Four years ago, in a WebMD/Medscape video editorial, I called for a national ban on partially hydrogenated trans fat, an artificially manufactured, harmful fat that promotes heart disease and diabetes. At that time it was commonly added to commercially prepared fried and baked foods, and average intake was estimated to be 5 to 6 grams per day with an associated 25% increase in heart disease risk in the US.
Calls like mine were commonplace among nutrition experts and some politicians, and since that time there has been an increasing amount of legislation at the city, county, and state levels restricting or discouraging the use of trans fats in prepared foods. The FDA has required foods with at least 0.5 grams of trans fat per serving to report the amount in the nutrition facts label. Many (but not all) fast food chains and major food companies have been reducing or eliminating trans fats from their products, such that there has been a dramatic decrease in the amount of trans fat in the food supply. I’ll guess it is currently about 1/3 of what it was. That is so much better, but there is no safe level. Health experts would like to see it gone altogether. Doing so would result in even greater projected reductions in future heart disease and diabetes.
Walmart, the largest grocer in the U.S., recently announced that they will be eliminating trans fats from their store-brand foods by 2015 (and making other favorable changes as well), which will directly impact a large number of consumers, and can potentially cause a large ripple effect by inducing competitors to follow suit.
This move by Walmart is newsworthy and has caused me to want to revisit — with the benefit of hindsight — whether my position in 2007 calling for a national ban was a good idea then or now.
As I discussed at the time:
“Opposition has focused not on whether the fats are unhealthy, but rather on whether paternalism and government intervention are necessary, appropriate, and desirable. My short answer is “yes,” but I would like to discuss this complex issue in greater depth.
There is widespread agreement that in a free-market economy, government regulation of the availability of goods and services is generally unnecessary, inappropriate, and inefficient. The burden of proof does and should rest on those who wish to regulate or ban any specific goods or services.
There is also widespread agreement that, in general, unhealthy foods should not be banned. For example, few would argue that cookies should be banned. People should be free to decide for themselves what to eat, even if the consequences of their unhealthy eating habits result in higher societal costs due to excess health problems.
There is also widespread agreement that newly proposed food additives (such as sugar and fat substitutes) should not be introduced into the food supply if there is any suggestion that they promote cancer or other illnesses. If partially hydrogenated fat was introduced as a new food additive today, there is no way that it would make it into the food supply, given what we now know about the adverse health effects.
So once a society learns that an artificial ingredient in the food supply promotes chronic health problems, the question boils down to whether public education is sufficient, or whether the government should require the elimination of the offending agent. Such issues need to be dealt with on a case-by-case basis. Important considerations include the extent of the damage caused by the offending agent, and the extent of the damage caused by requiring (rather than promoting) elimination of the offending agent.
In the case of partially hydrogenated fats, the health damage is substantial, although it is diffuse and chronic, and easy to ignore. The forced elimination of partially hydrogenated fat would be relatively painless for the consumer because food manufacturers would be able to offer the same foods with minimal effect on taste or price. The effect on food manufacturers would be acute (during the time it takes to perfect new recipes), but short-lived.
Loss of freedom and acceptance of paternalism would be important costs of employing a ban on partially hydrogenated fat. Some individuals believe that there are no circumstances in which such sacrifices seem acceptable. For others, the fact that children eat these unhealthy fats because we have failed to ban them is compelling enough to warrant government action.
In the case of partially hydrogenated fat, I believe that a ban is necessary to overcome the inertia that has prevented the free market from acting in the best interest of society, consumers, and especially children.”
Today we are not terribly far behind where I was hoping we’d be by now. The past 4 years have seen a dramatic improvement in the amount of artificial trans fat in the food supply, and things continue to move in the right direction. There is really no question that partial trans fat bans in major cities such as New York City, Boston, and in all of California have accelerated the pace of trans fat reduction on a national level, and there is no question that the mandatory reporting on food labels has done the same. The price we paid as consumers and citizens was not significant in terms of reduced food palatability or cost, but occurred as a result of increased government intervention at the local or state level. We do not want any more government regulation or laws than we truly need, or at least significantly benefit us as a society.
Looking back, I’m glad I took the position I took 4 years ago. I believe that my family has benefited in a meaningful way from the government actions. I am skeptical that trans fat levels would be nearly as much reduced as they are now without such government intervention. I believe the free market would have produced reductions in trans fats as a result of companies responding to consumer demand, but I do not believe such dramatic and rapid improvements would have occurred during the past 4 years.
This is important to me in part because my children are now 9, 7 and 4, and the amount of trans fat they have consumed during the past 4 years — during a significant portion of their growth years including brain development etc. — has been directly affected by the speed and magnitude of the changes in food levels. Something that still bothers me is the high amount of trans fats in cake frosting — and my kids seem to attend birthday parties every few weeks. I’m not going to stop my kids from eating frosting at birthday parties. I’m waiting for someone or something to “force” those companies who make frosting to reformulate. All the trans fat they still eat is in situations like this, where they are eating treats or at a restaurant, and nobody is aware of the amount of trans fat in the food. I suspect the same is true for most Americans. We still eat trans fat simply because food companies and restaurants still add it to certain foods.
I am still in favor of a national full ban on artificial trans fats. You can bet that if trans fats caused cancer instead of heart disease and diabetes they would have been banned many years ago. Instead, I predict trans fats will continue to linger in many foods for many years to come, and we will simply tolerate their presence along with many of the other toxins in our environment.
The sad thing is that this particular toxin is so easy to remove from our environment by simply pulling the plug. It is not in America’s best interest to keep it around when such an easy and painless fix is available. Our children will not be impressed when they look back to see their parents and grandparents missed a relatively easy opportunity to have helped them live cleaner, healthier lives. That’s why I have raised this issue again and I hope others who agree with my position can help us finish the job a number of forward-thinking politicians, policy-makers and food company executives have started.
- Michael Dansinger, MD