Why I don't fear full-fat dairy (and neither should you)
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I don’t fear full-fat dairy and neither should you. I drink whole (3.25% fat) milk instead of skim, use cream in my coffee, eat full-fat cheeses and wholeheartedly enjoy yogurt ranging from 3-10% milk fat.
If you are like me, you may have grown up on low-fat dairy or at least switched to it in the 80’s or 90’s. Much of the health messages of yesteryear were aimed at reducing fat (both total fat and saturated fat) and thanks to these ‘low-fat’ messages, my household growing up made the switch to skim (or fat-free) milk, low-fat yogurt and lower fat cheese. But...now as an adult (and a as Registered Dietitian), I have put a stop to this low/no fat dairy in my own house. I’m here to tell you that you shouldn’t fear dairy fat and if you enjoy full-fat dairy, you shouldn’t deny yourself of it, either.
Here are my main 3 reasons for making the switch:
Science!
I’m an evidenced-based Dietitian and as such, I’m going to start off with some data to backup my claim that you no longer fear dairy fat. Much of the motivation behind the recommendations steering us towards low-fat dairy and the low-fat messages, in general, are due to risk of heart disease and stroke. That being said, would it surprise you to find out that there is research showing that full-fat dairy either has a neutral or beneficial effect on your risk of heart disease or stroke? I was.
In a 2018 study involving 2907 participants over a 22-year span, researchers found that phospholipid biomarkers that resulted from drinking dairy (i.e. these markers act as evidence of dairy consumption) were not significantly associated with total mortality or incidence of cardiovascular disease. One specific phospholipid biomarker (heptodecanoic acid) was inversely related to death due to cardiovascular disease (CVD) and stroke. This means that higher concentrations of this specific biomarker was associated with lower CVD risk.
In another study involving 6814 participants over a 10-year period, it was found that a higher intake of fat from dairy was associated with lower CVD risk and no associations were found between butter and CVD risk. Similarly, a meta-analysis of 15 studies involving 764,635 people found that high-fat dairy, butter or cream were not significantly associated with risk of stroke. Another study looking into butter fat, this time a systematic review and meta-analysis involving 636,151 participants, found that butter consumption was not significantly associated with cardiovascular disease, coronary heart disease or stroke and was inversely associated with type two diabetes.
In the Multi-Ethnic Study of Atherosclerosis (MESA), which monitored 2617 people over 7 years, it was found that a marker for dairy fat intake (trans-palmitoleate) was associated with lower triglycerides (or blood fats), lower fasting insulin and lower systolic blood pressure (those are all good). Admittedly, researchers did find that trans-palmitoleate was associated with a higher LDL (or, so called “bad” cholesterol) which is not generally thought to be a good thing, however, an increase doesn’t not automatically mean “out of healthy range”, nor is evaluation of CVD risk a matter of one number being out of range. We need to look at the whole picture including HDL (or “good” cholesterol), triglycerides, blood sugars and blood pressure. There also is a growing movement investigating the role in inflammation in the development of cardiovascular disease. If inflammation is at least one part of the cardiovascular disease puzzle (which it likely is) the good news is that in a review of 52 clinical trials it was found that the “consumption of dairy is associated with anti-inflammatory properties in humans.” In agreement with this, a systematic review of 8 randomized controlled trials also found that dairy intake was not associated with pro-inflammatory state.
One of the most interesting trials (in my opinion) is this study which compared the the classic DASH (or Dietary Strategies to Stop Hypertension) diet, which includes 2-3 servings of low-fat dairy per day, to a modified DASH which switched the low-fat for high-fat dairy. The DASH is characterized by having lots of fruits and veggies, lean meats, fish, legumes, whole grains, and nuts. It is low in sodium, and high in potassium, magnesium and calcium. Study after study has found that the DASH way of eating not only improves blood pressure but also improves blood sugars and blood cholesterol profiles. [for more on this read - The DASH Diet - The best diet you probably don’t know about). Other than the dairy component, all other dietary characteristics remained the same except there was a slight difference in carbohydrate and fat percentages to keep the overall calorie content of the diets the same (this was achieved by reducing fruit juices consumption in the high-fat group).
So, what did the study find when it compared the low-fat to the high-fat DASH diet? Were the cardiovascular parameters worse because of the addition of dairy fat? Researchers found that both diets lowered blood pressure and LDL cholesterol similarly compared to the control diet. When the two DASH diets were compared to each other, there was also no significant differences in LDL cholesterol, however, there was a trend towards larger, fluffier LDL particles with the high-fat DASH diet. These larger LDL particles are thought to be better than the small dense LDL particles, which are associated with a higher risk of heart disease. In addition to the slight differences in LDL particle size, the high-fat DASH diet exhibited lower triglyceride, or blood fat, levels (this is a good thing) compared to the regular DASH diet. However, this could have, in part, been due to the slightly lower carbohydrate/sugar content of the high-fat DASH diet.
