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Andrew Lansley argues against trans fat ban

Latest: Mr Lansley's response - 8 October 2010
And Our further questions - 22 October 2010

In May 2010 tfX write to Andrew Lansley, the new Health Secretary, to enquire as to the Government's policy on trans fats, and in particular if they would follow the example of Denmark, New York City and other jurisdictions in setting legally binding limits on trans fats in food.

This is the response received in Mr Lansley's letter of 21 June 2010:

"The FSA in 2007 carried out a comprehensive review of the health impacts of trans fats, industry action to reduce artificial trans fats in foods and assessed consumers' dietary intakes. The results of this review demonstrated that voluntary action by the UK food industry had reduced levels of trans fatty acids in fats and oils used in food production to a minimum [1]. The review showed that levels had decreased from around 55% [2] to less than 2%. These benefits are equivalent to those achieved through legislation in Denmark and New York City. [3]

Industry action had reduced people's average dietary intakes to around one per cent of food energy. This is significantly less than the 2 to 4 % estimated by Mozaffarian and Stampfer in the British Medical Journal article cited by your constituent [4]. Moreover, trans fats levels [5] have been reduced to around just half the maximum average intake level recommended by the UK's independent Scientific Advisory Committee on Nutrition. Further assessments of people's intakes of trans fatty acids carried out in 2008/9, as part of the National Diet and Nutrition Survey, have estimated that average intakes account for just 0.8% of food energy. [6]

The low levels of average trans fatty acid intakes by the UK population, which reflect both artificial and naturally occurring trans fatty acid intakes from some meat and dairy products [7], are considered to be within safe levels. [8]

In contrast dietary intakes of saturated fats, which are a contributory factor to coronary heart disease, are around 20% higher than the maximum recommended intakes of 11 per cent food energy. Therefore reducing saturated fat intakes offer a far greater public health benefit [9]. In recent years the FSA has been working to raise consumer awareness of the health implications of consuming too much saturated fat. The food industry has also taken steps to reduce the amount of saturated fats found in our food.

Notes:

  1. Wrong - the review refers specifically to the trans isomerisation that occurs during the refining and deodorising of natural vegetable oils, not to trans in hydrogenated oils.
  2. Wrong - it referred to a maximum of 55%, with typical levels much lower than 55%.
  3. Wrong: there are products on sale in the UK which would be illegal in NYC and Denmark, and people eating these are getting high levels of trans that they would not be attainable there.
  4. Wrong - the paper actually refers to peer reviewed research published in 1994 applicable worldwide, so it is not an estimate and does not refer specifially to the UK.
  5. They presumably mean average - individuals could be getting a lot more.
  6. True, but misleading - the concern is for individuals and groups who could be getting much higher levels of trans, notwithstanding the average figure.
  7. Misleading - they are trying to blur the distinction between natural TFAs found in butter etc which in their particular isomeric mix do not generally appear to be harmful to health, and the IPTFAs which are clearly demonstrated to be harmful to health.
  8. Wrong - there are no 'safe' levels of IPTFAs as such. The less you eat, the less damage they will do to your health. In particular, there is no such thing as a safe average level of intake, so long as within that average there are individuals and groups eating high levels of trans which are damaging their health.
  9. Wrong - gram for gram, IPTFAs are about ten times as bad for cardiovascular health as a typical mix of saturated fatty acids. So even a small reduction in IPTFA intake produces greater benefit than over-concentration on saturated. Moreover the reductions in IPTFAs can be achieved by regulation with no detriment to consumer enjoyment of food, while much of the saturated fat comes in foods we enjoy, like butter, cheese, meat, and eggs, and do not want to give up.

General: Lansley is constantly quoting average intake figures but what mattters, as recently highlighted by NICE, is that specific groups and individuals are exposed to levels of IPTFAs much higher than the average. These IPTFAs come mainly from imported products, and from 'hidden' hydrogenated oil in bakery products, take-aways, restaurants, canteens etc, where there is no labelling requirement for hydrogenated oil. The most effective, efficient way to deal with this problem is to set a maximum level of IPTFAs as a % of the fat content in any foodstuff.

