A Consumer's Guide to Fats by Eleanor Mayfield Once upon a time, we didn't know anything about fat except that it made foods tastier. We cooked our food in lard or shortening. We spread butter on our breakfast toast and plopped sour cream on our baked potatoes. Farmers bred their animals to produce milk with high butterfat content and meat "marbled" with fat because that was what most people wanted to eat. But ever since word got out that diets high in fat are related to heart disease, things have become more complicated. Experts tell us there are several different kinds of fat, some of them worse for us than others. In addition to saturated, monounsaturated and polyunsaturated fats, there are triglycerides, trans fatty acids, and omega 3 and omega 6 fatty acids. Most people have learned something about cholesterol, and many of us have been to the doctor for a blood test to learn our cholesterol "number." Now, however, it turns out that there's more than one kind of cholesterol, too. Almost every day there are newspaper reports of new studies or recommendations about what to eat or what not to eat: Lard is bad, olive oil is good, margarine is better for you than butter-- then again, maybe it's not. Amid the welter of confusing terms and conflicting details, consumers are often baffled about how to improve their diets. FDA recently issued new regulations that will enable consumers to see clearly on a food product's label how much and what kind of fat the product contains. (See "A Little Lite Reading" in the June 1993 FDA Consumer.) Understanding the terms used to discuss fat is crucial if you want to make sure your diet is within recommended guidelines (see accompanying article). Fats and Fatty Acids Fats are a group of chemical compounds that contain fatty acids. Energy is stored in the body mostly in the form of fat. Fat is needed in the diet to supply essential fatty acids, substances essential for growth but not produced by the body itself. There are three main types of fatty acids: saturated, monounsaturated and polyunsaturated. All fatty acids are molecules composed mostly of carbon and hydrogen atoms. A saturated fatty acid has the maximum possible number of hydrogen atoms attached to every carbon atom. It is therefore said to be "saturated" with hydrogen atoms. Some fatty acids are missing one pair of hydrogen atoms in the middle of the molecule. This gap is called an "unsaturation" and the fatty acid is said to be "monounsaturated" because it has one gap. Fatty acids that are missing more than one pair of hydrogen atoms are called "polyunsaturated." Saturated fats (which contain saturated fatty acids) are mostly found in foods of animal origin. Monounsaturated and polyunsaturated fats (which contain monounsaturated and polyunsaturated fatty acids) are mostly found in foods of plant origin and some seafoods. Polyunsaturated fatty acids are of two kinds, omega-3 or omega-6. Scientists tell them apart by where in the molecule the "unsaturations," or missing hydrogen atoms, occur. Recently a new term has been added to the fat lexicon: trans fatty acids. These are byproducts of partial hydrogenation, a process in which some of the missing hydrogen atoms are put back into polyunsaturated fats. "Partially hydrogenated vegetable oils," such as vegetable shortening and margarine, are solid at room temperature. Cholesterol Cholesterol is sort of a "cousin" of fat. Both fat and cholesterol belong to a larger family of chemical compounds called lipids. All the cholesterol the body needs is made by the liver. It is used to build cell membranes and brain and nerve tissues. Cholesterol also helps the body produce steroid hormones needed for body regulation, including processing food, and bile acids needed for digestion. People don't need to consume dietary cholesterol because the body can make enough cholesterol for its needs. But the typical U.S. diet contains substantial amounts of cholesterol, found in foods such as egg yolks, liver, meat, some shellfish, and whole- milk dairy products. Only foods of animal origin contain cholesterol. Cholesterol is transported in the bloodstream in large molecules of fat and protein called lipoproteins. Cholesterol carried in low-density lipoproteins is called LDL-cholesterol; most cholesterol is of this type. Cholesterol carried in high-density lipoproteins is called HDL-cholesterol. (See "Fat Words.") A person's cholesterol "number" refers to the total amount of cholesterol in the blood. Cholesterol is measured in milligrams per deciliter (mg/dl) of blood. (A deciliter is a tenth of a liter.) Doctors recommend that total blood cholesterol be kept below 200 mg/dl. The average level in adults in this country is 205 to 215 mg/dl. Studies in the United States and other countries have consistently shown that total cholesterol levels above 200 to 220 mg/dl are linked with an increased risk of coronary heart disease. (See "Lowering Cholesterol" in the March 1994 FDA Consumer.) LDL-cholesterol and HDL-cholesterol act differently in the body. A high level of LDL-cholesterol in the blood increases the risk of fatty deposits forming in the arteries, which in turn increases the risk of a heart attack. Thus, LDL-cholesterol has been dubbed "bad" cholesterol. On the other hand, an elevated level of HDL-cholesterol seems to have a protective effect against heart disease. For this reason, HDL-cholesterol is often called "good" cholesterol. In 1992, a panel of medical experts convened by the National Institutes of Health (NIH) recommended that individuals should have their level of HDL-cholesterol checked along with their total cholesterol. According to the National Heart, Lung, and Blood Institute (NHLBI), a component of NIH, a healthy person who is not at high risk for heart disease and whose total cholesterol level is in the normal range (around 200 mg/dl) should have an HDL-cholesterol level of more than 35 mg/dl. NHLBI also says that an LDL- cholesterol level of less than 130 mg/dl is "desirable" to minimize the risk of heart disease. Some very recent studies have suggested that LDL-cholesterol is more likely to cause fatty deposits in the arteries if it has been through a chemical change known as oxidation. However, these findings are not accepted by all scientists. The NIH panel also advised that individuals with high total cholesterol or other risk factors for coronary heart disease should have their triglyceride levels checked along with their HDL- cholesterol levels. Triglycerides and VLDL Triglyceride is another form in which fat is transported through the blood to the body tissues. Most of the body's stored fat is in the form of triglycerides. Another lipoprotein--very low- density lipoprotein, or VLDL--has the job of carrying triglycerides in the blood. NHLBI considers a triglyceride level below 250 mg/dl to be normal. It is not clear whether high levels of triglycerides alone increase an individual's risk of heart disease. However, they may be an important clue that someone is at risk of heart disease for other reasons. Many people who have elevated triglycerides also have high LDL-cholesterol or low HDL-cholesterol. People with diabetes or kidney disease--two conditions that increase the risk of heart disease--are also prone to high triglycerides. Dietary Fat and Cholesterol Levels Many people are confused about the effect of dietary fats on cholesterol levels. At first glance, it seems reasonable to think that eating less cholesterol would reduce a person's cholesterol level. In fact, eating less cholesterol has less effect on blood cholesterol levels than eating less saturated fat. However, some studies have found that eating cholesterol increases the risk of heart disease even if it doesn't increase blood cholesterol levels. Another misconception is that people can improve their cholesterol numbers by eating "good" cholesterol. In food, all cholesterol is the same. In the blood, whether cholesterol is "good" or "bad" depends on the type of lipoprotein that's carrying it. Polyunsaturated and monounsaturated fats do not promote the formation of artery-clogging fatty deposits the way saturated fats do. Some studies show that eating foods that contain these fats can reduce levels of LDL-cholesterol in the blood. Polyunsaturated fats, such as safflower and corn oil, tend to lower both HDL- and LDL-cholesterol. Edible oils rich in monounsaturated fats, such as olive and canola oil, however, tend to lower LDL-cholesterol without affecting HDL levels. How Do We Know Fat's a Problem? In 1908, scientists first observed that rabbits fed a diet of meat, whole milk, and eggs developed fatty deposits on the walls of their arteries that constricted the flow of blood. Narrowing of the arteries by these fatty deposits is called atherosclerosis. It is a slowly progressing disease that can begin early in life but not show symptoms for many years. In 1913, scientists identified the substance responsible for the fatty deposits in the rabbits' arteries as cholesterol. In 1916, Cornelius de Langen, a Dutch physician working in Java, Indonesia, noticed that native Indonesians had much lower rates of heart disease than Dutch colonists living on the island. He reported this finding to a medical journal, speculating that the Indonesians' healthy hearts were linked with their low levels of blood cholesterol. De Langen also noticed that both blood cholesterol levels and rates of heart disease soared among Indonesians who abandoned their native diet of mostly plant foods and ate a typical Dutch diet containing a lot of meat and dairy products. This was the first recorded suggestion that diet, cholesterol levels, and heart disease were related in humans. But de Langen's observations lay unnoticed in an obscure medical journal for more than 40 years. After World War II, medical researchers in Scandinavia noticed that deaths from heart disease had declined dramatically during the war, when food was rationed and meat, dairy products, and eggs were scarce. At about the same time, other researchers found that people who suffered heart attacks had higher levels of blood cholesterol than people who did not have heart attacks. Since then, a large body of scientific evidence has been gathered linking high blood cholesterol and a diet high in animal fats with an elevated risk of heart attack. In countries where the average person's blood cholesterol level is less than 180 mg/dl, very few people develop atherosclerosis or have heart