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IT
E IJT1JRE OF DIETARY INTERVENTION
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INTRODUCTION
William E. Connor
I would like to make several points in the way of
introducing this section of the report, the future of
dietary intervention. Dietary intervention to improve
human health is older than recorded history. Usually,
the intervention is a part of the folklore of the people
and is informal rather than a matter of official policy.
Aphorisms about food such as "a mackerel a day keeps the
doctor away" or "fish is brain food" illustrate this
folklore. Hippocrates suggested, "let thy food be thy
medicine. n Humans have always used food to prevent
disease--it is not a new concept.
The necessity for continual nutritional intervention
rests on the rather static genetic makeup of humans
coupled with an ever-changing world and technology.
Basically, twentieth century humans have the same genetic
makeup as Stone Age people, who obtained food only by
hunting, fishing, and gathering from nature. They had
limited technology and lived on the precarious edge of
survival. The problem was to get enough food.
Successive agricultural revolutions have provided us
today with an abundance of foods, both natural and highly
processed. The maldistribution and overconsumption of
food have led to new diseases, some in epidemic
proportions. There is a wealth of scientific evidence
that faulty nutrition is responsible for a host of
disease processes in people who live in underdeveloped
and impoverished parts of the world, as well as in people
who live in developed parts of the world. Some are
listed in Table 1.
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TABLE 1 Diseases of Affluence and Poverty
Diseases of Affluence
Diseases of Poverty
Coronary heart disease
malnutrition
Obesity
Hypertension
Diabetes mellitus (adult)
Cancer (e.g., breast, colon,
prostate)
Gallstones
Protein-calorie
Xerophthalmia (vitamin A
deficiency)
Anemia (iron deficiency)
Pellagra (niacin
deficiency)
It is noteworthy that both the diseases of affluence
and the diseases of poverty so prevalent in the
developing countries have occurred because human cultures
have strayed considerably from the dietary patterns
developed over hundreds of thousands of years,
particularly during the hunting and gathering stages
during which the genetic makeup of modern man was
developed. During the hunting and gathering stages, the
diet characteristically included almost completely
unprocessed food from both plant and animal sources. The
animals and fish, as well as the plant foods and insects,
that humans consumed had a relatively low fat content and
were rich in nutrients such as vitamins, protein, and
minerals. The food supply of the hunters and gatherers
was diverse, with hundreds of individual foods gathered
from nature. In particular, the animals were lean and
their meat had a much more polyunsaturated fatty acid
composition as compared with the saturated fat of the
feedlot animals consumed by humans today. The rich
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diversity of the food supply meant that diseases of
poverty, including vitamin and mineral deficiencies, were
undoubtedly much less common. The main point I wish to
make here is that both present-day diseases of affluence
and diseases of poverty have resulted from technological
advances. In the Ueste`~1 world the human diet is too
rich and in developing countries the diet is stereotyped,
for the most part, with there being a great dependence on
single or several foodstuffs without the widely varied
supply that our ancestors, the hunters and gatherers,
consumed.
Technology has provided problems and opportunities.
The agricultural revolution meant that given the proper
distribution, all peoples of the world, including those
of the United States, can have an ideal diet that will
help them to produce healthy children and healthy adults
free from the diseases of civilization with which so many
are now afflicted. Technology means a safe, and
tasteful, food supply. Both the diseases of
overconsumption and diseases of poverty can be
ameliorated by modifying the nutritional life-styles of
both the relatively affluent and the poor.
Before I stress official public policy, important as it
is, I want to emphasize the importance of the private,
informal networks of dietary intervention. Take, for
example, atherosclerosis and coronary heart disease. The
private network that is of the opinion that dietary
cholesterol and fat are bad for the heart began in the
1940s and 1950s in the United States. Remember Paul
Dudley White, Louis Katz, Ancel Keys, William Dock, and
Isadore Snapper? They said it all. The public listened,
but it is impossible to change food habits without
recipes, so low-fat cookbooks appeared. Dobbin and
Goffman published one in 1952, and even today it is up to
date. The American Heart Association issued a formal
statement with dietary recommendations to prevent
coronary heart disease in 1960. By the late 1970s, it
was apparent that the mortality from coronary disease in
the United States was 20 to 30% less. People had changed
their diets. This did not please the egg producers. The
info meal networks operating in a literate and
individualistic society had worked. In contrast, in
Great Britain there were few medical leaders who said
anything about diet and coronary disease--there was only
skepticism. The press and the communications network in
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that country were silent, and the incidence of coronary
disease increased in England while it decreased in the
United States.
The United States is now at the stage of history of
nutritional intervention when public policy by government
can provide a further impetus for proper nutrition,
especially for those of our citizens, the underclass, who
are not in touch with these informal educational networks
that provide so much nutritional guidance--for those who
don't read Jane Brody in the New York Times or attend
lectures by distinguished physicians. It is this group,
the underclass, that particularly needs the benefits of
governmental action to help them change their faulty
nutritional life-styles, a matter that this section of
the report emphasizes.
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