* A waste product of the cotton industry.
* We now know that trans fats in products like Crisco interfere with the production of sex hormones, like testosterone and estrogen (more on that later in the book). Crisco was likely to make the children of these mothers less interested in sex.
† Besides all the health risks of partially hydrogenated oils, modern Crisco contains residues of strong defoliating chemicals. [Cotton: Harvest Aid Chemicals, http://ipm.ucanr.edu/PMG/r114800111.html, accessed September 18, 2016.]
* Windaus won a Nobel Prize in Chemistry in 1928 for his work on sterols and their relation to vitamins. The main focus of his work involved the transformation of cholesterol through several steps to vitamin D3 (cholecalciferol). He gave his patents to Merck and Bayer, which in 1927 brought out Vigantol, a vitamin D3 supplement still in use today. [Haas J. Vigantol—Adolf Windaus and the history of vitamin D. Wurzbg Medizinhist Mitt. 2007, 26:144–48.]
* The rate of deaths from heart disease has declined since the 1960s, but even today, heart disease is still the leading cause of death in the United States, with over six hundred thousand per year according to some sources, costing more than one hundred billion dollars annually. [https://www.cardiosmart.org/Heart-Basics/CVD-Stats. Accessed Dec. 13, 2015.]
* Getting human subjects to consume the right amounts of various fats—including bizarre diets that contained large amounts of pure saturated or polyunsaturated fatty acids—to determine their effect on blood cholesterol levels is not an easy task. “We had an awful time at first,” said Dr. Ahrens in a 1984 interview. “It was boring as the devil for the patients, who had to eat the same diet every day for weeks. It was hard on the dietitians, and we didn’t have precise enough control of the dietary mix.” At the suggestion of a pediatrician at Rockefeller, who advised him to “feed them like babies,” he put his patients on a diet of formula, becoming one of the first researchers to use this now-common technique. One is justified in asking what relevance studies on bottle-fed inmates have for normal people living in the real world and eating real food. [http://www.nytimes.com/2000/12/16/us/edward-ahrens-cholestrol-researcher-is-dead-at-85.html. Accessed Dec 13, 2015.]
† I lived with a French family in Montpelier, France, in 1968—a location as Mediterranean as Mediterranean can be. We ate ham, pâté, cheese, butter, eggs and meat every day. We ate fruits and vegetables occasionally—strawberries (with cream) in the late spring and sometimes a green salad—but never beans. Bread, of course, came with every meal. When journalist Nina Teicholz asked a Keys associate why the eminent scientist never included France in his surveys, she learned that “Keys did not like to travel in France.”. [Teicholz N. The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. New York: Simon & Schuster, 2014, p. 37.]
* Both Ancel Keys and Fred Stare received substantial funding from the sugar industry, and both vigorously objected to the premise that excess sugar consumption might be harmful, thus deflecting attention from sugar to animal fats as a cause of heart disease. [Taubes G and Couzens C. Big sugar’s sweet little lies. http://www.motherjones.com/environment/2012/10/sugar-industry-lies-campaign?page=2. Accessed Dec 15, 2015. b Keys A. Sucrose in the diet and coronary heart disease. Atherosclerosis. 1971, 14:193–202.] In a 1971 paper, Keys cherry-picked data in order to attack John Yudkin, a British researcher who argued that sugar consumption was a major culprit. “The public is grossly misled by repetitions in print of the claim that victims of CHD tend to be persons who habitually consume more sugar than the average for the population.” b He objected to Yudkin’s use of statistical associations, a practice at which Keys was a master.
* The physiological explanation goes like this: when excess polyunsaturates are built into the cell membranes, resulting in reduced structural integrity or “limpness,” cholesterol is sequestered from the blood into the cell membranes to give them necessary “stiffness.” This results in lower cholesterol levels in the blood, at least temporarily.
* Milk replacer given to calves today contains animal fat as the third ingredient. Human babies are not so lucky. They get polyunsaturated oils in their formula—no animal fats and no cholesterol for them!
* Powdered milk containing oxidized cholesterol is often added (without labeling) to reduced-fat milk—to give it body—which the American public has accepted as a healthier choice than whole milk.
