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Fat: the good, the bad and the trans fat truth and how it applies to people with special needs.

"Zero grams trans fat!"

This is the proclamation made on many packaging labels these days. That's great, right? Maybe not. There are so many different messages about fat in the news. What are trans fats? How bad are they really? Do you know which fats are just as bad? Just as there is good blood cholesterol (HDL) and bad blood cholesterol (LDL), there are good fats and bad fats in the foods we eat. Lastly, how should fats be monitored in the diets of children and adults with disabilities and special health care needs?

Fat in the Body: Is A Fat-Free Body the Goal?

Before we look at the fats we eat, let's look at fat in the body. Some fat is not only good for us but also required for the body. We may think of fat as those flabby areas we want to be rid of: thighs, hips, stomach, upper arms and maybe some other spots, too. But fat has some important roles in our body. Fat allows for efficient energy storage, which is important if you are sick and not eating; it serves as a thin cushioning layer under the skin, helping your body absorb Vitamins A, D, E, and K; and it is a normal part of the make-up of the body's cells. Fat is also important for proper growth and development and maintenance of good health.

Blood levels of cholesterol, triglycerides, LDL and HDL are measured in terms of health risk. What is being measured? Triglycerides make up the most common type of fat in the body. Extra calories eaten are turned into triglycerides. So, a person who regularly eats more calories than he burns will have high blood triglycerides. Another measuring stick is cholesterol, and many people know their "cholesterol number". That is a total cholesterol value. Two other commonly measured types of cholesterol in the blood are LDL and HDL, which basically work in opposite directions.

Low-density lipoproteins (LDL) deliver cholesterol from the liver, which makes cholesterol from the food we eat and packages it for transport to the rest of the body. When LDL cholesterol is high, it means there is fat traveling through the blood to be stored in the body, and this fat can be deposited on the walls of the coronary arteries. Plaque is another name for these fatty deposits on the artery walls. Because of this artery blocking activity, LDL cholesterol is often referred to as the "bad" cholesterol. This is the cholesterol number to lower.

High-density lipoproteins (HDL) carry cholesterol in the blood from body storage sites back to the liver in the process of eliminating it from the body. HDL is less "sticky", which makes it less likely that excess cholesterol in the blood will be deposited in the coronary arteries. HDL cholesterol is often referred to as the "good" cholesterol so a higher HDL number is good.

Triglycerides are another form of fat in the body and can be broken apart for those good things the body needs. An excess of triglycerides is converted by the liver into LDL and transported through the blood for storage in the body.

Food Fats

There are various ways of categorizing fat in the foods we eat, but the familiar Nutrition Labels required on most foods today break fats down into saturated, polyunsaturated, and monounsaturated fats and also outline cholesterol and trans fat.

What about cholesterol? Because high cholesterol in the blood is bad, eliminating it from the diet might seem the correct course of action. However, research has shown that saturated fats and trans fats raise LDL levels in the blood more than cholesterol in the diet. Remember that our bodies can make cholesterol from saturated fat even if we eat no cholesterol at all.

Now, to distinguish between the other good-for-you fats and the not-good-for-you fats, an elementary chemistry lesson is needed. Simply, fats are made up of carbon, oxygen and hydrogen atoms. A fat that is "saturated" is stuffed full of hydrogen, which is the easiest element to take on and off. A monounsaturated fat is missing some hydrogen. A polyunsaturated fat is missing even more hydrogen. That's it--we're done with chemistry!

Good fats are the monounsaturated and polyunsaturated fats and vegetable oils-found in foods like canola and olive oil-which can reduce LDL (bad cholesterol) and increase HDL (good cholesterol). Nuts and vegetable oils are the best sources of mono and polyunsaturated oils. Generally, the good fats are soft or liquid at room temperature.

Then there are saturated fats. These are fats that are generally solid at room temperature. They raise LDL levels and contribute to the risk factors for heart disease. Think butter or the fat in steak. Animal fats are usually saturated.

Another type of fat came into being through modern food manufacturing techniques, hydrogenated fats. Hydrogenation is the process by which vegetable oil is saturated, or stuffed full of hydrogen, until it is becomes a solid fat. Think shortening and hard stick margarine. The result of this is the production of trans fatty acids, also called trans fats, which are formed when manufacturers turn liquid oils into solid fats by adding hydrogen. So not only is hard margarine or shortening a saturated fat (not good for you), but it also contains trans fat as well.

