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04 Mar 2024
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7 min read
Publications Weight management

Eating yogurt is associated with healthy weight management

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Yogurt consumption is associated with reduced body mass index (BMI), reduced body weight or weight gain, thinner waist and reduced body fat.

Yogurt is linked to reduced risk of overweight and obesity and smaller waist circumference

Adults

Yogurt may be classified as a protective food against long-term weight gain, as demonstrated in numerous studies.

A recent meta-analysis including 32,330 individuals (11,947 overweight/obesity cases) across five studies conducted in the USA, Spain and Korea found a 13% reduction in risk of overweight/obesity for every 50 g (~2 ounce) increase in daily yogurt consumption.

Eating more yogurt was associated with less weight gain per 4-year period among 120,877 healthy non-obese adults in the USA followed for 12–20 years. For each additional serving of yogurt per day there were 372 g (~13 ounces) less weight gain over 4 years.

In the USA Framingham Heart Study Offspring Cohort, predominantly overweight people who ate three or more servings of yogurt per week gained about 55% less weight over a year than those who ate less than one serving per week. When it came to waist size, high-yogurt consumers gained 20% less circumference than low yogurt consumers.

Data from the USA NHANES (1999–2014) study revealed a reduced prevalence of obesity in adults associated with consumption of yogurt or a probiotic supplement.

A large Spanish cohort study in non-overweight adults found that people who ate seven or more servings of yogurt per week had a 20% lower risk of overweight or obesity after 6 years when compared with low-yogurt consumers (up to two servings per week).

In a Canadian study, yogurt consumption was associated with lower body weight, waist-to-hip ratio and waist circumference, and tended to be associated with a lower BMI when compared with no yogurt consumption – benefits which were sustained over 6 years of follow up.

In a UK study, increasing consumption of fermented dairy products (low-fat yogurt or cheese) was associated with a smaller increase in body weight among 15,612 adults followed for 3.7 years.

Higher consumption of low-fat yogurt (>3 servings/week) was associated with less visceral and intermuscular fat and smaller waist circumference among women.

Yogurt and weight management - figure - YINI

Children

Results from the USA NHANES (2005–2008) study of children aged 8–18 years and the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study showed that yogurt consumption was associated with less body fat compared with non-consumption. Among overweight or obese adolescent girls, increased dairy consumption (4 servings/day of milk, low-fat yogurt, cheese) was associated with improved body composition in the absence of weight loss.

Yogurt may support body weight reduction when dieting

Some evidence exists to suggest that including yogurt in an energy-controlled diet leads to greater weight loss.

A 3-month trial in 34 obese people found that those who included three servings of fat-free yogurt daily as part of an energy-restricted diet lost 22% more body weight and 61% more body fat than those not eating yogurt.

Consumption of yogurt fortified with calcium, protein and probiotics within a low energy diet versus a low energy diet without yogurt or with plain yogurt led to greater improvement in BMI, waist circumference, body fat percentage and reduction in body fat mass among obese people over 8–10 weeks.

How might yogurt influence body weight and body fat?

Several theories have been put forward.

  • Yogurt consumption increases the feeling of fullness and decreases the feeling of hunger.
  • Yogurt consumers tend to choose healthy diets and healthier lifestyles compared with non-consumers
  • Live bacteria in yogurt may beneficially alter the gut microbiota and influence weight, although the mechanism for this is as yet unclear.
  • Calcium in yogurt may affect body fat by reducing its absorption from the intestine, increasing breakdown of fats,125 and causing less fat to be stored in fat cells.
  • Yogurt naturally contains B vitamins and fortification of yogurt with complementary B vitamins may contribute to body weight management through modification of energy-yielding metabolism this has been shown to aid weight loss among overweight and obese people.
  • Obesity is accompanied by chronic, low-grade inflammation in various tissues. A Brazilian population-based study suggested that increasing yogurt consumption may protect against inflammation.

