ASA Adjudication on The Vegetarian & Vegan Foundation

Ad

A leaflet, for the Vegetarian & Vegan Foundation (VVF), was headlined "Up to 100 millions pus cells in every glass … If that doesn't shake you, nothing will". The centre pages of the leaflet were headlined "White lies" and stated "… milk is presented almost as a wonder food, essential to health - strange considering that Americans lap it up and have some of the worst health statistics going while Japanese barely touch it and are some of the healthiest, long-living people on Earth."

A section of the leaflet was entitled "Milk magnificent for kids?" and stated "Childhood diabetes (type 1), for which insulin injections are needed, is dramatically on the up in under fives. Cow's milk formulae and early milk drinking can be important triggers, particularly in genetically susceptible children. Type 2 diabetes is also skyrocketing. It used to affect only adults but is now being found in children. Research in 40 Countries shows the more milk (and meat) kids eat the higher their risk."

In a section entitled "Milk - fat of the land?" the leaflet stated "Sure is and particularly the most damaging kind - saturated fat. Breast cancer in the UK is up 80 per cent since 1971 and hits one in nine women. It's one in 10,000 in rural China, where dairy is a rarity. The difference is due to diet, not genes."

The leaflet also referred to ovarian, prostate and bowel cancers, as well as heart disease, calcium loss, arthritis, constipation, Crohn's disease, gall stones, kidney stones, migraines, multiple sclerosis and obesity.

Issue

One complainant:

1. objected that the headline, "Up to 100 millions pus cells in every glass ...", misleadingly implied that the white blood cells in milk were the same as pus cells;

2. objected that the leaflet misleadingly implied that milk was largely responsible for Japanese people being healthier than Americans;

3. challenged whether the claim "Childhood diabetes (type 1) ... Cows milk formulae and early milk drinking can be important triggers, particularly in genetically susceptible children" was misleading and could be substantiated;

4. challenged whether the claim "Type 2 diabetes ... Research in 40 countries shows the more milk (and meat) kids eat, the higher the risk"; and

5.  objected that the leaflet misleadingly implied that milk consumption was largely responsible for breast cancer rates in the UK.

6. Another complaint objected that the leaflet was misleading and appealed disproportionately to fear because it implied that milk drinkers were at risk of several serious medical conditions.

CAP Code (Edition 11)

Response

The Vegetarian & Vegan Foundation (VVF) sent a large number of scientific studies and reports to support their response to each complaint.

1. VVF said cows responded to infection in the same way as humans by generating white blood cells (somatic cells), which migrated to the affected area to combat infection.  They said those cells, along with cellular debris and necrotic tissue, were a component of 'pus' excreted into cow's milk and a high level of white or 'pus' cells indicated infection in cows.  They believed the word 'pus' was a more familiar term to readers than 'somatic cells'.  VVF said the Dairy Council stated that, on average, bulk milk in the UK contained 200,000 cells per millilitre or 50 million per 250ml, and that that was half the permitted amount.  They therefore believed it was not an exaggeration to state that a 250ml glass may contain "Up to 100 million pus cells".  

VVF asserted that high somatic cell count, i.e. high levels of 'pus' in milk, was perceived by some scientists as an indicator of potential microbiological hazard. They said many of the bacteria responsible for causing mastitis in dairy cows,such as escheria coli, staphylococcus aureus and streptococcus agalactiae, were also the causative agents of human diseases. VVF accepted that the pasteurisation of milk was generally effective in killing such pathogens but believed evidence suggested that certain species might survive pasteurisation. VVF said a high somatic cell count was an indication of the level of infection and might indicate the general level of hygiene within the herd. They said the point of the leaflet was to increase awareness of scientific research that raised concerns about the health consequences of consuming cow's milk.

2. VVF maintained that the leaflet did not state that milk was largely responsible for Japanese people being healthier than Americans.  They believed the wording implied only that milk was not essential to human health and the example of Japanese people being healthier than Americans illustrated that.  VVF said the World Health Organisation (WHO) suggested several ways to improve health and lose weight including "moving from saturated animal-based fats to unsaturated vegetable-oil based fats".  They pointed out that most dairy products, apart from skimmed and non-fat products, contained significant amounts of saturated fat and cholesterol, but were low in polyunsaturated essential fatty acids, which were required in the diet for good health. VVF maintained that peer-reviewed literature showed that, as milk consumption increased, so did the incidence of many illnesses and diseases.

