Butter: Is it Good or Bad?

Butter is the vexing ingredient. Some say it is a great food, others say this pile of saturated fat is responsible for heart disease, cancer, and bad breath. But a recent analysis of multiple articles show that eating some butter does not increase the risk of dying from heart disease – and in fact, eating more butter may result in a decreased risk of diabetes.

What we have learned is that those who consume butter do not put themselves at an increased risk of strokes or heart attacks. That butter by itself is neither the devil – nor is it an angel? You don’t need to over-consume butter because it will not save you from overly bad habits. Butter is, well, just butter. Don’t overdo it, don’t be afraid of it.


Saturated Fats – Red Meat and Heart Disease

The problem with saturated fats is that the data is conflicting. It is not clear, although some seem to think it is clear – but here are the examples:

A recent report stated, “There is insufficient evidence from a prospective epidemiologic studies to conclude that dietary saturated fat is associated with an increase risk of congestive heart disease, stroke, or cardiovascular disease.”

In contrast there were other studies that showed as you increase polyunsaturated fat for saturated fat that there is a lower risk of heart disease.

Finally some unpublished data came out of people who were served “good fats” for a couple of years and saturated fats. While the vegetable oils did reduce the levels of cholesterol, it also increased the risk of dying. Those who ate the saturated fats had higher cholesterol levels (not high to the point of worry, but higher) and they had a lower risk of dying.

So where does the truth lie? We cannot say, because the associations are not strong enough other than to note a few facts: over half the fat in “red meat” are not the type of fat that raise low-density lipoproteins.

Does this mean butter is back? What we have is a lot of evidence and analysis of the evidence that shows that saturated fat isn’t healthy, nor is it horrible. People who eat diets lower in saturated fats tend to eat healthier diets, with more vegetables and fruits, so when data is examined, the non-red meat eaters do a bit worse. But again, epidemiologic data has not shown us the answer, it has confused the literature.

The biochemistry of the fats, and the types of fats are complex, as are the types of fat found in food sources. It isn’t simple.

Take the Hegsted equation – a mathematical model showing increase in serum cholesterol as you increase saturated fat. Sounds bad – turns out that model works well in the short term when added to a low fat diet, but falls apart when you go beyond a few weeks. Meaning- if you start out with a low fat diet and add saturated fats you will have a predictable rise in serum cholesterol- to a point. Then the effect is lost. Other studies show that reducing dietary saturated fan can reduce some of the LDL by as much as ten percent, in some people.

Some people are profoundly affected by reduction of saturated fat – some, but not all.

The epidemiologic work in this field begins with Ancel Keys, but his work and study are now almost seventy years old. The work of Ancel Keys started from the assumption that saturated fats were a primary cause of cardiac disease in the western world. He noted the low incidence of heart disease among the Mediterranean area, and as a result advocated that different fats caused different reactions, and set about to prove this with his studies of the eating habits of different countries and their relative risks of heart disease.

Keys contention was that Americans were eating too much meat, milk, ice cream, and butter and these were contributing to heart disease. This was not popular when he first presented the hypothesis, but eventually it became engrained into the thinking of the world such that people will say one of the reasons they eat a healthy diet is they have given up red meat.

Keys felt there was a difference between the fats, and that saturated fat was responsible for raising the blood level of cholesterol, which was the cause of heart disease. The thinking at the time was that polyunsaturated fats (corn and fish) would cause cholesterol to fall, monounsaturated fats would have no effect on the blood level of cholesterol, but saturated fats would increase cholesterol levels and thus heart disease. Those pesky extra hydrogen atoms causing all that vascular damage – or not.

Keys was long before science unveiled some of the complex nature of cholesterol biochemistry, but he understood enough to realize that eating cholesterol didn’t raise cholesterol. He thought the answer was in saturated fat, and for 70 years the attempts to make a connection has either found small statistical significance or none at all, or a small inverse correlation. The correlation statistically is nothing remotely close to the correlation of lung cancer and tobacco (on a relative risk scale that would be 20, the best correlation with saturated fat and heart disease is 1.3 the risk of butter and dying is 1.01).

Which would you prefer in your coffee? Butter or Cream?

Which would you prefer in your coffee? Butter or Cream?

Adulterating Coffee with the Wrong Saturated Fats

Perhaps you saw the photo of the stick of butter sticking out of a cup of coffee. Or maybe you saw the infomercial where a man was loudly proclaiming his coffee was safer than others and when combined with butter and the magic MCT oils provided him a boost that he never felt before. He also claims to have hacked his inner self for the best foods, and he is happy to sell you his coffee kit.

