October 14, 2005

What About Trans Fats?

I try to avoid a high amount of fat in my diet. I continue to hear about trans fats, and wonder what they are, where they come from, and what harm they do. Could you give a little insight on them for me?

Trans fats occur naturally in small amounts in animal products. But the problem with them started about 100 years ago when food chemists began looking for ways to substitute a cheap fat for expensive butter.

They took vegetable oil, and discovered that by heating it and then bubbling hydrogen through it, they could make a firmer fat. This, of course, was the beginning of margarine. Unfortunately, the healthful vegetable oil had been converted into an unhealthful partially hydrogenated trans fat.

Trans fat is probably worse than saturated fat. Saturated fats raise the LDL cholesterol and the good HDL cholesterol. But trans fats raise the bad LDL and lower the good HDL, so their potential is a double whammy.

Studies out of Harvard University have shown a close correlation between trans-fat consumption and heart disease. These researchers believe possibly 30,000 deaths a year in the United States are attributable to trans fats in the diet.

Dr. Walter Willett, one of the famous researchers at Harvard University, suggests the increased abdominal girth seen most commonly in men probably relates to trans-fatty acids in the diet, among other things. Insulin resistance, the hallmark of type 2 diabetes, may also be a result, in part, to trans fats in the diet. Trans fats are believed to stimulate an enzyme that converts HDL cholesterol to LDL cholesterol, and also to increase another kind of cholesterol, lipoprotein--the small, dense LDL particles. This latter kind is associated with more blocked smaller arteries.

There is probably no safe or recommended intake of trans fats. However, there is probably an amount that makes no measurable difference. The story of trans fats reemphasizes the importance of getting as much of our diet as possible from unrefined or unprocessed foods. Trans fats may be hidden in many products, from baked goods to breakfast cereals. The labeling of products with trans-fat content means we should become serious about checking labels.

We need to use oils rather than the stiffer fats, and by doing our own baking, we avoid hidden contents in our food. Do you remember the smell of that homemade bread? M'mmmmm, that's good!

My granddaughter is 16 years old. She is petite, but her breasts are not! They are far too large for her build, height, and weight. It is an embarrassing problem for her. They have red streaks on them. Could that be broken skin? What can be done to correct her too-large breasts?

Your question raises some interesting points. The question of embarrassment is one I will discuss first. Many young people become embarrassed by the changes of adolescence--young men by the growth of hair; both sexes by the appearance of acne; and, of course, young women by the development of their breasts. It is not uncommon for girls to slouch over in embarrassment. Even height can become an embarrassment. Young people should revel in their newfound bodily proportions, as they indicate normal progress to full maturity.

But you do give an insight that may reflect an objective measure on this growth of breast tissue; that is the presence of "red streaks." These "striae," or "stretch marks," indicate rapid growth. Although we are not sure of the cause, they probably reflect interplay between steroid hormones and stretching skin. Many women find that abdominal stretch marks accompany abdominal enlargement in pregnancy.

While some women have converted what some might consider an embarrassing liability into a hallmark endowment, others may have real problems with oversized breasts. Apart from embarrassment, oversized breasts can cause back strain and painful cutting of bra straps into the shoulders. And the embarrassment you mention can be very traumatic, and damage an individual's self-esteem.

I suggest you encourage your daughter to take your granddaughter to see her doctor--after, of course, discussing the problem with her. It is essential to determine if the problem is not just one you perceive, but is a problem to the patient as well. If she is distressed by the problem, allow a professional to assess the reality of the situation.

Some developing breasts may, in addition to overgrowth, become markedly asymmetrical, with one being hugely overgrown compared to the other. I am feeling a little cautious here, because the majority of people have a degree of asymmetry from one side to the other. However, I am not talking about a slight difference in size. The doctor will give an objective opinion.

Should your granddaughter wish, and the doctors agree to the medical need, it is possible to perform what is called a "reduction mammoplasty." It would be wise to wait for full breast development before such surgery, and certain factors should be considered before doing it.

Such an operation will, to a greater or lesser extent, interfere with the ability to breast-feed an infant. I have known women to be successful, but several others I have known experience significant difficulties in lactation. The scars of surgery are often more obvious than you might anticipate. While several pounds of tissue may be removed, this includes some skin. And the incisions extend around the areola area of the nipple, and beneath the breast like an anchor in outline. The healing of such incisions is dependent as much on the nature of one's skin as on the surgeon's skill. The scars may take a couple of years to settle down to their final, least-visible state.

For persons who have experienced physical symptoms of discomfort, the relief can be dramatic. Also, a person's overall appearance can be brought into conformity with the average.

Such surgery should be performed by qualified, experienced plastic surgeons. And I must stress that it should be done only at the express concern of the patient--not other family members who are trying to be "helpful."

By the same token, family members who are biased against such procedures do well to reserve their opinions for their personal treatment.

Allan R. Handysides, M.B., Ch.B., F.R.C.P. (c), is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.