1990 M-No.5724





- AND -





Beaufort House,
15 St. Botolph Street,


I. J's meaning*, broken down into its constituent parts

*Ruling 20.11.95; 26 AD

1. McD's food is very unhealthy

* the food; other than occasionally

2. McD's know this*, but

*that their food is v. unhealthy, for both (all) the stated reasons.

II. J's ruling as to defamatory effect of these allegations*:
*26F 27A

[Plainly defamatory of both pffs]

III. These are obviously connected: the allegation of deceit flows from the knowledge that the food is v. unhealthy. Statements made innocently, in the honest (but mistaken) belief that they were true, could not constitute deceit.

IV. This analysis shows that the defamatory allegations are allegations of fact, not comments:

V. It follows that the allegations must be shown to be (substantially) true, ie, proved as facts: viz, it must be shown (by clear & convincing e., because the allegations are very serious):

VI. So the qq. of fact, in order, are:-


FAT 1. Is 'the food' high in fat?

1.2 What food?

1.3 Some of it is obviously fatfree - eg coke, black coffee

1.4 Some of it is obviously nearly so - eg salad w/o dressing

1.5 Some has modest amounts: eg

*P VI/7 (1993) hashbrowns or hamburgers*

p.46(?) TF 7. 8g TF 8. 6g

SF 1. 5g SF 4 . 0g

1.6 Some has (comparatively) large amounts:

* (same ref.) eg ¼ lbr : 22g +10.3g*

or ¼~ lbr w.cheese : 27.7g + 13.9g

Choice of meal

1.7 Sensible thing is to look at a meal remembering always that by no means all

those who visit McD's eat meals, as such

e.g black coffee & donut on the way to

work each day*


P VI/A/45/

207: "Lighter

users spend Can't look at every possible meal combination

more than heavy


and 204: 1.8 So what I've done is to take what McD's themselves see as a 'typical' meal


has strongest 2+/5 customers (1991): entrée, fries, beverage also popular with children. *

following of

heavy McD's


*P VI A/45/298


but I've also added a pudding, to make a 'worst case' scenario.

1.9 Thus:

- Cheeseburger

- FF(R)

- Apple pie

- Coca Cola (M)

1.10 This has been chosen by ref. to fat content, simply because, of all the ingredients of

*SF= saturated a McD's meal, fat, and particularly SF*, is the

fat one which, on the evidence, is mostly closely associated with illhealth,

in the form of CHD* .

*See Admission

(more later)

1.11 I haven't chosen the fattiest possible meal (eg ¼lbr, FF(L), Donut + milkshake); nor, on the other hand, the least fatty (eg hamburger, salad, black coffee no pudding)

but tried to pick something which would fairly represent an 'average' sort of meal for

a person of any age (though small children might struggle to finish it!).

1.12 I will start with fat, for the reason stated, then examine each of the other constituents

which that meal happens to have: only when that has been done is it possible to give

a factual answer to the umbrella q:-

Is the food high in fat, etc low in fibre, etc

1.13 I have taken different years, both in UK and US, to test the allegation over a period of

time; this has been partly dictated by the availability of appropriate info. in the evidence.

1.14 Thus:

*P VI/4 and 5 UK: 1989* P VI/6/368 McD's Food:

are from 1985: The Facts.

they don't

give fig.s 1 1993: P VI/7/?46: McD's Nutrition

for SF at all Information

and apple pie

wasn't on menu

so no pt. using them for

this comparison US: 1987: P VI/19/?: McD's Food:

The Facts

1988: P VI/20/?: McD's Food:

The Facts

1989: P VI/15/?: Nutritional


(Hazelton Labs.)

[1990: P VI/22 gives the same figures as 1989]

1.15 Methodology:

* Total fat (1) See what the TF* and SF content is of each item, in grammes.

(2) Since the epithet 'high', as applied to a particular constituent/ingredient of a

food or a meal is necessarily a word of proportion, the q. is, as a proportion of what?

*Any other Ans: Energy supply/requirement

measurement in k/cal (which seems to be the universal approach). *

such as

proportion by

weight is

obviously useless.

(3) Since the fat content of a particular food item, expressed as a proportion of the

*eg, Prof Naismith's energy derived from thatitem, is a meaningless calculation*, I have ignored it.


(4) Equally, the fat content of a single meal, expressed as a % of the total energy

derived from that meal, is likely to be valueless in answering the q "Is the food


So I have ignored that, too. The correctness of this approach confirmed by:

* 259 : 30;1231:18 Crawford *

+ 14 : 62:2463:8 - supported by Wheelock +

x 253 : 20:3841 - and Naismith

(5) These expert opinions confirm that it is, of course, the effect on diet that matters.

However, on the way to answering that (eventual) question, it may be relevant

to ask the preliminary q:

- what contribution to the customer's total daily energy intake/requirement

does the fat content of this meal make?

(6) There is, on the evidence, no clear or final scientific agreement or conclusion

about the precise max. (actual) % of daily energy requirement/intake which fat

should contribute.

(7) However, there does seem to be agreement (VW, Cannon, Crawford+)

+269 that the recommendations of COMA (41 and 46) should be given weight.


*Also Naismith,


( Crawford

started to

retreat a bit

later on!)

(8) Since there is nothing better, I propose

to use those, and thus to calculate the %

contribution which the fat content of the

chosen meal makes to the EAR for

energy per day (as expressed in COMA

*Not the 41 (1991)) for different age groups* and

whole range! to compare that with the DRVs for fat

See below. recommended by COMA (as % of EAR for

energy) .

(9) In this way, and probably only in this way,

can one begin to see how the meal fits, or may fit,

into its consumer's overall diet, in relation to his/her fat consumption.

(10) When I go on to consider such things as

sodium, vitamins, minerals and fibre,

which are also important I shall use a

similar approach, though some of the materials will,

nec., be different.

(11) In passing -

(a) I propose to ignore two elements

of the "high in" category of supposed


"animal products" and "sugar"

(b) Reasons:

(i) "animal products" is meaningless;

except in so far as they contain

fat, salt, vitamins and minerals,

all of which must be considered

*See, eg, Arnott: 254:61 (Ans. J) separately (proteins*, as such,

* See COMA 41: 5.5, iiv on p.73. have not made anything but a

fleeting appearance in the case),

"animal products" contribute

nothing to the debate.

(ii) "Sugar" is also irrelevant, but for

a different reason: its only direct

effect on health is cariogenesis,

which has nothing to do with

cancer or CHD. * Otherwise, it is

a benign source of energy.

Choice of consumers

UK 1.16 (1) As will be seen in due course, overall

the most important category of McD's

customers in the UK is the age group

1634: not only do they constitute c.56%

of all those who visit McD's 1 x pa or

more often, they also constitute c.81% of

OMNIMAS those who visit McD's 1 x pw or more

[AF new often,(1624s = 60% in this cat.)

tables, 1995]

US (2) In the US the 1434s are 46% of

P VI A/45/212 (1991) he total, whilst the 1834s are

39%. Thus, though the spread is

1444s = 65% somewhat greater in the US*, the

* teenager young adult group is

2044s = 54% probably the single most important

2544s = 42% group (013s = 18%, 3555s = 36%).

1634's (3) Therefore, to represent this group, I

have taken a 17 year old male and a 25

year old female (who has a lower EAR

than a 17 yr old girl).

Children (4) Since children are also an important

group (partic. on a/c of the allegations

made about McD's advertising), I have

also taken a boy and a girl, each 8 yrs old.

(5) I have given each of these agegroups

the EAR for energy set out on xix of

COMA 41 in Table 1.1.

(6) These are, in fact, minima:

see pp 247 of COMA 41.

eg If you give a 20 yearold male a

'moderately active' PAL (1.7: see Table

2.3 on p.24), and you weigh him in at

75kg (11st 11lb), then you find that his

* 1 MJ EAR is actually 13 MJ/d (=3087.5 Kcal/d*

= 273.5 Kcal Table 2.7 on p.27. Whereas, according

to Table 1.1 on p . xix, his EAR is only

10.6 MJ/d (or 2550 Kcal). Looking back

at Table 2.7, one can then see that that

is (approx.) the EAR for a 75kg 20 yr

old male with a PAL of 1.4, ie,

active neither at work nor in his

* See Table 2.3 leisuretime* which is a v. unusual 20 yr old male!

on p. 24

(7) In the result, by giving the 4 consumers

minimum EARs, and by adding in a

pudding, I have produced a much gloomier

picture than reality suggests is likely to be

true or fair. No matter.

1.17 The calculations: see the tables which follow.

The Food


Table 1

UK: 1989 : P VI/6136


Cheeseburger           13.6                   6.7                     295                    

FF (R)                 14.5                   7.9                     236                    

Apple pie              15.4                   4.3                     259                    

Cola (R)               -                      -                       105                    

Total                  43.5                   18.9                    895                    

1 g Fat = 9 Kcal

Therefore: 43.5g. TF= 391.5 Kcal (1)

18.9g. SF = 170.1 Kcal (2)

17 yr. old male: EAR: 2755 Kcal/d DRVs:

(1) = 14.2% EAR TF: 33%

(2) = 6.2% EAR SF: 10%

(COMA 41:

25 yr. old female: EAR: 1940 Kcal/d

(1) = 20.2% EAR

(2) = 8.8% EAR

*based on 8 yr.old boy* EAR:1970Kcal/d* DRVs

table 2.2,

p.21) (1) = 19.9% EAR TF: 35% (no alc)

(2) = 8.6% EAR SF: 11% (no alc)

(COMA p. xx)

8 yr. old girl EAR: 1740 kcal/d

(1) = 22.5% EAR

(2) 9.8% EAR

Table 1A

The total Kcals derived from the meal in Table 1: 895

As a % of EAR:

17 yr old male (2755)= 32.5% (1/3)

25 yr old female (1940)= 46.1%

8 yr old boy (1970)= 45.4%

8 yr old girl (1740)= 51.4%

Table 1B

Recalculation of Table 1, excluding apple pie from the meal

for the two 8 yr olds, on grounds of common sense/experience and

also because the 'typical' children's meal ref. to in P VI

A/45/208 does not inc. a pudding: 'entree, fries, beverage').

(1) TF: 28.1g = 252.9 Kcal

(2) SF: 14.6g = 131.4 Kcal

Boy (1970)

(1) = 12.8%

(2) = 6.7%

Girl (1740)

(1) = 14.5%

(2) = 7.5%


And if you do the same for the 17 yr old male and the 25 yr old female,

so as to produce the 'typical' McD's meal, you naturally get similar


A: (1) = 9.2%

(2) = 4.8%

B: (1) = 13%

(2) = 6.8%

Table 2

UK: 1993 : P VI/7/6 th p. (?46)

                              TF(g)                          SF(g)                          

Cheeseburger                  13.3                           7.0                            

FF(M)*                        20.3                           4.4+                           

Apple pie                     13.8                           4.5                            

Coca Cola (R)                 -                              -                              

Total                         47.4(1)                        15.9(2)                        

* New since 1989

+ After replacement of beef tallow with vegetable oil as frying medium.

(1) 47.4g = 426.6 Kcal

(2) 15.9g = 143.1 Kcal

17 yr old male (2755)

(1) = 15.5% EAR

(2) = 5.2% EAR

25 yr old female (1940)

(1) = 21.9% EAR

(2) = 7.4% EAR

8 yr old boy (1970)

Exc. apple pie

(1) = 21.7% EAR Totals: (TF: 33.6g) (1) = 15.4% (302.4 ÷ 19.7)

(2) = 7.3% EAR (SF: 11.4g) (2) = 5.2% (802.6 ÷ " )

8 yr old girl (1740)

Exc. apple Me

(1) = 24.5% EAR Totals: (TF: 33.6g) (1) = 17.4% (302.4 ÷ 17.4)

(2)=8.2% EAR (SF: 11.4g) (2) = 5.9% (102.6 ÷ 17.4)

- Also, of course, if you replace FF(M) with FF(R): TF: 14.3g} giving residual totals

SF: 3.1g} of: TF: 41.4g = 372.6 Kcal

SF: 14.6g = 131.4 Kcal

you get corresponding reductions in the % obtained from fat as proportion of EARS.

