Copyrighted by Steven Aldana, 2004

Chapter 6

Swapping Bad Fats for Good Health

The need for change bulldozed a road down the center of my mind. Maya Angelou (1928-)

When I was a child growing up in Idaho, I ate a bowl of ice cream every day after dinner. My parents would buy it in large, three gallon containers. Because the containers were so big and handy, my mother would save them. The lids made great frisbees and the containers made great drums. At that time, no one even questioned the possibility that eating a bowl of ice cream everyday could be unhealthy. On most mornings I ate eggs, bacon, and heavily buttered toast, and a big glass of whole milk straight from the dairy down the street. Neither I nor my parents ever thought there was anything wrong with the way we were eating. After all, this was the same way my grandparents ate, it was the way my friends ate, it was part of my cultural and family heritage. That was life in Idaho.

Other cultures in the U.S. are not without their high fat foods. Southerners are known for their Southern hospitality and food which often includes fried foods, barbeque, biscuits and gravy, and lots of meat. Texas is known for its superb cattle industry where they believe plentiful grasses and proper animal care provide the finest steaks in the world.

One of the hardest parts about living a healthy lifestyle is trying to adjust our cultural and ethnic identities to what is known about good health. To most people that means asking, “What do I have to “give up” in order to be healthy.” Well, there is no simple way to achieve good health. It takes some adjustment and change, and, yes, it even requires some drastic changes in the way we live.

For example, to have good health, it is not a good idea to smoke. If you do, you should quit—the sooner the better—and you should never smoke again. Smokers will need to completely forsake their smoker’s lifestyle. This might mean no longer going to locations where smoking might be a temptation, finding something else to do besides smoke, and maybe even throwing out all the ashtrays, matches, and unused cigarettes. This is a drastic solution to a very dangerous health issue. It is the best way for the 23% of American who smoke to dramatically improve their health.

Humans don’t have to smoke to live, but they do have to eat. Since we are all going to continue eating, all that is really needed is to change the types of foods we eat. I still eat breakfast everyday, but I don’t eat the foods I used to eat, and ice cream is an occasional indulgence.

The Dietary Fat Hit List

Dietary fat has been on the nutrition hit list for about 20 years. Today we see the battle against fat every where we go. Jared, the spokesperson for Subway sandwiches, has been leading the way to healthy body weight by eating low fat, healthy Subway sandwiches. He claims to have eaten low-fat Subway sandwiches every day and lost over 100 pounds. Lay’s potato chips can be purchased baked rather that fried like traditional potato chips, and sales of the chips at Frito-Lay have exploded. There is low fat ice-cream, low fat chocolate, low-fat salad dressings, just about everything that used to be high in fat now has a low-fat version.

Now there are fake fats, like Olestra (Olean) which is used in commercially produced foods. It tastes like fat, but passes through your digestive system impervious to your body’s attempt to digest it. The digestive system thinks they are fats and tries to digest them, but cannot. (Broekmans, 2003)

This is actually an amazing property of these fake fats. They are so close to the real thing that our bodies are completely fooled. Vitamins and phytochemicals that are in the foods we eat aren’t automatically absorbed into the blood stream during digestion. To get through the intestinal wall, they have to bind with a fat that acts like an escort. Together, they cross the intestinal wall and enter the blood stream. Without fat in the diet, vitamins and phytochemicals they can’t get into your blood and help keep you healthy. When phytochemicals and vitamins attach to fake fats, they think they are getting a ride through the intestinal wall and into the blood, but in reality the only ride they are getting is a one-way trip on the porcelain express. Because they are not absorbed by your body, you don’t get any benefit. Even though fake fats may have some good properties like taste, it appears they may not be healthy. Research on individuals who have been eating fake fats shows a reduction in the number of phyotochemicals in their bodies. (Weststrate, 1995) Though the FDA currently allows fake fats to be used in processed foods, they have yet to allow fast food manufacturers to use them to fry foods. Until the entire effects of these designer foods are better understood, the prudent thing to do would be to avoid them.

Dietary fat got blackballed and placed on the nutrition hit list just like any other publicly recognized health concern. Research at the time had formed a picture of good health, and excessive dietary fat wasn’t in the picture. Studies of the effects of diet on cancer in rodents showed that different amounts of dietary fat could change the rate at which cancers could grow and predict the total number of cancers these animals would get. (Welsch, 1992)

Saturated fat, the type of fat that comes from animals and is solid at room temperature, is shown to have strong ties to heart disease because it increases bad cholesterol. (Schafer, 2002; Renaud, 2001; Nicolosi, 2001) It was also clear to health experts that the countries that consumed the most fat had the highest rates of certain cancers and cardiovascular disease. (Prentice, 1989) Leading health authorities started recommending that saturated fat be limited. Despite intense efforts to make the best recommendations, the message that evolved was “all fats are bad.”

