Eliminating trans fats

{***Pause/Music***}
{***Noah***}

Coming up on Harvard Chan: This Week in Health…

Celebrating a major public health milestone.

{***Walter Willett Soundbite***}
(We have a lot to think about and keep on our mind and we just shouldn’t have to worry about something like trans fats, which is something that produces only harm and no good.)

As of June 18, U.S. food manufacturers are banned from using artificial trans fats. In this week’s episode, a closer look at the decades-long battle to eliminate these harmful fats from our food supply—and how this ban could improve health in the years ahead.

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{***Noah***}

Hello and welcome to Harvard Chan: This Week in Health. It’s Thursday, June 21, 2018. I’m Noah Leavitt.

{***Amie***}

And I’m Amie Montemurro.

{***Noah***}

Amie, this week we’re marking a major public health milestone.

As of Monday, June 18, U.S. food manufacturers are banned from creating products with artificial trans fats—found in partially hydrogenated oils.

{***Amie***}

This trans fat ban is the culmination of decades of research and work.

{***Walter Willett Soundbite***}
(We started our scientific work back in the late 1970s and by 1992, ’93, the evidence had become quite strong that trans fats were harmful to human health. First, we saw for heart disease, then for diabetes, now many other conditions like dementia.)

{***Amie***}

That’s Walter Willett, professor of epidemiology and nutrition at the Harvard Chan School, and one of many public health researchers who helped expose the harms of trans fats.

{***Noah***}

Trans fats were introduced commercially in the early 20th century and quickly became ubiquitous in the United States.

At one point, the Food and Drug Administration—or FDA—estimated that 100% of crackers, 95% of prepared cookies, and 80% of frozen breakfast products contained trans fat.

{***Amie***}

And Willett says that at peak usage, industrially produced trans fats were likely contributing to about 50,000 early deaths each year in the U.S.

{***Noah***}

In this week’s episode: a brief history of trans fats.

We’ll explore how they became such a mainstay in American foods, the work to expose their risks, and the public health impact of eliminating them.

{***Amie***}

And we begin in the late 19th century in Europe, when the process of partial hydrogenation, which produces trans fats, was discovered.

{***Noah***}

French chemist Paul Sabatier was actually awarded a Nobel Prize for his discovery that metal catalysts could be used to precipitate this process of hydrogenation.

{***Amie***}

Walter Willett says trans fats quickly found their way into the food supply as a replacement for liquid vegetable oils.

And he says a major reason was cultural: The food supply was dominated by Northern Europe, which traditionally relied on things like butter and lard, as opposed to the Mediterranean which used olive oil.

{***Walter Willett Soundbite***}
(People didn’t know what to do with this liquid vegetable oil, which the process for extracting that from seeds had become much better a couple of decades earlier. And if we had a dominant southern European food supply, we would have taken that liquid vegetable oil and put some green food coloring in it, Mala flavor, and sell it for– as olive oil or sort of an alternative to olive oil. We needed to have something that was a hard fat so we could have margarine, which looked like butter, and Crisco, which looked like lard.)

{***Amie***}

But the other major reason involved the partial hydrogenation process itself, which destroys essential fatty acids.

{***Noah***}
These are part of the structure of every cell in our body and also play a role in regulating critical biological processes, such as inflammation.

But products containing these fatty acids tend to go bad if they sit on store shelves for weeks or months.

So, by replacing these fatty acids with trans fats it allowed foods—particularly baked goods to have a longer shelf life.

{***Amie***}

When you combine that with the low cost of partially hydrogenated oils—compared to butter for example—it became an easy choice for manufacturers.

But Willett says the health community actually shares some of the blame here too.

{***Walter Willett Soundbite***}
(In the 1960s, the health community got behind promotion of trans fats because butter and lard are relatively high in saturated fat, and there was a belief that saturated fat was the worst possible thing we could consume. So, anything that wasn’t saturated fat was thought to be good for us and hence, all these margarines that were very high and trans fats were pushed by the prevention community as something that we should be eating for health reasons. So, all those reasons piled up and trans fat became embedded in almost every commercially made product in the United States. They were just very, very ubiquitously.)