Also see the Daily Mail article of 1 July 2010: They kill 7,000 people a year, but trans fats won't be banned.

What now?

A few important points about this letter:

Further questions

tfX has now put additional questions to Andrew Lansley and we await his response ...

1. Trans fat levels in the British diet clearly have reduced as a result of voluntary action by the British food industry. However there are still products on the market which are made using partially hydrogenated oils with high levels of Industrially Produced Trans Fatty Acids (IPTFSs). Some culinary ingredients aimed at the catering sector also comprise, in all or part, partially hydrogenated oils, also high in IPTFAs. Furthermore some products are imported into the UK which contain high proportions of partially hydrogenated oils, with high levels of IPTFA. Such products are clearly injurious to health.

The danger here is that while the average level of IPTFA consumption may be greatly reduced, specific individuals and groups may nonetheless be eating high levels of IPTFAs at levels sufficient to damage their health.

The Institute for Health and Clinical Excellence (NICE) has further reported on the topic of trans fats in its 22 June 2010 "Prevention of cardiovascular disease at population level" report. It raises the concern that, followiing the FSA and SACN work reported in 2007, "New concerns have now emerged, particularly in relation to imported products and fried food prepared in some settings. People from disadvantaged groups are likely consume more of these products which, in turn, could be an important contributory factor to health inequalities." It consequently advises that the policy goal should be to "Ensure all groups in the population are protected from the harmful effects of IPTFAs."

Would Mr Lansley please set out what plans he has to protect the health of those groups and individuals, who are eating high levels of IPTFAs.

2. In its report, referred to above, NICE recommends the following measures in pursuit of that policy objective:

  1. Eliminate the use of IPTFAs for human consumption.
  2. In line with other EU countries (specifically, Denmark and Austria), introduce legislation to ensure that IPTFA levels do not exceed 2% in the fats and oils used in food manufacturing and cooking.
  3. Direct the bodies responsible for national surveys to measure and report on consumption of IPTFAs by different population subgroups - rather than only by mean consumption across the population as a whole.
  4. Establish guidelines for local authorities to monitor independently IPTFA levels in the restaurant, fast-food and home food trades using existing statutory powers (in relation to trading standards or environmental health).
  5. Create and sustain local and national conditions which support a reduction in the amount of IPTFAs in foods, while ensuring levels of saturated fat are not increased. Encourage the use of vegetable oils high in polyunsaturated and monounsaturated fatty acids to replace oils containing IPTFAs. Saturated fats should not be used as an IPTFA substitute.
  6. Develop UK-validated guidelines and information for the food service sector and local government on removing IPTFAs from the food preparation process. This will support UK-wide implementation of any legislation produced on IPTFAs.

NICE further goes on to say that, if this advice is implemented resulting in reduced IPTFA intake, "between 4500 and nearly 7000 lives might be saved in England".

Would Mr Lansley please respond to the advice from NICE and explain how he wishes to progress their recommendations.

3. The UK Food Safety Act 1990 section 7 makes it an offence to "render food injurious to health". Would Mr Lansley agree that the provision of food containing a high proportion of IPTFAs may, in fact, already be in breach of the 1990 Act? Will he and his colleagues in Government provide guidance accordingly to local authorities and the Food Standards Agency to bring prosecutions against producers, importers, distributors and retailers of such foods, with ligh levels of IPTFAs, under the 1990 Act?

Mr Lansley's response of 8/10/10

After some delay, Mr Lansley responded via Oxford East MP Andrew Smith as follows:

"The Food Standards Agency currently has responsibility for developing policy on the issue raised. I am sorry on their behalf for the delay in replying [1].

As I am sure you are aware, the National Institute for Health and Clinical Excellence (NICE) report contained a wide range of recommendations, which support action to improve public health and reduce the incidence of cardiovascular disease [2]. In light of the ongoing development of the Government's White Paper on Public Health, which will be published later in the year, I do not believe it would be appropriate to respond to the recommendations individually [3].

