Reductionism is the term used to describe one person’s perspective of causality being attributed to just one thing. We can all be guilty of it, right? Who hasn’t blamed that person going 43km in a 50km zone for their late arrival to an important meeting, ignoring the fact they were 10 minutes late leaving the house and had misjudged the distance to the arranged meeting spot?
Nutrition is rife with it, with scientists going head-to-head on pinpointing which nutrient is responsible for a certain disease state. In this case, though, headlines in the media have turned the spotlight on an old favourite: butter. This has caused my inbox to be overwhelmed with people concerned that their recent switch back to wholesome, natural butter — made after the (not-so recent) news that “butter is back” — is increasing their risk in the long term of heart disease.
What gives?
Ask a different health professional and you’ll likely get another answer, however I thought I’d share my views for a slightly different perspective. I understand the minor panic felt by the public who rely on the media as their source of trusted information.
Particularly around butter, right? I mean, we’ve long believed that butter was best avoided due to its nutrient make-up. Made from cream and salt, it’s a rich source of saturated fatty acids (SFA), known to contribute to high cholesterol and therefore heart attack and cardiovascular disease (CVD) risk.
To have this turned on its head a few years ago was mind-blowing, particularly for us health professionals who had (to this point) recommended butter substitutes (or no substitute) over actual butter as a healthier alternative. This led me and many of my colleagues to change our thinking around nutrition and disease risk.
Does butter raise cholesterol levels?
Absolutely — there is no dispute about that. Does this rise in cholesterol levels increase risk of CVD? The state of the science suggests no.
There have been many studies published over the past five years that have looked at the association between dairy fat and cardiovascular disease risk outcomes. A review published in 2012 of large population-based trials revealed that, though dairy fat from butter and full fat milk increased total and LDL cholesterol levels, it also increased HDL cholesterol — lowering the ratio of TC/HDL cholesterol.
This is now understood to be a more important indicator of CVD risk. The outcomes of either no-effect or an inverse relationship between dairy fat and both cardiovascular disease risk and stroke, led the authors to conclude there is a net protective effect.
A 2016 paper, reporting on three large observational studies that included almost 5.5 million person-years of follow-up also found no association between dairy fat intake and risk of CVD or stroke.
If we look at the consumption data for New Zealand, we can clearly see that — if anything — there has been a decrease in the consumption of butter over the past four years, not an increase. If heart disease risk is increasing, we need to widen our view and consider the ageing population, the increase in adults who are over-fat, and the rapidly increasing diabetes rates, all independent risk factors for heart disease.
We are often warned against the danger of a high cholesterol level and heart disease risk, but this is too-simplistic a picture; half of the people who suffer from a heart attack have a low cholesterol level. Our blood sugar control, levels of HDL cholesterol, triglycerides, inflammatory markers, blood pressure and waist circumference are well understood to be better indicators of risk than LDL cholesterol.
Do I have my own biases?
Of course! And nutrition is a tricky science — despite arguing that randomised controlled trials (RCTs) are what we need to find a definitive answer for cause and effect, we can’t conduct an RCT to test a hypothesis that increased butter consumption causes an increase in heart attacks.
Not only is it ethically unsound to potentially place people at risk of an adverse outcome, it would be incredibly resource-heavy (read: millions of dollars) and must rely on, well, people!
Add humans to the mix and you get a whole heap of additional logistical problems. Further, even if it was possible (and ethical) to conduct such a study, the next hurdle would be getting it published, which anyone who dives deep into the literature knows may well be a flawed process.
My stance on nutrition is that minimally processed food trumps that which is man-made every time. Though I bang on about sugar (as you know) if we are going to pinpoint this rise in heart disease risk to anything, I’d say it’s not one food or one nutrient.
The combination of fat, sugar AND salt in the package of processed food is the more likely contributor to the current poor health climate. The combination of refined grains, processed meat and poor quality fats, and a lack of fruit, vegetables and fibre are the perfect storm for increased health risk.
This describes what is referred to as the Western dietary pattern and is pretty much what most people continue to eat, despite what they read in the papers.
In addition to this, we are more stressed, less active (in everyday life) and sleeping less than we have previously — all known risk factors for poor health and premature death. Is it any wonder, then, that the prevalence of diabetes, cancer and CVD continues to rise?
Until public health nutrition messages get back to advocating minimally processed food, and there is a massive shift in how we live our everyday lives, there are likely to be no big downward shifts in these disease trends.
So is it the butter? Not in my opinion.
