Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today, we're discussing how dairy impacts your health. As with many topics, there seem to be good arguments for and against eating dairy. So how do we know what to listen to? Well, at Zoe, we consult the latest research to draw our conclusions. In this episode, our two resident professors join us to unpack what the science says about dairy and your health. But first, Tim debunked a common myth about dairy and stronger bones.

The latest research shows that milk doesn't actually protect you against osteoporotic fractures, which was my big special.

What are osteoporotic fractures? Other than hard to say.

Bone fragility fractures or hip fracture, wrist fracture, fracture Those are things that tend to become more common as you get older, I think about them. Brittle bone disease. Brittle bone disease is what it's commonly known as, and it's something that affects about one in three women.

So it's incredibly common.

Yes. So you start with a wrist fracture in your 60s Then you might get a loss of height due to vertebral fracture. Then in your 80s, highly susceptible to hip fractures, which can really end up changing your life. So really important big epidemic of this. We were telling everyone 10 years ago to drink more milk, particularly around the menopause, this would protect you.

Which is what I thought you were supposed to do.

Yes. Well, that was up to very recently, the latest advice. But all the actual evidence now suggests that milk drinkers have no protection against hip fracture compared to non-milk drinkers. And it makes sense because the biggest milk drinkers in the world are the Dutch and the Scandinavians, and they have the highest fracture rates in the world.

So all of that calcium is in your milk and it's going to protect you.

It all turns out to be nonsense. It all turns out to be nonsense, yes. That's what the science is now telling us. And there's many other sources of calcium. We always think of milk as the only source of calcium, but actually there's so much in green leafy vegetables, in kale, in broccoli, in nuts, in almons, all kinds of different areas we can get much more easy access to this calcium. And so I don't think we should be really pushing milk as much as we have been.

And is that true for all dairy? So we talked about milk.

I think, Jonathan, it's important to pick up on the osteoporosis question here regarding milk, that whether all dairy should be classified as not being helpful in that situation. There's studies that have taken place in care homes, for example, where they will take a number of different care homes, and some care homes have added to the dairy. Now, this isn't just milk, though. This is like adding yogurt, cheese, and other dairy, and then other care homes that haven't. It's part of a clinical trial. The care homes that add dairy to the diets of the people that are living there, they do have a reduction in lots of different fable health outcomes, including fractures. Overall, what we know from population studies is people that consume more dairy have lower rates of type 2 diabetes. That's really consistent, the evidence for that. We also know populations that have higher intakes of dairy have lower rates of cardiovascular disease. It's less consistent, but the majority of the data would support that, and we're starting to understand mechanistically why that is. We also know that people that have higher intakes of dairy tend to have better weight overall. We also know that dairy may be protective against some cancers.

There's really consistent evidence that people that have higher intakes of dairy have lower risk of colon cancer, for example. But then we need to look at the different types of dairy to see which types are more protective than other types. I think the best way we as nutritionists would separate them out is typically the fermented and non-fermented. Then once we look at the fermented, then we'd separate them out according to whether they're liquid or hard. When we talk about fermented, we mean cheese, we mean yogurt. When we're talking about the non-fermented, Scented, we mean milk, and we mean butter.

To make sure I've got that, you're saying, overall, actually, when you look back at people living their entire lives and what they ate, then actually the people who are eating dairy have tended to look healthier. But within that, it's like there's this mix of different things. So some of those dairy might be really quite good for you. Some of those dairy might not be very good for you, and you mix it all together. On average, that might be better than someone who's not eating dairy. I guess the risk always is, are they drinking Coca-Cola? What are the alternative choices? It's quite complex compared to many of these things where maybe it's just clear that if you eat a whole grain, it's better than a highly refined grain.

Yeah. Dairy is a huge food group. Whilst we can say, broadly speaking, if you consume more dairy, you tend to be healthier, we need to look at all of the different components of the food groups. There's also quite a lot of clinical trial that we can draw on as well to look at whether dairy itself is what's improving health or whether it's all the other factors that normally complicate how we understand if food impacts our health. So is it that people that have higher overall diet quality tend to consume more dairy, or is it the dairy itself?

What's the answer?

My interpretation of the evidence is that for cheese and for yogurt, it's the dairy itself that's conferring a favorable impact. We're starting to understand why this is as well.

The data, as Sarah is saying on cheeses and yogurts, is actually stronger than for milk. I don't think there's comprehensive data about it being fracture-protective, but it's certainly suggested that way, certainly. I think all the fermented dairies have all these extra advantage of the probiotic microbes in there that we know now from clinical trials are good for the immune system. They have an effect within a few weeks. They do hang around in our gut to energize the other microbes there, have lots of effects. We still don't understand in our body. And I think we should still be pushing those. And all the evidence about yogurt and cheese is much more positive than for milk alone.

That's amazing. Before we dig into the individual things, the number two question that we had from literally about a thousand people was about full fat versus lower low fat dairy. I guess this can apply right across whether it's milk or if it's cheese. Lots of people saying, Well, the government advice makes really clear that I am supposed to swap my full fat milk for low fat milk or my full fat cheese for low fat cheese. We did our research, and both the UK government and the US government are currently saying that. I know that you don't always agree with whatever the existing advice, which we know goes through a process that means sometimes it's a bit out of date. What's your personal views on this?

