Health & Fitness | Nutrition-supplements

But even the most respected chefs of this and other pastries are being ordered to make changes by Tuesday - the day New York's trans fat ban takes full effect.

New York is the first American city to adopt such a stringent rule.

Starting this week, the ban extends to almost all prepared food in restaurants, bakeries, cafeterias, salad bars and food carts. There will be a three-month grace period before big fines are slapped on violators. The artery-clogging substance was first banned from cooking oils last year.

Chefs who relied on trans fats to make their pie crusts flaky, their crackers crispy and their muffins moist have worked overtime finding substitute ingredients. They have burned through hundreds of gallons of oil, shortening and margarine trying to retool old recipes without damaging flavor, texture or color.

Yet, with the deadline looming, it appears that few, if any foods, are getting whacked.

Fast food giants from McDonald's to Taco Bell say they have banished trans fats without having to drop a single item from their menu.

Baking supply companies have introduced a host of replacements for the partially hydrogenated vegetable oils that are the biggest source of trans fats. Not even Crisco is made of Crisco anymore. The company reformulated all of its products last year to have "zero grams of trans fat per serving."

Even the cannoli has been spared.

New York's biggest maker of fried dough shells for the classic Italian dessert reports that after four months of sometimes frustrating experimentation, cooks finally produced a trans-fat-free replacement that is just as crisp and delicious as the original.

"There is a little difference in taste," acknowledged Mauricio Vasquez, general manager of Ariola Foods, which has been turning out pastries in Queens for 85 years. But, he added, "If you weren't familiar with the shell beforehand, you'd never know the difference."

City health commissioner Thomas Frieden, who launched the anti-trans fat initiative, said it is too early to tell what percentage of the city's restaurants will fully comply by Tuesday. But he said his department had heard relatively few complaints so far from frustrated chefs.

"We think it is going extremely well," he said.

Those who reject the ban and get caught face a $2,000 fine starting Oct. 1.

Americans have been baking with vegetable shortening loaded with trans fats since the invention of Crisco. Unlike frying oils, whose main purpose is to conduct heat, shortening is a major contributor to taste and texture.

There are plenty of substitutes, including natural fats like butter or lard, palm oil, and a growing list of new oil blends. However, for some bakers, adjusting has been painful.

"We're banging our heads against the wall right now," said Manny Alaimo, an owner of the respected Villabate Pasticceria in Brooklyn.

Italian breads and cookies made with the zero-trans-fat shortening just haven't come out right, he said. A few demanding customers have complained about subtle changes in taste and texture, he said.

"It's going to be a really bumpy. People are just going to have to get used to it," he said.

Such fears have kept other cities from following New York's lead.

Family owned bakeries in Philadelphia raised such a ruckus that city lawmakers gave them an exemption from the trans fat ban that passed there last year.

The New York ban may have had its biggest effect on fast food chains, which have transformed recipes nationwide.

Dunkin Donuts eliminated trans fats from its doughnuts in October, months ahead of the deadline for frying oils. The company's cooks began experimenting with a replacement oil back in 2003 and tested 28 different substitutes, sometimes with disastrous results, before picking a new blend of palm, soybean and cottonseed oil.

The company sold 50 million trial doughnuts in secret, to see how customers would react, before announcing it had made the switch.

Dunkin Donuts said customers didn't notice the change.

In fact, Laura Stanley, a consultant who has been working with smaller New York restaurants seeking to adapt, says there doesn't seem to be a food that can't be saved.

She worked with a program based at New York City College of Technology in Brooklyn that tested replacement ingredients, held classes, and came up with fixes for recipes that seemed particularly problematic.

"We were pleasantly surprised," Stanley said. "We'd anticipated a lot of problems with flavor, but for most of these items the new products performed fine."

The one disappointment is that many chefs have been turning to products high in saturated fats, like palm oil, as a replacement. Some research suggests those fats might be just as bad for you as trans fats.

But there's hope: a second generation of low-cholesterol oils is coming out now. Stanley said there have been encouraging signs that they might be improved enough to persuade chefs to use them.

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On the Net:

NYC Trans Fat Help Center: http://www.notransfatnyc.org/

© 2008 The Associated Press.

Kelly Perkins, 46, and her husband, Craig, led by big-wall guide Scott Stowe, began the climb Thursday and reached the top of the iconic 8,842-foot-high dome Saturday afternoon.

The ascent completed an important circle for her. In 1996, 10 months out of the hospital with her new heart, she finished the first of many post-transplant climbs by hiking up the easier backside of Half Dome.

"I feel great. Physically, I feel I'm stronger than I've ever been," Perkins said by cell phone from the top of Half Dome. "It was a great full circle for me to climb the other side. It was a tricky climb, but it also was a very interesting and beautiful climb."

Since 1996, Perkins has become the first person with another person's heart to summit some of the world's best-known peaks - California's Mount Whitney, Switzerland's Matterhorn, Japan's Mount Fuji, Tanzania's Mount Kilimanjaro and the face of Yosemite's El Capitan. She also climbed a remote peak in the Andes, near Argentina's border with Chile, and New Zealand's Mount Rolling Pin.

