Now On Our Health Food Menu: Ice Cream topped with Maple Syrup?

The Obesity Epidemic

Epidemiologist agree that America is facing an obesity crisis. Three-quarters of U.S. adults are now overweight or obese¹, and about one in five children are obese.² There are likely several factors that are responsible for the rapid increase in obesity over the last 50 years, but the simplest explanation may be the American predilection to eat ever more highly refined calories while being ever less active.

But there is some good news. While it might seem obvious that the answer to obesity would be fasting and extreme exercise the actual science is much more nuanced, and leaves room for ease and comfort, and even delight.

Obesity Work Arounds

For example, we now know that what one eats may matter more than how much one eats, so changing one’s dietary preferences may be the best solution for most people. This isn’t as easy as it sounds, of course, but simply choosing healthful foods and avoiding highly processed products may be enough to let most people opt out of the obesity epidemic.

Which dietary changes have the biggest impact? Avoiding sugary sodas is the quickest win. And consuming less beef and more beans will also improve one’s health while reducing one’s food budget because protein from beans costs a third as much as protein from steak. An article published in the prestigious New England Journal of Medicine (NEJM)³ expands this list of foods to avoid to include potato chips and processed meats. On the flip side, adding more yogurt or nuts to one’s diet was associated with weight loss. Importantly, the effects of these changes aren’t small. For example, adding just one sugar-sweetened beverage a day produced a pound of weight gain over four years; adding a serving of yogurt was associated with losing a pound. Here’s the figure reproduced from the NEJM paper:

And there’s more good news: it turns out that the group of healthful foods may actually include some items that seem counter intuitive, perhaps even too-good-to-be-true. For example, I highlighted above the finding in the NEJM study that yogurt prevents weight gain. This comes as no surprise, because yogurt was first pitched as a health food 8,000 years ago in Indian Ayurvedic medical texts, and it continued to enjoy its special status through ancient Greece (where it was called oxygala) right up until today when modern research has cemented yogurt’s status as a health food.

Ice Cream?

But here’s a less well-known story. As epidemiologists were studying yogurt’s benefits they were also looking into other dairy products, and they uncovered an unexpected, and for them problematic, finding. It turned out that ice cream provided as many health benefits as did yogurt. This created an enormous headache for Ardisson Korat, a grad student at Harvard’s Harvard T.H. Chan School of Public Health at the time. In 2018 Ardisson stumbled upon the health benefits of ice cream in the course of researching his PhD thesis (Dairy Products and Cardiometabolic Health Outcomes). He found that eating a half cup of a day of ice-cream lowered the risk of heart disease by about 20%. Oh, and ice cream also reduced the risk of cancer, also by about 20%. Here’s a table from Korat’s thesis:

His PhD committee was troubled by such a preposterous finding; after all, ice cream has all that sugar! And all that cream! At first this finding was assumed to be an error in Ardisson’s analysis, but no amount of statistical exertion could make the health benefit of ice cream go away. The fact that ice cream also seemed to prevent cancer was deemed so improbable that this finding is only mentioned in a single table (S2.3), and never commented on in the text of Ardisson’s thesis. But other researchers have since confirmed the health benefits of ice cream, including a very well-done case control study by Collatuzzo et al (2022⁴) that found a 40% reduction in distal colon cancer in those who consumed the most ice cream.

Are such results even plausible? Actually, yes. For example, while ice cream does have a lot of sugar, it’s unique absorption profile results in a glycemic index that is actually lower than that of brown rice. And while ice cream does have a high fat content, it turns out that fat from ice cream is much less harmful to cardiovascular health than fat from meat.⁵ Why this is so isn’t clear, but some research suggests that the "milk-fat-globule membrane,"⁶ a triple-layered membrane that encases the fat within mammalian milk, makes ice cream more metabolically neutral than foods like butter where the membrane is lost during its churn. This membrane may also protect probiotic bacteria during gastrointestinal transit, important because once these bacteria become part of the colonic microbiome, they then can support production of short-chain fatty acids which are important to colonic health. So, there’s way more to ice cream than just “sugar and fat”.

It's perhaps surprising that such interesting findings aren’t much discussed by the researchers who stumble upon them. But we can get some insight into what’s going on when we notice that the health benefits of yogurt were widely publicized, but not the benefits of ice cream. It turns out that researchers are only human, and while “reasonable” results (yogurt!) can be safely discussed, when an improbable result emerges from the data (ice cream?), well, one doesn’t want to invite ridicule which might adversely affect one’s career and future funding sources. Better just to report the finding in some table deeply buried in one’s publication and hope the news media doesn’t find it.

