When the U.S. Food and Drug Administration proposed to eliminate artery-clogging fats from all foodstuffs last week, they could look across the Atlantic Ocean at one recipe for success. Denmark placed tight restrictions on its own partially hydrogenated oils—the main source of trans fats—a decade ago.

In fact, U.S. action follows in the footsteps of a cadre of nations that have sought to limit trans fat intake already. And their results and playbook could provide a glimpse of the future in the U.S. In 2003 Denmark green-lighted legislation that limited the same substance in its food. Their law did not ban the substance, but it did force manufacturers to limit its use—any food could only have up to 2 percent of its fat made of trans fat, substantially shrinking the presence. Later, Austria, Switzerland, Iceland and Sweden followed suit. And parts of the U.S., including New York City and California, independently took action in recent years to pass legislative limits on trans fat in the food served in restaurants.

Canada introduced its own country-wide mandatory labeling of trans fat in prepackaged food in 2003, three years before the U.S. made a similar move to require trans fat labels on store-bought foods. Public health experts posited that by labeling trans fat on nutrition labels, consumers could make better decisions and prod companies to voluntarily reduce trans-fat use. To some extent, it seemed to work. Manufacturers have reformulated products to reduce trans-fat content, and as a result, Americans are now eating less of it. Still, because approximately one third of the food Americans eat is prepared outside of the home, trans-fat labels can only go so far, public health advocates say. Trans fat remains unregulated and unlabeled in a large segment of the food supply. Soon that may change.

The FDA is looking at exactly what could clear regulatory hurdles in the U.S.—including setting an allowable level for trans fat in food (as Denmark has done) and asking for comment on how long it would take to reformulate products to remove the substance from all foods. Trans fat is formed during food processing when some hydrogen is added to vegetable oil to increase solidity. It is typically added to food to increase its shelf life, improve its texture and maintain its flavor. It’s a staple in products including microwavable popcorn, pizza and cake icing.

The problem is that scientific evidence has shown that the substance raises the “bad” cholesterol in our bodies and stokes the risk of developing heart disease. The new move by the FDA seeks to remove these partially hydrogenated oils from our foods (although it would not impact the small quantities of trans fat naturally produced in the guts of some grazing animals that show up in some of our milk and meat). The change could prevent an estimated 20,000 heart attacks and 7,000 deaths from heart disease each year. The proposal would force companies that want to continue to use the substances in food to procure special waivers. Removing partially hydrogenated oils from the U.S. food supply could cost about $8 billion, the FDA said in its proposal.

During the proposal's public comment period (open to January 7, 2014), industry will likely cite concerns reminiscent of those raised in Denmark, nutrition experts say. Denmark’s law, which applies both to homegrown foods and those that were imported, initially fueled concerns about impacting the taste and texture of key foods including Danish pastries, but chefs and bakers have found they were able to adapt. Steen Stender, one of the leading Danish trans-fat experts who lobbied for the anti–trans fat law spoke with Scientific American about desserts, Danish health and current actions in the European Union to regulate trans fats.

[An edited transcript of the interview follows.]

What was the science that led Denmark to take this action?
There was a paper in the journal The Lancet from Walter Willett’s group at Harvard University from the Nurses’ Health Study that found an increase in coronary heart disease related to the intake of trans fat. It was published in March 1993. That was the first real indication of the harmful effect of trans fat. I remember the front page of the newspaper then—it said, "butter more healthy than margarine." The heart association had said the opposite for years, and suddenly this was on the front page!

How did industry respond?
Some bakers said that what you call a "Danish" can’t be made in the right way anymore, that we can’t get it to flake in the right way. Then one baker from one of the supermarket chains found that if he used a very meticulous scheme of temperature control during incubation of the fat and other ingredients at just the right temperature and time, he could make Danishes without any trans fat. This company put up a big poster saying “Have a Danish, we are baking for your heart without trans fat.” And in no time other bakers put up signs in their windows saying, “We are baking for your heart without trans fat.” So the industry went along with this initiative.

What does the law say exactly?
No more than 2 percent of the fat used for food can be trans fat. In certain cases you can get two years in jail if you circumvent the law several times. The Danish country will have been without trans fat for 10 years come March.

Any foods that could not adapt?
The legislation was such that one could apply for exceptions. Makers of licorice that you can buy in bags—that is very popular in Denmark—applied to use trans fat. A tiny surface layer of trans fat around licorice will keep the pieces from sticking to each other in the bag. The amount of trans fat was small enough that they got this exception right away, but otherwise I am not aware of any companies that needed the exemption.

We [also] have not had the problem with imported food containing trans fat. I haven’t found any in the large supermarkets for many years. Of course, I have to say there might be some small shops in Copenhagen where people filled their carts with wafers and biscuits when they were on vacation outside the country and then brought the products back to sell, which is illegal.

What about foods like icing? Any issues there, even with importing it?
No, I have not heard about anything like that. We have a lot of cakes with icing, but I never have heard of it being made with trans fat.  Even with trans fat in icing it would be such a small part of a person’s diet that it would not be a big health problem. I like to say, though, that trans fat should only be in shoe polish—it’s excellent for that.

And what were the health impacts of Denmark’s law?
That is a very difficult question because coronary mortality in Denmark has fallen 70 percent since 1980, and it continues to fall. Something is going very well in relation to coronary heart disease in Denmark, but it’s also happening elsewhere. In Denmark we have very heavy antismoking campaigns and we also promote exercise and eating fruits, and each deserves a share of the success in the decline in coronary heart disease. How much of that is due to the reduction in trans fat is very difficult to say.

What is going on across the European Union with trans fat legislation?
Last Tuesday I spoke to a trans fat working group in the E.U. parliament. There is still a lot of trans fat in Europe, especially in eastern Europe.

Some countries have adopted the Danish legislation but not all—England, Germany and France have not. What you have done in the U.S. [with the FDA proposal] will really benefit the drive on the ban in Europe, so it’s really hot right now.

The E.U. is considering three models: One is like Denmark’s. Another is to label trans fat—they have partially hydrogenated fat labels on food right now, which do not mean anything to people. Another consideration is to label the amount of trans fat in a serving.

Really, we need an E.U. ban like Denmark’s. In Demark we don’t mention trans fat. It is a word you do not need to know or care about it. There’s no information campaign needed or anything like that because people are protected.