The Australian Dietary Guidelines recognise the importance of including milk, cheese and yoghurt in the diet and acknowledge that these foods can protect us against heart disease and stroke and can reduce our risk of high blood pressure.
Heart disease in Australia
One in six Australians has heart disease, which is the leading cause of death in Australia.1 Cardiovascular disease (CVD) is a term used to describe all diseases of the heart and blood vessels. Coronary heart disease (which includes heart attacks and angina) and stroke are common forms of CVD. In terms of lives lost and health spending, CVD is still considered to be Australia’s most costly disease.2
Risk factors for heart disease
There are a number of risk factors associated with developing CVD.3 Some risk factors such as increasing age, male gender and family history of premature CVD cannot be changed. Other risk factors which can be addressed include excess weight, physical inactivity, an unhealthy diet, smoking and excessive alcohol consumption.
High blood pressure (hypertension) and high blood cholesterol are two other major risk factors for CVD. It is estimated that one in three Australian adults has either hypertension (blood pressure ≥ 140/90mmHg)4 or high cholesterol (total blood cholesterol ≥5.5mmol/L).5 The good news is these risk factors can also be addressed through a healthy lifestyle.
Evidence for dairy and improved heart health
Dairy foods have long been known for their role in bone health but the Australian Dietary Guidelines also recognise the importance of including milk, cheese and yoghurt in the diet, particularly for reducing the risk of heart disease, stroke and hypertension.6 In a recently published meta-analysis, consumption of dairy foods was associated with a 12% reduced risk of CVD and 13% reduced risk of stroke.7 These findings were based on 22 studies with over 900,000 participants.
However, most Australians aren't consuming enough milk, cheese and yoghurt in their diet and are missing out on the health benefits. It is estimated that 9 out of 10 Australian adults need to increase their intake of dairy foods in order to achieve the levels recommended by the Australian Dietary Guidelines.8
Dairy linked to a reduced risk of hypertension
A number of studies have shown three daily serves of milk, cheese and yoghurt is linked to a reduced risk of hypertension. The DASH (Dietary Approaches to Stop Hypertension) diet is widely recommended for prevention and management of hypertension. This diet is characterised by a high intake of fruits and vegetables, is low in sodium and high in low-fat dairy. Evidence has shown consumption of the DASH diet is favourable for heart health, including CVD and stroke.9, 10, 11 While the DASH diet focuses on low or no-fat dairy, a new randomised controlled trial has also found similar reductions in blood pressure can occur with regular-fat dairy.12 These findings don’t just apply to adults. In a recent study of adolescents, it was found that consumption of both regular and reduced-fat dairy was significantly associated with reductions in blood pressure.13
The National Heart Foundation of Australia has also removed their restriction for healthy Australians on eating full-fat milk, cheese and yoghurt. Based on their review of the evidence, they concluded that this type of dairy had a neutral effect on heart disease risk and stroke.14
Cheese is not associated with increased cholesterol
The fat in dairy products has a reputation for being bad for heart health and cholesterol levels. This is why some health professionals recommend limiting dairy in the diet, particularly regular or higher-fat dairy, such as cheese. However, studies show that people who regularly consume milk, yoghurt and cheese (including regular-fat varieties) are more likely to have a reduced risk of heart disease than those who don’t. Danish researchers compared the effect of cheese and butter on cholesterol levels and found cheese did not increase low-density lipoprotein (LDL) or total cholesterol. In this study, participants ate about 140g of cheese a day, which is much higher than the Australian Dietary Guidelines serve recommendations.15 A more recent meta-analysis of randomised controlled trials also supported these findings – where consumption of hard cheese lowered total cholesterol by 5%, in comparison to butter.16
The dairy matrix and heart health
The exact reason the dairy food group can help to prevent and manage heart health is still being explored, however research suggests the unique combination of minerals and proteins in these foods play a major role. Milk, cheese and yoghurt contain several essential nutrients and bioactive substances (such as casein and whey) which may play a role in reducing risk of cardiovascular disease. For example, calcium and potassium particularly from dairy (as opposed to other sources) may be beneficial to those with high blood pressure. In addition, the high calcium content of cheese may increase faecal fat excretion, which may be favourable for cholesterol levels.17 It’s thought that dairy food components may act synergistically, meaning it is important to consider the entire food matrix as opposed to isolated nutrients.
