Butter, eggs or olive oil? What heart doctors now say about food

Butter is bad. Then butter is fine. Then it is eggs, red meat, oat milk, or seed oils. If you follow food news, you may have stopped knowing what to believe. A new statement from the American College of Cardiology steps back from the individual food battles and looks at what the evidence actually says about diet and heart health.

What this document is

The American College of Cardiology published a scientific statement in September 2026. A scientific statement is an evidence review written by a group of experts. It is not a new study in which volunteers are assigned to different diets.

The authors considered randomised trials, where people are assigned to different diets and followed over time. They also looked at long-term cohort studies, which follow large groups of people for years, as well as laboratory research into how food affects the body. So there is no single number of participants. The weight of the statement comes from the many studies it brings together.

What it says about food

The focus is less on individual nutrients, such as fat or cholesterol, and more on whole foods and overall eating patterns. How processed the food is also matters.

For most people, the statement supports replacing saturated fat, found mainly in foods such as butter, fatty meat, and full-fat dairy, with unsaturated fat from foods such as olive oil, nuts, seeds, and fish. It also supports eating more fibre, less sodium, and fewer ultra-processed foods, particularly sugary drinks and processed meat. Overall, the advice is to build meals around minimally processed foods.

Four eating patterns are highlighted: the Mediterranean diet, DASH (an eating pattern designed to lower blood pressure), vegetarian diets, and other plant-rich patterns. Clinical trials suggest that these patterns can improve blood pressure, cholesterol, blood sugar, and body weight. In long-term studies, they are also associated with lower rates of cardiovascular disease and premature death.

But there is an important point here: this is population-level advice. It tells us what tends to work across large groups of people. It does not necessarily tell us what is optimal for you as an individual.

What it cannot tell you

The statement is only as strong as the evidence behind it. Much of the long-term research is observational. These studies can show that certain eating patterns are associated with better health, but they cannot prove that one food caused the difference. Those who eat more vegetables, for example, may also exercise more, smoke less, or have higher incomes.

Diet trials have their own problems. People know what they are eating, and many do not stick perfectly to the diet. Long-term trials on eating habits are particularly difficult to run. The statement is also written primarily for American healthcare and eating habits, so not every detail translates directly to Sweden. And most importantly, none of it is tailored to you.

What this means for you

The useful part is that the overall direction of the advice has been remarkably consistent for years. You do not need a new food rule every season. If you want to make one change, start with either the amount and type of fat you use, or the amount of fibre you eat.

Use olive oil instead of butter most of the time, and eat plenty of fibre-rich foods. Raspberries, blackberries, peas, chia seeds, avocados, pears and nuts are all useful options.

In our clinic, we usually start with one change that fits your everyday life, rather than asking you to follow a completely new diet.

Salt is also worth looking at if your blood pressure is high. Reducing sodium intake lowers blood pressure, particularly in people with hypertension. Most salt in a typical diet comes from processed foods such as bread, cured meat, cheese, and ready meals, not the salt we add ourselves. If you eat mostly minimally processed foods and have normal blood pressure, there's usually less reason to worry about the salt you add at the table.

The statement puts whole foods and eating patterns ahead of individual nutrients and supplements. If you are considering a supplement, talk to your doctor or practitioner first. If you already take medication for blood pressure or cholesterol, keep taking it as prescribed and talk to your doctor before making any changes.

Everyone is different

The advice in the statement works on average, across large groups of people. But people do respond differently to the same food. Some people see their LDL cholesterol rise substantially when they eat a lot of saturated fat, while others see a smaller change. Your genes, weight, hormones, overall diet, and other factors all play a part.

General advice is a good place to start. But the most useful question is: what is your cholesterol level? To know, you need to test it.

The heart test you only need once

One important heart-risk marker everyone should test at least once is lipoprotein(a), or Lp(a). Lp(a) is a cholesterol-carrying particle similar to LDL, and lifestyle has relatively little influence on your level. A standard cholesterol test does not include Lp(a), so you can have good cholesterol results and still not know your Lp(a) level.

A 2026 meta-analysis of 22 cohort and registry studies, involving more than 580,000 people, found that people in the highest Lp(a) groups had a 61% higher relative risk of major cardiovascular events than those in the comparison groups. That does not mean that a high Lp(a) gives you a 61% chance of having a heart attack or stroke. It means that, across the studies, people with higher Lp(a) had a higher relative risk.

Because Lp(a) levels are largely genetically determined and remain relatively stable, measuring once in adulthood is usually enough. If yours is high, it does not mean you will get heart disease. It tells you how closely you need to think about the things you can change, like LDL cholesterol, blood pressure, blood sugar, smoking, physical activity, and overall diet.

Where do you stand?

A blood test can show your cholesterol, blood sugar, and Lp(a), and a blood pressure check adds another important piece of the picture. Retesting after a few months can show whether changes are working for you.

At Wellth, we look at your blood fats and blood sugar alongside what you actually eat, rather than focusing on one number in isolation. We don't give you another list of foods you can or cannot eat. Instead, we help you understand what matters for you and what you can change. Our practitioners can go through your results with you.

Sources

Hu FB, Beleslin B, Blaha MJ, et al. Food and Health: Nutrition for Prevention and Management of Cardiovascular Disease: 2026 ACC Scientific Statement: A Report of the American College of Cardiology. J Am Coll Cardiol. 2026. doi:10.1016/j.jacc.2026.08.025
Shiha JK, et al. Lipoprotein(a) as a Predictor of Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Cohort Studies (2016–2026). Cureus. 2026. PMID: 42764843
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111–188. PMID: 31504418