Trans Fat, Heart Disease and Food Service : Transforming the Food Environment CASA Beth S. Torin , RD, MA, Associate E

1. Trans Fat, Heart Disease and Food Service : Transforming the Food Environment CASA Beth S. Torin , RD, MA, Associate Executive Director Bureau of Food Safety and Community Sanitation New York City Department of Health and Mental Hygiene

2. LEADING CAUSE OF DEATH IN US 2003

3. TAKE CARE NEW YORK:10 steps to live longer, healthier lives. • Have a Regular Doctor or Other Health Care Provider • Be Tobacco Free • Keep Your Heart Healthy • Know Your HIV Status • Get Help for Depression • Live Free of Dependence on Alcohol and Drugs • Get Checked for Cancer • Get the Immunizations You Need • Make Your Home Safe and Healthy • Have a Healthy Baby

4. Trans Fat in the Diet Average daily intake 2.6% of total calories (approx 5.8 grams) 79% Artificial Source: Partially Hydrogenated Vegetable Oil 21% Naturally Occurring Source: Meat and Dairy Products Source: FDA Consumer magazine. September-October 2003 Issue. Pub No. FDA04-1329C

5. Trans Fat : A brief History • About 100 years ago the discovery was made that liquid oils could be converted to solid fats (which were more useful in food manufacture) by a procedure called hydrogenation. As hydrogen was added to liquid unsaturated oil it gradually became a solid saturated fat (also called a hydrogenated fat).

6. Early 1900 • Scientist Wilhelm Normann finds that liquid oils can be hydrogenated to form trans fatty acids.  He patents the process.  Trans fat is the first man-made fat to join our food supply.

7. Trans Fat : 1911 • Many American kitchens were first introduced to partially hydrogenated vegetable oil in 1911 with the product Crisco®.

8. 1940’s • After the Second World War the process for making hydrogenated and hardened fats from cheaper sources of vegetable oils was widely adopted. Margarines were developed and marketed as alternatives to butter, and vegetable shortenings increasingly replaced the animal fats in cooking.

9. 1957 • The American Heart Association first proposes that reducing dietary fats, namely saturated fats found in foods like butter and beef, can reduce the chance of getting heart disease.

10. 1960s and 1970s • In the 1960s and '70s, it became common for health-conscious consumers to replace butter with margarine, which at that time was composed of about 25% trans fats.

11. 1984 • Consumer advocacy groups campaign against using saturated fat for frying in fast-food restaurants. • In response, most fast-food companies begin using partially hydrogenated oils containing trans fat instead of beef tallow and tropical oils high in saturated fats.

12. 1990’s • Studies conducted during the 1990s, revealing correlations between trans fatty acids and increased LDL (bad) cholesterol levels and a higher incidence of heart disease. 

13. 1990’s •   Perhaps saturated fats weren’t alone in harming heart health after all.

14. 1990’s • Around this time nutrition labels became a hotly debated topic.  Scientists and food manufacturers argued over whether to require a separate listing of trans fat content on food packages.

15. 1993 • Following the release of several scientific studies, health advocacy groups call for fast-food restaurants to stop using partially hydrogenated oils in their deep fryers.

16. 1999 The U.S. government proposes a law requiring food manufacturers to list trans fat amounts on nutrition labels.  The proposal is not passed as law.

17. 2003 Denmark is the first and only country to regulate trans fat on a national basis, putting a very small cap on the amount that food may contain.

18. 2003 Later in 2003, the U.S. Food and Drug Administration (U.S. FDA) passes a law requiring that trans fat be listed on the Nutrition Facts label on food products; food manufacturers have three years to comply.  Many have reformulated their products to limit trans fat.

19. 2006 Trans fat labeling becomes mandatory in the United States.  The American Heart Association becomes the first major health organization to specify a daily limit:  less than 1 percent of calories from trans fat. 

20. 2006 Later in the year, New York becomes the first U.S. city to pass a regulation limiting trans fat in restaurants.  Multiple cities and states have since proposed similar regulations.