This message has been the call to action for many food manufacturers, health programs, and popular diet and health programs, and there has been some success. The Dean Ornish Heart Disease Reversing Program requires program participants to eat a plant-based diet and to limit dietary fat to no more than 10% of all calories. (Ornish, 1998) That is extremely low considering the average American consumes about 34% of total calories from fat. Most Ornish Program participants start the program with advanced stages of cardiovascular disease and if they can exercise, maintain the diet, and practice stress management, there is evidence that they can actually reverse blocked arteries and dramatically improve heart health. Other programs that appear to have had success with the “all fats are bad” message are the Pritikin Program, and the Coronary Heart Improvement Program (CHIP). (Esselstyn, 1999, Aldana, 2002)

Low fat diets also appear to be helpful for individuals who are trying to lose weight or maintain weight loss. (Jequier, 2002) There are about 3,000 individuals who have lost significant amounts of body fat and maintained the lost weight for several years. These long-term weight loss success stories are documented as part of a national weight loss database called the National Weight Control Registry. When asked how they were successful at keeping weight off, the registry members identified two key behaviors, regular physical activity and a low fat diet. Low fat diets appear to have some effect on long-term weight loss and cardiovascular disease, but if you seriously consider the more recent nutrition evidence, it is obvious that the all-fats-are-bad message needs to be updated.

Fat Increases While Fat Decreases

Under the all-fats-are-bad diet, fats are cut from the diet and have to be replaced with either more protein or carbohydrates. The low fat diets and health programs previously mentioned aim to replace the calories removed from fat with additional calories from whole grains, fruits, and vegetables. This is a great trade off. Perhaps that is why these programs have been able to demonstrate improved health and weight loss. However, when the public cuts dietary fat, it most likely gets replaced with simple carbohydrates or sugars, not health-promoting whole foods.

Since 1965, there has been a decline in the percent of total calories that come from fat. Today men and women consume approximately 32% of calories from fat whereas 40 years ago dietary fat accounted for 45% of all the calories eaten. (Continuing Survey, 1995; CDC, 2004) During this same time period the percent of Americans who are obese or overweight has been increasing. The decrease in dietary fat and the increase in weight is shown in Figure 6.1. You would think that if people are eating less fat, they would weigh less, but obviously this is not the case when we look at the entire U.S. population.

Figure 6.1 Increases in body weight and decreases in dietary fat in the U.S. The dashed line is the trend in the percent of adults who are overweight or obese, the solid line is the trend in the percentage of calories from fat over the same period. (Continuing Survey, 1995; BRFSS, 1990-2002; CDC 2004)

Physical activity during this time has been relatively unchanged with only 25% of Americans getting the recommended amount of physical activity. Since 1971, the total number of calories being eaten every day per person has increase by about 168 calories for men and about 335 for women. (CDC, 2004) That means men are eating an amount equivalent to three apples and the women are eating the equivalent of five apples more each day than they did in 1971. Most of these increased calories are believed to come from eating more foods away from home, salty snacks, soft drinks, pizza, and increased portion size. (Neilsen, 2002; Nielson 2003)

Let’s try to make some sense of this data. The nation’s physical activity has stayed the same, dietary fat has come down, daily calories have increased, and as a nation, we are fatter now than at any other point in history. It is tempting to look at this graph and conclude that the reductions we’ve experienced in dietary fat are somehow causing the dramatic increases in weight being experienced by Americans. Unfortunately, we don’t know if this is the case because there are many other possible explanations for this apparent link.

During this same time frame food has become more affordable, with even the poorest in our society consuming too many calories. Food has become more convenient as the number of fast food restaurants continues to grow. The number of calories consumed per person has also increased over this same time period. This suggests that the fat that has been reduced in our diets is being replaced with carbohydrates and protein. This substitution does not appear to be an equal trade of calories, but more of a small reduction in fat calories for a large increase in other calories.

Sorting Out Fats from Fiction

You will recall that there are many phytochemicals in the whole foods we eat, so many that most have yet to be identified. The basic unit of fat is called a fatty acid and, like phytochemicals, there are many different types. Based on their chemical structure, most fatty acids fall into four main categories.

Saturated Fat

Saturated fats have all the hydrogen atoms they can hold. Because they are saturated with hydrogen atoms they have unique properties. Just about any plant or animal product that has fat in it has some saturated fat. Saturated fats generally come from animals and animal products. It is solid at room temperature. Butter, shortening, fat trimmed from meat, and high fat dairy products have saturated fat. Saturated fat raises blood cholesterol which increases the risk for heart disease and stroke.

