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Butter and Your Heart: The Facts

Published on November 6, 2013,

More evidence of mainstream coverage for ideas previously only found lurking in fairly obscure parts of the internet comes from a full page article in the [UK] Times last week by Dr John Briffa, author of The Diet Trap, entitled “Butter and your heart: The facts”. This is an extract…

Butter Dr BriffaMany of us will know the gustatory gratification butter can give us, whether spread on a piece of bread or toast, infused in mashed potato or melted over some veggies. However, we also likely to be only too aware of butter’s rich stash of saturated fat, which we’re warned raises our risk of heart disease via an elevating effect on cholesterol. Butter has inevitably been damned tonutritional hell by official health bodies, which have eagerly advised us to opt for lower-fat and cholesterol-reducing spreads instead.

This week, though, a British Medical Journal article by cardiologist Dr Aseem Malhotra which urges us to choose butter every time hit the headlines. So, are our beliefs about the ‘heart-healthy’ properties of margarine built on solid scientific foundations, or just the result of slick marketing and misinformation? Is it time we got our fats straight?


While the saturated fat that makes up the bulk of butter might boost cholesterol levels in our blood, any effect here is actually irrelevant: it’s the impact it has on health that counts. All the most recent, major scientific reviews of the evidence simply fail to find any link between intakes of saturated fat and risk of heart disease…

A comprehensive review of the literature encompassing almost 50 such studies was published by researchers from the respected Cochrane Collaboration in 2012. Reducing and/or modifying fat in the diet did not reduce the risk of heart disease (or stroke, or any other chronic disease) at all. Life expectancy was not extended by a single day either. The evidence as a whole strongly suggests that our belief that saturated fat causes heart disease and has broadly harmful effects on health is a myth…


The original health claims for margarine centred on its lower saturated fat content compared to butter. But, seeing as the evidence essentially exonerates saturated fat, this claim has no legs.

Margarine’s principal ingredient comes in the form of ‘vegetable’ oils such as sunflower, corn or safflower oil. These oils are rich in so-called omega-6 fats – one of the two main forms of ‘polyunsaturated’ fats. Omega-6 fats are vigorously promoted as ‘healthy’, but in general terms promote inflammation and blood clotting – two things that would be expected to raise heart disease risk. In recent years, many researchers have raised concerns about the considerable glut of this type of fat in the diet, including from processed foods…

Cholesterol-reducing margarines

Recent years have seen the emergence of cholesterol-reducing spreads into the market. It’s often assumed that cholesterol reduction is beneficial to heart health. However, several cholesterol-modifying drugs have not been found to deliver on their promise, and some have been found to actually harm heart health. Plus, overall, taking dietary steps to reduce cholesterol has not been found to have broad benefits for health.

Again, the effect that a foodstuff has on cholesterol levels should not be our focus, but the impact it has on health. What evidence do we have that cholesterol-reducing margarines reduce the risk of heart disease, heart attack or overall risk of death? Not one single study of this nature exists in the scientific literature.

Some cholesterol-reducing margarines contain ‘plant sterols’ that partially block absorption of cholesterol from the gut. However, sterols may make their way into the bloodstream too, and evidence links higher levels of sterols in the blood with increased risk of cardiovascular disease. Perhaps worse still, there are several studies that show sterols have the ability to damage tissue and induce worse health outcomes in animals.

While the British Heart Foundation and many doctors heartily support the use of sterols, the National Institute of Health and Care Excellence (NICE) explicitly advises against their routine use.

In the final analysis, I find it impossible to reconcile margarine’s heart-healthy image with the facts.  The fat-phobia that drove our broad switch from butter to margarine in recent decades never did have any meaningful scientific support, and I believe has been a huge retrograde step in terms of our health.

I am a practising doctor and the author of several books on nutrition, and in over 20 years I have not bought a single tub of margarine, nor have consciously limited butter in my diet. There’s little doubt in my mind that butter is better, and not just in terms of how it tastes. To my mind, butter need not be a guilty pleasure at all, but just a pleasure.

More at:  My piece in The Times which (I think) settles the butter versus margarine debate once and for all

Infographic: How To Use Good Fats – a Free Guide From Empowered Sustenance

Published on March 5, 2013,

The issue of good and bad fats has become one of the most confusing areas of nutrition with so much conflicting advice about not only what types of fats are best but also how they should be used to make sure good fats stay good and don’t turn into bad fats in the cooking process. To help, the health and nutrition blog Empowered Sustenance has produced this handy free guide (link below to print out version)…

How To Use Good Fats

How To Use Good Fats

Here’s a link to Empowered Sustenance for a printer friendly PDF version

More at: Choose and Use Good Fats (print-out!)


