SOP Bulletin No. 69

Decision Support Unit

4 — th Floor AMP Place, 10 Eagle St Brisbane  3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

2 April 2003

Malignant Neoplasm of the Prostate – Animal fat factor and ulcer diet

DSU monitoring of the use of the increased animal fat consumption factor in the malignant neoplasm of the prostate SOP has been undertaken, with a report published in February 2003.

That monitoring exercise identified a series of claims where it had been contended that a diet high in animal fat was taken as prescribed treatment for a peptic ulcer and the taking of that diet satisfied the increased animal fat consumption factor in the SOP.

The DSU investigated this subject and undertook to obtain expert advice on the animal fat content of ulcer diets.  A report has now been obtained from Dr Ruth English, Nutrition Consultant, who also prepared an earlier report on animal fat in civilian and WW2 diets in Australia and who has been involved in AAT cases concerning the increased animal fat factor.

That report and additional investigations undertaken by the DSU form the basis for the information that follows.

Specific diets were prescribed as maintenance treatment for peptic ulcer disease in the 1950s and 1960s.  The practice went out of favour thereafter when it was established that such diets were ineffective and that milk consumption actually stimulated gastric acid production.

The principles followed in such diets were:

1.Frequent feeding to neutralise and dilute gastric juices

2.High consumption of milk, other dairy products and proteins to counteract or diminish gastric acids

3.Avoidance of foods that contained irritants or that stimulated acid production, particularly:

•           fried foods
•           foods high in fibre
•           seeds and skins of fruit
•           spices and condiments
•           alcohol

Full details of the diets are contained in the attachments to Dr English's report.

Such diets were bland, would seem unpalatable to most people and would have been difficult to comply with, particularly given that they would have been largely ineffective in controlling peptic ulcer symptoms.  The likelihood of anyone adhering to such a diet over the long term would seem low.

Maintenance ulcer diets from the 1950s and 1960s from two of the major Australian dietitians training hospitals have been analysed for their animal fat content.  That analysis has used the animal fat definition from the current malignant neoplasm of the prostate SOPs.  The analysis provides estimates for the two diets of 138.0 g and 139.6 g of animal fat.

The animal fat content of the average Australian civilian diet from before, during and after WW2 has been previously reported on by Dr English in 1998.  She has now provided updated figures, taking account of changes made by the RMA to the definition of animal fat in the SOPs since 1998, as follows:

1936-38  126.0 g

1944 — 129.0 g

1948-49 — 108.4 g (rationing in effect)

1958-59 — 117.1 g

The increase in animal fat consumption in the ulcer diets over the average civilian diets is as follows:

38. 9.5 – 10.8%

1944 — 7.0 - 8.2%

1948-49 — 27.3 – 28.8%

1958-59 — 17.8 – 19.2%

The malignant neoplasm of the prostate SOP animal fat factor requires a 40% increase in animal fat consumption for at least 20 years (25 years for BOP).

It is evident that a typical ulcer diet would not have resulted in a 40% increase in animal fat consumption over an average civilian diet at the time the ulcer diet was likely to have commenced.  It is possible that a 40% increase could have resulted in an individual case if a diet lower than average in animal fat was being consumed prior to commencing the ulcer diet.

It would seem quite unlikely that anyone would persevere with an ulcer diet over a 20 or 25 year period.  Some modification of such a diet, particularly involving milk consumption for acute symptom relief, may have been followed over an extended period.

A necessary step in dealing with an ulcer diet contention is to consider whether the peptic ulcer for which the diet was taken can be related to service using the current peptic ulcer disease SOP.

In dealing with an “ulcer diet” claim the contention should not be simply accepted at face value.  There is a need to:

• identify in some detail the dietary history in the individual case
• establish whether the requirements of the SOP factor have been satisfied
• establish whether the taking of that diet can be related to service.