How to confuse the media and public: Butter them up

Time to jump on the bandwagon of saturated fat? 

Read the headlines about diet this year and you could easily think, "Why not?"

"Butter is back" said the New York Times in a headline on Mark Bittman's March 28 column. In his opening, Bittman sounded joyful, almost giddy, at the prospect of eating unlimited amounts of saturated animal fats:

Julia Child, goddess of fat, is beaming somewhere. Butter is back, and when you’re looking for a few chunks of pork for a stew, you can resume searching for the best pieces — the ones with the most fat. Eventually, your friends will stop glaring at you as if you’re trying to kill them.

"Eat Butter," read the cover of Time, headlining a lengthy cover story in June by science writer Bryan Walsh.  

"Butter is bad — a myth," declared Joanna Blythman, of The Guardian. 

This surprising development in dietary medicine made headlines around the world. Almost unnoticed in the aftermath was the strong pushback from the international research community. 

Perhaps the pushback didn't make headlines because it wasn't what lovers of cheese, meat and butter wanted to hear. 

All the "butter is back" stories began with a discussion of a meta-analysis, a study of other studies, published recently in the Annals of Internal Medicine. The analysis looked at coronary risk — heart attacks and strokes — in relation to the consumption of fatty acids, including butter. 

"My take on this is that it's not saturated fat that we should worry about," declared lead author Dr. Rajiv Chowdhury, an epidemiologist at Cambridge, who led the meta-analysis of 72 other studies comprising 500,000 participants and questionaire respondents. 

Chowdhury and his 13 co-authors concluded by calling for more study on the topic, as scientists almost always do at the end of papers. Emanuele Di Angelantonio, a co-author and colleague of Chowdhury's at Cambridge, was quoted saying that new guidelines for the consumption of saturated fat were warranted, and called for more study to determine what they should be, according to a wire report from Medscape. 

So does Chowdhury's study give us the "green light" to eat saturated fat, as Frank Hu of Harvard put it in an interview with The New York Times? 

Many, probably most, of the leading experts in public health do not think so, including Hu, who recently published a clinical study on the question. But the researchers saying "Hey, wait a minute!" appear to be getting drowned out in the hubbub of buttery joy.

David Katz, editor of the journal Childhood Obesity, as well as director of a health research center at Yale, did not take the "butter is back" message well. He let frustration show in his column on the Chowdhury paper in a blog post for the Huffington Post. 

Go ahead, eat more meat, butter and cheese. Let me know how it turns out for you. I certainly won't be going with you, despite the current popularity of the proposition. 

In recent columns he's used words such as "follies," "nonsense," "clueless," and "doom" in reference to the current avalanche of pro-saturated fat writing. In a telephone interview, he admitted to being frustrated with the nature of the research, with the reporting on the research, and with the gullibility of the public. 

Katz argues that Chowdhury's study misses the point:

You never get a good answer to a bad question. They asked: Do we see variation in heart disease rates with the observable variation in fatty acid intake in our population? The answer, for the most part, was no. Well, frankly there wasn't much variation in the consumption of fats by the people in this study, compared to people who eat optimally. So the question and answer, although reasonable, wasn't very illuminating. If you have a small variation in x and ask is there a big variation in y, and the answer is no, then you're kind of left saying, 'Well, duh.'" 

Katz said that researchers have shown in many studies that people who try to eat less saturated fat often compensate by eating more carbohydrates and sugary foods, which the meta-analysis didn't study and didn't mention. He compared this to studying the consequences of consuming a diet laced with mercury against a diet rich in arsenic.

Although Katz doesn't put it quite so bluntly in his column, he scoffs at the suggestion that eating more saturated fat is healthy for you. "Less bad" does not equal "good,'" he said. 

There is no case — none — that eating more meat, butter and cheese would be good for us. Rather, the case is advanced these days — as it has been before, but we've forgotten so it's new again — that arguments for eating less meat, butter and cheese (or, if you like, 'saturated fat') didn't make us healthier. Therefore, the advice must have been wrong, and therefore the opposite advice must be right. So, bring on the meat, butter and cheese.

Katz went on to express great frustration with the media's sloppy reporting on the paper in general, and with Bittman's enthusiastic endorsement of eating saturated fat in particular. 

