« Cheese by its diversity can reconcile pleasure with dietetics »

A. Chicoulaa, CIDIL dietitian

Good afternoon, Mrs Chicoulaa. First of all, could you explain to us what dietetics is ?

Its the set of principles concerning the food we consume which allows us to maintain the best possible state of health. According to its etymology, “dietetics” comes from the Greek dieta meaning « art of living ». It is therefore synonymous with a balanced diet, and it must link this equilibrium with a simultaneous quest for pleasure in eating.

More precisely, what does your occupation consist of ?

We are food technicians. By our training we understand the value or otherwise of foodstuffs and their involvement in the organism Thus we are qualified to give advice on food and to adapt it in case of health problems. Our suggestions are always concrete concerning the preparation of dishes, meals and menus within a framework adapted to each individual : his or her work rhythm, means, tastes, age, physical activity, morphotype, food intake habits and family situation are all taken into account. What is most interesting in this job is its individual dimension. Otherwise you can take any magazine and apply their advice !

What’s the difference between what you do and a nutritionist ?

In general it is doctors, often endocrinologists working in a health context, concerned with pathologies, who contact us. Often following a diagnosis, these specialists hand the patients over to us for the setting up of a diet : that is to say designing appropriate menus.

Practically speaking then, you create diets, do you ?

Yes, according to their objectives ; but all diets, whether for health or for general well-being, should always maintain a connotation of pleasure, including slimming diets. Taste, as well as sensorial discovery and curiosity are very important. For example, yes, you can eat stuffed tomatoes or custard in the context of a slimming diet ; you simply have to learn how, how much, etc …

In the case of diets linked to a pathology, we work from medical prescriptions ; our goal then is to advise a food intake which covers all the needs of the organism in spite of the illness. As for slimming diets, which are not necessarily linked to a health problem (except obesity, of course) but a quest for well-being, which should above all not be neglected, we will work more on a readjustment of calorie intake and on meal reorganisation.

For example, the rhythm of meals is very important. Already by respecting these instructions, we are not hungry between meals. We start by being hungry more or less every 3 to 4 hours. To some extent you have to accept this sensation of hunger, so as to eat the right amount and with pleasure ; what you are doing is responding to the organism’s requirements.

An association is often made between dietetics, starvation diets and diets. What’s your opinion ?

In people’s minds a diet, and by extension dietetics, is synonymous with privation. In the best cases the food is gloomy and tasteless. In general they only reluctantly come to consultations ! Yet in the end they eat better, in a more organised way, and finish by reappreciating the pleasures of eating without the feelings of guilt – and that is enough to slim. Food deprivation has never helped people to slim (unless you fast for 40 days !) because the body needs this energy ; very often there then follows compensation in the form of excessive amounts of food.

And the role of cheese in all this ?

Cheeses came into existence 10,000 years ago as a means of conserving milk, a so precious but perishable product. They are veritable « concentrations of milk », since they are obtained by coagulation, which confers nutritional qualities.

With milk, cheese constitutes the main source of food calcium. 99% of the calcium contained in the body goes on building and maintaining the skeleton, , the remainder serving a number of mechanisms including acardiac activity, muscular contraction, blood coagulation, the functioning of certain enzymes … which would otherwise not exist. And when this 1% is not available, the organism will go and look for it in a bone, thus fragilising it. From where the interest comes in providing it in our food. Bone cells degenerate and are renewed continuously ; it must be realised that we ‘remanufacture’ the whole of our skeleton 3 to 4 fimes during our lifetime ! Whatever our age, we need an intake of calcium every day ; everyone is concerned, and in particular children and adolescents. Seniors too must also not be forgotten. The former are constructing their skeletons, while the latter must face the risk of osteoporosis (brittle-bone disease).

Calcium from dairy produce has a big advantage over other sources (mineral water, fruit and vegetables, etc.), because it is better processed by the body. In addition, it is recognised as the “reference” calcium , since it contains proteins, lactose, minerals and vitamins. So as to be absorbed efficiently, calcium has to be associated with other nutrients, which are phosphorus, proteins, with vitamin D and with lactose (sugar from milk). These elements are all present in milk.

Which cheeses are the richest in calcium ?

Cheeses will be more or less rich in calcium according to their manufacturing processes and their water content. The more “dense” or hard the cheese, the richer in calcium, because the less water it contains. Customarily, we speak of Emmental, Comté, etc. as being milk- concentrated.

