Full-fat dairy foods and cardiovascular disease: Is there a connection?

Full-fat dairy foods and cardiovascular disease: Is there a connection?

It’s true. Milk does the body good.

Milk and other dairy foods provide protein, calcium, potassium, phosphorus, vitamins A, D, and B12 and other nutrients that are vital to your body and how it functions.

On the flip side, however, some dairy foods also contain saturated fat — a fat that can raise low-density lipoprotein (LDL) cholesterol, which increases the risk of heart disease. But some recent research suggests that eating milk, cheese and yogurt — regardless of fat content — is not directly associated with a higher risk of heart disease or stroke.

This doesn’t mean you should cook with butter for every meal and not worry about your cholesterol level. But it may give you more flexibility when choosing the fat level in your milk, cheese and yogurt options. Here’s an overview of current research and important points to consider when choosing between full-, reduced-, low-fat or fat-free dairy foods.

Some full-fat dairy foods may not negatively affect the heart as previously thought

Cardiovascular disease (CVD) is the No. 1 contributor to death in the United States. Research demonstrates that saturated fat can raise blood levels of LDL, commonly called the “bad” cholesterol. High levels of LDL can raise the risk of heart disease and stroke.

A main reason that national health organizations began recommending low-fat or fat-free dairy was to help meet the recommendation that people limit saturated fat to less than 10% of their total daily calories. This recommendation was based on the assumption that saturated fat is directly or indirectly linked with heart disease.

But newer research shows this isn’t always the case. Studies in the United States and abroad suggest that full-fat milk, cheese and yogurtmay not have the negative effects on heart or vascular health as previously thought.

For example, researchers compared dairy consumption with the rate of CVD and stroke among a large cohort of adults in France. The analysis showed that despite being a major dietary source of saturated fats, full-fat dairy consumption was not associated with the risk of heart disease or stroke. In addition, fermented full-fat cheese and yogurt were associated with a reduced risk of stroke.

A 2023 review with more than 1,400 participants found little evidence that a higher dairy intake — including full-fat dairy — increased blood pressure or cholesterol. Another review showed that red meat and butter were associated with an increased risk of heart disease, but cheese and yogurt correlated with a lower risk.

In addition, researchers analyzed data of nearly 148,000 adults from 21 countries collected from the Prospective Urban Rural Epidemiology (PURE) study. They concluded that a diet comprised of higher amounts of fruits, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions.

So what’s going on?

Dairy foods, saturated fat, cholesterol and heart disease: It’s complicated.

Part of the confusion about the impact that full-fat dairy foods have on cardiovascular health is due to limitations of the available research. It is challenging to conduct a long-term randomized and controlled trial (RCT) that directly tests the effects that dairy has on heart health. However, there are some short- and medium-term RCTs that suggest consuming whole milk dairy food may not increase LDL cholesterol.

Many of the reviews on dairy consumption have analyzed the dietary habits of groups of people and compared what happens to their health over a period of time, but this doesn’t prove cause and effect.

Kyla M. Lara-Breitinger, M.D., M.S., a cardiologist at Mayo Clinic, agrees that more research is needed. “The relationship between dairy foods and heart health is complex, and the current literature is based mostly on large retrospective and prospective observational studies.” She adds, “It’s difficult to predict the total effect of food based on a single nutrient, especially when you consider that diet as a whole contributes a net effect to overall health.”

Whole foods are a mix of nutrients, minerals and numerous compounds that have complex effects on health and disease — a concept known as the “food matrix.” For example, it is well documented that saturated fats raise the level of bad cholesterol in the blood. But that doesn’t tell the whole story. Saturated fats also raise the level of high-density lipoprotein (HDL) cholesterol, known as the “good” cholesterol. Plus, there is evidence that HDL cholesterol may protect the heart against some forms of disease.

Plus, whole milk dairy foods contain over 400 unique fatty acids, not just saturated fats. This complex matrix might be one of the reasons that some research results indicate a neutral association between consuming whole milk dairy foods and heart disease.