Well, I think there's no evidence at all that full fat milk is more harmful compared to skimmed or semi-skimmed milk. There's no evidence or any advantage of low fat milk. And lots of theoretical reasons why they might be less good for you by skimming off the fat because you're losing a lot of the nutrients.

Okay, so the reason that the government have put out these low fat guidelines, not just in the UK and the US, it's actually if you look at nearly all guidelines across many different countries, they recommend you to have the low fat versions of dairy. One is because in most instances, all of the healthy nutrients are maintained. If you have skin milk versus full fat milk, you still retain the calcium, the iodine, the potassium, and many of the other really healthy nutrients. But what you also do is by going to low fat milk is you reduce your saturated fat content. We've always believed, and the evidence would support the increasing saturated fat increases your cholesterol, increases your risk of cardiovascular disease. This is why the government have recommended us to have low fat, to cut down the saturated fat intake. What do you believe? But what I believe is that whilst it's very clear that low fat dairy has a favorable impact on health. It's also clear that full fat dairy has some favorable impact on health, but just not quite as favorable as low fat dairy.

My big problem with this is that this was a theoretical argument, and you made the good theoretical case for it. But all the clinical trials have failed to show any real difference between these two arms. And by saying you have to take out the fat by spinning it basically in a centrifuge to get the fat globules off, you take out lots of stuff you may not know about because milk is incredibly complex.

Just to keep it really simple. My dad's listening to this right now, and he would be drinking full fat milk, but the medical advice advice he's been given is he should swap out the full fat milk for skimmed milk because he's got high cholesterol. How important is that advice for him to follow, do you think, Sarah?

I think based on evidence from observational studies, we know that it's very clear that people that consume more full or low fat dairy have reduced risk of cardiovascular disease and typically lower cholesterol. There's also randomized control trials that look to this. There's one quite well-known randomized control trial where people were allocated to either follow no dairy diet or for 12 weeks, follow a low fat dairy diet, and for 12 weeks, follow a high fat dairy diet. What they did is they particularly focused on cholesterol and the different types of cholesterol. What they found, interestingly, is those following either the no dairy, low fat dairy, or the full fat dairy had absolutely no difference in blood cholesterol levels. This is not what you'd expect It's based on a really high saturated fat content of dairy, which is why dairy is so special, because we know that there's something more interesting and complicated going on with the food matrix. I would say to someone, if your doctor says, No, you have to go to low fat or you have to avoid dairy, I would say that it's perfectly healthy and actually beneficial, potentially, to include cheese and to include yogurt.

I don't see the harm in having skimmed milk or semi-skimmed milk versus whole milk.

I'd love to talk about a few of the fermented dairy because I think that lots of people will believe that these are foods they shouldn't eat, and I'd like to share what the latest data shows. Could we start with yogurt? How healthy is this? Should we be eating it?

I think yogurt and cheese are a fantastic part of our diet. They're packed full of great nutrients, including calcium, iodine, potassium, fantastic types of proteins. It's a complete protein, so it provides all of the proteins that our body can't make. Actually, a fortunate part of cheese and yoga is there seems to be something really special about the matrix, so the food structure, that means that despite having a high saturated fat content, they actually don't increase our cholesterol.

That sounds a bit magic. We're talking about milk and saying on balance, it's not terrible for you, but it's not a health food either. I've taken the milk, I've I suppose it left it sitting out there for a long time, and now, magically, you're telling me it's better for me?

What's quite interesting is if we do studies where we compare butter versus cheese, despite having the same amount of saturated fat, cheese does not raise our cholesterol. Certainly in comparison to butter, it lowers our cholesterol. It lowers our bad cholesterol despite having the same fat. What this highlights is that we have to really be careful when we're looking at either back-a-pack labeling of taking that really reductionist view of thinking just of the nutrients. We have to think of the food.

Could we have some actionable advice? Let's say you're going to the grocery store, to the supermarket, you're trying to decide what to eat. Can you share some tips?

Small portions Little and often is what you want with fermented dairy. And there's something called kefir, which is fermented milk, which has about seven to 10 times the amount of microbes that yogurt does have. And it's like a super yogurt, it's thinner. If you ask for something for its health benefits, then switching from yogurt to kefir is really good, and you can make it yourself very cheaply. We've noticed you have to have them at least every day or two. You can't just have a giant dairy binge once a week because it won't be present all the time to have those benefits on your gut microbi. So these have it quite regularly. So small amounts regularly is what we're after. And again, try and move to kefir as well as these cheeses. Pick, if you can, artisanal cheeses Avoid highly processed cheeses, which are dead. If you can get raw milk cheeses, and increasingly, you can get raw milk cheeses, go for them because they do have a greater variety of microbes, particularly on the rinds, et cetera. And go You're going to enjoy, but pick the stuff that you enjoy and try and get diversity of your cheese, because the more diverse your cheese is, the more diverse the microbes you're going to be ingesting.

In terms of yogurts, as we've discussed before, it's going for the full fat unadulterated. So you know it's not processed if it's full fat. That's the other really important reason why I really say to people, go for full fat. You know it hasn't been tampered with. And go for ones without vanilla. You go ones without additives. It's got no fruit, and you can add stuff yourself so you know what's in it. That's the basic rule. All those full fat yogurts will be fine. Make sure there's no artificial sweeteners, and they haven't done anything to it on the back of the pack, and you'll be fine.

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