New York City Bans Artificial Trans Fats in Restaurants

NEW YORK, Dec. 6 -- The action by this city's Board of Health to ban the use of artificial trans fats in restaurants, ranging from pizzerias and delis to bakeries and upscale restaurants, could have fallout for mouths and lipid levels across the nation.

Health Commissioner Thomas Frieden announced yesterday that restaurants will be barred from using most frying oils containing trans fats by July 1, 2007 and will have until July 2008 to eliminate the trans fats from all foods.

After weighing complaints from the restaurant industry that the original deadline was too tight, the Board of Health, which passed the ban unanimously, relaxed the timing slightly. Dr. Frieden said he had taken seriously industry complaints that the proposal would not give them enough time to develop new recipes. For that reason, the deadline was relaxed slightly to July 2008.

The ban has several exceptions. For example, restaurants would be allowed to serve foods that come in the manufacturer's original packaging. FDA labeling regulations allow manufacturers of foods packaged for direct sale to consumers to list trans fat content as "0 grams" if the product contains less than 0.5 grams per serving.

Moreover, there is naturally occurring trans fat in meat and dairy foods.

Chicago is also considering a trans-fat law, albeit more lenient, that would severely restrict the amount used in kitchens in large restaurants with more than million in annual sales.

Overall, health advocates were thrilled by New York's action, although the American Heart Association suggested that the city should not rush restaurants to keep them from substituting other unhealthy fats. Predictably, the restaurant industry was aghast.

In another measure passed by the Board of Health, some restaurants, mainly fast-food restaurants and other major chains, that chose to inform customers of calorie content will have to list the information prominently on the menu. A director of nutritional policy for the restaurant association said the rule would be a disincentive for restaurants to provide any nutritional information.

Trans fats are formed when liquid oils are converted to solid fats by hydrogenation. Common examples are stick margarine and shortening, and cooking oils used for frying and baking. Processed foods made with trans fats are cookies, pizza dough, and crackers, as well as other favorites such as hamburger rolls, French fries, and donuts. Trans fats have a long shelf life and are also found in pre-made blends of pancake mix and hot chocolate mix.

The fats are believed to contribute to coronary heart disease by raising low-density lipoprotein cholesterol (LDL-C) and lowering high-density lipoprotein cholesterol (HDL-C).

Mayor Michael Bloomberg, who championed the ban on smoking in bars and restaurants here, dismissed criticism from the National Restaurant Association that "misguided social engineers" in New York are trying to legislate diets. "Nobody wants to take away your French fries and hamburgers -- I love those things too. But if you can make them with something less damaging to your health, we should do that."

Many food makers had already stopped using trans fats after the FDA began requiring companies to list trans fat content on their labels.

For the most part, health and medical groups applauded the New York ban, although the American Heart Association expressed concern that the trans-fat ban in restaurants in its current form might not be the best course of action. If restaurants can't comply in time, the AHA said, the ban could force cooks to substitute partially hydrogenated vegetable oils and shortening with oils such as palm and coconut oil, which are high in saturated fat.

Fast-food restaurants and other major chains can't simply substitute one ingredient for another, but must rework recipes and disrupt nationwide supply operations, not to mention convincing customers that the new fries and donuts will be as tasty as the originals.

"The chief concern about dietary fats is their role in promoting coronary heart disease, while other concerns relate to their possible roles in the genesis of obesity and cancer," wrote Matthew Gillman, M.D., of the Harvard School of Public Health, in a review of dietary fats and coronary heart disease. "Evidence is mounting that the type of fat may be considerably more important than total fat intake."

Dr. Gillman's topic review appeared in UpToDate, a Web-based clinical information service (Rose, BD (Ed), UpToDate, Waltham, Mass, 2006).

The evidence suggests that saturated fat (derived chiefly from animal products) and trans fats contribute to the genesis of heart disease, Dr. Gillman pointed out, while monounsaturated fats (olive and canola oil) and polyunsaturated fats (safflower and other plant oils) are protective.

On the basis of data from the Nurses' Health study, the risk of coronary heart disease would be reduced by 53%, if 2% of energy from trans fats was replaced by energy from unhydrogenated, unsaturated fat and by 42% if 5% of energy from saturated fat were replaced by energy from unsaturated fats.

Some trans fatty acids occur naturally in foods, especially those of animal origin, although most trans fatty acids, the target of the New York City ban, are produced by the industrial hydrogenation of polyunsaturated fatty acids (plant oils such as safflower, sesame, sunflower, and corn oils). Partial hydrogenation in fats produces margarine and shortening and other fats that are easier to cook with and spoil less easily than naturally occurring oils.

The chemical configuration of trans fatty acids raises levels of blood LDL cholesterol and lowers HDL cholesterol levels. An outpatient feeding study compared the effects of six diets containing different types of fat, but with total fat kept at 30% of energy, among 18 women, and 18 men.

Compared with a butter-enriched diet (high saturated fat), diets relatively higher in trans fat resulted in smaller reductions in LDL-cholesterol and significantly larger reductions in HDL-cholesterol. The stick-margarine diet, highest in trans fatty acids, resulted in a total LDL-HDL cholesterol ratio that was 4% higher (a low ratio being preferable) than the high saturated fat diet.

The diets with the most favorable lipid profiles were the soybean and liquid margarine diets, characterized by low amounts of both saturated and trans fatty acids.

By comparison, consumption of saturated fats also raised the LDL cholesterol concentration, but did not lower HDL. Thus, while saturated fats adversely affect the lipid profile, they did not appear as harmful as trans fatty acids.

Trans fatty acids may also interfere with the desaturation and elongation of omega-3 fatty acids. These are important for the prevention of heart disease and complications of pregnancy.

Some studies have linked the consumption of trans fatty acids, or foods that contain them, with adverse cardiovascular outcomes. An analysis of Nurses' Health Study data found that for each increase of 2% of energy from trans fat, the relative risk for incident coronary heart disease was 1.93 (95 percent confidence interval 1.43 to 2.61). On the other hand, total fat intake was not related to the risk of coronary disease.

There are no known physiologic benefits related to the consumption of trans fatty acids; thus, reduction in their intake makes sense. A clue to their presence are the words "partially hydrogenated" on the list of package ingredients. Starting in 2006, the FDA has required that nutrition labels provide trans fat content.

Physicians counseling patients who do not require special diets for existing diseases are advised as follows, according to Dr. Gillman.

• Avoid restricting total fat as a primary recommendation. Recommend natural alternatives to foods high in animal and hydrogenated fats, such as fruits, vegetables, legumes and whole grain products.
• Recommend reducing intake of trans fatty acids by avoiding stick margarine and reducing consumption of commercially baked goods and deep-fried foods.
• Recommend reducing saturated fat intake by substituting skim or 1% milk for whole milk and by replacing animal products with those of vegetable origin as much as possible, and by avoiding tropical oils such as palm and coconut oil, which are high in saturated fat.
• When fats are needed for cooking or spreads, recommend oils with monounsaturated oils (olive oil, canola oil) and/or polyunsaturated fatty acids (corn, safflower, sesame, and sunflower oils), especially monounsaturated fats such as (canola and olive oil) and to a lesser extent soybean oils. Patients may also consume nuts and seeds in moderate amounts.