PLEASE NOTE THAT THIS IS A VERBATIM TRANSCRIPT WHICH HAS NOT YET BEEN REVIEWED FOR ACCURACY OR SPELLING. WE WILL BE POSTING THE EDITED VERSION AS SOON AS IT IS AVAILABLE. (Posted on March 10, 2000). 1 1 THE UNITED STATES DEPARTMENT OF AGRICULTURE 2 In the Matter of: ) 3 MILLENNIUM LECTURE SERIES ) 4 SYMPOSIUM ON THE GREAT ) 5 NUTRITION DEBATE ) 6 The Jefferson Auditorium 7 U.S. Department of Agriculture 8 14th Street and 9 Independence Avenue, S.W. 10 Washington, D.C. 11 Thursday, 12 February 24, 2000 13 The above-entitled matter was convened, pursuant 14 to notice, at 10:10 a.m. 15 BEFORE: CAROLYN O'NEIL, Moderator 16 APPEARANCES: 17 SHIRLEY WATKINS, Under Secretary for Food, 18 Nutrition and Consumer Services 19 DAN GLICKMAN, Secretary of Agriculture 20 Presentations: 21 DR. ROBERT C. ATKINS 22 DR. BARRY SEARS 23 DR. MORRISON C. BETHEA 24 DR. KEITH-THOMAS AYOOB 25 DR. DENISE C. BRUNER 26 DR. JOHN MCDOUGALL 27 DR. DEAN ORNISH 2 1 C O N T E N T S 2 Page 3 Opening Remarks: 4 SHIRLEY WATKINS, UNDER SECRETARY FOR FOOD, 3 5 NUTRITION AND CONSUMER SERVICES 6 DAN GLICKMAN, SECRETARY OF AGRICULTURE 5 7 Presentations: 8 DR. ROBERT C. ATKINS, 18 9 AUTHOR OF DR. ATKINS' NEW DIET REVOLUTION 10 DR. BARRY SEARS, AUTHOR OF THE ZONE 35 11 DR. MORRISON C. BETHEA, 48 12 CO-AUTHOR OF SUGAR BUSTERS! CUT SUGAR TO TRIM FAT 13 DR. KEITH-THOMAS AYOOB, 61 14 ALBERT EINSTEIN COLLEGE OF MEDICINE 15 DR. DENISE C. BRUNER 70 16 PRESIDENT, AMERICAN SOCIETY OF BARIATRIC PHYSICIANS 17 DR. JOHN MCDOUGALL, 76 18 CHAIRMAN, "DR. MCDOUGALL'S RIGHT FOODS" 19 DR. DEAN ORNISH, 86 20 AUTHOR OF EAT MORE, WEIGH LESS 21 DR. ERIC WESTMAN, DURHAM VA MEDICAL CENTER 111 22 Closing Remarks: 23 DAN GLICKMAN, SECRETARY OF AGRICULTURE 135 3 1 P R O C E E D I N G S 2 (10:10 a.m.) 3 MS. WATKINS: Good morning. 4 ALL: Good morning. 5 MS. WATKINS: I'm Shirley Watkins, the Under 6 Secretary for Food, Nutrition and Consumer Services here at 7 the Department of Agriculture. We're delighted to see all 8 of you and look forward to an exciting morning. 9 I know we're going to have a lively two or three 10 hours. This is going to be a wonderful opportunity for us 11 here at the Department of Agriculture, and we hope that you 12 will have as much fun as we're going to have during this 13 session and even afterwards. 14 I know you're perhaps wondering why did the 15 Department of Agriculture organize something called The 16 Great Nutrition Debate? Well, I'll tell you. This morning 17 about 2:30, my usual wake up time, I thought well, we could 18 have said The Great Nutrition Conversation, but, anyway, 19 it's going to be a conversation that is long overdue. 20 The USDA Center for Nutrition Policy and Promotion 21 sponsored a seminar last year, and it was entitled Why We 22 Eat What We Eat. That symposium had followed one we had 23 earlier on childhood obesity prevention, and those seminars 24 were held right here in this room. The rooms were packed, 25 as we had expected, and in the course of the Secretary of 4 1 Agriculture's remarks he turned around and looked at me and 2 said Shirley, why don't we get all of these leading doctors 3 together and have a debate? 4 Now, we did not put that in his remarks, so 5 obviously I was quite flabbergasted, and I said what any 6 loyal person here at USDA would say. Yes, sir, Mr. 7 Secretary. We'll get it done. Yes, sir, Mr. Secretary, 8 we've done exactly what you asked us to do. 9 Dr. Raj Anand, who is head of the Center for 10 Nutrition Policy and Promotion, and his staff, along with 11 Clyde Williams in the Secretary's office and Dan Dager on my 12 staff, have worked tirelessly putting this together and 13 insuring that we had a distinguished panel of guests. Each 14 one of our panelists here today bring a unique perspective 15 to this whole issue of how and what we eat. 16 I'm reminded of a joke I heard recently, and I 17 can't help but share it with you. A man goes into his 18 doctor's office, and there's a banana stuck in one ear and a 19 carrot stuck in another one and a cucumber up his nose. The 20 man said, "Doctor, this is terrible. What's wrong with me?" 21 The doctor simply said, "Well, first of all, you're not 22 eating right." 23 (Laughter.) 24 MS. WATKINS: Well, we're all concerned to varying 25 degrees about our nutrition and about our health, and few 5 1 subjects occupy the American consciousness as much as 2 dieting, and few issues have as a profound and lifelong 3 effect on health. Here at USDA, good nutrition is the 4 foundation of all of our programs, so it follows that we 5 would want to sponsor a public discussion of diets and 6 eating habits. 7 Each one of you in the audience today will have an 8 opportunity to submit a question, and I hope you have your 9 cards so you can write your question down as the panelists 10 are speaking. We'll have people in the audience to pick up 11 those cards, and I can't promise you that your question will 12 be asked and answered, but we're going to get as many 13 answered as we possibly can. 14 So welcome again to all of you, and thanks to our 15 distinguished panel for being with us today, and now I'd 16 like to turn the event over to the mastermind of today's 17 event, our beloved Secretary of Agriculture, Dan Glickman. 18 Mr. Secretary? 19 (Applause.) 20 MR. GLICKMAN: Thank you. Thank you, Shirley. 21 Shirley Watkins and her team does an outstanding job, and I 22 want to thank them plus Clyde Williams of my staff for 23 setting this event up. 24 I think there were two things that precipitated 25 this. One, we had this couple of forums here on nutrition 6 1 and obesity, and I did mention this to Shirley, and then I 2 happened to be at a White House dinner I guess it was a few 3 months ago, and I sat next to Dr. Ornish, and we talked 4 about the fact that how it would be good to bring people 5 together in and further enlighten the public, so out of that 6 came this particular forum. 7 I'll tell you an interesting story. When I was 8 nominated to be Secretary of Agriculture and I went before 9 the Senate for my confirmation hearings, before the hearings 10 began somebody asked me what were my qualifications to be 11 Secretary of Agriculture, and I responded that when I was 12 young my mother would tell me to eat, eat, eat, and the fact 13 of the matter, however, is that's the problem in this 14 country. We eat too much. 15 There's so many of us that are overweight and 16 unhealthy, and given the fact that our studies indicate that 17 as many as one in five children are obese and a lot of these 18 eating patterns start in the earliest stages of life, and 19 consumers are spending millions, hundreds of millions of 20 dollars, maybe even more, to find ways on how to be healthy 21 and particularly how their diet affects their health 22 I thought this was an appropriate place for us to 23 have a discussion of not only the diets, but of the whole 24 issue of diet and nutrition from the perspective of some of 25 the leaders in the country, at least leading authors and 7 1 some nutritionists, and try to give some not only balance, 2 but to give some clarity to the American people as to, you 3 know, what they ought to do and what isn't necessarily 4 appropriate. 5 We at USDA do a lot of things. In addition, of 6 course, to helping farmers, which is a big part of what we 7 do, we run virtually all federal nutrition programs. The 8 school lunch program was perhaps the greatest social program 9 in modern history started after the second world war by 10 Harry Truman to insure that there was at least one meal a 11 day that everybody in this country would have. Of course, 12 we manage those programs and buy much of the food for them. 13 We run the food stamp program, the women, infants, 14 children program. Along with the Department of Health and 15 Human Services, we are engaged in periodically updating 16 national dietary guidelines, which is basically information 17 to consumers about what kinds of foods or food groups, more 18 than foods, that they should eat. 19 But the fact of the matter is that as a society, 20 I'm convinced that we remain very confused and conflicted 21 about what it is that we should eat. In addition to that, 22 the question is not just losing weight, but the question is 23 how to keep it off and maintain a nutritionally balanced, 24 healthy lifestyle over the long term. 25 You know, these are factors that I think are 8 1 really high priority in the American people's minds, so we 2 decided to hold this forum to try to if not clear up the 3 confusion, at least bring the issues out in an objective way 4 so that the country can make its own mind up because we're 5 not here to endorse any diets, any particular perspective at 6 least at this forum, but it is to give both the public, as 7 well as our own people here at USDA, some opportunities. 8 We run most of the nutrition laboratories in this 9 country. The two perhaps ones that most people have heard 10 of are the Tufts University Center in Boston and Baylor 11 School of Medicine, School of Nutrition, primarily for 12 children, at the University of Texas Medical Center. Those 13 are USDA laboratories. 14 Most of the nutrition research done by the 15 government is done by this department, and we know that diet 16 relates a lot to health, and health we spend billions and 17 billions and billions of dollars a year. One of the things 18 we've found and all of us believe is that we can improve our 19 health by improving our diet, so we want to ask the right 20 questions. That's the purpose of this hearing today. 