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Exploring a fiscal food policy: the case of diet and ischaemic heart diseaseCommentary: Alternative nutrition outcomes using a fiscal food policy

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7230.301 (Published 29 January 2000) Cite this as: BMJ 2000;320:301

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VAT ON SATURATED FATS

VAT ON SATURATED FATS

Saturated animal fats are blamed for coronary artery disease (CAD).
For this reason Tom Marshall suggests that foods such as full-cream milk,
cheese and butter should be taxed[1] to tempt people to change to
"healthier" carbohydrates and unsaturated fats.

But there have been untoward effects such as lower HDLC and enhanced
insulin resistance in women who replaced fat with carbohydrates[2].
"Healthy" high-carbohydrate diets elevate both fasting and postprandial
triglyceride concentrations, changes that are associated with
atherogenesis[3]. In conjunction with reduced fat intake, they increase
CAD in post-menopausal women[4] and diabetics[5], as well as increasing
breast cancer risk[6]. "Healthy" polyunsaturated fats also increase cancer
risk[7].

On the other hand the fatty acid, conjugated linoleic acid (CLA), is
a powerful anticarcinogen[8]. For maximal inhibition of tumorigenesis a
continuous intake of CLA is required[9]. But CLA is found exclusively in
the fat of ruminant animals, the best sources being the very whole milk,
butter, and cheese[10] that Marshall would tax.

Evidence that animal fats play a causal role in heart disease is
unconvincing. A recent report from the ongoing Framingham Heart Study
found: "In our data, intakes of fat and type of fat were not related to
the incidence of the combined outcome of all cardiovascular diseases or to
total or cardiovascular mortality"[11]. And we must not lose sight of the
fact that, when CAD was unknown and cancer incidence only a fraction of
today’s, the only fats eaten were from animal sources. Even after half a
century of research, this subject is still controversial.

Ill health costs money and taxing "unhealthy" foodstuffs may seem
like a sensible move in the right direction. But what of the consequences
if foods that were taxed turn out to be the healthy options after all?

Yours sincerely

Barry Groves

Chipping Norton, Oxon
OX7 6LP


Email: barry@2nd-opinion.freeserve.co.uk

References

1. Marshall T. Exploring a fiscal food policy: the case of diet and
ischaemic heart disease. BMJ 2000; 320: 301-305.

2. Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on
plasma lipoproteins of a prudent weight reducing diet, with or without
exercise, in overweight men and women. N Eng J Med 1991; 325: 461-6.

3. Abbasi F, McLaughlin T, Lamendola C, Hee SK, Tanaka A, Tao W,
Nakajima K, Reaven GM. High carbohydrate diets, triglyceride-rich
lipoproteins, and coronary heart disease risk. Am J Cardiol 2000;85:45-48.

4. Jeppeson J, et al. Effects of low-fat, high-carbohydrate diets on
risk factors for ischemic heart disease in post menopausal women. Am J
Clin Nutr 1997; 65: 1027-33

5. Chen YD, et al. Why do low-fat, high-carbohydrate diets accentuate
postprandial lipemia in patients with NIDDM? Diabetes Care. 1995; 18: 10-
16

6. Silvia Franceschi, et al. Intake of macronutrients and risk of
breast cancer. Lancet 1996; 347: 1351-6.

7. Wolk A, et al. A prospective study of association of
monounsaturated fat and other types of fat with risk of breast cancer.
Arch Intern Med 1998;158: 41-45

8. Shultz T D, Chew B P, Seaman W R, Luedecke L O. Inhibitory effect
of conjugated dienoic derivatives of linoleic acid and beta-carotene on
the in vitro growth of human cancer cells. Cancer Letters 1992; 63: 125-
133.

9. Ip C, Scimeca JA, Thompson H. Effect of timing and duration of
dietary conjugated linoleic acid on mammary cancer prevention. Nutr
Cancer. 1995; 24(3): 241-7

10. Lin H, Boylston TD, Chang MJ, Luedecke , Shultz TD. Survey of the
conjugated linoleic acid contents of dairy products. J Dairy Sci. 1995;
78: 2358-65.

11. Gillman MW, Cupples LA, Millen BE, Ellison RC, Wolf PA. Inverse
association of dietary fat with development of ischemic stroke in men.
JAMA 1997; 278: 2145-50.

Competing interests: No competing interests

10 February 2000
Barry Groves
Medical author and journalist
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