“Increasing yogurt consumption is proportionally associated with lower body weight and reduced weight gain over several years. Daily yogurt consumption is also linked to other indicators of healthy body composition including lower body fat and smaller waist circumference, both in adults and in children. “

Professor Barbara Rolls

Download the complete booklet “Yogurt for Health: The evidence so far” (standard pdf format)
References:
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26 Feb 2024
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6 min read
Healthy Diets & Lifestyle

Lifting the lid on the link between ultra-processed foods and chronic diseases

NOVA processed food processed meat sugary drinks Ultraprocessed food UPF
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Latest research has cast doubt over the widely-held view that all ultra-processed foods (UPFs) are unhealthy. While some UPFs, such as meat products and sugary drinks, are clearly associated with an increased risk of chronic diseases, others may be less harmful, the research suggests (1). These trend-buckers include ultra-processed breads and cereals as well as plant-based alternatives.

Processed products are ousting fresh foods

Consumption of UPFs has soared around the world and today represents more than half of the daily energy intake in some high-income countries, with middle- and low-income countries following hot on their heels.

The alarm has been raised by a string of research showing that eating a higher proportion of UPFs is linked with an increased risk of weight gain, obesity and risk of chronic conditions such as cancer, cardiovascular disease, and diabetes. But the latest findings from a large pan-European study reveal that it’s not just a simple case of good versus bad. It all depends on the type of UPFs we are eating.

Investigating the effects of UPFs on health

In the first study of its kind, researchers from the European Prospective Investigation into Cancer and Nutrition (EPIC) trial investigated the relationship between UPF consumption and the risk of developing at least two chronic conditions, including cardiovascular disease and type 2 diabetes (together known as cardiometabolic diseases), and cancer (1).

The researchers assessed food and drink consumption among 266 666 healthy volunteers across seven European countries over the course of a year. They then followed these volunteers for an average of 11 years to see who developed cancer or cardiometabolic diseases.

They also investigated the consumption of individual types of UPFs and their relationship with these disease outcomes.

Overall, UPFs are associated with increased risk of long-term illness

After an average of 11 years, nearly 4 500 volunteers in the study had developed more than one of the chronic conditions being assessed. The researchers found that, as a whole, higher consumption of UPF was associated with a higher long-term risk of developing cancer and cardiometabolic diseases. For every 260 g/day increase in UPFs eaten, the study participants had a 9% increased risk of developing more than one chronic condition. Higher UPF consumption was also individually associated with a higher risk of developing cancer, cardiovascular disease, and type 2 diabetes.

Eating certain types of UPF may carry a higher risk than eating other types

But when the researchers delved deeper into the effects of nine different types of UPFs, they found a more complex story. Their results showed that animal-based products and sugar-sweetened beverages stood out as particularly concerning possible contributors to long-term health risks; both were associated with a 9% increased risk of developing more than one chronic condition for every 260 g/day increase in consumption.

Eating sauces, spreads and condiments was also linked with an increased risk of developing cancer and cardiometabolic diseases, but to a lesser extent.

Some UPF types don’t show the expected effects

In contrast, eating other types of UPFs did not seem to contribute to these long-term health risks, the study suggested. Eating sweets and desserts, savoury snacks, plant-based alternatives, and ready-to-eat/heat mixed dishes weren’t significantly associated with the long-term risk of developing cancer and cardiometabolic diseases. In fact, eating ultra-processed breads and cereals even seemed to be associated with a small reduction in the risk of these chronic diseases.

So, what does this mean for dietary choices?

These results highlight the importance of viewing the various types of UPFs separately, and raise questions about whether eating different UPFs can have different effects on our long-term health.

The mechanisms by which UPFs may influence our risk of chronic diseases are not fully understood, but there are several theories:

  • One explanation could be their effect on weight gain since obesity is an important risk factor for many chronic diseases (2-4). Although UPFs tend to be more energy-dense than less processed foods, they are not equally high in their energy-density (5)
  • While diets with a high proportion of UPFs have been associated with a lower nutritional quality (6), individual UPFs also differ in their nutrition profile (5)
  • Non-nutritional mechanisms through which UPFs could be hazardous for health include alteration of the food matrix and the inclusion of food additives during processing (7)

This study suggests that reducing consumption of certain UPFs, particularly meat products and sugary drinks, could play a crucial role in helping to prevent cancer and cardiometabolic disease, the researchers point out. Dietary recommendations, public health policies and interventions should take account of these findings.

‘Lowering consumption of certain ultra-processed foods by replacing them with similar but less processed foods may be beneficial for the prevention of cancer and cardiometabolic multimorbidity.’ – Cordova R, et al. 2023

How are processed foods classified?

