Is European cheese better for managing hypercholesterolemia than American cheese?

European vs. American Cheese for Cholesterol Management

There is no significant evidence that European cheese is better than American cheese for managing cholesterol levels. Based on current guidelines, the type of cheese matters less than the overall dietary pattern and total saturated fat intake 1.

Cheese and Cholesterol: What the Evidence Shows

The European Society of Cardiology (ESC) guidelines indicate that the primary dietary factors affecting LDL cholesterol are:

• Saturated fatty acids (SFAs) have the strongest impact on LDL-C levels, with each additional 1% of energy from saturated fat increasing LDL-C by 0.02-0.04 mmol/L (0.8-1.6 mg/dL) 1
• Trans fatty acids have similar cholesterol-raising effects as saturated fats 1
• Replacing saturated fats with monounsaturated or polyunsaturated fats is more beneficial than replacing them with carbohydrates 1

Recent Research on Cheese and Cholesterol

Several studies have examined cheese consumption and its effects on cholesterol:

• A randomized controlled trial found that high intake of regular-fat cheese for 12 weeks did not alter LDL cholesterol differently than reduced-fat cheese or carbohydrate-rich foods 2
• Another study demonstrated that cheese intake in large amounts actually lowered LDL-cholesterol concentrations compared with butter of equal fat content 3
• A trial examining Norwegian cheeses showed that cholesterol levels did not increase after high intake of 27% fat Gouda-type cheese over 8 weeks, and participants with metabolic syndrome had reduced cholesterol 4

Dietary Recommendations for Cholesterol Management

Rather than focusing on European versus American cheese, guidelines recommend:

1. Reduce overall saturated fat intake: Limit saturated fat to less than 7% of total calories 1
2. Choose a healthy dietary pattern: The DASH diet has been shown to lower LDL-C by 11 mg/dL compared to a typical American diet 1
3. Consider fat composition: Replace saturated fats with monounsaturated and polyunsaturated fats when possible 1
4. Increase fiber intake: Soluble fiber from legumes, fruits, vegetables, and whole grains has direct cholesterol-lowering effects 1
5. Moderate cheese consumption: Cheese can be part of a healthy diet when consumed in moderation, regardless of origin 1

Practical Approach to Cheese Consumption for Cholesterol Management

• Portion control: Limit cheese to moderate portions (about 1-2 oz or 30-60g daily)
• Fat content: Consider reduced-fat options if total saturated fat intake is high
• Overall diet quality: Focus on the entire dietary pattern rather than single foods
• Cheese alternatives: For those with very high cholesterol, consider plant-based cheese alternatives or cheeses made with vegetable oils 5

Common Pitfalls to Avoid

• Focusing only on cheese type: The geographical origin of cheese is less important than its fat content and your overall dietary pattern
• Ignoring total saturated fat intake: Even if consuming European cheese, overall saturated fat intake should remain within recommended limits
• Neglecting other lifestyle factors: Physical activity, weight management, and smoking cessation are equally important for cholesterol management 1

For individuals with hypercholesterolemia, dietary therapy should be the first approach, with drug therapy reserved for those at high risk or with severe hypercholesterolemia 6. The decision about cheese consumption should be made within the context of the entire diet rather than based on European versus American origin.