Prime Time Replay:
Dr. Marion Nestle
on Government Dietary Guidelines
MsgId: *breakthrough(14)
Date: Wed Nov 13 22:03:36 EST 1996
From: moderator At: 206.80.165.14
Good evening and welcome to Breakthough Medicine. Tonight Dr. Marion Nestle will be joining me for our chat. Dr. Nestle will speak about her work in preparing dietary guidelines. Dr. Nestle is Professor and Chair of the Department of Nutrition and Food Studies at New York University.
MsgId: *breakthrough(17)
Date: Wed Nov 13 22:06:30 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Hi. This is Dr. Marion Nestle. I'm happy to be chatting with you tonight.
MsgId: *breakthrough(18)
Date: Wed Nov 13 22:08:10 EST 1996
From: moderator At: 206.80.165.14
Dr. Nestle, some of our viewers have already expressed interest in your work on the American Cancer Society dietary guidelines, so let's start with that.
MsgId: *breakthrough(19)
Date: Wed Nov 13 22:09:13 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
I chaired a committee advising the ACS about new dietary guidelines. These have just been published.
MsgId: *breakthrough(20)
Date: Wed Nov 13 22:10:39 EST 1996
From: moderator At: 206.80.165.14
Let's discuss the philosophy behind the guidelines, and any changes that appear in the new ones that have just come out.
MsgId: *breakthrough(21)
Date: Wed Nov 13 22:11:55 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
The committee approved four guidelines. These are basically to eat less fat, eat more fruits, vegetables, and grains, balance calories in with calories out, and if you drink alcohol, don't drink much.
MsgId: *breakthrough(22)
Date: Wed Nov 13 22:12:40 EST 1996
From: moderator At: 206.80.165.14
What were the changes from the previous guidelines?
MsgId: *breakthrough(23)
Date: Wed Nov 13 22:13:26 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
The previous guidelines were much fuzzier. These are quite clear about how to eat less fat--eat less red meat, for example. The ACS can say this, but the federal government can't.
MsgId: *breakthrough(24)
Date: Wed Nov 13 22:15:16 EST 1996
From: moderator At: 206.80.165.14
I'd like to talk about the difference in preparing the guidelines for the ACS and the U.S. government, but first can we dwell a little longer on the effect of the ACS guidelines on patient health and recuperation?
MsgId: *breakthrough(28)
Date: Wed Nov 13 22:20:02 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
The guidelines aren't meant to help patients. They are meant for prevention. This is a very important distinction. The guidelines are meant to prevent cancer, not to treat it.
MsgId: *breakthrough(27)
Date: Wed Nov 13 22:19:00 EST 1996
From: moderator At: 206.80.165.14
Moderator: So what would you recommend to patients who have cancer and want to use diet to help themselves?
MsgId: *breakthrough(28)
Date: Wed Nov 13 22:20:02 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
There are several research studies that are looking at these guidelines to see if people with cancer won't get recurrences if they follow these recommendations.For example, I am involved in a study of breast cancer recurrance where women with breast cancer are being encouraged to drink fruit and vegetable juices. Juices are a concentrated source of cancer-fighting components of fruits and vegetables.
MsgId: *breakthrough(30)
Date: Wed Nov 13 22:22:24 EST 1996
From: moderator At: 206.80.165.14
Are researchers looking at the chemistry involved in these results--what are the agents in juice that prevent illness?
MsgId: *breakthrough(31)
Date: Wed Nov 13 22:23:25 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Fruits and vegetables contain antioxidant vitamins--A, C, and E--as well as so-called "phytochemicals" that appear to protect against cancer. How these work is uncertain at the moment.
MsgId: *breakthrough(33)
Date: Wed Nov 13 22:24:33 EST 1996
From: moderator At: 206.80.165.14
Let's go back to politics. Can we discuss the different processes involved in creating food guidelines?
