Cheese & Your Health: CVD, Cancer & Metabolic Syndrome - Cheesy Science or Scientific Revelation? A Brief Review

Cheese & Your Health: CVD, Cancer & Metabolic Syndrome - Cheesy Science or Scientific Revelation? A Brief Review

cheese dairy diet health healthy diet healthy eating lose fat

Cheeses come in all forms and colors.

Cheese is not exactly the first food that comes to mind when we think about "healthy eating". Rightly so? Today's overview of recent cheese studies tries to answer this question.

The article will, among other things, also address the claim that cheese was addictive (see red box) and / or that the consumption of a dairy product with a saturated fat content that is second only to that of butter would harm your cardiovascular and metabolic health.

So, where do we start? Netherlands? Well, even though the Dutch are famous for the many different types of cheese they produce and consume, they are probably not the ones who "invented" it. Rather than that it appears to be certain that the first cheeses were produced 5,000 BC - accidentally.

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Back in the day, humans had not invented pottery and thus stored their foods - including their milk - in animal stomachs, ... stomachs the cuagulating enzyme content of which turned milk into curd during storage (Fox. 1993). The first recorded "production" of cheese, in that case Gorgonzola dates back to the year 897, however (see Table 1).

Table 1: First Recorded Date for some Major Cheese Varieties (Fox. 1993).

Another cheesy fact about the Netherlands is that the Dutch would be the world's #1 cheese producer and consumer. Both is not the case! Rather than that, France holds both the title of the greatest producer (1.3 m tonnes) and consumer (22kg / per capita | Fox. 1993 // relative to their total dairy consumption, the Italians are the kings of cheese w/ up to 28% and 33%  of the dairy intake from cheese of women and men in the province Ragusa | Hjartåker. 2002). It is thus also France, where we will probably find the most significant evidence with regards to the health effects of cheese consumption. The most prominent study investigating this issue comes from the Aarhus University (Zheng. 2015)..

Is cheese the reason for the "French paradox"?

In said study, Zheng et al. used an NMR-based metabolomics approach "to investigate the differentiation between subjects consuming cheese or milk and to elucidate the potential link to an effect on blood cholesterol level" (Zheng. 2015). To this ends, the researchers recruited fifteen healthy young men for a full crossover study during which all subjects consumed three isocaloric diets with similar fat contents that were either (1) high in milk, (2) high in cheese or (3) contained only limited amounts of dairy for 14 days.

Only the fat "Norvegia" gouda has cholesterol-lowering effects in an 8 week RCT (Nilsen. 2015).

Question 1 - Does the type of cheese matter? High fat may matter. Well, "fake cheese" that's made from vegetable oils + tons of additives, as you will find it on most frozen Pizza from the supermarket is obviously not an option, but even among "real" cheeses there appear to be differences in terms of their individual health effects. The results of a 2015 study from Norway, for example, show that only fat gouda (80g/day), yet not fat- and salt-free Gamalost, a traditional form of Norwegian cheese will significantly reduce elevated cholesterol levels in non-medicated men and women over 18 years of age (Nilsen. 2015).

As the data from the scientists urine and feces analyses shows, the cheese diet significantly reduced the urinary citrate, creatine, and creatinine levels and significantly increased the microbiota-related metabolites butyrate, hippurate, and malonate compared to the milk diet. Overall, the study shows...

"[...] that cheese consumption is associated with an increased level of SCFAs in the gut, possibly induced by stimulation of beneficial gut microbiota, as well as an increased extent of lipid excretion with resultant beneficial effects on cholesterol metabolism"(Zheng. 2015 | my emphasis).