In the local coffee shop the barista, Scott, tells me that after the magazine cover came out stating that butter was back he had multiple requests to add butter to the coffee, and asked if he had coconut oil. The next day, he tells me, he had purchased plenty of both for his customers, who would tell him how much better they felt drinking the coffee with butter and coconut oil in it. I think baristas are like bartenders, people tell them everything.

Here is the recipe, should you wish to try this:

  • 2 cups of coffee
  • 2 tablespoons (minimum) of grass-fed, unsalted butter
  • 1-2 tablespoons of coconut oil
  • Mix in a blender and serve.

Does this work? Do you feel better with the butter and the coconut oil? Well, you may feel better, but there is no basis for it. When it comes to coffee, simple cream works quite well.

As for the coffee that was supposed to be one of the few free from some toxins, most coffee sold doesn’t have this as an issue.

In terms of taste, it’s simple: coffee with cream tastes great, while coffee with butter and MCT oil tastes not quite as good. Scott says that after a few of his coffee drinkers tried it, and did it for a week or two, they slowly converted back to cream.

Is there a benefit to drinking with MCT oil? No.

When the studies about saturated fat are examined, they look at a reasonable level of it, not some super high level of saturated fat. All foods have a level at which they are no longer useful, and even if you fall into the religious group that praises saturated fat, be warned, this is a lot of saturated fat at once, and it will have an acute change in your blood levels. So, no, don’t do this: it doesn’t taste good and contains more saturated fat than your average seventy-two-ounce porterhouse steak.

In seventy years, there has been no convincing science, nor biochemistry to show saturated fat is evil or it is angelic. So before we move on, perhaps a simile about roads and heart disease.

Oil and Water, Trucks, and Heart Disease

Glucose is soluble in the bloodstream. It dissolves into plasma without an issue. The liver helps maintain a level of glucose appropriate to maintain cellular function; all the cells do is pulling that currency inside when they need fuel. Fats are a bit more complex. Just by their nature, fats in the bloodstream do not dissolve (think oil and water). In order to avoid a fatty emulsion in the blood, the liver makes carriers for the fats. These are protein carriers allowing the fats to be transported, by the blood, to their needed tissues. Without them, we humans would have been made to be constantly shaking like a paint mixer (think salad dressing of oil and vinegar).

Back to trucks. Think of the blood vessels of the body as a network of roads and highways, with access to every vital organ and to every bit of the body. Now you need trucks to carry the various fats to the sites that are needed, and those empty containers and trucks come in various sizes, like big, medium, and small. The size of the truck depends on what that truck carries. Now the nerdy chemists who first looked at these carrier proteins classified them according to their size, or rather their density (very low density lipoprotein). But I will make this workable.

The liver is a manufacturing plant, a distribution center, and it is your body’s port, like New York harbor. It has to assemble containers before loading them with the ingredients your body needs—triglycerides, fats, cholesterol—and sending them along their way to do the work of the body.

You were familiar with one of those trucks, chylomicron, which is made by the endothelial cells of the intestines. In order to transport triglycerides to the liver and the rest of the body, the fat has to be complexed with protein so it won’t have the effect of oil and water (blood is the water). (Now when I see the term “oil and water,” I picture a person constantly shaking to emulsify oil and water.) That is all a chylomicron is: a truck built to carry the energy rich triglycerides (fats) to the liver and some of the rest of the body. The liver makes its own version of this truck to take the triglycerides around the body; it’s called very low-density lipoprotein, or VLDL (and no, you don’t have to remember the name). The truck (VLDL) unloads the triglycerides to the cells that need it and head back to the liver.

But unloading a truck means the cells have a dock where the truck stops, unloads, and then moves on. Every cell has a dock, a place that is recognized by the truck, and when the truck gets to that cell, it docks, unloads and then moves back to the bloodstream. Besides the dock (technically they are called a receptor), the cell has a signal that it gives, and if the signal isn’t on then the truck passes the cell. There’s no sense in every body cell getting fat if they don’t need it.

So, the truck empties its material and now the empty truck makes its way back to the liver, and is given a new job. The liver modifies or changes the truck. Think of a truck that carried boxes, but now your body needs it to carry liquid, so the liver modifies it for a new cargo. This new truck is now altered so it can carry cholesterol for your cells. The new truck has a name—low-density lipoprotein (LDL), and you probably know it as “bad cholesterol.”

Suppose you have too much cholesterol in your tissues, and the body needs to return it to the liver. The body has a special truck designed for that called HDL. Some call this the good cholesterol.

HDL – The Good Cholesterol – Removing Bad Stuff from Your System.