21 I want to thank this distinguished panel for being 22 here and giving them the opportunity of presenting their 23 perspective on what we ought to be doing, and at the close 24 after the questions I may have a few comments to try to tie 25 the whole thing up, but again I appreciate everybody being 9 1 here very much. 2 Our moderator we're pleased to have for today's 3 program as Carolyn O'Neil from CNN. In addition to serving 4 as executive producer and senior correspondent for CNN's "On 5 the Menu," she is a registered dietician, holds a Master's 6 degree in Nutrition, is also the chief travel reporter now, 7 and I think that we're very, very honored to have her 8 leading the effort here, so now I'd like to turn things over 9 to Carolyn O'Neil. 10 (Applause.) 11 MS. O'NEIL: Good morning, and welcome to Who 12 Wants to Be a Millionaire Diet Doctor. 13 (Laughter and applause.) 14 MS. O'NEIL: Welcome to our panel. It's terrific 15 to see you all in one place at one time. I've seen many of 16 you, met many of you through the years in different places 17 at different times, but this is certainly unprecedented and 18 a great service, I think, to everyone who wants to know 19 about diet and nutrition today. 20 You know, I think a lot of people will be very 21 interested in the outcome of this debate or the 22 conversation, as Shirley has renamed it, to decide what diet 23 to go on tomorrow, so this is in your hands. 24 I did tons of research, and I went through all of 25 the descriptions of all of the diets, and just to put you at 10 1 ease, too, as you try and find the common ground and see 2 what's different, see where the challenges are, even as a 3 registered dietician with a Master's degree in Nutrition, it 4 is still very complicated, and it is still something that 5 you need to do great study, and that's why this 6 conversation/debate is important today. 7 But, I did check with some experts in the third 8 grade. I was driving my daughter to school the other day in 9 the car pool, and I said hey, kids. They said why are you 10 going to Washington, and I told them about the debate. They 11 said well, Mom, we sing a song in the third grade that's all 12 about why people are fat. 13 Well, I'm not going to sing it, but I will tell 14 you the words. It goes like this. All you people can't you 15 see, can't you see, what happens when you eat too many 16 calories? Every pound we gain, the more you weigh, and that 17 makes you larger than life. 18 (Laughter.) 19 MS. O'NEIL: I hope today we can find some common 20 ground because that, of course, is the most helpful thing to 21 the American public and the public of the world to figure 22 out what to eat when. 23 From time to time, I don't know if you've noticed, 24 but in the past year or so menu print has gotten so much 25 smaller, and I have to use glasses now. This also is an 11 1 indication that I've been at CNN for a long time. I've 2 covered a cavalcade of diets over the decades, and I've 3 essentially come out of retirement from the nutrition beat 4 to moderate this significant session on popular diets. 5 I have not written a diet book. Therefore, I 6 don't have a conflict of interest yet. I now do CNN "Travel 7 Now," and if I'm not surfing I'm snorkeling, and if I'm not 8 snorkeling I'm sightseeing in Sydney, and it's really a 9 whole lot of fun, but it's really about food, culture and 10 discovery, and I think people need to know more about the 11 diets of the world and cultures of the world to understand 12 the foods and the diets that we enjoy wherever we live. 13 So I wanted to share a secret before we get going, 14 and I have a slide that through the years I've learned how 15 the media covered health and nutrition. 16 (Whereupon, a slide was shown.) 17 MS. O'NEIL: Do you see the slide yet? You do. 18 Now, here we go. There are three wheels that we spin in the 19 news, and the first one is the offending practice or 20 product. Is this the three wheeled slide? Okay. I can't 21 see it. 22 You spin that, and you figure out what people are 23 eating wrong. Then the second one you spin, and that gives 24 you the cause, whether it's a positive or negative effect, 25 and then the next one you spin gives the affected 12 1 population, so you can see you can just do that. 2 (Whereupon, a slide was shown.) 3 MS. O'NEIL: Now, here's how the American public 4 sees nutrition information we give them. They just do their 5 own spin. This is how we might integrate what we say today. 6 This gentleman says, you know, it's not fat. It's just that 7 new fat substitute. 8 (Laughter.) 9 MS. O'NEIL: So with a sense of humor, and 10 hopefully no bullets will be discovered today, I'm afraid. 11 Well, maybe we will. What will emerge perhaps today again 12 is that common ground. 13 You know, there's been lots of misinformation 14 about nutrition. No news to anybody, but, as everyone on 15 this panel will tell you, there's been misinformation and 16 myths about their theories, their beliefs, their thoughts, 17 so that's why this exchange of ideas if very important, too, 18 so if you're going to criticize something, you should really 19 know about it. That's an old line from Steve Martin, who 20 said don't criticize things you don't know about. 21 So let's get to introducing the panel, and I will 22 start with Dr. Atkins. Dr. Atkins is the author of Dr. 23 Atkins' New Diet Revolution and is the founder and medical 24 director of the Atkins Center for Complementary Medicine in 25 New York City. 13 1 A 1951 graduate of the University of Michigan, he 2 received his medical degree from the Cornell University 3 Medical School in 1955 and went on to specialize in 4 cardiology. He's been a practicing physician for 30 years 5 and continues to see patients daily. Dr. Atkins, a 6 modern-day founder of complementary medicine, supports 7 natural healing arts as an alternative to pharmaceutical 8 drugs and surgery. Dr. Atkins? 9 I wanted to say that Dr. Atkins' diets were 10 popular in the 1970s. They've certainly come back full 11 circle. So have bell bottoms, -- 12 (Laughter.) 13 MS. O'NEIL: -- so we'll find out why they're both 14 back in fashion again. 15 The next panelist I will introduce is Barry Sears. 16 Dr. Sears is author of The Zone and president of Sears 17 Laboratories. He has a Ph.D. in Biochemistry from Indiana 18 University. 19 A former research scientist at the Boston 20 University School of Medicine and the Massachusetts 21 Institute of Technology, Dr. Sears has dedicated his 22 research efforts over the last 25 years to the study of 23 lipids and in particular over the past 15 years to the 24 development of drug delivery technologies using lipids. He 25 holds 12 U.S. patents in the areas of intravenous drug 14 1 delivery systems and hormonal regulation for the treatment 2 of cardiovascular disease. 3 I don't know why you're not in your villa in the 4 Caribbean. 5 (Laughter.) 6 MS. O'NEIL: Next on the panel, Morrison Bethea. 7 Is that correct how you say your last name? 8 DR. BETHEA: Close enough. 9 MS. O'NEIL: Welcome from New Orleans. Dr. 10 Bethea, a co-author of Sugar Busters! Cut Sugar to Trim Fat, 11 completed his post-graduate training in thoracic and cardiac 12 surgery at Columbia University Presbyterian Medical Center 13 in New York. He's a graduate of Davison College and Tulane 14 University School of Medicine. 15 Currently he practices thoracic, cardiac and 16 vascular surgery in New Orleans. He's an author of many 17 publications in the field of cardiovascular disease and is a 18 diplomate of the American Board of Thoracic Surgery. 19 New Orleans, of course, world famous for enjoying 20 what they eat in that city, and so it's amazing to find out 21 that Sugar Busters! has taken the city by storm and, of 22 course, the rest of the country. I'm looking forward to 23 that. 24 Next, Dr. Keith-Thomas Ayoob is director of 25 nutrition sciences as Rose Kennedy Children's Evaluation and 15 1 Rehabilitation Center and clinical assistant professor of 2 pediatrics at Albert Einstein College of Medicine in New 3 York. He's a board-certified pediatric nutritionist, and he 4 counsels children and caregivers on issues including 5 oversight and underweight, nutritional deficiencies and 6 eating behavior problems. 7 He has a Doctorate in Education, Master of 8 Education and Master of Science degree in Human Nutrition 9 from Columbia. He earned his Bachelor's degree in Nutrition 10 Science at the University of California at Davis. We look 11 forward to hearing from you as well. 12 Dr. Denise Bruner is president of the American 13 Society of Bariatric Physicians with a medical practice in 14 Arlington, Virginia. Dr. Bruner received her undergraduate 15 education at the University of Southern California and at 16 George Washington University. She received her Doctor of 17 Medicine degree from the Howard University College of 18 Medicine in Washington. 19 She has been in private practice of bariatric 20 medicine and family medicine since 1981. Recently she has 21 appeared on several television programs discussing a range 22 of topics, including the medical treatment of obesity, so 23 certainly Dr. Bruner has been in the grassroots of working 24 with patients to find out what works and perhaps what 25 doesn't work. 16 1 Next, John McDougall, M.D., is a board-certified 2 internist and author of ten national best-selling books. 3 Dr. McDougall is the medical director of the live-in 4 McDougall program at St. Helena Hospital in the Napa Valley. 5 Do you do diet foods and wine pairings there? 6 In addition, he's the chairman of "Dr. McDougall's 7 Right Foods" and has a weekly national television show, 8 "McDougall, MD," not to be confused with "Doogie Houser, 9 MD," -- 10 (Laughter.) 11 MS. O'NEIL: -- along with a monthly newsletter, 12 "To Your Health." 