MARCH/APRIL 1990 ; RITION VOL 7NUMBER2 TSSN 0748-8165 THE MACROBIOTIC DIET: NO CANCER CURE : Johanna Dwyer, D.Sc., RD. ‘Macrobiotics is a quasi-religious philosophical system founded by George Ohsawa (1893-1966) and popularized in the United States by Mishio Kushi. The’ system advocates a vege- tarian diet in which animal foods are used as condiments rather than as fullfledged menu items. The optimal diet is said to be achieved by balancing “yin” and “yang” foods. The yin/yang classification does not correspond to nutrient composition but rather to activity characteristics of the universe as defined by r~ tient philosophy. i Kushi appears to believe that diet is the major factor in the development of cancer and should play a major role in its treatment. In The Cancer Prevention Diet (1983), he stated that “cancer is the body’s healthy attempt to isolate toxins ingested and accumulated through years of eating the modern unnatural Get and living in an artificial environment.” Kushi also appears antagonistic to medical treatment. In Cancer and Diet (1980), he stated, “Ofprimary importance in dealing with cancer... is not to disturb this natural mechanism by taking out and destroying the cancer.” And in The Cancer Prevention Diet, he says that “when a person with cancer has received chemotherapy, cobalt radiation, or undergone surgery... . recovery may be somewhat tmore difficult” and that, “except in. .. lifesaving situations, we do not encourage patients to combine the Cancer Prevention Diet with surgery, radiation, or chemotherapy.” The “Standard” Macrobiotic Diet According to literature from the Kushi Institute, the “standard” macrobiotic diet for persons living in temperate climates enarpaneg the folowing: comprise 50-60% of each meal. Fourprodssnoodes and cracked pan, suchas nyeastod whole wheat breads, whole wheat and buckwheat noodles, oatmeal, bulgur wheat, cornmeal, and other cracked grains may be used to complement main servings of whole cereal grains. + About 5-10% of the daily food intake should be soup ‘made with vegetables, seaweed, grains, or beans. Seasonings are usually miso or tamari soy sauce. + Vegetables comprise 20-30% of each meal. Two thirds are cooked; one third may be eaten raw, as pressed salad, or as pickles. Those vegetables for daily use include green cabbage, kale, broccoli, Chinese cabbage, bok choy, dandelion, mustard greens, carrots, squash, scallions, and onions. Pota- toes, tomatoes, eggplant, peppers, asparagus, spinach, beets, zucchini, and avocado should be avoided. + Whole beans or soybean-based products, cooked to- tether with ea vegetables, comprise 5-10% othe daly intake * Beverages include herbal teas, cereal grain teas, spring or well water, and small quantities of frit juices. + + A small amount of white meat fish (Qounder, carp, halibut, or trout) may be included 1-3 times a week. _* Seasonally available fruit may be eaten 2-3 times a ‘week in small amounts. + Snacks can include nuts and seeds (dry-roasted and seasoned with sea salt or tamari soy sauce). Popcorn, rice cakes, roasted grains, or beans can also be eaten in'small amounts. + Meat, animal fat, eges, poultry, milk products, refined sugars, soda, Coffee, “chemically treated” foods, refined grains, hot spices, and canned, frozen, or irradiated foods should be eliminated. Vitamin/mineral supplements are usually avoided, and fluid restriction is common. Specific diets, which are vanants of this general pattern, are sometimes proposed for different types of cancer. ‘The macrobiotic “way of life” includes chewing food at least 50 times per mouthful (or until it becomes liquid), not ‘wearing synthetic or woolen clothing next to the skin, not taking Jong hot baths or showers (unless too much salt or animal foods have been consumed), having large green plants at home to enrich the oxygen content of the air, and singing a happy song. every day. Why Cancer Patients are Vulnerable During the past few years, there has been so much publicity about diet and cancer that many people who develop cancer believe that dietary factors are the sole cause. Macrobi- otic proponents claim that cancers arise from imbalances in the J.B. Lippincott Companyw NUTRITION FORUM body and buildups of poisons or impurities, and that detoxifica- tion can be accomplished through dietary means. This provides a seemingly straightforward dietary explanation for iliness and suggests that a nontoxic, self-administered, home-based treat- ‘ment using food is the answer. Patients conclude that macrobi- ofic diets are harmless, nontoxic, and may be beneficial, often after reading a testimonial book or encountering anecdotes about supposed cures from well-meaning friends or relatives. ‘Most patients are interested in self-help, especially through dietary measures. The macrobiotic diet can satisfy their desire for involvement in their own care, since a considerable amount of special food purchasing and preparation is necessary. Personalized attention is provided not only by the various advisers or counselors, but also through the activities of groups ofke-minded individuals. The emphasis on spiritual dimensions may help cancer patients overcome guilt about aspects of their previous lifestyle that they feel may have caused their iliness. Each of these characteristics can be attractive to patients who are frustrated by the toxic side effects of radiation or chemo- therapy or who believe they are not involved enough in the treatment process, are not receiving enough emotional support ‘romtheir doctors, orem beng comforted about theiriliness by their religious or philosophical beliefs. “Macrobiotics cloaks itself in the trappings of status and respectability. Its proponents suggest that experts and author- itative groups agree with this therapy. The macrobiotic diet is low in fat and high in fiber, which is also a characteristic of the preventive diet recommended by the American Cancer Society and other authoritative bodies, although the macrobiotic det is ‘muuch more restrictive. Because of this, many people assume thatit can cure cancer as well. The factis, however, that neither the