Bone Health.Many cheeses are an excellent source of calcium and a good source of protein and phosphorus, each of which have been demonstrated to support bone health (7,12). In addition, cheese is a dietary contributor of other nutrients (e.g., magnesium, zinc, vitamins A and K) which play a beneficial role in bone health (7). Calcium is the specific nutrient most important for supporting normal growth and development of the skeleton in the early years and helping maintain bone health in later life (7,31). Many government and health professional organizations recommend foods such as dairy foods, including cheese, as the preferred source of nutrients for bone health (5-8,31).
Gastrointestinal Health. Many aged cheeses, because of their negligible lactose content, are a well tolerated source of dairy nutrients for lactose maldigesters (31). Primary lactose maldigestion is a genetically determined condition in which the amount of lactose (milk sugar) consumed exceeds the amount of the enzyme lactase necessary to metabolize lactose. Lactose intolerance is defined as the occurrence of gastrointestinal symptoms which may result from the incomplete digestion of lactose. Studies demonstrate that many lactose maldigesters can consume cheese without developing symptoms of intolerance (32,33). Because many cheeses, particularly hard or aged cheeses (e.g., Cheddar, Swiss, mozzarella), are high in calcium yet naturally very low in lactose, several health professional organizations recommend cheese as a dairy option for people with lactose maldigestion (5,6,34). The interim final rule revising regulations governing the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food packages recommends lactose-reduced or lactose-free dairy foods as an important first option before non-dairy choices for those with lactose intolerance and allows amounts of cheese that exceed the maximum substitution amounts for those who obtain medical documentation (35).
Dental Health. Multiple factors, including diet, dental plaque bacteria, saliva flow and composition, and a susceptible tooth, influence dental caries, an oral health disease affecting nearly 42% of U.S. children and adolescents and 90% of adults (36). Findings from experimental animal studies and human investigations suggest that several varieties of cheese (e.g., Cheddar, Gouda, blue, Monterey Jack, mozzarella, Swiss, process) do not contribute to dental caries and that they may even help reduce the risk of caries (4,31,37,38). Also, certain cheese components such as protein (e.g., casein, bioactive peptides), fat, calcium, and phosphorus may contribute to this food’s caries protective effect. Potential mechanisms by which cheese may play a protective role in dental caries include its ability to stimulate saliva flow, inhibit plaque bacteria, and provide calcium and inorganic phosphate, which reduce demineralization and enhance remineralization of tooth enamel (31,37,38).
While evidence to date suggests a protective effect of cheese against dental caries, additional research is needed to determine whether all cheeses deliver a similar degree of benefit and to determine the precise mechanism(s) responsible. However, the general public (39) and dental health professional organizations such as the American Academy of Pediatric Dentistry (AAPD) (40) and the American Dental Association (41) recognize that cheese supports dental health. The AAPD (40) states that:
- “Certain cheeses have been shown to have characteristics that disrupt the development of cavities when eaten alone as a snack or at the end of a meal.”
- “Cheeses such as aged cheddar, Swiss, mozzarella, and monterey jack stimulate the flow of saliva, clearing the mouth of food debris and acting as a buffer to neutralize the acids that attack teeth.”
- “The calcium and phosphorus found in cheese also reduce or prevent decreases in pH levels of saliva and promote remineralization of tooth enamel.”
Cardiovascular Health. Cheese in moderation can be included in heart-healthy diets that meet total fat, saturated fat, and sodium recommendations (42-45). The Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which is a low-fat diet including two to three servings of dairy foods and eight to 10 servings of fruits and vegetables a day, has been shown to reduce risk factors for heart disease. These include high blood pressure (hypertension) (46), total and low-density lipoprotein (LDL) cholesterol (47), and homocysteine (an amino acid thought to be an independent risk factor for heart disease) (48), as well as obesity (49). A week of sample menus of the DASH eating plan based on 2,000 calories a day includes reduced-fat cheeses five of the seven days (50). The American Heart Association (AHA)’s 2006 Diet and Lifestyle Recommendations to reduce the risk of cardiovascular disease offers the DASH diet and Therapeutic Lifestyle Changes as examples of healthy eating patterns that meet AHA guidelines (51). Both dietary patterns include two to three daily servings of low-fat and fat-free milk and milk products, including cheese (51).
Small human intervention studies have demonstrated that cheese intake has a relatively minor LDL cholesterol-raising effect compared to a similar quantity of fat from butter (42,52,53). Also, cheese intake has been shown to be positively associated with serum HDL cholesterol in a large cross-sectional study (54). Although further research is needed to confirm these findings and to identify the mechanism(s) involved, recent observational studies support the addition of moderate amounts of cheese in a heart-healthy diet (44,55,56). Findings that cheese may be less cholesterolemic than suggested by its fat/saturated fat content may involve other components in cheese such as calcium, protein (bioactive peptides), sphingolipids, and long-chain menaquinones (vitamin K2) (29,31,43,45,55,56).
A review of a conference convened to examine dairy fat in relation to cardiovascular disease led the researchers to conclude, “There is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD [cardiovascular disease]. Of the major types of dairy foods, limited evidence to date indicates that cheese appears most likely to be associated with reduced CVD risk” (57).
Studies have shown that moderate consumption of cheese is not associated with increased risk of coronary heart disease and that cheese can be included in a heart-healthy diet such as the DASH dietary pattern.
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