Be afraid. There’s a plot to poison you with fat, trans fats to be precise or trans fatty acids to be even more exact. There are two articles in the Annals of Internal Medicine (here and here) which give a pretty good idea where medicine is heading. You’ve likely heard about trans fats. Their chemical structure is shown below compared to cis fats.
Following Denmark’s lead New York City has made it illegal for restaurants to use the stuff in preparing food. The reason for banning trans fats is that doing so will convey a health benefit. No matter that no study has shown that doing so actually reduces the risk of heart attacks, what counts is that there is “no nutritional benefit” from this lipid. I guess a calorie doesn’t count. By this standard chocolate has no nutritional benefit. I’m not sure what epidemiologists and nutritionists mean when they talk this way, but they get a lot of attention by doing so. What they should be saying is that trans fat intake has effects on cholesterol metabolism that may be harmful. They’re not going to get a lot of press saying that and they’re also not going to get the law changed so they stretch the facts.
The first paper in the Annals says that trans fats “poses a substantial risk to heart health.” The next sentence concedes that there are no randomized controlled studies demonstrating that reducing dietary trans fat conveys a cardiac benefit. You’ll have a hard time finding that lowering cholesterol by itself conveys a benefit. The reason? It doesn’t. Let me explain. Lowering cholesterol is unquestionably beneficial in patients with other cardiac risks, eg hypertension, diabetes, family history, pre-existing heart disease, perhaps obesity. But if your cholesterol is high and you have no other risk factor for heart disease lowering cholesterol (so called primary prevention) has never been show to be beneficial. The authors of this first article who work for the New York City Department of Health are frustrated. They warned the public about the putative ill effects of trans fats, but the public didn’t listen. So the Department decided on coercion. “Because artificial trans fat is both harmful and fully replaceable, allowing continued use, even with disclosure, could not be justified.” These guardians of the public’s health are not impressed with their regulations being called “nanny state meddling.” They know what’s good for you and if you don’t like it eat in a different city.
The second paper is an editorial by the former director of the Centers for Disease Control. Another bureaucrat, she’s even more sure of the harm of trans fats than the New Yorkers. “The scientific rationale for eliminating exposure to artificial trans fatty acids is rock solid…..they are certainly harmful.” In the next paragraph she too concedes that this certainty “is still untested.” She means that lowering dietary trans fat intake has not yet been shown to reduce heart disease. Yet she wants everyone to stop eating it even if they are in a group that could not possibly benefit from dietary parsimony.
Would it surprise me if eliminating trans fats from New York’s or the nation’s or the world’s food supply had a beneficial effect? No. But it couldn’t be very large given all the other variables that cause heart disease. But the issue is not trans fats. It’s government deciding that educating the public is only worth while if the public listens. It’s unelected officials taking it on themselves to tell the unenlightened how they should behave. It’s enlightened force. It’s a harbinger of what’s to come as the government gets even more involved with medical care as it certainly will. Expect someone with a slippery grasp on both science and ethics to increasingly order you to live the way they think is best for you even if you disagree. Keeping the drinking water safe and eliminating infectious disease apparently are not enough for the folks in the Department of Health, they want watch over you at every step. Remember intentions and outcomes are synonymous.