attacks. In many countries where a lot of people have blood cholesterol levels above 220 mg/dl, such as the United States, heart disease is the leading cause of death. High rates of heart disease are commonly found in countries where the diet is heavy with meat and dairy products containing a lot of saturated fats. However, high-fat diets and high rates of heart disease don't inevitably go hand-in-hand. Learning from Other Cultures People living on the Greek island of Crete have very low rates of heart disease even though their diet is high in fat. Most of their dietary fat comes from olive oil, a monounsaturated fat that tends to lower levels of "bad" LDL-cholesterol and maintain levels of "good" HDL-cholesterol. The Inuit, or Eskimo, people of Alaska and Greenland also are relatively free of heart disease despite a high-fat, high- cholesterol diet. The staple food in their diet is fish rich in omega-3 polyunsaturated fatty acids. Some research has shown that omega-3 fatty acids, found in fish such as salmon and mackerel as well as in soybean and canola oil, lower both LDL-cholesterol and triglyceride levels in the blood. Some nutrition experts recommend eating fish once or twice a week to reduce heart disease risk. However, dietary supplements containing concentrated fish oil are not recommended because there is insufficient evidence that they are beneficial and little is known about their long-term effects. Omega-6 polyunsaturated fatty acids have also been found in some studies to reduce both LDL- and HDL-cholesterol levels in the blood. Linoleic acid, an essential nutrient (one that the body cannot make for itself) and a component of corn, soybean and safflower oil, is an omega-6 fatty acid. At one time, many nutrition experts recommended increasing consumption of monounsaturated and polyunsaturated fats because of their cholesterol-lowering effects. Now, however, the advice is simply to reduce dietary intake of all types of fat. (Infants and young children, however, should not restrict dietary fat.) The available information on fats may be voluminous and is sometimes confusing. But sorting through the information becomes easier once you know the terms and some of the history. The "bottom line" is actually quite simple, according to John E. Vanderveen, Ph.D., director of the Office of Plant and Dairy Foods and Beverages in FDA's Center for Food Safety and Applied Nutrition. What we should be doing is removing as much of the saturated fat from our diet as we can. We need to select foods that are lower in total fat and especially in saturated fat." In a nutshell, that means eating fewer foods of animal origin, such as meat and whole-milk dairy products, and more plant foods such as vegetables and grains. n Eleanor Mayfield is a writer in Silver Spring, Md. Fat Words Here are brief definitions of the key terms important to an understanding of the role of fat in the diet. Cholesterol: A chemical compound manufactured in the body. It is used to build cell membranes and brain and nerve tissues. Cholesterol also helps the body make steroid hormones and bile acids. Dietary cholesterol: Cholesterol found in animal products that are part of the human diet. Egg yolks, liver, meat, some shellfish, and whole-milk dairy products are all sources of dietary cholesterol. Fatty acid: A molecule composed mostly of carbon and hydrogen atoms. Fatty acids are the building blocks of fats. Fat: A chemical compound containing one or more fatty acids. Fat is one of the three main constituents of food (the others are protein and carbohydrate). It is also the principal form in which energy is stored in the body. Hydrogenated fat: A fat that has been chemically altered by the addition of hydrogen atoms (see trans fatty acid). Vegetable oil and margarine are hydrogenated fats. Lipid: A chemical compound characterized by the fact that it is insoluble in water. Both fat and cholesterol are members of the lipid family. Lipoprotein: A chemical compound made of fat and protein. Lipoproteins that have more fat than protein are called low-density lipoproteins (LDLs). Lipoproteins that have more protein than fat are called high-density lipoproteins (HDLs). Lipoproteins are found in the blood, where their main function is to carry cholesterol. Monounsaturated fatty acid: A fatty acid that is missing one pair of hydrogen atoms in the middle of the molecule. The gap is called an "unsaturation." Monounsaturated fatty acids are found mostly in plant and sea foods. Monounsaturated fat: A fat made of monounsaturated fatty acids. Olive oil and canola oil are monounsaturated fats. Monounsaturated fats tend to lower levels of LDL-cholesterol in the blood. Polyunsaturated fatty acid: A fatty acid that is missing more than one pair of hydrogen atoms. Polyunsaturated fatty acids are mostly found in plant and sea foods. Polyunsaturated fat: A fat made of polyunsaturated fatty acids. Safflower oil and corn oil are polyunsaturated fats. Polyunsaturated fats tend to lower levels of both HDL-cholesterol and LDL-cholesterol in the blood. Saturated fatty acid: A fatty acid that has the maximum possible number of hydrogen atoms attached to every carbon atom. It is said to be "saturated" with hydrogen atoms. Saturated fatty