The trans fats in junk food are responsible for the deaths of around 7,000 people a year in the UK - and teenagers are most at risk. Elsewhere, these toxic substances are banned. So why are they still legal in this country?
This excellent article explains clearly why young people and others on low incomes are the ones likely to pay the highest price for the UK government's current refusal to ban toxic trans fats from our food supply.
The emphasis added in places is our own, as are the links to some of the research and other information cited.
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An investigation by Clare Dwyer Hogg.
When the comedian Micky Flanagan reels out his gag about craving chicken from a local takeaway, he always gets a laugh. Desperate for food, he has to run the gauntlet of teenagers outside. "Teenagers love chicken," he says, imitating the hunched-up shoulders, hands in pockets, hood-pulled-low look so beloved of that age group. He does the mandatory teenage walk across the stage, a kind of stiff-legged bounce. They're the "chicken children", he says. "They come at you from the side." His observational humour is spot-on: takeaways have some sort of gravitational pull for a lot of teens as they spurt up, always starving. And if the food is cheap? All the better.
Cheap and greasy aside, it should be a reasonable assumption that the convenience food and snacks British teenagers might be inclined to eat – while not exactly coming top of the healthy eating list – won't contain any substances that are actually toxic. If you're raising your children in Denmark, for instance, or Switzerland, or even New York City, with its plethora of delis and fast-food outlets, you could be pretty sure that this was true: the law says so.
But if they're eating food in the UK, it's best not to assume so. Within many shop-bought pastries, cakes, doughnuts, crisps, processed meats, soups, frozen food, biscuits, chocolate bars, breakfast cereals and takeaway food, exists an ingredient that the World Health Organisation (WHO) declared toxic in 2009. It's hydrogenated vegetable oil, otherwise known as trans fat, and it doesn't even have to appear clearly on ingredients labels. Have a look, and you might find it called 'shortening', or 'hydrogenated fats', maybe 'hydrogenated vegetable oils' (HVOs), perhaps 'partially hydrogenated vegetable oils' (PHVOs), or... not mentioned at all.
Whatever they choose to call it (there's no regulated terminology) it's one of the food industry's handiest industrial ingredients. The process of hydrogenation, in use since about 1900, works miracles: it hardens up liquid oil, making it last much longer, so that it increases shelf-life; it's significantly cheaper than using butter or non-industrialised ingredients; and it willingly transforms according to what a particular food might need – it can make a doughnut glaze more velvety, increase the bulk of a pastry, or add bite to something crunchy. But when it's ingested, our bodies don't know what to do with it.
It's toxic, so it clogs up arteries, raises 'bad' cholesterol, and reduces 'good' cholesterol. Its nutritional values are zero. Experts have compared it to eating candle wax or melted Tupperware. Which is why trans fats have been banned in Denmark, Switzerland, Iceland, Sweden, Austria, New York City, Seattle, and the state of California. But not in the UK.
Here, last year, the NHS watchdog NICE published recommendations that the Government completely eliminate industrialised trans fats from processed food and takeaways. Paul Lincoln, Guidance Developer and Chief Executive of the National Heart Forum, who was on the board, said at the time that, among other things, the recommendations were to "help to promote and protect the health of children and young people, especially the most vulnerable and disadvantaged. We have the public health evidence on how to virtually eliminate these conditions (heart disease and stroke), so it's vital to take action now to save lives."
He was making a link between the presence of trans fats in certain types of food and how socio-economics had a real bearing on who would be eating those foods.
That idea holds, if the shops that were first to ban trans fats are anything to go by. Waitrose, Marks & Spencer, and the Co-operative are now completely free of trans fats in their own brands, and were so long before the Government initiative. They're undeniably upmarket. And because there isn't an outright ban across the country, it makes sense to conclude that it depends where you shop whether your everyday food will contain trans fats or not.
But that's if you know what they are. Even if you do know, label-reading takes a certain type of dedication. Teenagers are as capable of reading a label as the rest of us, but if most adults don't know what trans fats are, it's fair to say that teenagers just might be thinking about other things.
In the light of last month's findings that about 40 per cent of us will be obese by 2030, Lincoln's hopes have an even darker shadow cast over them. The teenagers today are the adults of tomorrow. The NICE report predicted that of the 150,000 cardiovascular disease deaths this year, 40,000 could be preventable, with a combination of eliminating industrial trans fats, and lowering salt and saturated fat intake. That would save the NHS over £1bn.
But the recommendations weren't greeted happily by the food industry, represented by the Food and Drink Federation. When the report was published, spokesman Julian Hunt told the BBC, "We're surprised that NICE has found the time and the money to develop guidance that seems to be out of touch with the reality of what has been happening for many years". He explained that big business was already dropping the trans fat levels to below the levels that the WHO recommended. He was referring to the upmost levels of 2 per cent (trans fats do occur in some foods naturally in small amounts) that the food industry were seeking to comply with.
The president of the Royal College of Physicians, Professor Sir Ian Gilmore, responded equally strongly to support the NICE findings, saying the recommendations would cost "the public purse little to nothing" and that "profits of private firms ought not to take precedence when compared with the health of the more than four million people at risk in this country".
Regardless, instead of an outright ban, the Health Secretary Andrew Lansley launched, on 15 March this year, the Public Health Responsibility Deal, under which signatories sign a voluntary pledge to remove artificial trans fats by the end of the year. Asda, Pizza Hut, Burger King, Tesco, Unilever and United Biscuits are some of 73 businesses who have agreed to do so.
