Wednesday, March 14, 2007

Trans

You may have heard that New York City will ban the use of trans fats in their restaurants, I think beginning July 1, and that other municipalities are considering following suit. Trans fats are those man made, partially hydrogenated fats that are terrible for your cardiovascular health, so bad, in fact, that the American Heart Association recommends you eat no more than 2 grams per day of them. They are found in foods that are deep fried, which some people say taste better when fried with trans fats versus other fats, and in commercially made pastries, because the trans fats make them stay moister for longer.

Should New York City and other communities be protecting their citizens by not letting them eat trans fats? It's an interesting question. It doesn't matter to me personally, because I don't eat that kind of stuff, but there are many who would say, hey, let me decide what is too bad for me to eat. Trans fats are just one of many substances that are bad for us, and other substances such as cigarettes and alcohol are perfectly legal. I guess that after the failure of Prohibition no one wanted to even think about banning alcohol again.

The argument for banning trans fats, instead of allowing individuals the right to harm themselves as they see fit, is that the state, or government, has an interest in keeping its people healthy because the state pays for much of the medical care of people. To the state, fewer trans fats means fewer Medicare payments for heart attacks and bypass surgery and so on. It's sort of like the old argument about whether the state can require motorcycle riders to wear helmets or not. Motorcyclists want to let their hair blow free; the state wants to pay less for rehabilitation of people with head injuries.

I'm pretty certain we won't come to consensus in this post or its comments about what is the right thing here, but if we're talking about banning bad foods, I think we really have to look at super sized soft drinks. When I was a kid, if you went to a hamburger joint and ordered a large Coke, you would get maybe a 16 ounce drink. Now a large must contain well over 20 ounces, and if you "biggie size" your order, the drink could serve a small family by itself. And let's not even talk about the Big Gulp from 7-elevens. How big are those things, anyway? 32 ounces? 48? Considering that a 12 ounce can of pop has the equivalent of about 14 teaspoons of sugar in it, soft drinks must be a huge contributor to the nearly endemic obesity occurring now. Fats get a lot of the attention when we talk about obesity, but these huge amounts of simple carbohydrates can be just as bad.

Personally, I don't mind it if the government bans trans fats or soft drinks in schools or sets maximum sizes for servings of pop, because we humans have shown time and again that rather than take care of ourselves, we would prefer to eat, drink, and smoke ourselves to death. But let me leave you with one final thought. If the government bans trans fats and saves money because of lower costs for cardiovascular care, won't it just have to spend more money on Social Security for the people who are living longer, and then eventually even more money on whatever disease they die from instead of heart disease, like maybe cancer? Just wondering....

P.S. Check out the latest Pediatric Grand Rounds.

19 Comments:

Blogger Geoff said...

I'm not sure the trans fat vs. alcohol etc. argument holds water. I thought the problem with trans fats is that they're often hidden and not disclosed on the label (esp. not in restaurants). So the public may be innocently consuming trans fats without knowing it, even on "reasonably" healthy food options. I think we're a little behind you on this one in the UK, although it is an issue. Is interesting to get a tiny insight into your dietary habits!

4:24 PM  
Blogger Magpie said...

And what about the fact that there are naturally occuring trans fats in butter and beef? There was an interesting piece in the NY Times last week: http://select.nytimes.com/search/restricted/article?res=F6061FFC3E550C748CDDAA0894DF404482

One result of the trans fat ban is that Starbucks has reformulated their food to eliminate butter, using margarine or palm oil instead. Sorry, I'd rather eat butter.

6:00 PM  
Anonymous crunchy mom said...

I got the whole banning smoking thing. Secondhand smoke is annoying (at the minimum) to nonsmokers and causes health problems for everyone. Even putting restrictions on alcohol has public safety implications-- too much public consumption equals a higher risk of drunk drivers on the road, which puts other drivers and pedestrians in danger.