13 Dr. McDougall received both his undergraduate and 14 Doctorate in Medicine from Michigan State University, and he 15 did his residency -- smart guy -- in internal medicine at 16 the University of Hawaii, so food and fitness there. Okay. 17 Dean Ornish. Dr. Dean Ornish received his medical 18 training at Baylor College of Medicine, Harvard Medical 19 School and the Massachusetts General Hospital. He is the 20 founder and president of the non-profit Preventive Medicine 21 Research Institute and clinical professor of medicine at the 22 University of California, San Francisco. 23 For the past 25 years, Dr. Ornish has directed 24 clinical research demonstrating for the first time that 25 comprehensive lifestyle changes may begin to reverse even 17 1 severe coronary heart disease without drugs or surgery, and 2 he got insurance companies to pay for it. That's 3 significant, too. 4 He has published in many peer-reviewed journals, 5 and he's the author of five best-selling books, including 6 Eat More, Weigh Less, and also, you know, Health Living for 7 Better Intimacy. Maybe we'll get to that later -- 8 (Laughter.) 9 MS. O'NEIL: -- after we're all skinny and 10 beautiful, you know. 11 Okay. Here are the ground rules. This is the 12 tough -- oh, there's Suzanne Somers is calling, I think. 13 Suzanne Somers on the phone. 14 (Laughter.) 15 MS. O'NEIL: No 800 numbers, guys, during this 16 presentation. 17 Anyway, I wanted to set the ground rules. During 18 the session here, each of the presenters will speak about 19 their signature diets, about their program in research, 20 etcetera. There will be no questions, no comments, strictly 21 timed for each of the participants here, so during that 22 period of time write down your questions for the Q&A 23 session. 24 Don't drink too much coffee or water either 25 because there are no breaks. 18 1 I wanted to begin and say, Dr. Atkins, from your 2 seat and each of you from your seats, if you would like to 3 begin? Thank you for setting us off on The Great Nutrition 4 Debate. 5 DR. ATKINS: Right from my seat. Okay. I've got 6 a lot to say and not a lot of time to say it, so I'm not 7 going to be very sociable. 8 After analyzing virtually every scientific paper 9 written on the low carbohydrate diet over the last 80 years, 10 beginning with when it was first offered as a treatment for 11 epilepsy, I am convinced that a diet low enough in 12 carbohydrate to automatically convert our stored fat into 13 the body's primary energy fuel is qualified at present to be 14 considered the treatment of choice for obesity and related 15 conditions such as diabetes, hypertension and 16 atherosclerosis. 17 I know that to gain mainstream acceptance of this 18 proposal I must first demonstrate that the nutritional 19 program, which I believe can put an end to the lion's share 20 of obesity right now, is both safe and effective over both 21 the short and the long term, so in the brief time allotted 22 let me do just that. 23 First PowerPoint. 24 (Whereupon, a slide was shown.) 25 DR. ATKINS: This is how the Atkins diet works. 19 1 Now, I can't see if the PowerPoint is up. Can you put it on 2 the monitor there so I can see that it's there? 3 Stored fat is, after carbohydrate, the body's 4 backup fuel system. The human body cannot store more than a 5 two day supply of carbohydrate. In the absence of dietary 6 carbohydrate, fat becomes the primary fuel. It's next on 7 the pecking order. 8 This metabolic changeover is supported by 9 biochemical catalysts which facilitate the steady burning of 10 fat, producing more energy, increased well-being and a 11 dramatic loss of appetite. 12 Next? 13 (Whereupon, a slide was shown.) 14 DR. ATKINS: What are ketones? They are simply 15 the energy fuels derived from our fat stores. Fat delivers 16 energy via ketones, just as carbohydrate delivers energy by 17 way of glucose. Enzymes are present within all our cells, 18 including our brain cells, to convert ketones into useable 19 fuel. 20 Next? 21 (Whereupon, a slide was shown.) 22 DR. ATKINS: When ketones are used as fuel, the 23 most consistent finding is a decrease in appetite. Insulin 24 is not involved in ketone production. Thus, the 25 consequences of elevated insulin, which are many -- there 20 1 are increases in triglycerides, in blood pressure, in 2 adrenaline, in cortisol; all of these are avoided. 3 Obese individuals and people who are overweight 4 are keto resistant. Pay attention to this term. What it 5 means is that there will be no accumulation of ketones in 6 the blood. 7 Next? 8 (Whereupon, a slide was shown.) 9 DR. ATKINS: The best documentation of keto 10 resistance was brought to us by two very important 11 researchers, the department heads of London's Middlesex 12 Hospital, Alan Keckwick and Gaston Pawon. 13 In their documentation they showed that obese 14 subjects given the ketogenic diet that I'll tell you about 15 momentarily produced a flat level of ketones rising from two 16 milligrams to an average of four milligrams, never more than 17 six, whereas the non-obese subjects had their ketones 18 escalate rapidly. 19 This is one reason why overweight people will 20 never have problems with ketosis, but ketosis is a negative 21 catch word for many people. The only reason can possibly be 22 that they're confusing it with diabetic ketoacidosis. 23 Next slide? 24 (Whereupon, a slide was shown.) 25 DR. ATKINS: But look how diametrically opposed 21 1 they are. Ketoacidosis occurs in Type I diabetes, meaning 2 it occurs because of an insulin absence or an insulin 3 deficiency. Benign ketosis is achieved in overweight 4 subjects whose metabolism is characterized by the fact that 5 they put out too much insulin. 6 Ketoacidosis is caused by an increased intake of 7 carbohydrate, benign ketosis by a decreased intake of 8 carbohydrate. There is, of course, acidosis in 9 ketoacidosis, but in benign dietary ketosis the pH is 10 normal. There is no acidosis. In ketoacidosis, patients 11 are extremely symptomatic, and in ketosis the subjects 12 describe an improvement in well being. Now, that's pretty 13 different. Don't let anybody confuse it ever again. 14 Much of the success of the low carbohydrate diet 15 is that it is extremely effective for people with large 16 appetites who enjoy eating, and these are the two main 17 reasons why. First, hunger is eliminated. Hunger is not 18 even allowed. Hunger is eliminated because the biochemical 19 changes I will outline momentarily reduce the appetite. 20 Secondly, and this is something that bears 21 emphasis. More weight is lost on low carbohydrate diets 22 than on balanced diets identical in calories. This benefit 23 is called metabolic advantage. We're going to look at these 24 two phenomena right now. First we'll look at the hunger 25 aspect. 22 1 Next slide? 2 (Whereupon, a slide was shown.) 3 DR. ATKINS: The guru of fasting as a weight loss 4 system, Dr. Garfield Duncan, back in the 1960s when fasting 5 was in vogue, he described a dramatic decrease in hunger 6 after the second day of a fast. He attributed this to high 7 levels of ketones. In his words, "In every case, there was 8 a relationship between hyperketonemia and loss of appetite." 9 Next slide? It's not a slide, but anyway. 10 (Whereupon, a slide was shown.) 11 DR. ATKINS: In 1963, Walter Lyons Bloom and 12 Gordon Azar in Atlanta discovered that the same degree of 13 ketosis could be achieved simply by eating protein and fat 14 containing foods and eliminating carbohydrate. There was no 15 need to fast. Instead of a fast, a meat and salad diet 16 would do the trick. Therefore, carbohydrate restriction 17 will suppress the appetite. 18 Bloom and Azar's paper convinced me to go on the 19 only diet I've ever been on. That was 36 years ago, and I'm 20 still counting, and I'm still on it, but here's the second 21 point. 22 Is a calorie is a calorie is a calorie really 23 true? This axiom that everyone repeats, is it really true? 24 The truly significant breakthrough came from Keckwick and 25 Pawon. After a series of animal experiments, including the 23 1 discovery that rats on a low carbohydrate diet put out a fat 2 mobilizing substance which, when injected into other 3 animals, caused an automatic weight loss, they directed 4 their attention to obese humans. 5 Two groundbreaking studies were published in 1956. 6 Next? 7 (Whereupon, a slide was shown.) 8 DR. ATKINS: First, they studied 1,000 calorie 9 diets, but it was a research study that they had done on 10 rats, and this is what they did. There were diets 90 11 percent fat, 90 percent protein, 90 percent carbohydrate. 12 They wanted to see the effect. 13 One thousand calories of 90 percent carbohydrate 14 produced no weight loss. As a matter of fact, there was a 15 slight weight gain. The 90 percent protein diet produced a 16 weight loss between three and a half and four pounds in the 17 week that people followed it. The 90 percent fat diet did 18 even better. Between five and six pounds of weight were 19 lost. That is a dramatic portrayal of how different foods 20 can lead to different amounts of weight loss. 21 But, of course, there were all 1,000 calorie 22 diets, and they wanted to look at diets with sufficient 23 calories not to provide guaranteed weight loss. 24 Next? 25 (Whereupon, a slide was shown.) 24 1 DR. ATKINS: So look at this one. Look at this 2 one. For an average of eight days, six subjects were 3 alternated between a 2,000 calorie balanced diet and a 2,600 4 low carbohydrate diet. 5 The 2,000 calorie balanced diet led to a one pound 6 weight gain, as you see on this slide, whereas the 2,600 7 calorie low carbohydrate diet given to the very same subject 8 -- it was a cross over study -- produced a three pound 9 weight loss in the same amount of time. Keckwick and Pawon 10 did water balanced studies, and it wasn't water. 