Taking effect on June 19, 2023, is the Department of Health (DOH) Administrative Order (AO) 2021-0039
which aims to abolish industrially-produced trans fatty acids (iTFA) in the country.
Enacted two years ago, AO 2021-0039 mandated food manufacturers to eliminate iTFA from their pre-packaged and processsed products.
The scariest type of fat, Trans Fats are produced by adding hydrogen to vegetable oils in order to extend the shelflife of products. The terms “hydrogenated oils” and “partially hydrogenated oils” seen in the ingredients of some products indicate the presence of TF.
"TF is liquid oil converted into solid oil. Hydrogen is added, becoming partially hydrogenated oil (PHO), kailanagan iwasan yan. Pag-nakita niyo sa label, it’s not good. Kapag meron unsaturated fat (monounsaturated or polyunsaturated), it increases good cholesterol. So, poly or mono unsaturated ang maganda na nakukuha sa salmon, avocado, and fish belly," said Dr. Lourdes Ella “Louella” Santos during the recent online Usapang Puso sa Puso (UPP) titled, “Trans Fat: The Fight is on!”
Dr. Louella Santos, a cardiologist and lipidologist, president of the Philippine Lipid and Atherosclerosis Society, elucidated the nature of cholesterol, and the dangerous nature of iTFA.
She said that Total Cholesterol is checked during a blood test, and has three components, namely, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins (LDL).
“Triglycerides come from sugar, flour, white rice, bread, and desserts to name a few. HDL is good cholesterol, LDL is bad cholesterol or Lechon de Leche, which we avoid because it clogs our arteries and could lead to either a heart attack or stroke.”
Hosted by PHA Director III and Advocacy Committee Chair Dr. Luigi Segundo, the June 28 UPP edition also guested Atty. Mikhail Laurence Millan, the Project Manager, ImagineLaw (Trans Fat Elimination/Front-of-Pack-Labelling,
HIV Prevention and Control). ImagineLaw has been advocating for the total eradication of Trans Fat in the country, and has partnered with the PHA, government, and other Civil Service Organizations (CSOs) in their campaign.
Atty. Milan referred to the ban on iTFA as “a victory for the Filipino Heart”, even if both Senate Bill 1286 and House Bill 8128 (Trans Fat-Free Philippine Act) remain pending in Senate Committees.
He called on all Filipinos to join in the efforts to enforce AO 2021-0039 by reporting any products or manufacturers that deviate. He said: “Two ways to report. The official one is on the FDA website for any violations, but we can also visit Trans Fat Free Philippines on FB, to act as a hotline for any reports."
For his part Dr. Segundo, echoed the value of undergoing risk factor screening. He said that even without feeling anything out of the ordinary, getting checked is crucial for preventive care especially since one's consumption of transfat is immeasurable in the same way that high cholesterol levels don't have physical manifestation in the body.
He added that the PHA’s Healthy Lifestyle Advocacy, 52100 (five servings of fruits & vegetables, not more than 2 grams of sodium, an hour of exercise, zero smoking, and zero sugary drinks, daily) is a viable means of keeping the risk factors at bay.
Overall, cholesterol issues can be addressed through a healthy lifestyle: healthy food choices, mindful eating, and exercise (one may begin by maintaining body mobility and not being a couch potato!)
Watch the webinar here:
https://fb.watch/lyfFE1DCmo/?mibextid=Nif5oz
Here are some interesting questions and answers during the webinar:
QUESTION: I heard not all fats are unhealthy? Some are actually good. Totoo ba ito, Doc? Ano ang examples ng mga healthy fats?
Doc Louella: Bigyan natin ng clarification. Kapag taba ang pinagusapan, iba-ibs ang types pag nag-blood test, Total Cholesterol has three components. Sum total of cholesterol: Triglyceridesl, High-density lipoprotein (HDL), Low-density lipoprotein (LDL). Triglycerides is yung taba na nakukuha sa asukal, harina, white rice, bread, desserts. HDL is good cholesterol, LDL is bad cholesterol or “Lechon de Leche”. Kaya po natin ayaw ang LDL: ito ang nagbabara sa ugat at sa puso leading to heart attack or stroke kung sa utak. Moving forward, we have different types of fats. Trans Fat ang pinaka nakakatakot na taba because ang ginagawa nito, dinadamihan ang LDL pagkinakain ang trans fat. We need to talk about how to limit, and identify TF in food. Importante ma-recognize ang good and bad cholesterol, TF.
QUESTION: “Wala daw po symptoms ang high cholesterol- malalaman mo lang na mataas kapag nagpa laboratory ka. Kailan po ba dapat magpa check sa laboratory ng cholesterol?
