MILK AND DIABETES, a second opinion

John McDougall, MD, receives my vote for America's best
practicing physician.

In today's column, Dr. McDougall reports that in high milk-
drinking populations, rates of Type-1 diabetes occur at a
frequency five times greater than in low milk consumption
groups.

I'm glad that you said that and not me, Dr. Mc-D! Similar
statements have gotten me tarred, feathered, and then boiled
in hot oil by the know-it-alls at vegsore.com. I've been
grilled, roasted, toasted, and then hung out to dry. Good
thing you've got a free pass! ;>)
_______________________________________________________
Dr. McDougall has written a magnificent paper on the link
between milk consumption and diabetes. I am pleased to
observe that his first two references are among the seven
that I include on pages 10-11 of my book, MILK: A-Z. As a
matter of record, four of my seven citations are among
McDougall's rigorously researched scientific references.

D IS FOR DIABETES:

http://www.notmilk.com/d.html

2002 John McDougall All Rights Reserved July 2002 - Vol. 1 -
No.7
__________________________________________
The Pancreas - Under Attack by Cow-Milk
__________________________________________

Most likely you will never know you have a pancreas, yet
without it you would become very sick, and likely die. So
this little organ is working 24/7 for you, most of the time
without a single complaint. Anatomically, the pancreas is
about six inches long and two inches wide, weighs about 3
ounces, and is situated in the posterior, upper left part of
your abdomen.

In the butcher shop this organ is sold as sweetbread (from a
cow). Based on its functions, the pancreas would best be
thought of as two separate organs: the organ that makes
digestive juices (the exocrine pancreas) and the one that
makes hormones for the whole body (endocrine pancreas).

The "exocrine pancreas" produces enzymes (delivered through
a duct to the first part of the small intestine) that digest
proteins, fats and carbohydrates, so they can be absorbed
through the intestine. The "endocrine pancreas" produces
hormones, like insulin, which regulate the use and storage
of the body's main energy sources, glucose (sugar) and fats.
These hormones (delivered through the blood stream) are
produced in very specific clumps of cells (islets). The
insulin-producing cells are called (beta) cells.

Type 1 (Childhood) Diabetes – The Milk-Drinkers Disease

Type 1 diabetes is often referred to as childhood type
diabetes, because this has historically been the most common
kind of diabetes in children, and also as insulin dependent
diabetes mellitus (IDDM), because patients must take daily
injections of insulin for the rest of their lives. However,
this relatively common disease is not restricted to children
and many times appears for the first time in adulthood. Over
1.6 million Americans have type 1 diabetes. A more common
form of diabetes is called type 2 (adult onset and non-
insulin dependent). This type 2 form is due to the high-fat
Western diet and resulting obesity, and occurs at least nine
times more frequently than type 1.

The evidence incriminating cow-milk consumption in the cause
of type 1 diabetes is sufficient to cause the American
Academy of Pediatrics to issue this warning, "Early exposure
of infants to cow's milk protein may be an important factor
in the initiation of the (beta) cell destructive process in
some individuals." and "The avoidance of cow's milk protein
for the first several months of life may reduce the later
development of IDDM or delay its onset in susceptible
people." (The American Academy of Pediatrics Work Group on
Cow's Milk Protein and Diabetes Mellitus – 1994).

The Milk-Invader and Molecular Mimicry

The problems all begin because of the natural condition of
the intestine of a very young infant. Proteins produced by
mother, and found in human mother's breast milk, serve to
promote an infant's health and immunity from disease. During
the first few months of life the intestinal wall of an
infant is quite permeable in order to allow the passage of
these intact proteins into the infant's body. Unfortunately,
serious health problems can develop when foreign proteins
are allowed into the infant's permeable intestinal tract.
Cow-milk proteins are unique in that they are usually the
first foreign proteins entering an infant's gut and body,
because most baby formulas are usually cow-milk based.

Once the cow-milk proteins are absorbed into the
bloodstream, our immune system recognizes them as invaders,
which as far as our bodies are concerned, could be the
foreign protein of a virus's coat or a bacteria cell wall.
The immune system responds with an appropriate defense –
antibodies are made against the foreign protein, and immune
cells, called T-cells, are directed to find and destroy
these trespassers.

