Mobilize for Total Nutrition!
From the laboratory, a warning to set the table better for all: by the Chairman, Committee on Food and Nutrition, National Research Council
by RUSSELL M. WILDER, M.D., an article in Survey Graphic, July, 1941
EVIDENCE PRESENTED AT THE NATIONAL NUTRITION Conference should convince everyone that the nation is faced with a serious problem of malnutrition; that despite a so-called surplus of foods a great many of our people are not receiving the fare they need for strength of mind and body.
The gravity of this situation, however, is mitigated by the hopeful and challenging fact that we now have the scientific knowledge, the means, and the national will to do something about it.
Significant studies made by the federal government, as long ago as 1936, bear witness that today’s mobilization to improve nutrition for all the people comes none too soon. These surveys revealed that in 1936 more than one third of all families were buying food which could not provide a diet rating better than “poor.” Not more than one family in four secured food which would provide a diet rated as “good.”
The conclusions drawn from these surveys have not been found acceptable to everyone. There are some persons who do not feel that they apply today. They maintain that times have improved since 1936—average incomes and purchasing powers are higher. Many physicians have been critical of the results set forth on the ground that none of the individuals included in the statistical totals was subjected to personal examination. However, in later studies carried out in villages of North Carolina and Tennessee, and in several other widely separated communities, physicians have made careful examinations of the people, and similar conclusions were reached.
In considering the total problem of nutrition, there has been criticism of the physician as well as by the physician. The scientists who, for twenty years or more, have studied nutrition in animals have indulged quite frequently in caustic comments on the failure of the medical profession to come to grips with malnutrition.
Practicing physicians, by and large, have been slow act on the developments in the nutrition field. I wish to take this occasion to explain their conservatism.
The past forty years and more have been a period of dramatic achievement in many fields of medical science and of marked success in the control of diseases used by bacteria and related organisms. The accomplishment of the average physician, in the complexity of human pathology, is highly creditable. Few persons not trained for the practice of medicine are even dimly conscious of the difficulties involved in the accurate diagnosis of disease.
Nor has the physician failed, except in nutrition, to recognize the predominant significance of preventive medicine. He has given freely of his time, usually on purely voluntary basis, to the campaigns which have been waged with such success against tuberculosis, syphilis, and maternal ill health. Also most of the legislation to which we owe that magnificent organization, the U. S. Public Health Service, has come about as a result of insistence by physicians. This is equally true of the fine collateral departments of public health in the states.
The medical profession has not been tardy, either—as workers in nutrition have sometimes thought—in granting early recognition to the new in science. Salvarsan was introduced in 1910, and by 1912 was in general use for the treatment of syphilis; insulin was discovered in 1921 and by 1923 was employed the world over. The value of sulfapyridine was recognized in 1938, and patients with pneumonia received its benefit almost immediately.
Fundamental knowledge in the science of nutrition is of very recent origin. Many physicians received their academic education before scientific nutrition had accumulated the body of fact which today seems so important. Moreover, the earlier investigations were made in scientific fields whose relation with medicine was not so clearly recognized as it is today. These important contributions were published in journals other than those which the average physician reads, and became embalmed, so far as he was concerned, in scientific literature.
As in the initial years of any new science, the early findings are vague and confused. According to a popular definition, “A vitamin is something that makes you sick if you don’t get it.” It could scarcely be expected that men trained in a school of tangible causes and effects should be greatly concerned with infirmities for which only a negative causation could be suggested; they found little substance in so vacuous a conception.
The average office practice of most physicians and even the wards of hospitals have not revealed much disability clearly related to diet. Most persons who are malnourished are scarcely sick enough to call physicians. If they do, it is for symptoms which the doctor in the past has thought were from mental or nervous disorders. Doctors long have recognized severe deficiency diseases. Pellagra, when it came full-blown with red, scaly skin on hands and neck, a red, sore tongue and diarrhea, was diagnosed correctly. But, in most places, the number of cases of pellagra has been very small. We encountered dropsy in patients with tender nerves and other symptoms simulating the disease which, in the Orient, is known as beriberi, but such clinical pictures were very rare. Frank scurvy, with its bleeding, swollen gums and skin spotted by blood which oozed into the tissues beneath the skin, likewise has been uncommon. Rickets in children once was terribly apparent, but of late years the general dosing of infants with cod liver oil and more recently the irradiation of evaporated and other milk has decreased immensely the incidence of rickets.
