Say Cheese?

Here’s a question for you. What’s the best way to live a longer, healthier life? Diet? Exercise? Both—eating healthy while doing jumping jacks? Welcome to the Nutrition Facts Podcast. I’m your host Dr. Michael Greger and I’m here to help you answer that question. We have tremendous power over our health destiny and longevity. The vast majority of premature death and disability is preventable with a healthy enough diet and lifestyle. And, I’m here to bring you the latest peer-reviewed research to give you the tools to put it into practice.

Today we ponder the merits of cheese.  Americans are eating record amounts of cheese. Ten  billion pounds of it a year.  That’s a lot of nachos.  So what do the studies tell us about the nutritional benefits or otherwise of all that cheese?

In a series of videos I did about saturated fat, I talked about a major campaign launched by the global dairy industry to “neutralise the negative image of milkfat among regulators and health professionals as related to heart disease.” That campaign continues, to this day, with the publication of a meta-analysis demonstrating “neutral (meaning non-harmful) associations between dairy products and cardiovascular disease and death.”

Okay, well, first of all, how do we know the dairy industry had anything to do with this study? Well, it was published in a journal that forces authors to disclose financial conflicts of interest and the study itself was explicitly funded by dairy. Okay, then.

The other big new one was this, suggesting that a little bit of cheese every day isn’t just neutral, but actually good for you. And they make it clear that they have “no conflict of interest;” they’re just employees of the Yili Innovation Center and the Yili R&D Center. You know, “China’s largest dairy producer”, making it one of the world’s largest dairy companies.

Okay, but how can cheese consumption be associated with better health outcomes? Well, most of these studies were from Europe, where cheese consumption is associated with a higher socioeconomic status. See, in Europe they’re not eating Cheez Whiz and Velveeta. “Cheese is generally an expensive product.”

And so, who eats cheese? Those with higher-paying jobs, higher socioeconomic strata, higher education levels—all of which are associated with better health outcomes, which may have nothing to do with their cheese consumption. Higher socioeconomic groups also consume more fruits and vegetables and more candies. So, I bet you could do a population study and show candy consumption is associated with better health. Shh, don’t tell the National Confectioners Association. Too late! Did you know that candy consumers have lower levels of inflammation, a “14% decreased risk of elevated…blood pressure”? Brought to you by the candy industry and the USDA, our government, which props up the sugar industry to the tune of a billion dollars a year.

It’s like when our tax dollars are used to buy up surplus cheese. Paul Shapiro wrote a great editorial. Imagine the headline “Government Buys $20 Million in Surplus Pepsi,” our hard-earned tax dollars “buying millions of unwanted cola cans, all as a favor to the flailing soda industry, which just kept producing drinks no one wanted. As outrageous as such a government handout to the soda industry would be, that’s exactly what the [USDA] is doing for the…dairy industry.”

Michele Simon did a great report on how our government colludes with the industry to “promote dairy junk foods.” The federal government administers “’check-off programs’ to promote milk and dairy.” McDonald’s has “six dedicated dairy checkoff program employees at its corporate headquarters” to try to squeeze in more cheese. That’s how we got “double steak quesadillas.” That’s how we got “3-Cheese Stuffed Crust Pizza,” complete with a “Summer of Cheese.” “These funds are being used to promote foods, which contribute to the very diseases our federal government is allegedly trying to prevent. Does it make sense to tell Americans to avoid foods high in salt, sugar, and saturated fat, while engaging in the promotion of those same foods?”

Look: “The meat and dairy industries can do what they like with their own money. But, the public power of taxation should be used for the public good”—not to support the dairy and candy industries.

In our next story, dairy is compared to other foods for heart attack and stroke risk.

When industry-funded studies suggest their products have “neutral” health effects, or are even beneficial, one question you always have to ask is: “compared to what?” Is cheese healthy? Compared to what? If you’re sitting down to make a sandwich, cheese is probably healthy—compared to bologna—but compared to peanut butter? No way. That’s the point Walt Willett made, former chair of nutrition at Harvard. “To conclude that dairy foods are ‘neutral’ could be misleading,” as it could be misinterpreted “to mean that increasing consumption of dairy foods would have no effects on cardiovascular disease or mortality. Lost is that the health effects of increasing or decreasing consumption of dairy foods could depend importantly on the specific foods that are substituted for dairy foods.”

Like, what are you going to put on your salad? Cheese would be healthy compared to bacon, but not compared to nuts. See, “consumption of nuts or plant protein has been found to be protectively associated with risks of coronary heart disease and type 2 diabetes; in contrast, intake of red meat for example has been…associated with” increased risk. “Therefore, it is reasonable to assume that the lack of association with dairy foods could put them somewhere in the middle of a spectrum of healthfulness, but certainly not an optimal source of energy or protein. More broadly, the available evidence supports policies that limit dairy production and encourages production of healthier sources of proteins and fats.”