11 The mathematics. A half a pound a day more weight 12 loss is 1,750 calories of advantage plus the 600 in the 13 extra food. This provided an edge totaling 2,350 calories 14 per day. That means they demonstrated for the first time a 15 phenomenon called metabolic advantage, a refutation of the 16 calorie theory where diets of different compositions lead to 17 disproportionate weight loss. 18 Keckwick and Pawon, despite their important 19 academic position, were met with skepticism, but nine years 20 later Dr. Fred Benwa and his colleagues at Oakland Naval 21 Hospital furthered the concept. Their technology allowed 22 them to measure body fat, and this is what they found. 23 Next? 24 (Whereupon, a slide was shown.) 25 DR. ATKINS: They compared a total fast, which 25 1 certainly was in vogue in those days, with a 1,000 calorie, 2 ten grams -- very low -- carbohydrate diet for ten days. 3 They found that the fasting took off 21 pounds, but only 4 seven and a half of those pounds were fat. The other 14 5 were lean body mass. 6 The low carbohydrate diet, despite the extra 1,000 7 calories, took over 14« pounds, all but one-half pound of 8 which was fat. Virtually none was lean body mass. Again it 9 met with skepticism, but it was quite logical. In 10 starvation, you will start to build your protein for fuel, 11 but when ample fat and protein are included in the diet 12 there will be no need to do so. 13 More skepticism and more studies. This time the 14 professor of medical nutrition at Cornell, Dr. Charlotte 15 Young, studied eight obese 23-year-old men, undergraduates 16 at Cornell and graduate students at Cornell. They were all 17 overweight, and she used an 1,800 calorie diet. 18 May I see the next? 19 (Whereupon, a slide was shown.) 20 DR. ATKINS: An 1,800 calorie diet of differing 21 amounts of carbohydrate. One was 104, moderate low; one was 22 60, even lower; and the other was 30 grams of carbohydrate a 23 day. She also did body fat estimations. 24 This is how much body fat they lost. Two pounds a 25 week for the nine weeks on the 104 gram diet, two and a half 26 1 pounds a week on the 60 gram diet, and 3.6 pounds per week 2 on the 30 gram diet. This means that cutting down from 60 3 to 30 grams, from low to even lower, without cutting 4 calories led to an increase ten and a half pounds of fat 5 being lost in the nine weeks of the study. 6 I hope I've proven that the diet is effective, so 7 now let's turn our attention to the safety. Over the years, 8 I've heard myriad concerns, but very little in the way of 9 observed complaints. In fact, in 1973 the AMA requested 10 that its members be on the lookout for adverse effects from 11 my diet and report them to AMA headquarters. 12 Three years later when we checked, despite the 13 fact that millions had been on my diet, no examples of 14 adverse reactions were in their files. None. Some 15 complaints, by the way, that organs such as the kidneys or 16 the liver are damaged by the diet must be dismissed 17 immediately as being total inventions fashioned out of the 18 whole cloth. Not a single case of kidney or liver damage 19 was ever reported, even as an isolated case history. 20 The major issue then seems to be the speculation 21 that it would be bad for the heart. I hope you agree that 22 it's not the cholesterol and fat in the diet that leads to 23 heart disease, but rather the cholesterol and fat in the 24 blood. If so, we can review the changes in the lipid 25 profile on low carbohydrate diets. They fall into a common 27 1 pattern. 2 The total cholesterol usually drops a bit, and 3 there is usually a tendency for the HDL to rise and the LDL 4 to fall, much as a recent study out of Wilmington, Delaware, 5 on a modified low carbohydrate diet shows. 6 Next? 7 (Whereupon, a slide was shown.) 8 DR. ATKINS: In this particular study, all the 9 lipid variables moved in the right direction. You will 10 notice that these people lost a lot of weight, and the first 11 group that I'm about to show you the changes were fairly 12 dramatic. 13 Next one? 14 (Whereupon, a slide was shown.) 15 DR. ATKINS: Another group was done with more 16 people who lost very little weight, but they had a major 17 effect on their blood sugar. They were diabetics. However, 18 again every single one of the parameters, the cholesterol, 19 the triglycerides and the LDL, all went down, and the HDL 20 went up. 21 Okay. Now, most of the other studies throughout 22 the years, and I've reviewed the literature, and it goes 23 back to the 1950s and 1960s -- there are about ten of them 24 -- report a striking improvement in triglycerides 25 particularly. 28 1 I want to talk about triglycerides because this is 2 much more important than you might imagine. It's logical, 3 by the way, that it should be beneficial in controlling 4 triglycerides because body fat biochemically in 5 triglyceride, and we know that the diet causes a loss of 6 body fat. 7 The first demonstration of this -- Next? 8 (Whereupon, a slide was shown.) 9 DR. ATKINS: -- was very dramatic, and it dates 10 back to 1966. It was done at Harvard, P.K. Ressel and his 11 colleagues. 12 That doesn't look like it. You better do one 13 more. 14 (Whereupon, a slide was shown.) 15 DR. ATKINS: Is that it? I can't see it. 16 The subjects had very high triglycerides in 17 Ressel's study. Their triglycerides ranged from 500 and up, 18 and a typical fall was from 1,300 down to 300. 19 There were many, many other studies, which I don't 20 have time to show, but you can be sure that high 21 triglycerides are corrected by a low carbohydrate diet. 22 May I see the next slide? 23 (Whereupon, a slide was shown.) 24 DR. ATKINS: All right. We'll leave that one. 25 The impact of high triglycerides cannot be 29 1 underestimated. Let's look at another Harvard study, this 2 one very recent, published in Circulation, October, 1997. 3 Gaziano was the senior author. 4 He took 340 patients who survived a myocardial 5 infarction and got out of the hospital. They were compared 6 with age and sex matched controls. Of all the lipids 7 studied, and they studied every lipid there was, they were 8 most fascinated by the elevation of triglycerides combined 9 with a low level of the good cholesterol, the HDL. 10 This is what the study showed. They divided them 11 into quartiles of this ratio, triglyceride to HDL. The 12 lowest quartile or the most ideal number, so to speak, was 13 given a factor of one. They were assigned that number. 14 Then 4.1 times more of that group in the second quartile 15 were in the heart attack group, 5.8 times in the third 16 quartile, but in the fourth quartile, the upper 25 percent, 17 there was 16 times more likelihood of being in the heart 18 attack group if you had triglycerides combined with low HDL. 19 This is the most powerful risk factor for heart disease ever 20 described. 21 If you look at what cholesterol does, it's maybe 22 two to one. If you look at what homocystine does maybe five 23 to one, but 16 to one? This is what you must be looking for 24 if you want to reverse heart disease. 25 Next PowerPoint? 30 1 (Whereupon, a slide was shown.) 2 DR. ATKINS: The importance of high triglycerides 3 then is that they are perhaps the most important cardio risk 4 factor at all, but they are a known surrogate market for 5 hyperinsulinism. Now, we haven't talked about 6 hyperinsulinism, but a lot of people have. High 7 triglycerides and low HDL are surrogates for this 8 phenomenon. 9 You do see, by the way, the same incidence of high 10 heart attack rates when you study insulin levels as well. 11 Even more important is that triglycerides are a known 12 responder to carbohydrate restriction. 13 Next? 14 (Whereupon, a slide was shown.) 15 DR. ATKINS: We've done a retrospective study on 16 319 subjects at the Atkins Center we're going to really skip 17 most of. We don't have time. I just want to point out that 18 in the group of 85 people who had triglycerides of over 150, 19 the value one year later was less than 50 percent of what it 20 was at the beginning of the study. 21 Go to the next two. Skip the next one, and we'll 22 go on to the next. 23 (Whereupon, a slide was shown.) 24 DR. ATKINS: To dismiss the complaint that the 25 Atkins diet skimps on fruits and vegetables, I would like to 31 1 point out that it is nutritionally naive to lump fruits and 2 vegetables together. There is a wide variance in their 3 phytochemical content. 4 In my latest book, Age Defying, I deal with this 5 issue. Carbohydrates per se are not nutritionally 6 essential, only the phytochemicals that they contain. 7 Future dieters will be instructed to select foods with a 8 high antioxidant to carbohydrate ratio. The best 9 phytochemicals act as antioxidants. 10 This is a very good study. By the way, it was 11 done out of Tufts, and I wonder if it was done from the 12 USDA. I hope it was because this work is very, very 13 valuable. 14 Let's look at the PowerPoint that shows it. 15 (Whereupon, a slide was shown.) 16 DR. ATKINS: These are the foods that have the 17 highest ratio of antioxidants, done by the Tufts study, per 18 gram of carbohydrate. 19 Fruits and vegetables were studied. Go to the 20 next one just briefly and then back to this one. 21 (Whereupon, a slide was shown.) 22 DR. ATKINS: All right. Now, you see there's a 23 lot of blue in the next one. That's the lower half. 24 Back to the previous one? 25 (Whereupon, a slide was shown.) 32 1 DR. ATKINS: You see that at the top of the list 2 are foods like garlic, kale, onions, leafy greens, spinach. 3 These are the foods with the highest ratios. The only 4 fruits on the list were berries. 5 If we now turn to the next list, you're going to 6 see the bottom of the list. 7 (Whereupon, a slide was shown.) 8 DR. ATKINS: You're going see that things like 9 apples and pears and bananas have a reading of 0.2, and yet 10 kale a reading of 6.5, so that if you pick the right green 11 vegetables you will do 30 times better than if you pick the 12 wrong fruits. 