Monounsaturated Fat

These fats are really oils. They are liquid at room temperature but get more solid when they are stored in the refrigerator. Chemists call the most common monounsaturated fat cis-9-octadecenoic acid. Physiologists call it oleic acid, but you and I call it olive oil. Olive oil can be mixed with vinegar to make an oil and vinegar salad dressing. This dressing is liquid at room temperature, but when it’s stored in the refrigerator it starts to solidify and becomes cloudy. When substituted for saturated fat in a person’s diet, monounsaturated fats appear to lower blood cholesterol which means they are actually be good for you.

Polyunsaturated Fat

Unless you get these fats from your diet, your body cannot produce them on its own. These fats differ chemically from monounsaturated fat. They are liquid both at room temperature and when kept in the refrigerator. For some reason, polyunsaturated fats actually help lower total blood cholesterol and are heart healthy. One of the most commonly talked about polyunsaturated fats is 4,7,10,13,16,19-docosahexaenoic acid or DHA, a nasty name for what the public calls fish oil. Polyunsaturated fats are also very common in seeds, plant oils, and whole grains.

Trans Fat

These fats are a little different than the ones above. They are altered polyunsaturated fats. Most trans fats are manufactured in a process called hydrogenation. Healthy vegetable oils are heated to about 400 degrees and hydrogen gas and a metal catalyst are added. This makes the unsaturated vegetable oil accept additional hydrogen atoms and presto, what used to be an unsaturated fat is now a saturated fat with special properties. It can be used to fry food over and over again with out going rancid and it has a very long shelf life. They are found in processed cookies, cakes, fried foods, and bakery goods. Trans fats increase bad cholesterol more than unsaturated fats.

Examples of the Four Types of Fat
Saturated fat	Monounsaturated fat	Polyunsaturated fat	Trans fat
cheese whole milk dark chocolate butter ice cream fatty meats coconut milk lard	olive oil canola oil peanut butter almonds nuts avocado sesame seeds pumpkin seeds	safflower oil corn oil sunflower oil soybean oil corn fish walnuts	margarine vegetable shortening any deep fried foods French fries most bakery goods Anything with shortening or partially hydrogenated vegetable oil in the ingredients

Many years ago I was working at Oklahoma State University. My family and I loved living in Oklahoma because everyone was always so nice and friendly. My oldest son had tasted beef spare ribs during dinner at a friend’s home and wondered if our family could go to dinner and have ribs. After much pleading, I gave in and took the family to one of the famous barbeque rib restaurants that are so popular in the Midwest. My son ordered a rack of barbequed beef ribs. As he was enjoying his ribs, the juices from the meat and barbeque sauce ran down his arm and made a small pool on the table. He really liked the ribs. As we finished dinner and had some time to visit, my son noticed that the small pool of juice that had dripped down his arm and onto the table had hardened. It looked like wax from a candle; in fact, he thought it was wax.

This was one of those moments when I was able to explain the difference between saturated fat and unsaturated fat. At cooking temperature, the fat from the ribs was liquid and could run like water, but after it cooled to room temperature, it hardened. If the same pool of juice had been placed in a refrigerator it would have hardened even more.

Think about the foods you eat during the day. Which ones contain fat and how can you tell? Well, deep fried foods, bakery goods, butter, high fat dairy products (like cheese and ice cream), and any food that leaves a shine on your fingers after you eat it are high fat foods. Salad dressings, fatty meats (like bacon and steaks), peanut butter, and French fries are also high in fat. However, just because a food is high in fat doesn’t mean it should be avoided. There are good fats and there are bad fats. The trick is to eat a diet that reduces one and increases the other.

Why You Should Care About Good Fats and Bad Fats

I know this next section may be difficult to believe, but try to forget all the hard work and time you have spent identifying and eliminating high fat foods from you diet. Try at least to consider the evidence before you make a decision about what you should and should not eat. As we discussed earlier, there is some limited support for the all-fats-are-bad approach to good health. When all fats are treated equally, dietary fat appears to be related to several chronic diseases; we have discovered that all fats are not the same. Each of the four main types of fat behaves differently.

In 1997, Dr. Frank Hu at Harvard published findings from the Nurses’ Health Study that gives a great example of these differences. (Hu, 1997) After following 80,000 women for 14 years the relationship between dietary fat and coronary heart disease was studied. The diets of all these women were monitored and the amounts of total, saturated, trans, polyunsaturated, and monounsaturated fats were measured. These measures of dietary fat were then used to determine the risk of having heart disease. When women with high fat diets were compared to women with low fat diets, there was no difference in the risk of having coronary heart disease. But when the different types of fat were looked at independently, a very different picture emerged.

