Fermented Dairy Intake Reduces the Risk of Cardiovascular Disease

Yogurt is the Most-popular Fermented Dairy Food Worldwide

Choose your Favourite Fermented Dairy Food to Protect Your Body against CVD Risk

Do you remember the boy in the ad with a milk moustache? Then you are probably an 80s or 90s kid who has grown up seeing and hearing about the goodness of consuming dairy and its benefits on bone health-in those days dairy products were the magicians who could provide individuals with stronger bones and muscles. But today, the effects of dairy have been made dark and twisted with the food group being beneficial or harmful depending on the people’s intake and needs. While it might not be the best way to a healthy body dairy indeed is the simplest way to equip yourself with calcium, vitamin D and proteins to enable optimal functioning of the heart, muscles, bones and overall body. Kids are constantly forced to drink between 2 and 3 glasses of milk for sufficient calcium levels and one should also not forget the fact that bones become stronger only up to the age of 3 after which bone mass starts deteriorating. Hence, parents insist that their children consume dairy products like milk, cheese, yoghurt and cottage cheese for maintaining bone density and reducing risk of fracture.
​
Fermented foods are the recent health craze and fermented dairy foods are no exception. Cheese and yoghurt are fermented foods that are a part of the Mediterranean diet, a diet that’s acclaimed for its protective nature against cardiovascular diseases (CVD). Dairy products have the capability to provide up to 60% of the recommended daily allowance (RDA) of calcium and fermented dairy products are an excellent source of vitamin K.  We have studies showing that fermented dairy products show beneficial effects on blood lipid profiles and the risk of heart disease compared to regular dairy products as they deliver probiotics that benefit the gut microbiota. The human gut has been the centre of attraction these days as they seem to regulate whole body health. Still, there are not many research studies providing insightful data on the benefits of fermented dairy foods.
​
Cardiovascular Benefits of Fermented Dairy Products on Australian Population
Type 2 diabetes mellitus (T2DM) and CVD are spreading like forest fire worldwide and researchers are trying various means to curb their rise. Of late, there has been an increasing interest in the relationship between dairy consumption, specifically fermented dairy foods, and its effect on T2DM and CVD risk.

We have meta-analysis from cohort studies showing that yogurt consumption has a positive effect on T2DM. Yet another meta-analysis of 29 cohort studies showed that consumption of fermented dairy products (such as milk products, cheese and yogurt) was inversely associated with CVD risk. There are not many studies that focus on middle-aged people as study participants and the Australian study discussed below examines the association between fermented dairy products and T2DM and CVD risk in Australian women.

The Australian Longitudinal Study on Women’s Health (ALSWH) is a population-based cohort study examining the health and well-being of >58,000 Australian women. The current study included data from 1946-1951 age cohort and these women were surveyed every 2-3 years since the start of ALSWH in 1996. Information on dietary intake was first collected in survey 3 in 1991 and this was used as a baseline for the present study. Surveys 5-7 once again included dietary intake. After implementing various exclusion criteria, the study was left with 7633 participants in the T2DM subcohort and 7679 participants in the CVD subcohort. T2DM and CVD was self-reported and during every survey, women were asked whether they were diagnosed or treated for diabetes and coronary heart disease (CHD) in the past 3 years. In the present study, CVD was defined as the sum of CHD and stroke and incidence was defined as the onset of T2DM and CVD at surveys 4-8.

Dietary intake was noted down with the help of a food frequency questionnaire (FFQ) that collected information on dairy consumption that included yogurt, cheese (different types of cheese such as hard cheese, soft cheese, firm cheese, ricotta or cottage cheese and low-fat cheese) and milk (including reduced-fat milk, skim milk, soya milk and flavoured milk). All the participants were asked to mark down their frequency of intake of dairy products over the last 12 months through the use of a 10-point scale (which has measurements from never to ≥3 times/d with the intake converted to grams per day) with milk being the only exception here whose intake quantity was reported between none and ≥750 ml/d. All the dairy products were classified as yogurt, total cheese (all types of cheese), total fermented dairy (sum of yogurt and total cheese), total nonfermented dairy (all types of milk) and total dairy (sum of total fermented dairy and nonfermented dairy).

