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

1. Libby P et al. “Plaque Progression and Rupture in Atherosclerosis.” J Am Coll Cardiol. 2020. Link
2. Ebinger J et al. “Coronary Atherosclerosis in Individuals with Markedly Elevated LDL-C from Carbohydrate-Restricted Diets.” JACC: Advances. 2025. Link
3. Zhang S et al. “Butter and Plant-Based Oil Intake and Risk of Mortality.” JAMA Internal Medicine. 2024. Link
4. Mensink RP et al. “Effects of dietary fatty acids on serum lipids.” Am J Clin Nutr.
5. Mozaffarian D. “Omega-3 Fatty Acids and Cardiovascular Disease.” N Engl J Med.
6. Schwingshackl L et al. “PUFA and risk of CVD.” BMJ.
7. Hu FB et al. “Types of dietary fat and risk of CHD.” Am J Clin Nutr.
8. Rose DP. “Dietary fat and breast cancer.” Am J Clin Nutr.
9. Parikh M et al. “Saturated fat intake and inflammation.” J Nutr Biochem.
10. 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.

>> Dr. Terry Simpson: Today we're going to tell you exactly why

butter raises your risk of death. How

ldl, uh, cholesterol drives the buildup of plaque into your

arteries, and why your favorite keto

influencer might be completely wrong about

what really causes heart disease. We'll break

down three major studies. One showing how higher

LDL equals worse plaque, another linking

butter to cancer and cardiovascular health, and a third proving that plant

based oils like olive and canola oil can, can

literally lower your risk of dying.

If you think plaque makes more plaque or that

butter has gotten a bad rap, this episode is going

to challenge that with fats, not

fads.

I am, um, your Chief Medical Explanationist, Dr. Terry Simpson,

and this is Forku Fork University,

where we make sense of the madness, bust a few myths,

and teach you a little bit about food and

medicine.

Let's start with the core issue.

Atherosclerosis. That is the

buildup of plaque inside your arteries.

Actually, technically, it's not inside your arteries.

It's inside the inside of your arteries.

Meaning? Well, it's inside the

endothelium, but it doesn't cause

symptoms at first. But it is the root

cause of heart attacks, strokes and cardiovascular

disease, as well as peripheral vascular disease,

blindness, amputations and kidney

failure. A recent study in the Journal of the

American College of Cardiology made this very

clear. The silent plaque doesn't just

sit there. It grows, it gets

unstable and eventually it can rupture and

cause a heart attack. And m, what causes that plaque

in the first place? Ldl, low density,

lipoprotein cholesterol, and more specifically,

APOB particles that carry

cholesterol around. Here's the part

the keto folks don't want to hear. It's not

the plaque that causes more plaque. It's the

LDL and the APOB that start and continue

the process. No ldl, no

plaque, period. Now, some folks

will like to say, well, my LDL high, but my triglycerides are low,

so I'm fine. Sorry, that's just not how

biology works. A, uh, 2025 study in the

Journal of the American Cardiology showed that people following

a low carb, high fat diet, these folks had elevated

ldl. And guess what they the

higher the ldl, the worse the plaque. That

was true. Regardless of how metabolically healthy

they looked on the outside. The six pack

of abs does not make your arteries look better. So

no. High LDL is not a benign marker.

It's the spark that lights the fuse.

Let's talk about butter. In a major study published

in the Journal of the American Medical Association Internal

Medicine researchers looked at data, uh, from

three large prospective US cohorts,

the Nurses Health Studies and the Health Professionals

Follow Up Study. They found that higher butter

intake was associated with an increased risk of

death from all causes, from cancer

and from cardiovascular disease. Now here's where

it gets interesting. When they looked at what would

happen if you replaced that butter with plant

based oils, things like olive oil, canola

oil and soybean oil, risk went

down, not a little

significantly. So yes,

swapping out three pats of butter a day

for a tablespoon of plant based oil was

associated with a real measurable

drop in your risk of dying. And no,

not all oils are equal. Olive oil,

yes. Canola oil, yes.

Soybean oil, surprisingly, also

yes, Corn and safflower oil. The data

was weaker, possibly because people just don't use them as

much or because how they're processed. But

overall, polyunsaturated and

monounsaturated fats like those found in olive and

canola oil, reduce inflammation,

lower LDL and protect your

arteries. This isn't a new theory.

These oils have been shown to have cardiovascular

benefits in randomized trials, in feeding

studies, and now again in large population

data sets. Now let's be

fair. Some of those older butter studies were

inconsistent, but they often

only measured diet once at baseline and

didn't look at long term patterns. The new study

using cumulative dietary data is

much more accurate and it's adjusted for things like

refined grains and glycemic load to avoid

blaming butter for what white bread did.

Even more fascinating, butter wasn't just linked

to heart disease. It was linked to cancer

mortality, particularly hormone

sensitive cancers like breast and prostate.

Why? Saturated fats like those in

butter can trigger inflammation in fat tissue and

alter hormone signaling that creates

a perfect storm for hormone driven

cancers. So here's the bottom

line. If your LDL is high, whether it's from butter,

bacon, coconut oil, those MCT pumped

keto shakes, your atherosclerotic risk

goes up and that atherosclerosis

progresses silently and can

suddenly become deadly. The

good news, it is not inevitable. You

can reverse the trajectory by lowering ldl,

replacing saturated fats with plant based oils,

and making better food choices more fiber

consistently over time.

So no, butter is not back, butter is not a

health food. And no, high LDL is not just

a number. And no, that guy on YouTube

with a six pack and 300 milligram LDL is

not a case study in heart health.

He's a case study waiting to happen.

That's it for today's episode of Fork U. If you

learned something new, or if you're about to swap your butter dish for an

olive oil croup, hit subscribe and

share this episode with someone who still thinks butter

is a multivitamin. For more information

about nutrition science, you can follow me on TikTok and

Instagram, where I am rtrterrysimpson.

Until next time, stay curious. Keep stay skeptical and

remember, fork you, because if you're not hungry

for science, you're just eating

beliefs. This episode was written

produced by me, Dr. Terri Simpson. And while I am

a physician, I am not your physician.

If you need to change your diet or discuss diet, please

talk to your board certified physician

and a registered dietitian. Not a chiropractor,

not an eastern trained physician. And this

episode was distributed by my friends at Simpler Media.

My good friend, the pod God, Mr.

Evotera. Have a good week everybody.

You know I like butter as well as the next person.

Grew up eating margarine because we were poor, face

it. But you know what I've discovered? I

actually like some of the great olive oils

better. Dipping bread in olive oil.

What a treat. Hope you're well. What do you

think? Olive oil, Butter? Both?

>> Speaker B: Hmm. Uh, tough call. I use them

differently. You know, butter I spread on bread.

Olive oil I dip bread in, as you said.

Maybe they made an olive oil

stick that I could spread onto bread.

Is that a thing?