In addition, soft-centred or in particular veined cheeses, equally have a high vitamin A content (good for the skin, vision, growth), vitamin D (calcium absorption, anti-rickets), vitamin B (good use of proteins, lipids, glucides, nerve impulse transmission).

Could you explain to us how the fat content of cheese is calculated ?

Today, the labelling of dairy products, including cheese, is based uniquely on a dry extract, that is to say on what is left when the cheese is completely dehydrated. This is not the case for other products, where all the content matter, including water, is taken into account. There is thus a confusion of terms : for example a jar of sandwich spread is calculated to have a 50% fat content, while a Camembert is put at 45%. This is a false comparison because if the same method of calculation were to be used, the Camembert would be shown in reality to be 20%. And only rarely do we eat 100g of it !

There is at present a discussion about making the labelling rules concerning dairy products the same as for other products ; not only does the current labelling lead to confusion, but such a system would promote a correct and comparable reading ,of the product much less worrying and guilt-making..

Would you say that the softer the cheese, the fatter it is ?

Wrong ! The softer it is, the more water it contains ; it is less dense, less “concentrated” thus it is has less fat.

How much cheese can one eat ?

If there’s no weight or health problem, we can eat one or two portions per meal (30 – 40g per portion). In the context of a slimming or anti-cholesterol diet, only one portion per day . will be authorised. We live within a cheese tradition, and we must hang on to this heritage ; it is very important, above all in relation to children, to enhance, explain and encourage curiosity in the heritage. It is true that for cheese fans, it is difficult to conform to the idea of only one piece of cheese … This is something that is learned : by varying the type of cheese, for example, so as to discover other tastes. Ideally you should have 3 or 4 cheeses at home : and by eating a small piece of each, there is a sense of discovery and the tastebuds are aroused. And in addition in a meal we should find a place for each item of food : know how to enjoy the cheese, but leaving a place for the fruit.

Does cheese make you fat ?

Once again, no, if you respect reasonable quantities : one portion per meal, up to three to give yourself pleasure.

I have high cholesterol, can I eat cheese ?

Yes, of course ! You’re allowed a little butter and a little cheese, but it’s above all the rest of your diet which is monitored. By the diversity its elements, cheese can reconcile pleasure and dietetics. The aim should always be to maintain all food groups, even if you are on a diet. Food is only a third responsible for hypercholesterolemy ; this condition is linked to genetics, the environment, physical activity and dietary habits. Even then, while cheese is certainly a source of cholesterol, it is not very significantly so, because much lower than cooked pork meats, giblets and offal. On the other hand, it must not be forgotten that cholesterol plays a role in the organism, by vehicling certain hormones in the manufacture of cell walls. We are born with it, and it is necessary.

There have always been anti-milk, anti-cheese and anti-dairy produce attitudes. Strangely enough, this also corresponds fairly well to sales of enriched margarines which claim to lower cholesterol levels. In point of fact, the experts have of course addressed themselves to this issue, and studies are under way to prove that certain fats, on the contrary, are believed to play a role in cholesterol regulation mechanisms ; but beware, howeve,r as the notion of quantity remains present.

And in the case of a salt-free diet ?

Cheese is only the 4th vector of sodium salt), behind cooking salt, salt contained in transformed (“ready-to-eat”) products and in foodstuffs themselves. It is true” that in France we are big consumers of salt : the first thing to do is not to systematically place a salt cellar on the table. If you wish to add salt to your food you should have to get up to do so. This simple gesture will also help us to cut down on our salt intake. For example, in most school cantines, salt quantities are pre-calculated during the preparation phase ; theoretically, the children should have no need to add any more.

I’m a vegetarian girl ; if I eat cheese do I have a balanced food diet ?

Yes. Of course vegetarians do not eat either meat, eggs or fish ; and there you’re eliminating mainly animal proteins. These proteins are to be found in dairy products. They should be completed by vegetable proteins : pulses, i.e.lentils, chick peas, split peas, etc.

What is meant by a vegan diet ?

In the case of this diet, all proteins from animal sources are prohibited ; it is totally unbalanced. It can lead to serious deficiencies in the organism since not only animal proteins are eliminated, but also the main sources of calcium. This can have grave consequences, especially in children and adolescents. It is to be ruled out.