Polyunsaturated fats reduced heart disease risk by 38% and monounsaturated fats reduced the risk by 19%. Both saturated and trans fats increased heart disease risk. Those who ate the most saturated fat compared to those who ate the least had a 17% greater risk of heart disease. Those who ate the most trans fats had a 93% increase in heart disease risk, almost 5.5 times greater than the risk associated with saturated fat. Taken individually, these four types of fat reveal a stark disparity in the way our bodies handle fats (see Figure 6.2). You can guess which of these fats are good and which are bad. Because good fats (polys and monos) tend to offset bad fats (saturated and trans). Past studies of the effect of total fat didn’t know that the benefits of the good fats cancelled out the harmful effects of the bad fats and the result was no effect.

Figure 6.2 Good fats decrease and bad fats increase heart disease risk in women. (Adapted from Hu, 1997)

Good Fats

Polyunsaurated fats have been studied quite extensively and can be further classified into plant oils and fish oils. Plant oils come from corn, sunflower, canola, and other plant sources such as nuts. Peanut butter is a good source of polyunsaturated fat. Plant oils have shown some remarkable tendencies to protect our bodies from chronic diseases. A diet that includes nuts and peanut butter can reduce the risk of diabetes by 21%. (Jiang, 2002; Harding, 2004) To get this much protection, you would have to eat about a half a cup of nuts every week. That is not very much if you spread it out over seven days.

Individuals who have increased the amount of polyunsaturated fat in their diets experience several changes in their metabolism. Bad cholesterol (LDL) goes down, good cholesterol (HDL) goes up, and total cholesterol can drop by as much as six percent. (Hu, 2002) These improvements in blood cholesterol translate into 12-44% reductions in the risk of heart disease, stroke, and other vessel diseases. (Dayton, 1969; Turpeinen, 1979; Leren, 1966; Morris, 1968) At the present time there is no clear data showing that polyunsaturated can prevent cancer and a few studies even suggested the possibility that they may be linked with prostate cancer. (Kushi, 2002) Much more research is needed before this part of the fat puzzle is completely understood.

A study of older adults showed that eating high amounts of polyunsaturated fats could reduce the risk of getting Alzheimer’s disease. The same study showed that those who eat higher amounts of saturated and trans fats double their risk of getting Alzheimer’s as they age. (Morris, 2003)

Think of monounsaturated fat as polyunsaturated fat’s little brother. They both act in similar ways. Both increase good cholesterol, decrease bad cholesterol, and reduce the risk of cardiovascular diseases. They are both liquid at room temperature and both can be found in plant oils. It is almost impossible to get one without the other. When you think of monounsaturated fats, think of olive oil. Olive oil is mostly monounsaturated fat.

In the 1960’s researchers looked at the death and disease rates of different countries and discovered a group of people who, despite having poor medical care, had the longest life spans in the world. They also had some of the lowest rates of heart disease, cancers, diabetes, and obesity found anywhere. These healthy souls were the citizens of Crete, Greece, and Southern Italy and they all shared a Mediterranean lifestyle.

Traditionally, these people consumed an abundance of plant foods including nuts, breads, pastas, beans, and fruits and vegetables. Olive oil was the primary source of fat. The diet also included some fish, poultry, dairy foods, meat, eggs, wine and was low is sweets. This diet had almost no trans fats and was low in saturated fats and high in monounsaturated fats. In the 1960’s this was the traditional diet of the general population. Since that time, however, the diet has become increasingly Westernized so that today the traditional Mediterranean diet has become a more Westernized hybrid. Fast foods and processed foods have become a substantial part of the regional diet.

Monounsaturated fats get most of their fame and attention from the health-promoting role they play in the traditional Mediterranean diet. They are believed to be responsible for much of the health benefits experienced in the region. (de Lorgeril, 2000) Parts of Italy, France, Portugal, Spain, Tunisia, Turkey, and Morocco also enjoy variations of this diet, but few are still completely true to their Mediterranean roots.

The Mediterranean diet appears to prevent chronic diseases in several ways. The good monounsaturated fats help to keep blood cholesterol and risk of heart and vessel disease low. An abundance of fruits, vegetables, and whole grains introduces a variety of anti-oxidants and phytochemicals into the body which may also help prevent vessel disease, but is also believed to prevent cancers, diabetes, obesity, and possibly Alzheimer’s disease. Olive oil, fish oil, and other whole foods may decrease colon and breast cancer risk.

