Spilling Milk On Asians
Those of us who grew up in Asian households understand that food--as a socio-political issue--is not to be taken lightly. There are certain rules, at least in Chinese food culture, that must be observed at mealtime. Most revolve around Chinese principles of thrift, balance and manners. My mother taught me at a very young age to finish every last grain of rice in my bowl. At the end of each meal, IÕd hold up my bowl and say coyly, "Can I go now?" Inevitably, she would point a long, unforgiving chopstick to a single, cold and lonely grain of rice that IÕd somehow overlooked, or forgotten to flick under the table. There are other rules of Chinese culinary culture, such as too much green on a dish should be balanced by some red. One should never be the first to move in on dinner, but defer to the guest who immediately will defer back to the host who must defer back to the guest. I have seen my Chinese grandfather engage in full-contact wrestling to pay a restaurant tab, and my mother run full-tilt, check clutched in her fist, toward a frightened cashier. There are more rules of Chinese dining I canÕt think of right now, but I know that drinking milk is not one of them. Dairy products do not factor into Chinese cuisine. My grandmother grows faint at the mere sight of cheese. Quite simply, Chinese and most Asian cultures have never looked to the cow to provide anything beyond meat and labor. Operating on instinct, common sense and oral tradition, the Chinese have never even had a list of four basic food groups, never mind the more technically advanced food pyramid of today. It looks, however, as if the California Milk Advisory Board is out to change all that. The milk board--part of the lobby responsible for "Every Body Needs Milk" and the recent "got milk?" ad campaigns--has recently released the third in a multi-pronged attempt to fork dairy products into the mouths of the burgeoning Asian immigrant culture in the golden state. They have created an Asian American version of the U.S. Department of Agriculture food-guide pyramid, which includes traditional Asian foods like rice, noodles, soy sauce and tofu along, with, er, milk, yogurt and cheese. On the cover, a user-friendly graphic includes a bowl of rice, an apple, hot chile peppers and a carton of milk, and is tagged with a headline that reads--translated from the Chinese brochure--"The Healthy Way to Eat." Written in Chinese, Japanese, Korean, Vietnamese and Tagalog (for Filipinos) the new pyramid is being distributed statewide through "Asian healthcare professionals," who received it in the mail from the milk advisory board. But do Asians really need dairy products? Do they need an American food guide at all? According to some nutritional researchers, most Americans could take a hint from Asian diets, which are traditionally high in fruits and fresh vegetables, low in sugars and meats, and devoid of high-fat, high-cholesterol dairy products. Critics of the dairy industry charge the milk board with pushing milk and dairy products on Asian cultures which have thrived until now on dairy-free diets and as a result have a lower digestive tolerance for such products than cultures weaned on milk. In fact, a recent diet and nutrition newsletter from Tufts University estimates that more than half of all Asians suffer gastrointestinal disorders from consuming milk. And the milk board campaign--including guides to using fluid milk and milk products in home cooking with recipes for pizza and grilled cheese sandwiches--comes at a time when the historically touted benefits of dairy products are souring in the minds of many. The national advocacy group Physicians for Socially Responsible Medicine--cooperating with such notable doctors as Benjamin Spock, Henry Heimlich and Dean Ornish--is currently on a campaign to re-label animal-product foods (including milk and dairy products) in the pyramid as optional, rather than recommended. Animal proteins like those found in dairy products, they assert, may actually contribute to osteoporosis and decreased calcium absorption by bones. Given these trends, is a dairy-inclusive food guide for Asians wise? Or just plain rude?Spilled Milk Linda Lau is a registered dietitian and paid consultant for the milk board who assisted with the Chinese version of the Asian pyramid. According to Lau, the new pyramid serves to fill a gap in Asian immigrantsÕ understanding of American foods. "ItÕs very necessary to help educate them," she says. "These brochures encourage Asians to take advantage of whatÕs available to them here." The press release that accompanies the Asian pyramid asserts that newcomers diets suffer due to a lack of understanding of new foods, as well as the unavailability of more familiar, native foods." My mother reads this over a bowl of winter melon soup and says, "What do they mean? We have everything here." SheÕs referring to the plethora of Asian food markets, restaurants and entire shopping malls that supply Asian households where she lives (the Bay Area) with everything from tofu to sea slugs. Granted, a Chinese immigrant in many parts of the land might have more difficulty locating red bean paste than a Chinese immigrant in the Santa Clara Valley in California, where megamarkets with internal restaurants and bakeries catering specifically to Asians gleam like Epicurean Taj Mahals. But Joanne Ikeda, consultant to ethnic nutrition programs for the USDA Department of Nutritional Sciences, insists many new immigrants are confused over the vast array of dairy products found on CaliforniaÕs traditional supermarket shelves. Ikeda has worked for the past three years with Hmong and Vietnamese immigrants from San Jose to the Central Valley, and says "many of the women do want to know what to do" with dairy and other American products. The immigrant Asian families Ikeda counsels are low-income, and recipients of dairy-specific coupons from the Women, Infants and Children (WIC) nutritional-supplement program. To help educate immigrants about dairy products, Ikeda sponsors tasting