Doc Louella: Tama, ang cholesterol walang symptoms. By the time may manifestation na ang bara it’s late: it’s a stroke or heart attack. Sa primary prevention, aalamin kung may risk. If may magulang na may sakit sa puso or mataas cholesterol, then genrtically may chance na mataas ang cholesterol. Kailan magpa-check? Meron lipid profile, kasama sa executive check up usually. Ito po, pag lumabas, we see total cholesterol (3 components). Kailan dapat tayo magpacheck? According to local guidelines, getting checked should be at 45 and above. Yung iba mas bata kasi may risk factors, like hypertension among family members, or diagnosed with diabetes, obese. These are some signs to be checked. Kung may additional risk factors o bisyo; these predispose cholesterol deposits, so get checked.
Doc Luigi: Blood test lang naman so no risk. Common na kapag abnormal ang results, may gamot sa cholesterol, mataas LDL. What do we do?
Doc Louella: We need to understand that the role of diet and lifestyle modifications are still important. Hindi lang ibig sabihin na mataas LDL gamot na habang buhay. Foods to avoid are the canned goods in the morning, eating out. Better to baon para alam kung ano ang meron, at meryienda; avoid processed foods. Exercise is important as well. Even just walking 30 mins everyday, LDL will go down, HDL will go up, and win-win because you’ll lose weight. The risk of Dementia, Alzheimer’s is also reduced
G from walking. So it’s not always gamot agad. Kaya importante magpa-check para habang buhay mababa ang cholesterol. Para ang kaildad ng buhay ay maganda.
Doc Luigi: For smokers, the ones that quit, maganda ang effect.
Doc Louella: Stopping smoking will raise good cholesterol, and di masyadong dikit ng mga ugat.
QUESTION: Sa annual medical exam ko, napaka taas daw ng bad cholesterol ko. Hindi naman ako malakas kumain ng red meat o taba at may regular exercise din ako. Kaya lang, dahil busy sa work, madalas sa labas ako kumakain. Minsan naman 3- in-1-coffee lang. Sabi ng nurse sa work, baka daw sa pagkain ko sa labas at pati sa 3-in-1. Pwede po ba yun?
Doc Luigi: Pabata nang pabata ang mga patients. Nakikita namin sa practice. Sabi nila, they exercise and eat well, but because they’re busy, they eat out, and masarap talaga ang 3-in-1. But could this be the source?
Doc Louella: Eating out, there are many options but we don’t prep it so we don’t know what’s in the food or kung ano ang oil na gamit, kung bago ang oil o hindi. So we don’t really encourage eating out because you don’t know how it was prepared. When you do, please choose healthier options. Pero, meron talaga limited ang options like night shift workers. Imbis na fried chicken, get fish, imbis na french fries, gulay. May mga restos with healthier options like red or brown rice. Sa pagkain natin, may mindful and mindless eating. Mindless, kasi pantawid gutom or antok na; pinapasok lang sa bibig at di pinag-iisipan. Di mo napapansin na naka-3 packs ka na ng chips while watching TV. As for 3-in-1, there are three components: coffee, sugar which we want to avoid, and creamer which is processed and adds up sa triglycerides, and has trans fat or PHO para tumagal ang shelflife. Kung maari, mag-shift sa kape na walang asukal o creamer. May clnical trials na walang detrimental effect ang kape; it’s not unhealthy. But dapat black, brewed and walang kasama.
Doc Luigi: Buti na lang may lumalabas na matanggal ang TF sa grocery, pre-packed and procesed food. Pero hindi pa sa mga resto. Hindi natin masusukat ang TF sa dugo?
Doc Louella: Hindi makikita sa katawan yung bilang ng TF, instead yung effect (high LDL, low HDL), kaya advocacies are important to eliminate or minimize TF.
Doc Luigi: Do you believe the data that if TF are removed, Filipinos' lives will improve?
Doc Louella: Malaki ang improvement. It’s not just in South East Asia, but the whole world. So we know what the weight of removing TF is, because every nation worldwide is moving to eliminate TF because of its effect on cardiovascular health. Remember, in the Philippines, the number one cause of mortality is still cardiovascular disease.
Doc Luigi: Starting June 19, last week, the first day that the TF AO was implemented. Can you tell us how we got here?
Atty. Millan: Multi-sectoral effort is what led us here, and we’ll be able to do more thanks to our ongoing partnerships. For those worried about eating TF in restos since no law yet, no worries. Top-down ang approach, so no TF in the top level (manufacturers) so the source is cut. But we still need to be diligent.
We have bills filed in Congress, and it should build institutional capacity, research for healthier alternatives. Yun po ang kagandahan ng bill, and we need support for complete protection from TF.
