To Nog or Not to Nog

Should we do the full dairy?

Posted Dec 10, 2016

“Go; and we'll have a posset for't 

 soon at night, in faith, at the latter end of a sea-coal 

 fire.” ~ The Merry Wives of Windsor (1.4. 7-9)

copyright Red Tail Productions, LLC
Source: copyright Red Tail Productions, LLC

The holiday season can be a time of conflict and contradiction. Competing decisions; desires versus discipline can yield confusion and despair. Serious debate can degenerate into a shouting match between Santa on one shoulder and his devilishly anagramic counterpart on the other. It can become feast or famine; both figuratively and literally.

These are the thoughts we tend as we wait patiently in line for our morning coffee, mentally calculating the risks and rewards of later consuming that ultimately indulgent adult holiday beverage – eggnog. A varying combination of milk, cream, eggs, sweetener, spices and alcohol it leaves nary a pleasure center unfulfilled. In short, it is simply an alcoholic custard. In reality, it is orally orgasmic.

copyright Red Tail Productions, LLC
Eggnog crème brûlée
Source: copyright Red Tail Productions, LLC

Like many of our current holiday celebrations, the origin of eggnog is lost amongst the snowdrifts of history. However, the eclectic combination of ingredients can be traced back at least 600 years to the posset; a drink consisting of milk, wine or ale. Even earlier relatives such as the caudle; which consists of wine or ale, various spices, and the use of a thickener, e.g. an egg yolk, can be traced back at least to the early Middle Ages if not substantially earlier.

But then our decadent reverie is shattered by the order in front of us; “Caramel Macchiato, Venti, Skim, Extra Shot, Extra-Hot, Extra-Whip, Sugar-Free.”

WTH. Skim?

And we wonder; are these the ravings of an extra-high maintenance, sanity- free individual or do they know something about dairy fat we do not?

What is the dish on dairy?

Current United States dietary guidelines continue to recommend the consumption of low-fat dairy products for improved cardiovascular health. However, despite these recommendations many randomized controlled trials (RCTs) dispute the wisdom of this strategy.

Such broad policies are traditionally focused on viewing isolated nutrients or components; oft in the context of their effect on specific variables or components. In the case of cardiovascular disease, the focus is often on the effect of raising or reducing LDL or “bad” cholesterol. The logic behind promoting low-fat or fat-free dairy alternatives (often containing significant additives) is to avoid consumption of the potentially cholesterol raising saturated fatty acids (SFAs) that are found in traditional dairy products.

Interestingly, the Institute of Medicine recently observed that the beneficial cardiovascular effects associated with the class of prescription medication of cholesterol-lowering drugs known as statins should not be extrapolated to dietary induced changes. In other words, the cardiovascular benefit of such drugs as statins may have other mechanisms in addition to, or independent of, any LDL cholesterol lowering effect. Statin medications are also known to have anti-inflammatory properties.

copyright Red Tail Productions, LLC
Source: copyright Red Tail Productions, LLC

Thus, with respect to full fat dairy products, does the data reveal them to be naughty or nice?

