In Defense of Ice Cream
A nutrient-dense dessert faces cognitive dissonance in nutrition science.
Ice cream is a beloved treat that many of us put near the top of our list of guilty pleasure foods. And while it is widely believed to be a dietary no-no, the ice cream aisle is as robust as ever. Global sales are estimated at over $70 billion and growing. Americans eat about 20lbs (4 gallons) each every year. As an ice cream enthusiast myself, I’m happy to do my part to increase overall consumption.
You may have noticed the many permutations of the classic recipe of cream, milk, sugar and eggs that are now available. Lactose free ice cream. Low fat. Low calorie. Sugar free. Non-dairy versions made with oat, almond, coconut and cashew "milks." Many of these interpretations I personally find to be downright inedible. Manufacturers seem to struggle to replicate the texture and taste of the original, sometimes resorting to a long list of ingredients to do so. But considering the space allocated to these non-traditional versions in the frozen dessert aisle, it appears that consumers are willing to pay for something, anything, that approximates a "healthy" makeover of the classic full fat dairy version of ice cream.
But what if the original recipe is not the dietary sin we assume it is? What if ice cream is— gasp— a health food?
A recent article in The Atlantic, Nutrition Science's Most Preposterous Result ("The Ice-Cream Conspiracy" is the title of the print version), discusses the "mysterious" finding in multiple studies that ice cream is not a danger to health. In fact, research consistently shows that it provides a health benefit. Regular consumption of ice-cream has been associated with lower risk of cardiovascular disease, diabetes and obesity. The health effects appear to be more pronounced for ice cream than for all other dairy foods including yogurt, the current darling of the dairy world.
It’s not a secret that nutrition research is problematic. It's difficult and expensive to do something akin to a drug trial with large test and control groups. Instead, much of human nutrition research relies on surveys that ask people to remember the details of what they have eaten. But memories are not perfect. And people are not always truthful. And there are lots of variables that cannot reasonably be accounted for. That's partly why we see many seemingly contradictory results. Which are then confidently shared as truth by a scientifically illiterate and incurious media. This understandably leads to confusion and frustration among people who want to do the right thing for their health.
It would not be crazy to think that the ice cream health benefit shows up as an artifact of flawed research. A mistaken conclusion that will be corrected with another, better, study showing that ice cream is really more like a danger to health. But we’re not just talking about a solitary study that has showed this health “signal” once; there are multiple studies over time that stubbornly show the same effect. Researchers have even gone over the study data and analyses repeatedly, searching for errors. Because they can't quite believe it themselves. And when the data, again, clearly shows a health benefit for ice cream, they are left with a finding that seems to embarrass and exasperate them. This clear, distinct finding is then dismissed and essentially swept under the rug. They don't even report the findings. Nothing to see here folks.
These nutrition "experts" appear to be like most people in that they believe the common wisdom that ice cream is on the whole bad for your health. After all, it has added sugar. It's calorie-rich. And worst of all, it's high in saturated fat, a favorite nutritional bogeyman.
But if it's indeed true that nutrition scientists don't want to talk about a potential health benefit of ice cream, I am disturbed by their self-censorship. Why not report and discuss the findings? And then investigate further. Could there actually be something special, something health-promoting, about ice cream?
The Merriam Webster dictionary defines ice cream as a "sweet flavored frozen food containing cream or butterfat and usually eggs." The Food and Drug Administration notes that ice cream must contain at least 10% milk fat. Ice cream shares the nutritional qualities of milk and yogurt including decent levels of protein and easily absorbable minerals and vitamins. But the cream content means that ice cream is high in saturated fat, the type of fat that often gets blamed for clogging arteries.
But the science is now pretty clear that saturated fat does not, in fact, clog your arteries. Saturated fat intake may raise total cholesterol and/or LDL-cholesterol. But these markers are horribly misunderstood. They have little relationship to cardiovascular disease risk, regardless of what the statin makers tell you. The saturated fat in dairy increases large, buoyant LDL lipoproteins that are not damaging to the vascular system. It is not associated with the formation of the small dense lipoproteins that are thought to promote arterial plaque formation.