Doc Luigi: May technicality na hindi laging 0 ang 0
Atty. Millan: We have two sources of TF. There’s artificial (PHO, HO) and naturally occurring TF sa dairy products for example. Mahirap tanggalin, so some products that take this into account, so sometimes zero doesn’t mean zero all the time.
Doc Luigi: May push for better labeling. If you exceed the serving size, hindi na 0 ang TF.
Atty. Millan: Even if 0 or 0.1, check the ingredients list. If you see HO or PHO, may TF na ‘yan.
Doc Luigi: kasama ba sa batas na simplified ang labeling, declaration of TF?
Doc Louella: Siguro kasi matagal na proseso ‘to, importante talaga na tayong mga netizens, patients, we understand it so advocacy is not only from policy makers, physicians. We need to be aware, and younger generations need to know as well and it begins at home. Throughout, by educating other people we can promote the advocacy from both sides.
QUESTION: What are the effects of TF on kids who prefer eating baked goods than vegetables?
Doc Louella: Baked goods, with TF, increases LDL. When we look at Atherosclerosis, deposition sa ugat, hindi pa predisposed ang mga bata until 18. When the habit is formed at childhood, it’ll continue into adulthood. It’s important to teach kids healthy practices at an early age, to avoid Athero in adulthood. Habang maaga pa lang, we need them to understand that healthier foods are more important. The effect of TF on younger individuals, it isn’t as impactful to them. We don’t encourage a lipid profile in adolescents because it changes.
Doc Luigi: Continuous exposure to TF, we theorize, could be because of TF and other unhealthy food products. So kahit walang direct effect on kids, it’s best not to form the habit.
Doc Louella: While we know parents are busy, readily-made foods aren’t always healthy and this has to be avoided as much as possible.
QUESTION: If we have a law, who is monitoring? How strong? Sanctions?
Atty: Technically, we don’t have a law but policies. The FDA monitors, checks compliance. Those with violations are given penalties. Either denial of application of certtificate of product registration (CPR), or cancellation/revocation of CPR. We also have the Trans Fat Free PH; regular citizens can help monitor alongside the FDA.
QUESTION: So drinking warm water doesn't clear clogged arteries. Pero ang pag-inom ng maraming tubig really helps and is good for the body?
Doc Louella: Yes. A majority of our organs need water, especially with our weather now. Water is a very big component of our daily diet; the 8 or more glasses, it’s best to go above it pa. But, it’s not because it can unclog arteries.
QUESTION: Is low-carb diet good?
Doc Louella: For a low carb diet, there’s a positive effect. But my advise to those on it, kasi naghahanap ng makakabusog. Sana ang kukunin mo ay isda at gulay, imbis na prito o karne. Kahit pumapayat, tumataas cholesterol and will lead to a heart attack or stroke.
QUESTION: Initial assessment ng PHA, ImagineLaw, ng public acceptance regarding yung Trans Fat ban?
Atty: While there’s no official assessment, what have received from consumers is enormous support. There are absolutely no health benefits sa TF. People have been very supportive of the policy, advocacy. Feedback has been positive.
Doc Luigi: Week one palang, so it is too early to say and there’s no concrete answer. We’re helping them live a healthier lifestyle by giving healthy choices.
Doc Louella: Awareness is also important; people preparing food a home don’t know about PHO or HO but they do now, thanks to our movement.
QUESTION: Visceral Fat - how do we remove it?
Doc Louella: Visceral fat isn’t good. It’s connected to CVD, but there’s no easy way to measure it yet. It’s the fat that lines the abdominal cavity.
QUESTION: Paano ang umoorder ng food online?
Atty. Milan: These could be pre-packaged or processed, but again, the top-down approach should ensure that there is no TF in restos, products.
Doc Luigi: In theory, their sources of TF have been cut already.
QUESTION: Is drinking omega fatty acids or fish oil is healthy?
QUESTION: The ones we have access to, here in Asia, the fish oil has Eicosapentaenoic acid (EPA) (good) and Docosahexaenoic acid (DHA) (negates positive effect of EPA), however the latter has been shown to increase LDL. So we don’t have a recommendation, as supplements don’t go through regulation.
QUESTION: The best lifestyle tandem: good diet and exercise?
Doc Louella: Not just exercise and diet: avoiding vices, the recommendation is now zero bottles of beer a daily, and choosing healthier options.
Heavenly HDL, LDL Lechon de leche, and with TF, tataas LDL bababa HDL. For the legacy of our children, we need to watch what we eat. As early as now, be proactive in what we take in our family.
#TransFatFreePhillippines
#becauseyourheartmatters
#cardiologyforall
#PHA
#showbitsnpieces
#Whatchamacalit
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