A Heart Letter reader asked about a short piece in our December 2021 issue, which noted that full-fat dairy products may be less harmful to heart health than experts have assumed. How does that square with advice from nutritionists and the American Heart Association, who have long recommended low-fat or fat-free dairy products? “I’d appreciate a ‘thumbs up’ or ‘thumbs down’ on dairy fat,” he wrote.
As is true for most dietary advice, the answer isn’t a simple yes or no; rather, it depends on a host of factors. These include the amount and source of the dairy fat (which could be butter, cheese, or Greek yogurt, for instance) and perhaps most importantly, what you would eat instead of dairy fat, along with the overall quality of your entire diet. The latest research suggests that either full-fat or low-fat dairy can be included in heart-healthy dietary patterns (see “Dairy and heart disease: What’s the link?”)
| Dairy and heart disease: What’s the link?A review in the September 2021 issue of Advances in Nutrition looked at the links between dairy product consumption and the risk of high blood pressure, stroke, and coronary artery disease. Researchers combined findings from 55 prospective cohort studies — the type in which groups of people are recruited and then followed over time.The researchers found moderate-quality evidence linking low fat dairy intake to a lower risk of high blood pressure. Both low- and high-fat dairy were tied to a lower risk of stroke, but the evidence for that connection was weak. As for heart disease, the evidence was mixed. On the whole, dairy products appeared to neither raise nor lower a person’s odds of cardiovascular problems. |
Dairy decisions
“I think that full-fat dairy in moderation can be part of a healthy diet,” says Dr. JoAnn Manson, professor of medicine at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital. Milk, yogurt, and cheese all count toward the three daily servings of dairy products that federal guidelines recommend. Calcium, one of the key nutrients in dairy products, is important for controlling blood pressure as well as maintaining healthy bones. Note that butter and cream aren’t classified as dairy products in the federal dietary guidelines, even though they’re made from milk, because they contain little or no calcium. However, soy milk and soy yogurt are classified with dairy products because they’re fortified with calcium as well as vitamin D. (The latter is also added to traditional dairy products.)
The low-fat rationale
What’s the reason behind the low-fat or fat-free dairy advice? Cow’s milk and related products contain saturated fat, and too much saturated fat in the diet can boost blood levels of LDL (bad) cholesterol and, in turn, heart disease risk.
But there’s no need to completely avoid saturated fat. The average recommended limit for the general population is around 18 grams per day. People with heart disease should aim for about half that limit, or about 9 to 10 grams per day. Because one serving of full-fat dairy has about 5 grams of saturated fat, most people could certainly consider using whole milk or 2% milk on their morning cereal, if they choose, or snacking on full-fat yogurt — if the rest of their diet has little saturated fat, says Dr. Manson.
Healthier choices
Low-fat dairy products have fewer calories as well as slightly more protein and calcium compared with their full-fat counterparts (see “Dairy decisions: Calories and beyond”). More important, however, is what you eat when you cut back on calories from saturated fat. “Often, people replace those lost calories with sugar and refined carbohydrates, and that does not lead to a lower risk of heart disease,” Dr. Manson explains. What may help is replacing dairy and other sources of saturated fat with foods rich in unsaturated fat, such as nuts, avocados, or olive oil.
If you like dairy, enjoy it with other healthy foods. Plain, full-fat yogurt topped with fresh fruit is better than nonfat or low-fat yogurt that comes with added fruit, since that addition comes in the form of sugary jam. Cheese, on the other hand, is often eaten with refined grains and meat — think pizza, burgers, macaroni and cheese, and Mexican food. Instead, have a small piece of cheese with whole-grain crackers or fruit, or sprinkle cheese on a salad.
| Dairy decisions: Calories and beyondDairy products are good sources of protein as well as calcium. Compared with nonfat or low-fat products, full-fat dairy products tend to be tastier and more filling. But because they contain more calories and saturated fat, it’s best to limit full-fat dairy products to one serving a day. The table below compares different dairy choices. | ||||||
| PRODUCT | SERVING SIZE | CALORIES | SATURATED FAT (GRAMS) | PROTEIN (GRAMS) | CALCIUM (MILLIGRAMS) | |
| Whole milk (3.25% fat) | 1 cup | 149 | 4.6 | 8.1 | 306 | |
| Reduced fat milk (2%) | 1 cup | 122 | 2.7 | 8.2 | 309 | |
| Nonfat or skim milk (0% fat) (unsweetened) | 1 cup | 83 | 0.1 | 8.4 | 325 | |
| Whole-milk yogurt, plain | 1 cup | 149 | 5.1 | 8.5 | 296 | |
| Nonfat yogurt, plain | 1 cup | 137 | 0.3 | 14 | 448 | |
| Whole-milk Greek yogurt | 1 cup | 200 | 4.7 | 21 | 200 | |
| Nonfat Greek yogurt, plain | 1 cup | 134 | 0.3 | 23 | 250 | |
| Cheddar cheese | 1 ounce | 115 | 5.4 | 6.8 | 199 | |
| Part-skim mozzarella cheese | 1 ounce | 72 | 2.9 | 6.9 | 222 | |
| Source: USDA FoodData Central, CalorieKing. |
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)
And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)
“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)
Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)
The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)
And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)
Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)
The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)
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