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Hydrogenated Oils and Trans Fatty Acids PDF Print E-mail
Monday, 30 March 2009

Image“There are two primary choices in life; to accept conditions as they exist, or accept the responsibility for changing them,” (Denis Waitley).

By Elena Voropay

If you were ever wondering why margarine are made of mostly Polyunsaturated vegetable oils yet they are solid, than here is the answer – margarine are oils bombarded with hydrogen.

Saturated lard is solid; Monounsaturated olive oil is cloudy in the fridge but liquid at room temperature; Polyunsaturated sunflower oil is liquid even when refrigerated. However, all oils which have been Hydrogenated remain solid and easy to use in cooking. All sides of the dietary controversy have come to the conclusion that any unnatural foods are bad for you. Just how bad depends on how much of your income depends on them. Very few foods are ever considered universally bad, and Partially Hydrogenated Vegetable Oils and Trans Fats are among these villains.

While vegetable shortenings are Cholesterol-free foods which were thought were healthy, new evidence suggests otherwise. Turning natural healthy oils into chemical concussions and promoting them as “health items” was another mistake made by greedy manufacturers from premature science conclusions.
 
The Story of Margarine

The roots of Hydrogenated Oil can be traced back to the discovery of  margaric acid in 1813 by Michael Eugene Chevreul. When Chevreul noticed the milky drops in his invention, he called this butter substitute after the Greek term for pearls, margarite. Margaric acid, like oleic acid and stearic acid, is one of the three fatty acids, which, in combination, formed most animal fats. In 1853, the German structural chemist Wilhelm Heinrich Heintz analysed margaric acid as being simply a combination of stearic acid and of the previously unknown palmitic acid.

Later, Emperor Louis Napoleon III of France offered a prize to anyone who could make a satisfactory substitute for butter which was then scarce and expensive. Hippolyte Mege-Mouriez won the competition in 1869 for the item. A substance he invented was first called oleomargarine, the name of which became shortened to the trade name "margarine" after its primary ingredient, margaric acid.

The manufacturing process involved oleo oil from beef tallow which was churned at 25 to 30 degrees Centigrade (77 to 86 degrees Fahrenheit) with water or milk. Later, other animal fats and vegetable oils were substituted in the process. In modern times margarine is manufactured from an oil or combination of oils through the process of hydrogenation.

Hydrogenation was developed in 1890s by Paul Sabatier, a French chemist who became a Nobel laureate in 1912. Sabatier summarised all this pioneering works in his book La Catalyse en Chimie Organique, which was translated into English by E.E. Reid in 1922 as Catalysis in Organic Chemistry.

Trans Fat is the first man-made fat to join our food supply. It was known that Trans Fats are present in Hydrogenated oils since 1902 thanks to the discovery a scientist named Wilhelm Normann who patented the process. Normann's patent would eventually revolutionise the world of oils and fats and change the eating habits of the world.

Image In 1905 Joseph Crosfield and Sons, Ltd. of Warrington, one of the three largest soap makers in England, made an agreement with Normann enabling them to work on perfecting the patented process. A year later, the first small runs of Hydrogenated oils for soaps were made later progressing to vast commercial possibilities.

Around this time electricity became commercially available and the candles made from crystallised cottonseed oil were not as popular anymore. As the sales dropped, various manufacturers started looking for new ways to market cottonseed oil. The greatest early potential for the use of hydrogenation lay in the United States is credited to the company Procter & Gamble in Cincinnati which acquired the US rights to the Normann patent. In 1907 Procter & Gamble created a solid fat (from cheap liquid cottonseed oil) that could be used as an inexpensive substitute for tallow in candle and soap making. The product was dubbed “Crisco” and sold as a substitute for butter and lard. The method of hydrogenation was perfected around 1910.

After the Second World War the process for making Hydrogenated and hardened fats from cheaper sources of vegetable oils was widely adopted. Margarines were developed and marketed as alternatives to butter, and vegetable shortenings increasingly replaced the animal fats in cooking.
Image
Before the use of hydrogenation, the production of shortening and margarine had been entirely dependent on animal fats as a source of raw materials. Increased demand soon caused these to grow scarce and expensive. So, the initial margarine production was triggered by the low cost of oils and shortage of expensive butter. Later, in the middle of the 20th century, health advocates brought intense pressure against the fast food industry for its heavy use of Saturated Fat implicated it in killing tens of thousands of Americans every year. In 1957 the American Heart Association first proposed that reducing dietary fats, namely Saturated Fats found in foods like butter and beef, can reduce the chance of getting heart disease. As we would expect, the fast food industry quickly decided to move to vegetable oils but found them unusable.