How to choose between full-fat, reduced-fat, low-fat or fat-free dairy foods

Dr. Lara-Breitinger explains that rather than targeting individual foods, it’s important to consider the overall pattern of eating a heart-healthy diet, “If you eat a full-fat yogurt snack instead of a bag of chips or a beef stick, then despite the saturated fat in yogurt, you are also getting far better nutrients like calcium, protein and probiotics when live and active cultures are added,” she says.

Most nutrition experts agree that dietary fat has a place at the table. Katherine A. Zeratsky, RDN, LD, a registered dietitian nutritionist at Mayo Clinic, points out that to help her patients make healthy choices regarding dairy foods, it is important to consider personal differences, preferences and health goals.

In general, “whole-fat dairy food can have a place within a healthy diet and lifestyle,” says Zeratsky, “but in the context of how much saturated fat you eat.”

Common foods that contain saturated fat include:

  • Meats, including beef, lamb, pork as well as poultry, especially with skin.
  • Lard.
  • Dairy products like butter and cream.
  • Whole or 2% milk, cheese or yogurt.
  • Oils from coconuts, palm fruits or palm kernels.

Foods that combine meat and dairy, like sandwiches, burgers, tacos and burritos, are common sources of saturated fats. So are baked goods with butter, full-fat ice cream and other desserts.

The Dietary Guidelines for Americans recommends limiting saturated fat to 10% or less of your daily calories. To figure out what that means for you, multiply the number of calories you eat in a day by 10%.

If you eat 2,000 calories a day, then no more than 200 calories should come from saturated fat. There are 9 calories in a gram of fat, so that equals 22 grams of saturated fat a day.

Keep in mind that individuals have different responses to consuming dietary fats. Some people are hyper-responders, which means that their LDL cholesterol increases at a higher rate when eating saturated fats. For those who need to keep-an-eye-on or lower their cholesterol, the American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat.

The Nutrition Facts label on packaged foods lists the amount of saturated fat for one serving. Just be sure to note how many servings are listed on the label.

Weight and obesity considerations

An important aspect when evaluating full-fat versus reduced-, low-fat or fat-free dairy foods is the implication for weight gain. A worldwide increase in the rates of obesity — in both children and adults — is linked to cardiovascular disease and many of its comorbidities like type 2 diabetes, high cholesterol and hypertension. Even modest weight gain is an independent risk factor for heart disease.

On the other side of the weight argument, Zeratsky notes: “Protein and fat play a role in satiety. We know that’s important for managing hunger.” Consuming yogurt and dairy foods that have higher fat content and protein can help you feel full for longer periods of time. When you feel full, you may eat less, which may cut down on overall calorie intake and help manage weight.  

There are some studies that indicate consuming dairy foods is associated with a lower body mass index (BMI). BMI is a screening method to determine weight category — underweight, healthy weight, overweight and obesity. A BMI that is too low or too high may lead to health problems. In addition, there is growing evidence that consuming whole milk dairy foods may not be linked to weight gain.

Focus on fermentation

Fermented dairy foods such as yogurt and kefir that have live and active cultures support the healthy bacteria in the gut. These “good” bacteria help manage cardiovascular risk factors, lower blood glucose and regulate insulin levels.

A 2019 study showed that fermented dairy foods like yogurt and cheese, might help reduce weight gain and body fat and lower the risk of CVD and type 2 diabetes. Fermented dairy foods are also a good source of vitamin K, which has been shown to lower the risk of heart disease. Another benefit is that the fermentation process reduces the amount of lactose, so people who are sensitive to lactose may tolerate fermented dairy foods better.

When selecting fermented food, choose yogurt, kefir and other dairy foods with labels that indicate they contain “live and active cultures.”

The bottom line

As is true for most dietary advice, the answer isn’t a simple “yes” or “no” when it comes to eating full-, reduced-, low-fat or fat-free dairy foods. 

Some current evidence suggests that milk and some types of dairy foods, regardless of fat content, have a neutral effect on cardiovascular outcomes. In addition, fermented dairy foods that contain active cultures like yogurt, kefir and some types of cheese may have a neutral or positive effect on heart disease and stroke.

People with heart disease, high cholesterol and other associated risk factors should limit their intake of saturated fat and follow their health care professional’s advice. Those without such conditions may be able to enjoy some whole-fat dairy foods as part of a heart healthy diet and lifestyle.