* Mary G. Enig attended the conference and overheard an argument between cochairman Basil Rifkind and two other conference organizers, who protested strenuously the choice of two hundred as the risk point. Average cholesterol levels in America are two hundred forty, they argued, so how could someone with average cholesterol levels be characterized as “at risk”? But Rifkind cut them off. “No, no,” he said, “at two hundred forty we wouldn’t have enough people to test” (and by inference, to treat). Today any adult with a risk factor for heart disease, such as overweight or obesity, gets a prescription for a cholesterol-lowering drug, even if their cholesterol is already dangerously low.
* The study also noted that the Yemenite Jews consumed no sugar, but those in Israel consumed sugar in amounts equaling 25–30 percent of total carbohydrate intake.
* The Okinawan diet, rich in lard, was described in a 1996 article appearing in Health magazine. Damage control soon followed with two books describing the Okinawan diet as low in animal fat—in the late 1990s, according to the authors, the Okinawans were dutifully cooking in canola oil. But the Okinawans who had made it to their eighties grew up long before canola oil ever existed. Like all peoples of Chinese extraction, they cooked in rendered pig fat. [Wilcox B et al. The Okinawa Program: How the World’s Longest-Lived People Achieve Everlasting Health—And How You Can Too. New York: Clarkson Potter, 2001; Wilcox B et al. The Okinawa Diet Plan: Get Leaner, Live Longer and Never Feel Hungry. New York: Clarkson Potter, 2003.]
* Krispy Kreme doughnuts used lard.
† OSHA lists diacetyl, the artificial butter flavor used in movie theater and microwave popcorn as a toxic substance; the vapors can cause Popcorn Lung Disease (bronchiolitis obliterans), characterized by lung inflammation, hardening and scarring, and other serious symptoms. The disease is rare, but those who suffer from it often require lung transplants, as it is irreversible and can be life-threatening, ultimately obstructing the lungs.
* Actually, a fat or oil or mixture of fats and/or oils is called a “liquid shortening” when it is used in baking and frying; similarly, when poured over lettuce and tomatoes, it is called a “salad dressing.”
* The pipe comparison is wrong for many reasons, one of which is the fact that saturated fats are liquid in the tropics, where the temperature hovers above 80 degrees. At 98.6 degrees F, our bodies are warmer than tropical.
* One very interesting fact emerged from the media discussions of the JUPITER trial—with JUPITER, cardiologists have finally acknowledged that cholesterol levels do not accurately reflect a tendency to heart disease. Dr. James Stein, MD, from the University of Wisconsin Medical School in Madison, praised the study for exposing the fact that current therapeutic LDL-cholesterol levels are not only arbitrary, but are in fact a poor indicator of cardiovascular risk. “Most patients with heart attacks have normal LDL-cholesterol values,” he stated. [http://junkfoodscience.blogspot.com/2008/11/when-news-sounds-too-good-statins-new.html. Accessed Oct 13, 2015.]
* Safflower, sunflower and canola seeds are fairly oily and can render their oils with a cold-press or expeller-extraction method. Nevertheless, these oils are usually obtained by industrial methods.
* Manufacturers are not allowed to use artificial colors in margarines and spreads—they must use a natural color—a comforting thought.
† Small amounts of natural trans fats occur in butter, meat fat and even in fish. These are not harmful but have beneficial effects.
* A 1997 study of university students tracked weekly cholesterol levels. Cholesterol levels rose “proportional to the degree of examination stress.” When the students were under stress, their bodies wisely made more cholesterol in order to produce hormones to help the students deal with the stress of exams. [Agarwal V et al. Examination stress: changes in serum cholesterol, triglycerides and total lipids. Indian J Physiol Pharmacol. Oct 1997, 41(4):404–8.]
* The exception, as explained in Chapter 2, is plant foods from tropical regions, like coconut and palm fruit.
* Most likely these recipes were for canned oysters from the Chesapeake Bay. Estimated oyster consumption on the East Coast in 1900 was three hundred to six hundred oysters per person per year, compared to less than one oyster per person per year in the United States today. [http://www.oysterva.com/oyster-consumption.html, accessed October 20, 2015. 2]
† Lettuce was a rare food in 1900; today we consume it frequently. Heart disease and cancer were rare in 1900; today they occur at epidemic rates. The obvious conclusion is that cancer and heart disease are caused by lettuce—at least according to the logic of the diet-heart promoters.