Many public health experts agreed, although usually in more technical language. From Australia to Vienna, from the Center for Science in the Public Interest to Harvard, researchers wrote to the Annals of Internal Medicine to criticize the paper. 

Walter Willett, chair of the Department of Nutrition at Harvard School of Public Health, said that the analysis was "seriously misleading" and contained "major errors and omissions." He called for the paper to be retracted. Like Katz, he stressed that the meta-analysis ducked crucial questions.

He wrote: 

The paper is bound to cause confusion. A central issue is what replaces saturated fat if someone reduces the amount of saturated fat in their diet. If it is replaced with refined starch or sugar, which are the largest sources of calories in the U.S. diet, then the risk of heart disease remains the same. However, if saturated fat is replaced with polyunsaturated fat or monounsaturated fat in the form of olive oil, nuts, and probably other plant oils, we have much evidence that risk will be reduced. 

Other experts in lipids who didn't want to point fingers at the meta-analysis, such as researcher Michael Miller at the University of Maryland, made clear that even if a little saturated fat is not bad for you, it doesn't follow that more saturated fat is good for you. Miller said:

One of my favorite fats, stearate, a primary fat in chocolate is in fact saturated and yet chocolate possesses cardioprotective properties! The bottom line is that small to moderate amounts of your favorite fat is less of an issue than overconsumption of any fat, carb or macronutrient for that matter.

Ironically, Chowdhury and his co-authors actually agreed with this point, if you look beyond the headlines. Chowdhury said in the body of a New York Times story immediately after the paper was released that dietary guidelines should focus more on "high carbohydrate and sugary diets," but that point appears to have gotten lost in the pro-butter excitement provoked by commentary such as Bittman's.  

Which raises a related issue: Who looks past headlines? A recent poll from the American Press Institute — if read closely — reveals that 6 in 10 of Americans read only the headlines of most stories in the media. They don't read the actual story.

Emanuele Di Angelantonio, one of Chowdhury's co-authors, nonetheless told Science that the paper had been "wrongly misinterpreted" by the media. 

He explained in a telephone interview: 

I think we are frustrated that the message did not come out in the public domain as we would have liked. We do not think the message was properly conveyed by the media, but in part that is up to the researcher to make clear. We are continuing to advise people to follow the existing guidelines regarding dietary fat, and we will respond soon to the criticisms in a letter regarding the study in the Annals.

Di Angelantonio corrected several numerical errors pointed out by Harvard's Walter Willett but refused to withdraw the paper in his lengthy July 1 response to numerous researchers. But Di Angelantonio did acknowledge many of the criticisms published in the Annals. In his response, he agreed that dietary guidelines should be based on "the totality of evidence." He also noted their point that a Mediterranean diet based on cooking with olive oil, not butter, has been shown to substantially reduce the risk of stroke. 

On the phone, Di Angelantonio echoed Katz's complaint: "One of the messages that came out in the media is that we can have more butter, we can eat more meat, and that's not what we found," he said. "We looked at saturated fatty acids versus other fatty acids and not at overall consumption." 

The public, Di Angelantonio said, didn't really want to hear the details — they just wanted to eat more butter, meat, and cheese. 

"The saturated fat story will always get a lot of reader attention, because we all like to hear that we can eat saturated fat," he said. "We don't want to be told to limit our consumption of these fatty acids."

And, as Katz said, "The problem was compounded by headlines that said go ahead and eat butter."

Such as this one, perhaps?  

In the story, writer Bryan Walsh digs into the meta-analysis and the issues it raises, and the balance of foods called for in a healthy diet. He quotes many experts, including Katz. He discusses the risks of low-fat diets and the risks of high-fat diets and the value of "real foods" that your grandmother would recognize, the ones food writer Michael Pollan has been extolling for years.

Walsh writes:

It's important to understand that the new science doesn't mean people should double-down on cheeseburgers or stir large amounts of butter into their morning coffee, as do some adherents of ultra-low-carb diets. While saturated fat increasingly seems to have at worst a neutral effect on obesity and heart disease, other forms of fat may be more beneficial. 

Despite his issues with the headline, Katz called the story "pretty good over all."

The irony? Only the "Eat Butter" headline and image are available today to non-subscribers: the story itself is locked behind a paywall.

Photo by Alpha via Flickr.