Whole-Fat Dairy Part of Heart Healthy Diet: Study

Global study shows PURE diet guards against heart disease and death, but critics say the evidence is scientifically weak

Mediterranean diet foods, which share overlap with PURE diet foods. Shutterstock

A new study suggests that the PURE diet promotes heart health and a longer life—and that life includes whole-fat dairy.

PURE, which stands for Prospective Urban Rural Epidemiology, focuses on six food categories: fruits, vegetables, nuts, legumes, fish, and whole-fat dairy. Higher intake of these food types equates to a higher PURE diet score, which ranges from zero to six.

In an observational study across 80 countries including more than 145,000 people, a team of international researchers found that a PURE diet score of five or higher consistently correlated with lower cardiovascular disease (CVD) and mortality rates. Additions of modest amounts of whole grains or unprocessed meats didn’t affect health outcomes.

Story continues below advertisement

While the PURE diet is similar to existing score-based diets, its global applicability is unique. Some doctors caution, however, that observational dietary studies have limited value.

The Study

The study was published in the European Heart Journal in June.

Some 21 percent of participants were from high-income, 60 percent from middle-income, and 19 percent from low-income countries, which was representative of the global wealth distribution at the midpoint of participant recruitment (2008).

Participants’ health outcomes were assessed after a median of 9.3 years. The mean PURE diet score was 2.95, with individuals from wealthier countries tending to score higher. North America, Europe, the Middle East, and South America achieved higher median scores, while South and Southeast Asia, China, and Africa fared worse.

Comparative analysis showed that the PURE score is slightly better at predicting all measured health outcomes (CVD, myocardial infarction, stroke, and all-cause mortality) than the Mediterranean, 2010 and 2015 Healthy Eating Index, and DASH (dietary approaches to stop hypertension) diet scores, and far superior in predicting these than the EAT-Lancet Commission’s planetary health diet.

The study offers new insight into the idea that heart disease risk may depend as much on eating too few high-quality, nutrient-dense foods as eating too many high-calorie, low-quality processed foods known to contribute to heart disease. This is important, given regional differences in diet.

Story continues below advertisement

“The current recommendations of what people should eat to prevent cardiovascular disease are largely based on studies initiated in high-income countries, or Western countries, like the United States and Europe, with limited information on what people eat in other parts of the world,” lead author Dr. Andrew Mente told The Epoch Times. “So it’s not known whether the conclusions that are derived from diets in Western countries are applicable to low- and middle-income countries.”

Dr. Mente, an epidemiologist at McMaster University in Ontario, Canada, noted that the study challenges current dietary recommendations to restrict whole-fat dairy. He and his colleagues published a 2018 study in The Lancet demonstrating that consuming whole-fat milk, yogurt, and cheese is associated with lowered CVD and mortality.

A Cardiologist’s Perspective

Dr. Steven Nissen, a cardiologist at Cleveland Clinic, told The Epoch Times that the PURE diet study’s findings should be handled with caution. He explained that observational dietary studies tend to be inaccurate because data is gathered based on participants’ memory of trivial events. He said it’s hard for people to remember what they ate for dinner last Wednesday, much less so how much dairy or fish they ate in the past year.

A prospective, randomized clinical trial comparing participants who followed the PURE diet to ones who didn’t would strengthen the PURE diet score’s credibility, according to Dr. Nissen.

The Mediterranean diet, which is similar to the PURE diet but limits dairy, is backed by one such study.

Story continues below advertisement

Conducted in Spain, the PREDIMED study compared cardiovascular health outcomes for participants who followed one of three diets: the Mediterranean diet supplemented with olive oil, the same diet supplemented instead with nuts, and a control (low-fat) diet. The risk of developing cardiovascular disease was approximately 30 percent lower overall in the Mediterranean diet groups compared to the control group.

Achieving a Heart-Healthy Diet

Dr. Mente said eating a balanced diet is the best way to achieve a heart-healthy diet. He stressed that the PURE diet is balanced, with only 27 percent of total energy coming from fats. Within the PURE diet’s food categories, he highlighted eating a variety of fruits and vegetables of differing colors and eating fatty fish.

Dr. Nissen recommends the Mediterranean diet to his patients at Cleveland Clinic.

“It has lots of fruits and vegetables, whole grains, more fish as a source of protein than meat or chicken, and uses olive oil in cooking and in salads,” he said.

Red meat is fine in moderation, but it isn’t necessary to ensure heart health.