Yesterday this headline appeared in Stuff.
Included in the article was a claim from Prof Rod Jackson that
“Butter consumption has increased and the underlying cause of heart disease is a diet high in saturated fat.”
Kiwis follow advice of advocates for high-fat, low-carb diets, who promote foods such as coconut oil and butter, to the detriment of their health, Jackson said.
“Everything was going in the right direction and now people are getting confused. Coconut fat should never go in your mouth, it’s saturated fat.”
We think this is a bit rich. A rise in heart disease was a predictable result of the huge increase in diabetes and obesity in recent years, the very epidemic we’ve been fighting with LCHF advice. The same reversal of mortality trends has happened in America, where LCHF is hardly being blamed. One place it’s not happening is Sweden, which has had mainstream LCHF diet advice and rising butter sales since 2008 – in Sweden heart attack death rates continue to drop steadily, with age-adjusted stats available as recently as 2015.
(In fact the Stuff article states that heart disease rates have already risen in Australia, a country which, as we shall see, is, according to Rod, eating far less butter than us, and where the dietary establishment has been suppressing LCHF advice viciously).
Another good reason why heart disease is rising is that we have an ageing population. The figures in Stuff were not age adjusted, there is a limit to how long life can be extended, and that limit is being reached all around the developed world. People have to die of something; we won’t really know if heart disease is rising until the statistics are age-adjusted – but we suspect it is, because this is an expected effect of a diabesity epidemic that Rod didn’t seem to think was very important with regard to heart disease when we spoke to him last.
How LCHF eating advice – a pattern of eating which reduces almost every cardiovascular risk factor – blood pressure, weight, triglycerides, HDL cholesterol, blood glucose and more – can be blamed for any increases in heart disease mortality is a wonder.
What about Rod’s claim that we’re eating more butter? He expanded on this in a recent edition of the Listener which re-opened the old debate, which is better, butter or margarine (non-dairy spreads)?
The case against butter was presented by Rod and Listener nutrition writer Jennifer Bowden, and the case for margarine was presented by oils and fats chemist Dr Laurence Eyres, so it was a balanced debate.
We don’t agree with their view that butter is bad for you, and causing untold health harms in New Zealand.
Before we go into it, we’re not telling people to eat butter. Olive oil is perfectly good and also has lots of uses. We just don’t see why the average person shouldn’t eat butter, especially in the context of a low carb diet. But we will point out that the category of margarine/non-dairy spread products suffers from multiple issues not addressed in the Listener article, which we’ll get to in a second part of this series.
So are we eating too much butter? First, we need to understand – just how much butter do we eat?
from Index Mundi – the 1986 spike is probably the result of an error that was corrected in 1996.
Professor Rod Jackson, interviewed by Nicky Pelligrino, told us the old historical narrative, that heart disease in NZ started falling as soon as butter intake started dropping from the 1960’s high of 20 Kg annually per capita (385g per week, on average, for every man, woman and child in the country), because saturated fat intakes fell, cholesterol fell, and so on.
The problem with this story is that saturated fat intakes fell slowly, there was a decline in monounsaturated fat too, and most of the replacement energy came from carbohydrates and products with trans fats (margarine became freely available in New Zealand in 1972). Any rise in polyunsaturated fat consumption was small and happened slowly, taking us from about 3% to 5% PUFA by the 1980’s.
There’s no version of the diet-heart hypothesis where a very gradual change of this type would cause a dramatic drop in heart attacks, effective immediately (or even at all, really). We were still eating diets high in saturated fat when heart disease started dropping, and we had been eating them for quite some time, and, per the classic version of the diet-heart hypothesis, coronary atherosclerosis is a slowly progressive disease and its reversal, if it happens at all, requires drastic dietary change.
In Rod Jackson’s version we started replacing butter with olive oil and canola in the late 60’s. No, we didn’t. Oils available in NZ in those days weren’t popular and usually tasted rancid, maybe because they got left in the cupboard for years. People didn’t really start using those products till the 1970’s, which was when the health food movement hit New Zealand. Canola oil wasn’t even invented till the mid-1990’s.
Be that as it may, the most remarkable claim in Rod Jackson’s story is that we are now eating as much butter as we did in the 1960’s. He’s on record from 2014 as saying that NZ per capita butter consumption was up to 11 Kg per annum in 2011, and now he’s saying it’s over 20 Kg and the highest in the world.
That’s right – every man woman and child in New Zealand eats, on average, 400g of butter every week (a block is 500g).
Judge Judy Scheindlin has a book titled “Don’t Pee on my Leg and Tell me it’s Raining”.
This is a case where a little observation on Rod’s part might help to correct a mistaken view. Is it really raining butter?
In the 1997 nutrition survey adult Kiwis (15+) were eating about 7.1% of the 35% of energy that came from dietary fat from butter (about 2.5% of total energy); children ate much less. In the 2008/9 survey, this was halved. Calculating from these figures, unlikely to be very reliable, only gives us around 2Kg a year. Yet even in this year Rod Jackson was quoted as saying “We average around 8kg a year – three times as much as Australians and 16 times more than the Japanese”. So according to Jackson, in 2008, before LCHF and Paleo became popular, the results of the Ministry of Health’s Food and Nutrition Study were completely and utterly wrong, and the average Kiwi was already eating more butter than a butter-friendly low-carber does today, and as much as the average inhabitant of France.