21. 2007 • Almost 100 years after is was first introduced to the market, Crisco has been reformulated and is trans fat free

22. Partially Hydrogenated Vegetable Oil (“PHVO”) = What Is Artificial Trans Fat? VegetableOil Hydrogen + Partially hydrogenated oils contain trans fat VS. Cis Trans

23. Trans Fat Is More Dangerousthan Saturated Fat Good (HDL) Bad (LDL) Cholesterol Cholesterol Trans fat Saturated fat

24. Trans Fat Intake IncreasesCoronary Heart Disease Risk There is “a positive linear trend between trans fatty acid intake and total and LDL-C concentration, and therefore increased risk of coronary heart disease…” – Institute of Medicine

25. Major Food Sources of Artificial Trans Fat for U.S. Adults Data Source: http://www.fda.gov/fdac/features/2003/503_fats.html

26. Amount of Trans Fat in Selected Foods

27. January2006 Finding Trans fat Ingredients: Liquid Corn Oil, Partially Hydrogenated Soybean Oil, Salt, Vegetable Mono And Diglycerides And Soy Lecithin (Emulsifiers), Sodium Benzoate (To Preserve Freshness), Vitamin A Palmitate, Colored With Beta Carotene (Source Of Vitamin A), Artificial Flavor, Vitamin D3

29. People Are Eating Out More

30. RestaurantSources INGREDIENTS: • Commercial Fry Oils • Vegetable shortening and margarine BAKED GOODS: • cakes, crackers, pastries, cookies, pies and hamburger buns PRE-FRIED and PRE-MIXED FOODS: • French fries, chicken nuggets, fish fillets, tortilla chips, donuts, pancake or cake mix

31. Changing the Food Environment:A Market-Based Trans Fat Strategy Trans Fat Education Campaign Consumers Suppliers Restaurants

32. New York City’s Trans Fat Education Campaign Strongly Recommended Consumers:Keep intake ‘as low as possible’, and ask about oils and trans fats used to prepare their food in restaurants Food Suppliers:Carry and promote trans fat free products and phase out trans fat containing products Restaurants: Eliminate artificial trans fat from the foods they serve

33. Trans Fat Use Did Not Decline Despite Voluntary Campaign Health Bulletin to 200,000 people 9,000 FSEs received additional info Info & tools to food suppliers and to >20,000 NYC restaurants % Restaurants Using Trans Fat in Oils and Spread Where Use Could Be Determined 7,800 restaurant operators trained

34. Assuring Safe Food • Dangerous: Like lead in paint, it’s dangerous, unnecessary and won’t be missed • Unavoidable in Restaurants: No way to know the trans fat content of food • Replaceable: Artificial trans fat can be replaced • Policy is Feasible: Phasing out is a feasible environmental policy to reduce heart disease in New York City • Health Code Amendment: within DOH authority

35. Sept 26, 2006 NYC Board of Health:Proposal to Partially Phase-Out Artificial Trans Fat • 6 months to switch to cooking oils, shortening, and margarines with less than 0.5 gram of trans fat per serving • 18 months for all other foods • Food served in manufacturers’ original packaging will be exempt • Applies to all NYC food service establishments and mobile vending commissaries

36. Sept. 26, 2006: Proposal Published in City Record

37. October 30, 2006:Public Hearing

38. December 5th 2006: Amendment to Health Code to Partially Restrict Trans Fat

39. Regulation July 1, 2007:oils, shortening, and margarine used for frying or as a spread must have with less than 0.5 grams of trans fat per serving. • Oils and shortening used to fry yeast dough and cake batter must comply with the second deadline.

40. Grace Periods • No fines were assessed for trans fat violations issued between July 1 and September 30 , 2007.

41. The Violations

42. Violations year to date

43. INITIAL INSPECTIONS COMPLIANCE WITH REGULATION

44. Year to Date Compliance Inspections

45. Success ! • In April we completed 1345restaurant inspections and 28 FSE’s trans fat violations • 99.9 % compliance with regulation

46. PHASE 2 July 1, 2008:all foods must have less than 0.5 grams of trans fat per serving. • Food served in manufacturers’ original, sealed packaging will be exempt

47. Grace Period • No fines will be assessed for trans fat violation issued between July 1 and October 1, 2008 with regard to all foods covered by second deadline, not first deadline.

48. PHASE 2 – challenges • Bakery’s are having trouble reformulating products for compliance • Price of flour has increased concern about increased price of oils and impact on pricing

49. "Trans fat-free baking shortenings are not available." Not true • At the present time, many bakers use trans fat-free palm oil as shortening. Palm oil contains no trans fat and works very well, but is not a healthy alternative as it is high in saturated fat. While it would be perfectly legal to use trans fat-free palm oil under New York’s and Philadelphia 's regulations, a lower saturated fat alternative should be used if possible for health reasons. There are many trans fat-free lower saturated fat alternatives on the market such as palm and canola blends and Crisco

50. “Trans fat-free oils make food taste bad." Not true. • A real oil tastes at least as good as an artificial oil and usually better. Let anyone who says that trans fat-free oils taste worse than artificial partially hydrogenated oils show us the results of even one consumer sensory panel. • You don't use partially hydrogenated oil for your home cooking. Think about it. Do you need to use partially hydrogenated oil for your home cooked food to taste good?