As much as we love cheese, and soft serve, and cream in our coffee, we know we shouldn’t overdo it: Dairy products, at least the full-fat variety, have long been associated with heart disease and other health problems. But research-based evidence for this link has been inconsistent, and two recent studies support the idea that certain types of dairy may not be the enemy after all.
The newest study, published today in the Lancet, found that people who had three servings of dairy a day had lower rates of cardiovascular disease and early death, compared to those with lower levels of consumption. Other recent research, presented last month week at the European Society of Cardiology’s annual congress in Munich, found that people who regularly ate cheese and yogurt had a lower risk of dying during the study period than those who didn’t.
But before you take these findings as an excuse to scarf down a pint of Ben & Jerry’s, it’s important to consider all the facts. Health took a closer look, and spoke with nutritionists, about the real bottom line.
What the research shows
The connection between dairy and heart disease risk has been in question for a while now: In 2014, a large, 20-year study published in BMJ found that women who drank lots of milk had double the risk of dying early compared to those who didn’t. Yet, in 2017, a meta-analysis of 29 studies published in the European Journal of Epidemiology found no link between the consumption of dairy products and deaths from either cardiovascular disease or all causes.
The new Lancet study is another in the plus column for dairy: It found that, among 130,000 people in 21 countries, consuming about three servings of dairy a day was linked to a lower risk of heart disease (3.5% versus 4.9% for those who consumed less) and death (3.4% versus 5.6%) over the nine-year study period. A serving of dairy, in this case, was considered a glass of milk, a cup of yogurt, a slice of cheese, or a teaspoon of butter.
Even people who consumed three servings of whole-fat dairy per day had lower rates of death and heart disease than those who consumed very little (less than half a serving per day) of the full-fat stuff. Based on their findings, the study authors wrote that “the consumption of dairy products should not be discouraged, and perhaps even encouraged, in low-income and middle-income countries where dairy consumption is low.”
Then there’s the research presented at the ESC meeting (but not yet published in a peer-reviewed medical journal), which involved 24,000 U.S. adults over an average follow-up period of about seven years. In that study, people who consumed the most dairy products had a 2% lower risk of dying during the study period than those who consumed the least. For cheese specifically, those who ate the most had an 8% lower risk than those who ate the least.
It wasn’t all good news for dairy, however: Those who drank the most milk had a 4% higher risk of dying from a heart-related condition compared to those who drank the least.
A meta-analysis of 12 previous studies largely confirmed those results: Milk consumption was again associated with a 4% increased risk of dying from heart disease. Those who reported eating fermented dairy products (like yogurt and kefir), however, had a 3% lower risk of death from heart disease compared to those who ate the least.
Those study authors say their research suggests that dairy consumption can have a protective effect, and that current guidelines to limit the consumption of dairy products, especially cheese and yogurt, should be revised and relaxed. At the same time, however, drinking full-fat milk should still not be advised—especially not in large quantities.
So does this change anything?
Ginger Hultin, RD, a Seattle-based dietitian and spokesperson for the Academy of Nutrition and Dietetics, says this study doesn’t change her overall view on dairy. It also doesn’t mean that current guidelines need to be adjusted, she says.
The U.S. Dietary Guidelines currently recommend “fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages” as part of a healthy eating pattern, Hultin points out. These guidelines recognize that intake of dairy products is linked to improved bone health, a reduced risk of cardiovascular disease and type 2 diabetes, and lower blood pressure.
In other words, we’re already encouraged to eat dairy—albeit the low-fat or fat-free variety—or to supplement with a calcium-fortified soy milk if we choose not to make dairy part of our diet.
“There are some obvious nutritional benefits to eating dairy foods,” says Hultin. “For example, they are good sources of protein and nutrients like calcium, phosphorus, and potassium. It doesn’t surprise me that people who include these nutrients in their diet fare well.”
As for the contradictory news about milk versus cheese and fermented products–and the surprising Lancet findings about full-fat dairy–Hultin says the science is still not entirely clear on the effects of different types of dairy, or on full-fat versus low-fat versions.
Because dairy is often high in saturated fat, she agrees that it’s smart to opt for low-fat versions, especially if you’re consuming it regularly. (It is worth mentioning, however, that even this debate hasn’t been settled by science—and that low-fat products aren’t always as healthy as they seem.)
Hultin also says that yogurt and kefir may have additional health perks because of their fermentation, but that “most of the benefits probably still come from the protein and the nutrients found in dairy.”
Health contributing nutrition editor Cynthia Sass, MPH, RD, agrees—but adds a word of caution: The studies “absolutely do not mean that you should load up on cheese, or that you’re protected if you eat dairy but also eat lots of sugar, processed carbs, and few veggies,” she says. (Now is probably a good time to mention that, while the average consumption in the Lancet study’s “high dairy” group was 3.2 servings a day, the average intake in America was considerably higher, exceeding 4 servings a day.)
The authors of an editorial published alongside the Lancet study also say that guidelines don’t need to change just yet. Even though the new study suggests that whole-fat dairy might be beneficial for preventing heart disease and early death, the research, they wrote, “is not the ultimate seal of approval for recommending whole-fat dairy over its low-fat or skimmed counterparts.” Readers should be cautious, they added, “and treat this study only as yet another piece of the evidence (albeit a large one) in the literature.”
What if you can’t, or don’t want to, eat dairy?
Of course, some people have allergies or intolerances to dairy products or choose not to consume them for other reasons. “The good news is that fortified soy beverage is considered a dairy alternative and is another way to meet these nutrients,” Hultin says. There are also many other foods that contain calcium, potassium, and dairy’s other nutrients.
Hultin’s recommendations for consuming dairy “really do vary from person to person,” she says. “Dairy is really nutrient-rich, but there are also alternatives if you want to cut out dairy. That’s fine if you do, but I want to talk about how you’re going to get the nutrition you’d otherwise get from dairy.”
If you do choose to include dairy in your diet, Sass recommends opting for yogurt and small portions of cheese—ideally grass-fed and organic—as part of a healthful overall pattern. And if you don’t eat dairy, she adds, “this research doesn’t mean you need to add it back again.”
“Bottom line: The most important factor that impacts your heart health and longevity is your overall eating pattern,” Sass says. “Whether you consume dairy or not, an eating pattern that includes plenty of veggies, along with fresh fruit, lean high-quality protein, whole food sources of carbohydrates, anti-inflammatory fats, and minimal sugar offers the best overall protection.”