Swiss cheese: measured against butter, defined by its holes

Across 5 pooled randomised trials, adults who ate about 145 g of hard cheese a day in place of butter of the same fat quality ended with LDL cholesterol 6.5 percent lower, that is 0.22 mmol/l (95% CI 0.14 to 0.29). HDL fell as well, by 3.9 percent or 0.05 mmol/l (95% CI 0.02 to 0.09), and triglycerides did not move. The comparison there is butter of the same fat quality rather than no cheese at all, so what the trials show is that cheese is gentler on LDL than butter. The reviewers say the reason for that is unsettled. An updated meta-analysis of 7 trials set 135 g of hard or semi-hard cheese a day for at least 14 days against about 52 g of butter. Total cholesterol came out 0.24 mmol/L lower (95% CI 0.15 to 0.34) and LDL 0.19 mmol/L lower (95% CI 0.12 to 0.27), while HDL moved 0.04 mmol/L on an interval that touches zero. Every trial in it carried some concerns for risk of bias, heterogeneity was considerable, and replacing cheese with milk gave no benefit in the two trials that tried it. None of this tested Swiss cheese by name. It tested hard cheese, and what makes a cheese Swiss in US law is shape and fat: holes or eyes throughout, at least 43 percent milkfat by weight of the solids, at most 41 percent moisture, under one standard that covers Swiss and emmentaler alike.

The numbers, per 100 g

What your body absorbs

• In 9 women given 400 mg of calcium as Emmental cheese, parathyroid hormone fell and urinary calcium ran 141 percent above control, above the 107 percent from milk and the 75 percent from a calcium salt. — 9 female volunteers, 400 mg calcium from Emmental cheese, milk, sesame seeds, spinach or a calcium salt in random order with a light meal, blood sampled over 6 hours (n = 9) Evidence B source
  Urinary calcium excretion 141 percent above control with cheese (P = 0.001), 107 percent with milk and 75 percent with a calcium salt, with a significant fall in intact parathyroid hormone after cheese (P = 0.002)
• Tyramine swallowed with a meal reached the blood 53 percent lower in total exposure and 72 percent lower at peak than the same 200 mg dose taken after an overnight fast. — healthy adult subjects given a single 200 mg oral dose of tyramine once fasted and once during a meal Evidence C source
  Systemic exposure reduced by 53 percent (p < 0.05) and maximum concentration by 72 percent (p < 0.05) when taken with a meal, with peak time delayed or prolonged

What cooking and storage change

• Tyramine and histamine are the two biogenic amines most often found at high concentrations in ripened cheese, and salt, moisture, fat and packaging all change how much builds up. — 14 studies of cheese ripening published between 2010 and 2024, laboratory and production settings rather than people (n = 14 studies) Evidence D source
  Tyramine and histamine most frequently high, up to 80 percent reduction in total biogenic amines with selected probiotic combinations, and accumulation shifted by salt, moisture, fat and packaging

