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"Drink Milk for Fitness": The Cultural Politics of Human Biological Variation and Milk

Consumption in the United States

Author(s): Andrea S. Wiley
Source: American Anthropologist, Vol. 106, No. 3 (Sep., 2004), pp. 506-517
Published by: Wiley on behalf of the American Anthropological Association
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"Drink Milk for Fitness": The Cultural Politics

of Human Biological Variation and Milk

Consumption in the United States
ABSTRACT Cow's milk is accorded a high cultural value in the contemporary United States. Its white color, association with the maternal
and the pastoral, and repeated mention in the Bible add positive symbolic weight to this major national agricultural commodity. Thus, it
comes as no surprise that influential policy-making institutions in the United States recommend milk consumption for all U.S. groups. This

is despite variation in adult populations' abilities to digest milk, which has been documented by biological anthropologists. This article
assesses various U.S. "stories" about milk consumption and its relationship to biological variation against the biological anthropological
explanation of variation in lactase activity/lactose tolerance. Many of these serve as normalizing discourses that ultimately pathologize

biological difference and may undermine the dietary traditions of some ethnic groups. In particular, the close relationship between
government and the dairy industry leads to policies that fail to seriously consider variation in digestive physiology among the diverse U.S.

populations. [Keywords: milk, lactase, nutrition policy, biological variation]

T HATpacity
VARYin with
to their
cato digest milk
is well

milk consumption and downplays the significance of other

among biological anthropologists and organizations in the

First, I outline the state of knowledge about the bi-

United States involved in the formulation and enactment

ology of lactase persistence, especially its genetic founda-

of food and nutrition policies. This variation in response

tions, and what is known about population variation in

these genotypes. The anthropological discussion builds on

to milk derives from genetic regulation of lactase, the enulations, lactase activity declines during childhood; in rel-

this genetic information and seeks to understand the evolutionary causes of population variation. Next, describe the

atively few does lactase activity remain high throughout

stories told by various U.S. institutions-the United States

adulthood. Cross-culturally, persistence of lactase activity

into adulthood correlates with (1) fresh milk consumption;

try, professional medical associations, nutritionists and di-

zyme that breaks down the milk sugar lactose. In most pop-

(2) a central role for milk production in the domestic economy; (3) positive evaluation of milk and other dairy products; and (4) physiological capacity to digest and, hence, tolerate lactose. This article is primarily concerned with how

the anthropological interpretation of lactase persistence

compares to those offered by institutions in the United
States that have an impact on dietary recommendations for
consumption of cow's milk, an important agricultural commodity. Because polices often reflect the biases and agendas
of their authors, the portrayal of lactase persistence by the
dominant ethnic group-U.S. citizens derived from northern Europe, who are largely lactase persistent-is likely to

indicate ethno- or biocentric bias, insofar as it promotes

Department of Agriculture (USDA) and the dairy induseticians, and antimilk coalitions. Despite widespread acknowledgement that a substantial minority of people in
the United States-and the majority in the world-are lactase impersistent as adults, it appears that the strong cul-

tural value placed on cow's milk and governmental support of the dairy industry inhibit policies that put the
anthropological understanding of lactase persistence into
practice. Thus, while the latter emphasizes biological variation in milk digestive physiology and the unique histor-

ical processes that produced it, this perspective has been

subsumed into subtly disguised normalizing discourses
that downplay the significance of this diversity and pro-

mote a modal biological response to milk that should

American Anthropologist, Vol. 106, Issue 3, pp. 506-517, ISSN 0002-7294, online ISSN 1548-1433. C 2004 by the American Anthropological Association.
All rights reserved. Send requests for permission to reprint to: Rights and Permissions, University of California Press, Journals Division, 2000 Center Street,

Suite 303, Berkeley, CA 94704-1223.

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Wiley * Biological Diversity and Milk Consumption in the United States 507
facilitate its consumption by all U.S. citizens throughout

Neither the mechanism underlying this age variation nor

its significance is well understood.

Given the interconnections between discourses of bi-

ological variation, dietary recommendations, and political

economic forces supporting the U.S. dairy industry, a biocultural perspective is particularly relevant to this analysis.
In using the biocultural label, I consider not only how cultural factors influenced biological evolution (as is surely the
case in the evolution of lactase persistence) but also how un-

derstandings of human biological variation are constructed

and elaborated within a cultural context.



Lactase (more technically, lactase-phlorizin hydrolase

[LPH]) is an enzyme found in the brush border of the jejunum of the mammalian small intestine. It functions to
break down lactose, a sugar found only in mammalian
milks, into its component sugars, glucose and galactose.
Because lactose cannot be absorbed directly, lactase is necessary for the digestion and metabolic utilization of milk

sugar. In most mammalian species, lactase production is

high at birth and begins to decline around the time of
weaning. As a result, adult mammals produce only residual quantities of lactase. Up through the latter part of the
20th century, researchers debated whether lactase activity

could be maintained or induced by a diet containing lactose. Although a few studies suggested that it could be, most

concluded that the decline of lactase production occurred

independently of lactose in the diet (Sahi 1994b). Human
studies from the 1960s indicated that contrary to earlier be-

liefs, most humans followed the basic mammalian pattern

(Bayless and Rosensweig 1966, 1967), and that lactase activity in adults could not be increased by providing lactose.
It is now well understood that the age-related decline in
lactase production is regulated genetically, and that there is
both individual and population variation in this trait. While
frequencies of adult lactase activity are somewhat continuously distributed across populations, two patterns are eas-

ily distinguished: (1) populations in which high frequencies of adults continue to produce high levels of lactase in

adulthood and (2) populations in which lactase production

declines to low levels by adulthood (Sahi 1994a). Several
thorough reviews describe population frequencies of lactase persistence (cf. Durham 1991; Flatz 1987; Sahi 1994a;
Scrimshaw and Murray 1988; Simoons 1978). While studies of individual populations vary tremendously in their
methodology and sample populations, it is clear that high
rates of lactase persistence are found only among northern

Europeans; South Asians; herding populations of the Middle East, Arabian Peninsula, and sub-Saharan Africa; and
descendents of these populations.


A number of terms are employed to describe the biological phenomenon of lactase activity in adults, and their usage provides insights into how various authors or institu-

tions view variation in this phenotype. The terms lactose

tolerance/intolerance are most common in vernacular usage.
These refer to the subjective experience of gastrointestinal

symptoms after lactose consumption (bloating, diarrhea,

cramps), which vary considerably across individuals. It is
quite possible to have high lactase activity but report intolerance or, more frequently, to have biologically assayed
low lactase activity but report no symptoms of intolerance.
Other terms are thus preferred, although there is no consen-

sus on which are best. In recognition that low levels of lactase activity are modal for the human species, many authors
prefer lactase persistence/nonpersistence, lactase restriction, or
high/low lactose digestion capacity.

