Freedom of speech vs health interests

[IJ]

The New England Journal of Medicine just ran a few articles (online, an interview: http://content.nejm.org/cgi/content/ful ... 4/2527/DC1 ) on marketing of junk food to children and the growing obesity epidemic. The institute of medicine just released a report that basically blames clever, research based, marketing efforts to convince children that junk is healthy and that kids should determine their own diets. As a result, some kids are taking in a full days calories just from sodas and 30% of calories from junk has become the norm. 3900 calories a day is our new norm (200-2500kcal would be more standard). Kids rapidly become adept at demanding brand names. Obesity rates are correspondingly rising.

Things that seem easily and immediately doable to improve things:
--actual phys ed in schools.
--no more serving of unhealthy food in our cafeterias. Much of it exceeds recommended fat, calorie, and salt content
--get heavily promoted junk foods out of school. why allow the sale of sugar water to increasingly obese youth?

The big question is whether to restrict marketing directed at kids. We know that kids aren't able to understand that an advertisement is trying to persuade them; they take this info as fact and go from there. They're also encouraging kids to make decisions they're not capable of making, that is, designing their diets. Advertisement is speech, and speech is free, and we've decided as a culture that advertising can carry important messages to the public. But when the target is vulnerable, and unable to think about the content of the speech, and the speech is a carefully designed effort to make money off of (quite successfully) promoting unhealth behaviors in kids, how free should it be?

See also:

Nestle M. Food Marketing and Childhood Obesity — A Matter of Policy. N Engl J Med 2006;354(24):2527-9.

Free full text at http://nejm.org

excerpts:

"Since the late 1970s, obesity rates have more than doubled among children 6 to 11 years of age and more than tripled among those 12 to 19 years of age. As one consequence, type 2 diabetes mellitus is no longer rare in pediatric practice.2 The IOM states its first conclusion politely: the diets of American children are "in need of improvement." As its report makes clear, this is a gross understatement: at least 30 percent of the calories in the average child's diet derive from sweets, soft drinks, salty snacks, and fast food. Soft drinks account for more than 10 percent of the caloric intake, representing a doubling since 1980. According to the U.S. Department of Agriculture, even babies consume measurable quantities of soft drinks, and pediatricians say it is not unusual for overweight children to consume 1200 to 2000 calories per day from soft drinks alone."

"Worth serious consideration, I believe, are restrictions or bans on the use of cartoon characters, celebrity endorsements, health claims on food packages, stealth marketing, and marketing in schools, along with federal actions that promote media literacy, better school meals, and consumption of fruits and vegetables. Without further changes in society, such actions may not be enough to prevent childhood obesity, but they should make it much easier for parents — and health care providers — to encourage children to eat more healthfully."

[stuff]

It all goes back to the parents. If you do not want your child to see things that encourage your youngin to gorge themselves on junk food. Then you control the junk food intake, not by banning poduct endorsements or advertisement selling junk food.

The last thing we need in the good ole USofA is more crap legislation to regulat what we see, hear, think and how we should live our lives.

[Gene DeMambro]

Actually, commercial speech is not as protected as non-commercial speech. The powers-that-be can limit advertising and commercial speech if they follow certain, strict conditions and meet certain tests.

Gene

[Bill Glasheen]

We also need to take into account the reality that we are dealing with KIDS and not adults.

• We don't let kids drive
• We don't let kids take jobs
• We don't let them drink, smoke, or have sex - by law. And recently we've taken a dim view to vendors of such services advertising in a manner that targets youth
• We don't allow kids to make their own decisions in many aspects of their lives.

Furthermore, truth-in-advertising should prevail. For example, Listerine advertised for years that it prevented the common cold. Then it was shown in peer-reviewed research NOT to be able to do that. But then they later discovered that the polyphenols in Listerine could prevent periodontal disease and tooth decay, so the product got a second life via endorsement from the ADA. Meanwhile, Listerine was asked to stop advertising that their product prevented colds.

