Randomized, placebo-controlled trial of dietary supplementation of alpha-tocopherol on mutagen sensitivity levels in melanoma patients: a pilot trial.

We evaluated the effects of vitamin E (dl-alpha-tocopherol) on mutagen sensitivity levels in a randomized placebo-controlled pilot trial. In brief, a dietary supplement of 1000 mg/day vitamin E or a placebo was randomly administered for 3 months to melanoma outpatients clinically free of the disease. Plasma vitamin E and mutagen sensitivity levels were measured at baseline and at the end of the trial after 3 months. At baseline, we found no significant differences in plasma vitamin E and mutagen sensitivity levels between the two groups. We also measured dietary intake at baseline and found dietary vitamin E to be a poor predictor of plasma levels of vitamin E. After 3 months of supplementation, we found that plasma levels of alpha-tocopherol increased significantly (P = 0.0005) in the vitamin E compared to the placebo group. We also found a non-significant, but consistent decrease in plasma gamma-tocopherol concentrations in the vitamin E supplemented compared to the placebo group. We did not find any significant difference between the vitamin E and placebo groups in mutagen sensitivity levels either at baseline or after 3 months of supplementation. We conclude that short term vitamin E supplementation, although it causes increased blood levels of alpha-tocopherol, does not provide protection against bleomycin-induced chromosome damage.

Minority women and advocacy for women's health.

US minority health issues involve racial/ethnic disparities that affect both women and men. However, women's health advocacy in the United States does not consistently address problems specific to minority women. The underlying evolution and political strength of the women's health and minority health movements differ profoundly. Women of color comprise only one quarter of women's health movement constituents and are, on average, socioeconomically disadvantaged. Potential alliances may be inhibited by vestiges of historical racial and social divisions that detract from feelings of commonality and mutual support. Nevertheless, insufficient attention to minority women's issues undermines the legitimacy of the women's health movement and may prevent important advances that can be achieved only when diversity is fully considered.

Soft drink "pouring rights": marketing empty calories to children.

Healthy People 2010 objectives call for meals and snacks served in schools to contribute to overall diets that meet federal dietary guidelines. Sales in schools of foods and drinks high in calories and low in nutrients undermine this health objective, as well as participation in the more nutritious, federally sponsored, school lunch programs. Competitive foods also undermine nutrition information taught in the classroom. Lucrative contracts between school districts and soft drink companies for exclusive rights to sell one brand are the latest development in the increasing commercialization of school food. These contracts, intended to elicit brand loyalty among young children who have a lifetime of purchases ahead of them, are especially questionable because they place schools in the position of "pushing" soft drink consumption. "Pouring rights" contracts deserve attention from public health professionals concerned about the nutritional quality of children's diets.

Halting the obesity epidemic: a public health policy approach.

Traditional ways of preventing and treating overweight and obesity have almost invariably focused on changing the behavior of individuals, an approach that has proven woefully inadequate, as indicated by the rising rates of both conditions. Considering the many aspects of American culture that promote obesity, from the proliferation of fast-food outlets to almost universal reliance on automobiles, reversing current trends will require a multifaceted public health policy approach as well as considerable funding. National leadership is needed to ensure the participation of health officials and researchers, educators and legislators, transportation experts and urban planners, and businesses and nonprofit groups in formulating a public health campaign with a better chance of success. The authors outline a broad range of policy recommendations and suggest that an obesity prevention campaign might be funded, in part, with revenues from small taxes on selected products that provide "empty" calories-such as soft drinks-or that reduce physical activity-such as automobiles.

Ethical dilemmas in choosing a healthful diet: vote with your fork!

Dietary guidelines for health promotion and disease prevention in the USA recommend a consumption pattern based largely on grains, fruit and vegetables, with smaller amounts of meat and dairy foods, and even smaller amounts of foods high in fat and sugar. Such diets are demonstrably health promoting, but following them raises ethical issues related to the role of nutritionists in advising the public about healthful dietary choices, as well as to the role of the food industry in food production and marketing. In the USA a shift towards a more plant-based diet would affect the economic interests of producers of food commodities, food products and meals prepared outside the home; it would also affect the environment, food prices, trade with other countries (developing as well as industrialized) and relationships among the food industry, government agencies (domestic and international) and food and nutrition professionals. In a free-market economy any dietary choice has consequences for food producers. Thus, considerations of ethical dilemmas in choosing healthful diets suggest that food choices are political acts that offer opportunities for all parties concerned to examine the consequences of such choices and 'vote with forks'.