{***Amie***}

Over time Willett and other researchers grew concerned about trans fats.

{***Noah***}

For Willett, he was struck by the destruction of those essential fatty acids.

Beginning in 1981, a series of studies showed links between trans fats and heart disease—because those fats can increase LDL—so-called “bad” cholesterol—and lower HDL—so-called “good” cholesterol.

Trans fats can also increase inflammation, and in animal studies they’ve been shown to promote obesity and resistance to insulin—the precursor to diabetes.

Despite the harms of trans fats being so clear now, Willett and others faced pushed back for their work.

{***Walter Willett Soundbite***}
(We knew there would be push-back from the industry because they had invested so much in very high trans fat products like margarines and Crisco and things like that, and their first reaction was to try to discredit our work, calling it weak science or fake science and finally, when they recognized the science was there, the findings were reproduced, that it’s a small problem, not a big problem, but you start to work out the numbers and it is a big problem that the amounts are there. It was not a trace chemical. We were consuming this and many gram quantities per day. But I was unprepared for the push-back from many of my colleagues in the scientific nutrition area that many people had made their careers on eliminating saturated fat, and they thought this stuff about trans fat was a distraction from the real problem.)

{***Noah***}
Despite that initial pushback, the evidence against trans fats became overwhelming—and establishing that scientific base was critical, says Michael Jacobson, senior scientist and former executive director of the Center for Science in the Public Interest—or CSPI.

We spoke to him over the phone from his office in Washington, DC.

{***Michael Jacobson Soundbite***}
(This whole effort to get rid of what turns out to be the most harmful fat in the food supply is based on the scientific research. And what we’ve tried to do is we’ll look at the mismatch between government– between the scientific research and government policies.)

{***Noah***}

Some industry leaders, like Unilever, recognized the danger of trans fats and removed them from products, but there was resistance from others.

And that’s where the importance of government regulation came in—and it came in incremental steps.

{***Amie***}

The first big victory came in 2006, at the urging of CSPI, the Harvard Chan School, and Fred Kummerow, a legendary biochemist who was an early opponent of trans fats.

That year, trans fats were added to food labels in the U.S., which led many manufacturers to begin reformulating products to remove partially hydrogenated oils, Jacobson says.

{***Michael Jacobson Soundbite***}
(The FDA’s labeling requirement really sent a signal to the industry that this is bad stuff. The rule was in 2003, due to go into effect in 2006, and in those several years, a lot of companies were quickly switching to substitutes because nobody wanted to have trans fat on the label showing how much trans fat there was.)

{***Amie***}

But a challenge remained in restaurants, which had no labels.

So, cities and states—such as Boston, New York City, and California began banning trans in restaurants.

{***Noah***}

Still some products that were using trans fat invisibly to consumers, even though, as Walter Willett explained, there was no scientific basis to keep trans fats in the food supply

Finally, in 2015, the FDA ruled that trans fats were no longer “Generally Recognized as Safe” and ordered manufacturers to stop using partially hydrogenated oils on June 18, 2018.

Willett says this FDA ruling will ban the process of partial hydrogenation of oil, which produces trans fats.

{***Amie***}

And this will also have an impact on restaurants, where trans fats were often found in frying oils.

Willett says that ending production of these products is the final nail in the coffin for trans fats.

{***Walter Willett Soundbite***}
(Even though, in some ways, the horse is 95% back in the barn, it will close the gates, and trans fats will be out of the food supply. And that’s important both for reasons of mopping up the last bit of trans fats, but also, we have a lot to think about and keep it on our mind, and we just shouldn’t have to worry about something like trans fats, which is something that produces only harm and no good.)

{***Amie***}

The health impacts of this trans fat ban will be immense say Willett and Jacobson—who estimate that eliminating trans fats will prevent a quarter of a million heart attacks and related deaths each year in the U.S.

