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A Nutritional Controversy

By Russell J. Down, M.D.

In an article entitled "Diet and the Elderly" which appeared in the March 21, 1985 issue of "Today," Chris Lecos challenges the concept that supplementary nutrition for the elderly is vital. He posits that many older persons are victims of false nutritional claims and believes that vitamins and mineral supplements as well as food products sold in health food stores are costly, do little good, if any, and may even be detrimental to one's health.

He quotes S. Jaime Rozovski, Ph.D., an assistant professor of public health at the Institute of Human Nutrition at Columbia University. In an article written by Rozovski in the April-May issue of "Aging Magazine," he said, "Older persons are a major target for opportunists who pander to people's needs to feel better, cure disease, look younger, and lose weight rapidly. They also play on people's fears by trying to convince them that they are being poisoned by food additives and pollutants, and by claiming that the whole food supply is being downgraded by processing." He suggests that those who may require supplements should first seek sound medical advice.

Concurring with this point of view, the National Institute on Aging, in its publication, "Age Page," believes that "a well-balanced diet will provide most elderly men and women who are in good health in fact, most people of all ages with the nutrients they need for healthy living." However, those who believe they require supplements, should first consult a doctor or a registered dietician.

Interestingly enough, it is a medical doctor who refutes these tenets. On March 26, 1985, Dr. Russell J. Down of Merritt Island, Florida, wrote the following letter to the editor of "Today":

Dear Sir:

This is to give you some of my reactions to your "Diet and the Elderly " article in the March 21 issue, page 14E.

Every movement begins on its own merits and the benefits it makes available to some number of people, is then invaded by entrepreneurs with selfish motives, and if favored by fortune, survives by virtue of good people and other virtues. Always, let the buyer beware; also, don't throw out the baby with the bath!

When I graduated from medical school in 1959, it was a much more benign and healthy physical environment, but one in which means to curb pathological processes had only recently made a dent in infectious diseases such as TB or in problems correctable by now routine surgery, etc. The disparaging attitude toward preventive medicine was summed up by one professor saying, "So you put the chlorine in the water (so what?; go into something interesting)." As for nutrition, during an intense and top of the line four year curriculum, we spent one afternoon touring the hospital kitchen and listening to the old woman who ran it explain to us how to order the diabetic and other special diets; that was it! Go ahead, ask your M.D. about vitamins, minerals, or any of the nuances of recent nutritional research; lots of luck! Your M.D. may excell as Mr. Fixit, or as the equivalent of Mr. Goodwrench for your H. sapiens land rover. But he is also likely to be a bit like a janitor who is so busy mopping up the floor that he never gets around to turning off the faucet. That would be bad enough, but then to compound the problem, when others not so deep in the forest as to be unable to see the trees come along with a more cause-oriented approach to problem solving, what do you suppose happens? Establishment medicine's response to the present situation with regard to the preventive, holistic and nutritional health movements is dominated by its old guard as represented by the AMA and its powerful lobby, media clout and ability to influence legislation, and the knee jerk type first response to the situation is comparable to an attempt, after a KEEP OUT sign proves ineffective, to locking the water closet door, lest someone else come along and turn off the faucet.

I'd like to address a few of the specific comments and word games of the "Diet . ." article.

1. "Popular nutritional cures" vs "sound medical ones" evokes images of two conflicting worlds. I prefer the image of two compatible worlds; "Popular nutritional programs" and "sound medical treatment" (only God cures).
2. "Natural foods have no higher nutritional value than conventional foods; they just cost more," states your article. What is being referred to? "Conventional" as used in that statement probably refers to food currently available to a mass market in supermarkets, much of it grown on spent soil using contrived systems of irrigation and application of petrochemically derived plant nutrients, which is anything but conventional in any historical sense. I recently saw the result of a test in which a given weight of supermarket tomatoes contained less than 30mg of potassium vs. over 1600mg in tomatoes grown naturally. How many other mass marketed foods just look like the vegetables and fruits we have accepted since childhood, while not even coming close to the book values based on analyses of foods done before 'current agricultural practices were begun? Food processing, fast food additives and stretchers, etc., are steps in the same direction and greatly compound the problem. Has your doctor gotten around to reading and being appalled by the content of the fast food industry trade magazines?
3. In the Toledo study of supplement users, 40% were physician-guided, 56% relied on other sources. In my opinion, both groups are at considerable hazard. As a 52 year old doctor having access to nutritional information from all sources including establishment medical channels, most of the considerable valuable and accurate nutritional knowledge I have gained has come from outside circles blessed by establishment medicine.
4. Conspicuous by their absence in your article are any remarks acknowledging the medically indisputable facts that for a significant small percent of the population, certain nutrients may be required in tenfold or more the published MDR amounts, and that as we get older our requirements for many vitamins and other nutrients increase just as our systems become less efficient at absorbing them. All of this is of course on a collision course with declining nutrient value remaining in our soils and in our mass grown, mass-marketed and mass-processed foods produced from the masses and for profit.

In this setting, just how dire do you suppose is the health threat of "people taking high-dose supplements of various vitamins and minerals without a doctor's advice in the hope of prevention or curing a disease or condition?" I've practiced in offices, emergency departments and clinics enough to have had over 75,000 patient encounters, and can count on my fingers the number of times a case seemed to have been negatively influenced by a patient's nutritional supplement program.

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