Several classification systems for processed foods have been developed to shape nutrition policy and food-based dietary guidelines. The NOVA classification system is most commonly used. It assigns foods to four groups based on how much processing they have gone through:

  1. Unprocessed or minimally processed – e.g., fresh, dry or frozen fruits or vegetables, grains, flours and pasta
  2. Processed culinary ingredients – e.g., table sugar, oils, salt
  3. Processed foods – e.g., cheese, simple breads, fruits in syrup, canned fish
  4. Ultra-processed foods – e.g., soft drinks, sweet or savoury packaged snacks, processed meat, and pre-prepared frozen or shelf-stable dishes

Find out more about NOVA and how certain foods such as yogurt can be good for you despite being classified as ultra-processed (8): see Food processing explained.

 

Source: (1) Cordova R, et al. Consumption of ultra-processed foods and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. Lancet regional health. Europe. 2023;35:100771.

Additional references

(2) Lane MM, Davis JA, Beattie S, et al. Ultraprocessed food and chronic noncommunicable diseases: a systematic review and meta-analysis of 43 observational studies. Obes Rev. 2021; 22e13146

(3) Cordova R, Kliemann N, Huybrechts I, et al. Consumption of ultraprocessed foods associated with weight gain and obesity in adults: a multi-national cohort study. Clin Nutr. 2021;40:5079–5088.

(4) Crimarco A, Landry MJ, Gardner CD. Ultra-processed foods, weight gain, and co-morbidity risk. Curr Obes Rep. 2022;11:80–92.

(5) Scrinis G, Monteiro C. From ultra-processed foods to ultraprocessed dietary patterns. Nat Food. 2022;3:671–673.

(6) Da Louzada MLC, Ricardo CZ, Steele EM, et al. The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil. Public Health Nutr. 2018;21:94–102

(7) Riboli E, Beland FA, Lachenmeier DW, et al. Carcinogenicity of aspartame, methyleugenol, and isoeugenol. Lancet Oncol. 2023;24:848–850

(8) Salomé M, Arrazat L, Wang J et al. Contrary to ultra-processed foods, the consumption of unprocessed or minimally processed foods is associated with favorable patterns of protein intake, diet quality and lower cardiometabolic risk in French adults (INCA3). Eur J Nutr. 2021 May 8. 

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19 Feb 2024
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6 min read
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by YINI Editorial team
Lactose intolerance Q&A

Focus on carbohydrates and lactose

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
carbohydrates carbs Lactose nutrient
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Carbohydrates are an essential part of our diet. They are present in a majority of foods and they provide the body with energy to sustain metabolic functions. Let’s focus on carbohydrates and especially the main one present in yogurt: lactose.

What are carbohydrates?

Carbohydrates are chains of sugar compounds linked together by chemical bonds. These chains can be as little as 2 sugars to over 20 sugars longs. Depending on how long the chains are and which sugars compose them, they will have different properties and effects in the body. Carbohydrates can be divided into 2 main categories: simple and complex.

The main carbohydrates - YINI

Simple carbohydrates are what we refer to as sugars.

They can be further divided into 2 categories: monosaccharides and disaccharides. Monosaccharides are the single sugar units that compose all carbohydrates, these are for example glucose, fructose and galactose. Disaccharides are carbohydrates which are made up of 2 sugars such as sucrose or lactose. Sucrose is what we know as table sugar and has a sweet taste.

All carbohydrates are broken down into the single units of sugar by specific enzymes that break the bonds between sugars. The monosaccharides are then absorbed into the body by the small intestine. Since there is one or no bonds in simple sugars, they are digested and absorbed quickly by the body and they will cause rapid changes in blood sugar. Simple sugars can be found naturally for example in fruits and vegetables or in milk. Or they can be added into food, for instance, table sugar is added to baked goods or sodas.

Complex carbohydrates are also called polysaccharides.

They are chains longer than 10 monosaccharides. Some examples of polysaccharides are starch, glycogen or fibre.

These are called complex carbohydrates because the body can’t digest carbohydrates in their chain form, it has to break them down to absorb the individual monosaccharides units. This process takes longer than for simple sugars causing a more stable gradual change in blood sugar.

