I polled members of my free Facebook group, and cheese came out the winner of the “What blog topic would you most like to see?” question. So if you could use some clarity around this loved but complicated food, you’re not alone!
Cheese is a good source of protein and calcium, right? (Plus zinc, vitamin A, B12, and lots more.) But don’t guidelines tell us to avoid saturated fat and choose low-fat milk products? And what about that pesky sodium? On balance, where does it fit?
The short answer is that cheese is fine in moderation if you like it, even if heart-related health concerns are a priority for you. The benefits balance out those downsides, and studies suggest that it’s either neutral or perhaps even slightly positive for some long-term outcomes, depending on what you’re comparing it to.
The main reason I say “in moderation” is because we want to leave room for foods with more clearly demonstrated benefits for cardiovascular health, like vegetables, fruit, nuts, beans, fish, and/or whole grains. But if you love cheese (and many do), that matters too!
There’s no rule that says you have to eat only foods that benefit health, after all. But since we focus on heart health here, I’ll share what I know, and as always, you decide what works for you.
Full disclosure: In wrangling this disparate research, I should disclose my bias. Nope — not that I do work for the food industry. I definitely don’t. It’s just that I love cheese too! I try to be objective, but that should probably be acknowledged.
What does the research say?
It says… we don’t have all the answers
As I’ve written about here before, cardiac nutrition is an imperfect and evolving science. It’s notoriously hard to do high quality research in this field, and these challenges apply to cheese for sure.
Another complication unique to topic is that some (mostly older) studies examine the effects of all saturated fats in the diet, whether they come from cheese, yogurt, bacon, or prime rib. But the health effects of a food come from much more than just the fat in it!
Some studies look at dairy as a whole, while some break it into high and lower fat options. But even milk, yogurt, and cheese differ in some key ways, independent of fat content.
See, imperfect. My head is spinning.
Okay, here goes…
The big picture
Will eating more cheese make you more likely to end up in the emergency room, cath lab, or worse? Most studies looking at morbidity and mortality show that cheese has either a neutral or slightly protective effect when it comes to your chances of developing heart disease or your risk of dying from that, or anything else. (Perhaps cheese is the answer to the famous French paradox!)
Why are some neutral and some positive?
Different studies do sometimes come to different conclusions, to the frustration of many trying to eat for better health. Don’t sweat it.
As always, the population being studied can affect the results. Do they typically eat cheese with fruit or on takeout pizza? Plus there are many different kinds of cheese — between bacterial fermentation, aging, sodium, fat, calcium content, and probably more, they can have different impacts on health.
Compared to what?
The other complication with nutrition studies is the fact that if people eat more of one thing (say cheese), they’ll inevitably eat less of something else. If you start eating cheese with your toast for breakfast instead of jam, you’d actually be better off (less sugar). But if you went from peanut butter to cheese, you’d likely be worse off (less healthy fats). In theory. One meal won’t make or break your heart health. These are just examples to illustrate the general findings.
You can see how the saturated fat issue got so complicated. The good news is that cheese isn’t harmful, despite the relatively high saturated fat content, but we wouldn’t want to have it completely take the place of more heart healthy protein sources like fish, nuts, and beans, or eat so much it displaced whole plant foods like fruit, vegetables, and whole grains.
This paper summarizing three of the largest observational studies compared people who ate about a serving of cheese a day to those who had it less than once a week found no significant association in terms of total mortality, or mortality from a specific cause, like cardiovascular disease or cancer. However, they did find foods that lowered risk, at least relative to all dairy: nuts, legumes, and whole grains. On the other hand, red and processed meat was associated with higher mortality.
Keep in mind, however, that these conclusions come from observational studies, in which we can only have limited confidence. Participants estimate their intake of various foods, which may or may not be accurate or stable over time.
One recent observational study took the food questionnaire accuracy problem out of the mix by checking participants’ blood for fatty acids commonly found in (all) higher-fat dairy foods and similarly found no significant links to any cause of death, including heart disease or stroke. In fact, there was actually a lower risk of stroke-related death tied to one of the fats.