Unfortunately, in an effort to do the right thing, some
people's immune systems become slightly confused and attack
not only the foreign cow-milk proteins, but also the
insulin-producing (beta) cells of the pancreas. The reason
this happens in only some people, and not everyone, is
unknown. One explanation has to do with the difference in
the permeability of intestinal walls. Some intestines allow
proteins into the body more easily, because of injuries
caused by viruses, environmental chemicals, medications
(NSAID, like Motrin and Advil), and the unhealthy, high-fat,
high cholesterol diet. This condition is sometimes called a
"leaky gut." A very "leaky gut" will indiscriminately allow
the influx of foreign proteins into the body.

Once the cow-milk protein is in the blood then a phenomenon,
known as "molecular mimicry," occurs. Foreign proteins, like
cow-milk, stimulate the production of antibodies directed
against small segments of their proteins – specific
sequences of amino acids. Unfortunately, these same
sequences of amino acids are also found on the body's own
tissues (a copy or mimic of the foreign protein segment). In
the case of type 1 diabetes, a segment of 17 amino acids has
been identified on the cow-milk protein that is identical to
a segment on the surface of the insulin-producing (beta)
cells of the pancreas. Antibodies appropriately produced to
attack and destroy the cow-milk protein find the (beta)
cells first -- they attach to the cell surfaces, activating
T-cells, which then attack and destroy these insulin-
producing cells. Once these cells are destroyed, the
pancreas can no longer produce sufficient amounts of insulin
for the body's needs.

The Handicap of Diabetes

Even though the process of � cell destruction may take
three to five years on the average, the onset of the disease
usually appears to be sudden and is often catastrophic. The
apparently well child (or adult) becomes very ill with
symptoms of excessive thirst, urination, and fatigue – many
times followed by coma, and sometimes death. The lifesaving
treatment is very specific: replacement of insulin by daily
injections.

Once the cells are destroyed they will not grow back,
therefore the disease is permanent and the patient will
always require insulin (unless some future technology
changes this). Insulin replacement therapy is far from
perfect and does not correct all of the underlying metabolic
problems. A patient living with a damaged pancreas has an
increased risk for premature development of serious
complications, such as kidney failure, blindness, heart
attacks, osteoporosis, and cancer. As you will recall, these
are also the problems faced by people without diabetes who
are on the Western diet. But the threats to a diabetic's
health are much greater.

Diabetics are metabolically handicapped people, hampered in
their ability to defend and repair themselves from outside
injuries, like an infection or an unhealthy diet (the high-
fat, high-cholesterol Western diet). Therefore, to help
counteract this disadvantage, people with this disease must
be cared for with vigilance – and that means very careful
control of their blood sugars with insulin injections, a
wholesome lifestyle, and most-importantly, a health-
supporting diet. This is a diet of starches with vegetables
and fruits – the less meat, dairy, processed foods and
vegetable oil the better. By this effort, the type 1
diabetic has the best chance to avoid premature death and
serious complications. In fact, the only people I have met
with long-standing diabetes who still have all their parts
working after 40 years of disease, have been those following
a low-fat nearly vegetarian diet – the best example are
those few fortunate people following the Kempner Rice Diet
from Duke University – sometimes for 50 years.

Inherited by an Education

There is some inherited tendency to develop type 1 diabetes,
but it is only a tendency, and actually most people (90%)
who develop this disease do not have close relatives with
it. In about 30% of identical twins, both get diabetes. To
bring out this genetic tendency requires an environmental
toxin. Infectious agents, like viruses, have been suspected
to cause type 1 diabetes. More likely, when an infection
like a virus is involved, it acts as a nonspecific stress,
late in the process of disease development, that increases
the body's needs for insulin and precipitates a rise in
blood sugar earlier than would have occurred otherwise.
Rather than through genetic inheritance or a transmitted
virus, the past 20 years of accumulated evidence has shown
the tendency to run in families is largely fostered by
mother and father teaching sons and daughters to consume
dairy products. Since the cow-protein is the culprit
activating the immune reaction, low-fat dairy products would
cause at least as much harm as the full-fat versions.

Evidence Incriminating Cow-Milk: Population Studies
(Epidemiology):

When populations of people who are genetically similar have
a different incidence of disease then something in the
environment must be suspected as the cause. The strongest
contact we have with our environment is our food. This
environmental relationship is further confirmed when people
migrate from an area of low incidence to high incidence, and
increase their risk of developing disease. This migration
phenomena has been seen, for example, when Samoan children
move to New Zealand and when Asians move to England.(2)

There is a strong correlation between total cow-milk
consumption and type 1 diabetes, worldwide.(3) For example,
Finland, a high milk-consuming population, has 36 times more
type 1 diabetes than does a country of low consumption, like
Japan.(4) A similar relationship has been found within a
single country, for example, between 9 regions of Italy –
regions consuming the most milk have the most diabetes.(5)

Type 1 diabetes is one of the fastest growing diseases in
the world. There has been a rapid increase (greater than 10-
fold) in type 1 diabetes in European countries in the past
few decades, especially in children under five years.(6)
This rise clearly points to an environmental, rather than a
genetic cause. This rise has been paralleled by an increase
in fluid milk intake.

