Volume 3 Number 11 p. 10
© 2006 American Diabetes Association
Explaining different types of food fats and how to replace the bad with the good, the saturated and trans with the unsaturated, can be confusing. Healthy eating requires some fats, but the permeation of unhealthy fats in so many readily available foods makes overconsumption easy.
reposted from: http://docnews.diabetesjournals.org/cgi/content/full/3/11/10
my highlights / emphasis / edits
Yet it is imperative that clinicians emphasize the important role food and nutrition play in their patients' health, says American Dietetic Association (ADietA) spokesperson Bethany Thayer, MS, RD.
"All patients should receive dietary advice on healthy eating habits from their physicians, and all patients at risk for obesity, cardiovascular disease, or diabetes (the great majority of adults in the U.S.) should see a registered dietitian at least once," concurs Dariush Mozaffarian, MD, MPH, of Harvard School of Public Health in Boston.
To help limit unhealthy fats in patients' diets, Thayer and Mozaffarian stress two main messages: The body does not need saturated or trans fats—both are unhealthy—and patients should avoid all foods containing partially hydrogenated vegetable oils, in which trans fats are found.
The 2005 Dietary Guidelines from the U.S. Department of Agriculture (USDA) suggest a total fat intake of 20–35% of daily calories, with the majority coming from unsaturated fats, <10%> saturated fats, and minimal amounts from trans fatty acids.1 Dietary guidelines for disease prevention from the American Diabetes Association and the American Heart Association suggest a total fat intake that does not exceed 35% of total daily calories consisting primarily of unsaturated fats, <7%> and minimal or <1%>trans fats.2,3
UNSATURATED: THE HEALTHIER FATS
The healthier food fats are unsaturated, found in foods such as monounsaturated and polyunsaturated vegetable oils, oily coldwater fish, nuts and seeds, and avocados.
Studies suggest that substituting unsaturated for saturated and trans fats and increasing consumption of omega-3 fatty acids from fish and plant sources are effective nutrition strategies for prevention of cardiovascular disease.4 Research also shows that replacing some carbohydrates with unsaturated fat lowers blood pressure and triglyceride levels and increases HDL cholesterol levels.5 Additionally, polyphenols in olive oil, especially higher phenolic content virgin olive oil, may reduce cardiovascular risk factors.6
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Unsaturated fats contain omega-3 fatty acids, which inhibit blood clotting and inflammation and relax arteries, as well as omega-6 fatty acids, which promote blood clotting and inflammation and constrict arteries, Thayer explains. Since these fatty acids tend to counteract each other, it is best to balance their intake, keeping in mind that corn oils used in processed foods, restaurant foods, and home cooking are higher in omega-6, while canola and olive oils and oily coldwater fish contain higher levels of omega-3.
SATURATED AND TRANS: THE UNHEALTHY FATS
Saturated fats come primarily from animal products—the meats and cheeses most people eat, notes ADietA spokesperson Cynthia Sass, MPH, MA, RD, LD/N. Saturated fats also are found in tropical oils (such as palm, palm kernal, and coconut oils), cocoa butter, and coconut.
"Trans and saturated fats hold products together and increase shelf-life and are therefore common in processed foods," Sass says.
Trans fats or trans fatty acids form during the partial hydrogenation of vegetable oils, which increases shelf-life and stability during deep-frying and creates solid fats for commercial cooking and food manufacturing.7 While they occur naturally in meat from cows, sheep, and other ruminants, dietary trans fats are found primarily in margarines, vegetable shortening, prepared and packaged baked goods, chips and crackers, commercially prepared fried foods, and fast food and restaurant foods.
"Gram for gram and calorie for calorie, trans fatty acids are the most harmful nutrient in the food supply for risk of coronary heart disease," Mozaffarian says, adding that analysis of research shows "adverse effects from trans fat intake at 1–3% of total energy, or 2–7 grams in a 2,000-calorie-per-day diet."
Avoidance is the best tactic, but since this is difficult for many Americans, the next best step is to read labels, ask questions, and monitor fat intake to minimize saturated and trans fats.
MONITORING FAT INTAKE
Food label nutrition boxes list fat content in grams and percentages. Both Thayer and Sass suggest ignoring the percentages: They are confusing and often misunderstood. Rather, the grams of fat per serving should be tallied to determine daily intake.
With so many Americans at risk for diabetes, obesity, and cardiovascular disease, a dietary fat intake goal for disease prevention seems reasonable. To maintain a total fat intake of <30%> intake of <7%,> eaten daily <33> be consumed. That would mean 1,500 kcal would consist of <50 g total fat and >2,000 kcal, <65> fat and <15>; and 2,500 kcal, <83> fat and <19>
Other tips for helping patients limit unhealthy dietary fats:
- Read labels to determine saturated and trans fat contents.
- Choose foods containing <1>
- Choose foods listing 0 g trans fats per serving. Caution: Foods labeled as such legally may contain <500> eating multiple servings of a single food or a combination of foods labeled as having zero trans fat, but which actually may contain 200–400 mg trans fats per serving (i.e., 4–5 crackers, 1–2 cookies, 1 tablespoon margarine), consumption may quickly reach 1–2% of trans fats per total calories.
