Diet, Longevity and a Custard Pie - 2 June 2000

Once every four years there's a conference in Washington calling itself the National Nutrition Summit.

It's not a government body, not an earnest or loony specialist in fad diets, it's, I suppose, a quango.

It started 35 years ago when President Lyndon Johnson called a White House conference on food, nutrition and health.

It was the first such government conference to report on the eating habits of the American people and also it was meant to encourage various experts - the surgeon general, the national institutes of health - to make regular surveys and advise the people on what, in the interests of health, they ought to be eating.

Last Tuesday evening the summit opened in Washington with a speech from the secretary of agriculture. Although the important and interesting talk came later the summit meeting got a publicity break which guaranteed it would have a lurid place on many front pages next day with a photograph that might have come out of an early Chaplin, or what we call "custard pie" film comedy.

At a lectern a bulky but distinguished middle-aged man has ducked sharply to his right, crumpling his beautiful white shirt and white tie, his left hand and cuff waving in mid air in the instinct to protect himself from a circular object - could have been a miniature satellite - that was flying through the air at him.

It had just left the outstretched hand of a slim, dark-haired woman. If you saw this on television, as I did, and pressed the button in time you could hear a shrill sentence of abuse also being hurled at Secretary Gluckman.

"Shame on you," she howled, "you meat head. Shame on you for promoting meat."

What she threw was a pie, a cream pie.

His immediate response, once she'd been collared and hustled away, was worthy of Robert Benchley or Cary Grant's screen writers.

"Not a very balanced meal she throws," he said.

It was a little rough to pick on the secretary of agriculture. His domain takes in, obviously, many more foods than meat and he wasn't promoting anything except at the end, reporting the expert recommendations of the government's nutritionists.

The main advice was very much what it's been since the discovery that high blood level of cholesterol brings an increased risk of coronary heart disease. And hence the following warning that the particular villains in raising cholesterol were the veined meats and the yolk of eggs.

And when did that awful warning go out? I put this question casually to friends and they say: "Oh 10, maybe 15, years ago."

Well I looked back and to my own surprise found that my first talk about cholesterol and the beginning of a national obsession with it was done from where I am now in April 1952.

Since then the government's advice on a healthy diet has varied very little and if there's one government official more than another likely to be a touch embarrassed by it it's the secretary of agriculture because the government has been urging people for at least five decades to eat more fruit and several different vegetables a day and only lean meat.

The basic watchword, as of old is "watch out for cholesterol, saturated - ie animal - fats, and go easy on salt."

This advice has become very easy to follow in recent years since by order of the government's Food and Drug Administration every packaged or canned food in every supermarket, mini market, grocery store, has to contain, on the package or tin, a printed code reporting the amount in grammes or milligrammes of saturated fat, cholesterol, sodium and protein.

When the conference was over I thought it odd that this advice should be given to Americans, of all people.

It seems to me that this was the bias I noticed when I first arrived here 68 years ago. And I recalled the journal of a travelling Englishman, written about that time, in 1931 in fact.

Here, after a long swing from coast to coast - mostly by train in those days - were his notes on American food:

"Americans of every class live on lighter foods than their English counterparts. Fruit, vegetables and cereals play a much larger part in their diet than with us, and" - here's a fine English touch - "they eat chicken much more than meat. By meat, of course, I mean beef and mutton."

By the way I've never heard an American refer to mutton or ever seen it on a menu.

"All this," the journal goes on, "all this is, no doubt, very healthful but personally I am a beef eater and I always expect my wife to provide me with butcher's meat once a day when I'm at home."

Which irresistibly brings to mind that immortal sentence of - an early editor of The Economist, was he not? - Walter Bagehot.

"The French," he wrote, "would be the best cooks in Europe if only they had got any butcher's meat."

The Englishman's 1931 journal ends up with an interesting item I don't think would be noted today:

"American meals nearly always start with a large slice of melon or grapefruit or something called a fruit cocktail. This is surely an austere welcome for a hungry man.

"Dessert, in my view, should be eaten at the end of the meal not the beginning. But the influence of American customs is now so all-pervading that during recent years I've noticed this habit creeping into England. It should be strongly repulsed.

"On the other hand shad roe and terrapin and the American Blue Point oyster are serious undertakings and the American lobster, captured off the coast of Maine, is unrivalled for succulence and flavour anywhere in the world."

I think it ought to be pointed out that these recommendations are the result, this year, of a thoroughly exhaustive clinical trial.

You can do a clinical trial on human behaviour, habits, just as well as you can test the efficacy of a drug or a method of treatment.

But I notice that even among so-called educated people everywhere that when it comes to recommending some nutritious food or a new medicine, a proposed cure or mollifier for any ailment or pain, few of us consult clinical trials.

We depend mostly on what doctors bemoan as "anecdotal evidence". You saw it in a magazine or "Uncle Fred took it and has done very well on it" or "Well, both Mary and her brother take Quickfix and they say it works."

This form of, shall we call it reasoning - what the ancients called the "one case induction method" - is universal.

But medicine progresses with the testing of a drug, a treatment, whatever, on a chosen sample - the bigger the better. Best thousands of people, divided into groups - two groups usually - one takes the pill or whatever, the other gets a harmless, useless, placebo.

In the better trials, which are known as blind, neither group knows which it's getting - the pill or the placebo.

The best clinical trials of all are double blind when neither the doctor nor the patient knows who's getting which.

So what this year moved the nutrition summit to stress yet again the superior value of vegetables, cereals and only lean meat - no mention of fruits by the way - was the result of a clinical trial undertaken to see if there was any true connection between diet and longevity.

No trial of such thoroughness has, I believe, ever been attempted.

It recruited, not Uncle Fred and Mary and her brother and aunts, but 42,254 American women for two years and because, at the same time, the large group included women who had breast cancer, women with benign breast disease, women with neither - the whole study had a follow-up for over five years. The average age was late 60s.

The 40-odd thousand were divided into four groups with various diets - one following the now prescribed vegetable, cereal, lean meat.

A fearsomely tricky regiment to gather and test - they were watched for other characteristics as well.

The result: the risk of death decreased gradually but continuously in women with the healthiest diets.

The final comment is: "This study strongly supports the belief that diets emphasising vegetables, whole grains, low-fat dairy products and lean meats are associated with reduced mortality."

Which being translated means a longer life.

The other factor vital but mentioned only along the way was some daily exercise - walking is best.

So the word, ladies and fellows, is never mind the aerobics and Dr Quackenbush's miracle diet, gobble the veggies, forget the sirloin, walk nine holes of golf - with or without the ball - and lay off the French fries.

There's another study, a United Nations study, childishly simple to understand, alarming to interpret.

It's simply the drawing of a pyramid. But you must imagine the pyramid upside down.

It's sliced across in layers. Each layer is named after a country. It's a vivid picture of the incidence of heart disease in most of the large countries of the world.

At the top, the long flat surface of the upside pyramid: 570 deaths of heart disease every 100,000 - the most - it is, wait for it, Northern Ireland.

Next in fatal line - Scotland. Then it goes Finland, Czechoslovakia, Ireland, Hungary, England and Wales, the Scandinavian countries next.

All of these top sinners - big meat eaters. It goes down, down.

And the countries with the least coronary heart disease in descending order: Greece, Spain, Portugal, France and, practically nil, Japan.

Much work has been done on this pyramid since it appeared in the middle 1980s.

The only positive item the researchers note is that the countries at the bottom use almost no butter and most olive oil.

There are many other factors that - considering the woeful Anglo-Saxon position - we won't go into just now.

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