Cheese and Heart Health: What’s the Story?

Cheese! Glorious cheese. Cheese might just be the most common food I see people avoiding unnecessarily for heart health. Tragic. 

We hear that we should avoid saturated fat and choose low-fat milk products. We know it’s yet another source of sodium. On the other hand, cheese is a good source of protein and calcium, right? (Plus zinc, vitamin A, B12, and lots more.) 

So on balance, where does cheese 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. 

For a review of the research, and a guide to selecting heart-healthier cheese, read on.

stack of assorted cheese

Cheese and cardiovascular outcomes

Will eating cheese make you more likely to end up in the emergency room, cath lab, or worse? Most studies looking at outcomes like this 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 it, 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 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. Of course, one meal won’t make or break your heart health. These are just examples to illustrate the general findings.

The good news is that cheese isn’t harmful, despite the relatively high saturated fat content, but we wouldn’t want to eat so much that it completely takes the place of more heart healthy protein sources like fish, nuts, and beans, or whole plant foods like fruit, vegetables, olive oil, 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.

A caveat

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.

But one 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.

And a recent study looked at the causal relationship between cheese and cardiovascular diseases (and biomarkers) by looking at the genetic effects. While this was limited to people of European ancestry, it did concur with the observational studies in finding that eating more cheese was associated with lower rates of type 2 diabetes, heart failure, coronary heart disease, hypertension and ischemic stroke.

So why do guidelines promote lower-fat cheese?

Unfortunately, guidelines take a while to be updated. In particular, the guidelines from the American Heart Association are quite conservative.

Another complication 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 type of fat in it! More recent studies have looked at cheese in particular and the findings have been more positive..

According to the authors of a 2016 review paper, “We also believe that the focus on low-fat dairy products in the current guidelines is not entirely supported by the existing literature.”

Heart disease risk factors

That 2016 review of evidence from randomized controlled trials found that in general, “Data do not support a detrimental impact of total dairy or high-fat dairy consumption on lipid-related cardiometabolic disease risk factors.”

Just a quick summary here of how cheese impacts various aspects of cardiovascular health, in case one of these is of particular interest to you.

LDL Cholesterol

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 LDL cholesterol. If cholesterol-lowering is a high priority for you though, you’ll want to leave plenty of room for nuts, oats, legumes, soy, olive oil, and other cholesterol-lowering foods, but you don’t have to skip the cheese completely. Yay!cheese and grapes

Blood pressure

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.)

The dairy foods are estimated to contribute about 50% of the blood pressure lowering effect of the DASH diet, so they’re worth including if you’re so inclined. 

But what about the sodium? Most cheese is pretty high in sodium (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. 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 favorable associations between intakes of cheese and the risk of developing type 2 diabetes. Other studies show cheese to be more neutral. In research 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, especially 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. 

Weight

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.

Choosing cheese

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!

Sodium

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.parmesan cheese

Protein

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!

Saturated fat?

A few common cheeses are naturally lower in fat: Cottage, soft goat, feta, ricotta, and mozzarella. (Now you know why they made frequent appearances in my 30 Minute Heart Healthy Cookbook.)

But life is too short for reduced-fat cheese, such as light* cheddar, wouldn’t you say? The difference in saturated fat is usually pretty small anyhow, and you may need to eat more to feel satisfied! But if you find one you really like, that’s fine too. 

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.

Lactose

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.

How much to have?

If you’re worried that you’re eating too much cheese, this paper found that cheese was most beneficial to cardiovascular health in people who ate about 40 grams a day, or a little more than an ounce.

Similarly, another meta-analysis found that a daily amount of 50 g of cheese “was associated with a statistically significant 10 and 14% lower risk of CHD in two meta-analyses including a large number of subjects.” But larger than that was neutral, as was a very small amount.

If you’re in the habit of eating much more than that, and are looking for fun, heart-healthy alternatives to cheese, I wrote more about that here.

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 here 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 heart 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. 

Do you have any comments or questions? Feel free to share on Facebook or email me.

* Health Canada guidelines stipulate that “light” foods have to be 25% lower in fat or calories, compared to a full-fat standard.


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