A controversial Senate report that recommends radical changes in American eating habits has come under attack from an increasing number of special interest groups.
The Report, which says its recommendations would lead to a longer and healthier life, is the most specific yet issued by the federal government. In the past its nutrition education has come in the form of admonitions to "eat something from the four food groups every day," and "all food is good food."
The attacks on the report prepared by the Senate Select Committee on Nutrition and Human Needs come as no surprise to one of its consultants. When "Dietary Goals for the United States" was published last January, Mark Hegsted, professor nutrition at Harvard, said: "There will undoubtedly be many people who will say we have not proven our point; we have not demonstrated that the dietary modifications we recommend will yield the dividends expected." He was right.
First, the cattle producers protested because the goals recommended reducing the consumption of meat and increasing the consumption of fish and poultry.
Then the sugar interests said the recommendation for reducing the intake of sugar by 40 per cent had no scientific basis.
The National Canners Assn., is upset because the report suggests using fresh and frozen instead of canned vegetables.
The egg producers had their say: The Nutrition Committee heard from them that cholesterol levels are not lowered by a reduction in egg consumption.
The most sweeping attack on the Dietary Goals, however, came from the American Medical Assn. The AMA said they should not be adopted because there is no proof that diet is related to diseas and besides, changing Americans' eating habits might lead to economic dislocation. The National Dairy Council endorsed the AMA's statement.
Ironically, about the same time the AMA was attacking the report, the respected British medical journal, Lancet, praised them. An editorial in the April 23 issue said: "The American goals will be welcomed by people who have thought serously about the diet of Western man."
It noted that the recommendations are similar to those made in a Scandinavian report adopted by Sweden and Norway.
The six dietary changes recommended are:
Increase complex carbohydrate (vegetables, fruits, grains) consumption to account for 55 to 60 per cent of caloric intake.
Reduce over-all fat consumptio from approximately 40 per cent to 30 per cent.
Reduce saturated fat consumptio to account for about 10 per cent of total calories; and balance that with polyunsaturated and mono-saturated fats, which should account for about for about 10 per cent of calories each.
Reduce cholesterol consumption to about 300 milligrams a day.
Reduce sugare consumption by about 40 per cent to account for about 15 per cent of total calories.
Reduce salt consumption by 50 to 85 per cent.
The AMA contends that "insufficient evidence exists at this time to support the need for or the benefit from major changes in the national diet as proposed."
It says the relationship between diet and deaths from heart disease is "suggestive, fragmentary and even conflicting"; the links "between diet and cancer of the colon and breast cancer are very tenuous": there is no proof "salt consumption is a major factor in causing hypertension in persons in the United States; there are no studies showing diabetes is in any way related to diet. Moreover," the AMA says, "patients with diabetes require diets tailored to the individual."
Community Nutrition Institute, a public-interest group which monitors federal food and nutrition programs, reviewed the AMA document, in its Weekly Report. It concluded that what bothered the association about the Dietary Goals was that they "infringed on the doctor-patient relationship." The gist of the AMA comments does appear to be that the proper way to deal with disease is through cure rather than prevention.
According to the association's comments:
The proper way to deal with high blood pressure is through detection via mass screening programs and then through treatment. "Medical management for some patients may include sodium restriction or calorie restriction or both."
"Diets to control diabetes (or other conditions) must be tailored to meet individual needs rather than seeking a uniform diet for all."
The problem of obesity, which is also addressed in Dietary Goals, should be dealt with through "individual medical advice, and, where appropriate . . . a prescribed individual diet."
"Adoption of national dietary goals is not an answer to obesity and could prove detrimental if followed by individuals properly requiring medical supervision for their particular condition."
The association concludes that there is "potential for harm for the radical longterm dietary change . . ."
What is more, it says, ". . . the recommendations carry with them the underlying potential for prohibiting the sale or discouraging the agricultural production of certain food products which may not in the view of the government be supportive of the dietary goals."
Hundereds of health professionals have endorsed "Dietary Goals for the United States." While some do not think it is perfect document, they feel it is an excellent place to begin revising the country's eating habits. Several of them, including three who worked on the Nutrition Committee report, were asked to comment on the AMA's statement.
Hegsted, the Harvard nutritionist, spoke for all of those interviewed when he characterized the AMA's comments as "not very surprising. The lack of interest or opposition of the AMA to nearly all efforts in preventive medicine and public health is well known."
Dr. Beverly Winikoff, anothe rconsultant on the Senate report and a physician with the Rockefeller Foundation, believes that the treatment of illness is "infinitely inferior to prevention." She said the AMA's "comments are very clearly designed to advocate treatment rather than prevention."
Taking not of their comments on dietary goals and diabetics, Joan Gussow, chairman of the program in nutrition education at Columbia Teachers College, said it sounds as if they are "really afraid diabetics might not go to doctors if we accept the dietary goals."
A registered dietitian who practices in the Washington area and asked that her name not be used, observed that the entire document showed a "profound absence of constructive alternatives. They have offered no updated dietary guidelines, which leaves consumer and health professionals withe the impression that the medical profession doesn't consider personal nutrition very important.
But Hegsted asserted, doctors aren't a very good source of nutrition information anyway. "Everyone who has considered this issue," he said, "is aware that most physicians know no more and often less about nutition than the patients they are about nutirtion than the patients they are supposed to counsel. It is obvious that even if they were expert in nutrition, preventive programs cannot be formulated on this basis."
Gussow asked what evidence the AMA has that "there is a potential for harmful effects from a radical long-term dietary change . . ." She feels the changes would be salutary and that much of what is suggested in the goals has already been advocated by the American Heart Assn. And Hegsted said that the American diet has already undergone some drastic changes in the last 50 years ". . . with little or no regard for health issues." He said our current diet "is happenstance related to our affluence, the productivity of our farmers and the activities of the food industry."
Several of those who commented were curious about the AMA's concern over the adverse effect adoption of the goals might have on the sales of certain unspecified agricultural products. Dr. Philip Lee, a physician at the University of California and a consultant to the Nutrition Committee, said it sounded as if the association was "speaking more from the viewpoint of the vested interests such as the meat, milk and dairy lobbies as opposed to the public interest."
Defending the Dietary Goals at a recent conference Hegsted said that those who want more research before any recommendations are made are unrealistic. "The public and the Congress are tired, and rightly so, of researchers who never know enough to reach a decision. Many, perhaps most, of the important public decision are made with much less evidence than we have.
"The question to be asked, therefore, is not why should we change our diet but why not? What are the risks associated with eating less meat, less fat, less saturated fat, less cholesterol, less sugar, less salt and more fruits, vegetables, unsaturated fat and cereal products . . . There are none that can be identified and important benefits can be expected."