Table 3

US : 1987 : P IV/19/40, 42, 45 (internal)

                       TF                     SF                      Kcal                   

Cheeseburger           16                     6.66                    318                    

FF                     11.5                   4.61                    220                    

Apple pie              14                     4.73                    253                    

Coca Cola              -                      -                       129                    

Total                  41.5                   16.00                   920                    

(1) (2)

Note: Since there are no US EARs for Kcal/d or agreed DRVs for % of energy from

TF/SF, COMA values are used below:

(1) = 373.5 Kcal

(2) = 144 Kcal

17 year old male (2755)

(1) = 13.6%

(2) = 5.2%

25 year old female (1940)

(1) = 19.2%

(2) = 7.4%

8 year old boy (1970)

Exc. apple pie

(1) = 18.9% (TF 27.5g) (1) = 12.6% (247.5 ÷ 19.7)

(2) = 7.3% Totals: (SF 11.27g) (2) = 5.1% (101.43 ÷ 19.7)

8 year old girl (1740)

(1) = 21.5% (1) = 14.2% (247.5 ÷ 17.4)

(2)=8.3% (2) = 5.8% (101.43 ÷ 17.4)

Table 3A

US: 1988 : P VI/20

                       TF                     SF                      Kcal                   

Cheeseburger           13.8                   5.17                    308                    

FF*                    11.5                   4.61                    220                    

Apple Pie              14.8                   4.83                    262                    

Coca Cola              -                      -                       144                    

Total                  40.1                   14.61                   934                    

(1) (2)

+ Significantly less than l987

* = 1987

x Slight increase on 1987

Note: See Table 3 (1) = 360.9 Kcal

(2) = 126.9 Kcal

17 year old male (2755)

(1) = 13%

(2) = 4.6%

25 Year old female (1940)

(1) = 18.6%

(2) = 6.5%

8 year old boy (1970)

(1) = 18.3% exc. apple pie

(2) = 6.4%

Totals: (TF25.3g) (1) = 11.6% (227.7 Kcal)

(SF 9.78g) (2) = 4.5% ( 88.02 Kcal)

8 year old girl (1740)

(1) = 20.7% (1)= 13%

(2) = 7.3% (2) = 5%


US: 1989: P VI/15/pp 3. 4 & 6 (NB: The figs for 1990 VI/22 are identical)


CHEESEBURGER           13.8                   5.17                    310                    

FF(R)*                 12.0                   5.05                    220                    

APPLE PIE              14.8                   4.83                    260                    

COCACOLA(S)            -                      -                       140                    

TOTAL                  40.6                   15.05                   930                    

(1) (2)

* Slight increase on 1988 and 1987: ? more fries/portion (or different analysis)

Note: See Table 3 (1) = 365.4 Kcal

(2) = 135.5 Kcal

17 year old male (2755)

(1) = 13.3%

(2) = 4.9%

25 year old female (1940)

(1) = 18.8%

(2) = 6.9%

8 year old boy (1970) exc. apple pie

(1) = 18.5% Totals: (TF25.8) (1)= 11.8% (232.2 ÷ 19.7)

(2) = 6.9% (SF 10.22) (2) = 4.7% (91.98 ÷ 19.7)

8 year old girl (1740)

(1) = 21% (1)= 13.3% (232.2 ÷ 17.4)

(2)=7.8% (2) = 5.3% (91.98 ÷ 17.4)



Recalculation of effect of Meal in Table 1 using PAL to give EAR

via Table 2.7 on p. 27 of COMA 41.

1. 20 year old male* weighing 75 kg (11st 11lb) with a PAL of 1.7 (moderate):

EAR is 13.0 MJ/d = 3087.5 Kcal

Therefore: (1) (391.5 Kcal) = 12.7% EAR

(2) (170.1 Kcal) = 5.5% EAR

2. 25 year old female weighing 55 Kg (8st 9lb) with a PAL of 1.6 (moderate):

EAR is 8.7 MJ/d = 2066.25 Kcal

Therefore: (1) = 18.9% EAR

(2) = 8.2% EAR

* No figs. given for younger male adults. But 1618s would be higher

see Table 1.1 on xix.


Calculation by ref to Prof. Crawford's tables

McD's meal (1): McChicken S/wich, FF (M) Coke (M)

TF: 37.0g = 333 Kcal ÷ by say, 19.40 (25 year old female: EAR 1940) = 17.2% EAR

SF: 5.58g = 50.2Kcal ÷ by say, 19.40 (25 year old female: EAR 1940) = 2.6% EAR

McD's meal (2): Hamburger, FF (M), Coke (M)

TF: 32g = 288 Kcal = 8% for same woman

SF: 6.32g = 56.8 Kcal = 2.9% for same woman

And if that same woman ate both these meals on the same day ...?!

she'd still only be getting 32% of her EAR from the TF of those

2 meals taken together and 5.5 % of her EAR from the total SF

See xx of Crawford: 269: 647; which demonstrated that for a 20 year old male who ate meal

(2) once in a week, the meal would be making a 1/32 (3.2%) contribution

to his recommended SF intake for that week and a 1/19 (or 5.4%)

contribution to his TF intake. So, as Prof. Crawfordsaid, the meal

makes a contribution to the fat load in the diet; but it is a minute

contribution. *

* See further, under



1.18 What these calculations show.

(1) They do not demonstrate precise conclusions, rather a general picture.

(2) They do show that the consumption of a 'typical' McD's meal entrée,

fries, beverage provides a fat intake, both of TF and SF, which for all

ages, falls below the recommended maxima/d.

- And except in the case of the 8yrold girl unsurprisingly

that remains so even when you add an apple

pie to a cheeseburger, fries and coke.

(3) This is not to say that there won't be people for whom that particular

meal will push their intake for the day (if that is a meaningful measure,

which it may not be) over the limit simply because they have had

bacon and eggs for breakfast or sausage and mash for supper.

(4) But that is not the q. at this stage. The q. at this stage is:

Is the food itself high in fat?

Ans., by ref. to the contribution which that meal makes

to that day's fat intake,



2. Is the food high in sodium?

2.1 I shall try to ans. this by ref. to the same meal used for FAT:


FF (R)

Apple pie

Coke (R)

- Remembering always

(1) that Na intakes do not, for most people, present the same 'risk factor'

as SF: see, eg, COMA: 46, 6.6.8.

(2) Naismith (253:31) as to the (comparatively) small effect of reducing dietary Na.

UK 2.2 I shall use COMA (41, but, in particular 46)

as the guide to appropriate intakes of Na.

2.3 Reason: COMA 41, 25.3.4 and Table 25.1 on p. 154, gives only RNI's

*As to RNI, (and LRNIs for Na. (1600 meld for adults)* .

see p.v

COMA 46, however, gives, in effect, a DRV:

R.2.9 on p.2

S.2.9.1 on p.12

6.6.10 on p.138

* COMA 41, The DRV is + 6g. NaC1/d

p. 154 at ** 1g. NaCl = 17.1 mmol Na *

1 mmol= 23 mg Na

Therefore 17.1 mmol = 393 mg Na

Therefore 1 g NaCl contains 393 mg Na

Therefore 6 g NaCl contain 2358 mg Na

Therefore DRV = 2358 m~ Na/d

US 2.4 No equiv. of COMA reports.

Nor, If you look at, eg, P VI/15&19 ff (198790) does there

appear to be a USRDA for Na (unlike other constituents).

Therefore, as with FAT, I shall use COMA DRVs.

2.5 The calculations: see Tables, post.

The Food Sodium

Table 7: UK: 1989: P VI/6/36-7

                                mg Na                                

Cheeseburger                    600                                  

FF(R)                           200                                  

Apple pie                       200                                  

Coke (R)                        Tr.                                  

Total                           1000                                 

(Tr. = trace)

DRV for adults: 2358 mg Na/d. (None for children: COMA 46,

R2.9, p.2 and S.2.9.1, p.l2)

Therefore, for the 17 year old male and 25 year old female, this meal gives c.42% of DRV.

For the two 8 year olds, this % would be higher.

And, once again, the amount is reduced by 20% if you leave out the apple pie (leaving c.34% of DRV).

Table 8: U.K: 1993: P VI/7

                                  mg Na                              

Cheeseburger                      700                                

FF(M)                             200                                

Apple pie                         200                                

Cola (R)                          Tr.                                

Total                             1100 = 46.7% DRV                   

Again, a reduction of 100 mg if you replace FF(M) with FF(R),

giving the same results as 1989. And if you leave out the AP as well,

you get down to 800 mg = 34% DRV (as for 1989).

Table 9: U.S: 1987: P VI/19

                                  mg Na                              

Cheeseburger                      740                                

FF                                110                                

Apple pie                         400*                               

Coke                               5                                 

Total                             1255 = 53% UK DRV                  

Table 10: U.S: 1988 : P VI/20

                                  mg Na                              

Cheeseburger                      750                                

FF(R)                             110                                

Apple pie                         240*                               

Coke (S)                           15                                

Total                             1115 = 47%                         

[Figs for US 1989: VI/15: are identical

and for US 1990: VI/22: are identical]

* Less AP, = 855 mg = 36%

Less AP = 875 mg = 37%

Maybe, if you are o/wt and/or hypertensive, you'd be better to leave out the AP!

2.6 Conclusion

The food not "high" in sodium.


3. Is the food low in fibre?

3.1 Same meal.

3.2 Remembering always that the role of 'fibre' in the diet is uncertain:

- COMA 41,Ch.4:p.61

4.5.1, 4.7.4:pp 65 and 67

- Also specific papers ref. to later.

and that 'dietary fibre' is an imprecise term: if anything is important, it must be

*whatever that the NSP fraction of fibre* :

may be. COMA 41:4.1:p.61

3.3 It shouldn't therefore be assumed that low

fibre content, in itself, is directly related

to health. It may simply be a 'marker' for

other dietary characteristics, positive and/or

negative. In other words, we are in the area

now of speculation/hypothesisgeneration. But

more of that anon.

3.4 For the present

A cautious DRV is to be found at COMA 41:4.9 1 on p.68

- But this is for NSP, not fibre as such.

- And there is no DRV for children, save that their intakes

of NSP should be proportionately less.

The DRV for NSP is 18g/d for adults.

3.5 McD's nutrition docs do contain figs. for

'fibre', so that, bearing in mind the need for

caution, a rough calculation of McD's food's

r/ship with DRV can be made for the UK.

3.6 The calculations: see Tables, post.

3. 6A No calculations can be made for the US

because the US docs. do not contain amounts

of fibre.

TABLE 11: UK: 1989: P W61367

                     g. fibre                

Cheeseburger         0.8                     

FF(R)                2.3                     

Apple pie            1.8                     

Total                4.9                     

27% of DRV for NSP for adults; higher % for children.

TABLE 12: UK: 1993: P VI/7

Significant increases over 1989

                     g. fibre                

Cheeseburger         4.0                     

FF(R)                8.2                     

Apple pie            4.3                     

Total                16.5                    

92% of DRV for NSP for adults; higher % for children in fact, the two 8 year olds might be overdosing!

Notes: 1. Coke excluded because no fibre.

2. If you exclude an AP for the 8 year olds, then fibre content will go down, with fat & Na.

3. Ditto if you reduce FF(M) of this meal to FF(R): fibre content 5.8g: diff 2.4g:

leaving 4.1g 78%DRVforNSP

3.7 Conclusion

Whichever way you look at it, the food not low in fibre.


4. Is the food low in vitamins and minerals (V&M) ?

4 .1 I shall deal with these together because, like

Na, they are essential nutrients. This is

important, because it means that the V and M

content of the meals is relevant not only to

the q. whether the meals are "unhealthy",

but also to the q:

"Are McD's deceiving their customers

when they say that their food is a useful

and nutritious part of any diet?

4 . 2 The calculations are complicated by the

following difficulties

(1) McD's UK does. for 1989 and 1993 do not

gives values for V and M (other than

Na) .

(2) The most recent doe. to give values for

Be, B12 and K is P VI/2, which is UK,


(3) The US does. give values for the other important

V and M and for the %s of USRDAs which those

values represent.

(4) COMA 41 gives EARs for most of the V

and Ms (except K; and B6 in a comprehensible

form) and RNIs for all.

(5) The values given by the US

McD's docs for vits. C, B1, B2, Niacin,

Ca and Fe and by P VI/2 for B6, B12

and K can then be set against the EARs

and RNIs in COMA 41.