* Chicken fat is mostly polyunsaturated and monounsaturated, but the AHA ignores this inconvenient fact.
* Pentadecanoic acid is a rare fifteen-carbon saturated fat and heptadecanoic is a rare seventeen-carbon saturated fat; both occur almost exclusively in butterfat.
* These two programs disappeared from the Internet shortly thereafter, but not before several individuals put them up on YouTube.
† Actually, no food is completely devoid of fat, not even skim milk.
* Such a horribly restrictive diet is probably worse than all the poking, pricking and drug side effects that come with conventional diabetes treatment. Yet the American Diabetes website assures diabetes patients, “Eating well is one of life’s greatest pleasures. Having diabetes shouldn’t keep you from enjoying a wide variety of foods including some of your favorites. People with diabetes have the same nutritional needs as anyone else.”
* To make matters confusing, the researchers found that eating a lot of meat and meat products was linked with worse odds of getting diabetes; but meat consumption is often a marker for consumption of processed food.
* These were the guidelines in the early 2000s. Today the ACS steers clear of strictures that specifically single out butter and other saturated fats, but promotes a diet that emphasizes plant foods, lean meat and limited amounts of “calorie-dense” foods. [http://www.cancer.org/healthy/eathealthygetactive/acsguidelinesonnutritionphysicalactivityforcancerprevention/acs-guidelines-on-nutrition-and-physical-activity-for-cancer-prevention-guidelines. Accessed January 4, 2015.]
* Monkeys fed diets moderately high in trans fats gained weight in the abdomen, even though the diet was not high in calories. Perhaps “beer belly” is not the right term—maybe we should call this type of weight gain the “trans fat belly.” (They also developed insulin resistance.). [Kavanagh K et al. Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys. Obesity. Jul 2007, 15(7):1675–84.]
* The good news about butter went unmentioned in the study abstract. One of the study authors, Alice Lichtenstein, has made a career of warning people away from foods containing “evil” saturated fats.
* Times have changed. During the nineteenth century, Americans considered robust “natural urges” a sign of disease. At the Battle Creek sanatorium, John Harvey Kellogg promoted cereals to the American public as a way to reduce excessive sexual activity, thought to result from the overheating properties of a high meat intake!
† True to form, the pharmaceutical industry has countered the negative publicity about decreased libido on cholesterol-lowering drugs by proposing statins to treat erectile dysfunction!
* The body produces ATP much more efficiently from fats than from carbohydrates. One molecule of glucose produces about 40 units of ATP in the mitochondria, while one molecule of fat produces more than 140. Furthermore, the production of ATP from glucose requires three times more enzymes and larger amounts of vitamins and minerals than the production of ATP from fat.
* The richest source of myristic acid is nutmeg. Myristic acid takes its name from the botanical name of nutmeg, Myristica fragrans.
* Thus supporting the folk custom of eating butter or drinking whole milk before a big night on the town.
* This is the likely explanation for the fact that cholesterol levels go up with age—we need more protection from this vital antioxidant.
* The term “arachidonic acid” comes from the modern Latin stem arachid-, which means “peanut.” Arachidic acid is a twenty-carbon saturated fatty acid that occurs uniquely in peanut oil.
* Inflammation and swelling cushion damaged and healing tissue. Without it, injuries would be excruciatingly painful, rather than merely sore and uncomfortable. Inflammation occurs in the arteries as a life-saving response to injury, usually from oxidized unsaturated fatty acids. Inflammation is also involved in the process of combating harmful microbes.
* In the early days of bodybuilding, men in training got their arachidonic acid naturally by eating egg yolks and liver. [http://www.westonaprice.org/health-topics/splendid-specimens-the-history-of-nutrition-in-bodybuilding/. Accessed February 2, 2016.]
* Coconut oil, palm oil and palm kernel oil contain valuable nutrients also, but a discussion of their benefits is beyond the scope of this book.
* What about the notion that eating carrots can improve eyesight? This was actually a piece of propaganda during the Second World War. The British did not want the Germans to know that they had developed advanced radar techniques, so they floated the rumor that British pilots were eating lots of carrots in order to be able to see German planes at night!.[http://www.smithsonianmag.com/arts-culture/a-wwii-propaganda-campaign-popularized-the-myth-that-carrots-help-you-see-in-the-dark-28812484/?no-ist.]
