[Congressional Record Volume 169, Number 205 (Wednesday, December 13, 2023)]
[House]
[Pages H6889-H6907]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                WHOLE MILK FOR HEALTHY KIDS ACT OF 2023


                             General Leave

  Ms. FOXX. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
to insert extraneous material on H.R. 1147.
  The SPEAKER pro tempore (Mr. Donalds). Is there objection to the 
request of the gentlewoman from North Carolina?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 922 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 1147.
  The Chair appoints the gentleman from Tennessee (Mr. DesJarlais) to 
preside over the Committee of the Whole.

                              {time}  1355


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 1147) to amend the Richard B. Russell National School Lunch Act 
to allow schools that participate in the school lunch program under 
such Act to serve whole milk, with Mr. DesJarlais in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule the bill is considered read the first 
time.
  General debate shall be confined to the bill and shall not exceed 1 
hour equally divided and controlled by the chair and ranking minority 
member of the Committee on Education and the Workforce or their 
respective designees.
  The gentlewoman from North Carolina (Ms. Foxx) and the gentleman from 
Virginia (Mr. Scott) each will control 30 minutes.
  The Chair recognizes the gentlewoman from North Carolina.
  Ms. FOXX. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I rise in strong support of H.R. 1147. It is Christmastime 
across America. For many, the season brings with it the annual return 
of cherished Christmas traditions, such as leaving milk and cookies out 
for Santa Claus and his reindeer to enjoy.
  As for my family, our traditional choice of dairy has always been 
whole milk. We want only the most nutritious option for Santa.

  The nutrients in whole milk, like protein, calcium, and vitamin D, 
provide the fuel Santa needs to travel the whole globe in one night. 
Whole milk is the unsung hero of his Christmas journey.
  Protein helps build and repair Santa's muscles. Hoisting heavy sacks 
of gifts up and down the chimney is no easy task.
  Calcium is vital for strong bones. It is calcium that keeps Santa 
strong and sturdy as he dashes from rooftop to rooftop.
  Vitamin D is essential to a strong immune system. Santa absolutely 
needs one as he braves the cold, wintry night. You see, it is not just 
the magic of the season that helps Santa deliver presents worldwide, it 
is also the fortifying nutrients in whole milk.
  Reflecting on Christmas traditions this year begs the question: If 
whole milk is a good option to fuel Santa's extraordinary Christmas Eve 
journey, then why isn't it an option for American schoolchildren in 
their lunchrooms?
  That is why I support Representative G.T. Thompson's Whole Milk For 
Healthy Kids Act, a bill allowing unflavored and flavored whole milk to 
be offered in school cafeterias.
  Since 2012, the National School Lunch and Breakfast Program has 
allowed only low-fat and fat-free milk options for American 
schoolchildren. This means 2 percent and whole milk have been excluded 
from the daily diets of an entire generation of kids.
  The USDA intends to finalize another rule which will further limit 
milk options. Anti-milk advocates advance one main argument against 
whole milk: that whole milk is bad for kids.

                              {time}  1400

  Rather, milk has 13 essential nutrients that are needed for children 
to live healthy lives and succeed in school. It is an essential 
ingredient to growth and development. Research shows that whole milk is 
associated with a neutral or lower risk of heart disease and obesity.
  Moreover, the USDA contradicts itself by limiting milk options for 
young children. On one hand, it recognizes that children are at risk of 
underconsuming dairy, yet on the other, it creates policies that will 
only exacerbate the problem.
  If Americans have learned anything from these past 3 years, it is 
that scientific authorities tend to contradict themselves. The truth is 
that whole milk is a significant source of vital nutrients for 
children's growth and development. The Federal bureaucracy should never 
stand between your children and a nutritious lunch.
  The Whole Milk for Healthy Kids Act isn't about advocating for one 
type of milk over another. It is about providing parents, schools, and 
food service providers with the option to choose what is best for our 
children's nutrition.
  This act does not aim to diminish the importance of other milk 
varieties. Rather, it seeks to restore the availability of a wholesome, 
natural option that has been a staple for generations. This bill is 
about choice. It is a chance to empower parents and schools to make 
informed choices about what goes into our children's diets.
  Whether it is a nutritional foundation for Santa's journey or your 
child's math homework, let's not discount the benefits of whole milk.
  Mr. Chair, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chair, I rise in opposition to H.R. 1147, the Whole Milk for 
Healthy Kids Act.
  School meals are critical to reducing child hunger and providing 
children with the healthy food they need. Milk, offered as part of 
these meals, can help deliver essential nutrients that are vital to a 
child's development. That is why it is so important that we provide 
students with the most nutritious milk options.
  Child nutrition standards for school meals, including milk options, 
are guided by the science-based Dietary Guidelines for Americans, or 
the DGAs, which are periodically updated based on recommendations from 
child nutrition experts and input from the public.
  The latest DGAs, along with the American Heart Association, American 
Academy of Pediatrics, the Physicians Committee for Responsible 
Medicine, the Academy of Nutrition and Dietetics, and over a dozen 
other public

[[Page H6890]]

health advocates, agree that fat-free and low-fat milk are the 
healthiest options for children.
  Regrettably, H.R. 1147 attempts to legislate nutrition standards and 
disregard the evidence-based recommendations made by the DGAs. 
Furthermore, the bill would undermine the Biden administration's 
ongoing rulemaking to better align school nutrition standards with the 
latest science.
  This bill would allow schools participating in the National School 
Lunch Program to offer whole milk and reduced-fat milk, violating the 
current science-based standards that protect children's health.
  Whole milk contains far more saturated fat, cholesterol, and calories 
than fat-free and low-fat milk. Conversely, fat-free and low-fat milk 
options offer the same vital nutrients, including calcium, vitamin D, 
vitamin A, protein, and potassium, as whole milk.
  Nutrition standards must be guided by scientists, not politicians. If 
someone wants to offer one study or another to be considered, use the 
DGA process, not the political process. This bill needlessly inserts 
politics into a science-based process.
  Lastly, I am disappointed by the majority's decision to depart from 
precedent by moving a child nutrition bill outside of a comprehensive 
child nutrition reauthorization. Rather than improve our Nation's child 
nutrition programs holistically, the majority has decided to prioritize 
interfering with evidence-based nutrition standards for our children's 
school meals.
  For that reason, Mr. Chair, I oppose the bill, and I reserve the 
balance of my time.
  Ms. FOXX. Mr. Chair, I would just like to tell my colleague something 
that I think will be easy to remember about why we are doing this. 
Scientists/experts built the Titanic, and amateurs built the ark.
  Mr. Chair, I yield 2 minutes to the gentleman from Wisconsin (Mr. 
Grothman).
  Mr. GROTHMAN. Mr. Chair, I thank Ms. Foxx for making Biblical 
allusions. Last week, we were here talking about National Bible Week. 
One of the phrases that you run across again and again as you read the 
Bible is that God promised Abraham a land flowing of milk and honey. I 
will let the body decide what type of milk the Lord was promising 
Abraham. I think I know.
  As somebody who has been drinking milk my whole life, I can tell you 
a better tasting milk, and a milk that I think is more likely to be 
consumed, is whole milk. For some reason, the current administration is 
waging war on milk. The USDA's current restrictions on school lunches 
are limiting nutritious options for kids. This comes at a time when it 
is found that 90 percent of Americans do not eat enough dairy to meet 
the dietary recommendations.
  Drinking milk leads to better bone health and lower risk for type 2 
diabetes and cardiovascular disease. Additionally, milk stands as a 
leading and accessible source of nine essential nutrients that children 
often fall short of.
  Proposed guidelines such as limiting milk options by age group and 
counting milk fat against weekly saturated allowance threaten to 
deprive students of essential nutrients.
  It is crucial that students have access to the nutritional benefits 
of milk. With these restrictions, they might choose to forgo milk 
entirely, if you have to drink the less tasty 1 percent, or even worse, 
fat-free milk.
  These proposed restrictions ignore several recent research studies 
examining the effect of higher fat milk consumption which found that it 
is associated with lower childhood obesity and concluded that dietary 
guidelines that recommend reduced-fat milk versions might not provide a 
benefit in lowering the risk of childhood obesity, which we are all 
for.
  I implore each of you to consider the Whole Milk for Healthy Kids Act 
of 2023 as a commonsense solution to ensure that we have healthy 
children.
  Mr. Chair, I ask my fellow Members to vote ``yes'' on H.R. 1147.
  Mr. SCOTT of Virginia. Mr. Chair, I yield such time as he may consume 
to the gentleman from Louisiana (Mr. Carter).
  Mr. CARTER of Louisiana. Mr. Chair, I thank Ranking Member Scott for 
his time and leadership in this matter.
  I rise today in opposition to this bill. Monday night, the Rules 
Committee considered my amendment, amendment No. 16, to H.R. 1147, 
which would have provided an alternative, a healthy alternative to our 
young people, people that cannot digest milk.
  I heard my colleagues on the other side of the aisle suggest that 
this was a choice. Well, if there were a choice, then why not add soy 
as a choice. Soy gives the equivalent of the nutritional values as 
whole milk, but it does not have the negative impact that whole milk 
has on a large swath of people in our community.
  I will tell you those numbers. Ninety-five percent of Native 
Americans have lactose intolerance. Ninety percent of African Americans 
are lactose intolerant. Sixty-five percent of Latino Americans are, in 
fact, lactose intolerant. Asian Americans, 90 percent. These are real 
numbers. This is not about taste. This is not about profit. This is not 
about bottom line. This is not about a powerful lobby. This is about 
the safety, nutrition, and well-being of our young people.
  We cannot ignore the impact that ingesting or attempting to digest 
things that your body cannot and what impact it has on one's ability to 
concentrate or do well in the classroom.
  My colleagues and I formed a diverse group, represented by chairs of 
the Congressional Hispanic Caucus, the Asian Pacific American Caucus, 
and a vice chair of the Congressional Black Caucus respectively. We all 
firmly believe that the full House should be allowed to debate this 
important measure, making sure that we were given the opportunity on 
the floor to debate this amendment. I believe if given the opportunity 
to be heard, even the other side could have and would have been able to 
support.
  What is most perplexing is how this amendment aligns with the purpose 
of the underlying bill, to expand choice and to deliver healthy 
beverages to the school counter. Our amendment is based on the text of 
my bill, H.R. 1619, the ADD SOY Act. It amends the Richard B. Russell 
National School Lunch Program to strike the onerous ``milk note'' 
requirement and to stipulate that the USDA reimburse school districts 
to make a plant-based dietary alternative that is nutritionally 
equivalent to cow's milk available in school. Yes, a choice, a real 
choice.
  When Congress enacted the milk mandate 80 years ago, the United 
States was less diverse, and we did not understand the exact science 
surrounding lactose intolerance. Between 70 to 90 percent of African 
Americans today are lactose intolerant. Ninety percent of Asians, 95 
percent of Native Americans, and 65 percent of Latinos are, in fact, 
lactose intolerant.
  The National Institutes of Health reports the majority of all people 
have reduced ability to digest lactose after infancy, and it adds that 
it is also very common in people from West Africa, Arab, Jewish, Greek, 
and Italian descent.
  Currently, if a student wants a nutritionally equivalent alternative 
to milk, they need to get a doctor's note or parent's note to obtain a 
plant-based beverage. Oftentimes, parents are working two jobs. 
Oftentimes, unfortunately, parents don't pay as much attention or are 
as in tune and have an opportunity to get to the school or even have 
healthcare to go to a doctor to get a note. Should that child still be 
punished and forced to drink something that their body simply cannot 
digest?
  How do you concentrate in the classroom when you are drinking and 
attempting to digest something that your body cannot? What happens to 
that child when they belly up to the desk and have to study or pay 
attention but their body is telling them that they have eaten something 
that does not agree with them? It causes a problem. It causes ridicule. 
It causes the ability or inability to concentrate and perform at their 
highest level. Because of this high barrier to entry, kids often don't. 
Many skip school or don't do well in school as an alternative.
  If 75 percent of African Americans are lactose intolerant, which is 
true in my family, why should three-quarters of kids have to get a 
note. It is not a medical disability to be African American. It is not 
a medical disability to be Vietnamese American. It is not a disability 
to be Native American. It is not a disability to be Latino.

  Lactose intolerance is genetic. This isn't complicated. Kids should 
be given

[[Page H6891]]

a healthy fluid beverage option that doesn't make them sick. Our 
amendment would have provided a sensible solution. Allow the USDA to 
reimburse school districts for soy milk, which so far is the only 
plant-based milk that has been recognized under the latest formulation 
of the 2020 American Dietary Guidelines to be healthy and nutritionally 
equivalent to cow's milk.
  Moreover, there is a primary reason that more than half of all milk 
given to children is thrown into a cafeteria trash can unused, carton 
after carton after carton of discarded cartons of milk that have never 
been opened. At some point kids realize it isn't good for them and they 
don't drink it. Whatever nutritional value you thought you were 
affording by giving milk doesn't happen if young people can't consume 
or digest it.
  Many kids don't want milk because it makes them sick. According to 
the USDA, 29 percent of cartons of cow milk served in our schools are 
thrown into the garbage unopened. This comes out to be somewhere around 
$300 million in annual waste of taxpayer funds for milk cartons. It is 
clear that not only is it a food waste issue but a failure on the NSLP 
to supply food to kids that are consumed and meet their daily 
nutritional requirement. The present rate of food waste and taxpayer 
losses is not acceptable.

                              {time}  1415

  Mr. Chair, I ask whether my Republican colleagues think it is a good 
policy. Is that good stewardship of our tax dollars? Is that delivering 
good health outcomes for all kids?
  If they believe it is, then they should agree and recognize that 
adding a true alternative is a good thing. I remind my colleagues that 
it is not a medical condition to be Black, Latino, Asian, Jewish, or 
other ethnicities.
  This is an issue of racial equity and inclusion, as well as 
tightening government spending and waste. It is both a matter of 
squandering tax dollars and a matter of fairness. The kids who have the 
least and who have the most difficulty raising their voices are being 
denied a food staple that they simply cannot stand.
  We must fix this. Let us strive to do better for the next generation 
and equip them with the nutritional sustenance at the lunch counter 
that can give them an opportunity to not just survive but thrive.
  Mr. Chair, I implore you to think about the children. Don't think 
about the profits. Don't think about the lobby. Don't think about the 
efforts of a winner or loser. Let's put children first.
  Let's make sure that we, as a Congress, recognize the value of 
fighting for those who have not been given the opportunity to fight for 
themselves.
  Add soy. Create true alternatives. Do not force people to digest 
things that their bodies simply cannot.
  Mr. Chair, it is for this reason and this reason solely that I cannot 
support this measure without true alternatives.
  Ms. FOXX. Mr. Chairman, I yield myself 1 minute.
  Mr. Chairman, we are very concerned about waste. One of the reasons 
there is so much waste is because whole milk is not allowed, and 
children don't like the taste of skim milk.
  We are putting children first. We are not excluding soy drink. It is 
not milk. It is a plant-based food. It isn't milk, so you can't call it 
soy milk. You can call it soy drink.
  It was under our first African-American President in this country 
that this was designed this way. The First Lady pushed through these 
rules and regulations to exclude whole milk, which, by the way, my 
colleague says has an enormous amount more fat.
  The fat content of whole milk is about 3\1/2\ percent. We are 
foisting on children 1\1/2\ percent milk, which doesn't have a very 
good taste to many of them. We are excluding them from 3\1/2\ percent. 
We do not exclude soy drink. This is about inclusion and equity. We 
want people to be able to drink the kind of milk they want to drink.
  Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania 
(Mr. Smucker).
  Mr. SMUCKER. Mr. Chairman, I rise in support of H.R. 1147, the Whole 
Milk for Healthy Kids Act, and I urge my colleagues to support this 
bipartisan, bicameral, and ``udderly'' fantastic bill.
  I proudly represent Pennsylvania's 11th District, which is one of the 
largest dairy producers in the Northeast. In 2022, 1,300 Lancaster 
County farms produced 2.1 billion pounds of milk.
  I have visited many of those farms, and I have had many discussions 
with local school administrators about the importance of child 
nutrition. We all agree that milk is a key vehicle for delivering 
protein, potassium, calcium, phosphorus, and vitamins A and D, 
especially for children.
  Let's not skim over the facts here. Whole milk is truly the cream of 
the crop in delivering these key vitamins and nutrients to growing 
children.
  Sadly, our Nation's kids are not consuming enough dairy. We have seen 
a decline in receiving those essential vitamins and nutrients since we 
banned whole milk in our schools. We can only begin to ``cow-culate'' 
the impact that has on their long-term health.
  Let's not curdle away the opportunity to expand dairy consumption in 
our Nation's schools and ensure our children are getting the nutrients 
necessary to grow strong bones and teeth.
  Mr. Chairman, all milk puns aside, I urge my colleagues to support 
this legislation. Expanding the universe of options for children to 
consume vital nutrients and vitamins is important for their long-term 
health. It also helps these kids be prepared for school, develop into 
adulthood, and cultivate a 21st century workforce.
  Mr. Chairman, healthy kids and supporting our dairy farmers are 
``moo-tually'' important.
  Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chairman, we received a letter from the National Alliance for 
Nutrition and Activity, which says in part that the passing of H.R. 
1147 ``would be a departure from the longstanding tradition of 
establishing food and nutrition standards for Federal child nutrition 
programs based upon the findings of independent reviewers and the 
scientific community. There are evidenced-based strategies to increase 
school meal consumption--and, by extension, potentially school milk 
consumption--that do not involve weakening nutrition standards. Changes 
to school nutrition standards should be guided by the Dietary 
Guidelines, not special interests, and as such, we strongly urge you to 
put children's interests first and uphold the science-based process and 
oppose the Whole Milk for Healthy Kids Act of 2023. Our children 
deserve no less.''
  It is signed by the Academy of Nutrition and Dietetics, Advocates for 
Better Children's Diets, American Academy of Pediatrics, American Heart 
Association, American Public Health Association, Ann & Robert H. Lurie 
Children's Hospital of Chicago, Balanced, Center for Biological 
Diversity, Center for Science in the Public Interest, Chef Ann 
Foundation, Friends of the Earth, Healthy Food America, Healthy Schools 
Campaign, Life Time Foundation, National WIC Association, and Public 
Health Institute.
  Mr. Chair, I include in the Record a letter from the National 
Alliance for Nutrition and Activity.
                                             National Alliance for


                                         Nutrition & Activity,

                                                December 11, 2023.
     Hon. Virginia Foxx,
     Chair, House Committee on Education and the Workforce, House 
         of Representatives.
     Hon. Robert ``Bobby'' Scott,
     Ranking Member, House Committee on Education and the 
         Workforce, House of Representatives.
       Dear Chairwoman Foxx and Ranking Member Scott: The 
     undersigned members of the National Alliance for Nutrition 
     and Activity, the nation's largest nutrition advocacy 
     coalition, strongly urge you to oppose H.R. 1147/S. 1957, the 
     Whole Milk for Healthy Kids Act of 2023. H.R. 1147/S. 1957 
     would allow school meals to offer full-fat (whole) and 
     reduced-fat flavored and unflavored milk, and arbitrarily 
     exempt full-fat and reduced-fat milk from current saturated 
     fat limits in school meals, both of which are inconsistent 
     with the recommendations of the 2020-2025 Dietary Guidelines 
     for Americans (DGAs).
       School meal standards, by law, must be aligned with the 
     Dietary Guidelines for Americans, which are reviewed and 
     revised every five years. The DGAs recommend full-fat (whole) 
     milk only for children under the age of two, and fat-free and 
     low-fat milk after that. In addition, the DGAs recommend 
     saturated fat should account for less than 10 percent of 
     calories per day. As such, both the National School Lunch 
     Program (NSLP) and School Breakfast Program (SBP) meal 
     patterns allow only fat-free and low-fat milk and require 
     that less than 10 percent of calories in the meal come from 
     saturated fat over the week. Earlier this year, the U.S. 
     Department of Agriculture (USDA) proposed

