Preventive Medicine Column

Dr. David L. Katz

I generally appreciate the work and writing of New York Times columnist, Mark Bittman.  But on one prior occasion, I was obligated to highlight his erroneous interpretation of an epidemiologic study about sugar, obesity, and diabetes.  Mr. Bittman responded cordially and graciously when I pointed out his error, and more generally, his want of training or qualifications to offer up seemingly expert opinion to the public on research studies.  I was pleased and gratified by the exchange that ensued between us, including a phone conversation and plans to meet for lunch, which alas, never came to fruition.

But old habits, it seems, die hard- and in last week’s New York Times, Mr. Bittman indulged once again in intellectual mission creep, citing a recent meta-analysis of dietary fat intake, and concluding that butter is now good for us.

Mr. Bittman is simply not qualified to assert the health effects of butter based on a recent meta-analysis I rather doubt he read in its somewhat excruciating detail.  In fact, he didn’t even seem inclined to pretend he read it; he references the work several times, but in each case, the links he provides lead to someone else’s blog about the study, each reaching a conclusion- surprise- aligned with his own.  He should restrain himself from such inclinations to impersonate an expert, and the New York Times should set the bar higher.

Overall, his column entitled “Butter is Back,” which turned out to be much about other things, such as limiting our overall intake of meat for ecological and humane reasons, is balanced, and thoughtful, and reaches generally reasonable conclusions about a diet of real foods, mostly plants – for the benefit of human health, our fellow species, and the planet alike.  This is a topic near and dear to my heart, and one to which I have devoted considerable, recent effort. But his conclusion that butter has now been exonerated of all harms formerly alleged is, in a word, wrong.

Consider that the meta-analysis, even if sound- which has been questioned- showed only that Western diets with lower and higher levels of saturated fat still produced roughly comparable levels of heart disease. Substituting in Mr. Bittman’s leap of faith, this might mean that typical Western diets with higher or lower amounts of butter produce about the same amount of heart disease.  On this basis, Mr. Bittman says: bring back the butter.

Before you do, consider that all ‘Western’ diets produce very high levels of heart disease, at least 80% of which has been shown to be outright preventable by a litany of studies spanning decades. Overall, the meta-analysis showed that some dietary fats can be beneficial to health, but saturated fats as a class were not among them.  The best the study said of saturated fats is: they don’t seem to make things worse than the prevailing status quo.

Other studies have blown the status quo away.  In his famous study years ago, Dean Ornish showed a relative 70% reduction in the rate of heart attack with a plant-based, low-fat diet that certainly did not feature butter.  The Lyon Diet Heart Study showed exactly the same, impressive, relative 70% reduction in heart attack rates.  But in this case, the intervention diet had no ascetic overtones; it was a Mediterranean Diet.  The control diet, which resulted in standard –and thus appallingly high- rates of heart attack was a diet typical not for the U.S., but Western Europe.

If you don’t mind living in a world where everyone you know over age 50 is on multiple medications to fix what lifestyle as medicine could fix far better, by all means add back the butter.  If you think it’s normal that most adults of a certain age have had their chests opened up or their coronaries ballooned open, butter away.

But we certainly know how to do far better than such variations on the theme of eating badly.  Even in the home of the famous French paradox, replacing butter with olive oil –among other things- slashed rates of heart disease.  In my unprofessional opinion, cold-pressed, extra virgin kalamata olive oil on fresh, whole grain bread is sublime.  In my professional opinion, it’s good for me.  I’m sticking with it for both reasons.

Butter is not, and never was, a singular nemesis– any more than sugar is, or wheat is.  But butter never did our health any favors either- however it may treat our taste buds.  Advice to add it back takes us back, not forward, to our nutritional future.  We know how to do far better.

 

-fin

 

Dr. David L. Katz