13 One leaf of lettuce has double the antioxidant 14 power as an entire banana, so let's no longer lump fruits 15 and vegetables together. Let's learn to be selective and 16 pick the vegetables that work. 17 All right. Next? Next PowerPoint? 18 (Whereupon, a slide was shown.) 19 DR. ATKINS: Now we have to deal with the 20 accusation that the Atkins diet is low in vitamin and 21 mineral content. Here's an example of a 2,000 calorie 22 version of my strictest diet from the standpoint of 23 carbohydrate. It only has 20 grams. It starts with a three 24 egg omelette of avocado and cheese and tomato and two strips 25 of bacon and so on. You can read the rest. I hope you can. 33 1 I can't from here, but maybe you can. 2 All right. I want to show you it measures up to 3 the RDI, which stands for the recommended daily intake, of 4 12 different vitamins. Next, please? 5 (Whereupon, a slide was shown.) 6 DR. ATKINS: Do you see that black line? That's 7 100 percent. These are 12 vitamins. Nine of the vitamins 8 go way over that line, two of them are virtually at the 9 line, and only one, pantothenic acid, is at the 50 percent 10 mark, and it's a question of whether we can do better. 11 Now, I personally believe in nutritional 12 supplements for everyone. I believe that people on the food 13 pyramid diet need nutritional supplements a lot more than 14 people on the Atkins diet, and so if I tell people to take 15 nutritional supplements it's not because my diet is 16 inadequate. It's because they were on an inadequate diet 17 before they started my diet. 18 Okay. Now the main question about the long-term 19 studies. No one has one. There are no long-term studies 20 showing that any diet for weight reduction is both effective 21 and safe. Mostly it's not hard to show that they're safe, 22 by the way, but none have been shown to be effective. To be 23 effective, they must be followed. They must be easy and 24 pleasant enough to follow. 25 The recidivism rate of most diets falls into the 34 1 95 percent range, which indicates that very few people want 2 to follow them. I predict that my diet will be the first 3 diet to achieve the long-term effectiveness award, and the 4 reason is -- let's see the next PowerPoint. 5 (Whereupon, a slide was shown.) 6 DR. ATKINS: The reason is that it is easy to 7 follow. It's easy to comply with. You're never hungry. 8 You have a metabolic advantage. You can take in more 9 calories than you can on other diets and still lose weight. 10 You can go to restaurants, order from the best of the main 11 courses. You can eat in luxuriously, and you will correct 12 an awful lot of other health problems. 13 It will correct diabetes, hypertension, most of 14 the risk factors for heart disease, gastritis, esophageal 15 reflux disorder, headaches and a variety of other problems, 16 and for all of these reasons I hope -- the reason I'm here, 17 by the way, is to help the people of our nation and of our 18 nation, and I hope that this misinformation that people have 19 had to abide by, all of the statements that a low 20 carbohydrate diet is scientifically unsupported, I hope 21 we've put an end to that this morning. 22 I hope that some government official will decide 23 okay, it's pretty clear that long-term studies are going to 24 have to be studied by the government and that they will do 25 that. When they do, they will begin to get some of the 35 1 exiting results, much as Dr. Eric Westman has gotten in his 2 short-term studies, and I hope we can hear from him. 3 Thank you. 4 (Applause.) 5 MS. O'NEIL: Thank you, Dr. Atkins. I promise 6 that the rest of the panel will be just as technical. I 7 can't wait to get to panel discussion and some of the 8 questions. 9 Didn't I see you at Smith and Walensky last night? 10 DR. ATKINS: No. 11 (Laughter.) 12 MS. O'NEIL: Thank you very much. 13 Our next panelist is Dr. Barry Sears, entering the 14 ring now. Dr. Sears, your time begins now. 15 DR. SEARS: Thank you. Presently we have an 16 epidemic spreading across our land that threatens to destroy 17 our entire health care system. Currently, 55 percent of all 18 American adults are overweight. Obesity has increased by 50 19 percent in the last seven years, and more than 300,000 20 Americans die each year due to excess body fat. 21 The question is what has caused this epidemic? 22 We've been told for the last 20 years that dietary fat is 23 the villain, and the question is we have basically pulled 24 dietary fat out of our diet, as shown in the first slide, 25 which I hope basically is up there. 36 1 (Whereupon, a slide was shown.) 2 DR. SEARS: It's there? Unfortunately, it's not 3 down here. 4 As you can see from that slide is that over the 5 last several decades we have reduced the amount of fat in 6 our diet as a percent of calories, but this leads to what I 7 call the American paradox. That is, we are reducing the 8 amount of fat in our diet, yet we are becoming the fattest 9 people on the face of the earth, and this trend is 10 accelerating. 11 Three of our most renown nutritional researchers 12 looked at this very carefully, reviewed all the long-term 13 studies and wrote a report published two years ago in the 14 New England Journal of Medicine. In this report they came 15 to two conclusions. The first was replacement of fat by 16 carbohydrate has not been shown to reduce the risk of 17 coronary heart disease. They also came to the conclusion 18 that beneficial effects of high carbohydrate diets on the 19 risk of cancer or body weight have also not been 20 substantiated. 21 In essence, they are quoting that great scientist, 22 Jerry Maguire, saying show me the data because they're 23 saying there is no data that very low fat, high carbohydrate 24 diets have significant health benefits when viewed from a 25 scientific perspective. 37 1 Now, if dietary fat is not the villain, what is 2 the cause of our epidemic of obesity in our land? The 3 answer is it's not excess dietary fat. It's excess levels 4 of the hormone insulin. Dr. Atkins would agree with me, and 5 even Dr. Ornish would agree with me indirectly from a quote 6 that he had published in JAMA stating that, "Insulin also 7 accelerates conversion of calories into triglycerides, 8 stimulates cholesterol synthesis and may enhance the 9 proliferation of arterial smooth muscle cells." 10 What we have to do to understand this epidemic is 11 now view food from a new perspective. View food no longer 12 as a source of calories, which it is, but really view food 13 as a drug. This is shown on the next slide. 14 (Whereupon, a slide was shown.) 15 DR. SEARS: Now we have to view this from the 16 standpoint of not only a powerful drug, but probably the 17 most powerful drug anyone will ever encounter, because we 18 have to look at food now from what will be the hormonal 19 effects on the diet. 20 Each time you eat, whatever you eat is composed of 21 macronutrients. What are macronutrients? Carbohydrate, 22 protein and fat. The power of nutrition in the twenty-first 23 century is looking at what the appropriate combination of 24 those macronutrients are to give the most ideal hormonal 25 response. 38 1 My background, as Carolyn has pointed out, is I'm 2 not a nutritionist. My background is development of 3 intravenous drug delivery systems for cancer patients where 4 you try to keep drugs in therapeutic zones. I began to 5 apply that philosophy to food some 20 years ago to treat 6 food as if it were a drug to maintain a therapeutic zone; in 7 essence primarily for hormone insulin, keeping it within a 8 zone, not too high, but not too low. 9 Now, from the standpoint we are not all 10 genetically the same when it comes to how we handle 11 carbohydrates -- is that slide up there? I'm guessing. 12 (Whereupon, a slide was shown.) 13 DR. SEARS: This is work done at Stanford Medical 14 School nearly 13 years ago taking normal weight individuals 15 who had no disease and giving them the same load of sugar. 16 You can see on the left-hand side of the slide their sugar 17 levels went up, and they came down. Nothing remarkable 18 about that. 19 But on the right-hand side of the slide, a very 20 different picture emerges. There was about one-quarter of 21 the population whose insulin levels never went up very high, 22 and they came back to baseline very quickly. These are the 23 genetic lucky ones because they can eat a high carbohydrate 24 diet and never have the ill effects of excess insulin 25 production. 39 1 However, the other 75 percent of the American 2 population will not be so genetically lucky. As they 3 consume more and more carbohydrates, they will create more 4 and more insulin, and it's excess insulin that makes you fat 5 and keeps you fat. 6 How can you tell which of those two groups you 7 fall into? A very simple test. Have a big bowl of pasta at 8 noon and see how you feel at 3:00. If you can barely keep 9 your eyes open and you're falling asleep and you're hungry, 10 then you know you fall into that category of the 75 percent 11 of Americans who genetically have a predisposition to make 12 lots of insulin. 13 But, having a predisposition to make insulin is 14 different than hyperinsulinemia where your insulin levels 15 are chronically elevated. This is shown on the next slide. 16 (Whereupon, a slide was shown.) 17 DR. SEARS: Because many of our major disease 18 states, coronary heart disease, the number one killer of 19 males and females in America, are related to 20 hyperinsulinemia, as is Type II diabetes. That's the 21 definition of a Type II diabetes. Somebody who's 22 hyperinsulinemic. Likewise, hyperlipidemia, hypertension, 23 polycystic ovary syndrome, the primary cause of infertility 24 in women, and obesity are all caused by excess insulin. 