This is the last night of Chanukah. While the holiday is associated with deep fried food such as potato latkes and jelly doughnuts (and in our home chille rellenos) it is also custom to eat dairy foods as part of the holiday celebrations. We do so in memory of the heroine Judith (Yehudit). For a people that honor feisty women, Yehudit, takes the cake.
Yehudit was a Jewish widow during the time of the Maccabeean uprising, who seduced and killed the Assyrian commander Holifernes, general of the Assyrian king Nebuchadnezzar, thus saving her city of Bethulia. The story goes that Judith fed the general salty cheese to make him thirsty and then offered him wine to slack his thirst, getting him so drunk that he fell asleep. Judith took the sword belonging to the sleeping Holifernes and decapitated him. When the Assyrian soldiers saw their general’s unattached head, they fled and the Jews were saved. 
[that last phrase, “and the Jews were saved” is a fairly common excuse for both a holiday and celebration with some sort of food.]
We might choose to contemplate the violence found within this story and how it might inform our nation’s recent experiences in the general geographical vicinity and with the cultures that would still honor such actions thousands of years later. We might also recall that we were once those on the other side of the balance of power. Instead let’s use this as an excuse to look at some current research on dairy foods, in particular whether they increase risk of cardiovascular disease in particular.
I’ve already mentioned the recent study that suggests that eating crème frache from an early age reduces risk of obesity.  This contradicts our generally held belief that dairy fat is bad for you. Thus I’ve started to watch for data that support or contradict this general assumption.
A paper published this past November from researchers at Harvard’s Feinberg School of Public Health, supports our general assumption, to a degree. The researchers compared food/nutrient intakes of people who were at low risk for cardiovascular disease against those who were not low risk based on standard predictors such as blood pressure, blood lipids and body mass index. To no one’s surprise those at lower risk for cardiovascular diseases ate more vegetable protein, fiber, magnesium, non-heme iron, potassium. They had lower total energy intake; lower intake of cholesterol, saturated fatty acids, animal protein and salt compared with individuals not at low risk. They ate more fruits, vegetables, grains, pasta/rice, fish and less meats, processed meats, high-fat dairy, and sugar-sweetened beverages than individuals not low risk. This certainly suggests that our general assumptions continue to hold true. 
Yet general data like this is easily misleading. These sorts of self-selected groups who choose to follow various eating patterns bring such a bias into the data that it is hard to sort out what is causing the effect. We can predict based on past data that those who were at lower risk for CVD in these cohorts were also better educated, richer, more likely to shop at Whole Foods, and a host of other attributes more reflective of social strata than what they ate. It’s part of the educated elite’s belief system that certain ways of eating are appropriate. Simply being wealthier is enough to decrease risk of CVD.
At this point we should acknowledge that the long-standing positions of the Price-Pottinger Foundation (http://www.ppnf.org/) often contradict our general culture’s basic assumptions about animal fat and heart disease. A number of our readers are strong adherents to the theories proposed and I do not wish them to think that I am discounting them, least I generate the usual angry rebuttals. This group favors what are termed “Traditional Diets,” which are patterns of food consumption that have been followed for long periods of time by groups of people before the advent of modern processed foods.
When it comes to fats, they suggest to, “use animal fats, lard and meat drippings, instead of vegetable fats.” And to, “Use butter, not substitutes.”  Not the common wisdom but an approach that in time may become more substantiated. Read on…..
An October 2011 review on the question of whether dairy products increase risk of cardiovascular disease suggests that the data are still unclear. In fact, “the evidence from prospective studies indicates that increased consumption of milk does not result in increased CVD risk and may give some long-term benefits…. Recent data suggest that the SFA [saturated fatty acids] in dairy products may be less of a risk factor than previously thought; although this is based on serum cholesterol responses which taken in isolation may be misleading…” 
An August 2011 report from Sweden is perhaps the most interesting.
[It seems that 2011 was the year for interesting things from Sweden. Not only did we have the Dragoon Tattoo books, but Ikea opened in Denver].