One way to really see if the Mediterranean diet is really that good would be to have people adopt the diet and track them across time. That is exactly what French researchers did. (de Lorgeril, 1999) They convinced 600 men and women who already had heart disease to either try a Mediterranean diet or one from the American Heart Association. The four-year study was stopped after just 2.5 years because the effects of the diet were obvious and there was no need to continue. The group that started on the Mediterranean diet had a 70% reduction in deaths from all causes—pretty good evidence that the diet is responsible for much of the good health in the Mediterranean region.

Learning from the Eskimos

Years ago researchers working in the Artic were surprised to learn that Eskimos rarely die of heart disease despite a diet extremely high in animal fat. It was believed at that time that animal fat was the same between animals and that if you ate a lot of animal fat you were asking for heart disease; not so among the Eskimos. Since this early observation, much has been learned about the type of fat consumed by Eskimos. It is a type of polyunsaturated fat we refer to as fish oils. Unlike the juicy ribs my son liked so much, the oil from fish, especially cold water fish like salmon and tuna, does not harden when it reaches room temperature; chemically it is different. The same types of fats are found in smaller amounts in seeds, walnuts, and soybean and canola oils.

These fats help keep the heart beating properly. (Jones, 2002; Lemaitre, 2003) This might not seem like a big deal unless you know that many of the heart disease deaths that occur each year are caused by a sudden change in the heart’s normal beating. The beat suddenly becomes rapid and irregular, and the first sign that anything is wrong is sudden death. Most sudden cardiac deaths occur this way. We are not exactly sure why, but in humans and in animals, those who eat higher amounts of these fats maintain regular heart beats.

At the time this book was being written, 19 studies had been published that looked at the relationship between fish intake and coronary heart disease. (Whelton, 2004) The participants in these studies were categorized as those who ate fish and those who ate little or no fish. Fish eaters had about 15 percent less risk of both heart disease and heart disease death and this is believed to be due to the healthy fish oils. These oils also help prevent blood from clotting, which reduces the chance of having a blocked artery, and they improve blood cholesterol. Several studies that encouraged individuals to eat more of this healthy fat have been published. They all generally agree that sudden cardiac death can be prevented, but that it is unclear if heart attacks, cancers, or strokes are affected. (Marckmann, 1999; Takahata, 1998) The added protection available from eating fish is why fish is so prominently shown in the Healthy Eating Pyramid shown in Chapter 5.

Bad Fats

Figure 6.2 shows the relationship between heart disease risk and the four types of fat. If you were to rank the fats from best to worst your list would look like this: polys, monos, saturated, and trans, implying that each is only slightly worse than the next. In reality, the scientific evidence available today suggests that trans fats are far worse than the other three, at least as far as heart disease risk is concerned. Most of the science that has been completed has focused on saturated fat which has been identified as one of the two unhealthy fats that are part of our diets. Saturated fat has received this reputation because study after study has suggested that individuals who have diets high in saturated fat are also at greater risk for heart disease, stroke, diabetes, breast cancer and maybe colon and prostate cancers. (Lefevre, 2004; Srinath, 2004; Spence, 2003; Steyn, 2004; van Dam, 2003; Richter, 2003; Nkondjock, 2003; Lichtenstein, 1998) Saturated fat has also been implicated as one of the causes of Alzheimer’s disease (Cooper, 2003) and appears possibly to be associated with schizophrenia. (Peet, 2003)

The biggest sources of saturated fats are animals and animal products. Whole milk, meat, cheese, butter, and other high fat dairy products (such as ice cream) are leading sources of saturated fat. From the plant world, palm kernel oil, coconut oil, and coconut milk are also high in saturated fats. Saturated fat is also found in other plant oils and plants, but in smaller quantities.

To really see how much saturated fat is in your diet you have to look at the labels on the foods you eat. We won’t spend time learning how to read the labels here, but I highly recommend you go to the FDA‘s website and use their well designed guides to learn how to evaluate food labels. You can find it on the web at www.cfsan.fda.gov/label.html. Food labels tell you how many grams of saturated fat there are in each serving of the food you are eating. The best guidelines to date suggest that you should not let saturated fats be more that 10% of all the calories you eat per day.

In general, women should eat no more than 20 grams per day and men should eat less than 25 grams. Look closely at labels and you quickly see how much saturated fat the food contains. If you have a food you are not sure about, you can most likely find the label on the web at www.nutritiondata.com. There, you can even look up fast foods.

It’s time for a little quiz. Here is a label from a popular snack. Evaluate the label for saturated fat and decide if you want to eat it.