American Cancer Society, the National Academy of Sci- ences, the National Cancer Institute, or any other scientific organization recommends any type of diet as a cure for cancer. ‘The American Cancer Society lists macrobiotic diets among its “unproven methods” and warns that “ifnot properly planned to be nutritionally adequate, such diets could provide insufficient nutrition for cancer patients” [Ca: A Cancer Journal for Physi- cians 39:248-251, 1989]. Clear-Cut Dangers : ‘What specific threats do macrobiotic diets pose? First, devotees of these regimens are often alienated from science- ‘based medical practices. Several studies have found that the parents of macrobiotic children had more negative attitudes toward conventional pediatric guidance than did Seventh-day Adventist vegetarians or nonvegetarians of similar educational levels, and their children exhibited less satisfactory nutritional status. Advocates of macrobiotic diets for those who are already ill often oppose surgery, chemotherapy, and radiation, which they view 4 harmful and unqatural Batients who folow thei counsel may abandon those therapies. Several years ago I interviewed a patient who, acting on the advice ofa macrobiic counselor, tad signed here out of the hospital onthe day she was scheduled for laser surgery for a vocal cord tumor. During the next year, she and her ly studiously adhered to a macrobiotic diet. Her increasing hoarseness was attributed by her counselors to dietary lapses. Only the intervention ofa physician friend of the family finaly led her to have surgery, which was completely successful. Most patients who abandon or delay treatment of a tumor for a year “\, are not so lucky. Their chances of cure (or lessened discorifort if only amelioration is possible) are likely to be considerably worse, ‘A second threat arises from the diet itself. Macrobiotic theory claims that improper-aiet and inadequate elimination of waste result in constitutional or metabolic contamination and cause cancer, and that cure results from righting the balance and eansing the body with special vegetarian diets, appropriate spiritual attitudes, and other measures. These misguided no- tions often lead to radical dietary changes that can compromise nutrient adequacy in patients whose nutritional status is already precarious. Among cancer patients, many of whom have great difficulty with’ their appetite, the dietary goal should be to maintain the best nutritional status possible. Appropriate nutri- tional support can maximize the chance of positive response to cancer treatment and minimize sickness and death from second- ary malnutrition. Sometimes nutritional support can help to slow ‘oF reverse weight Toss, wasting of lean body mass, lack of appetite, and lack of an immune response. When this is not possible and these signs represent an unpreventable part of the disease process, dietary modification may still help the patient feel more comfortable. The macrobiotic diet does not conform toany accepted theory of nutritional support of cancer patients, nor has it been demonstrated by properly controlled experi- ments to be helpful in maintaining nutritional status among cancer patients. ‘When healthy adults who are accustomed tousual Amer- a ican fare go on macrobiotic diets, they usually experience weight loss, sometimes toa profound degree. Cancer patients, who have litle appetite to begin with or who have complications due to a cancer located in their digestive tract, can il afford to accelerate their weight loss. Since macrobiotic diets are formu- lated by adherence toa philosophy rather than nutrient need and foodpreferences, there is no guarantee they will be nutritionally quate. Nutrion Forum (ISSN 0748-8165) is published bimonthly by J.B. LUppincot Company, Downsvile Pk, Route 3, Box 20-5, Hagerstown, MO 21740, Business offices are located at East Washington Square, Papi Pa 18105 Prd ith U.S.A; Copy 190 by 8 Lppinctt Company. inal Subscription Raies: 0S. $30.00 individ ‘al, $35.00 instuton: all other countries except Japan, incia, Nepal, Bangladesh, and Si Lanka, $35.00individual, $40,00insbttion. Single ‘copies $7.00, Rates for airmail delivery avaiable upon request. Sub- Sctptions, orders, or changes of address (except Japan, ina, Nepal, Bangladesh, and Sn Lanka) Journal Fufliment Department, 8. Lip: Pinca Downsvile Pike, Route 3, Box 20-B, Hagerstown, MD 21740, or Gal goo 080; Maryan cal cobs 1-24-7200 Japan, incorporated, 422-11, Kakasa, Edogawaki, Tokyo 134, Japan. In India, Nepal, Bangladesh, and Sri Lanka, Universal Subscrip- tion Agency Pvt. Lic, 19jet02 Community Contre (FF) Saket, New Deln-t 10017, Inca, eples willbe ‘wthout charge fhe publisher receives a roquest within 60 days of the mailing dat nthe E'S. orwitin 5 mortns mn al ofr countries. Editorial correspondence shouldbe sentto Stephen Barret, MO.,P.O. Box 1747, Alentown, PA 18108. POSTMASTER: Sond address changes to Nutiion Forum, Downsvile Pike, Route 3, Box 20-8, Hagerstown, MD 21740,NUTRITION FORUM i No Evidence of Benefit ‘The metaphysical concepts of macrobiotics are not amenable to testing, but curative claims are testable. So far, however, no study that meets accepted scientific criteria has been published. Most reports gf cure are based on anecdotes and personal testimony rather than on careful comparisons of effectiveness in double-blind controlled studies of the diet ‘versus other treatments or a placebo. Documentation is rarely furnished thatthe patients had cancer, and, ifthey did, that their survival time was improved by the diet. Reports about single patients or small groups of patients are too small to rule out chance or biased selection. Also, follow-ups are often incom plete or for too short atime to make sound conclusions. Thus it ‘simpossible to separate out the actual postive effects (ifany) of the macrobiotic diet from placebo effects or coincidence due to thenatural history of the cancer itself. Finally, none of the claims of cure have been subjected to the scrutiny of peer review in scientific journals. Rather, nonmedical channels and the popular press have been used to disseminate