The term adult-type hypolactasia has gained currency as

a way to describe low levels of lactase activity among adults,

although Timo Sahi (1994b), a leading proponent of this

terminology, dismisses the possibility of using hyperlactasia as its counterpart. However, given that hypolactasia is
the norm for the species, individuals with higher lactase ac-

tivity in adulthood could properly be described as having

hyperlactasia. Lactase deficiency implies pathology, as do the
descriptors lactose maldigestion and malabsorption. Further-

more, terminology that includes the word lactose implies

that lactose is part of the diet; lactose maldigestion or malabsporption would never manifest if lactose was not being
consumed.' Changes in lactase activity or the digestion of
lactose among adults can also stem from nutritional factors
(e.g., protein malnutrition), pathologies of the small intestine, and gastrointestinal infections. When any of these result in low levels of lactose digestion, secondary hypolactasia,

malabsorption, or maldigestion is the diagnostic label. Adult-

type hypolactasia that derives exclusively from age-related

declines in lactase activity is considered primary.
Throughout this article I will use the terms lactase persistence/impersistence. These are preferred because they are

relatively value free, implying neither pathology nor having too much or too little or high or low lactase activity.

Variation in adult lactase production appears to be under

strong genetic control, and genealogical studies have found
a pattern that is consistent with a dominant mode of ex-

Populations also vary in the age at which lactase activity

declines, from one to two years to 20 years. Those groups
with high rates of persistence exhibit later average ages of

pression for the alleles associated with lactase persistence

(Kretchmer 1972; Sahi 1994a). The gene for the lactase enzyme is found on chromosome 2 and is not variable across
populations in ways that correlate with differences in lactase persistence. Regulation of the lactase gene is variable,

onset among members who are impersistent (Sahi 1994a).

however, and there are four common variants of the lactase

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508 American Anthropologist * Vol. 106, No. 3 * September 2004

haplotype (A, B, C, and U). A is most common in northern

observation by Gebhard Flatz and Hans Rotthauwe (1973)

Europe, with declines in frequency across southern Europe

that the presence of lactose in the small intestine enhances

and India, where B and C are more common. U is notably

absent among Indo-European populations but is found in
most others. Haplotype diversity is greatest in sub-Saharan
African populations (Hollox et al. 2000). Lactase persistence is most frequently associated with the A form but
is found occasionally with the other forms (Harvey et al.
1998; Hollox et al. 2000).

calcium absorption. Vitamin D is synthesized in skin cells

Recently a noncoding segment of DNA upstream from

the lactase gene has been identified as a site of variation

in adult lactase activity (Enattah et al. 2002). Individuals
with the C nucleotide at a locus in the 13th intron or a

G in the 9th intron (these two introns being eight kilobases apart) within a neighboring gene about 14 kilobases
upstream from the lactase gene were lactase impersistent,

in the presence of UV light and facilitates calcium uptake,

but when exposure to UV light is reduced-and Vitamin

D synthesis is, thus, likewise diminished-lactose, which is
found only in fresh milk, can increase calcium absorption.
The calcium absorption hypothesis was recently subjected

to critical review by Simoons (2001), who concluded that

there is scant osteoarchaeological, historical, or biomedical evidence to support it. Further, while this may help explain the very high frequencies of lactase persistence found
among northern Europeans, it has little relevance for understanding lactase persistence in populations at lower lat-

itudes. There, other nutritional advantages to adult milk

consumption, such as hydration or the use of lactose as a

while those with T or A at these same loci were lactase

carbohydrate, a nutrient rare in the diets of exclusive pas-

persistent. Although the exact mechanism by which these

loci regulate lactase production remains unclear, current ev-

toralists, may have accrued to those able to digest fresh milk.

idence points to their action at the level of gene transcription, as most studies demonstrate variation in mRNA levels
between those who are lactase persistent or impersistent, a
pattern that becomes evident during childhood (Wang et al.

It is widely accepted that the origins of animal domestication set the stage for selection favoring the ability to digest lactose in adulthood-for without exposure
to mammalian milk in adulthood, presumably no advantage would derive from continued production of lactase.
Indeed, all populations with high rates of lactase persis-

Another hypothesis that has received relatively little

attention is that since the genetic markers associated with
lactase persistence are known in geographically diverse areas, lactase persistence could have spread prior to the rise
of dairying cultures. B. Anderson and C. Vullo (1994) pro-

posed that lactase impersistence was selected for as a defense against falciparum malaria, the most deadly form of

the parasitic disease. Milk is a very rich source of the Bvitamin riboflavin, and malarial parasites require riboflavin
to multiply in red blood cells. In the context of riboflavin

deficiency at a level tolerated by a human host, malarial

reproduction is significantly inhibited (Dutta et al. 1985).

tence have long histories of dairying. Given that milk is rich

in several nutrients (protein, fat, calcium, sugar), Frederick
Simoons (1978, 2001) proposed that individuals with a mutation allowing them to consume the milk of domesticated

Thus, early reduction in lactase production would lead to

mammals throughout life would have been healthier and

deleterious to the child. Because populations vary in the age

at which lactase activity may decline, later age of onset of

better nourished than those without it. Researchers have

earlier termination of breastfeeding; this in turn would generate riboflavin deficiency (from decreased milk intake) suf-

ficient to reduce malarial infection without being overly

suggested that a three to seven percent fitness advantage

lactase impersistence would have been tolerated in popula-

would have been sufficient to generate the high frequencies of lactase persistence found in dairy-dependent popu-

tions not exposed to deadly forms of malaria (e.g., northern

lations (Flatz 1987; McCracken 1971). However, as William

Durham (1991) pointed out, there are many populations
with long histories of domesticating dairy animals that also
have low rates of lactase persistence. These groups often

Europeans, who have both high rates of lactase persistence

and later ages of onset of impersistence among those with
that genotype). However, a study in Sardinia showed that
three villages with varying exposure to malaria did have different frequencies of other known adaptations to malaria

make use of fermented milk products (e.g., yogurt, kefir) or

(e.g., G-6PD deficiency and f-thalessemia) but did not vary

cheese. Bacterial fermentation results in dairy products that

are low in lactose, while the process of cheese making involves draining off the lactose-rich whey from milk solids.

in their rates of lactase persistence (Meloni et al. 1998).

