14
Jan
12

Effective technocracy: You’re doing it wrong

Back in October, Denmark imposed a surtax on foods containing saturated fat:

(Aside: That article is an abysmal piece of journalism.)

Blah blah paternalism blah blah blah nanny state blah, you know the drill.  But at least they’re doing something, albeit something brute-force and heavy-handed, to address the Growing Obesity Epidemic, right?  If Danes won’t eat right by their own volition, maybe they’re better off with a bit of a nudge (okay, this one’s more of a shove) in the right direction.  Northern European governments are often held up as models of outcome-improving neoliberal technocracy, and this looks like just one more example to shove in the libertarians’ faces of a freedom-reducing policy that actually ends up making people happier.  Right?

No points for guessing.

Just before the Danes started taxing saturated fats, this paper came out in the Netherlands Journal of Medicine:

The dietary intake of saturated fatty acids (SAFA) is associated with a modest increase in serum total cholesterol, but not with cardiovascular disease (CVD). Replacing dietary SAFA with carbohydrates (CHO), notably those with a high glycaemic index, is associated with an increase in CVD risk in observational cohorts, while replacing SAFA with polyunsaturated fatty acids (PUFA) is associated with reduced CVD risk. […]  We conclude that avoidance of SAFA accumulation by reducing the intake of CHO with high glycaemic index is more effective in the prevention of CVD than reducing SAFA intake per se.

D’oh!  It turns out that the Danish government has committed the idiot’s misunderstanding of the lipid hypothesis: If serum SAFA accumulation is associated with cardiovascular disease, then cutting down on dietary SAFA ought to help, right?  Well, maybe, in an alternate dimension where humans don’t have livers and nutrients seep directly from the duodenum into the bloodstream.  In the real world, things are a lot more complex:

High CHO intakes stimulate hepatic SAFA synthesis and conservation of dietary SAFA . Hepatic de novo lipogenesis from CHO is also stimulated during eucaloric dietary substitution of SAFA by CHO with high glycaemic index in normo-insulinaemic subjects and during hypocaloric high-CHO/low-fat diets in subjects with the metabolic syndrome. The accumulation of SAFA stimulates chronic systemic low-grade inflammation through its mimicking of bacterial lipopolysaccharides and÷or the induction of other pro-inflammatory stimuli. The resulting systemic low-grade inflammation promotes insulin resistance, reallocation of energy-rich substrates and atherogenic dyslipidaemia that concertedly give rise to increased CVD risk.

That’s about as clear a statement of the “carbs are teh debil” hypothesis as I’ve yet seen.

None of this is particularly new information, incidentally.  Results of this sort have been finding publication in high-quality journals for a decade or two now.  But like classroom laptop bans, this isn’t about improving outcomes at all — it’s about punishing gluttony and reinforcing authority.

That said, maybe the Danish fat tax will manage to improve outcomes after all, in a back-handed sort of way.  Even if saturated fat isn’t the problem, at least a tax on the stuff will discourage people from eating high-cholesterol foods by association.  That’s still a health-improving intervention, right?  Surely your humble blogger isn’t introducing the question just to link to another iconoclastic paper, is he?

[E]xisting epidemiological data have clearly demonstrated that dietary cholesterol is not correlated with increased risk for CHD. Although numerous clinical studies have shown that dietary cholesterol challenges may increase plasma LDL cholesterol in certain individuals, who are more sensitive to dietary cholesterol (about one-quarter of the population), HDL cholesterol also rises resulting in the maintenance of the LDL/HDL cholesterol ratio, a key marker of CHD risk.

SUMMARY: The lines of evidence coming from current epidemiological studies and from clinical interventions utilizing different types of cholesterol challenges support the notion that the recommendations limiting dietary cholesterol should be reconsidered.

Okay, yeah, I admit to stringing that point along just so I could post that link.  Again, this isn’t particularly new information — the above paper was a meta-analysis of existing research.  That’s not stopping our Benevolent Overlords from ignoring the work and issuing utterly counterproductive (at least from a health standpoint) dietary guidelines.

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