MsgId: *breakthrough(34)
Date: Wed Nov 13 22:24:55 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
As I mentioned, the ACS guidelines are clearer than the federal ones, mainly because the ACS committee was not subject to political considerations. I was on the dietary guidelines advisory committee that did the 1995 guidelines. We received five feet of documents from lobbyists wanting us not to say anything negative about their food products, particularly alcohol. The alcohol lobbyists were particularly busy. They sent in hundreds of comments about the health benefits of wine. Small amounts of alcohol do seem to reduce heart disease risk, particularly in middle-aged men, but breast cancer is still an issue. Even small amounts of alcohol seem to increase the risk of breast cancer.The ACS committee wanted to give the best advice we could based on the science. This advice is necessarily cautious. The best news is that eating fruits and vegetables is really good for health. Most people don't eat nearly enough of them.
MsgId: *breakthrough(40)
Date: Wed Nov 13 22:31:11 EST 1996
From: moderator At: 206.80.165.14
When lobbyists want to get their message into guidelines, what do they use as proof of health benefits? Where are they getting their studies?
MsgId: *breakthrough(41)
Date: Wed Nov 13 22:32:22 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Actually, there are dozens of studies linking moderate alcohol intake to a lowering of heart disease risk. I don't think there is any question about that. But it's one thing to recommend that a middle-aged man have a glass of wine with dinner, and quite another to advise the general public to start drinking more. Not a good idea, given the extent of alcohol abuse in this country. I don't think lobbyists lie; they just select data and use it for their own purposes.
MsgId: *breakthrough(43)
Date: Wed Nov 13 22:33:32 EST 1996
From: moderator At: 206.80.165.14
How can studies ignore the mitigation of one disease, but the increase of another?
MsgId: *breakthrough(44)
Date: Wed Nov 13 22:34:41 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
They don't ignore conflicting studies. Instead, they argue that more people die of heart disease than cancer, implying that cancer is less important. Personally, I would prefer to die of heart disease than breast cancer, but that's a personal choice.
MsgId: *breakthrough(45)
Date: Wed Nov 13 22:35:21 EST 1996
From: moderator At: 206.80.165.14
So the public is basically on their own.
MsgId: *breakthrough(46)
Date: Wed Nov 13 22:36:28 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
It may appear that way, but I don't think that is correct. I think we know exactly what a healthy diet consists of: less fat (translation: less meat, dairy, and processed food), more plant foods, reasonable body weight, alcohol in small amounts if at all. These recommendations have never, never changed since health experts first began advising the public about diet and heart disease and cancer risk. I think it's really too bad that people feel confused when we have so much evidence that this dietary pattern really does promote health.
MsgId: *breakthrough(48)
Date: Wed Nov 13 22:38:55 EST 1996
From: moderator At: 206.80.165.14
So why do people ignore this sound advice, which they've heard their whole lives?
MsgId: *breakthrough(49)
Date: Wed Nov 13 22:40:13 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Well for one thing, such advice is boring. It doesn't sell newspapers and it doesn't sell food products. The selling of food products is a big issue. Food is a more than 700 billion dollar a year industry. We overproduce food. The food industry is hugely competitive and constantly advertises profitable foods that may not promote health necessarily. I call this the 3700 calorie a day problem. The U.S. food supply contains 3700 calories per day per capita--man, woman, child. Most of us need much less. The rest gets thrown out. If you eat this, it means you are not eating that. Therefore--advertising and new products to encourage sales.
MsgId: *breakthrough(51)
Date: Wed Nov 13 22:43:22 EST 1996
From: moderator At: 206.80.165.14
It seems that education of the consumer is important. Could we talk about who is teaching the public, and the industry, how to promote what people eat?
MsgId: *breakthrough(52)
Date: Wed Nov 13 22:44:13 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
The main source of nutrition information is the media. Here again, it's a matter of money. Everyone complained when the USDA spent a million dollars to develop the Food Guide Pyramid, but nobody blinks when food companies spend 20-30 million dollars to advertise a candy bar or soft drink. Food advertisers spend $30 BILLION dollars annually as compared to just a few million for government education efforts. So the playing field isn't exactly level.
MsgId: *breakthrough(54)
Date: Wed Nov 13 22:46:19 EST 1996
From: moderator At: 206.80.165.14
The nutritional expertise of physicians is often thought to be crucial to health, but medical schools don't promote nutrition classes. Where does this lead?
