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Big, Fat TRANSgression

In other words, the best diet for our health depends, as it ever has, not on replacing trans fat with any one oil from any one nut up any one tree; but on seeing the forest.
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Trans fat is going, if not yet gone, and good riddance to it. The word on the street is that the FDA is acting to "ban" partially hydrogenated oils from the food supply. The slightly more banal reality is that the agency is finalizing an action, begun two years ago, to formalize the position that trans fat is no longer "generally recognized as safe." Whereas a ban would be an active prohibition, this is a more passive removal of blanket allowance. Companies might, in fact, still be able to make select use of these oils, but would now have to petition for FDA permission to do so.

But even if the FDA action is more about not saying yes than it is about saying no, it will do. Tans fat will go, altogether or nearly so. The action is welcome.

I have been asked if it will matter much, and the honest answer is no. While the agency has clearly done the right thing, and it is important in principle, the effect in practice is much reduced by progress at the notorious speed of government. The Center for Science in the Public Interest has been making noise about the harms of trans fat since 1993 at least. My friend Dr. Walter Willett has been a leader in the campaign against use of this inadvertent Frankenfat based on data from his own research since at least 1997.

Even my own efforts began nearly a decade and a half ago. We have been advising children, and their parents, to look out for and avoid "partially hydrogenated oil" in any ingredient list since the very earliest version of our Nutrition Detectives program. We have warned as well that "0 grams trans fat" on the front of pack was unreliable, since federal rules allowed for the dubious combination of small portion size, and rounding down. The NuVal system, too, was designed from the start to penalize that hidden trans fat, since zero has not reliably meant zero.

The result of such efforts, and innumerable others like them, has been a decisive verdict in the court of public opinion. Concerned parents have long since cast votes against trans fats at the nation's cash registers. Attentive manufacturers, ever eager to keep the customer satisfied, have removed this toxin from more and more products.

The reason the FDA action will make a modest rather than a great difference is not because it is unimportant, but rather because it is late in the game.

As for the good that will result from the end of the trans fat era, there are reasons for caution even amidst the cheers.

For one, we have, for literal decades, fixed our eyes and our ire on one nutrient at a time, and missed the forest for the trees. What matters to health is the overall composition of foods, and the contribution they in turn make to the overall composition of the diet. The presence, or absence, of any given nutrient does not reliably indicate overall food, or diet quality. We have gotten this wrong before, in a dysfunctional collusion between demand and supply, and could conceivably get it wrong again. Let's be careful, see the big picture, and navigate around any replication of the costly follies of nutritional history.

For another, in a world of commerce, one supplier's loss is another's potential gain. While it's clear that trans fat is far worse for our health than the so-called "tropical oils" it displaced in its heyday, it is far less clear that those oils are the panacea their ardent proponents (and sellers) contend. The saturated fat in coconut oil is predominantly lauric acid, a short (12-carbon) fatty acid that accumulating evidence suggests may be innocuous. But that evidence is not yet decisive, and importantly- "innocuous" is as good as it gets. I have seen no evidence to suggest health benefits, just lack of harm. Those are not the same, however exuberant the marketing claims.

For yet another, we have surrendered the luxury of thinking about our foods and ingredients independently of their environmental impacts. Historically, the tropical oils to which the food industry will likely return to replace trans fat have come from orchards planted where tropical rain forests once stood. Much as I want to avoid trans fat, I don't want its replacement in my food to be the reason why the world's last orangutan can't find a tree to climb.

The propagation of trans fat through the modern food supply was, without doubt, a big, fat nutritional transgression. The FDA announcing the beginning of the end of that boondoggle is most welcome.

But the action is perhaps too late to matter much, since the government is only catching up with changes in both the demand, and supply of food. More importantly, the action is too little to confer reliable benefit. We could, if so inclined, eat trans-fat free junk food, just as we have managed to eat low-fat, low-carb, sugar-free, and now gluten-free junk food, and get fatter and sicker all the while.

The best approach to avoiding trans fat is the same as it ever was, and requires no action by the FDA; it is to choose wholesome foods in sensible combinations. Foods direct from nature, and minimally processed foods were never delivery vehicles for trans fat in the first place. Get the foods right, with a particular emphasis on the usual suspects- vegetables, fruits, whole grains, nuts, seeds, beans, lentils- and the nutrients generally take care of themselves, and us.

In other words, the best diet for our health depends, as it ever has, not on replacing trans fat with any one oil from any one nut up any one tree; but on seeing the forest. That same view is the best hope we have for not just avoiding trans fat, but actually eating well; and while we're at it, of preserving those trees for orangutans to climb; and for sustaining the forests that are the purifying lungs of the world. We don't need FDA authorization to start shopping accordingly- today.


David L. Katz, MD, MPH, FACPM, FACP has never met an orangutan he didn't like. Speaking of which, check out this phenomenal effort to foster health, sustainability, and economic vitality in the part of the world where orangutans live.

Director, Yale University Prevention Research Center; Griffin Hospital

Editor-in-Chief, Childhood Obesity

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