Why do manufacturers continue hydrogenating oils? It increases shelf life. For example, crackers will stay fresh and crisp longer. It increases stability of food products, including taste, so they do not go rancid as quickly. Both oils and butter go rancid quicker than a hydrogenated fat.

Trans fats are found in vegetable shortenings, some margarines, crackers, cookies, snack foods and other foods made with or fried in oils that are fully or partially hydrogenated.

Trans fats are also found naturally in small amounts in some foods like beef, pork, lamb, milk and butter. Most trans fats we eat come from processed foods. See Figure 1 for percentages that make up American diets.

The labeling of trans fat began in 2006 and today's consumers have a greater awareness of what trans fat is. For this reason, manufactures want to reduce trans fats in foods but are in a bit of dilemma on how to accomplish this without sacrificing shelf life.

What do trans fats do in the body? Like the saturated animal fats they replaced, trans fats contribute to clogged arteries. They raise LDL or "bad" cholesterol levels, contributing to the buildup of plaque in the arteries. Clogged arteries increase your risk of both heart attack and stroke. Other studies indicate even more problems trans fats may cause, including an increased risk of diabetes.

How much trans fat is too much? Research is ongoing, which means there are no definitive answers to that particular question; therefore, no recommendations as to a safe amount of trans fats can be prescribed. It is known that trans fat raises LDL levels, but little is know yet about what it does to HDL levels. The statement can be made that less trans fat in the diet is better and reduces risk factors for heart disease. In the Nurse's Health Study, women who consumed the greatest amount of trans fats in their diet had a 50% higher risk of heart attack compared to women who consumed the least.

Remember that one food will not make or break a person's health or your diet; it is balancing good choices with bad that make a difference in overall health. You can use all the squeeze margarine you want on your toast each morning if it is balanced out the rest of the day. For instance, putting large amounts of margarine on your toast and then eating nothing but cheese (saturated fat) and crackers, snack cakes and cookies, all of which are potentially high in trans fat or saturated fats, is not a healthy choice. Now, is choosing that squeeze margarine a better choice than stick margarine? Certainly! Like all choices for good health, each step counts in the overall picture. Be sure to pay attention to the whole day's intake. For instance, don't be so proud of the squeeze margarine choice that you think that fills the "good choice" quota for the day. It's a step--a good step--but always look ahead to that next step.

Children With Special Needs

Of course, one of the reasons parents must learn to make better food choices is to help the entire family to be healthy. Parents set the example for children. These healthy choices become even more important for parents who have children and adolescents, and even adult children, with special health care needs.

For those who need to gain weight, fat is often a concentrated source of calories that is recommended. It increases calories for children who may not be able to eat a larger volume of food. Therefore, paying attention to the source of the fat and increasing the use of the monounsaturated and polyunsaturated fats is the healthiest choice. While cheese and butter fit this bill, olive oil, canola oil, walnut oil, nuts, peanut butter and avocados are also healthy choices when higher fat intake is needed as a way of gaining weight.

For those who need to lose weight or prevent gain, making healthy food choices is also important. In choosing a variety of foods, some fat is important (remember all those good things fat does for the body that were mentioned at the outset of this article), including increasing the favorable taste of food. Fat also helps the eater "feel full." Additionally, choosing the "good" fats in a diet will decrease health risks for heart disease.

For those with special needs who have very particular eating habits, expanding food choices can be a challenging and daunting task for parents. Compare labels. Brands differ in the choices offered. Your child may only eat one brand of chips or crackers, but try others that have less saturated or trans fat or try to work other foods into the diet through the rest of the day. It may be a slow process, but having the knowledge of which are the best choices enables you, as the parent, to make progress over time.

One other benefit of reducing risk factors through healthy diet and lifestyle choices is to hopefully eliminate the need for heart disease medications. Many children with special health care needs are already on a variety of medications; most of these, like cholesterol-lowering medications, often have interactions or side effects. By lowering saturated fat and trans fat when your child is young, you can reduce the chance that your child will need to take these medications later in life, and even if these drugs do, ultimately, become a necessity perhaps the dosage will be lower.

