Live yogurt cultures have properties that improve digestion of lactose.
Lactose maldigestion is common in adults
Lactose is a natural sugar found in milk and other dairy products. It can be broken down in the small intestine by the enzyme lactase into glucose and galactose, two simpler sugars that are readily absorbed into the bloodstream.
After weaning, our ability to digest lactose declines because we produce less lactase. Difficulty in digesting lactose due to this normal reduction in lactase production/activity is known as lactose maldigestion.
Undigested lactose reaching the colon is broken down by the resident microbiota, resulting in the production of short-chain fatty acids (SCFAs) and gases. In most people, this maldigestion produces no noticeable symptoms.
When lactose maldigestion gives rise to symptoms such as bloating, cramps, diarrhoea, and flatulence, this is called lactose intolerance.
People with lactose intolerance may eat moderate amounts of dairy products without experiencing significant symptoms
Dairy products are widely recognised as an important part of a healthy diet as they are a source of several nutrients. Dairy products are particularly important for providing calcium, for which it is difficult to achieve the recommended daily intake from a dairy-free diet without supplements.
It is therefore important that dairy products are part of everyone’s diet, including people with lactose maldigestion or intolerance.
People with lactose intolerance or lactose maldigestion can generally tolerate up to 12 g (~0.4 ounces) of lactose (equivalent to about one glass of milk or 240 g/~8 ounces of natural yogurt), particularly when consumed as part of a meal, with no or minor symptoms. There is some evidence that a daily intake of 24 g (~0.8 ounces) of lactose can be tolerated if it is distributed throughout the day and consumed with other foods.
Since dairy products vary in the amount of lactose they contain, the amount of lactose ingested depends upon the type and quantity of dairy products consumed. In particular, a reduced level of lactose is found in yogurt containing the two active bacterial cultures L. delbrueckii subsp. bulgaricus and S. thermophilus.
Yogurt may improve lactose digestion
The live bacteria L. delbrueckii subsp. bulgaricus and S. thermophilus produce lactase which breaks down some of the lactose in yogurt.
The bacteria survive their passage through the gut and the bacterial lactase helps further with digestion of lactose in the small intestine.
Unlike milk, yogurt’s semi-solid state benefits lactose digestion by slowing transit through the gut.
Several studies show that yogurt with live active cultures may significantly enhance lactose digestion and reduce symptoms of intolerance in people with lactose maldigestion.
“Yogurt consumption is recommended by health authorities as part of a healthy balanced diet, even for people with lactose maldigestion or intolerance. In fact, yogurt containing live active cultures may improve lactose digestion and reduce symptoms of intolerance in people with lactose maldigestion.”
Professor Bob Hutkins
Yogurt is recommended by health authorities for people with lactose maldigestion
The European Food Safety Authority (EFSA) has approved the claim that yogurt improves digestion of lactose.
The EFSA’s conclusions were based on 13 studies showing that consumption of live cultures in yogurt improved digestion of lactose in yogurt among people with lactose maldigestion.
To qualify for this claim, yogurt must contain at least 108 CFU live starter bacteria (L. bulgaricus and S. thermophilus) per gram of yogurt, and therefore fresh yogurt is best. Ultra-high temperature (UHT) yogurt or yogurt labelled ‘long-life’ has been heat-treated and this process kills the beneficial bacteria.
Several medical organisations recommend that people with lactose maldigestion – including those with lactose intolerance – consume yogurt as part of a balanced diet.
“The live bacteria in yogurt survive passage through the gut. The lactase they produce breaks down some of the lactose in yogurt and this allows people suffering from lactose maldigestion/ intolerance to gain the nutritional benefits of yogurt and of other dairy products as well.”
Rozenberg S, Body JJ, Bruyère O, et al. Effects of dairy products consumption on health: Benefits and beliefs – a commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int. 2016;98:1–17.
Saviano DA, Hutkins RW. Yogurt, cultured fermented milk, and health: a systematic review. Nutr Rev. 2021;79:599–614.
Suchy FJ, Brannon PM, Carpenter TO, et al. NIH Consensus Development Conference Statement: lactose intolerance and health. NIH Consens State Sci Statements. 2010;27:1–27.
Muehlhoff E, Bennett A, McMahon D. Milk and dairy products in human nutrition. Food and Agriculture Organization of the United Nations. 2013.
EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on the substantiation of health claims related to live yoghurt cultures and improved lactose digestion (ID 1143, 2976) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal. 2010;8:1763.
EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific Opinion on lactose thresholds in lactose intolerance and galactosaemia. ESFA Journal. 2010;8:1777.
Lukito W, Malik SG, Surono IS, et al. From ‘lactose intolerance’ to ‘lactose nutrition’. Asia Pac J Clin Nutr. 2015;24(Suppl 1):S1–8.
Casellas F, Aparici A, Casaus M, et al. Subjective perception of lactose intolerance does not always indicate lactose malabsorption. Clin Gastroenterol Hepatol. 2010;8:581–6.
Wilt TJ, Shaukat A, Shamliyan T, et al. Lactose intolerance and health. Evid Rep Technol Assess (Full Rep). 2010;(192):1–410.
Savaiano DA. Lactose digestion from yogurt: mechanism and relevance. Am J Clin Nutr. 2014;99(5 Suppl):1251S–5S.
Bailey RK, Fileti CP, Keith J, et al. Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement. J Natl Med Assoc. 2013;105:112–27.
Masoumi SJ, Mehrabani D, Saberifiroozi M, et al. The effect of yogurt fortified with Lactobacillus acidophilus and Bifidobacterium sp. probiotic in patients with lactose intolerance. Food Sci Nutr. 2021;9:1704–11.
