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EDITORIAL: ETIOLOGY OF N U T R I T I O N A L FADS

WILLIAM
J.

DARBY,

A N D NUTRITION
scientists have,
through scientific study, striven to develop full understanding of the composition
and biological functions of food an d its components since the advent of modern medicine
and s c i e n ~ e . T~ h*e~ early
~
clear demonstrations of curative an d preventive properties for
scurvy of fruits and vegetables during the
16th to 18th centuries, and the studies by
Lavoisier on energy in the 1770s to 1790s
mark the beginnings of the modern scientific
effort.2*8
Prior to and since these beginnings man has
perceived food in many lights, some bright,
others shadowy. James Harvey Young has
identified many of the extensive variety of
food images-and I might add mirages-in a
fascinating essay entitled The Agzle Role of Food:
Some Historical Rejections. l3 These roles include
patriotism, manifestation of ones personality,
medicinal, poison, panacea, status symbols,
expressions of revolt or of political affiliation, etc.
Food, nutrition an d cancer, whether considered from therapeutic or preventive viewpoint, is but another expression of the ageold interest in the medical use of food. Young
writes13:
OOD

MD, PHD*
tient. . . . During the medieval and
Renaissance periods, spices doubled as
food condiments a n d as drugs. One
scholar points o u t that the terms
spices, drugs, a n d aromatics were generic
and interchangeable through all these
years. . . . T h e late sixteenth century
English herbalist, John Gerard, summed
u p the double role: In the first ages of
the world . . . (plants) were the ordinary meate of men, and have continued
ever since of necessary use both for
meates to maintaine life, and for medicine to recover health.

In ancient Egypt a n d in all subsequent cultures, multiple medicinal uses have been assigned to every class of foodstuff^.^ Only a few
of these traditional myths have proved to have
a biological base a n d , where so, the bioactivity
has been demonstrable in curative medicine.
Mans imaginative ability and his wish for
fulfillment in relation to health combine to
provide a nearly unlimited series of food
myths throughout the ages. Magnus Pyke
has aptly stated:
Food myths a r e by their very nature nonsense because the hypotheses upon which
they are constructed are, unlike scientific
From the
times man has emhypotheses, not subject to verification on
ployed the same botanicals as both food
the hard touchstone of observation and
experiment,
and drugs. This was certainly true at both
myths and
ends of the Fertile Crescent, in ancient
scientific hypotheses, although they are
Egypt a nd in Mesopotamia. The borderderived from different kinds of intellectual processes, both embody popular
line between dietetic and pharniacological treatment, Henry Sigerist wrote,
ideas concerning natural phenomena.
sharp. * . . In the
was by no
And the conception of such ideas,
Western tradition, this fusion became
whether they are mythical or scientific,
strong because Of the key
a re acts of the imagination a n d intuition.
given by the Hippocratic corpus to diet in
the physicians effort to help his pa- H e further discusses myths as wish fulfillment:
Presented at the American Cancer Society and NaA doctor faced with a sick patient has at
tional Cancer Institute National Conference o n Nutrihis disposal some measure of scientific
tion in Cancer, June 29-July 1, 1978, Seattle, Washingunderstanding
by means of which he can
ion.
From the Nutrition Foundation, New York, New York
expect to bring about certain cures by the
and Washington, D. C.
rational application of established prin* President.
ciples. At the same time his knowledge
Address for reprints: William J . Darby, MD, PhD, T h e
and powers a re limited, yet he is faced
Nutrition Foundation, Inc., 489 Fifth Ave., New York,
NY 10017.
. . . with a sick patient. . . . H e is.
Accepted for publication September 18, 1978.
therefore, compelled to reinforce scien0008-543W79/0500/2 121 $0.70 0 American Cancer Society