Can you guess what it is? It’s a Hostess® fruit pie. One pie contains 11 grams of saturated fat. No you won’t die if you eat it. If the rest of your diet during the day also includes foods with saturated fats, most likely you will be consuming too much. It’s great to indulge in an occasional treat, but keep an eye on the labels, they tell you what you are really eating. Your health is determined by the overall quality of your diet, not any one item you may eat.

Trans Fats

Research findings in the past few years have identified trans fats as a serious threat to good health, in fact trans fats are quickly becoming public enemy number one. Of all the calories Americans eat, just about 3% come from trans fats. Trans fats are manufactured, so they appear most often in processed foods. Of all the trans fats in our diets, half come from cakes, cookies, crackers, pies, and bread. The rest come from animal products, margarine, fried potatoes, potato chips, corn chips, popcorn, shortening, salad dressing, breakfast cereal, and candy.

Food producers use trans fats instead of healthier unsaturated fats because foods prepared with trans fats stay fresh longer and have a texture most people like. For example, margarine which is mostly made from trans fats is softer than real butter and easier to work with. Pie crusts, crackers, and croissants are flakier when made with trans fats and it is cheaper to fry foods in trans fats because they last much longer than unsaturated frying oils.

If you compare a gram of saturated fats and a gram of trans fats, trans fats impose a risk of heart disease that is ten times greater than the risk associated with saturated fats. As bad as saturated fats are, they impose only a fraction of the health risk believed to be caused by trans fats. Four very large cohort studies revealed approximately the same results. (Ascherio, 1996; Pietinen, 1997; Hu, 1997; Oomen, 2001) The consumption of trans fats was positively associated with a 25% increase in heart disease risk.

From 1977 to 1995 the number of heart disease deaths in Denmark was cut by half, and during the exact same time the entire population of Denmark cut its consumption of trans fats by 75 percent. (Thom, 1994) These two trends may be related. Nine different studies compared the effect of saturated fat and trans fats on both good and bad cholesterol. (Stender, 2004) Both decreased the good and increased the bad, but the effect of the trans fats was 2.5 times worse than the effect of the saturated fats, suggesting that saturate fats are bad, but trans fats are much worse.

Other studies of trans fats have found no evidence that trans fats can cause cancer, but they may be one of the many causes of diabetes. (Stender, 2004; Salmeron, 2001) Armed with this information the Institute of Medicine has recommended that the intake of trans fats be as low as possible. The minimum amount of trans fats a person can consume and not increase risk is zero.

Where Are the Trans Fats?

If the safe recommended amount of trans fats is zero, the trans fats we currently eat should be identified and eliminated from our diets. How can you know if the food you eat has trans fats? This is where the battle for good health gets complex. Before the health risks of trans fats were known, the food industry had no reason not to use them. So after decades of food development and design, many of the processed and prepackaged foods we consume are prepared with trans fats. The fast food and bakery industries are dependent upon reliable, inexpensive frying oil to help them prepare foods. Table 6.1 shows the saturated and trans fats content of common foods. Total fat grams is the sum of all four types of fats in a food.

Product	Common Serving Size	Total Fat g	Sat. Fat g	Trans Fat g
French Fries	Medium	27	7	8
Butter	1 tbsp	11	7	0
Margarine, stick	1 tbsp	11	2	3
Margarine, tub	1 tbsp	7	1	0.5
Mayonnaise (Soybean Oil)	1 tbsp	11	1.5	0
Shortening	1 tbsp	13	3.5	4
Potato Chips	Small bag	11	2	3
Milk, whole	1 cup	7	4.5	0
Milk, skim	1 cup	0	0	0
Doughnut	1	18	4.5	5
Candy Bar	1	10	4	3

Table 6.1 Fat content of common foods (source: adapted from FDA, 2003)

Unless the foods you eat are listed in this table, you may have no idea if they contain trans fats. Even if you look at the nutrition label, you still won’t be able to determine if trans fats are included. That’s because food manufactures are currently not required to list trans fats on their food labels. As early as 1994 the FDA received formal requests that trans fats be listed. Public comment, additional research, and discussion delayed any label changes. Action on the new label requirement wasn’t finalized until 2003 when the FDA gave food manufacturers until January 2006 to have their labels updated. The FDA estimates that three years after the effective date, the new labels will prevent from 600 to 1,200 heart attacks and save 250–500 lives in the first year. This improvement in health will translate into a cost savings of $900 million to $1.8 billion per year in medical costs, lost productivity, and pain and suffering. So for now you only have two options. You can buy foods from food manufacturers that really care about your health and have already changed their labels or you can read the ingredients and see if the food was made with trans fats. One such label looks like this:

Total Fat 6g

Saturated Fat  0.5g

Trans Fat  0g

As of the writing of this book Frito Lay has already included trans fat content on most of its brands, including LAY’S®, DORITOS®, CHEETOS®, FRITOS®, TOSTITOS®, RUFFLES®, ROLD GOLD®, and SUNCHIPS®. In fact, the fat label above is from a package of Tostitos Corn Chips. Way to go Frito Lay! They have aggressively accepted this new requirement and have reduced or eliminated trans fats from most of its foods. This demonstrates to the public and the best nutrition experts in the world that they are serious about providing healthy foods.