This is where the Partially Hydrogenated Vegetable Oils saved the fast food industry. Animal fat and tallow are very durable at high temperatures, resistant to rancidity and will stay “fresh” for many months. But this is the dangerous fat, the one that we tried to avoid at all costs. What were the options? Vegetable oils. However, in their natural states, most vegetable and grain oils are liquids, degrade quickly at high temperatures and rapidly became rancid. This not only worsens the taste of food, but ladens it with toxins. Therefore, vegetable unsaturates are unsuitable to be used in many commercial food products and baking. To ensure the customers will come back for the items, you'd have to change the oil on practically a daily basis - very expensive. To overcome this, manufacturers "stiffen" Polyunsaturate Fats up by partially and fully hydrogenating them.

Before food makers add vegetable oil to cookies, crackers, doughnuts, French fries and other stuff, they heat the oil and force Hydrogen ions into the double bonds of the Polyunsaturated and Monounsaturated Fatty Acids at high pressure. This makes the Hydrogen atoms bond to the Carbon atoms and turns liquid into solid. The new substance turns from liquid healthy oil in what is now called Hydrogenated oil.

What Is Margarine:
Oil, Butter, Margarine – Trans The Difference

What makes Hydrogenated Fats different from butters and oils? All fatty foods consist of chain-like molecules. In Saturated Fats these chains are very flexible. During hydrogenation, the hydrogen atoms are on opposite sides of the carbon chain and the molecule has a more linear configuration, like that of a Saturated Fatty Acid. This is called the trans form. By contrast, the molecules in vegetable oils have rigid kinks which restrict their flexibility. In nature, the Polyunsaturated Fatty Acids are usually found in the form where the hydrogen atoms are attached to the carbons on the same side of the carbon chain. It is called the cis form which allows the molecule to bend at the double bond. The more flexible the chain the more easily it can become a hard fat on cooling, so vegetable oils are more likely to stay liquid at room temperature.

So, cis and trans are terms that refer to the arrangement of chains of carbon atoms in a fat molecule. Full hydrogenation of fats turns cis double bonds into trans – hence the name. Partially Hydrogenated Oil can be called margarine, shortening, Trans Fat, or Trans Fatty Acid. After hydrogenation, Trans Fats become similar to Saturated Fats but their structure lacks the metabolic activity of Saturated Fats.

Why Trans Fats Are Added To Foods

Hydrogenated vegetable oils are as creamy as natural butters, less reactive than oil and less expensive to make and preserve. Because these fats are resistant to heat, air and rancidity, turning Unsaturated oils into margarine extends the shelf life of all foods made with these fats, improves texture and flavour of cookies and cakes so that our mouths and tongues feel the crunch, the palatability and the full saturated “shortness” of plain flour and sugar. Fresh and sweet, with a nicely acidic edge, Hydrogenated Fats in baking softens the flour and prevents the formation of  long strands from gluten protein, so baked foods remain tender.

Another reason manufacturers use shortening in a cookie recipe is that oil saturation also raises the melting point of a fat - it melts at a higher temperature, so the dough holds its shape longer in the oven, allowing the flour and eggs to set. This doesn't let the cookies to collapse or spread very much keeping them firm, thick and chewy.  That’s why commercial baked goods use shortening – it makes the food taste good and last forever.

 Fully Hydrogenated vegetable oils will be completely solid and can become almost as hard as a rock.Image Partially Hydrogenated oils will be solid, yet softer. All of these features make it very convenient for manufactures who add artificial colouring to margarine to give it a golden "butter" colour - otherwise it would resemble an unappetising wax. However, vegetable shortening adds nothing to the flavour and “bakes out” all the otherwise beneficial nutrients of a cookie, but virtually all store-bought cookies are made with it. Using butter or margarine (which has a melting point only a degree or two above butter) produces a cookie that spreads out more.

While margarines are solid at room temperature and fully saturated with hydrogen, they do not behave the same as natural butters. The dangerous part is that this oil solidifying produces massive quantities of "trans" fatty acids (so named because of their physical structure).

The Good Trans Fats -
Yes They Exist!

