Dairy Products and Heart Disease

Written by Dr. Steve Chaney on . Posted in Dairy and Heart Disease

Will Eating Cheese Help You Live Longer?

Author: Dr. Stephen Chaney

 

dairy products and heart diseaseA recent study is generating lots of headlines. Here are some examples:

  • Eating Dairy Foods Can Help Reduce Heart Disease Risk.
  • Fermented Dairy-Products May Protect Against Heart Attack.
  • Full-Fat Dairy May Actually Benefit Heart Health.
  • Eating Cheese Might Help You Live Longer.
  • Eating Cheese and Butter Every Day Linked To Living Longer.

My favorite headlines were the ones about cheese and longevity. For example, one headline read: “New Study Finds People That Eat Cheese Live Longer.” The article opened by saying “Sprinkle on another handful of mozzarella on your pizza, add an extra slice of American cheese on your burger, or grab a bite of sharp cheddar with your crackers. A new study published in The Lancet claims that eating cheese reduces your risk of stroke and cardiovascular disease. Now that’s something we like to hear.”

A lot of people must like to hear good news about cheese. The headlines about cheese making you live longer outnumbered all the other headlines by about 3 to 1.

In summary, the claims ranged from dairy foods in general to milk & fermented dairy foods, full-fat dairy foods, cheese, and cheese & butter. Let’s look at the study behind the claims to see which of these claims about dairy products and heart disease are true and which are wishful thinking.

 

How Was The Study Designed?

dairy products and heart disease relationshipThe study behind the headlines (M. Dehghan et al. The Lancet, 392: 2288-2297, 2018 ) was a very ambitious study called PURE (Prospective Urban Rural Epidemiology study). It was a large multinational study of 136,384 individuals aged 35-70 from 21 countries in five continents.

At the beginning of the study participants filled out a country-specific food frequency questionnaire. The data from this survey were broken down into total dairy foods, milk, yogurt, cheese, and butter. The data were also subdivided into low-fat and full-fat dairy foods.

The participants were followed for an average of 9.1 years. The outcomes measured at the end of the study were overall mortality, cardiovascular mortality, cardiovascular disease, heart attack, stroke and heart failure. The way these outcomes were measured was also country specific because the way these data are collected varies from country to country. [Note: There were some other outcomes measured, but for the sake of simplicity I have not included them in the discussion. Their omission does not change the discussion.]

Finally, in case you were wondering, this research was not funded by money from the dairy industry.

 

Dairy Products and Heart Disease Risk?

dairy products and heart disease milkThe results were interesting:

  • Higher intake of total dairy foods (>2 servings/day compared with no intake) was associated with a lower risk of overall mortality (17% less), cardiovascular mortality (23% less), cardiovascular disease (22% less) and stroke (34% less). No association of dairy consumption with heart attack or heart failure was seen.
  • Higher intake of milk (>1 serving per day compared with <0.5 servings/day) was associated with a lower risk cardiovascular disease (18% less).
  • Higher intake of yogurt (>1 serving/day compared with <0.5 servings/day) was associated with a lower risk of overall mortality (17% less) and cardiovascular disease (10% less).
  • No significant effect of cheese was observed for any of the outcomes measured.
  • Butter intake was low and was not associated with any of the outcomes measured.

The authors concluded: “We observed that higher dairy consumption was associated with lower risks of mortality and cardiovascular disease, particularly stroke. Our study suggests that consumption of dairy products should not be discouraged and perhaps should even be encouraged in low-income and middle-income countries where dairy consumption is less.”

 

Will Eating Cheese Help You Live Longer?

  • dairy products and heart disease cheeseThe claims you have been seeing about consumption of dairy foods in general, milk, and yoghurt reducing heart attack risk are supported by this study and several other recent studies.
  • I hate to disappoint you, but the claims about cheese and butter consumption reducing cardiovascular disease and extending lifespan are clearly wishful thinking. They are not supported by this study.