This truck, HDL, is responsible for carrying cholesterol from tissues to the liver. Sometimes referred to as the “good cholesterol.” You can imagine that if a tissue has too much you want something to carry it back to the liver. That reverse transportation has been associated with reduced risk of heart disease. If you reduce the level of your HDL by one mg per 100 cc of blood, then you increase the risk of heart disease by three to four per cent.

But even more than that, HDL helps to recycle the LDL back to the liver. In addition, HDL acts as the maintenance crew for the roadway—it helps to repair the walls of the arteries.

If you have a high blood level of HDL then you have a lower incidence of cardio vascular disease, and thus everyone is encouraging people to raise their HDL levels by consuming copious quantities of fish oil and nicotinic acid. But simply raising HDL with a supplement or medication, as we mentioned earlier- doesn’t decrease the risk of heart disease. Raising it with diet does (think salmon, trout, mackerel, walnuts, and those eggs with higher levels of omega-3 fatty acids).

Other things that raise levels of HDL that appear to have an impact on future cardiovascular disease include decreasing simple carbohydrates (those pesky refined fructose and sugars), weight loss, increasing soluble fiber to the diet (vegetables), increased diets with fish, consumption of medium-chain triglycerides (caproic, caprylic, capric, and lauric acid) and removing trans-fatty acids from the diet. It also increases when you stop smoking and with a bit of alcohol.

Heart Disease

There are families that have high cholesterol and many die young from heart disease. There are a number of genetic defects in these trucks, and one of them is called familial hypercholesterolemia. In one of these diseases there is a defect in the docks for one of the trucks (LDL). Simply put, the truck passes by the cells, because the dock signal doesn’t always work correctly letting the truck know to stop, dock, and unload its freight. While these cells of the body cannot get the LDL ship to stop, attach, and unload its cargo, they still need the raw ingredients, so the cells keep sending a signal to the liver: “Hey, send more cholesterol.” In response to the signal the liver makes more trucks and more cholesterol, packing them into the truck and sending them out. The result is the roads (bloodstream) have a lot of trucks carrying cholesterol (LDL).

Here’s the problem: The more trucks that are on this road, the more the road gets used, and the more there is damage to the road. The most well used of those roads are the arteries going to the heart (coronary arteries)—hence, those roads, those arteries, get damaged the most.

When there is damage to the arteries, they need to repair themselves. That means they need cholesterol, and it turns out there is a lot of that available.

The cells of the arteries, endothelial cells, have the dock that allows LDL truck to dock at these cells. Once they have attached they fuse with the cell because of another enzymatic reaction from a phospholipase enzyme.

The LDL truck attaches to the artery cell, fuses, and dumps the cholesterol. These cells process the cholesterol and dump the excess cholesterol in the second layer of the artery. In the lining of the artery are the same type bouncer cells I talked about in the immunology of the gut. It is called a macrophage, and its job is to clean up things. When it sees the excess cholesterol it begins to “eat it” and it eats so much of cholesterol that the cell becomes trapped beneath the cells that line the artery. Now you have a little bump in the road. But that macrophage also causes damage, releasing oxidative material (like bleach) that causes more damage to your artery. These inflammatory changes in the artery are the beginning of a bump, or plaque in the artery.

The more an artery repairs itself, the more presence of lots of material that will cause more inflammation, and make a larger plaque or build-up of the artery. This happens at a microscopic level at first, but it builds over time.

Think of a road that keeps getting cracks in it, and keeps getting filled. But every time you fill a pothole you put a bit of extra asphalt on top. After a while you have a speed bump, but eventually it takes more and more work to go over that repaired area in the road. Now imagine this happens in a tunnel. In time, over years, you have less room to maneuver.

There are two consequences: the more build-up of plaque the less blood flow to the heart, and if that blood flow becomes insufficient the heart gets ischemic, like a muscle that aches when you exercise too much. This is the chest pain that people feel with exertion, or sometimes with rest.

In this case imagine on the other side of the tunnel is a village that needs food and supplies. But the tunnel that started out as wide and open only has a limited amount of room for the trucks to get through. As a result, there is starvation, and the people cry out. This is heart ischemia, chest pain, when there is not enough blood flow to that part of the heart and it screams out for relief.

At some point, in the process of that repair and inflammatory cycle, the unstable plaque deteriorates and comes apart. The body quickly forms a blood clot to cover it, and that clot in the artery prevents blood flow to the heart, and you have death of the heart muscle (myocardial infarction). If there is no intervention such as bypass surgery, angioplasty, or stent, or giving material to stop the blood from clotting in the coronary artery, this process leads to heart attack and possibly death.