Other food manufacturers, however, may be more concerned with profits than customer health. After all, Altria (formerly Phillip Morris) still advertises cigarettes. Like they really care about your health! Altria also owns Nabisco which is part of Kraft foods. Kraft Foods offers a line of food products that are full of saturated and trans fats, many of which are leaders on the saturated and trans fat list of heavy hitters. In 2003, Kraft was threatened with a law sued for its aggressive promotion of Oreo cookies in the schools in California. Just a few days after the suit was announced Kraft declared that it would reformulate the cookies and make a version without trans fats. Traditional Oreo cookies have 3.5 grams of trans fats per serving. Law suits can sometimes bring about needed change. Kraft has also listed trans fats on its Triscuit crackers, and has produced a version that is free of trans fats. Progress is being made, but a company like Kraft has a lot of work to do before it’s food products can really promote and not threaten health. Much of the food industry fought against the new labels. But, it appears public health is going to eventually overcome food industry protectionism. For a rather chilling view of the aggressive tactics of the food industry I suggest Marion Nestle’s book— Food Politics.

I predict that within the next few years someone will sue some school district because the schools only provide unhealthy fast foods and candies in their vending machines. The vendors sell mostly foods that are high in trans fats, saturated fats and soft drinks, the schools maintain very lucrative contracts with the vendors, and the children at the schools are given very few healthy options from vending machines. Because many schools are unwilling to remove the unhealthy foods for fear of losing the vending profits, they may be guilty of a failure to provide a safe school environment. Several leading pediatric medical journals have warned pediatricians about this very issue, but I’m not sure schools are able look past the money to hear the message. (Ballew, 2000; French, 2003) I hope they start to make changes voluntary changes, without painful and expensive litigation.

Perhaps the food producers that are going to get away without a scratch are in the fast food industry. Since the food is purchased hot, it is not required to have a nutrition label and customers will never really know about the foods’ trans fat content. Think of all the fried foods in American fare. French fries, onion rings, corn dogs, popcorn, seafood, chips, and oooh those bakery goods. Maple bars, doughnuts, croissants, éclairs—all of them are deep fried in trans fats. The only way you would know would be if you were to see a list of the ingredients.

Here is the food label and ingredients list for an American icon—the glazed doughnut. The label shows that one doughnut has 13 grams of fat, of which 3 are saturated. So far it doesn’t look really bad except that the other fat grams are not accounted for. Surely there must be some healthy fats in there, but you can’t tell from the label.

The clue to this mystery is in the ingredients list. Bolded you will see “partially hydrogenated soybean and/or cottonseed oil.” It might say vegetable shortening, or partially hydrogenated vegetable oil, but this is your sign that trans fats are used to make the food. The closer it is listed to the beginning of the ingredients list, the more of it there is in the food. The ingredients for this doughnut include bleached flour, dextrose (used to get the yeast to work well), and trans fats. From Table 6.1 you can see that a simple glazed doughnut has 5 grams of trans fats.

Take a look at the label of your favorite peanut butter. All the popular brands list trans fats in the ingredients, but the trans fat content of the peanut butter is so low that even when the new labeling requirements are enforced, you won’t see any trans fats listed on the label. (Sanders, 2001) The amount of trans fats in peanut butter is below the amount needed to be listed. So go ahead, smear some peanut butter on that sandwich.

McDonald’s restaurants announced in 2002 that they were going to introduce a new cooking oil into all of its restaurants. The oil is supposed to have half the amount of trans fats as their previous frying oil. Two years later, the change hasn’t happened. Hopefully it will.

Ingredients: Enriched bleached wheat flour contains bleached wheat flour, niacin, reduced iron, thiamine mononitrate, riboflavin, folic acid), dextrose, vegetable shortening (partially hydrogenated soybean and/or cottonseed oil), water, sugar, soy flour, egg yolks, vital wheat gluten, yeast, nonfat milk, yeast nutrients (calcium sulfate, ammonium sulfate), dough conditioners (calcium dioxide, monocalcium and dicalcium phosphate, diammonium phosphate, sodium stearoyl-2-lactylate, whey, starch, ascorbic acid, sodium bicarbonate, calcium carbonate), salt, mono- and diglycerides, ethoxylated mono-and diglycerides, lecithin, calcium propionate (to retain freshness), cellulose gum, natural and artificial flavors, fungal alpha amylase, amylase, maltogenic amylase, pentosanase, protease, sodium caseinate, corn maltodextrin, corn syrup solids and BHT (to help protect flavor).