What’s interesting about this study is that, for the most part, the background diet components are the same (albeit there was less fruit juice in the high-fat DASH group). Both of these diets are rich in fruits and vegetables, plant-based proteins, and fiber. We know all of these components are associated with a lower risk of cardiovascular disease. The addition of dairy fat into an already proven healthy diet didn’t cause catastrophic results when in comes to heart health. This, for me, is more evidence that we need to look at the diet as a whole and not to single out one nutrient or food (like dairy) as the cause of a disease state.
After looking over the available literature on dairy fat and cardiovascular disease, I came to the same conclusion as researchers of a 2009 review published in the European Journal of Nutrition who concluded “Despite the contribution of dairy products to the saturated fatty acid composition of the diet, and given the diversity of dairy foods of widely differing composition, there is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD.”
Let’s move on to my next point, shall we?
(Dairy) Fat doesn’t make you fat
Let’s face it, we live in a fatphobic society. We have been bombarded with public health messages about obesity and told that we have to fight this ‘epidemic’ by reducing the fat in our diet. As a result, we’ve seen a marked increase in low-fat or no-fat food products. Many times, perfectly wholesome foods have been processed so they can fit into a low-fat category, even if the new product isn’t actually healthier (I’m looking at you low-fat peanut butter and sugary low-fat yogurt!). Despite all these ‘decrease the fat’ messages, it has not done much to alter our population’s body composition (or rate of heart disease, for that matter).
Here’s my message - fat doesn’t make you fat. Cutting the fat out of your diet does not necessarily make your leaner or healthier. We need a certain amount of fat in our diet. Dietary fat does not automatically translate to body fat. This can be hard to accept, especially if we’ve heard the ‘low-fat’ messages for a good chunk of our life. We need fat to help absorb fat-soluble vitamins, to make hormones, to insulate our body, to protect our nerve fibers and it is an essential part of each one of our cell membranes. It’s actually sort of important to keep this macronutrient in our diet. Our goal should not be to go as low as we can.
Since I’m focusing dairy in the article, let’s look at what some of the studies say about dairy fat and weight gain. A 2013 literature review found that there is not evidence to support high-fat dairy being associated with obesity and that the data available at the time “suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk.” In other words, intake of high-fat dairy, alongside a healthy diet, does not appear to be linked with being overweight or obese. Another study of 1500 men, followed over a 12-year period, found that consumption of high-fat dairy was associated with lower central obesity and that low-fat dairy was associated with a higher risk of central obesity. In another similar study, this time in over 18,000 women, it was found that greater intake of high-fat dairy products was associated with less weight gain over an 11-year period. A more recent literature review and meta-analysis, found that higher dairy consumption was associated with reduced risk of abdominal obesity and risk of being overweight. This data is in agreement with the conclusions drawn from another study of 1352 participants in which total dairy intake was inversely associated with obesity and that those who consumed the highest amount of high-fat dairy had “significantly lower odds of being obese”.
While nutrition research is never perfect, I think there is enough data to form the conclusion that dairy fat likely isn’t the cause of our expanding waistlines. Weight gain and obesity are multi-factorial and, again, we can’t (and shouldn’t) point to a single food or nutrient as the cause.
And onto my last (and possibly, best) reason for choosing high fat dairy….
I like it!
I know, this is a purely subjective reason for drinking whole milk (and consuming other full-fat dairy products) but I like it. I do. Full-fat tastes good and when it comes down to it, shouldn’t we be choosing food that we like? Who wants to eat foods that are less than enjoyable, when there are perfectly healthy and enjoyable alternatives out there for them? No me.
I didn’t write this article to convince you to drink full-fat milk, or even to drink milk if you are not a milk drinker (if this is you read: Can You Get Enough Calcium Without Dairy?). I wrote this to let you know that you don’t have to choose skim milk, low-fat cheese or low-fat yogurt, if you don’t want to. If you prefer dairy with a little more fat in it, that’s okay. In the same regard, if you love drinking skim milk, continue doing so. What’s really important is the overall quality of your diet. Your health isn’t going to come down to one type of food you are eating. We need to start looking at the bigger picture when it comes it diet and not focus on a single nutrient or food (like dairy fat).