(6) The assumption can then reasonably be

made that the amounts of V and M found in

the US meals for 198790 are likely to

be approx. the same as those which would be

found in UK meals for the same period: eg, Na content:

Table 7: UK 1989 : 1000mg (P VI/6)

Table 10: US 1989 : 1115mg (P VI/15)

(7) By this route, it is poss. to make a fair stab at judging

how, eg the UK 1989 meal (Table 1) might have

matched up to COMA's EARs and RNIs for the

V and Ms given by the US docs.'

(8) Greater disparity may be present between 1989

values and the values for B6, B12 and K given

by P VI/2, because these date from 1985: eg Na content:

Table 7 :UK 1989:1000 ma. Table 10: US 1989: 1115 mg; but,

P VI/2 :UK 1985:1357 ma.

(9) All this means is that the figs. for B6,

B12 and K which I have calculated by

ref. to P VI/2 and COMA 41, must be

treated with some caution or, at least, more caution.

(10) The 'rogue' is Vit A. Although the US

does. and P VI/2 give amounts for A,

they do so in units of measurement (IU)

which are different from those used by

COMA (micro g/d. ) Since I have not

been able to discover how to transpose

/convert one into the other, I've had to

ignore A. This is a pity, because A is an

important vitamin and is available in

significant quantities (as retinal) in dairy

products (COMA 41:8.2 on p.85).

[See also PVI/4/p.18 and p.10.]

4.3 The tables which follow must therefore be read

with all these qualifications in mind.

4.4 Not but what, the burden is on the Ds to

prove that the food is low in V & Ms: these

calculations, however broadly they must be

viewed, suggest quite the reverse; and the Ds

have offered no e to contradict that suggn.

TABLE 13 US : 1987 P VI/19

                        CHEESEBURGER       FF         APPLE PIE          TOTALS         

                 EAR     mg     % US     mg    % US     mg     % US    mg     % US    % EAR  
                 mg/d            RDA            RDA            RDA             RDA           

1. Vitamin C      25    2.05      4    12.53    20     >0.85    -     15.43    24     61.7   

2. Thiamin B1    0.83   0.30     20     0.12     8     0.02     -     0.44     28      53    

3. Riboflavin     1     0.24     15     0.02     -     0.02     -     0.28     15      28    

4. Niacin        15.2   4.33     20     2.26    10     0.19     -     6.78     30      44    

5. Calcium       750    169.0    15      9       -      14      -      192     15     25.6   

6. Iron          8.8    2.84     15     0.61     4     0.62     4     4.07     23     46.8   

NOTES: . .

Vit. C 1. EARs in Table 17.1 on p 120 of COMA 41. The EAR given here is for the whole population

over 15. The EAR for 8 year olds is 20 mg/d, so that this meal would yield 77% of his/her

EAR of Vit. C (73% of the AP is removed).

B1 2. Table 9.1 on p.91; EARs expressed in mg/1000 Kcal. For the whole population 150+,

EAR is 0.3 mg/1000 Kcal. The EAR for B' which is given here is that of the 17 year

old male (EAR for energy: 2755 KcaVd. 0.3 x 2.755 = 0.83 mg/d). The EAR for a

25 year old female (1940) would therefore be 0.48 mg/d, so the meal would yield

75.9% of her EAR . The EARs for the 2 8 year olds must also be adjusted accordingly

(0.59 (M) and 0.52(F), so that 0.44 = 74.% and 84.6% respectively).

(Removal of AP virtually insignificant.)

B2 3. Table 1.1 on p. 96. The EAR given is for males 1150+. Those for females and young children

are lower, so that the contribution from this meal to their EARs for B: would be

correspondingly higher:

25 year old F: EAR 0.9 mg/d: Therefore 0.28 mg = 31%

8 year old M/F: EAR 0.8 mg/d: Therefore 0.28 mg = 35%

(Removal of AP virtually insignificant).

Niacin. 4. Table 11. 1 on p. 100. EAR's expressed as mg/1000 Kcal. It is 5.5 mg/1000 Kcal for the

whole population. The EAR given here is for a 17 year old male (5.5 x 2.755 = 15.2).

For 25 year old female (i940) it would be 10.7 mg/d: 6.78 mg = 62.7%

For 8 year old boy (1970) it would be 10.8 mg/d: 6.78 mg= 62.7%

For 8 year old girl (1740) it would be 9.6 mg/d: 6.78 mg = 70.6%

(Removal of AP is virtually insignificant).


Ca 5. Table 22.3 on p. 141. EAR given is for 17 year old male.

25 year old F: 524: 192 = 36.5% EAR

8 year old M/F: 425: 192 = 45% EAR (without AP = 41.9%)

Fe. 6. Table 28.2 on p. 163; EAR given is for 17 year old male.

25 year old F: 11.4*: 4.07 = 35.7% EAR

8 year old M/F: 6.7: 4.07 = 60.7% EAR (without AP = 51.5%).

*But see nn at on p. 163

TABLE 14 US: 1989 P VI/15

                       CHEESEBURGER        FF(R)              AP                 TOTALS           

           EAR mg/d     mg       %        mg       %        mg       %        mg       %      % EAR   
                               USRDA             USRDA             USRDA             USRDA            

VITAMIN C     25       2.15      4       8.16      15      11.4      20     21.35      39      85.4   

 THIAMIN      .83      0.29      20      0.14      10      0.06      4       0.49      34       59    

RIBOFLAVIN   1.00      0.21      15       0        -       002       -       0.23      15       23    

  NIACIN      15       3.86      20      1.84      10      0.32      -       6.02      30       40    

    Ca        750     198.51     20      9.93      -      10.65      -      219.09     20       29    

    FE        8.7      2.3       15      0.52      2       0.71      4       3.53      21      40.6   

Notes: 1. This meal gave 930 Kcal (Table 4);

The UK meal for the same year (Table 1) gave 895 Kcal.

It is therefore likely that the UK meal would yield similar values for V or M.

2. The 1993 UK meal (Table 2) would yield higher values for most of these nutrients

because FF (M) was used instead of FP (R).

3. The EARs given are as for Table 13 (see the on. thereto).

Recalculation of the figures given in this table for the 25 year old female and the two

8 year olds gives the following results (EARs in mg/d).

Vitamin C: 25/F (25): 85.4%

*boy and girl 8/b and g* (20): 106%

B1: 25/F (0.58): 84.5%

8/b (0.59): 83%

8/g (0.52): 94%

B2: 25/F (0.9): 25.5%

8b/g (0.8): 28.8%

Niacin: 25/F (10.7): 56%

8/b (10.8): 55.7%

8/g ( 9 6): 62.7%

Ca: 25/F (525): 41.7%

8b/g (425): 51.6%

Fe: 25/F (11.4): 30.9%

8b/g( 6.7): 52.7%

4. % of EARs are > % of RNIs because RNIs > EARs.

4.1 Recalculation of Vitamin C values using RNIs instead of EARs.

Table 1.4 of COMA 41 (p.xxii) gives the following RNIs:

17 year old male }

} : 40mg/d

25 year old female }

8 year old boy and girl : 30 mg/d

Thus Table (14! gives the following results in % RNI:

17M/25F: 53%

8/b & g: 71%

Table 13 (1987) gives:

17M/25F: 38.6%

8/b & g: 51.4%

4.2 B1: Table 9.1 on p.91 of COMA41 gives RNIs in mg/1000 Kcal.

Using the same formula as in n.2 to table 13, ante, Tables

13 and 14 give the following %s of RNI (mg/d):

Table 13

17/M (1.1): 40%

25/F (0.78): 56.4%

8/b (0.79): 55~7%

8/g (0.69): 63.8%

Table 14

17/M: 44.5%

25/F: 62.8%

8/b: 62%

8/g: 71%

4.3 B2: Table 10.l on p.96 gives RNIs in mg/d. Therefore:

Table 13

17/M (1.3): 21.5%

25/F (1.1): 25.5%

8/b&g (1.0): 28%

Table 14

17/M: 17.7%

25/F: 20.9%

8/b&g: 23%

4.4 Niacin: COMA 41 Table 11.1 on p.l00: RNIs in mg/1000 Kcal.

Same formula as in note 4 to Table 13, ante, to give RNIs in (mg/d):

Table 13

17/M (18.2): 37.25%

25/F (12.8): 52.9%

8/b: (13.0): 52%

8/g: (11.5): 58.9%

Table 14

17/M: 33%

25/F: 47%

8/b: 46%

8/g: 52%

4.5 Calcium: COMA41 Table 22.3 on p.141: RNIs in mg/d. Therefore:

Table 13

17/M (1000): 19.2%

25/F ( 700): 27%

81b&g: ( 550): 34.9%

Table 14

17/M: 21.9%

25/F: 31.3%

8/b&g: 39.8%

4.6 Iron COMA 41 Table 28.2 on p. 163. RNIs in (mg/d), Therefore:

Table 13

17/M (1 1.3): 36%

25/F (14.8): 27.5%

81b&g (8.7): 46.8%

Table 14

17/M: 31%

25/F: 23.9%

8/b&g: 40.6%

4.5 Comment .

(1) The USRDAs are obviously significantly higher then the COMA EARs.

This may be because they are closer to RNIs (which, in COMA 41, are

consistently higher than the EARs)*.

*see note 4 to Table 14, ante.

(2) EARs, however, may be the better criterion, because they are an average,

rather than an umbrella: it would not be right to answer the q: Is McD's

food low in V and M?, by reference to the maximum and minimum

requirements within a group. The right q. is:

Is the nutrient content of the meal sufficient to constitute a valuable

proportion of the average person's daily requirements for those nutrients?

In the result,

however, this

probably does not

matter see pare.

4.6, post.


ie missing from

the McD's Charts

198793 (3) The 'missing' vitamins:

A : already explained

( B6: readily available from protein,

( inc. meat, fish and egg sources

Both in ( (COMA 41: 12.2 and P W4/11)

As to ) McD's (

these, { food: { B12: readily available from protein,

see (4),) see eg ( inc. meat, fish and egg sources

post. ) P VI/2/9 IJ ( etc

(also potassium)( (COMA 13.1.2: P W4/11)

( (but not plants)

D : Not readily available from many

dietary sources: main

requirement is sunlight

(COMA 18.2.2)

E : PUFA intakes determine E

requirements. Therefore not

poss. to set DRVs RNIs or

EARs, etc. (COMA 19.4.1).

Therefore figs wd. be meaningless.

(4) As to B6 and B12:

(i) B6.

Table 12.1 on p.103 of COMA 41

gives EARs (and RNIs) expressed

as mg/g protein which, to me at

least, is unhelpful!

Table 1.4 on p.xxii give RNIs

expressed as mg/d related to protein

providing 14.7% of EAR for energy

which is not much better!

However, the relevant RNIs are as follows:

17 yr old male: 1.5 mg/d

25 yr old female: 1.2 mg/d

8 yr old boy/girl: 1.0 mg/d

P VI/2/9 Id (1985) gives the following

values for B6 in mg/serving:

Cheeseburger: 0.04

FF(R) 0.33

AP: 0.02 (Coke:0)

Total: 0. 39

If those values can legitimately be compared with the RNIs given in

Table 1 .4 of COMA 41, then the results are:

17 yr old male: 26% RNI

25 yr old female: 32.5%

8 yr old b/g : 39%

(ii) B12

Table 13.1 on p.107 of COMA 41 gives EARs as mg/d:

17 yr old male }

:}1.25 micro g/d

25 yr old female }

8 yr old big : 0.8 micro g/d

P VI/2/9 I gives, for a Cheeseburger (FF,AP and coke

irrelevant: no B12 in plants):

0.8 mg

This gives, as % of EARs:

17/M (1.5)} 17 yr old m. }

25/F (1.5)} = 53% 25 yr old f. }: 64%

8/b&g(1.0) = 80% 8 yr old big: 100%

(5) The only 'missing' mineral of any importance is potassium.

COMA 41 does not five any EARs for K.

But Table 26.1 on p.157 gives RNIs in mg/d:

17 yr old m : 3500

25 yr old f :

8 yr old b/g: 2000

Pink VI/2/I,J and L give the following values (in mg)

Cheeseburger : 153

FF(R) : 602

AP : 52

Coke : 3

Total : 810 mg

This gives, as % of RNIs:

17 yr old m. )

25 yr old f. ) 23%

8 yr old b/g: 40.5%

4.6 Conclusion

On these figures, the 'food' could not conceivably be said to be 'low' in any of the more important vitamins or minerals (in so far as they are obtainable from food at all). On the contrary, for some of them (in particular, vit.C, which may have a special significance in relation to cancer & CHD), it is conspicuously high. And this is so whether the food's contribution of each nutrient is measured as a % of EAR or of RNI: see the Summary Tables, post.