Women self-reported on height, weight and other body measurements; physical activity was calculated according to total metabolic equivalent (MET in min/wk) into ‘sedentary or low physical activity level’ (<600 MET min/wk), ‘moderate physical activity level’ (from 600 to <1200 min/wk) or ‘high physical activity level’ (≥1200 min/wk). BMI measurements were calculated and categorized as underweight (BMI <18.5), healthy weight (BMI from 18.5<25), overweight (BMI from 25-30) and obese (BMI ≥30).

Results
The mean age of 8748 women enrolled in the study was 52.5 years and mean BMI was 26.8. Women belonging to the highest tertile of energy-adjusted total dairy intake were likelier to have a lower BMI, were higher educated, never smoked, rarely drank and were physically active. Above all, they had a lower intake of total energy with median intakes corresponding to 20 g/d for yogurt, 14 g/d for total cheese, 35 g/d for total fermented dairy, 202 g/d for nonfermented dairy and 369 g/d for total dairy. 7633 were diabetes-free at baseline and were followed-up for ≤15 years. During follow-up 701 (9.2%) T2DM cases were reported. Results showed that:

1. Women in the highest tertile of yogurt intake had lower odds of T2DM than those in the lowest tertile
2. Of the 7679 women free of CVD at baseline a total of 835 (10.9%) new cases were reported at follow-up.
3. High intake of yogurt and total fermented dairy intake was associated with a lower risk of CVD compared with the lowest tertile of dairy product intake.
4. Intake of yogurt and fermented dairy products was associated with a lower T2DM and CVD risk in obese women compared to nonobese women.
5. Inverse association between yogurt, total cheese and total fermented dairy and CVD risk was pronounced in women with diabetes than those without it.
   
   

The study proved a significant link between high intake of total fermented dairy and lower CVD risk. Diet intake might be a great contributor to the inverse association between fermented dairy and CVD risk.

Fermented Dairy Intake & CVD Disease Risk in Men
Researchers at the University of Eastern Finland studied 2,000 men for their risk of CVD on consumption of fermented dairy products. All the participants’ dietary habits were assessed at the start of the study (1984-89) and followed up for around 20 years during which 472 of them experienced coronary heart disease event. All the participants were split into four groups depending on how much dairy (that is, fermented dairy products with less than 3.5% fat) they consumed and the researchers compared the groups with the highest and lowest consumption. Results showed that the incidence of coronary heart disease was 26% lower in the highest consumption group compared to the lowest consumption group, sour milk was the commonly used low-fat fermented dairy product and consumption of high-fat fermented dairy products such as cheese was not associated with coronary heart disease risk. On the other hand, increased consumption of non-fermented dairy products (such as milk whose intake was as high as 0.9 litre/day in some individuals) was associated with an increased risk of coronary heart disease. The practise of dairy consumption is changing all over the globe and in Finland (where this study happened) too people are moving away from the consumption of dairy products such as milk and sour milk to those fermented dairy products such as cheese, yogurt and others. Hence, men who eat plenty of fermented dairy products are at a reduced risk of CHD than men who eat less of these products.

A study comparing fermented and non-fermented dairy products in a Swedish cohort found that there was a 32% increased hazard in consuming non-fermented milk compared to fermented milk. In another crossover-controlled study yoghurt consumption increased HDL levels in 29 hypocholesterolaemic women and we have other studies showing that fermented dairy intake has positive or neutral effects on fasting plasma glucose levels. Many studies revolve around the hypothesis that fermented dairy products induce cardioprotective effects due to the intake of bacterial metabolites and probiotics. Fermented dairy seems to be way better in every way compared to non-fermented dairy and individuals should take greater care to consume such products.

References
Total Fermented Dairy Food Intake is Inversely Associated with Cardiovascular Disease Risk in Women: https://academic.oup.com/jn/article/149/10/1797/5514556

Fermented Dairy Products May protect Against Heart Attack, Study Suggests: https://www.sciencedaily.com/releases/2018/10/181030102828.htm

Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867544/

Fermented Dairy Food & CVD Risk: https://pdfs.semanticscholar.org/336d/1c0782de6bcf3ee2056c0481119e088380a2.pdf

---

Don't Be Surprised When you Realize the Long List of Advantages of Consuming Fermented Dairy