Letters to the Editor
Soup? It may be hazardous to your health!
Risk factors and coronary heart disease
To the Editor: Dr. George E. Burch (AM. HEART J. 91:267, 1976) very aptly describes soup as containing everything one finds in plant and animal tissues, and as being the ideal replacement fluid: t r u e - i f it is home-made, that is. Industrially prepared soups contain all those ingredients, and then some. Rarely is soup nowadays truly "home-made." Whether served in restaurants, homes or hospitals, it's mostly prefabricated, and 20,000 tons of Monosodium Glutamate are dumped into such soups annually in the U.S. Very few commercially prepared soups are without it, because of its effect on the taste and quantitatively, it is the most widely used food additive. The harmfulness of MSG to children is acknowledged and it has been barred from baby foods. Its effects on adults are accepted as a curious nuisance, which susceptibles may avoid by keeping a respectful distance from Wonton soup. Experiments have pinpointed the symptoms susceptibles develop such as burning sensations, and substernal pain? However, these experiments were done on healthy adults and not on people with cardiovascular disorders. I have seen reactions involving frequent ventricular premature beats, and considerable discomfort beginning shortly after eating in a Chinese restaurant. None of the other common sensations were present, but the arrythmia continued for hours and triggered a lengthy period of reduced functional capacity of the heart. Sometimes there is an easy clue which may draw attention to the link such as the preceding consumption of Chinese food, while other such incidents with similar unpleasant responses can be traced to MSG, if histories include such questions. In patients with a tendency to episodic arrhythmias, it is worthwhile to explore whether, before such an attack, they had consumed food items possibly containing Monosodium Glutamate. Commercially prepared soups are suspect, not just Chinese dishes, and while most brands of soups contain substantial amounts of MSG, little of it (a gram) can be enough to produce reactions in susceptibles. Because sensitivity to MSG is not rare and because of the unpredictable consequences given a damaged, vulnerable, or irritable myocardium, patients with a tendency to rhythm disturbances should be made wary of prefabricated soups, and meat "tenderizers," in addition to the fare of Chinese restaurants. Incidentally, the term "Chinese restaurant syndrome," while picturesque, is too narrow considering the tons of MSG used in less exotic foods. The syndrome should really be termed what it is, an MSG atopy. And the cardiovascular system is its chief target.
To the Editor:
Hans H. Neumann, M.D. Director, Preventive Medicine Department of Health City of New Haven One State St. New Haven, Conn. 06511
REFERENCE 1. Schaumburg, H. H., Byck, R., Gerstl, R., et al.: Monosodium L-ghitamate: Its pharmacology and role in Chinese Restaurant Syndrome, Science 163:826, 1969.
266
Werko's review (AM. HEART J. 91:87, 1976) omits the "risk factor" we have found most useful in the rehabilitation of patients with coronary heart disease. That risk factor is sedentary living. A significant degree of risk reduction is associated with the vigorous life style. "Mileage covered on foot" is one index of this vigor. Populations which cover twenty kilometers a day on foot burn approximately 1,200 kcals, and have very little atherosclerosis. This is noted in the Masai warriors who herd cattle on foot 1 and the Tarahumara Indians who take part in ceremonial runs. ~ Longevity is associated with mileage. Extreme examples of longevity have been reported among the Hunza and other remote mountain villagers who must walk a great deal2 Longshoremen who burned 1,800 kcal. per day show reduced heart disease2 This is the caloric equivalent of 30 Kms. We have been unable to substantiate a single atherosclerotic death among marathon runners.:' The marathon run is 42 Kms. in length and is suitable activity for rehabilitated heart patients.
Thomas J. Bassler, M.D. Centinela Hospital Inglewood, Calif. 90307
REFERENCES 1. Ho, K. J., Biss, K., Mikkelson, B., et al.: The Masai of East Africa: Some unique biological characteristics, Arch. Pathol. 91:387, 1971. 2. Groom, D.: Cardiovascular observations on Tarahumara Indian runners--the modern S p a r t a n s , Am. Heart J. 81:304, 1971. 3. Leaf, A: Unusual longevity: The common denominators, National Geographic 143:93, 1973 (January) 4. Paffenbarger, R. S., and Hale, W. E.: Work activity and coronary heart mortality, N. Eng[. J. Med. 292:545, 1975. 5. Bassler, T. J., Steiner, R., and Cardello, F.: Marathon vs. distance running, N. Engl. J. Med. 294:114, 1976.
Reply To the Editor: It is obvious that Dr. Bassler has not understood the purpose of my review-to point out difficulties and flaws in well-known, extensively published studies. I am, however, grateful to him for his remarks as this gives me opportunity to point out that there are no controlled studies that support his statement in the letter. On the contrary, it is quite clear t h a t athletes, and especially marathon runners and cross-country skiers, are a self-selected group with quite different physical and mental make-up compared to the general population. It is thus impossible to draw any conclusions from such anecdotic evidence that Dr. Bassler cites. It is furthermore not at all clear that athletes have a better cardiovascular health than other groups. Studies in Finland and Sweden have been rather disappointing in this respect. A controlled studY of the effect of standardized physical training after myocardial infarction t h a t was done in GSteborg also demonstrated the slight gain in comparison to, for example, stopping smoking cigarettes. 1 The marathon
A u g u s t , 1976, Vol. 92, No. 2
Soup? It may be hazardous to your health!
