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and dangerously misleading report which dismissed the role of cholesterol as a risk factor in the development of cardiovascular disease. The report, "Toward Healthful Diets,” advised that healthy Americans need no longer be concerned about modifying or restricting their intake of saturated fats and cholesterol.

The report's recommendations contradict recently published Federal nutritional guidelines which strongly recommend the reduction of saturated fats and cholesterol as one way of reducing the risk of heart disease. This advice has been endorsed by numerous domestic and international health organizations including the American Heart Foundation, the Surgeon General, and the World Health Organization.

Where before we had unanimity we now have contradiction. Americans are confused. Many have already altered their dietary habits and are now concerned about the credibility of public health warnings. When experts disagree, the public wonders to whom it can turn for reliable advice?

I believe the answer is clear. It rests with the overwhelming weight of scientific opinion.

For over two decades researchers, physicians, nutritionists, and public health officers have advised that reducing the dietary intake of saturated fats and cholesterol-ladened foods is a critically important factor in reducing the risk of heart attack. It's good advice.

Americans have a deep interest in improving their health. They have responded to these warnings. Consumption of foods containing high levels of saturated fats and cholesteral has decreased. Mr. Chairman, it is no accident that the incidence of heart disease in this country has also declined.

By following public health recommendations and modifying personal diets and lifestyles, Americans have begun to take an active role in maintaining good health. As a result, we are feeling better and living longer than ever before. This is good news and represents a trend to be praised and encouraged.

But Mr. Chairman, in the absence of rigorous analysis and careful explanation, the Academy's report threatens to set back 20 years, gains we have made in the prevention of heart disease.

That the National Academy of Sciences could be the source for such a report is disturbing. It presents no new data. It ignores an enormous body of scientific evidence and concludes that not enough is yet known about cholesterol. This conclusion gives rise to the cavalier, perhaps irresponsible recommendation that healthy Americans need not be concerned about excessive consumption of cholesterol.

Since granted its formal charter by Congress in 1863, the National Academy of Sciences has been noted for its commitment to scientific excellence. In many respects the Academy represents the pinnacle of scientific achievement and credibility. This most recent report, “Toward Healthful Diets,” contrasts poorly with the Academy's traditionally high standards.

In fact, the report's publication may tell us more about the operation of the Academy than it does about the relationship between diet and heart disease. Its release under the Academy's auspices calls into serious question the body's scientific objectivity, the process by which members of the Food and Nutrition Board are selected and the procedure by which the report was prepared, reviewed and approved for publication.

While I am surprised by the source of this report, I am not surprised by its content. The theme is all too familiar. For years the tobacco industry tried to convince Americans not to believe a causal relationship existed between smoking and its "statistical association" with lung cancer. The use of this tired argument, this time in defense of cholesterol, is no more valid today than when it was used to defend tobacco years ago.

Mr. Chairman, not only do I believe the views expressed in the Academy's recent report are inaccurate and potentially biased, but to those concerned about maintaining a strong public health policy, they are quite dangerous. If Americans follow the Academy's recommendations—and if those recommendations are wrong-I am convinced the incidence of heart disease in this country will increase. This is a frightening prospect and I am anxious the subcommittee subject this report, its authors, and assumptions to the closest scrutiny.

I look forward to the testimony of our witnesses this morning. Thank you.

Mr. RICHMOND. Thank you, Mr. Chairman. It is a pleasure to have you with us. I hope you will spend today and tomorrow at these hearings because we do need your counsel on this most vital problem.

Our first witness this morning is Dr. Mark Hegsted, Administrator of the Human Nutrition Center, Science and Education Administration of the U.S. Department of Agriculture.

It is always a pleasure to have Dr. Hegsted with us. He is certainly the most knowledgeable man in the Department of Agriculture today.



Dr. HEGSTED. Good morning, Mr. Chairman and members of the subcommittee, I appreciate the opportunity to be here.

"Toward Healthful Diets,” the recent statement issued by the Food and Nutrition Board of the National Academy of Sciences, agrees with many points in an earlier report of the Department of Agriculture and the Department of Health, Education, and Welfare, now the Department of Health and Human Services.