The discussion of full-fat versus low-fat dairy products is more complicated. You are undoubtedly aware that most current dietary guidelines recommend avoiding full-fat dairy foods in favor of low-fat alternatives. Studies like this have led some to question whether these dietary guidelines should be changed.

Interestingly, the authors of the PURE study did not make any claims about the benefits of full-fat dairy foods in their discussion of the results. These claims have all come from internet blogs and articles. Why were the authors of the study reluctant to make that claim? To answer that question I turned to reviews of the study published in the Science Media Center by experts in that field of study. Here were some of their comments:

  • Because dietary guidelines recommending the consumption of low-fat dairy foods exist primarily in western countries (specifically, the US, Canada & Europe) the distribution of low-fat dairy and full-fat dairy was not evenly divided between counties. Most of the low-fat dairy consumption occurred in western countries. In contrast, most of the full-fat dairy consumption occurred in developing countries. That introduces a couple of confounding variables that are unique to this study. For example:
    • In developing countries, diets are often primarily plant-based and tend to be low in sugar and highly processed foods, while in western countries, diets are often primarily meat-based and are high in sugar and highly processed foods. The addition of full-fat dairy to a plant-based diet may not have the same effect as adding it to a pizza or hamburger.
  • In developing countries, people with higher incomes, a healthier lifestyle, and better access to health care are often the ones who consume more dairy products. In other words, the PURE study can’t tell us whether consumption of full-fat dairy lead to better health outcomes in those countries or whether wealthier and healthier people in those countries had the means to consume more dairy.
  • In many developing countries, a large segment of the population is lactose intolerant. Increased full-fat dairy consumption by these people would be largely yogurt and other fermented dairy foods which have health benefits of their own.

In short, confounding variables unique to this study make it difficult to say with confidence that full-fat dairy foods were just as beneficial as low-fat dairy foods.

In western countries the results of previous studies are mixed. Some suggest that full-fat dairy foods are just as effective as low-fat dairy foods at reducing heart disease risk. Others report that the primary heart-health benefits come from low-fat dairy foods.

 

Dairy Products and Heart Disease:  Diet Context Matters

dairy products and heart disease dietWhy so much confusion? Some recent studies suggest that diet context matters. Simply put, that means the effect of the overall diet is more important than single food groups (dairy). To illustrate this point, let’s look at two other studies.

The first study (M Chen et al, The American Journal of Clinical Nutrition 104: 1209-1217, 2016 ) was published two years ago by investigators at the Harvard Chan School of Public Health. That study included data from 43,000 men in the Health Professionals Follow-Up Study, 87,000 women in the Nurses’ Health Study, and 90,000 women in the Nurses’ Healthy Study II. All these study participants were from the United States. This study put dairy fat consumption into the context of the overall diet. The main findings were:

  • Full-fat dairy foods did not increase heart disease risk compared to a diet that contains high amounts of refined carbohydrates and sugar (the typical American diet).
  • However, when dairy fat was replaced with the same number of calories from:
    • vegetable fat, the risk of heart disease decreased by 10%.
    • polyunsaturated fat, the risk of heart disease decreased by 24%.
    • healthy carbohydrates (fruits, vegetables, and whole grains), the risk of heart disease decreased by 28%.

In other words, the effect of dairy fat on heart disease depends on the overall diet. If you add dairy fat to an already bad, heart-unhealthy diet, it does not further increase heart disease risk. (This finding may explain why several recent studies of western populations have found no difference between full-fat and low-fat dairy consumption.) However, this study also shows that addition of full-fat dairy to a heart-healthy diet is likely to increase heart disease risk.

The lead author of that study was quoted as saying: “These results suggest that dairy fat is not an optimal type of fat in our diets. Although one can enjoy moderate amounts of full-fat dairy such as cheese, a healthy diet pattern tends to be low in saturated fat. These results strongly support existing recommendations to choose mainly unsaturated fats from vegetable oils, nuts, seeds, avocados, and some oily fish for a heart-healthy diet.”