[[Page H6892]]

     updates to the school nutrition standards to more closely 
     align with the 2020-2025 DGAs, which did not change the 
     saturated fat limit nor increase the milkfat allowed to be 
     served in school meals. Singling out milk--in this case, 
     whole and reduced-fat milk--to be exempt from the 
     recommendations of the Dietary Guidelines is a slippery slope 
     for allowing--special interests to carve out exemptions in 
     school meal program rules. Allowing the change in the service 
     of whole and reduced-fat milk will negate the progress that 
     has been made in the planning and service of healthier foods 
     to children in schools.
       Milk is an important part of a well-balanced diet. Milk 
     contains nutrients of concern, such as vitamin D and calcium. 
     However, unlike fat-free and low-fat milk, full-fat milk 
     contains too much saturated fat to be part of a healthy food 
     pattern. According to USDA data, one cup of whole milk 
     contains around 4.5 grams of saturated fat. Full fat milk is 
     so high in saturated fat that the government prohibits its 
     labels from claiming that calcium can reduce the risk of 
     osteoporosis; fat-free and low-fat milk, however, can make 
     these claims. By allowing full-fat milk in lunch and 
     adjusting saturated fat allowances accordingly, H.R. 1147/S. 
     1957 would allow an additional 4.5 grams of saturated fat 
     daily in school meals beyond the science-based limit that is 
     currently in place.
       School meal nutrition standards were strengthened 
     significantly in 2012. These updates were an overwhelming 
     success, particularly for children in who are part of 
     households with fewer financial resources. A 2021 study found 
     that school meals are the single most healthy source of 
     nutrition for children--more nutritious than grocery stores, 
     restaurants, worksites, and others. Yet even with the current 
     nutrition standards that limit saturated fat in school meals, 
     most children, on average, still consume more saturated fat 
     than is recommended. According to the DGA, more than 80 
     percent of children ages 5-8 years, more than 85 percent of 
     youth ages 9-13, and over 75 percent of youth ages 14-18 
     consume too much saturated fat. Allowing full-fat milk in 
     schools would only worsen this problem.
       The fat content of school milk is neither the cause nor the 
     solution to the decades-long decline in fluid milk 
     consumption in the United States and the struggles of the 
     dairy industry. According to a 2013 Economic Research Service 
     (ERS) report, younger generations consume less milk than 
     preceding generations, but this trend is not exclusive to 
     schoolchildren. According to the ERS economists, 
     ``individuals born in the 1970s, for example, drank less milk 
     in their teens, 20s, and 30s than individuals born in the 
     1960s did at the same age points. Those born in the 1980s and 
     1990s, in turn, appear likely to consume even less fluid milk 
     in their adulthood than those born in the 1970s.'' Rather 
     than acknowledging the fact that 36 percent of Americans 
     experience lactose malabsorption, (with African Americans, 
     American Indians, Asian Americans, and Hispanics/Latinos 
     experiencing at higher rates than non-Hispanic White 
     Americans), H.R. 1147 perpetuates the cumbersome requirement 
     that students must obtain a doctor's note documenting a 
     disability to receive a substitute for fluid milk, while 
     arbitrarily increasing access to the less-healthy full-fat 
     milk.
       We thank you for your attention to this matter. Passing 
     H.R. 1147/S. 1957 would be a departure from the long-standing 
     tradition of establishing food and nutrition standards for 
     federal child nutrition programs based upon the findings of 
     independent reviewers and the scientific community. There are 
     evidence-based strategies to increase school meal 
     consumption--and by extension, potentially school milk 
     consumption--that do not involve weakening nutrition 
     standards. Changes to school nutrition standards should be 
     guided by the Dietary Guidelines, not special interests, and 
     as such, we strongly urge you to put children's interests 
     first and uphold the science-based process and oppose the 
     Whole Milk for Healthy Kids Act of 2023. Our children deserve 
     no less.
           Signed,
         Academy of Nutrition and Dietetics, Advocates for Better 
           Children's Diets, American Academy of Pediatrics, 
           American Heart Association, American Public Health 
           Association, Ann & Robert H. Lurie Children's Hospital 
           of Chicago, Balanced, Center for Biological Diversity, 
           Center for Science in the Public Interest, Chef Ann 
           Foundation, Friends of the Earth, Healthy Food America, 
           Healthy Schools Campaign, Life Time Foundation, 
           National WIC Association, Public Health Institute.

  Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my 
time.
  Ms. FOXX. Mr. Chairman, I yield 5 minutes to the gentleman from 
Pennsylvania (Mr. Thompson), the author of this legislation.
  Mr. THOMPSON of Pennsylvania. Mr. Chairman, I thank the chairwoman 
for her leadership and support.
  Mr. Chairman, I rise today in strong support of my legislation, the 
Whole Milk for Healthy Kids Act, that supports students and dairy 
farmers across America.
  Milk is an essential building block for a well-rounded and balanced 
diet, offering 13 essential nutrients and numerous health benefits.
  Out-of-touch Federal regulations have imposed dietary restrictions on 
the types of milk students have access to in school meals.
  Our ranking member is a dear friend of mine, and we have worked 
together. I have been here for 15 years and him a little longer. We 
have a great relationship and have had a lot of bipartisan bills 
together, like we marked up yesterday.
  Mr. Chair, I have to say, the only special interest here is our kids. 
It is our kids who have been cheated out of the nutrition that they 
need. Case studies have shown that the rate of obesity and being 
overweight increased dramatically after access to whole milk and flavor 
was taken out of the schools in 2007-2008, which was a baseline. In 
2010, a Democrat-led initiative demonized milk fat. In 2020-2021, there 
was a study of that same cohort, and obesity has gone up without this 
beverage.
  Mr. Chairman, regarding my good friend from Louisiana, who just 
spoke, everybody is entitled to their own opinion but not their own 
facts. The facts are that it is the underlying law that was passed back 
in 2010 by a Democratic House and signed by a Democratic President 
that, quite frankly, required a physician prescription for health 
reasons.
  That is a good part of the law, and we didn't touch that. We didn't 
address that in this bill, so I am not sure why he is talking about it. 
It is not germane to the topic we are talking about today. That is the 
underlying law.
  The bottom line is that students and parents do have choice. There is 
a mechanism to honor that. The only choice they don't have, though, is 
access to the most nutritious beverage, which is whole milk--
specifically, whole milk and flavor.
  Mr. Chair, I appreciate the gentleman from Louisiana sharing how much 
waste there was and what that amounts to in cartons and half pints and 
what it amounts to in dollars. That is because of the taste experience. 
It is not that these kids are throwing the milk away because it is 
unhealthy for them. It is just a terrible taste experience when you are 
drinking low-fat or nonfat milk.
  Students have been limited to fat-free or reduced-fat milk since the 
Healthy, Hunger-Free Kids Act was enacted in 2010.
  While some of my friends on the other side of the aisle have argued 
that we should not reform individual aspects of child nutrition, it was 
that legislation more than a decade ago that singled out milk for 
regulation, which is why we are here today.
  There are several reasons why these top-down regulations are harmful 
to students and school districts that are forced to comply with them.
  First, we have seen students opt out of consuming milk altogether if 
they don't have access to a variety that they enjoy. According to the 
``Scientific Report of the 2020 Dietary Guidelines Advisory 
Committee,'' more than two-thirds of school-age children failed to meet 
the recommended levels of dairy. No kidding. We took out most nutrition 
and most taste and made it inaccessible to them.
  Let's face it, the only way to benefit from milk's essential 
nutrients is to consume it. We are not force-feeding anybody anything. 
This is about choice. When students turn away from milk, they often opt 
for far less healthy alternatives that are highly caffeinated, sugar-
sweetened, or lack key nutrients.
  These regulations also perpetuate baseless claims that milk is bad 
for our kids. Research has shown time and time again that whole and 2 
percent milk are not responsible for childhood obesity and other health 
concerns. In fact, these beverages are so nutritious that research 
shows positive health outcomes for kids who consume whole milk.
  Mr. Chairman, I include in the Record academic studies from 
researchers around the world, including from top institutions such as 
Boston University and Tufts, who have studied the health effects of 
full-fat dairy.

           [From the American Journal of Clinical Nutrition]

 Whole Milk Compared With Reduced-Fat Milk and Childhood Overweight: a 
                  Systematic Review and Meta-Analysis


                              Introduction

       Childhood obesity has tripled in the past 40 y, with nearly 
     1 in 3 North American children now overweight or obese (1-3). 
     Over the

[[Page H6893]]

     same period, consumption of whole-fat cow-milk has halved 
     (4). The American Academy of Pediatrics and the Canadian 
     Paediatric Society recommend that children switch from whole-
     fat cow-milk (3.25%) to reduced-fat cow-milk (0.1 to 2%) at 2 
     y of age to limit fat intake and minimize the risk of 
     childhood obesity (5, 6). European (7), British (8), and 
     Australian (9) health authorities have provided similar 
     recommendations. Healthcare providers (10) and families (11) 
     frequently follow this guideline, and school and child-care 
     nutrition policies (12-14) often reflect them. Since 1970 
     whole-cow-milk availability has dropped by 80% in North 
     America, whereas reduced-fat milk purchases have tripled (15, 
     16).
       Given that cow-milk is consumed daily by 88% of children 
     aged 1 to 3 y and by 76% of children aged 4 to 8 y in Canada 
     (17) and is a major dietary source of energy, protein, and 
     fat for children in North America (17, 18), understanding the 
     relation between cow-milk fat and risk of overweight or 
     obesity is important. Systematic reviews and meta-analyses on 
     the relation between total dairy consumption and child 
     adiposity have had conflicting findings. According to these 
     studies, higher cow-milk intake in children is associated 
     with taller height and better bone and dental health (19-21). 
     Although these studies evaluated total dairy consumption, 
     they did not consider cow-milk fat specifically. The 
     objectives of this study were to systematically review and 
     meta-analyze the relation between whole-fat (3.25%) relative 
     to reduced-fat (0.1 to 2%) cow-milk and adiposity in 
     children.


                                Methods

       A systematic review and meta-analysis of the literature was 
     conducted. The study was designed according to the Preferred 
     Reporting Items for Systematic Reviews and Meta-Analyses 
     guidelines (PRISMA-P) (22) and registered as a PROSPERO 
     systematic review and meta-analysis (registration number: 
     CRD42018085075).


                           inclusion criteria

     Types of studies
       Studies included in the search were original works 
     published in English in a peer-reviewed journal. Cross-
     sectional, cohort, case-control, and longitudinal studies, as 
     well as intervention trials, both controlled and not 
     controlled, were included in the search strategy. There were 
     no restrictions on date or length of follow-up.
     Population
       Studies that included healthy children aged 1-18 y with 
     10 human subjects were considered. Studies that 
     examined undernourished or disease populations (other than 
     asthma) were excluded.
     Exposures
       The primary exposure was cow-milk fat, categorized as skim 
     (0.1% fat), 1% fat, 2% fat, or whole or homogenized (3.25% 
     fat). Measures of exposure included FFQ, multiday food 
     record, 24-h food recall, or any other validated or 
     nonvalidated measurement tool. Dietary pattern analyses were 
     not included.
     Outcomes
       The primary outcome was childhood adiposity. These measures 
     included BMI z-score (zBMI), BMI, weight for age, body fat 
     mass, lean body mass, waist circumference, waist-to-hip 
     ratio, body fat percentage. skinfold thickness, and 
     prevalence of overweight or obesity as defined by the WHO 
     (23), CDC (24), or International Obesity Task Force 
     (IOTF)(25) cutoffs. When sufficient information was not 
     available in the full text publication, study authors were 
     contacted by email to obtain additional data.
     Meta-analysis
       Meta-analysis included studies that reported the number of 
     children who consumed whole (3.25%), 2%, 1%, or skim (0.1%) 
     milk regularly (a priori defined as typically, daily, or 
     4 times per week), as well as the number of 
     children from each of these groups who were classified as 
     either healthy weight, or overweight or obese (overweight and 
     obese were included as 1 category) assessed using BMI 
     standardized according to the WHO (23), CDC (24), or IOTF 
     (25) criteria.


                             search methods

       A comprehensive search strategy was developed by a research 
     librarian (NT) with expertise in systematic reviews. From 
     inception to August 2019, Embase, CINAHL (Cumulative Index to 
     Nursing and Allied Health Literature), MEDLINE, Scopus, and 
     the Cochrane Library were searched on March 23, 2018 and 
     updated on August 2, 2019 using Medical Subject Headings 
     (MeSH) and keywords (see Supplemental Methods for search 
     strategies).


               Data extraction, management, and analysis

     Study selection
       To evaluate study eligibility 2 reviewers (MA and SMV) 
     independently reviewed study titles, abstracts, and full 
     texts if needed. Both reviewers applied inclusion and 
     exclusion criteria and differences were examined and resolved 
     by consensus, which was achieved 100% of the time. Full-text 
     articles were retrieved for potentially eligible studies and 
     reviewed. Characteristics of included full-text studies were 
     summarized.
     Data extraction
       Two reviewers (MA and SMV) extracted data from eligible 
     studies using standardized data extraction tables adapted 
     from the Cochrane Data Extraction Template (26). Differences 
     were resolved by consensus 100% of the time.
     Data management
       Covidence (27) software was used to select studies, review 
     results, and resolve discrepancies between reviewers. All 
     included study records were kept in spreadsheet format.
     Data synthesis
       Studies included in the analysis were described according 
     to a standardized coding system that captured key elements of 
     each study including descriptors of the study setting, 
     population size and age (mean and range), exposure or 
     intervention, comparator group, method of data collection, 
     outcome measures, type of analysis, and results.


               Risk of bias and study quality assessment

       Risk of bias was assessed using the Newcastle-Ottawa Scale 
     (NOS) (28) for nonrandomized analyses, which expresses the 
     risk of bias on a numerical scale ranging from 0 to 9; scores 
     <7 are considered low risk. (NOS criteria can be found in 
     Table 2.) The NOS-guided review included an examination of 
     participant selection, comparability of children consuming 
     whole or reduced-fat milk, and exposure and outcome measure 
     ascertainment. To allow sufficient follow-up time for a 
     meaningful change in adiposity to occur, the minimum 
     acceptable follow-up time was prespecified as 1 y. Study 
     comparability, defined as whether studies adjusted for 
     similar confounding variables, was specified a priori as 
     studies that adjusted for important characteristics 
     including: birth weight or baseline weight (for prospective 
     cohort studies), milk volume consumed, and parent BMI. 
     Studies that adjusted for each of these factors were awarded 
     2 points, whereas 1 point was allocated if adjustment was 
     performed using angle4 other covariates. Reports 
     were assigned 1 point for ascertainment of exposure only when 
     structured interviews or medical records were used for data 
     collection. Risk of bias was assessed by 2 reviewers (MA and 
     SMV) and consensus was achieved 100% of the time.


                          Statistical analysis

       For each study, participant information, design, and 
     results were summarized. We derived crude ORs and extracted 
     adjusted ORs, whenever available, for overweight or obesity 
     among children who consumed whole (3.25%) milk, compared with 
     children who consumed reduced-fat (0.1-2%) milk regularly. A 
     random effects model based on the restricted maximum 
     likelihood estimator was decided a priori and used to 
     separately pool crude and adjusted ORs of overweight or 
     obesity. Each study was included as a random effect to 
     account for between-study variation in this model. 
     Sensitivity analyses were performed using the Knapp-Hartung 
     method and inverse-variance weights. Because prospective 
     cohort studies can reveal different relations than cross-
     sectional studies, we performed a subgroup analysis according 
     to study design. Additionally, we analyzed studies in 
     subgroups according to risk of bias (high compared with low) 
     and age (1-5 y, 6-11 y, and 12-18 y). Subgroup analyses were 
     accompanied by tests for interaction between each subgroup 
     and the main effect from the random-effects metaregression, 
     by using an interaction term in metaregression models for 
     study design (cross-sectional compared with prospective 
     cohort), risk of bias (high compared with low), and age group 
     (1-5 y, 6-11 y, and 12-18 y). Heterogeneity across included 
     studies was estimated using the I\2\ statistic. Heterogeneity 
     was considered low (<40%), moderate (40-60%), or high (>60%). 
     Publication bias was assessed using a funnel plot and Egger 
     test.
       Finally, we conducted a dose-response metaregression to 
     quantify the association between percentage of fat in cow-
     milk consumed and the odds of overweight or obesity. Only 
     studies that reported group-specific odds for 
     angle3 types of cow-milk fat were included in this 
     analysis. For the dose-response analysis, we first used a 
     fixed-effect approach to estimate the dose-response relations 
     within each study. Then, we used a random-effects approach to 
     combine across studies the dose-response estimates that were 
     generated in the first step for each study to obtain 
     regression coefficients, and their respective standard 
     errors. R software version 3.2.2 was used for all analyses, 
     using the ``metafor'' package.


                                Results

       The database search identified 5862 potentially eligible 
     studies. After exclusion of duplicates (n = 1861), 4001 
     reports underwent title and abstract review. Studies that did 
     not meet inclusion criteria (n = 3915) were removed resulting 
     in 86 published studies that underwent full text review. 
     Reasons for exclusion included wrong exposure, wrong outcome, 
     wrong patient population, dietary pattern analysis only, or 
     wrong study design such as case reports or editorials. 
     Twenty-eight studies met all inclusion criteria. Of these, 20 
     were cross-sectional and 8 were prospective cohort studies. 
     No interventional studies were identified. Most studies (n = 
     23) compared consumption of whole milk (3.25% fat) with 
     reduced-fat milk (0.1%, 1%, or 2% fat). Four studies (36-39) 
     compared whole and 2% milk with 1% and skim milk. One study 
     compared whole milk with 2% milk.
       Nineteen studies used zBMI, 4 prospective cohort studies 
     used percentage body fat change, and 5 studies used 
     overweight or obesity categories as the primary adiposity 
     outcome. Three studies used 2008 WHO growth standards, 14 
     studies used 2000 CDC growth

[[Page H6894]]

     standards, 7 used 2000 IOTF growth standards, and 4 studies 
     either did not specify or used other standards for zBMI 
     measurement.
       Eighteen (36, 38, 39, 41-45, 47-49, 51, 52, 57, 58, 60, 63, 
     65) studies reported that higher cow-milk fat was associated 
     with lower child adiposity. Ten studies (37, 40, 46, 50, 53-
     56, 59, 61) reported no association between cow-milk fat and 
     child adiposity.


                        Risk-of-bias assessment

       Risk of bias assessed using the NOS suggested that 1 of 8 
     prospective cohort studies and 0 of 20 cross-sectional 
     studies were low risk of bias. Common limitations that 
     increased risk of bias included cross-sectional study design, 
     nonstandardized dietary assessments that were either study 
     specific or not validated, lack of adjustment for clinically 
     important covariates (including volume of milk consumed, 
     parent BMI, and child adiposity assessed prior to the 
     outcome), and study duration too short to detect a meaningful 
     change in adiposity (defined a priori as 1 y).


