February 2011 Issue

Make Room for Cheese — If Incorporated Wisely, It Can Be Part of a Healthful Diet
By Diane Welland, MS, RD
Today’s Dietitian
Vol. 13 No. 2 P.16

Sure, it’s high in saturated fat. But cheese also offers calcium and other beneficial nutrients. Help clients form a positive relationship with blue, feta, or whatever their preference by educating them on proper portion sizes and more.

Americans love cheese—on burgers, sandwiches, and pizza; in soups and salads; and with just about any other food, not to mention as a stand-alone snack. But all that cheese can add up. Consider the numbers: The 2009 cheese consumption rate in the United States reached nearly 33 lbs per capita. Although still a far cry from the cheese consumption rates in European countries (eg, 68 lbs per capita in Greece, 57 lbs per capita in France, 50 lbs per capita in Germany), the rate is more than triple that which Americans reported eating in 1970.1

Dietitians know cheese is high in calories and the major source of saturated fat in the diet. But telling cheese-loving clients to simply omit their favorite food just isn’t practical—and it may be unnecessary. When managed properly, cheese can be a valuable and important food and can fit into just about any diet.

Here’s what your clients need to know so they can have their cheese and enjoy it, too.

Cow’s Milk Cheese 101
Cow’s milk cheese has a lot going for it. It has a unique taste, texture, and versatility; is convenient; and with more than 300 varieties produced in the United States, it offers something to suit every taste. Nutritionally, cheese is an excellent source of high-quality protein and an easy way for many people, especially vegetarians, to reach their protein quota. It’s high in calcium, too. Just 2 oz of many cheeses can provide 40% to 50% of a person’s daily calcium needs. Cheese also contains other essential vitamins and minerals, including vitamin A, vitamin B12, riboflavin, phosphorous, and zinc.2,3

Sodium is another mineral found in cheese, and it comes from two places: the sodium naturally present in milk and the salt added during the cheese-making process. Salt not only provides flavor but is also essential for producing the texture and quality of a cheese as well as protecting it from pathogenic organisms; thus, salt is necessary on a food safety level. For these reasons, cutting the salt in cheese, particularly natural cheeses, is not always possible.

If clients are concerned about salt content, remind them that some cheeses are saltier than others. Take, for instance, a feta with 317 mg of sodium per ounce or a Roquefort (French blue cheese) with about 500 mg of sodium per ounce and compare them with a Swiss cheese with 54 mg of sodium per ounce (the lowest-sodium natural cheese). On average, most natural cheeses range between 100 and 200 mg of sodium per ounce. Processed cheeses and cheese foods contain 350 to 450 mg of sodium per ounce. Some of these cheeses do have low-sodium counterparts.

People who are lactose intolerant can usually handle eating aged cheese (vs. fresh cheese). “This is because the lactose naturally present in milk is removed with the whey,” explains Gregory D. Miller, PhD, MACN, executive vice president of science and research for the National Dairy Council. “Some of the little that’s left behind gets broken down during the aging process.”

What About Fat?
With whole milk cheeses containing 6 to 10 g of fat per 1-oz serving and more than one half of those grams being saturated (4 to 6 g per serving), fat is certainly a concern for many people.

“The 2010 Scientific Dietary Guidelines Advisory Committee stresses minimizing your consumption of saturated fat, and while cheese is a great food, the biggest issue is that it’s high in saturated fat,” says Katherine Tallmadge, MA, RD, an American Dietetic Association spokesperson who has a private practice in Washington, D.C. “If you’re aiming for 10 to 20 g of saturated fat a day, which represents 7% of total calories, depending on a person’s individualized calorie needs—an advisory committee recommendation—eating cheese can be challenging when 1 oz has about 6 g of saturated fat. Even some of the lower-fat cheeses aren’t really that low.”

Still, Tallmadge says she never tells her clients “don’t eat cheese.” Instead, she focuses on education, teaching clients how to read labels and make good choices. “I determine their personalized level of saturated fat, based on 7% of daily calories, and tell them they have this amount of saturated fat to play with. Then they decide where they want that [saturated] fat to come from. They can have 2 oz of low-fat cheese, 1 oz of natural cheese, or no cheese. It’s their own personal decision, their choice.”

Tallmadge does not typically recommend specific cheese varieties. “I don’t usually talk about specific cheeses because every store carries different brands and people have their own personal preferences, which I respect,” she says. “And you may not be able to find this or that cheese at the store where you shop. I let my clients decide what pleases them and how best to use their saturated fat allotment.”

