Butter and Health: What Does the Evidence Say?

Editor's Note:
The following is an edited commentary by endocrinologist-nutritionist Boris Hansel, MD, an obesity management specialist who practices in Paris, France. This commentary has been translated from French.

Butter and Health

What impact does butter have on health? This is a sensitive and frequently debated topic in France, where butter is a staple in culinary tradition and very important to the industry. In the background is the issue of the relationship between consuming saturated fatty acids and cardiovascular (CV) health.

Traditionally, the recommendation has been to limit saturated fatty acid intake in favor of unsaturated fatty acids. Because butter is one of the foods highest in saturated fat, the advice often given by practitioners has been to limit butter consumption.

Is Butter Harmful?

Does eating butter increase the risk of developing CV disease? Admittedly, at present, no study formally answers this question. A meta-analysis recently published in PLOS One^[1] even questions the hypothesis that butter has a harmful effect. Its authors, who compiled nine observational studies carried out in 15 countries, came to a clear conclusion—that eating butter is not associated with an increase in CV risk. Nor did they find a dose/effect relationship.

In addition to these neutral CV findings, the meta-analysis yielded the following:

Consuming butter is associated with a lower risk for diabetes; and
Consuming butter is associated with a discrete but significant increase in overall mortality.

How Should These Results Be Interpreted?

The mainstream media quickly picked up on this study to extol the virtues of butter, claiming that this wrongly accused food is even beneficial to our health. Such restating of the findings of the PLOS One study is inappropriate and, in my opinion, poses a risk to public health.

The meta-analysis included only observational studies, with all of the biases inherent in this type of study. Furthermore, most of these studies involved healthy persons—not people at high CV risk.

Finally, in nutrition, eating more of one thing means eating less of another. The authors of the meta-analysis said, "People who eat butter probably eat fewer sweets and processed foods, such as refined, processed grain products." Therefore, butter is perhaps better than certain processed foods, but it can't be concluded that it is, in itself, a healthy food. Bear in mind that butter is the fat with the highest fatty acid content: 10 g of butter contains 5 g of saturated fat. By comparison, 10 g of olive oil contains 1.5 g of saturated fat.

Butter and Cholesterol Levels

What is not debated is butter's cholesterol-raising effect. Butter increases the blood low-density lipoprotein cholesterol level, even when consumed in moderate amounts. As for saturated fat intake and the incidence of CV disease, what emerges overall is the potential benefit of replacing saturated with unsaturated fats, especially when the latter are provided by vegetable oils. This is the conclusion of a very recent analysis of cohorts of US health professionals published in JAMA Internal Medicine.^[2]

We sometimes hear butter consumption being promoted because of its high vitamin A content. Admittedly, 100 g of butter contains a large amount of vitamin A, but this benefit is of no great value, because butter is eaten in moderate amounts. In fact, one would have to eat 100 g of butter daily to get the recommended dietary allowance of vitamin A. The best way to achieve the recommended allowance is to eat certain fruits and vegetables containing vitamin A precursors.

In short, when talking about butter, we need to have a balanced discussion that is in line with current knowledge:

First, butter is not necessary for maintaining good health. It is not a "health food" per se.
Second, butter is one of the foods with the highest saturated fat content, and consuming it on a regular basis promotes an increase in blood cholesterol levels.
Third, butter is not a poison. There is, therefore, no justification for stigmatizing butter. It should be considered a pleasure food for those who are fond of it, provided that it is consumed in moderate amounts and not consumed in addition to other foods that are high in saturated fatty acids.

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