Cheese: the comparison is doing the work

Cheese lowers LDL cholesterol. The sentence is true and it is incomplete, because the thing cheese was compared with in every trial is butter. Pooling seven trials, 135 g of cheese a day lowered LDL by 0.19 mmol/L against about 52 g of butter. An earlier meta-analysis put the same result at 6.5 percent. HDL fell a little too. When the same review compared cheese with milk instead, nothing separated them, and that comparison rested on two small trials with 29 people between them. So the honest version reads: if you are eating butter, cheese is the better of the two.

The numbers, per 100 g

What your body absorbs

• The popular explanation was tested and did not hold: more calcium inside the cheese lowered LDL without sending more fat out in the stool. — 7 healthy men with BMI 18-25 who completed all three arms (n = 7) Evidence B source
  No significant difference in faecal fat excretion in grams a day between diets (P = 0.066); fasting LDL-C was significantly lower after the high-calcium cheese than after the other arms (P = 0.002); faecal calcium differed across all diets (P = 0.001)

What cooking and storage change

• Against milk rather than butter the cheese advantage disappeared, and the whole comparison rests on two small trials with 29 people between them. — 29 adults across 2 small crossover randomised controlled trials, 163 g of cheese a day against 1085 mL of milk a day (n = 29) Evidence A source
  Total cholesterol, LDL-C, HDL-C and triglycerides were similar after the two dairy treatments

What it does to your health

• Swapping butter for the same amount of fat as cheese lowered LDL cholesterol by about 0.19 mmol/L, and it lowered HDL slightly too. — adults in 7 pooled trials out of 10 included articles, eating a mean 135 g of cheese a day for at least 14 days against about 52 g a day of butter (n = 10 trials) Evidence A source
  Fasting total cholesterol -0.24 mmol/L (95% CI -0.34, -0.15; I2 59.8%), LDL-C -0.19 mmol/L (-0.27, -0.12; I2 42.8%) and HDL-C -0.04 mmol/L (-0.08, -0.00; I2 58.6%) relative to butter
• An earlier meta-analysis found the same direction and put a percentage on it: hard cheese instead of butter took LDL down 6.5 percent and HDL down 3.9 percent. — healthy adults, weighted mean difference in intake 145 g of cheese a day (n = 12 trials identified, 5 pooled) Evidence A source
  LDL-C fell 6.5% (-0.22 mmol/L; 95% CI -0.29 to -0.14) and HDL-C fell 3.9% (-0.05 mmol/L; -0.09 to -0.02) against butter, with no change in triglycerides; against tofu or fat-modified cheese, cheese raised total cholesterol or LDL-C as the fat ratio predicted

Safety, limits and interactions

• About one soft cheese sample in forty carried Listeria in a pooled estimate, and the studies disagreed enough that the authors warn against using the global number for risk assessment. — ready-to-eat foods sampled worldwide: deli meat, soft cheese and packaged salad (n = 100 studies) Evidence C source
  Prevalence of Listeria monocytogenes 2.4% in soft cheese (95% CI 1.6 to 3.6), 2.9% in deli meat (2.3 to 3.6) and 2.0% in packaged salad (1.2 to 3.1); heterogeneity was high in every food group and meta-regression did not explain it
• In pregnancy the same organism lands mostly in the third trimester, and that is the reason the advice about soft cheese exists at all. — nine systematic reviews covering 330 studies and 487 patient reviews of listeriosis in pregnancy and up to four weeks after birth (n = 9 reviews) Evidence C source
  Infections occurred in the third trimester in 66% of cases against 3% in the first; symptoms were mostly fever and flu-like fatigue; prevention rested on avoiding unpasteurised dairy and reheating leftovers until steaming; first-line treatment was intravenous amoxicillin or ampicillin

What people believe that the data does not support

• Europe turned down all twelve health claims submitted for cheese, including the one about children and dental health. — — Evidence E source
  Status Non-authorised; across the register, 12 entries mention cheese and 0 are authorised

Who this works differently for

• Who that cheese trial actually studied narrows what it can say: healthy men aged 18 to 35 with no dairy intolerance, recruited in Dublin. — 10 recruited from the general population in Dublin between May 2017 and May 2018; inclusion was male, 18-35 years, BMI 18-25, reportedly healthy, no dairy intolerance or allergy; 7 completed all three arms (n = 10 recruited, 7 completed) Evidence B source
  Three of ten dropped out, one for the demanding protocol and two lost to follow-up

