The following letter first appeared on July 21, 2009 in Annals of Internal Medicine:
To the Editor:
The authors of the Perspective piece "Cholesterol Control Beyond the Clinic: New York City's Trans Fat Restriction" (Annals' July 21 issue) want to be congratulated for finding that their own regulatory approach has succeeded -- according to them. The NYC Dept. of Health passed a regulation restricting the use of trans-fats (TFAs) in chain restaurants, and the authors have discovered that -- lo and behold! -- this law is being obeyed.
But what have they accomplished in terms of public health? That is a difficult question to answer.
The amount of TFAs in one's diet is repeatedly referred to as a "recognized risk factor" for heart disease. However, this assessment is based entirely on observational dietary studies -- and diet is not listed among the main coronary risk factors. Further, based upon my twenty-plus years practicing internal medicine, I can attest to how devilishly hard it is to significantly reduce lipid levels through diet, despite all the stringent diet programs we so assiduously distributed to our at-risk patients. Now, at last, the authors assert that they have found the culprit: TFAs! By eliminating these heart attack generators, so goes their story, we can relax and throw away those statins.
Not so fast. Is there a shred of evidence that manipulating TFA intake in this manner will actually lower lipid levels -- much less reduce the toll of cardiovascular disease? No. So why are the authors trumpeting how their new regulations have led to restaurant food with "healthier fatty acid profiles?
Health issues aside, where will such measures lead us? In the editorial, Dr. Geberding says, "Unfortunately, relying on consumers alone to make healthy choices about food intake is a strategy that has not worked, as our growing obesity epidemic demonstrates." Since when is "allowing" Americans to choose their own food a public health strategy? And what does TFA intake have to do with the obesity epidemic? Not a thing, as I'm sure Dr. Geberding well knows.
If the authors are allowed to merely declare that their government regulatory program on TFAs is a "success", there are in all likelihood more such strategies for "guiding" consumer health choices coming down the pike, to your local pharmacies, restaurants--and your kitchens. The authors apparently believe that we cannot be trusted to figure out our own diet choices regarding our health, while they nominate the NYC Dept. of Health to be our food arbiter of first resort. This would be a bad idea, for health and for personal responsibility.
Conflict of Interest:
The American Council on Science and Health, a non-profit consumer education organization, accepts no-strings-attached donations from corporations, individuals, and foundations. Food-related companies have contributed well under 2% of our budget.