Diet and Lifestyle Guidelines
Dr. Black: I looked at the recommendations for diet and lifestyle. If there was ever a boilerplate, that's it. There is very little that's new. The thing that is missing, in my opinion, is how to do it. We all know how much sodium you should eat, or at least we think we do. We all know that you should eat a healthy diet. We all know what that healthy diet is. But what that document doesn't seem to address is how one should do that. That's hard.
Dr. Weber: I think it's worse than hard. It borders on impossible. Let me just recall a very successful trial called the DASH diet. That was a diet with a lot of fresh fruits, vegetables, and low-fat foods. It was a very good, very healthy diet. People's blood pressures came down and it looked very, very desirable. The problem was that if you went home and tried to create that diet at home, it would be your life's work to go shopping for this, shopping for that, cooking it this way, cooking it that way.
Dr. Black: I think it's even worse. The original study was a 7-week feeding study in which the subjects got all their meals at the centers, all 4 of them. Even on the weekends, they got food to go home. That's not exactly how we practice. So that's an efficacy study, not an effectiveness study.
Dr. Weber: Exactly.
Dr. Black: And how much do we do with it?
Dr. Weber: The only success I have seen so far, Henry -- and perhaps I'm hearing propaganda rather than hard data -- comes from Britain, where they persuaded food manufacturers who make packaged foods to start reducing the amount of salt in the diet. They realized that if they went too far, people would say that there is something wrong with the food, that it has lost its flavor and the characteristics that they enjoy. So every year, they are all to reduce the amount of salt in all of those foods by 5%. So it'll take a few years. Maybe after 10 years, we'll probably still be eating more salt than we ought to, but it will be a lot better than it was. I think that's how we have to approach it here too. You can't tell people to eat less salt and eat fewer calories. They don't do it.
Dr. Black: What I think is very interesting is our timeframe for how long a public health recommendation takes to work. It took 25 years -- from 1964 when the advice came out until the late 80s -- before we actually saw smoking rates go down. So we have to have a very long timeframe to decide whether a particular thing is effective or not.
Dr. Weber: In a way, smoking is easy when it comes to stopping because you stop. With eating, it's different because you don't stop eating. You just modify. For people who are already middle-aged and have become very accustomed to a certain eating style, so-called portion control and careful selection of ingredients is very difficult. That's not to say that it's not worth trying or that some patients don't succeed at modifying their diet quite effectively and keeping it that way long-term. It's not totally futile and we shouldn't say that it's a waste of time, because it's not.