The bottom line

The explanation usually offered has now been tested and did not hold. The idea was that calcium in cheese binds fat and carries it out in the stool. A crossover trial varied the calcium inside the cheese itself and measured five days of stool: LDL was lower after the high-calcium cheese, and fat excretion did not differ. Seven men finished that trial, all aged 18 to 35, all with a BMI under 25 and no dairy intolerance, which is a narrow window to read anything through. On safety, about one soft cheese sample in forty carried Listeria in a pooled estimate from 100 studies, and the authors warn that the studies disagreed too much for that number to be used as a risk estimate. It matters in pregnancy, where two thirds of listeriosis cases fall in the third trimester. Europe has authorised none of the 12 health claims submitted for cheese, including the one about children and dental health.

Sources

1. che-dr-04 · randomised crossover controlled feeding trial
   There was no significant difference in faecal fat excretion (g/day) between the diets (P = 0.066)...Fasting LDL-c was significantly lower following the HCC diet vs. the other arms (P = 0.002).
   Eur J Nutr, 2023 · checked 2026-09-22
2. che-dr-02 · systematic review and meta-analysis of randomised controlled trials
   The effect of the mean daily intake of 163 g cheese intake (163 g/d) compared with isoenergetic substitution with milk (1085 mL/d) on fasting blood lipid outcomes was investigated in 2 small crossover RCTs with only 29 participants.
   Adv Nutr, 2023 · checked 2026-09-22
3. che-dr-01 · systematic review and meta-analysis of randomised controlled trials
   Pooled analyses of 7 RCTs showed a reduction in fasting total cholesterol, LDL-C and HDL-C concentrations after ≥14 d mean daily intake of 135 g cheese (weighted mean difference [WMD]: -0.24 mmol/L; 95% confidence interval (CI): -0.34, -0.15; I2 = 59.8%, WMD: -0.19 mmol/L; 95% CI: -0.27, -0.12; I2 = 42.8%, and WMD: -0.04 mmol/L; 95% CI: -0.08, -0.00; I2 = 58.6%, respectively) relative to ∼52 g/d butter.
   Adv Nutr, 2023 · checked 2026-09-22
4. che-dr-03 · systematic review and meta-analysis of randomised controlled trials
   Compared with butter intake, cheese intake (weighted mean difference: 145.0 g/d) reduced low-density lipoprotein cholesterol (LDL-C) by 6.5% (-0.22 mmol/l; 95%CI: -0.29 to -0.14) and high-density lipoprotein cholesterol (HDL-C) by 3.9% (-0.05 mmol/l; 95%CI: -0.09 to -0.02) but had no effect on triglycerides.
   Nutr Rev, 2015 · checked 2026-09-22
5. che-dr-06 · systematic review and meta-analysis of prevalence studies
   We included in the review 100 studies with a sample size restriction of ≥100, and we estimated L. monocytogenes prevalence in deli meat at 2.9% (95% confidence interval [CI], 2.3 to 3.6%), in soft cheese at 2.4% (95% CI, 1.6 to 3.6%), and in packaged salad at 2.0% (95% CI, 1.2 to 3.1%).
   J Food Prot, 2019 · checked 2026-09-22
6. che-dr-07 · umbrella review of systematic reviews
   Listeriosis infections were likely to occur in the third trimester (66%) rather than in the first trimester (3%) of pregnancy.
   BJOG, 2022 · checked 2026-09-22
7. che-dr-08 · regulatory register entry
   POL-HC-6306 Dairy products (milk and cheese) Dairy foods (milk and cheese) promote dental health in children. -/- Non-authorised
   EU Register on nutrition and health claims, заява POL-HC-6306, знімок 2026-09-21 · checked 2026-09-22
8. che-dr-05 · randomised crossover controlled feeding trial, participants
   Inclusion criteria were: male, aged 18–35 years, with a BMI of 18–25 kg/m2, and reportedly healthy, with no dairy intolerance or allergy.
   Eur J Nutr, 2023 · checked 2026-09-22