When it came to the recognition of the more subtle forms of malnutrition and their relationship with the vitamins, physicians were wary. This is entirely understandable, for it must be remembered that diet, for centuries, has been a fertile field for quackery. Food fads have come and gone by the score. Physicians are, perhaps, more conscious of the evils of charlatanism than others without the same training.
Furthermore, the early evidence on vitamins was limited for a long time to what was learned from animal experimentation. Physicians must be careful about accepting for man conclusions based on work with lower forms of life. I beg that what I am recording will not be interpreted as lack of appreciation of work in animal nutrition. Without the basic information thus obtained, the later more convincing work could never have proceeded. My intent is, rather, to point out that the concept vitamin activity seemed to the physician academic rather than practical. The earlier suggestions in nutrition that this or that vegetable or fruit was an excellent, a fair, or a poor source of this or that ill-defined activity were unconvincing to a profession becoming accustomed to methods of precision both in diagnosis and treatment.
Thus, physicians demanded other evidence that the newer knowledge of vitamins applied to man. That evidence came in part from the brilliant contributions of chemists who isolated or made available by chemical means, the vitamins in forms which could be smelled, weighed, and measured for effect.
Additional evidence came from nutritional physiologists, chemists, and clinical investigators. Methods were devised for measuring with precision the amounts of each of the several vitamins contained in foods. Methods of determining the amount of vitamins in blood and urine were likewise established so that diagnosis of vitamin deficiency could be made in the clinical laboratory. Physicians can now think and work in terms of micrograms of vitamins that bear chemical names. At least this is true for several of the vitamins. The chemical designations of these substances provide a distinct advantage, for the use of alphabetical designations—A, B, C and so on—has created much confusion.
With these tools at hand, physicians in recent years have begun to display the long awaited interest in scientific nutrition. After all, in a dynamic society we cannot demand complete scientific knowledge before acting. “Greater mistakes will be made by waiting for the golden age than by acting on knowledge at hand and changing course as newly acquired knowledge may suggest,” as M. L. Wilson has said.
Another reason for the growing acceptance of nutritional science by physicians is the increasing knowledge of the actual requirement, per person, of each of the several nutrients contained in food. We know today, beyond all doubt, that the average American diet does not provide what men and women ought to have, nor what the children of today need, to become vigorous citizens of tomorrow.
In consequence, physicians now are even more concerned than are some of the scientists with the problems of health which malnutrition has created. Specialists in children’s diseases were first to crystallize their interest, but of late, discussion of some aspect of human nutrition finds a place on the program of nearly every medical gathering in the nation.
The American Medical Association organized a Committee on Foods some fifteen years ago. This body, composed of a group of leading nutritional scientists and a number of physicians, undertook to inform the medical profession and the public concerning the reliability of nutritional claims made in connection with advertising and labelling of foods. This earlier committee more recently has been renamed the Council on Foods and Nutrition. As such, it is concentrating attention on the nutritive qualities of foods in general use and on the effects of various methods of processing, distribution, and preparation on those qualities.
When the President called the National Nutrition Conference for Defense, the Council on Foods and Nutrition and the Board of Trustees of the American Medical Association pledged to it their full support. They recognize the need for awakening public interest in the many problems here to be considered. They appreciate, however, that many kinds of experience are required to solve effectively the diverse problems facing us. Physicians in every community will cooperate in what needs doing, but with them must be ranged many other groups with other special training.
Scientific guidance is demanded from experts in nutrition. To provide this guidance, the Committee on Food and Nutrition of the National Research Council has been organized. The broad policy of this committee, as formalized by its resolutions, is to assist in securing adequate nutrition for the greatest number of people. In what it has done to date, consideration has been given and in the future such consideration will continue to be given both to the nutritional requirements and to the supply of essential nutrients in all foods. Every effort has been and will be made to supply this demand through natural foods, and the committee is emphasizing educational and research projects and other forms of assistance designed to develop methods for the fuller and better utilization of natural foods. However, partly due to emergency conditions which now exist, specific enrichment procedures may need to be recommended. One has already been recommended, namely enrichment of flour and bread. Others will be considered individually, each on its own merits.
