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IT E IJT1JRE OF DIETARY INTERVENTION 111
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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. 113
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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 114
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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 115
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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. 116