What it does to your health

• In a meta-analysis of 5 randomised trials, about 145 g of hard cheese a day in place of butter of the same fat quality lowered LDL cholesterol by 6.5 percent and HDL by 3.9 percent. — healthy adults in 12 randomised controlled trials, of which 5 comparing hard cheese with butter at a similar polyunsaturated to saturated fat ratio were pooled (n = 5 trials) Evidence A source
  LDL cholesterol -6.5 percent, that is -0.22 mmol/l (95% CI -0.29 to -0.14), HDL -3.9 percent, that is -0.05 mmol/l (95% CI -0.09 to -0.02), no effect on triglycerides
• An updated meta-analysis of 7 randomised trials found that 135 g of hard or semi-hard cheese a day for at least 14 days lowered fasting total cholesterol by 0.24 mmol/L against about 52 g of butter. — adults in 10 randomised controlled trials of isoenergetic substitution of hard or semi-hard cheese with other dairy products, 7 pooled (n = 7 trials) Evidence A source
  Total cholesterol -0.24 mmol/L (95% CI -0.34 to -0.15), LDL -0.19 mmol/L (95% CI -0.27 to -0.12), HDL -0.04 mmol/L (95% CI -0.08 to 0.00) against butter, and no benefit when cheese was replaced with milk
• In 49 adults who took 13 percent of their energy as hard cheese or as butter for 6 weeks each, the cheese period ended with lower total, LDL and HDL cholesterol and higher glucose than the butter period. — 49 men and women, two 6-week crossover periods after a 14-day run-in on their habitual diet (n = 49) Evidence B source
  Lower serum total, LDL and HDL cholesterol and higher glucose after cheese than after butter, no difference in faecal fat excretion, and no rise in LDL against the habitual diet
• Nine adults who ate 25 g of hard cheese after dinner for 5 days shifted mouth pH toward the basic side for a few hours and lowered the Streptococcus mutans to sanguinis ratio. — 9 orally healthy adults eating 25 g of Grana Padano for 5 consecutive days, supragingival samples and pH at three time points (n = 9) Evidence C source
  Significant shift of oral pH toward basic conditions held for a few hours, and a lower S. mutans to S. sanguinis ratio at the last time point

Safety, limits and interactions

• Aged cheese is the food behind the cheese reaction with monoamine oxidase inhibitors, and in 12 healthy men meals carrying about 400 mg of tyramine from aged cheeses caused no blood pressure crisis on a 6 mg selegiline patch. — 12 healthy adult male volunteers, tyramine challenges as a component of aged cheeses during placebo and during 13 days of a 6 mg per 24 hour selegiline transdermal system (n = 12) Evidence C source
  No clinically significant change in cardiovascular vital signs and no pressor response at about 400 mg of dietary tyramine on the 6 mg patch

What people believe that the data does not support

• In US law Swiss cheese and emmentaler cheese are one and the same standard, with holes or eyes throughout, at least 43 percent milkfat by weight of the solids and at most 41 percent moisture. — cheese sold in the United States under the name Swiss cheese Evidence E source
  Minimum 43 percent milkfat by weight of solids, maximum 41 percent moisture, holes or eyes required

The bottom line

The 49-person crossover underneath those reviews is worth reading on its own. Adults took 13 percent of their energy as hard cheese or as butter for 6 weeks each, and the cheese period ended with lower total, LDL and HDL cholesterol and higher glucose than the butter period. It also cost the field its tidiest explanation. Faecal fat excretion came out the same on both diets, so the idea that calcium in cheese carries fat out in the stool did not hold there, and against the participants' own habitual diet LDL did not rise on either arm. The calcium does get in. In 9 women given 400 mg of calcium as Emmental with a light meal, urinary calcium ran 141 percent above the control session (P = 0.001) and parathyroid hormone fell (P = 0.002), against 107 percent for milk and 75 percent for a calcium salt. Sesame seeds and spinach were given in the same series of sessions, and the abstract reports no excretion figure for either. Nine women and a single load, and urinary calcium with a hormone dip are markers of calcium having been absorbed rather than a measure of bone. In the mouth, 9 adults who ate 25 g of hard cheese after dinner for 5 days shifted pH toward the basic side for a few hours and had a lower Streptococcus mutans to sanguinis ratio at the last sampling. That study had no control group, the cheese was Grana Padano, and what it counted was bacteria rather than cavities. The caution here is aged cheese meeting one class of drug. Aged cheese is the food behind the cheese reaction, the hypertensive crisis that made monoamine oxidase inhibitors rare. In 12 healthy men on a 6 mg per 24 hour selegiline patch for 13 days, meals carrying about 400 mg of tyramine from aged cheeses produced no pressor response and no clinically significant change in the cardiovascular signs the study measured. That is one drug at one dose in twelve men, and it does not lift the diet for oral monoamine oxidase inhibitors, where the cheese reaction is the reason the diet exists. Food itself blunts tyramine. A single 200 mg dose taken during a meal reached 53 percent lower total exposure and 72 percent lower peak than the same dose after an overnight fast, though that was pure tyramine in a capsule and the abstract gives no participant count. How much tyramine sits in any given wheel is not a fixed number. Across 14 ripening studies published between 2010 and 2024, tyramine and histamine were the amines most often reported at high concentrations. Salt, moisture, fat and packaging all shifted how much accumulated, and selected probiotic combinations cut total amines by up to 80 percent. Those are laboratory and production measurements with nobody eating anything. What is absent is worth saying plainly. We found nothing on Swiss cheese for portion size, for children, for pregnancy, or for what melting does to it, and no retention factors exist for the product. Nothing on this page states how much sodium, saturated fat or energy comes with the 145 g a day those trials fed, because no composition card was found for it. The USDA table holds four Swiss records, low fat and low sodium among them, and no trial on this page tested any of the four.