Thus, having a history of dairying is necessary but not

sufficient for explaining global variation in lactase persistence, and only populations drinking substantial amounts
of fresh milk would have benefited from the ability to digest

Noting that lactase persistence and fresh milk consumption correlated with latitude, Durham (1991) proposed that the low levels of UV light found at high latitudes
would have selected for lactase persistence among dairying
populations living there. This hypothesis was based on the

This hypothesis also fails to explain why some populations

would remain lactase persistent throughout life, given that
this is the derived (i.e., evolutionarily recent) condition for

While selection probably played a key role in the spread

of lactase persistence among some dairying populations,

other evolutionary forces have also contributed to global
diversity in adult lactase activity. Genetic drift may have

been important in reducing diversity in genes associated

with lactase activity in non-African populations, given that
there is greater variation within contemporary African pop-

ulations (Hollox et al. 2000). Clearly, gene flow has also

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Wiley * Biological Diversity and Milk Consumption in the United States 509
played an enormous role among historical and contemporary populations, especially in areas colonized by northern European populations (Flatz 1987). Collectively, these
forces have generated the more-or-less continuous distribution in population frequencies of lactase persistence.

The anthropological story of lactase persistence is a story

of human variation: Lactase impersistence is the norm for

the species and persistence is the unusual condition. Individuals in most populations experience declines in lactase production during childhood and, hence, have little of
the enzyme required to fully digest milk in adulthood. As

expected, these are also populations that historically have

made little use of fresh milk. Conversely, populations with
high rates of lactase persistence have included dairy farming

as an intrinsic part of the food economy and extensive use

of dairy products in their cuisines (Durham 1991). These

practices have become entrenched in many areas permanently colonized by Europeans in particular (e.g., United,
States, Canada, New Zealand, Australia). While the extent
to which fresh milk was a large part of traditional European

diets is unclear, it is now widely consumed in Europeanderived populations in the United States. Milk is especially
recommended for children, teenagers, and adult women; it
is considered necessary to support the needs of fetal growth

during pregnancy and milk production during lactation,

to build and maintain a strong skeleton, and to ward off
osteoporosis at older ages. Whether these recommendations are well supported by evidence is a matter of some
contention, especially given that other populations maintain adequate fetal and child growth and bone density in
the absence of milk consumption (cf. Bertron et al. 1999;
Feskanich et al. 1997; Heaney 2000; Specker and Wosje
2001; Weinsier and Krumdieck 2000). While I have reviewed

this topic elsewhere (Wiley 2004), here the question is

whether the anthropological story of variation in lactase activity has any currency in policies promoted by U.S. policymaking institutions dealing with food, nutrition, or health,

given the hegemony of European culinary traditions and

agricultural practices. What other discourses about this aspect of human biological variation are constructed by such

USDA and the National Dairy Council (NDC)

The USDA has a dual mandate within the U.S. government:
to promote U.S. agricultural interests and to issue food and

nutrition guidelines that promote the health of U.S. citizens. That these two missions might be at odds with one
another was apparently not considered when the USDA

tween these goals is becoming more visible as rates of obesity and its concomitant health problems continue to rise
(Nestle 2002).

Dairy products make up about 11 percent of U.S.

agricultural commodities (U.S. Department of Commerce
2002). In the Dairy Production Stabilization Act of 1983,
the U.S. government authorized the USDA to oversee national programs for "dairy product promotion, research,
and nutrition education as part of a comprehensive strategy

to increase human consumption of milk and dairy products" (USDA 2002:5). In 1990, the Fluid Milk Promotion
Act specifically targeted fluid (fresh) milk. In justifying this

act, Congress stated that

(1) fluid milk products are basic foods and a primary
source of required nutrients such as calcium, and otherwise are a valuable part of the human diet; and (2) fluid
milk products must be readily available and marketed efficiently to ensure that the people of the United States

receive adequate nourishment; and (3) the dairy industry plays a significant role in the economy of the United

States. [USDA 1990]

These programs are run by groups such as the Fluid Milk

Board, the National Dairy Council (NDC), and the National
Dairy Promotion and Research Board (NDPRB), among
other state and regional organizations. Under a check-off
system, local dairy farmers pay a mandatory fee per unit
of milk produced to support the activities of these groups,
the vast majority of which focus on advertising (USDA

The USDA is also responsible for developing and promoting dietary guidelines for U.S. citizens. The food pyra-

mid, the most widely disseminated guide to eating in

the United States, includes a separate category for dairy
products and recommends two to three servings of dairy
products per day (
The primary (though not exclusive) justification for such

a recommendation is based on milk products as rich

sources of calcium. Moreover, even though there are
some "alternative" nonofficial food pyramids designed for

minority populations accessible through the USDA site,

all of them also contain dairy products (www.nal.usda.
gov/fnic/etext/000023.html#xtocid2381818). As Marion
Nestle (2002) noted in her careful study of links between
government diet and nutrition policy and food industries,
several representatives of the dairy industry including the
NDC and NDPRB were on the advisory committee charged
to develop the 2000 Dietary Guidelines for Americans. Not
surprisingly, they opposed any suggestion to include alternatives to dairy foods, especially as sources of calcium (such
as fortified soy "milk") in the dairy section.2 Among other
blatant conflations of government policy and the dairy industry was the 1998 appearance of then-secretary of health

was created. At the time, undernutrition was a considerable

and human services Donna Shalala in one of the popular

problem; however, in the current dietary environment of

hyperabundance of relatively cheap agricultural commodities (e.g., corn, wheat, milk) and dietary guidelines that en-

"got milk?" advertisements.