Heart health resources
Hearth health white paper
Download the It's ok to recommend cheese white paper
1 The Heart Foundation. Cardiovascular disease fact sheet [Internet]. The Heart Foundation, Deakin Available from: http://heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/cardiovascular-disease-fact-sheet
2 Australian Institute of Health and Welfare. Cardiovascular disease: Australian facts 2011 [Internet]. 2011 [cited 2015 Feb 09]; Cardiovascular disease series no.35.Cat.no.CVD 53.Canberra:AIHW. Available from: http://www.aihw.gov.au/publication-detail/?id=10737418510
3 Australian Institute of Health and Welfare. Cardiovascular disease: Australian facts 2011 [Internet]. 2011 [cited 2015 Feb 09]; Cardiovascular disease series no.35.Cat.no.CVD 53.Canberra:AIHW. Available from: http://www.aihw.gov.au/publication-detail/?id=10737418510
4 Australian Bureau of Statistics [Internet]. Canberra: ABS;2013. Australian Health Survey: Health Service Usage and Health Related Actions, 2011-12. Hypertension. Cat 4364.0.55.002. [updated 2013 April 12; cited 2016 Feb 09] Available: http://www.abs.gov.au/ausstats/abs@.nsf/lookup/322DB1B539ACCC6CCA257B39000F316C?opendocument
5 Australian Bureau of Statistics [Internet]. Canberra: ABS;2013. Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12. Cholesterol. Cat 4364.0.55.005. [updated 2013 August 5; cited 2016 Feb 09]. Available: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4812278BC4B8FE1ECA257BBB001217A4?opendocument
6 National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013.
7 Qin LQ et al. Dairy consumption and risk of cardiovascular disease: an updated meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr. 2015;24:90-100.
8 Doidge JC, Segal L. Most Australians do not meet recommendations for dairy consumption: findings of a new technique to analyse nutrition surveys. Aust N Z J Pub Health. 2012;36(3):236-40.
9 Appel L, Moore T, Obarzanek E, Vollmer W, Svetkey L, Sacks F et al. A clinical trial of the effects of dietary patterns on blood pressure. New Engl J Med. 1997;336(16):1117-24.
10 Kris-Etherton PM et al. Milk products, dietary patterns and blood pressure management. J Am Coll Nutr. 2009;28(1):103S-19S.
11 Ralston RA, Lee JH, Truby H, et al. A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods. J Hum Hypertens. 2011;26:3–13.
12 Chiu S, Bergeron N, Williams P, Bray G, Sutherland B, Krauss R. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. Am J Clin Nutr. 2015;103(2):341-47.
13 O’Sullivan T, Bremner A, Mori T, Beilin L, Wilson C, Hafekost K et al. Regular fat and reduced fat dairy products show similar associations with markers of adolescent cardiometabolic health. Nutrients. 2016;8(1):22.
14 Heart Foundation (2019) Dairy and Heart Healthy Eating: Dietary Position Statement. NHFA: Melbourne.
15 Hjerpsted J, Leedo E, Tholstrup T. Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content. Am J Clin Nutr. 2011;94(6):1479-84.
16 de Goede J, Geleijnse J, Ding E, Soedamah-Muthu S. Effect of cheese consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2015;73(5):259-75.
17 Rice BH, Cifelli CJ, Pikosky MA, Miller GD. Dairy components and risk factors for cardiometabolic syndrome: recent evidence and opportunities for future research. Adv Nutr. 2011;2(5):396-407.