Dairy - The Good, the Bad or The Ugly? Latest Studies On Heart Disease, Diabetes, Cancer, Obesity and Co. Plus: What Dairy Peptides Do For Your Heart, Gut, Brain, etc.

Do you take Liz Hurley's word and set all warnings about the "non-paleo-ness" of dairy in general and milk in particular at naught? Or do you put faith into the "got milk?" campaign? Personally, I'd suggest not to do one or the other. I'd rather suggest you join me and take a look at a selection of recent studies.

If you've been following the SuppVersity Facebook News and / or have read previous SuppVersity articles on milk and dairy, you will be aware that I am not exactly convinced that the mere existence of allergic reactions and the "fact" that "our ancestors did not drink milk before ..." *put your favorite guesstimate here* allows for the conclusion that we are "not meant" to consume cow's milk. I am nevertheless open to scientific arguments that would convince me that dairy is bad for me - it's just that I don't see this evidence outside of "western diet + dairy makes you fat and that makes you sick" contexts.

What I do see, though, are papers such as the one Sandra Abreu or the recent review by Flávia Galvão Cândido et al. - studies that tell us that the intake of milk is negatively associated with the clustering of cardiometabolic risk factors in adolescents (Abreu. 2013), and reviews which conclude that "the consumption of low-fat dairy products may be an important strategy to prevent and control T2DM [type 2 diabetes]" (Cândido. 2013).

The evidence that dairy is bad for us all is simply not there

But hey, ... let's tackle the evidence one by one. I mean, there is plenty of news-worthy material here and we don't want the fun to be over prematurely, do we? So, let's start with a brief sketch of what Sandra Abreu and her colleagues from the University of Porto base their assessment that the intake of milk, but not total dairy, yogurt, or cheese, is negatively associated with the clustering of cardiometabolic risk factors in Spanish adolescents - shall we?

No! Full-fat dairy is not bad for you: While most of the epidemiological studies with their hilariously unreliable food questionnaires appear to suggest that only low fat dairy was good for your heart, a recent study from the Harvard School of Public Health found a clever way to test the association more objectively. Instead of questioning their subjects, 2837 US adults aged 45 to 84 years, they tested the amount of certain phospholipids in their blood and found that "plasma phospholipid 15:0, a biomarker of dairy fat, was inversely associated with incident CVD [-19%] and CHD [-26%]." (de Oliveira Otto. 2013) The fact that other dairy related phospholipids were not associated (neither positive nor negative) with cardiovascular and coronary heart disease risk does yet, as the scientists rightly point out, warrant further investigation.

"To test th[e] hypothesis [that a higher dairy product intake is associated with lower cardiometabolic risk factor clustering in adolescents], a cross-sectional study was conducted with 494 adolescents aged 15 to 18 years from the Azorean Archipelago, Portugal. We measured fasting glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, body fat, and cardiorespiratory fitness. We also calculated homeostatic model assessment and total cholesterol/high-density lipoprotein cholesterol ratio. For each one of these variables, a z score was computed using age and sex. A cardiometabolic risk score (CMRS) was constructed by summing up the z scores of all individual risk factors. High risk was considered to exist when an individual had at least 1 SD from this score. Diet was evaluated using a food frequency questionnaire, and the intake of total dairy (included milk, yogurt, and cheese), milk, yogurt, and cheese was categorized as low (equal to or below the median of the total sample) or “appropriate” (above the median of the total sample). The association between dairy product intake and CMRS was evaluated using separate logistic regression, and the results were adjusted for confounders." (Abreu. 2013)

I know that sounds really sophisticated, but in the end, it's just standard procedure for cross-sectional studies like this - studies with one unfortunate downside: It's impossible to detect causal relationships. 