          C         B1         B2        B6        B12      Niacin       Ca        Fe         K      

 %*    EAR   RNI  EAR   RNI   EAR   RNI   EAR  RNI   EAR   RNI   EAR  RNI   EAR   RNI   EAR   RNI  EAR   RNI  

17/M   62    39    53   40    28    22     -    26   64    53    44    37   26    19    47    36    -    23   

25/F   62    39    76   56    31    26     -    33   64    53    63    53   37    27    36    28    -    23   

 8/b   77    51    75   56    35    28     -    30   100   80    63    52   45    35    61    47    -    41   

 8/g   77    51    85   64    35    28     -    39   100   80    71    59   45    35    61    47    -    41   

* %s rounded up/down

Summary Table I: Results from Table 13 (1987); with those for B6, Bl2 and K based on P VI/2 (1985)

Notes: 1 EARs for B6 and K not given by COMA.

2 % RNI uncertain n because of mode of expression of RNI by COMA


              C              B1             B2           Niacin           Ca             Fe       

  %*      EAR     RNI     EAR     RNI     EAR     RNI     EAR     RNI     EAR     RNI     EAR     RNI   

 17/M     86      53      59      45      23      18      40      33      29      22      41      31    

 25/F     86      53      85      63      26      21      56      47      42      31      31      24    

  8/b     106     71      83      62      29      23      56      46      52      40      53      41    

  8/g     106     71      94      71      29      23      63      52      52      40      53      41    

* %s rounded up/down

Summary Table II: Results from Table 14 (1989); Without B., Bl2, and K (because no data more recent than

for Table 15; i.e. treated as constant).


VIII 1. The first q was:

Is the food (very unhealthy because it is) high in fat, sugar animal products and salt (sodium) and low in fibre, vitamins and minerals?

2. That q. has now been examined in detail. The answer to it must be:


3. This applies both to the UK and the US . And, because of the broad

uniformity of McD's food throughout the world, the same

conclusion can safely be drawn for the whole world. In fact, for most

people, the meal is remarkably wellbalanced from a nutritional p.o.v.

4. Nevertheless, it might be said,

"Ah yes; but for some people at some ages, the content of, eg, saturated fat is so high that, if the same or a similar meal is eaten repeatedly over a period of time, such people will be endangering their health."

5. There are two ways of approaching that question:

(1) Take Table 1, with the 8 yr old as its consumer; and assume

she eats (or is made to eat) the AP along with all the rest:

(i) Her DRVs (ex COMA) for FAT are:

*We assume she TF: 35% of her EAR for energy/d

doesn't drink SF: 11% of her EAR for " *


COMA 41, xx, (ii) The meal gives her:

Table 1.2

TF: 22.5%, leaving (only) 12.5% for the rest of the day.

SF : 9.8%, leaving (only) 1.2% for the rest of the day.

(iii) But the same meal gives her:

(a) plenty of fibre: Table 11: and

(b) very substantial proportions of her average

daily requirements for Vs and Ms, in particular:

C, B1, B12, Niacin, Ca and Fe. :

Summary Tables I and II

% EARs % RNIs

C : 106% (II) 71%

B1 : 94% (II) 71%

Bee : 100% (I) 80%

Niacin: 63% (II) 52%

Ca : 52% (II) 40%

Fe: 53% (II) 41%

(iv) Approaching the q. in this way, the answer may still be

'NO', because, as will be seen later on, the quantities

of beneficial nutrients in p'lar C, which are

consumed at the same time as the SF may well mean

that the malign effects (if any) of the SF are neutralised.

(v) Another important consequence of this approach is that

it bears very powerfully on the further q:

"Do McD's know that their food is very unhealthy?"

(2) But there is another approach: this is to try to answer the

further qq. which this q. begs:

(i) How often must one eat such a meal in order to give

rise to any significant health risk?

(ii) How often, in practice/reality do people eat such meals?

(3) That approach foreshadows consideration of the next part

of J's meaning: see following.


J. Mng. part (2) (i)

IX 1. The q. is:

"Is McD's food very unhealthy because eating it may well make your diet high in fat, sugar, animal products and salt (sodium) and low in fibre, vitamins and minerals"?

2. Some preliminary observations:-

V&M (1) It is clear from the analysis which

I have done of the constituents of

a 'typical' McD's meal that,

however often you eat it, it will

not make your diet low in Vs or MS

*the only - even if you eat little else*.


'deficiency Fibre (2) The only effect that repeated

would be Be consumption might have on the

@ 35% and 29% fibre content of your diet is that,

EAR: this if you ate the meal, say, twice in

increases a day, you might feel disinclined

dramatically to eat anything else; thus

(to 98% and depriving yourself of your full

74%) if you intake of fibre for that day. But

substitute a that is a reductio ad absurdum: in

vanilla the real world, the meal makes a

milkshake for perfectly satisfactory contribution

the coke: but to daily fibre intake.

then you also

raise TF & SF!)

(ditto Ca. )

Sodium (3) The sodium content of the meal is

never more than about ½ the DRV

- (for adults) for a day.

Tables 7-10 (COMA 46, R.2.9 etc.)

So, again, looked at as a matter of

reality, the food is not going to

make your diet high in sodium.

TF (4) Roughly the same is true of the

TF content, except where the 25

yr old female is concerned, who

gets, variously, c.55-60% of her

Tables 1-5 DRV (33% of EAR) from the meal;

and the two 8 yr olds who, if they

eat the AP, are getting about the

same proportion (if they don't eat

the AP, then the proportions come

down significantly, to a range

between 33% (8/b, Table 3A) and

49. 7% (8/g, Table 2) ) . So again,

you are going to find it difficult

to make your diet high in TF by

eating McD's food-unless you have

an appetite for it that exceeds the

bounds of imagination.

SF (5) The SF content of the meal generally

constitutes a higher proportion of the

DRVs (10% for adults, 11% for children)

than the TF content: from just under ½

(17/M: Tables 3A and 4) to nearly 90%

(8/g: Table 1, with AP) .

It follows that, if there is a danger to

* because health* in exceeding the DRVs for SF

of the link over a period of time regardless of the

with CHD. other constituents of the diet during

that time (which is by no means 100%

clear, on the evidence), then all but

the 17 yr old male should probably

refrain from eating such a meal more than

one a day for any period of time which is

long enough to allow the food to become

"a substantial or dominant part of

the diet"

Crawford: 269: 31: 12-15

(6) In reality, that is, of course, another

reductio ad absurdum: more of this later,

under actual frequency.

(7) Finally, by way of introduction to the

related qq. of diet and the frequency of

consumption of McD's food,

(i) In the context of a libel action,

where McD's are accused of selling

food which they know to be very

unhealthy, I am unwilling to

concede the relevance of the

consumer's choices of food from

other sources: that is the

consumer's responsibility (or

his/her parents'), not McD's.

(ii) Thus,

"Do not eat too much of the kind of

food that McD's sells; you may well

make your diet high in fat, etc, if you

do (with adverse consequences for

your health)."

is not defamatory of McD's.

(iii) Whereas,

"Do not eat McD's food; it may

well make your diet [etc, as

above] . "

plainly is.

(iv) Here, the allegation is of the second

(defamatory) type:

"Eating McD's food may well

make your diet high in fat, etc"

(v) Suppose, then, a person who eats the

'typical' McD's meal (Table 1 ff.) for

lunch twice a week: in itself, harmless

(indeed, probably beneficial) .

(vi) But then suppose that that person

also eats, on most days of the week,

- bacon and eggs for breakfast

- fish and chips, sausage and mash,

steak sad kidney pie (etc) for


(vii) Or suppose that he/she eats

- the McD's meal twice a week

- a similar BK meal twice a week

- a KFC meal twice a week

- fish and chips twice a week

- pub sandwiches twice a week

- pizzas twice a week

- Berni Inn steaks twice a week

(= 14 meals out of 21).

(viii) Such a person would, almost certainly,

be overloading on TF, SF and (probably)

Na during that week.

(ix) And if that were the pattern of his diet

(as to the meaning of which,

see later) then it might fairly be

said that his diet was 'unhealthy'.

(x) But what is it in that diet which has

made it unhealthy? Is there a 'prime


(xi) Is it

- the McD's meals?

- the BK meals?

- the fish and chips?

- the pub sandwiches?

- the bacon and eggs?

- and so on.

(xii) The obvious answer is:

individually, none of them;

- in combination, all of them.

(xiii) This means that no single food source

can make a diet 'unhealthy', however

regularly it is eaten; unless it is, on its

own, a very substantial - probably

dominant (see later) - element of the diet.

(xiv) Absent such 'dominance', no single

food source - be it McD's, BK, fish and

chips, pub sandwiches or bacon and

eggs - can logically, for fairly,

be inculpated as the prime because

('maker') of an 'unhealthy' diet.

(xv) To complete the circle: consumption

of McD's food does not make its consumer

eat fish and chips, BKs, pork pies, etc; nor

is the reverse true.

(xvi) Each makes a contribution, and the extent

to which each makes that contribution is

the whole extent of its responsibility for

the overall diet. * (<10% 51%! )

*see, eg,

Dr. Lobstein:


(and Prof.


see later)

3. There are 4 qq:

(1) What is 'diet'?

(2) With what frequency must a person

eat particular categories of food

for them to become "a [substantial

* In fact, on or]* dominant part of the diet"?

the evidence,

"substantial" (3) With what frequency do people eat

should be McD's food?

omitted because

it doesn't matter (4) Is there any significant number of

(and anyway is people for whom McD's food is a

imprecise). substantial or] dominant part of

their diet"?

4. There is, of course, a fifth q. flowing from

(4) above: -

If there is, does it matter?

- But that is the 3rd and last limb

of this enquiry.

Q.(1) 5. What is diet?

(1) No wholly satisfactory definition: but

it is, perhaps, clear what it isn't:

"These arguments (against fast food)

use lack of balance to dramatise a point

that would be seen instantly to be

ludicrous if presented reasonably. No

one in their right mind would live

exclusively on sausages or hamburgers

or meat pies (or sweets or crisps) but the

arguments are presented as if they would. "

Comment BNF May 1987. Professor David

Conning, Director General, British

Nutrition Foundation, (attrib. ) .

P VI/6/13.

(2) If diet has any relevance to this case,

- it is only in relation to the effect which

it may (or may not) have on the incidence

of 3 degenerative diseases: CHD and cancer

of the breast and colon.

(3) Those diseases are called degenerative

because they develop over time. In all 3

cases, they are generally diseases of

later life, often old age, because they

take many years to develop to a stage

where their symptoms show and they

have a discernible effect on health:

thus a cancer may be initiated many

before promotion to tumour starts (if it

does) and symptoms finally appear (if

they do).

(4) No clear relationship has been shown in

this case between the time for which a

particular diet is eaten and the time

when symptoms of disease first appear:

the nearest one gets is some of the

longer prospective cancer studies;

but even then it is impossible to know what

the starting point of the relationship

might have been - if, indeed, there ever

was one.

(5) Notwithstanding these difficulties, it is

obviously not sensible to look at diet,

in the context of degenerative disease,

in terms of weeks or months, or probably

*See Naismith even sever years*. The most that a

252:22:42-8 'snapshot' of that kind might be capable

of telling one is what sort of diet the

person is likely to have been eating in

the past and is likely to continue to eat

over a much longer period of time -

though obviously such inferences require

a good deal of caution.

(6) This is an important consideration,

because (leaving aside all other qq. s)

what the actual figures for frequency of

consumption of McD's food tend to show

is that frequency is at a peak between

the ages of about 16-24 (slightly longer

in the US), whereafter it declines


(7) The final word on this q: what is diet?,

might be left to Prof. Naismith:


Q (2) 6. How often do you have to eat a particular food

for it to become a [substantial or]

dominant part at your diet?

Not easy, but the best answer is probably:

When that kind of food is providing

the majority [or a substantial part]

of your energy requirement for each

day over a long period of time.