acids are mostly found in animal products such as meat and whole milk. Saturated fat: A fat made of saturated fatty acids. Butter and lard are saturated fats. Saturated fats tend to raise levels of LDL- cholesterol ("bad" cholesterol) in the blood. Elevated levels of LDL-cholesterol are associated with heart disease. Trans fatty acid: A polyunsaturated fatty acid in which some of the missing hydrogen atoms have been put back in a chemical process called hydrogenation. Trans fatty acids are the building blocks of hydrogenated fats. n --E.M. Government Advice Dietary guidelines endorsed by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services advise consumers to: Reduce total dietary fat intake to 30 percent or less of total calories. Reduce saturated fat intake to less than 10 percent of calories. Reduce cholesterol intake to less than 300 milligrams daily. ---------- Taking the Fat Out of Food A Reprint from FDA Consumer Magazine by Paula Kurtzweil [Graphic Omitted] Food manufacturers are making it easier for fat-conscious consumers to have their cake and eat it, too--and their cheeses, chips, chocolate, cookies, ice cream, salad dressings, and various other foods that are now available in lower fat versions. These products can help adult consumers reduce their fat intakes to recommended levels while allowing them to enjoy foods traditionally high in fat. A diet high in fat can contribute to heart disease and some forms of cancer and, because fats are calorie-dense, to excessive body weight. A host of fat substitutes that replaces most, if not all, of the fat in a food, makes these lower fat foods possible. Most of these fat replacers are ingredients already approved by the Food and Drug Administration for other uses in food. For instance, starches and gums are approved as thickeners and stabilizers. New compounds, such as olestra, have undergone or will undergo close scrutiny by FDA to assess their safety. In theory, the perfect fat replacer is one that contributes everything fat does in a food but without the calories, saturated fat, and cholesterol. The question remains: Can fat-reduced products actually reduce people's overall calorie intake and have a significant impact on their total fat intake? Fat in the Diet Fat is a difficult substance to replace because it has many important functions. A major nutrient, it is important for proper growth and development and maintenance of good health. Fats carry the fat-soluble vitamins A, D, E, and K and aid their absorption in the intestine. They are the only source of the essential fatty acids linoleic and linolenic acids. They are an important source of calories for many adults and for infants and toddlers, who have the highest energy needs per kilogram of body weight of any age group. Fat provides 9 calories per gram, compared with 4 calories per gram for protein and carbohydrates. As a food ingredient, fat is important in food preparation and consumption because it gives taste, consistency, stability, and palatability to foods and helps us feel full so we stop eating. But there are limits on the amount we should eat because of fats' link to heart disease, cancer and overweight. The Dietary Guidelines for Americans recommend limiting total fat intake to no more than 30 percent of calories and saturated fat to no more than 10 percent. Cholesterol intake should be limited to no more than 300 milligrams a day. Saturated fat and cholesterol are the substances in fat that contribute to the formation of plaque, which clogs arteries, leading to heart disease. Americans appear to be heeding the experts' advice because, according to a 1995 annual survey by the Food Marketing Institute--an organization of grocery retailers and wholesalers--65 percent of the consumers surveyed--the highest level to date--rated fat as their No. 1 nutrition concern. More than three-fourths of the consumers said they stopped buying a specific food because of the amount of fat listed on the nutrition label. A 1995 survey by the Calorie Control Council--an international association of manufacturers of low-calorie, low-fat, and diet foods and beverages--found that 72 percent of respondents who said they look for "light" foods said they are most attracted to food products claiming to be "reduced in fat." Manufacturers are responding by adding more and more reduced-fat foods to their product lines. That corresponds to the Department of Health and Human Services' Healthy People 2000 goal of increasing to 5,000 from 2,500 in 1986 the number of brand items reduced in fat and saturated fat. Regulation Fat replacers can help reduce a food's fat and calorie levels while maintaining some of the desirable qualities fat brings to food, such as "mouth feel," texture and flavor. Under FDA regulations, fat replacers usually fall into one of two categories: food additives or "generally recognized as safe" (GRAS) substances. Each has its own set of regulatory requirements. Food additives must be evaluated for safety and approved by FDA before they can be marketed. They include substances with no proven track record of safety; scientists just don't know that much about their use in food. Examples of food additives are polydextrose, carrageenan and olestra, which