Perkins says she chose Half Dome for her latest climb "because it's broken in half but it still stands strong. There's a spirit-building message there. You may not be 100 percent, but you can still be as strong as others. I'm out there doing things and not worried about being within driving distance of the nearest hospital."

With each ascent, the 5-foot-2, 103-pound Perkins tries to get across the message that transplants can save lives and that transplant recipients can still lead active lives. She also wrote a book, published in 2007, about her struggles, achievements and goals.

Perkins' heart started failing in 1992 after she and her husband returned from a backpacking trip in Europe. The former Lake Tahoe resident, now living in Laguna Niguel, Calif., contracted a virus that made her so weak that Craig had to carry her around their home.

Found to have cardiomyopathy, which inflames heart muscles, Perkins got a new heart at UCLA Medical Center in November 1995 from a woman in her 40s who died in a fall from a horse.

Dr. Jon Kobashigawa, medical director of UCLA Medical Center's transplant program, said he knows of no other woman with a heart transplant who has achieved one high-elevation climb after another, as Perkins has. He likened her to "a type of Lance Armstrong."

Perkins faces problems not encountered by other mountaineers. Transplanted hearts usually lack nerves linking them to the brain, which means Perkins' heart doesn't know when her muscles need more oxygen. She suffers severe shortness of breath until she can establish a pace.

But Kobashigawa said Perkins, through an arduous exercise regimen, may have regrown some of those nerves, enabling a partial response to physical demands on her donor heart. "Sheer will" also is a key factor, he said.

On her ascents, she also has to bring something needed by few other climbers - a backpack crammed with prescription drugs, medical supplies and blood-pressure monitoring gear.

"It's not that I'm a great climber or super-athletic," she said. "I just do my best. What it really represents is that I have the freedom and opportunity and good health to do this, to go out and fully live life, not sit back."

"Someone asked me how long I'm going to do this, now that I'm 46 years old. What am I supposed to do? Roll over and play dead? My time was up before. Now I'm fully functioning and stronger than I've ever been. I'm not slowing down in any way until my body finally tells me, 'No.'"

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On the Internet:

Kelly Perkins: http://www.theclimbofmylife.com

© 2008 The Associated Press.

Under a new program announced Thursday, officials have set an ambitious goal of testing a quarter million adults in the Bronx, one of five boroughs that make up New York City, within three years.

"We need every single individual to know their status," said Dr. Monica Sweeney, an assistant health commissioner who specializes in HIV prevention.

Like dozens of other states, New York now requires doctors to obtain a patient's written consent and provide a brief counseling session before giving them a test for the AIDS virus, a process that can take up to 20 minutes. That's enough to deter doctors and nurses from suggesting HIV tests to patients routinely, according to the city.

Now officials want health clinics to offer the tests to anyone who seeks care, even for something as simple as a broken wrist.

Federal health officials recommended routine HIV testing for all Americans ages 13 to 64 nearly two years go, but the effort has stalled. Some doctors have questioned whether so much testing is necessary, or worth the bureaucratic cost.

HIV testing in the Bronx is already fairly widespread. Nearly 7 of 10 Bronx adults have been tested at least once in their lifetime. But as many as 250,000 adults have never been tested, and statistics indicate that many are diagnosed far too late.

AIDS killed 357 residents of the borough in 2006, about a third of all AIDS deaths in the city.

City health officials have also urged changes in state law that would do away with both the consent form and the mandated counseling sessions, arguing that they have little benefit. Those changes have been opposed by some AIDS activists.

"We find that period of time extremely useful," said Marjorie Hill, chief executive officer of the Gay Men's Health Crisis.

She said it gives doctors a time to talk with patients about ways to avoid HIV, or deal with an HIV infection.

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On the Net:

New York City Department of Health: http://www.nyc.gov/html/doh/html/home/home.shtml

© 2008 The Associated Press.

The plan announced Thursday comes as the federal government also begins a new effort to encourage many businesses to stockpile anti-flu drugs in case of a pandemic. Those private stockpiles would supplement a national stockpile that contains enough doses to treat only a fraction of the population.

But stockpiling is a big upfront investment for a threat that may never arrive - and requires replacing supplies whenever drug doses expire. Roche Holding AG says its new plan would remove some of those barriers for companies otherwise interested in Tamiflu.

The U.S. government, in an unusual move, congratulated Roche on the program and helped to publicize it.

"We applaud them," said Tevi Troy, deputy secretary of the Department of Health and Human Services, which directs the nation's pandemic flu preparations. "Preparedness is a shared responsibility that extends across all levels of government and all levels of society."

Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people have never experienced. There is concern that the Asian bird flu known as H5N1 might trigger one if it acquires the ability to spread easily from person to person.