6.1 If that is a reasonable approach, then it is

worth looking back at Table 1A: the four

age-categories are getting between 1/3 and 1/2

(respectively) of their EARs for daily energy

(at the lowest levels of EAR) from that meal.

So If they were eating that meal every day

over a substantial period of time, you could,

no doubt, reasonably say that the food

constituted a substantial or dominant part of

their diets.


Q(3) 7. How often do people eat McD's food?

7.1 The ans. to this q. appears to be a bit

different according to whether you look at the

UK or the US figures, at any rate so far as

*1 x pw or the most frequent customers (HUs*) are

more often concerned:

*inc. SHUs: in the US, HUs = 22% of customers*

P. VIA/45/216

and 218

in the UK, HUs = 12% of customers*


(See later)

7.2 P VIA/45 does not, alas, allow one to

calculate precisely how many McD's customers

there were in the USA in 1991.

US 7.3 It is, however, possible to make an educated


7 .4 (1) Assume that the proportion of the US

pop. that visits McD's at least once in

the course of year is significantly

higher that it is in the UK.

(2) This is a reasonable assumption because:

(a) Fast-food, and, in p'lar

hamburgers, have been part of the

American way of life for a long

*Green 46:54-55 time:* and McD's have been in

business in the US since 1955.

(b) McD's are the market leader in both

the QSR sector and the hamburger

*Green: 43:21 group within that sector. * They

have 4096 of the 33% -which

hamburgers have of the QSR

*Green: 43:20 sector sector = 13.2% of QSR*

*AFT, pp 6-7. (UK:11.2%)*.

Y Vl3

(c) The 'density' of McD's rests. per

1000s of pop. is much greater in

the US than it is in the UK:

*P VI A/45/212 US. In 1991, the US pop. was 251.4m*.

In that year, McD's had 8764

*P III/5/135 rests. in the US*.

This means that in 1991,

there was 1 McD's rest. for every

28,686 people in the US, (say

29,000) .

UK. In 1995, the UK pop. was 56.6m.

In that year, McD's had 680 rests.

So 'density' was 1 McD's rest. for

every 83,235 people in the UK

( say, 83,000) .

C. Therefore US density was nearly 3

times UK density.

D. Therefore accessibility to McD's/nos.

of people is very significantly

greater in US than in UK.

(d) Green (who ought to know) said

that he thought the figure was

*46:7 likely to be between 85% and 95%*.

(In the UK, the fig. in 1995 was

about 40% (39.8) : see later.)

7.5 If one therefore makes the (reasonable)

assumption that the proportion of the US

pop. that visited McD's at least once in 1991

was about 90%, the number of people would

be about 226.26m.

7.6 Using that figure, and making the

(reasonable) assumption that the % in each age

- group in the pop. at large was (roughly)

reflected in the 'McD's visitors' population,

one can arrive at an estimate of the average

frequency with which each age-group visited

McD's in the US during 1991.

See Table 17, over, in which the figures

in cots. 1,2,3 and 5 are taken from

P VI A/45/212.

TABLE 17: Average frequency by age-group: US 1991

Customer base: 226.26m

            1            2             3            4             5            6             7       

        AGE GROUP    NUMBER IN     % US POP     NUMBER OF       NO OF        NO. OF      FREQUENCY   
                      US POP.                     McD's       VISITS TO    VISITS PER   : 1x EVERY   
                        (m.)                    CUSTOMERS    McD'5 (m.)     CAPUT pa     .....DAYS   

  1        0- 7         29.6         11.8          26.7         520.9         19.5       18.7 (19)   

  2        8-13         21.4          8.5         19.2         ~352.1         18.3       19.9 (20)   

  3       14-17         13.5          5.4          12.2         323.1         26.5       13.8 (14)   

  4       18-19         7.7           3.0          6.8          217.0         31.9       11.4 (11)   

  5       20-24         18.9          7.5         16.9-         559.5         33.1       11.02 (11)  

  6       25-34         42.7         17.0          38.5        1114.1         28.9       12.6 (13)   

  7       35-44         38.3         15.2          34.4         911.5         26.5       13.8 (14)   

  8       45-54         26.4         10.5          23.8         410.0         17.2       21.2 (21)   

  9        55+          52.8         21.0          47.5         414.8         8.7        41.9 (42)   


1: The figs in Col.4 are the Col 3 %s of 226.26 m.

2. Col. 6 represents Col. 5 divided by Col. 4.

3. Col. 7 represents 365 divided by Col. 6

4. Col. 4 totals only 226 m because of rounding up/down.

5. The % of 0-13s visiting McD's in a year might be higher than shown in Col. 4, simply because of McD's popularity with families: if so, their average frequencies (Col. 7) would be lower.

7.7 To get an accurate picture of actual frequency

by age-group, you need to know how many

people within each age-group visited with what

frequency. This can be done for the UK

(see later), but not for the US.

7.8 One can go a little further, however, with the

HUs (inc. SHUs) in the US.

7.9 P VI A/45/216 and 218: HUs totalled 22% of

McD's customers in 1991.

7.10 If McD's customers totalled 226.26m., then HUs

numbered 49.8m.

7.11 P VI A/45/212: The total number of

visits was 4822.9m., of which 72%

*P VI A/45/216 were contributed by HUs* = 3472.5m visits.

7.12 Therefore, the average frequency for HUs

was 69.7 times in 1991 1.3 x pw or

1 x every 5.2 days.

7.13 Unfortunately, a split between HUs (1-3 x

pw) and SHUs (4+ x pw) is impossible to

achieve. The reason is that the final colt on

P VIA/45/216 must be wrong: if SHUs visit

more often than HUs, then, if the no. of SHUs

*11% in each and HUs is the same*, SHUs would be

case expected to generate substantially more visits

* 23% and 49% than the HUs, not < ½!*

7.13.1 Nor do the figures work if you assume that

the two 11%s are correct, but that the 23% and

the 49% are the wrong way round: if you

assume, for example, that SHUs average 5 x

pw,then each SHU would be averaging 260

visits pa.

- 49% of total visits = 2363.22, which would

need 9.08m SHUs at 260 visits each.

- 9.08m = 11% of only 82.6m total no.

of customers (<2 x the UK total!).

7.13.2 5 times a week is about once every

day-and-a-half (1.4) .

If one assume that SHUs were about 2% (not

11%) of 226.26m, they'd number 4.53m.

If they generated 23% of the visits

(1109.27m), then they'd be averaging about

245 visits each once every 1.5 days (which

seems reasonable).

7.13.3 If, therefore, the HUs are about 20% (not

*Assumed at 11%) of the customers* they'd number 42.25m.

226.26m Since they generate 49% of the visits

(2363.22m), their average annual frequency

would be about once every 6 ½ days, ie slightly

more often than once a week (which also

seems reasonable).

7.13.4 So if the total no. of HUs (inc. SHUs) was

about 47m., this means that the rest of the

customers (about 179m) were visiting less

often than once a week.

7.13.5 These 'calculations' are obviousb somewhat

speculative; but since the broad picture they

give is consistent with the much more precise

picture that can be drawn for the UK (see

later), they may be worth something.

7.14 The only other thing worth noting is that if

the figs. in colt 7 of Table 17 are even

broadly accurate, they tend to suggest that

most of the HUs (inc. SHUs) are likely to be

found amongst the 18-24s, with some in the

35-44s and some in the 14-17s.

7.15 This accords with the UK picture (next),

except that the graph of declining use with

age from 24 onwards is probably less steep in

the US than it is in the UK.

7.16 One can also notice from Table 17 that the

only age-group whose average frequency was

more than about once a fortnight were the


UK: 7.17 Here we have some (relatively) harder figs.:

OMNIMAS 1995 (exAF/TN) (explain how it works)

7.18 These figs. give the following results:

(1) Total who ate at McD's at least once in 1995:

22,511,000 (= 39.8% of UK pop. of 56.6m)

(2) Of those 22.5m:


Category 1           Every day            0                    0                     

Category 2           Nearly every day     55,000               0.24}                 

Category 3           Several times per    477,000              2.1 }                 

Category 4           Once a week          2,139,000            9.5                   

                     Total                2,671,000            11.84 (say 12%)       

These are the HUs of the UK (no HU/SHU split).

(3) Table 18, over, gives the above figs. split by age-group and

gender (for categories 2, 3 and 4).

TABLE 18: Frequency by age and sex: UK: 1995


2. = Nearly every day

3. = Several times a week

4. = Once a week

Cate 16-18 19-2   M    F   25-34  M     F   35-4   M    F   45-54  M     F   55-6   M    F   Total 
gory        4   16-24 16-2                   4                                5+               s   

 2     0    38   38    0     0    0     0    8     8    0     6    0     6    3     0    3    55   

 3    242   83  166   160   79   55    25   39    27   12    28   22    6     5    5     0    476  

 4   459   772  727   504  481   175  306   255  123   131  128    67   61   45    21   24   2140  

Tota  701  893   931  664   560  230   331  302   158  143   162   89   73    53   26    27  2671  

(000   1594                                                                                       

Notes: 1. All figures in OOOs.

2. 50% of all in category 3 were 16-18. -

3. The 38,000 19-24 males were 69% of the total in category 2.

4. 60% of all HUs were 16-24.

5. 81.% of all EllJs were 16-34.

6. 86% of the 25-34s were in category 4

7. 68% of all those in categories 2 and 3 were 16-24; of those, 56% were M and 44% were F.

8. See Table 19 (over) for graphic representation of usage by age: all HU's

and Table 20 (over) for graphic representation of usage by age: HUs in categories 2 and 3 ('SHU's?).

TABLE 19 Heavy usage by age: UK 1995 (categones 2, 3 and 4)

TABLE 20 'Super' heavy usage by age: UK 1995 (categories 2 & 3)

7.19 This analysis allows some important

conclusions to be drawn (remembering always

*market that the figs. are not precise* and are more

research: valuable as showing general trends and

sample of patterns than exact nos. ):

8204 people

(1) Total no. of customers who are 'heavy

users' is relatively small:

2.7m/22. Sm (c.12%)

(2) Of those 2.7m, 2.14m (or about 80%) are

in category 4: ie, they eat at McD's once

a week, but no more often than that .

So one can forget them.

(3) Of the remaining 531,000 (merely) - and

now one is approaching statistical

insignificance (531,000 = 2.4% of all

customers) - a mere 55,000 (0.24%) are in

category 2: nearly every day.

(4) Of that 55,000, 38,000 (69%) were males

of 19-24, whose EAR for energy, at the

lowest level, is on average 2,550

*COMA 41 xix Kcal/d*: at a more realistic level for

Table 1.1: that age group (PAL 1.7), their EAR

19-50 would be in the region of 3000 Kcal/d.

(5) Of the 531,000 in categories 2 and 3,

363,000 are aged 16-24 (68%); and 242,000

(46%3 are aged 16-18

(M:EAR: 2755 Kcal/d minimum)

(F: EAR: 2110 Kcal/d minimum)

(6) As Tables 19 and 20 show, particularly

the latter, heavy McD's usage is largely

the preserve of the 16-24s (most of them

* cf. Hawkes: (56%) males)*, after which comparatively

41:13:38-43 tender (and energetic) age, interest in

* does not McD's as an habitual* weekly source of

inc. 1 x low food declines rapidly: the number of

25-34s in categories 2 and 3 is just over

1/5th of the number of 16-24s in those

categories; whilst, from 35 onwards, the

numbers decline to insignificance.

(7) Prof. Conning's aphorism (P VI/6/13)

is thus shown to be well-judged:

- Not very many people in the UK

are using McD's food as a 'staple'!

- Those that are are of an age when

it doesn't matter in the least.

- The age-range is very narrow 16-24

- Beyond that age the frequency

(once a week or less) is, for any

significant no. of people,


Note: The above conclusions as to frequency and

age can be confirmed by a different route.

(i) OMNIMAS 1995 shows, that, of the total

no. of customers in 1995 (22.5m):

16 - 24s = 6.344m = 28%

25 - 44s = 10.790m = 48%

45 - 65+s = 5.730m = 2496

(ii) p.1 of AFI in Y V/3 shows- that, in

*ie 1993, the % of visits* by age group was:


of sales

16 - 24: 47%

25 - 44: 43%

45 - 65+: 11% (=101%)

(iii) Thus (assuming the figs., in %s, to be

roughly the same in 1993 and 1995):

28% of the customers (16-24) yielded 47% of the visits

48% " " " (25-44) " only 43% " " "

and 24% " " " (45-65+) " " 11% " " "

(iv) This, too, emphasises the importance of

the 16-24s and the fairly rapid decline

of usage with age.