Have you ever bothered to watch the commercials for sugar-laden cereals, sodas, and fast food? Some employ "the hook" without ever mentioning anything about nutrition. But some of the advertisements are downright misleading, if not false.

Given what happened to the tobacco industry, I wouldn't want to be advertising my junk food product without a good deal of caveats. Look how easily a company like Merke gets sued for producing a drug that saves lives but hurts a few people via the side effects experienced by a few. When you consider the damage that sugar and fat-laden products do to people over time - without any appreciable benefit - I'm thinking it's only a matter of time before the class action lawsuits start coming in droves. If I was McTrashburgers, I'd be putting warning messages on my ads about obesity as of yesterday. Same for the colored sugar water with dissolved CO2 (a.k.a. sodas). Sutton's law says it's only a matter of time before someone sniffs out those greenbacks.

It is indeed a complicated subject. I think it deserves careful thought, and an intelligent solution. If it was only about the money, then we'd let Ronald McDonald go at it, and the ambulance chasers follow him in droves. We'd even open up the school doors and let the drug pushers do an honest day's work. Personally it pains me to see any of said groups profit at the expense of our youth.

And if you think parents can control what their kids get exposed to 24/7, then you must live in another generation. It's even worse today when economics make it necessary for both parents or a single parent to work, and leave junior at the mercy of whatever babysitters during and after school.

- Bill

[IJ]

I understand the appeal of the "if you don't like what's on TV turn it off / if you want your kids to have healthy food don't buy junk / if you want your kids to get a good education get as phD then quit working to home school them" kind of approach. But its not practical. Parents don't have total control over a kid's intake of calories, for example, when they go out and buy stuff on their own. Or when the soda machine at school is full of full sugared drinks. Or when the school's own food is junk. That's the case even for a well educated empowered mom and dad, and fact is some of our chubbiest kids are the lower income / under educated ones. It does, to some extent, take a village, and mom cannot compete with a multibillion dollar ad campaign from every company who wants to profit off the diabetization of her kid. Especially when kid cannot digest the ads independently and mom cannot watch all the tv her kid watches with the kid--otherwise, she probably would be able to get rid of it.

Bill, I think the McGarbage lawyers have a reason for holding off on warnings. The McDonald's lawsuit push fell thru, because it was considered common knowledge that their food was horrible (I think I heard the details in "Supersize me" because they used the companies own defense (the food we serve is obviously lethal) against them). If memory serves such lawsuits were actually outlawed. They may be at the point tobacco is now, where new users can't claim they were suckered. Plus to be the first chain to say their food is lethal is a risky business proposition.

I would like to see easy to use food labels (maybe a warning system like the (admittedly nonfuncitonal) terror threat system or at least an end to baseless claims such as "part of this nutritious breakfast" or "this food will be part of a meal containing healthy foods if you eat it with some other, healthy foods."

[benzocaine]

I voted for more phys-ed and education.

Kids should have daily calisthenics ... seriously

Stricter guidlines on what schools feed kids should be mandated from a federal level. A kid in Sanfransico will het a much more healthy meal than the kid from New Castle Virginia.

The market will work itself out. Look at McDonalds over the past few years. They have salads, (good salads..well acceptable ) and their happymeals give the choice of milk and apple slices.

[Bill Glasheen]

The market will work itself out.

There's nothing to substantiate that claim, Ben. Research has shown that even moms don't come to McTrashburgers to eat the salads. They go there to eat the same fries and burgers that everyone else eats. When they want healthy food, they don't go to McTrashburgers.

The truth is that sugar and fat sell. Most people eat for taste, and eat for convenience. Sugar is sweet, and most flavor molecules are fat soluble. So when you eat for taste ONLY, you'll likely eat crap. Meanwhile, intelligent information about nutrition can't compete in the airways with the mega dollars spent pushing the sugar-laden cereals and the fast food.

We shouldn't just pick on Ronald McTrashburger.