* According to researcher NW Solomans, government reports on blindness from nonfat dry milk were declared secret and stored in a locked file cabinet.
* Apparently polar bear liver contains a toxin at certain times of the year, so the symptoms reported in Arctic explorers may not be due to large amounts of vitamin A. Nevertheless, all students in university nutrition courses get warnings about the toxicity of polar bear liver.
* While many scientists promoting vitamin D supplementation claim that levels of vitamin D [in the form of 25 (OH)D] in the blood should be 50 ng/ml or above, the optimum level is probably in the range of 30–35 ng/ml. [http://www.westonaprice.org/health-topics/update-on-vitamins-a-and-d.]
* Recent analyses of cod liver oil indicate that the major form of vitamin D is not actually D3, but some other—and still obviously natural—form derived from D 3. [http://www.westonaprice.org/health-topics/cod-liver-oil/vitamin-d-in-cod-liver-oil/.]
† One explanation for the increased effectiveness of vitamin D from food is the matrix in which it occurs. Vitamin D occurs in foods that contain ample amounts of saturated fatty acids. Increasing levels of polyunsaturated and monounsaturated fatty acids in the diet decrease the binding of vitamin D to D-binding proteins, necessary to carry vitamin D in the blood, whereas saturated fatty acids do not have this effect. [Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 1999, 69:842–56.]
* Higher levels of D in conventional butter (from confinement cows) compared to butter from pastured cows is likely due to the addition of vitamin D to feed rations.
† In 1931, these line tests found that cod liver oil was one hundred times more potent—more able to cure rickets—than vitamin D2 from irradiated yeast. [(page 114) Aaron J. Studies on the history of rickets I: recognition of rickets as a deficiency disease. Pharmacy in History. 1974, 16(3)83–88.]
* How many other centenarians got cod liver oil early in life? It’s a question researchers usually fail to ask.
* Much credit for solving the mystery about which nutrient corresponds to Activator X goes to Chris Masterjohn, PhD, who also has described all the research on the benefits of vitamin K2.
* Osteocalcin is a protein responsible for putting calcium and phosphorus in bones and teeth. Cells only produce this protein in the presence of vitamins A and D; it will only accumulate in the extracellular matrix and facilitate the deposition of calcium salts, however, once it has been activated by vitamin K2. Vitamins A and D regulate the expression of another important protein, called matrix Gla protein (MGP), which is responsible for mineralizing bone and protecting the arteries from calcification; like osteocalcin, however, MGP can only fulfill its function once it has been activated by vitamin K2. [Oliva A et al. Effect of retinoic acid on osteocalcin gene expression in human osteoblasts. Biochem Biophys Res Commun. 1993, 191(3):908–14; Koshihara Y and Hoshi K. Vitamin K2 enhances osteocalcin accumulation in the extracellular matrix of human osteoblasts in vitro. J Bone Miner Res. 1997, 12(3):431–38; Farzanheh-Far A et al. Transcriptional regulation of matrix gla protein. Z Kardiol. 2001, 90(Supp 3): 38–42; Kirfel J et al. Identification of a novel negative retinoic acid responsive element in the promoter of the human matrix Gla protein gene. Proc Natl Acad Sci USA. 1997, 94(6):2227–32; Berkner KL and Runge W. The physiology of vitamin K nutriture and vitamin K-dependent protein function in atherosclerosis. J Thromb Haemost. 2004, 2(12):2118–32.]
† We need vitamin A to prevent vitamin D toxicity; vitamin K2 may also play a role in preventing vitamin D toxicity. Toxic doses of vitamin D can cause anorexia, lethargy, slow growth, bone resorption and soft tissue calcification—very similar to the symptoms of deficiencies in vitamin K. In fact, the synergy of vitamin K2 with vitamins A and D is exactly the type of synergy that Dr. Price attributed to Activator X.
* Or the bacteria may just be there to clean up dead and dying tissue. Have we falsely accused bacteria of causing tooth decay just as we have falsely accused cholesterol—the body’s repair substance—of causing heart disease?