25 Now, this is why we're concerned about obesity in 40 1 our landscape. If it was simply a cosmetic problem, no one 2 would care, but the fact is a greater number of deaths -- as 3 I said earlier, over 300,000 a year -- can be attributed to 4 excess body fat because of the effect of excess insulin on 5 cardiovascular disease and Type II diabetes. 6 Let me show you some data that supports my 7 contention that excess insulin is one of our primary 8 predictors. This was published in the New England Journal 9 of Medicine some four years ago, taking patients who had no 10 trace of heart disease and following them for a five year 11 period and then asking what in the blood predicted who would 12 or would not develop heart disease. 13 It was not high cholesterol. It was not high 14 blood pressure. It was slight elevations of insulin, which 15 could predict with frightening certainty, as you can see by 16 that P factor there, who would and who would not develop 17 heart disease. 18 Another study has demonstrated, a prospective 19 study looking at individuals who had no trace of heart 20 disease and following them for a five year period and again 21 asking what blood parameters were most predictive of heart 22 disease. It turns out by far and away the most predictive 23 was increased levels of fasting insulin. This is followed 24 by increased levels of triglycerides and even increased 25 levels of LDL cholesterol, the so-called bad cholesterol, 41 1 were not nearly as predictive. 2 If you don't measure insulin levels, are there any 3 other blood parameters that can be markers of insulin? It 4 turns out the ratio of triglycerides to HDL cholesterol is a 5 very good surrogate marker for insulin. As insulin levels 6 increase, triglyceride levels increase. As insulin levels 7 increase, HDL levels decrease. 8 This is the work that Dr. Atkins had talked about 9 from Harvard Medical School looking at people who had 10 survived heart attacks and matched them with individuals who 11 had not. We can see a dramatic increase in the likelihood 12 of a heart attack the higher the ratio of triglycerides to 13 HDL cholesterol. 14 If you have high cholesterol, you are twice as 15 likely to get a heart attack. We have made a national war 16 against cholesterol. If you smoke, you are four times more 17 likely to get a heart attack. We have made a national war 18 against smoking. 19 But according to Harvard Medical School, if you 20 have high levels of triglyceride to HDL, which is really a 21 surrogate marker for insulin, so we can say if you have high 22 levels of insulin you are 16 times more likely to get a 23 heart attack, yet we hear nothing about the war on reducing 24 hyperinsulinemia, and until that war is fought successfully 25 we'll continue to become fatter and more likely to develop 42 1 heart disease. 2 If you do have hyperinsulinemia, how do you treat 3 it? Well, there is one drug that does exist. That drug is 4 called food, but you have to treat food with the same 5 respect you would treat any prescription drug, and part of 6 our trouble, why we have debates like these, we don't have 7 good definitions. We have to have a definition of what 8 diets are, and that's why we talk about putting a 9 mathematical prescription behind the zone diet. 10 We could call a high carbohydrate diet is any diet 11 that has more than double the amount of grams of 12 carbohydrate relative to the grams of protein. We can call 13 a high protein diet any diet that has more grams of protein 14 compared to grams of carbohydrate. 15 Between those two extremes lies the zone where 16 looking at balancing protein and carbohydrate, no different 17 than you're balancing a carburetor of a car because if you 18 have high levels of carbohydrate in your diet and you're 19 genetically predisposed to develop high levels of insulin, 20 that will lead to fat accumulation and increased likelihood 21 of cardiovascular disease. 22 On the other hand, if you're following a high 23 carbohydrate diet -- excuse me; a high protein diet -- you 24 will increase the production of the hormone glucagon, and 25 that will lead to ketosis, so we could call the zone diet is 43 1 that diet that stands just beyond ketosis and before you 2 reach hyperinsulinemia, but better to put it on a mathematic 3 format and now look at the literature, the scientific 4 literature, that supports that concept that controlling the 5 ratio of protein to carbohydrate will lower insulin and will 6 decrease heart disease. 7 The first of these studies actually appeared last 8 year from Harvard Medical School. They took adolescent, 9 overweight boys who were already hyperinsulinemic, and they 10 gave them meals of equal number of calories. The only 11 difference was the ratio of protein to carbohydrate. When 12 they consumed the high carbohydrate meal, their insulin 13 levels for the next four hours were highly elevated. When 14 they consumed the zone meal, their insulin levels had been 15 increased by nearly 50 percent, and again with a high degree 16 of statistical significance. 17 My work has primarily focused on Type II diabetics 18 because, as I said earlier, they're characterized by high 19 levels of insulin. Is the slide up there? Yes, it is. 20 (Whereupon, a slide was shown.) 21 DR. SEARS: This is one study we did for an HMO in 22 Texas taking their elderly Type II diabetic patients and 23 putting them on a zone diet for a six week period of time. 24 What you can see from the slide is several key 25 factors. One, insulin levels dropped by some 23 percent. 44 1 Notice the ratio of triglyceride to HDL cholesterol dropped 2 by almost the equivalent amount. That's why I say that high 3 levels of insulin and high levels of triglycerides to HDL 4 are surrogate markers. Notice they also lost body fat 5 because the only way you can lose excess body fat is to 6 lower insulin. There's nothing magical about this. You 7 have to lower insulin. 8 Now, the key of science is not whether I do an 9 experiment. It's whether can somebody else do the same 10 experiment someplace else in the world and get the same 11 results. Those results were actually replicated in 12 Australia two years ago when Australian investigators took 13 both hyperinsulinemic overweight individuals and 14 hyperinsulinemic Type II diabetics and put them on a zone 15 diet, and within three days their levels of insulin had 16 dropped dramatically. 17 Another study published last year looking at 18 long-term effects taking overweight individuals and put them 19 on diets of equal number of calories. The only difference 20 was the ratio of protein to carbohydrate. Those on the high 21 carbohydrate diet lost less fat, actually almost one-half 22 less fat, than those on the zone diet. 23 Finally, the long-term aspects. We have data gain 24 from Harvard Medical School stating that on a high 25 carbohydrate diet you're more likely to get a heart attack 45 1 than on a zone diet. You're 26 percent less likely. 2 Now, we say it's too hard to follow this program. 3 All you need is your hand because all the rules we need is 4 saying you never, ever eat any more low fat protein in a 5 meal than you put on the palm of your hand. That is three 6 to four ounces. Every nutritionist in America agrees with 7 that. 8 Now, you take your plate at each meal, divide it 9 into three sectors. On one-third of that plate you put some 10 low fat protein not bigger and no thicker than the palm of 11 your hand. The other two-thirds of the plate you fill it 12 full of fruits of vegetables until it's overflowing. You 13 add a dash of heart healthy monounsaturated fat, and now you 14 have a zone meal to keep insulin controlled for the next 15 four to six hours. 16 If we put this into a food pyramid, we get the 17 zone food pyramid. Notice the base of this you're eating 18 lots of fruits and vegetables. How many? Ten to 15 19 servings a day followed by low fat protein, followed by 20 small amounts of heart healthy monounsaturated fat and using 21 grains and rices in moderation. 22 We compare this to the USDA food pyramid. We see 23 two different pyramids. One is almost guaranteed to 24 increase insulin levels because of the high reliance on high 25 density carbohydrates such as grains and starches. 46 1 What about high protein diets? The zone has been 2 accused of that, but, as you can see from this picture, 3 there is really no relation between a high protein diet and 4 a zone diet because in a zone diet you're eating more 5 carbohydrates than protein, and the fat you are eating is 6 heart healthy monounsaturated fat, as opposed to heart 7 unhealthy saturated fat. 8 Millions of people have lost weight on high 9 protein diets. Unfortunately, the same millions have gained 10 them back. The question is why? I think there are reasons. 11 The longer you stay in ketosis, you turn yourselves into fat 12 magnets, and you accumulate body fat more readily. The more 13 saturated fat you eat, you tend to basically make yourselves 14 more resistant to insulin. Finally, the longer you stay in 15 ketosis, you begin to oxidize lipoproteins, so these are 16 long-term consequences which begin to explain why high 17 protein diets fail. 18 Now, Dr. Ornish will tell you later today that his 19 diet has cured heart disease, reversed it. Let's say what 20 are the facts? This is the data he presented in 1995. Yes, 21 his patients lost weight, but look. Their HDL levels went 22 down dramatically. Their triglyceride levels increased, and 23 he has said already earlier and been quoted that that is due 24 to basically high levels of insulin, increased 25 triglycerides, and the ratio of triglycerides to HDL 47 1 increased. According to Harvard Medical School, that's not 2 good. 3 The lead author of that study was actually K. 4 Lance Gould, one of the leading cardiologists in our 5 country, saying frequently triglyceride levels and HDL 6 cholesterol levels decrease for individuals on a vegetarian 7 high carbohydrate diet since low HDL cholesterol, 8 particularly with high triglycerides, incurs a substantial 9 risk of coronary events. 