There are notable exceptions to this strong positive
correlation between cow-milk consumption and type 1 diabetes
– but there is also a scientific explanation for the
discrepancies. (7,8) Examples of this apparent inconsistency
are seen in Iceland, New Zealand, and the Maasai people of
Tanzania, Africa. In these populations there is high milk
consumption and low diabetes. The explanation is: cow-milks
from different herds have important differences in their
proteins. The cow-milk found in populations with a low
incidence of type 1 diabetes has a much lower fraction of A1
and B caseins (instead they have the A2 variant). The A1 and
B forms of caseins are believed to be the proteins that
cause the body to respond by destroying the insulin-
producing cells of the pancreas. When these variants of cow-
milk are taken into consideration then the correlation of
cow-milk consumption and type 1 diabetes becomes evident. It
is estimated that 80% of dairy cows have this A1 and or B
variant. One reason this may be so frequently found is
because cows have been selectively bred this way to increase
the protein content of the cow-milk (a quality desired by
dairy producers).(9)

Case Studies:

Studies comparing populations of people with type 1 diabetes
with healthy individuals indicate the risk of developing
type 1 diabetes is 5.4 times greater in high milk consumers
(3 or more glasses a day) compared to those who drink less
milk (less than 3 glasses a day). (10)

Milk-induced Changes in the Immune System:

Children newly diagnosed with type 1 diabetes have been
found to have increased levels of antibodies directed to
several different cow-milk proteins.(11-13)

Antibodies against cow-milk protein (specifically bovine
serum albumin and an ABBOS peptide of 17 amino acids) were
found to react with a similar-looking sequence of amino
acids on the cells of the pancreas in 100% of children newly
diagnosed with type 1 diabetes. (1)

Antibodies to insulin often appear in children who develop
type 1 diabetes. This is caused by exposure of an infant
(before the age of three months) to cow's insulin (bovine
insulin) found in the milk the child drinks.(14) These
antibodies to cow-milk also attack human insulin and may be
the trigger for the autoimmune response that causes
diabetes.

Immune cells, known as T-cells, have been found to
proliferate in response to cow-milk proteins in newly
diagnosed type 1 diabetic children.(9) These T-cells, once
activated by cow-milk, then attack the cells of the pancreas
and destroy them. Molecular mimicry appears to be involved.

Avoidance of cow-milk through exclusive breast feeding
prevents the development of antibodies to cow-milk protein
(casein).(15) Only bottle-fed infants show reactions to cow-
milk proteins. Increased levels of antibodies to these cow-
milk proteins are found in children with type 1 diabetes.

Please note: A nursing mother consuming cow-milk can pass
the proteins to her infant through her breast milk.16
Whether this kind of cow-milk protein consumption is a cause
of type 1 diabetes is not known, but it would be prudent for
a nursing mother to avoid cow-milk in her diet.(17)

Animal studies:

Experimental animals (mice and rats) fed cow-milk have been
found to develop diabetes.18-20 It is important to note that
soy protein and wheat protein have also caused experimental
animals to develop diabetes.(21) This is another reason
breast feeding exclusively is the right choice and why soy-
based infant formulas are not an acceptable substitute for
cow-milk based formulas (see next month's newsletter for
even more compelling reasons to use soy with caution). For
maximum benefit for the young child, feed mother's breast
milk exclusively for six months and then as a decreasing
part of the diet until the child is two years of age. (For a
comprehensive discussion of the importance of breast feeding
read The McDougall Program for Women).

Sensible Action: Cow-milk Avoidance:

The dairy industry makes attempts to argue against their
products causing type 1 diabetes. (You can view their very
selective use of the scientific literature to defend the
safety of their products here (long URL-you must paste
this):

http://www.nationaldairycouncil.org/lvl04/nutrilib/relresearch/diabetes_6.html

These arguments don't fool the American Academy of
Pediatrics and hundreds of top scientists worldwide, and
they don't fool me. I would suggest you take the less risky
road for your family. Since cow-milk is ideal for baby cows
and was never intended for human children, act naturally and
avoid a potential tragedy. With the same action you will be
reducing the risk of constipation, arthritis, ear
infections, asthma, bed-wetting, eczema, lactose
intolerance, and obesity, as well as future cancers, strokes
and heart disease. There is no human nutritional requirement
for cow-milk. It is deficient in dietary fiber, essential
fats, niacin, vitamin C, and iron, and overloaded with
calories, saturated fat, environmental chemicals, and
disease pathogens (bacteria and viruses).