Ask me what my cholesterol level is, says Dr Briffa

Published on December 4, 2012,

Dr John Briffa, the author of ‘Escape The Diet Trap’, has written a fascinating article on cholesterol in men and how widespread concern about ‘raised’ cholesterol is due, in large part, to the way the levels are set. What’s more, he argues, even if you believe the conventional wisdom around ‘raised cholesterol causing heart disease’ (and he doesn’t), there appears little to be gained trying to modify the levels. This is from Dr Briffa…

In my practice and through other work that I do I encounter a steady stream of men who are ‘concerned’ about their cholesterol. These men have turned up a ‘raised’ cholesterol on routine screening, Their doctor may have suggested that they swap cholesterol-reducing margarine for butter and cut back on cheese, eggs and red meat. However, if that doesn’t work (like it hardly ever does), the next step is to ‘go on a statin’.

I really have lost count of the number of men for whom ‘raised’ cholesterol is the only supposed abnormality in their blood markers of health as well as other measurements such as weight and blood pressure. Many of these men live what would generally be regarded as healthy lives: non-smoking with a decent diet and some physical activity thrown in for good measure. So, how can it be that so many people have so much evidence of good health throughout the body, yet quite consistently fail in this one measure (cholesterol)? What occurs to me when I see men like this is just how the ‘raised’ cholesterol sticks out like a sore thumb.

Well, one reason has to do with concept of what is termed ‘normal’? Usually, what is normal is determined by so-called ‘normal ranges’. Basically, the normal range is the range of levels of, say, sodium or thyroid hormones, seen in a ‘healthy’ population of people. The middle of the normal range normally corresponds to the average level of a substance in a population.

However, for cholesterol, normal ranges are not set in this way. The upper level of cholesterol is not represented by the upper end of the normal range in a population, but decided by panels of people who ‘weigh up the evidence’ and then set an arbitrary ‘upper limit’ of cholesterol over which, we are told, risk of heart disease is raised and efforts should be made to lower cholesterol.

Average cholesterol levels in the UK in men are about 5.5 mmol/l (213 mg/dl). The ‘recommended’ level of cholesterol is 5.0 mmol/l or lower (193 mg/dl). So, by definition, more than half of men are going to find themselves being diagnosed with a ‘raised’ cholesterol and at ‘increased risk of heart disease’, however healthy they are.

Even if one believes the conventional wisdom around ‘raised cholesterol causing heart disease’ (I don’t), then the real issue men like the ones I describe above are faced with is how much they stand to gain for taking advice to modify their cholesterol. It’s generally assumed that putting downward pressure on cholesterol is inherently good, but what does the evidence show?

Based on the best available evidence we know that taking dietary steps to reduce cholesterol by cutting back on saturated fat will not reduce the risk of heart disease, heart attack or overall risk of death, and there’s simply no evidence at all that eating cholesterol-reducing margarine benefits health. Turning our attention to pharmacological approaches we know that taking a statin (or any other drug, for that matter) will not extend the man’s life by a single day. And what of other benefits? Well, 50-100 men would need to be treated with a statin for 5 years to prevent one heart attack (in other words, only 1-2 per cent of men will benefit from treatment in terms of heart attack prevention). But let’s balance this with the facts that of these 50-100 men, one or more men will develop type 2 diabetes as a result of the statin treatment and about 20 per cent or even more of men will develop adverse symptoms such as muscle weakness, fatigue and memory loss. Others may go on to suffer from adverse effects such as liver or kidney damage.

Once we go through the numbers in this way, then most men come to the conclusion that their cholesterol level isn’t really ‘raised’ at all, and that doing something about their ‘raised’ cholesterol is very unlikely to benefit their health, and quite likely to harm it. Most determine that they can get on with their healthy lives as theY were before with no need to swallow drugs or highly-processed, chemicalised cholesterol-lowering ‘health’ foods like margarine.

Sometimes when talking to someone about their cholesterol, I ask them to ask me what my cholesterol is. Then I answer: “I have no idea, because I never have it checked.” That’s not because I take an ostrich-like stance on matters that relate to my health – it’s because the great likelihood is that knowing my cholesterol numbers would not lead to me having a different view on my health or have any bearing on how I live my life. End of.

More at:  Ask me what my cholesterol level is

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