10 I do not recommend a high carbohydrate diet, and 11 the reason why? Because two years later the data came out 12 that those who followed the Ornish diet had twice the number 13 of fatal heart attacks. Perhaps when Dr. Ornish speaks 14 today he can explain how can he reverse heart attack and 15 double the number of fatal heart attacks. 16 (Whereupon, a slide was shown.) 17 DR. SEARS: Just one last slide. We want to take 18 this whole debate out of the area of politics and make it a 19 medical statement. The blood will tell you. Your blood 20 will tell you whether you're naughty or nice. You want to 21 keep your blood levels of insulin under ten microunits per 22 ml. If they're more than 15, change your diet. If you 23 don't have insulin levels, it's the ratio of triglycerides 24 to the HDL. Keep that under two. 25 If your numbers are in the right zone, I don't 48 1 care if you're eating Pop Tarts. Keep eating the Pop Tarts. 2 They're working for you. 3 MS. O'NEIL: Thank you, Dr. Sears. Thank you. 4 The food fight is starting to shape up. 5 (Applause.) 6 MS. O'NEIL: Does Dr. Bethea need the slide 7 changer? 8 DR. BETHEA: Yes. 9 MS. O'NEIL: You do need it? Okay. Can someone 10 help me with this? I'm not sure, unless there's one on the 11 side of that table. It doesn't seem to extend very far. I 12 don't know if audibly you could just ask them to change. 13 It's interesting in listening to the comments and 14 concentrating. I guess everyone on this panel understands 15 what the other presenters are saying, and yet they still 16 disagree. 17 Go ahead, Dr. Bethea. What's happening that took 18 Sugar Busters! from the streets of New Orleans to the rest 19 of the country? 20 DR. BETHEA: Secretary Glickman, Ms. Watkins, 21 fellow panelists, members of the USDA, guests and press, 22 it's an honor for me to be here today to talk to you about 23 Sugar Busters! 24 I will get started as soon as my slides come up. 25 If you'd put it on the monitor, please? Could you put the 49 1 slide on the monitor? 2 (Whereupon, a slide was shown.) 3 DR. BETHEA: Corn is for cattle, and potatoes are 4 for pigs. So say the French. More specifically, Michaele 5 Montinak. Michaele Montinak wrote Dine Out and Lose Weight, 6 and he's the one who peaked our interest in the way the 7 French have eaten for hundreds of years. 8 Now, what is the French connection? Is it the 9 wine? No, I really don't think so. Let's look at World 10 Health Organizational data. Age adjusted, the French have 11 less obesity, lower cholesterol and fewer strokes and heart 12 attacks than other westernized people. 13 Why do we diet? We diet usually because of 14 appearance and/or our health, and when we speak of our 15 health, it's usually the cardiovascular system. You've 16 heard some of the other panelists speak of heart attacks, 17 and that's how I got interested in the Sugar Busters! 18 concept because I am a heart surgeon. 19 Now let's look at the nutritional industry in the 20 United States. Through 1998, we are spending $33 billion on 21 diets, nutritional aids, additives, supplements, gimmicks, 22 all kinds of ways to lose weight. We're spending another 23 $50 billion on health care costs directly attributable to 24 obesity, and there's another $23 billion a year being spent 25 annually, or lost, should I say, in wages, compensation and 50 1 other forms of remuneration because people are either in a 2 hospital or going to see a doctor. That's over $100 billion 3 a year problem for this country, simply stated, because of 4 fat. 5 Now let's put things in perspective. I like to 6 play golf. We're only spending $15 billion a year on golf, 7 and that's after Tiger Woods. 8 Now let's look at what that investment or cost has 9 gotten us. Slide, please? 10 (Whereupon, a slide was shown.) 11 DR. BETHEA: In 1970, one in five Americans were 12 overweight; in 1990, one in three; in 1998, one in 2.5; and 13 today over half of our children are overweight. This comes 14 with a 16 percent reduction in fat intake. We're eating 15 less fat, and we're getting fatter. 16 Let me show you something else even more alarming. 17 Look at the increase in incidence of diabetes over that same 18 period of time in the U.S. population. It has tripled. 19 Look at your chance of becoming diabetic as you become more 20 overweight. 21 Now, does anybody have any idea why this is 22 happening? Well, let's look at the consumption of refined 23 sugar. You know, we didn't have refined sugar until about 24 500 A.D. The Persians figured out how to refine it, but it 25 was expensive and not readily available, and not many people 51 1 could afford it. 2 By the 1900s, it became readily available and 3 inexpensive, and look at the graph. Through 1994, Americans 4 were consuming about 150 pounds of added refined sugar a 5 year. That's over a third of a pound a day. Now, that's 6 not broccoli and asparagus and cauliflower. That's added 7 refined sugar. If you don't believe it, start looking at 8 USDA labels that are on foods we eat where it says sugars. 9 Now, I don't mean to imply that you in Washington 10 are eating that much sugar, but in New York, Philadelphia, 11 and, unfortunately, in New Orleans, my hometown, they 12 definitely are. 13 Now let's look at what we eat because there's a 14 lot of confusion. No matter who fixes it, where it's 15 prepared or how much it costs, we eat carbohydrates, fats, 16 proteins and fiber. Carbohydrates are broken down to 17 sugars, about 80 percent glucose and the rest fructose and 18 galactose, simple sugars. Fats are broken down to 19 triglycerides, proteins to amino acids, and fiber is 20 cellulose. Our digestive tracts do not absorb fiber, but 21 fiber plays an important role, as we will see, in our 22 digestion. 23 Now, sugars, amino acids and triglycerides are 24 presented to our metabolic computer. Our metabolic computer 25 is our liver. Our livers as we know them today developed 52 1 400,000 years ago. Unfortunately, we can't take our 2 metabolic computer into the computer superstore and have an 3 Intel Pentium chip put in, so when we overload this 4 computer, what happens? We start having medical problems. 5 Now, this computer is programmed by two important 6 hormones, insulin and glucagon. Insulin is secreted by the 7 beta cells of our pancreas in response to a carbohydrate or 8 sugar meal. We cannot live without insulin, but we can live 9 much better without too much insulin. 10 What does insulin do? Well, it facilitates the 11 transport of glucose across the cell membrane so that we can 12 get sugar in the cell for an energy source. It promotes the 13 conversion of glucose to glycogen and fatty acids in the 14 liver, and it promotes the storage of free fatty acids as 15 triglycerides in fat cells. 16 Yes, we start out with sugar, and under the 17 influence of insulin we end up with fat. Insulin also 18 blocks hormone sensitive lipase, which helps us burn fat, 19 and insulin stimulates our livers to produce cholesterol. 20 High insulin levels do two other things. They act 21 on our blood vessels to produce aging or arteriosclerosis, 22 and they act on the muscle of our hearts, predominantly our 23 left ventricles, to produce cardiac enlargement or left 24 ventricular hypertrophy. As a heart surgeon, these are two 25 things I can tell you you do not want to have. 53 1 Let's look at glucagon. Glucagon is secreted by 2 the alpha cells of our pancreas in response to a protein 3 meal. It helps us break down glycogen, that first storage 4 form of glucose, and it helps us break down triglycerides or 5 fat to fatty acids. This is the form of fat that we can 6 burn as an energy source. 7 Let's look at what happens to consumed sugar, any 8 sugar, all sugar. A few milligrams maintains our blood 9 sugar, which is always kept within a precise range. Seven 10 hundred grams is converted to glycogen, which is stored in 11 our livers and muscle, but many kilograms is converted to 12 fat. Remember, it's 2.2 pounds to the kilogram. 13 What is this Sugar Busters! diet concept? We want 14 you to eat in a fashion so that you modulate your insulin 15 secretion downward and you modulate your glucagon secretion 16 upward. If you could do this by eating pecan pie and 17 Haagen-Daas ice cream, so be it, but I can't. Sugar 18 Busters! is not anything new. It is an existing way of 19 eating which we have validated with current medical 20 knowledge of biochemistry and physiology. 21 Now let's look at what happens to glucose, insulin 22 and glucagon after you have a high carbohydrate and after 23 you have a high protein meal. As you would expect, after a 24 high carbohydrate meal glucose goes up. After a high 25 protein meal, glucose stays relatively flat. Insulin, after 54 1 the high carbohydrate meal, goes up, and you would expect 2 that because insulin tracks glucose. After the high protein 3 meal, insulin moves very little. After a high carbohydrate 4 meal, glucagon, which helps you burn fat, is actually 5 depressed, but after the high protein look what happens to 6 glucagon. It goes up. Glucagon helps you burn fat. 7 Is there any scientific verification for the 8 harmful effects of high insulin level? Absolutely. The 9 Bogalusa heart study published in Circulation, one of the 10 most prestigious of medical journals, states that the first 11 measurable abnormality in young adults before the onset of 12 hypertension, obesity, diabetes and symptomatic 13 cardiovascular disease was a rising insulin level. 