  • LDL cholesterol: The data from both meta-analyses and a number of RCTs suggest that increasing the consumption of dairy products (including high-fat) has no net effect on the LDL cholesterol concentration in otherwise healthy individuals. Even consuming such a paragon of dairy derived saturated fat as cheese had no effect on LDL cholesterol concentrations in postmenopausal women. Consuming other fermented dairy products like yogurt likewise had no net effect on LDL cholesterol concentrations in otherwise healthy women compared to a dairy free diet. Even when a high dairy fat was compared to a similar, but low dairy fat diet; there was no significant difference in the LDL cholesterol levels.
  • HDL-cholesterol: The comparison of a diet high in dairy versus a low dairy alternative yielded no difference in HDL, or “good” cholesterol levels. Likewise, there was no impact when comparing low dairy fat alternatives to more traditional high fat dairy foods. The data suggests that dairy fat per se has no impact on HDL cholesterol concentrations. This is important because by affecting neither the LDL nor HDL cholesterol level, the LDL to HDL cholesterol ratio remains unchanged. This ratio correlates well with overall cardiovascular risk.
  • Triglycerides: Triglycerides are another blood lipid parameter that correlates with cardiovascular health. A recent study found that a Mediterranean style dietary approach utilizing whole milk products and yogurt for three weeks significantly reduced the fasting triglyceride concentrations compared to a similar diet that replaced the whole fat products with skim versions of milk and yogurt. Overall, the consumption of various types of dairy foods does not appear to significantly impact the fasting or postprandial triglyceride levels.
  • Inflammation: Many of the disabilities and diseases associated with consumption of the modern Western diet are associated with underlying inflammation. A recent meta-analysis looking at high risk individuals, overweight and obese adults, found no adverse risk from dairy consumption with respect to circulating biomarkers of inflammation. Other studies have found that high dairy consumption compared to low dairy consumption had no impact on plasma C-reactive protein (CRP) concentrations. CRP levels are associated with generalized inflammation. Dairy consumption had no impact on other inflammatory biomarkers such as adiponectin, IL-1β, IL-6, monocyte chemoattractant protein 1, and TNF-α.
  • Insulin resistance: Insulin resistance is the hallmark of type II diabetes (T2D) which has reached epidemic proportions in the United States. A close examination of the meta-analysis and the RCTs gives some insight into some of the previously contradictory findings with respect to the consumption of dairy, insulin resistance, and T2D. Short-term studies reveal no significant negative impact on insulin resistance with dairy consumption. However, studies in which there was a longer period of dairy consumption (twelve weeks or greater) suggest that over the long term such dairy consumption is associated with favorable changes in glucose and insulin homeostasis. Such findings are in concordance with epidemiological studies which suggest that dairy intake is associated with a lower risk of T2D.
copyright Red Tail Productions, LLC
Source: copyright Red Tail Productions, LLC

In the face of such data, one of the studies adroitly concludes:

The purported detrimental effects of SFAs on cardiometabolic health may in fact be nullified when they are consumed as part of complex food matrices such as those in cheese and other dairy foods. Thus, the focus on low-fat dairy products… in the current guidelines is not entirely supported by the existing literature, because no evidence currently supports a detrimental effect of regular- or high-fat dairy products compared with low-fat dairy on a large spectrum of cardio-metabolic disease risk factors.[1]

So make this holiday season, and the years to come, about being real, authentic and full of flavor and fun when making your food choices. For as William Shakespeare might have asked, “To nog, or not to nog? That is the question.”

To which the answer seems to be; “Two Nog!”

[1] (Drouin-Chartier, et al., 2016)

References

Benatar, J., Sidhu, K., & Stewart, R. (2013). Effects of high and low fat dairy food on cardio-metabolic risk factors: a meta-analysis of randomized studies. PLoS One , 8:e76480.

Buckley, D., Fu, R., Freeman, M., Rogers, K., & Helfand, M. (2009). C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. . Ann Intern Med , 151:483–95.

Chiu, S., Bergeron, N., Williams, P., Bray, G., Sutherland, B., & Krauss, R. ( 2016). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. . Am J Clin Nutr, 103:341–7.

Drouin-Chartier, J., Brassard, D., Tessier-Grenier, M., Côté, J., Labonté, M.-È., Desroches, S., . . . Lamarche, B. (2016). Systematic review of the association between dairy product consumption and risk of cardiovascular related clinical outcomes. . Advan Nutr , 7:1026–40.

Drouin-Chartier, J.-P., Côté, J. A., Labonté, M.-È., Brassard, D., Tessier-Grenier, M., Desroches, S., . . . Lamarche, B. (2016). Comprehensive Review of the Impact of Dairy Foods and Dairy Fat on Cardiometabolic Risk1. Advances in Nutrition, 7:1041–51; doi:10.3945/an.115.011619.

Fenster, M. S. (2016). Ancient Eats (Volume 1): The Greeks and Vikings. New York: Koehler Books.