Another problem is that rigorously studying the effect of ice cream would require a decade of effort and tens of millions of dollars, not the sort of project Ben and Jerry’s typically budgets for. And then there’s this: ice cream can’t be patented. This problem was acknowledged with a sly wink by Dariush Mozaffarian, the dean of policy at Tufts' nutrition school, when he observed that if ice cream had been a patented drug, “you can bet that the company would have done a $30 million randomized control trial to see if ice cream prevents diabetes.”⁷

Optimizing Ice Cream

And all these benefits come from ordinary, off-the-shelf ice cream. Suppose one were to optimize ice cream. Could ice cream be even healthier? Actually, yes. Valerio Sanguini and coworkers created a natural antioxidant ice cream in 2016 and carefully evaluated its effects in a well done single blind crossover placebo-controlled trial.⁸ This new ice cream was created by adding dark cocoa powder and hazelnut and green tea extracts to conventional ice cream, additions that improved every health measure examined in their research: the test ice cream increased levels of serum polyphenols, reduced oxidative stress, increased endothelium flow-mediated vasodilation, and reduced heart rate and blood pressure after a cycloergometer stress test. You may be asking “where can I get this stuff?” Sadly, it hasn’t been developed as a commercial product. But green tea ice cream is available, so perhaps a more comprehensive healthy ice cream will come along soon.

Maple Syrup?

And it’s not just ice cream. It turns out that against expectations maple syrup may also be a health food. Many years ago, when I was in medical school, we were taught that while maple syrup might taste good, really it was just sugar, because chemically it was mostly sucrose (white table sugar) and water, with trace amounts of other organic molecules that give maple syrup the color and taste that people love. But it turns out that those other molecules are immensely important, and there are quite a number of them: not only micronutrients (vitamins, minerals) but also a host of unique polyphenols like quebecol and lignans as well as 26 other phytochemicals many of which show antioxidant activity⁹.

Does this witches’ brew of organic molecules in maple syrup matter? It seems likely. Building on earlier work in mouse models, earlier this year Morissetta and coworkers compared maple syrup to artificially flavored sucrose solution in a rigorous randomized, double-blind, controlled crossover trial in human subjects that appeared in The Journal of Nutrition¹⁰. Over a period of 8 weeks volunteer experimental subjects consumed 5% of their total caloric intake (~20 ml) either as maple syrup or a concoction of artificially flavored sugar syrup. The researchers found that maple syrup significantly reduce key cardiometabolic risk factors compared with substitution with sucrose syrup, possibly because of specific changes in gut microbiota. After 8 weeks of maple syrup “therapy” systolic blood pressure dropped by 3 mm, and android fat (fat stored in the abdominal region of the body) was reduced by 70 grams, a small but possibly important decrease because visceral adipose tissue (a component of android fat) is a major risk factor for cardiometabolic diseases.

So, should we all follow every meal with a bowl of ice cream topped with maple syrup? It’s probably too soon to put complete faith in maple Sundays as the elixir of longer life. But newer research suggests that the earlier knee jerk response of nutritionists “ice cream has cream and sugar, so it must be killing us” now seems too simplistic, even unscientific.

If It’s Science, Why Does It Keep Changing?

When I was a kid, it was “finish your peas!” But, with a little more research parents might be admonishing their children to “finish your maple syrup sundae!” It’s not as improbable as it sounds. History is replete with examples of foods that were once shunned as unhealthful and later redeemed by better research. For example, in the early 19th century, tomatoes were widely considered poisonous but eventually became a health food¹¹, and today top the list of healthy foods. More recently, eggs that for many years were believed to cause heart disease (all that cholesterol!), have since become an important source of protein in our diet. Butter is an especially egregious example because it led nutritionists to recommend margarine, which proved to be a far greater health risk than butter ever was¹². Nuts, dark chocolate (but not milk chocolate!)¹³, coffee, all were at one point derided as unhealthful but are now defended as healthy dietary choices.

If it seems that the right answers keep changing, it’s because they do. This is not to disparage the scientific method which doesn’t actually claim to know what’s true; it only claims to be a method that allows the truth to emerge eventually. Of course, we can’t know when “eventually” is, so every scientific truth is necessarily provisional.

So, while we await definitive studies on maple syrup ice cream Sundays, we can revel in the observation that just because something tastes good to you doesn’t necessarily mean it is bad for you. It may make sense to enjoy ice cream and maple syrup right now, just in case the food police come along sometime later to take this delightful combo off the health food menu.

¹Three-Quarters of U.S. Adults Are Now Overweight or Obese

²Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2015–2016

³Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men

⁴Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study

⁵Dairy and Cardiovascular Disease: A Review of Recent Observational Research

⁶Improving Human Health with Milk Fat Globule Membrane, Lactic Acid Bacteria, and Bifidobacteria

⁷Is eating ice cream healthy for you?

⁸Natural antioxidant ice cream acutely reduces oxidative stress and improves vascular function and physical performance in healthy individuals

⁹Further Investigation Into Maple Syrup Yields Three New Lignans, a New Phenylpropanoid, and Twenty-Six Other Phytochemicals

¹⁰Substituting Refined Sugars With Maple Syrup Decreases Key Cardiometabolic Risk Factors in Individuals With Mild Metabolic Alterations: A Randomized, Double-Blind, Controlled Crossover Trial

¹¹The History of Tomatoes in America

¹²Butter vs. Margarine
¹³Chocolate intake and risk of type 2 diabetes: prospective cohort studies