Episode 73
Butter, LDL, and the Myth of Plaque
Butter, LDL, and the Myth of Harmless Plaque
Why High Cholesterol Isn’t Just a Number—and What the Latest Science Says About Oils, Fats, and Your Risk of Death
By Dr. Terry Simpson, MD – The Culinary Medicine Doc
We’ve all heard the story: butter’s back, LDL doesn’t matter, and as long as you’re low-carb, your heart is safe.
But what if I told you that the science—real, peer-reviewed science—tells a different story?
In this post, I’ll walk you through three powerful studies that dismantle the myth of “harmless” LDL and show why swapping butter for plant-based oils could literally save your life.
1. LDL and ApoB: The True Origins of Arterial Plaque
Atherosclerosis—the buildup of plaque inside arteries—often starts silently. But over time, it becomes the leading cause of heart attacks, strokes, and cardiovascular disease.
A key study from the Journal of the American College of Cardiology found that the primary trigger for plaque formation is not “existing plaque” as some influencers claim—but rather, LDL cholesterol and ApoB-containing lipoproteins that penetrate the arterial wall and kick off the inflammatory cascade that builds plaque [1].
Once inside, these particles don’t just hang out—they lead to plaque progression and destabilization, which is what causes heart attacks. No LDL, no plaque. It’s that simple.
2. High LDL, Worse Plaque—Even on Keto
A 2025 study published in JACC: Advances examined people on carbohydrate-restricted diets—many of whom had very high LDL cholesterol levels [2].
While some hoped the data would vindicate high LDL in the context of keto, that’s not what happened. The study found that the higher the LDL, the worse the atherosclerotic plaque—regardless of dietary pattern.
Bottom line: High LDL is still atherogenic, even if you’re “metabolically healthy.” That six-pack doesn’t protect your arteries.
3. Butter Increases Mortality. Plant-Based Oils Reduce It.
Let’s talk fats. Specifically: butter.
In a major pooled analysis of three large U.S. cohorts—the Nurses’ Health Studies I & II and the Health Professionals Follow-up Study—researchers found that butter consumption was associated with increased total, cancer, and cardiovascular mortality [3].
But here’s the good news: Replacing butter with plant-based oils—like olive, soybean, and canola oil—reduced the risk of death.
The substitution analysis showed that replacing just 15 grams of butter (about 3 small pats) with 15 grams of plant-based oil (about 1 tablespoon) led to statistically significant reductions in mortality risk.
These plant oils are rich in polyunsaturated and monounsaturated fats, which have been shown in trials to:
- Lower LDL cholesterol [4]
- Reduce inflammation [5]
- Improve lipid profiles [6]
- Decrease overall mortality [7]
4. Butter, Cancer, and Inflammation
It gets worse for butter.
The same study found a strong association between butter intake and cancer mortality, especially hormone-sensitive cancers like breast and prostate [3].
Why? Saturated fat—found in high levels in butter—can increase inflammation in fat tissue and alter hormone activity, both of which are risk factors for these cancers [8,9].
And no, this wasn’t confounded by white bread or pastries—the researchers adjusted for those too.
5. Are All Plant-Based Oils the Same? Not Exactly.
Olive oil, canola oil, and soybean oil showed consistent protective effects. Corn and safflower oil? The data were weaker—possibly due to low use or degradation during cooking [3].
Some commercial corn oil is also more likely to be oxidized or partially hydrogenated, especially in older food systems [10]. So, while vegetable oils generally fare better than saturated animal fats, quality and cooking method still matter.
Final Thoughts: What the Data Say
High LDL is not “just a number.” It’s a powerful driver of atherosclerosis and death.
Butter, despite its nostalgic appeal, increases risk of death. And plant-based oils? They reduce it—even in small amounts, even in real-world diets, and even over decades.
So next time someone tells you to throw out your olive oil for butter, ask them to show you the data. You now have three major studies that say otherwise.
TL;DR:
- LDL and ApoB cause plaque — not existing plaque.
- Higher LDL = worse plaque, even on keto.
- Butter increases mortality — especially from cancer and heart disease.
- Plant-based oils reduce mortality, especially olive, canola, and soybean oil.
- Replace 3 pats of butter with 1 tablespoon of plant oil to lower your risk.
