Most CVDs can be prevented by modifying our behaviour: not smoking, reducing our alcohol intake, being physically active and watching our weight and waistlines. Monitoring our diet, particularly our intakes of saturated fat, is also important. Elevated intakes of dietary saturated fat have been associated with increased LDL cholesterol and increased risk of heart disease since Ancel Keys’ Seven Country Study in the 1970’s (2). Because of this, people are advised to reduce consumption of foods that are high in saturated fat, although population intakes are generally greater than dietary recommendations.
In recent years, there is some evidence (although this is far from conclusive) that questions the link between dietary saturated fats and CVD. In one meta-analysis (where the results from several other studies are pooled together and analysed) intakes of saturated fat were not associated with mortality, heart disease or stroke (3). One explanation for these discrepancies is that a reductionist approach, which examines how one nutrient is associated to one health outcome, is too simplistic. Our diet consists of whole foods that are consumed alongside other foods as part of a meal, which combined together creates an overall dietary pattern. To put it simply, we eat foods and not nutrients in isolation.
Saturated fat is found in many different types of foods ranging from eggs, coconut oil, cakes, biscuits, meats and dairy. There is some suggestion that taking the food source into consideration is important. Whilst saturated fats from meat are associated with detrimental health effects, those from dairy, particularly fermented dairy products like cheese and yoghurt, may have a more positive impact.
Cheese is high in saturated fat but are also rich in nutrients like protein, calcium and vitamin B12. It is also one food in particular that people watching their cholesterol levels avoid. However, research from longitudinal cohorts (studies where individuals are followed over a long period of time) suggests otherwise. In these studies, saturated fats from dairy were separated from those from saturated fat from different sources and their relationship to health was examined. Dairy foods and cheese had a neutral and, in some cases, a beneficial effect on CVD. In one study, high cheese consumption compared to low was associated with a 10-14% lower risk of CVD (4). Other research also found that individuals who consumed high amount of cheese did not have elevated cholesterol levels compared to low consumers (5). Interestingly, this study also found that high dairy consumers were also slimmer and had lower blood pressure.
This observational research is also backed up by several intervention studies. In these studies, consuming saturated fat in the form of cheese resulted in different effect on cholesterol than consuming the same amount of saturated fat as butter. Cheese consumption tends to result in lower total and LDL cholesterol than butter (6, 7). When we consider that cheese and butter contain the same types of saturated fat the importance of the food structure or “cheese matrix” is evident.
It is still unclear as to why cheese does not necessarily result in elevated cholesterol, but there are several theories. One is that the composition of cheese, despite being high in fat, is more similar to yogurt than butter because of its protein, micronutrient and milk fat globule membrane content, which may modulate cholesterol and fat uptake (8). The high calcium content in cheese could also combine with the dairy fat to form insoluble soaps, resulting in reduced fat absorption in the gut.
The importance of the food source, particularly in terms of saturated fat, is clear when examining its relationship to health. We need to look beyond nutrients in isolation- continuing to examine how foods and dietary patterns relate to health will provide interesting insights.