MsgId: *breakthrough(55)
Date: Wed Nov 13 22:46:55 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
This is an old, old issue. The first complaints about the lack of nutrition education in medical schools were in 1960 and nothing much has changed since then. The real problem is lack of reimbursement for preventive health services, including nutrition. I'm working now with gastroenterology residents who have just been required to learn nutrition as part of their training. Just now, in 1996!The new focus on managed care may help if everyone figures out that prevention is better and less costly than treatment, but I'm not optimistic.
MsgId: *breakthrough(58)
Date: Wed Nov 13 22:50:15 EST 1996
From: moderator At: 206.80.165.14
You recently published a letter in the New England Journal of Medicine, describing the lack of hospital meals which conform to the national recommendations for diet.
MsgId: *breakthrough(59)
Date: Wed Nov 13 22:51:28 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
This was Adam Singer's work. He is an MD at Stony Brook. He's been appalled by hospital diets and wanted to find out why they were so awful. He polled university medical centers to find out what they were serving patients who made no special requests. Many of them routinely offered foods high in fat, salt, sugar, etc. Everyone who has ever been in a hospital knows how awful the food is except in places that are making special efforts. We thought that university hospitals ought to be setting an example and were disappointed at the results.
MsgId: *breakthrough(61)
Date: Wed Nov 13 22:53:12 EST 1996
From: moderator At: 206.80.165.14
Wouldn't these meals affect recuperation?
MsgId: *breakthrough(62)
Date: Wed Nov 13 22:53:48 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Here too, there are lots of excuses, mainly having to do with short hospital stays these days, but it is just so self-evident that good food would make people feel better.
MsgId: *breakthrough(64)
Date: Wed Nov 13 22:54:36 EST 1996
From: moderator At: 206.80.165.14
Isn't there a philosophy among nutritionists that food can be part of your medical regimen?
MsgId: *breakthrough(65)
Date: Wed Nov 13 22:55:25 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
I hate to think of food as medicine. I like food as food--its taste matters a lot and it plays such an important role in culture and society. The trouble with the food-as-medicine approach is that companies start singling out individual nutrients and treating them like drugs. We know from clinical trials that single nutrients don't work very well. Food is very complex and contains lots of nutrients and other substances that may promote health. That's why nutritionists nearly always push food, not supplements.
MsgId: *breakthrough(67)
Date: Wed Nov 13 23:00:59 EST 1996
From: moderator At: 206.80.165.14
I think people would like some guidance with the foods they choose, but there is limited reimbursements for nutritionists services. Yet it is considered preventive medicine. Do you see a change in this situation?
MsgId: *breakthrough(68)
Date: Wed Nov 13 23:01:47 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Maybe. I'm not sure. Managed care is changing everything--it remains to be seen whether the changes are for the better. You would think that there would be more emphasis on prevention (and nutrition), but we'll have to wait and see.
MsgId: *breakthrough(69)
Date: Wed Nov 13 23:02:57 EST 1996
From: moderator At: 206.80.165.14
A while back a guest to our interview asked what you ate today. Can we talk about your view of daily food consumption?
MsgId: *breakthrough(70)
Date: Wed Nov 13 23:04:49 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
My department--Nutrition and Food Studies at New York University--is unique among nutrition departments in that all of us love food and we eat all the time. We always have food in the department. Today, we ate leftover turkey from a testing of 8 turkeys done by the New York Times yesterday. And for dinner I went to a food event celebrating a new cookbook on Greek Vegetarian cooking. The food was wonderful and definitely met dietary recommendations. And I walked a mile there and back so I met all the recommendations.
MsgId: *breakthrough(72)
Date: Wed Nov 13 23:08:03 EST 1996
From: moderator At: 206.80.165.14
Dr. Nestle, our time is up. I want to thank you for an informative chat about nutrition and the forces that shape our food choices.
MsgId: *breakthrough(73)
Date: Wed Nov 13 23:08:22 EST 1996
From: Dr._Marion_Nestle At: 128.122.35.14
Bye Madeleine. Thanks so much. This was odd, but fun.
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