* Butter oil is not the same as ghee. Dr. Price made butter oil by centrifuging clarified butter to obtain an oil (in which the vitamins concentrated) and a very hard fat.
* Certain forms of vitamin K2 are produced by fermentation, and small amounts occur in fermented foods like sauerkraut. The best source of vitamin K2 in the Asian diet is a slimy fermented soy food called natto. Natto is definitely an acquired taste for westerners—most living in America and Europe would prefer to get their vitamin K2 from delicious animal foods like cheese and pâté.
* One researcher reported severe, progressive myocardial inflammation and scarring in rats fed partially hydrogenated fish oil—fish oil being more unsaturated than vegetable oil. [Schiefer HB et al. Long-term effects of partially hydrogenated herring oil on the rat myocardium. Drug Nutr Interact. 1982, 1(2):89–102]
† As early as 1978, researchers recognized the fact that unsaturated fatty acids directly kill white blood cells. [Meade CJ and Martin J. Fatty acids and immunity. Adv Lipid Res. 1978, 127.]
* This 1995 study seems to have disappeared from the PubMed database.
* The fat of ruminant animals, like butter and tallow, contains a small amount of natural trans fats that are beneficial, not harmful.
* Actually, these aldehydes occur in vegetable oils at temperatures well below those regularly used for frying and long before the oils start to smoke or smell.
* While warning American mothers to avoid vitamin A, health officials admit that vitamin A deficiency is a public health problem in more than half of all countries in the world, especially in Africa and Southeast Asia, where it results in half a million cases of blindness each year. [Checkley W et al. Maternal vitamin A supplementation and lung function in offspring. N Engl J Med. 2010, 362:1784–94.]
* The researchers noted that “pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A–rich liver and liver foods, based upon unsupported scientific findings,” and go on to recommend sources of beta-carotene, rather than true vitamin A. As discussed in Chapter 6, plant sources of beta-carotene cannot supply adequate vitamin A, especially for pregnant women and developing children.
* Only cod liver oil was associated with the reduction in diabetes, not vitamin D alone. The researchers conjectured that it was the omega-3 fatty acids in cod liver oil that provided protection; but the likely explanation is that the vitamin A in cod liver oil supports the action of vitamin D.
* No one has looked at the effect of low-fat dairy on fertility, starting at age two, as government agencies recommend. The odds are that infertility due to lifelong fat starvation—which is what most girls today engage in—will not be so easily reversed by a temporary return to high-fat dairy foods.
* His study did not find any benefits from a largely plant-based diet. [http://www.westonaprice.org/book-reviews/the-china-study-by-t-colin-campbell/.]
† Maybe so, but Dr. Spock’s mind became so addled that he began recommending a vegan diet for growing children.
‡ Restriction of animal protein and fat in children’s diets will reduce these adult diseases in one way only—by preventing them from reaching adulthood at all.
* Salt is essential for growth and intellectual development in children—a subject beyond the scope of this book.
* These flavored dairy beverages often contain more sugar than sodas!
* Surprisingly, after those on the high-fat diet, pilots on the high-carbohydrate diet performed best, with the worst performance from pilots on the high-protein diet.
* For many reasons, the artificially colored red candy would not be a good food for Billy.
* Physicians and psychologists often blame this tendency for children to look sideways or away on “cold parenting”—especially laying blame on mothers who may appear “emotionally remote” or “cruel.” But these parents usually love their children very much. The tendency to look away results from a flaw in the retina, not faulty parenting techniques.
† Vitamin A is also extremely important for the maintenance of healthy intestinal flora—remember that Billy’s mother was gluten intolerant, a sign of disrupted gut bacteria.
‡ Megson also stresses the importance of salt for autistic children. If there is a G-protein defect, three of the channels that remove calcium from the cells are blocked. The only other major means of removing calcium is with salt. If there isn’t enough salt in the diet, there is the danger of brain cell calcification.
* The physician then put them back on Accutane to treat their acne. Surely a better solution is to have them keep taking the natural vitamin A.
† I knew of a woman who was able to get off her antidepressants by taking cod liver oil; when she reported the happy news to her psychiatrist, however, he warned her vehemently against this old-fashioned remedy, claiming that it would destroy her liver. She dutifully stopped taking it and soon after needed to go on antidepressants again.
* A major source of calcium in the Eskimo diet is fermented fish bones.