Food habits offer difficulties which only experience in psychology and education will overcome. Assistance here can be looked for from the Committee on Food Habits, organized by the National Research Council.
Economics is importantly involved in any consideration for the improvement of national nutrition. Here the advice of the social economist is essential.
Very many families are unable to secure enough “protective foods.” Milk, meat, eggs, fresh vegetables, and fruits are relatively expensive. Whole wheat bread and other whole grain cereals are perishable—a factor which adds to the cost of their distribution. The farmer in most cases can keep a cow and have a garden and an orchard; but on some poor lands, this is impossible. The city dweller is always dependent on the market for the variety of foods available to him and the amounts which his dollar will purchase.
Families with incomes below a certain level must have assistance in tangible form if they are to secure the foods which provide an adequate diet. Assistance may take the form of a money dole, or it may involve the direct distribution of food. Experience has shown that money payments, as a rule, are ineffective. Distribution may be accomplished by means of tokens or stamps, good only for the purchase of food and not interchangeable. The Food Stamp Plan of the Surplus Marketing Administration has succeeded amazingly. I was told by a physician in New York that the complexion of the clientele in a large dispensary changed dramatically after the Food Stamp Plan was introduced in that community. Before its adoption, almost every patient was overweight or underweight. (And I may say that overweiht is as common a symptom of malnutrition as is underweight.) Many of the patients also presented other signs of malnutrition. After the adoption of the stamp plan, the appearance of more than half the patients decidedly improved. One of the women declared, “Doctor, I’m beginning to live again!”
Another way of supplementing the diets of low income families is to distribute food in kind. This can be done by some arrangement for communal feeding. The school lunch program, so long in operation in this country, has proved its value. Sir John Orr, director of the Rowell Research Institute in Aberdeen and director of the Bureau of Animal Nutrition, recently wrote from England that when the schoolday diets of malnourished children were supplemented with milk and other protective foods, their ability to learn markedly improved. In a private school in Connecticut, where malnutrition had not been conspicuous before, the average grades rose 10 percent when special attention was given to the nutritional adequacy of the food served.
Similar methods of improving the nutrition of industrial workers have produced encouraging results in Britain, according to Orr. The introduction of supplementary meals in factories has been followed by an increase in production and a marked reduction of accidents.
A method of attack of special value is to improve the nutritional qualities of certain staples, which, because they are inexpensive, form an unduly large proportion of the diets of families with small incomes. It is almost impossible, even for experts, to plan nutritionally good diets costing less than 20 cents a day when the sugar, flour, rice, and edible fats have had most of the minerals and vitamins removed by methods of refining. In some foods, all of these valuable elements have been lost.
It is here that the several food industries must mobilize. Happily and to the eternal credit of the milling and bread industries they now have improved their products in accordance with the recommendations of the National Research Council’s Committee on Food and Nutrition. What has been done may not represent the ideal solution of the flour-bread problem, but neither in my opinion does any other course available today. Brown bread has never been acceptable to more than a very small number of the population and for many persons the irritative action on the bowel of the bran contained in undermilled flours is undesirable. The miller, in time, will be able to present us with a white flour, so made that it retains most of the vitamins and mineral values of wheat. But, until he learns how to make such a flour—and that will take time—addition to plain white flour of those nutrients which the National Research Council’s Committee on Food and Nutrition has prescribed for flour and breads labelled “enriched,” will do much to facilitate the planning of good diets.
Many uninformed persons have blamed the food industrialist for our diet problems. The criticisms in large part have been unintelligent, misleading, and grossly unfair. Modern methods of processing were developed before there was knowledge of vitamins and the methods contributed importantly to improving the sanitary quality of foods. The methods also have provided products with better cooking qualities. In some processing methods, the vitamins are better preserved; in others, they are lost—together with other nutritive essentials. Before altering accepted procedure, the food processor, like the physician, demanded proof that human diets needed changing. Only recently has the evidence convinced him.