But trans fats are between the person consuming them and....whom? Family members? The health insurance issue is moot since we don't have truly socialized medicine here in the US. Even seniors, who qualify for medicare, must purchase a secondary insurance and drug coverage to be fully covered. Medicare doesn't take care of everything. I do support stricter labeling requirements for trans fats, and perhaps even some sort of warning label, but whether or not I choose to heed those warnings should be up to me, not Mayor Bloomberg.

7:22 PM  
Blogger SuperStenoGirl said...

Someone once told me:

"Life is not about arriving at the grave in a perfectly fitted Armani suit with your hair and make up done by a famous stylist. It's about sliding in sideways, covered in mud, a martini in one hand and chocolate in the other while screaming "WOOOOOO what a ride!".

Not sure if that really applies to your post or not. But it's one of my favorite sayings.

8:05 PM  
Anonymous Ariella said...

I don't know what your political bent is, but if you're interested in the subject of sugary drinks and the link to obesity, I suggest you pick up a copy of "The Republican War on Science." The author includes a chapter that outlines how the Bush Administration has systematically quashed references to the fact that sugary sodas have no nutritional value and lead to obesity in our young people. Most interesting to me is that although 80% of the rest of the world has a food pyramid that recommends no more than 10% of daily calories come from refined sugar (like sodas, candy, ice cream, and the ever-present corn syrup), the Bush Administration has also refused to take up that recommendation and has denied its truth in all reports.

Go. Read. And be disgusted.

Oh, and, as a lawyer I think the bans on trans-fats are silly. Just another way for the government to think they should be in our lives. If people are willing to educate themselves as to the dangers of trans-fats, then they have the right to eat whatever the heck they want to eat. Plenty of people are trying to compare this to the smoking bans, but there are huge differences -- the main one being that second-hand smoke causes death to those who are near it, yet if my friend consumes trans-fats near me, I won't die...

8:13 PM  
Blogger Fat Doctor said...

Lemme get this straight. Trans fats bad, Atkins good? Is that what the media is telling us today? Hmmm. That's why I read mostly blogs. By the way, this renewed low-carb dieter is big on fat, no matter cis or trans. If you'll excuse me, I'm going for some pork rinds now.

8:23 PM  
Anonymous Anonymous said...

Seems like everything these days will kill you one way or another. A medicine that might help one problem can put you at risk for another. Being that we live in a world where every thing we eat and every medicine we take can kill us somehow...or have extreme side affects (according to commercials of most drugs)...I'm not sure I'm too worried about trans fat....please pass that pork rinds fat doc.

9:00 PM  
Anonymous Anonymous said...

What happened to the post on nurses calling in sick??

10:37 PM  
Anonymous Anonymous said...

I do not believe the government should be able to ban trans fats....if they will allow cigarettes, alcohol, etc. I don't know where to drawn the line on that.

However, I do think restaurants should have to disclose the information so people can make an informed choice. Instead of spending so much of our tax money trying to ban something, why not use it to educate the public instead? We know the trans fats are bad, so just start putting it on labels and menus.

As to the comment regarding sodas and politics, (sigh) let me just say that I absolutely LOVE Diet Coke. I know there are healthier choices but I still drink it within reason. Not everyone is responsible to limit consumption of soda but they do so at their own peril (and they know it). If the government placed restrictions on the serving size, people would just buy two or three...

The general population completely understands that sugary sodas are not nutritious and can lead to obesity if consumed excessively. I don't buy the argument that the President is "hiding" something when it is simple common sense. Good Grief!!! Contrary to popular belief, not everything is the fault of President Bush. He doesn't shove soda down my throat, I do.

With regard to childhood obesity, I do believe we should remove junk food from schools. However, it is the parents'responsibility to educate their children and stop buying twinkies and sodas for them to have at home. It's really time people started taking responsibility for their own actions and stopped blaming the government.

9:27 AM  
Blogger Dream Mom said...