In conjunction with the significant reduction of the subjects' TMAO production [Trimethylamine N-oxide has been associated with increased CVD and even cancer risk] of which the authors rightly say that it could "also contribute to potential beneficial effects of cheese intake on the risk of CVD" (Zheng. 2015), the results of this controlled human trial are in stark contrast to the cheese = "high cholesterol" = "bad for your heart" myth that's still so prevalent:

"Overall, this metabolomics study suggests that cheese could be an important piece in the French paradox puzzle. However, further studies are needed to explore the exact metabolic mechanisms linking cheese consumption, stimulation of the gut microflora, and cholesterol metabolism" (Zheng. 2015 | my emphasis)

Just as many other researchers working in this area, Zheng et al. received support for their study from the dairy industry - a factor that is as prevalent in other areas of nutrition research, but interestingly most heavily criticized for dairy (Armstrong. 2005) and, obviously, artificial sweeteners.

Percentages of women reporting a craving for a given food at four different timepoints during their menstrual cycle (Rodin. 1991). 

Question 2 - Is cheese addictive? Prolly not! Even though the whole concept of food addiction is still contested (Rogers. 2000; Corwin. 2009; Albay-rak. 2012; Ziauddeen. 2012; Hebebrand. 2014), the Internet is full of "information" about the addictive nature of cheese. Claims that are not really backed up by science, as the data from Judith Rodin et al.'s study of the food cravings of women during different phases of the menstrual cycle in the Figure (left) shows (Rodin. 1991) - the real world does thus not confirm the relevance of the theor. addictive potential of casomorphines (Freye. 2004).

In general, rather than a role for individual molecules, the existing data appears to suggest "addictive", or rather hyperpalatable foods share common macronutrient compositions that distinguish a dairy queen chocolate ice cream cone with 34 g sugar 10 g fat and 160 mg sodium (+22 extra ingredients) per serving from roasted chicken breast or an apple (Gearhardt. 2011). This does not exclude that you can be "addicted" to cheese, but the same goes for carrots of which Kaplan reported 10 years ago that they got a 49-year-old woman addicted (Kaplan. 1996).

The reasons why I would argue that you can still put faith into the accuracy of the results Zheng et al. present in their paper are: (1) they openly declared the funding, i.e. support by The Danish Council for Strategic Research, Arla Foods, and the Danish Dairy Research Foundation in the project “FIAF - Milk in regulating lipid metabolism and overweight. Uncovering milk’s ability to increase expression and activity of fasting-induced adipose factor” (10-093539) and (2) the supporting evidence from various previous studies:

• Beneficial effect on CVD health - "The majority of prospective studies and meta-analyses examining the relationship between milk and dairy product consumption and risk of CVD show that milk and dairy products, excluding butter, are not associated with detrimental effects on CVD mortality or risk biomarkers that include serum LDL-cholesterol" (Lovegrove. 2016).
  

  

  Figure 1: Unlike 40 g dairy fat from butter, 40g of fat from matured cheddar cheese do not sign. affect the levels of total cholesterol and LDL in a 4 weeks cross-over study in healthy subjects (Nestel. 2005).

  With the latest evidence for this claim coming from an impartial source, namely Iran, where Sadeghi et al. found that higher cheese intakes are are associated with 19% reduced risk of metabolic syndrome and 13% reduced risk of suffering from (too) low HDL-C level, one may still doubt the objectivity of this claim being made at a conference about animal products, but can hardly argue that there was only potentially biased research to support Lovegrove's claim and the conclusions of the latest meta-analysis of its effects on blood lipids (de Goede. 2015):

  "Compared with butter intake, cheese intake (weighted mean difference: 145.0 g/d) reduced low-density lipoprotein cholesterol (LDL-C) by 6.5% (−0.22 mmol/l; 95%CI: −0.29 to −0.14) and high-density lipoprotein cholesterol (HDL-C) by 3.9% (−0.05 mmol/l; 95%CI: −0.09 to −0.02) but had no effect on triglycerides" (de Goede. 2015).

  In addition every regular gouda (and many other classic cheeses) contains peptides that have proven to have anti-hypertensive effects (Saito. 2000) and will thus lower the #1 risk factor for stroke and related cardiovascular problems - including death (Fagard. 2008).
• Reduced breast cancer risk -  A case-control study from the Netherlands suggests that each 60g increase in gouda intake will reduce the breast cancer risk of 25-64 year-old women (analysed according to age groups) with a 34% reduced risk of breast cancer.
  

