November 1, 2006 (New York, NY) – In a story that has garnered headlines across the country, it appears that partially hydrogenated vegetable oil might be drummed out of New York City for good. Earlier this week, medical societies, cardiologists, pediatric and family-care physicians, and representatives from the food and restaurant industry, as well as many members of the public, gathered in New York City to voice their opinions on the proposed citywide ban on partially hydrogenated vegetable oil, also known as trans fat. Although many were in favor of the ban, including the American College of Cardiology (ACC), one high-profile voice, the American Heart Association (AHA), offered only conditional support of the proposal.
Dr Howard Weintraub (New York University, NY), who spoke on behalf of the ACC, told the board of health that the American populace "resembles Mr Potato Head" and that there is a problem when physicians are able to recognize their patient's risk by the "part of the anatomy that enters the office first." Although the comments elicited laughs, Weintraub said the numbers are simply not funny. Citing a recent New York Times article, he said that 125 million people in the US have increased LDL-cholesterol levels, while another 50 million are "essentially studying to become diabetics." In addition to those with the metabolic syndrome, 21 million people have diabetes, with many more having the disease but not aware of it.
"These kinds of facts place people with the metabolic syndrome at incipient risk of developing a disease that makes cancer look like a picnic," said Weintraub. "Cancer will play with you in a very bad way and over a year or two, your fate will be decided. However, with diabetes, in the first year or two, it just starts to get going. After five or 10 years, you'd be willing to make a deal with the devil, although there is usually nobody there to broker this affair. It becomes important to try to prevent this, because once patients head down that road, it becomes an impossibility."
Clear, scientific evidence, says the ACC
Speaking with heart wire , Weintraub said the proposal to ban trans fats in all New York City restaurants is based on "clear, scientific evidence" that shows the intake of trans fat to be associated with an increase in the risk of coronary heart disease, mainly through an increase in LDL cholesterol and a decrease in HDL cholesterol. In addition, he said, there are data to suggest that trans fats are more dangerous than saturated fats and that replacing trans fat with heart-healthy alternatives can reduce coronary heart disease events.
In addition to the ACC, the proposed ban to eliminate trans fat and to make caloric labeling mandatory was supported by a number of other organizations, including the American Diabetes Association, National Hispanic Medical Association, the American Academy of Pediatrics, and the Center for Science in the Public Interest. The New York State Restaurant Association and the National Restaurant Association did not endorse the ban on trans fat, telling the board of health that the well-intentioned plan was not fully thought out and would adversely affect small business owners. The American Council on Science and Health also does not support the ban, saying there are concerns that eliminating trans fat from restaurants will lead to increased consumption of saturated fat, thereby offsetting any potential health benefits.
Conspicuously absent from the board of health hearing was the American Heart Association. Speaking with heart wire , AHA president Dr Robert Eckel (University of Colorado at Denver and Health Sciences Center) said the AHA "conditionally supports" the proposed ban, which he defined as supporting the removal of partially hydrogenated vegetable oil, but not the way the city was going about it. While expressing a desire to get trans fat to the lowest possible levels, Eckel said the sudden removal of trans-fatty acids from restaurants is not a practical solution, telling heart wire that many individuals, from "field to mouth," are involved in the process and need to be consulted. He said the ban is unrealistic and unfairly punitive to the food and restaurant industry.
Regarding the proposal, Eckel said the AHA would like to see a ban phased in slowly, giving restaurants time to adapt, as well as ensuring that heart-healthy oils are available, both physically and financially, to restaurants looking to make the change. During a recent AHA conference in Washington, DC, policy experts, clinicians, and representatives from the food industry gathered to discuss the scientific evidence available to support a possible ban on trans fat. Based on these discussions, instead of fully endorsing the proposal, Eckel said the AHA would like to see more consumer education, as well as increased collaboration with those affected by the proposal.
"This really is a very big decision to make, and it involves a lot of different people who are going to be affected by it," said Eckel.
While it is sympathetic to effects such a ban would have on business owners, a bigger concern, according to the AHA, is the possibility that restaurants and bakeries would replace the partially hydrogenated vegetable oil with saturated fat. As pointed out by speakers from the New York and national restaurant associations, as well as by representatives from the American Council on Science and Health, the move to trans fat occurred as a result of decision made 20 years ago to switch from saturated fat to trans fat, as the latter was thought to be healthier.
"We need to study this issue to determine the effects such a ban would have," said Eckel. "For example, if you ban trans fat, what oils should restaurants be using then? Are they better than what they're replacing, or are restaurants simply switching back to saturated fats, which are unhealthy?"
To heart wire , Eckel said that while the AHA does receive funds from the food and restaurant industry, such funding did not influence its decision to not attend the New York City hearing or to offer only conditional support. He said that the AHA is "interested in the best science," pointing out that the current AHA guidelines recommend limiting the intake of saturated fat to 7% and trans fat to 1% daily energy intake. In addition, Eckel noted that the observational studies used to calculate the number of lives saved from the elimination of trans fat are "highly risky" and that it is difficult to know from an experimental point of view the effects of eliminating trans fat on long-term clinical outcomes, like coronary heart disease and MI.
Chair of the ACC prevention committee, Dr Roger Blumenthal (Johns Hopkins University Medical Center, Baltimore, MD), who did not speak at the hearing, told heart wire that it is the position of the ACC that the evidence available to act against partially hydrogenated vegetable oil is sufficient.
