The Dairy Paradox

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. It encompasses a range of heart and blood vessel disorders, such as coronary artery disease, cerebrovascular disease, deep vein thrombosis, and strokes [1, 2]. Among the various risk factors for CVD, diet plays a pivotal role. While many dietary recommendations emphasise reducing saturated fat intake, the role of dairy foods including whole- and reduced-fat products remains a topic of considerable debate. 

Composition of Dairy Fat

Dairy products, whole-fat or reduced-fat, provide essential nutrients, including calcium, protein, phosphorus, various vitamins and bioactive peptides [5–7]. Whole-fat dairy contains saturated fatty acids, which have long been associated with elevated low-density lipoprotein (LDL) cholesterol, a risk factor for CVD. However, dairy fat also contains bioactive compounds like conjugated linoleic acid (CLA), butyrate, and certain sphingolipids, which may have health benefits [7, 8]. Reduced-fat dairy products, on the other hand, have lower saturated fat content but may be fortified with nutrients such as vitamin D. The reduction in fat often leads to changes in taste and texture, with some products incorporating added sugars to enhance palatability, raising concerns about their overall healthfulness [9–11].

Epidemiological Evidence

The relationship between dairy consumption and CVD has been extensively studied in epidemiological research, including cohort studies, meta-analyses, and randomised controlled trials (RCTs). Many studies indicate moderate dairy consumption, regardless of fat content, is not strongly associated with increased CVD risk and may even confer protective effects [12, 13]. For instance, recent meta-analysis of cohort studies have found higher dairy consumption, including whole-fat products, was associated with a lower risk of cardiovascular and all-cause mortality [14, 15]. Some research highlights fermented dairy products like yoghurt and cheese may have neutral or beneficial effects on heart health due to their unique fermentation-derived compounds [9, 10].

Contrary to earlier assumptions, not all saturated fats are equally harmful. Saturated fats in dairy products may have a different impact on lipid profiles and cardiovascular health compared to those from other sources, such as processed meats and confectionery [3, 16, 17]. While reduced-fat dairy is often recommended for individuals at higher risk of CVD, studies suggest that whole-fat dairy, when consumed as part of a balanced diet, may not significantly elevate cardiovascular risk [5, 11, 17].

Mechanisms of Action

The impact of dairy fat on CVD risk involves several physiological mechanisms. Saturated fats in dairy can increase LDL cholesterol, often termed ‘bad cholesterol’ [9]. However, dairy fat also tends to raise high-density lipoprotein (HDL) cholesterol, or ‘good cholesterol’, which may counterbalance the negative effects [3, 13, 16]. Additionally, whole-fat dairy products contain specific fatty acids, such as odd-chain fatty acids like pentadecanoic acid (C15:0), that have been linked to reduced inflammation and improved metabolic health [6, 13].

Fermented dairy products like yoghurt and cheese may also contribute to cardiovascular health by improving gut microbiota composition, reducing blood pressure, and enhancing endothelial function [10, 18]. Furthermore, dairy’s rich mineral content, particularly calcium, potassium, and magnesium, plays a role in regulating blood pressure, a key factor in CVD prevention [5, 19].

Whole-Fat Dairy: Risks and Benefits

Whole-fat dairy has traditionally been viewed as a risk factor for CVD due to its saturated fat content. However, this perspective is being revisited considering emerging evidence. Recent studies suggest the association between saturated fat and CVD may be more complex than previously thought [3, 16, 20]. For instance, whole-fat dairy’s nutrient-dense profile provides essential vitamins and minerals that may offset potential risks associated with its saturated fat content.

The benefits of whole-fat dairy appear to be particularly pronounced in the context of fermented products. Cheese, for example, contains bioactive peptides that may improve vascular health, while yoghurt has been associated with reduced risk of hypertension [9, 10]. Importantly, the overall impact of whole-fat dairy on CVD risk depends on its integration into dietary patterns. When consumed alongside fruits, vegetables, wholegrains, and lean proteins, whole-fat dairy may contribute to a heart-healthy diet [5, 6].

Reduced-Fat Dairy: Risks and Benefits

Reduced-fat dairy products are often marketed as a healthier alternative due to lower saturated fat content and caloric density. These products are recommended in dietary guidelines, particularly for individuals with elevated LDL cholesterol or other cardiovascular risk factors [11, 13]. One advantage of reduced-fat dairy is its lower calorie content, which may be beneficial for weight management, an important factor in CVD prevention. However, there are potential drawbacks. While plain reduced-fat dairy products usually do not contain additional ingredients, reduced-fat flavoured varieties often contain added higher refined sugars in order to compensate for the loss of flavour and texture caused by fat removal [21]. High refined sugar intake is a known risk factor for CVD, which may undermine the intended health benefits of reduced-fat options [9, 14].

Despite these concerns, reduced-fat dairy can still play a role in a heart-healthy diet, particularly for those who prefer the taste, mouthfeel or need to reduce calorie intake. The key is assessing total diet quality. Flavoured reduced fat dairy with lower refined sugar can be part of a balanced diet [5, 10].

Beyond Cardiovascular Disease

It is important to consider the broader health implications of dairy consumption. Dairy foods are a major source of calcium, essential for bone health [5, 7, 19]. Additionally, some studies suggest dairy may reduce the risk of type 2 diabetes, another significant risk factor for CVD. Dairy’s role in weight management, satiety, and muscle preservation further underscores its value in a balanced diet [9, 11].

Practical Recommendations

Based on current evidence, both whole- and reduced-fat dairy can be part of a heart-healthy diet. For individuals with elevated CVD risk, reduced-fat options may be preferable, especially when paired with other nutrient-dense foods. However, whole-fat dairy, particularly fermented products like cheese and yoghurt, should not be universally excluded, as they offer unique health benefits [5, 10].

Conclusion

The relationship between whole- and reduced-fat dairy foods and cardiovascular disease is complex and context-dependent. Emerging evidence challenges the traditional view that whole-fat dairy is detrimental to heart health, highlighting the importance of considering the full nutrient profile and overall dietary context. While reduced-fat dairy remains a valuable option for those managing specific health concerns, whole-fat dairy, particularly in fermented forms, may offer unique cardiovascular benefits.

Ultimately, the choice between whole- and reduced-fat dairy should be guided by individual health needs, preferences, and dietary patterns. Future research should continue to explore the mechanisms underlying dairy’s impact on heart health, providing clearer guidance for consumers and healthcare professionals alike.

Dr Anneline Padayachee has a PhD in Nutritional Food Science, is a professional member of the Nutrition Society of Australia and a Fellow of the Australian Institute of Food Science and Technology (AIFST). She sits on the Australian Academy of Science’s National committees for Nutrition and Agriculture and Food.

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