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; 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 weaker correlation with the unsaturated fats. Now here you can see for the United States the numbers of cases a year that appear to be related to diet. We have 40.9 percent of the total incidence for males and about 60.1 percent of the total incidence for females and these are in general the forms of cancer that tends to be dependent on nutrition because of epidemiologic studies that correlate with nutritional factors Stomach, liver, breast, prostate. There are a few other forms of cancer for which evidence is being collected,,but we don't have yet as strong evidence as we have,for these•forms of cance here. Again, I want to emphasize we are not saying that there is a strict close relationship between diet and these particular fo of cancer. The only thing we have are strong clues that dietary factors play a preponderant role in the development of these tumors. If this is true, then it would seem desirable that we try to put some priority on our research and action to see what it is that causes these imbalances and eventually leads to the rms formation of cancers. In other terms, we all hear about excesser ?1;in the deficiencies of nutrients. What we need to define in 11 1?!ithe first place is what'is normal nutrition. What should people i ?3f!eat in the first place? ~ ?;1 In order to define this, we need to develop elements of ?S.evidence that may be valid in a general term at the statistical TIMN 211007

182 I 1 2 levels for the average American,'but we must develop information that can be useful for the individual citizen that presents 3 4 5 6 7 8 13 14 15 16 17 18 19 20 21 22 23 24 Inc. 25 himself to a doctor and wants to have a tailor-made recipe for what it is that he should eat. It should be emphasized that we don't need any new breakthrough in basic research. Nutrition science has developed essentially all the basic knowledge that is necessary to achieve this goal; namely, trying to find out what people should eat. What we.need to do is to engage in detailed and extensive biometric studies that may be able to pinpoint what the individu differences are among the various people that make up our popu- lation, the various conditions that they have. For instance, we are different in terms of body size, sex, age, metabolic conditions, and all this influences our nutritional requirements We are different in terms of behavioral types. Some of us are very active. Some of us are a little slower.. And this would require, of course, a different nutritional input. One element is the environment. Some of us live•in condi- tions that require more'calories, for instance, than others. People that live in Alaska during the winter obviously have different requirements than people that may live in Florida. A1 these elements need to be put together in some coordinated form requiring some massive approach to the study of the population iihich then could be translated into what we have heard yesterday so that we may come up with some useful, practical suggestions " TIMN 211008

183 1 2 3 4 5 6 7 8 9 10 11 12 13 16 ~I is the need of educating our people. Education is important, but it's also important to have . the right things to educate with, the right information,to dis- tribute. Besides trying to define what people should eat, what normal nutrition is, it is very important that we develop methods to assess the nutritional status of individuals. Today these methods by and large exist only and can be operated only in very sophisticated settings of some sophisticated hospital center. Again here, the basic information needed to develop these tests is available. We don't need any major breakthrough. It is important, though; to develop these tests for assessi nutritional status-so,that they can be performed in the field without too much technical difficulties and, therefore, it could ~ 1 14 be applied i; i 15 :! population to the analysis of the nutritional conditions of the in general. obviously has significance not only to the indi- A11 this so 18. wi 11 have .i 1Q ' instance. 17 ;: vidual i ~ that we may better approach his nutritional needs, but significance in terms of defining food policy, for We all say we have heard that people are hungry, but ?o;'we have not defined very well yet what they are hungry for. If 21'we can define the nutritional conditions better, then we may be :2 able to have a more enlightened•and more rational approach to a 23 foad policy that may restore good nutritional conditions in r F }•>these populations. ~4...~... .» ! 251 The third element is that we should know what the nutrition ng 61 TIMN 211009