Ibrahim SA, Gyawali R, Awaisheh SS, et al. Fermented foods and probiotics: An approach to lactose intolerance. J Dairy Res. 2021;88:357–65.
Morelli L, Amrani N, Goulet O, et al. Lactose intolerance: clinical symptoms, diagnosis and treatment. Global Diabetes Open Access Journal. 2019;1:1–10.
Kok CR, Hutkins R. Yogurt and other fermented foods as sources of health-promoting bacteria. Nutr Rev. 2018;76(Suppl 1):4–15.
YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
Nausea, abdominal pain, diarrhoea, bloating; lactose intolerance is certainly no bundle of fun for those who suffer from it. If you’re one of them, you may well go to great lengths to keep the symptoms at bay by avoiding milk and dairy products.
But having these symptoms of lactose malabsorption or intolerance doesn’t necessarily mean you have to totally give up the dairy foods, scientists say. In fact, the symptoms are often confused for other conditions. And cutting out dairy, a vital source of nutrients from your diet, could leave you more vulnerable to long-term disease – especially if you’re an older person (1).
What causes lactose intolerance?
Most people are born with an ability to absorb and digest lactose, a sugar found naturally in milk. To do this, babies have a plentiful supply in their gut of the enzyme lactase, which breaks down lactose into glucose and galactose. But after weaning, most of us are genetically programmed to become deficient in lactase, reducing our ability to absorb lactose. Hence, it’s normal to have lactose malabsorption.
As a result, more undigested lactose passes into the large intestine, where it may cause symptoms for some people. About one in three people with this lactase deficiency develop symptoms of lactose intolerance.
The terms ‘lactose malabsorption’ and ‘lactose intolerance’ are commonly muddled, even among doctors – with the result that studies of lactose intolerance can be misinterpreted.
Why is getting the diagnosis right so important for older people?
Until now, the common way of managing symptoms of lactose intolerance has been to cut out milk and dairy products from their diet.
But experts are calling this approach into question as dairy products are such an important source of nutrients that can’t always be obtained from other foods. This is particularly important for older people, for whom nutrients found in dairy products are essential for helping to keep us from becoming frail as we age.
According to a group of researchers who have reviewed the science, a large body of evidence has also linked dairy intake to the prevention of other long-term conditions in the elderly, such as heart disease (2-4). So restricting dairy product intake in older people can be harmful and should be the last resort when it comes to treating gastrointestinal symptoms, say the researchers.
This is all the more so because symptoms of lactose intolerance may overlap with other gut diseases that are common among older people, such as irritable bowel syndrome (IBS). Anxiety can also hamper the diagnosis, perhaps increasing the risk of symptoms after eating a food containing lactose. Anxiety arising from the fear that eating certain foods will trigger the symptoms can cause some people to restrict their food intake, leading to malnutrition.
That’s why, if you think you have lactose intolerance, a clinician should always take a careful medical history to assess symptoms and guide the correct diagnosis, the researchers stress. Lactose malabsorption should be at the bottom of the list of suspects, and treatment for IBS and other common conditions should be tried first, the researchers believe.
‘… a close temporal relationship between the ingestion of milk and dairy products and the onset of symptoms may suggest actual lactose intolerance.’ – Gallo A, et al. 2023
How should older people with lactose intolerance be treated?
The researchers advise that after the diagnosis has been made, treatment should start with a temporary avoidance of milk and dairy products so that the symptoms go away. Dairy products should then be gradually re-introduced to ensure you get sufficient nutrient intake.
To raise the threshold dose at which the symptoms are brought on, you may be advised to drink milk together with other foods, distribute the daily milk amount in small meals, or add a product containing lactase enzyme to milk at mealtime (5).
In studies, most people with lactose malabsorption found that their symptoms didn’t worsen after small doses of lactose (12-15 g/day, about 240 ml of milk).
Yogurt contains the enzyme lactase, produced by the bacteria used to make it, and which helps to digest the lactose contained in the product (6).
Why it’s important for older people to consume dairy products
Milk and dairy products are a vital source of several nutrients, and their consumption has been associated with multiple benefits for older people:
Bones: Dairy products are rich in calcium and protein, which are essential for building and maintaining healthy bones. Cutting down on dairy product consumption due to lactose intolerance is particularly concerning among older people because of their risk of osteoporosis and bone fractures. A greater consumption of dairy products by older adults has been associated with a lower risk of loss of muscle mass and strength that occurs as we age. (7)
Heart and blood vessels: Studies have shown that people who consume the most milk and dairy products have the lowest rate of cardiovascular disease (CVD) and lowest risk of type 2 diabetes. (2-4) Dairy products may play a role in maintaining a healthy blood pressure because of their calcium content.
Colorectal cancer: Dairy product intake has been associated with a reduced risk of developing colorectal cancer; this could be due to its calcium and vitamin D content, regulators of cell growth. (8,9)
‘The approach to lactose malabsorption in older adults deserves careful considerations, starting from an accurate collection of medical history to avoid potentially misleading diagnostic tests. All confounding factors, including the psychological domain, should be thoroughly investigated to devise the best intervention strategy and limit dietary restriction to selected cases.’ – Gallo A, et al. 2023
Each month, we’ll share with you the key data about one specific nutrient. For this first edition, let’s focus on dairy proteins. Proteins constitute a diverse family of compounds with both functional and structural roles in the body.
Functionally, proteins serve as enzymes, hormones, contributors to immunity, and agents for transport. Structurally, they play a role within cell membranes and intracellular organelles.