References
- Libby P et al. “Plaque Progression and Rupture in Atherosclerosis.” J Am Coll Cardiol. 2020. Link
- Ebinger J et al. “Coronary Atherosclerosis in Individuals with Markedly Elevated LDL-C from Carbohydrate-Restricted Diets.” JACC: Advances. 2025. Link
- Zhang S et al. “Butter and Plant-Based Oil Intake and Risk of Mortality.” JAMA Internal Medicine. 2024. Link
- Mensink RP et al. “Effects of dietary fatty acids on serum lipids.” Am J Clin Nutr.
- Mozaffarian D. “Omega-3 Fatty Acids and Cardiovascular Disease.” N Engl J Med.
- Schwingshackl L et al. “PUFA and risk of CVD.” BMJ.
- Hu FB et al. “Types of dietary fat and risk of CHD.” Am J Clin Nutr.
- Rose DP. “Dietary fat and breast cancer.” Am J Clin Nutr.
- Parikh M et al. “Saturated fat intake and inflammation.” J Nutr Biochem.
- Choe E, Min DB. “Oxidative stability of oils and fats.” J Food Sci.
Want more unfiltered nutrition science?
Subscribe to FORK U — the podcast where we bust myths, decode headlines, and teach you how to use food as medicine. And follow me on TikTok & Instagram @drterrysimpson.
Transcript
>> Dr. Terry Simpson: Today we're going to tell you exactly why
Speaker:butter raises your risk of death. How
Speaker:ldl, uh, cholesterol drives the buildup of plaque into your
Speaker:arteries, and why your favorite keto
Speaker:influencer might be completely wrong about
Speaker:what really causes heart disease. We'll break
Speaker:down three major studies. One showing how higher
Speaker:LDL equals worse plaque, another linking
Speaker:butter to cancer and cardiovascular health, and a third proving that plant
Speaker:based oils like olive and canola oil can, can
Speaker:literally lower your risk of dying.
Speaker:If you think plaque makes more plaque or that
Speaker:butter has gotten a bad rap, this episode is going
Speaker:to challenge that with fats, not
Speaker:fads.
Speaker:I am, um, your Chief Medical Explanationist, Dr. Terry Simpson,
Speaker:and this is Forku Fork University,
Speaker:where we make sense of the madness, bust a few myths,
Speaker:and teach you a little bit about food and
Speaker:medicine.
Speaker:Let's start with the core issue.
Speaker:Atherosclerosis. That is the
Speaker:buildup of plaque inside your arteries.
Speaker:Actually, technically, it's not inside your arteries.
Speaker:It's inside the inside of your arteries.
Speaker:Meaning? Well, it's inside the
Speaker:endothelium, but it doesn't cause
Speaker:symptoms at first. But it is the root
Speaker:cause of heart attacks, strokes and cardiovascular
Speaker:disease, as well as peripheral vascular disease,
Speaker:blindness, amputations and kidney
Speaker:failure. A recent study in the Journal of the
Speaker:American College of Cardiology made this very
Speaker:clear. The silent plaque doesn't just
Speaker:sit there. It grows, it gets
Speaker:unstable and eventually it can rupture and
Speaker:cause a heart attack. And m, what causes that plaque
Speaker:in the first place? Ldl, low density,
Speaker:lipoprotein cholesterol, and more specifically,
Speaker:APOB particles that carry
Speaker:cholesterol around. Here's the part
Speaker:the keto folks don't want to hear. It's not
Speaker:the plaque that causes more plaque. It's the
Speaker:LDL and the APOB that start and continue
Speaker:the process. No ldl, no
Speaker:plaque, period. Now, some folks
Speaker:will like to say, well, my LDL high, but my triglycerides are low,
Speaker:so I'm fine. Sorry, that's just not how
Speaker:biology works. A, uh, 2025 study in the
Speaker:Journal of the American Cardiology showed that people following
Speaker:a low carb, high fat diet, these folks had elevated
Speaker:ldl. And guess what they the
Speaker:higher the ldl, the worse the plaque. That
Speaker:was true. Regardless of how metabolically healthy
Speaker:they looked on the outside. The six pack
Speaker:of abs does not make your arteries look better. So
Speaker:no. High LDL is not a benign marker.
Speaker:It's the spark that lights the fuse.