- Choose foods labeled low fat, which must contain
3 g fat per serving. - Choose deli meats and cheeses with the lowest possible fat content according to nutrient content brochures located at deli counters.
- Watch serving sizes. One serving of cheese is about one slice or 1/4 cup and may contain 3–6 g fat per serving.
- Avoid foods tasting smooth or creamy and those feeling greasy or leaving a greasy stain on a napkin. They are probably high in unhealthy fats.
- Use cooking oils, such as canola, with little saturated and no trans fat.
Most important, read ingredient lists and ask questions. "For now, consumers can only definitively determine that a product contains zero trans fats if there are no partially hydrogenated vegetable oils in the ingredient list," Mozaffarian says. And unless restaurants, fast-food outlets, and supermarkets voluntarily state their use of partially hydrogenated oils, consumers must inquire whether these oils containing trans fat are used. 
NYC Bans Trans Fat
BY NICK KOLAKOWSKI
For some time, health professionals have drawn attention to the dangers of trans fat, suggesting that Americans—particularly those with diabetes—slash their intake as close to zero as possible. Now, the New York City Board of Health has taken things one giant step farther by voting for a near-total ban of the substance in the city's restaurants. A public hearing on the issue was scheduled for late October, followed by a final vote at the end of the year.
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Trans fat, created by adding hydrogen to vegetable oil in order to improve the shelf life and stability of foods, raises LDL cholesterol levels and individual risk of coronary heart disease. It is found in vegetable shortenings and some types of margarine, as well as a variety of snacks and fried foods. New York City's plan, approved unanimously by the board of health on September 26, would limit its more than 20,000 restaurants to 0.5 g of artifi cial trans fat per serving of any menu item.
"Human life is much more important than shelf life," Lynne D. Richardson, a board of health member and professor of emergency medicine at Mount Sinai School of Medicine in New York, told The New York Times.1 "I would expect to see fewer people showing up in the emergency room with heart attacks if this policy is enacted."
If the measure is approved, restaurants have until July 2007 to switch to oils, margarines and shortening with less trans fat and until July 2008 to eliminate menu items, including cakes or chips, that exceed the limit. The exceptions would be naturally occurring trans fat and packaged food items that remain in the packaging while served.
The typical American currently consumes some 5.8 g trans fat per day, according to the U.S. Food and Drug Administration (FDA). While this raises the risk of heart disease in all individuals, the problem is particularly acute for those with diabetes, whose heart disease death rate is two to four times higher than that of those without the condition. More than 700,000 adults in New York City have been diagnosed with diabetes. Other cities, such as Chicago, are considering similar measures, but recent news reports suggest that restaurants and food companies will fight New York's ban in the courts.
"The commissioner [Health Commissioner Thomas R. Frieden, MD] in New York should be commended for his efforts to remove them [trans fats] from restaurant diets," says John Buse, director of the Diabetes Care Center at the University of North Carolina–Chapel Hill and vice president, medicine and science, of the American Diabetes Association. "They're a clear and present danger for cardiovascular disease, for people who have diabetes as well as those who don't."
Nationwide, the FDA now requires that trans fat be listed on nutrition labels, joining the saturated fat and dietary cholesterol listings that have been there since 1993.
Footnotes
Resources for monitoring daily nutrient intakes:
• ADA's Web site, www.diabetes.org/nutrition-and-recipes/nutrition/overview.jsp
• USDA's www.MyPyramid.gov
• A free diet and exercise journal Web site, www.my-calorie-counter.com
• www.nutrition.gov, for consumer information on food and nutrition
• Diabetes Carbohydrate and Fat Gram Guide, 3rd Edition, a book by Lea Ann Holzmeister, RD, CDE, available at the ADA's online bookstore, http://store.diabetes.org.
References
1. Department of Health and Human Services and the U.S. Department of Agriculture: Dietary Guidelines for Americans 2005. Available online at www.healthierus.gov/dietaryguidelines. Accessed September 25, 2006.
2. American Diabetes Association: Nutrition recommendations and interventions for diabetes–2006 (Position Statement). Diabetes Care 29:2140–2157, 2006.
3. Lichtenstein AH, Appel LJ, Brands M, et al.: Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation 114: 82–96, 2006.
4. Hu FB, Willett WC: Optimal diets for prevention of coronary heart disease. JAMA 288:2569–2578, 2002.
5. Appel LJ, Sacks FM, Carey VJ, et al.: Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: Results of the OmniHeart randomized trial. JAMA 294:2455–2464, 2005.
6. Covas MI, Nyyssonen K, Poulsen HE, et al.: The effect of polyphenols in olive oil on heart disease risk factors: A randomized trial. Ann Intern Med 145:333–341, 2006.
7. Mozaffarian D, Katan MB, Ascherio A, et al.: Trans fatty acids and cardiovascular disease. N Engl J Med 354: 1601–1613, 2006.
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