Trading Calories

You can add more poly- and monounsaturated fats to your diet by eating more foods that contain these fats, but that would increase the number of calories you eat and possibly cause you to gain weight. Instead of adding these fats to your diet, a better way would be to substitute good fats for bad fats. The average man eats about 2,700 calories a day and the average woman eats about 1,800 calories. Most of these calories (52%) come from carbohydrates, 14% comes from protein. The rest (34%) comes from the four different fat sources. The pie chart in Figure 6.3 shows the sources of the calories we eat.

Total fats = 34%

Figure 6.3 Sources of the Calories We Eat (Continuing Survey, 1995; Allison, 1999)

When substituting bad fats for good fats, trans and saturated fats would be reduced and unsaturated poly and mono fats would be increased. You get a double benefit. You reduce the fats that increase your risk of chronic disease, and you increase the fats that can help protect you against chronic disease. Suppose you decided to reduce the amount of saturated fat in your diet by 5% of total calories and increase the unsaturated part by the same amount. You could do this if you avoided high fat dairy products and fatty meats and ate more plant oils. If you really made this change, data from the Nurses’ Health Study show that the health benefits of this substitution would reduce your chances of heart attack and death by 40%. (Willett, 2001) If you substituted just 2% of total calories from trans fats with the same amount of good fats, you could reduce the risk by 50%. In other words, replacing most dietary trans fats with healthy fats could potentially prevent 347,877 heart disease deaths per year. (Willett, 2001; Kochanek, 2004)

Putting It All Together

I do not wish to be the bearer of bad food news. On the contrary, the purpose of this book is to share with the public what researchers already know. The research that is reported in scientific journals rarely trickles down to the public unless someone puts it into understandable English and finds a way to make it applicable to real people living real lives. In that regard, I’m just a messenger. I hope you will remember these highlights:

• The all-fats-are-bad approach to eating may be like throwing out the baby with the bath water
• There are both good and bad fats, the best are polyunsaturated and monounsaturated fats and the worst are saturated and trans fats
• Americans are eating less fat, but getting more calories
• Trans fats are the worst of the four fats and the best way to remove them from your diet is to substitute trans fats with good fats
• New food labels will soon make this a little easier
• Eat fish, poultry, or eggs 0-2 times per day

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CALL OUT BOX

Nuts: No Longer Dietary Bad Boys

One of the unfortunate side effects of the all-fats-are-bad message has been the demise of nuts in the American diet. As you’ve read, nuts are a high-fat food containing mostly good fats, some saturated fats, and no trans fats. In the last ten years considerable research has shown that nuts might have been unfairly singled out, and they should be reintroduced into the American diet. Nuts and peanut butter have now been identified as having the ability to lower the risk of heart disease and diabetes. (de Lorgeril, 2003; Alper, 2003) Women who ate peanut butter five times a week or more had a 21% reduction in the risk of getting diabetes. (Jiang, 2002) A diet that included walnuts caused the arteries of the participants to be more responsive to changes in blood pressure (Ros, 2004), and a diet high in macadamia nuts improved blood cholesterol. (Garg, 2003)

When trying to help patients lower blood cholesterol, doctors are generally quick to prescribe a blood cholesterol lowering medication. In a head-to-head study of a healthy diet that included nuts, compared to patients who were only on medication, there was no difference between the two groups. Both the patients on the healthy diet and the patients on the medication saw their blood cholesterol drop about 30%. (Jenkins, 2003) The group on the healthy diet also got the added benefits of whole grains, fruits, vegetables, and healthy fats.

 There are two concerns often expressed with eating nuts. One is that they may cause allergies in some people and the other is that they are calorie dense and might cause people to gain weight. Peanuts and nuts that grow on trees can cause allergic reactions in some people. It is estimated that possibly 1% of adults may have an allergic response. (Sicherer, 2003) If you are in this group you may need to monitor you consumption of nuts. Weight gain from eating a diet with nuts is so far unfounded. (Garcia-Lorda, 2003; Sabate, 2003) 
 In studies where participants were forced to eat diets high in nuts, none of the participants gained weight. Studies that gave people the option of eating a diet with nuts found that participants actually lost a little weight. Even though it appears no one is gaining weight from eating nuts, it still might be safe to substitute nuts for sugars or refined flour already in excess in the diet. Either way you should start including nuts in your diet; they taste good and they are good for you. 

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