Figure 1: Dietary intake in the low and "adequate" dairy-, milk-, yogurt-intake groups (Abreu. 2013)

Keep that in mind, when you take a closer look at the data in Figure 2 which indicates that the average adolescent milk connoisseur of whom you can see in Figure 1 that he / she consumes significantly more energy on a daily basis has a significantly reduced cardiometabolic risk (predicted by cardiometabolic risk score; CMRS):

Figure 2: Cardiometabolic risk in "adequate" vs. low dairy, milk, yogurt and cheese consuming adolescents; adjusted for parental education , pubertal stage, low-energy reporter, energy intake, total fat , protein , and dietary fiber intake.

I personally was surprised to see a statistically significant protective effect only with milk - it's not that I had expected to see that for all forms of dairy, but based on previous studies I would have expected the fermented yogurt products to outperform conventional milk.

The negative effects of cheese on the other hand are by no means surprising. Food logs do after all include all types of "cheese" including the fake yellow vegetable oil based cheese analogues the kids shovel down with their pizzas, burgers and the rest of the fast food dirt. A high cheese intake has thus (unfortunately) become an indicator of low diet quality and the results of the study at hand hardly a credible marker that cheese is bad for you.

If 95% of your "dairy intake" comes from pizza, you are unlikely to see...

... any of the following benefits of dairy peptides, Blanca Hernández-Ledesma, María José García-Nebot, Samuel Fernández-Tomé, Lourdes Amigo, and Isidra Recio summarized in a soon-to-be-published review in the peer-reviewed scientific journal International Dairy Science:

• 

  Figure 3: Reduction of systolic blood pressure in mmHg per mg/kg of the said peptide you consume - mind the logarithmic scale(!); data calculated based on rodent studies summarized in Hernández-Ledesma (2014)

  Cardiovascular health effects due to the antihypertensive, anti-inflammatory, general antioxidant and hypocholesterolaemic properties of various dairy peptides
• Intestinal health effects due to the ability of dairy peptides to modulate and regenerate the gut mucosa, increase mineral absorption, exert local anti-inflammatory effects at the gastrointestinal level
• Antidiabesity effects that are related to both direct pro-insulinogenic effects of dairy peptides ant their ability to increase satiety. 
• Central nervous system relaxant and antinociceptive (pain-killing) effects
• Immune health which is promoted by antimicrobial and immunomodulatory peptides that are either already present in dairy or arise during the digestion process
• Anticancer effects that are mediated by the overall anti-inflammatory properties of certain dairy peptides, as well as direct anti-proliferative effects of dairy

Now, it goes without saying that you won't see the same effect from eating some goat kefir as Miguel et al. (2010) observed it, when they administered fraction 58-68 of goat casein to their lab rodents, but the data in Figure 3 can explain the well-established blood pressure lowering effects of dairy in general and the whey and casein induced BP reduction Figueroa et al. observed only recently in a study with obese women (Figueroa. 2013; see SuppVersity Facebook News).

Bottom line: You can't expect dairy to fully protect you against diabesity, cancer and a leaky, you can't expect it to lean you out in days, and you can't expect it to build muscle overnight, but you can expect general health benefits not detriments from incorporating a variety of fermented and unfermented dairy products into your diet - as long as you ain't lactose intolerant.

"Are Camels the Better Cows? Cancer, CVD, Allergies,Infections & More - Camel Milk Prevents or Fixes All These Ailments" | more

One thing you should keep in mind, though, is the unfortunate fact that the amount of "non-dairy" cheese, cream and other products is increasing by the day. Especially the former, the fake yellow vegetable oil based cheese analogues is something you want to avoid. The same goes for many of low fat products. While much of the "magic" is in the peptides, most of the commercially available "diet" products contain tons of sugar and all sorts of questionable additive to make up for the loss of color, taste and texture that's brought about by the removal of the fat. And lastly all products that extend the shelf-life to "eternity" by adding questionable preservatives.