Thus, in both of its roles the USDA is involved in

courage consumption of calorie dense foods, conflict be-

promoting the consumption of dairy products-especially

fresh milk-among all U.S. citizens. However, the agency

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510 American Anthropologist * Vol. 106, No. 3 * September 2004

has been forced to recognize that substantial numbers of
ethnic minorities may have low levels of the enzyme lac-

but "fortunately, tolerance to lactose can be improved by

adjusting the amounts and types of dairy foods consumed"

tase or consider themselves lactose intolerant. With the in-

(NDC 2003a). These modifications include drinking small

creasing presence of peoples of Asian, Latin American, or

African descent in the United States, up to 25 percent of
the adult population may be lactase impersistent. The NDC

amounts of milk with meals to slow the process of absorption, starting with small servings and slowly working up to

recognizes that approximately 100 percent of all Native

tolerance to lactose. Other solutions to intolerance include

Americans, 90 percent of all Asian Americans, 80 percent of

consuming aged, hard cheeses, yogurt with active bacterial

cultures, lactose-free milk, or taking over-the-counter lac-

all African Americans, 53 percent of all Hispanic Americans,

and 15 percent of all Caucasians are "lactose maldigesters"

(NDC 2003b).
In their publications, the USDA and the various dairy
promotion organizations first make a clear distinction between their preferred term lactose maldigestion and lactose

larger quantities in a process that suggests the building of a

tase enzyme tablets or drops prior to the consumption of

lactose-containing dairy products. Nondairy sources of calcium are denigrated as having much less calcium than milk,
or it is suggested that their calcium is much less bioavailable
than that in milk.3

intolerance. Lactose intolerance refers to the "gastrointesti-

nal symptoms experienced by some individuals who have

low levels of lactase, the enzyme necessary to digest lactose" (NDC 2003b). These symptoms include nausea, vomiting, bloating, cramps, and excess flatulence. However,
they argue that this condition is relatively rare, and that
lactose maldigestion is more common. Importantly, individuals with lactose maldigestion may have low levels of lactase
but do not experience gastrointestinal symptoms following
consumption of lactose-containing dairy products so long

as their physiological capacity to digest lactose is not exceeded. Thus, according to the NDC, such people can-and
should-consume milk.

The NDC contends that rates of reported lactose

maldigestion are likely to overestimate those who actually
suffer negative symptoms after milk consumption, also in

part because these symptoms may mimic those of other

gastrointestinal illnesses. Individuals who suspect they are
lactose intolerant should be objectively tested by a physician using the breath hydrogen test, which measures the
amount of hydrogen expelled in a person's breath following
digestion of lactose. The NDC is, however, careful to note
that those tests may generate false positives (again inflating

the rate of "true" intolerance) because the lactose challenge

is much greater than that found in a glass of milk. Furthermore, many individuals may claim to be lactose intolerant not because they have physiological symptoms but,
rather, because of negative "culturally based attitudes to-

wards milk learned at a young age" (NDC 2003b). Such

persons may never acquire a taste for milk if they live in

a family that does not make milk a part of their regular


The USDA and dairy promotion agencies recommend

"several easy steps to overcome lactose intolerance." The
first and most vital step is to see a physician immediately
in order to be correctly diagnosed. If a low level of lactase

activity is verified, an individual must not conclude that

he or she should avoid dairy products but, rather, find creative ways to include dairy products in the diet. The NDC

warns that "avoiding dairy foods can cause inadequate intakes of calcium and many other essential nutrients. A deficiency of calcium increases the risk of developing osteoporosis, hypertension, and possibly some types of cancer,"

Nutrition and Dietetics Perspectives

The reach of the U.S. government's nutrition policy is extensive. Its impact is clear in the nutritional recommendations
made by practicing nutritionists and dieticians, as well as in
the food assistance programs that the USDA supports. Organizations such as the American Dietetics Association (ADA),

the professional unit to which registered dietitians belong;

the American School Food Service Association (ASFSA); and
nutrition textbooks tend to take the approach of the USDA
and NDC. Given that nutritionists and dieticians are those

who provide dietary advice to individuals in clinical, public

health, food assistance program-related, and other settings,
their interpretation of lactase impersistence is likely to have
practical significance.
A popular nutrition text has a separate "nutrition focus" section on lactose intolerance in which there is dis-

cussion of population variation in the ability to digest lac-

tose, although reduction in lactase activity is described

as a "primary disease" (Wardlaw and Insel 1996). Individuals suspecting lactose intolerance should find out by trial
and error how much lactose they can comfortably tolerate

easily adjust the amount of dairy products in their diet.

Such people need not avoid all milk and milk prod-

ucts; nor is this recommended because these foods are

very good sources of calcium, riboflavin, potassium, and

magnesium. Although these four nutrients are present in
other food groups, many people don't eat much of these
alternative sources. [Wardlaw and Insel 1996:75-76]

The ADA presents a "fact sheet" on lactose intolerance, which was supported by a grant from McNeil Consumer Products, makers of Lactaid?. The fact sheet reviews population variation in lactase production-and, in
an interesting departure from NDC statements-suggests
that lactose intolerance is very common. It does, though,
go on to recommend that individuals adopt the various
strategies outlined by the NDC-for example, consuming
smaller amounts of dairy more frequently or choosing lower
lactose-containing dairy products, but, not surprisingly, two

of its six suggestions include taking exogenous lactase.

Nestle (2002) has noted that among professional nutrition

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Wiley * Biological Diversity and Milk Consumption in the United States 511
associations, the ADA is more likely to promote food industry interests in its publications, and it is one of the links

(the other being the NDC) listed at,

the interactive website of the popular "got milk?"

The ASFSA, a nonprofit organization of professionals in

school nutrition programs, also vigorously promotes milk

consumption in part through its close association with the

National School Lunch Program. Since the 1946 inception

of the National School Lunch Act, the government has required that fluid milk be offered as part of meals that are
eligible for federal reimbursement. Note that the National
School Lunch program, like the USDA, has a dual purpose,
as outlined in the Act of 1946:

It is hereby declared to be the policy of Congress, as

a measure of national security, to safeguard the health
and well-being of the Nation's children and to encourage the domestic consumption of nutritious agricultural

commodities and other food, by assisting the States,

through grants-in aid and other means, in providing an
adequate supply of food and other facilities for the establishment, maintenance, operation and expansion of
nonprofit school lunch programs. [USDA 2003]

Twenty years later, private institutions devoted to the care

and education of children were also made eligible for these
federal milk reimbursements. And, in 1968, an amendment