    Association between cow-milk fat and child overweight or obesity

       Fourteen (38, 42-44, 46, 47, 49, 51, 52, 57, 58, 60, 62, 
     65) studies met the meta-analysis inclusion criteria; 11 were 
     cross-sectional and 3 were prospective cohort studies. All 
     studies included in the meta-analysis compared whole (3.25% 
     fat) milk with reduced-fat (0.1-2%) milk consumption, 
     allowing an OR to be calculated. A total of 20,897 healthy 
     children aged 1-18 y were included in the meta-analysis. 
     Children were from 7 countries (United States, United 
     Kingdom, Canada, Brazil, Sweden, New Zealand, and Italy). 
     Anthropometric standards used to determine overweight or 
     obesity categories included the WHO, CDC, or IOTF growth 
     standards in 6, 5, and 3 studies respectively.
       Crude analysis of all 14 studies revealed that among 
     children who consumed whole milk compared with reduced-fat 
     milk, the pooled OR for overweight or obesity was 0.61 (95% 
     CI: 0.52, 0.72; P < 0.0001). Heterogeneity measured by the 
     I\2\ statistic was 73.8% (P < 0.0001 ). A sensitivity 
     analysis using inverse-variance weights did not reveal 
     different results. Subgroup analysis by study design revealed 
     no significant interaction between cross-sectional and 
     prospective cohort studies. For the 11 cross-sectional 
     studies (n = 9413), the pooled OR of overweight or obesity 
     was 0.56 (95% CI: 0.46, 0.69; P = 0.0001), and for the 3 
     prospective cohort studies (n = 11,484) it was 0.76 (95% CI: 
     0.63, 0.92; P = 0.006).
       Risk of bias (high compared with low) and age group were 
     also not significant modifiers of the relation between cow-
     milk fat and child adiposity. Analyses of 5 studies (49, 51, 
     52, 57, 58) that reported adjusted ORs did not show 
     differences between crude and adjusted estimates (adjusted 
     OR: 0.53; 95% CI: 0.44, 0.63; crude OR: 0.55; 95% CI: 0.46, 
     0.66). Results of the sensitivity analysis using the Knapp-
     Hartung method to pool the 14 studies (crude OR: 0.62; 95% 
     CI: 0.52, 0.73) were similar to the main results (crude OR: 
     0.61; 95% CI: 0.52, 0.72)). Publication bias, visualized 
     using a funnel plot was difficult to ascertain given the high 
     heterogeneity (I\2\ = 73.8%) and relatively low number of 
     included studies.
       Data were available from 7 studies (38, 39, 44, 52, 57, 58, 
     65) which included 14,582 children aged 2 to 11 y, and 
     demonstrated a linear association between higher cowmilk fat 
     and lower child adiposity. For each 1% higher cowmilk fat 
     consumed, the overall crude OR for overweight or obesity was 
     0.75 (95% CI: 0.65, 0.87; P = 0.004; t\2\ = 0.01; I\2\ = 
     64%).


                               discussion

       This systematic review and meta-analysis has identified 
     that relative to reduced-fat cow-milk, whole-fat cow-milk 
     consumption was associated with lower odds of childhood 
     overweight or obesity. The direction of the association was 
     consistent across a range of study designs, settings, and age 
     groups and demonstrated a dose effect. Although no clinical 
     trials were identified, existing observational research 
     suggests that consumption of whole milk compared with 
     reduced-fat milk does not adversely affect body weight or 
     body composition among children and adolescents. To the 
     contrary, higher milk fat consumption appears to be 
     associated with lower odds of childhood overweight or 
     obesity.
       Findings from the present study suggest that cow-milk fat, 
     which has not been examined in previous meta-analyses, could 
     play a role in the development of childhood overweight or 
     obesity. Several mechanisms have been proposed that might 
     explain why higher cow-milk fat consumption could result in 
     lower childhood adiposity. One theory involves the 
     replacement of calories from less healthy foods, such as 
     sugar-sweetened beverages, with cow-milk fat. Consumption of 
     beverages high in added sugar has been associated with 
     increased risk of overweight and obesity during childhood. 
     Other theories involve satiety mechanism such that higher 
     milk fat consumption might induce satiety through the release 
     of cholecystokinin and glucagon-like peptide 1 thereby 
     reducing desire for other calorically dense foods. Another 
     possibility is that lower satiety from reduced-fat milk could 
     result in increased milk consumption causing higher weight 
     gain relative to children who consume whole milk, as observed 
     in the study by Berkey et al.
       Cow-milk fat might offer cardiometabolic benefits. The 
     types of fat found in cow-milk, including trans-palmitoleic 
     acid, could be metabolically protective. Higher circulating 
     trans-palmitoleic acid has been associated with lower 
     adiposity, serum LDL cholesterol and triglyceride 
     concentrations, and insulin resistance, and higher HDL 
     cholesterol in several large adult cohort studies. However, 
     diets that replace dairy fat with unsaturated fatty acids 
     might also offer cardiometabolic protection.
       Confounding by indication and reverse causality are 
     plausible alternate explanations. Parents of children who 
     have lower adiposity might choose higher-fat milk to increase 
     weight gain. Similarly, parents of children who have higher 
     adiposity might choose lower-fat milk to reduce the risk of 
     overweight or obesity. The majority of children included in 
     this systematic review were involved in prospective cohort 
     studies, in which the potential for reverse causality is 
     lower than in cross-sectional studies. Results from these 
     11,484 children were consistent with the overall findings. 
     Two of the included prospective cohort studies attempted to 
     address confounding by indication by adjusting for baseline 
     BMI; 1 of these repeated the statistical analysis only among 
     participants with normal-weight BMI values, with similar 
     findings. Clinical trial data would have provided better 
     evidence for the directionality of this relation; however, 
     none were available.
       This study had a number of strengths. The meta-analysis 
     included a large, diverse sample of children from around the 
     world. The number of potentially eligible studies was 
     maximized by the comprehensive search strategy and contact 
     with authors to obtain missing data. Also, study selection, 
     data collection, and risk of bias assessment were performed 
     by 2 independent reviewers, which improved accuracy and 
     consistency. All studies included in the meta-analysis used 
     trained individuals to obtain anthropometric measurements, 
     and weight status was standardized using growth reference 
     standards (WHO, CDC, and IOTF). Using metaregression 
     techniques, differences in study design, risk of bias, and 
     age group were taken into account. Finally, a dose-response 
     meta-analysis was conducted, which demonstrated a linear 
     relation between higher cow-milk fat and lower child 
     adiposity.
       This study had a number of limitations. First, included 
     studies were all observational. Only 1 study in this analysis 
     was considered to have low risk of bias, and all studies in 
     the meta-analysis had high risk of bias. Risk of bias 
     included cross-sectional designs and lack of adjustment for 
     clinically important covariates. For example, cow-milk volume 
     was accounted for in only 11 of 28 studies in the systematic 
     review, and in 5 of 14 studies in the meta-analysis. 
     Adjustment for volume in future studies would allow for a 
     clearer understanding of whether higher cow-milk fat protects 
     against higher adiposity, or reduced-fat cow-milk increases 
     adiposity. However, among these studies. comparison of 
     adjusted compared with crude odds demonstrated consistent 
     findings. Residual confounding by variables not accounted for 
     in the individual analyses is also possible; this is a common 
     limitation for meta-analyses of observational studies. 
     Heterogeneity was relatively high (I\2\ = 73.8%), which might 
     have been attributable to a variety of factors including 
     varied methods of ascertainment of exposure and outcome, and 
     differences in study design and follow-up duration. Although 
     subgroup analyses of prospective cohort studies revealed 
     results comparable to the overall metaregression, these 
     comparisons might not have had sufficient power to detect 
     clinically meaningful differences. However, 11,484 children 
     were involved in prospective cohort studies making large 
     differences in effect size unlikely. Although only studies 
     with standardized dietary measurements were included, 
     measurement error was possible due to recall bias or lack of 
     validation of dietary assessment tool. Error in adiposity 
     measurement could also have introduced bias. although weights 
     and heights were measured by trained individuals and 
     standardized protocols were used in all studies included in 
     the meta-analysis. Differences in adiposity measurement 
     (i.e., body fat percentage, zBMl, BMI), and different growth 
     standards could have contributed to heterogeneity. For 
     example, use of the WHO rather than IOTF or CDC standards 
     could have resulted in a greater proportion of overweight or 
     obese children being reported. Future studies using WHO 
     growth standards, which are believed to represent optimal 
     child growth, would help to minimize heterogeneity and 
     overcome these limitations. Consideration for relevant 
     outcomes such as cardiovascular risk should be included in 
     future analyses to understand other effects of cow-milk fat. 
     Publication bias was also possible as demonstrated by a 
     funnel plot and Egger test.
       In conclusion, observational evidence supports that 
     children who consume whole milk compared with reduced-fat 
     milk have lower odds of overweight or obesity. Given that the 
     majority of children in North America consume cow-milk on a 
     daily basis, clinical trial data and well-designed 
     prospective cohort studies involving large, diverse samples, 
     using standardized exposure and outcome measurements, and 
     with long study duration would help determine whether the 
     observed association between higher milk at consumption and 
     lower childhood adiposity is causal.

[[Page H6895]]

  


           [From the American Journal of Clinical Nutrition]

Dairy Foods, Dairy Fat, Diabetes, and Death: What Can Be Learned From 3 
                       Large New Investigations?

                        (By Dariush Mozaffarian)

       Dairy products are a major component of most diets, 
     contributing 10% of calories in the United States. 
     Surprisingly, for such a major share of the food supply, 
     their health effects remain remarkably uncertain, 
     insufficiently studied, and controversial. Dietary guidelines 
     on dairy remain largely based on theoretical considerations 
     about isolated nutrients (e.g., theorized benefits of calcium 
     or vitamin D; theorized harms of total fat or saturated fat) 
     or short-term dietary pattern studies of surrogate markers, 
     rather than on the mounting evidence on how milk, cheese, 
     yogurt, butter, and other dairy foods relate to major 
     clinical endpoints. Such evidence on health outcomes is 
     crucial, because dairy products appear to be a heterogeneous 
     class with complex effects dependent upon the interplay of 
     diverse nutrients and processing characteristics (e.g. 
     probiotics, fermentation, milk fat globule membrane, and 
     more).
       In this issue of the Journal, 3 new publications report on 
     dairy consumption and risk of type 2 diabetes or mortality. 
     Ardisson Korat et al. evaluated estimated dairy fat 
     consumption and onset of diabetes in 3 cohorts of US health 
     professionals. After adjustment for other risk factors, 
     higher dairy fat intake, in comparison with carbohydrate, was 
     associated with lower diabetes risk in 1 cohort of middle-
     aged women, and was not significantly associated with 
     diabetes in the other 2 cohorts or among all 3 cohorts 
     combined. In subgroup analyses, dairy fat intake was 
     associated with lower risk of diabetes at younger ages (<65 
     y) and in women, the 2 subgroups among whom 70-80% of 
     diabetes cases occurred--although these interactions by age 
     and sex did not achieve statistical significance. When dairy 
     fat was statistically compared with carbohydrate from whole 
     grains, the latter was associated with lower risk of diabetes 
     (per 5% energy, 7% lower risk), whereas, compared with other 
     animal fats (largely form red meat and poultry) or with 
     carbohydrate from refined grains, dairy fat consumption was 
     associated with lower risk of diabetes (per 5% energy, 4-17% 
     lower risk). Dairy fat consumption was not associated with 
     incident diabetes when compared with vegetable fat, 
     polyunsaturated fat (total, v	6, or v	3), or monounsaturated 
     fat from plant sources. Because dairy fat in these cohorts 
     was associated with several unhealthy lifestyle factors, 
     including higher BMI, more current smoking, less physcial 
     activity, fewer fruits and vegetables, and a less healthy 
     overall dietary pattern, this suggests that residual 
     confounding, if present--the major limitation of 
     observational cohorts such as this one--would tend to cause 
     bias toward dairy fat appearing more harmful (less 
     beneficial) than it actually may be.
       These findings add to a growing body of literature which 
     call into question the soundness of conventional dietary 
     recommendations to avoid dairy fat. As noted by Ardisson 
     Korat et al., dairy fat contains a complex mix of different 
     SFAs, other unsaturated and conjugated fatty acids, and other 
     constituents, each with varying biological effects. 
     Physiologic effects of dairy fat further vary according to 
     content of milk fat globule membrane, which alters 
     cholesterol absorption and perhaps skeletal muscle responses 
     to exercise. Also, cheese, the major source of dairy fat in 
     most diets, is a fermented food and a rich source of 
     menoquinones which may improve insulin secretion and 
     sensitivity through osteocalcin-related pathways. In a recent 
     pooling project of de novo individual-level analyses from 16 
     prospective cohort studies across 4 continents (including 2 
     of the 3 US cohorts evaluated by Ardisson Korat et al.), 
     objective blood biomarkers of odd-chain saturated fats and 
     trans-palmitoleic acid, each found in dairy fats, were 
     associated with significantly lower risk of diabetes. 
     Together with these prior findings, the new results by 
     Ardisson Korat et al. provide little support for metabolic 
     harms of dairy fat, and indeed suggest potential benefits 
     amoung younger adults, among women, and as a replacement for 
     other animal fats or refined carbohydrates.
       A second report in this issue of the Journal assessed how 
     changes in dairy foods, assessed using serial questionnaires, 
     related to incident diabetes in the same 3 US cohorts of 
     health professionals. After multivariable adjustment, 
     participants who decreased their total dairy intake by >1 
     serving/d over a 4-year period experienced 11% higher 
     incidence of diabetes, compared with stable intake. Among 
     dairy subtypes, changes in low-fat milk, whole milk, and 
     cream were not significantly associated with diabetes, 
     whereas decreases in ice cream, increases in some types of 
     cheese, and decrease in yogurt were each associated wih 
     higher risk. Several factors complicate the interpretation of 
     this analysis. Foremost, none of these findings were 
     symmetrical for increases compared with decreases in intake: 
     i.e., when decreased consumption of total dairy or a dairy 
     subtype was linked to diabetes risk, increased consumption 
     was not linked in the opposing direction, and vice versa. 
     This counters expected biology and the important Bradford 
     Hill criterion of dose-response, which for example has been 
     evidenced in these cohorts for dietary changes and long-term 
     weight gain. In addition, results for each of the dairy 
     subtypes appeared generally inconsistent across the 3 
     cohorts, with little uniformity (I \2\ values were not 
     reported). Some of the findings counter expected causal 
     biology--e.g., that decreasing ice cream increases diabetes--
     raising concern for reverse causation. The dietary instrument 
     was also variably reliable for assessing different dairy 
     foods: for example, as compared with multiple dietary 
     records, the FFQ reliably measured consumption of yogurt (r = 
     0.97), but not hard cheese (r = 0.38). In light of the 26 
     prior cohort studies which have reported on dairy consumption 
     and incident diabetes, in sum suggesting lower risk from 
     total dairy and especially yogurt consumption, the internal 
     inconsistencies of the present findings for changes in dairy 
     foods raise more questions than they answer.
       In the third publication in this issue, Pala et al. 
     investigated dairy consumption and death from cancer, 
     cardiovascular disease, and all causes in a community-based 
     Italian cohort. After adjustment for other risk factors, 
     compared with no consumption, moderate milk intake 
     (200 g or 6.5 ounces per day) was associated with 
     25% lower mortality, largely owing to 50% lower 
     cardiovascular mortality, but consumption at higher levels 
     was not associated with lower risk. Findings were similar for 
     low-fat comparew with whole-fat milk. Intakes of yogurt, 
     cheese, and butter were not significantly associated with 
     mortality. As the authors concluded, the lack of linear dose-
     response for milk raises questions about the validity of the 
     observed benefits, but none of the findings support the 
     hypothesis that milk, yogurt, cheese, or butter consumption 
     increases mortality.
       The global pandemics of obesity and type 2 diabetes, 
     together with high rates of cardiovascular disease and 
     cancer, have stimulated a new popular frenzy around healthier 
     eating. Although the resulting attention on diet-related 
     health impacts, economic burdens, and corresponding policy 
     solutions has been positive, the craze of competing popular 
     diets and their proponents have simultaneously fueled 
     confusion, controversy, and skepticism. For example, ignoring 
     the preponderance of evidence, some popular books and social 
     media headlines claim that dairy foods are toxic. At the same 
     time, prevailing dietary guidelines exacerbate the confusion, 
     remaining mired in outdated conceptual frameworks and 
     hesitating to acknowledge new paradigms of complexity.
       As is always true in science, these 3 new investigations 
     cannot by themselves definitively eliminate confusion or 
     answer all questions. Yet, these studies aimed to address 
     crucial questions on dairy and health in large and well-
     designed prospective cohorts. Together, the findings provide 
     little support that consumption of total dairy, dairy 
     subtypes, or dairy fat is harmful, and they continue to build 
     the case for possible benefits. As recently reviewed, the 
     dizzyingly complex characteristics and molecular effects of 
     different dairy foods belie any simplistic overall summary or 
     synopsis. These 3 new studies highlight this complexity and 
     the urgent need for additional long-term prospective studies, 
     interventional trials, and mechanistic investigations of 
     dairy foods and health.

  Mr. THOMPSON of Pennsylvania. Mr. Chairman, these studies show, among 
other things, that full-fat dairy foods have little to no association 
with high blood pressure, cardiovascular disease, type 2 diabetes, 
obesity, blood pressure, or cholesterol.
  In fact, several of these studies show that full-fat foods help 
improve or lower negative health outcomes for children who drink more 
full-fat dairy beverages.
  The Acting CHAIR (Mr. Fulcher). The time of the gentleman has 
expired.
  Ms. FOXX. Mr. Chair, I yield an additional 2 minutes to the gentleman 
from Pennsylvania.
  Mr. THOMPSON of Pennsylvania. Mr. Chairman, additionally, since whole 
milk was removed from school lunchrooms, the childhood obesity rate has 
increased, according to the CDC and several case studies. Whole milk is 
not the problem.
  For our children to excel in the classroom and beyond, they must have 
access to more nutritious options, not fewer.
  The Whole Milk for Healthy Kids Act will allow schools participating 
in the National School Lunch Program to serve all varieties of flavored 
and unflavored milk, including whole milk.
  It is important to remember that this legislation does not require 
any student to drink, or any school to serve, whole milk. Rather, this 
legislation simply gives schools the flexibility to serve a broader 
variety of milk in the school lunchroom.
  Additionally, if students have a documented medical condition or 
disability that prohibits them from safely or comfortably consuming 
milk, schools are required to offer them an alternative beverage. This 
legislation would not change that standard.
  Mr. Chair, I am proud to have 134 bipartisan cosponsors from 44 
States.

[[Page H6896]]

The bottom line is the Whole Milk for Healthy Kids Act is about 
ensuring students have the necessary nutrients to learn and grow.
  Mr. SCOTT of Virginia. Mr. Chairman, may I inquire as to how much 
time is remaining on both sides.
  The Acting CHAIR. The gentleman from Virginia has 17\1/2\ minutes 
remaining. The gentlewoman from North Carolina has 13\1/2\ minutes 
remaining.
  Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chairman, the gentleman from Pennsylvania and I have enjoyed 
working together on many different bills, but on this bill, we happen 
to disagree. He has presented evidence on the floor that, instead of 
being considered by Members of Congress, really ought to be considered 
by the experts in the normal scientific process.

