Dr. Attwood's Low-Fat Prescription for Kids
Book Review and Summary by Leigh Langlais
Dr. Attwood is a practising pediatrician in Louisiana who has been observing and studying the development of arteriosclerosis for over thirty years. This clogging of the arteries - leading to heart disease, stroke and cancer - is the most common cause of death in the U.S., and it begins as early as the age of three. The main cause of arteriosclerosis is the increasing amount of fat in the American diet - particularly saturated animal fat.
In the 1980's Americans became more aware of the dangers of cholesterol and saturated fat and made some effort to reduce these in their diets. Unfortunately, even among adults who have reduced their fat intake moderately - coronary heart disease is the number-one cause of death. The National Cancer Institute estimates that 35% of all cancers are linked to food - some researchers estimate up to 70% are food-related. Lifetime eating habits are usually established by the age of 8. Around the world, children whose diets are high in fat record a high rate of heart disease and cancer in adulthood. Among cancers, breast and prostate cancer may be the most likely to stem from children's eating habits. The highest rates of prostrate cancer is found in elderly men in the U.S. and England, who have typically been meat-eaters since childhood. Seventh-Day Adventists raised as vegetarians have lower rates of cancer during their later years than those who become vegetarians later in life. Breast cancer is less common among women who ate little or no meat during childhood. There is very little breast cancer among Asians - except those who grew up in Western countries. Even adult Asian women who emigrate and adopt a Western diet maintain low statistics of breast cancer. Other studies suggest the link is that a high fat diet during puberty later increases chances of breast cancer.
A solution: consuming a diet in which fat constitutes only 10 - 15% of calories, starting in childhood, practically eliminates the risk of coronary -artery disease, (except for those with rare genetic disorders) strokes, hypertension, diabetes and many cancers. In 1988, the first National Cholesterol Conference decided on recommending diets with up to 30% of calories from fat (10% from saturated fat) , not because this was scientifically sound, but because they thought this is what the public would accept. They felt lower recommendations would be rejected by the public. Originally this was recommended for adults, and then in 1992 the same was recommended for children over two. Dr. Attwood found this unacceptable and conducted his own research, which resulted in a seminar teaching a slow reduction of a child's fat intake. After the age of two, saturated fat and cholesterol are not essential nutrients. One out of two children born today will develop heart disease; one out of three will get cancer.
Diseases of poverty: Malnutrition, infectious diseases, gastroenteritis. Diseases of nutritional extravagance: Coronary heart disease, cancer, stroke, hypertension, adult-diabetes, obesity. |
Dr. Castelli (director of the Framingham Study) states, "Of the 5.3 billion people of the world, 4 billion virtually never have arteriosclerosis or colon cancer. These 4 billion people have one thing in common: they eat a low or no-meat diet that's also very low in saturated fat, about 12 to 15 grams of fat a day, as opposed to the 40 or 50 grams that are eaten daily in the U.S.. Studies of other cultures also show:
Countries where children have a diet high in monounsaturated fat (eg olive oil) rather than saturates have almost no coronary disease as adults. In China, people generally eat 30% more calories than Americans but have no obesity. Japan has the longest lifespan of any nation. |
Dr. Attwood exposes and explains many current myths about children's diets and habits.
Myth I: Controlling cholesterol can wait
The American Heart Association estimates that 36% of children have high blood-cholesterol levels. In every nation where children have high cholesterol levels (Finland, North Ireland, Scotland, England, USA), there is a high death rate from coronary heart disease among adults. In countries where cholesterol level is low in children, so to is the risk of death from heart disease as adults. Prevention of diet - related disease (mainly education) would cost only 5% of what is now spent on treatment of these disorders. Prevention starts with children - checking blood-cholesterol levels and lowering intake of saturated fat and cholesterol. Each percent decrease in calories from saturated fat in the diet produces a decrease in the blood-cholesterol of about 3 mg/dl. Since 1970, bypass surgery has gone up 2800%.
Myth II: Controlling obesity can wait
There is a direct relationship between number of hours watching t.v. and the prevalence of obesity. Not only inactivity; children are exposed to t.v. advertising - 41% of which on Saturday morning are high fat commercials. It is also unfortunate that chubby children are considered healthier. Overweight children are more likely to become overweight adults with increased risk of heart disease. Also, overweight adults are more likely to raise overweight children. Twenty-five percent of all children were overweight in 1993. The rate of obesity among all Americans has risen by nearly one-third in the past decade. Since 1900, consumption of wheat, fresh vegetables, and corn is down by 41, 23, 84%. Beef consumption increased by 44%, fat and oil by 49%, poultry by 344%, and cheese by 440%.
Myth III: The fat-taste is natural and inborn
There are no specific fat taste buds - it is perceived by a combination of taste buds, smell and texture. A liking of fat is established by repeated exposure and association with pleasant experiences, rewards and social events. Dr. Attwood concludes that even occasional fat consumption maintains the desire for fat. So lowering animal fat intake can increase the craving for it, but after just a few weeks of no animal fats - a child will develop a preference for vegetables, fruit, grains, and legumes.