In the case of fibre, the body can’t break the structure down as it does not possess the enzyme to do so and it will pass through the small intestine without being absorbed and get fermented in the colon by the gut bacteria. This fermentation produces short chain fatty acids which help nourish the bacteria and protect the gut.

Dietary recommendations for carbohydrates

It is recommended that 45-60% of total daily energy intake in the diet come from carbohydrates and to consume at least 25g of fibre a day.

It is also recommended to keep the added sugar consumption to less than 10% of the total energy intake of the diet.

Focus on lactose

Lactose is a carbohydrate composed of 2 sugar compounds which are glucose and galactose. Lactose is the main sugar in milk. As it is naturally present in milk, it does not count towards added sugar consumption.

Lactose is a sugar without sweet taste. Its sweetening capacity is 30% of the one of saccharose (whereas fructose is 110% and glucose 70%). And it has a low glycaemic index of 46, compared to glucose (GI=103) or saccharose (GI=65).

Human milk contains 7.2% of lactose, which provides up to 50% of an infant’s energy needs. Compared to only 4.7% of lactose in cow’s milk.

Its individual sugar components have different roles in the body. Glucose is the preferred source of energy of the body and galactose is utilised in core body functions such as, for example, being a part of the antigen that determines the ABO blood types. Although glucose could be found in several types of foods, lactose is the only source of galactose.

During digestion, lactose is broken down by the enzyme lactase which separates the 2 sugars that are then absorbed separately.

The ability to digest lactose naturally decreases after weaning as we produce less lactase. People with lactose intolerance don’t produce enough lactase. Undigested lactose reaches the colon and is broken down by the gut microbiota through fermentation, which produces short chain fatty acids and gas. This can lead to symptoms such as bloating, cramps, diarrhoea and flatulence. Only 1/3 of lactose maldigesters have symptoms and are lactose intolerant.

Yogurt and lactose

The amount of lactose in dairy products varies depending on their type and processing. Cheese has only traces amounts of lactose and yogurt as over half the amount found in milk.

Lactose in dairy - YINI

The reduced amount of lactose contained in yogurt can be explained by the specific bacterial cultures present in it (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus). They produce lactase and break down some of the lactose in the yogurt. The bacteria also survive passing through the gut and will help digestion of lactose even further in the small intestine. As yogurt is semi-solid, it has been found to take longer to go through the digestive tract than milk making the breakdown of lactose even more effective. Yogurt is a good source of easily digestible galactose.

Lactose intolerance - how does it work ? - YINI

In general, it is recommended to consume 2 to 3 portions of dairy products each day. Dairy is nutritionally dense as it provides a multitude of nutrients needed in a healthy diet. Yogurt is an easily digestible source of dairy recommended by EFSA as a dairy product for lactose maldigesters. When choosing yogurt, it is preferred to opt for a plain yogurt over a sweetened one so as to limit the amount of added sugar consumed in the diet.

For more information:

Sources

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
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12 Feb 2024
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5 min read
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by YINI Editorial team
Lactose intolerance Publications

Yogurt improves lactose digestion and reduces symptoms of lactose intolerance

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
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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.

Lactose intolerance - how does it work - YINI

When lactose maldigestion gives rise to symptoms such as bloating, cramps, diarrhoea, and flatulence, this is called lactose intolerance.

Self-diagnosis of lactose intolerance is common, but it is often incorrect and in fact very few people have confirmed clinical 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

Lactose intolerance - how does it work ? - YINI

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.”

Professor Naïma Lahbabi-Amrani

Download the complete booklet “Yogurt for Health: The evidence so far” (standard pdf format)
References:
  • 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.
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05 Feb 2024
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6 min read
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by YINI Editorial team
Adult Lactose intolerance

Dairy products play a key role in nutrition for older people – even if lactose intolerant

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
dairy Lactose Lactose intolerance seniors
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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