information. When challenged, macrobiotic proponents respond that their philosophical or quasi-religious beliefs are not amenable to the standards of proof that apply to testing physiologic or biochemical theories. Those who object to these views are often characterized as bigots who, for economic or ideologic reasons, fail to recognize the newer therapies. Because no benefit has been demonstrated and the risks, are substantial, there is no reason to recommend macrobiotic. diets for cancer patients. Dr. Dwyer is director of the Frances Stern Nutrition Center, New England “Medical Center Hospitals, and Professor of Medicine (nutrition and Commanty Health at Tuts University Medical School. The next issue of Nutrition Forum wil describe the macrobiotic marketplace and a seminar atthe Kush Insitute BRIEFS Suit filed over new RDAs. Victor Herbert, M.D.,.J.D., is sting the National Academy of Sciences for copyright infringe- ment. Dr. Herbert believes that the chapters on vitamin By, iron, and folate appearing in the 1989 RDA book were derived from work he produced and copyrighted while serving on the 1980-1985 RDA Committee (see NF 7:8]. Antiquackery crusader dies. Paul Sage, the FDA official ‘who petitioned the agency to use criminal prosecutions to clean upthe illegal’ marketplace, died on February 18th. (Bditors note: He will be sorely missed by those of us who believe the FDA should develop policies tough enough to deter the marketing of supplements with bogus therapeutic claims. ] sus “Candida” product tackled by FTC. Nature's Way, of. >, Utah, and its president, Kenneth Murdock, have signed a consent agreement to stop ding unsubstantiated claims that Cantrol is helpful against yeast infections caused by Candida albicans and to pay $30,000 to the National Institutes of Health to support research on yeast infections. The product is a conglomeration of capsules containing acidophilus, eveni primrose oil, vitamin E, linseed oil, caprylic acid, pau d’arco, several other substances. It is one of many products marketed by the health food industry manufacturers for the treatment of “candidiasis hypersensitivity,” a fad diagnosis called “specula- tive and unproven” by the American Academy of Allergy and Immunology [NF 3:14, 3:28, 4:84~85]. Cantrol has been pro- ‘moted with a sel-test based on common symptoms the manu- facturer claimed were associated with yeast problems. How- ever, the FTC charged that the test was not valid for this purpose. FTC Commissioner Andrew J. Strenio objected to the terms of the agreement, because the penalty “looked pty” compared to the estimated $6 million consumers spent for the product. He also was disturbed that the agreement did not apply tothe ‘company’s entire product line but just to products based on Cantrol’s primary ingredients. Last year the FDA seized a supply of Cantrol from Nature’s Way. [Editor's note: Public protection would have been much greater if either agency had eet 1985 when I reported what Nature’s Way was doing ‘wrong. Stuart Berger attacked. CBS's “Inside Edition” has aired two programs vilifying Stuart Berger, M.D., a Park Avenue “diet doctor” who is being investigated by state licensing authorities. During the first program, a reporter described what happened when she visited Berger complaining of fatigue, as did a prominent New York allergist who probed Berger with a similar complaint. Both noted that their contact with him lasted about two minutes, included no physical examination, and culminated with a diagnosis of chronic fatigue syndrome and allergy to yeast (Candida), The reporter's cost was $845 for the first visit, with an estimated total of about $1,500 through the third visit. A former patient described a similar experience, which had cost over $1,000, A former employee said that Berger ordered his employees to indicate on blood test reports that every patient was allergic to wheat, dairy products, eggs, and yeast. ‘The reporter's visit had been filmed with a hidden camera. Berger obtained a court order stopping “Inside Edi- tion” from showing the tape during the initial Two weeks later, however, after the U.S. Supreme Court sided with the producers, the tape was shown. During the interim, infor- ‘mation was received from more than a hundred former patients and employees. In 1985, Dr. Berger's Immune Power Diet became an overnight best seller following Berger's appearance onthe “Donahue Show” [NF 3:24] Inthe book, claims are made that overweight and numerous other health problems are the result of an “immune hypersensitivity response” to common foods, and that “detoxification” and weight loss followed by food supplements can tune and strengthen the immune system. ‘There is no scientific evidence to support these claims. World Food Prize status shaky. The advisory council for the World Food Prize has announced that continuation of the award is in jeopardy. General Foods established the $200,000 annual prize in 1986.to honor individuals who have made an outstanding contribution toward improving the quality, quantity, or availabilty ofthe global food supply. However, the company, which is now a subsidiary of Philip Morris, Inc., has announced that it will no longer support the prize. The advisory council hopes to find a new sponsor.Zz NUTRITION FORUM Anti-irradiation update. A two-year moratorium on the sale ‘or manufacture of itradiated food (except, spices) has been enacted by the New Jersey State Legislature. New York adopted a similar ban last year, and Maine has banned the sale of inradiated food indefinitely. Quaker Oats and H. J. Heinz Com- ‘pany have announced that they will not market irradiated foods. Irradiation, which can prolong the shelf-ife of foods, has been unfairly attacked by consumer groups and segments of the health food industry. “Misting” machine update. After tracing an outbreak of Legionnaires’ disease to a Louisiana supermarket’s vegetable- spraying machine, the National Centers for Disease Control have concluded that, for the most part, such machines do not appear to pose widespread risks to public health. The disease resulted from bacteria that multiplied