He wasn’t just speculating. This was based on three famous Harvard studies involving hundreds of thousands of men and women exceeding five million “person-years of follow-up.” This was really the first large-scale prospective study to examine dairy fat intake compared to other types of fat in relation to heart attack and stroke risk. So, replacing like 100 calories of fat worth of cheese with 100 calories of fat worth of peanut butter on a daily basis might reduce risk up to 24%, whereas substitution with other animal fats might make things worse. Here’s how it breaks down for heart disease. Swapping dairy fat for like vegetable oil would be associated with a decrease in disease risk, whereas swapping dairy for meat increases risk. Dairy fat calories may be as bad, or worse, as straight sugar. The lowest risk would entail swapping to a whole plant food, like whole grains.

Yeah, dairy products are a major contributor to the saturated fat in the diet, and have thus been targeted as one of the main dietary causes of, you know, the #1 killer of men and women. But the dairy industry likes to argue there are other things in dairy products, like fermentation byproducts in cheese that could counteract the saturated fat effects—all part of an explicit campaign by the dairy industry to “neutralise the negative image of milkfat among regulators and health professionals.”

If Global Dairy Platform looks familiar, they were one of the funders of the milk-and-dairy-is-neutral study, trotting out their dairy-fat-is-counteracted notion. To which the American Heart Association responds that “no information from controlled studies supports the assertion that fermentation adds beneficial nutrients to cheese that somehow counteract the harmful effects of its saturated fat.”

We need to cut down on dairy, meat, coconut oil no matter what their respective industries say. In fact, that’s the reason the American Heart Association felt that they needed to release this special Presidential Advisory in 2017. They wanted to set the record straight on why well-conducted scientific research overwhelmingly supports limiting saturated fat in the diet.

In our final story: how the meat and dairy industries design studies showing their products have neutral or even beneficial effects on cholesterol and inflammation.

Observational studies suggesting dairy might not be so bad, can be confounded by extraneous factors, such as the fact that people who eat more cheese tend to be of higher socioeconomic class. Fine, but what about this interventional study? A randomized, crossover trial, which compared a high-fat cheese diet, to a high-fat meat diet, to a low-fat diet. A high-cheese diet: CHEESE, which is loaded with saturated fat; a high meat diet: MEAT, which is loaded with saturated fat; versus CARB, a low-fat diet. And, people ended up with the same cholesterol levels.

Let’s see how they did it. Half the study was paid for in part by the dairy industry, and the other half paid for by dairy, dairy, dairy, and dairy. If you’re the dairy industry, and you’re trying to design a study to show that a high-cheese diet doesn’t raise cholesterol, how would you go about doing that?

The beef industry was in the same pickle as the cheese industry. Beef has saturated fat, which raises cholesterol, which raises the risk of dying from our #1 killer. What’s an industry to do? So, they designed a study where they added beef, and cholesterol went down.

How is that possible? They did this by cutting out so much dairy, poultry, pork, fish, and eggs that their overall saturated fat intake was cut in half. They cut saturated fat levels in half, and the cholesterol levels went down. Well, duh. They could have swapped in Twinkies and said snack cakes lower your cholesterol, or frosting or anything.

Okay, so now that you know the trick, let’s go back to this study. The way to get the same cholesterol levels is to make sure all three diets have the same amount of saturated fat. How are you going to get a high-fat cheese diet and a high-fat meat diet to have the same saturated fat level as a diet with neither? Unless… Wait, don’t tell me. What? They added coconut oil or something to the other diet? They added so much coconut oil and cookies to the so-called low-fat diet that they all had the same amount of saturated fat, and voilà! That’s how you can make a cheese or meat-rich diet that doesn’t raise cholesterol.

That reminds me of the desperation evident in this study that compared the effects of dairy cheddar cheese to a non-dairy cheddar cheese called Daiya. Milk consumption has plummeted in recent years as people have discovered plant-based alternatives like soy milk and almond milk. And now there’s plant-based cheese alternatives? What’s the National Dairy Council to do? How are you going to design a study that shows it’s healthier to eat cheese; design a study where cheese causes less inflammation than the vegan alternative. They got their work cut out for them. Daiya is no health food by any stretch, but definitely three times less saturated fat than cow cheese. So, I give up. How could you possibly show more inflammation from Daiya?

Well, there is one fat that may cause more inflammation than milk fat: palm oil. In fact, it may raise cholesterol levels as much as trans fat-laden partially hydrogenated oil. Yeah, but what are you telling me? They like slipped the Daiya group some extra palm oil on the side. Yes, can you believe it? They compared cheese to Daiya “plus palm oil”—so much extra palm oil that the vegan alternative meal ended up having the same amount of saturated fat as the cheese meal. That’s like proving tofu is worse than beef by doing a study where they compared a beef burger to a tofu patty…stuffed with lard. Oh, wait, the meat industry already did that, but at least they had the decency to concede that “Replacement of meat with tofu in the habitual diet would not usually be accompanied by the addition of lard.”

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