However they assess intake, researchers then track health outcomes, which may be affected by a number of factors in addition to the variable of interest (cheese, in this case). They do their best to adjust for things like income, education, exercise and more, but it’s not perfect and so can’t prove cause and effect.
That’s why I don’t get worked up about the headlines coming from one such study. But when researchers write review papers gathering together many of these studies, in different populations, and the results are reasonably consistent, then we have more confidence.
And for health conditions like heart disease that take many years to emerge, this kind of research is usually the best we have to go on. Randomized controlled trials, which would address these limitations, seldom go on for long enough to see the development of heart disease in enough people to form conclusions. We can look at cholesterol or blood pressure changes, but whether or not those translate into more or fewer heart attacks isn’t a given. What if cholesterol goes down but triglycerides go up? Plus people can’t very well be blinded to whether or not they’re eating cheese, unlike a drug study with a placebo for comparison. Ugh.
But despite these limitations, the consensus is that cheese, as part of an overall heart-healthy approach to eating, is at least neutral for overall and cardiac health, if not ever so slightly positive. See below for some strategies to make it work even more to your advantage.
Heart disease risk factors
Just a quick summary here of how cheese impacts particular aspects of metabolic health, in case one of these is of particular interest to you.
While randomized controlled trials find that cheese doesn’t raise LDL cholesterol compared to butter, it also doesn’t lower it like olive, canola, and other predominantly unsaturated fat foods do either.
Why would this be? We don’t know for sure, but researchers speculate that perhaps the relatively high calcium level in cheese inhibits fat absorption in the gut, or perhaps changes that occur during fermentation of cheese get credit.
Whatever the reason, the good news is that cheese is essentially neutral in terms of effect on cholesterol. If cholesterol-lowering is a high priority for you though, you’ll want to leave plenty of room for nuts, oats, pulses, soy, olive oil, and other cholesterol-lowering foods, but you don’t have to skip the cheese completely. Yay!
A 2016 systematic review found that people who eat more dairy in general are actually less likely to develop high blood pressure (hypertension), while cheese consumption had no effect on this outcome, positive or negative.
This is consistent with findings from the landmark study behind the blood-pressure lowering Dietary Approaches to Stop Hypertension (DASH) eating plan, which, interestingly, included about an ounce (30g) a day of cheese! (Along with about two cups of low-fat milk or yogurt.)
Together with a diet rich in whole plant-based foods, the dairy approximately doubled the blood-pressure lowering effect of the DASH foods, so it’s worth including if you’re so inclined.
DASH eating even lowers LDL cholesterol (yay!), but a follow-up study using only high-fat dairy didn’t. (It did still lower blood pressure though.) So some cheese yes. All cheese maybe not so much. 😉
But what about the sodium? Most cheese is pretty high in sodium (200-300mg/ounce – see below for lower-sodium cheese options). And your overall sodium intake certainly can affect blood pressure.
But the goal isn’t zero sodium, but rather less than 1500-2000mg per day, depending on which guidelines you believe. As sources of sodium go, this is a relatively nutritious (and delicious) one. Another reason I’d say fine, in moderation, i.e. balanced with lower-sodium foods.
Blood sugar control and insulin resistance
Moderate-quality evidence actually suggests neutral and sometimes even favorable associations between intakes of cheese and the risk of developing type 2 diabetes. In studies looking at milk products and diabetes in general, yogurt is more helpful, but cheese doesn’t hurt.
The Diabetes Canada guidelines suggest that a diet high in dairy foods (of all kinds) helps with insulin resistance, if only as a replacement for sugary drinks and foods. As above, the important question is “Compared to what?” But for people who are concerned about sugar cravings, it may be nice to know that nibbling on a slice of cheese is heart-healthier than a cookie, if that hits the spot for you.
Interestingly, there is some evidence that dairy (yogurt in particular) might protect against unintended weight gain, but honestly, for cheese, it’s not a very strong case.
Similarly, some evidence suggests that increasing dairy intake might help with weight and fat loss, but when you dig into it, you find that we’re talking about less than a kilogram (on average), and only in studies less than a year long where people were restricting calories as well.
But the good news is, cheese doesn’t seem to drive weight gain either. It’s higher fat content might mean more calories per bite, but it’s satiating, which seems to balance that out.