in the reservoir of adevice in which some of the water recirculated and could stagnate. ‘More than 90% of misting machines spray water that comes directly from the tap, which poses no hazard. Fat substitute approved. The FDA has given the Nu- traSweet Company permission to market imitation ice cream made with Simplesse, a new fat substitute. Simplesse is made ‘by processing egg white and/or milk protein, plus water, pectin, sugar, and citric acid into a creamy mixture that has the taste and texture of fat. ‘NutraSweet’s ice cream, called Simple Pleasures, will be available in six flavors. It will have about half the calories of regular ice cream and contain less than a gram of fat and 5-15 grams of cholesterol per 4-ounce serving. Regular ice cream (10% fat) contains 10-12 grams of fat per 4-ounce serving, The company plans to seek permission to market mayonnaise, salad dressing, sour cream, yogurt, dips, marga- rine, butter, and cheese spreads made with Simplesse in place of fat. Additional information can be obtained by contacting the NutraSweet Company’s consumer affairs center, 1-800-321- 7254, 9:00 am to 3:00 pm CST. Con man foiled again. Peter Foster, who received a4-month jail sentence for advertising "Cho Low Tea,” a nonexistent product claimed to lower blood cholesterol levels [NF 6:46-47], has been foiled in an attempt to place ads for another bogud product. Shortly after his release, he asked many newspapers for credit to place ads for Ageless Aging, a nutrient product claimed to help maintain energy, control stress, increase stam- ina and endurance, and counter toxins that’ “stimulate the production of free radicals, chemicals which contribute greatly tothe aging process.” Foster’s request aroused the suspicion of a newspaper official, who asked the American Newspaper Publishers Association Credit Bureau ted to investi- gate. ANPA/CBI vice president James Ralph quickly deter- mined that the letters and ptoduct were bogus and, together with his staf, spent an entire day telephoning newspapers to wam them. Many had been processing the ad for publication. [Editor's note: James Ralph did another great job in stopping a mail-order scam whose promoter was attempting to cheat newspapers as well as consumers. However, had Foster's ‘request been accompanied by payment, his ad would have been published by many newspapers that don't seem to care whether their subscribers are cheated.] ‘Tryptophan lawsuits. Many lawsuits are being fled by individuals stricken with eosinophila-myalgia syndrome linked to the taking of L-tryptophan. In February, to faiitate exchange of information among the plaintiffs, the L-Tryptophan Litigation Group was formed by the Association of Trial Lawyers, 1050 Bist St., N.W., Washington, DC 20007. In March, the FDA expanded its recall to all Léryptophan products in tablet, capsule, powder, or liquid form, as well as mult-ingredient nonprotein supplements that contain L-tryptophan, Retail sales were an estimated $50-75 milion a year. Food allergy report. A 36-page booklet about allergies and other adverse reactions to foods is available for $3 from the ‘American Council on Science and Health, 1995 Broadway, New York, NY 10023. Individual membership in the Council, which includes its quarterly magazine Priorities and a 50% discount on all ACSH scientific reports, now costs $25 per year. Sustaining individual membership, which includes the magazine and all new ‘ACSH publications, is now $50 per year. Organic labeling bill. A 117-page bill outlining a national standard for “organic” food production was introduced on February 8, 1990, by Senator Patrick Leahy (D-VT). The bill (G. 1896), titled the Organic Foods Production Act of 1990, would establish a USDA “organically produced” label for prod- ucts meeting certain production standards. Other uses of the word “organic” would be prohibited. The standards call for production without the use of synthetic pesticides, annual inspection of each farm, periodic residue testing of products, and cil penalties for violations. State programs may contain stricter guidelines if approved by the U.S. Secretary of Agricul- ture. The bill's sponsors believe it will: 1) help eliminate consumer confusion about unsubstantiated claims for “organic” and “natural” foods; 2) provide safer food alternatives; and 3) sive farmers incentives to use fewer chemicals. The bill's critics believe it will certify nonsense, promote confusion, and increase {food costs. Twenty-two states have passed statutes setting up “organic” definitions. Information about the bill can be obtained from Kathleen M. Merrigan, U.S. Senate Committee on Agri- culture, Nutrition and Forestry, SD-647 Dirksen Building, ‘Washington, DC 20510 (Telephone: 202-224-5207). Pesticide-free certification. Scientific Certification Sys- tems, of Oakland, CA, doing business as NutriClean, tests foods and offers a “No Detected Pesticide Residue” standard with stickers retailers can use in marketing the foods. According to anartcle in the July 1989 East West Journal, about 40 shippers of fruits and vegetables and 1,000 of the nation’s 17,000 food stores are involved. NutriClean was founded in 1984 by Stan Rhodes, a chemist who had spent eight years in the natural foods business. He hopes that his, testing-and-certfication system will pressure growers nationwide to sharply curtail their use of pesticides. Howafer, critics quoted in the article charged that NutriClean's program is simply a marketing gimmick that preys on consumer concems and that there.is.no reason to believe that foods certified “free of residue” are safer than those that have not been certified. NutriClean also tests foods for nutrient content and certifies those found to have higher values than government-reported averages.NUTRITION FORUM B ‘New newsletter. Consumer Magazines Digest, edited by Keisten MeNut, Ph.D. J.D., summarizes mitron ates appearing in current issues of more than 40 popular magazines, Published monthly, it costs $67/year. Subscriptions or a free ‘sample copy can be ordered from Consumer Magazines Digest, P.O. Box 1985, Evanston, IL 0204. Cholesterol