Changing the diet of a nation: Population/regulatory strategies for a developed economy.

The principal nutritional problems of developed economies are related to the excessive and unbalanced intake of energy and nutrients. During the 20th century, as economies improved and food production became more efficient, conditions related to undernutrition were replaced by epidemics of coronary heart disease, certain cancers and other chronic conditions related to food overconsumption. In developed countries such as the United States, obesity became the predominant public health nutrition problem. To prevent obesity, people must consume less energy and be more active, but the food supplies of developed economies offer their populations amounts of energy that greatly exceed physiological need. Food overproduction causes competition in the food industry, limits its expansion, and leads food producers to invest heavily in marketing. To increase sales, food companies must encourage people to consume more of their products, substitute their products for others or develop new markets. Such efforts create an environment in which food is readily available at all times and readily overconsumed. Marketing expenditures for any single food product greatly exceed the total amounts available to governments for national campaigns to prevent chronic diseases. Existing government policies often support this environment through price supports and other means. To reverse obesity and its health consequences, governments need to consider ways to address the food environment through policies in education, agriculture, school meals, pricing, taxation and other means, as well as to develop mechanisms to fund new programme initiatives.

Animal v. plant foods in human diets and health: is the historical record unequivocal?

An ideal diet is one that promotes optimal health and longevity. Throughout history, human societies have developed varieties of dietary patterns based on available food plants and animals that successfully supported growth and reproduction. As economies changed from scarcity to abundance, principal diet-related diseases have shifted from nutrient deficiencies to chronic diseases related to dietary excesses. This shift has led to increasing scientific consensus that eating more plant foods but fewer animal foods would best promote health. This consensus is based on research relating dietary factors to chronic disease risks, and to observations of exceptionally low chronic disease rates among people consuming vegetarian, Mediterranean and Asian diets. One challenge to this consensus is the idea that palaeolithic man consumed more meat than currently recommended, and that this pattern is genetically determined. If such exists, a genetic basis for ideal proportions of plant or animal foods is difficult to determine; hominoid primates are largely vegetarian, current hunter-gatherer groups rely on foods that can be obtained most conveniently, and the archeological record is insufficient to determine whether plants or animals predominated. Most evidence suggests that a shift to largely plant-based diets would reduce chronic disease risks among industrialized and rapidly-industrializing populations. The accomplish this shift, it will be necessary to overcome market-place barriers and to develop new policies that will encourage greater consumption of fruits, vegetables and grains as a means to promote public health.

Interpretation of dietary change in the United States: fat as an indicator.

Measurement of dietary trends poses methodologic issues of great complexity and intellectural challenge. Confidence in the ability to draw inferences about trends increases when the results of various measurement methods point in the same direction, are of comparable magnitude and are consistent with one another as well as with external sources of related data. This paper illustrates these issues by reviewing inconsistencies in available data sources since the early 1970s on intake of fat in the United States.

The selling of olestra.

The Procter & Gamble Company spent 30 years and an estimated $500 million to bring its non-digestible fat substitute, olestra, to market. The Food and Drug Administration approved olestra as a food additive but requires products containing olestra to carry a warning statement about its potential effects on gastrointestinal function. In obtaining approval for olestra, P&G conducted a lengthy, persistent, and comprehensive campaign to enlist support from members of Congress; FDA staff; and food, nutrition, and health professionals. This campaign raises larger questions about corporate influence on government policies, and the relationships of corporations to health professionals. To address these larger concerns, the author reviews the history of olestra's approval; describes P&G's campaign to obtain support from FDA and Congress, to defend olestra against critics, and to market it to professionals, the press, and consumers; and suggests implications for public health policies.

Broccoli sprouts in cancer prevention.

Recent research has aimed to identify specific phytochemicals in Brassica vegetables, such as sulforaphane in broccoli, that may confer protection against cancer. Clinical, dietary, and policy implications are discussed.