References

• Abreu, S., Moreira, P., Moreira, C., Mota, J., Moreira-Silva, I., Santos, P. C., & Santos, R. (2013). Intake of milk, but not total dairy, yogurt, or cheese, is negatively associated with the clustering of cardiometabolic risk factors in adolescents. Nutrition Research.
• Cândido, F.G., Ton, T. S., & Alfenas, R. D. C. G. (2013). Dairy products consumption versus type 2 diabetes prevention and treatment; a review of recent findings from human studies. Nutr Hosp, 28(5), 1384-1395.
• de Oliveira Otto, M. C., Nettleton, J. A., Lemaitre, R. N., Steffen, L. M., Kromhout, D., Rich, S. S., ... & Mozaffarian, D. (2013). Biomarkers of dairy fatty acids and risk of cardiovascular disease in the multi‐ethnic study of atherosclerosis. Journal of the American Heart Association, 2(4), e000092.
• Figueroa, A., Wong, A., Kinsey, A., Kalfon, R., Eddy, W., & Ormsbee, M. J. (2013). Effects of Milk Proteins and Combined Exercise Training on Aortic Hemodynamics and Arterial Stiffness in Young Obese Women With High Blood Pressure. American Journal of Hypertension, hpt224. 
• Freedman, B. J. (1980). Sulphur dioxide in foods and beverages: its use as a preservative and its effect on asthma. British Journal of Diseases of the Chest, 74, 128-134.
• Hernández-Ledesma, B., García-Nebot, M.J., Fernández-Tomé, S., Amigo, L.,
  Recio, I., Dairy protein hydrolysates: Peptides for health benefits, International Dairy Journal(2014), ahead of print
• Iammarino, M., Di Taranto, A., Palermo, C., & Muscarella, M. (2011). Survey of benzoic acid in cheeses: contribution to the estimation of an admissible maximum limit. Food Additives and Contaminants: Part B, 4(4), 231-237.

Are Camels the Better Cows? Cancer, Heart Disease, High LDL and Triglycerides, Diabetes, High Blood Pressure, Allergies, Viral and Bacterial Infections and Trace Mineral Deficiencies, Camel Milk Prevents or Fixes Them All!

Image 1: To the average inhabitant of the Western hemisphere camels are probably not the most beautiful animals under the sun; but hey, cows aren't either, hah?

When muscle-heads think of dairy, they think of whey, they think of casein, they think of cottage cheese... but I bet few of them will think of camels! Even if you just went by the mere amino acid composition (see. figure 2 at the end of the article), of which you, as an educated SuppVersity student should by now be aware that it does not give you the 'whole picture', as far as the biological effects of a given protein and peptide containing foodstuff is concerned, it appears that camel milk would at least make an excellent alternative for cows milk, in case global warming is progressing and Europe and the US turn into desert wastelands... but all jokes aside, muscle is not everything and I bet that after reading this article you will be interested to register for the US' first official camel milking seminar *rofl*

7+1 reasons you may want to slaughter your grass fed cows and replace them with camels

While the idea of drinking the milk of an ugly desert ship may appear hilarious at first, I guess my compilation of purported and scientifically established benefits of camels milk will have you reconsider if the Sheikh Hamdan bin Mohammed bin Rashed Al-Maktoum, Crown Prince of Dubai, may not have made a very good investment, when he spent $16.5 million dirham ($4.5 million USD) on the winner of a 2008 beauty pageant in the United Arab Emirates’ capital city of Abu Dhabi (FYI, the guy in image 1 is not the Sheikh, just tom make sure I don't get sued, here ;-):

Image 2 (DrCate.com): Homogenization makes milk more convenient, but it disrupts the natural structure of the fat globules and releases the otherwise bound xanthine oxidase of which scientists hypothesized that it could trigger heart disease, a hypothesis, btw., that was not disproven, but simply kept quiet for the past 25+ years (Deeth. 1983)