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CANCER
, V qSupp1omu)it 1979

tific facts with such intuition as h e can


command. Naturally, he hopes that his efforts will be successful. H e may sotnetimes hope so strongly that his judgment
is clouded and h e comes to believe that
what he wishes to be so, is so. Under these
circumstances myths may be originating. . . .
Pyke then cites phlebotomy, castor oil,
purging, and unless therapeutic diets as examples. We can add laetrile, krebiozen, and B,5.
Since myths may grow from ideas about
natural phenomena, it is not surprising
that they develop from the ideas o f
people, such as doctors, whose business
it is particularly to deal with the intricacies of nature. Nor does the understanding of science in o n e area of nature appear to act as a deterrent to the development of myths in some other area. O n
the contrary, scientific observations themselves appear to have served as a fertile
stimulus to the generation of iatrogenic
myths. . . .
T h e annals of food faddism a n d myths are
filled with creations of individuals with professional or scientific training and who often a r e
of recognized scholarly attainment in other
fields yet have not been deterred from generation of such iatrogenic myths in nutrition.
Societies express themselves symbolically in
their customs and traditions. This symbolic
collective system is comprised of the elements
of its composite individuals. Individual food
faddism-the individuals food behavior or
beliefs stemming f r o m food myths-has its
origin . . . in acute or chronic psychological a b e r r a t i ~ n a n~d is relevant mainly to
the field of individual psychology, although
society may provide the tension or conflict a n d
the frame in which the deviant behavior is
developed.
De Garine5 describes the deviation of social
food faddistn as coming about
. . . through acceptance by a g r o u p of
stereotyped dietary practices designed to
improve health or cure diseases. I t may be
cultural or simulated for profit. In this
case food cultisms appear as a n efficient
effort to integrate into a social g r o u p
(whether a limited association or the
general public). T h e origin of the process
can be compared to the origin of clubs,
young mens associations, initiation
groups, etc. . . . in many traditional

Vol. 43

societies. We could . . . ask if, besides


his craving for profit, the food quack is
not in some cases half-convinced of the
truth of his arguments. H e might even
pretend of having been cures or saved
by applying what he recommends. This
situation is very similar to what has been
observed among initiators of messianic
movements, the magicians and shamans
i n primitive societies.
Food cults in o u r societies would then try
to satisfy t w o cravings-first answering a
need for social integration . . . ; secondly, falling back to a type of thinking
parallel to rational and scientific thinking.
This latter is a return to nonconceptual
mystical thinking or imagination in the fields
ot art a n d religion and implies believing
rather than understanding.
Bruch has vividly documented examples
of individual food faddism by reference to
John Gunthers book, Dmth Br Not Proud, the
true stor)of his 16-year old sons fight against
brain cancer.
This intelligent, sophisticated, a n d wellinformed family used the best neurologists a n d brain surgeons in a renowned
medical center and, at the same time,
turned to whatever hearsay remedy
seemed available, including health foods,
vegetable juices, freshly squeezed juice,
o r calves liver, a n d so on. Though there
were intervals of seeming improvement,
the family had been told that there was n o
hope, a n d thus they felt compelled to try
ecerything. I n their desperate efforts to
save the boy, they felt they could not leave
any stone unturned, any possibility untried.
She further cites:
Fictional examples found in the novel,
C m u r Ward by Solzhenitsyn, of how

potentially everybody-regardless
of
education, intelligence a n d background
-when desperate a n d confronted with
the danger of death, may come to believe
in or hope for miracle drugs a n d secret
formulas, or special herbs and foods. I t
offers a moving portrayal of a g r o u p of
men of the greatest diversity of background, each a n individual in his own
distinct way, who face the terror of decay,
suffering, a n d death in utter loneliness,
though living and sleeping side by side in
the same ward.