Writing in the European Journal of Epidemiology, Sonestedt et al, reported their analysis of data from the Malmo cohort looking for an association with dairy product consumption and incidence of cardiovascular disease. They compared dietary intake between 26,455 people without history of heart attacks, stroke or diabetes against 2,520 people who had either heart attacks or strokes. Overall, those who ate the most dairy products had a lower risk of cardiovascular disease, what is called an inverse relationship. Fermented milk products (yogurt and sourcream) had a statistically significant effect on their own. Those who consumed the most of these products had a 15% lower risk of heart attack or stroke than those who rarely consumed them. (95% CI: 5-24%; P 0.003). In women, cheese intake was associated with decreased CVD risk in women (P (trend) = 0.03), but not in men (P (trend) = 0.98). This study suggests that it is important to examine the type of dairy products when talking about their health effects. They don’t all have the same effect. 
A review in 2009 forewarned us that our assumptions about dairy might have been off. JB German and other food scientists from the University of California, Davis, writing in the European Journal of Nutrition, informed us it was time for a, “… reappraisal of the potential effects of dairy foods, including dairy fats, on cardiovascular (CVD)/coronary heart disease (CHD) risk.” While food manufacturers and public health recommendations are directed toward lowering saturated fats, this panel of experts concluded that there, “…is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce dairy food consumption irrespective of the nature of the dairy product should be made with caution.”
This information of course does not take into account that a decent percentage of our population is lactose intolerant. Those individuals should still be mindful of the lactose content of dairy products. It also doesn’t account for those that are allergic to dairy proteins or that certain milk products may serve as triggers for autoimmune reactions such as diabetes. This is a complicated subject and we are not going to attempt to cover all aspects in one day, especially a day when we are having dinner guests and I am supposed to be in the kitchen cooking.
Speaking of complexities, I must mention the music of our dear friend, Hal Aqua. Hal is among the most creative and multi-talented individuals I know. He is the graphic artist who designed our clinic logo two decades ago. He is also a musician. I had the pleasure of listening to Hal perform the other night, in particular a rendition of Bob Dylan’s classic song, “Homesick Blues” done in rap to klezmer music. http://halaqua.com/page2/files/page2_3.mp3
And people complain that the issues I write about are too complicated!
Coming back to the story of Yehudit, and her using cheese to increase the thirst of Holifernes, one must imagine that the cheese in question was perhaps what we now call labneh, a cheese made from salted yogurt. A nicely illustrated recipe can be found at: http://www.onetribegourmet.com/2010/10/labneh-a-homemade-yogurt-cheese-with-sumac-extra-virgin-olive-oil/
It should also be mentioned that the long assumed link between salt and high blood pressure has come into question of late. But that too shall wait for another day.
1. “Judith was left alone in the tent, with Holofernes stretched out on the bed, for he was overcome with wine (Judith 13,2)… She went up to the post at the end of the bed, above Holofernes’ head, and took down his sword that hung there. She came close to the bed and took hold of the hair of his head, and said: “Give me strength this day, O Lord God of Israel!” And she struck his neck twice with all her might, and severed his head from his body (Judith 13,6-8)… After a moment she went out and gave Holofernes’ head to her maid (Judith 13, 9)”.
2. Huus K, Brekke HK, Ludvigsson JF, Ludvigsson J. Relationship of food frequencies as reported by parents to overweight and obesity at 5 years. Acta Paediatr. 2009 Jan;98(1):139-43. Epub 2008 Sep 24.
3. Shay CM, Stamler J, Dyer AR, Brown IJ, Chan Q, Elliott P, et al. Nutrient and food intakes of middle-aged adults at low risk of cardiovascular disease: the international study of macro-/micronutrients and blood pressure (INTERMAP). Eur J Nutr. 2011 Nov 6. [Epub ahead of print]
5. Givens DI. Milk in the diet: good or bad for vascular disease? Proc Nutr Soc. 2011 Oct 17:1-7. [Epub ahead of print]
6. Sonestedt E, Wirfält E, Wallström P, Gullberg B, Orho-Melander M, Hedblad B. Dairy products and its association with incidence of cardiovascular disease: the Malmö diet and cancer cohort. Eur J Epidemiol. 2011 Aug;26(8):609-18. doi: 10.1007/s10654-011-9589-y. Epub 2011 Jun 10.
7. German JB, Gibson RA, Krauss RM, Nestel P, Lamarche B, van Staveren WA, Steijns JM, de Groot LC, Lock AL, Destaillats F. A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr. 2009 Jun;48(4):191-203. Epub 2009 Mar 4.