Risk factors and coronary heart disease
To the Editor: Dr. George E. Burch (AM. HEART J. 91:267, 1976) very aptly describes soup as containing everything one finds in plant and animal tissues, and as being the ideal replacement fluid: t r u e - i f it is home-made, that is. Industrially prepared soups contain all those ingredients, and then some. Rarely is soup nowadays truly "home-made." Whether served in restaurants, homes or hospitals, it's mostly prefabricated, and 20,000 tons of Monosodium Glutamate are dumped into such soups annually in the U.S. Very few commercially prepared soups are without it, because of its effect on the taste and quantitatively, it is the most widely used food additive. The harmfulness of MSG to children is acknowledged and it has been barred from baby foods. Its effects on adults are accepted as a curious nuisance, which susceptibles may avoid by keeping a respectful distance from Wonton soup. Experiments have pinpointed the symptoms susceptibles develop such as burning sensations, and substernal pain? However, these experiments were done on healthy adults and not on people with cardiovascular disorders. I have seen reactions involving frequent ventricular premature beats, and considerable discomfort beginning shortly after eating in a Chinese restaurant. None of the other common sensations were present, but the arrythmia continued for hours and triggered a lengthy period of reduced functional capacity of the heart. Sometimes there is an easy clue which may draw attention to the link such as the preceding consumption of Chinese food, while other such incidents with similar unpleasant responses can be traced to MSG, if histories include such questions. In patients with a tendency to episodic arrhythmias, it is worthwhile to explore whether, before such an attack, they had consumed food items possibly containing Monosodium Glutamate. Commercially prepared soups are suspect, not just Chinese dishes, and while most brands of soups contain substantial amounts of MSG, little of it (a gram) can be enough to produce reactions in susceptibles. Because sensitivity to MSG is not rare and because of the unpredictable consequences given a damaged, vulnerable, or irritable myocardium, patients with a tendency to rhythm disturbances should be made wary of prefabricated soups, and meat "tenderizers," in addition to the fare of Chinese restaurants. Incidentally, the term "Chinese restaurant syndrome," while picturesque, is too narrow considering the tons of MSG used in less exotic foods. The syndrome should really be termed what it is, an MSG atopy. And the cardiovascular system is its chief target.
To the Editor:
Hans H. Neumann, M.D. Director, Preventive Medicine Department of Health City of New Haven One State St. New Haven, Conn. 06511
REFERENCE 1. Schaumburg, H. H., Byck, R., Gerstl, R., et al.: Monosodium L-ghitamate: Its pharmacology and role in Chinese Restaurant Syndrome, Science 163:826, 1969.
266
Werko's review (AM. HEART J. 91:87, 1976) omits the "risk factor" we have found most useful in the rehabilitation of patients with coronary heart disease. That risk factor is sedentary living. A significant degree of risk reduction is associated with the vigorous life style. "Mileage covered on foot" is one index of this vigor. Populations which cover twenty kilometers a day on foot burn approximately 1,200 kcals, and have very little atherosclerosis. This is noted in the Masai warriors who herd cattle on foot 1 and the Tarahumara Indians who take part in ceremonial runs. ~ Longevity is associated with mileage. Extreme examples of longevity have been reported among the Hunza and other remote mountain villagers who must walk a great deal2 Longshoremen who burned 1,800 kcal. per day show reduced heart disease2 This is the caloric equivalent of 30 Kms. We have been unable to substantiate a single atherosclerotic death among marathon runners.:' The marathon run is 42 Kms. in length and is suitable activity for rehabilitated heart patients.
Thomas J. Bassler, M.D. Centinela Hospital Inglewood, Calif. 90307
REFERENCES 1. Ho, K. J., Biss, K., Mikkelson, B., et al.: The Masai of East Africa: Some unique biological characteristics, Arch. Pathol. 91:387, 1971. 2. Groom, D.: Cardiovascular observations on Tarahumara Indian runners--the modern S p a r t a n s , Am. Heart J. 81:304, 1971. 3. Leaf, A: Unusual longevity: The common denominators, National Geographic 143:93, 1973 (January) 4. Paffenbarger, R. S., and Hale, W. E.: Work activity and coronary heart mortality, N. Eng[. J. Med. 292:545, 1975. 5. Bassler, T. J., Steiner, R., and Cardello, F.: Marathon vs. distance running, N. Engl. J. Med. 294:114, 1976.
Reply To the Editor: It is obvious that Dr. Bassler has not understood the purpose of my review-to point out difficulties and flaws in well-known, extensively published studies. I am, however, grateful to him for his remarks as this gives me opportunity to point out that there are no controlled studies that support his statement in the letter. On the contrary, it is quite clear t h a t athletes, and especially marathon runners and cross-country skiers, are a self-selected group with quite different physical and mental make-up compared to the general population. It is thus impossible to draw any conclusions from such anecdotic evidence that Dr. Bassler cites. It is furthermore not at all clear that athletes have a better cardiovascular health than other groups. Studies in Finland and Sweden have been rather disappointing in this respect. A controlled studY of the effect of standardized physical training after myocardial infarction t h a t was done in GSteborg also demonstrated the slight gain in comparison to, for example, stopping smoking cigarettes. 1 The marathon
A u g u s t , 1976, Vol. 92, No. 2