booklet. The Channing L. Bete Co., 200 State Road, South Deerfield, MA 01373, has published “About Cho- lesterol,” an excellent booklet on diet, cholesterol, and heart disease prevention. The booklet is simple enough for use in elementary schools yet comprehensive enough for adult well ness programs. A free review copy can be obtained by calling 1-800-628-7733. Calcium supplements. The Medical Letter, a highly re- spected drug and therapeutic advisory for physicians, has reviewed the evidence regarding calcium supplements [31:101- 103, 1989] and concluded: “Differences in the absorption and adverse effects of different calcium salts are generally small. Large doses of medicinal calcium may interfere with absorption of other nutrients; food sources are probably safer. Whether calcium from any source can prevent osteoporosis remains tobe established.” Poorly formulated products may not readily disin- tegrate or dissolve in the stomach. Therefore, if supplements are used, Medical Letter consultants recommend chewable tablets such as Tums or Os-Cal 500 Chewable or tablets labeled as meeting U.S.P. standards for dissolution. HAVE YOU SEEN YOUR VITAMITICIAN LATELY? James J. Kenney, Ph.D., R.D. Great Earth Vitamin Stores—the nation’s second larg- est health food store chain—is advertising a “Free Vitamin Fitting” by “highly trained Vitamiticians who tailor a nutritional support program that’s a perfect fit for you.” According to the ad, the program is based on a “Nutritional Fitness Profile” developed by “a noted Jobns Hopkins physician.” ‘The Profile contains 29 multiple-choice questions per- taining to det, symptoms, ilinesses, and lifestyle factors. Each ‘question has three possible answers, with #1 indicating no problem, #2 indicating a slight problem, and #3 indicating a significant problem. To obtain my “vitamin fitting,” Ivsited two Great Earth stores in the Los Angeles area. One displayed a large poster offering the service, while the other had posted copies of the Profile throughout the store. In both stores I completed the questionnaire, In the first store, the “Vitamitician” referred to a docu- ment about ten pages long while reviewing my answers. My ‘overall score was “53,” which he said was “pretty good.” Nevertheless, for each response #3 I'd checked, he recom- mendeda supplement. For example, question 23 asked whether ny cholesterol level was “low,” I don't now, ” or “high.” [had checked “high.” For this, he recommended Cholesterol Counter, a product composed of packets that cost $19.95 for a 30-day supply. Each packet contained four : 500 mg of niacin, 500 mg of vegetable sterols, 400 mg of Omega-3 fish oil, and 1000 mg of oat bran and other fibers. He told me that taking ‘a packet with each meal would help lower my cholesterol level. He also recommended a digestive enzyme supplement because Thad checked “Regularly” in response to question 11, “Do you frequently sulfer from gas, flatulence or heartburn?” ‘The second “Vitamitician” appeared more confident and did not refer to any document when giving advice. Instead of Cholestral Counter, he recommended a 500 mg timed-release niacin tablet with each meal, She said I would notice ushing of my skin which would indicate that “the niacin was flushing toxins, including cholesterol, out of my system.” She also recommended the enzyme supplement, but switched to an acidophilus product and a milder enzyme product when I de- scribed having had gnawing stomach sensations in the past. Both “Vitamiticians” assured me that the supplements would reduce flatulence even though I told them it had started when I began eating beans and oat bran. Both “Vitamiticians” recommended a vitamin E supple ‘ment because I had checked that I live where the level of pollution is “High much of the time. ” (I live near smoggy Los Angeles.) The second "‘Vitamitician” also recommended a 500, mg vitamin C supplement to help deal with “toxins.” Both recommended a high-dose multivitamin and mineral supplement even though I said I was already taking one with 100% of the Recommended Dietary Allowances. The second ‘‘Vitamitician” said “the RDAs were developed 50 or 90 years ago and were the minimum needed to prevent a deficiency.” Although my experiences do not indicate the full extent of Great Earth’s newest sales gimmick, itis clear that som is wrong. The 29 questions, either separately or together, do not provide a rational basis for any type of supplement recom- mendation, The advice I received was completely unfounded. ‘The scientific evidence that megadoses of vitamins C or E can Protect against pollution is suggestive at best. The idea that digestive enzyme supplements can reduce flatulence due to a high-fiber dit is utter nonsense. The nutrient intake I described (even without a supplement containing 100% of the RDAs) was more than adequate to prevent deficiency. So there was no rational basis for prescribing an additional vitamin and mineral supplement. Worse yet, the advice about niacin was potentially dangerous. Although niacin can be a valuable drug for controlling blood cholesterol levels, it should never be used outside of a comprehensive, medically supervised program that begins with attention to diet, exercise, and other factors related to heart disease risk. When niacin use is appropriate, the dosage should be built up gradually to minimize the incidence of side effects, and blood tests should be performed regularly to detect liver problems or other toxic effects (such as increased blood sugar or uric acid levels). But neither “Vitamitician” mentioned the potential dangers. Are Great Earth's “Vitamiticians” highly trained? Or are they merely sales clerks with a new ttle? After returning home, I telephoned the first store and asked another Vitamitician about her training. There “really wasn't any,” she replied. “All you really have to know is how to sell supplements.” Dr. Kenney, whois certiiedby the American Board of Nutrition, isthe nutrition specialist for Pritikin Longevity Centers.u NUTRITION FORUM BOOK REVIEW Title: Heart Failure: A Critical Inquiry into American Medicine and the Revolution in Heart Care