The dairy industry's main selling point is calcium; however
a thorough review by researchers at the Department of
Nutritional Sciences, University of Alabama, of 57 studies
on cow-milk and bone health came to this conclusion: "In
fact, of the studies providing strong evidence, only 29%
showed favorable effects and 14% showed unfavorable effects
on bone status. These values suggest that there is little
risk of harm to the skeletal system if recommendations to
the general population to consume dairy foods are heeded.
However, these values do not provide a solid body of
evidence to support this recommendation." (22) By the way,
most of the studies reviewed here were paid for by the dairy
industry – and they still failed to show their products met
the manufacturer's multimillion dollar advertising claims.
No one has ever become ill or died from a lack of cow-milk.
Without a doubt, the opposite is true for billions of
people.

Pancreatic Cancer

Pancreatic cancer is the fifth leading cause of cancer death
in the United States. Because of the deep location of the
pancreas inside the abdomen, diagnosis of the disease is
difficult, and as a result it is nearly always fatal in a
matter of months – 90% have died within 12 months of
diagnosis. Even with the best that modern medicine has to
offer, approximately 25,000 people die from this disease
yearly. Therefore, if you want to effectively win the war on
cancer of the pancreas you must do so by prevention.

The only well-established causative factor is cigarette
smoking. However, diet, I believe, is the most likely cause
of most cases. This is disease of developed countries –
where the rich Western diet is consumed. There are data that
show a diet high in fruits and vegetables is associated with
a lower risk of pancreatic cancer.(23,24) Obesity, alcohol,
coffee, saturated fat, animal protein, high-fat dairy
products, and low physical activity increase the risk. There
is also an association with chronic pancreatitis and
diabetes – both are diseases of the Western diet (discussed
above and below).

Prevention is the key to dealing with pancreatic cancer. But
what can be done for those less fortunate patients already
with pancreatic cancer? A case control study demonstrated
that patients with metastatic pancreatic cancer who ate a
diet of fruits and vegetables (a macrobiotic diet) lived
longer (17 months versus six months) and enjoyed an improved
quality of life.(25) This study from researchers at Tulane
University showed half of those on the macrobiotic diet were
alive after one year, compared to only 10% on the regular
diet. The researchers concluded that the macrobiotic
approach may be an effective treatment, writing "This
exploratory analysis suggests that a strict macrobiotic diet
is more likely to be effective in the long-term management
of cancer than are diets that provide a variety of other
foods."

Pancreatitis

Pancreatitis is an inflammatory condition of the pancreas
that is very painful and at times deadly. The mortality rate
of acute pancreatitis is about 10%. Chronic forms of
pancreatitis can devastate a person's life over many years.
Patients suffer abdominal pain and malnutrition, and have a
higher risk of pancreatic cancer. Chronic alcohol abuse and
an unhealthy diet are known to cause acute and chronic
pancreatitis.(26) A high protein ketogenic diet has been
reported to cause pancreatitis that killed a child.(27) (The
Atkins diet is a high protein, ketogenic diet). Diets high
in sugar and fat will cause the level of blood fats, known
as triglycerides, to rise in some people. The elevated
triglycerides seem to interfere with the circulation of the
pancreas and cause severe inflammation, known as
pancreatitis. A low-fat, complex carbohydrate diet and
alcohol avoidance is the foundation to preventing further
attacks.

References:

1. Karjalainen J. A bovine albumin peptide as a possible
trigger of insulin-dependent diabetes mellitus. N Engl J
Med. 1992 Jul 30;327(5):302-7.

2. Verge C. Environmental factors in childhood IDDM. A
population-based, case-control study. Diabetes Care. 1994
Dec;17(12):1381-9.

3. Dahl-Jorgensen K. Relationship between cows' milk
consumption and incidence of IDDM in childhood. Diabetes
Care. 1991 Nov;14(11):1081-3.

4. LaPorte R. Geographic differences in the risk of insulin-
dependent diabetes mellitus: the importance of registries.
Diabetes Care. 1985 Sep-Oct;8 Suppl 1:101-7.