"The question becomes, How much evidence do you need to have before you act?" said Blumenthal. "We think the evidence is overwhelming, although to be fair, there are no perfect studies. But there are no perfect smoking studies either, and yet we know that smoking causes cancer and heart disease. . . . The time is now for New York City to send a message to the rest of the country and the food manufacturing industry about the health benefits of eliminating these harmful oils from foods."
Eckel told heart wire that the lack of agreement between the ACC and the AHA is not the result of a fundamental divide. Instead, he says, lack of communication is at play. For many years, the AHA has "been drivingthe bus" when it comes to consumer education, especially as it relates to nutrition, and has always supported reducing trans-fat consumption. He said the ACC had not been in touch with the AHA prior to the hearing and as a result might not be aware of the full extent of the issues such a citywide ban might entail.
What the NYC Board of Health proposal entails
While the ban on partially hydrogenated vegetable oil garnered headlines and spurred the most debate, the New York City Board of Health and Mental Hygiene public hearing looked at two specific and separate issues. According to one proposed article, no foods containing artificial trans fat can be stored, distributed, held for service, used in preparation of any menu item, or served in any food-service establishment. Restaurants have until July 1, 2007 to switch to oils, margarine, and shortening with less than 0.5 g of trans fat per serving and until July 1, 2008 to eliminate trans fat from all other foods.
In a related amendment, the board of health is also proposing that all food-service establishments post on menu boards and menus the caloric content next to the listing of each menu item.
The New York City plan is believed to affect approximately 24 000 "food-service establishments." While the hearing Monday is not final, the board of health, an independent regulatory body headed up by Commissioner Dr Thomas Frieden, is expected to vote on the proposal in December. On Monday, designed to gain as much attention as possible, Kentucky Fried Chicken announced that it would no longer be cooking with partially hydrogenated cooking oil. Burger King will also begin testing trans-fat-free cooking oil in some restaurants within 90 days, while Wendy's has already made the switch. McDonald's isn't so keen, though, as the company has yet to follow through on similar promises made in 2003.
The data are there, say experts from Harvard
One of the speakers in favor of the ban is Dr Dariush Mozaffarian (Harvard Medical School, Boston, MA). To the board, Mozaffarian outlined the "clearly established" detrimental effects of trans fat on blood-cholesterol measures, noting that trans fat increases LDL-cholesterol and decreases HDL-cholesterol levels. In addition, trans-fat consumption also increases inflammation, as well as adversely affecting endothelial health.
"Based on these powerful adverse effects of trans fats on risk factors, one would predict a powerful, harmful effect of trans fat on clinical outcomes," said Mozaffarian. "Indeed, that is exactly what is seen. In large studies, involving more 140 000 patients, trans-fat consumption is consistently associated with higher risk of coronary heart disease. Importantly, that risk is seen at very low levels of consumption. These studies span the range of populations and cultures, including studies in the US, Europe, Australia, and Central America."
Agree to disagree . . .
During the five-hour hearing, a majority of those testifying supported the proposed ban. One of those who did not was Charles Hunt, executive vice president of the New York State Restaurant Association, who argued that there were not enough manufacturers to ensure that all 24 000 restaurants had access to the healthier oils, a concern that has previously been rejected by the board of health. Hunt also expressed concern for the "little guy," the mom-and-pop restaurants, as well as others who might rely on trans fat for their diverse dishes. Sheila Cohn Weiss of the National Restaurant Association pushed for greater consumer education to alert the public to the risks of partially hydrogenated vegetable oil. Arguing for the proposed ban, Dr Diane Hes (New York Methodist Hospital) regaled the board with stories of young patients treated at her obesity clinic. Some grade-schoolers are now asking for elevator passes as they are too fat to walk up the stairs, said Hes.
When looking at the evidence, Mozaffarian said that there was a 23% increased risk of coronary heart disease for each 2% of daily calories consumed from trans fat. Based on a 2000 kcal/day diet, this translates into only 40 kcal from trans fat needed to have a staggering effect on heart-disease risks. If statins reduce coronary heart disease risk by approximately 25%, said Mozaffarian by way of analogy, then this small amount of trans fat is capable of wiping out the effects of one of the most powerful heart-disease drugs on the market. Based on conservative estimates that take into account only the effect of trans fat on total and LDL cholesterol, 6% of heart attacks in New York City are due to the consumption of artificial trans fat, said Mozaffarian, adding that this number could be as high as 22%.
"Whether the true effect is 6% or as high as 22%, artificial trans fats are a dangerous additive in our food supply," he said. "They have no nutritional value. They have great potential for harm, and they can easily be replaced by natural fats and oils without any changes in food taste, price, or availability."
Weintraub agreed, noting that the change will be a step toward preventing chronic, debilitating diseases, such as cardiovascular disease, stroke, peripheral vascular disease, and diabetes. Regarding caloric labeling, he told heart wire that this would help individuals make informed choices regarding their meals. Simply cutting out 100 calories per day, or once slice of bread, would result in weight loss of 12 pounds per year, an amount that would "have a profound effect on metabolic consequences and eventual cardiovascular risk."The complete contents of Heart wire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.
Heartwire from Medscape © 2006 Medscape
Cite this: Michael O'Riordan. NYC Proposes Ban on Trans Fat - Medscape - Nov 01, 2006.