Lee Shelly Wallace, MS, RD, LDN, FADA, is employed by The Boling Center for Developmental Disabilities (BCDD), a part of the University of Tennessee's Health Science Center in Memphis, TN (www.utmem.edu/bcdd). The Boling Center is an interdisciplinary program that supports children and adults with developmental disabilities and their families through training, service, applied research, information dissemination, planning, and policy development. Ms. Wallace is also the immediate past Chair of the Dietetics in Developmental and Psychiatric Disorders (DDPD), a dietetic practice group of the American Dietetic Association. Ms. Wallace currently serves on the EP Editorial Advisory Board.

Practical Tips For Lowering Consumption Of Saturated Fat, Trans Fat, and Cholesterol While Consuming a Nutritionally Adequate Diet

* Read the Nutrition Facts panel to compare foods. Choose foods lower in saturated fat, trans fat and cholesterol.

* Replace saturated and trans fats (shortening, butter, hard margarines, butter, processed foods) with monounsaturated and polyunsaturated fats, including olive oil, canola oils, soybean oil, corn oil, sunflower oil and foods like nuts, peanut butter and avocado.

* Consider fish. Most fish are lower in saturated fat than other meat. Some fish, such as mackerel, sardines and salmon, which contain omega-3 fatty acids, are being studied to determine if they offer protection against heart disease.

* Choose lean meats, such as skinless, non-fried poultry, as well as lean, un-fried beef and pork, not fried that has had the visible fat trimmed off.

How Do You Keep Up With Trans Fat When You Eat Out?

Restaurants do not have to list trans fats or saturated fats in foods, although some may have that information available, if you ask. Ask. The worst that will happen is they will say they don't have it. Chain restaurants are more likely to have this information available, either in the store or online, as they have a more standardized and reproducible recipe for each food item at each location.

Does Your Dietary Supplement Contain Trans Fats?

Dietary supplements may contain trans fats from partially hydrogenated vegetable oils as well as from saturated fat. Read the label. If a product contains more than .5 grams of saturated fat or trans fat, it must be listed on the label. Some of the supplement products that are most likely to contain saturated fats or trans fat include energy and nutrition bars.

How Food Labels Can Help Or Mislead

Food labels have carried cholesterol and saturated fat information since 1993. Labels had to carry trans fat information starting in January 2006. This information is found on the food label, the "Nutrition Facts Panel", directly underneath the line for saturated fat.

The Nutrition Facts Panel can help you choose food lower in saturated fat, trans fat, and cholesterol. While you might think cholesterol is the most important fat to watch out for, since it is measured in the blood, it's not. The body is perfectly capable of making cholesterol from the fat we eat, so limiting saturated fat and trans fat is the most important step toward reducing the risk factors for heart disease.

How can a food label mislead you? You must pay attention to the details. If a product says "0 grams trans fat" that doesn't mean it's good for you because you also have to look at the saturated fat content. Remember: it is difficult for manufacturers to produce cookies, crackers, and other snack foods that have a long shelf life. So, manufacturers add naturally "saturated' fats into their products, instead, and can still wear the "0 grams trans fat label" proudly. Here's the difficulty; you health risks are also affected by the saturated fat, so READ THE LABELS! Make healthy choices.

As well as paying attention to details, be aware of what the claims that manufacturers make really mean. Cholesterol, for example, is only found in animal products; therefore, all vegetable fats, saturated or not, can be labeled "cholesterol-free". So, solid shortening, stick margarine, crackers or cookies can be labeled "cholesterol free", but they still contain saturated fats and trans fat, which, as has already been established, is not conducive to good health.
Figure 1
Estimated sources of Trans fat in an average American diet

40% cakes, cookies, crackers, breads, pies, and similar foods

17% margarines

13% fried potatoes, potato chips, corn chips, popcorn and similar
 foods

30% miscellaneous items like candy, salad dressings, shortening, some
 cereals, other processed foods and trans fat found naturally
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Article Details
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Title Annotation:Nutrition
Author:Shelly Wallace, Lee
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Feb 1, 2007
Words:2519
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