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For decades, conventional wisdom warned us to stay away from saturated fats—especially those found in full-fat dairy. Skim milk was in, butter was out, and low-fat yogurt became a supermarket staple. But as I explored in a recent podcast episode with cardiologist Dr. Anthony Pearson, the science has evolved—and in some cases, flipped the script entirely.

Dr. Pearson, known to many as The Skeptical Cardiologist, has spent the last decade challenging dogma around heart disease prevention. A practicing cardiologist and prolific writer, his evidence-based approach takes a fresh look at how diet, lifestyle, and technology can help us not only reduce risk but also make smarter, more personalized decisions about heart health.

The Croissant That Started It All

Our conversation began with a relatable story: brunch, croissants, and a disagreement about butter. Early in his career, Dr. Pearson followed the mainstream dietary guidelines to the letter—skim milk, non-fat yogurt, egg white omelets. But when his wife challenged his food choices over a buttery croissant, he did what any good skeptic would do: he went back to the literature.

What he found surprised him.

A state-of-the-art review showed that full-fat dairy products were not associated with increased cardiovascular risk. In fact, some studies suggested that dairy consumption was linked to lower mortality. A more recent 2024 review in the journal Advanced Nutrition further supported this, showing that fermented and full-fat dairy products may actually reduce the risk of cardiometabolic diseases like diabetes, hypertension, and obesity.

This growing body of research prompted Dr. Pearson to rethink the one-size-fits-all message that “all saturated fat is bad.” Instead, it appears that dairy fat behaves differently from the fats found in red meat, perhaps due to its unique structure or what scientists call the “food matrix effect.”

Reconsidering Keto and Paleo Diets

From dairy, our conversation turned to another hot topic: high-fat, low-carb diets. Many people adopt paleo or keto eating patterns to lose weight or manage blood sugar. But in some cases, especially among lean individuals, these diets can send LDL cholesterol—the so-called “bad” cholesterol—to abnormal levels.

Dr. Pearson’s takeaway? Keto can be helpful for weight loss, but if your LDL spikes, it’s time to rethink the plan—or consider medication. Use more plant-based fats like olive oil and avocado oil, and work with your doctor to monitor your cardiovascular markers.

The Calcium Scan: A $100 Window Into Your Arteries

If there’s one potentially underused tool in the preventive cardiology toolkit, it’s the coronary artery calcium (CAC) scan. For around $100, this quick CT scan measures how much calcified plaque is present in your coronary arteries. It’s non-invasive, carries minimal radiation, and—most importantly—can help you and your physician better personalize your risk assessment.

Traditional risk calculators, like the pooled cohort equations, often misclassify patients, especially younger or older adults. As Dr. Pearson explained, up to one-third of heart attack victims would not have been flagged as high risk using current tools. That’s where CAC scans shine: they offer a real-time picture of plaque burden, not just a statistical estimate.

A zero score? Great news. A high score? It’s time to take action—not with stents or surgery (which studies like the ISCHEMIA Trial showed aren’t effective in asymptomatic patients), but with lifestyle changes and medications that lower your risk over time.

A Balanced Approach to Prevention

The message here isn’t that everyone should eat more butter or jump on the keto bandwagon. Rather, it’s about tailoring your approach. Nutritional science isn’t static, and neither should our choices be.

If you’re someone who enjoys full-fat dairy and your health markers are solid, you may not need to worry. But if your LDL skyrockets on a high-fat diet—or you’re unsure about your heart health—there are practical, evidence-based tools available to guide you.

The bottom line? Prevention isn’t about chasing the latest trend or fear-mongering headlines. It’s about understanding the science, personalizing the approach, and making decisions that fit your unique physiology and goals.

Final Thoughts

At the end of our episode, I thanked Dr. Pearson for two things: first, for reassuring me that I can enjoy a bit of butter guilt-free; and second, for reminding us that smart screening—like the calcium scan—can be an empowering part of our longevity journey.

If you’re curious about how your diet may be impacting your heart, or whether a CAC scan makes sense for you, bring it up with your doctor. You can also explore more of Dr. Pearson’s insights at The Skeptical Cardiologist and on MedPage Today.

Because it’s not just about living longer—it’s about living well, with a happy heart.