Professional Medical Associations

Given that government nutrition policy explicitly targets
milk for consumption by U.S. citizens to maintain optimal

health, how do medical institutions, whose members are

involved in clinical practice, assess the issue of milk consumption and lactase impersistence? Publicly available materials from three relevant medical organizations (American
Academy of Pediatrics [AAP]; American Academy of Family Practitioners [AAFP]; and American College of Gastroenterology [ACG]) provide insight into this issue. These groups
all make the crucial distinction between lactose intolerance
and lactase impersistence but tend to focus on lactose intolerance. This makes sense in that from their perspective, lactose

intolerance is the relevant clinical condition; individuals

experiencing uncomfortable or painful symptoms because

of underlying lactase impersistence would be those most

likely seek medical help.
While medical organizations appear to consider lactase
impersistence as "normal" for the human species, citing the
usual surveys of its frequency in different populations, their
language nonetheless tends to medicalize it and treat it as

the deviant condition. For example, the AAP uses the language lactose maldigestion, but in the discussion of global
variation, it refers to lactase deficiency:
late-onset lactase deficiency (adult hypolactasia) is a com-

mon disorder. Approximately 90% of adult American

blacks and 60% to 80% of Mexican-Americans, native
American Indians, Asians, and most middle-Eastern and
Mediterranean populations have abnormal findings on
lactose tolerance tests. [AAP 1985, emphasis added]5

to the Child Nutrition Act was approved that read: "Minimum nutritional requirements shall not be construed to
prohibit substitution of foods to accommodate the medical or other special dietary needs of individual students"
(USDA 2003). Presumably, this covered those with lactose intolerance. Of note is a presentation from the ASFSA
website that celebrates Boston schools' success at promoting lactose-free milk in their food programs, which resulted in increases in milk sales (Focus on Children: Boston
Public Schools 2003); also educational materials from the

emphasis added). Note that these are descriptions of lactase

impersistence, not specifically the clinical symptoms asso-

NDC are easily accessed though the ASFSA site (www.asfsa.

ciated with lactose intolerance.


The Special Supplemental Nutritional Assistance

Program for Women, Infants, and Children (WIC) was authorized in 1974 to provide subsidies for specific nutrient-

rich foods for pregnant or breastfeeding women and infants and children up to five years of age. Fluid milk
and cheese are featured among the foods that are al-

lowed (others are infant formula, cereal, eggs, dried

beans, peanut butter, tuna fish, and carrots). The majority (over 60 percent) of WIC recipients (which numbered
over eight million in 2002) are minorities--the largest
percentage of which are Hispanics, African Americans,
Asian Americans, and Native Americans, all populations
with high frequencies of lactase impersistence (www.ers. In recognition of individuals with "special" dietary needs, WIC allows
lactose-reduced or lactose-free milk, or the substitution of
more cheese for milk in its food packages, but no nondairy


Likewise, lactase impersistence is described by the ACG

as: "a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine" (,

Unlike the NDC, which recommends an objective

lactose-challenge test by a clinician, medical organizations
tend to favor self-diagnosis of lactose intolerance. In their
educational materials, both the AAFP and ACG recommend

that individuals diagnose themselves by eliminating all

dairy products from their diet for several weeks to ascer-

tain whether this eases their symptoms. This is followed

by a dairy challenge to see if symptoms reappear. If they
do, the "treatment" is simple: Avoid dairy products. However, they also suggest that by trial and error individuals
should figure out how much of which dairy products they

can tolerate without negative symptoms. Those who find

themselves reacting to most dairy products are advised to
take exogenous lactase before they consume them.
Again, the concern for those who avoid milk products
is that they would not meet their calcium needs. Most medical organizations recommend dairy products such as yogurt,
cheese, or lactose-reduced milk, especially for children, who
are seen as particularly in need of not only the calcium in

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512 American Anthropologist * Vol. 106, No. 3 * September 2004

dairy products but also the protein, Vitamin D (which is
not an intrinsic part of milk; milk is fortified with Vitamins

A and D), and, in the case of fresh milk, water for hydra-

tion. Other fortified foods, such as orange juice, or dark

green leafy vegetables, legumes, and fish are recommended,

Lactose, a milk sugar, is made up of two other sugars,

glucose and galactose. Galactose has been identified as a
causative factor in heart disease, cataracts, and glaucoma.

Most adults "lack" the enzyme, lactase, to break down

lactose. Instead, lactose is broken down by bacteria in the

lower intestines. Their own body wastes combine with

and calcium supplementation is advised for those who

those sugars to ferment into toxins causing bloating and

"significantly limit their dietary intake of milk products"


( 7E 1.pdf).

While the AAP expresses concern that children with

lactase impersistence obtain sufficient calcium, their state-

ment also outlines the potential problems associated with

milk consumption among such children. The nutrients in
milk may not be fully absorbed; if diarrhea results, nutrients are lost and there is a risk of dehydration. Furthermore,

the AAP and others express concern about the use of lactose in medicines such as birth control pills, antacids, and
other prescription and over-the-counter drugs (AAP 1985).
Lactose is used as a filler, an anticaking agent, and a flavor
to make pills more palatable. While only a very few individuals with severe intolerance are likely to be sensitive
to these small amounts, including lactose among the inactive ingredients in medicines (estimated at up to 20 percent
of prescription drugs and six percent of over-the-counter
indicates a lack of appreciation for population diversity in
physiological responses to lactose.

Once a correct diagnosis is established, there is a simple

cure: NOTMILK!

In April of 1999, the Journal of Clinical Gastroenterology

(volume 28:3) reported: "Introduction of a lactose-free

dietary regime relieves symptoms in most patients... who
remain largely unaware of the relationship between food

intake and symptoms." [Cohen 1998]

Unlike the dairy industry, which claims that the prevalence of lactose intolerance is overestimated, Cohen suggests
that it is underdiagnosed as a source of gastrointestinal com-

plaints. And, instead of following the "simple steps" that

the dairy industry outlines for individuals with symptoms
of intolerance, the solution is straightforward: Avoid dairy
products. Because the antimilk contingent considers there
to be sufficient evidence that milk may cause rather than
prevent various health problems, this avoidance is not deleterious but, in fact, beneficial to one's health.
A related resource, accessible from,
is the website of Steve Carper, author of Milk: Not for Every
Body (1995; the site can also be accessed at http://ourworld.

Antimilk Groups
Despite overt sponsorship of milk consumption by state
and federal governments, there is vigorous-if not wellcoordinated-antimilk sentiment, suggesting that milk's
merits are not entirely uncontested within the United
States. Two primers for this "movement" with intentionally sensationalist titles are Milk: The Deadly Poison by Robert

Cohen (1997), the self-proclaimed "notmilkman" who also

maintains a website, and Don't Drink
Your Milk! The Frightening New Medical Facts about the World's

