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1162

LETTERS

TO

THE

EDITOR

between our results and those of Hill and Wynder (1). Our study only measured prolactin on day 1 1 of the menstrual cycle (foblicular phase) whereas they took measurements 2 wk apart on unstated cycle days. The recent paper by Hill et ab. (2) also compared the serum prolactin levels in the premenopausal South African black women with those of premenopausal white American women. They found an average value of approximately 15 ng/ml in the American whites compared to approximately 8 ng/mb in the South African blacks on their usual diet. Most of this difference may simply be due to differences in the time at which the two groups awakened. We have found that probactin levels decreased by approximately 17% per hour during the first 3 h after awakening (G. E. Gray, M. C. Pike, and B. E. Henderson, unpublished data). All samples were drawn between 9:00 and 9:30 AM, and if the South African blacks awakened at 6:00 AM while the Americans awakened at 8:00 AM, then two-thirds of the observed difference in means would be explained. Further studies of the effects of diet on plasma prolactin levels are clearly needed. Such studies need to cover both parts of the menstrual cycle. Based on the results of Hill and Wynder (1), blood sampling would best be done on sleeping subjects, but sampling as late as 3 h after awakening would appear to be satisfactory. In this latter case adjustment must be made for the actual interval between

awakening and blood sampling. In addition, in studies involving changes of diet, more careful control of the subjects diet is necessary. Chances in the intake of nutrients other than fat undoubtedly occurred in all of the studies, and it is possible that the changes found by Hill and coworkers (1, 2) were due to changes of some component of the diet other than total fat. Our subjects reduced their caloric intakes and lost weight on the low-fat diet, while those of Hill et al. (2) gained weight on a high-fat diet, attesting to the difficulty of controlling caloric intake when changing the fat intake of free-living subjects. Gregory E. Gray, Ph.D.

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Malcolm Brian Department of Family Medicine University of Southern Medicine Los Angeles, California

C. Pike,

Ph.D. M.D.

E. Henderson, and Preventive School

California 90033

of

References
I . Hill P, Wynder E. Diet and prolactin release. Lancet 1976;2:806-7. 2. Hill P. Garbaczewski G, Helman P, Huskisson J, Sporangisa E, Wynder EL. Diet, lifestyle, and menstrual activity. Am J Clin Nutr 1980:33: 1 192-8.

Diet
Dear

and plasma
Sir:

prolactin

Gray et al. (1), who transferred eight healthy nonobese premenopausal women from their customary diet to a low fat diet for 2 months, found no significant change in plasma prolactin levels. However, Wynder et ab. (2) have reported a significant decrease in prolactin in Caucasian women fed a vegetarian diet. To explain this difference, Gray et al. (1) has suggested three factors may be involved: 1 ) time when blood sampling was taken after awakening; 2) difference in prolactin in fofficular-luteab phases; 3) modification of different dietary components in the two studies.

We suspect that the conflicting data reflect a difference in the experimental diets and the CNS response to these diets. In 1976, we reported (not quoted by Gray et al.) the daily level of prolactin was decreased in serum in Caucasian women fed a vegetarian diet for 2 months (2). Alternate day blood sampling, starting the 2nd day of mense during the second menstrual cycle on the vegetarian diet showed a decrease, although variable, in prolactin levels. A second similar feeding study confirmed our original finding (3). Alternatively, feeding a Western diet to vegetarian rural black South African

LETTERS

TO

THE

EDITOR

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premenopausal and postmenopausal women increased plasma prolactin (4). In our study of the nocturnal release of prolactin in premenopausal women, who retired at 2 100 h, we stated that the vegetarian diet reduced the fat intake from 40 to 33% of the daily calories and the cholesterol intake to 250 rng per day. This meatless vegetarian diet has been used in all our studies. While irregular and inconsistent changes in prolactin occur during the menstrual cycle, higher prolactin levels have been reported in the luteal phase (6): A difference which we found previously (2). As we were aware of the importance ofthe time of blood sampling, blood samples from Caucasian and black South African women were taken within two hours from awakening which was comparable in both groups. Using isocaloric diets, our subjects unlike those of Gray et al. had no weight change associated with diet modification. Our concept of the dietary modification of prolactin, in view of the multifactorial regulation of its release, is based on modification of the composition of dietary protein. Maclndoe and Turkington (7) have reported L-tryptohan administration increases plasma probactin. Evidence that bedtime beverages (8), amino acids including tryptohan (9) or alternatively a high carbohydrate-low fat diet modify sleep patterns, and therefore, release of pituitary hormones indicate that dietary components could modify probactin, growth hormone, and can modify gonadotrophin release (3). Consequently, failure of a low fat diet used by Gray et al. to modify plasma prolactin levels, suggests that it may not be the dietary fat, but dietary protein or a combination of these components which relates to the lower plasma prolactin in black South African women and in vegetarian Caucasian. Our failure to find a change in plasma prolactin

in urban Japanese women when switched from a 28 to 40% fat diet (3) would also support this concept. Concomitantly, in these studies a consistent reduction in menstrual flow and a shortening of the menstrual cycle occurred in Caucasian women fed the meatless vegetarian diet. Interestingly, a bight menstrual flow, few climacteric symptoms and also rarity of osteoperosis in black South African women (10), suggests differences in endocrine physiology in these women and implies how little is known of the environmental factors affecting endocrine metabolism in women. P. Hill

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American Valhalla, References

Health Foundation New York 10595

1. Gray GE, Pike MC, Henderson BE. Dietary fat and plasma prolactin. Am J Clin Nutr 1981:34:1160-2. 2. Wynder EL, Chan P, Cohen C, MacCormack F, Hill P. The etiology of breast cancer and its significance as a preventive measure. In: Grundmann E, Beck L, eds. Early diagnosis of breast cancer. Stuttgart: Gustav Fisher Verlag, 1972:1. 3. Hill P. Garbaczewski L, Helinan P. Walker ARP, Wynder EL. Diet and breast cancer. Cold Spring Harbor Conference, Oct. 9-10, 1980, (in press). 4. Hill P, Garbaczewski L, Helman P, Huskisson J, Sporangisa E, Wynder EL. Diet, lifestyle and menstrual activity. Am i Chin Nutr 1980;33:l 192. 5. Hill P. Wynder EL. Diet and prolactin release. Lancet 1976;2:806. 7. Maclndoe JH, Turkington RW. Stimulation of human prolactin secretion by intravenous infusion of L-tryptophan. J Chin Invest 1973;52: 1972. 8. Southwill PR, Evans CR, Hunt iN. Effect of a hot milk drink on movements during sleep. Br Med J l972;2:429. 9. Lacey JH, Stanley P, Hartmann M, Koval J, Crisp AH. The immediate affect of intravenous specific nutrients on EEG sleep. Electroencephal Clin Neurophysiol. 1978:44:275. 10. Walker ARP, Isaacson C, Segal J. Fatty streaks and atherosclerosis. Lancet 1980;2:974.

Fiber:
Dear Sir:

new terminology

or new

concepts?

In addition to the observations made by Spiller and Briggs (I) on Heatons letter (2) we would add the following. 1 ) Heatons concepts clearly concern only the fiber part of the term edible fiber.

Fiber is used to cover a wide range of heterogenous substances with very diverse actions which will continue to be investigated for many years. On the other hand, the term edible presents no such difficulties since its