To Cheese or Not to Cheese? With PsA, That Really Is the Question

You may not need to break up with cheese completely. Vegan cheeses could be the answer. 

There’s something romantic about cheese. We associate it with wine tasting, holidays, and picnics with a date. It can make us feel nostalgic — think of a beloved pizza parlor from your youth or a visit to a foreign country.

“Cheese is something that speaks to the soul,” said Miyoko Schinner, former CEO of Miyoko’s Creamery. This vegan cheesemaker is profiled in the Netflix docuseries “You Are What You Eat.”

“When you eat it,” she said, “somehow you just feel high.” That may be because milk-based cheese contains casein, which releases casomorphins — plant compounds that trigger the release of dopamine in your brain.

Schinner has dedicated years to producing vegan cheeses using plant-based milk, staying close to a centuries-old cheesemaking process (though without that casein, you may not experience the same kind of romance). And she may be onto something big.

In 2020, plant-based cheese sales totaled $270 million in the United States alone. That was a 42% increase over the previous year, meaning that plant-based cheese is one of the fastest-growing categories of plant-based foods.

The result is an array of cheese flavors, some of them quite convincing. “It’s good,” a foodie friend said recently, when I put out a block of Miyoko’s smoked gouda, “but it isn’t cheese.” Easy for her to say — she can still enjoy cheese. But what if you don’t have that privilege?

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Fat, vegan cheese, and the anti-inflammatory diet

As someone living with psoriatic arthritis (PsA), I’ve chosen to follow an anti-inflammatory diet, and I find that eating dairy products can bring on a flare. Though there’s conflicting information about whether dairy should be eliminated from your diet, many people find it to be an inflammatory food.

And even if you don’t follow an anti-inflammatory diet, you might have lactose intolerance — a 2017 research review suggests that 68% of people worldwide may experience it.

So, what are the choices for those of us who can’t consume dairy products? Cheese producers such as Miyoko’s and Rebel Cheese make beautiful vegan products, but beyond concerns about flavor, texture, and meltability, one question looms: If avoiding dairy helps you avoid PsA flares, is eating vegan cheese really a healthy alternative?

To answer that question, it’s important to compare the nutritional values of dairy cheese and vegan cheese. Most dairy cheeses contain some calcium, vitamin B12, phosphorus, magnesium, zinc, and even vitamin A. And while dairy cheeses contain protein, they are also high in saturated fat.

We need a certain amount of fat in our diets (about 50–65 grams daily, depending on how many calories we eat) because it insulates our organs, helps with brain function, and can quell hunger. But health experts advise that most of those fats should be unsaturated or monosaturated fats, the kind found in salmon and avocados, which people often refer to as “good fats.”

These good fats are emphasized in anti-inflammatory diets such as the Mediterranean diet, which has been shown to help ease symptoms of PsA.

When it comes to choosing between dairy cheese and vegan cheese, calories aren’t really a huge issue since, on average, an ounce of either type has about 100 calories. The issue here is fat, and saturated fat in particular. And both vegan cheese and dairy cheese tend to be high in saturated fat.

According to registered dietitian and nutritionist Jenness Hayden Keller, “While the studies regarding saturated fat intake can be contradictory, it is generally believed that eating saturated fat in moderation (10% or less of your total calorie intake) can be part of a heart-healthy diet.”

While this may surprise the rest of us, it isn’t news to those in the field of nutrition. As far back as 2010, Harvard Medical School reported that the “dozen or so saturated fats that show up in our food are important building blocks and important energy depots for many organisms.” But Hayden Keller reminded us to avoid trans fat, which is often created during processing of certain foods.

And while some vegan cheeses contain cashew milk, which adds protein, versions that contain coconut oil are high in saturated fat. “Some people think that coconut oil is healthy, but the studies don’t necessarily support this,” said Hayden Keller. “Consuming coconut oil is shown to increase serum low-density lipoprotein (LDL) levels.”

LDL particles can contribute to heart disease and increase the risk of heart attack or stroke (because the buildup of cholesterol in your blood leads to deposits of plaques in your arteries).

As the amount of saturated fat you eat increases, so does the amount of LDL cholesterol your liver produces. So, even though it doesn’t contain dairy and may not trigger a PsA flare, vegan cheese can still increase your LDL level and cause concerns about heart health.

Recommendations

If you’re going to eat vegan cheese, choose cashew-, soy-, or tofu-based cheeses, which are higher in protein. Some vegan cheeses have no protein at all.

“Not all vegan cheeses are created equal,” Hayden Keller said. She advised avoiding those that are highly processed; those that are high in saturated fat, starch, and sodium; and those that have little protein.

“Consumers should check to make sure the vegan cheeses they choose are fortified with calcium, vitamin B12, and vitamin D,” she said. 

Even so, Hayden Keller added a caveat: “While nutrients added to foods are often well absorbed, the body doesn’t regulate absorption in the same way as it does with foods that naturally contain these nutrients.” And of course, she added, avoid vegan cheeses that contain preservatives and color additives.

With all this new information on vegan cheese, your head might be spinning, and you’re not alone. Having PsA and sticking to an anti-inflammatory diet is challenging enough, and most of us are learning more about wellness than we ever imagined.

You have to learn about nutrition, decipher product labels, and pay special attention to restaurant menus. And since vegan cheese is becoming a more widely available alternative, it’s important to take time while shopping to carefully read nutrition labels.

Pay close attention to the serving size. An ounce may contain only 100 calories and 5 grams of fat, but an ounce is usually a small slice, so enjoy vegan cheese in small amounts.

And though vegan cheese may have nutrients, many of them can be found in foods that have more protein, such as fish, tofu, and lean meats. However, Hayden Keller reminded us that some vegan cheeses contain probiotics, which are good for digestion and overall health and may prove to be especially helpful for those living with PsA.

The bottom line

Living with PsA often means having to adapt and let go of things we once loved doing. But maybe that doesn’t have to mean giving up cheese — maybe vegan cheese could fulfill that desire.

While it’s important to admit that you might no longer be in a relationship with dairy cheese, you may not need to break up with cheese completely. Just don’t expect to fall in love the same way.