Cheese is a versatile and beloved food enjoyed worldwide. However, it can interact with certain medications and supplements. These interactions are not always well-known but can have serious consequences. Understanding these interactions ensures safe and effective use of medications while enjoying cheese.
Monoamine oxidase inhibitors (MAOIs)
Aged cheeses like Cheddar, Parmesan and blue cheese contain high levels of tyramine. This compound forms when proteins break down during ageing.
MAOIs, used to treat depression or Parkinson’s disease, inhibit the enzyme monoamine oxidase. This enzyme normally breaks down tyramine in the body. When MAOIs are taken with aged cheeses, tyramine levels can spike.
Mechanism: Excess tyramine causes a rapid release of norepinephrine, a stress hormone. This can lead to dangerously high blood pressure, known as a hypertensive crisis.
Examples: Common MAOIs include phenelzine (Nardil), tranylcypromine (Parnate) and selegiline (Emsam).
Advice: Avoid aged cheeses like Cheddar, Parmesan and blue cheese while taking MAOIs. Fresh cheeses like Ricotta or Mozzarella are safer alternatives.
Antibiotics
Some antibiotics, particularly tetracyclines and quinolones, can interact with cheese. These drugs are used to treat bacterial infections.
Mechanism: Calcium in cheese binds with antibiotics in the gut, forming insoluble complexes. These complexes cannot be absorbed, reducing the drug’s effectiveness.
Examples: Tetracyclines like doxycycline (Vibramycin) and minocycline (Minocin or Minomycin) or quinolones like ciprofloxacin (Cipro) and levofloxacin (Levaquin).
Advice: Avoid consuming cheese two hours before or after taking these antibiotics. This ensures proper absorption of the medication.
Bisphosphonates
Bisphosphonates, like alendronate, treat and prevent osteoporosis by improving bone density. Calcium-rich foods, including cheese, can interfere with these medications.
Mechanism: Calcium competes with bisphosphonates for absorption in the gut. This reduces the medication’s bioavailability.
Examples: Common bisphosphonates include alendronate (Fosamax) and risedronate (Actonel).
Advice: Take bisphosphonates on an empty stomach with water. Avoid cheese and other calcium sources for at least two hours.
Levothyroxine (thyroid hormone replacement)
Levothyroxine treats hypothyroidism by supplementing thyroid hormones. Its absorption can be affected by dietary calcium.
Mechanism: Calcium in cheese binds to levothyroxine in the gut. This reduces the amount of medication absorbed into the bloodstream.
Examples: Levothyroxine is available under brand names like Synthroid, Euthyrox, Levothroid and Oroxine.
Advice: Take levothyroxine on an empty stomach. Wait four hours before eating cheese or other calcium-rich foods.
Statins
Statins lower cholesterol levels and reduce the risk of heart disease. While cheese does not directly interact with statins, its fat content matters.
Mechanism: High-fat cheeses can raise cholesterol levels, counteracting the benefits of statins.
Examples: Popular statins include atorvastatin (Lipitor) and simvastatin (Zocor).
Advice: Choose low-fat or reduced-fat cheeses when on statin therapy.
Iron supplements
Cheese is a significant source of calcium. Consuming it with iron supplements can reduce their absorption.
Mechanism: Calcium competes with iron for absorption in the intestines. This interaction reduces the effectiveness of iron supplements.
Examples: Common iron supplements include ferrous sulfate, ferrous gluconate and ferrous fumarate.
Advice: Space iron supplements from cheese consumption by at least two hours.
Zinc supplements
Zinc is essential for immune function and wound healing. However, calcium in cheese can interfere with zinc absorption.
Mechanism: Calcium competes with zinc for transport pathways in the gut, reducing zinc uptake.
Examples: Zinc supplements are often labelled as zinc gluconate, zinc sulfate or zinc acetate.
Advice: Avoid consuming cheese when taking zinc supplements. Opt for timing gaps of two to three hours.
Antacids
Some antacids contain calcium carbonate to neutralise stomach acid. Combining these with cheese can increase calcium levels excessively.
Mechanism: Excess calcium from both sources can lead to constipation or impaired absorption of other medications.
Examples: Antacids like Tums, Rolaids, Mylanta, Gaviscon and Maalox often contain calcium carbonate.
Advice: Monitor calcium intake if you regularly consume cheese and antacids. Discuss dietary habits with your doctor if needed.
Blood pressure medications
Cheese, particularly processed and aged varieties, is often high in sodium. Sodium can impact blood pressure management.
Mechanism: Excessive sodium intake can counteract the effects of blood pressure medications like ACE inhibitors or diuretics.
Examples: ACE inhibitors like lisinopril (Zestril) and enalapril (Vasotec or Renitec) or diuretics like hydrochlorothiazide (Microzide or Dithiazide).
Advice: Choose low-sodium cheeses or limit cheese consumption if managing high blood pressure.
Conclusion
Cheese is a delicious and nutritious food, but it can interact with various medications and supplements. The calcium, sodium, and other compounds in cheese are the main culprits. To avoid complications, understand how cheese interacts with your medications.
Consult your healthcare provider for tailored advice. By planning your diet wisely, you can enjoy cheese safely while maintaining your health.
References
- Gül, N. (2020). “Drug-food interactions: A focus on calcium-rich foods.” Journal of Clinical Pharmacy and Therapeutics. DOI: 10.1111/jcpt.13204
- Kellie, D., & Lambert, S. (2018). “Understanding tyramine and its effects with MAOIs.” Journal of Mental Health Practice. Retrieved from mentalhealth.org
- Dorrington, C., et al. (2017). “The impact of dietary calcium on antibiotic efficacy.” Pharmacological Reviews, 69(2), 154–163.
- American Thyroid Association. (2023). “Levothyroxine and dietary considerations.” Retrieved from thyroid.org
- National Heart, Lung, and Blood Institute (NHLBI). (2022). “Managing cholesterol with statins and diet.” Retrieved from nhlbi.nih.gov
- Young, L. J. (2019). “Calcium-zinc competition: Implications for supplementation.” Nutrition Insights, 34(6), 124–130.
Consult these sources or your healthcare provider for further details about drug-cheese interactions and safe dietary practices.
Cheese lover. Scientist. Created a website and a Youtube channel about cheese science because he could not find answers to his questions online.