High levels of dietary saturated fat increase the risk of cardiovascular disease (CVD) and type 2 diabetes, two main causes of morbidity and mortality in America. Over the years, the evidence supporting this relationship has grown stronger. So it’s not surprising that the recently released 2010 Report of the Dietary Guidelines Advisory Committee (DGAC) on the Dietary Guidelines for Americans targets saturated fat. The new report recommends limiting saturated fat to less than 7% of total fat (about 15 g of saturated fat based on a 2,000-kcal diet) with an interim step of 10% (about 22 g of saturated fat). Current saturated fat rates for Americans hover around 11% to 12%.4

However, when it comes to dairy foods, the relationship to saturated fat is not so clear-cut, according to Miller. “Cheese doesn’t raise blood cholesterol as you would predict from its saturated fat content,” he says. “We’re not exactly sure why, but we do think multiple mechanisms are involved, probably related to calcium, protein, and other bioactive components.”

In fact, during the last six years, scientific evidence has mounted that milk and cheese may even protect against heart disease. It is this research that Miller believes prompted the 2010 Dietary Guidelines Committee Report to state that low intakes of milk and milk products (eg, cheese) may lead to an increased risk of CVD and type 2 diabetes.

Potential Health Benefits
In addition to possibly protecting against CVD and diabetes, scientists believe cheese and dairy products may be linked to other conditions. Here’s what we know:

Bone Health
Since cheese contains many of the nutrients we know support bone health, such as calcium, magnesium, zinc, and vitamins A and K, many people assume there’s a positive connection. Research in the area, however, has been sketchy and results inconsistent, particularly for adults.4 The data between cheese and improved bone health is stronger for children.5

Dental Cavities
Studies show that certain cheeses, such as cheddar, Gouda, blue, Monterey Jack, mozzarella, Swiss, and processed cheese, do not promote cavities and may actually help protect against them. Dental caries form when bacteria ferments carbohydrates, producing acid that breaks down tooth enamel.2,6 “There’s evidence that eating cheese at the end of the meal” neutralizes the effect of this fermentation by raising mouth pH (lowering acid levels), which can reduce the risk of cavities, says Miller. “At the same time, we’ve also seen that calcium and phosphorous levels in saliva go up. These minerals remineralize the tooth, which means they may actually repair any early damage that was done.”

High Blood Pressure
Thanks to data from the Dietary Approaches to Stop Hypertension (DASH) diet, we now know that three servings of low-fat or nonfat dairy products can help reduce blood pressure. Along with a diet high in fruits and vegetables and moderate in fat, Miller says participants on the DASH diet were given low-fat or nonfat cheese six out of seven days.

Weight Control
While early studies looking at weight loss and high-calcium dairy foods demonstrated an antiobesity effect, later studies did not and some even showed the opposite, most likely as a result of increased calorie levels.7 However, a two-year study published in the American Journal of Clinical Nutrition in November 2010 found that those dieters who got the most calcium (equivalent to about 11/2 cups of milk or a little more than 2 oz of reduced-fat cheddar cheese) lost 5 lbs more than the group who got the least amount of calcium, suggesting that high-calcium dairy foods may boost weight loss on low-calorie diets. Nevertheless, more research is needed.

Get Your Goat and Sheep
According to the USDA Economic Research Service, in the United States, cow’s milk dominates the domestic cheese culture. In the natural category, top cheeses consumed are mozzarella (10.6 lbs per person), cheddar (10.1 lbs per person), Swiss (1.21 lbs per person), and Provolone (1.14 lbs per person). According to the National Dairy Council, if processed cheese-type products were added to the list, they would rank third in consumption at nearly 7 lbs per capita.

Nevertheless, other types of cheeses from goat’s and sheep’s milk are becoming increasingly popular among consumers. Over the last decade, goat cheese in particular was one of the fastest-growing segments in the specialty cheese category. Although the United States imports more than 50% of the goat cheese consumed in this country (mainly from France), American artisan cheese makers have earned a reputation for making high-quality goat cheese that can rival its European counterparts.8

Today, dairy goats can be found in every state, but the largest numbers reside in Wisconsin, California, Iowa, and Texas. Since most domestic goat cheese comes from small cottage industries, which make and sell their cheese on a local or state level, the kinds of cheeses one will find vary from region to region.

The sheep’s milk cheese industry, although much smaller than the goat’s milk cheese market, is also gaining ground. The lion’s share of the sheep’s milk cheese that Americans eat and buy is imported from Europe.

