Two pieces of research in Europe on trans fat underline the complexity of dietary science and, therefore, the formulation of product development strategies and public health messages. Ben Cooper reports.
Dietary science is complicated. Consumers may wring their hands in despair when nutritional advice appears to contradict itself and changes over time but to a degree this goes with the territory. Scientific research provides answers, yields enlightenment and leads to change.
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There is nuance. Simplistic rationalisations and solutions appear to have caused problems. And yet, preventive health measures are more effective if messaging is simple. The dilemma for public health agencies is clear to see and the tendency to seek simple abiding rules that will result in the most good is quite understandable.
Food companies carry a particular burden. The reformulation of products is based on dietary science. When it was considered that reduction in saturated fat was the primary goal, food companies reduced fat in products but at the cost of increasing carbohydrate levels.
Current thinking on carbohydrates suggests many low-fat variants have done more harm than good but it could be argued food companies were acting on the best information and responding to the received wisdom of the time.
No area exemplifies the problems of conflicting and evolving dietary advice than how the pros and cons of carbohydrate and fat in the diet have been understood and communicated in recent years – and the last fortnight has provided some more conflicting information for consumers on the subject.
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By GlobalDataWhile fat has been overtaken by sugar as the primary nutrient of concern, with even certain saturated fats finding redemption and the term "good cholesterol" entering the food lexicon, concern over trans fats in food has remained consistently high.
A study conducted by academics from Lancaster, Liverpool and Oxford universities in the UK, published recently in the British Medical Journal, suggested a total ban on trans fatty acids in processed foods could prevent or postpone about 7,200 deaths from coronary heart disease (CHD) over the next five years, as well as reduce inequality in mortality from CHD by about 15%. The research also suggested a ban would save the UK National Health Service around GBP265m a year.
The study's authors concluded "a regulatory policy to eliminate trans fatty acids from processed foods in England would be the most effective and equitable policy option" and that "simply continuing to rely on industry to voluntary reformulate products could have negative health and economic outcomes".
The research suggested a ban on trans fats in Denmark, first initiated in 2004, had made "an important contribution to declines in coronary heart disease" and pointed to bans in other countries such as Austria, Switzerland, Iceland, Hungary and most recently in Norway. Meanwhile, in June the Food and Drug Administration in the US told food manufacturers they would have to remove partially hydrogenated oils, the primary source of dietary trans fats in processed foods, from products within three years.
However, Dr Alison Tedstone, chief nutritionist at Public Health England, told UK newspaper The Guardian that, while trans fats are harmful, UK consumption is "already well within recommended levels and is falling". Dr Tedstone, along with other academics, pointed out the majority of trans fats in UK diets nowadays come from natural sources such as meat and milk.
There is a sense here public health campaigners and policymakers have, as it were, bigger fish to fry, and again one thinks of the current focus on carbohydrate and particularly on sugar.
The Food and Drink Federation (FDF) also defended its members' record on voluntary reduction of trans fats in processed foods. It said "evidence linking artificial trans fatty acids (TFAs) to heart disease is clear, which is why many years ago the UK food industry took decisive action to remove artificial TFAs from the food chain, proving the success of voluntary action".
The FDF said the latest National Diet and Nutrition Survey showed total consumption of TFAs in the UK had fallen from 2.1% of total energy intake in 1985 to an estimated 0.6-0.7% in 2012. "This is well below the maximum UK and WHO recommendations and would be close to what would be expected from intakes of naturally occurring TFAs. The UK government has concluded that TFAs at current intake levels do not pose a health risk to UK consumers," an FDF spokesperson said.
What was even more surprising was the subsequent publication in the European Heart Journal of research from German academics, which suggests naturally occurring trans fats may even carry specific health benefits. Researchers at Heidelberg University looked at levels of trans fats found in the red blood cells of 3,300 heart patients in Germany. Able to differentiate between artificial and natural trans fats, they found that those patients with higher levels of naturally occurring trans fats were 37% less likely to suffer a sudden heart-related death than those with low levels.
There are plenty of caveats. The study was not designed to prove a direct causal link but the authors stressed that increased levels of artificial trans fats did not seem to increase a patient's risk of dying.
The generally low levels of trans fats in the German patients also adds some cause for caution which was acknowledged by the researchers. Trans fats in the blood of the German heart patients was just below 1%, against a national average in the US of 2.6%.
The German research has not received the level of public attention that the BMJ study attracted but those consumers hearing about it might well be confused.
Twenty years ago the idea there was good and bad cholesterol would have been viewed very sceptically. Today it is an accepted truth, and an increasingly important element in dietary advice. The idea that we might one day be talking about "good trans fats" cannot be viewed as all that fanciful given how dietary science evolves as more research is undertaken.
The German research will certainly be welcomed – and one expects loudly discussed – by the meat and dairy sectors, not least in the US where the debate over the next iteration of the Dietary Guidelines for Americans continues to rage.
The report of the 2015 Dietary Guidelines Advisory Committee (DGAC), published in February, has probably been the most controversial since the guidelines were first introduced in 1980, with its position on nutrient taxes proving particularly controversial.
Advocates for the meat industry believe the report's authors have continued to emphasise risks associated with the consumption of meat and saturated fat in spite of what they perceive as increasing evidence that some of those risks have been overstated. The North American Meat Institute (NAMI) publicly criticised the lack of emphasis placed on the suggestion lean meat could be part of a healthy diet. They might well point to the recent German research on naturally occurring trans fats as supporting that contention.
The Dietary Guidelines for Americans are intended to provide simple, clear guidance for the public. Is it possible the more we come to know about diet and health the less possible it is to arrive at clear, simple and definitive advice?
Aphorisms of bygone ages such as "moderation in all things" and "a little bit of what you fancy does you good" may not be as outmoded as they first appear.