No. 5

NUTRITIONAL
FADS

Yet this atmosphere of isolation is suddenly changed as described in Chapter


eleven, headed Cancer of the Birch
Tree. Kostoglotov, a frustrated intellectual who has survived labor camps a n d
exile, and who, when attacked by a
rapidly growing tumor, had dragged
himself to the cancer hospital, shares with
his fellow patients a letter he has received
from a n oldtime physician. H e had heard
rumors that this doctor knew about a fungus, o r cancer, of the birch tree with
extraordinary healing qualities and had
written to him. In this physicians observation, peasants, who brew a n infusion
of this outgrowth in place of tea, a r e conspicuously free of cancer. Kostoglotov is
touched by this doctors selflessness; to
him, this healer is a great humanitarian
who has given of his precious time by
writing a letter in answer to his humble
postcard. All these patients who had
struggled to come to this special hospital
as a last resort are united in a deeprooted mistrust of doctors who, after all,
d o not know everything, and they share
the feeling that overwillingness to agree
with the arguments of science is just
another idol of the market place, a voluntary acceptance of other peoples errors.
Whatever medication he receives, a n d
whether he is responding well o r not,
each one in the ward has had the experience that, in the face of disaster, the
hardest thing of all is to remain passive, to
just wait for death to come. Hope of doing
something, of proving oneself a man, the
master of his fate, sustains each and
everyone in his determination to start on
a private search for this magical fungus.
Most complex is the motivation of Kostoglotov, who had literally forced his way
into the cancer hospital. His life experiences had been such that he has come
to mistrust existing authorities and would
turn to anything not officially approved.
H e had smuggled a poisonous root, supposedly a panacea, into the hospital, and
this is a matter of pride to him. H e feels
there is something noble about treating
ones self with strong poison. H e knows
that he owes his survival to his resourcefulness; the hormone therapy, which his
physicians have planned for him, is unacceptable because he considers it a threat
to his initiative a n d virility.
T h e behavior of these men also illustrates

Darby

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how a patient will turn to most advanced


medical treatment a n d , simultaneously,
desperate a n d hopeless a n d haunted by
fear of pain a n d death, will look for something else, beyond what scientific medicine offers. . . .
T h e fatally ill are not the only people who
seek help from the mysterious remedies
of folk medicine and from so-called
health foods. T h e great tnajority are not
physically ill at all but are anxious about
the uncertainties and threats of living and
become concerned about their bodies and
health. . . . T h e more chronic a condition, the more susceptible a sufferer to
the false promises of cure.
Millions who make the fad diet quacks rich
and the health food store the tnost profitable
of food businesses are those not physically
ill-but anxious and misled by false hopes of
better health, of freedom from cancer, heart
disease, etc., ifonly they follow a given dietary
fad or take great quantities o f x elixir o r megavitamin preparation.
Bruch also underscores that:
T h e r e is another aspect to the preoccupation with health food. In many ways, the
scientific teaching of nutritionists has
paved the way for faddist exploitation.
For the teaching of better nutrition, it
was necessary t o publicize the close association of good nutrition with health, and
of poor nutrition with ill health and
definite diseases. A t times, premature
conclusions from scientific data have led
to unwholesome results, such as deficiency diseases from overpurified products, leading to the discovery of the
importance of vitamins. Although these
errors have been corrected, the notion
lingers on that there is something wrong
with purified food, that the naturalness
has gone out of it. T h e whole industry of
health foods is based on the fear that
something valuable has been removed
from the food sold in the ordinary
grocery store.
Nutrition teaching has not always avoided
preying o n fear a n d anxiety in order to
promote good food habits. T h e attack on
obesity proceeds frequently by threatening overweight people with the dire
consequences of staying fat. T h e number
of diets prescribed by physicians and
nutritionists is legion, but their longrange effectiveness is rather limited.

