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i i • Ernest L Q ynder, M.D.: All of us who have been ill know that there can be no improvement in the quality of life until we are healthy. But from the motivation point of view, it is very difficult to get people to think in terms of health until they are ill, and then it is often too late So today we are being practical. ke are putting the emphasis on the economic problems associated with tllness. It isn't just that health care costs have gone up higher than anything else, but that we are also dealing with chronic illnesses that we cannot effectively treat. All of a sudden, consequently, preventive medicine has become very respectable. President Nixon even men- tioned it in his State of the Union Address, which was very pleasing to our ears. So I think we are entering a new era, one where preven- tive medicine is getting a renewal on life, and one where we have to take a stand on major public health issues - even before every member of the scientific community is in complete agreement about what should be done. For having served on many government task forces, I can assure you that you couldn't get 100% agreement on whether motherhood is a good thing. Guidance from and for Industry: In some respects, we are looking at health as you look at a product. I am frequently impressed with how industry develops its products, does_marketing research, communicates their advantages, and finally puts them on the market. This is exactly what we intend to do, once our Board of Scientific Consultants has approved the total report- of this committee. That means, of course, we will try to educate the Amer- ican people in what we believe the facts are. If we can get the American housewife oriented to what she ought to buy for the family, and she in turn puts pressure on manufacturers to produce certain foods, then we will have one very powerful way of affecting the kind of foods that are produced and marketed. There are many other considerations, but certainly economic incentive is the motivating force most needed if we are to con- vince manufacturers to change their products. Relevant Qutstions (cont.) nary heart disease. Such determinants include food pref- erences; eating patterns, smoking habits, physical ac- tivity, and how he interprets and reacts to anxiety- inducing situations. Our focus in the present review is on diet-an environmental factor clearly affecting serum lipid patterns and one over which the individual has considerable control. - t; Clearly, the American diet has been and is sti11 chang- ing. There is every reason to-believe that changes will continue and thai< with guidelines established by appro- priate expert groups, individuals can make nutritionally desirable modifications in their diets The food industry can provide products to facilitate these changes. Question: What aspects of contemporary American life are identified as determinants fauoring atherosclerosis and coronary heart disease? The past thirty years have yielded abundant data implicating genetic. hormonal, and dietary factors as deter minants of abnormal serum lipid patterns. Genetic factors have also been identified. Hormonal influence is evidenced by the serum cholesterol-lowering effects of certain hormones and the frequent association of hyperlipidemia and abnormal lipid metabolism with diabetes. While present knowledge is incomplete regarding serum lipid levels of children, there is little doubt that, in the United States, there is a relatively rapid rise in serum cholesterol. Environmentally-induced hyperlipidemia is no longer a remote concept. Studies emanating from the laboratories of nutritionists and from dinical meta- bolic wards indicate that such nutritional factors as calorie increases resulting in weight gain and increased consumption of saturated lipids and cholesterol are the most significant factors in the commonest type of hyper- cholesterolemia lType II Non-Familiall. The amount and type of simple sugars and alcohol are also factors in elevating serum triglyceride levels in certain types of hyperlipidemia lTypes 1, IV, and V). Sodium salts in the diet-may also influence the develop- ment of hypertension. Thus several critical dietary factors may work synergistically to provoke hyperlipid- emia, carbohydrate intolerance, and hypertension -all of significance in the metabolic pathogenesis of coronary heart disease. With respec{ to coronary heart disease, the following major risk factors have been identified: hypercholes- terolemia (elevated serum lipids), hypertension, exces- sive cigarette smoking. These three interact to increase the incidence of a first major coronary event. The major risk factors are confounded by other factors which have significant although less readily measured effects on risk of coronary attack: obesity, diabetes and impaired glucose tolerance, physical inactivity, and psychic stress. .Thus it is apparent that certain characteristics of our present way of life are enhancing the risk of coronary heart disease. 11 I

Chofesterol: It's not all good...It's not all bad /Reprinted/rom-the Spring 1971 issue of "The American Heart"-pu6lished by TheAmerican Heart Assoeiatian and its A jfiliates. ) Many Americans are aware that if they eat foods low in cholesterol they may retard the process of hardening of the arteries and reduce their risk of heart attack and stroke. But few know what cholesterol is and what it `does. Cholesterol is not all bad. In proper amounts, it is involved in a number of functions vital to body health. A fat-like chemical substance, cholestgrol is found in every living animal cell, reaching its highest concentra- tion in the cells of the tentral nervous system. Not all of its roles are clear, but this chemical is known to be essen- tial to the proper architecture of the cell membrane. As such it presumably plays a key role in regulating whet ~ gets in and out of the cell. It is also the forerunner ot li number of other agents including the sex and adrEnal hormones. What makes cholesterol such a potential biological bug- aboo is that an excess amount of it in the blood may in- crease susceptibility to heart attack. There's a lot of evidence that when there is an excess of cholesterol it piles up in the coronary arteries (along with other fatty substances) and can reduce or shut off blood flow to the heart muscle. Result: heart attack. Cholesterol is present in varying amounts in foods of animal origin (eggs, meat, poultry, and dairy products) and in sea food. Egg yolks, fish roe, shellfish (lobster, shrimp, crabs, dams, and oysters) and organ meats (brains, sweetbreads, kidney, and liver) are particularly rich in cholesterol. The body also makes cholesterol and the amount made apparently depends on the kinds of fat we eat. Animal or saturated fats tend to increase cholesterol levels in The American Health Foundation, Inc. 2 East End Avenue New York" N.Y. 10021 the blood. Presumably they spur the liver to manufao ture more of it. Polyunsaturated fats (such as those found in oorn oil, cottonseed oil, soybean oil, and sun- flower oil) tend to decrease cholesterol levels. Knowing that cholesterol--fatty in feel and pearly in color - is neither all good nor all bad, but somewhere in between, should encourage Americans to modify diets so intake of cholesterol is kept within due bounds. Total cholesteroal content of various foods (mQ/100Pm werwe~QnrY Msei. aee/.s.oa.d 116 seef.t:.e. 262 sed. prk.... 11 . e«e....r.d 92 v..l as L.-e u t-bb b.er 118 e- 215 H.m 126 Porl cb:.-1... sa cbKk... b.. aoo T..r.r _ 110 Ff.6 ..d .u Iood CLs, 122 c.d 43 ibunde. 41 H.dderY 13 H.libu. -]e or... 112 s.l eon 65 Sb.imp l3b -h.. )d l Ihiry prod- auuer )e7 CLe..e. Ammc.n 173 C6ee.e- bleu 17. Caee,e..,e.m 140 c6..... s.i.. - )so c...n.. wn - 40 C.e.m. wd, - 140 Mab Ta eep 1962 L.,d 143 •$ouru ihe wietan Insntute o+Anatomr and e,oiogy - Ales 6'e Spcara, Ph.D. P. Lor:::srd Comyany 2525 E::3t 1:arkot St. GraenaCoro, N. Car. 27420 No~ Pio1,i O.g U. S. Pos,ngr PAID New York, N v. Pe,, No 5292