Author: Thomas J. Moore ‘Publisher: Random House, New York Price: $19.95, Hardcover, 308 pages Reviewed by: Mark A. Kantor, Ph.D. ‘Thomas Moore is an award-winning journalist with a bent toward investigative reporting. If he set out to create controversy with his latest book, he most assuredly succeeded. Within days ater a lengthy excerpt of Heart Failure appeared in the September 1989 issue of Atlantic Monthly, officials at the ‘National Heart, Lung and Blood Institute (NHLBD were scram- bing to respond to Moore's allegations that the benefits of lowering elevated cholesterol levels have been grossly exagger- ated, that diet has relatively litte effect on heart disease risk, and that the entire National Cholesterol Education Program (NCEP), which recommends cholesterol screening for all ‘American adults isill-conceived at best, and dangerous at worst. Does Thomas Moore say we do not have to worry about cholesterol any more? Does he advocate a return to bacon and eggs for breakfast, served with buttered toast? Is this book the {dle musings ofjust another nutrition charlatan? No onall counts. ‘Moore recognizes that a high blood cholesterol level increases the risk of heart disease. But he is very troubled about how ‘public policy decisions are made that affect large segments of the population. And that's what this book is really about. For starters, Moore takes dead aim at the NCEP with simple but provocative questions: “What is the nature of the process that determines that millions of Americans without symptoms are at risk (for coronary heart disease) and require expensive medical treatment? What kind of scientific evidence is required? How are adverse effects (of treatment) monitored and the benefits measured? Is the new assault on cholesterol built on as solid a scientific foundation as the campaign against hypertension?” He is especially troubled that the NHLBI never conducted a cost-benefit analysis before launching the NCEP, and that the program was never approved by Congress. Both are legitimate gripes. But when Moore starts td dispute the evidence linking die, cholesterol, and heart disease, he overextends his authority and his case begins to break down. In reviewing some of the major scientific findings that save rise to the NCEP, Moore concluded that the program is Lnjustfied because NHLBI’s own clinical trials failed to show, by and large, that lowering blood cholesterol levels reduces heart disease, However, although he cites scores of scientific refer- ences, he did not do his homework very well. Rather than considering the evidence as a whole, he focused on the negative aspects of only a few studies such asthe “MRFIT” trial. He also ignored studies in progress whose preliminary data were avail- able atthe time he wrote the book. In so doing, he failed to see the big picture. ‘While discussing the topic of cholesterol, which occupies nearly the first third ofthe book, Moore made several technical errors in his descriptions of cell memibranes and lipoproteins. But his greatest mistakes were errors of omission and mislead- ing innuendoes. For example, he is puzzled that the NCEP dietary recommendations for reducing serum cholesterol were never tested to see whether they are safe or effective. But the NCEP advises using ordinary foods to help lower cholesterol levels. Is he suggesting there is something inherently danger- ‘ous about eating fruits, vegetables, and whole grains? He also states that laboratory tests for cholesterol are inaccurate, but doesn’t mention that substantial progress has been made in improving them. ‘Moore complains that the much-heralded Coronary Pri- ‘mary Prevention Trial (CPT), the study that sowed the seeds of the NCEP, failed to show that lowering cholesterol prolongs. life. He also accused the investigators of udging their statistics. “In scientific research, people tend to find what they are looking for, to see what they expect to see,” he writes, especially when ‘huge amounts of time and money have been invested. But the ‘issues of marginal statistical significance and overall mortality were discussed openiyin the medical literature at the time the study was published. Despite these drawbacks, experts around the world stil consider the CPPT a success because so many positive trends were associated with reducing cholesterol. Moore describes how a small circle of friends is respon- sible for formulating the nation’s major policy decisions on cholesterol. These members of the “medical elite” chair scien- tific meetings, control million-dollar research grants, advise the EDA on drug safety, and interface closely with the NHLBI. Sometimes they even take jobs with drug companies. Moore doesn't doubt the integrity of these individuals or suggest that less-qualfied people assume their responsibilities, but he cau- tions that such a group of like-minded insiders may become too attached to a single point of view. “The terrible danger of sucha closed loop is that important and basic questions are neither asked nor answered,” writes Moore (an “unbiased” outsider). But many dissenting opinions were heard at the NHLBI consen- sus conference, and continue to be voiced at meetings and in scientific publications. If there is one thing that everyone agrees ‘upon, it is that the riddle of heart disease has yet to be solved. Moore reserves his harshest criticisms for the giant pharmaceutical companies. He claims they have failed to dem- onstrate the safety of their drugs and are making enormous profits from the NCEP. In fact, he states that what started out asa campaign for the public good has become “intertwined with greed,” with physicians and food companies also cashing in mightily on cholesterol. He even wonders if reducing choles- terol is such a good idea in the first place, as he points out that ‘Some cancer patients have low serum choiesterol levels. “A sea of uncertainty surrounds the territory of cholesterol levels below 200 mg/dl,” he warns in a chapter entitled “The Dangers of Low Cholesterol.” The American Cancer Society, however, doesn't share Moore's fear. In fact, it endorses a low-fat diet plan