The forerunner to this, a draft health manifesto written by a group Lansley drew together called the Public Health Commission, had already involved private business in the consultation process. Led by David Lewis, chairman of Unilever UK, it was a mix of health professionals and big business, including Tesco, Asda and Diageo. This led to conspiracy theories, and one accusation printed in Private Eye magazine in July 2010, suggesting that until 2009, when he was still in opposition, Andrew Lansley was receiving £134 an hour for his services to an advertising agency that represented Walkers crisps, Pizza Hut, Mars and others.
"According to the register of members' interests," Private Eye wrote, "the then opposition health spokesman supplemented his parliamentary salary earning around a £1,000 a month from a London 'Digital Marketing Agency' called Profero for 'attending board meetings and advising on strategy and vision'."
Andrew Lansley was not available for interview for this article, but on his role for Profero, an aide said "all these interests were declared before the general election" and Lansley was "not in any client facing role, but was a non-executive director". A spokesperson from the Department of Health answered questions over e-mail about the Public Health Commission. Like the Food and Drink Federation, they pointed to "dramatic reductions in trans fats levels in foods... by UK businesses", and justified a voluntary approach as "more proportionate" than an outright ban. They noted, "intakes of trans fats are well within recommended levels", referring to research that says average intakes for adults and children across the UK (0.8 per cent) are around half the maximum average recommended by the Scientific Advisory Committee on Nutrition.
But many health professionals are not happy with the voluntary nature of the deal. Simon Capewell, Professor of Clinical Epidemiology at the University of Liverpool, was on the NICE body that recommended a ban, and has a problem with using average intakes as a justification. There are pockets of ethnic minorities, young people and those in deprived areas, he says, who will be consistently eating food with higher levels of trans fats. Their intake, when lumped in with the whole country, may produce an average that is apparently low, but that doesn't mean it's representative of what's happening on the ground.
"Mr Lansley and the Department of Health have shifted the focus to supermarkets and the big-hitters," he says. "But at the other end, small outlets for fast food, takeaways, kebabs, fry-ups? Heaven knows what's happening. When you measure trans fat, sometimes it's low and sometimes it's high... The Government's current approach is not to measure it at all, but instead pretend it's not happening."
The problem with the little takeaways and local chicken shops is that often the oil they use to fry their food contains trans fats. And the more the oil is heated and reheated, the more trans fats increase. By definition, the more sloppy the practices of the particular café, the higher the content of trans fats.
Are these the places that teenagers are likely to shop, or will they choose Waitrose and M&S down the road? "Young folk think they'll live forever," says Capewell. "They have limited money and limited information from government; junk food is cheap and convenient. This is also increasing the inequality between rich and poor."
By contrast, in Iceland, Denmark and Sweden, among others, it doesn't matter where you choose to get snacks or fast food: a very low limit in the amount of trans fats that are legally allowed in cooking oil – less than 2 per cent – means the amount that any one person ingests is trivial. In fact, data shows that in Demark, consumption of trans fats has dropped to around zero.
Back in the UK, in a British Medical Journal (BMJ) editorial last year, Dr Dariush Mozaffarian, researching at Harvard University, suggested that industrial trans fats are killing about 7,000 Britons a year. "There's amazing government complacency in the UK," Capewell says. "Trans fat intake is down to 1 per cent on average, yet it's still killing 5,000-7,000 people a year... The link between smoking and lung cancer was discovered in 1952, but tobacco advertising was not banned until 2004. The industry had a 50-year successful run of ... voluntary agreements. Does Mr Lansley want to repeat that for his friends in the food industry?"
Dr Mozaffarian, speaking to me over e-mail, agreed: "Voluntary efforts can help but do not work nearly as well as direct limits," he writes. "The influence of industry lobbying is the only plausible reason not to institute a ban. There is no reason to have industrially-produced trans fats in the food supply."
Health professionals seem in no doubt that trans fats are bad news. Dr Pelham Barton, writing in the BMJ on 28 July, believes that "a strategy to reduce consumption of industrial TFAs trans fats by even 1 per cent of total energy intake would be predicted to prevent 11,000 heart attacks and 7,000 deaths annually in England alone". Barton was concerned, too, at the effects these toxic substances are having on young people. He called for a national policy to "protect all susceptible populations including children and socio-economically disadvantaged sub-groups". This is just one voice among many.
One notable pioneer in the field is Doctor Alex Richardson at Oxford University. A senior research fellow, and founder director of the charity, Food and Behaviour Research, she's interested not just in what happens to the body when trans fat are ingested, but their effects on the brain. This is particularly pertinent when it comes to teenagers, and those with attention-deficit problems. Given that 60 per cent of the brain's dry mass is fat, she says, what type of fat we eat matters. "The problem is the industrialisation of food, when food is turned into a commodity," Richardson says. "Good foods make bad commodities; good commodities make bad foods."
She describes partial hydrogenation of vegetable oils as "twisting, warping, making the molecule the wrong shape". And the shapes of molecules are, she says, hugely important. "It's like a key that needs to fit a lock, and trans fats are literally twisted, warped versions of natural polyunsaturates... That makes them bad."
She cites research earlier this year into how trans fats react with some drugs, which showed that in combination with repeated amphetamine use, trans fats exacerbate the well-known psychotic effects. "This is a common street drug, and we also give amphetamines to ADHD children, albeit at much lower doses," she says, referring to medications like Ritalin. "This study showed that trans fats can increase the physical brain damage and manic behaviour associated with amphetamine abuse."
She points to other research, outlined in a paper this year, which shows that in students with a remarkably low average intake of trans fats (just 0.4 per cent of calories), their risk of depression over six years of follow-up was directly linked to their trans fats intake in a dose-dependent manner. "There was a 50 per cent increase in depression in the highest consumers of these toxic substances versus the lowest," Dr Richardson says. "How can this and the abundant evidence of physical health problems continue to be ignored, when there's literally no benefit to trans fats, apart from to the food industry's profits?"