Huffington Post. (2015, January 15). The Most Obnoxious Starbucks Drink Orders. Retrieved from Huffington Post: http://www.huffingtonpost.com/2013/07/30/starbucks-drink-orders_n_3671496.html

Huth, P., Fulgoni, V., Keast, D., Park, K., & Auestad, N. (2013). Major food sources of calories, added sugars, and saturated fat and their contribution to essential nutrient intakes in the U.S. diet: data from the National Health and Nutrition Examination Survey (2003–2006). . Nutr J , 12:116.

Institute of Medicine. (2010). Evaluation of biomarkers and surrogate endpoints in chronic disease. Washington (DC): The National Academies Press.

Jones, K., Eller, L., Parnell, J., Doyle-Baker, P., Edwards, A., & Reimer, R. (2013). Effect of a dairy- and calcium-rich diet on weight loss and appetite during energy restriction in overweight and obese adults: a randomized trial. Eur J Clin Nutr, 67:371–6.

Kaptoge, S., Seshasai, S., Gao, P., Freitag, D., Butterworth, A., Borglykke, A., . . . Lowe, G. (2014). Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis. . Eur Heart J , 35:578–89.

Labonté, M., Couture, P., Richard, C., Desroches, S., & Lamarche, B. (2013). Impact of dairy products on biomarkers of inflammation: a systematic review of randomized controlled nutritional intervention studies in overweight and obese adults. Am J Clin Nutr , 97:706–17.

Labonté, M., Cyr, A., Abdullah, M., Lepine, M., Vohl, M., Jones, P., . . . Lamarche, B. ( 2014). Dairy product consumption has no impact on biomarkers of inflammation among men and women with lowgrade systemic inflammation. . J Nutr, 144(11):1760–7.

Lamarche B, C. P. (2014). It is time to revisit current dietary recommendations for saturated fat. . Appl Physiol Nutr Metab , 39(12):1409–11.

Lamarche, B., & Lewis, G. (1998). Atherosclerosis prevention for the next decade: risk assessment beyond low density lipoprotein cholesterol. . Can J Cardiol, 14:841–51.

Leiter, L., Fitchett, D., Gilbert, R., Gupta, M., Mancini, G., McFarlane, P., . . . Anand, S. (2011). Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group. Can J Cardiol , 27:e1–33.

Libby, P., Ridker, P., & Hansson, G. (2009). Inflammation in atherosclerosis: from pathophysiology to practice. . J Am Coll Cardiol , 54:2129–38.

Ras, R., Streppel, M., Draijer, R., & Zock, P. (2013). Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol, 168:344–51.

Sadrzadeh-Yeganeh, H., Elmadfa, I., Djazayery, A., Jalali, M., Heshmat, R., & Chamary, M. (2010). The effects of probiotic and conventional yoghurt on lipid profile in women. . Br J Nutr , 103:1778–83.

Stephenson, T. (2014, December 23). A Short and Sweet History of Winter Boozing. Retrieved from Time.com: http://time.com/3642195/winter-alcoholic-drinks-eggnog/

Thorning, T., Raziani, F., Bendsen, N., Astrup, A., Tholstrup, T., & A., R. (2015). Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. . Am J Clin Nutr , 102(3):573–81.

Turner, K., Keogh, J., & Clifton, P. (2015). Dairy consumption and insulin sensitivity: A systematic review of short- and long-term intervention studies. . Nutr Metab Cardiovasc Dis , 25(1):3–8.

Van Loan, M., Keim, N., Adams, S., Souza, E., Woodhouse, L., Thomas, A., . . . Bremer, A. (2011). Dairy foods in a moderate energy restricted diet do not enhance central fat, weight, and intra-abdominal adipose tissue losses nor reduce adipocyte size or inflammatory markers in overweight and obese adults: a controlled feeding study. . J Obes , 989657.

Xun, P., Wu, Y., He, Q., & He, K. (2013). Fasting insulin concentrations and incidence of hypertension, stroke, and coronary heart disease: a meta-analysis of prospective cohort studies. . Am J Clin Nutr , 98:1543–54.