similar to the NCEP’s to help prevent cancer. ‘Nowhere in hisbook does Moore mention the Choles- terol-Lowering Atherosclerosis Study, which provides strong evidence that reducing cholesterol levels slows the progression of plaque, or reverses deposits already formed. And he belitles ‘or ignores other major trials and decades of epidemiologic research, animal experiments, and metabolic ward studies, all of ‘which point toa strong link between diet, cholesterol, and heartNUTRITION FORUM E disease. In fact, he doesn’t seem to understand that clinical trials, by their very nature, are only capable of showing modest changes in heart disease incidence and mortality. Even the longest studies are still relatively short, inasmuch as the buildup of plaque occurs gradually over the lifetime of an individual. Despite these numerous shortcomings, Heart Failure is a captivating book that is more than just a story about choles- terol. In later chapters, Moore unleashes his considerable ‘writing skils to describe the early battles against heart disease. He gives a riveting account of the major breakthroughs, includ- ing coronary bypass surgery, balloon angioplasty, thrombolytic therapy with “clot-busting” drugs, and the people behind tem, ‘But throughout, he returns to his central theme. How much do we really know about the long-term effectiveness of these procedures? Are they worth their incredible expense? ‘And most importantly, do they save lives? The problem, as Moore sees it, is simple: modern medicine places too much ‘emphasis on developing high-tech treatments but invests fat too little time, money, and attention in measuring their outcomes. Moore also weaves suspense into his book, as he describes the perils of open heart surgery, during which life literally hangs by a thread. Later, he whisks the reader to a quiet neighborhood where a recent heart attack victim is locked in a deadly race against time, waiting for paramedics to arrive. And, in several chilling chapters, he recounts what happens when the ‘mortality rate from heart surgery starts to rise inside a presti- ‘gious medical center. It isnot just human lives that are on the line, but big egos and big money as well. ‘Moore criticizes other aspects of American medicine, from coronary care units (do they really save lives?) to the emergency medical system (why is itnotavalable in allcommu- nities?). In an engaging comparison, he pines that the airline industry is more accountable for the safety and well being ofits passengers than hospitals are for their patients. And he is baffled by the “chaotic and uncontrolled” process that allows physicians to decide whether to try new procedures on patients, quite unlike the orderly process used by the FDA for testing and evaluating new drugs. Heart Failure is a compelling book that has raised the blood pressure of more than a few individuals. It is intended to highlight a lack of accountability that Moore believes ails modem medicine. Moore asks questions that need tobe asked. It willbe unfortunate if he also leads readers to abandon dietary caution. Dr, Kantor isan assistant professor and food and nutrition specialist withthe University of Maryan Cooperative Extension Service, anda regional com ‘municator forthe Insitute of Food Technologists. His postdoctoral research ‘wasin cholesterol and poprotein metabolism. FLUORIDATION ATTACKED UNFAIRLY Newsweek magazine has published an article based on an unauthorized release of data from an experiment in which rats and mice were exposed to high dosages of fluoride. The ‘experiment was conducted by the National Toxicology Program (NTP), a branch of the National Institute of Environmental Health Sciences. A fact sheet released by NTP indicates that ‘more than 1000 rats and mice drank water containing 0, 11, 45, and 79 ppm of fluoride. There were 80 animalsin the control and high-dose groups and 50 in the low- and medium-dose groups. ‘No mice showed any signs of cancer, but one male rat in the 45 pm group and four males in the 79 ppm group developed bone cancer. In addition, one male rat in the 45 ppm group, three female rats in the'79 ppm group, and one female rat in the control gaup developed tumors ofthe mouth ‘TP emphasized that the data were preliminary. Before conclusions are drawn, data normally go through an extensive peer review process by a panel of pathologists and epidemiolo- officials, while noting that it was too early to comment on the study's’ specific data, ‘emphasized that human studies have repeatedly demonstrated floride’s safety. Among other things, they noted that: 1) the doses given to the rodents were much higher than would be obtained by drinking water fluoridated at 1 ppm; 2) data in one or two animal strains might have nothing to do with what happens in humans; 3) while the number of people uoridated water has been rising steadily, the incidence cof bone cancer (which is not common) has not changed; and 4) ‘many studies comparing fluoridated and nonfluoridated commu- nities have found no evidence that fluoridation affects cancer rates. Thus, while the NTP study is ikely to furnish ammunition for antiforidation propaganda, it is unlikely to be regarded as significant by the scientific community. [Editor's note: I believe that Newswee’s article is the most irresponsible analysis of a public health topic ever published by a major national news outlet. How sad it is that a magazine which has ignored the real ‘gists at the agency. But in this case, raw datahad been leaked to _dangers of cigarette smoking is willing to devote two pages to the press before the review took place. attacking a nonexistent danger.) ‘The American Dental Association and public health EDITORIAL BOARD EDITOR: Stephen Bare, MS; Vato E. Tye, Ph. Eleanor N. Whitney, M.D. SENIOR ASSOCIATE EDITOR: Mantrd Kroger, Ph.D. ASSOCIATE EDITORS: Michael Bots, Esq., Darlene Forester, Ph... FLD; Mary Abbott Hess, FLD., M.S.; Willam T. Jarvis, Ph; James Lowel, Ph.D.; CONTRIBUTING EDITORS: Jon Cunningham, Ph.D; Johanna Se. A.D. Mark Fuerst; Kathy King Holm, .D.; Vcior Herbert N.D., J.D: James J. Kenney, Ph.D, R.0.; Barbara Levine, Ph.D..F.D.; A. Nistor, MS, Grace Powers Monaco, Esq; Anita Owen, FLD, W.A.