The second major study is the 7th-Day Adventist study, which I have described in detail in my book “Slaying The Food Myths.”  This study showed that a lacto-ovo vegetarian diet was less heart healthy than a vegan diet but is far heart-healthier than the typical American diet.

 

What Does This Study Mean For You?

dairy products and heart disease questionsDairy foods are good for you: Increased consumption of dairy foods, milk, and yogurt are associated with decreased risk of heart disease. As I have said before, we have 5 food groups for a reason. Dairy foods are an essential part of a healthy diet.

  • If you are lactose-intolerant I have good news for you. Yogurt and other fermented dairy foods are probably even better for you than non-fermented dairy foods.
  • If you are avoiding dairy for other reasons, be sure to get your calcium, magnesium, and vitamin D from other sources. There may be other important nutrients in dairy that are heart-healthy, but these are the ones we are sure of.

The jury is still out on full-fat dairy products: It is best to follow current dietary guidelines and consume primarily low-fat dairy products.

If you are a cheese lover, it is probably OK to consume moderate amounts of cheese or other full-fat dairy foods on occasion as part of a heart-healthy, primarily plant-based diet. In short, it is probably better to add a little cheese to a green salad than it is to add it to pizza or a hamburger. It is probably better to pair your cheddar with an apple than with crackers.

Hopefully, this gives you a better understanding of the relationship between dairy products and heart disease.

 

The Bottom Line 

A recent study looked at the consumption of dairy products and heart disease risk, and overall mortality risk in a study with 134,000 participants from 21 countries on five continents. The media response to this study has been overwhelming. Some of the recent headlines are:

  • Eating Dairy Foods Can Help Reduce Heart Disease Risk.
  • Fermented Dairy-Products May Protect Against Heart Attack.
  • Full-Fat Dairy May Actually Benefit Heart Health.
  • Eating Cheese Might Help You Live Longer.
  • Eating Cheese and Butter Every Day Linked To Living Longer.

The first two claims were supported by the study results. The claims about cheese and butter were wishful thinking. They were not supported by the study results. The claim about full-fat dairy was supported by the data, but the authors of the study did not make that claim because of study limitations.

Another recent study of 220,000 participants in the United States provides a better estimate of the effect of full-fat dairy foods on heart health. The main findings of this study were:

  • Full-fat dairy foods did not increase heart disease risk compared to a diet that contains high amounts of refined carbohydrates and sugar (the typical American diet).
  • However, when dairy fat was replaced with the same number of calories from:
    • vegetable fat, the risk of heart disease decreased by 10%.
    • polyunsaturated fat, the risk of heart disease decreased by 24%.
    • healthy carbohydrates (fruits, vegetables, and whole grains), the risk of heart disease decreased by 28%.

In other words, the effect of dairy fat on heart disease depends on the overall diet. If you add full-fat dairy to an already bad heart-unhealthy diet, it does not further increase heart disease risk. However, if you add full-fat dairy to a heart-healthy diet, it is likely to increase heart disease risk.

For more details and a thorough discussion of the full-fat versus low-fat controversy read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Omega-3 Benefits: Lower High Blood Pressure

Posted July 16, 2019 by Dr. Steve Chaney

What Does the FDA Say About Omega-3 Benefit Claims?

Author: Dr. Stephen Chaney

 

 

Among omega-3 benefits is lower high blood pressure.  That claim can be made according to the FDA. 

lower high blood pressureHeart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing.  That is concerning because:

High blood pressure is a killer! It can kill you by causing heart attacks, strokes, congestive heart failure, kidney failure and much more.

High blood pressure is a serial killer. It doesn’t just kill a few people. It kills lots of people. The American Heart Association estimates that high blood pressure directly or indirectly caused 410,000 deaths in 2014. That is almost 1 person every second and represents a 41% increase from 2000. It’s because high blood pressure is not a rare disease.

  • 32% of Americans have high blood pressure, also called hypertension, (defined as a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more).
  • Another 33% of Americans have prehypertension (systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg).