  

  Figure 2 A high intake of gouda is associated with highly significant reductions in breast cancer risk even after adjusting for familial history, smoking,education, contraceptive use, age at menarche and first full-term pregnancy, parity, body mass index, and geographic area in Dutch women (van't Veer. 1989)

  What is also interesting about the effects plotted in Figure 2 is that a similar beneficial effect was not observed for milk (had no negative effect, either) or similarly low intakes of other fermented dairy (van't Veer).
• Anti-NAFLD and prometabolic effects - At least in comparison to a butter-fat based diet a similarly low fat (20%) likewise AIN76 (that's std. rodent chow) based diet with freeze-dried cheese powder significantly reduced the accumulation of triglyceride and cholesterol in the liver (P = 0.016 and P < 0.001, respectively) of rats who received the cheese or control diet in a 9-week study.
  

  

  Figure 2: Liver triglyceride (a) and total cholesterol (b) concentrations in rats fed control or cheese diet. Mean ± standard error. Asterisks indicate significant differences between groups (Higurashi. 2016)

  Just like the previously reported human studies, the rodent study als found significant increases in HDL and decreases in non-high-density lipoprotein (non-HDL) cholesterol, as well as elevated levels of metabolically healthy serum adiponectin concentration at week 9 in rats fed the cheese diet. To which degree this effect was due to or related to the increase in fat excretion in the feces will have to be determined in future studies. What appears to be clear, though, is that these "results suggest that cheese mediates various beneficial effects for preventing the development of metabolic syndrome by suppressing the accumulation of fat in the liver" (Higurashi. 2016).
• High nutritional value - Cheese is a low carbohydrate food that's packed with high concentration of essential amino acids saturated fats that could be good, not bad for your health (e.g. conjugated linoleic acid and sphingolipids present in cheese may have anti-carcinogenic properties, too), a lot of highly bioavailable calcium with beneficial effects on bone, teeth, blood pressure and weight loss (when combined with low-energy diets). Reason enough for researchers to state that "[c]heese is an important dairy product and an integral part of a healthful diet due to its substantial contribution to human health" (Walther. 2008).

Whether the average young, whites, female knows all the above or whether there's another reason that this part of US society consumes the highest amounts of cheese (Glanz. 1998) is something I cannot tell you. What I can tell you, though, is that the previously presented evidence suggests that weight concerns should not, as they still were in 1998 in the US (Glanz. 1998), be a reason for you not to consume cheese (in controlled amounts). Rather than that you should follow the example of the rich and intelligent of which a more recent study shows that they tend to consume the most cheese in Europe (Sanchez-Villegas. 2003).

A high cheese will also increase the level of the "good lipoproteins" HDL and apo A-I (Thorning. 2015a).

Bottom line: Don't get me wrong. The purpose of today's article is not to promote a "cheese only diet" or to tell you to consume at least X amounts of cheese per day. It is rather meant to critically evaluate the irrational fear that still characterizes the relationship of many health-conscious dieters to (esp. fatty) cheeses.

When consumed in moderation, cheese is not just a highly nutritious food, but can, as a lot of the more recent studies indicate, even have beneficial effects on your cardiovascular and metabolic health that are probably mediated by key nutrients and the beneficial effect cheese will have on your microbiome | Comment!

References:

• Albayrak, Ö., Sebastian Mathias Wölfle, and Johannes Hebebrand. "Does food addiction exist? A phenomenological discussion based on the psychiatric classification of substance-related disorders and addiction." Obesity facts 5.2 (2012): 165-179.
• Corwin, Rebecca L., and Patricia S. Grigson. "Symposium overview—food addiction: fact or fiction?." The Journal of nutrition 139.3 (2009): 617-619.
• de Goede, Janette, et al. "Effect of cheese consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials." Nutrition reviews 73.5 (2015): 259-275.
• Fagard, Robert H., et al. "Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension." Hypertension 51.1 (2008): 55-61.
• Fox, P. F. "Cheese: an overview." Cheese: chemistry, physics and microbiology. Springer US, 1993. 1-36.
• Freye, Enno. "Exorphine (exogene Opioidpeptide) und β-Casomorphine." Opioide in der Medizin. Springer Berlin Heidelberg, 2004. 323-324.
• Gearhardt, Ashley N., et al. "Can food be addictive? Public health and policy implications." Addiction 106.7 (2011): 1208-1212.
• Glanz, Karen, et al. "Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption." Journal of the American Dietetic Association 98.10 (1998): 1118-1126.
• Hebebrand, Johannes, et al. "“Eating addiction”, rather than “food addiction”, better captures addictive-like eating behavior." Neuroscience & Biobehavioral Reviews 47 (2014): 295-306.
• Higurashi, Satoshi, et al. "Cheese consumption prevents fat accumulation in the liver and improves serum lipid parameters in rats fed a high-fat diet." Dairy Science & Technology (2016): 1-11.
• Hjartåker, A., et al. "Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35955 24-hour dietary recalls in 10 European countries." Public health nutrition 5.6b (2002): 1259-1271.
• Lovegrove, Julie A., and Ditte A. Hobbs. "Plenary Lecture 2: Milk and dairy produce and CVD: new perspectives on dairy and cardiovascular health." Proceedings of the Nutrition Society (2016): 1-12.
• Nestel, P. J., A. Chronopulos, and M. Cehun. "Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects." European journal of clinical nutrition 59.9 (2005): 1059-1063.
• Nilsen, Rita, et al. "Effect of a high intake of cheese on cholesterol and metabolic syndrome: results of a randomized trial." Food & nutrition research 59 (2015).
• Rodin, Judith, et al. "Food cravings in relation to body mass index, restraint and estradiol levels: a repeated measures study in healthy women." Appetite 17.3 (1991): 177-185.
• Rogers, Peter J., and Hendrik J. Smit. "Food craving and food “addiction”: a critical review of the evidence from a biopsychosocial perspective." Pharmacology Biochemistry and Behavior 66.1 (2000): 3-14.
• Saito, T., et al. "Isolation and structural analysis of antihypertensive peptides that exist naturally in Gouda cheese." Journal of Dairy Science 83.7 (2000): 1434-1440.
• Sanchez-Villegas, A., et al. "A systematic review of socioeconomic differences in food habits in Europe: consumption of cheese and milk." European journal of clinical nutrition 57.8 (2003): 917-929.
• Thorning, Tanja K., et al. "Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial." The American journal of clinical nutrition 102.3 (2015): 573-581.
• Thorning, Tanja K., et al. "Cheddar Cheese Ripening Affects Plasma Nonesterified Fatty Acid and Serum Insulin Concentrations in Growing Pigs." The Journal of nutrition 145.7 (2015b): 1453-1458.
• van't Veer, Pieter, et al. "Consumption of fermented milk products and breast cancer: a case-control study in The Netherlands." Cancer research 49.14 (1989): 4020-4023.
• Zheng, Hong, et al. "Metabolomics investigation to shed light on cheese as a possible piece in the French paradox puzzle." Journal of agricultural and food chemistry 63.10 (2015): 2830-2839.
• Ziauddeen, Hisham, I. Sadaf Farooqi, and Paul C. Fletcher. "Food addiction: is there a baby in the bathwater?." Nature Reviews Neuroscience 13.7 (2012): 514.

Silicon-Powered Anti-Heart Disease Sausages / High Protein Breakfast, High Satiety, No Change in Food Intake / 49% Higher Chance of Healthy Aging Depends on Moderation

Silicon-Powered Anti-Heart Disease Sausages / High Protein Breakfast, High Satiety, No Change in Food Intake / 49% Higher Chance of Healthy Aging Depends on Moderation

aging atherosclerosis cholesterol health healthy aging healthy diet healthy eating lose fat nutrition on short notice silicon VLDL

Can you pump them up w/ silicon and to negate their atherosclerotic effects!? 