3. & 4. VVF said the leaflet did not claim that milk was largely responsible for childhood diabetes but rather stated clearly that it was 'a major trigger'.  They pointed out that they had taken care to clarify that milk was 'a', rather than 'the', major trigger.  They believed it was obvious from the claim that there were other major triggers apart from milk.  VVF said WHO described the global rise in diabetes as an 'epidemic'; in 1985 an estimated 30 million people worldwide had diabetes, a decade later the figure had increased to 135 million and by 2000 an estimated 171 million people had diabetes. They acknowledged that the increase in diabetes was attributed to a range of factors including population growth, an ageing population, diets high in saturated fat and cholesterol, obesity and lack of physical exercise.  VVF said type 1 diabetes was an autoimmune disease caused by exposure to an environmental trigger coupled with a genetic predisposition and type 2 diabetes was linked to obesity and a sedentary lifestyle. They said many scientific studies linked type 1 diabetes to the early exposure of infants and adolescents to cow's milk.  Furthermore, they maintained that other studies showed a diet low in animal fats, such as those in milk and dairy products, could reduce the need for diabetes medication.  

5. VVF said the leaflet did not imply that dairy was the major cause of breast cancer, it merely stated the facts.  They said breast cancer in the UK had increased by 80% since 1971 with one-in-nine women now affected.  They pointed out that research had shown that only 5% of cases were due to abnormal genes.  VVF maintained that the vast majority of breast cancer cases were a result of diet and lifestyle.  They pointed to research from the Dunn Human Nutrition Unit in Cambridge, which showed a strong link between breast cancer and saturated animal fat, which was found mostly in whole milk, butter, meat, cakes and biscuits. They believed Harvard Medical School backed up those findings and confirmed that red meat and high-fat dairy foods such as whole milk, cream, ice cream, butter, cream cheese and cheese were associated with breast cancer.  VVF said a major review of diet and breast cancer in 40 countries showed a link between meat, milk and cheese and breast cancer and noted researchers involved in those studies suggested that hormones in milk may be responsible.  They also pointed out that researchers at Princeton University found that growth hormone insulin-like growth factor 1 (IGF-1) stimulated the growth of human breast cancer cells in the laboratory. VVF maintained that researchers were concerned that IGF-1 might survive pasteurisation and be absorbed across the gut and that regular milk consumption after weaning could produce enough IGF-1 in mammary tissue to encourage cell division thus increasing the risk of cancer.

6. VVF said they had listed all the diseases with which they believed there was a causative link to dairy products and milk.  They provided an extensive list of research, which, they believed, demonstrated the causative link for each of the conditions featured in the leaflet. VVF said the research showed that consumers of milk and dairy products were at increased risk of several medical conditions.  They therefore maintained that the leaflet was not misleading and did not appeal disproportionately to fear but performed an important public function, being the first campaign to tackle the links between dairy and ill health. Taking each of the conditions in turn:

VVF said ovarian cancer was the fourth most common cancer among women in the UK with around 6,900 new cases each year.  They said sugar in milk (lactose) was a risk factor and a study showed that women who consumed the most lactose had twice the risk of one type of ovarian cancer than women who drank the least.  They said another study showed that women who consumed four or more servings of dairy foods a day had double the risk of ovarian cancer compared with low or non-dairy consumers.  In other countries, consumption of dairy foods increased risk while pulses protected against ovarian cancer.  

VVF pointed out that one in 14 men in the UK developed prostate cancer. They said a link with dairy products was first discovered in the 1980s. Since then, they believed other studies had identified the components of milk which might be responsible including oestrogen and the growth hormone, IGF-1. They also pointed out that researchers at the Preventative Medicine Research Institute in California used a vegan diet (dairy free) to slow the growth of early prostate cancer.

VVF said coronary heart disease (CHD) was the biggest killer in the UK and was caused by a build up of fatty deposits (plaques) in the arteries.  They pointed out that saturated fats increased cholesterol levels which in turn increased the build up of plaques. VVF said research in the 1980s identified dairy products as a major source of saturated fat and now the UK government has recommended avoiding or cutting down on fatty foods, including egg yolks, red meat, butter, whole milk, cheese, cakes and chips.  They said other studies had shown that replacing milk protein (casein) with soya protein reduced cholesterol, even when the total fat intake remained the same.  They also said the Oxford Vegetarian Study showed that vegans had lower cholesterol levels than meat-eaters, fish-eaters or vegetarians. VVF maintained that the research indicated that saturated animals fats increased cholesterol and the risk of CHD.