                              {time}  1430

  If the schoolchildren get the benefit of his studies, then tell it to 
the experts and not the politicians. I would hope that we would stick 
with the scientific process, as we are doing. Let's stick with the DGAs 
and not the political process in changing the process by trying to 
convince Members of Congress who are subject to political pressures on 
one side or another. So I would hope that we would stick to that 
process and not the political process.
  If we have studies, then show it to the experts and not the 
politicians.
  Mr. Chair, I reserve the balance of my time.
  Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentlewoman from 
Illinois (Mrs. Miller), who is the vice chair of the Education and the 
Workforce Committee.
  Mrs. MILLER of Illinois. Mr. Chair, I thank Ms. Foxx for yielding.
  Mr. Chairman, I thank Chairman Thompson and Chairwoman Foxx for 
sponsoring this important legislation.
  I rise in support of H.R. 1147, the Whole Milk for Healthy Kids Act. 
This crucial legislation recognizes the nutritional benefits of whole 
milk for our children.
  As a result of the radical Obama Administration policies led by 
Michelle Obama, only fat-free and low-fat milks can be served in school 
meals.
  H.R. 1147 would end this practice and allow schools to serve whole 
milk. Whole milk is a rich source of essential nutrients, including 
calcium and vitamin D, which are vital for developing strong bones and 
a healthy immune system.
  Studies have also shown that whole milk can contribute to healthier 
weight in children. I raised my seven children on whole-fat milk, and 
they are all within normal weights. I also have recognized that 
children who have high-fat diets stay full longer.
  I am proud to support this bill on behalf of parents, and I want to 
thank America's dairy farmers for producing milk for our families.
  Ms. FOXX. Mr. Chair, I include in the Record two scientific articles.
  [From the Friedman School of Nutrition Science and Policy]

Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix 
                     Compared with Single Nutrients

                        (By Dariush Mozaffarian)


                              Introduction

       Conventional dietary guidelines from around the globe have 
     focused on individual nutrients to maintain and improve 
     health and prevent disease. This is due to the historical 
     focus, developed in the last century, on single nutrients in 
     relation to clinical nutrient deficiency diseases. However, 
     this reductionist approach is inappropriate for translation 
     to chronic diseases.
       A look back at the history of modern nutrition science 
     provides important perspectives on the origins of the 
     reductionist approach to nutrition. In 1747, the British 
     sailor and physician James Lind tested whether citrus fruits 
     prevented scurvy, but it was not until 1932 that vitamin C 
     was actually isolated, synthesized, and proven to be the 
     relevant ingredient. The period of the 1930s to 1950s was a 
     golden era of vitamin discovery, when all the major vitamins 
     were identified, isolated, and synthesized, and shown to be 
     the active constituents of foods relevant for nutrient 
     deficiency diseases such as pellagra (niacin), beriberi 
     (thiamine), rickets (vitamin D), and night blindness (vitamin 
     A). This scientific focus on nutrient deficiencies coincided 
     with global geopolitics, in particular the Great Depression 
     and World War II, which accentuated concerns about 
     insufficient food and nutrients. For example, the birth of 
     RDAs was at the National Nutrition Conference on Defense in 
     1941, which focused on identifying the individual nutrients 
     needed to prevent nutrient deficiencies in order to have a 
     population ready for war. Together, these scientific and 
     historical events led to the concept of food as a delivery 
     system for calories and specific isolated nutrients.
       It was not until the 1980s that modern nutrition science 
     began to meaningfully consider nutrition in association with 
     chronic diseases, such as obesity, type 2 diabetes, 
     cardiovascular disease (CVD), and cancer. Intuitively, the 
     reductionist paradigm that had been so successful in reducing 
     the prevalence of nutrient deficiency diseases was extended 
     to chronic diseases. Thus, saturated fat became ``the'' cause 
     of heart disease, whereas now, excess calories and fat are 
     ``the'' causes of obesity.
       What recent advances in nutrition science have 
     demonstrated, however, is that although a single-nutrient 
     focus works well for prevention of deficiency diseases, such 
     as scurvy or beriberi, this approach generally fails for 
     chronic diseases such as coronary artery disease (CAD), 
     stroke, type 2 diabetes, or obesity. For such complex 
     conditions, the focus should be on foods.


                        Calories in/Calories out

       The US obesity epidemic is a recent phenomenon, starting in 
     the mid-1980s, and the rise of obesity globally is even more 
     recent. The strategies to address this epidemic have not yet 
     caught up with advances in nutrition science. Most current 
     dietary recommendations and policies across the globe remain 
     calorie and fat focused, recommending foods based on these 
     reductionist metrics rather than their complex, empirically 
     determined effects on health. For example, nearly all 
     guidelines recommend low-fat or nonfat dairy foods to reduce 
     calories, total fat, and saturated fat in the diet, based on 
     the theory that this will help maintain a healthy weight and 
     reduce the risk of CVD. This is seen, for example, in the 
     2015-2020 US Dietary Guidelines; National School Lunch 
     Program, NIH Dietary Guidelines for Kids; and CDC Diabetes 
     Prevention Program.
       However, foods are not simply a collection of individual 
     components, such as fat and calories, but complex matrices 
     that have correspondingly complex effects on health and 
     disease. Recommendations based on calorie or fat contents 
     fail to consider the complex effects of different foods, 
     independent of their calories, on the body's multiple, 
     redundant mechanisms for weight control, from the brain to 
     the liver, the microbiome, and hormonal and metabolic 
     responses. This growing evidence indicates that different 
     foods, calorie-for-calorie, have different effects on the 
     risk of long-term weight gain and success of weight 
     maintenance.


                         Dairy Foods and Weight

       Although dairy products contribute  cents10 
     percent of all calories in the US diet, until recently, 
     little direct research had evaluated the health effects of 
     different dairy foods. The complex ingredients and matrices 
     of different dairy foods, from milk to yogurt to cheese, 
     appear to have varying effects on weight.
       Although considerable research has focused on optimal diets 
     for weight loss among obese individuals (secondary 
     prevention), fewer studies have evaluated determinants of 
     gradual weight gain (primary prevention). Among nonobese US 
     adults, the average weight gain is  centslb (0.45 
     kg) per year. This represents a very slow, modest increment, 
     but when sustained over many years, this small annual weight 
     gain drives the obesity epidemic. This gradual pace also 
     makes it difficult, if not impossible, for individuals to 
     identify specific causes or remedies.
       To identify specific dietary factors associated with long-
     term weight gain, we performed prospective investigations 
     among 3 separate cohorts that included 120,877 US men and 
     women who were free of chronic disease and not obese at 
     baseline. We examined weight gain every 4 y, for up to 24 y 
     of follow-up, and its association with the increased intake 
     of individual foods. Within each 4-y period, participants 
     gained an average of 3.35 lb. On the basis of increased daily 
     servings of different foods, those strongly linked to weight 
     gain were generally carbohydrate-rich, including potato chips 
     (per daily serving, 1.69 lb greater weight gain every 4 y), 
     other potatoes/fries (1.28 lb), sugar-sweetened beverages 
     (1.00 lb), sweets (0.65 lb), and refined grains (0.56 lb). 
     Other foods were not linked to weight gain, even when then 
     intake was increased, including cheese, low-fat milk, and 
     whole milk. Other foods were actually related to less weight 
     gain: the more they were consumed, the less weight was 
     gained. This included vegetables (-0.22 lb), whole grains 
     (-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt 
     (-0.82 lb) When sweetened vs. plain yogurt were evaluated, 
     each was associated with relative weight loss, although when 
     sweetened, about half the benefit was lost.
       What could explain these findings? We hypothesize that 
     different foods have varying effects on multiple redundant 
     mechanisms for weight gain, including effects on hunger and 
     fullness, glucose, insulin and other hormonal responses, de 
     novo fat synthesis by the liver, gut microbiome responses; 
     and the body's metabolic rate.
       Based on these findings, certain foods, when consumed over 
     the long term can have relatively neutral effects on weight, 
     others promote weight gain, whereas still others promote 
     weight loss.
       Interestingly, although we found that cheese, low-fat milk, 
     and whole-fat milk were each unassociated with weight change,

[[Page H6897]]

     there is evidence that dairy foods may promote healthier body 
     composition. Consistent with our findings, a systematic 
     review and meta-analysts of 37 randomized clinical trials 
     with 184,802 participants, which assessed the effect of dairy 
     consumption on weight and body composition, found that 
     overall, dairy consumption had little effect on BMI. Body 
     composition, however, changed significantly. Dairy 
     consumption led to a reduction in fat mass (0.23 kg) and an 
     increase in lean body mass (0.37 kg). Overall, high-dairy 
     intervention increased body weight (0.01, 95 percent CI: 
     -0.25, 0.26), and lean mass (0.37, 95 percent CI: 0.11, 
     0.62); decreased body fat (-0.23, 95 percent CI: -0.48, 0.02) 
     and waist circumference (-1.37 95 percent CI: -2.28, -0.46).
       In subgroup analyses, such effects appeared larger in 
     trials also having energy restriction, but such subgroup 
     findings should be interpreted cautiously The types and 
     frequency of dairy products consumed varied among these 
     trials, making it difficult to make distinctions in this 
     meta-analysis about the effects of different types of dairy 
     products such as low-fat or whole fat, or milk, yogurt, or 
     cheese. When viewed in combination with our long-term 
     observational findings, the joint results suggest that dairy 
     foods do not promote weight gain, that dairy consumption may 
     reduce body fat and augment muscle mass, and that the type of 
     dairy product (milk compared with cheese compared with 
     yogurt) may be more important for preventing long-term weight 
     gain than the dairy fat content.


              Dairy Foods, Probiotics, and the Microbiome

       Many pathways appear relevant to the concept that foods 
     cannot be judged on calorie content alone for risk of 
     obesity. Among these, the gut microbiome is particularly 
     interesting. Substantial evidence demonstrates that the 
     quality of the diet strongly influences the gut microbiome. 
     Among different factors, probiotics have been studied for 
     their effect on the microbiome; as well as potential benefits 
     of fermented foods, which may be greater than the sum of 
     their individual microbial, nutritive, or bioactive 
     components.
       For example, in an experimental model, mice genetically 
     predisposed to obesity were provided control diets or a 
     ``fast-food'' chow with and without probiotic-containing 
     yogurt or a single probiotic (Lactobacillus reuteri) in 
     water. Without probiotics, mice on the fast-food chow gained 
     significant weight. However, the addition of either 
     probiotic-containing yogurt or water prevented this weight 
     gain. Crucially, the probiotics did not appear to reduce the 
     amount of calories consumed; rather, the benefits appeared 
     related to changes in microbiome function and inflammatory 
     pathways. The results support weight benefits of probiotics 
     and, more importantly, provide empiric evidence that 
     challenges the widely accepted conventional wisdom that 
     the effects of different foods on obesity depend largely 
     on their calories.
       Consistent with this animal experiment, a recent systematic 
     review and meta-analysis of 15 randomized controlled trials 
     examined the effects of probiotics, either in foods or as 
     supplements, on body weight and composition in overweight and 
     obese subjects. Administration of probiotics significantly 
     reduced body weight percent (-0.60 kg), BMI (-0.27 kg/m\2\), 
     and fat percentage (0.60 percent), compared with placebo. A 
     separate meta-analysis of randomized clinical trials 
     demonstrated that consumption of probiotics in foods or 
     supplements significantly improves blood glucose, insulin, 
     and insulin resistance. The trials in these two meta-analyses 
     were neither long-term nor large--in all, a total of about 
     1,000 subjects were included in each meta-analysis, with 
     trial durations ranging from 3 to 24 wk and with varying 
     designs in terms of controls, disease conditions, and 
     composition of probiotic preparations evaluated. Nonetheless, 
     together with observational and experimental evidence, these 
     studies provide compelling evidence to support weight and 
     metabolic benefits of foods rich in probiotics.


                     Dairy Foods, CVD, and Diabetes

       Although an important risk factor for type 2 diabetes and 
     CVD, growing research suggests that specific foods may also 
     directly alter disease risk. In a meta-analysis of 29 
     prospective cohort studies including 938,465 participants who 
     experienced 93,158 deaths, 28,419 incident CAD events, and 
     25,416 incident CVD events, neither total dairy nor milk 
     consumption was significantly associated with total 
     mortality, CAD, or CVD. Notably, findings were similar when 
     total whole-fat dairy, or low-fat dairy were separately 
     evaluated. In contrast, the intake of fermented dairy 
     products (predominantly cheese, plus yogurt and fermented 
     milk) was associated with modestly lower risk of total 
     mortality and CVD, with about 5 percent lower risk of each 
     per 50 g daily serving. In addition, the consumption of 
     cheese alone, the dairy product with the highest amount of 
     dairy fat, was associated with a significantly lower risk of 
     both CAD and stroke.
       In the Multi-Ethnic Study of Atherosclerosis cohort, 
     including 5209US adults with Caucasian, Asian, black, and 
     Hispanic backgrounds, different food sources of saturated fat 
     were analyzed for their relation with subsequent CVD risk, 
     adjusted for sociodemographics, medical history, and other 
     dietary and lifestyle factors. A higher intake of saturated 
     fat from dairy sources was associated with significantly 
     lower CVD risk (per each 5 g/d, RR = 0.79, 95 percent CI = 
     0.68, 0.92), whereas a higher intake of saturated fat from 
     meat sources was associated with higher CVD risk (per each 5 
     g/d, RR = 1.26, 95 percent CI = 1.02, 1.54). Intakes of 
     saturated fat from other sources, such as butter and plant 
     oils/foods, were too low to identify any associations.
       These findings suggest that saturated fat from different 
     food sources may have varying effects on CVD risk. This may 
     partly relate, for example, to differences in the types of 
     saturated fatty acids in meat compared with dairy. Compared 
     with meat, dairy has a greater proportion of short-chain and 
     medium-chain saturated fatty acids, with correspondingly less 
     palmitic and stearic acids. Compared with their longer chain 
     fatty acids, growing evidence suggests that shorter and 
     medium-chain triglycerides have different physiology, 
     including potential benefits on metabolic risk, weight gain, 
     obesity, and the gut microbiome.
       In addition, cardiometabolic effects of different dairy 
     foods appear to vary depending on other characteristics, such 
     as fermentation or the presence of probiotics. The large 
     European Investigation into Cancer and Nutrition (EPIC) 
     cohort across 8 European countries evaluated the consumption 
     of different dairy foods and risk of diabetes among 340,234 
     participants with 12,403 new cases of diabetes during follow-
     up. In the fully adjusted model including adjustment for 
     estimated dietary calcium, magnesium, and vitamin D, the 
     consumption of milk (low-fat and whole-fat) was not 
     significantly associated with type 2 diabetes. Individuals 
     who consumed more yogurt or thick fermented milk experienced 
     a nonsignificant tend toward lower risk (across quintiles: RR 
     = 0.89, 95 percent CI = 0.77, 1.03; P-trend = 0.11), whereas 
     individuals who consumed more cheese had significantly lower 
     risk of diabetes (RR = 0.83, 95 percent CI = 0.70, 0.98, P-
     trend = 0.003). A higher combined intake of fermented dairy 
     products (cheese, yogurt, and thick fermented milk) was also 
     associated with a lower risk of diabetes (RR = 0.85, 95 
     percent CI = 0.73, 0.99, P-trend = 0.02).
       Similarly, in the Malmo Diet and Cancer Cohort following 
     26,930 participants over 14 y, different food sources of fat 
     and saturated fat had very different associations with 
     incidence of diabetes. Overall, low-fat dairy consumption was 
     associated with a higher risk of diabetes (across quintiles: 
     RR = 1.14, 95 percent CI = 1.01, 1.28; P-trend = 0.01), 
     whereas whole-fat dairy consumption was associated with a 
     substantially lower risk RR = 0.77, 95 percent CI = 0.68, 
     0.87, P-trend < 0.001). However, relations varied further by 
     subtype. For example, nonfermented, low-fat milk was 
     associated with higher risk; nonfermented, whole-fat milk was 
     not associated with risk; and fermented, whole-fat milk was 
     associated with lower risk. Cheese intake showed a 
     nonsignificant trend toward lower risk (RR = 0.92, 95 percent 
     CI = 0.81, 1.04; P-trend = 0.21), whereas red meat intake was 
     associated with significantly higher risk (RR = 1.36, 95 
     percent CI = 1.20, 1.55; P-trend < 0.001). When estimated 
     intakes of individual fatty acids were evaluated, intakes of 
     saturated fatty acids with 4-10 carbons, lauric acid (12:0), 
     and myristic acid (14:0) were associated with decreased risk 
     (P-trend = 0.01).
       In addition to the consumption of whole foods such as milk, 
     cheese, or yogurt, significant amounts of dairy fat can be 
     consumed as relatively ``hidden'' ingredients in creams, 
     sauces, cooking fats, bakery desserts, and mixed dishes such 
     as casseroles containing butter, milk, or cheese. Self-
     reported questionnaires may miss many of these sources, 
     leading to inaccurate measurement of true dairy fat 
     consumption in individuals. Biomarkers can partly reduce this 
     mismeasurement. In a global consortium combining de novo 
     individual-level analyses across 63,602 participants in 16 
     separate cohort studies, higher blood concentrations of odd-
     chain saturated fatty acids (15:0, 17:0) and a natural 
     ruminant trans fatty acid (trans-16:1n-7), objective 
     circulating biomarkers of dairy fat consumption, were 
     evaluated in relation to onset of diabetes. Each fatty acid 
     was associated with lower incidence of diabetes, with 20-35% 
     lower risk across the interquintile range of blood 
     concentrations. It is unclear whether such lower risk is 
     related to direct health benefits of specific dairy fatty 
     acids, or to other aspects of foods rich in dairy fat. For 
     example, the major source of dairy fat in most diets is 
     cheese, a fermented food rich in vitamin K2 (menoquinone) 
     which is converted from vitamin K by the action of bacteria. 
     Menoquinone, which cannot be separately synthesized by 
     humans, is linked to lower risk of type 2 diabetes in 
     prospective observational studies, with supportive 
     experimental evidence for potential benefits on glucose 
     control and insulin sensitivity. The biologic mechanisms that 
     could explain metabolic and diabetes benefits of dairy foods 
     and dairy fat have been recently reviewed.
       Based on all the evidence, the relation of dairy foods to 
     obesity, CVD, and diabetes does not consistently differ by 
     fat content, but rather appears to be more specific to food 
     type. In particular, neither low-fat nor whole milk appear 
     strongly related to either risks or benefits, whereas cheese 
     and yogurt (as well as other fermented dairy such as 
     fermented milk) may each be beneficial. These findings 
     suggest that health effects of dairy may depend on multiple 
     complex characteristics, such as probiotics, fermentation, 
     and processing, including homogenization and the presence or 
     absence of milk fat globule membrane.

[[Page H6898]]

  



                    Holistic Dietary Recommendations

       Conventional dietary guidelines generally recommend 2-3 
     daily servings of low-fat or nonfat dairy foods, without 
     regard of type (yogurt, cheese, milk); largely based on 
     theorized benefits of isolated nutrients for bone health 
     (e.g., calcium, vitamin D) and theorized harms of isolated 
     nutrients for obesity and CAD (e.g., total fat, saturated 
     fat, total calories). Advances in science indicate that 
     updated dietary guidelines must incorporate the empirical 
     evidence on health effects of different dairy products on 
     weight, body composition, CVDs, and diabetes. These findings 
     suggest that recommendations for milk, cheese, and yogurt 
     should be considered separately, based on their differing 
     relations with clinical outcomes. These findings further 
     suggest that whole-fat dairy foods do not cause weight gain; 
     that overall dairy consumption increases lean body mass and 
     reduces body fat; that yogurt consumption and probiotics 
     reduce weight gain; that fermented dairy consumption 
     including cheese is linked to lower CVD risk; and that 
     yogurt, cheese, and even dairy fat may protect against type 2 
     diabetes.
       Based on the current science, dairy consumption is part of 
     a healthy diet, and intakes of probiotic-containing yogurt 
     and fermented dairy products such as cheese should be 
     especially encouraged. Based on little empiric evidence that 
     low-fat dairy products are better for health, and at least 
     emerging research suggesting potential benefits of foods rich 
     in dairy fat, the choice between low-fat compared with whole-
     fat dairy should be left to personal preference, pending 
     further research. Such recommendations are consistent with a 
     growing focus on and understanding of the importance of foods 
     and overall diet patterns, rather than single isolated 
     nutrients.
                                  ____


    [From the European Journal of Clinical Nutrition, Dec. 11, 2017]

Effect of Whole Milk Compared With Skimmed Milk on Fasting Blood Lipids 
         in Healthy Adults: a 3-Week Randomized Crossover Study

            (By Sara Engel, Mie Elhauge, and Tine Tholstrup)


                              Introduction

       Dairy is a source of saturated fat (SFA) and dietary 
     recommendations for choosing low-fat dairy products are 
     mainly based on predicted effects of macronutrients, such as 
     SFA, which are known to increase LDL cholesterol 
     concentration in the blood. However, there is disagreement 
     between dietary guidelines and results from meta-analysis of 
     prospective cohort studies reporting no association between 
     dairy and risk of cardiovascular disease (CVD) and an inverse 
     association with type 2 diabetes (T2D). A meta-analysis 
     including studies comparing diets of equal SFA content from 
     cheese and butter reported a beneficial effect of cheese on 
     LDL cholesterol. Moreover, a comparison between regular and 
     reduced fat cheese found no difference in effect on LDL 
     cholesterol and risk markers of the metabolic syndrome, 
     although a significantly higher SFA content in the regular 
     fat cheese diet. This could suggest that the expected effect 
     on LDL cholesterol was mediated by a combination of nutrients 
     or bioactive components in the cheese matrix. Every day, 
     people make a choice between whole milk and skimmed milk in 
     the super market. Thus, a comparison between these high and 
     low-fat dairy products is a real-life practical issue for the 
     consumer that makes it possible to further examine the effect 
     of milk fat on health. Two studies compared milk with 
     different fat content and found no difference in changes in 
     LDL and HDL cholesterol; one between two control diets with 
     semi-skimmed and skimmed milk (1.9 vs. 0.3%) and another 
     between whole milk and skimmed milk (3.4 vs. 0.2%) but with 
     only eight participants and therefore underpowered. Current 
     evidence from randomized controlled trials (RCTs) indicate 
     that milk consumption has no effect on risk of T2D in terms 
     of fasting insulin and glucose concentrations, although not 
     consistently. The aim of this study was to investigate the 
     effects of whole milk compared with skimmed milk on serum 
     total, LDL, and HDL cholesterol, and triacylglycerol 
     concentration and secondarily on glucose and insulin 
     concentrations in healthy subjects. We hypothesized that 
     whole milk would increase fasting blood cholesterol 
     concentration moderately compared to skimmed milk.