It would take months to custom-brew a vaccine against a new super-flu. So the government has stockpiled enough antiviral drugs, mostly Tamiflu, to treat 50 million people, and is urging states to purchase enough for 31 million more.

The antiviral drugs also can be used to prevent infection before a vaccine arrives. Until recently, federal health officials didn't recommend employer stockpiling for fear that there wasn't enough Tamiflu being produced to satisfy global demand during regular flu seasons, and to build up the pandemic stockpiles of the U.S. and other governments.

But Roche increased global production 15-fold - and U.S. guidelines proposed earlier this month not only say that employer stockpiling is feasible, but encourage businesses to set aside enough antiviral drugs to help their workers ward off infection and stay on the job.

"Businesses that provide goods or services essential to community health, safety, or well-being have an obligation to plan and prepare for continued operations in the event of a pandemic," say the guidelines.

Roche already has sold varying amounts of Tamiflu to more than 300 U.S. businesses, said George Abercrombie, chief executive of Hoffman-La Roche Inc., the company's U.S. arm.

Under the new program, others companies could reserve Tamiflu instead of buying and storing it themselves. They would pay a yearly fee of $6 for every 10 capsules to be set aside in Roche storage and delivered within 48 hours of demand.

Upon delivery, companies would pay the going wholesale price, currently $74 per 10-pack. If a pandemic had begun, the price conceivably could spike. But Abercrombie rejected that as "a bit of a cynical view," adding, "that is not the way our company operates."

Why 10 capsules? That's the dose to treat a single ill person. To prevent infection requires a capsule a day as long as someone is potentially exposed to the virus.

In estimating how much to reserve, participating companies would have to decide how many employees they wish to cover, for either treatment or prevention - and if they'll also provide Tamiflu to workers' families. Roche has said the program requires a minimum order of 2,500 10-capsule packs, but Abercrombie said he was willing to work with smaller companies.

"This will encourage a lot of businesses that were on the fence," said Ann Beauchesne of the U.S. Chamber of Commerce, which is working with companies and the federal government on corporate pandemic preparations.

In January, Roche announced that sales of Tamiflu had dropped 19 percent to $1.92 billion, as government stockpiling in wake of bird-flu fears eased. Abercrombie said Thursday that production has been scaled back because of abundant supply - governments around the world had ordered 215 million courses of therapy out of 400 million available - but could ramp up again if necessary.

© 2008 The Associated Press.

New England - with a rate of uninsured people less than half that of the Southwest - has the largest proportion of its population covered, the study found.

The study marks the first time the Centers for Disease Control and Prevention has compared different regions of the country by health insurance status, said Robin Cohen, the lead researcher.

Cohen declined to theorize why Arizona, New Mexico, Texas and Oklahoma together have higher rates of uninsured people than other parts of the country.

But another expert said it likely comes from a combination of factors, including state policy decisions and the fact that many jobs in the Southwest are service, construction or other jobs without good health benefits.

Aggressive steps by states such as Massachusetts to increase coverage of their uninsured may widen the gap between regions like New England and the Southwest, said the expert, Ken Thorpe of Atlanta's Emory University.

"There are substantial inequities in coverage depending where you live, and they seem to be getting worse," said Thorpe, a health policy researcher.

The CDC study's results are based on a national, in-person household survey of more than 106,000 families in 2004 through 2006.

The researchers focused on non-institutionalized people under the age of 65, the age when Medicare insurance for the elderly kicks in.

The study presented estimates for the 41 states that had at least 1,000 respondents. But the researchers pooled data from the other states as well to come up with regional estimates.

Among those states for which there were data, Oklahoma had the highest percentage of people uninsured - more than 33 percent. Hawaii and Massachusetts were tied with the lowest percentage, at 9.5 percent.

The Southwest has a large American Indian population served by the Indian Health Service. The Indian Health Service was not counted as a form of insurance, in keeping with definitions used in other health insurance studies. But even if it had been counted as coverage, the Southwest still would have had the highest uninsurance rates, Cohen said.

In the six-state New England region, 11 percent of non-elderly adults were uninsured, as were a little under 4 percent of children.

Next best? Three regions that include the Great Plains, Great Lakes in the upper Midwest and the Northeast each had uninsurance rates of 14 to 15 percent for adults and about 6 to 7 percent for children.

The Southeast was the second-worst region, with nearly 23 percent of adults uninsured. The Rocky Mountain states were second worst for children, with nearly 12 percent uninsured.

For the nation as a whole, nearly 17 percent of people under 65 were uninsured at the time they were interviewed.

A second study by the CDC, also released Wednesday, presented 2007 data from the same annual survey. It found about 16.5 percent of Americans were uninsured at the time they were interviewed that year. That survey only covered 20 states and did not give a regional breakdown.

The CDC estimates that as many as 54 million Americans went uninsured during at least part of the year, and nearly 31 million were uninsured for a period of more than a year.

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On the Net:

The CDC's National Center for Health Statistics: http://www.cdc.gov/nchs

© 2008 The Associated Press.

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