VVF believed a major review of recent scientific studies on calcium and bone health, published in the journal of the American Academy of Paediatrics in 2006, shattered the misleading notion that children needed cow's milk for good bone health. They said the review examined the effects of dairy products and total dietary calcium on bone health in children and young adults and found that dairy products were not needed for strong bones. VVF pointed out that over three-quarters of the world's population did not consume cow's milk and an increasing amount of evidence now showed cow's milk was not the best source of calcium.  In addition, they maintained that research suggested that physical exercise was the most critical factor for maintaining healthy bones, followed by improving the diet and lifestyle; eating plenty of fresh fruit and vegetables, and for young adults cutting down on caffeine and avoiding alcohol and smoking.

VVF pointed out that osteoporosis was another disease on the increase, with one in two women and one in five men suffering a fracture after the age of 50. They said the scientific evidence suggested that cow's milk and dairy products may be part of the problem rather than the solution.  They maintained that American women were among the biggest consumers of calcium in the world yet they had one of the highest levels of osteoporosis. VVF said a 12-year study of over 75,000 women came to the conclusion that dairy products may increase the risk of fracture. They believed other studies had shown that high intakes of animal protein from dairy, eggs, meat and fish had an acidifying effect leading the body to try to neutralise the acid by leaching calcium from its bones.  They pointed out that WHO acknowledged the issue and referred to it as the 'calcium paradox' whereby the beneficial effects of calcium may be outweighed by the harmful effects of animal protein.

They also sent studies which they believed showed milk and dairy had a causative link with arthritis, constipation, Chrons disease, food poisoning, gallstones, kidney stones, migraines, multiple sclerosis and obesity.

Assessment

The ASA obtained expert advice.

1. Upheld

We noted milk contained white blood cells, also known as somatic cells and that those white blood cells were a natural part of an animals defence system and were not only found in cows milk but also in human breast milk as they were a natural part of lactation.  We understood that the level of somatic cells permitted in milk was carefully monitored and controlled under EU regulations.

We noted the leaflet claimed that there were up to a hundred million 'pus' cells in each glass of milk.  We considered that readers were likely to understand the word 'pus' to denote the yellowish liquid produced in abscesses, sores and pimples as a result of infection. We also considered that the vast majority of readers would regard such a substance in a negative light, whereas we understood that white blood cells or somatic cells were a natural constituent of cow's milk.  We considered that to refer to the white blood cells naturally present in milk as 'pus' was misleading.

On this point, the leaflet breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).

2. Upheld

The expert said it was possible to eat a healthy balanced diet that excluded milk and dairy, and indeed all animal products, and people who chose to do so tended to be healthier.  However, how much of that was due to those peoples diet as opposed to other aspects of their lifestyle (for example they tended to be leaner, take more exercise and not to smoke) was unclear.  He said identifying causal links between individual components of the diet and chronic diseases, such as cancer, was not straightforward. Much evidence came from observational epidemiology, which had several advantages. Prospective cohort studies could observe typical populations consuming ordinary diets over long periods of time, and measure important outcomes such as cancer incidence or deaths.  However, all such studies were subject to confounding, where an association between an exposure and outcome may not be causal but be due to a relation between the measured exposure and another unmeasured or unknown exposure.  He said there was no perfect way of mitigating this problem even in well conducted epidemiological studies.  However, randomised controlled studies, if well designed and executed, excluded the possibility of confounding.  The expert said that differences in health between Americans and Japanese might be due, for example, to levels of physical activity.  

We noted the claim focused on the question of whether milk was "a wonder food, essential to health" and understood that, generally, Japan had better comparative health statistics than the US.  We noted the low consumption of milk by the Japanese was used as an example that it was possible for populations to be healthy without consuming milk but there were many reasons, beyond milk consumption, including other dietary factors, physical activity and genetics that might be responsible for differences in health between Americans and Japanese.  Although we noted VVF believed the claim stated only that milk was not essential to health, we considered that readers were likely to infer that milk was the main or one of the main cause of the differences in health between Japanese and American people.  Because VVF had not demonstrated that, we concluded that the leaflet was likely to mislead.