Proteins and amino acids
Proteins can exist as long chains, linear or branched, folded or unfolded, and spatially organized or unstructured. Amino acids are the fundamental building blocks of proteins. While there are numerous amino acids, the human body utilizes only twenty, known as “proteogenic” amino acids, to construct proteins. Among these, 11 can be synthesized by the human body, while the remaining 9 are considered essential, as the body cannot produce them in sufficient quantities and thus must acquire them through the diet. The amino acid composition of proteins is a critical factor when evaluating the protein quality of a diet. Additionally, amino acids, being nitrogen-rich, serve as the primary source of this essential element in our bodies.
Dietary Sources of Proteins
The quality of dietary protein sources is determined by their ability to meet protein and essential amino acid requirements.
Animal Proteins: Found in milk and dairy products, eggs, fish, and meat, animal proteins are relatively rich in proteins and contain all essential amino acids. Animal proteins are generally slightly more digestible than plant proteins.
Vegetable Proteins: Mainly sourced from cereals and legumes, vegetable proteins may lack certain essential amino acids. For example, cereals may lack lysine, and legumes may lack sulfur-containing amino acids. To achieve a balanced amino acid profile from plant proteins, combining different plant foods is necessary. This can involve pairing legume seeds (lentils, beans, peas, etc.) with cereals (rice, wheat, corn, etc.).
Understanding the roles of proteins and the importance of amino acids in the diet helps in formulating nutritionally balanced and complete dietary plans that cater to the body’s functional and structural needs.
Assessment of Protein Quality
Several criteria are employed to assess protein quality:
The Biological Value (BV) estimates tissue protein utilization in the body. The higher the BV, the better the protein utilization.
The Net Protein Utilization (NPU) represents the amount of protein actually absorbed by the body.
The Protein Efficiency Ratio (PER) ranks proteins in relation to each other. The higher the PER, the higher the quality of the protein.
The PD-CAAS (Protein Digestibility Corrected Amino Acid Score) is a chemical index corrected for digestibility. It measures protein quality based on the availability of essential amino acids and digestibility. It serves as an index of protein source quality or dietary coverage of essential amino acid requirements.
The DIAAS (Digestible Indispensable Amino Acid Score) is gradually replacing the PD-CAAS index. It assesses the quality of proteins by considering their composition in essential amino acids and their bioavailability, taking into account individual digestibility in the small intestine.
Dairy proteins generally demonstrate good quality across these different markers.
Nutritional requirements for proteins
The Recommended Dietary Allowance (RDA) for protein is approximately 0.8 grams of protein per kilogram of body weight, with the reference range for adults being 10 to 20% of Total Energy Intake. This translates to a daily protein requirement estimate of:
For Men (Total Energy Intake of 2600 kcal) 65g to 130g/day
For Women (Total Energy Intake of 2100 kcal): 52.5g to 105g/day
Protein requirements become especially crucial during “critical” periods such as growth, pregnancy, or post-surgery. Beyond these periods, maintaining an adequate protein intake is essential throughout life to preserve muscle mass and support various bodily functions.
About Yogurt and Dairy Proteins
Dairy and yogurt proteins stand out due to their high nutritional value, comparable to other animal proteins. Their good digestibility and rich content of essential amino acids contribute to their effectiveness. Additionally, yogurt proteins benefit from milk coagulation, leading to the hydrolysis of certain proteins, particularly caseins, enhancing their intestinal absorption with a digestibility ranging from 95% to 97%. The fermentation process further enhances digestibility by breaking down proteins into more easily digestible forms.
Protein content in different yogurts:
Standard plain yogurt typically contains an average of 4 to 5.3 g/100g of proteins.
Greek yogurt, a concentrated fermented milk, is richer in proteins, containing 9 to 10g/100g.
Skyr, a fermented fresh acid-curd soft cheese made from skim milk, boasts a protein content of 8.8 to 11g/100g, approximately twice that of plain yogurt.
Incorporating yogurt and dairy proteins into the diet provides not only a delicious source of protein but also a nutritionally valuable one, offering essential amino acids and high digestibility.
(8)
Mariotti, F. Plant protein, animal protein, and protein quality. In Vegetarian and plant-based diets in health and disease prevention(pp. 621-642). 2017. Academic Press.
The 14th European Nutrition Conference (FENS) took place in November in Belgrade, and we were there to cover and share with you some insightful topics.
Oliver Witard from the School of Basic & Medical Biosciences at King’s College, London, UK, delved into the topic of “Taking a Food-First Approach to Protein Recommendations: The Matrix Effect.”
“Taking a Food-First Approach to Protein Recommendations: The Matrix Effect”, briefly:
Muscle protein synthesis (MPS) is vital for building and repairing muscle proteins. Recommended protein intake for maximizing MPS is around 0.24g/kg in each meal in young adults and 0.40g/kg bodyweight in older adults (1).
MPS is triggered by amino acids via protein intake, particularly during the postprandial period and exercise recovery. The “leucine trigger” hypothesis suggests that leucine is the primary stimulus for MPS (2). Studies (3,4) looking at the effect of isolated protein sources consumption (casein, whey and soy protein) on MPS support this hypothesis: whey protein consumption leads to a rapid rise in blood leucine concentration as compared to other protein sources, and a consequently greater postprandial MPS.
However, recent studies using whole food protein challenge this notion. In a study (5) comparing skimmed milk and beef ingestion during exercise recovery, skimmed milk showed a greater MPS response than minced beef, despite the latter leading to a quicker leucine appearance in the blood. The improved MPS with skimmed milk may be attributed to the food matrix effect, where interactions between nutrients and non-nutrient components would impact protein digestion and amino acid absorption rates.
The food matrix effect is highlighted in several studies. Whole milk (which is richer in fats) lead to a greater amino acid utilization during exercise recovery than skimmed milk (that contains no fat), emphasizing the potential influence of fat and protein interaction (6). Similar findings were observed with raw eggs (containing a fat-rich yolk) compared to egg whites alone, suggesting a positive impact of fats on MPS (7). Additionally, glycation (meaning the attachment of sugars to the milk proteins) in milk powder hindered postprandial amino acid availability, especially lysine, which might be due to the interaction of sugars and proteins (8).