Nutritionists have been aware of a shortage in diets of vitamin A, calcium, and iron. The natural food sources for these are green, leafy vegetables, milk and butter. Many people obtain too few of these. Unable to purchase butter, they use in place of butter, either vegetable or animal fats which carry no vitamin A and may be lacking in other nutritional values. Something must be done to improve the nutritive qualities of the vegetable and animal fats, as now distributed. A problem the food industry must face is the need for larger distribution of milk than now obtains. The nutritional inadequacies of sugar create difficulties. Many diets are inadequate in protein. A wider distribution of lean meats and of leguminous proteins such as are contained in the peanut or the soybean would be advantageous.
Fortunately, an army of women, trained in schools of home economics, is already in the field. They have been there for several years, holding the front, so to speak, with almost no support and very little appreciation from the rest of us. The job of feeding the family is not woman’s work alone, as men so often have supposed. Responsibility for the health of the family is as much that of the husband as the wife. The county agent, the Farm Security agent, and others in the Agricultural Service have left too much to the home demonstration people.
One division of the nutrition army already in the field is composed of dietitians. They are invaluable assistants to physicians. We frequently are unable to devote the necessary time to teaching patients how to put in practice what we prescribe. Dietitians receive excellent training. Their numbers need augmenting to permit their wider employment in maternal and child health centers, in community feeding projects, in dispensaries, and as teacher of nutrition in many other situations.
The dental profession has been creditably active in nutrition, sometimes with greater zeal than wisdom. More emphasis on the fundamentals of nutritional physiology is desirable in schools of dentistry, as it is in schools of medicine. Nurses likewise ought to receive more training than they do in the principles of sound dietetics and nutrition.
The machinery for government regulation of foods was devised to prevent the sale of spoiled, adulterated, or misbranded foods. The interest has been more in protecting pocketbooks than health. Also unhappily some food legislation has discriminated in favor of special interest groups with large political influence, to the detriment of the public at large. Here, also, criticism must be tempered with appreciation of the fact that proof of damage done has only lately been presented. Our legislators and public administrators are now hearing about nutrition for the first time, and from now on a change in emphasis may be anticipated—more attention to nutritional needs by administrators, and, by legislators, greater resistance to political pressures that affect unfavorably the nutritional needs of the people.
Last to be named, but foremost in importance, in this army which now is mobilizing on the nutrition front, are the people in research—the pioneers with the courage and what else it takes to scout in advance of the main forces, to locate the enemy and establish outposts. Nutrition, as I said, is a newcomer in the ranks of science and much remains to be learned about it. A new world awaits exploration.
We are mobilizing now for a military emergency, mobilizing on many fronts. The outcome, if war is prolonged, will be determined in large measure by what we do with our foods.
I am confident that the physician, aware of the seriousness of the problems presented by nutrition, will cooperate in the campaign for better nutrition with the same zeal he has exhibited in other public health activity. In the application of nutritional knowledge to the treatment of disease, his leadership must be sought and recognized. The over-all problem of national nutrition is beyond the physician’s immediate sphere of action, but its solution will be the more speedily attained if his sympathetic support becomes an integral part of the program.
The campaign for better nutrition is complicated by cultural, social, psychological, and economic problems. The principal battles of the army of nutrition will be fought in fields of education, economics, and industry. Guidance can be provided by research, but the success of the campaign will depend on the effort of each of the several groups with special trainings.
We must come to recognize as a nation that everyone of us individually carries a responsibility for the welfare of our fellow citizens. May we hold as an ideal that this nation will some day be a buoyantly healthy one.
How to Cite this Article (APA Format): Wilder, R.M. (1941). Mobilize for total nutrition!. Survey Graphic, 30(7), 381. Retrieved [date accessed] from http://socialwelfare.library.vcu.edu/eras/great-depression/mobilize-total-nutrition/
Transcription Source: New Deal Network, http://newdeal.feri.org/survey/sg41381.htm
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