Speaker:Let's talk about butter. In a major study published
Speaker:in the Journal of the American Medical Association Internal
Speaker:Medicine researchers looked at data, uh, from
Speaker:three large prospective US cohorts,
Speaker:the Nurses Health Studies and the Health Professionals
Speaker:Follow Up Study. They found that higher butter
Speaker:intake was associated with an increased risk of
Speaker:death from all causes, from cancer
Speaker:and from cardiovascular disease. Now here's where
Speaker:it gets interesting. When they looked at what would
Speaker:happen if you replaced that butter with plant
Speaker:based oils, things like olive oil, canola
Speaker:oil and soybean oil, risk went
Speaker:down, not a little
Speaker:significantly. So yes,
Speaker:swapping out three pats of butter a day
Speaker:for a tablespoon of plant based oil was
Speaker:associated with a real measurable
Speaker:drop in your risk of dying. And no,
Speaker:not all oils are equal. Olive oil,
Speaker:yes. Canola oil, yes.
Speaker:Soybean oil, surprisingly, also
Speaker:yes, Corn and safflower oil. The data
Speaker:was weaker, possibly because people just don't use them as
Speaker:much or because how they're processed. But
Speaker:overall, polyunsaturated and
Speaker:monounsaturated fats like those found in olive and
Speaker:canola oil, reduce inflammation,
Speaker:lower LDL and protect your
Speaker:arteries. This isn't a new theory.
Speaker:These oils have been shown to have cardiovascular
Speaker:benefits in randomized trials, in feeding
Speaker:studies, and now again in large population
Speaker:data sets. Now let's be
Speaker:fair. Some of those older butter studies were
Speaker:inconsistent, but they often
Speaker:only measured diet once at baseline and
Speaker:didn't look at long term patterns. The new study
Speaker:using cumulative dietary data is
Speaker:much more accurate and it's adjusted for things like
Speaker:refined grains and glycemic load to avoid
Speaker:blaming butter for what white bread did.
Speaker:Even more fascinating, butter wasn't just linked
Speaker:to heart disease. It was linked to cancer
Speaker:mortality, particularly hormone
Speaker:sensitive cancers like breast and prostate.
Speaker:Why? Saturated fats like those in
Speaker:butter can trigger inflammation in fat tissue and
Speaker:alter hormone signaling that creates
Speaker:a perfect storm for hormone driven
Speaker:cancers. So here's the bottom
Speaker:line. If your LDL is high, whether it's from butter,
Speaker:bacon, coconut oil, those MCT pumped
Speaker:keto shakes, your atherosclerotic risk
Speaker:goes up and that atherosclerosis
Speaker:progresses silently and can
Speaker:suddenly become deadly. The
Speaker:good news, it is not inevitable. You
Speaker:can reverse the trajectory by lowering ldl,
Speaker:replacing saturated fats with plant based oils,
Speaker:and making better food choices more fiber
Speaker:consistently over time.
Speaker:So no, butter is not back, butter is not a
Speaker:health food. And no, high LDL is not just
Speaker:a number. And no, that guy on YouTube
Speaker:with a six pack and 300 milligram LDL is
Speaker:not a case study in heart health.
Speaker:He's a case study waiting to happen.
Speaker:That's it for today's episode of Fork U. If you
Speaker:learned something new, or if you're about to swap your butter dish for an
Speaker:olive oil croup, hit subscribe and
Speaker:share this episode with someone who still thinks butter
Speaker:is a multivitamin. For more information
Speaker:about nutrition science, you can follow me on TikTok and
Speaker:Instagram, where I am rtrterrysimpson.
Speaker:Until next time, stay curious. Keep stay skeptical and
Speaker:remember, fork you, because if you're not hungry
Speaker:for science, you're just eating
Speaker:beliefs. This episode was written
Speaker:produced by me, Dr. Terri Simpson. And while I am
Speaker:a physician, I am not your physician.
Speaker:If you need to change your diet or discuss diet, please
Speaker:talk to your board certified physician
Speaker:and a registered dietitian. Not a chiropractor,
Speaker:not an eastern trained physician. And this
Speaker:episode was distributed by my friends at Simpler Media.
Speaker:My good friend, the pod God, Mr.
Speaker:Evotera. Have a good week everybody.
Speaker:You know I like butter as well as the next person.
Speaker:Grew up eating margarine because we were poor, face
Speaker:it. But you know what I've discovered? I
Speaker:actually like some of the great olive oils
Speaker:better. Dipping bread in olive oil.
Speaker:What a treat. Hope you're well. What do you
Speaker:think? Olive oil, Butter? Both?
Speaker:>> Speaker B: Hmm. Uh, tough call. I use them
Speaker:differently. You know, butter I spread on bread.
Speaker:Olive oil I dip bread in, as you said.
Speaker:Maybe they made an olive oil
Speaker:stick that I could spread onto bread.
Speaker:Is that a thing?