• Little to no xanthine oxidase (=reductase) - While the idea that XOR (xanthine oxidoreductase), which is supposedly released during homogenization of bovine milk, could be a potential contributor to overall inflammation and cardiovascular disease has disappeared from the 'scientific radar' within the past couple of years (cf. Deeth. 1983; Berry. 2004) , it may still be of interest (and for certain populations such as people with increased gut permeability even of great importance) that camel milk apparently contains little to no xanthine oxidase - irrespective of whether you drink it raw, pasteurized or homogenized (Baghiani. 2003).
• Anticancer effects - Camels milk has been shown to trigger apoptosis (controlled cell death) in human breast cancer and liver cancer cells via epigenetic mechanisms (Korashi. Feb 2012; Korashi. May 2012).
• Antibacterial & antiviral effects -Camel milk prevents gram positive bacteria from growing and reduces the amounts and activity of gram-negative cultures (el Agamy. 1992). With the latter being among the primary drivers of lipopolysaccharide (LPS) and endotoxin induced inflammation (Ulevitch. 1999), camel milk could thus help to reduce local and systemic inflammation. Aside from its activity against rotavirus, the lactoferrin faction from camel milk appears to have protective effects against hepatitis C, as well (Redwan. 2007).
• Camel milk whole- & beta-caseins act as natural anti-oxidants and ACE-inhibitors - As Salami et al have shown the whole casein and beta-casein (β-CN) faction(s) of camel milk exert Angiotensin Converting Enzyme (ACE)-inhibitory (=blood pressure reducing) and antioxidant activity after they were hydrolyzed in the stomach (Salami. 2011). In a previous study, the same researchers had already determined that the whey fraction of camel milk exhibits significant anti-oxidant and antimicrobial activities, as well, and that those were up to 100% greater (depending on the essay and fraction the scientists used) than those of bovine whey protein (Salami. 2010).



Figure 1: A certain part of the population in Rajasthan (India) who consumes camel milk on a daily basis has been found to have a significantly reduced incidence of diabetes (not a single one!), impaired fasting glucose (-6%/-11%) and impaired glucose tolerance (-10%/-10%) than both non-camel milk drinking parts of the Raica community or other non-camel milk drinkers from the same region (based on Agrawal. 2007)

• Profound and long-lasting anti-diabetic effects - Camel milk has a long history of being used to tread type 1 diabetes in the Middle East (see figure 1; cf. Mohamad. 2009). Studies from animal models (dogs, Sbou. 2010) and humans (Agrawal. 2009; Mohamad. 2009) improved blood glucose, microalbumenia and secondary symptoms such as diabetic neuropathy. Probably also as a consequence of the small, but biologically active natural insulin content of camels milk (Malik .2012), the type 1 diabetics in a 2009 study by Agrawal could even reduce their insulin medication by 32% from 41µ/day to 28µ/day. In the 2-year follow up, the researchers report that "out of 12 subjects receiving camel milk, insulin requirement in 3 subjects reduced to zero" (Agrawal. 2011) - try that with metformin, let alone some of the other 'diabetes prolongation drugs'.
• Improved lipid metabolism - The 24 type one diabetics who consumed 500ml of plain camel milk per day for 6 months in the aforementioned 2009 study by Agrawal et al. for example exhibited -30% decreases in LDL and -66% decrease in triglycerides.
• Camel milk is an extraordinary good source of trace minerals - According to Al-Awidi et al. Camel milk contains 7-20x and 1-10x higher levels of manganese and iron than human milk, more zinc and comparable amounts of selenium, copper and other protein bound and thus highly bioavailable trace minerals (Al-Awadi. 2001).

And best of all, based on studies on people with cow's milk allergy, we know that the incidence of allergic reactions to camel milk is not only much lower, but also that 80% of cow's milk allergy sufferers can actually ingest camel milk without any unwanted side-effects (Cardoso. 2010; Ehlayel. 2011).