parties where participants sample various kinds of milk, yogurt and cheese. "Some of the Hmong women thought that cheddar cheese was bad, because they thought it smelled like vomit," she relates. "I am not pushing milk and dairy on new immigrants. But they need to know how to use them." But Dr. Ronald Cridland, a family physician based in Rohnert Park, CA, and a member of Physicians for Socially Responsible Medicine, says the dairy industry uses government programs like WIC to pawn off its excess product. "TheyÕre trying to get you hooked and thinking that you need this," he asserts. "A conscientious nutritionist would tell them to throw the coupons away and show them how their native diet has developed through centuries to be healthy and fully adequate." But Ikeda disagrees. "You canÕt insulate a population from the greater society," she says, adding that new immigrants are pressured by their children to buy and use dairy products that they receive at school and from friends. Yu-Chu Pwu, a clinical dietitian at the OÕConnor Hospital in San Jose, says she has received the milk board pyramid--and plans to use it. "This will help them to choose better," she says. "Asians need to know how important calcium is for our health. Dairy is not the sole source of calcium, but it is a very excellent source." At the San Francisco Department of Public Health, nutritionist Katherine Wong says, "All my clients are totally confused about dairy products." Pointing to a dearth of nutritional guides written in Asian languages, Wong is grateful for the bilingual help. Wong adds, "I like what the milk council has come out with. ItÕs cute, and I can use it to counsel them.""Deceptive and Outrageous" It would be naive to think, however, that the California Milk Advisory Board is releasing Asian food guides strictly for the purpose of improving the health and welfare of Asian immigrants. The food-guide pyramid makes little distinction between high- and low-fat milk products. And, although it includes drawings of traditional Asian foods in all other of the food groups, the pyramid sports drawings only of dairy products in the "Milk and Calcium Group"--while noting in print that "additional sources of calcium include: tofu, small dried fish with bones, leafy green vegetables." "That was a very small space to put anything," says Nancy Gere with the public relations firm the Montgomery Group, which is fronting the milk boardÕs Asian campaign. "ThatÕs whatÕs on the USDA pyramid," she notes. All of the illustrative graphics in the pamphlet include a dairy product like cheese or yogurt, and "snacking" recommendations include a "cheese slice with crackers or fruit," "cereal with milk," and "graham crackers with milk." The milk boardÕs guides to using milk and milk products include milk and butter as ingredients for curry and custard recipes. The pamphlets assert that "foods made from milk are natural, nutritious ... [and] contain nutrients you need to grow and stay healthy," and include non-specific, milk-toast statements about calcium and the prevention of osteoporosis. Those who are currently lobbying to reform the USDA food pyramid of its dairy and meat habit say the milk boardÕs current campaign is insidious. "ItÕs one thing to promote milk through an advertisement. ItÕs another thing to pass it off as nutritional advice from so-called experts," says Dave Wasser, communications director for Physicians for Socially Responsible Medicine. "This is basically a propaganda campaign--itÕs deceptive and outrageous." Outspoken members of Physicians and other nutrition groups observe that most dairy products--like most animal products--are high in fat and cholesterol and thus contribute to obesity and heart disease. Immigrants often pick up these American health problems within one generation of adopting a more western diet. Further, Asians, like African Americans and Latinos, are more prone to lactose intolerance than Caucasians and often suffer digestive problems when they drink milk. The milk board suggests those Asians try Lactaid pills, lactose-reduced milk, or, as Lau recommends, start with small amounts of milk and increase consumption slowly. But milk and dairy products can cause problems for both Asians and Caucasians alike. Research published in the New England Journal of Medicine, the American Journal of Clinical Nutrition and other respected publications shows links between dairy products and various food allergies, insulin-dependent diabetes, and blood loss in infants. Some research indicates that calcium absorption is better when calcium is consumed in vegetable form, like in kale, Brussels sprouts or broccoli. And some research seems to show that animal proteins like those found in meats, milk and milk products may actually inhibit the absorption of calcium into the bones, if not actually leach it from the bones. As a result, doctors like Neal Barnhard of the Physicians group question the recommended daily allowance of calcium, observing that we may not need more calcium, or even the U.S. recommended daily allowance, but need to limit our intake of animal proteins.Dare We Push Dairy? Those who have studied Asian diets say it would be shameful to introduce dairy products to cultures which seem to have done just fine--thank you--without them. Japan, for example, has the worldÕs highest life expectancy rate, and a very low dairy-consumption rate. In Japan and China, cholesterol levels are half those in the U.S., and Japanese men suffer 30 percent less coronary heart disease than U.S. men. Breast cancer rates are also lower in Japan, as are rates for colon, prostate and rectal cancers. Dr. T. Colin Campbell is director of the China Project, an exhaustive nutritional research project sponsored by Cornell and Oxford Universities, the Chinese Academy of Preventive Medicine and the Chinese Academy of Medical Sciences. The project spans more than 10 years and 170 villages in China and Taiwan. According to Campbell, research from this "most comprehensive study on diet and disease in the history of