Does full fat cheese and cream protect from dementia?

8 minute read – Fact checked

There has been a lot of research and discussion throughout the years as to which foods and dietary patterns may protect, or increase the risk of dementia, which has divided opinions of scientists and nutritionist alike, as well as causing a lot of public confusion.

Now, a 25 year prospective study of twenty seven thousand participants published in the Neurology journal (1), appears to suggest that a higher intake of high-fat cheese & high-fat cream may be associated to lower risks of developing all-cause dementia, although the findings were not observed in participants carrying the Alzheimer’s gene, nor with low-fat cheese intakes.

How the study was conducted
The study included a total of 27,670 community-dwelling adults in Sweden who were free from dementia at baseline. They were middle-aged on average, with a mean age of about 58 years at the start of the study. Approximately 61 % were female. Participants were followed for a median of about 25 years to track the development of dementia. Over the follow-up period, 3,208 participants developed dementia. Dietary intake was assessed using food diaries and questionnaires about frequency of consumption of high-fat cheese, high-fat cream, and other dairy products. The researchers adjusted their analyses for important confounders including age, sex, education, and overall diet quality when investigating associations.

Key outcomes in a nutshell:
– High-fat cheese: Associated with lower risk of dementia (figure 1).
– High-fat cream: Also associated with lower risk (figure 1).
– No significant protective associations were found with other dairy types: low-fat milk, low-fat yogurt, butter, low-fat cheese (figure 1, 2).
– They specifically separated high-fat from low-fat products and different forms (e.g., cheese vs. cream vs. milk) to examine whether the fat content or dairy type mattered for cognitive outcomes.
– No associations observed in persons carrying the Alzheimer’s gene (figure 2)

Study strengths and limitations
Strengths
1) This study has several notable strengths, including its large sample size, prospective cohort design, and long follow-up period (~25 years), which strengthen the reliability of observed associations and reduce the likelihood of reverse causation. Dementia outcomes were identified using national health registers, improving diagnostic consistency, and analyses adjusted for multiple confounders such as age, sex, education, and lifestyle factors.

2) Another strength of the study were it’s sensitivity analyses (2), which tests whether the results hold up or change under different assumptions when the investigators:
– adjust for additional confounders
– exclude certain participants
– use alternative definitions or models
– account for missing data in different ways

3) Further, it was noted that when replacing 20 g/day of high-fat cheese intake with the equivalent amount of other foods, increased all-cause dementia risk was observed for milk, fermented milk, high-fat red meat, and processed meat. Increased all-cause dementia risk was observed for more foods when replacing high-fat cream, which appears to suggest high fat cheese / cream could in fact be protective.

4) The findings appear to be corroborated by a number of other published studies (1).

Limitations
1) However, there are important limitations in this study. As an observational study, it cannot establish causality, and residual confounding (e.g. socioeconomic status, unmeasured lifestyle or dietary patterns) may explain part of the associations.

2) Dietary intake was self-reported, potentially introducing recall and measurement bias (3), and diet was largely assessed at baseline, which may not reflect long-term dietary changes. Additionally, the findings come from a Swedish population, which may limit generalisability to other cultural or dietary contexts, especially as total dairy intake has shown a protective association with dementia in Asian populations, but not in European populations, which makes the findings of this study interesting as it involved a Swedish cohort.

3) Further, dairy products vary in processing methods and content (ie natural vs added sugar etc), food matrix (ie semi solid vs liquid), fat and nutrient content, which may differentially influence their purported health effect, and therefore the study outcomes.

4) Although sensitivity analyses can help strengthen confidence in the robustness of the findings, it is still limited by the observational nature of the study, which means that a causal relationship still cannot be conclusively established.

5) Although the findings may be also supported by a number of other studies in the literature, they are mostly observational in nature, and not all studies are in agreement (1).

Why could high fat cheese / cream be protective?
A plausible reason for the findings could be the high content of Vitamin K2 in cheese (4), although the K2 content varies by cheese variety and maturation. Recent research indicates that vitamin K2 may be vital for preserving brain health and cognitive function (4) as shown in figure 3.

Traditionally recognised primarily for its role in blood coagulation, vitamin K has emerged in recent years as a nutrient with diverse biological effects essential for healthy aging. A growing body of evidence from both observational and interventional studies underscores the pivotal role of vitamin K2 in mitigating arterial calcification by synthesising vitamin K-dependant proteins (5), and improve blood circulation, which may aid in the delivery of oxygen and nutrients to the brain (figure 4).

These mechanisms may potentially help link vascular health to cognitive function, and suggest that vitamin K2 could play a critical role in the prevention of cognitive impairment in aging populations by preserving the vasculature. However, full fat cream is not a considerable source of Vitamin K2, and so it may not fully explain these associations.

Cheese and cream are nevertheless high in saturated fats, which could influence cholesterol profiles and lipid metabolism, especially important as the brain is approximately 60% fat by dry weight, and 20% fats by weight (6). Phospholipids in dairy fats (e.g., phosphatidylcholine) may influence cell membranes and signalling in the brain, and some lipid classes have been linked to cognitive health in observational studies (7).

Phospholipids, cholesterol, and fatty acids, are essential for neuron membrane structure, myelin sheaths (insulation for nerve signals), cell signalling and synaptic function (8). Additionally, dairy fat contains vitamins that are better absorbed in the presence of dietary fat, vitamins such as vitamin D, E and K which have been studied for potential neuroprotective roles, though the evidence remains conflictive and inconclusive (9).

Caution warranted
However, irrespective of the findings of this study, it is not a justification to recommend consuming high fat cheese / cream, as these food groups, even Vitamin K2 or other fat soluble vitamins, could be contraindicated in a particular individual for several reasons, thus would require a personalised assessment and dietary approaches. It is in these areas where my strength lies as a Registered Nutritional Therapy practitioner.

Optimising brain health and reducing risks of Alzheimer’s disease
As part of my academic studies during my undergraduate research project for my honours degree, and my dissertation for my postgraduate Masters, I extensively researched the literature and developed plausibility and mechanistic understanding of the role of dietary strategies and types of fat on brain energy metabolism in Alzheimer’s disease, and the risk of developing Alzheimer’s disease from Mild Cognitive Impairment (MCI), especially in those carrying the Alzheimer’s gene.

There is certainly much more nuance that I can discuss and explain as to why the findings of the study may or may not relate to reduced to dementia risks, or whether they may be recommended or not at an individual level. These conversations I reserve for participants in my MCI and Alzheimer disease prevention programme.

Any middle aged adults (35-65yr old) who may have a family history of dementia or worried about developing dementia, and even older adults (65yrs+) with or without a dementia diagnosis, can sign up to my preventative and brain optimisation programme called BRAINCOG, which has several clients signed up and already having amazing positive effects on cognitive and memory, as well as improving quality of life. Learn more by visiting my BRAINCOG page where you can find a self-assessment memory tool to check your brain health.

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