Fat, Foreboding, and Flatulence

• Placebo effect
• Fat substitutes
• Diarrhea
• Abdominal pain
• Snacks

In this issue, Sandler and colleagues (1) tell us that snacks of potato chips and their congeners made with olestra or vegetable oils caused inconsequential symptoms to study participants who ate them during a 6-week period. The participants were mostly “high consumers” who were selected because they had volunteered for other studies; in this one, they ate a median daily amount of more than 1 ounce of chips. Although men ate more chips at a time than women, women ate chips more often and thus consumed a greater total median amount.

Medical commentaries too often get bogged down with cabalistic statistics, but, heeding Aristotle, who suggested that the beginning of wisdom is knowing when not to measure, I will review the broad picture rather than statistical niceties. When this editorial was requested, conflict of interest was mentioned, which makes me confess that I am regarded as fat. I fight weakly against additional weight gain, so I welcome olestra-containing products as potential allies. After my one oral encounter with them, I did have some unwonted cramps and diarrhea, but I have not replicated that n-of-1 study.

Although the authors of the current study (most of whom work for Procter & Gamble, the manufacturer of olestra) hedged their conclusions with such partisan adjectives as “clinically meaningful” or “bothersome,” it was apparent that roughly one third of persons who consumed olestra the most often or in the largest amounts had more frequent bowel movements than those who did not eat as much. This increased frequency made no difference in their daily activities, which is not surprising; they were, after all, part of a study that provided them a substantial amount of free goodies.

Olestra, a mixture of sucrose-fatty acid esters that is neither digested nor absorbed, increases the frequency and volume of …