With all the talk about hydrogenation, let me clearly state that there is such a thing as healthy natural Trans Fats. Yes, they exist and are very different from man-made creations. Natural Trans Fats are made in the stomachs of ruminant animals such as cattle, sheep, goats, and make their way into the fat stores of the animals. Therefore, the milk fat and the fat within the meat of these animals can provide natural healthy Trans Fats. These have been thought to have some potential benefit to aid in both muscle building and fat loss efforts. Keep in mind that the quantity of healthy Trans Fats in the meat and dairy of ruminant animals is greatly reduced by mass-production methods of farming – grass-fed free-range animals have plenty of healthy fats, but grain- and soy-fed animals don't.

One such natural Trans Fat that you may have heard of is called Conjugated Linoleic Acid (CLA) which has been isolated and marketed by many supplement companies as an ergogenic aid. One thing to keep in mind is that a lot of CLA pills you see in the stores are artificially made from plant oils. Check out the source of the product and whether it comes from a reputable company before you waste your money of a faulty product. Once again, man-made stuff just doesn't compare to the benefits of natural sources.

Is Margarine A “Healthy Butter”?

Because it was thought that animal fats raise total and bad (LDL) cholesterol levels and vegetable oils lower it, margarine seemed to be a better alternative. It was known that hydrogenation produces Trans Fats, but initially these were thought to be better than saturated fats since they come from plant oils. The artificial hardening of vegetable oils by hydrogenation unexpectedly changes molecular shapes during the process and forms unhardened Trans Fats, which cannot be properly digested by the body. Before we found out how these Trans Fats act in our bodies, we were eating tons of them thinking that these were as healthy as heavily promoted oils. It seemed to work, and we didn't know any better. Weight for weight, Trans Fats are probably worse for your heart than the Saturated Fat that we tried to avoid.

Although many researchers in 1970s knew the dangers of Trans Fats, their voice of reason was lost to the huge lobbying power of the edible oil industry. However, in 1990 scientists made a startling discovery: Trans Fats found in Partially Hydrogenated oils may be even worse than any other fats known to man. As nutrition labels became a hotly debated topic, scientists and food manufacturers argued over whether to require a separate listing of Trans Fat content on food packages.

The Health Price of Trans Fats

Ingesting a tiny bit of Trans Fats probably won’t kill you if these come in trace amounts from natural sources found in dairy and meats. But eating a lot of them will help kill tens of thousands of people each year. In high quantities, the Partially Hydrogenated Unsaturated Fats lose their health benefits and become some of the most toxic and dangerous "food" elements you can put into your body. It is not too difficult to overeat Trans Fats because the range of uses runs a wide gamut and hides in countless food items. In cooking, margarine is often employed as an ingredient in the making of pie crusts, cakes, casseroles, biscuits, pizza dough and many desserts. Margarine spread is often found at the breakfast table, providing a quick and tasty addition to toast, potatoes, bagels, and English muffins. Melted margarine also works well as an additive to hot cereals and a topping on cooked green vegetables. At snack time, melted margarine is an excellent topper for freshly popped popcorn.

Several decades of research show consumption of Trans Fatty Acids promotes heart disease, cancer, diabetes, immune dysfunction, obesity and reproductive problems. Trans Fatty Acids raise serum levels of LDL-cholesterol, reduce levels of HDL-cholesterol, can promote inflammation, cause endothelial dysfunction, and influence other risk factors for cardiovascular diseases.

Hydrogenated oils are so dangerous that the World Health Organisation urged all member countries to outlaw it decades ago (in 1978). Man-made Trans Fats are right up there with smoking, binge drinking, sedentary lifestyle and lack of sleep all combined in terms of their degree of danger to your health. After all, they are one of the factors for the explosion of heart disease since approximately the 1950's.

According to a paper published in the American Journal of Clinical Nutrition, 30,000 premature deaths per year are attributed to Trans Fats. If Americans can detect the danger in food labels and cut back on Trans Fats, this would prevent 6,300 heart attacks a year, says the U.S. Food and Drug Administration. In addition, eliminating Trans Fats in just 3% of breads and cakes and 15% of cookies and crackers would save up to $59-billion in health care costs in the next 20 years, predicts the FDA.

Would You Like Your Fat With That?

Being a chemically-treated vegetable oil with artificial yellow colour and artificial flavourings to make it seem like butter, Hydrogenated oils and margarine are almost indigestible, they can't be properly broken down by the body's digestive enzymes, release free radicals which adds to the body's toxic load. Researchers found that Trans Fats interfere with the activity of a cell receptor involved in inflammation, glucose metabolism and change the way your body responds to foods, supplements and training. The news is even worse for bodybuilders. Unlike natural Saturated Fats and Polyunsaturated Oils, Trans Fats:Image

  • weaken the immune system
  • slow down the recovery
  • enhance muscle breakdown
  • increase abdominal fat
  • decrease Testosterone levels
  • limit tissue growth
  • lower Insulin sensitivity
  • increase C-reactive protein, a marker of inflammation
  • alter liver enzyme activity
  • accelerate ageing


In short, they speed up every reaction which prevents you from being what you want to be – healthy, strong and young.