Most Overrated Nutrient by Frank Oski (1977). The Physi-

cian's Committee for Responsible Medicine (PCRM) and

People for the Ethical Treatment of Animals (PETA) are two

organizations actively promoting the message that milk is

neither an ideal nor necessary food.6 Both groups cite studies implicating milk consumption as a contributing factor to
numerous health problems (from prostate and breast cancer

to osteoporosis; see or

Lactose intolerance is on the list of potential problems associated with milk consumption; as with clinicians, antimilk groups are more concerned with negative physiological
outcomes and less interested in lactase impersistence per se.
The latter is folded into lactose intolerance in this description:
LACTOSE INTOLERANCE: Fifty million Americans experience intestinal discomfort after consuming milk, cheese,
or ice cream (Postgraduate Medicine 1994:95). Symptoms
include stomach pain, gas, and diarrhea. On Carper's
"lactose planet," the lactose intolerance clearinghouse has
an extensive array of information, much of which reads
like the discussion in an introductory biological anthropol-

ogy textbook. Again a clear distinction is made between

lactose intolerance and lactase impersistence, and the evolutionary explanation for lactase persistence is presented (i.e.,
pastoralist or Vitamin D-deficient populations gained some
advantage by drinking milk). Carper is not opposed to milk
consumption per se but wants to alert the public about the
myriad potential problems associated with milk consumption and provide information on alternatives.
The clash between the antimilk platform of the PCRM
and the promilk agenda of USDA and NDC came to a head
in two articles in the Journal of the National Medical Associa-

tion, a journal devoted to health issues that concern peoples

of African descent ( At the heart of the
debate was the policy significance of biological variation in

adult lactase production. Authors from the PCRM alleged

that the Dietary Guidelines for Americans are biased against
minorities insofar as dairy products are recommended for

all U.S. citizens (Bertron et al. 1999). They concluded that

the Guidelines

encourage dairy products for daily consumption by all

Americans, despite differences in tolerances for dairy
products, preferences for other calcium-rich foods and
susceptibilities to osteoporosis, as well as the lack of scientific evidence of benefit from dairy products for members of racial minorities. In this regard, federal nutrition

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Wiley * Biological Diversity and Milk Consumption in the United States 513
policies do not yet address the needs of all Americans.
[Bertron et al. 1999:156]

In this case, recognition of significant population variation

in lactase persistence and relatively high frequencies of impersistence among minorities in the U.S. warrants rethink-

ing the explicit national policy of encouraging-indeed,

mandating-dairy product consumption by all. Those with
different digestive biologies are being forced to conform to

European-derived norms of dietary behavior, which the authors contend are associated with increased risk for various

diseases such as osteoporosis and ovarian cancer, among

others. This charge echoed a 1979 lawsuit in which the
Federal Trade Commission sued the California Milk Produc-

ers Advisory Board for its advertising campaign "Everybody

needs milk." However, the judge ruled that there was insuf-

ficient evidence that milk was a significant threat to individuals with lactose intolerance, arguing further that
Milk is one of the most nutritious foods in the nation's

diet, and from the standpoint of the population as a

whole, or even significant population groups, is literally
"essential, necessary and needed." The withdrawl of milk

from the PCRM of racial stereotyping. The NDC materials

explicitly confirm that the Dietary Guidelines are for all U.S.

citizens, that dairy foods are required to provide nutrients

not found in other types of foods, and that minorities are
especially at risk of calcium-deficiency diseases as a function

of lower dairy consumption (NDC 2003b).


At the heart of these various stories about lactase persistence/impersistence are two key issues. One is the nature

and significance of biological diversity in lactase production in adulthood and its relationship to milk consumption. The second, and related, issue is the appropriateness
of milk in the diet of contemporary U.S. citizens, which
should be reflected in food and nutrition policies. All of
the stories contain some appreciation for biological diversity of adult lactase production. They acknowledge that lactase impersistence is very common in the world and that
there are substantial minorities within the U.S. who are lac-

nutritional disaster. [Katz 1981:267]

tase impersistent. Some go further in describing the evolutionary scenarios that might have generated differences
in lactase activity, focusing on the nutritional benefits that

A response to PCRM appeared in the same journal three

might have accrued to populations that were able to exploit

fresh milk. Thus, the older advertising slogan "Drink Milk

from any major population group would amount to a

years later in an article titled "Overcoming the Barrier of

Lactose Intolerance to Reduce Health Disparities," authored
by NDC researchers (Jarvis and Miller 2002). In this coun-

a blanket statement that suggested that everyone's physi-

terclaim, the authors argued that the relatively high rates of

lactose maldigestion and the concomitant low milk intake

cal and, perhaps, Darwinian fitness might be enhanced by

milk consumption. While it makes sense that the dairy in-

for Fitness" had an unintentional (?) link to evolutionary

explanations, but, of course, it went further by making this

among minority populations are significant contributors to

dustry would want to endorse this concept, with the ex-

their higher rates of several chronic diseases (osteoporosis,

hypertension, stroke, colon cancer). The basis of the claim

ception of the antimilk contingents, milk continues to be

recommended by diverse institutions, albeit in forms and

is evidence suggesting that calcium and "other dairy related

quantities that individuals find physiologically acceptable.

This suggests the entrenched nature of milk in U.S. culi-

nutrients" may reduce the risk of these diseases, although

at present most studies presenting such results have relied
on correlations and retrospective data, rather than demon-

nary culture, national identity, and agricultural economy.

As Melanie DuPuis (2002) has shown, even in the 19th cen-

strating a direct causal link between milk consumption and

tury when milk consumption was more often than not as-

lower risk of these diseases. Thus, to reduce disparities be-

tween the relative health advantages enjoyed by whites,

"Physicians can help reduce the disease burden and health

care costs in minority populations by committing themselves to helping their clients overcome the barrier of lactose

intolerance" (Jarvis and Miller 2002:64). This is to be accomplished by providing such clients with "several simple
strategies that allow those with low lactase activity to consume dairy products," as outlined previously. Furthermore,

sociated with infectious disease from the unsanitary con-

ditions of its production and distribution, it had already

achieved the status of "nature's perfect food." Milk's positive symbolism is overdetermined: its white color, association with things pastoral and maternal and the innocence
of babies, and its biblical references (several being odes to a
"land that floweth with milk and honey"), among others.
In the 20th century, with improvements in sanitation (pasteurization, refrigeration) and discoveries in nutrition, one

in a separate publication, the NDC argues that although

nutrient in particular-calcium-has come to symbolize the

"Many minorities have low levels of lactase ... stereotyping

inherent goodness of milk. The current justification for promoting milk rests almost exclusively on this mineral, and

all minorities as lactose intolerant is inappropriate" (NDC

2003b). Thus, the claim of bias against minorities evident
in recommendations to consume milk is turned on its head

to suggest that individuals who fail to consume milk be-

the United States, it is proclaimed, is facing a "calcium cri-

sis" (NDC 2003b). This crisis-whether real or imaginedcorrelates with a decline in milk consumption and evidence

cause of fears of symptoms (often misplaced, the NDC researchers claim) from lactose maldigestion are at risk of major chronic diseases and well-known health deficits because