184 1 2 3 4 5 6 7 9 10 11 12 13 14 • 15 16 17 18 19 20 21 22 23 value of foods is. The Department of Agriculture has been doing and is still doing a valient effort in this area, but they woulI need some additional major support to now develop this informa- tion to a greater•detail. In summary then, we don't want to indicate that the eviden~ we have gives a clear causative link between nutrition and cancer. As•I said before, nutrition is not like smoking. We can all do without cigarettes, but eat we must. The evidence that we have rather indicates that imbalances in our diet, either increases or deficiencies, cause such metabolic distur- bances over a period of many years that eventually they favor the appearance of certain cancers. Therefore, it appears obvious that more research and niore knowledge has to be applied in this direction to find out whether we can reverse this particular chain of events. Many factors may be involved in the causation of cancer. Nutrition is one of them and it appears that if we could modify just this particular factor we may be able to influence by and large the frightful cancer incidence that we experience in this country. This does not mean that we should not do research on other carcinogens that may be present in the diet, like food additive or colorants and other intentional or unintentional carcinogens. 24 ;I i( It simply means that the evidence we have today of the link 25;~ ~1between nutrition and cancer does not point to particular e TIMN 211010

1 2 3 4 5 6 7 8 9 10 11 12 13 carcinogens, but rather to the influence of diet itself. This is the evidence that we have. Therefore, I feel personally that greater emphasis should be put to study those nutritional dietary elements that may be causative off cancer or may be conducive to cancer. Besides the aspects of nutrition in the ethiology of cance4, obviously nutrition is important to the cancer patient. The cancer patient by and large loses his appetite. Food tastes bal to the cancer-patient and this in turn becomes a vicious cycle. He loses weight, becomes nauseous and loses his capacity to cope with his disease or with the•aggressive forms of therapy that are used today -- surgery, chemotherapy, radiotherapy. Therefore, we need and we have initiated research to see whethe we can reverse this process and persuade the cancer patient to ingest more food. As we.said before, the cancer patient loses taste for foodj . .l ~ We can possibly modify his perception so that food tastes good again or we can change the taste of the food itself so that food again can be ingested. We can also try behavioral approac es persuading the patient to ingest more. For patients that cannot inqest food and cannot digest it, like patients with cancer in the head and neck, cancer of the gastrointestinal tract, then i we have other techniques developed like gastric feeding or intravenous feeding,parenteral nutrition as it is known. Again, in this field, we don't need any basic information to be TIMN 211011

1 developed. All the basic information is available. All we need 2 l i d is to conduct extensive clinical trials that prove w l an 3 reinforce what we already know so that these techniques of the 4 elimination of the cancer patient could come- out of the very 5 specialized cancer centers where they are pra cticed today. Ther 6 may be four or five in the country that can d o this and become 7 available to the small hospital any place in the United States, 8 hi h i i ome. ent s n or perhaps even to the ambulatory pat 9 This is a particularly cruel program with children. Childre 10 are finicky by nature even when they are well and when they are 11 sick, particularly with cancer, it is a real problem and a cruel 12 problem and a heartbreaking-problem to try to feed.them properlyl. 13 We are therefore addressing specific and particular attention 14 h h di i ere. c program e pe atr to t 15 In summary then, we have in our program at the Cancer 16iInstitute six major goals. We're trying to assess better what l~;iis the role of nutrition in the causation of cancer and therefor 18.!if we know this, in the prevention of cancer. In order to do 19 this we will have to do some studies that may help define what '~ we should eat in the first place; what is normal for us to eat; 11 •' uhat is desirable, according to our body build, to our behaviora rharacteristics, to our environmental characteristics. We need, ~ `1`to define the nutritive value of foods and to develop methods 6 1 4r..„,,, ylt'"ssess the individual status, individual nutritional status. :t have to study the potential of nutrition in helping the TIMN 211012

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 patient to survive the aggressive therapies we are using today and, lastly, to develop educational methods that could put forward all this knowledge at the different levels at which it has to be used --.for the physician. And we all heard yesterdAy how little physicians today know of nutrition, but this is not surprising. It's not their fault. The physician needs to have something to-go by. Today, by and large, we cannot provide the physician with a body of information that is useful to him in confronting a cancer patient. I don't mean that we have to provide a cookbook here that the physician has to look in, but.at least we should provide him with a textbook from which he can get useful infor- mation that he can apply to the•individual that presents to his office. The same is true for the nurses, the dietitians, the school that may have to impose or foster a nutritional educationton the population at large, on the children, and we believe that the problem cannot be solved -- the educational problem cannot be ~ solved very rapidly. After all, our practices today are the nutritional practice which are the heritage of 2,000 years or more of food tradition. We have a tradition to break and to modify in our families in terms of traditional foods, traditional preparation, traditional tastes. Perhaps we need to modify feeding habits since the beginning. TIMN 211013