                                Methods

     Subjects
       Subjects were recruited through postings on the Internet 
     and around university campus area in Copenhagen. A total of 
     25 subjects were screened through telephone calls, 19 were 
     assessed for eligibility, 18 were enrolled in the study, and 
     1 subject dropped out after randomization. Exclusion criteria 
     were: previous or current CVD, diabetes, or other severe 
     chronic disease: BMI (in kg/m\2\) <18.5 and >30; age <20 
     years and >70 years; pregnancy or planning of pregnancy 
     during study period; excessive physical activity (>10 h/wk); 
     milk allergy or lactose intolerance; blood donation <1 mo 
     prior to and during study period; use of supplements, lipid-
     lowering medication, as well as medicine that might affect 
     study outcomes; known or suspected abuse of alcohol, 
     medication, or drugs; blood pressure >140/90 mmHg; and 
     inability to follow study protocol. After receiving oral and 
     written information about the study all subjects gave their 
     informed consent in writing and completed a lifestyle 
     questionnaire including questions about current and previous 
     disease.


                              Study design

       The study was a crossover RCT. The two intervention periods 
     of whole milk and skimmed milk (in random order) were 3 weeks 
     long with no wash-out period, as the lipids in the blood are 
     known to adjust after 2 weeks. The study was not blinded as 
     the appearance of the test beverages could not be concealed. 
     However, analyses of blood samples as well as statistics were 
     done blinded. Sample size was based on a previous study on 
     dairy fat in which butter significantly increased LDL 
     cholesterol compared with olive oil (control) (difference in 
     concentration 0.17 mmol/L). Thus with a standard deviation 
     (SD) of 0.19 mmol/L, a total of 12 subjects had to be 
     included in order to detect a similar difference (assuming a 
     significance level of 5 and 80% power). The study was carried 
     out at the Department of Nutrition, Exercise, and Sports, 
     Faculty of Science, University of Copenhagen, Frederiksberg, 
     Denmark from 3 October to 17 December 2015. The study was 
     approved by the Municipal Ethical Committee of Copenhagen 
     (Report H-15011908) and conducted according to the Helsinki 
     Declaration.


                              Intervention

       The test foods were provided to the study subjects, 
     consisting of 0.5 L conventional skimmed milk (0.1%, Arla 
     Foods, Denmark) and whole milk (3.5%, Arla Foods, Denmark) 
     from cows and from the same season. The energy content and 
     macronutrient composition of the milks are shown in Table 1. 
     Subjects were instructed not to consume yogurt, ice-cream, or 
     milk besides the test milk. For other dairy products such as 
     cheese and butter and for cooking oils subjects were 
     instructed to keep the same dietary pattern throughout the 
     intervention. Apart from the test foods and restrictions in 
     dairy intake the remaining diet was self-selected and 
     study subjects were asked to maintain their usual diets 
     and their regular level of physical activity throughout 
     the intervention periods. Subjects were instructed in how 
     to substitute the test foods for food items from their 
     habitual diets (usually the milk they normally drank). 
     Weekly subjects visited the department to collect the milk 
     and for weighing and follow-up making sure they adhered to 
     the test diet and kept a stable body weight during 
     intervention periods. Compliance was measured as a 
     percentage of milk consumed according to a diary kept 
     throughout the intervention compared with the milk handed 
     out. Subjects completed 3-d dietary records the last week 
     of each period and were instructed to include 1 weekend 
     day and 2 weekdays to take account of differences in 
     nutrient intake. Dietary intake was assessed using Dankost 
     Pro dietary assessment software (Dankost).


                        Clinical investigations

       Fasting blood samples were taken at baseline, after 3 weeks 
     and after 6 weeks. Prior to the blood sampling subjects 
     fasted (12 h) and were asked to refrain from smoking (12 h), 
     extreme sports (36 h), alcohol or medicine (24 h). Blood 
     samples were drawn for assessment of following: serum lipids 
     (total, LDL, and HDL cholesterol and triacylglycerol), 
     insulin, and plasma glucose. Samples for assessment of blood 
     lipids and insulin were collected into dry tubes, and samples 
     for glucose were collected into tubes with a 1 3 mL-fluoride 
     citrate mixture. To coagulate blood samples were stored at 
     room temperature for 30 min. Further, blood samples for 
     assessment of blood lipid and insulin concentrations were 
     centrifuged at 2754 g for 10 min at 4  deg.C and stored at 
     -80  deg.C until the concentration was analyzed. For glucose, 
     samples were centrifuged at 2754 g for 10 min at 20  deg.C 
     and stored at -80  deg.C until the concentration was 
     analyzed. LDL and HDL cholesterol concentrations were 
     assessed by enzymatic colorimetric procedure (ABX Pentra LDL 
     Direct CP and ABX Pentra HDL Direct CP, respectively; Horiba 
     ABX). Concentration of total cholesterol was assessed by 
     enzymatic photometric test (CHOD-PAP from ABX Pentra 
     Cholesterol CP). Triacylglycerol and glucose concentrations 
     were assessed by enzymatic colorimetric procedure (ABX Pentra 
     Triglycerides CP and ABX Pentra Glucose HK CP; Horiba ABX, 
     respectively). Blood lipid concentration was analyzed on an 
     ABX Pentra 400 Chemistry Analyzer (Horiba ABX). Interassay 
     CVs for total, LDL and HDL cholesterol, triacylglycerol, and 
     glucose were 2.2, 2.7, 2.0, 2.6, and 2.5%, respectively. 
     Intra-assay CVs for total, LDL and HDL cholesterol, 
     triacylglycerol, and glucose were 0.9, 0.7, 1.2, 3.8, and 
     1.1%, respectively. Insulin concentrations were assessed by 
     the solid-phase enzyme-labeled chemiluminescent immunometric 
     assay with an Immunlite 2000 XPi (Siemens Medical Solutions 
     Diagnostics). Interassay and intra-assay CVs for insulin were 
     3.5 and 4.2%, respectively.
       Insulin resistance was evaluated by using homeostasis model 
     assessment--insulin resistance (HOMA-IR) with the following 
     formula: HOMA-IR = Fasting serum insulin (U/mL) 
     fasting plasma glucose (mmol/L)/22.5.
       Fasting body weight was measured at baseline, 3 and 6 weeks 
     to the nearest 0.1 kg wearing light clothing and having 
     emptied their bladder in advance. Height, body weight for BMI 
     calculation, and waist circumference were also measured at 
     screening. Height was measured without shoes to the nearest 
     0.5 cm with a wall-mounted

[[Page H6899]]

     stadiometer (Seca) and waist circumference was measured 
     horizontally at the midpoint between the bottom rib and the 
     top of the hip bone.


                          Statistical analysis

       Statistical differences for outcome measures were analyzed 
     with linear mixed models that incorporated systematic effects 
     of period and treatment and their interaction. Approximate F-
     tests were used to evaluate the interaction between time and 
     treatment and if non-significant to evaluate a time-
     independent treatment effect. Baseline values and relevant 
     covariates: sex, age, waist circumference, and baseline-BMI 
     were included. Subject-specific random effects were included 
     to account for inter-subject variability and to adjust for 
     non-specific differences that could not be explained by the 
     explanatory variables included. For dietary records 
     statistical differences were based on paired t-test or 
     Wilcoxon Signed Rank test for non-parametric variables. 
     Treatment differences were reported in terms of unadjusted 
     mean levels with corresponding standard errors. All models 
     were validated by graphical assessment of normal quantile 
     plots and residual vs. fitted plots. When departure was 
     detected logarithmic transformation of the variables were 
     made. Variance homogeneity was visually inspected and showed 
     similar variance. Concentration of glucose and insulin were 
     correlated to blood lipid responses using Pearson correlation 
     test or Spearman correlation test for non-parametric 
     variables. A two-tailed P-value < 0.05 was considered 
     significant. The statistical software R version 3.1.3 2015 
     was used for all statistical evaluations.


                                Results

     Subjects
       Of the 18 recruited subjects, 1 dropped out in the first 
     period because of inability to follow study protocol. 
     Baseline characteristics of the 17 subjects who completed the 
     study are outlined in Table 2. No difference was observed in 
     body weight during the intervention between whole milk and 
     skimmed milk periods (P = 0.59). The compliance for intake of 
     milk during the first and second period was 99.7 and 98.5%, 
     respectively.


                              Blood lipids

       Results from fasting blood lipid measurements at the end of 
     each period are listed in Table 3. HDL cholesterol was 
     significantly higher with whole milk than with skimmed milk 
     (P < 0.05). There were no significant differences between the 
     periods for any of the other blood lipids. For total 
     cholesterol there was a tendency for a higher concentration 
     with whole milk than with skimmed milk (P = 0.06).


                          Insulin and glucose

       Results of glucose and insulin concentrations measured at 
     the end of each period as well as calculated HOMA values are 
     listed in Table 3. There were no significant differences 
     between the periods for any of these outcomes. However, 
     correlation analysis with skimmed milk showed that insulin 
     and LDL cholesterol were moderately positively correlated (r 
     = 0.54, P < 0.05) and with whole milk that glucose and HDL 
     cholesterol were moderately negatively correlated (r = 0.52, 
     P < 0.05).


                             Dietary intake

       Total energy intake was significantly higher with whole 
     milk than with skimmed milk (P < 0.05). Fat intake (in grams 
     and percentage of energy) was significantly higher with whole 
     milk than with skimmed milk (P < 0.001). Also, the intake of 
     saturated, monounsaturated, and polyunsaturated fat 
     was significantly higher with whole milk than with skimmed 
     milk (P<0.001, P<0.05, and P<0.05, respectively). Intake 
     of carbohydrate was significantly higher with skimmed milk 
     than with whole milk (P<0.01). There were no differences 
     between the periods for intake of protein, calcium, 
     alcohol, and dietary fiber.


                               Discussion

       In the present study we showed that a daily intake of 0.5 L 
     whole milk for 3 weeks did not increase LDL cholesterol 
     compared to an equal intake of skimmed milk in healthy 
     subjects. Moreover, although small, a significant increase in 
     HDL cholesterol concentration was shown with whole milk 
     compared to skimmed milk, which was significantly, 
     moderately, and negatively correlated with glucose 
     concentration. None of the other outcome measurements showed 
     a difference between the periods. The increase in HDL 
     cholesterol following intake of whole milk was expected due 
     to the higher content of SPAs known to increase HDL and LDL 
     cholesterol concentrations. The Nordic Nutrition 
     Recommendations as well as the American Dietary Guidelines 
     advice that SFA should be limited to less than 10E%, due to 
     the predicted effect on LDL cholesterol. In comparison, the 
     amount of SFAs in the whole milk diet was almost 5 E% above 
     and in the skimmed milk diet close to recommendation (14.4 
     and 11.3 E%, respectively), according to the dietary records. 
     Thus, the result of no difference in LDL cholesterol was 
     unexpected and opposite to the dietary guidelines and our 
     hypothesis, despite of the dominating macronutrient content 
     of SFA with whole milk. Studies of the association between 
     HDL cholesterol concentration and CVD has shown that HDL is 
     protective. However, it is necessary to be cautious when 
     interpreting low concentration of HDL cholesterol as a CVD 
     risk factor. Mendelian randomization studies have shown that 
     genetically decreased HDL cholesterol was not associated with 
     increased risk of myocardial infarction, questioning the 
     causality of an association between low HDL concentration and 
     CVD. Still, HDL cholesterol concentration, as a marker of 
     cardiovascular health, should be taken into consideration 
     when interpreting the effect of dairy or SFAs in the diet.
       Our results are in line with two previous intervention 
     studies from 2009 and 1994 comparing milk of different fat 
     content that also showed no effect on total and LDL 
     cholesterol concentration after 12 months and 6 weeks with 
     similar milk intake (500 and 660 ml/d, respectively); 
     however, contrary to our results also no effect on HDL 
     cholesterol. Fonolla et al. compared semi-skimmed milk and 
     skimmed milk and therefore a smaller difference in milk fat 
     (1.9 vs. 0.3%), which could explain the lack of difference in 
     HDL cholesterol compared to the present study. Steinmetz et 
     al., the more comparable study and of good quality, also 
     compared skimmed milk with whole milk in a crossover design, 
     but in a background diet designed to meet the AHA 
     recommendations. Steinmetz et al. reported a significantly 
     higher concentration of total and LDL cholesterol with whole 
     milk compared to skimmed milk. However, the statistical 
     analysis was not adjusted for baseline measurements, and thus 
     not adjusted for differences between periods, and in addition 
     the sample size was small (n = 8). Still, the analysis of 
     difference in change from baseline between the two diets was 
     also reported which showed no difference between total and 
     LDL cholesterol, in line with our results. Nevertheless, the 
     study reported higher Apolipoprotein B concentrations with 
     whole milk compared to skimmed milk known to be a predictor 
     of cardio metabolic risk.
       Although the dietary records showed a significantly higher 
     energy intake with whole milk compared to skimmed milk, it 
     seems that the study subjects compensated for the extra 
     energy with whole milk by lowering their intake of 
     carbohydrate which was significantly lower compared to 
     skimmed milk. The content of calcium and protein were similar 
     in the two milk types, but whole milk has a higher content of 
     milk fat globule membranes (MFGM), which encloses the fat. A 
     possible matrix effect of MFGMs was suggested in a recent 
     study showing an impaired lipoprotein profile after a butter 
     oil diet, low in MFGMs, compared with a whipping cream diet, 
     high in MFGMs. One proposed mechanism, based on a mice study, 
     is through lowering of cholesterol absorption by inhibition 
     of cholesterol micellar solubility possibly due to presence 
     of sphingomyelin in MFGM fragments. Thus, one could speculate 
     that an expected higher LDL cholesterol concentration after 
     whole milk may be modified by a dairy matrix effect of MFGM.
       The strength of the present RCT was the imitation of real-
     life settings by not matching the diets for energy content or 
     macronutrient composition, which made it possible to directly 
     compare whole milk and skimmed milk as whole foods. The free-
     living design of the study was a limitation, thus allowing 
     the presence of potential confounding by other lifestyle and 
     dietary factors. However, the crossover design minimizes this 
     potential confounding as study subjects were their own 
     control,
       In conclusion, the results indicate that intake of 0.5 L/d 
     of whole milk does not adversely affect fasting blood lipids, 
     glucose, or insulin compared to skimmed milk in healthy 
     adults. Moreover, intake of whole milk increased HDL 
     cholesterol concentration compared to skimmed milk. These 
     findings suggest that if the higher energy content is taken 
     into account, whole milk can be considered as part of a 
     healthy diet among the normocholesterolemic population.

  Ms. FOXX. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from 
Tennessee (Mr. Rose).
  Mr. ROSE. Mr. Chair, today I rise in support of the Whole Milk for 
Healthy Kids Act which will allow schools to offer both unflavored and 
flavored whole milk for students.
  Whole milk provides children with 13 essential nutrients for growth, 
development, immunity, and brain function. Whole milk also serves as 
the top source of protein, calcium, potassium, and vitamin D for 
children.
  I am a proud cosponsor of this vital legislation, and I thank my good 
friend, Chairman Thompson, for introducing this commonsense bill.
  For too long, poor Federal policy has kept whole milk out of our 
school cafeterias. This commonsense legislation puts the health and 
well-being of our children first. As the father of two young sons 
myself, I am proud to support this bill, and I urge my colleagues to 
join me in doing so.
  Also as a father, I would note that I see every day the illustration 
of how my children react to whole milk versus skim milk. I would just 
give that firsthand impression.
  I also would say the science supports it.
  Mr. Chairman, I include in the Record these scientific studies, as 
well.

[[Page H6900]]

  


 Comparison of the DASH (Dietary Approaches to Stop Hypertension) Diet 
      and a Higher-Fat DASH Diet on Blood Pressure and Lipids and 
              Lipoproteins: A Randomized Controlled Trial


                              INTRODUCTION

       The Dietary Approaches to Stop Hypertension (DASH) dietary 
     eating pattern, which emphasizes fruit and vegetables, low-
     fat dairy foods, and whole grains, is one of the most widely 
     prescribed dietary modifications for reducing blood pressure 
     (BP) and cardiovascular disease risk. Notably, in the Nurses' 
     Health Study, self-reported greater adherence to a DASH-style 
     diet was associated with a lower risk of coronary artery 
     disease and stroke. Because LDL cholesterol is lower with the 
     consumption of the DASH diet than with a typical Western diet 
     due in part to its limitation of saturated fatty acids, it is 
     believed that its lower saturated fat content may contribute 
     to reduced risk of cardiovascular disease.
       The degree of dietary adherence strongly determines the 
     efficacy of dietary interventions. A recent review of 9 
     trials of the DASH diet with objective measures of compliance 
     reported poorer adherence when dietary advice rather than 
     foods was provided. A common reason for low adherence or high 
     attrition is the difficulty of following prescribed diets. In 
     the original DASH trial, lack of menu variety was a primary 
     reason for lapses in dietary adherence. This suggests the 
     potential value of providing options for the DASH diet that 
     permit variation in macronutrient composition while 
     preserving benefits on BP and lipid risk factors.
       One such variation is the substitution of fat for 
     carbohydrate. Appel et al. reported that the replacement of 
     10% of energy from carbohydrate with unsaturated fat 
     (primarily monounsaturated) in a DASH-like diet resulted in a 
     reduction in triglycerides and an increase in HDL 
     cholesterol, with no change in LDL cholesterol, and a further 
     reduction in the Framingham risk score. There is evidence 
     that long-term compliance to diets with reduced saturated fat 
     is poor, even with intensive counseling, and that moderate-
     fat diets may yield better dietary adherence than low-fat 
     diets. Furthermore, the mean intake of individuals who 
     consumed the DASH diet in the ENCORE (Exercise and Nutrition 
     Interventions for Cardiovascular Health) study failed to meet 
     the low total fat and saturated fat targets.
       The effects on lipids and BP of replacing carbohydrates 
     with saturated fats within a DASH-like diet have not been 
     reported, to our knowledge. In the present study we tested 
     the effects of substituting full-fat dairy products for 
     nonfat and low-fat dairy foods (thereby increasing saturated 
     fat from 8% to 14% of energy) in conjunction with a reduction 
     of 12% of energy in carbohydrate, primarily from sugars.