less than the Recommended Daily Allowance (RDA) for cal-

of their dietary choices, as well as to accuse the authors

least 1,000 milligrams; USDA 1998).7 Whether the RDA for

that most U.S. citizens, milk drinkers included, consume

cium (the average is 801 milligrams, while the RDA is at

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514 American Anthropologist * Vol. 106, No. 3 * September 2004

calcium is too high or too low is a matter of some contention
(Anderson 2001; Matkovic and Ilich 1993), but suffice it to

knowledge that a large portion of adults-particularly in minority populations in the United States-are likely to have

say here that the solution to the calcium "crisis," at least

according to the USDA and NDC, is to consume more milk

low levels of lactase, this should not prevent them from

rather than consume other foods rich in calcium-such as

been focused on determining just how much milk people

who self- or medically diagnose lactose maldigestion can
consume; their published studies show that up to two or
even three cups of milk can be consumed by individuals

fish bones, dark green leafy vegetables, nuts, or legumes.

The USDA notes that milk and dairy products make up 73
percent of the calcium available in the U.S. food supply and,

hence, dairy is the best and most readily available source

of calcium (NDC 2003b). It should be noted that huntergatherers living on wild foods are able to consume ample
quantities of calcium (above the U.S. RDA) from nondairy
sources (Eaton et al. 1999). On the other hand, it appears
that much of the world's population consumes well below
the U.S. RDA for calcium without apparent detriment (Food
and Agriculture Organization 2002).
By and large, aside from the allegations of the antimilk

consuming milk. Much research sponsored by the NDC has

testing positive for lactose maldigestion, as long as these are

spread throughout the day (Suarez et al. 1997, 1998). Anthropological studies have also noted discordance between
lactase status and symptoms of intolerance. For example,
Susan Cheer and John Allen (1997) found that Tokelau
islanders in New Zealand had high frequencies of lactase
impersistence, as diagnosed in breath hydrogen tests, but
lactase status was not highly correlated with either consumption of dairy products or perceived symptoms of lac-

groups, the NDC and the USDA constitute the main voice
in shaping the dominant rhetoric about biological diver-

tose intolerance.

sity in lactase production. Their story is constructed around

milk is not an acceptable strategy, regardless of one's lac-

From the USDA and NDC's perspective, avoidance of

the inherent goodness of milk and the benefits of a biolog-

tase status. To consume milk in the United States is to be

ical make-up that allows for daily consumption of abun-

healthy; to avoid milk is to put oneself at risk of a variety of

dant quantities. As DuPuis noted, the apparent superiority

achieved by European dairying cultures during the colonial

long-term ailments. Thus, diversity in adult lactase produc-

period was in part attributed to their dairy-based diet. She

quotes the famous nutritionist E. V. McCollum in National
Dairy Council advertisements from the 1920s:
The people who have achieved, who have become large,
strong, vigorous people, who have reduced their infant
mortality, who have the best trades in the world, who
have an appreciation for art, literature and music, who
are progressive in science and every activity of the human
intellect are the people who have used liberal amounts of

milk and its products. [DuPuis 2002:117]

Not only was drinking milk and consuming other dairy

products seen as superior, it was also viewed as normal

and normative. This perspective endured through the 1960s
when studies began to demonstrate population variation in
lactase persistence, with the modal global form being lactase

impersistence. However, despite widespread recognition of

this distribution, lactase impersistence remains implicitly

pathological, as evidenced in widely used terminologies

tion is essentially meaningless for most individuals who,

they suggest, can happily consume milk and be healthier
for it. At the same time, the NDC retains a vision of lactase

impersistence as problematic, not so much because it may

provoke gastrointestinal symptoms but, rather, because it

may result in reduced milk consumption. The very term

maldigestion suggests a malady, and the following passage
describes the deviant nature of this condition: "Data from
most studies suggest that individuals with primary lactose
deficiency consume less milk than those who digest milk
normally" (Jarvis and Miller 2002:58, emphasis added). So
while they acknowledge underlying biological variation, it
is of no practical significance; it should not be a barrier to
consuming milk and enjoying the health benefits it confers
to those who have a history of drinking milk and continue

to do so regularly. One can and should "overcome" this biological deficit to achieve full participation in U.S. culinary
culture and its self-evident salutary consequences.

Because biological variation is discounted, the NDC

and definitions. Such medicalizing of non-Western, partic-

suggests that it is negative cultural attitudes about milk that

ularly African biologies appears in the colonial period and

remains evident in the example of lactase impersistence (cf.
Comaroff and Comaroff 1992; Gould 1981; see Tapper 1995

reduce its consumption by minority groups. Arthur Whaley

noted this same trend in epidemiological studies: "Ethnic/racial groups are often seen as having misperceptions

and unhealthy behaviors learned through cultural social-

for discussion of the analogous example of sickle-cell anemia). To be fair, lactose intolerance, which may result from

ization that increase their risk for adverse health outcomes"

lactase impersistence, is a cluster of uncomfortable physiological symptoms for which a person might seek medical

educated about the value of milk in their diets and en-

help, but it is important to acknowledge that these only

manifest in the context of milk consumption.
The significance of biological variation in lactase per-

(2003:738). Hence, individuals in such groups should be

act behavioral changes; the source, value, or integrity of

diverse "cultural attitudes" are dismissed. Drinking milk
is no less than full enculturation into U.S. life. Yet the

sistence is downplayed by the USDA and dairy industry.

increasing diversity of the U.S. public must be acknowl-

First, they consider it to be an "overblown" issue, citing ev-

edged and celebrated to some extent, especially if the goal

is to sell more milk and reverse the decades-old downward

idence that lactase impersistence is not always associated

with symptoms of lactose intolerance. Although they ac-

trend in milk consumption. Thus, efforts to embrace that

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Wiley * Biological Diversity and Milk Consumption in the United States 515
diversity while simultaneously unifying it into a common

milk-drinking experience have escalated.8 It is impossible

to avoid the images in popular culture from the wildly
successful "got milk?" advertising campaign, which feature famous role models of various ethnic backgrounds
sporting milk mustaches.9 This campaign has both increased milk sales and reached iconic status. This practice is not lost on antimilk groups, who complain that it
is misleading because of the relatively high frequency of
lactase impersistence/lactose intolerance among groups of
African, Asian, or Latin American descent (and who have
also subverted the "got milk?" slogan in various ways; see Given the rapid growth of this demographic group, the NDC explicitly targets Hispanics in
its current advertising strategy (USDA 2002); by using minority role models, it hopes to instill a positive association
with milk and encourage milk consumption among minority children. Given that food preferences are established in
childhood (Rozin 1983, 1990), this strategy should pay off
for the dairy industry in the short and long term.

