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Monday, May 21st 2007

We Know What's Good For You: No Trans Fat

NYC Prepares For Its Ban Limitations On Cooking With Trans Fat

The sad thing about trans fats being dictated out of New York City is that no one probably cares. Whatever outrage there is, is ageless, and is certainly not addressed in this interview with Dr. Thomas Frieden – who can only muster that it is no different than the government cleaning up the water supply.

But, in reality it doesn’t rise to the government’s responsibility for the water supply at all, does it?

No one denies that stupid double bond in the trans configuration is bad for health. If you read only one article read this review of the literature – “Trans Fatty Acids and Cardiovascular Disease” – which is free on the NEJM website. Or you can read one of the seemingly innumerous studies which point to the health consequences of TFA consumption. Such include the Seven Nations Study, the Zutphen Elderly Study, the Nurses’ Health Study, or this BMJ published study looking at dietary fat in men and the risk of CHD.

While there’s still some questions out there about specific trans fats and the risks of heart disease the amount of congruency between the studies, in terms of TFAs contribution to coronary heart disease, is pretty impressive. But that is beyond the point. The level of the scientific acceptance of the fact alone shouldn’t determine public policy. As with all choices in life we need to weigh the consequences. Which include trying to quantify TFAs health impact.

Trying to quantify the contribution of trans fat to heart disease is difficult in some ways.

Relative Risk Of Coronary Heart Disease With 2% Trans Fat Diet

Supposedly low estimates contribute more than 30,000 American deaths a year to a diet with 2% of its calories coming from trans fatty acid. And that is only the contribution to deaths related to heart disease.

But while 30,000 is a shocking figure – and admitting the number may be much higher – it needs to be put into perspective.

Consider the relative risk of coronary heart disease with a sedentary lifestyle is likely higher than a diet in which you get 2% of your energy from trans fats. Because sitting on your ass watching television probably contributes to even more fatalities, are we on our way towards forcing mandatory exercise?

While the gut reaction is to sit there and claim a huge distinction between denying people something which is bad for them and forcing them onto a treadmill, philosophically is it really that much of a stretch?

Indeed, beyond that, there are some question about the broad nature of these bans which are taking place or being considered across America. This study found a statistically significant correlation between the consumption of a specific trans fatty acid isomer (C18:1) and a history of adverse cardiovascular events, but not with trans fatty acids over all.

Okay, that study is a tiny one from the Czech Republic. Let’s just drop it. It really has no bearing on the main argument and can only distract from it. :)

And that main argument is that the level of harm, including the monovariable nature of the relationship between the offending agent and disease, and, perhaps less importantly, the temporal cause and effect relationship need to be really freaking obvious (a technical, quantifiable term) for the government to come in and play parent.

This isn’t health inspectors trying to make sure the chef doesn’t contaminate the chicken with salmonella. This isn’t keeping lead out of the water supply. This is prohibition (85,000 alcohol related deaths a year) or banning smoking outright (not just in public places for the sake of other’s health).

No matter how insignificant the health department plays up the liberty of eating trans fat or cooking with trans fat, the fact remains that this ban is an infarction on liberty.

How lightly can that be taken?

Irrespective of the argument above, for those more pragmatic, it is good to note that virtually all the same lengthy cohort studies which established the link between TFAs and heart disease, also found a pretty significant and astounding drop in the average Americans consumption of trans fat over the decades. There’s no doubt health education and the market was reducing the amount of trans fat in consumer foods…but apparently not fast enough for the government of NYC. Not to mention the decline in myocardial infarctions from the time trans fat use peaked (the 1950s and 60s) until recent decades.

It’s certainly true we can and should always do more to improve this country’s health. But, however effective it proves, should doing more really entail the government deciding what is best for us and limiting personal freedom?

Finally, the argument over the cost in paying for the health care of those who chow down on the trans fats falls flat. There are ways to hold such people accountable without limiting their choice of foods. If you’re willing to take the consequences, including the health care costs on your own dime, then the trans fat ban is nothing but the government deciding what is best for you.

And that is disgusting.

At The Least You Have To Admit This Is Another Step Down The Slippery Slope