Given that protein recommendations are based on isolated protein sources, revisiting them to incorporate the food matrix effect may be necessary to optimize MPS, especially in the context of exercise recovery.
Key Messages :
The ingestion of protein-dense whole foods stimulate a robust MPS response despite eliciting a slower rise in leucine availability during exercise recovery. Thus, the “leucine trigger” hypothesis may be more relevant after the ingestion of isolated protein sources rather than the consumption of whole food protein sources
The food matrix effect i.e.the ingestion of whole foods and the associated (non)nutrient-nutrient interactions, facilitates a greater MPS response than the individual actions from each individual nutrient
A paradigm shift is needed in human nutrition to re-define protein recommendations based on commonly consumed protein-rich food
Oliver Witard: My name is Oliver Witard, and I am a Senior Lecturer in Nutrition and Exercise Metabolism at King’s College London in the UK.
What does the Food Matrix bring to the topic when studying exercise metabolism?
Oliver Witard: When we talk about the Food Matrix, we’re talking about the application of protein nutrition as opposed to mechanisms that underpin the response of muscle to protein-derived amino acids.
Historically, studies looked at the response of the muscle to individual amino acids or isolated intact proteins. And those studies were set up for a good reason, because they enabled us to understand what was happening, the mechanisms of action. Why is it that perhaps one protein source stimulates the muscle greater than another protein source? They had a really strong place within protein nutrition and have advanced our understanding.
The concept of the matrix effect allows us to offer more applied information. By studying the muscle’s response to commonly consumed protein foods, we can provide practical recommendations since people consume food, not isolated nutrients. This approach may not contribute significantly to mechanistic understanding, but it proves invaluable for applied perspectives, shaping more relevant dietary advice.
What does this change for athletes, for example, for sportspeople? Is that going to change their approach to their protein intake?
Oliver Witard: It might not drastically alter their approach, but it will bring more information and knowledge. The UK Institute of Sport, for example, adopts a “food-first” approach in their nutritional recommendations, emphasizing the essential role of food before considering supplements.
Athletes need a solid food foundation before considering additional supplements like protein supplements, creatine, or omega-3s.
While it might not change the guidelines, this perspective underscores the interest of prioritizing whole foods in nutritional recommendations.
As dairy, yogurt, or skyr are known for their protein content. How do they fit into this food approach? What is your opinion on protein from dairy products?
Oliver Witard. A Dutch intervention study with quark showed that both in young and older adults, the consumption of quark, results in a robust stimulation of muscle protein synthesis.
There’s no reason to believe that other forms of proteins, of yogurts, won’t also stimulate a robust increase in protein synthesis, given the protein content alongside other nutritional profiles of yogurts. Personally, I find yogurt to be an excellent source of protein and believe there’s much more to explore regarding its protein supply.
To go further, in the context of weight loss, there’s a notable study from McMaster University by Andrea Josse, showing promising results in terms of body composition and bone mineral density with yogurt consumption. It underscores the importance of considering the body composition rather than focusing solely on weight reduction.
To conclude, what would be the key messages from your presentation today?
Oliver Witard: Our current understanding of protein recommendations primarily stems from studies on isolated proteins or free amino acid sources rather than commonly consumed food sources.
Exploring how these recommendations hold up when applied to everyday protein foods is an area worth investigating.
The Matrix effect is intriguing, suggesting interactions between nutrients. Studies with milk protein, eggs, and omega-3s indicate a growing body of evidence supporting a matrix effect in stimulating protein synthesis.
Dr Oliver Witard is a senior Lecturer in Exercise Metabolism & Nutrition at the King’s College, London, UK. His research focus is healthy ageing. He is interested in understanding the physiology that underpins why we lose muscle mass and quality with age. His research also explores the role of exercise and novel nutritional interventions – primarily protein nutrition – to offset age-related perturbations in muscle metabolism. He has extensive expertise in stable isotopic tracer methodology for measuring in vivo muscle protein turnover in humans. He also applies these techniques to athletic populations to optimize training adaptations, body composition and performance.
YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
Dr. Alida Melse-Boonstra from Wageningen University in the Netherlands delved into the crucial topic of “Bioavailability of Micronutrients from Whole Foods: Zooming In on Dairy, Fruit, and Vegetables.”
Bioavailability of Micronutrients from Whole Foods, briefly
Bioavailability is defined as the fraction of nutrient absorbed from the diet and used for physiological function or storage (retained in body). Bioavailability is an important intermediate between dietary intake and requirements, involving both food-related factors (such as the amount of nutrient, food matrix or food processing…) and host-related factors (gut health, body composition, infectious diseases, genetics…)
How to assess bioavailability?
Various methods exist to assess micronutrient bioavailability:
In vitro techniques, designed to simulate the in vivo environment, are based on a simulated digestion process and assess element availability. While fast, inexpensive, and highly controllable, they have limitations as they only provide a proxy for in vivo bioavailability.
In vivo techniques (conducted in animals or humans) use various methods (chemical balance, isotopic…) and are quantitative but more complex, expensive, and less controllable.
Milk, dairy, fruits and vegetables
Delving deeper, the focus shifted to the micronutrient bioavailability from milk and dairy, compared to that from vegetables and fruits.
Both milk and dairy as well as vegetables and fruits are nutrient-dense foods that provide nutrients which impact human metabolism and health. They contain a myriad of nutrients, for some of which the bioavailability is now well-understood, whereas others still require further study. They also contain many bioactive components and have a complex matrix, which affect the kinetics of nutrient release, absorption, and bioavailability.