Using cheese to your advantage
You can see from this quick review of the research that cheese is pretty much neutral for heart health. Maybe a little bit beneficial in some ways, depending on which cheese and what you’re comparing it to.
Want to make it more of a heart-health ally? Consider pairing it with more cardioprotective foods if that helps you eat more of them – think roasted asparagus with parmesan, black beans and rice with shredded cheddar, sliced pears and havarti. If cheese can help you get more vegetables, fruit, legumes, whole grains, fish etc, now we’re talking!
Another strategy is to include cheese when you need more protein, which for many people is breakfast or an afternoon snack. Cheese on a chicken sandwich isn’t helping you as much as adding cheese to the apple that holds you over until dinner.
With cardiac health in mind, there are a few considerations that may make a difference for you. The differences are pretty small though, so as always, factor in what you like!
Naturally lower-sodium cheeses include goat, Swiss, fresh mozzarella, and ricotta. (Ricotta is so nice as a little snack, mixed with blueberries or mango and just a sprinkle of sugar. Highly underrated.)
Keep in mind that higher sodium cheeses like feta and parmesan are usually so flavourful that you don’t need much, so if you’re watching sodium, you can still have them. Just go easy, and pair with lower-sodium foods. My favourite for jazzing up a salad.
If you want the most bang for your buck, protein-wise, cottage and ricotta cheese are good choices. Just watch the sodium in cottage cheese (about 400mg per half-cup). And parmesan is a bit higher on the protein too. Yay parmesan!
Life is too short for reduced or low-fat cheese, wouldn’t you say? The difference in saturated fat with most is pretty small anyhow, especially if you have to eat more to feel satisfied! But if you find one you really like, that’s fine too.
A few common cheeses that are naturally light*: Cottage, soft goat, feta, ricotta, and mozzarella (including fresh). Now you know why soft goat and fresh mozzarella cheese made appearances in my cookbook**.
Reducing saturated fat in your diet can help with cholesterol-lowering, but only seems to translate into fewer heart problems if you eat more healthy fats (and perhaps whole grains) in place of it. Think nuts, fish, olive oil, avocado, etc. over pretzels, rice cakes, and frozen yogurt.
If you have lactose intolerance, you’ve probably already figured out that hard cheeses like cheddar, swiss, and parmesan are lower in lactose, and may be easier for you to tolerate, at least in small amounts.
Cheeses to avoid?
Nutritionally, cream cheese doesn’t have much going for it. It might be relatively low in sodium, but it’s not a good source of protein or calcium like most cheese. It’s kind of like butter. Fine if you like it, but how about melted cheddar, avocado, or peanut butter for a little more nutrition on your bagel?
And I’d skip processed cheeses like Cheese Whiz and American slices, at least from a nutritional standpoint. They’re the highest in sodium, with less calcium and protein.
Please don’t take the heart health considerations above to mean that you can’t enjoy brie, blue cheese, cheddar, or other higher fat and sodium cheese. You definitely can! In fact, some of them are so intensely flavourful that just a small amount will do nicely.
A final word of perspective
I just wanted to add that after reviewing all of these papers, I was impressed by the heart health benefits of yogurt! So if you’re not a regular yogurt eater, that might be something to consider too. I did a deep dive into yogurt last fall if you need help figuring out which one to choose.
And finally, a friendly reminder that you don’t have to make every food decision based on physical health! The sweet spot is what’s healthy, delicious, and right for you. Your wellbeing also depends on good mental health, which means you might eat some foods just because you enjoy them thank you very much.
If cheese isn’t for you, you certainly don’t have to have it. If, on the other hand, you love any of them, from creamy camembert to smoked gouda, enjoy! We have plenty of flexibility in nutrition.
And if you’re concerned that you might be eating too much cheese, and looking for alternatives, I wrote more about that here.
Do you have any comments or questions? Feel free to share on Facebook or email me.
*Light using the Health Canada labeling definition – at least 25% reduced fat, compared to cheddar.
** That’s an affiliate link. That means if you buy something from Amazon after clicking that link, I get a small percentage. But not much! Order from your local bookstore if you can.