Most fast food chains are the same. Even the allegedly "healthy" ones sneak the crap in. Two smoothie chains that just opened up near me (Squeeze and Tropical Smoothie Cafe) advertise their "healthy" selections. The problem is, Tropical Smoothie sneaks sugar in all their smoothies. You have to go out of your way to ask either for a non-nutritive sweetner, or - in my case - say you don't want any of it. Squeeze does the same by putting sherbet in all but 2 of their selections, and has no non-sugar alternative.

Every time I go down the cereal aisle of the grocery store, I get pissed off. I've got 2 selections among the hundreds down the aisle that have not snuck in either sugar or high fructorse corn syrup. I can remember one brand with almonds and raisins that came out and I really liked. Then one day I saw the dreaded thing on the box - New, Improved Flavor! I looked at the ingredients. Damn... my premonition was spot on. I called the 800 number on the box. Did they listen? Hell no. I got this lecture about how the "New, Improved!" version won out in a taste test. Well of course, bonehead! Give Middle America addicted to sugar a choice, and they'll always choose the sugar-laden product - by taste alone. I told the person I didn't care what their cereal tasted like if they stuck sugar in it. I got silence at the other end of the line. They really didn't want to listen to their customer; they wanted to engage in a marketing exercise with me. So much for six sigma and "Voice of the Customer." Meanwhile... I was right about one thing. Six months after they made the change, the cereal went off the market. These boneheads obviously knew nothing about their market niche.

It really is possible to use a little "good" fat in food, have it flavorful, and have it healthy. The body actually needs some omega 3, omega 6, and omega 9 fatty acids. Fish oil, nut oil, canola oil, and olive oil are all very good for you - in moderation. Saturated and hydrogenated (trans fat) fatty acids are not. You might as well just stuff your coronaries with mayonaise and be done with it.

And what's wrong with some fresh fruit and vegetables? That's the way we should be eating our sweets. Concentrating certain aspects of nutrition at the expense of others (soluble and insoluble fiber, phytonutrients, etc.) isn't healthy and most certainly isn't natural.

Do I have a right to complain about the habits of others? Absolutely. Every day when I look at the health experience of tens of millions of people in my health data, I see the evidence of "Syndrome X." This is the array of things that happen to people when they eat crap and don't exercise. They drive the cost of MY bleepin health insurance up, and then want to sue their doctors when they have miserable lives in their thirties and beyond. Then instead of just NOT EATING, they want to have their stomachs cut and/or banded. It's very, very sad when you look at the big picture and think about it.

It doesn't work, Ben. People are addicted to this stuff - quite literally. Poor nutrution sells. Bad food makes big bucks, and people can't eat enough of the schit. It's as addictive to some as heroine. And convenience food has some of the worst nutritional elements in it - partly because it's too difficult to make fresh, healthy food convenient. It's the perishability of the product. It's the expense of the transportation. It's the whole food chemistry thing. Lower income people on the run end up getting the shaft.

There's a fortune to be made for the first pharmaceutical company that figures out how to affect brain chemistry so that these addictions go away.

- bill

[IJ]

Bill:

1) JAMA recently published the results of a study that found a THC receptor blocker helped (short version) beat these addictions. I'll dig up the exact findings in a few. Sad that we need a drug for this.... people should be able to choose to live somewhere where we're immersed in healthy choices, get used to them (and feeling better, living longer etc) and let everyone else pay for their diseases of affluence.

2) Clarification: hydrogenated fats are not necessarily transfat. Transfat (fat where the lipid chain makes a right then a left instead of a right and another right) occurs when unsaturated fats are partially hydrogenated. Fully hydrogenated fats are just saturated. They're bad for you, just like most animal and palm fats. But at least they're not transfat, which is a substance that didn't exist until we started boiling fats with hydrogen gas--the body does not know what to do with these novel fats, so they end up lodged in your heart. Even half a gram a day is bad for you. Luckily the FDA requires a transfat tally on every food package--however, they can round that value down, so less than a gram comes out as if its "zero" even when most people eat three servings of whatever junk it is three times a day and might get 5 grams, which'll kill ya. Other countries have simply forbidden these things from getting into the foods at these levels. (sounds simple eh?). The only way to protect yourself is to trust mother nature, who doesn't make transfat, and to read the labels and throw out anything with "partially hydrogenated" in the ingredients. This will mean almost all commercial desserts, baked goods, flour tortillas, and so on. I personally don't want to have to scan the ingredient llist of a piece of bread to see if any artificial poisons were added for the marketer's convenience and my ill health.