Therefore (8) Even making the assumption that eating McD's

food 'nearly every day; or even 'several times

a week' is a bad idea (which, on the evidence

of part 1 of this enquiry, is a false


(a) the small no. of people actually doing


(b) the ages of those people, and

(c) the short length of time for which they

are doing it

all mean that McD's food Poses no threat

whatever to the health of the adult

*And: Energy (16-65+) population in this country *




Mins. . ?

(9) For the generality of McD's customers, who eat

there not > 1 x pw, the case is put beyond

doubt by some conclusions demonstrated in

XX of Prof. Crawford on his return

(25.6.96)* I used the analyses done by his

*269: 64 - 7 dept. which are behind his latest statement.

See Table 6 I took the McD's meal consisting of

ante. hamburger, FF(M) and coke: this gave a total

SF content of 6.32g (higher than the other

McD's meal).

I then took a 20 yr old male with an EAR

(minimum) of 2550 Kcal/d.

If his DRV for SF is 10% of 2550, then he can have

255 Kcal from SF/d 9 = 28.3 g/d x 7= 198.3 g/w

whereas 6.32g x 7= 44.24 g/w

This means that even if he ate this meal

every day for a week, McD's would be

contributing < ¼ (22.3%) of his SF 'load' for

the week! And if he ate it 1 x that week:

1/32 or 3.2%!

"Substantial" ?

"Dominant" ?

(TF: DRV 30% of 2550 Kcal = 765 = 85g.

This meal: 32g = 38% of DRV)

(85 x 7 = 595; 32 = 1/19 or 5.4%

of week's TF load!).

7.20 Children in the UK


(i) Of the 55,000 customers in category 2

(nearly every day : 7.18, ante), 40,000

had children.

(ii) But this does not mean that 40,000

customers took their children to McD's

nearly every day!

(iii) This is easy to see: 38,000 of the 55,000

in cat. 2 were males arced 19-24, leaving

8,000 35 - 44s, all M

6,000 45 - 54s, all F

3,000 55+s, all F = 17,000,

with no cat. 2s at all in the

25 - 34 age group and no F in the

19-24 age group.

(iv) Thus, even if all those 17,000 35 - 55+s

had children (unlikely), that still means

that 23,000 of the 38,000 19-24 yr old

males had children (if < 17,000 of the

older people had children, then > 23,000

of the 19-24 Ms must have done).

(v) Does one envisage, as a matter of

reality, that 23,000 (or more) 19-24 yr

old young men were taking their

children to McD's, on their own, nearly

every day?

(vi) Obviously not. What one envisages is a

young man of say, 20 or 21, who regularly

goes to McD's for his breakfast or his lunch

during the working week. He has a wife

and a small child at home (maybe 2, if he's

23 or 24). They all go to McD's, as a family,

from time to time (the wife might be,

for example, in cat.4 or lower).

(vii) The same sort of realistic approach can

be (should be) - used for category 3

(several times per week).

(viii) Of the 477,000 customers in cat. 3,

227,000 (47.6%) had children.

(ix) At the same time, of those 477,000,

242,000 were aged 16-18

and 83,000 were aged 19-24

(25+s: 152,000)

(x) Qq:

- how many of the 16 -18s are

likely to have had children at all?


whom, - how many of the 234,000 19+s*

obviously, were likely to be to be taking

most of the their children several times a

227,000 with week.


must be (xi) Beyond categories 2 and 3, no

attrib. reason to enquire: children

visiting McD's once a week or less often

are of no concern at all.

7.21. Children in the US

(i) If, as suggested, the actual numbers

of children visiting McD's in 1991 (or in

any other year) was greater than

in Table 17, then, though the figs. given

in that table are for average frequency,

the chance that there were any significant

nos. of children visiting more than once

a week must be very small.

(ii) If so (and, probably, even if not,

limits ! ), then in the US, as in the UK,

one can, by the application of common

sense and experience, forget about

McD's so far as the health of children


(iii) Thus if one goes back to the two 8 yr

olds in Table 4 (US: 1989/90), the fact

that they are getting, respectively 18. 5%

and 21% of their EARs for energy/d from

the TF content of that meal, or 6.9% and

7.8% from its SF content,is immaterial to

the q. whether

"eating McD's food may well make your

(children's) diet high in fat...".

8. Social Class

8.1 OMNIMAS 1995:

(1) Of McD's total no. of customers (22.511m. )

ABCIs = 10.038m = 44.6% of McD's total

C2DEs = 12.474m = 55.4% of " "

(2) Of the total eating-out population (EOP) (44.08m)

ABCIs = 18.412m = 41.8%

C2DEs = 25.669m = 58.2%

Therefore (3) ABCIs form a greater %, and C2DEs

a smaller %, of McD's customers than they

do, respectively, of the total EOP.

(4) Moreover

Of the 18.412m. ABCIs who ate out in 1995,

10.038m = 54.5% used McD's at least lx.

Whereas, of the 25.669m. C2DEs

who ate out in 1995,

12.474m = only 48.6% used McD's at least 1x.

(5) So McD's is, proportionately, more

popular with the ABCI eaters-out than it

is with the C2DEs.

(6) Heavy use amongst ABCls and C2DEs who use McD's.


So, again, there is very little to choose between the two groups

when it comes to the higher frequencies.

(7) The only area in which C2DEs out --score ABCls is in actual numbers that used

McD's in 1995: 12.474m v. 10.038m. But this may only reflect the fact (as the total

EoP numbers would suggest) that C2DEs outnumber the ABCls in the pop. as a


(8) So any suggestion that McD's is somehow the preserve of the undereducated, underpaid or underprivileged is completely exploded by these figures; and the conclusions sought be drawn by Prof. Crawford are, so far as McD's contribution to the diets of the population (by social class) is concerned, shown to be without foundation.

J. Mng. part (2)(ii)

X 1. The q. is :

"If eating McD's food may well make your diet

high in fat, etc., and low in fibre, etc.,

does that carry with it the very real risk that

you will suffer cancer of the breast or bowel or

heart disease as a result?"

2. Preliminary.

2.1 If the first 2 parts of this enquiry

- the content of the food and

- the frequency with which it is eaten

lead, as they do, to the conclusion that the

first part of the question - the premise - is

unsustainable, then it is tempting to suggest

that the second part is a sterile enquiry:-

If there is no real likelihood that

consumption of the food is going to make

people's diets high in fat, etc., and low

in fibre, etc., then the q. what the#

effect on their health might be if there

were such a likelihood, is, whilst

interesting, immaterial to the issue.

2.2 This is a real temptation, because, although

there has been a great deal of evidence about

the r/ship between diet and health, most

. . obviously cancer of the breast and colon,

nevertheless, the combined effect of parts 1

and 2 of this enquiry is really so strong that

a further enquiry into the r/ship between

consumption of McD's food and health is very

difficult to justify

- the more so when one considers that

McD's, as Pffs, don't actually have to

prove anything.

2.3 Not but what, I will, out of a proper sense of

caution, summarise what I take to be the

effect of the evidence in this part of the

case and try to produce a sensible answer to

the q.

2.4 In making that attempt, I shall concentrate on

the evidence of only four of the witnesses:

Prof. Naismith: nutrition.

Dr. Arnott : cancer.

Prof. Crawford: blood chemistry.

Prof. Campbell: nutritional chemistry

(Prof Wheelock has been largely incorporated

in parts 1 and 2).

2.5 These are what I call 'proper' experts:

they have

(i) the necessary academic and

professional qualifications; and

(ii) the necessary experience in their respective fields.

2.6 Where so difficult and important a subject as

the relationship (if any) between diet and

cancer is concerned, or the degree of risk of

heart disease generated by diet, no less than

a 'proper' expert is worth attention.

2.7 Thus I shall ignore, without implying anything

at all about their qualifications to speak

about other matters elsewhere, the following:

*By qualification Barnard : none of the necessary

and experience qualifications* (and anyway

(practice), a wholly unbalanced in his

psychiatrist. presentation of the relevant

* As to this, see material*).

his XX (whole)

on Days 34-36.

Cox : no qualifications (if, indeed,

he was giving e. about

nutrition at all - seemed to

have more to say about

marketing) .

Cannon : ditto: no better placed than

any other intelligent laymen

to deduce - as J. must do -

the answers (if any) from the

work of the true experts.

Bronhy : Somewhat different, in

that she does work in

nutrition. But it turned out

her work was more

educational than scientific

and that she did not propose

herself as an expert in any of

the relevant disciplines.

2.7.1 A word in passing about the assertion* that

*DM: all or most of the Pffs' witnesses on this

topic (and others) are in some way

'compromised' by an association with McD's or

the food industry, whereas the Ds' witnesses

are all completely independent, having, as it

were, descended from Olympus to explain to

the Court why McD's food is so unhealthy.

2.7.2 Pffs' witnesses

Wheelock: Professor of Food Science,

retained by McD's to advise

them on nutrition.

Naismith: Emeritus Professor of Nutrition

at KCL (etc. ): no connection

with McD's.

Arnott: Consultant in Radiotherapy

and Oncology at Bartis (etc.): no

connection with McD's.

2.7.3 Defts' witnesses

Barnard: Consultant to PETA (animals) and

* 37:62:39-60 an associate of both Cox* and

*256:20: 6-9 Campbell*.

Cox: Correspondent for Campbell in this

*Campbell (1): country* and an associate of

PB IC/H/3 Barnard (see above), both of

whom are cited in Cox's book,

Encyclopaedia of Vegetarian Living,

whose 'credo' (p. 1 ) is the refusal

to eat animals.

*256:6:3-14 Campbell: Associate of Crawford* (and

Barnard and Cox: see above); also

co-Chairman of Cannon's

organisation's Diet and Cancer

*Cannon (2) Project. *


Crawford: Associate of Campbell (see above).

Cannon: Associate of Campbell (see above); also,

via the London Food

Commission/ National Food

Alliance, of Lobstein

*55:49:18-60 (and Dibb, Millstone). *

(possibly also


2 . 7 .4 Not that any of this is terribly sinister.

Simply that it makes a nonsense of DM's

adulation of his witnesses' supposed

'independence' (and of his silly, and

offensive, assertion that the Pffs' witnesses

*More later are 'tainted')*. In fact, one has a suspicion,

under Malice: grounded both on their mutual associations

it is assumed and on the nature of their evidence, that the

that he spoke Ds' witnesses may be part of a dedicated

for HS, too. 'anti-animal-fat' clique or coterie

(motivated, in some cases - Cox, possibly

Barnard, - by a concern for animals rather

than human health) which saw this trial as a

convenient platform for the promulgation of

its views. Which is not to say that their

views are, for this reason alone, to be

disregarded (they are wrong because the -

evidence shows them to be wrong); simply

that their supposed status as wholly

independent Olympians may not be entirely


3. Going back to the meaning -

What is a "very real risk"?

3.1 A "real risk" is one that has been

demonstrated or established. It can be

observed to have real consequences.

3.2 A "very real risk" describes the degree of the

risk: deny its existence at your peril!

3.3 So, perhaps, "very + real" = "serious" or "strong".

3 .4 Thus -

1933: The Nazis in Germany may present

a threat to European stability.

1938: The Nazis are a real threat to peace in Europe.

1940: The Nazis are a very real threat to

continued existence of this country.

3.5 In addition, two kinds of 'risk' must be


(1) If there is more than a fanciful

possibility that, eg, diet will in due

course be found to have a role in the

aetiology of cancer, even though that

role has not been established, then, in

one sense, the person who pays no

attention to what he eats is taking a

* = "It may be so. 'risk', viz, the risk that the possibility*

On the other hand, it - or hypothesis* - will turn out to be

may not be so". out to be the fact.

That is not, in this context, a

real risk, still less a very real risk.

(2) A real risk - a fortiori, a very real

risk, - is one which is known to

accompany a particular activity:

- eg, the risk of death or injury

involved in mountaineering or

riding a motorbike without a

crash helmet

- or, closer to home, the risk of

cancer or heart disease

- involved in ~ smoking


(3) Thus a real risk is one which has been

identified, established (demonstrated)

and accepted by all reputable authorities

over a period of time.