† It is interesting to ponder the reason for this reservoir of vitamin K2, right in the middle of the body.
* New evidence indicates that gut flora can produce a variety of endorphins, including serotonin. [http://www.naturalchoice.net/blogs/Art13_Gut_Flora_Probiotics_Affect_Mood.html. Accessed Feb 7, 2016.]
† Chris Masterjohn, PhD, has described the relationship of fat-soluble nutrients with our moods and emotions in his brilliant article “The Pursuit of Happiness.” [is http://www.westonaprice.org/health-topics/the-pursuit-of-happiness/.]
* This influx is tightly controlled: the cell deliberately keeps the concentration of calcium outside its boundaries ten-thousand-fold higher than the concentration of calcium within its boundaries; only when told to do so by another chemical signal will the cell open the calcium channels that will let this mineral come flooding in. [Weaver CM and Heaney RP. Calcium. In Shils et al., eds. Modern Nutrition in Health and Disease, 10th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2006, pp. 194–210.]
* Feeling pain? Eat a banana! Bananas contain 40–50 parts per million of dopamine. Other fruits and vegetables come in at much lower values, around 1 part per million. Unfortunately, ingested dopamine does not get past the blood-brain barrier but it might ameliorate a pain in your knee or elbow.
* The material for the Time Magazine article mostly came—without attribution—from Nina Teicholz’s The Big Fat Surprise.
* One of the study authors was William Castelli, former director of the Framingham Study.
* Phytosterols used in “functional” cholesterol-lowering spreads like Benecol are hormone-like compounds from plants, present in large numbers in the effluent from the wood pulp industry. Water contaminated with phytosterols causes endocrine damage to fish downstream from wood pulp plants. The fish become “sex-inverted” and hermaphroditic; fertility is also reduced. Phytosterols also have the classic estrogenic effect of stimulating the growth of uterine tissues, which may explain their folkloric use as abortifacients. There is a remarkable similarity between the chemical structure of plant sterols and diethylstilbestrol, the synthetic hormone associated with reproductive cancers in women. This is one reason scientists seriously considered them as natural antifertility agents in place of the modern synthetic contraceptive pill. This potential usage was abandoned when phytosterols were found to have harmful side effects. But food manufacturers think it is okay to add them to spreads and margarines. [http://www.westonaprice.org/health-topics/toxins-on-your-toast/.]
† Meanwhile, findings from a large European study indicate that animal fats from meat, eggs and dairy products do not increase a woman’s risk of breast cancer. [Pala V et al. Meat, eggs, dairy products, and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Am J Clin Nutr. Sep 2009, 90(3):602–12.]
* Fat that contains more than 60 percent long-chain saturated fatty acids is hard and unspreadable, even at room temperature.
* The technical name is (E)-Octadec-11-enoic acid, but we will stick with trans-vaccenic acid.
† Kangaroos have the highest levels of trans-vaccenic acid in their fat.
* Natural trans fats occur in fish oils as well; they are manufactured by marine fungi, which fish consume.
* Surprisingly, the higher value in the range came from conventional butter, the lower one from butter produced by cows on pasture. The likely explanation is the fact that vitamin D3 is added to the feed.
† Cows on pasture get their vitamin D by licking their fur—and the fur of other cows. Sunlight activates the cholesterol-rich lanolin on their coats and transforms it into vitamin D3.
‡ The real powerhouses of vitamin K2 in the western diet are the fat and livers of ducks and geese, followed by aged cheese.
§ The scientific term for vitamin E is tocopherol, which comes from the Greek words tokos, meaning “offspring,” and phero, meaning “to bear.” Tocopherol literally means “to bear children.” The vitamin is so named because it is essential to healthy fertility. A study performed in 1922 showed that rats whose diet was devoid of vitamin E became infertile. Once they were given wheat germ oil (rich in vitamin E) as part of their diet, the rats’ fertility was restored. [Murray MT. Encyclopedia of Nutritional Supplements: The Essential Guide for Improving Your Health Naturally. New York: Three Rivers Press. 1996.]
* For this reason, children who drink skim milk have diarrhea at rates three to five times greater than children who drink whole milk. [ Koopman JS et al. AJPH, 1984, 74(12)1371–73.]