[benzocaine]

Bill,

I understand that most of the consumers in America eat for two things. 1) Taste 2) price of food. Often the two conveniently merge into the perfect marraige of the McDonads-Wendys- BK-KFC product.

Still, with that in mind let me re-state my belief that a little education can go a long way. Not everyone in Ameriica know about things like Glycemic index and calorie counting. Many don't know the difference between high fructose corn syrup, honey, molassas , and how they can all be stored as fat differently. Hell..... many companys have the gaul to put out a product as "light" because it has no fat- but instead is full of sugar.

I know this. You know this. Most of America does not. I believe some education could go a long way. Diet and excersize should be part of all public schools education.

America is getting fatter and fatter. Diabetes is rampant through todays youth. This is the first generation expected to have a SHORTER lifespan than there parents. Education coud hopefully change there eating and lifestyle habbts.

Maybee that would change the market some. Maybee not.

[IJ]

I hear what you're saying but believe that

1) I spend a lot less money for not buying any processed food and

2) think it will take decades to see if a few million in education efforts can compete with billions of ads from the junk pushers. In the meantime, the cost will be too high, and it might not even work.

[Bill Glasheen]

Ian

I read up on my chemistry a bit, and got up to speed.

A clarification on your clarification... You stated that trans fats don't occur in nature.

transfat, which is a substance that didn't exist until we started boiling fats with hydrogen gas

Not eactly. You are mostly right. From Wikipedia...

Hydrogenation of edible oils was invented by the German chemist Wilhelm Normann, who patented the process in 1902. In 1909 Procter & Gamble in Cincinnati acquired the US rights to the Normann patent and in 1911 they began marketing Crisco, the first hydrogenated shortening, which contained a large amount of partially hydrogenated cottonseed oil. Further success came from the marketing technique of giving away free cookbooks with every recipe calling for Crisco. Hydrogenation strongly stimulated whaling, as it made it possible to stabilize whale oil for human consumption.

******

Trans fatty acids are made when manufacturers add hydrogen to vegetable oil, in the presence of small amounts of catalyst metals such as nickel, palladium, platinum or cobalt -- in a process described as partial hydrogenation. If the hydrogenation process were allowed to go to completion, there would be no trans fatty acids left, but the resulting material would be too solid for practical use. A claimed exception to this is The J.M. Smucker Company's new trans fat free Crisco which contains the wax-like fully hydrogenated cottonseed oil blended with liquid vegetable oils to yield a shortening much like the previous Crisco which was made from partially hydrogenated vegetable oil. In a natural fatty acid, the hydrogen atoms are usually on the same side of the double bonds of the carbon chain. However, partial hydrogenation reconfigures most of the double bonds that do not become chemically saturated, so that the hydrogen atoms end up on different sides of the chain. This type of configuration is called trans (which means "across" in Latin).

However...

Although synthetically created trans fatty acids have been a significant part of the human diet for just over 100 years, the biochemistry of trans fatty acids is poorly understood. Little is known about how trans fatty acids are incorporated into the developing fetal brain tissue, cell membranes, and arterial plaque. Some clinical studies suggest a possible association of trans fatty acids with obesity, metabolic syndrome and diabetes. It is unclear whether the naturally present trans fatty acids in beef, mutton and dairy products (created through fermentation processes in the stomach of ruminant animals) pose the same risks.