5. Fava D. Relationship between dairy product consumption
and incidence of IDDM in childhood in Italy. Diabetes Care.
1994 Dec;17(12):1488-90.

6. Patterson C. Is childhood-onset type I diabetes a wealth-
related disease? An ecological analysis of European
incidence rates. Diabetologia. 2001 Oct;44 Suppl 3:B9-16.

7. Elliott R. Type I (insulin-dependent) diabetes mellitus
and cow milk: casein variant consumption. Diabetologia. 1999
Mar;42(3):292-6.

8. Thorsdottir I. Different beta-casein fractions in
Icelandic versus Scandinavian cow's milk may influence
diabetogenicity of cow's milk in infancy and explain low
incidence of insulin-dependent diabetes mellitus in Iceland.
Pediatrics. 2000 Oct;106(4):719-24.

9. Cavallo M. Cell-mediated immune response to beta casein
in recent-onset insulin-dependent diabetes: implications for
disease pathogenesis. Lancet. 1996 Oct 5;348(9032):926-8.

10. Virtanen S. Cow's milk consumption, HLA-DQB1 genotype,
and type 1 diabetes: a nested case-control study of siblings
of children with diabetes. Childhood diabetes in Finland
study group. Diabetes. 2000 Jun;49(6):912-7.

11. Savilahti E. Children with newly diagnosed insulin
dependent diabetes mellitus have increased levels of cow's
milk antibodies. Diabetes Res. 1988 Mar;7(3):137-40.

12. Dahlqvist G. An increased level of antibodies to beta-
lactoglobulin is a risk determinant for early-onset type 1
(insulin-dependent) diabetes mellitus independent of islet
cell antibodies and early introduction of cow's milk.
Diabetologia. 1992 Oct;35(10):980-4.

13. Saukkonen T. IgA bovine serum albumin antibodies are
increased in newly diagnosed patients with insulin-dependent
diabetes mellitus, but the increase is not an independent
risk factor for diabetes. Acta Paediatr. 1995
Nov;84(11):1258-61.

14. Vaarala O. Cow's milk formula feeding induces primary
immunization to insulin in infants at genetic risk for type
1 diabetes. Diabetes. 1999 Jul;48(7):1389-94.

15. Monetini L. Bovine beta-casein antibodies in breast- and
bottle-fed infants: their relevance in Type 1 diabetes.
Diabetes Metab Res Rev. 2001 Jan-Feb;17(1):51-4.

16. Jakobsson I. Dietary bovine beta-lactoglobulin is
transferred to human milk. Acta Paediatr Scand. 1985
May;74(3):342-5.

17. Murch S. Diabetes and cows' milk. Lancet. 1996 Dec
14;348(9042):1656.

18. Elliott R. Dietary prevention of diabetes in the non-
obese diabetic mouse. Diabetologia. 1988 Jan;31(1):62-4.

19. Karges W. Immunological aspects of nutritional diabetes
prevention in NOD mice: a pilot study for the cow's milk-
based IDDM prevention trial. Diabetes. 1997 Apr;46(4):557-
64.

20. Scott F. Potential mechanisms by which certain foods
promote or inhibit the development of spontaneous diabetes
in BB rats: dose, timing, early effect on islet area, and
switch in infiltrate from Th1 to Th2 cells. Diabetes. 1997
Apr;46(4):589-98.

21. Akerblom H. Putative environmental factors in Type 1
diabetes. Diabetes Metab Rev. 1998 Mar;14(1):31-67.

22. Weinsier R. Dairy foods and bone health: examination of
the evidence. Am J Clin Nutr. 2000 Sep;72(3):681-9.

23. Stolzenberg-Solomon R. Prospective study of diet and
pancreatic cancer in male smokers. Am J Epidemiol. 2002 May
1;155(9):783-92.

24. Potter D. Pancreas cancer--we know about smoking, but do
we know anything else? Am J Epidemiol. 2002 May
1;155(9):793-5.

25. Carter J. Hypothesis: dietary management may improve
survival from nutritionally linked cancers based on analysis
of representative cases. J Am Coll Nutr. 1993 Jun;12(3):209-
26.

26. Athyros V. Long-term follow-up of patients with acute
hypertriglyceridemia-induced pancreatitis. J Clin
Gastroenterol. 2002 Apr;34(4):472-5.

27. Stewart W. Acute pancreatitis causing death in a child
on the ketogenic diet. J Child Neurol. 2001 Sep;16(9):682.