on dairy and particularly milk and our upcoming dietary guidelines, we always say it's better to pair and not P-E-A-R. But that is a fruit. But pair, P-A-I-R. And so when you're reaching for that dairy, what are the other paired foods that you can have that promote that nutrition? So fruits, vegetables, healthy grains, and protein. And that really should set your foundation for physical health and mental wellness.

So Alan, I really appreciate you giving me this time to share what we're seeing in our practice and just every day tips on how to be more nutritious.

Alan Bjerga: We've been speaking with Dr. Priscilla Mpasi, a pediatrician and advocate for children, and an expert on equity and nutrition. Thank you so much for joining us.

Dr. Priscilla Mpasi: Thank you again for having me.

Alan Bjerga: For more on the Dietary Guidelines for Americans and how you can make your own thoughts known on them, visit our website NMPF.org and click on the big red box that says, "Act now, support dairy and science in the dietary guidelines for Americans." And if you want to find more Dairy Defined podcasts, go to Apple Podcast, Spotify. We're on all of them. And search for Dairy Defined. Till next time.