Is the idea of replacing meat by cheese, which came to the fore during the “mad cow crisis”, a well-founded one ?

It is not enough for adolescents, because they are still in the growing phase. But in general, meat can be substituted by cheese, in certain conditions. Especially since it has been established that the older people get, the more they turn away from meat ; that is when milk can become a source of animal proteins. It is a good complement, and there is less mastication. But generally speaking, variety in eating is nonetheless recommended.

Can I eat cheese if I’m allergic to milk ?

Allergy is an immune problem  : the sufferer is unable to consume proteins from a dairy- product source, thus ano dairy products from whatever animal. This allergy is generally identified at birth and regresses by itself to around 3 years, very much rarely until 15 years and extremely rarely into adulthood. Calcium needs are then provided from other food sources : fruit, vegetables and water together with a medicinal complement.

Intolerance to milk is very different from being allergic ; it is linked to the digestive function. Sufferers cannot digest lactose (sugar from milk) or do so with difficulty. Nevertheless in general, they can tolerate the equivalent of a mug of milk per day, which is acceptable. Conversely, this intolerance does not in any way call into question other dairy products, especially cheese since it no longer contains any lactose ; which has been transformed into lactic acid. Inversely, another person who does not want to eat cheese can perfectly well cover his/her needs by drinking milk.

Dairy products should only be totally excluded in allergy cases, confirmed by a recog-nised allergist : the stakes and health risks are too high.

Can milk be replaced by soya milk ?

Absolutely not. First of all, the name “soya milk” is false ; milk can only have one source, which is animal. It is more appropriate to talk about soya water. Regulations are at present being prepared to rename it correctly. On the other hand, this soya water cannot be a substitute for milk since it does not contain the same nutrients and cannot cover as many as the organism’s needs as milk can. By the way, the AFSSA has advised against the use of soya by toddlers under the age of three years.

Does mineral water contain as much calcium as milk ?

No, even the most enriched in calcium contains less than 50% than milk.

What is your reaction to our “all cheese” meals ?

On that subject, I can tell you something amusing : last November, I organised a one-day conference for Midi-Pyrenees dieteticians on the image of dairy products for professionals in the health sector. And the midday meal was a cheese buffet ! I can tell you that we, as dieteticians, are all for it ! Obviously, we won’t advise it as an everyday practice, but it does remain an exceptional, extraordinary occasion. It’s like sauerkraut or cassoulet : these dishes are totally unbalanced when eaten, but they should be enjoyed with water, bread, a little wine, fruit, cooked and raw vegetables (crudités)… These provide fibres and temper the richness of the fat. Perhaps this sort of meal can also be “stretched out” over a longer period of time (tomorrow, I won’t have any cheese, but more salad, eat lighter …). But, once again, above all, no fasting. Cheese contains proteins, minerals, vitamins : in itself it’s a very balanced food. To conclude, in this type of meal there are always left-overs : I’m convinced that we don’t eat enormous quantities (except for the crudités ! – ed.)

In France more than anywhere else, the factors of “pleasure”, “conviviality” and “taste” are brought to the fore ; our culture is composed of values which are highly present in the representation of our meals. Ditto for meal rhythms, which are very much more noticeable in France than in English-speaking countries, where eating can take place at any time and in excessive quantities. I remember in New York having seen bottles of water significantly more expensive than fizzy drinks …

The tradition of cheese eating forms part of the French culinary patrimony, and according to Ocha, 59% of French people are believed to be very attached to it ! And they are perfectly right … Interview conducted by Maya Marin, February 2007.

Agnès Chicoulaa has been practising her profession in both clinics and her own surgery. Thus her experience in dietetics has its source in the context of pathologies (how to eat correctly in case of illness), and for personal well-being. Today her mission within the CIDIL is more educational : accompanying, advising and training teachers to transmit the message of balanced diets to children in their daily lives. From 1 to 20 years the message is “motivate physical activity, explain the importance of calcium for growth, alert children to the need for a healthy food hygiene ; these are elements which will help them later on to make the correct choices, in total independence”.

For further information :
 CIDIL (Inter-Professional Centre for Dairy Information and Documentation) : www.cidilait.com
 AFSSA (French Agency for the Safety of Foodstuffs) : www.afssa.fr
 OCHA (CIDIL Observatory of Food and Eating Habits] : www.lemangeur-ocha.com
 Our behaviour and habits