                                METHODS

     Study design and diets
       A 3-period randomized crossover study in free-living 
     participants was conducted between August 2011 and December 
     2013 at our clinical research center in Berkeley, California. 
     The participants consumed a 1-wk run-in diet, consisting of a 
     mixture of 2 or 3 d of each experimental diet, and then 
     consumed in random order a control diet, a standard DASH 
     diet, and a higher-fat, lower-carbohydrate modification of 
     the DASH diet (HF-DASH diet) for 3 wk each. Each experimental 
     diet was separated by a 2-wk washout period, during which 
     participants ate their own foods but continued to abstain 
     from alcohol. Participants were assigned their diet sequence 
     in randomly determined blocks of 3, 6, 9, or 12 individuals 
     by using a uniform random-number generator. Diet sequences 
     were kept in sealed envelopes and assigned to the participant 
     by the study nutritionist 1-2 d before starting the first 
     experimental diet. Participants were blinded to diet order, 
     but because of the nature of the diets they were likely able 
     to identify each diet. Clinic personnel were not blinded to 
     diet order. Laboratory personnel and investigators were 
     blinded to diet order, and unblinding was performed after 
     data collection before analysis. Participants met with study 
     staff weekly for counseling, to receive study foods, and to 
     be weighed. At the end of each experimental diet, 
     participants visited the clinic on 2 consecutive days for 
     clinical and laboratory measurements. In addition, a fasting 
     blood sample was taken after each washout period to document 
     a return to baseline for standard lipid and BP measurements.
     Study population
       Participants included generally healthy men and women >21 y 
     of age with an average diastolic BP between 80 and 95 mm Hg 
     and systolic BP <160 mm Hg for 2 screening visits. Exclusion 
     criteria included the following: use of nicotine products or 
     recreational drugs, history of coronary artery disease, 
     diabetes, or other chronic disease, use of hormones or 
     medications known to affect lipid metabolism or BP; use of 
     dietary supplements within the past 3 mo; unwillingness to 
     refrain from alcoholic beverages during the study; BMI (in 
     kg/m\2\) 35; total and LDL cholesterol >95th percentile for 
     sex and age; fasting triglycerides >500 mg/dL; fasting 
     glucose 126 mg/dL; and abnormal thyroid-stimulating hormone 
     concentration. Participants were recruited primarily through 
     our database of previous study participants, Internet 
     advertisements, and community health events. The protocol was 
     reviewed and approved by the Institutional Review Board of 
     Children's Hospital and Research Center Oakland. All 
     participants provided written informed consent.
     Dietary provision
       The Bionutrition Core of the University of California, San 
     Francisco, Clinical and Translational Science Institute 
     developed and prepared diets for a 3-d cycle menu at 5 levels 
     of energy intake (1800, 2100, 2600, 3100, and 3600 kcal). 
     Participants whose energy needs were between main-menu 
     calorie levels received unit foods (100 kcal) that matched 
     the macronutrient and mineral content of the experimental 
     diets. The control and DASH diets were designed to match the 
     characteristics of the diets used in the original DASH trial. 
     The higher-fat and lower-carbohydrate content of the HF-DASH 
     diet was achieved by replacing nonfat and low-fat dairy with 
     full-fat dairy products, mostly in the form of whole milk, 
     cheese, and yogurt, and by reducing sugars, mostly from fruit 
     juices, which constituted 59% of total fruit intake in the 
     DASH diet. The DASH and HF-DASH patterns were otherwise 
     developed by using similar recipes and foods, provided in 
     different amounts to meet each diet specification. As in the 
     original trial design, emphasis was placed on an abundance of 
     fruit and vegetables, increased whole grains and dairy 
     products; limited servings of meat, poultry, and fish, and 
     inclusion of nuts, seeds, and legumes several times weekly. 
     The nutrient composition of the diets was initially assessed 
     by using Nutrition Data System for Research Software (NDSR 
     2010; Nutrition Coordinating Center, University of Minnesota) 
     and validated by compositional analysis of g the 3-d cycle 
     menus (Covance Laboratories). The sodium, potassium, 
     magnesium, calcium, and fiber contents of the DASH and HF-
     DASH patterns were similar; the diets differed only in the 
     amount of total fat, saturated fat, cholesterol, and 
     carbohydrate they provided.
       Dietary control was achieved by providing participants with 
     2 standardized entrees and accompanying side dishes daily 
     (lunch, dinner, and some snacks), representing 50% of total 
     energy. Detailed menus, shopping lists, and food preparation 
     instructions were provided for the remaining food items 
     (mostly dairy, produce, and cereal products) to be purchased 
     and prepared at home. Participants were required to come to 
     the clinic weekly to pick up study foods, submit receipts 
     documenting study food purchases, and to meet with the 
     nutritionist to assess compliance with the dietary 
     protocol and adjust energy intake to maintain a stable 
     weight (within 3% of baseline, at 10 pounds 
     maximum). They were also required to maintain their usual 
     physical activity levels during the study and to monitor 
     daily steps by pedometer. Compliance was assessed by 
     measuring 24-h urinary potassium at the end of the second 
     week of each experimental diet. Twenty-four-hour urinary 
     sodium was measured as an indicator of sodium intake.
     Experimental measurements
       After each 3-wk dietary period, body weight and waist and 
     hip circumference were measured and the percentage of body 
     fat was assessed by bioimpedance (TBF 551 body-weight scale; 
     Tanita). BP was measured at the clinic by using a Dinamap 
     monitor (GE Pro 100 or Critikon Pro 300) after the second 
     week of each diet and on 2 consecutive days at the end of 
     each experimental diet, and the 3 values were averaged. At 
     each instance, BP was measured in a sitting position after 5 
     min rest 3 times, and the last 2 measurements were averaged. 
     Participants were also provided with a portable BP cuff 
     (Model BP791IT, Omron Healthcare, Inc) and were instructed to 
     self-measure BP twice in the morning and twice in the evening 
     for the last 7 d of each experimental dietary period. Data 
     were automatically recorded on the BP instrument and 
     downloaded for analyses. Urinary potassium and sodium were 
     measured in 24-h urine collections by an outside clinical 
     laboratory (Quest Diagnostics).
       Fasting plasma samples collected on 2 consecutive days at 
     the end of each experimental dietary period were analyzed for 
     plasma lipids and lipoproteins, glucose, and insulin. Total 
     cholesterol, HDL cholesterol, triglycerides, and glucose were 
     measured by enzymatic end-point measurements with the use of 
     enzyme reagent kits (Ciba-Corning Diagnostics Corporation) on 
     an AMS Liasys 330 Clinical Chemistry Analyzer. LDL 
     cholesterol was calculated by using the Friedewald equation. 
     Total cholesterol, HDL cholesterol, and triglyceride 
     concentrations were monitored throughout by the CDC-National 
     Heart, Lung, and Blood Institute Lipid Standardization 
     Program. Apolipoprotein B (apoB) and apolipoprotein A-I (apo 
     A-I) were measured by immunoturbidimetric assays (Batton 
     Assay Systems; AMS Liasys 330 analyzer).
       Lipoprotein particle concentrations and LDL peak diameter 
     were measured by gas-phase electrophoresis (ion mobility), as 
     previously described, with a modified procedure for initially 
     separating the lipoproteins from other plasma proteins. 
     Lipoprotein intervals were defined as previously described.
     Statistical analysis
       The primary objective was to compare the DASH and HF-DASH 
     diets for lipid and lipoprotein measurements. At 80% power, 
     an n of 36 would yield a minimum detectable difference 
     between diets of 0 14 mmol/L for LDL cholesterol (SD of 
     response = 0.30 mmol/L), 0.04 g/L for apoB (SD of response = 
     0.09 g/L), 0.03 mmol/L for HDL cholesterol (SD of response = 
     0.07 mmol/L), 4.1 mm Hg for systolic BP (SD of response = 8.6 
     mm Hg), and 2.2 mm Hg for diastolic BP (SD of response =

[[Page H6901]]

     5.3 mm Hg). The detectable changes in BP were sufficient to 
     confirm the differences observed in the original DASH trial. 
     Treatment differences were determined by ANOVA for a 3-
     treatment crossover design. Pairwise comparisons between 
     diets were adjusted by the Bonferroni method for 3 group 
     comparisons (HF-DASH diet compared with control diet, HF-DASH 
     diet compared with DASH diet, and DASH diet compared with 
     control diet), and P < 0.017 corresponding to an overall 2-
     tailed P < 0.05 was considered significant. ANOVA and paired 
     t tests were used to compare triglycerides and total, LDL, 
     and HDL cholesterol after each of the 2 washout periods with 
     baseline to test for the effectiveness of the washout period 
     for normalizing plasma lipids. The analyses were restricted 
     to those subjects who completed all 3 diets.


                                RESULTS

     Study participants
       Thirty-six participants completed all 3 experimental diets 
     and are included in analyses. Fasting plasma triglycerides 
     and total, LDL, and HDL cholesterol measured after each of 
     the 2 washout periods showed no significant differences 
     between screening values and their values after the first or 
     second washout period (analyses not shown), indicative of 
     their return to baseline concentrations.
       As expected, 24-h urinary potassium excretion was 
     significantly higher with the DASH and HF-DASH diets than 
     with the control diet (P < 0.0001 for both, adjusted for 
     period) and did not differ between the DASH and HF-DASH diets 
     (mean  SE: HF-DASH diet, 81.5  3.5; 
     DASH diet, 83.5  3.5; and control diet, 50.5 
      3.5 mmol), consistent with good dietary 
     compliance. Urinary sodium excretion did not differ between 
     diets (mean  SE: HF-DASH diets, 116.6 
      7.8; DASH diet, 119.3  7.8; and 
     control diet, 129.0  7.8 mmol; P = 0.49, adjusted 
     for period). Body weight remained stable throughout the study 
     and there were no differences by diet (mean  SE: 
     HF-DASH diet, 79.7  0.1; DASH diet, 79.6 
      0,1; and control diet, 79.8  0.1 kg; 
     P-treatment = 0.62).
     Effects of diets on BP
       Table 3 presents the statistical evaluation of the 
     crossover design's treatment, period, and sequence effects 
     along with the adjusted treatment means and their SEs. 
     Significant treatment effects were observed for systolic and 
     diastolic BP, such that the DASH and HF-DASH diets produced 
     significant and comparable reductions relative to the control 
     diet, with no differences between the DASH and HF-DASH diets.
       There were no significant sequence effects, but there were 
     significant carry-forward effects for both systolic and 
     diastolic BP and a significant period effect for systolic BP. 
     The carry-forward effect appeared to be due to lower systolic 
     and diastolic BP after the HF-DASH diet compared with the 
     DASH, control, or no previous diet. Mean BPs were, in fact, 
     lower at the end of the washout period after the HF-DASH diet 
     than after the other diets for systolic (mean  
     SE: -4.1  1.7 mm Hg; P = 0.02) and diastolic 
     (-0.9  1.1 mm Hg; P = 0.40) BPs. The carry-
     forward effect did not appear to be the result of any 
     individual participant.
       Both morning and evening systolic and diastolic BPs 
     measured by the participants at home were similarly reduced 
     with the DASH and HF-DASH diets compared with the control 
     diet, confirming the treatment effect of the DASH and HF-DASH 
     diets on BP. There were no significant sequence, period, or 
     carry-forward effects for home BP measurements.
     Effects of diets on plasma lipids and lipoproteins
       Significant treatment effects were observed for plasma 
     concentrations of triglycerides, total cholesterol, LDL 
     cholesterol, and HDL cholesterol, apo A-I, LDL peak diameter, 
     large and medium VLDL, intermediate-density lipoprotein 
     (IDL), and large LDL concentrations.
       For the primary comparison of the DASH and HF-DASH diets, 
     the latter resulted in significantly lower plasma 
     triglycerides, large and medium VLDL concentrations, and 
     significantly higher LDL peak particle diameter. There were 
     no significant differences between the DASH and HF-DASH diets 
     for any other lipid or lipoprotein measurement after 
     Bonferroni correction.
       Both the DASH and the HF-DASH diets significantly reduced 
     total cholesterol compared with the control diet. The DASH 
     diet also significantly decreased LDL cholesterol, HDL 
     cholesterol, apo A-I, IDL concentrations, large LDL 
     concentrations, and LDL peak diameter compared with the 
     control diet. Except for lower total cholesterol, none of the 
     lipid and lipoprotein measurements differed significantly 
     between the HF-DASH and control diets after Bonferroni 
     correction.
       There were no significant sequence effects for any of the 
     lipid and lipoprotein variables examined. None of the 
     variables that showed a significant treatment effect 
     exhibited significant carry-forward or period effects.


                               DISCUSSION

       The DASH diet, which was developed and validated as a means 
     for lowering BP, was formulated to include low-fat and nonfat 
     dairy foods. In this study, we tested whether the BP benefit, 
     as well as a favorable lipid and lipoprotein profile, could 
     be maintained by the HF-DASH diet that includes full-fat 
     dairy foods, with a corresponding increase in total and 
     saturated fat, and a reduction in carbohydrate achieved 
     primarily by reducing fruit juices and sugars, because sugar 
     intake is associated with detrimental effects on 
     cardiovascular disease risk factors. The HF-DASH diet lowered 
     both systolic and diastolic BP to an extent similar to the 
     DASH diet, indicating that the diet components responsible 
     for the BP reduction were retained in the HF-DASH diet. 
     Although the sodium content of the control diet was slightly 
     higher than that of the 2 experimental diets, this difference 
     was similar to that observed in the original DASH trial. 
     Furthermore, 24-h urine sodium measurements were similar on 
     all 3 diets, indicating that the BP reductions with the DASH 
     and HF-DASH diets were not attributable to lower sodium 
     intake.
       When substituted for carbohydrates or unsaturated fats, 
     saturated fats have been consistently shown to increase LDL 
     cholesterol. We previously showed that with limitation of 
     carbohydrate intake, the increase in LDL cholesterol induced 
     by saturated fat is due primarily to large, cholesterol-rich 
     LDL particles and not small, dense LDL particles. Indeed, in 
     the present study, we found that the reduction in LDL 
     cholesterol with the DASH diet compared with the control diet 
     occurred in conjunction with lower concentrations of large 
     LDL particles as well as of IDL particles, which both 
     contribute cholesterol content to the standard LDL-
     cholesterol measurement. However, despite a 6% of energy 
     higher saturated fat content to the HF-DASH diet compared 
     with the DASH diet, there were no significant differences in 
     LDL cholesterol or any of the LDL subclasses between these 
     diets. There may be features of the DASH diet that mitigate 
     the increase in LDL cholesterol that is typically observed 
     with higher saturated fat intake.
       It is of interest that there was a significantly higher LDL 
     peak particle diameter with the HF-DASH diet compared with 
     the DASH diet. Although this difference was of relatively 
     small magnitude, it corresponded to a trend, albeit 
     nonsignificant, for relatively higher concentrations of 
     larger LDL particles and lower concentrations of smaller LDL 
     particles with the HF-DASH diet with no net difference in 
     total LDL particle concentrations. This change in the 
     distribution of LDL particles may be more easily detected by 
     the peak diameter than the individual subtractions. The shift 
     toward larger LDL particles with the HF-DASH diet may be 
     attributed at least in part to the lower carbohydrate content 
     of this diet compared with the DASH diet, because a shift 
     from smaller to larger LDL particles was previously shown to 
     correlate with reductions in plasma triglyceride and VLDL 
     concentrations resulting from reduced carbohydrate or sugar 
     intake. The reductions in triglycerides and VLDL particle 
     concentrations with the HF-DASH diet compared with the DASH 
     diet observed in the present study were relatively modest as 
     might be expected from the moderate difference in 
     carbohydrate content between the diets (43% compared with 55% 
     of energy). It is possible that these differences were not of 
     sufficient magnitude to elicit the significant reductions in 
     small, dense LDL particles as well as in apoB (an index of 
     LDL particle number) that have been observed previously with 
     more substantial reductions in carbohydrate intake.
       The present study confirmed previous observations that the 
     DASH diet lowers HDL cholesterol, which is consistent with a 
     significant reduction in apo A-I compared with the control 
     diet. These changes were not observed with the HF-DASH diet, 
     although the differences between the effects of the HF-DASH 
     and DASH diets did not reach significance. The basis for the 
     reduction in HDL cholesterol with the DASH diet is not known, 
     although it is noteworthy that this effect was not associated 
     with a change in HDL particle concentrations, suggesting that 
     it may represent a change in HDL composition.
       Other investigators have also tested modifications of the 
     DASH diet on BP or lipid risk factors. The OmniHeart trial 
     tested the replacement of 10% of energy from carbohydrate in 
     a DASH diet with 10% of energy from unsaturated, primarily 
     monounsaturated, fat or 10% of energy from protein. The 
     protein and monounsaturated fat diets yielded similar or 
     greater reductions in BP compared with the standard, high-
     carbohydrate DASH diet. Replacing carbohydrate with 
     monounsaturated fat reduced total cholesterol and 
     triglycerides and increased HDL cholesterol with affecting 
     LDL cholesterol. Replacing carbohydrate with protein reduced 
     total, LDL, and HDL cholesterol and triglycerides. The Beef 
     in an Optimal Lean Diet Study found that the inclusion of 
     lean beef in a low-saturated-fat DASH-like diet resulted in 
     comparable effects on lipid and lipoprotein measures compared 
     with a standard DASH diet. Sayer et al. recently showed that 
     a DASH-style diet containing either lean pork or chicken and 
     fish similarly reduced BP. Together with results from the 
     present study, the above findings provide evidence that 
     aspects of the DASH diet can be modified without compromising 
     its benefits on BP or LDL-cholesterol lowering, offering 
     flexibility in food choices for individuals following the 
     DASH diet.
       The crossover design of this trial was largely successful 
     in that lipids and lipoprotein returned to baseline 
     concentrations and there were no significant sequence effects 
     and no carry-forward effects for most of the variables. The 
     exceptions were the clinic measurements of systolic and 
     diastolic BPs, whose reductions showed significant carry-
     forward on the HF-DASH diet, an unexpected and unexplained 
     effect because there was no such carry-forward effect for the 
     home BP measurements.

[[Page H6902]]

       Strengths of our study include high dietary compliance as 
     measured by urinary biomarkers and lack of weight change as a 
     potential confounder. Limitations include a relatively small 
     sample size and a short intervention duration.
       In conclusion, the results of this study indicate that 
     modification of the DASH diet to allow for more liberal total 
     and saturated fat intake in conjunction with moderate 
     limitation of carbohydrate intake, primarily from fruit 
     juices and sugars, results in lower concentrations of 
     triglycerides and VLDL particles, with no increases in total 
     or LDL cholesterol and no attenuation of the favorable BP 
     response to the standard DASH diet. Therefore the modified 
     HF-DASH diet studied here presents an effective alternative 
     to this widely recommended dietary pattern, with less-
     stringent dietary fat constraints, which may promote even 
     broader implementation.

  Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my 
time.
  Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from 
Pennsylvania (Mr. Joyce).
  Mr. JOYCE of Pennsylvania. Mr. Chair, I thank Dr. Foxx for yielding.
  Mr. Chair, I rise in support of the Whole Milk for Healthy Kids Act. 
As a doctor, I know the benefits of whole milk, and I know that whole 
milk can have benefits for Americans of all ages.
  Whole milk is 96\1/2\ percent fat-free. According to a study that was 
conducted that lasted for more than 15 years and was published in The 
Lancet journal of medicine, individuals who consume more than two dairy 
products each day have a lower risk of cardiovascular disease. There is 
lower morbidity associated with those who have whole milk and whole 
milk products in their diet.
  The 13 essential nutrients that are found in milk are vital to the 
development of bones, muscles, and even brain tissue in our Nation's 
children.
  By banning healthy milk products from our schools, misguided policies 
that were crafted and implemented by the Obama administration, that has 
led students to turn away from milk and dairy products and turn to 
highly caffeinated and sugary drinks. Those drinks have very little 
nutritional value.
  Pennsylvania's 13th Congressional District is home to the most number 
of dairy cows in our Commonwealth. Recently, I had the chance to visit 
Galliker's Dairy Company in Johnstown, Pennsylvania.
  For the past four generations, Galliker's has processed milk from 46 
regional family dairy farms for retailers, grocery stores and schools 
across the Northeast.
  The Whole Milk for Healthy Kids Act will ensure that the whole and 2 
percent milk processed at facilities like Galliker's will make its way 
into school lunchrooms across the country.
  Mr. Chair, I urge all of my colleagues to vote for nutrition by 
supporting this legislation.
  Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.
  Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from 
Wisconsin (Mr. Van Orden).
  Mr. VAN ORDEN. Mr. Chair, I thank the gentleman from Louisiana for 
painting a vivid and completely disingenuous picture of junior high 
school students being held down and having milk forced down their 
throats in a school cafeteria.
  I will also take the opportunity--I can't believe I am doing this--
the milk fat content of whole milk is actually 3.25 percent making it 
96.7 percent fat-free.
  So when we look at the science, we read this definition: Milk means 
the lacteal secretion practically free from colostrum obtained by the 
complete milking of one or more healthy cows.
  The reason soy milk is not in there is because it is not milk. 
Neither is almond milk. Milk comes from a mammal.
  Mr. Chair, I strongly support this bill, and I am looking forward to 
having our children have healthy and nutritious choices in their 
schools.
  Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.
  Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from New 
York (Mr. Molinaro).
  Mr. MOLINARO. Mr. Chair, I am proud to cosponsor the Whole Milk for 
Healthy Kids Act, and I urge my colleagues to support its adoption.
  After over 10 years of schools having to comply with a nonsensical 
ban, I am excited to work on this bill to provide full-favor, nutrient-
dense milk to kids once again. Parents and physicians have known the 
benefits of milk for generations. Nearly 70 percent of milk consumed at 
home is whole or 2 percent because it actually tastes good. It is 
packed with vitamins, and, most importantly, kids actually love it. I 
know my four do.
  Full-fat milk gives parents alternatives to soda that their kids 
actually want to drink, but kids have been barred--strangely barred--
from having their favorite milk choices in schools.
  The result has been a decline in milk consumption in schools, and 
when kids are drinking less milk, they are losing out on nutrients that 
are critical for their healthy development.
  Milk is the top source of protein, calcium, phosphorus, and vitamin D 
for kids. It provides seven of the 14 nutrients the American Academy of 
Pediatrics recommends for brain development.
  The bottom line is that limiting milk in schools reduces consumption 
of essential nutrients, pushes kids towards sugary alternatives, and 
has led to less healthy kids.
  As the Representative for hundreds of family-owned dairy farms in New 
York, and as a parent to four kids, I have one special interest: the 
health standard of the kids growing up in our communities.
  I am excited to take this long overdue action to repeal a ridiculous 
ban. I am grateful to Chairman Thompson for his leadership to get the 
full-fat milk back in schools.
  Mr. Chair, I encourage my colleagues to vote for this bipartisan 
bill.
  Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my 
time.
  Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentleman from 
California (Mr. Costa), who is my classmate.
  Mr. COSTA. Mr. Chair, I thank the gentlewoman and my classmate for 
yielding.
  Mr. Chair, let me speak in favor of this important bipartisan 
legislation. The Whole Milk for Healthy Kids Act is an investment, I 
believe, in our children's health and future.
  This proposed legislation, let's be clear, does not change the 
underlying law. For the 19 years that I have been on the House 
Agriculture Committee, the school lunch and breakfast program has been 
and should be a focus of attention by the House of Representatives and 
the Congress.

  Why?
  It is because we provide the support for the school lunch and 
breakfast programs.
  And why else?
  It is because we want our children to have the most nutrition 
possible from lunch and breakfast.
  In addition, we want to deal with issues of obesity and issues of 
allergies. It is important for a healthy future.
  Now, let me say that I know a little bit about this. My family and I 
have been involved in the dairy business in California for three 
generations, since the early 1920s. Dairy plays a critical role in the 
nutritional diet of children as a leading food source for nutrients 
that are critical for development and growth. We must provide healthy 
nutrient-packed options that children will actually choose to consume, 
ranging from nonfat to whole.
  Milk provides 13 essential nutrients, as has been mentioned, 
including three of the four nutrients of public health concern that 
involve calcium, potassium, and vitamin D.
  A few months ago I visited the Fresno Unified Nutrition Center. 
Fresno Unified is the third largest school district in California with 
73,000 students. They prepare 45,000 lunches a day and 15,000 
breakfasts at 85 school centers. It is a big undertaking for this 
nutritional program.
  What we know is that for many of the kids, the breakfast or the lunch 
they get is sometimes the best meal they get in a day, so, therefore, 
we need to be focused on this. Our schools must be equipped with 
nutritional school milk options. We must be available and flexible to 
new scientific developments that are made.
  The Acting CHAIR. The time of the gentleman has expired.
  Ms. FOXX. Mr. Chair, I yield an additional 1 minute to the gentleman 
from California.
  Mr. COSTA. Mr. Chair, our schools must be equipped with nutritional 
school milk options, and this is what this legislation attempts to try 
to do.
  When kids like their school milk options that are flavorful and 
tasty, they

[[Page H6903]]

consume them in the levels that they should. When kids, I think, like 
their choices for lunch or breakfast, America succeeds.
  Let me close by saying that every body needs milk.
  Mr. SCOTT of Virginia. I am prepared to close, and I reserve the 
balance of my time.
  Ms. FOXX. Mr. Chair, we are waiting for one more speaker to come, so 
I will yield myself 1 minute.
  Mr. Chairman, I want to reiterate some points that were made before. 
We are not being driven by any special interest group lobby. We are 
being driven by the special interest group of children. We want 
children in school to have access to whole milk, which, as my 
colleagues have pointed out, is 96.75 percent fat-free, but it provides 
one of the most nutritious meals that children can have.
  We are seeing tremendous waste in the schools. We are not excluding 
soy drink. The policy that we are trying to overcome here by providing 
whole milk to children was a policy passed under the Obama 
administration. We are not trying to harm minorities in any way 
whatsoever. We want everybody to have the choice to drink a soy drink, 
whole milk, skim milk, 1 percent milk, whatever.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Ms. FOXX. Mr. Chair, I yield an additional 15 seconds to myself.
  Ms. FOXX. Mr. Chairman, this bill has been terribly mischaracterized 
by our colleagues on the other side of the aisle. It is about healthy 
choices for children.
  Mr. Chair, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, may I inquire how much time is 
remaining on both sides.
  The Acting CHAIR. The gentleman from Virginia has 16\1/2\ minutes 
remaining. The gentlewoman from North Carolina has 3\1/4\ minutes 
remaining.
  Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.

                              {time}  1445

  Ms. FOXX. Mr. Chair, I yield 1 minute to the gentleman from 
Pennsylvania (Mr. Meuser).
  Mr. MEUSER. Mr. Speaker, I thank Chairwoman Foxx very much for her 
leadership on this very important issue.
  Mr. Chair, kids love milk, but our schools have been prohibited from 
providing children whole milk since 2010 and, frankly, it was based 
upon false science.
  Milk is a healthy choice for our children. It has 13 essential 
nutrients that kids need--calcium, protein, iron, vitamin D, potassium, 
and more. Compared to soda or iced tea, which kids will turn to without 
a healthy alternative, a carton of milk has only one-third of the sugar 
as a can of Coca-Cola.
  We, as adults and Representatives, need to give our children and 
grandchildren the options to make healthy choices. We need this 
legislation to put whole milk back in our schools.
  Mr. Chair, would you be surprised to know that whole milk is 96.75 
percent fat free? To say whole milk is unhealthy for kids is, if you 
will, ``udderly'' ridiculous.
  Let's do the right thing by our children, families, and dairy farmers 
by passing the Whole Milk for Healthy Kids Act. It is time to ask 
American schoolchildren if they, once again, ``Got Milk?''
  Mr. SCOTT of Virginia. Mr. Chair, I yield myself the balance of my 
time.
  Mr. Chair, I am disappointed that my Republican colleagues are 
attempting to make school meals less healthy by ignoring the latest 
science and undermining President Biden's work to strengthen school 
meal nutrition.
  The latest DGAs have already made clear that fat-free milk and low-
fat milk are the healthiest options for children. If anybody has 
studies or research to the contrary, they should submit it to the 
experts in the normal process rather than politicians.
  This bill goes against the dairy industry's recent commitment to 
ensuring students have access to the healthiest dairy options 
consistent with the DGAs.
  Mr. Chairman, we should be committed to ensuring that students have 
access to the healthiest dairy options in accordance with science-based 
guidelines, but H.R. 1147 contradicts this commitment by interfering 
with the independent process that aligns child nutrition standards with 
the latest science.
  I am also disappointed that we are considering a bill that does 
nothing to meaningfully address child nutrition or hunger. This is in 
stark contrast to the comprehensive science-based reauthorization of 
the Federal child nutrition programs that committee Democrats advanced 
last Congress to, among other things, strengthen evidence-based 
nutrition standards for school meals beyond just milk.
  The bottom line is that Congress should not inject politics into 
child nutrition standards at the expense of nutritious meals that our 
children need to grow healthy.
  Mr. Chair, I, therefore, urge my colleagues to oppose H.R. 1147, and 
I yield back the balance of my time.
  Ms. FOXX. Mr. Chair, I yield myself the balance of my time.
  Mr. Chair, I have seen a lot of bills mischaracterized on this floor 
in my time here, but I think this is one of the worst.
  Passing the Whole Milk for Healthy Kids Act would be a critical step 
toward empowering parents and securing our children's well-being. Whole 
milk isn't just a beverage; it is a vital source of nutrients essential 
for children's growth. Denying access to its calcium, vitamin D, and 
protein threatens to inhibit their development.
  To the anti-milk advocates, I have one thing to ask of you: What do 
you have against milk?
  If you scrutinize them closely, you might be convinced that Democrats 
are waging a war on dairy. The Democrat administration has presided 
over a 15 percent milk price increase in the grocery store.
  A Democrat proposal, the Green New Deal, calls for the elimination of 
cows for their so-called greenhouse gas emissions.
  A Democrat policy is slashing the milk available to newborns through 
the Special Supplemental Nutrition Program for women, infants, and 
children by four quarts.
  A Democrat interest group, PETA, has called milk a so-called white 
supremacist symbol. How patently absurd.
  Let's end the war on milk and pass the bill.
  Together, we can ensure that our children have access to the 
nutritional foundation they need to thrive and become the healthy, 
vibrant leaders of tomorrow.
  Mr. Chair, I urge all my colleagues to vote ``yes'' on this bill, and 
I yield back the balance of my time.
  The Acting CHAIR (Mr. Moolenaar). All time for general debate has 
expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  The amendment in the nature of a substitute recommended by the 
Committee on Education and the Workforce, printed in the bill, shall be 
considered as adopted. The bill, as amended, shall be considered as an 
original bill for purpose of further amendment under the 5-minute rule 
and shall be considered as read.

                               H.R. 1147

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Whole Milk for Healthy Kids 
     Act of 2023''.

     SEC. 2. WHOLE MILK PERMISSIBLE.

       Section 9(a)(2) of the Richard B. Russell National School 
     Lunch Act (42 U.S.C. 1758(a)(2)) is amended--
       (1) by amending subparagraph (A) to read as follows:
       ``(A) In general.--Lunches served by schools participating 
     in the school lunch program under this Act--
       ``(i) shall offer students a variety of fluid milk;
       ``(ii) may offer students flavored and unflavored whole, 
     reduced-fat, low-fat and fat-free fluid milk and lactose-free 
     fluid milk; and
       ``(iii) shall provide a substitute for fluid milk for 
     students whose disability restricts their diet, on receipt of 
     a written statement from a licensed physician that identifies 
     the disability that restricts the student's diet and that 
     specifies the substitute for fluid milk.''; and
       (2) by adding at the end the following:
       ``(D) Saturated fat.--Milk fat included in any fluid milk 
     provided under subparagraph (A) shall not be considered 
     saturated fat for purposes of measuring compliance with the 
     allowable average saturated fat content of a meal under 
     section 210.10 of title 7, Code of Federal Regulations (or 
     successor regulations).''.

  The Acting CHAIR. No further amendment to the bill, as amended, shall 
be in order except those printed

[[Page H6904]]

in House Report 118-308. Each such further amendment may be offered 
only in the order printed in the report, by a Member designated in the 
report, shall be considered as read, shall be debatable for the time 
specified in the report equally divided and controlled by the proponent 
and an opponent, shall not be subject to amendment, and shall not be 
subject to a demand for division of the question.


                  Amendment No. 1 Offered by Mrs. Luna

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in House Report 118-308.
  Mrs. LUNA. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 3, line 6, insert ``organic or non-organic'' before 
     ``whole milk''.
       Page 3, line 17, insert ``organic or non-organic'' after 
     ``unflavored''.

  The Acting CHAIR. Pursuant to House Resolution 922, the gentlewoman 
from Florida (Mrs. Luna) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Florida.
  Mrs. LUNA. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I am happy to be here today to draw attention to something 
that is important to our children's health, parental choice, and the 
many farmers across our Nation.
  For years, America's school lunches have lagged behind other 
countries' programs in terms of health and nutrition. European and 
Asian students often have access to fresher and healthier meals than 
students in the United States.
  This problem has been worsened by the Federal Government's 
overregulating what schools are allowed to serve our children, in 
particular, preventing schools from offering whole milk to students. 
The Whole Milk for Healthy Kids Act would allow students who 
participate in the National School Lunch program to serve their 
students whole milk, but my amendment goes a step further by ensuring 
schools may also offer their students to use organic milk as well.
  The food we give our children and where it comes from is incredibly 
important. My amendment empowers parents and the ability that they have 
to decide what is healthiest for their children.
  As many parents know, high-quality nutrition is closely related to 
better academic and behavioral outcomes in children. Allowing parents 
to choose organic milk is a step in the right direction.
  Studies have also found that organic milk contains more omega-3 fatty 
acids and antioxidants than nonorganic milk, which helps with brain 
function, heart health, and fighting disease, respectively.
  Of course, it is vital that we also know where this milk comes from, 
organic or not. Far too often, Congress listens to special interest and 
big ag lobbyists and ignores the countless family farmers who are the 
backbone of our country.
  Our organic family farmers and the countless unseen families who feed 
our Nation are invaluable to our country. These farmers work many long, 
thankless hours to bring us nutrient-rich, high-quality milk.
  Mr. Chair, on behalf of my family and I, I thank them. I am thankful 
to be able to be here today to continue to empower and fight for our 
children, and I thank those that are helping to bring organic milk to 
our country.
  Mr. Chair, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chair, I claim the time in opposition to 
the amendment.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chair, nothing in this bill prevents schools from offering 
organic milk under current law. As the main barrier for schools 
offering organic milk is cost, nothing in this amendment provides 
additional funding or support to help schools offer organic milk, if 
they prefer.
  Fundamentally, this amendment does not fix the flaws of the 
underlying bill. It invites Congress to legislate on specific foods 
served in school meals at the expense of evidence-based recommendations 
from experts.
  According to those experts, milk is the top source of saturated fat 
in American diets. Whole and 2 percent milk can raise bad cholesterol, 
the cause of heart disease, and contains more fat, saturated fat, 
cholesterol, and calories than 1 percent and fat-free milk.
  This has led to organizations such as the CDC to recommend nutrient-
rich 1 percent or fat-free milk instead of 2 percent or whole milk.
  For children aged 2 and up, the inclusion of whole milk in the bill 
disregards the healthy dietary patterns backed by the dietary 
guidelines for Americans, the scientific, evidence-based comprehensive 
set of nutrition recommendations.
  Over 60 organizations have expressed concerns over attempts to bring 
whole milk back into school meal programs. Regardless of whether milk 
is organic, inclusion of whole milk in this bill is detrimental to 
American youths' health and well-being, and the amendment fails to 
alter that fact.
  Mr. Chair, I oppose the underlying bill and oppose the amendment, and 
I reserve the balance of my time.
  Mrs. LUNA. Mr. Chair, may I inquire as to the time remaining.
  The Acting CHAIR. The gentlewoman from Florida has 3 minutes 
remaining.
  Mrs. LUNA. Mr. Chair, I yield myself the balance of my time.
  Mr. Chair, I hear a lot from my colleagues across the aisle on the 
experts, but I also wonder how many people in Congress have had to use 
National School Lunch programs; and, frankly, I have been one of those 
people.
  When I hear people speak in opposition to this saying that it is 
going to hurt minorities, it is going to hurt those of us who have 
actually had to use the program, I find it ironic. Frankly, I think 
that we need more people in office that have had rougher upbringings to 
bring a different lens and perspective.
  To hear that whole milk is bad for children, to hear the arguments 
against organic milk, and to hear the arguments that are coming from 
across the aisle, I don't know that it represents, necessarily, the 
best interests of the American people other than political spite.
  Mr. Chair, I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chair, I yield back the balance of my 
time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Florida (Mrs. Luna).
  The amendment was agreed to.


                  Amendment No. 2 Offered by Mr. Mills

  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in House Report 118-308.
  Mr. MILLS. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, line 10, strike the period and quotation mark at 
     the end and insert the following:
       ``(E) Prohibition on certain purchases.--The Secretary 
     shall prohibit schools participating in the school lunch 
     program under this Act from purchasing or offering milk 
     produced by China state-owned enterprises.''.

  The Acting CHAIR. Pursuant to House Resolution 922, the gentleman 
from Florida (Mr. Mills) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Florida.
  Mr. MILLS. Mr. Chair, this amendment prohibits schools from 
participating in the school lunch program under the act from purchasing 
or offering milk produced by Chinese state-owned enterprises that may 
be operating here within the United States or elsewhere.
  As many of us know, in 2008, the melamine scandal exposed systemic 
corruption and disregard for the safety standards within China's own 
dairy industry. This scandal resulted in the death of six infants and 
sickened thousands more, highlighting the devastating consequences of 
lax regulations and unethical practices.
  The evidence is clear: These enterprises pose a serious threat to our 
consumers' health, our economic security, and our national interests. 
We can't allow CCP enterprises to export their dangerous practices to 
our school lunches.

[[Page H6905]]

  This is an issue of maintaining American control of critical supply 
chains. Chinese state-owned enterprises have no business being in our 
schools.
  Florida is one of the largest cattle producers in America, and there 
is no way I will allow producers in my State to be compromised by the 
CCP or the PRC. If we fail to act, we risk losing our family farms and 
jeopardizing the livelihoods of thousands of Americans.
  This is not about trade isolationism; it is about protecting our 
children in schools from unsafe products, ensuring fair competition for 
American producers, and safeguarding our national security.
  The potential consequences of inaction are simply too great for me to 
ignore. The quality and safety of food that we provide to our children 
is paramount, and we cannot compromise on these standards. We must be 
vigilant about our source and production practices of the products that 
are present in our educational institutions and safeguard them from 
adversaries that do not share our same interests.