When people say that heart disease is inflammatory, and the result of oxidative stress, they are partially correct. But the source of that issue is the liver. Taking supplemental antioxidants won’t help, but medicine does have some therapies that do work.

It’s a myth that lowering the risk of heart disease can be done by having a diet free of cholesterol and saturated fat. In reality, in study after study, diets that avoid cholesterol and saturated fat had little impact on heart disease. Cholesterol is made by the liver in response to needs of the cells, and while diet may make small changes, the levels of cholesterol in your blood are very tightly regulated, and excess cholesterol is moved out of the blood stream by the liver effectively. Intervention with diet at best reduces blood levels less than twenty percent and usually less than ten percent.

Digesting Fats

Fats, like carbohydrates and proteins, are complex chemicals that the gut breaks down using a combination of mechanical and enzymatic digestion. The breakdown of fat, be it in the guts from food or in the fatty tissue, to supply energy for your body is called lipolysis.

In the stomach the dietary fats are emulsified. Think of it this way. Take your average salad dressing that has a lot of fat suspended in it, and shake it up a bit to where there is an even-looking solution. That is emulsification. The stomach takes the fat, warms it to stomach temperature, and the agitation of the Vitamix stomach serves to mix up the fats into a fine emulsion. Similar to digestion of proteins and carbohydrates, stomach digestion is both incomplete, and unnecessary. But in the normal stomach as much as thirty percent of the breakdown of fats can take place.

When fats are broken down into component parts, free fatty acids are a basic building block of fats. Short- and medium-chain fatty acids are absorbed directly by the guts.

From the hamburger you have several sources of fat: the fat that is in the burger itself, providing a bit of the juiciness and mouth-feel. These are called “saturated” fats because of their chemical structure. Every cell of the meat, the lettuce, and the tomato is composed of fats. If you chose a bit of avocado on your burger (and you should, because if you read this book you care about good food) there is a fair bit of fat in that luscious berry (yes, avocado is a fruit).

Fat absorption mostly happens in the small bowel with bile acids, from the liver, pancreatic enzymes, and another factor called co-lipase bind onto the oil droplets, and all continue the rapid breakdown of fats.

Bile itself is not a digestive enzyme; rather bile is needed to keep the fats emulsified in the guts and serves to separate fatty acids from reforming triglycerides by separating them (remember how your parents separated you when you and your sibling were forming a fighting unit). By keeping them apart, this facilitates absorption. With bile, over 97% of the triglycerides are absorbed, but without it only half of the triglycerides are absorbed. Why is this important – because if you have low levels of bile you will get a fatty diarrhea – this sometimes happens after removal of the gallbladder.

Fats that cannot be completely broken down into small- and medium-chain fatty acids are absorbed. Another action of bile salts is to help re-arrange the fats into what are called micelles, which can be easily transported across the intestines and absorbed into the bloodstream. A small emulsion droplet is four to seven nanometers in length. It takes one billion nanometers to make a meter, or roughly a yard, and the micelle is four thousand times smaller than the smallest emulsion droplet. It is these micelles that are easily brought into the cells that line the small intestine, the enterocyte (the ones that look like the sea anemone).

Now the fun begins. Once these micelles are in the cell of the intestine, they reform triglycerides and they are packaged with cholesterol and vitamins A, D, E, and K to form chylomicrons. These are too large to enter the bloodstream, so they enter the lymphatic system and find their way into circulation where the lymph enters the bloodstream in the chest.

These chylomicrons are then broken down by an enzyme found in the cells lining the blood vessels, and those fatty acids diffuse freely into cells.

Most of the fat in the diet of a human is in the form of triglycerides, which is emulsified into oil droplets, broken down by enzymes, delivered into the cells that line the guts, then re-assembled into triglycerides and delivered to the bloodstream where they are broken down and passively go into cells.

Fats and the Colon

Xenical is a drug that attaches to the lipases and blocks their action on fat. Using Xenical, the fat that is not absorbed is delivered to the colon, where either bacteria consume it or it quickly passes. Unabsorbed fat is a potent stimulator of the colon, as any who take Xenical will tell you.

People who have undergone gastric bypass for obesity (or a duodenal switch) have bypassed the first portion of the intestine, and if they eat too much fat in their diet there is not enough small bowel left to absorb it. Thus they are prone to diarrhea from the unabsorbed fat (and the bacteria that enjoy eating the fats you don’t).

Other conditions that lead to malabsorption of fats include people who have pancreatic insufficiency, be it from accident, a disease like cystic fibrosis, or abuse from alcohol.


Back to butter — enjoy it- its delicious.

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Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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