TWO WEEKS ago the National Academy of Sciences' Food and Nutrition Board issued a report that said there is no need for healthy Americans to reduce their intake of fat and cholesterol. The controversy continues to grow because such advice is contrary to that of at least 20 scientific and government organizations.
Yesterday the consumer liason panel to the Food and Nutrition Board severed its relationship with that board because of the report.
The action of the 15-member consumer panel, an advisory group, was just the most recent flap in a series that has occured since May 27.
In a letter to the Academy's president, Dr. Philip Handler, the liason panel said; "in issuing 'Toward Healthful Diets' the board has used the well respected name of the National Academy of Sciences to promote, in a highly irresponsible manner, its insulated view of the relationship between diet and heart disease. It is impossible for us to continue to affiliate our names with a scientific committee that shows such little concern for the public or its peers."
The panel membership includes: Bonnie Liebman, a nutritionist with the center for Science in the Public Interest; James Turner, a lawyer; Katherine Clancy, a nutritionist with the Federal Trade Commision; Eleanor William, nutrition professor at the University of Maryland; Mary Goodwin, nutritionist with the Montgomery County Department of Public Health and Tom Hanna with the Family Life Development Center at Cornell.
In addition some nutrition experts have called for a Congressional investigation of the quasi-government board and one of its own members has said he may resign because of the procedure the board used in preparing its report.
Ironically the board said it had issued the report "in effort to reduce confusion in the mind of the public that has resulted from (these) many conflicting recommendations..."
Instead what it has succeeded in doing is confuse the public even further and there are already signs taht segments of the food industry affected by reccommendations to reduce fat and cholesterol consumption -- the meat, dairy and egg producers -- will use the board's paper in an effort to force the Department of Agriculture to reverse its support of a reduction in fat and cholesterl consumption.
Last February USDA and HEW issued the following recommendations; Eat a variety of foods; maintain ideal weight; avoid too much fat saturated fat and cholesterol; eat foods with adequate startch and fiber; avoid too much sugar; avoid too much sodium; if you drink alcohol, do so in moderation. USDA is working on menus and recipes that would implement its recommendations.
In releasing the guidelines Agricluture Secratary Bob Bergland said, "For a long time we had nothing but conflicting statements from a variety of sources. Now the scientists of USDA and HEW are making recommendations based on an emerging consensus within the scientific community." The Surgeon General's report "Healthy People" and the report from the conservative American Society for Clinical Nutrition were part of that consensus.
Mark Hegsted, director of USDA's Human Nutrition Center, finds the whole flap "unfortunate. It certainly doesn't appear to me that the board has clarified the situation as far as consumers are concerned. They say every person should be aware of his risk factor profile and then if any are abnormal they should consult their physicians. They don't define what they mean by abnormal but from my point of view almost half of Americans die from heart attacks; 20 percent more are hypertensive; 20 to 30 percent are obese; 5 to 10 percent have diabetes so that if we could really define risk, practically the whole population should be on a diet."
Hegsted, who is one of the driving forces behind both the Senate report, Dietary Goals for the United States, and the UDSA/HEW dietary guidelines, believes "the only sensible approach is to reccommend moderate intake. We are telling people taht dietray guidelines are the most sensible advice we can give based on current knoweledge and there is no risk associated with them. I don't know how they could reach such a contrary conclusion."
The Food and Nutrition Board concurred in some of the recommendations made by UDSA/HEW but it was their disagreement with two of them which has caused the furor. The board said there was not enough evidence to "make specific recommendations about dietary cholesterol for healthy persons," and "infants, adolescent boys, pregnant teen-age girls, as well as adults performimg heavy manual labor, probably have no need to reduce the fat level of thier diets below 40 percent of calories." Most nutritionists recommend a maximum of 30 percent fat from calories.
In order to reach their conclusions the six-member panel of the food and Nutrition Board which prepared the document chose to ignore some of the evidence. Dr. Robert Olson from St. Louis University, who prepared the section of the report dealing with heart disease said during a television interview that the committee had discounted the epidemiological evidence -- evidence of association but not of cause and effect -- linking heart disease to overconsumption of fat and cholesterol.