Myth IV: Small reductions in fat will do
Small reductions in fat consumption do not significantly reduce the risk of coronary heart disease. In 1993, only 29.3% of meals prepared at home included vegetables, not counting potatoes. Switching from red meat to poultry and fish does not significantly reduce cholesterol levels in people. Fat must be reduced to 10 - 15% of calories to reduce cholesterol levels significantly. Timid doctors and government agencies admit they are afraid people won't make any change if they recommend too drastic a fat reduction. Many leading heart disease experts in the U. S. have urged government groups to lower the recommended level of fat intake. Dr. Attwood suggests fat should be taxed. Total dollar costs and deaths from excess dietary fat far exceeds costs and deaths from all forms of substance abuse, including tobacco, alcohol and illegal drugs combined.
Myth V: Children's diets are getting better
In 1984, a lot of Americans were trying to eat less fat. The typical American teenager's diet now practically mirrors that offered by fast food restaurants - up to 60% of calories from fat. In the late 1980's a few reports were misunderstood by the media - they suggested fat and cholesterol were not so bad after all. Fat consumption went back up immediately. In 1992-93, sales of eggs, cheese and dairy, and bacon were all up; some to record-breaking levels. Fast food restaurants introduced new items containing more fat than ever before.
Myth VI: Meat is needed for protein and iron
Children and adults in America obtain two-thirds of their protein from animal sources. Studies have shown that changing animal protein to plant protein but maintaining fat intake reduces blood-cholesterol levels. Animal protein has a definite cholesterol - raising effect. High levels of iron in the diet (from animal meat) have also been shown to contribute to coronary-artery disease. Children and adults in the U.S. consume almost double the Recommended Daily Allowance of protein. Dr. Attwood then lists vegetables that derive up to half of their calories from protein.
Myth VII: Milk is needed for calcium and protein
Cow's milk protein is one of the main causes of severe allergy, such as asthma and eczema. Also, allergy to milk protein in susceptible individuals may be one of the causes of Type I diabetes in children. Countries with the highest rates of osteoporosis consume the most milk. Excessive protein in a child's diet increases calcium excretion by the kidneys and therefore encourages poor bone density. In closing this chapter, Dr. Attwood lists sources of calcium as a percentage of calories and thus demonstrates that milk is not the best source of calcium. He again stresses the availability of protein from vegetables.
Myth VIII: Low-fat diets lack vitamins and minerals
As long as fat taken out of the diet is replaced by fruit, vegetables, and grains - there is no shortage of vitamins and minerals. Vitamin B12 is a concern for many people, but it is rare to find a deficiency in vegetarian children of adults. Dr. Attwood gives details on non-animal sources of all the needed vitamins and suggests a multi-vitamin supplement for children of parents who are still concerned.
Myth IX: Low-fat diet means limited choice
Dr. Attwood suggests parents stress what is available rather than what they "shouldn't" eat. He lists vegetables, fruits, grains, and legumes with charts showing nutritional density comparisons.
Myth X: Low-fat diets retard growth
This myth emerged because of surveys including malnourished children eating low-fat diets. Studies of children raised on strictly vegetarian diets since birth showed essentially the same standard growth patterns as all other American children.
Myth XI: It's obvious which foods are high in fat
Dr. Attwood uses the acronym MEDICS to teach the sources for fat. Meat, Eggs, Dairy, Invisible fats (sweets, nuts, avocado), Condiments, Snacks. He then suggests many low-fat snack alternatives.
Myth XII: No one knows what's really best for my child
There is a lot of conflicting information available. The dairy and beef industries provide educational material, many legitimate, sound scientific studies have been done, but unscientific, misinformed studies are also presented to the public. People must listen carefully to who is doing the study and giving out the information.
Part Two - Practical Approaches
Dr. Attwood gives details of his four-stage approach to lowering children's fat intake to the ideal 10-15% of calories. Each stage takes 3-6 weeks - time to establish the new eating habits. For each stage he recommends alternatives to high-fat foods. He then takes the reader through every aisle of a hypothetical supermarket and discusses the foods that can be bought that contribute to the low-fat diet. He explains why to avoid some foods, what to look for on food labels, which oils are best, and what's better as meat for the first two cutting down stages. He summarizes, and gives; "Six Tips to Combat Health - Hype". He advises parents to read labels carefully and explains many adjectives used on food labels.
The pesticide issue is discussed next. For those people avoiding fruits and vegetables out of concern for pesticides: the World Health Organization and the Food and Agriculture Organization (both agencies of the United Nations) have estimated that pesticides found on fruits and vegetables in the U.S. result in the ingestion of one quarter to one percent of the allowable amounts, even if consumed every day for a lifetime. Also, greater chemical concentrations are found further along the food chain, in milk, red meat, chicken, and turkey; fish contain both PCBs and DDT.