                              {time}  1500

  By prohibiting schools from purchasing or offering milk produced by 
China's state-owned enterprises operating in the United States and 
elsewhere, we aim to send a clear message about our commitment to 
health and the safety of our children.
  Last year, over 30 million schoolchildren relied on school lunches 
for their nutrition. We have seen how the CCP has approached other 
industries, and we cannot allow such an important sector to become 
vulnerable in a time of crisis.
  Therefore, I urge you to join me in preventing the CCP-supported 
entities from infiltrating school lunches and a key American supply 
chain. This is a necessary step to protect the health and well-being of 
our citizens, safeguard our economy, and defend our national interests. 
Let us send a clear message that we will prioritize the safety and 
security of our Nation's schoolchildren above all else.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself such time as I 
may consume.
  Mr. Chairman, nobody disputes that the dairy industry is a crucial 
part of domestic supply chains and provides an important economic 
benefit to the tune of over $753 billion to the U.S. economy.
  In 2022, just five States--California, Wisconsin, Idaho, Texas, and 
New York--collectively produced more than 50 percent of the U.S. annual 
milk supply.
  School breakfast and school lunch programs are already required to 
purchase domestic agricultural commodities and food products. Although 
exemptions exist, milk is produced in sufficient quantities in the U.S. 
and at competitive prices to severely restrict the ability of any 
school to purchase foreign-produced milk.
  To this end, the amendment does not fix the flaws in the underlying 
bill and makes no meaningful improvements to buy-American policies.
  We can make sure that Chinese milk is not breaching our supply chain 
with continued monitoring and enforcement of present law. A recent 
report found that Chinese seafood has been served in schools, 
highlighting the need for additional diligence in enforcing present 
law.
  I do not support the underlying legislation, and I oppose the 
amendment as being unnecessary.
  Mr. Chairman, I reserve the balance of my time.
  Mr. MILLS. Mr. Chairman, it is interesting, and I understand that 
facts, for whatever reason, seem to sink in a lot slower on the left 
than they do in America's party, so I will say this once more.
  In 2008, the melamine scandal exposed systemic corruption and 
disregard for our complete safety in milk and other dairy products 
produced by China, so it is interesting that the gentleman says they 
are not actually weakening anything when they had infants and children 
by the thousands who died or were sickened by their actual production 
capacity capabilities or incapabilities.
  Again, facts are a very finicky thing. They oftentimes slowly leak in 
on the left, but you can't dispute that China's production of dairy has 
been less safe and less put under the regulations of rigorous streams 
than they do in American production with the FDA.
  Mr. Chairman, I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself the balance of my 
time to close.
  I just reiterate that present law requires domestic purchase, and so 
this is unnecessary. If Chinese milk has gotten into the supply, we 
need to monitor that. It violates present law. To suggest that we are 
ignoring science, the underlying bill ignores science. That is the 
purpose of the underlying bill.
  I hope that we reject this amendment and reject the underlying bill.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Florida (Mr. Mills).
  The amendment was agreed to.


                 Amendment No. 3 Offered by Mr. Tiffany

  The Acting CHAIR. It is now in order to consider amendment No. 3 
printed in House Report 118-308.
  Mr. TIFFANY. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, line 10, strike the period and quotation mark at 
     the end and insert the following:
       ``(E) Limitation on authority.--The Secretary may not 
     prohibit any school participating in the school lunch program 
     under this Act from offering students the milk described in 
     subparagraph (A)(ii).''.

  The Acting CHAIR. Pursuant to House Resolution 922, the gentleman 
from Wisconsin (Mr. Tiffany) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Wisconsin.
  Mr. TIFFANY. Mr. Chair, first of all, merry Christmas.
  My bipartisan amendment prevents the USDA from issuing any rule that 
bans any of the milk covered in this bill, including chocolate milk. 
This would ensure that all types and flavors of milk are available to 
schoolchildren and not subject to bureaucratic rulemaking.
  Some may ask why are we focusing on this issue. Unfortunately, it is 
because the USDA has set its sights on getting rid of chocolate milk in 
schools. It is now up to us to act.
  This summer, it was reported that the Department of Agriculture is 
considering a ban on chocolate milk in elementary and middle schools. 
USDA issued a proposed rule that would set a new nutrition standard for 
school meals. These new standards could limit the availability of 
flavored milk, like chocolate and strawberry, in high schools while 
children in elementary and middle schools would have no access at all.
  For those of you with young children or grandchildren, go and ask 
them what they think about USDA's new rule. I think I can speak for 
most folks when saying that when I was young, chocolate milk was 
usually the highlight of having lunch at school, but this new rule 
would mean that roughly 30 million students who participate in the 
USDA's school meal programs would no longer be able to have chocolate 
milk, or any flavored milk for that matter.
  According to the Journal of the American Dietetic Association, 
removing flavored milk from schools resulted in a 62 to 63 percent 
reduction in milk consumption by kids in kindergarten through fifth 
grade, including a 50 percent reduction in sixth through eighth grades.
  Milk is full of rich nutrients that support bone growth and 
development, and millions of children enjoy drinking it. We should not 
allow rules that would limit our children's access to delicious and 
nutritious products like milk and its varieties covered in this great 
bill.
  Mr. Chair, I say to the USDA, come and take it.
  I urge my colleagues to vote ``yes'' on this bipartisan amendment, 
and I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman is recognized for 5 minutes.

[[Page H6906]]

  

  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself such time as I 
may consume.
  Mr. Chairman, current law requires that school meals and beverages 
offered under the school meal programs be consistent with the dietary 
guidelines for Americans, the DGAs, which are drafted by an advisory 
committee of experts. These are evidence-based recommendations set to 
provide nutritional guidance to ensure children receive the most 
nutritious meals possible.
  This amendment would effectively undermine the unbiased evidence-
based guidelines of DGAs by prohibiting USDA from doing its work and 
replacing that process with a process where evidence will be presented 
to politicians and we get to decide the science. It is critical that 
actual scientists and experts make the recommendations and guide the 
process in determining options in schools and that regulations are 
updated to align with current DGAs.
  Experts, not Members of Congress, should be the ones determining the 
nutrition standards to ensure that our children get the healthiest 
meals possible.
  This amendment, like the underlying bill, reinforces the precedent 
for Congress to legislate on specific foods, at the behest of one 
industry or another, that would be served in schools.
  There is a reason that the school lunch program does not contain 
specific nutrition standards for foods and beverages, and that is to 
ensure that nutrition standards can adapt to the latest science and 
expert recommendations. Both this amendment and the underlying bill 
upset this policy and open the program to politicization in favor of 
district interests and single-food lobbies over the health and well-
being of our children.
  Dozens of organizations, including the Academy of Nutrition & 
Dietetics, the American Academy of Pediatrics, American Heart 
Association, and a lot of others have urged Congress not to interfere 
with that process and to respect the science-based process.
  For these reasons, I urge a ``no'' vote on the amendment, and I 
reserve the balance of my time.
  Mr. TIFFANY. Mr. Chairman, oh, those experts, those experts have done 
us so well in the United States of America. Why are we $33 trillion in 
debt? Why do we have childhood obesity that is off the charts at this 
     point?
  Oh, those experts serve us so well, those experts that told us that 
butter is not good for us. Remember that a number of decades ago? 
Growing up on a dairy farm in western Wisconsin, I couldn't believe the 
experts were telling us that butter is not good for us. Well, all of a 
sudden, they are changing their tune on that.
  They told us that we shouldn't possibly drink whole milk. They are 
beginning to turn on that also and saying maybe that is good for our 
children.
  Yeah, the experts, they have done us so well.
  The reason I bring this before the House of Representatives is I did 
listen to experts, those people who run the school lunch programs.
  I will never forget a day about a decade ago when I stopped at a 
local gas station in northern Wisconsin, and a school lunch director 
came up to me--I didn't even know her--she said, at that time, Senator 
Tiffany, would you tell the Federal Government to get out of our school 
lunch program? We are throwing away so much food.
  Remember Michelle Obama's school lunch dictates that she put in 
place? The school lunch director said, Don't do that to us. I had 
multiple school lunch directors across northern Wisconsin, in my 
district, asking the Federal Government to stay out of their school 
lunch programs: We know what we are doing, we are trained in what we 
are doing, and we see what happens in our schools.
  Mr. Chair, I urge my colleagues to vote in favor of this amendment, 
and I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself the balance of my 
time to close.
  I include in the Record a letter signed by dozens of organizations 
opposing this changing the science and the process.
                                                   March 20, 2023.
     Hon. Patty Murray,
     Chair, Committee on Appropriations,
     U.S. Senate, Washington, DC.
     Hon. Martin Heinrich,
     Chair, Committee on Appropriations, Subcommittee on 
         Agriculture, Rural Development, Food and Drug 
         Administration, and Related Agencies,
     U.S. Senate, Washington, DC.
     Hon. Susan Collins,
     Ranking, Committee on Appropriations,
     U.S. Senate, Washington, DC.
     Hon. John Hoeven,
     Ranking, Committee on Appropriations, Subcommittee on 
         Agriculture, Rural Development, Food and Drug 
         Administration, and Related Agencies,
     U.S. Senate, Washington, DC.
     Hon. Kay Granger,
     Chair, Committee on Appropriations,
     House of Representatives, Washington, DC.
     Hon. Andy Harris,
     Chair, Committee on Appropriations, Subcommittee on 
         Agriculture, Rural Development, Food and Drug 
         Administration, and Related Agencies,
     House of Representatives, Washington, DC.
     Hon. Rosa DeLauro,
     Ranking, Committee on Appropriations,
     House of Representatives, Washington, DC.
     Hon. Sanford Bishop Jr.,
     Ranking, Committee on Appropriations, Subcommittee on 
         Agriculture, Rural Development, Food and Drug 
         Administration, and Related Agencies,
     House of Representatives, Washington, DC.
       Dear Chairs Murray, Heinrich, Granger, and Harris, and 
     Ranking Members Collins, Hoeven, DeLauro, and Bishop: As you 
     craft the fiscal year (FY) 2024 Agriculture, Rural 
     Development, Food and Drug Administration, and Related 
     Agencies spending bill, the undersigned organizations urge 
     you to oppose any policy riders blocking implementation of 
     stronger nutrition standards in the National School Lunch and 
     School Breakfast Programs.
       We strongly support the U.S. Department of Agriculture 
     (USDA)'s proposed rule to strengthen nutrition standards 
     consistent with the 2020 Dietary Guidelines for Americans 
     (``Child Nutrition Programs: Revisions to Meal Patterns 
     Consistent With the 2020 Dietary Guidelines for Americans''). 
     We must preserve and build on the progress schools and the 
     food industry have made over the past decade to meet science-
     based nutrition standards. These improvements are an amazing 
     success story and one of the most important public health 
     achievements in a generation. For children in poverty, the 
     risk of obesity declined substantially each year after 
     implementation of stronger nutrition standards in 2012 such 
     that obesity prevalence would have been 47 percent higher in 
     2018 if the nutrition standards had not been updated. 
     Additionally, a 2021 study found that school meals are the 
     single most healthy source of nutrition for children--more 
     nutritious than grocery stores, restaurants, worksites, and 
     others. Research shows that children like the healthier 
     school meals and while food waste remains a problem in this 
     country, the amount of food wasted in schools has not changed 
     since the standards were updated in 2012, according to the 
     USDA's largest and nationally representative study of school 
     meals. For many children participating in the program, school 
     breakfast and lunch are the only meals they receive that day.
       Despite the overwhelming success of the nutrition 
     standards, improvements are still needed to align school 
     meals with the Dietary Guidelines, which the current proposed 
     rule aims to do. The USDA issued a proposal that is 
     pragmatic, flexible, gradual, and most important--achievable. 
     The rule proposes, for the first time, to reduce added 
     sugars, with product-based limits for the top sources of 
     added sugars beginning School Year 2025-2026, and to phase 
     into a limit of added sugars averaged over the week beginning 
     School Year 2027-2028. These standards are critical: among 
     children, excessive intake of added sugars has been 
     associated with poor diet quality, cavities, and increased 
     risk of cardiovascular disease, yet more than 92 percent of 
     schools exceed the Dietary Guidelines limit for added sugars 
     for breakfast and 69 percent exceed it for lunch.
       Further, sodium reduction is paramount to protect 
     children's health: nine out of ten children consume too much 
     sodium, putting them at risk of hypertension and 
     cardiovascular disease into adulthood. The USDA proposes new, 
     gradual 10-percent sodium reduction levels every two school 
     years for breakfast (through School Year 2027-2028) and lunch 
     (through School Year 2029-2030). The USDA also maintains at 
     least 80 percent of the weekly grains offered are whole 
     grain-rich.
       The rule aims to align dietary patterns for sodium and 
     whole grains with the recommendations of the Dietary 
     Guidelines, but the USDA recognized that a gradual, 
     incremental approach to meeting those recommendations is more 
     feasible for schools and the food industry to implement. For 
     instance, children up to age 8 would still consume close to 
     their day's worth of sodium (83 percent) from just breakfast 
     and lunch combined. Sodium and whole grain-rich standards 
     have been the subject of many riders over the past decade, 
     causing confusion and stymying industry innovation and 
     improvements to children's health. The USDA has listened to 
     Congress; the proposals in this rule on sodium and whole 
     grains are within the spirit of those previous riders.
       This gradual, incremental approach was crafted by the USDA 
     to be feasible for schools and the food industry. And these 
     standards are feasible. The largest food companies have many 
     K-12 products that meet

[[Page H6907]]

     the USDA's proposed added sugars, sodium, and whole grain-
     rich standards. Further, schools have been able to meet, and 
     in some cases, exceed the current nutrition standards during 
     the pandemic. In the first-of-its-kind study, a nationally 
     representative study of elementary schools found that meals 
     were meeting existing nutrition standards in 2022, and for 
     sodium, average sodium decreased and the vast majority of 
     schools were close to or already meeting future sodium-
     reduction levels on par with this rule. There are plenty of 
     examples where schools have reduced sodium beyond the USDA's 
     requirements or provided more whole grains and still been 
     able to serve healthy, delicious, and culturally-relevant 
     foods to their students.
       Opponents of the rule claim that the meal nutrition 
     standards cannot be strengthened due to labor shortages, 
     supply chain disruptions, and other issues facing school food 
     service programs. These are real challenges but require 
     different solutions than stalling progress for healthier 
     school meals. Over the past decade, the USDA and Congress 
     have learned that schools need the additional assistance to 
     meet stronger standards and they have also recognized current 
     pandemic-related constraints, and therefore have committed 
     millions of dollars to helping schools provide healthier 
     meals while weathering these challenges. In September 2022, 
     the USDA launched its $100 million Healthy Meals Incentive 
     Initiative with the stated goal of improving the nutritional 
     quality of school meals. Of that, $30 million is available 
     for small and rural schools and $50 million will go toward 
     working with food manufacturers on innovative solutions to 
     increase the availability of nutritious school foods. 
     Congress has also increased technical assistance funding each 
     year for the past three fiscal years (FY) ($1 million in FY 
     2021; $2 million in FY 2022 and 2023), with $1 million of 
     that funding being directed to assist with sodium 
     reduction efforts in FY 2022-2023. These investments will 
     be transformational, but the impact of inflation on school 
     nutrition programs means schools still struggle to make 
     ends meet. Therefore, increased meal reimbursement rates 
     will be critical to the future success of school meals 
     programs.
       Beyond riders blocking implementation of the new proposed 
     standards, there are other ongoing attempts to undermine 
     evidence-based nutrition standards. For instance, the 
     proposed rule allows for potatoes to be served in breakfast 
     up to four out of the five school days, if a school chose to 
     serve vegetables in place of fruit in breakfast. Therefore 
     the existing breakfast potato rider--which allows schools to 
     serve potatoes before other vegetables at breakfast--does not 
     need to be included in the spending bill. Further, we are 
     similarly concerned about attempts to bring whole milk into 
     the school meals program. The Dietary Guidelines is explicit 
     in its recommendation that everyone 2 years and older should 
     limit their intake of saturated fat and choose fat-free or 1-
     percent low-fat milk instead of 2-percent reduced-fat or 
     whole milk. The proposed rule reiterates this, while 
     providing flexibilities for flavored 1-percent milk. Yet 
     continued industry attempts to circumvent the science 
     persist.
       Finally, there are evidence-based strategies to increase 
     school meal consumption that do not involve weakening 
     nutrition standards, for instance, enabling students to have 
     sufficient time to eat (at least 20 minutes of seat time) 
     with longer lunch periods, having recess before lunch, 
     serving lunch at an appropriate time of day, presenting food 
     in an appetizing and easily eaten way, making the cafeteria 
     inviting, and limiting competitive foods (snacks and 
     beverages sold in vending machines and a la carte) during the 
     school day. While some of these strategies cannot be 
     addressed at the federal level, we encourage you to support 
     these efforts.
       In conclusion we urge you to oppose any riders that block 
     or weaken stronger nutrition standards for children.
           Sincerely,
       Academy of Nutrition & Dietetics; Advocates for Better 
     Children's Diets; Alianza Nacional de Campesinas, Inc.; 
     American Academy of Pediatrics; American Cancer Society 
     Cancer Action Network; American Heart Association; American 
     Institute for Cancer Research; American Public Health 
     Association; Ann and Robert H. Lurie Children's Hospital of 
     Chicago; Association of State Public Health Nutritionists; 
     Balanced; California Association of Food Banks; Center for 
     Digital Democracy; Center for Science in the Public Interest; 
     Chef Ann Foundation; Chilis on Wheels; Coalition for Healthy 
     School Food; Colorado Children's Campaign; Community Food 
     Advocates; Council on Black Health, Inc.; Cultiva la Salud; 
     DC Greens.
       Dolores Huerta Foundation; Environmental Working Group; 
     FARE (Food Allergy Research and Education); Farm to Table-New 
     Mexico; Food Research & Action Center (FRAC); FoodCorps; 
     Friends of the Earth; From Now On Fund; Healthy Food America; 
     Healthy School Food Maryland; Healthy Schools Campaign; Hope 
     Community Services Youngstown; Illinois Public Health 
     Institute; Independent Restaurant Coalition; Interfaith 
     Center on Corporate Responsibility (ICCR); Johns Hopkins 
     Center for a Livable Future; Latino Farmers of the Southeast; 
     National Association of Pediatric Nurse Practitioners; 
     National Association of School Nurses; National Education 
     Association; National Farm to School Network; National League 
     for Nursing; National PTA; National WIC Association.
       Nebraska Appleseed; North American Society for Pediatric 
     Gastroenterology, Hepatology and Nutrition; Northeast Ohio 
     Black Health Coalition; Northwest Coalition for Responsible 
     Investment; Office of Kat Taylor; Oklahoma Black Historical 
     Research Project, Inc.; Public Health Advocates; Public 
     Health Institute; Redstone Global Center for Prevention and 
     Wellness; Roots of Change; Rural Advancement Fund of the 
     National Sharecroppers Fund, Inc; Rural Coalition; Seventh 
     Generation Interfaith Coalition; Sisters of Charity of Saint 
     Elizabeth; Sisters of St. Francis of Philadelphia; Society 
     for Nutrition Education and Behavior; Society of Behavioral 
     Medicine; Springfield Food Policy Council; Stanford Medicine 
     Children's Health; The Laurie M. TIsch Center for Food, 
     Education and Policy, Teachers College, Columbia University; 
     The Praxis Project; Trust for America's Health; UnidosUS; 
     Union of Concerned Scientists; Urban School Food Alliance.

  Mr. SCOTT of Virginia. Mr. Chair, this amendment would make it 
impossible to update the science based on new evidence. We should be 
basing our decisions on science, not what somebody tells us at the gas 
station. I hope that we defeat the amendment and the underlying bill, 
and I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Wisconsin (Mr. Tiffany).
  The amendment was agreed to.
  The Acting CHAIR. There being no further amendments, under the rule, 
the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Kiley) having assumed the chair, Mr. Moolenaar, Acting Chair of the 
Committee of the Whole House on the state of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 1147) to 
amend the Richard B. Russell National School Lunch Act to allow schools 
that participate in the school lunch program under such Act to serve 
whole milk, and, pursuant to House Resolution 922, he reported the bill 
back to the House with sundry further amendments adopted in the 
Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment reported from the 
Committee of the Whole? If not, the Chair will put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. FOXX. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________