Figure 2: Even if you go solely by the amino acid composition (here expressed relative to the total amino acids), camel milk protein could be a valid replacement for bovine proteins (data based on Davis. 1994 & Beg. 1987)

This is also worth mentioning, because the host of great effects I listed above do - at least in parts - also occur with the unwarrantedly vilified bovine (=cow's) milk, which also contains ACE precursors (Saito. 2008), exert anti-cancer effects (Gill. 2000), and so much more (see "suggested readings" at the end of this article).

So, in the unfortunate case that you "ain't got no camel handy" at the moment and, due to "the current economy" (I hate when people say that) lack the $1300 to $1700 (Debacle. 2006) to buy your own, obviously not  pageant winning $16.5 million dirham camel, and tolerate bovine milk, just stick to the milk of the farmer you trust. After all, even if Camels were the better cows, you better have a gallon of cows milk in the fridge than a camel in the Arabian desert, right? Ah, wait that was a bird in the hand, right? ... ah, whatever ;-)

Suggested readings:

• Ask Dr. Andro: Are Colostrum and Milk Products in General Healthy Muscle Builders, a Waste of Money or Toxic Waste?
• Childhood Asthma: Children Born to Mothers Who Consume Semi-Skimmed Milk 8% More Likely, Kids of Whole Milk Drinking Mothers 15% Less Likely to Develop Asthma
• The Fat Truth Behind the Dairy Weight Loss Miracle: MUFA and PUFA Impair, Saturated Fat and Plenty of Micronutrients Drive Full-Fat Dairy-Powered Fat Loss.
• Higher Calcium Intake Greater Fatty Acid Oxidation!? True: Chronic & Acute Effect Size Comparable to Caffeine
• Read all about milk here at the SuppVersity

References:

1. Agrawal RP, Budania S, Sharma P, Gupta R, Kochar DK, Panwar RB, Sahani MS. Zero prevalence of diabetes in camel milk consuming Raica community of north-west Rajasthan, India. Diabetes Res Clin Pract. 2007 May;76(2):290-6.
2. Agrawal RP, Dogra R, Mohta N, Tiwari R, Singhal S, Sultania S. Beneficial effect of camel milk in diabetic nephropathy. Acta Biomed. 2009 Aug;80(2):131-4. 
3. Agrawal RP, Jain S, Shah S, Chopra A, Agarwal V. Effect of camel milk on glycemic control and insulin requirement in patients with type 1 diabetes: 2-years randomized controlled trial. Eur J Clin Nutr. 2011 Sep;65(9):1048-52. doi: 10.1038/ejcn.2011.98. Epub 2011 Jun 1.
4. Al-Awadi FM, Srikumar TS. Trace elements and their distribution in protein fractions of camel milk in comparison to other commonly consumed milks. J Dairy Res. 2001 Aug;68(3):463-9.
5. Baghiani A, Harrison R, Benboubetra M. Purification and partial characterisation of camel milk xanthine oxidoreductase. Arch Physiol Biochem. 2003 Dec;111(5):407-14.
6. Beg OU, von Bahr-Lindström H, Zaidi ZH, Jörnvall H. Characterization of a heterogeneous camel milk whey non-casein protein. FEBS Lett. 1987 Jun 1;216(2):270-4.
7. Berry CE, Hare JM. Xanthine oxidoreductase and cardiovascular disease: molecular mechanisms and pathophysiological implications. J Physiol. 2004 Mar 16;555(Pt 3):589-606.
8. Cardoso RR, Santos RM, Cardoso CR, Carvalho MO. Consumption of camel's milk by patients intolerant to lactose. A preliminary study. Rev Alerg Mex. 2010 Jan-Feb;57(1):26-32.
9. Davis TA, Nguyen HV, Garcia-Bravo R, Fiorotto ML, Jackson EM, Lewis DS, Lee DR, Reeds PJ. Amino acid composition of human milk is not unique. J Nutr. 1994 Jul;124(7):1126-32.
10. Deeth HC. Homogenized milk and atherosclerotic disease: a review. J Dairy Sci. 1983 Jul;66(7):1419-35.
11. Gill HS, Cross ML. Anticancer properties of bovine milk. Br J Nutr. 2000 Nov;84 Suppl 1:S161-6. Review.
12. Ehlayel MS, Hazeima KA, Al-Mesaifri F, Bener A. Camel milk: an alternative for cow's milk allergy in children. Allergy Asthma Proc. 2011 May-Jun;32(3):255-8.
13. el Agamy EI, Ruppanner R, Ismail A, Champagne CP, Assaf R. Antibacterial and antiviral activity of camel milk protective proteins. J Dairy Res. 1992 May;59(2):169-75. 
14. Gill HS, Cross ML. Anticancer properties of bovine milk. Br J Nutr. 2000 Nov;84 Suppl 1:S161-6. Review.
15. Korashy HM, El Gendy MA, Alhaider AA, El-Kadi AO. Camel milk modulates the expression of aryl hydrocarbon receptor-regulated genes, Cyp1a1, Nqo1, and Gsta1, in murine hepatoma Hepa 1c1c7 cells. J Biomed Biotechnol. 2012;2012:782642. Epub 2012 Feb 27.
16. Korashy HM, Maayah ZH, Abd-Allah AR, El-Kadi AO, Alhaider AA. Camel Milk Triggers Apoptotic Signaling Pathways in Human Hepatoma HepG2 and Breast Cancer MCF7 Cell Lines through Transcriptional Mechanism. J Biomed Biotechnol. 2012;2012:593195. Epub 2012 May 13.
17. Debacle J. Long or Short Capital. Camels, The Next Big Thing. August 1, 2006. < http://longorshortcapital.com/camels-the-next-big-thing.htm > received on July 13, 2012
18. Malik A, Al-Senaidy A, Skrzypczak-Jankun E, Jankun J. A study of the anti-diabetic agents of camel milk. Int J Mol Med. 2012 Sep;30(3):585-92.
19. Mohamad RH, Zekry ZK, Al-Mehdar HA, Salama O, El-Shaieb SE, El-Basmy AA, Al-said MG, Sharawy SM. Camel milk as an adjuvant therapy for the treatment of type 1 diabetes: verification of a traditional ethnomedical practice. J Med Food. 2009 Apr;12(2):461-5.
20. Salami M, Moosavi-Movahedi AA, Ehsani MR, Yousefi R, Haertlé T, Chobert JM, Razavi SH, Henrich R, Balalaie S, Ebadi SA, Pourtakdoost S, Niasari-Naslaji A. Improvement of the antimicrobial and antioxidant activities of camel and bovine whey proteins by limited proteolysis. J Agric Food Chem. 2010 Mar 24;58(6):3297-302.
21. Salami M, Moosavi-Movahedi AA, Moosavi-Movahedi F, Ehsani MR, Yousefi R, Farhadi M, Niasari-Naslaji A, Saboury AA, Chobert JM, Haertlé T. Biological activity of camel milk casein following enzymatic digestion. J Dairy Res. 2011 Nov;78(4):471-8.
22. Redwan el-RM, Tabll A. Camel lactoferrin markedly inhibits hepatitis C virus genotype 4 infection of human peripheral blood leukocytes. J Immunoassay Immunochem. 2007;28(3):267-77.
23. Saito T. Antihypertensive peptides derived from bovine casein and whey proteins. Adv Exp Med Biol. 2008;606:295-317. Review.
24. Sboui A, Khorchani T, Djegham M, Agrebi A, Elhatmi H, Belhadj O. Anti-diabetic effect of camel milk in alloxan-induced diabetic dogs: a dose-response experiment. J Anim Physiol Anim Nutr (Berl). 2010 Aug 1;94(4):540-6.
25. Ulevitch RJ, Tobias PS. Recognition of gram-negative bacteria and endotoxin by the innate immune system. Curr Opin Immunol. 1999 Feb;11(1):19-22.