medicine" actually shows increased osteoporosis rates in areas of China where dairy consumption is higher. "There is nothing in dairy that the Chinese need. [The food guide] is one of the more foolish things that the dairy board has done. I imagine the dairy industry would very much like to see the Chinese use dairy. And that would be, for the Chinese at least, both foolish and stupid." The milk boardÕs Asian food guide, he says, "is blatant commercialism at its worst." But why do most registered dietitians, even Asian dietitians, seem to support the use of dairy products for calcium intake? While Campbell comments that registered dietitians are "generally the most informed group I talk to," he also claims many "tend to reflect the views of their associations and institutes, and theyÕre not necessarily at the forefront of the latest research, which shows that dairy food contains proteins that cause calcium to be lost from the body." Even milk industry consultants verify research showing that animal proteins cause an "increase in the urinary excretion of calcium," according to Joan Walsh, Ph.D., R.D. and part-time consultant for the milk board. Walsh argues, however, that "there is no research that shows that [animal proteins] negate the benefits of [general] calcium intake" through dairy products. But studies at the University of Connecticut at Storrs show that protein, particularly animal protein, can create a "negative calcium balance" when more calcium is lost than retained in the body. Some studies support Dr. CampbellÕs findings, and show that countries with the highest meat and dairy intake also have the highest rates of osteoporosis. Apparently, the jury is still out with the dairy verdict. Dr. Walsh refers to studies that show a positive correlation between dairy products and prevention of osteoporosis. The National Institutes of Health continues to recommend a high daily calcium intake, especially for teens, lactating mothers and post-menopausal women, and recommends dairy products as a "preferred source" of calcium. The NIH also recommends further study on the matter. As nutritionist Wong says, "ThereÕs a tremendous lack of data in this area. I donÕt think weÕre ready to push or not push milk." ThereÕs currently no evidence to suggest that Asian immigrants are somehow suffering higher rates of osteoporosis and need increased calcium. Research physiologist Marta VanLoan with the USDAÕs Western Human Nutrition Research Center is in the process of studying Asian bone density, along with that of other ethnic groups. While VanLoan says her studies are still in the data-gathering stage, "I have no sense that the bone-density values [of Asians] as a group are low." In fact, one Asian woman VanLoan interviewed ate no dairy products but had an exceedingly high bone density. "At least for this young woman, lack of dairy was not an issue. To recommend dairy at this point may be a bit premature." Consultants for the California Milk Advisory Board say the Asian-targeted campaign doesnÕt promote dairy products as much as it makes accessible a food guide that already has the U.S. governmentÕs stamp of approval. But doctors like Barnard and Campbell say powerful U.S. dairy and meat lobbies have historically and unduly influenced the USDAÕs food guides. "The dairy industry has certainly taken part in nutritional education, as have other industries," says Nancy Gere for the milk board. Milk board consultant Joan Walsh counter-charges Barnard and his organization with political activism. "His group is not a scientific research group," she says. "Their agenda is not to include meat products [in the American diet] at all." Gere adds, "WeÕre not saying to take dairy products over other sources of calcium." But certainly the milk board is not paid by dairy producers to hawk tofu. And itÕs true that the dairy industry has been busily tooting its own horn for some time. "The dairy industry is extremely powerful and has millions of dollars," says Campbell of the China Project, "and I have 10 cents."Asian Pyramid Despite controversy over the current USDA food pyramid--and the milk boardÕs versions of it--pyramids are definitely the trend. ThereÕs the USDA food pyramid, the revised USDA food pyramid, the vegetarian food pyramid and the new, avant-garde and controversial Mediterranean food pyramid for those who prefer their food groups have a continental flair. Dr. Campbell helped initiate many of the above challenges to the traditional animal-based American diet, and testified at a press conference organized by physicians to initially crack the old, four food groups model. Next on the agenda? You guessed it. Campbell, Cornell University, the Oldways Trust and the Harvard School for Public Health intend to reveal their own Asian food-guide pyramid--without food lobby support--at the 1995 International Conference on the Diets of Asia. According to Greg Drescher, director of education at the Culinary Institute of America at Greystone and co-chair of the Oldways Trust, a nonprofit organization whose mission is "preserving the healthiest aspects of traditional diets," the new Asian food pyramid--though still in rough draft form--represents "the healthiest of the food traditions of south and east Asian cultures." The pyramid will include only a small amount of optional "low-fat dairy," reflecting the dairy-inclusive diet of India. Otherwise, the pyramid will reflect a traditional Asian diet that is similar to that shown in the Mediterranean food pyramid: high in complex carbohydrates, fruits and vegetables and low in animal-products. When informed of the milk boardÕs recently released USDA pyramid, Drescher is not surprised. He sees the campaign as a preemptive maneuver on the part of the milk board to get a dairy-inclusive pyramid into the hands of nutritionists and Asians before the consortium sponsoring the upcoming conference can release its pyramid. "The last thing we want to do is encourage the people who have come to our shores from healthy dietary traditions to adopt our bad eating habits," he says.