However, I would like to see trans fats eliminated from the UK diet [4] through further voluntary action by the food industry [5]. Industry-led action so far has reduced average intakes of trans fats to less than half the maximimum average level recommended by the UK's independent Scientific Advisory Committee on Nutrition [6], and the NICE Report has provided no new detailed dietary evidence to support the claimed risk to particular groups [7]."

Our commentary

In his letter, Mr Lansley fails to respond meaningfully to a single point raised in the latter, or answer a single question. Part of the problem is that he has just passed it on to the ever-pathetic FSA - appearing unwilling or incapable of thinking for himself on this issue. On trans fats at least, we are up against the culture of perpetual government. Ministers and administrations may come and go, but the policies stay exactly the same. So much for democracy!

And so much also for 'best value' in the NHS. Imposing legal limits on IPTFAs is an essentially zero-cost measure as far as the public purse is concerned, which will bring about considerable public health benefits and reduce costs to the NHS of dealing with heart disease in its many forms.

Re the specific points in the letter:

  1. This suggests that rather than actually take responsibility for the issue as Health Secretary, he has passed the buck on to the FSA. That's why he is apologising for the FSA's delay in getting him the answers to send to tfX.
  2. Of course tfX is aware of the NICE report - that's what most of the letter to him was about! Padding.
  3. A total non-sequitur here. Basically this is an excuse to avoid answering some perfectly reasonable questions.
  4. Hooray! But oh dear, read on, only by "further voluntary action by the food industry".
  5. The problem is that voluntary action has run its course. UK food producers have almost given up putting hydrogenated oil in their products. Vegetable oils in the UK are refined to a high standard producing low levels of IPTFAs. All the main British food retailers have got rid of hydrogenated oil from their products. But what is now left is a residuum of HVO used in parts of the food industry that are unreponsive to persuasion, such as the 'value supermarkets' selling cheap imports, and the catering sector that does not have to label its ingredients.

    That's why we need regulation, to deal with these 'recalcitrant sectors' that have failed to respond to persuasion. If we are to meet NICE's demand for the elimination of IPTFAs from the UK's food, that is.

  6. True - sort of. Mr Lansley refers to the SACN Update on trans fatty acids and health. The report does actually recommend any particular maximum level of IPTFAs, but rather states:
    "260. Taking into account the totality of the evidence reviewed in this report the Committee endorse the recommendation made by COMA in 1994 that average trans FA intakes should be no more than 2% of food energy intake. The Committee agreed that there is currently no firm scientific basis for revising the recommendations."

    So we remain stuck with a 1994 figure that ignores the vast wealth of scientific knowledge on the damage to health from IPTFAs to emerge subsequently!
    Mr Lansley is also careful to refer to average intakes. The concern, set out in the letter to him and in the NICE report, is not about average intakes but about individuals and groups receiving greater than average intakes due to their diet - for example those who eat lots of takeaways fried in hydrogenated oil, or bakery goods rich in hydrogenated oil. This he has ignored.

  7. True - but so what? NICE refers to the evidence put forward by WHO to this effect, and raises it's own concerns as follows:
    "3.47 ... New concerns have now emerged, particularly in relation to imported products and fried food prepared in some settings. People from disadvantaged groups are likely consume more of these products which, in turn, could be an important contributory factor to health inequalities ... Some products (this includes fried food from take-away venues) may contain substantial levels of IPTFAs ... some people may be consuming this sort of meal on a frequent basis. Hence, it considered that IPTFA consumption across different population groups is relevant - and that simply looking at average intake will not suffice."

