Wednesday, December 26, 2018

Should you eat only low fat or no fat dairy products? The answer may surprise you.



This advice plus other advice to limit saturated fats rapidly led to a massive shift in America to use of low and no fat dairy products from whole fat diary. Unfortunately, for whatever reasons, today America has an epidemic of obesity, overweight, metabolic syndrome, diabetes and perhaps now an increasing incidence of cardiovascular disease.   

Was the dairy advice correct or not? A recent perspective article in the J of the American Medical Association asked experts and suggests that the answer is simply not clear. 

One observation is that Americans use cheese primarily to create pizzas, cheeseburgers and junk foods, while Europeans use cheese as cheese itself.

What is known about the health benefits or non-benefits is based on observational studies which amount to associations rather than clear cause and effect as would be found in a randomized trial where some group gets full fat diary and the other does not. Still, observational studies at least give directions for consideration. 

In the PURE study of 136,000+ individuals 35-70 years of age, a higher intake of dairy fat was actually associated with lower risk of cardiovascular events and mortality. “Whole fat dairy seemed to be more protective than nonfat or low-fat dairy”

Another approach is to look at biomarkers, in this case by examining the blood content of three specific fatty acids are primary derived from dairy products. It turned out that when 16 such studies were pooled with 63,00 participants, those with higher levels of the three fatty acids were less likely to develop diabetes during the time of the trial. 

What about weight gain? It turns out there is no clear-cut evidence that full fat dairy is more likely to lead to weight gain than low fat or no fat diary consumption. An expert quoted in the article noted that there is no strong data to show that full fat diary leads to more weight, more cardiovascular disease or more metabolic syndrome. Rather observational studies suggest just the opposite. 

Another expert interviewed suggested that the key is not to worry about any one ingredient in the diet but what is most important is the overall dietary pattern. This makes good sense to me.

Rubin, R, Whole-fat or nonfat dairy? the debate continues, J Amer Med Assoc, 2018; 320:2514-2516

Some 40 years ago, the Dept of Agriculture recommended a switch to no or low-fat milk and dairy products as part of the effort to reduce the consumption of saturated fats.

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Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).