On this point, the leaflet breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).

3. Not upheld

The expert said there was a body of evidence, largely but not completely consistent, which showed that early life exposure to cows milk was linked to an increased risk of type 1 diabetes.  He considered that the studies provided by VVF supported the link between early exposure to cows milk and the risk of type 1 diabetes. He said, with all conditions, the environmental exposure interacted with any genetic disposition.  We noted the claim stated that milk was an "important factor", not the only factor, and made clear that genetic disposition was a factor.  We concluded that VVF had substantiated the claim "Cows milk formulae and early milk drinking can be important triggers, particularly in genetically susceptible children".

On this point, we investigated the ad under CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness) but did not find it in breach.

4.  Upheld

The expert said type 2 diabetes was mainly determined by insulin resistance as a consequence of someone being overweight or obese, against a background of genetic or other possible predispositions.  The expert considered that there was insufficient evidence of a causal link with any dietary component, including milk and dairy.  He said the possibility of confounding as the basis for any observed association was high.  We considered that the ad implied that milk was a specific trigger for type 2 diabetes and concluded that VVF had not substantiated that it was.

On this point, the leaflet breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).

5. Upheld

The expert referred to the World Cancer Research Fund (WCRF) report, published in November 2007.  He said the report judged the evidence to be too limited in quality, quantity or consistency to draw any conclusions as to a causal link between milk/dairy consumption and breast cancer.  He said all but one of the studies sent by VVF had been evaluated by the WCRF expert panel but other studies, which did not show a link between breast cancer and dairy, had also been reviewed.  He said the WCRF report concluded that there was neither a convincing nor probable causal link between milk/dairy and breast cancer.

We noted the WCRF review was the most up-to-date, comprehensive, independent scientific review of the scientific evidence available on cancer prevention.  We noted the VVF leaflet compared the incidence of breast cancer in the UK with that in rural China and stated that the difference was due to diet, not genes. We noted, however, there were numerous differences between the lifestyles of people in the UK and those in rural China.  We considered that the leaflet implied that there was a causal link between milk/dairy and breast cancer.  Because the scientific evidence was insufficient to demonstrate a causal link we concluded that the claims were likely to mislead.

On this point, the leaflet breached CAP Code clauses 3.1 (Substantiation) and 7.1 (Truthfulness).

6.  Upheld

The expert said a body of literature existed, which implicated dairy consumption, specifically galactose with ovarian cancer.  However, the evidence was inconsistent and the WCRF panel judged it too limited to draw a conclusion on whether or not a causal link existed.  

With regard to bowel cancer, the expert said the WCRF panel judged that milk consumption, either measured directly or using dietary calcium as a marker, was probably protective.

For prostate cancer, the expert said the WCRF panel judged that high calcium intake was a probable cause of cancer.  He said for milk and dairy specifically the evidence, though suggestive, was judged too limited to draw a firm conclusion of a causal link.

With regard to the other conditions referred to in the ad, the expert said although there might be sporadic reports of associations and putative mechanisms linking dairy with the conditions, there was not a substantial body of evidence to support a confident claim of causality.

We noted the WCRF judged that a diet high in calcium was a probable cause of prostate cancer.  Although there was no specific evidence relating to dairy and milk, we noted the WCRF report stated that calcium could be a marker for dairy intake in high income populations such as in US and UK.  We noted the ad stated that prostate cancer was a major killer and "milk can play a part".  We considered that the evidence was sufficient to support such a claim.

We noted a diet low in saturated fat helped to prevent CHD. We noted butter, full fat milk and cheese were high in saturated fat.  We considered however, that the way the claims were presented suggested that all dairy, including low fat versions such as skimmed milk, were responsible for CHD.

We noted the evidence presented did not support the claims of milk's association with the other conditions listed.  We considered that readers were likely to infer that milk consumption significantly increased their chances of developing the medical conditions in the ad.  Because the evidence did not prove that (except in the case of prostate cancer), we concluded that the leaflet was likely to mislead and appealed to fear in a manner disproportionate to the risks involved in consuming milk.

On this point the leaflet breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), 9.1 and 9.2 (Fear and Distress).

Action

The ad should not appear in its current form.  We advised the VVF to consult CAP Copy Advice before making similar claims in future.

Adjudication of the ASA Council (Non-broadcast)