For example, we observe that milk for instance enhances the absorption of zinc from rice, which contains phytate, an anti-nutrient that may inhibit the absorption of zinc or iron. In the same way, guava fruit enhances the absorption of iron, but not of zinc, from a rice-based meal.
Key Messages:
Bioavailability is a vital intermediate between dietary intake and nutritional requirements.
Milk and dairy products generally contain many enhancers and few inhibitors of nutrient absorption and bioavailability.
Vegetables and fruits, with food matrix complex structures, may impede nutrient absorption.
Nutrient bioavailability is not a fixed number but a result of the complex interplay between food-related and host-related factors.
Dr. Alida Melse-Boonstra’s insights underscore the intricate dynamics that shape the bioavailability of micronutrients from whole foods.
A. Melse-Boonstra: I’m Alida Melse-Boonstra, an associate professor at the Division of Human Nutrition and Health at Wageningen University in The Netherlands.
Can you tell us what would qualify the challenge of studying bioavailability?
A. Melse-Boonstra: Studying bioavailability poses significant challenges, requiring meticulous planning and study design. The complexity, technical demands, and associated costs make these studies inaccessible to everyone. Fortunately, organizations like the International Atomic Energy Agency offer crucial support, both technically and financially, making these studies feasible. Nevertheless, conducting in vivo studies on bioavailability remains inherently challenging.
You presented some data about bioavailability in dairy. How does the bioavailability of different micronutrients vary among dairy products, and which factors contribute to these differences?
A. Melse-Boonstra: Each micronutrient possesses unique and intricate properties, influenced by its chemical characteristics. Divalent metals, for example, exhibit a consistent pattern in their behavior concerning enhancers and inhibitors. However, other nutrients showcase distinct chemical properties.
Variations exist within different dairy products. Factors such as acidic conditions prove advantageous for divalent metals, while fermentation products can stimulate the absorption of certain vitamins, like vitamin K. The matrix of a food, including these differences, plays a defining role in how a specific nutrient is absorbed.
Dr. Alida Melse-Boonstra is currently an Associate Professor at the Division of Human Nutrition, Wageningen University & Research. She focuses her research on new and sustainable solutions for micronutrient malnutrition in low- and middle-income countries. She studies vitamin A, iron, iodine and zinc deficiencies in relation to growth and health in vulnerable population groups such as pregnant women, infants, children and adolescents. She applies various stable isotope dilution technique to assess nutrient status and absorption. Major highlight of her research during the past few years is the research on biofortified cassava in Kenya and in Nigeria
Yogurt is widely known for its health benefits. Being a nutrient dense food, it is packed with vitamins, minerals such as calcium, and proteins. The physical and biological properties of milk proteins in yogurt differ from those in raw milk, which could improve their digestibility.
Because consuming proteins that are both digestible and easily absorbed is necessary for muscle mass maintenance, yogurt could be an interesting source of proteins. As a high-quality protein source, milk has been extensively studied for its benefits on muscle health, but the role of milk proteins in yogurt remains unclear (1).
The digestion & absorption of yogurt proteins may be better than that of milk proteins
Milk mainly contains two kinds of proteins: casein and whey protein.
When making yogurt, milk undergoes heat treatments and lactic acid fermentation, both of which partially break down these proteins, potentially making them easier to absorb and digest.
Some studies reported a slower absorption rate of protein in yogurt than in milk. This could be due to the yogurt’s longer gastric emptying because of its higher viscosity compared with milk. Thus, yogurt processing ensures low viscosity for an optimal absorption.
On the other hand, studies examining blood Total Amino Acids (TAA) after dairy consumption reported higher TAA after yogurt or fermented milk absorption than raw milk (2). Similar results were found for unfermented milk acidified by the addition of lactic acid.
These findings suggest a role of yogurt acidity and texture in improving proteins absorption and digestion.
Yogurt proteins intake may enhance muscle protein synthesis
Interventional studies using marked amino acid to track Muscle Protein Synthesis (MPS) after meals found more marked amino acid incorporation into muscle proteins after consuming yogurt than with unfermented milk or unfermented acidified milk, suggesting an improved MPS. This was consistent with a higher increase of blood amino acids after yogurt ingestion (3).
After meals, the increase in blood amino acid and insulin stimulates skeletal MPS by triggering two cellular pathways (PI3K/ Akt mediated pathways). Interestingly, studies showed an increased activation of these pathways after consuming yogurt compared to unfermented milk.
While these studies suggest an acute post-meal MPS enhancement, other studies yielded more contrasted results regarding long-term yogurt consumption and its association with skeletal muscle mass maintenance or increase.
Yogurt could be beneficial for muscle health via lactic fermentation
In addition to being a good protein source, yogurt could help muscle via lactic fermentation and the gut-muscle axis – the relationship between intestinal microbiota and skeletal muscle.
Studies investigating the relationship between intestinal microbiota and muscle mass have reported a positive correlation between the presence of lactic acid bacteria in intestinal microbiota and muscle mass (4).
And according to a recent review, the age-related gut microbiota disruption and the increased intestinal permeability might explain the decreased protein absorption and chronic inflammation resulting in sarcopenia (age-related loss of skeletal muscle mass). Additionally, lactic bacteria produce bioactive peptides during fermentation that might exert anti-inflammatory effects and thus improve MPS (5).
However, while probiotics supplementation with lactic acid bacteria and bifidobacteria enhanced both muscle mass and strength, no study was conducted using S. thermophilus and L. delbrueckii subsp. bulgaricus supplementation – the bacteria used for yogurt production.
While these findings are promising, further studies are needed to establish a clear link between yogurt consumption and muscle health benefits.