That’s over 65% of Americans with abnormal blood pressure!

High blood pressure is a silent killer. That’s because it is a very insidious disease that sneaks up on you when you least expect it. Systolic blood pressure increases 0.6 mm Hg/year for most adults over 50. By age 75 or above 76-80% of American adults will have high blood pressure.  Even worse, many people with high blood pressure have no symptoms, so they don’t even know that their blood pressure is elevated. For them the first symptom of high blood pressure is often sudden death.

Blood pressure medications can harm your quality of life. Blood pressure medications save lives. However, like most drugs, blood pressure medications have a plethora of side effects – including weakness, dizziness, fainting, shortness of breath, chest pain, nausea, diarrhea or constipation, heartburn, depression, heart palpitations, and even memory loss. The many side effects associated with blood pressure medications lead to poor compliance, which is probably why only 46% of patients with high blood pressure are adequately controlled.

You do have natural options. By now you are probably wondering whether there are natural approaches for controlling your blood pressure that are both effective and lack side effects. The answer is a resounding YES! I’ll outline a holistic natural approach for keeping your blood pressure under control in a minute but let me start with the FDAs recent approval of what they call “qualified claims” that omega-3s lower blood pressure.

 

What Does the FDA Say About Omega-3 Benefits?

omega-3 benefitsIn my book “Slaying The Supplement Myths” I talk about the “dark side” of the supplement industry. There are far too many companies who try to dupe the public by making outrageous and unsubstantiated claims about their products.

Only the FDA stands between us and those unscrupulous companies, and they take their role very seriously. That is why it is big news whenever the FDA allows companies to make health claims about their products.

Even then, the FDA is very cautious. They allow what they call “qualified” health claims. Basically, that means they are saying there is enough evidence that the health claim is probably true, but not enough evidence to say it is proven.

Of course, if you understand the scientific method, you realize there will always be some studies on both sides of every issue. That is why the only health claims the FDA allows are qualified health claims.

With that background in mind, let’s look at the qualified health claims the FDA allows for omega-3 benefits.

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added five qualified health claims about omega-3s and blood pressure. The 5 claims are very similar, so I will only list two below for the sake of brevity.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.
  • Of course, they add the usual wording about the evidence being inconsistent and inconclusive.

 

Omega-3 Benefits?

measure omega-3 benefits levelWe’ve known for some time that omega-3 fatty acids help lower blood pressure, but two recent studies were instrumental in convincing the FDA to allow these qualified health claims. These studies have highlighted just how strong the effect of omega-3s on lowering blood pressure is.

The first study was a meta-analysis of 70 randomized, placebo-controlled clinical trials of long chain omega-3 (EPA + DHA) supplementation and blood pressure (Miller et al, American Journal of Hypertension, 27: 885-896, 2014 ).

This study showed:

  • In the group with normal blood pressure at the beginning of the study EPA + DHA supplementation decreased systolic blood pressure by 1.25 mm Hg.
  • Given that systolic blood pressure rises an average of 0.6 mm Hg/year in adults over 50, the authors estimated that omega-3 supplementation alone would delay the onset of age-related high blood pressure by 2 years.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by an impressive 4.51 mm Hg and diastolic blood pressure by 3.05 mm Hg.
  • The authors noted that this decrease in systolic blood pressure could “prevent an individual from requiring medication [with all its side effects] to control their hypertension” or decrease the amount of medication required.

However, the doses of omega-3s used in these studies ranged from 1 to over 4 grams/day (mean dose = 3.8 grams/day). That sparked a second study (Minihane et al, Journal of Nutrition, 146: 516-523, 2016) to see whether lower levels of omega-3s might be equally effective. This study was an 8-week double-blind, placebo-controlled study comparing the effects of 0.7 or 1.8 grams of EPA + DHA per day (versus an 8:2 ratio of palm and soybean oil as a placebo) on blood pressure.