Trans Fats lead to heart disease.

If you thought Saturated Fat, Cholesterol, processed sugars were dangerous for the heart, then Trans Fats are murderous. First, Trans Fats lead to high levels of lipoprotein Lp(a), a type of “bad” LDL cholesterol which clearly increases your risk of heart disease. When this lipoprotein is elevated, it slowly kills the heart, even independent of other cholesterol levels.

Not only Trans Fats increase “bad” LDL cholesterol, but they also strip levels of “good” HDL cholesterol, the kind that helps unclog arteries. With less good cholesterol and more bad cholesterol, you become more likely to have hardened, clogged arteries adding to our risk of cardiovascular disease. When you eat foods with Trans Fats, that bad cholesterol builds up as plaque on the inside of your artery. One day, a little piece of that plaque will break off, your body will try to clot up the nick in the artery, and you may be on your way to the Heart Attack or Stroke City.

Trans Fats make you fatter in the belly.

A burger a day gives you a bigger “beer belly” - no beer required. When you control the total dietary calories, eating a diet rich in Trans Fat makes you gain more fat than if you simply eat the same foods with healthy essential fats. If this is not bad enough, Trans Fat causes a redistribution of fat tissue into the belly. This is the conclusion of the study conducted by the researchers at Wake Forest University Baptist Medical Center over a period of six years.

Two groups of monkeys were supplied just enough food to maintain body weight. Their diets were identical in every respect with the same amount of total fat of 35% of all calories. The difference was in the source of the fat. One group ate a diet with 8% of its calories from Trans Fats, equivalent to one fast-food burger-and-fries meal a day. The other group ate same foods except the Hydrogenated Oil was substituted for a healthy Monounsaturated Fat found in olive oil. While both groups ate the same total calories, just enough for subsistence, interestingly, all monkeys gained weight.  

After six years on the diet, Trans Fat-fed monkeys gained an extra 7.2% of their body weight, compared to just 1.8% in the control monkeys. Using CT scans the researchers estimated the amount and position of body fat in the monkeys and noted that the monkeys gained the excess body weight primarily in their abdomen. Burger-monkeys had 30% more abdominal fat, which increases the risk of diabetes and heart disease.
 
The purpose of the study was to determine the relationship between Trans Fat and atherosclerosis. The abdominal fat discovery was completely unexpected.
Trans Fats prevent the body from using essential Omega fats properly.

Essential fatty acids (EFAs) are nutrients that your body needs to be able to function properly. EFAs are absolutely critical to building muscle while increasing stamina required for bodybuilding. These healthy fats are the building-blocks used to produce other fatty acids that your body requires to rebuild muscle tissues and protect joints while working out. Unlike other types of fat, they are used for body functions instead of being stored as fat. EFAs are also required for brain functions, nerve tissue development, mood regulation, metabolism, hemoglobin production, and hormone production. On top of all that EFAs assist the liver with breaking down protein from your diet to build muscle, have anti-inflammatory properties and boost your immune system.

Even if you consume plenty of the naturally occurring Essential Fatty Acids together with Trans Fats you may be deficient in vital nutrients. The reason is that after hydrogenation, Trans Fats actually inhibit the activity of an enzyme desaturase which is used to synthesise highly unsaturated fatty acids such as EPA (eicosopentaenoic), DHA (docosahexaenoic acid) and AA (arachidonic acid). Not only the natural wonders of oils are destroyed when fats are Hydrogenated, their consumption limits the amount of EPA, DHA, and arachidonic acid to be absorbed. When you eat margarines with their Trans Fats instead of butter and healthy natural oils, you actually displace essential fats from your diet which brings a host of health problems.

Trans Fats increase the chances of getting cancer.

At the start of 2008, researchers from Harvard reported that increased intakes of Trans Fatty Acids may increase the risk of cancer and non-aggressive prostate tumours by up to 100%! The study published in the January issue of Cancer Epidemiology Biomarkers & Prevention (Vol. 17, pp. 95-101) found that the highest blood levels of Trans Fats (oleic acid 18:1n-9t and linoleic acid 18:2t) were associated with a 116% and 97% increase in the risk of non-aggressive prostate tumours, respectively, compared to the lowest levels. Furthermore, the fats may also raise the risk of breast cancer by 75%, according to data from the French part of the European Prospective Investigation into Cancer and Nutrition.