LMAO at Fat Doctor!

9:29 AM  
Anonymous brockton said...

Lots of interesting ideas here. I always thought the deal with trans fats was that they were kind of the leading example of what's bad about overprocessed, factory foods, and banning them was a way to take one step back toward real food. I didn't know that butter has its own trans fat. Maybe in much smaller quantities?

I agree with those who observe that there's little point in trying to stamp out every last health risk. Not to be too cavalier, but we all have to die of something, and dying of too many Ho-Hos doesn't seem like such a bad thing.

I think it's true that extending people's lifespans by getting rid of trans fat (if that is in fact a real effect) would increase lifetime healthcare costs by increasing the lifetime itself. The same phenomenon occurs with smoking, except in reverse - smoking reduces healthcare costs by killing you early.

I'm happy to eat foods with fewer trans fats in them, but the whole thing still strikes me as health-fad-du-jour, and I'm not sure it's a good idea to write today's hot diet into law.

9:40 AM  
Anonymous Dianne said...

If the government bans trans fats and saves money because of lower costs for cardiovascular care, won't it just have to spend more money on Social Security for the people who are living longer, and then eventually even more money on whatever disease they die from instead of heart disease, like maybe cancer?

I have a vague recollection of reading somewhere (in other words, don't take this comment too seriously as stand alone evidence), that most people who die in extreme old age (ie >100) die of no particular disease. Most just don't wake up one morning. Given how expensive treating end stage disease is, I strongly suspect that, if this is true, a society where 90% of people live to 100+ and die quietly without spending much time in the hospital is going to spend less money on its elderly population than one in which the average person dies at 70 of heart disease, cancer, or other preventable illness. But I don't have any particular proof of this assertion.

10:45 AM  
Blogger Ada said...

If the government's goal is to reduce obesity rates (for whatever reason it chooses), perhaps an advertising campaign would be more effective? I'm Canadian, so I don't know how the whole smoking issue is treated in the States, but here in Canada there's a strong advertising campaign going on. Each pack has to have, by law, half of its packaging covered in a color photo of what happens when you smoke (ie: black lungs) with a warning. Here's the list of them: http://www.hc-sc.gc.ca/hl-vs/tobac-tabac/legislation/label-etiquette/graph/index_e.html . There is at least one federally-funded quitting program, not to mention the number of quitting hotlines and support groups. On TV, there are graphic (and eerie) ads warning parents of the dangers of second-hand smoke to their children. I think all of the major cities have banned smoking in restaurants and bars. The list goes on and on. Honestly, I think it might be working -- I don't know of as many smokers any more. Either way, it's a more positive approach to getting the desired result from a group of people. Instead of banning something (thus making the government more of a "nanny state"), why not encourage people to choose something else?

4:22 PM  
Blogger Ada said...

Sorry, it looks like blogger didn't copy the whole URL. Canadian cigarette package warnings are here .

4:24 PM  
Blogger Bertalan said...

Have you heard about that story mentioning you?

2:46 AM  
Anonymous Katherine said...

Wow! You're getting to be quite famous, ND. I found your blog in the first place because you were mentioned on foxnews.com.

1:13 PM  
Blogger neonataldoc said...

Thanks, everyone. Fat Doctor, I assume you're eating the baked pork rinds, not the fried ones. (Just what are pork rinds, anyway?)

Dianne, good point. I don't care if you have proof or not- it sounds good.

Bertalan, thanks for the link to the story. It's interesting. I thought I was being pretty careful about protecting my patients' anonymity, but maybe I should do better.

6:33 PM  
Anonymous Katherine said...

I think a lot of people miss the basic point about this ban. There's a difference between banning types of foods (using that term loosely to include sugary sodas as well as fast food) and banning particular INGREDIENTS in those foods. If we were talking about a kind of food coloring with a proven link to cancer, would people defend their right to their Red Dye #578 so vociferously?

1:15 AM  
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