We heard yesterday of the problems that the unborn child has if the mother does not have the proper nutrition. There ar other problems in terms of setting feeding habits since the ~ 4 beginning. The way we feed children today with our formulas may not be the right one. After all, we just try to be conveni t 6 or the mother today so that she can feed a big bottl e three or 7 four times a day to this child, and we feel that he' s happy whe ' he's full like a keg and'burps. Perhaps this is not what he should do. Under natural conditions a child is likely to be 10 attached to his mother's breast for a long time and eats rather 11 small amounts of food very'frequently, which perhaps may deter- 12 mine the size of his stom ach and the reflexes to which he's 13 used in order to consider himself satiated. 14 TheiA, of course, all the other problems with children, 15 with teenagers, the problem of advertising, the problems of 16 industry. We have again a tradition that we ha ve to face with 17 industry itself, with agricultural practices. We'have to face 18 the realities. It is cheaper:to grow a pound o f fat than to. 19 raise a pound of meat or protein and it's cheap er to produce 20 starches than it is to produce protein again.. It's cheaper to 211)roduce sugar than it is to produce starch in many instances. 22.. All these economic patterns somehow will clash with some 13nf the suggestions that turn out from the experimental°evidence q1that we have and will have to be faced. This, of course, again 0 A..+.1.rr %.. ! .ri11 require some time, some good will from a variety of people. TIMN 21101

189 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 It cannot be solved overnight. We need to impose on our- selves some long-range goals before all these things can be achi but I believe personally that the proper information developed at the right time presented in the proper way, not necessarily legislative position, could persuade our society to'turn to mor healthy food habits. Thank you very much. Senator McGovern. Thank you, Dr. Gori. All right. If you could just take your place at the table, Dr. Gori, there's one statement in your prepared testimony that I found very striking and I think-it summarizes a major point that needs to be called to the attention of the committee and needs to be underscored in our hearing record. I want to make sure that'I understand the full implications of it. You say at the top of page 3 of your statement that diet is an important factor in the caiusation of various forms f cancer; that it is correlated to more than half of all cancers 18., in women and 19 1 at least one-third of all cancers in men. I think that's an incredible statement. '0 ~ Are you not telling us, in effect, that bad eating habits ,1 is a more important cause of cancers, based on the present JJ evidence, than cigarette smoking? Dr. Gori. For males, they are probably equivalent. For w;f'*'•lies, you're really right, sir. The dietary component in concentration is far more important than anything else. The vec TIMN 211015

190 1 2 3 4 5 6 7 8 9 10 11 12 1 13 ~ 14; ~ fact is'that females smoke less than males. That's the only thing that allows us to make that statement. Senator McGovern. Well, Dr. Gori, before we go on to the next witnesses -- and I want to advise Senator Percy that we have suggested that each witness try to limit himself to ten minutes in their opening statement. I wanted to just make some preliminary observations about what I think we have already learned and then perhaps•you other gentlemen can comment on it, but I have been very impressed in listening to the testimony both yesterday and in reading through the testimony today -- we have seen that eating more is not necessarily eating better. This committee has looked at the problem of hunger in the United States and underconsumption and I think Dr. Lee was right~' yesterday when he 15 i have played 16 ~I that there 17 ;I get enough a are said that our investigations and our hearings central role millions of to eat, but Dr. 18"official in the government, in alerting the nation to the fact Americans who are hungry who don't Cooper, the nation's leading health confirmed yesterday that six out of 19 ten of the leading causes of death in the United States are 20 related to bad eating habits; not necessarily too little to eat; 11yin some cases top much; in other cases the wrong kinds of food. ?? I think it's time for a major initiative in the United :3 States to eliminate bad eating habits and to make this the JS highest possible national priority. I have been impressed in watching'these Olympic games the last few days with the way the TIMN 211016