In an early 19th-century best seller, a famous food writer offered a cure for obesity and chronic disease: a low-carbohydrate diet.
DIET DOUBTS Many food manufacturers use perceived health benefits to sell products. A new study calls into question how much benefit people can gain with diet.
STUDY LEADER Dr. Jacques Rossouw, in his office. His response to critics: "What we achieved is probably what was achievable."
The notion that what you eat shapes your medical fate has exerted a strong pull throughout history. And its appeal continues to this day, medical historians and researchers say.
"It's one of the great principles — no, more than principles, canons — of American culture to suggest that what you eat affects your health," says James Morone, a professor of political science at Brown University.
"It's this idea that you control your own destiny and that it's never too late to reinvent yourself," he said. "Vice gets punished and virtue gets rewarded. If you eat or drink or inhale the wrong things you get sick. If not, you get healthy."
That very American canon, he and others say, may in part explain the criticism and disbelief that last week greeted a report that a low-fat diet might not prevent breast cancer, colon cancer or heart disease, after all.
The report, from a huge federal study called the Women's Health Initiative, raises important questions about how much even the most highly motivated people can change their eating habits and whether the relatively small changes that they can make really have a substantial effect on health.
The study, of nearly 49,000 women who were randomly assigned to follow a low-fat diet or not, found that the diet did not make a significant difference in development of the two cancers or heart disease. But there were limitations to the findings: the women assigned to the low-fat diet, despite extensive and expensive counseling, never reached their goal of eating 20 percent fat in the first year —only 31 percent of them got their dietary fat that low. And the study did not examine the effects of different types of fat — a fact that critics say is a weakness at a time when doctors are advising heart patients to reduce saturated fat in the diet, not overall fats.
The researchers also found a slight suggestion that low fat might make a difference in breast cancer but the results were not statistically significant, meaning they may have occurred by chance.
Still the study's results frustrate our primal urge to control our destinies by controlling what we put in our mouths. And when it comes to this urge, it is remarkable how history repeats itself. Over and over again, medical experts and self-styled medical experts have insisted that one diet or another can prevent disease, cure chronic illness and ensure health and longevity. And woe unto those who ignore such dietary precepts.
For example, Jean Anthelme Brillat-Savarin, the French 19th-century food writer, insisted that the secret to good health was to avoid carbohydrates. Brillat-Savarin, a lawyer, also knew the response his advice would provoke.
" 'Oh Heavens!' all you readers of both sexes will cry out, 'oh Heavens above!" he wrote in his 1825 book, "The Physiology of Taste." "But what a wretch the Professor is! Here in a single word he forbids us everything we must love, those little white rolls from Limet, and Achard's cakes and those cookies, and a hundred things made with flour and butter, with flour and sugar, with flour and sugar and eggs!"
Brillat-Savarin continued, "He doesn't even leave us potatoes or macaroni! Who would have thought this of a lover of good food who seemed so pleasant?
" 'What's this I hear?' I exclaim, putting on my severest face, which I do perhaps once a year. 'Very well then; eat! Get fat! Become ugly and thick, and asthmatic, finally die in your own melted grease."
The Frenchman's recipe for good health was only one of many to come. A decade later, the Rev. Sylvester Graham exhorted Americans to eat simple foods like grains and vegetables and to drink water.
Beef and pork, salt and pepper, spices, tea and coffee, alcohol, he advised, all lead to gluttony. Bread should be unleavened, and made with bran to avoid the problem of yeast, which turns sugar into alcohol, he continued. It is also important, he said, to seek out fresh organic fruits and vegetables, grown in soil without fertilizers.
The reward for living right, Graham promised, would be perfect health.
A few decades later came Horace Fletcher, a wealthy American businessman who invented his diet in 1889. He was 40 and in despair: he was fat, his health was failing, he was always tired and he had indigestion. He felt, he said, like "a thing fit but to be thrown on the scrap-heap."