In today's installment of the Nutrition Research Update in the Short News, I am going to tackle three studies that deal with the surprisingly pronounced, yet practically potentially irrelevant benefits of eating a high protein breakfast, silicon... not in breasts, but sausages as a means to protect you from heart disease and the fact that calories count so much that even on a "healthy diet" only those who eat in moderation will age healthily.

That sounds interesting? Fine! I am not going to waste any more time and will fast forward to the first study...

Read more short news on various topics here at the SuppVersity

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Read the Latest Ex. Science Update

• Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age - In the eponymous study, Baum et al. determined whether consumption of a protein-based breakfast (PRO) increases postprandial energy metabolism and substrate oxidation, reduces hunger, and reduces food intake at lunch compared with a carbohydrate-based breakfast (CHO) in normal weight (NW) vs. overweight/obese (OW) children. Both, the normal and over-weight children participated in the same randomized, crossover protocol that arranged for all participants to be served a
  • high PRO [344 kcal, 21% protein (18 g), 52% carbohydrate, and 27% fat] or 
  • high CHO [327 kcal, 4% protein (3 g), 67% carbohydrate, and 29% fat]
  breakfast, after which the energy expenditure (EE), substrate oxidation, appetite, and blood glucose were measured over a 4 h period. To access whether the high protein intake would also affect the participants appetite, the subjects had free access to a lunch buffet and food intake was recorded.
  

  

  Figure 1: Energy expenditure, fat and carbohydrate oxidation in the 4h post breakfast (Blum. 2015).

  The results were unambiguous: After breakfast, OW children in the PRO group had higher (P < 0.0001) EEs and fat oxidation over the 4 h period than did the NW children in the CHO and PRO groups. Of these, the increase in energy expenditure was transient and didn't last for the full 4h period. The increase in fat oxidation in response to the high protein intake, on the other hand, lasted for the full 4 h period (+16%; P < 0.05) and went hand in hand with a surprisingly pronounced 32% increase in carbohydrate oxidation in the PRO vs. CHO (P < 0.01) trial.
  

  

  Table 1: Despite decreased hunger and increased fullness, the protein breakfast did not reduce the total energy intake or modify the macronutrient ratio of the foods the kids selected at the lunch buffet (Baum. 2015).

  Now, all this sounds great, but even though the subjects experienced decreased feelings of hunger (−14%; P < 0.01) and increased fullness (+32%; P < 0.05) after the PRO than the CHO breakfast, the lack of effect on the intake at the subsequent ad-libitum lunch is disappointing to say the least. This and the lack of long-term data make it very difficult to predict if a similar increase in protein during breakfast only would actually help the subjects lose weight.  
• Silicon ... not breasts, but enhanced meat may protect older individuals against atherosclerosis - That's at least what a recent rodent study by Garcimartin et al. (2015) suggests.

  "Research has shown that silicon can play an important role in protecting against degenerative diseases. Restructuring pork by partially disassembling meat would permit the incorporation of active components with potential functional effects. However, there has been no research to date on the impact that silicon, as a functional ingredient in restructured pork (RP), has on lipoprotein composition, metabolism, and oxidation" (Garcimartin. 2015).

  In order to find out whether the addition of silicon would actually have a meaningful effect, the scientists added 1.3g/kg silicon to sausages that were then fed to one group of old rodents while the rest received regular, non-enriched sausages as part of regular and pro-atherogenic cholesterol-enriched diets.
  
  The results were quite astonishing, as is partially normalized the changes induced by the high cholesterol diet. Compared with the rodents who received the regular sausages, those on the silicon sausages had lower VLDL compound concentrations (P < 0.001; e.g., 75% less VLDL cholesterol) and a significantly reduced VLDL oxidation (65% less conjugated dienes and 85% less TBARS) that went hand in hand with an increase in LDL-receptor expression (200% more).
  

  

  Figure 1: The silicon in the sausages increased the LDL receptor density to (almost) normal, the amount of cholesterol protecting AE in the blood and liver, as well as its ratio to the amount of cholesterol. The result is obvious: With as little oxidized VLDL in the blood as the control, we can safely assume that the rodents that consumed the silicon enriched sausages have a sign. lower atherosclerosis risk (Garcimartin. 2015).

