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I generally appreciate the work and writing of Mark Bittman. But\u00a0on one prior occasion<\/a>, 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.<\/p>\n But old habits, it seems, die hard- and\u00a0in this week\u2019s\u00a0New York Times<\/em>, Mr. Bittman is indulging again in intellectual mission creep<\/a>, with predictable consequences. While not trained as a chef, Mr. Bittman has established himself among the foodie elite, and is thus qualified to opine expertly on the culinary merits of butter. Or, at least, I am not qualified to say he is unqualified to do that- I defer to\u00a0Jacques Pepin<\/a>.<\/p>\n But Mr. Bittman is absolutely not qualified to assert the health effects of butter based on arecent meta-analysis<\/a>\u00a0I rather doubt he read in its somewhat excruciating detail. (In fact, he doesn\u2019t even seem inclined to pretend he read it;\u00a0he references the work several times<\/a>, but in each case, the links he provides lead to someone else\u2019s 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\u00a0New York Times<\/em>\u00a0should set the bar higher. Experts should earn the rarefied real estate of\u00a0New York Times<\/em>\u00a0pages only for their domain of actual expertise; the public probably expects, and certainly deserves, no less.<\/p>\n Mr. Bittman\u2019s writing is, as ever, engaging and stylish. Overall, his column entitled \u201cButter is Back<\/a>,\u201d which turns 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\u00a0a topic near and dear to my heart<\/a>, and one to which I have devoted\u00a0considerable, recent effort<\/a>.<\/p>\n But speaking of hearts, his conclusion that butter has now been exonerated of all harms formerly alleged is, in a word,\u00a0wrong<\/a>.<\/p>\n Since the study Mr. Bittman cites was about fatty acids, not foods, and only headlines in pop culture said anything about butter or cheese, we might begin with: what, exactly, are the saturated fatty acids in butter, and how did they fare specifically in the meta-analysis in question? I am betting you don\u2019t know or care-but my point is, I bet the same of Mr. Bittman.<\/p>\n We could, perhaps productively, wade into just such weeds of the meta-analysis, but I\u2019ve done that already, and see no value in redundancy here.\u00a0My prior column<\/a>\u00a0is accessible to you. Note, as well, that\u00a0colleagues have identified potentially quite important flaws in the actual analysis<\/a>, the investigators themselves have conceded those flaws, and an outright retraction of the paper is at least being discussed.<\/p>\n But we can leave all of that alone and grind better grist altogether. Consider that the meta-analysis, even if sound, showed only that Western diets with lower and higher levels of saturated fat still produced roughly\u00a0comparable levels<\/span>\u00a0of heart disease. It actually showed slightly less heart disease with lower saturated fat intake, but statistically speaking, that\u2019s picking a nit, so we can let it go. Let\u2019s accept that\u00a0without addressing at all what replaces the saturated fat<\/a>, a fairly typical Western diet produces about the same amount of heart disease whether higher or lower in saturated fat content. Substituting in Mr. Bittman\u2019s 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.<\/p>\n On this basis, Mr. Bittman says: bring back the butter.<\/p>\n Before you do, consider these points, in no particular order:<\/p>\n 1) All \u2018Western\u2019 diets produce very high levels of heart disease,\u00a0at least 80% of which has been shown to be outright preventable by a litany of studies spanning decades<\/a>.<\/p>\n 2) The new meta-analysis did NOT consider what was replacing the saturated fat in the diets of those who ate less, but others have told us that:\u00a0mostly refined starch and sugar<\/a>. Importantly, then, despite Mr. Bittman\u2019s assertions that these are the \u2018real\u2019 culprits in our diets- diets\u00a0lower<\/span>\u00a0in saturated fat did NOT show\u00a0higher<\/span>\u00a0levels of heart disease, as we might expect if we were replacing a false culprit with the real ones (i.e., cutting saturated fat, adding sugar). So, the new study might just as well be interpreted to show that \u2018adding sugar and starch to the diet in the place of saturated fat\u2019 does not increase heart disease rates. So on what basis does this study indicate these are the \u2018real\u2019 culprits? Mr. Bittman just brought his preconceived notions along for the ride. (My view? Excesses of saturated fat, sugar, and refined starch are in on it together, and all still wanted for further questioning.)<\/p>\n 3) The new study did show lower rates of heart disease with higher intake of omega-3 fat. There was a favorable trend with polyunsaturated fats in general, but this was not significant.