Clean Your Plate!

Subjects in a diet-health study must eat exactly what Hopkins gives them. No more. No less. And no cheating.

December 24, 2004|By David Kohn | David Kohn,Sun Staff

Essie Wilkie places the cherry tomato on the scale: too heavy. She picks up a knife and carefully trims a sliver from the offending orb. She weighs it again, verifies that the surgery has been successful, and drops the tinier tomato into a container of salad -- which is now exactly 68 grams.

Wilkie is not being obsessive about her diet. She is, however, being obsessive about someone else's. She works in the Johns Hopkins University ProHealth kitchen, which makes food for scientific research into the links between diet and human health.

By comparing the effects of different diets, the scientists hope to arrive at the healthiest way to eat. To ensure that results are accurate, participants must consume ruthlessly precise amounts of food -- hence Wilkie's tomato-paring.

Sometimes, even factory-sliced bread doesn't meet the ProHealth standard, says senior dietitian Phyllis McCarron, who oversees the kitchen. "It has to be 46 grams, and the manufacturer makes it 50 or 43," she complains.

A gram, by the way, is about 1 / 30th of an ounce.

Located in a two-story, red-brick building in suburban Woodlawn, the kitchen at first appears unremarkable -- until you notice the abundance of expensive precision digital scales.

Every weekday, Wilkie and nine other workers carefully weigh and assemble salads, sandwiches, snacks and entrees, each with an exact amount of calories, salt, fats and nutrients.

"We try to control all the factors," says Dr. Larry Appel, a Johns Hopkins medical professor who runs the research.

And he means all.

Those who participate in his "feeding studies" must agree that for the duration of the research, they'll subsist solely on food prepared by McCarron and her employees. That means no doughnuts, no fried chicken, no chili dogs -- not even an extra pinch of salt to add pop to a flavorless veggie burger. Subjects aren't even allowed to eat any additional healthy food because that would throw off the precise portioning.

There are a few exceptions: Participants may drink unlimited amounts of water and limited quantities of unsweetened tea and coffee, as well as diet soda and an occasional alcoholic beverage. And they can sprinkle their food with pepper, because, unlike salt, it doesn't raise the blood pressure.

Over the past decade, the kitchen has provided food for five feeding studies. The most famous is Appel's DASH study (Dietary Approaches to Stop Hypertension), which firmly established the cardiovascular benefits of eating a low-salt, low-fat diet. It is now a cornerstone in the treatment of high blood pressure.

The current trial, conducted with Brigham and Women's Hospital in Boston, is called OMNI-Heart (Optimal Macronutrient Intake and Heart Disease). The $6 million study will compare three diets for their effect on high blood pressure, cholesterol and overall cardiovascular health.

One regimen is high in "healthy" fats such as olive and fish oils; another offers lots of protein; the third emphasizes carbohydrates. But subjects don't gorge on tuna, cheeseburgers or pasta. As much as possible, ProHealth dieticians try to use vegetables and fruits in their recipes.

Researchers actually don't want participants to slim down. Losing weight -- or gaining it -- would add another variable to the experiment, which is supposed to evaluate the effect of diet alone. So every weekday at the center, subjects are weighed. If they've lost weight, the staff adds calories to their meals. Those who put on pounds get less food.

On completion, subjects receive the unprincely sum of $250. Appel says offering more might actually undermine the study. People who join to make money might be more likely to cheat, he suspects, because they wouldn't be inherently motivated to stick with the diet.

Over five months, subjects will spend five weeks on each of the three diets. The regimen can be demanding. "I never liked tomato juice. And suddenly I'm drinking three cans of tomato juice a day," says environmental engineer Ken Guttman, one of more than 160 subjects in the OMNI-Heart study.

The diet's constraints can vex researchers too. McCarron says it's not easy coming up with recipes that include the proper nutrients, vitamins and calories -- and also taste good. She throws tasting parties, using kitchen employees and former participants as guinea pigs. She and her colleagues tried 25 different versions of macaroni and cheese before hitting on an acceptable version.

The stringent requirements can lead to some strange concoctions. To meet the daily quota of olive oil, workers sometimes add it to yogurt. Otherwise, subjects would have to gulp it plain.

Most feeding-study fare, however, appears fairly normal. Spaghetti and meatballs, macaroni and cheese, salad and yogurt are all part of the menu. But the diet tends to have much less salt and saturated fat than the average American is used to.

"The food is so bland, it takes a while to get used to it," says 61-year-old Ron Jackson, another OMNI-Heart study subject.

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