{***Noah***}

Willett says a key will be what people choose to replace trans fats with—if people choose healthy unsaturated fats, the potential impact will be even greater.

{***Amie***}

And Jacobson says there’s already some evidence that local action on trans fats is improving health.

He cited a study from Yale University which compared the death rates in New York cities and counties which banned trans fats to those that did not.

{***Michael Jacobson Soundbite***}
(And they found a significant difference. The counties that were getting rid of trans fat were actually saving lives from doing it, and nobody’s extrapolated from those local communities to the nation, but it’s getting rid of trans fat is clearly providing real health benefits to the country. And the World Health Organization has been trying to encourage countries around the world to get rid of trans fat.)

{***Amie***}

You heard that Jacobson touched on the World Health Organization’s efforts to combat trans fat. They recently called for global elimination of trans fats by 2023.

{***Noah***}

While it’s an ambitious goal, both Willett and Jacobson say it may be difficult to achieve.

One factor is that the WHO does not have any regulatory or legal authority, says Willett.

{***Walter Willett Soundbite***}
(So, they are advisory, but they carry a lot of weight in many countries. So, we know it’s possible to eliminate trans fat. It will be more challenging for some of these countries because they don’t have the scientific resources. They don’t have, many times, the financial resources to make this transition. So fortunately, Michael Bloomberg has set up a foundation that is meant to support these low and middle income countries in helping them make this transition. The good thing is they have a lot of experience to borrow upon because United States is not the first country to eliminate trans fat. Denmark did that about a decade ago. Chile now, for quite a few years, has been trans fat free. So, there’s a lot of industry and technical experience that can be used by other countries as well.)
{***Noah***}

Eliminating trans fats is a major nutritional win, but there are still other battles to fight.

Two key ones: reducing sodium levels in food and limiting sugar-sweetened beverage consumption.

{***Amie***}

Willett says that a clear lesson from the work to eliminate trans fats is that it’s not an easy path from the science to policy change.

{***Noah***}

Sodium also represents a tricky challenge compared to trans fats or sugar-sweetened beverages.

With trans fats or sugar, there’s clearly a harm, so the goal is to drive those levels to zero.

But sodium is an essential nutrient, so Willett says the key is finding a “sweet spot” where sodium levels don’t negatively impact health.

{***Amie***}

But the approach there needs to be the same—to attack salt at the manufacturing level, says Michael Jacobson.

That’s because it’s much harder to get consumers to make healthier choices on their own.

{***Michael Jacobson Soundbite***}
(If you can impact the food supply, you don’t have to worry about the dietary practices of individual consumers. You know, you go upstream and make those changes. Eating more fruits and vegetables is a little harder because in most cases, consumers have to make a decision every time they go to the grocery store to buy more fruits and vegetables. Switching from white bread to whole wheat bread is easier than eating more fruits and vegetables because you just switch from– you go to the bread aisle and you buy a whole grain instead of a white bread.)

{***Amie***}

Willett says the fight over trans fats represents something important about nutritional epidemiology—that it will always be a bit of a work in progress, where new research is needed to assess the effects of diet on health and then craft healthy eating recommendations.

{***Walter Willett Soundbite***}
(When I started essentially looking broadly at the issue of diet and health back in the 1970s, I realized we were being given messages, avoid this, eat that, and you scratch the surface and there was almost no evidence to support that. So, what we’ve tried to do is build that evidence base, and that isn’t built over just a few years. These– many of the facts of diet take decades to play out and turn up as increased risk of heart disease or cancer or something like that. So, we and others have then started large long-term studies like this, and we have a lot better basis for providing guidance. We’re still working on details and nuances. There’s still definitely plenty to learn.)

{***Amie***}

Thank you for Walter Willett and Michael Jacobson for taking time to chat about their work on trans fats.

{***Noah***}

If you want to learn more about the fight to eliminate to trans fats, there’s much more information on our website, hsph.me/thisweekinhealth.

{***Amie**}

And before we go, a quick programming note that as we enter the summer months we’ll be posting new episodes every other week. We’ll resume our weekly schedule again in the fall.