It concurs with “Dietary Guidelines for Americans” published jointly earlier this year by both Departments on the points which follow. First, dietary guidance must take into account the fact that nutritional needs vary depending on age, sex, physical activity, and other conditions such as pregnancy or illness.

Second, obesity is generally recognized as a risk factor in such chronic diseases as hypertension, diabetes, coronary artery disease, and strokes.

Third, gradual steady weight loss involving long-term eating discipline is both safer and more likely to be successful than fad diets which promise quick results.

Fourth, a moderate increase in physical activity is important and helpful in a weight loss program.

Fifth, a healthy diet means eating a variety of foods.
Sixth, most Americans eat more

sodium than they need and should reduce their sodium intake.

Seventh, alcohol should be consumed only in moderation. Eighth, reductions in consumption of sugars, fats, and alcohol are often necessary to maintain ideal weight and prevent obesity.

The reports agree further that there is abundant evidence that dietary fat and cholesterol are factors which determine serum lipid levels and serum lipid levels are risk factors of atherosclerosis and coronary artery disease.

Where the reports disagree are on the implications of the facts about dietary fat and cholesterol for the American public. The Food and Nutrition Board concludes that the evidence warrants no specific recommendations about dietary cholesterol for the healthy person and that the average person does not need to be concerned about fat intake.

An average person is not defined though the report does say at one point that "(I)nfants, adolescent boys, pregnant teenage girls, and adults performing heavy manual labor, probably have no need to reduce the fat level of their diets below 40 percent of calories,” while "sedentary persons attempting to achieve weight control may be well advised” to reduce calories by reducing fat.

The two U.S. Government Departments most concerned with food and health chose a more conservative prudent approach. Based on evidence of a relationship between dietary fat intake and heart disease, as well as obesity, and lacking any evidence that a low fat diet is harmful to anyone, we recommend that Americans avoid too much fat, saturated fat, and cholesterol in their diets.

Mr. RICHMOND. Dr. Hegsted, could you tell many of us who do not know medical terms exactly what serum lipids are. I am sure that term will appear in all of our testimony in the next few days.

Dr. HEGSTED. Fats are not soluble in water, so they have to be transported around the body in conjunction with proteins. We are really talking about lipoprotein levels. Cholesterol and serum fat are transported through the blood as lipoproteins.

Certain lipoproteins, particularly the low density lipoproteins, are clearly associated with a risk of heart disease.

It is also important to note that the Food and Nutrition Board accepted precisely that reasoning in recommending that Americans reduce their salt consumption, saying that

There is no reason to believe that reduction of sodium chloride intake * would be harmful for healthy persons, and it may be helpful for the prevention of hypertension in susceptible individuals * * *

The Board however rejects a similar risk reduction approach in the case of cholesterol and fať.

The Board does not deal with the issue of sugar and dental caries even though the American people spend more than $2 billion a year on dental care and the American Dental Association and the National Institute of Dental Health believe that much of the damage of cavities is related to the consumption of sugary materials.

We point out that 40 to 50 percent, nearly half, of Americans die of heart attacks. About 30 percent of adult Americans are obese and another 5 to 10 percent suffer from diabetes. In fact, practically the total population is at risk from one of these diseases associated with diet.

According to "Healthy People," the Surgeon General's Report on Health Promotion and Disease Prevention, about one-third of today's


obese adults were obese as children and an obese child is at least three times more likely to be an overweight adult.

Statistics such as these clearly indicate that a substantial proportion of the American population is at risk of one or more of the chronic diseases may be related to dietary factors.

It is small wonder that Americans are concerned about the food they eat and its effects on their health. Study after study has illustrated that concern and there is strong evidence that the concern is justified.

Last May, after an exhaustive study on the association between dietary factor and chronic disease, the American Society for Clinical Nutrition issued consensus papers which relate directly to this controversy. The society found associations between alcohol consumption and liver disease, between sugar and dental cavities, between salt and hypertension, and between cholesterol and saturated fat and coronary artery disease.

Many national and international expert committees have reached similar conclusions. It is important to note that no new evidence is cited by the Food and Nutrition Board in reaching their contrary opinion.