Sources

1. swch-r2-04 · RCT, acute calcium load
   Four hundred milligrams calcium from either Emmental cheese, milk, sesame seeds, spinach, or calcium salt (calcium lactate gluconate + calcium carbonate) or no additional calcium (control session) were given to nine female volunteers...The urinary calcium excretion with cheese was 141% (P = 0.001), with milk was 107% (P = 0.004), and with calcium salt was 75% (P = 0.02) above that of the control session.
   Am J Clin Nutr, 1997 · checked 2026-09-24
2. swch-r2-07 · clinical pharmacokinetic study
   A single 200-mg dose of tyramine was administered orally to healthy subjects both after an overnight fast and during a meal. Systemic exposure to tyramine was reduced by 53% (p < 0.05), and the maximum concentration of tyramine was reduced by 72% (p < 0.05) when the dose was administered during a meal.
   J Clin Pharmacol, 2003 · checked 2026-09-24
3. swch-r2-08 · systematic review, food science
   Among the identified biogenic amines, tyramine and histamine were most frequently reported at high concentrations...Environmental factors such as salt, moisture, fat content, and packaging methods significantly influenced biogenic amine accumulation.
   J Food Prot, 2026 · checked 2026-09-24
4. swch-r2-01 · meta-analysis of RCTs
   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...Whether these findings can be attributed to calcium, specific types of saturated fatty acids, or the food matrix of cheese warrants further research.
   Nutr Rev, 2015 · checked 2026-09-24
5. swch-r2-02 · meta-analysis of RCTs, 2023
   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...these findings indicate that dairy fat consumed in the form of cheese has a differential effect on blood lipid responses relative to some other dairy food structures
   Adv Nutr, 2023 · checked 2026-09-24
6. swch-r2-03 · RCT, crossover, 6 weeks per arm
   The study included 49 men and women who replaced part of their habitual dietary fat intake with 13% of energy from cheese or butter...After 6 wk, the cheese intervention resulted in lower serum total, LDL-, and HDL-cholesterol concentrations and higher glucose concentrations than did the butter intervention.
   Am J Clin Nutr, 2011 · checked 2026-09-24
7. swch-r2-05 · prospective cohort, oral microbiome
   GP cheese significantly modifies oral pH, causing a shift toward basic conditions which are kept for a few hours. The Streptococcus mutans/Streptococcus sanguinis ratio lowers in the last observed timepoint.
   J Transl Med, 2022 · checked 2026-09-24
8. swch-r2-06 · tyramine challenge, phase I
   Monoamine oxidase inhibitors are well recognized as effective antidepressant agents but are rarely used due, in part, to the risk of hypertensive crisis following the ingestion of foods high in tyramine ("cheese reaction")...Ingestion of tyramine-enriched meals following 13 consecutive days of treatment with the STS 6 mg/24 hr (pharmacokinetic steady-state) produced no clinically significant changes in cardiovascular vital signs in 12 healthy adult male subjects.
   CNS Spectr, 2007 · checked 2026-09-24
9. swch-r2-09 · regulation
   It has holes or eyes developed throughout the cheese...The minimum milkfat content is 43 percent by weight of the solids...the maximum moisture content is 41 percent by weight
   21 CFR 133.195, Swiss and emmentaler cheese · checked 2026-09-24