are used as fat replacers. Manufacturers of food additives must test their products, submit the results to FDA for review, and await agency approval before using them in food. GRAS substances, on the other hand, do not have to undergo rigorous testing before they are used in foods because they are generally recognized as safe by knowledgeable scientists, usually because of the substances' long history of safe use in foods. Many GRAS substances are similar to substances already in food. Examples of GRAS substances used as fat replacers are cellulose gel, dextrins, guar gum, and gum arabic. Sources Fat replacers may be carbohydrate-, protein- or fat-based substances. The first to hit the market used carbohydrate as the main ingredient. Avicel, for example, is a cellulose gel introduced in the mid-1960s as a food stabilizer. Carrageenan, a seaweed derivative, was approved for use as an emulsifier, stabilizer and thickener in food in 1961. Its use as a fat replacer became popular in the early 1990s. Litesse (polydextrose) came on the market in 1981 as a humectant, which helps retain moisture. Others in this category include dextrins, maltodextrins, fiber, gums, starch, and modified food starch. FDA has affirmed many carbohydrate-based fat replacers as GRAS. Although their original intent was to perform certain technical functions in food that would improve overall quality, some carbohydrate-based fat replacers are now used specifically to reduce a food's calorie content. They provide from zero to 4 calories per gram. They are used in a variety of foods, including dairy-type products, sauces, frozen desserts, salad dressings, processed meats, baked goods, spreads, chewing gum, and sweets. Protein-based fat substitutes came along in the early 1990s. These and fat-based replacers were designed specifically to replace fat in foods. One form, Microparticulated Protein Product (MPP), such as Simplesse and Trailblazer, is made from whey protein or milk and egg protein. These fat replacers provide 1 to 4 calories per gram, depending on their water content, and are approved for use in frozen dessert-type foods. FDA has agreed that whey-based MPP conforms to FDA's definition of whey protein concentrate, such as the fat replacer Dairy-Lo, a GRAS substance. Therefore, whey-based MPP can be used in other foods, including reduced-fat versions of butter, sour cream, cheese, yogurt, salad dressing, margarine, mayonnaise, baked goods, coffee creamer, soups, and sauces. Another type of protein-based fat replacers, called protein blends, combine animal or vegetable protein, gums, food starch, and water. They are made with FDA-approved ingredients and are used in frozen desserts and baked goods. Olestra Olestra is an example of a fat-based fat replacer. FDA approved olestra (brand name Olean), made by Procter & Gamble Co. of Cincinnati, in January 1996, for use in preparing potato chips, crackers, tortilla chips, and other savory snacks. Procter & Gamble said it expected to begin test-marketing olestra-containing products in 1996. Olestra has properties similar to those of naturally occurring fat, but it provides zero calories and no fat. That's because olestra is undigestible. It passes through the digestive tract but is not absorbed into the body. This is due to its unique configuration: a center unit of sucrose (sugar) with six, seven or eight fatty acids attached. Olestra's configuration also makes it possible for the substance to be exposed to high temperatures, such as frying--a quality most other fat replacers lack. As promising as olestra sounds, it does have some drawbacks. Studies show that it may cause intestinal cramps and loose stools in some individuals. Also, according to clinical tests, olestra reduces the absorption of fat-soluble nutrients, such as vitamins A, D, E, and K and carotenoids, from foods eaten at the same time as olestra-containing products. Tests by Procter & Gamble show that no reduction in absorption of fat-soluble vitamins will occur when proper levels of vitamins are added for compensation to olestra-containing foods. To address these concerns, FDA approved olestra on conditions that vitamins A, D, E, and K be added to olestra-containing foods and that Procter & Gamble continue studies on consumption and long-term effects of olestra. These studies will be reviewed at an FDA Food Advisory Committee meeting in mid-1998. To provide consumers with information about olestra's possible effects, FDA also required that the following interim labeling statement appear on products made with olestra: "This Product contains Olestra. Olestra may cause abdominal cramping and loose stools. Olestra inhibits the absorption of some vitamins and other nutrients. Vitamins A, D, E and K have been added." FDA has invited public comment on the need for such a label statement and on the statement's adequacy and clarity. The agency will evaluate those comments before issuing a final label statement. Concern with olestra's drawbacks led one of olestra's critics, the Center for Science in the Public Interest--a nonprofit consumer advocacy organization--to file an objection to FDA's approval. FDA's response to the objection is pending. Other Replacers Some other fat-based replacers