-Zev Remba (Washington Correspondent); Sheldon Fovin,6.0.S., , PRD.,AD,; Eleanor A. Young, Ph., RD; Jack Z. Velv, M.D., Ph.D.; and staf! members of The Pennsyivania State University Nutrition Information and Resource Center.i NUTRITION FORUM : AIDS FRAUD RAMPANT IN HOUSTON Nicolas Martin” Between September 20 and October. 12, 1989, the Consumer Health Education Council (CHEC) surveyed 41 Houston-area health food stores to determine the extent to which bogus treatments for AIDS are recommended. CHEC volunteers telephoned the stores and asked to speak with the person who provided nutritional advice, Each volunteer caller then explained that he had a brother with AIDS who recently ‘was hospitalized with AIDS-related pneumonia and was now at ‘home with hs family. The brother was said to not be taking AZT (the only approved AIDS drug) but was Seeking a more effective alternative against the HIV virus. The caller explained that he was the family member given the responsibility for locating the “alternative” treatment and would forward information or prod ucts to his brother...The caller also informed the health food store employee that the brother's wife was still having sex with her husband and was seeking products that would reduce her tisk of being infected, or make it impossible. Despite the illegality oftheir actions, all 41 retailers gave ‘what amounted to medical advice for treating or preventing AIDS. Twenty-nine did so over the phone, while twelve asked the caller to visit the store, None referred the caller to a physician, clinic, or any organization that assists people withthe disease. All stated that AIDS affects the immune system of the infected person and that they sold products that could “boos “enhance,” “improve,” or otherwise benefit the brother's ‘mune system. While several expressed minor uncertainty about the wife having sex with her infected husband, none suggested that she be advised to cease such a practice or be told of her high probability of becoming infected by HIV. None advised using a condom. All said that their stores sold products that would improve the woman's immunity and protect her against possible harm from the HIV virus. Twenty-seven claimed that ifthe wife took certain supplements she would be protected against infec- tion, Our callers emphasized that they Were seeking a genu- ine cure for AIDS, not simply a way to prolong lifespan margraly. Ty ofthe employes sad they sod prot that cure AIDS. When this was questioned by the caller, most stood firmly by this claim. Some expressed slight reservations, like “I'm pretty confident it will work,” and some assured the caller that “people are having good hick” with whatever they recommended. Many of the employees emphasized the influence of the rind on the susceptibiity to infection or bodily reaction to HIV. Several said the products would be more effective if meditation or other ways to induce “positive thinking” were also utilized. ‘One health food store “nutritional counselor,” to whom our volunteers were referred by the AIDS Foundation and other local AIDS support groups, said by phone that “people doing drug therapy are not doing well tal” and that it would be better to tur to “natural healing.” Severalshealth food stores sug- gested referrals to herbalists or “nutritional” consultants in private practice. One employee, who recommended hydrogen peroxide, other products, and literature, said that her sister- in-law had died of AIDS. ‘The recommended pféducts included: vitamins (41 stores); vitamin C (38 stores); immune boosters (38 stores); coenzyme Q10* (26 stores); germanium (26 stores); lecithin (19 stores); ornithine and/or arginine (9 stores); lino- lenie acid* (7 stores); raw glandulars (7 stores); hydrogen peroxide (5 stores); homeopathic salts (5 stores); Bach flower remedies (A stores); blue-green algae* (4 stores); cysteine (3 stores); and herbal baths (2 stores). (Editor's note: Those marked with an asterisk (*) have been subjected to federal regulatory actions but are still being marketed. Several subjects were pessimistic about the benefits of using AZT, and some discouraged its use. CHEC knows of cases in which infected individuals decided to take “natural” treatments instead af AZT, a decision that can shorten their life. ‘Unfortunately, ‘the Houston news media have shown little interest in what we did. Only United Press International and a weekly paper in Houston's heavily homosexual district ran stories based on our survey. One television station used a hidden camera to fim a health food store employee claiming to be able to cure AIDS, but the story was not aired. The media seem to view criticism of AIDS product fraud as an attack upon the victims rather than the perpetrators. Mr. Martinis executive director of the Consumer Health Education Counc a nonprofit agency located in Houston QUESTION BOX. Q. What is “alternative agriculture”? A. A recently released report by a committee of the ‘National Academy of Sciences states that it is not a single system of farming practices. Rather, “it includes a spec- trum of farming systems, ranging from organic eystems that attempt to. use. no purchased synthetic chemical inputs to those involving the prudent use of pesticides or antibiotics to control specific pests or diseases. Alterna- tive farming encompasses, but is not limited to, farming systems knowns biological, low-input, ors +, Tegener- ative, or sustainable. Itincudes a range of practices such as integrated pest management; low-density animal pro- duction systems; crop rotations designed to reduce pest damage, improve crop health, decrease soil erosion, and, in the case of legumes, fix nitrogen in the soil; and tillage and planting practices that reduce soil erosion and help control weeds.” In te bea at tibiotis, and synthetic protecting sll quality and re- ‘maining profitable. The 464-page NAS repart Alternative Agriculture is available for $19.95 (softcover) or $29.95 (hardcover) ftom the National Academy Press, 2101 Constitutio Ave., N.W., Washington, DC 20418. _| L~™