****

Trans fats occur naturally in the milk and body fat of ruminants (such as cows and sheep) at a level of 2-5% of total fat. *

****

* SM Innis, DJ King (1999). "trans Fatty acids in human milk are inversely associated with concentrations of essential all-cis n-6 and n-3 fatty acids and determine trans, but not n-6 and n-3, fatty acids in plasma lipids of breast-fed infants". American Journal of Clinical Nutrition 70 (3): 383–390.

- Bill

[IJ]

By golly, you're right. For once They told us in med school that 50% of what we learned would be proven wrong, and they did in fact promise us in biochemistry that the reason transfats were so bad for you was because they didn't exist until man made them with hydrogenation so the body had no idea what they were or what to do with 'em. I missed the ruminant transfat mention made in this 4/06 article:

Great source (dense, but bear with me, as transfats are far more likely to kill you than islamofascism or an SUV). Short version: the US could outlaw transfats in our food supply with no noticeable effect on our foods as far as cost, taste, or availability, and avert 228,000 heart attacks a year as well as reduce diabetes, stroke and other conditions influenced by unhealthy fats. Denmark has already done the experiment by successfully eliminating these killer fats, with great success. Not doing this immediately, IMHO, is totally insane.

NEJM Volume 354:1601-1613 April 13, 2006 Number 15
Trans Fatty Acids and Cardiovascular Disease
Dariush Mozaffarian, M.D., M.P.H., Martijn B. Katan, Ph.D., Alberto Ascherio, M.D., Dr.P.H., Meir J. Stampfer, M.D., Dr.P.H., and Walter C. Willett, M.D., Dr.P.H.

"Trans fats, unsaturated fatty acids with at least one double bond in the trans configuration (Figure 1), are formed during the partial hydrogenation of vegetable oils, a process that converts vegetable oils into semisolid fats for use in margarines, commercial cooking, and manufacturing processes. From the perspective of the food industry, partially hydrogenated vegetable oils are attractive because of their long shelf life, their stability during deep-frying, and their semisolidity, which can be customized to enhance the palatability of baked goods and sweets. The average consumption of industrially produced trans fatty acids in the United States is 2 to 3 percent of total calories consumed.1 Major sources of trans fats are deep-fried fast foods, bakery products, packaged snack foods, margarines, and crackers (Table 1). Naturally occurring trans fats are consumed in smaller amounts (about 0.5 percent of total energy intake) in meats and dairy products from cows, sheep, and other ruminants; these trans fats are produced by the action of bacteria in the ruminant stomach."


The New York City Department of Health and Mental Hygiene has asked 20,000 restaurants and 14,000 food suppliers to eliminate partially hydrogenated oils from kitchens and to provide foods and food products that are free of industrially produced trans fatty acids.5 Denmark has enacted, and Canada is considering, legislation to eliminate industrially produced trans fats from food supplies

As compared with the consumption of an equal number of calories from saturated or cis unsaturated fats, the consumption of trans fatty acids raises levels of low-density lipoprotein (LDL) cholesterol, reduces levels of high-density lipoprotein (HDL) cholesterol, and increases the ratio of total cholesterol to HDL cholesterol, a powerful predictor of the risk of CHD.21 Trans fats also increase the blood levels of triglycerides as compared with the intake of other fats,20 increase levels of Lp(a) lipoprotein,22 and reduce the particle size of LDL cholesterol,23 each of which may further raise the risk of CHD. Thus, trans fatty acids have markedly adverse effects on serum lipids. Although these effects would be expected to increase the risk of CHD, the relation between the intake of trans fats and the incidence of CHD reported in prospective studies has been greater than that predicted by changes in serum lipid levels alone,20,22 suggesting that trans fatty acids may also influence other risk factors for CHD....the inflammatory effects of trans fats may account in part for their effects on cardiovascular health

On a per-calorie basis, trans fats appear to increase the risk of CHD more than any other macronutrient, conferring a substantially increased risk at low levels of consumption (1 to 3 percent of total energy intake