As demand grows and these industries expand, it’s becoming easier to find goat and sheep cheeses in supermarkets and specialty grocery stores around the country.

What kinds of goat’s or sheep’s milk cheese are available largely depends on the area, but the majority of goat cheese sold is in the form of fresh, soft cheese. In many places, this type of goat cheese is also called chevre, which is French for goat. Other types of goat cheeses, such as goat cheddar, Gouda, feta, and blue, are also appearing in markets.

Of the sheep’s milk cheeses, the Italian Pecorino Romano is probably the most famous, followed by the Greek feta. But with rising interest in European cheeses such as Manchego, Roquefort, and Idiazabel, sheep’s milk cheese is also growing in leaps and bounds.

How do these cheeses differ from cow’s milk cheeses? Aside from physical qualities such as flavor, texture, and color, milk composition is the main difference. Goat’s milk is higher in protein and several vitamins and minerals, including niacin, calcium, iron, and potassium. It’s also slightly higher in fat content (about a 2-g difference), although the type of fat is different. Sheep’s milk is even richer. It contains almost twice as much solids as cow’s milk as well as higher protein (75% to 100% more) and about twice as much fat. It’s also higher in calcium, phosphorous, vitamin E, vitamin B6, and other vitamins and minerals. But since this milk is so concentrated, it takes about one half the amount of sheep’s milk compared with cow’s milk to make the same amount of cheese. (About 5 lbs of sheep’s milk will make the same amount of cheese [1 lb] that 10 lbs of cow’s milk will make.)9

Both goat’s and sheep’s milks have a greater number of short- and medium-chain fatty acids. The fat globules are smaller, too, and evenly dispersed, making them more easily digestible, especially for people with lactose intolerance. Thus, both milks naturally homogenize, which means the milk does not separate when it sits.10,11

When it comes to making cheese, nutrient content (mainly fat, water, and protein content) is largely dependent on the type and style of cheese, including how long it was aged. So although some sheep’s milk cheeses can be richer (high in fat and calories) than cow’s milk cheeses, some may not be, depending on the cheese maker. The same holds true for goat cheese. The one exception to this is fresh goat cheese, which, as a rule, is generally lower in fat and calories than fresh cow’s milk cheese (cream cheese). The reason has to do with processing. Fresh goat cheese is processed via an acid-coagulated process while the majority of fresh cow’s milk cheese is processed using a rennet or enzymatic coagulation process. During acid coagulation, some fat molecules are drained off in the whey; this is partly because the fat globules in goat milk are so small and partly because of the coagulation process. The result is a fresh goat cheese with about 70 kcal and only 6 g of fat per ounce (4 of them saturated), making it lower in fat and calories than most fresh and many aged cow’s milk cheeses, too.

Color is another point of differentiation. Both goat’s and sheep’s milk cheeses have high levels of preformed vitamin A (higher than cow’s milk). Cow’s milk, on the other hand, has high levels of beta-carotene. This explains why both sheep’s and goat’s milk are bright white, while cow’s milk has more of an orange hue.

Another component that is not typically found in conventional cow’s milk but is naturally present in goat’s and particularly sheep’s milk is conjugated linoleic acid (CLA). CLA is primarily found in the meat and dairy of grass-fed animals. In animal studies, CLA has been shown to have anti-carcinogenic properties and may help protect against heart disease.12,13

Exploring the Options
Considering the many cheeses available in the marketplace, it’s best to let your clients make their own decision as to which cheeses they will buy based on personal preferences, individual tastes, and lifestyle as well as nutrient content. But to help guide them, the following are several things to consider:

• Low-fat and reduced-fat cheeses: These cheeses have come a long way from the plastic, rubbery slices that were introduced to the market in the ’80s. Many of today’s brands can easily stand up to full-flavored cheeses in terms of taste and texture. Part-skim mozzarella and reduced-fat cheddar are the leaders in this category, but there are others, too, such as light brie, light havarti, and low-fat feta. Although these cheeses tend to be a bit higher in sodium, their main difference results from the type of milk they use—skim vs. reduced-fat or low-fat milk.

The choice may depend on what clients would like to do with the cheese. “Our 75% reduced-fat cheddar is an ideal choice for slicing, sandwiches, and snacking,” says Regan Jones, RD, nutrition communications manager at Cabot Creamery in Montpelier, Vt. “On the other hand, our 50% reduced-fat cheese is a perfect choice for when you’re concerned about meltability—for instance, when you are making a cheese sauce.”