Trans Fats effect fertility.


The more Trans Fats a woman eats, the more likely she is to be infertile. Researchers from the Harvard School of Public Health in Boston have found that eating just 2% of the total daily calories from Trans Fats instead of healthier monounsaturated fats can reduce women’s chances of conceiving by 70%. For a woman eating 1,800 calories a day, 2% of energy intake in Trans Fats equals 4 grams. In the study, the researchers looked at 18,500 women trying to conceive, and found 438 cases of ovulary problems.

Win The Lottery Of Trans Fats In Food


It is amazing how easily fat substitution can change the way we eat and learn to like our foods. If your taste buds are trained to eat processed foods, you may not detect the artificial ingredients and even may crave them more. This is particularly true for delicacies made with Trans Fat. The worst bit is that this tolerance builds up slowly. It is like an addiction – the more of them you eat, the more you want to eat. Limiting or cutting Trans Fats and saturated fats out of your diet will go a long way toward keeping that beautiful heart of yours nice and healthy.

Most North Americans consume 10-15 g of Trans Fatty Acids per day. Ideally we should consume none. Now the U.S. Food and Drug Administration recommends that you eat less than 2 grams of Trans Fats per day. For perspective, a single donut can have as much as 5 grams of Trans Fat.

The good news is, food companies are gradually lowering the level of Trans Fat in their products. The United States is leading the way, due to a series of court cases against food companies (notably Kraft with its Oreo biscuits, and McDonalds with its cooking oil).

Image To help us eat, live and be merry, the Food and Drug Administration made it mandatory in 2006 for food manufacturers to list Trans Fats content of packaged foods ensuring that you get less than the 2-gram daily maximum.

Unfortunately, this can be trickier than it seems thanks to a loophole in labelling laws. Your best move is to religiously read nutrition labels and make sure any food you eat contains zero grams of Trans Fats. Many packaged food items in your grocery store will have "No Trans Fats!" boldly splashed across the front of the box. According to government regulations, all products which contain less than 500 mg Trans Fat per serving can be labelled as "zero grams" Trans Fat. But look at the list of ingredients, and you will see: "Partially Hydrogenated soybean oil." Scan the list of ingredients and look for shortening or Partially Hydrogenated soybean oil. If they're listed, you're about to dive into some Trans Fats, no matter how much the rest of the packaging denies this fact. Incredible.

If a food contains up to 0.49 gram of Trans Fats per serving, it will read as zero grams of Trans Fats on the label. That's not all that big a deal if you consume only one serving and only this one food per day. Who eats the standard minuscule serving sizes nowadays, especially if the food is yummy and loaded with protein, like the sausage? Bodybuilders need more nutrients than the average couch potato eating ten serving sizes of the trans-loaded food per day!  And those five servings could serve you up to 4.9 grams of Trans Fats, twice as much as what the AHA recommends!

A good example of this would be commercial peanut butter, which contains a tiny amount of Partially Hydrogenated Oil to prevent separation. Second, products that contain fully Hydrogenated oils are Trans Fat free. Crisco's Trans Fat free shortening falls into this category.

Sometimes the terms "Hydrogenated" and "Partially Hydrogenated" are used interchangeably. Fully Hydrogenated oils have more saturated fats and will be Trans Fat-Free. If a package simply lists "Hydrogenated oil," without expressly stating whether it is partially or fully Hydrogenated, it may or may not be Trans Fat free.

Better yet, if you see the terms "Partially Hydrogenated" or "Hydrogenated" oil of any kind, drop the junk and walk away. After all, you are not starving for a processed food. If anything, your body craves quality nutrients from natural wholesome ingredients.

If you decide to try one of these new margarines, be prepared to spend a few more dollars when you go shopping as they cost significantly more than regular margarine.

Recommendations For Trans Fats


Until manufacturers are required to tell you the exact level of Trans Fat on the label, your best chances of minimising the amount you eat are to stay away from processed foods. As far as the rest of your diet, there are no other naturally occurring fats that you should always avoid as long as you take a balanced approach to fat intake.

Avoid deep-fried fast foods and take-aways.

