HEALTHFUL DIETS AND HEALTHFUL BEHAVIOR GO HAND IN HAND
by John W. Crayton, MD, Professor of Psychiatry at Loyola University Medical School and Chief, Section of Biological Psychiatry, Hines Veterans Administration Hospital, Maywood, Illinois.
Recently, we have seen a remarkable explosion of diet- and nutrition-related research in the country's first line journals. Nutrition was once the exclusive province of specialty journals or, more likely mass-media magazines, not an object of large-scale, government-funded research by scientists at leading academic medical centers. However, recently reports about this kind of large-scale research have hit the headlines at a breathtaking pace. This fact, in itself, is worthy of comment as an indication of the gradual but relentless emergence of an awareness of the importance of nutrition to health maintenance.
It is common knowledge that physicians are—or have been—woefully uneducated as to the importance of nutrition to health. In large part because of the proddings of groups such as NOHA and their individual members, who have undertaken to provide badly-needed remedial education to their own doctors, physicians are much more likely today than they were even five or ten years ago to address issues of diet and nutrition in the maintenance of health. Members of NOHA need hardly be cautioned that there is still much more educating to be done!
The articles that have appeared recently can be seen as illustrating an important theme that is both different from nutrition per se, but also central to any clear understanding of the role of diet and nutrition in health maintenance. The theme is that nutritional interventions must occur within a comprehensive health maintenance program that includes—most importantly—healthful behaviors.
Antioxidant Supplements and Lung Cancer
What is wrong here? The problem is that the way to reduce lung cancer is to stop smoking, not to keep smoking and take a dietary supplement. The description of this study as a "primary prevention" study is grossly misleading; "primary prevention" (meaning a preventive strategy that prevents the disorder from ever happening) would involve devising a program of smoking cessation, which would have drastically reduced the incidence of lung cancer and cancer deaths in the study group. (From an ethical point of view, one wonders if the participants were informed that they were selected precisely because they were engaged in a potentially fatal behavior, and if they did not carry on that potentially fatal behavior, they would be dropped from the study.)
What did we learn from this study? We didn't learn anything about the possible healthful effects of antioxidant supplements because relatively small but significant effects of these agents were overwhelmed by the effects of the potentially fatal behavior (smoking). We did learn, once again, that smoking causes lung cancer and that the one best way of reducing the incidence of lung cancer is to stop the potentially fatal behavior.
Antioxidants and Colon Cancer
But let us review the rationale for this study: "Although the causes of colorectal cancer are incompletely understood, dietary factors appear to be important. Rates of colorectal cancer are lowest in populations whose diets typically are rich in vegetables and fruits. In studies of individual subjects, high levels of consumption of vegetables and fruits are consistently associated with lower risk of colorectal cancer. One explanation for these findings is that people who eat more vegetables avoid possible carcinogens in meats and fats. Another is that vegetables and fruits contain anticarcinogens that block the development of colorectal tumors."
Thus, the authors decide to try to prevent cancers by giving an antioxidant supplement. The implicit assumptions here are that 1) individuals can continue to consume potentially carcinogenic meats and fats and 2) the supplements will make up for the fruits and vegetables, which the participants are not eating.
Potentially Fatal Behaviors
At the same time that dietary and nutritional studies are receiving the attention that they have long deserved, there is also an emerging awareness that much human illness is, at bottom, a problem of humans selecting potentially fatal behaviors over healthful behaviors. This problem is complex and multifaceted. It is related to the process of addiction (whether to drugs, alcohol, nicotine, or fatty foods), which is still poorly understood. It is also related to other behavioral issues: people engage in potentially fatal behaviors because of low self-esteem, depression, anxiety, hopelessness, loneliness, or despair. These are widespread human problems that must be addressed at the individual, family, community, and societal levels.
Individuals also engage in potentially fatal behaviors because there is little immediate, direct cost to them, and what cost does occur is remote: teenagers can smoke with impunity because a pack of cigarettes is very cheap, and the costs—chronic bronchitis, cancer, heart disease, and death—are still years away. Here, one answer is, in principle, readily at hand. Make potentially fatal behaviors immediately expensive: tax them. Taxes on using cigarettes, alcohol, fast cars, empty calories, and fat should at least cover the eventual costs of these behaviors, (medical treatment, lost productivity, and burial costs), if not be at a high enough level to serve as an educational redirective toward healthful behaviors.
As our congressmen and women move toward implementing a "universal health care system" we will be sorely remiss if we do not demand of them that their programs deter potentially fatal behaviors and promote healthful ones. Subsidies for tobacco, sugar, cattle production and empty calorie, high fat foods have no place in a universal health care plan. Programs that support good nutrition, healthful exercise, rewarding work and relationships, and mental well-being are inextricably intertwined and essential elements of effective health programs. As the National Institutes of Health plans its research agenda for the future, we should advocate studies that address all of these factors necessary for "optimal health."
Article from NOHA NEWS, Vol. XIX, No. 4, Fall 1994, pages 5-6.