<\/p>\n 4) Overall, then, the study showed that some dietary fats can be beneficial to health, butsaturated fats as a class were not among them<\/a>. The best the study said of saturated fats is:they don\u2019t seem to make things worse<\/a>\u00a0than the prevailing status quo.<\/p>\n 5) But to rephrase point 1: the status quo stinks!<\/p>\n 6) Other studies have blown the status quo away. In his\u00a0famous study<\/a>\u00a0years 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.<\/p>\n 7) Perhaps of more general interest: the\u00a0Lyon Diet Heart Study<\/a><\/em>\u00a0showed 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 \u2013and thus appallingly high- rates of heart attack was a typical Western diet. But the Lyon Diet Heart Study, as the name suggests, was centered in Lyon, France- and conducted in European countries. The \u2018typical\u2019 diet was not American junk- it was the real-food diet of Northern Europe, dripping in, among other things, butter.\u00a0Other Mediterranean Diet studies have shown much the same<\/a>.<\/p>\n 8) Combining point 7 with the new study could be said to show this: saturated fat (and therefore, maybe, butter) may not be bad for hearts and health\u00a0compared to<\/em><\/strong>\u00a0other things that are bad for hearts and health. But there is no evidence they are\u00a0good<\/span>\u00a0for hearts and health. That hardly seems cause to start shmearing.<\/p>\n 9) In contrast, a balanced portfolio of monounsaturated and polyunsaturated fats-characteristic of all of the world\u2019s most healthful diets<\/a>; particularly associated with the Mediterranean diet; and derived from foods such as olives, avocadoes, nuts, seeds, with or without fish and seafood- is decisively associated with lower rates of all chronic disease, dramatic reduction in the rate of heart attack, and reduction in the rate of premature death overall. And that\u2019s without buttering it up.<\/p>\n 10) Well, I guess I\u2019m done. Just reread 1-9, and there you go.<\/p>\n I don\u2019t think butter is poison. Go ahead and have some if so inclined. But do it for pleasure, not health. The new study was not about butter, but had it been, it could have concluded that there are things we can eat instead that are just as good, or just as bad. Either way, there was no hint that adding butter to our diets would improve our health. Since\u00a0other studies do show us how to do just that<\/a>, why would we settle for a lateral move, and stay mired in a place where coronary disease is practically a middle-aged rite of passage? There are places around the world that get the\u00a0healthy living formula<\/a>\u00a0right where heart disease is all but unknown.<\/p>\n I have opinions about cuisine-but they are just opinions. I cannot, and do not, claim culinary expertise. Mr. Bittman, by popular affirmation, can-and I, like many of you, am happy to listen and learn when he does so. But he is no scientist, and when he forgets that, he becomes a potential\u00a0danger to public heath<\/a>, misdirecting his considerable influence, and exploiting the faith of his followers. When it comes to clear messaging about nutrition and health, we all should be a bit more careful about which side of the bread is being buttered, and who wields the knife.<\/p>\n If you don\u2019t mind living in a world where everyone you know over age 50 is on multiple medications to fix what\u00a0lifestyle as medicine<\/a>\u00a0could fix far better, by all means add back the butter. If you think it\u2019s normal that most adults of a certain age have had their chests opened up or their coronaries ballooned open, butter away.<\/p>\n 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 \u2013among 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\u2019s good for me. I\u2019m sticking with it for both reasons.<\/p>\n Butter is not, and\u00a0never was, a singular nemesis<\/a>– any more than\u00a0sugar<\/a>\u00a0is, or\u00a0wheat<\/a>\u00a0is. 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.<\/p>\n -fin<\/em><\/strong><\/p>\n Dr. David L. Katz<\/a>\u00a0<\/strong>has authored three editions of a nutrition textbook for health care professionals. He is editor-in-chief of the peer-reviewed journal,\u00a0Childhood Obesity<\/a><\/em><\/strong>,<\/strong>\u00a0and President of the\u00a0American College of Lifestyle Medicine<\/em><\/a>.\u00a0<\/strong>He was commissioned by\u00a0Annual Review in Public Health<\/em>\u00a0to write the review article,\u00a0Can We Say What Diet is Best for Health?<\/a>\u00a0<\/strong>He is the author, most recently, ofDisease Proof<\/a>.\u00a0<\/em><\/strong>He likes olive oil.<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" http:\/\/www.linkedin.com\/today\/post\/article\/20140327141338-23027997-bittman-butter-and-better-than-back-to-the-future Bittman, Butter, and Better than Back to the Future March 27, 2014 I generally appreciate the work and writing of Mark Bittman. But\u00a0on 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 … Continue reading Katz on Butter<\/span>