“Among the dairy foods considered a high-quality protein source, yogurt may be a particularly good source for increasing muscle mass […]. However, since there is little solid evidence for this benefit of yogurt, especially in humans, further efforts are needed. – ”Sumi K, et al – 2023
The 14th European Nutrition Conference (FENS) took place in November in Belgrade, and we were there to cover and share with you some insightful topics.
In the session “Plant-based Diets: Transition to a Healthy Plate and Planet,” Professor Wim Verbeke from Ghent University focused specifically on consumer interest in health and sustainable diets.
Consumer Interest in Health and Sustainable Diets, briefly:
The consumer expectations in food production and products are growing, driven by a heightened awareness of the interconnection between dietary habits, environmental impact, and health outcomes. Integrating health and sustainability goals has become a crucial focus, acknowledging the potential for developing diets that are both environmentally sustainable and healthy. The success of such diets, however, hinges on consumers’ willingness and ability to change their behavior.
Investigating the consumer perceptions of the match between healthy and sustainable diets may help build accurate insights into consumers’ motivation to eat healthily and sustainably.
In a study assessing consumers’ involvement in healthy and sustainable eating, four distinct consumer segment profiles have been identified (1):
uninvolved segment,
moderately involved,
involved in healthy eating
the health and sustainability involved segment.
Approximately half of the participants demonstratedhigh involvement in healthy eating, with one-third showing interest in both healthy and sustainable eating.
Consideration of consumers’ levels of involvement in health and sustainability is essential for targeted and effective interventions. Informational food policy actions targeting both healthy and sustainable food consumption behaviors are recommended. Tailoring strategies to address the preferences and concerns of different consumer segments is crucial.
The images of a healthy diet, a sustainable diet, and a plant-based diet are perceived as highly compatible among European consumers and the strong match between perceptions of health and sustainability concepts suggests a convergence in consumer understanding.
Key Messages :
Consumers have increasingly high expectations related to various attributes of food, including health, taste, environment, and safety.
A multitude of factors, including health and sustainability considerations, shape consumers’ food choice decisions.
There is a robust alignment between the concepts of “health” and “sustainability” in consumers’ perceptions.
Professor Wim Verbeke’s insights underscore the nuanced and diverse nature of consumer preferences, emphasizing the importance of understanding and addressing individual motivations and levels of involvement in order to promote healthy and sustainable eating
Wim Verbeke: I’m Wim Verbeke. I’m a professor of agro-food marketing and consumer behavior at Ghent University in Belgium. I’m a bioscience engineer, so I have a background in natural sciences and also an MBA in marketing management. I combine natural and social sciences backgrounds. Most of my research is on food consumer behaviors, consumer decisions related to food safety, nutrition, health, sustainability.
Regarding the consumers, how can we address them to promote a plant-based sustainable diet?
Wim Verbeke: Effective communication for promoting a plant-based sustainable diet must be tailored to the specific needs and interests of consumer groups. As I discussed in the presentation, there are segments, groups of consumers that are absolutely not interested. In my opinion, it makes little sense to target your communication to those groups, but what matters really is those segments that are still a little bit undecided. There is a group of people who are enthusiastic about protein transition and novelties, who are already convinced. These segments deserve focused attention and communication efforts.
And what are the barriers that these segments encounter and why don’t they go further?
Wim Verbeke: Barriers vary widely based on product type and consumer preferences.
The barrier can be unfamiliarity, so that means if you can make those people familiar with the product, they may be keener on trying it. For some, it will be the fear of trying something new and for others, there is skepticism about health benefits, or an interest in sustainability. In that case, providing knowledge may help.
It’s really depending on the segment, on the product, on the person to some extent as well and making information available is really crucial.
During the FENS congress, we saw another presentation made by Esther Papies, where the key message was that we communicate a lot about sustainability and health and that we should communicate more about the taste and enjoyment of plant-based food. Do you think it could help the very hesitant or target?
Wim Verbeke: In those segmentation studies, some groups prioritize taste and pleasure. Offering a clear promise and convincing them about the delightful aspects of plant-based products, through opportunities to taste, can be effective.
Others may be willing to compromise a bit on taste for the promise of a healthier product. It all depends on the specific consumer segment.
In your presentation, you mentioned that elderly consumers are more interested in plant-based protein. Did you mean raw products like beans, or more processed foods?
Wim Verbeke: In the study, the focus was on alternative proteins, not specifically defined as plant-based proteins. Elderly consumers tended to think more about raw products, possibly associating with pulses and legumes, which they might be more familiar with than younger generations. Their interest leaned towards raw products rather than ingredients like powders found in protein shakes.
Wim Verbeke is professor at Faculty of Bioscience Engineering at the Ghent University, Belgium. His research disciplines are Agricultural and natural resource economics, environmental and ecological economics, consumer behavior, market research and marketing.
The 14th European Nutrition Conference (FENS) took place in November in Belgrade, and we were there to cover and share with you some insightful topics.
In the sessions on “Nutrition and the Environment, Sustainability, and Biodiversity,” Dr. Esther Papies from the University of Glasgow in Scotland addressed the crucial theme of “Sustainable Consumption in Practice,” focusing specifically on effective communication about plant-based foods.
“How to Talk About Plant-Based Food”, briefly
As the global community grapples with the escalating health implications of climate change, it has become an urgent public health concern worldwide. The imperative to limit global warming between 1.5°C and 2°C implicated swift and substantial reductions in greenhouse gas (GHG) emissions. Food systems play a pivotal role in GHG emissions, varying depending on the type of food produced and consumed. Notably, meat tops the list in emissions, while vegetables, fruits, and pulses have a lower environmental impact.