In 1993, 25 million children regularly ate lunch at their school cafeterias. The U.S. Department of Agriculture set guidelines for lunch programs (including that 30% or less of calories should come from fat) but there was no requirement that schools abide by these guidelines. Of 545 schools inspected, 99% offered lunches exceeding guidelines by 25%. Sodium recommendations were exceeded by 100%. Also, the amounts of carbohydrates and fruit and vegetables were below guideline percentages. Until 1994, schools were required by federal mandate to offer whole milk; the availability of low-fat and skim milk was lift to the discretion of individual schools. The Western Dairyfarmers' Association plans to extend nationally a program to increase children's consumption of whole milk by making available and even higher-fat root-beer flavor. Until 1995 the only school lunch requirement that had to be followed were those making available high-fat foods such as meat and dairy. The government buys surplus meat, poultry, butter and cheese for distribution to schools, and pays a fixed higher price for the highest-fat products.
There are school-lunch reform success programs. Increasing the number of low-fat foods available in school cafeterias, and changing ingredients in popular dishes to low-fat alternatives has had success.
Minnesota has the LUNCHPOWER! Intervention Program; a 5 month session that involved registered dietitians, food-service directors and cook managers and the students. Heart Smart in New Orleans has a similar program, and in Arizona, the Heart Healthy Lessons for Children. New legislation and the Senate bill Better Nutrition and Health for Children Act of 1994 are helping to change lunches in all schools for the better.
The next three chapters discuss studies, expert opinions and other cultures to give proof of the benefits of a low-fat diet, beginning in childhood. The Bogalusa Heart Study was started in 1973 and followed the effects of diet and exercise in 14000 children. The study has shown that elevated cholesterol and LDL levels could be found in children as young as 6 months of age, and those with high levels usually maintain them. This study has been covered in 400 articles and 3 textbooks, but is not well known by pediatricians or family physicians. Other independent and university studies also show the early - childhood beginnings of coronary heart disease. John Hopkins researchers followed over a thousand young men for 42 years; beginning at an average age of 20. Those with the highest cholesterol at age 20 were three times as likely to have heart attacks and nine times as likely to die of them. The report concluded that having high cholesterol at age 20 was one of the strongest predictors of later heart disease, even better than family history. Dr. Attwood published his position in 1992, in favor of universal cholesterol testing for adults and children. Now the guidelines suggest that the only children that need testing are those whose parents or grandparents have or have had heart disease or high cholesterol. Many studies have shown that lowering the amount of fat in the diet lowers blood cholesterol in children very quickly.
In Asia, fat intake and coronary heart disease have traditionally been low, but changes to diets in urban centers has changed both. Western food, especially fast-food outlets now proliferate in cities, and there is a corresponding increase in cholesterol levels and coronary disease. McDonald's reported in 1993 that Japan was it's largest overseas market. And the biggest McDonald's restaurant in the world is in Beijing; where they serve 10000 customers each day. The rural populations throughout Asia continue to have low-fat diets and low incidents of coronary disease. An increase in dietary fat is also being seen in some areas of South America and South Africa, as adult's and children's diets become more and more Westernized. The body of evidence continues to grow - that coronary heart disease and other chronic adult diseases begin in childhood and are the direct result of excessive saturated fat in the diet.
A conference was held in 1991, bringing together elite nutritional scientists and concerned physicians (including T. Colin Campbell, and Dr. Dean Ornish) from all over the U.S.. A resolution was prepared that covered the opinions and recommendations of 10 of the 13 panel members. The points:
Current national guidelines for fat and saturated fat consumption would not prevent coronary-artery disease. People who already have coronary disease experience a progression of it while following these guidelines. An ideal diet for preventing, arresting, and reversing coronary disease would be one deriving 10 - 15% of calories from fat, and consisting of vegetables, fruits, grains and legumes. This kind of diet has also been shown to reduce the risk of cancer of the breast, colon, prostate and ovary. A diet such as this is safe for children over the age of 2 and should be introduced early for the development of proper eating habits and optimal nutrition. They suggested that schools have the unique opportunity to promote such a low-fat diet. The affluent Western high-fat diet has spawned an epidemic of heart disease and cancer. Therefore, they feel the medical profession should recommend to the public a diet that protects them from these diseases. |
The panel agreed that the American people have a right to know the facts about their dietary risk; they must be informed and will decide for themselves.
Scientific facts have, in recent years, been reported in a way that misrepresents them. Flawed studies and misleading media reports have understandably confused the public. A 1993 survey showed that only 39% of people were making an effort to eat properly - down from 41% in 1991. One of the chief reasons was confusion. Dr. Attwood discusses several studies and misinterpretations that have led to the current confusion.
The last two chapters of the book are by Victoria Moran - "A Mom's Guide to Happy, Low-Fat Kids", and "Suggested Menus". A summary of the points she discusses for children from infancy through preschool:
• Mother's milk or formula is the primary food for the first year. |
Suggestions for school age children:
• Teach children the importance of a low-fat diet. |
The last chapter details the menus... many suggestions and recipes for every meal and snack; thought out to be appealing to children of all ages.