Source: (1) Gallo A, Pellegrino S, Lipari A, et al. Lactose malabsorption and intolerance: What is the correct management in older adults? Clin Nutr. 2023 Dec;42(12):2540-2545. doi: 10.1016/j.clnu.2023.10.014. Epub 2023 Oct 20. PMID: 37931373.
Additional references:
(2) Yu E, Hu FB. Dairy Products, Dairy Fatty Acids, and the Prevention of Cardiometabolic Disease: a Review of Recent Evidence. Curr Atheroscler Rep. 2018 Mar 21;20(5):24.
(3) Drouin-Chartier J-P, Brassard D, Tessier-Grenier M, et al. Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Adv Nutr 2016; 7: 1026e40.
(4) Dehghan M, Mente A, Rangarajan S, et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2018;392:2288e97.
(5) Montalto M, Nucera G, Santoro L, et al. Effect of exogenous beta-galactosidase in patients with lactose malabsorption and intolerance: a crossover double-blind placebo-controlled study. Eur J Clin Nutr 2005;59:489e93.
(6) Suarez FL, Savaiano DA, Levitt MD. Review article: the treatment of lactose intolerance. Aliment Pharmacol Ther 1995;9:589e97.
(7) Gil A, Ortega RM. Introduction and executive summary of the supplement, role of milk and dairy products in health and prevention of noncommunicable chronic diseases: a series of systematic reviews. Adv Nutr 2019;10:S67e73.
(8)  Aune D, Lau R, Chan DSM, et al. Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol 2012;23:37e45.
(9)  Amiri M, Diekmann L, von Köckritz-Blickwede M, Naim HY. The diverse forms of lactose  intolerance and the putative linkage to several cancers. Nutrients 2015;7:7209e30.
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29 Jan 2024
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Nutri-dense food Q&A

Focus on proteins

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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

Amino acids - building block of protein - YINI

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

Average proteins content - YINI

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.

Protein quality assessment - YININutritional 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 proteins -YINI

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.

For more information:

References
  1. (1) ANSES, les protéines.
  2. (2) Hoffman JR, Falvo MJ. Protein - Which is Best? J Sports Sci Med. 2004;3(3):118-130
  3. (3) Phillips SM, Current Concepts and Unresolved Questions in Dietary Protein Requirements and Supplements in Adults. Front. Nutr. 2017, 4:13
  4. (4) Tome D. Criteria and markers for protein quality assessment – a review. Br J Nutr. 2012; 108 Suppl. 2: S222-9.
  5. (5) Boye J, Wijesinha-Bettoni R, Burlingame B. Protein quality evaluation twenty years after the introduction of the protein digestibility corrected amino acid score method. Br J Nutr. 2012; 108 Suppl. 2: S183-211
  6. (6) European Food Safety Authority, Scientific Opinion on Dietary Reference Values for protein. EFSA Journal 2012; 10(2):2557.
  7. (7) Rylee T Ahnen, Satya S Jonnalagadda, Joanne L Slavin, Role of plant protein in nutrition, wellness, and health, Nutrition Reviews, Volume 77, Issue 11, November 2019, Pages 735–747
  8. (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.
  9. (9) Herreman L, Nommensen P, Pennings B, Laus MC. Comprehensive overview of the quality of plant- And animal-sourced proteins based on the digestible indispensable amino acid score. Food Sci Nutr. 2020;8(10):5379-5391. Published 2020 Aug 25.
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by YINI Editorial team
Echoes from FENS 2023 Expert interviews Nutri-dense food

Taking a food first approach to protein recommendations: the matrix effect by Oliver Witard

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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

Sources:

(1) Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, Phillips SM. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. J Gerontol A Biol Sci Med Sci. 2015 Jan;70(1):57-62. doi: 10.1093/gerona/glu103. Epub 2014 Jul 23. PMID: 25056502.

(2) Zaromskyte G, Prokopidis K, Ioannidis T, Tipton KD, Witard OC. Evaluating the Leucine Trigger Hypothesis to Explain the Post-prandial Regulation of Muscle Protein Synthesis in Young and Older Adults: A Systematic Review. Front Nutr. 2021 Jul 8;8:685165. doi: 10.3389/fnut.2021.685165. PMID: 34307436; PMCID: PMC8295465.

(3) Burd NA, Beals JW, Martinez IG, Salvador AF, Skinner SK. Food-First Approach to Enhance the Regulation of Post-exercise Skeletal Muscle Protein Synthesis and Remodeling. Sports Med. 2019 Feb;49(Suppl 1):59-68. doi: 10.1007/s40279-018-1009-y. PMID: 30671904; PMCID: PMC6445816.

(4) Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men. J Appl Physiol (1985). 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9. PMID: 19589961.