Far from agreeing with the Food and Nutrition Board that general dietary guidance should not be made, we believe that many Americans want dietary advice from reliable, unbiased sources. We believe that the preponderance of evidence suggests that recommendations can and should be made so that Americans can increase their awareness of the role of diet in health promotion and disease prevention.

We agree with the Food and Nutrition Board that food is for nourishment and enjoyment. It was in their spirit that we presented the dietary guidelines—not as a panacea, a prescription, or a nutritional insurance policy, but as prudent advice based on the best current scientific knowledge and a growing consensus of the scientific community:

The guidelines are these. Ēat a variety of foods. Maintain ideal weight. Avoid too much fat, saturated fat, and cholesterol. Eat foods with adequate starch and fiber. Avoid too much sugar. Avoid too much sodium. If you drink alcohol, do so in moderation.

Thank you, Mr. Chairman.

Mr. RICHMOND. Thank you, Dr. Hegsted. Dr. Hegsted, we all know that for 30 years you were a distinguished research scientist before you became a major public administrator, so you have experience on both sides of this question. Can you give us your own honest opinion of the statement "Toward Healthful Diets"?

Was it developed in the same scientific manner in which you, yourself, have directed other reports to be developed?

Dr. HEGSTED. I believe, Mr. Chairman, that, for reasons that are not apparent to me, it was not developed quite the way that many Academy reports are developed.

It is clear that we all have our biases and may interpret data somewhat differently. When you are setting up a committee of this kind, those biases should be clearly recognized. I would point out that the panels that considered issues of these kinds for the American Society of Clinical Nutrition were deliberately developed to represent the range of opinion that we know exists. I think that is the only procedure that can be used in issues wherein there are differences of opinion.

Mr. RICHMOND. You were recently quoted in the Washington Post as having said, “I do not know how they could reach such a con

trary conclusion.” Were you questioning their credentials as scientists, or were you questioning the manner in which they worked and the research material they had at hand? What did you mean when you said, "I do not know how they could reach such a contrary conclusion"? Dr. HEGSTED. As has been pointed out, there have been many scien

. tific groups going back at least 20 years—the American Heart Association, the World Health Organization, the Royal College of Physicians, the Intersociety Committee on Atherosclerosis, and many many expert committees that have looked at these issues and arrive in general at the kinds of conclusions that are expressed in the dietary guidelines.

As I say, I do not see how an appropriate examination of the data could yield the conclusions that fat and cholesterol are of no significance to the American public.

Mr. RICHMOND. Thank you, Dr. Hegsted.
It is a pleasure to have you with us, Mr. Brown.
Mr. Brown. Thank you, Mr. Richmond.

Dr. Hegsted, if I may explore one issue with you, I am concerned about the methodology of risk/benefit analysis in studies of this sort. It would appear that there was weighed in the balance here some evaluation of risk based upon a diet containing high levels of fat and cholesterol and perhaps a calculation as to certain nondietary benefits such as the health of the beef and egg industry, which are valid considerations.

To your knowledge, is there any way or has there been any effort to quantify the health risks to the consumer versus the economic benefits to the producer in making an evaluation of this sort !

Dr. HEGSTEAD. I suspect, Mr. Brown, that it is probably impossible to do that adequately, although I think there have been some misinterpretations of what we mean by the dietary guidelines.

The dietary guidelines do not necessarily call for reduced consumption of meat or dairy products. What we are asking for are leaner products.

I guess I would have to say that I do not think any set of dietary recommendations will be acceptable to the total food industry. Americans now are eating as much food as we can practically. All the evidence indicates that we are eating too much. Therefore, any recommendation to eat more of something would necessitate that people eat less of something else.

I do not think the dietary guidelines are calling for a reduced consumption of some of the products. We are trying to recommend changes in composition.

Mr. Brown. Would you have any recommendations with regard to this specific kind of a scientific problem of how we balance risks and benefits, particularly when it involves two diverse groups that are bearing the risks or getting the benefits? That, I presume, has not been an element in the kind of studies that you have made.

You have dealt strictly with the health risks or the health benefits of a particular diet or level of diet and have not tried to concern yourself with looking at the total impact, let us say, on the American society and economy in connection with something like that.

Dr. HEGSTED. We are not unaware of that but I think nutrition is like many other things. It influences the marketplace and does have a role to play. At least, we hope it does.


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