Instead of eating manufactured biscuits, cakes and pies, bake your own treats with all natural ingredients. This way, you can tailor each recipe to your own needs and taste. Why bake cookies at home instead of picking one of the hundreds of packages off the shelf at the grocery store? Because you can make a cookie that tastes a lot better, is healthier and may have all the goodness of the natural ingredients than store-bought. From my perspective of taste, nourishment and versatility of use,  butter wins hands down. Some people may disagree, however, and this is a democracy, after all.

Choose liquid vegetable oils, or try soft spreads that contain no Trans Fats.

Many margarines, shortenings and spreads are now available with low or zero levels of Trans Fats. To be clear: just because the fat is low in Trans Fats, it is not low in fat. One tablespoon of Trans Fat-Free shortening contains 110 calories, 12g of fat, 3g of which is saturated. It is cholesterol free, however.

Two new spreads have appeared in the margarine and butter section of the grocery store that specifically address the issue of Trans Fats and blood cholesterol levels. They are called Benecol and Take Control. Both of these products contain substances derived from plant sources such as vegetable oils, soybeans, and corn called plant sterols. These compounds are thought to be effective in reducing blood cholesterol levels by blocking the absorption of cholesterol in the digestive tract, thereby lowering the bad LDL cholesterol while maintaining the good HDL cholesterol.

References


Food Labeling: Trans Fatty Acids in Nutrition Labeling. Government Publishing Office.

Ascherio A, Hennekens CH, Buring JE, Master C, Stampfer MJ, Willett WC. Trans-fatty acids intake and risk of myocardial infarction. Circulation. 1994; 89:94-101.

Bernard-Gallon DJ, Vissac-Sabatier C, Antoine-Vincent D et al. Differential effects of n-3 and n-6 polyunsaturated fatty acids on BRCA1 and BRCA2 gene expression in breast cell lines. Br J Nutr 2002 Apr;87(4):281-9 2002.

Chavarro Jorge E, Rich-Edwards Janet W, Rosner Bernard A and Willett Walter C (2007-01). "Dietary fatty acid intakes and the risk of ovulatory infertility". American Journal of Clinical Nutrition 85 (1): 231–237. PMID

Katan MB, Zock PL, Mensink RP. Trans fatty acids and their effects on lipoproteins in humans. Annual Review of Nutrition. 1995; 15:473-93.

Kaufman M. McDonald's To Give Fat A Break; Fast-Food Chain to Use Healthier Oil for Cooking. Washington Post: Sept. 4, 2002, A07.

Lopez-Garcia, E., Schulze, M. B., Meigs, J. B., Manson, J. E., Rifai, N., Stampfer, M. J., et al. (2005). Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J Nutr, 135(3), 562-566.

Lovejoy, JC (2002). "The influence of dietary fat on insulin resistance". Current Diabetes Reports 2 (5): 435—440. PMID 12643169.

Mahfouz M (1981). "Effect of dietary trans fatty acids on the delta 5, delta 6 and delta 9 desaturases of rat liver microsomes in vivo". Acta biologica et medica germanica 40 (12): 1699–1705. PMID 7345825.

Mozaffarian D, Pischon T, Hankinson SE, et al. Dietary intake of trans fatty acids and systemic inflammation in women. American Journal of Clinical Nutrition. 2004; 79:606-12.

Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006 Apr 13;354(15):1601-13.

Mozaffarian, D. Trans Fatty Acids-Effects on Systemic Inflammation and Endothelial Function. First International Symposium on Trans Fatty Acids and Health. 2006; 7: 29-32.

Pelletier, Allen et al. Patients’ Understanding and Use of Snack Food Package Nutrition Labels. The Journal of the American Board of Family Practice. 2004; 17: 319-323.

 
Skeaff, Murray et al. Home use of margarine is an important determinant of Plasma Trans Fatty Acid Status: a biomarker study. British Journal of Nutrition. 2006; 96: 377-383.

Thomas LH, Jones PR, Winter JA, Smith H. Hydrogenated oils and fats: the presence of chemically-modified fatty acids in human adipose tissue. American Journal of Clinical Nutrition. 1981; 34:877-86.

Willett WC, Stampfer MJ, Manson JE, et al. Intake of trans fatty acids and risk of coronary heart disease among women. Lancet. 1993; 341:581-5.

Wu M, Harvey KA, Ruzmetov N, Welch ZR, Sech L, Jackson K, Stillwell W, Zaloga GP, Siddiqui RA. Omega-3 polyunsaturated fatty acids attenuate breast cancer growth through activation of a neutral sphingomyelinase-mediated pathway. Int J Cancer. 2005 Nov 10;117(3):340-8., PMID: 15900589.

 
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