    NICE's very reasonable proposition is supported by the SACN report, which quotes findings (pp.154-155) that the 2.5 percentile of population with the highest TFA intake are eating more than 2 percent of their food energy as TFA, and in the low income group this rises to 2.6 percent.
    All necessary evidence is already there. So just why should NICE have to publish new detailed dietary evidence to make its point? Surely it is up to Mr Lansley, and the FSA, to do further detailed dietary research themselves? As NICE called on the Government to do, to "Direct the bodies responsible for national surveys to measure and report on consumption of IPTFAs by different population subgroups - rather than only by mean consumption across the population as a whole", and to "Establish guidelines for local authorities to monitor independently IPTFA levels in the restaurant, fast-food and home food trades using existing statutory powers (in relation to trading standards or environmental health)."
    Just to put these SACN figures into context, one fortieth of the population are eating levels of transfats that are at or above the level of known substantial harm. That's over 1.5 million people. Some of them - a group disproportionately including low income people - are eating a lot more than that.

Mr Lansley has also failed to make any response at all to the point (3) in my letter:

3. The UK Food Safety Act 1990 section 7 makes it an offence to "render food injurious to health". Would Mr Lansley agree that the provision of food containing a high proportion of IPTFAs may, in fact, already be in breach of the 1990 Act? Will he and his colleagues in Government provide guidance accordingly to local authorities and the Food Standards Agency to bring prosecutions against producers, importers, distributors and retailers of such foods, with ligh levels of IPTFAs, under the 1990 Act?

Our further questions - 22/10/10

Again, sent to Mr Lansley via Andrew Smith MP.

Your Ref: JM/TICK04002/01101909 MC06400 FSAPO00525561

Please pass on my thanks to Mr Lansley for his letter of 8 October 2010, in connection with my enquiries on trans fatty acids.

I am delighted to see that he "would like to see trans fats eliminated from the UK diet". However I should add a proviso. Much of the trans fat in the British diet is of animal origin, arising from bacterial fermentation in the guts of ruminant animals. This 'natural' trans fat is present in ruminant meat and dairy products and there is little prospect of its removal.

Fortunately these natural trans fats do not appear to be associated with damage to health, as are the trans fats of industrial origin formed during the processing of vegetable oil, mainly during hydrogenation but also in the course of refining and deodorising. These are the 'Industrially Produced Trans Fatty Acids' or IPTFAs referred to by NICE in its 2010 report "Prevention of cardiovascular disease at population level". It is probably best to confine our discussion to these IPTFAs - and I shall assume that Mr Lansley was in fact referring to IPTFAs.

Further to this point, I am however disappointed that Mr Lansley qualifies his laudable aspiration to eliminate IPTFAs with the words "through further voluntary action by the food industry".

As he is surely aware, the NICE report commends the FSA and the British food industry for its efforts to date in reducing levels of IPTFAs. There have indeed been major improvements over the last five years. However this does not mean that voluntary action can bring about the further improvements sought to achieve his aspiration.

There is, on the contrary, reason to suppose the reverse - that voluntary action by the food industry has largely fulfilled its potential, and that substantial further improvements will require regulation. NICE identifies two 'recalcitrant' sectors of the food industry in terms of reducing IPTFA levels:

  • cheap imported food products, mainly from continental Europe, which continue to employ hydrogenated oil. These products are often sold in 'value supermarkets' and street markets, where price rather than quality is the main determinant of perceived value.
  • the catering / unpackaged food sector, comprising:
    • fresh bakery foods such as buns, pies, pastries, cakes and savoury snacks;
    • canteen food sold in schools, hospitals, workplaces, prisons, homes for the elderly;
    • food sold in pubs and restaurants;
    • take-away food.

Unlike the packaged food sector, the catering sector is not required to provide information on ingredients. So the consumer pressure that has been at work in the packaged food sector to remove the term "hydrogenated oil" and its many variants from ingredients lists is largely lacking, on all but high profile companies. Likewise with the 'value' sector, many consumers have not grasped the nature of the health risks posed by IPTFAs, so again consumer pressure for reform is lacking.

I would therefore like to ask Mr Lansley: does he have any plan as to how to bring about the desired elimination of IPTFAs in foods in these two 'recalcitrant' sectors, in the absence of regulation? If so, what is his plan?

