Which to Choose: Full-fat, Low-fat, or Non-fat Dairy?

In 1980, the first-published Dietary Guidelines for Americans recommended low-fat or fat-free dairy as a healthier substitute for full-fat dairy foods.  The 2015–2020 edition of the Dietary Guidelines for Americans continues to specifically recommend the consumption of low-fat and fat-free dairy as part of a healthy eating pattern to reduce the risks of metabolic syndrome, diabetes, cardiovascular disease, and obesity.  A quick walk through any supermarket’s dairy section indicates that many Americans are, in fact, following the recommendations by choosing low and fat-free dairy as an alternative to full-fat dairy.

The claimed health benefits of low- and fat-free dairy have, however, come into question.  Many nutrition researchers now believe that the recommendations of the Dietary Guidelines for Americans have not been based on evidence of whole dairy foods in relation to health outcomes.  Instead, these recommendations have relied on extrapolations of the health effects of single nutrients and food components studied in isolation.  A growing body of evidence suggests that full-fat dairy foods do not exert the detrimental effects on cardiometabolic health as previously predicted on the basis of their saturated fat content alone.

Published in Advances in Nutrition, the international review journal of the American Society for Nutrition, “Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base” looks at our current understanding of the link between full-fat dairy consumption and cardiometabolic health, including cardiovascular disease, type 2 diabetes, and obesity.  The authors examined relevant randomized controlled trials, prospective cohort studies, systematic reviews, and meta-analyses that looked at the relationship between full-fat dairy consumption and cardiometabolic health.  They then contrasted the findings of these studies with the findings from similar studies of low-fat and fat-free dairy foods.

According to the authors, “the current state of the evidence, although incomplete, lacks compelling support for the recommendation to consume only low-fat and fat-free dairy and avoid full- and reduced-fat dairy foods to support cardiometabolic health.”  In fact, study results suggest that fermented dairy foods such as full-fat yogurt and cheese may be protective against cardiovascular disease and type 2 diabetes.  These results run contrary to what would be predicted based on the saturated fat content of full-fat yogurt and cheese alone, “which may be related to effects of the food matrices of these products.”

The authors do note that their review is “limited by heterogeneity in results and the reliance on observational studies for all evidence regarding disease incidence endpoints.”  They therefore believe that “additional experimental and observational studies are needed to establish a comprehensive understanding of the effect of full-fat dairy food consumption on cardiometabolic health.”  In particular, the authors recommend that “future studies should focus on whole-dairy foods in the context of dietary patterns and consider metabolic phenotype, meal composition, and energy balance.

Despite these caveats, the authors believe that “the current evidence supports the view that the full-fat dairy foods milk, yogurt, and cheese are nutrient rich and may be consumed without producing adverse effects on the cardiometabolic risk marker profile.”  Individual needs may vary, however.  Anyone considering a change in diet should consult with their health care provider.

Reference Kristin M Hirahatake, Arne Astrup, James O Hill, Joanne L Slavin, David B Allison, Kevin C Maki. Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base. Advances in Nutrition: An International Review Journal, DOI: https://doi.org/10.1093/advances/nmz132.