• Lower-fat natural cheeses: Some cheeses are lower in fat than others. For example, triple crème cheeses can contain as much as 75% butterfat and 12 g of fat per 1-oz serving. Double crèmes contain less fat, but the amount is still high. On average, most whole milk natural cheeses run around 8 g of fat per ounce. These cheeses are usually not a good choice for individuals who are watching their weight. Best bets for healthier, lower-fat natural cheeses include fresh goat cheese, or chevre, at 6 g of fat per ounce, hard Parmesan at 7 g of fat per ounce, and feta at about 6 g of fat per ounce.

How can your clients determine which cheeses are best for them? Teach them to read labels. It’s the only way they can tell whether a cheese can work for them.

• Full-fat, high-flavored cheese: Although it may seem counterintuitive, it’s possible to work small amounts of full-fat cheeses into a healthful diet. The key is to choose strong-flavored cheeses such as blue, any smoked cheese, and feta and stretch them out by crumbling over salads, grating, or sprinkling over vegetables. Flavored cheeses (eg, jalapeno, horseradish) are other options. In this case, think of cheese more as a flavor enhancer rather than just an ingredient.

“Sometimes a bit of a strong-flavored cheese … can go a long way toward making a dish super flavorful and yet still be relatively low in fat and calories,” says Jones.

Educate to Empower
When it comes to advising clients on eating cheese, empowerment is a dietitian’s best strategy. Educate clients about the many different kinds of cheeses on the market and how to use them. Teach them what to look for on labels and then let them make their own decision. Give them the confidence to make their own choices.

The following are some other things you can do:

• Hold tasting events to introduce clients to new cheeses and encourage experimentation. Remember to choose cheeses that are easily accessible and affordable for your clientele, then pass out recipes.

• Show clients how to pair cheese with healthful foods such as fresh fruits and vegetables rather than fatty foods such as high-fat crackers. Most importantly, however, emphasize that balance is key to following any healthful diet. So if your clients do include cheese in their diet, they should be sure to increase their intake of fresh fruits and vegetables for that day. Ensure they bear in mind that when it comes to cheese, a little bit can go a long way.

— Diane Welland, MS, RD, is a dietitian and freelance food and nutrition writer based in Springfield, Va.

 

References
1. International Dairy Federation. The world dairy situation 2010. Presented at: International Dairy Federation World Dairy Summit; Auckland, New Zealand; November 2010.

2. Walther B, Schmid A, Sieber R, Wehrmüller K. Cheese in nutrition and health. Dairy Sci Tech. 2008;88:389-405.

3. National Dairy Council. The role of cheese in healthful diets. Dairy Council Digest. 2009;80(6):31-36.

4. USDA Center for Nutrition Policy and Promotion. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010. Appendix E-1-18. Available at: http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm

5. Cheng S, Lyytikäinen A, Kröger H, et al. Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: A 2-y randomized trial. Am J Clin Nutr. 2005;82(5):1115-1126.

6. Miller GD, Jarvis JK, McBean LD. Handbook of Dairy Foods and Nutrition, 3rd ed. Boca Raton, Fla.: CRC Press; 2007:245-261.

7. Zemel MB. Proposed role of calcium and dairy food components in weight management and metabolic health. Physic Sports Med. 2009;37(2):29-39.

8. Geisler M. Dairy goats. Agricultural Marketing Resource Center, Iowa State University. April 2010. Available at: http://www.agmrc.org/commodities__products/livestock/goats/dairy_goats.cfm

9. Haenlein GFW. The nutritional value of sheep milk. University of Delaware. 2006. Available at: http://www.smallstock.info/issues/sheepmilk.htm - table16

10. Cornell University. Nutrient content of milk varieties. Updated June 2010. Available at: http://www.milkfacts.info/Nutrition Facts/Nutrient Content.htm

11. Berger YM. Sheep’s milk and its uses. Wisconsin Sheep Dairy Cooperative. February 2007. Available at: http://www.sheepmilk.biz/sheepmilk.html

12. Dhiman TR, Anand GR, et al. Congugated linolenic acid content of milk from cows fed different diets. J Dairy Sci. 1999;82:2146-2156.

13. Nutrition Research Newsletter. CLA-rich cheese is heart friendly. June 2009. Available at: http://findarticles.com/p/articles/mi_m0887/is_6_28/ai_n32144775