(5) Burd NA, Gorissen SH, van Vliet S, Snijders T, van Loon LJ. Differences in postprandial protein handling after beef compared with milk ingestion during postexercise recovery: a randomized controlled trial. Am J Clin Nutr. 2015 Oct;102(4):828-36. doi: 10.3945/ajcn.114.103184. Epub 2015 Sep 9. PMID: 26354539.

(6) Elliot TA, Cree MG, Sanford AP, Wolfe RR, Tipton KD. Milk ingestion stimulates net muscle protein synthesis following resistance exercise. Med Sci Sports Exerc. 2006 Apr;38(4):667-74. doi: 10.1249/01.mss.0000210190.64458.25. PMID: 16679981.

(7) van Vliet S, Shy EL, Abou Sawan S, Beals JW, West DW, Skinner SK, Ulanov AV, Li Z, Paluska SA, Parsons CM, Moore DR, Burd NA. Consumption of whole eggs promotes greater stimulation of postexercise muscle protein synthesis than consumption of isonitrogenous amounts of egg whites in young men. Am J Clin Nutr. 2017 Dec;106(6):1401-1412. doi: 10.3945/ajcn.117.159855. Epub 2017 Oct 4. PMID: 28978542.

(8) Nyakayiru J, van Lieshout GAA, Trommelen J, van Kranenburg J, Verdijk LB, Bragt MCE, van Loon LJC. The glycation level of milk protein strongly modulates post-prandial lysine availability in humans. Br J Nutr. 2020 Mar 14;123(5):545-552. doi: 10.1017/S0007114519002927. Epub 2019 Nov 15. PMID: 31727194; PMCID: PMC7015880.

Learn more with Oliver Witard

Hello, can you introduce yourself?

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.

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18 Jan 2024
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Echoes from FENS 2023 Expert interviews

Bioavailability of micronutrients from whole foods, by Dr Alida Melse Boonstra

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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.

Source: Melse-Boonstra A. Bioavailability of Micronutrients From Nutrient-Dense Whole Foods: Zooming in on Dairy, Vegetables, and Fruits. Front Nutr. 2020 Jul 24;7:101. doi: 10.3389/fnut.2020.00101. PMID: 32793622; PMCID: PMC7393990.

Learn more with Alida Melse-Boonstra

Hello, can you introduce yourself?

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

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15 Jan 2024
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Athletes Nutri-dense food

Could yogurt proteins be the key to good muscle health?

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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

Source (1) : Sumi K.,Tagawa R., Yamazaki K., Nakayama K., Ichimura T., Sanbongi C., Nakazato K., Nutritional Value of Yogurt as a Protein Source: Digestibility/ Absorbability and Effects on Skeletal Muscle. Nutrients 2023, 15, 4366. https://doi.org/10.3390/ nu15204366

Additional references:

(2) Horstman A.M.H.; Ganzevles R.A.; Kudla U.; Kardinaal A.F.M.; van den Borne J.J.G.C.; Huppertz T. Postprandial bloodamino acid concentrations in older adults after consumption of dairy products: The role of the dairy matrix. Int. Dairy J. 2021, 113, 104890

(3) Ato S.; Fujita S. Regulation of muscle protein metabolism by nutrition and exercise. J. Phys. Fit. Sports Med. 2017, 6, 119–12

(4) Liu C.; Cheung W.H.; Li, J.; Chow S.K.; Yu J.; Wong S.H.; Ip M.; Sung J.J.Y.; Wong R.M.Y. Understanding the gut microbiota and sarcopenia: A systematic review. J. Cachexia Sarcopenia Muscle 2021, 12, 1393–1407.

(5) De Marco Castro E.; Murphy C.H.; Roche H.M. Targeting the Gut Microbiota to Improve Dietary Protein Efficacy to Mitigate Sarcopenia. Front. Nutr. 2021, 8, 656730.

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11 Jan 2024
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Benefits for planet health

Consumer interest in healthy and sustainable diets by Wim Verbeke

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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

Source: Van Loo E, Hoefkens C, Verbeke W, Healthy, sustainable and plant-based eating: Perceived (mis)match and involvement-based consumer segments as targets for future policy, Food Policy, 2017, 69:46-57

Learn more with Prof. Wim Verbeke

Hello, can you introduce yourself?

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.

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