Rod’s data come from the Food and Agriculture Organization (FAO) of the UN, but there are other data available, which come from the dairy industry itself, and the International Dairy Federation has our per capita butter consumption for 2015 at 4.9 Kg, placing us in 7th equal place in world butter consumption.
They should know. But also look around you. My (GH) family of four eats and my (GS) family of five eat butter, and we don’t buy any non-dairy spreads. The two adults, but not the teenagers, eat LCHF (both GS and GH). We buy one 500g block most weeks (some weeks we don’t need to replace it). We use a little ghee too (GH). Together this adds up to about 550g butter fat; that’s 7.2 Kg per year per capita. But we’re exceptional families (maybe?), because someone is still buying the margarine and non-dairy spreads, someone is still cooking with soy and corn oil, and someone is still using vegetable shortening in their baking. Canola oil consumption in NZ is almost double that of butter, according to the industry data. These things haven’t gone away – and most of them didn’t exist in the 1960’s, when butter was the main fat in recipe books, and the only spread in the shops. We sometimes see butter in other people’s shopping trolleys, but more often see the cheaper oils and spreads. New Zealanders don’t eat more fat today than we did in the 60’s, so how do we fit all these oils and spreads in if we’re now eating the same amount of butter we ate back then?
Another factor is that Kiwis eat out more often and eat more processed and fast food than we did in the 1960’s. Takeaway food and processed food are hardly ever made with butter, and even restaurant food doesn’t supply much. The 1960’s equivalent of processed food was Edmonds’ Cookbook recipes made with equal quantities of butter, sugar and flour, or white bread with butter and jam, cheese, or luncheon meat (and if there were any adverse health effects of butter in the 1960’s NZ diet, you don’t need to look any further than those combinations, which accounted for most of the butter eaten).
So it looks to us that the IDF estimate of around 5 Kg per annum has to be much closer to the truth than the FAO estimate of 20 Kg, even if, as we expect, butter consumption per capita is increasing.
Why does this matter?
It’s important that public health advice be based on statistics that are as accurate as possible. Rod Jackson is fairly representative of the anti-saturated fat approach in New Zealand public health. In 2008 he called for a tax on butter (“professor calls for tax on poison butter“).
His colleagues present proposals modelling the effects of saturated fat taxes in New Zealand. If Jackson and his colleagues are basing their thinking on the FAO estimate, and it is badly wrong, as we think it may well be, then these models, such as they are, will be inaccurate. Further, if a scare story is published claiming we eat too much butter, and this is why we’re having heart attacks (sure, it has nothing to do with low-fat sugary treats and KFC cooked in canola oil), and the estimate of how much butter is being eaten in that story is out by a factor of 3 or 4, then the claim is based on an alternative fact.
Plainly, we need much more reliable data than we currently have to make any claims about butter consumption in NZ today.
As for the claim that coconut oil is somehow responsible – coconut oil is expensive. It’s not a big seller in supermarkets. It’s being bought by health conscious people and used as part of a diet that’s overall lowering their risk. It’s very unlikely to have come anywhere near the rise in heart attacks; we note that both the Stuff article and a recent Listener article focus on the stories of younger people who had heart attacks with no warning, because their cholesterol was low. So that hardly tells us that butter or coconut oil are dangerous – it tells us, rather, that Rod Jackson’s preferred risk marker is dangerously unreliable.
To make public health recommendations about a food like coconut oil is a step way past any criterion that should be used by public health practitioners. More specifically the criteria set out by Bradford Hill are simply not met. Its time to get sensible about public health recommendations around saturated fat and coconut oil.
For metabolic syndrome, maybe it’s time to look at other results, like the fasting TG/HDL ratio and HbA1c, and to start taking the epidemic of diabetes, obesity, and the metabolic syndrome more seriously, seriously enough to start applying effective measures like LCHF more widely.
Addendum: some more realistic data on the butter increase
Here’s some figures that seem to fit the facts. They come from the US Department of Agriculture’s yearly reports and are based on industry monitoring.
– From 2009 -2011, NZ butter consumption was at its lowest ever – 20 thousand metric tonnes. In 2012, about the time we (GS and GH) started to eat LCHF, Pete Evans went Paleo, and so on, it went up 5%, and went up another 4.7% in 2013. Consumption has stayed stable since then, on 22 thousand metric tonnes.
So a 10% increase over the lowest-ever consumption rate can possibly be attributed to LCHF, Paleo, and the Real Food movement, etc (and to New Zealand’s ever-growing population).
However, in 2013, rapeseed oil (canola) increased 5.71% and in the following year 2.70%
Palm oil consumption also increased by 36% in this period, and is now equal to butter consumption.
Soybean oil, the other main oil in spreads and other processed foods, fluctuated a fair bit but overall stayed stable during this period.
Canola and palm oil together – oils and spreads – accounted for a bigger increase in saturated fat intake in NZ than butter during the period in question, proving that Kiwis in general didn’t turn away from these foods at all.
In part 2 of this series we’ll look at What, if Anything, is Wrong with Margarine?
 Jody C. Miller, Claire Smith, Sheila M. Williams, Jim I. Mann, Rachel C. Brown, Winsome R. Parnell, C. Murray Skeaff. Trends in serum total cholesterol and dietary fat intakes in New Zealand between 1989 and 2009. Aust NZ J Public Health. 2016; Online; doi: 10.1111/1753-6405.12504.