Guidelines for a prudent diet

Despite the disappointing results of the intervention trials with P-carotene discussed in section 7.2.6, epidemiological studies of the type discussed in section 7.2 do provide useful information on dietary factors that may be important in the development of the diseases of affluence. Diet is not the sole cause, as these diseases are all due to interactions of multiple factors, including heredity, a variety of environmental factors, smoking and exercise (or the lack of it). Nonetheless, diet is a factor that is readily amenable to change. Individuals can take decisions about diet, smoking and exercise, whereas they can do little about the stresses of city life, environmental pollution or the other problems of industrial society, and nothing, of course, to change their genetic make-up, which determines the extent to which they are at risk from various environmental and nutritional factors.

The epidemiological evidence linking dietary factors with the diseases of affluence shows that in countries or regions with, for example, a high intake of saturated fat there is a higher incidence of cardiovascular disease and some forms of cancer than in regions with a lower intake of fat. It does not show that people who have been living on a high-fat diet will necessarily benefit from a relatively abrupt change to a low-fat diet. Indeed, the results of a number of intervention studies, in which large numbers of people have been persuaded to change their diets, have been disappointing. Overall, premature death from cardiovascular disease is reduced, but the total death rate remains unchanged, with an increase in suicide, accidents and violent death.

Nevertheless, the epidemiological data are irrefutable, and there is general agreement among nutritionists and medical scientists about changes in the average Western diet that would be expected to reduce the prevalence of the diseases of affluence. Changing diets in the way suggested below is not a guarantee of immortality, and indeed some of the evidence is conflicting. As new data are gathered, old data reinterpreted and the results of long-term studies become available, it is inevitable that opinions as to what constitutes a prudent or desirable diet will change.

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