This study showed:

  • In the group with normal blood pressure at the beginning of the study, EPA + DHA supplementation caused no significant decrease in blood pressure. This could be due to the smaller number of subjects or the lower doses of EPA + DHA used in this study.
  • In the group with elevated blood pressure not taking medication at the beginning of the study, EPA + DHA supplementation decreased systolic blood pressure by 5 mm Hg and, the effect was essentially identical at 0.7 grams/day and 1.8 grams/day.
  • The authors concluded “Our data suggest that increased EPA + DHA intakes of only 0.7 grams/day may be an effective strategy for blood pressure control.”

 

A Holistic Approach to Lower High Blood Pressure

holistic approach to lower high blood pressureThe FDA’s allowed claims about omega-3s are good news indeed, but that’s not the only natural approach that lowers blood pressure. You have lots of other arrows in your quiver. For example:

  • The DASH diet (A diet that has lots of fresh fruits and vegetables; includes whole grains, low fat dairy, poultry, fish, beans, nuts and oils; and is low in sugar and red meats) reduces systolic blood pressure by 5-6 mm Hg. [Low fat, low carb and Mediterranean diets also lower blood pressure, but not by as much as the DASH diet].
  • Reducing sodium by about 1,150 mg/day reduces systolic blood pressure by 3-4 mm Hg.
  • Reducing excess weight by 5% reduces systolic blood pressure by 3 points.
  • Doing at least 40 minutes of aerobic exercise 3-4 times/week reduces systolic blood pressure by 2-5 mm Hg.
  • Nitrates, whether derived from fresh fruits and vegetables or from supplements probably also reduce blood pressure, but we don’t yet know by how much.

If you’ve been keeping track, you’ve probably figured out that a holistic lifestyle that included at least 0.7 grams/day of long chain omega-3s (EPA + DHA) plus the other omega-3 benefits in the list above could reduce your systolic blood pressure by a whopping 18-22 mm Hg.  What

That’s significant because, the CDC estimates that reducing high systolic blood pressure by only 12-13 mm Hg could reduce your risk of:

  • Stroke by 37%.
  • Coronary heart disease by 21%.
  • Death from cardiovascular disease by 25%.
  • Death from all causes by 13%.

 

A Word of Caution

While holistic approaches have the potential to keep your blood pressure under control without the side effects of medications, it is important not to blindly rely on holistic approaches alone. There are also genetic and environmental risk factors involved in determining blood pressure. You could be doing everything right and still have high blood pressure. Plus, you need to remember that high blood pressure is a silent killer that often doesn’t have any detectable symptoms prior to that first heart attack or stroke.

My recommendations are:

  • Monitor your blood pressure on a regular basis.
  • If your blood pressure starts to become elevated, consult with your doctor about starting with natural approaches to bring your blood pressure back under control. Doctors are fully aware of the side effects of blood pressure medications, and most doctors are happy to encourage you to try natural approaches first.
  • Continue to monitor blood pressure as directed by your doctor. If natural approaches are insufficient to bring your blood pressure under control, they will prescribe the lowest dose of blood pressure medication possible to get your blood pressure where it needs to be.
  • Don’t stop making holistic lifestyle choices to reduce blood pressure just because you are on medication. The more you do to keep your blood pressure under control with a healthy diet and lifestyle, the less medication your doctor will need to use (That means fewer side effects).

 

The Bottom Line

Heart Disease is still the number 1 cause of death in this country. And, while deaths from heart disease have been declining in recent years, deaths due to high blood pressure have been increasing. That is why anything we can do lower blood pressure naturally is important. What does the FDA say about omega-3s and blood pressure?

  • Since 2004 the FDA has allowed the qualified claim “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”
  • A few weeks ago, they added qualified health claims about omega-3s and blood pressure. For example, they now allow the following claims.
  • “Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease).”
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure.

For more information on the studies that convinced the FDA to allow claims about omega-3s and blood pressure and for a discussion of holistic natural approaches for lowering blood pressure, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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