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CANCER
May Supplement 1979

Vol. 43

Harper then quotes Ruth Gay, from her


Does this not remind the reader of laetrile
and other noncures? It is the age-old legend of article in the American Scholar' as follows:
the ~ n i c o r n . ~
Although w e learned long ago to abanIf the effectiveness of these is limited for
don magical thinking in connection with
obesity, a condition for which we know the
weather, crops, the care of animals a n d
pathogenesis-if not always the effective way
other natural phenomena, it still has us in
to motivate the patient-how certain can one
its grip when w e think of o u r diet. Our
be relative to advice concerning less well
latest thinking about food, based o n fear,
understood complex diseases? This question
is proportionately retrograde-willing to
has been sharply raised by Harper' in a peraccept, indeed seeking out, the consolaspective on nutrition: Dietary Goals-A Skeptions of magic, the mute practices of
tical View. 1 d o not have time to review his
peasants, a n d the quaint devises of folkarguments in detail, but his concluding paralore.
graphs state in part':
T h e scientific community seriously concerned
with the objective identification of the
T h e rationale for the proposed dietary
goals for the treatment of chronic dis- roles of food and nutrition as possible risk
eases bears a striking resemblance to that factors in chronic diseases must not promote
of the nutrition healers who recommend dietary change as a n oversimplistic solution of
large doses of vitamins to prevent colds, these complex diseases. Promising more than
scientifically sound nutritional guidance can
influenza a nd cancer and large doses of
deliver eventually will further undermine the
vitamin E to ensure sexual potency and
credibility of science, medicine, governmental
freedom from heart disease an d aging.
agencies, Congress, and industry. It can but
T h e nutritional healers and the pro- drive more customers to the perveyors of fadponents of the dietary goals both say dism and into the food cults. It well may cause
there are no risks involved an d important further retrenchment in support for much
benefits can be expected. This is also the needed research, so essential to ultimate solustock in trade of food faddists and nutri- tion of our health problems.
tional supplement companies. Neither
May each objective scientist, then, critically
consumers nor nutrition professionals a n d conservatively examine the soundness of
stand to gain from this approach to health whatever data base he employs in arriving at
problems. I t has great potential for dietary advice or positions concerning food,
undermining both the science of nutri- nutrition a n d cancer. Failure to d o so well may
tion and nutrition education. It raises place him a n d his advice in the category of the
false hopes among consumers on inade- advocate of faddism and quackery promising
quate grounds. It is a promise to deliver a the anxious o r suffering a n unobtainable
relief.
panacea that cannot be delivered.
REFERENCES

9. Olson, R. E.: Clinical nutrition: An interface between human ecology and internal medicine (W. 0.Atwater Memorial Lecture). Nufr. Reu. 36:161 - 178, 1978.
10: Pyke. M.: T h e development of food myths.In Food
Cultism and Nutrition Quackery. G. Blix, Ed., Symposium of the Swedish Nutrition Foundation VIII.
Uppsala, Almqvist 8c Wicksell, 1970;pp. 22-29.
11. Stewart, C. P., and Guthrie, D.: Lind's Treatise on
Scurvy:
A Bicentennial Volume Containing a Reprint
1976.
of the First Edition of a Treatise of the Scurvy by James
5. deGarine. I.: T h e socio-cultural background of food Lind, M.D., With Additional Notes. University Press,
habits in developing countries (traditional societies). I n
Edinburgh, 1953;pp. 440.
Blix, loc. c i f . , pp. 34-46.
12. Todhunter, E. N.: Chronology of some events in
6. Gay, R.: Fear of fond. Amm'can Scholar 45:437, the development and application of the science of
1976.
nutrition. Nulr. Rm. 34:353-365. 1976.
7. Harper, A. E.: Dietary goals-A skeptical view.
13. Young, J. H.: T h e agile role of food: Some historical
A m . j . Clin. Nufr. 31:310-321. 1978.
reflections. In Nutrition and Drug Interrelations, J.
8. Lusk, G.: Nutrition. Cleio Medica Series, Paul h. Hathcock, and J. Coon, Eds. New York, Academic Press,
Hoeber, Inc.. New York, 1933.
1978;pp. 1-18.
1. Bruch, H.: T h e allure of food cults and nutrition
quackery. Nutr. Rev. 32(Suppl. 1):62-66,1974.
2. Darby, W. J.: Nutrition science: An overview of
American genius. Nu&. Rev. 34:l-14, 1976.
3. Darby, ~ . ' J . T
: h e unicorn and other lessons from
history. Nu&. Rev. 32(Suppl. 1):57-61, 1974.
4. Darby. W. J., Ghalioungui, P.. and Crivetti, L.:
Food: T h e Gift of Osiris. Academic Press Inc., London.