- Thus our Govt. is able to compel the

tobacco companies (even the French! ) to

print stark warnings on cigarette


*Qv on RR's Gitanes 'Smoking causes cancer'*

(attached). 'Smoking causes heart disease'*

- This does not mean that everyone who

smokes will get cancer or CHD. But it

does mean that all those that do smoke

run a real risk (perhaps a very real

risk) of doing so

- in greater or less degree, no

doubt, according to their genes,

their weight, their life-style, and so on.

(4) The qq. arising in this case are different for cancer and CHD: (i) For cancer and diet, the q. is, Does the given diet carry with

it a (very) real risk of cancer at all? (ii) For CHD, the q. is, What is the degree of (real)

risk which that diet carries? 4. CHD 4.1 The Pffs' admission: (1) That there is a considerable amount of

evidence of a relationship between a diet

high in saturated fat and sodium, and

(In writing: obesity, high blood pressure and heart

15.12. 93) disease; and

(2) That that relationship is causal in

(RR in Ct) nature.

4.2 Note that this says nothing of diabetes: nor

does the leaflet: nor shall I. It is


4.3 The admission is an admission that there is a

real risk - not a theoretical or hypothetical

one - of suffering CHD (etc) if your diet is

high in SF and Na.

4.4 But it makes no concession as to the degree of

risk; nor as to the relative importance of SF

and Na in creating that risk.

4.5 As to this last q. (SF v Na):

It seems tolerably clear that 'high' Na

intakes do not, for most people, present the

same degree of risk as high SF intakes, at

any rate so far as CHD is concerned (stroke

might be different, but that is outwith this


- See, eg, COMA 46:6.6.8 on p 138.

- and Naismith:

- Hypertension on p.7 of his

*252:21 report*;

- Day 253: 31-2, as to the

effect of lowering systolic blood

pressure by 2 or 3 mg

(misstatement/misprint for 2-3

mm/Hg?) by dietary Na reduction

vs. benefits to be obtained by use

of drugs.

4.6 So far as SF intakes are concerned, the q. is

more complicated:

(1) How much SF?

(2) For how long?

(3) What other factors are/may be

important in increasing/ reducing


4.7 Q. (1) above: how much?

No clear answer. So the 'best bet' is

probably COMA 41 :3.4.18 on p. 49 (1991)

(10% of EAR for energy in Kcal/d); endorsed

by COMA 46(1994), which is, of course,

specific to CVD: R.2.1 on p.1.

4.8 Q. (2) above: for how long?

4.8.1 CHD is, in general, a disease of later life;

which is (obviously) one reason why its

incidence is greater in more affluent

*more accurately: societies (people live longer)*:

more people live

long enough to

get CHD.

*OV/26 (i) WHO Report (1990), p.28*.

(ii) Naismith: 252:54(end)-55:16

57 (ens J)

253: 22-24

(iii COMA 46: pp 42-3:

- Contrast Tables 2.5a and 2.5b

- Take, eg, Males in England:

2.5a (under 65s):

*Total Rate: c. 92/100,000* pop by 1990

52,000 <1/1000 (1087)

2.5b (all ages):

* Total Rate: c. 290/100,000* pop by 1990.

164,000 >1/350 (345)

- This means that once you get past

65, your chances of dying from

CHD increase dramatically. And

this is so for both sexes in all

parts of the UK.

- This is confirmed by Fig. B .3 in

App. B on p.181, which breaks

down the rates in different age

-groups under 65:

Males: 35-44: c. 30/100,000 (1/3333) 1990



45-54: c.160/100,000 (1/625)

55-64: c.500/100,000 (1/200)

- And the rate no doubt increases with age after 65.

4.8.2 What is not clear - nor ever could be, because

individuals vary so much - is the

frequency/amount: years ratio between intake

of, say, SF and the Onset of CHD.

- For example, what accounts for the

*Total 30/100,000* deaths amongst 35-44s?



Vast quantities of SF in early life?

Lack of exercise?


(more later) Lack of fruit and vegetables?

Congenital weaknesses?

etc. etc.

4.8.3 The only conclusion one can safely draw is

that, since the risk of death from CHD

increases sharply with age, whatever role diet

plays in the creation of that risk (and it is

accepted it plays a role), a considerable no.

of years must pass before it has its effect

for the majority of people who eventually

suffer from CHD.

4.8.4 And that is why (amongst other reasons) the

age/frequency figures for McD's customers

are important.

4.8.5 So the ans. to q. (2) is:

no precise estimate can be achieved, but,

since, in general, CHD is a condition of

late development, many years.

*252:22:42-8 4.8.6 Professor Naismith put it like this:*

Q(HS): Consistent advice has been that a

high consumption of sat. fats

increases the risk of heart

disease. Is that not right?

A: That is so, yes. That has been

consistent for probably 30 years.

Not simply high consumption; a diet

that is high in fat consumed over a

life-time is more likely to cause

heart disease than one that is low

in saturated fats.

(emphasis added)

4.9 But the degree of (real) risk is another

matter. This is what q.(3) addresses:

What other factors are/may be important in

increasing/reducing risk?

4.9.1 It is clear that the causes of CHD are

"multifactorial" - through obviously some of

the risk factors are likely to be related in

some cases

e.g. lack of exercise and obesity.

(see later) .

4.9.2 For the full range of possibilities it is

necessary to consult the evidence of Prof.

Naismith who summed the whole thing up at

252 : 22:26-40

- SF is only one of many factors.

4.9.3 The full range, according to Naismith - some

bad, some good (protective: Pj - is:

252: 7(and 23): Smoking (more

important than diet)

7: Genetics

7: Folic acid (P)

7: anti-oxidants (P)

8: stress

*The French 16-18: alcohol(P)*

paradox: 23: fruit and veg (more important

more later. than reducing fat consumption)


37: potassium (P)

253: 16: physical activity (P)

16: obesity.

4 . 9 .4 Thus, assuming the same intake of SF and

the same genetic predisposition, the fat:

person who smokes cigarettes, takes little

exercise and eats few vegetables or fruits is,

if his habit/life-style persists for a long

time, at much greater risk than the thin

person who doesn't smoke, - is physically

*Dr Arnott: has "a good intake of fruit and vex.'!*

254: 6 and 62

4.9.5 An important point about obesity.

If obesity is an important 'risk factor' for

CHD (which it is), and if increasing obesity

in men (2 x) over the last 10 years cannot be

Naismith: attributed to a change in diet,* then the

253:16 'culprit' is likely to be lack of exercise.

4.9.6 This is not to say that fat (whether SF or

PUFA) may not contribute to obesity, or that

obesity is the only deleterious consequence of

a high SF diet (increased serum LDLs, eg) .

But what it illustrates is that reasonable

quantities of fat (inc. SF) do no harm

provided that the rest of the consumer's

life-style (including, but by no means

confined to, his diet) is reasonably well


4.9.7 The French paradox (and the German)

See the composite sheet taken from COMA 46.

4.9.8 This is not a fanciful exercise. However

'crude' the intake figures may be, the

contrast between the intakes of supposedly

'unhealthy' foods and the incidence of CHD

mortality in France and Germany, on the one

hand, and the UK, on the other, is really

very striking (all the experts, inc. Crawford

and Campbell, agreed that, if the figs . were

accurate, the amounts by which French and

German intakes of the 'unhealthy' foods exceed

ours are significant). Nor is the contrast

confined to the figures for intakes. It also

extends (as one would expect, if the figs. for

intakes are broadly accurate)-$o the supposed

indices of risk for CHD: blood cholesterol,

blood pressure and body weight.

4 . 9 . 9 So what is the explanation? No-one can say,

it seems (hence "paradox").

- More fruit and vegetables?

- More wine/beer/alcohol generally?

- Less smoking?

- Less stress?

- Different gene pools?

4.9.10 The important point to be drawn from this is

not that SF is not a 'risk factor' (it is accepted

by everyone that it is), but

(i) that it bears out Prof. Naismith's emphasis on the multifactorial character of the aetiology of CHD; and

(ii) that it illustrates very vividly the dangers of using cross-population studies for anything other than hypothesis - generation .

4.10 Finally, .

4.10.1 Despite McD's rapid expansion in this country and throughout the world over the last 20 years or more, CHD mortality rates have been declining during that time, not only in this country, but in the USA and Australia as well:

COMA 46: Fig 2.6 on p.46

What the reasons for this might be is anybody's guess:

- arlier diagnosis?

- better treatment?

- less smoking?

- more exercise?

- less SF?

- more vegetables?

But it is interesting that in the USA, in particular, where McD's have by far their largest market (proportionately as well as numerically), and where fast-foods and hamburgers in particular, are more firmly entrenched in the way of life than elsewhere, the rate had by 1988 declined to well under 200/100,000 and was very considerably lower than ours.

4.10.2 None of this is to say that 290/100,000

164,000 deaths from CHD in this country in

1990 - or, more particularly, 52,000 amongst

men under 65 and 15,000 (26/100,000)

amongst females under 65 - is anything to be

pleased about - or ignored.

4.10.3 But what it does suggest is that the almost hysterical obsession with fat, and particularly animal fat, which may be seen in some quarters (Barnard, Cox, eg) is s scientifically unjustified - and socially irresponsible: a alarmist.

Much better the dispassionate balanced view of Naismith, Wheelock,

COMA 41 AND 46:

A diet which is high in fat, and particularly

SF, and low in fruit and vegetables does carry with it a real risk that if you persist in such a diet for many years you may get heart disease. Therefore, balance your diet, and your life-style, give up smoking, and you will reduce the risk considerably.

*3. 2-3

+"Serious" is

here used to

connote degree.

In the


sense, any risk

of death from CHD

is serious!

4.10.4 All of which is to say that the degree of risk, though real, and though obviously more than slight, does not warrant the description veer real: for, as suggested earlier*, those words must import a flavour of serious+ danger.

Put another way, it would be sufficient to indicate the degree of risk of CHD which, on the evidence, the 'wrong' kind of diet, in itself, may create simply to describe it as a real risk.

If you then added to diet, all, or some, of:

- smoking

- obesity

- lack of exercise

- stress

you might be justified in describing the risk as very real.

5.0 Cancer

5.1 The q. was:

Does a diet which is high in fat, etc, and low in fibre, etc, carry with it a real risk of cancer of the breast or bowel?

5.2 'Real' emphasised in order to distinguish the

risk in q. from the 'risk' that hypothesis and

theory may mature into accepted fact in the


5.3 The key witness is Dr Arnott; first, because

*the other the study of cancer and its causes are part

part is its of his life's work*; second, because his

treatment opinions are in accordance with all the

authorities whose duty it is to consider such

qq. and report their conclusions to the public in order that the public may be enabled to know what they should do (or not do) in the interests of good health; and, third, because his I impartiality and objectivity cannot be impugned (despite w which,-both HS and DM made the attempt*).

*254 : 6:14 (HS);

254 : 59:41-5

(DM): more later under


5.4 Dr Arnott summarised the state of scientific

knowledge about the relationship between diet

and cancer on numerous occasions, both in

1994 and when he returned in May 1996. The

most comprehensive summary is perhaps that

given on 22.5.96 (Day 254:4:3 -- 5:42),

ending with this:

"What we have seen in all the studies regarding diet a and cancer is inconsistency in the results, and that is what I have tried to say all along. We do not know what the relationship between diet and cancer is. It is certainly not a clear-cut relationship, particularly r regarding cancer of the breast and bowel. If we were expecting to see evidence of a stronger relationship, I think all of the studies would have been more consistent than they have been".

5.4.1 Thus, in Dr Arnott's view, the overall picture

has become even cloudier than it was when he

gave evidence 2 years earlier.

5.5 The views of the national and international authorities:

(separate) 1982: Diet, Nutrition and Cancer, NRC(US): p.5

Then 6 years pass and we find that even that kind of (qualified) confidence seems to have ebbed away:

(own file) 1988: US Surgeon - Gen. 's Report: pp 224-5

(DI/2/58) 1989: UK response to EECis

"Europe against Cancer"

Initiative: Health

Education Authority: pp 18-19; 27

(bar chart)

(O IV/2/26) 1990: FAO/WHO - p 62, 3.3, 3.3.3, 3.3.6

- cf 3.3.5

pp. 90 and 91,

paras 4.1.2 and 4.1.3

1991: COMA 41 3.5-3.5.6, p.52

(PB IA/11/ 1991: Cancer of the Colon and Rectum: National

ref 6: Cancer Institute (US) : pp. 6 and 7

Barnard (2) ) (both pages of text)

5.5.1 The idea that the panels of experts who are

responsible for these reports . and

recommendations are somehow creatures of the

food industry or otherwise too craven to tell

the public what it needs to know for the sake

of its health is self-evidently absurd (as

well as offensive to the experts concerned).