Of four prospective studies evaluating the relation between the intake of trans fatty acids from ruminants and the risk of CHD, none identified a significant positive association, whereas three identified nonsignificant trends toward an inverse association.53,54,69,70 The absence of a higher risk of CHD associated with the intake of trans fatty acids from ruminants as compared with the intake of industrially produced trans fatty acids may be due to lower levels of intake (typically less than 0.5 percent of total energy intake), different biologic effects (ruminant and industrial trans fats share some, but not all, isomers), or the presence of other factors in dairy and meat products that balance any effects of the small amount of trans fats they contain. Although each of these potential explanations deserves further investigation, the sum of the current evidence suggests that the public health implications of consuming trans fats from ruminant products are relatively limited.

Thus, from a nutritional standpoint, the consumption of trans fatty acids results in considerable potential harm but no apparent benefit. In addition, adverse effects are seen even at low levels of intake: 1 to 3 percent of total energy intake, or approximately 20 to 60 calories (2 to 7 g) for a person consuming 2000 calories per day. Thus, complete or near-complete avoidance of industrially produced trans fats — consumption of less than 0.5 percent of the total energy intake — may be necessary to avoid adverse effects and would be prudent to minimize health risks.

However, the producers of foods that contain less than 500 mg of trans fatty acids per serving will be allowed to list the content of trans fatty acids as 0 on the packaging, so even consumers who read the labels might unwittingly consume substantial amounts of trans fats in multiple servings (for example, several pats of margarine or several cookies per day). Inspection of the ingredients list for the content of partially hydrogenated oils will be the only way to identify these foods. (Fully hydrogenated oils are typically listed simply as "hydrogenated" and do not contain trans fatty acids.) More important, food labels are not obligatory (and are rarely seen) in restaurants, bakeries, and many other retail food outlets. Avoidance of trans fats at these sites will depend on consumers' knowledge of the type and quantity of oils used in food preparation. Acquiring this knowledge is a potentially daunting but important task, because as trans fatty acids are increasingly eliminated from packaged foods, most trans fats will be consumed from food obtained at these sites.

For example, in 2004, Denmark mandated that all oils and fats used in locally made or imported foods must contain less than 2 percent industrially produced trans fatty acids. This legislation essentially eliminated the use of partially hydrogenated vegetable oils in Denmark.6 Comparisons of foods before and after the legislation demonstrated that partially hydrogenated oils were replaced mostly with cis unsaturated fatty acids in soft margarines, packaged snacks, and fast foods, with some saturated fatty acids from tropical oils or fully hydrogenated vegetable oils used in certain cookies and bakery products.6 Overall, the consumption of saturated fat did not increase. Both government and industry representatives agreed that these changes did not appreciably affect the quality, cost, or availability of food.6,73,74 Thus, french fries and chicken nuggets from U.S. fast-food restaurants located in Denmark contain virtually no trans fatty acids, whereas the same foods in the United States contain 5 to 10 g of trans fatty acids per serving (as discussed by Stender et al. elsewhere in this issue of the Journal75). In Norway, Finland, and the Netherlands, cooperative efforts between government agencies and food industries have also resulted in substantial reductions in the use and consumption of trans fat without notable increases in the cost of foods or reductions in the quality or availability of foods.

On the basis of the predicted changes in total and HDL cholesterol levels alone (Fig. 2),21 a meaningful proportion of CHD events (3 to 6 percent) would be averted. However, we believe that this reduction is an underestimate, since trans fats may also influence the risk of CHD through other mechanisms, such as inflammatory or endothelial effects. On the basis of reported relations between trans fat intake and CHD events in prospective studies (Figure 4), which may account more satisfactorily for the total effects of trans fatty acids, 10 to 19 percent of CHD events in the United States could be averted by reducing the intake of trans fat. Thus, given the 1.2 million annual myocardial infarctions and deaths from CHD in the United States,82 near-elimination of industrially produced trans fats might avert between 72,000 (6 percent) and 228,000 (19 percent) CHD events each year.