Climate change’s ramifications extend to food systems and security, introducing challenges such as agricultural droughts and heat stresses. Simultaneously, demographic trends indicate a growing global population, placing increased stress on food production.
Addressing these challenges calls for a shift towards more sustainable diets, emphasizing the reduction of meat consumption and an increase in plant-based foods. Dr. Papies highlighted the need for a focus on consumption and reward simulations to enhance the appeal of plant-based foods.
Key messages:
Both vegans and omnivores approach plant-based and meat-based foods in terms of consumption and reward.
Despite this, food packages and social media posts tend to use less consumption and reward language for plant-based foods, even when created by or for vegans.
Plant-based foods are often presented in ways that diminish their appeal.
To generate desire, there is merit in describing food in terms of the experience of eating it.
This discussion underscores the critical role of effective communication in promoting sustainable dietary choices, particularly the need for positive framing and emphasis on the positive aspects of plant-based food consumption.
Learn more with Esther Papies
Hello, can you introduce yourself?
Esther Papies: My name is Ester Papies, and I’m an associate professor in the Social and Public Health Sciences Unit at the University of Glasgow.
How does the way of communicating about plant-based foods impact consumption habits?
Esther Papies: The communication around plant-based foods, in supermarkets, on pack or on social media, often revolves around health, nutrition, and dietary groups, For instance, vegan meals are typically presented in terms of ingredients, nutrients, and preparation methods. However, we know that these factors don’t necessarily drive people’s motivation to consume.
When individuals choose a food, they are concerned about the taste experience, the pleasure derived from it, and the overall reward. Emphasizing those components in foods and especially in plant-based foods, which are often novel to consumers, will make it more appealing for people to try out.
This involves focusing on the overall experience, including taste, mouthfeel, temperature of the food, the social context of consumption, and the immediate emotional impact. Instead of highlighting long-term consequences, the focus should be on the immediate reward.
While this approach may not drastically change existing habits, it can entice people to try new foods. Once individuals give them a chance, they often discover a liking for these options, facilitating a shift in dietary habits.
What would be the Do’s and Don’ts when communicating about plant-based food?
Esther Papies: When communicating about plant-based food, it’s advisable not to overly focus on health and sustainability. While educating consumers about the current Western diet’s impact on health and the environment is important, it’s not the primary driver of food choices at the moment.
Ideally, the emphasis should be on the immediate pleasure derived from consuming plant-based foods. Depicting these foods in consumption settings that inspire enjoyment and positive feelings is crucial. Visuals, such as photographs, should convey the pleasure of eating and be complemented by language emphasizing immediate benefits and enjoyment, rather than solely focusing on health or sustainability benefits.
Esther Papies’ research addresses the cognitive processes underlying the regulation of behavior and behavior change, especially in the domains of health and climate change. Together with her team in Healthycognitionlab.org, she examines the social and psychological processes in the transition to a healthier, more sustainable and more equitable society, with a special focus on food and eating behavior.
Regular yogurt consumers of all ages tend to eat and live healthily. They are less likely to eat unhealthy foods, or smoke or drink alcohol to excess, and are more likely to exercise regularly than people who don’t.
Regular yogurt consumers tend to choose healthy diets
Yogurt consumption is associated with better diet quality, measured using validated indices of healthy eating, among both children and adults in the USA, Canada and Europe.
Regular yogurt consumers are less likely to consume unhealthy food and more likely to stick to dietary guidelines than non-consumers.
In adults
Compared with those who eat little or no yogurt, people who eat yogurt frequently have a better diet quality and tend to follow dietary guidelines more closely.
Yogurt consumers score more highly on the Healthy Eating Index (HEI) than non-consumers, which could be partly explained by a significant increase in fruit, grain and dairy consumption.
Yogurt consumers are more likely to have a diet with more fruits, vegetables, nuts, legumes, fish and seafood, and fewer fast foods such as French fries and fried foods, processed and red meats, pizza, snacks, soft drinks and alcohol.
People who frequently consume yogurt have higher nutrient intakes than those who do not often eat yogurt even when yogurt is not a source of these nutrients. Hence frequent yogurt consumers (at least one serving per day) have been found to have higher intakes of folic acid, copper, manganese and iron.
Both in children and in adults (in Spain and the USA), swapping high-calorie, nutrient-poor snacks for full fat yogurt with fruit could help boost key nutrients and improve dietary quality without contributing to dietary excess and obesity.
In children
Young children who regularly consume yogurt have a better diet quality and the overall nutrient content of their diets is higher than those who don’t.
The diets of children who eat yogurt regularly are better overall than non-consumers – they consume more fruit, whole grains and total dairy and fewer fatty foods
Yogurt consumption is a marker of a healthier lifestyle
Numerous studies suggest yogurt consumption is also a signature of a healthy lifestyle. Compared with people who do not eat yogurt, those who do consume yogurt:
are generally healthier and leaner. They also tend to be more highly educated and of higher socioeconomic status.
show healthier non-nutritional behaviour: they are less likely to smoke, tend to drink less alcohol and are more likely to be physically active in their leisure time than non-consumers.
tend to have a better health-related quality of life and mental health.
Children who regularly consume milk and yogurt are more likely than those who don’t to engage in healthy lifestyle behaviours with more physical activity and less sitting in front of a screen.
“Yogurt consumption is a signature of healthy living. Compared with non-consumers, people who regularly eat yogurt tend to have better diet quality, have a more active lifestyle, drink less alcohol, and are less likely to smoke. “
D’Addezio L, Mistura L, Sette S, et al. Sociodemographic and lifestyle characteristics of yogurt consumers in Italy: results from the INRAN-SCAI 2005–06 survey. Med J Nutrition Metab. 2015;8:119–29.