However, in achieving such broad acceptance, the

anthropological context for appreciating biological and
cultural diversity is easily lost, especially when it threatens
to thwart marketing goals or undermine accepted wisdom,
in this case, about the inherent goodness of milk for "every

body." When it comes to describing biological variation,

the axiom that biological variation within populations is
greater than variation between populations is rarely appreciated, as populations are labeled as lactose intolerant or lactase persistent. Yet in the quest for examples of patterned genetic variation among human populations, work in biological anthropology may promote this interpretation, reifying
population differences while downplaying the tremendous

amount of individual variation in response to lactose. This

is where the evolutionary perspective is most useful, in the
sense that it describes the process by which genetic change
comes about and the important social and natural environmental factors that generate such change without reference
to discrete population groupings.

This example further illustrates the utility of a biocul-

So how do we construct reasonable food policy based

on our current understanding of population variation in
adult lactase production? Both the NDC and PCRM have

understand how human biology, especially human biological variation, is constructed and elaborated within a cultural

valid claims-that to characterize minorities as lactase im-

context. Here, biological variation in lactase production in

tural perspective in anthropology, and one that attempts to

persistent (or lactose intolerant) is to engage in racial stereo-

adulthood runs up against a dietary culture characterized

typing and that to mandate milk consumption for all U.S.

by extensive use of dairy products and a political economic

citizens is discriminatory against those with lactase imper-

context in which the USDA and dairy industry ally to in-

sistence (and especially those with lactose intolerance). To

crease milk consumption among a U.S. public of increas-

some extent the claims and counterclaims about the health-

ing biological, ethnic, and dietary diversity. The story that

iness of milk are irrelevant to this discussion, although it is

whose consumption will surely prevent chronic disease, nor

they tell about lactase persistence has become the dominant story; challenges to it are trivialized or described as
subversive. This axis of biological variation, so celebrated
by biological anthropologists, is relegated to a somewhat

is biology destiny-drinking moderate amounts of milk is

interesting yet, ultimately, meaningless fact, except insofar

a travesty to attribute health deficits among minorities to

their "failure" to drink milk. Milk is neither the elixir of life,

not likely to be seriously problematic for most people with

lactase impersistence. Various lactose-reduced options ex-

as it threatens to impede full enculturation into a dairyconsuming culture.

ist for those who wish to consume dairy, but at the same
time, an increasingly diverse U.S. public is being led to believe that they must consume milk to be healthy, and tradi-

tional cuisines and alternate sources of calcium are largely


ANDREA S. WILEY Program in Anthropology, James

Madison University, Harrisonburg, VA 22807

Acknowledgments. I gratefully acknowledge the help of a group of

excellent anthropology students atJames Madison University, most


It is heartening to see widespread acknowledgment of hu-

man biological variation in adult lactase activity among

policy-making institutions in the United States. The evolutionary stories that go along with it have received less
attention, except insofar as they acknowledge that some
benefit accrued to certain populations that were able to exploit milk throughout life. These benefits are hailed and emphasized by those institutions promoting milk; they are less
evident in the stories told by those who question milk's cul-

tural and biological supremacy. The biology that facilitates

ongoing milk consumption is likewise celebrated; other di-

gestive physiologies are seen as abnormal or deficient in

some way and need to be "overcome."

especially Adam Southall, for his careful research and comments

on this manuscript. Likewise, Angel Shockley, Naheed Ahmed,

Haley Thrift, and Jessica Fowler contributed useful insights. Kim

Butler's thesis work on milk advertising was particularly helpful.
Ric Thompson, Alex Brewis, and Richard Lippke all provided valu-

able feedback on earlier drafts of this article. The editors of AA were

very helpful in recasting the article for the broadest anthropological


1. A lack of consistency in terminology is evident in introductory

biological anthropology textbooks. In a sample of four textbooks,
two referred to lactase impersistence simply as lactose intolerance
(Jurmain et al. 2000; Relethford 2003); one referred to it as lactase deficiency (Stein and Rowe 2000); and another referred to it as
low digestive capacity (Boyd and Silk 2003).

2. In a preliminary proposal for new revised Dietary Guidelines,

calcium-enriched soy products are added as an alternative

in the dairy category (see

update/FGP%20docs/TABLE%201.pdf). It remains to be seen

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516 American Anthropologist * Vol. 106, No. 3 * September 2004

whether this will be kept in the final version, although Dean

Foods, one of the largest dairy corporations, also owns Morningstar,

which makes Sun Soy, a soymilk brand.

3. Robert Heaney and Connie Weaver (1990) found that the

calcium available in kale was higher than that in milk. Other
sources disparage the calcium density and bioavailability of veg-

etable foods: "A person would need to consume 8 cups of spinach,

nearly 5 cups of red beans, or 2 cups of broccoli to get the same
amount of calcium absorbed from 1 cup of milk" (NDC 2003b).

4. It should also be noted that many schools have "pouring rights"

contracts with soft drink corporations, and students often choose
soft drinks over milk at school. Given the high sugar content of soda
and its potential contribution to the current epidemic of childhood
obesity, this issue is a key concern of ASFSA members.

5. These population groupings are regularly used in descriptions

of variation in lactase activity in the United States. That these are

diverse kinds of groups, which reflect commonly used national,

regional, "racial," or ethnic identities is not considered.

6. These groups have been described as "the most immediately

dangerous," because of their sometimes terrorist tactics (Heaney
2001:160). Further, their influence is decried:

We confront a recent, very modern efflorescence of mil-

itant groups that oppose all use of animal products and

aim to effect a nutritional policy outcome similar to that
of the creationists with regard to evolution. Those who
care about nutrition, those who think nutrition impor-

tant for the public health general, need to realize that

the present-day skirmishes may be only the first wave of

a growing battle. [Heaney 2001:163]

7. This decline in milk consumption is usually traced to the rise in
the consumption of soda, bottled water, juice, and sports drinks.
Also, while U.S. citizens widely acknowledge that milk "does a body
good," this earlier advertising slogan had little positive impact on
milk consumption. Only after the initiation of the "got milk?" cam-

paign did milk consumption rebound somewhat (Manning 1999).

8. Promilk attitudes and governmental policies are increasingly

evident on a global scale. Thus, immigrants to the United States
may already come with attitudes shaped by these policies from

their home countries.

9. Recently, some have started wearing lactose-reduced milk


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