He also states that "Industry-led action so far has reduced average intakes of trans fats to less than half the maximum average level recommended by the UK's independent Scientific Advisory Committee on Nutrition." However he does not engage with concerns about those individuals and groups who are eating high levels of IPTFAs.

As NICE puts it, "Some products (this includes fried food from take-away venues) may contain substantial levels of IPTFAs ... some people may be consuming this sort of meal on a frequent basis. Hence, it considered that IPTFA consumption across different population groups is relevant - and that simply looking at average intake will not suffice."

Instead Mr Lansley appears to dismiss the proposition on the basis that "the NICE Report has provided no new detailed dietary evidence to support the claimed risk to particular groups." However the proposition stands in the absence of any such "new detailed dietary evidence":

  • first, there is nothing obviously deniable or even arguable within NICE's proposition;
  • second, the proposition is supported by evidence, for example as reported in the 2007 SACN report Update on trans fatty acids and health. It quotes findings (pp.154-155) that the 2.5 percentile of population with the highest TFA intake are eating more than 2 percent of their food energy as TFA. In the income group this rises to 2.6 percent. This indicates that one fortieth of the population, around 1.5 million people, are eating levels of trans fats above the level of known substantial harm. Further that some of those 1.5 million - a group disproportionately including low income people - are eating a lot more than that.

I agree that it would be desirable to have more detailed information on this point to further elucidate the precise population distribution of IPTFA intake. This was in fact a specific recommendation made by NICE, that Mr Lansley should "Direct the bodies responsible for national surveys to measure and report on consumption of IPTFAs by different population subgroups - rather than only by mean consumption across the population as a whole." However even the information currently available is sufficient to support NICE's proposition.

Please also thank Mr Lansley for drawing my attention to the forthcoming White Paper on public health. I note that he does not wish to pre-empt the White Paper by responding to specific points made by NICE. But in fact, his letter already does precisely that:

  • first, in dismissing NICE's proposition of disproportionate health damage to individuals and groups eating high levels of IPTFAs, on the paradoxical grounds (given that sufficient evidence is already published in the 2007 SACN report) of "no new detailed dietary evidence";
  • second, in insisting that the desired outcome, the elimination of IPTFAs in the British diet, should be achieved through "further voluntary action by the food industry", apparently ruling out the NICE recommendation to: "In line with other EU countries (specifically, Denmark and Austria), introduce legislation to ensure that IPTFA levels do not exceed 2% in the fats and oils used in food manufacturing and cooking."

I am therefore concerned that in the process leading up to the White Paper on Public Health, Mr Lansley has already ruled out the most important recommendation made by NICE in its report with regards to IPTFAs, to impose legal limits on IPTFAs similar to those applying in Denmark and Austria. Please could Mr Lansley clarify his position in this regard.

I would also draw Mr Lansley's attention to the third point made in my earlier letter, namely:

3. The UK Food Safety Act 1990 section 7 makes it an offence to "render food injurious to health". Would Mr Lansley agree that the provision of food containing a high proportion of IPTFAs may, in fact, already be in breach of the 1990 Act? Will he and his colleagues in Government provide guidance accordingly to local authorities and the Food Standards Agency to bring prosecutions against producers, importers, distributors and retailers of such foods, with high levels of IPTFAs, under the 1990 Act?

To my surprise Mr Lansley has failed to respond to this. However, the points raised here are important ones as they would provide a means for the Government to reduce the incidence of IPTFAs to minimal levels without any need for new legislation or regulations. Expert bodies - for example the FSA, SACN and NICE - would simply have to produce an agreed form of words to the effect that food in breach of a defined standard as regards IPTFAs (the Danish standard might be adopted for this purpose) was considered "injurious to health" for the purposes of Section 7 of the 1990 Act.

This statement would then provide a basis for local authorities to prosecute offenders. In practice, few prosecutions would need to be brought since the mere threat of criminal proceedings under the 1990 Act would have the desired effect in near-eliminating IPTFAs from the UK food supply.

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