are being considered or developed: Salatrim (which stands for short and long-chain acid triglyceride molecules) is the generic name for a family of reduced-calorie fats that are only partially absorbed in the body. Salatrim provides 5 calories per gram. A petition seeking FDA's affirmation that Salatrim is GRAS was filed in June 1994. An example of its use is in Hershey Co.'s reduced-fat baking chips, semi-sweet chocolate flavor. Caprenin, another Procter & Gamble product, is a 5-calorie-per-gram fat substitute for cocoa butter in candy bars. A petition seeking FDA's affirmation that Caprenin is GRAS was filed in 1991. Emulsifiers are fat-based substances that are used with water to replace all or part of the shortening content in cake mixes, cookies, icings, and vegetable dairy products. They give the same calories as fat but less is used, resulting in fat and calorie reductions. Other fat replacers are being developed, according to the Calorie Control Council and other organizations. They include DDM (dialkyl dihexadecylmalonate), a fat-based substance that is not absorbed into the body and can be used in frying and baking. Frito-Lay Inc. has been studying this fat substitute since 1986, although it has not yet petitioned FDA for approval. Also on the horizon is a fat substitute made by combining starches or gums with small amounts of oil. Opta Food Ingredients Inc. received an exclusive license from the U.S. Department of Agriculture last February for the process, called Fantesk. This fat replacer would give foods the taste and texture of regular fat but provide less than 0.5 grams of fat per serving. Reducing Dietary Fat Can these fat replacers help consumers make positive dietary changes? Can they help those who are overweight lose weight? It may be too early to say, and studies to date give varying answers. For example, in a study of lean non-dieting men, one group ate breakfasts of conventional fat foods, while the other ate olestra-containing foods. Those who ate the olestra-containing foods made up their usual daily calorie intake by eating more carbohydrate-containing foods. The study, sponsored partly by Procter & Gamble and published in a 1992 issue of the American Journal of Clinical Nutrition (Volume 56), suggested that a diet of reduced-fat foods can help reduce fat intake without affecting total calories. Fat intake also was decreased in a study of 96 men and women "habitual snackers." One group was fed potato chips prepared with olestra, while the rest ate potato chips prepared with conventional frying oil. The group fed olestra chips ate on average 29 grams less fat and 270 fewer calories a day than those fed regular chips--even though those who knew they were eating fat-free chips ate 10 grams of chips more than those who ate regular chips. This study, done at Pennsylvania State University, also was partly sponsored by Procter & Gamble. A possible concern about fat replacers is: Can foods claiming to be reduced in fat inadvertently influence people to eat more? Another study at Pennsylvania State University suggests they might. In this study, women were fed the same yogurt labeled either "high-fat" or "low-fat." The group fed the low-fat-labeled version ate more in a lunch that followed the yogurt than the group eating the high-fat-labeled yogurt. As a result, the group eating what they thought was low-fat yogurt took in more calories than the other group. "It appeared that these women regarded the low-fat label as a license to overeat," wrote Debra Miller, a doctoral student in biobehavioral health and nutrition at Pennsylvania State, in an article she prepared for Weight Control Digest. Still, reduced fat foods appear to be an important part of a fat-reduction diet, according to a study involving the Women's Health Trial. The study, designed to determine the role of low-fat diets in the prevention of breast cancer, found that eating "specially manufactured" low-fat foods was one of the most easily adopted dietary practices for those who received prior dietary instruction. Avoiding meats and giving up fats as flavorings (for example, eating bread without butter or margarine) were among the most difficult practices to adopt. In using reduced-fat foods, the American Dietetic Association cautions consumers to realize that fat-free doesn't mean calorie-free. The calories lost in removing regular fat from a food can be regained through sugars added for palatability, as well as fat replacers, many of which provide calories, too. Consumers should refer to the Nutrition Facts panel on the food label to compare calories and other nutrition information between fat-reduced and regular-fat foods. Many nutrition experts agree that, used properly, fat replacers can play an important role in improving adult Americans' diets. But, as with any diet or food, they emphasize variety and moderation to ensure a healthy intake. "These [fat replacers] are truly innovative ideas," said Dennis Gordon, Ph.D., a food scientist at North Dakota State University, Columbia. "But they shouldn't be looked at as a total panacea. [The advice] is the same as with anything: Be prudent." Paula Kurtzweil is a member of FDA's public affairs staff. FDA Consumer magazine (July-August 1996