  In spite of the fact that there are differences in the susceptibility of mouse and man to the pro-atherogenic diets of the results do - just as the authors point out - still suggest that silicon added to restructure pork can strongly counterbalanced the negative effect of high-cholesterol-ingestion and, as I would like to add, the negative effects of endogenous cholestrol (by increasing its uptake by LDL receptors and decreasing its susceptibility to oxidation) thus "functioning as an active hypocholesterolemic, hypolipemic, and antioxidant dietary ingredient" (Garcimartin. 2015).
• Healthy eating requires a controlled (not restricting) energy intake to increase one's chance of "aging healthily" by almost 50% - If you question if eating "healthy" and not eating everything in sight is even worth it, you will like the results of a recent study from the Sorbonne in Paris (Essmann. 2015).
  
  In her latest study Karen E Essmann and her colleagues analyzed the diets of a subgroup of 2769 participants of the SU.VI.MAX (SUpplémentation en Vitamines et Minéraux AntioXydants) trial. They identified subjects consuming "healthy" and those on the "standard Western diet", adjusted the data for a large number of potential confounders and the influence of high(er) and low(er) energy intakes.
  

  

  Table 2: Overview of the criteria the scientists applied to identify "healthy eating" - CES-D, Center for Epidemiologic Studies–Depression Scale; DKTMT, Delis-Kaplan version of the Trail Making Test; IADL, instrumental activities of daily living; MMSE, Mini-Mental State Examination; RI-48, 48-item cued recall test; SF-36, Medical Outcome Study Short Form 36; SPPB, Short Physical Performance Battery.

  In that, the scientists found that the association between "healthy eating" and "healthy aging" was mediated by low(er) energy intakes. Only in subjects with median or lower energy intakes, the association between "healthy eating" and "healthy aging" reached statistical significance, so that the non-gluttonous "healthy eaters" were 49% more likely to age healthily.
  
  Since we are already talking "healthy eating", let's briefly mention that scientists from the University of Eastern Finland just confirmed the obvious (Haapala. 2015): A poorer diet quality is associated with worse cognition in children. What is a bit surprising, though, is that the relationship was stronger in boys than in girls.

In contrast to Blum's study, a previous study with high fat breakfasts showed sign. reduced 24h food intakes | more

Bottom Line: So what did we learn today? I guess if you want to find a general bottom line it is as simple as "when it comes to nutrition, things are never as straight forward as it is often portrayed in the mainstream media". High protein breakfasts, for example will help you to control your energy intake (by increasing satiety and fullness) and increase your energy expenditure, but they (certainly) won't make you lose weight in a scenario where you simply eat whatever is in sight. The same goes for the link between "eating healthy" and "aging healthy" which is significant (+49%) only in those who don't overeat on their healthy diets (note: a median intake is enough, you don't have to fast!).

And if that was not complex enough, take a look at the silicon sausage study. With the right additives even something as junk-foody as sausages can have almost "medical" effects. Whether silicon supplements have the same effects in men and women, though, would require future (long-term) studies | Comment on Facebook!

References:

• Assmann, et al. "A Healthy Dietary Pattern at Midlife, Combined with a Regulated Energy Intake, Is Related to Increased Odds for Healthy Aging." J. Nutr. first published on 5 August 2015 doi:10.3945/jn.115.210740
• Baum, et al. "Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age." J. Nutr. first published on 12 August 2015 doi:10.3945/jn.115.214551
• Garcimartín, et al. "Silicon-Enriched Restructured Pork Affects the Lipoprotein Profile, VLDL Oxidation, and LDL Receptor Gene Expression in Aged Rats Fed an Atherogenic Diet." J. Nutr. first published on 5 August 2015 doi:10.3945/jn.115.213934
• Haapala, et al. "Associations of diet quality with cognition in children – the Physical Activity and Nutrition in Children Study." British Journal of Nutrition (2015): FirstView Article.