I have three children who love doughnuts. We will occasionally indulge ourselves for breakfast and get a box of them. In December 2006, New York City board of health voted to ban trans fatty acids from restaurants and fast food establishments. Why? And what does this have to do with our doughnuts?

Dietary fats are perceived to be associated with heart disease and obesity among other things. Certain fats increase total cholesterol and LDL cholesterol which can increase cholesterol buildup (plaques) and inflammation within the coronary arteries increasing the chance of a plaque rupturing into the coronary artery causing a heart attack, which may lead to death. The logical reaction is to avoid fats, right? Wrong! The evidence is weak that a high fat diet causes heart disease or even obesity. Not all fats are created equal.

What types of fat are there? Saturated fatty acids (SFA) are chiefly from animal products (red meat, milk products). SFA increase total serum cholesterol which, in turn, increase coronary events and mortality slightly. A reduction in SFA decreases total serum cholesterol and LDL-cholesterol and decreases coronary heart disease.

Monounsaturated fatty acids (MFA) found in olive and canola oil, tend to decrease LDL-cholesterol, triglycerides (also associated with coronary heart disease) and maintain HDL-cholesterol ("good" cholesterol, protective of coronary heart disease). In addition to the cholesterol benefits, MFA also tend to have some beneficial effects on the blood vessels helping to protect against coronary heart disease. This tends to be the basis for the recommendation of a "Mediterranean" diet.

Polyunsaturated fatty acids (PFA) come in two varieties, linoleic acid and alpha-linolenic acid. Linoleic acid is found in safflower, sunflower and corn oils. Compared with saturated fatty acids, the tend to lower LDL-cholesterol, HDL-cholesterol and triglycerides. The net effect appears to be a slight benefit in reducing coronary heart disease.

Alpha-linolenic acid is found in fish oils. These oils tend to have less of an effect on cholesterol, but appear to decrease platelet aggregation (clumping of a blood product necessary for a heart attack), triglyceride levels and reduce cholesterol buildup with in the coronary blood vessels. These fatty acids appear to be cardioprotective.

Trans fatty acids (TFA) may be found in nature but most are industrially manufactured by pumping hydrogen gas into liquid fat (partial hydrogenation) creating fats that will stay solid at room temperature and last forever. These are found in pie crusts, cookies, cakes, fried foods like fried chicken, french fries (freedom fries anyone?) and, yes, doughnuts! TFA raise the LDL-cholesterol a little, but lower the HDL-cholesterol a lot. Even saturated fatty acids don't interfere with the beneficial effects of HDL-cholesterol. In addition, TFA interfere with the beneficial effects of omega-3 fatty acids. In one study, for each 2% increase in energy from TFA, the incidence of coronary heart disease doubles! In other words, these are really bad for you.

Well what about our doughnuts? At present, they contain TFA. There are substitutes for most things. Yeast doughnuts may be duplicated with safer ingredients, but cake doughnuts and fried dough products are more difficult to duplicate. How does the New York legislation affect our Fredericksburg doughnuts you ask? Because of the legislation, many companies are actively researching alternative fat substitutes (Dunkin' Doughnuts, Au Bon Pan and Ruby Tuesday). Once a satisfactory solution is found in New York, most likely recipes and fat substitutions will occur nationwide. Until that time, make sure you read labels on foods (June 2006, FDA requires trans fat labeling) and ask at your favorite restaurant.

As an addition to a previous article on allergy shots, there is good news! For most patients a response to their allergy shots typically occurs in months, and certainly within the first year. In fact, in Europe they at times give allergy shots only for a few months before the pollen season, and this works for the season though doesn't result in permanent relief. Often if the allergy injections continue monthly for the full 3-5 year period the improvement will last for years after the allergy shots have ceased. It is the only treatment that has been shown to change the natural course of the disease.

Dr. Jeffrey Rehm, father of three, is a pulmonologist at both Mary Washington Hospital and
521 Park Hill Drive. Phone is (540)899-1615.