Curiously the board's current position is contrary to one it took several months ago when it released an update on Recommended Daily Allowences for vitamins and minerals. At the time it said people should reduce their fat intake.
On the other hand, based on what some scientists consider even less conclusive evidence, the board made two other recommendations; reduction in sodium intake and obesity. "there is no reason to believe that reduction of sodium chloride intake to levels of 3 grams per day would be harmful for healthy persons, and it may be helpful for the prevention of hypertension in susceptible individuals . . ."
In addition the board said"...reduction in the incidence of obesity should be a major objective"...because "in many persons obesity is associated with significant increases in morbidity and morality from such diseases as hypertension, diabetes, coronary heart disease and gall bladder disease and that mortality from these diseases is reduced with weight reduction."
Dr. Alfred Harper, a University of Wisconsin scientist and chairman of the FNB, was asked to explain why the board recommended some diet changes but not others. Harper said the board could give advice on sodium because it is an essential nutrient for which levels have been set.
He also said that recommendations were made about obesity because it's socially undesireable and obese people have limitations on physical activity."
Harper said he had no idea there would be such strong reaction. He blamed the press. "The reaction from the press was almost hysterical," Harper said said. In many respects the press did a disservice by not putting this in perspective."
Some members of Harper's own board think the board is responsible for not putting things in perspective. Two of them make their views known when earlier drafts of the report were circulated, but these views were not incorporated.
Dr. Irwin Rosenberg from the University of Chicago said he had told the board it should "be careful not to put out a report that had a negative anti-activist tone. I think what was meant to be a scholarly statement turned out to be negative and probably was defended more negatively than was ever intended because of the selection of people who defended it. I happen to be one of those people who does agree even if the benefits of decreasing fat and cholesterol are not totally proved, the risks do seem to be minimal."
Sol Chafkin of the Ford Foundation, told the board that "it would be hard to suggest any changes of dietary patterns if one insisted on incontrovertible scientific proof of the benefits of the proposed change. It struck me," he said "that if there was a situation where a proposed dietary change did not appear to be harmful that the board could say that, even if the benefits were uncertain. And the board could say that too."
The board did not take either piece of advice.
Both Rosenberg and Chafkin also wondered why a press conference was called.
It was not a decision discussed with board members," Rosenberg said. "I'm not sure I understand how the decision was made to have anyone there but the chairman of the board."
The other board member at the press conference was Dr. Robert Olson, whose view on diet and heart diseases, like those of Harper have been known for years. The fact that Olson is a paid consultant and scientific advisor to the American Egg Board and the Dairy Council of California, and that other members of the board receive grants from and consult for the food industry, became the subject of many stories after the inital report was released. These board members do not see such sources of income as conflicts of interest.
Not everyone agrees. Michael Jacobson, director of the Center for Science in the Public Interest, said: "I can't think of any instance where a scientific organization has been more discredited because of the poor science and corporate involvement."
Observers of the Food and Nutrition Board have seen these problems coming for a long time. In 1977 a visiting committee was appointed to make recommendations on how to make the board more relevant. The Committee concluded that the board was "not in the vanguard in dealing with many critical and important issues." Overall obstacles to leadership it said, are the result of "the inability of the FNB for various reasons to move from its traditional patterns of work to address present day problems in food and nutrition."
None of the committee's recommendations for change was implemented. Says critic Rod Leonard, director of Community Nutrition Institute, "the board is no longer a scientific body. It's an advocacy group for a certain point of view." Leonard believes "the people on the board are upset that they have not been able to control the development of the (USDA/HEW) guidelines so they are trying to undercut public confidence in the guidelines."
Chafkin wondered why the guidelines were not used as a starting point. "If I had to do it over again, frankly I would start with what has been offered to the public as official advice. It doesn't hurt to have a second opinion.
"It puzzles the hell out of me," Chafkin said, "why they didn't ask for comments from Mark Hegsted, one of the most respected members of the nutrition community. A good scientist would deliberately seek out somebody who is going to be the roughest critic."
Said Chafkin: "If you say we can't propose any changes without proof of benefits and without conclusive proof that there is no harm, then you have to turn the question around. Can the people who think our diet pattern now is pretty good demonstrate that it does no harm? The present report doesn't deal with proving that the present diet pattern does no harm."