Wajszczyk B, Charzewska J, Chwojnowska Z, et al. [Yogurt consumption and nutritional quality of daily diets in four years old children.] Żywienie Człowieka i Metabolizm [Human Nutrition and Metabolism]. 2013;40:166–80.
Lecerf J-M, Colin J, Hebel P, et al. Les consommateurs de produits laitiers frais : des consommateurs comme les autres? Analyse de leurs profils alimentaires et nutritionnels (Who are fresh dairy products consumers? Analysis of their dietary and nutritional profiles). Nutrition Clinique et Métabolisme. 2016;30:11–21.
The 14th European Nutrition Conference (FENS) took place in November in Belgrade, and we were there to cover and share with you some insightful topics.
In the “Nutrition and the Environment, Sustainability, and Biodiversity” sessions, Dr. Bhavani Shankar from the University of Sheffield, UK, addressed the critical question: ‘Can everyone afford a healthy and sustainable diet?’
“Can Everyone Afford a Healthy and Sustainable Diet?”, briefly
Poor diets significantly contribute to the global burden of disease, and current dietary patterns pose negative environmental implications.
The challenge lies in enhancing diets to benefit both human health and the health of the planet.
A healthy diet meeting WHO norms can reduce greenhouse gas emissions by 17%. However, achieving further emission reductions necessitates additional decreases in meat, dairy, and soft drinks consumption, coupled with increases in vegetables, beans, pulses, and nuts.
Historically, the primary focus has been on health aspects, including WHO dietary norms and specific health outcome targets. The recent shift towards reference diets aims to address both health and sustainability through restricted categories of foods (e.g., vegetarian, vegan, flexitarian, pescatarian) and diets like the EAT-Lancet diet.
The affordability of sustainable diets poses a significant question:
Ensuring sufficient energy intake at low cost is a priority for lower-income consumers and countries.
Many key food groups for healthy and sustainable diets are expensive sources of calories (e.g., fruits and vegetables).
Conversely, some less healthy food groups are cheaper sources of calories (oils, fats, sugar).
In lower-income countries, nutritious foods are often more expensive than in higher-income countries.
When assessing the affordability of the EAT-Lancet diet, it becomes evident that for 1.58 billion people, mainly in lower-income countries, even the lower bound planetary health diet exceeds total income. Fruits and vegetables account for the highest proportion of diet costs globally (31%), followed by animal source foods (28%), and legumes and nuts (19%). On average, the EAT Lancet diet is 60% more costly than a diet that simply meets essential nutrient requirements.
Key Messages :
Environmental co-benefits from healthier diets present a real opportunity for action.
The global relative costs of nutrient-dense foods, especially in low-income countries, are high.
Integrating sustainability considerations alongside health aspects increases diet costs.
Many people, particularly in low-income countries, cannot afford sustainable healthy diets.
Challenges also exist in high-income countries, particularly for low-income households.
Dr. Bhavani Shankar’s insights highlight the intricate balance needed to make healthy and sustainable diets accessible to all, emphasizing the economic challenges.
Learn more with Bhavani Shankar
Hello, can you introduce yourself?
Bhavani Shankar: Hi, I’m Bhavani Shankar, a professor of food systems, nutrition, and sustainability. I work as an applied economist at the University of Sheffield in the UK, engaging in interdisciplinary research that spans food systems, nutrition, and various related fields.
What are the limits to making a sustainable diet accessible and affordable to all?
Bhavani Shankar: There are several barriers, particularly when viewed through an economic lens.
The relative prices of nutrient-dense foods, such as animal source foods or fruits and vegetables, are often prohibitively high in low-income settings.
We have to take them from a situation of being a luxury to being something that’s affordable in a mainstream way to all the people. Nutrition and diet quality cannot be a rich person’s indulgence. It has to be something that’s accessible to all.
And I think that we can elaborate all the possible diets that will meet planetary and health aspects. But until we get people to move towards those diets, it’s very difficult, and there’s an economic aspect to it.
Overcoming this challenge involves addressing economic, behavioral, and knowledge-related difficulties that people face in understanding and adopting sustainable diets.
You talk about working in an interdisciplinary team. Why is it important to work with others and to work together?
Bhavani Shankar: It is crucial because food consumption and food systems inherently involve multiple disciplines. As an economist, I might analyze income and prices, but understanding behavioral change and knowledge barriers requires collaboration with psychologists, food scientists, and food technologists. Different disciplines have distinct languages and methodologies, making interdisciplinary teamwork essential for tackling complex issues like sustainable food systems.
At the end of your presentation, you presented some solutions. What were they?
Bhavani Shankar: To make nutritious diets available to everyone, we need income support for the poorest individuals, as their lack of income is a major hurdle to accessing expensive yet nutritious diets Another aspect is to lower the prices of nutrient-dense foods. We need to make them cheaper somehow, and to do so, we can, for example:
invest in agriculture and horticulture related to these nutrient dense foods.
develop more R&D in these areas, not only focused on wheat, maize and rice but actually think about nutrient dense foods, like fruits and vegetables or dairy for example
develop infrastructure in order to have less food waste, because the most nutritious foods are also the most perishable ones and it spoils very quickly. Unless you have the infrastructure, the block chains and the market capacity to handle these foods, you will lose a lot of food. This keeps the prices high and the availability low.
Bhavani Shankar’s current research interests include sustainable diets, climate and nutrition-sensitive food systems, food and nutrition policy evaluation and inequities in food systems and nutrition. Much of his work is of an interdisciplinary nature, conducted in collaboration with nutritionists, geographers and health, agricultural and environmental scientists.
We uses cookies on this site. With your consent, we will use them to measure and analyze the use of the site (analytical cookies). For more information, please read the legal notice.
Functional
Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Nutritional requirements for proteins