Dairy consumption in general has has been shown to decrease the likelihood of vascular disease and Type 2 diabetes. But there are signs that the more naturally occurring dairy fat one eats, the more benefits accrue. A randomized study showed that whole milk increases beneficial HDL versus skim milk. Full fat dairy supports healthy body composition, less abdominal fat, and better blood sugar. For example, a Brazilian study of over 15,000 people age 35-74 showed that full fat dairy is inversely associated with metabolic syndrome, a collection of interrelated risk factors for cardiovascular disease and Type 2 diabetes. Reduced fat dairy consumption did not show this effect.
Full fat dairy products are also a natural source of fat soluble nutrients like A, K, D and E. Cream is particularly rich in vitamin A, a critical nutrient for cell formation, metabolism, vision, wound healing, and immune function. The form of vitamin A in dairy cream is easily absorbed and ready to be utilized immediately. Beta carotene, an inactive form of vitamin A in fruits and vegetables must be converted via a series of relatively inefficient biologic steps. And unfortunately, 45% of people are considered low responders to beta carotene, meaning they have an even harder time converting the provitamin to active vitamin A. Animal-derived foods like full-fat dairy, liver, and fish deliver vitamin A in a form that is easy for the body to absorb and utilize. Lower fat dairy like skim milk and yogurt is sometimes fortified with vitamins A and D by the manufacturer in order to partially replace naturally occurring nutrients that were stripped out when the fat was removed.
Egg yolks, a common ingredient in ice cream, add to the nutritional value of ice cream. Yolks are high in fat soluble vitamin A and E, B vitamins, and minerals like zinc and calcium. Eggs are high in cholesterol and thus were unfairly condemned to nutritional purgatory for decades. They were finally freed, somewhat grudgingly, about 10 years ago when the “experts” concluded that the cholesterol content was not a health danger.
Ice cream is relatively high in sugar and calories. One 2/3 cup serving of vanilla Haagen Dazs has 25 grams of sugar and 340 calories. But the high fat content that drives the calorie count and the 6 grams of protein are helpful in blunting the effect of sugar on blood glucose. Given that full fat dairy appears to have a beneficial impact on body composition and obesity, the metabolic impact may be more complicated than one might assume when looking strictly at calories and sugar content.
The combination of saturated fats, fat soluble vitamins, minerals and protein make ice cream look a whole lot like a nutrient dense food. This nutrient density may drive any health benefits and compensate for the relatively high sugar content. Perhaps ice cream improves certain nutrient deficiencies? Vitamin A deficiency is common in less developed countries. Could it be that sub-clinical deficiencies in the U.S. are more common that previously assumed? Restrictive diets, diets high in ultra-processed foods, gut malabsorption, and commonly prescribed medications may all lead to deficiencies in a variety of nutrients, fat soluble and otherwise. In these cases, a food like ice cream could be very nutritive.
Perhaps the fats and nutrients also drive satiation to the extent that people are less likely to crave and gorge on other sweets that are not as nutritionally dense. I wonder if creme brulee, which has similar ingredients, would lead to the same outcome.
I'm not recommending all-ice cream diets anytime soon in my practice. But for people who like and tolerate traditional ice cream, and don’t experience any negatives like digestive issues or increased cravings, I say keep it in and enjoy it. Don’t try to replace it with a weird imitation if you don’t have to. Buy a good quality full-fat product that is made with cream. Avoid extra sugary flavors, sugar alcohols, artificial sweeteners and brands with a long list of ingredients.
I hope to see more unbiased and uncensored research on ice cream and full fat dairy in the future. In the meantime, I plan to do some homegrown research this summer by making my own ice cream. I’d like to understand how much the sugar content can be reduced while maintaining sufficient ice cream-ness, at least for my palate. I'm guessing there will be many taste tests. Anything for the benefit of science!