5.6 The key word in all of this is "consistency" (or "inconsistency").

5 . 7. Thus, when Sir Richard Doll first published

his findings on smoking amongst doctors and

lung cancer, people could no doubt say (and

did) that this was only one study, that it was

too soon to tell, and so on. But as the years

have passed, the evidence supporting a

positive relationship has been (virtually) all

one way, with the result that, for some years

now, it has been possible to assert with

confidence that the one is a cause of the

other, even though the precise mechanism of

causation was not known (and the same would

be true of smoking and CHD). This is why,

on the 1-10 scale of risk which Dr. Arnott

*17: 58-9 described in July 1994*, he felt able to put

smoking and lung cancer at the top (10). In

other words, the evidence has been

consistent over a long period of time; with

the result that all responsible scientists

(inc. medical men) feel able to say that

smoking cigarettes in any quantity gives rise

to a real risk of lung cancer.

5.8 But with diet and the risk of cancer of the

breast and bowel, the evidence has been

inconsistent and conflicting. Thus Dr Arnott

gave the following scores on his scale (in

ascending order of 'risk'):

1. Fat and breast cancer.

2. Calorie intake and bowel cancer.

3. Fat and colon cancer.

3. Calorie intake and breast cancer.

4. Plant fibre as a protection (from both

cancers ) .

All those scores were in the 'pale grey' area

of the scale, that is, "meriting continuing

*17: 59:13-15 investigation, but certainly not proven facts"*

(whereas smoking and lung cancer, at 10, was

'black': x is almost certainly the cause of y.)

5.9 The scientific papers which have been studied

during this case simply bear this out. And

that includes Prof. Campbell's China study (of

which more later). The only thing which has

changed since 1994 is that fruit and veg.

might now merit a slightly higher score as a

protective element (more later).

5.10 The general pattern is:

(i) cross-population studies have suggested an association between diet and the 2


(ii) So have some animal studies, and some prospective (cohort) studies; but

(iii) many of the case-control and, in particular, the prospective studies do not support an association.

5.11 All these kinds of studies have their


(i) cross-population studies are too crude:

- they tend to. be based on 'food

disappearance' figures,

- they cannot take account of variations in diet and life-style across the different populations


- their chief value is for hypothesis - generation .

(ii) animal studies are chiefly valuable as a means of testing mechanisms: eg, the effect of high calorie/high fat diets on promoting tumours which have been deliberately induced in pure-bred species which have a known susceptibility to particular carcinogens.

- If they are used as a means of drawing conclusions about the role of diet in human physiology, they are dangerously unreliable.

- Again they are hypothesis-generators

- if this is possible in

animals, may it, or something

like it, be happening in

humans ?

(iii) Case-Control studies may study too few people for too short a period and may be distorted: by variations (or changes) in the diets of the cases, brought about by the mere fact that they are cases.

(iv) Cohort (prospective) studies may study too small a range of dietary intakes (too homogeneous) and, except in the very longest examples, may be too short. Nevertheless, they are probably the most reliable: *0 IV/ 2/26 Wheelock, Arnott, WHO (P62)*, Hill(1995, p.4) + +Behind Arnott (2) and Kinlen (1991, p 464); also Prof. Walker°.

Y V/12

O IV/2/7

° 26:31:4-30

5.12.1 Another problem (upon which Dr Arnott and Prof. Campbell agree) is that it is, in the end, impossible to disentangle the various elements of diet in such a way as to enable one to inculpate any particular element or elements .

5 .12 . 2 Thus there is a debate (which at present is wholly inconclusive) whether, if diet is implicated in either of these cancers,

(a) the 'villains' may be:

- fat

- saturated fat

- total energy intake

- cooking methods

- or something else

entirely; or a combination.

(b) or the 'goodies'

- fibre

- antioxidants (eg Vit C,

Vit E)

- micro-nutrients in fruit and veg (same thing?)

- calcium

- selenium

- n-3 PUFAs from oily fish

- Some unidentified

substances in Chinese

vegetables (!)

*Aspirin?: - or something else entirely*; Thun ( 1992 ) - or a combination.


(c) or whether what you need is a combination of all or some of both ( (a) and (b).

5.12.3 Dr Arnott gave a good example of this


*254 : 69:5-9


referring to "Experiments have been done which show

Kritchevsky that high calorie intake and low fat

(1984): intake animals get breast cancer more

O IV/2/11) frequently than animals who are given

high fat diet and low calorie intake."

(emphasis added)

5.12.4 Another striking example is the Finnish/NY

*O IV/2/25 study by Reddy et al (1978)*

(Colon cancer) - It was assumed (on the basis of other

- work) that the Finns were low-risk and the New Yorkers high-risk for colon cancer.

- For the 2 populations, the levels of fat and protein intake were the same, but the sources of fat were different (dairy v. meat) and the Finns' intake of cereal products (fibre) was greater.

- In the result, if the assumption was correct, there is no way of telling what,

* Perhaps calcium if anything*, in the differences in diet

in the Finns' dairy might account for the differences in

food? See: risk.

Morson (1990),

O IV/141 p.600,

1st Col.; and

Arnott : 17:46:22-5.

5.13.1 Prof. Campbell seemed to deprecate what he called the 'reductionist' approach, that is, the search for particular elements in the diet

which, separately or together, might be identified with confidence as increasing or reducing the risk of these cancers.

5.13.2 But, with respect to a distinguished scientist, he must be wrong about that. For it is not until you can say with some confidence that this, that or the other element or elements are likely (at least) to be concerned that you have the foundation for an assertion that diet is causally (as opposed to historically or accidentally) associated with these cancers. For it is not until you have reached that minimum position that you can assert the "biological plausibility" which Prof. *256:10:51-11:12 Campbell himself regarded as necessary.* Unless or until you are in that position, you remain in the position which, for all the detail of his China study, Prof . Campbell necessarily still finds himself today:

"These data are suggestive of the hypothesis that . . . "

or even

"they lend some support to the existing hypothesis that..."

5.13.3 The reason why such precision is necessary is that diet (unlike tobacco-smoking orb lack of exercise, which, qualitively, are unitary concepts) is an almost infinitely variable concept:

- thus, in relation to CHD, one can now say that a diet which is high in saturated fat (and, probably, low in fruit and veg. ) carries a real *for the reason, risk of disease*.

amongst others,

that the biological

mechanisms are



- but one cannot say the same of a diet which is high in fat (simpliciter) . the Greeks, Spanish, Italians

- If, therefore, one is going to propose that a diet of one kind or another is causally related to cancer of one kind or another, one has got to try and identify the particular element(s) in the diet (such as SF in relation CHD) from which it may plausibly be concluded the risk is derived.

- Unless you do this, you risk missing the

key Elements and, in the process, finding that your over-general proposition is unsustainable. *

*For example, if

you inculpate

'animal fat',

and people

therefore stop

eating dairy

produce, you. may

simply find,

in the end,

that all you

have achieved

is the removal

of significant


elements from

the diet.

5.13.3 This is not to belittle the work of Prof. Campbell and his colleagues. It may (when it is complete) turn out to be a very valuable contribution to the debate.

But if I were a scientist, I'd be thinking that it raised more questions than it answered - some of which are suggested by a q. (answered in the affirmative) which *256 :59: 14-36 J. asked -Campbell*:


Animal Fat?


What vegetables?

Chinese vegetables?

What in vegetables?

What in which vegetables?

What in which Chinese vegetables?

And if I were seeking an ens. to the q, does a high fat/low fibre diet carry a real risk of cancer?, I'd want to know, in the light of existing evidence, the answers to at any rate some of those qq.

5.13.5 Test the matter in this way:

*I have read - Suppose I am a learned* and responsible

and digested scientist. I might be an epidemiologist,

all the relevant a nutritionist, a biochemist or an

material. oncologist.

- I am given Prof. Campbell's article about the China study and the chapters in the

book written by him. I read them with care. A number of things strike me at once:

(1) Smoking seems not to have been taken into account.

(2) There is a weak positive correlation between fat intake and breast cancer. (article: 11585,Col.l)

(3) There is a weak inverse correlation between large bowel cancer and dietary carbohydrate and fibre intake (article: 11585,Col.2)

(4) Plasma ascorbate (vit.C) shows the

strongest inverse association

*but for males, with cancers*: (book: p.97)

not females:

the 'confounder'

might be smoking

(256:48): i.e. vit.C protects

against the effects


- I then read Yuan (1995) and Hunter (1996) .

And I conclude that really nothing has changed, except that a stronger protective role for (fruit and) vegetables is beginning to emerge as a

possibility, perhaps displacing the old favourite, fibre.

5.13.6 This demonstrates why, as Dr. Arnott said, one must look for consistency over time and not be misled by the promise of one particular study: for, as soon as that has appeared, along come others which cast doubt on it (thus Campbell (1994), followed by Yuan (1995) and Hunter (1996)).

5.13.7 The studies which best illustrate the validity of Dr. Arnott's account of current knowledge


(1) Breast cancer

Kinlen (1987) O IV/2/9

Kinlen (1991) 7

Jones (1987) 23

Willett (1992) 5

Kushi (1992) 24

Ip (1993) Behind Crawford (1) in PB IA/9

Campbell (1994) Behind Campbell in PB IC/H/5(?)

(also colon)

Yuan (1995) Behind Campbell in PB IC/H/5(?)

Hunter (1996) Behind Arnott (2) in Y V/12

(2) Colon Cancer

Reddy (1978) O IV/2/25

Willett (1989) Behind Crawford (1) in PB IA/9

(also breast)

Willett (1990) 0 IV/2/3

Morson (1990) 14

Thun (1992) 19

Shibata (1992) 20

(3) General

Doll (1988) O IV/2/16

Albanes (1987) 12

Hill (1995) Behind Arnott (2) in Y V/12

As to this last (Hill), see in particular pp 3-10; 18-21; 22-4; and 28 - end. See also Table 5 on p.11, which shows that, despite the differences in diet between the UK and France and Germany (see composite COMA chart and 4.9.8 - 10, ante), the death rates from large bowel cancer in men are virtually the same; whereas, if the hypotheses about diet and cancer were correct, one might expect the French and German mortality rates to be significantly higher.

5.13.8 These studies and articles (and others), taken together and read carefully and objectively, lead to this conclusion and this conclusion only:

5.14 Conclusion

There may be a causal relationship between diet and cancer of the breast and bowel. On the other hand, there may not be. The question is unanswered and requires further research. At the moment, we do not know whether it is so; still less do we know how it might be so.

I transpose the origins' q. (having regard to the burden of proof in this action and the weight of the scientific evidence) as follows:

Can it be shown that a diet which is high in fat, sugar, animal products and sodium, and low in fibre, vitamins and minerals, gives rise to a very real risk that you will suffer cancer of the breast or bowel?

Plainly, it cannot be. Nor can it even be shown that there is a risk in such a diet which is real. There is a theoretical risk, and the theory is certainly more than fanciful: but that is as far as current learning, objectively regarded, will allow the proposition to be pushed.

J Mng. part 2

IX 1. The qq. are (in shorthand):

(1) Do McD's know that their food is very unhealthy?

(2) Do they hide that fact?

(3) Do they lie to their customers about the nutritional value of

their food?

2. This is easily answered:

(1) You can't know what isn't true.

(2) You can't hide a fact which isn't one.

(3) You can't lie about something which you don't know is false.

3. Against the formidable factual background recently rehearsed, see what McD's do say about their food and its place in its customers' lives:

*Note Arnott's (1) UK: 1985: P VI/5*

comments 8

on these 1989: 6*

at 17:60-1

1993: Nutrition:

* front of P VI a question of balance:*

*P VI/16 and 17 (2) US: 1982} identical*


*P III /2/ 60-4 (3) Annual Report 1990:*

* Note Wheelock's

comments on

this at 14: 64-5. (4) On the evidence, these statements are both accurate fair - and pretty comprehensive.

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