See also:

Effects of Different Forms of Dietary Hydrogenated Fats on Serum Lipoprotein Cholesterol Levels
Lichtenstein A. H., Ausman L. M., Jalbert S. M., Schaefer E. J.
Abstract | Full Text | PDF
N Engl J Med 1999; 340:1933-1940, Jun 24, 1999.

Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects
Mensink R. P., Katan M. B.
Abstract
N Engl J Med 1990; 323:439-445, Aug 16, 1990. Original Articles

High Levels of Industrially Produced Trans Fat in Popular Fast Foods
Stender S., Dyerberg J., Astrup A.
Extract | Full Text | PDF
N Engl J Med 2006; 354:1650-1652, Apr 13, 2006. Correspondence

"The cooking oil used for french fries in McDonald's outlets in the United States and Peru contained 23 percent and 24 percent trans fatty acids, respectively, whereas the oils used for french fries in many European countries contained only about 10 percent trans fatty acids, with some countries as low as 5 percent (Spain) and 1 percent (Denmark). At KFC, some values for trans fatty acid content were above 30 percent. Within the same chain in the same country, large variations in these values were observed — for instance, between KFC outlets in Hamburg and Wiesbaden in Germany and between Aberdeen and London in the United Kingdom.

Owing to the very high content of industrially produced trans fatty acids in certain fast foods, in many countries it is possible to consume 10 to 25 g of these trans fatty acids in one day and for habitual consumers of large amounts of this food to have an average daily intake far above 5 g. This is a matter of concern, particularly for low-income people, who already have an increased risk of ischemic heart disease owing to other lifestyle factors."

[Bill Glasheen]

The cooking oil used for french fries in McDonald's outlets in the United States and Peru contained 23 percent and 24 percent trans fatty acids, respectively, whereas the oils used for french fries in many European countries contained only about 10 percent trans fatty acids, with some countries as low as 5 percent (Spain) and 1 percent (Denmark). At KFC, some values for trans fatty acid content were above 30 percent. Within the same chain in the same country, large variations in these values were observed — for instance, between KFC outlets in Hamburg and Wiesbaden in Germany and between Aberdeen and London in the United Kingdom.

- NEJM


Interesting. From the American Journal of Clinical Nutrition article I cited above, Ian, comes the following information (courtesy of Wikipedia).

It has been established that trans fats in human milk fluctuate with maternal consumption of trans fat, and that the amount of trans fats in the bloodstream of breastfed infants fluctuates with the amounts found in their breast milk. Reported percentages of trans (compared to total fats) in breastmilk range from 1% in Spain, 2% in France and 4% in Germany to 7% in Canada.

Sounds like the Canadians like their junk food.

But seriously... That's pretty scary when you think about it. Not all breast milk is created equal, and the nasty content can be related to the amount of crap you eat. That can affect junior who gets his brew from mama's tap.

- Bill

[Glenn]

The cooking oil used for french fries in McDonald's outlets in the United States and Peru contained 23 percent and 24 percent trans fatty acids, respectively, whereas the oils used for french fries in many European countries contained only about 10 percent trans fatty acids, with some countries as low as 5 percent (Spain) and 1 percent (Denmark). At KFC, some values for trans fatty acid content were above 30 percent. Within the same chain in the same country, large variations in these values were observed — for instance, between KFC outlets in Hamburg and Wiesbaden in Germany and between Aberdeen and London in the United Kingdom.

So are they comparing McDonald's fries in the U.S. to McDonald's fries in other countries? Or are they comparing McDonald's fries in the U.S. to fries in general cooked in these other countries? This paragraph is not explicite on this, but the difference would affect the interpretation. I am assuming the former given that in another quote there is the statement:

Thus, french fries and chicken nuggets from U.S. fast-food restaurants located in Denmark contain virtually no trans fatty acids, whereas the same foods in the United States contain 5 to 10 g of trans fatty acids per serving

but does anyone know for certain?

[Glenn]

As for the poll, I favor options 2-4 as a set.