14 Despres, in the New England Journal of Medicine, 15 has shown that high insulin levels carried the same risk 16 factor for coronary artery disease as hypertension, smoking, 17 heredity and the other accepted risk factors. 18 So what is the practical application of Sugar 19 Busters!? We want you to reduce your intake of refined 20 sugar products and processed grain products. Processing 21 alters a product to its detriment. Have you ever wondered 22 why they enrich flour? It's because they have stripped out 23 all the beneficial components, and they have to put it back 24 in. 25 (Whereupon, a slide was shown.) 55 1 DR. BETHEA: Look at what happens to your blood 2 sugar levels with the same gram equivalent amount of whole 3 grain, cracked grain, coarse grain and fine white grain. 4 The only difference is they have been processed, and fiber 5 has been removed. Look how quickly the processed grain or 6 the fine white grain elevates the blood sugar and thus your 7 insulin level. 8 (Whereupon, a slide was shown.) 9 DR. BETHEA: Now, the glycemic index is a 10 characteristic of a carbohydrate, which shows how quickly it 11 is absorbed and causes a rise in blood sugar. They're 12 usually broken into three groups, low, intermediate and 13 high. This is a glycemic index showing several different 14 foods. You will notice the new potato and sucrose. Sucrose 15 is table sugar. 16 If you were to take a baked potato and scoop out 17 the flesh of the potato and fill the skin with table sugar, 18 you get the same glycemic index as if you eat the potato. 19 The blood sugar goes up just as quickly and insulin tracks 20 it, so the next time you eat that baked potato think about 21 that. 22 Now, what is the Sugar Busters! lifestyle? High 23 fiber vegetables, stone ground whole grains, lean and 24 trimmed meats, fruits and, if you choose, alcohol 25 responsibly and in moderation. 56 1 Now, Sugar Busters! is very concerned about you 2 having too much fat, but we need some fat for the proper 3 function, but try to bake, broil or grill meats rather than 4 deep frying, which involves a fat on oil, and with cooking 5 pick a cooking oil that is high in mono and polyunsaturated 6 fats and low in saturated fats, such as canola oil. 7 Now, there's some eating patterns you have to 8 follow with Sugar Busters! because if you choose the right 9 foods, you can't eat all you want. You should eat three 10 meals a day. Missing meals does not help you lose weight. 11 You should limit liquids with meals because we only secrete 12 a finite amount of digestive enzymes, and if you drink a lot 13 of liquids with a meal it will dilute these enzymes and make 14 digestion incomplete and indigestion complete. 15 Moderate portions. We talk in our book about the 16 give a dinner plate. Everybody knows what it looks like. 17 It's got a round bottom, flanged sides. Your meat and 18 vegetables should fit neatly on the bottom of the plate. It 19 should not be on the sides. It shouldn't be stacked, and it 20 shouldn't fall over the sides, and when you fill it up 21 correctly once, don't go back and fill it up twice. If you 22 do that, and we've run experiments with it, you get the 23 exact amount of foods that you should have, and you don't 24 overeat. 25 Fruit is a snack because fruit only uses 57 1 two-thirds of the insulin that many other carbohydrates use. 2 Drink six to eight glasses of water a day. We need plenty 3 of water. Don't drink it with meals. I said a little 4 earlier avoid potatoes. Add beets, corn and carrots. How 5 can a physician stand up here and tell you not to eat a 6 carrot? 7 What is it about the carrot that's beneficial? 8 It's the beta carotene, the precursor of Vitamin A. Where's 9 the beta carotene on the carrot? It's the pigment that 10 gives it its color. You can get that same beta carotene 11 from sweet potatoes, from broccoli, from cauliflower, 12 without having to have the flesh of the carrot, which is 13 pure sugar. 14 Next slide? 15 (Whereupon, a slide was shown.) 16 DR. BETHEA: Alcohol does have some benefits. It 17 increases the HDL-2 and -3, the good HDL, and it decreases 18 platelet stickiness and also plasma fibrinogen, which makes 19 the blood less likely to clot. Red wine, having 20 bioflavonoids, gives you the added value of decreasing the 21 oxidized portion of LDL cholesterol, which is harmful. 22 But remember, too much alcohol, you have a car 23 accident and an injury, and you're brain dead. You're just 24 as dead as if you had a heart attack, so the risk/reward 25 ratio for alcohol is U Shaped. Responsibly and in 58 1 moderation if you use it. 2 Women have a couple of problems I would like to 3 mention specifically, although our greatest successes have 4 been with women on Sugar Buster! Women are more efficient 5 fat storers because for many of their lives they're feeding 6 an infant or unborn child. They exercise less vigorously, 7 and even if they exercise as vigorously, they don't have as 8 big a muscle mass to burn as much food sources. 9 The Achilles heel is that they snack more 10 frequently, and they snack on all the wrong things. Women 11 taking high doses of Progesterol will see that they gain 12 weight because progesterone is a vigorous appetite enhancer, 13 as well as enhancing fat storage. 14 Exercise is a tremendous component to Sugar 15 Busters! because the first measurable effect of exercise, 16 even before you begin to lose weight, is a lowering of the 17 insulin levels and an increase in insulin sensitivity. 18 I'd like to mention cholesterol. From diet we may 19 take in anywhere from zero to 400 milligrams of cholesterol 20 a day. We only absorb 40 percent of that from our 21 intestinal tract, so that's only 160 milligrams. From 22 synthesis we manufacture in our livers 500 to 1,000 23 milligrams of cholesterol a day under the influence of 24 insulin. Insulin activates HMG CoA reductase, which is the 25 rate limiting enzyme in cholesterol manufacture, so with 59 1 lower insulin levels you manufacture less cholesterol. 2 Next slide? 3 (Whereupon, a slide was shown.) 4 DR. BETHEA: Some before and after pictures. 5 Again, women have been our greatest success stories. Many 6 have lost over 100 pounds, but Sugar Busters! is not just 7 for people that want to lose weight. It's people that want 8 to eat in a healthy fashion. 9 As a heart surgeon, I'm very concerned about the 10 cardiac risk factors, and Sugar Busters! has greatly 11 affected those. We haven't done much for heredity, but I've 12 had patients tell me that if they had to do it over again, 13 they would choose different parents, and I've had parents 14 tell me they would choose different children, so that's a 15 wash. 16 Smoking is obviously bad. Slide, please? 17 (Whereupon, a slide was shown.) 18 DR. BETHEA: But high blood pressure, high 19 cholesterol, triglycerides have been greatly benefitted. 20 Diabetes has been markedly improved. We have many patients 21 that are now off all medications. Obesity, stress, and 22 obviously we're looking right at sugar. Remember, most fat 23 on our bodies comes from sugar, not fat. When you go into 24 your grocery store and see low fat, it usually means high 25 sugar, and high sugar is usually high refined sugar. 60 1 How is Sugar Busters! being accepted? With the 2 current magazine, Prevention, out this month, they looked at 3 some of the newer diets, and they picked Sugar Busters! as 4 the best. Sugar Busters! involves no additives or 5 supplements. It is about eating lean and trim meats, high 6 fiber vegetables, whole grains and fruits in an effort to 7 modulate insulin secretion and blood sugar levels downward. 8 It is a balanced diet of 45 percent carbohydrate, 9 30 to 35 percent fat, 20 to 25 percent protein with more 10 than 25 grams of fiber. It is logical, practical and 11 reasonable. It does not involve weighing, counting or 12 measuring. Try it. I think you're like it. 13 MS. O'NEIL: Thank you. Thank you, Dr. Bethea. 14 Thank you. 15 (Applause.) 16 MS. O'NEIL: Okay. Let's think about this for a 17 minute. If I was I guess a member of the public right now, 18 I'd come to the conclusion I needed to get on one of those 19 low insulin diets, and I would want to know what foods had 20 insulin in them. 21 (Laughter.) 22 MS. O'NEIL: I'm just using that accent because 23 I'm from Atlanta, too. 24 You know, that's what I think people are left 25 with. You know, they process the information, which is very 61 1 complex and certainly well detailed by each of you so far, 2 but that is where people jump and say which foods have low 3 insulin? We'll move on. I know you explain it in all your 4 books and everything, but I'm just going for the basics here 5 that people grasp immediately. 6 Our next presenter is Dr. Keith-Thomas Ayoob from 7 the Albert Einstein College of Medicine. I understand 8 you're also speaking on behalf of the American Dietetic 9 Association as a representative today, so if you would go 10 ahead with your presentation? Your time starts now. 11 DR. AYOOB: Okay. Can you hear me? Okay. Great. 12 I think probably the best way to lose weight is to 13 listen to a lot of people discussing hormone secretion and 14 platelet aggregation. It doesn't do anything for your 15 appetite. No offense intended, please. 16 (Laughter.) 17 DR. AYOOB: It gets really technical, and it 18 shouldn't. I mean, it really should be a lot more about 19 basics and things, and we're all guilty of that to some 20 degree. 21 What we've heard so far here are presentations on 22 several popular diets, and actually as different as they all 23 are, they have one thing in common. Okay. They all work. 24 They all work. They can all produce weight loss, and they 25 actually do it all the same way. 62 1 Slide, please? Slide? Oh, slide? No. Actually, 2 it's a PowerPoint slide. Well, until they get the slide 3 together, I'll tell you how they work. They all cut 4 calories. Okay. 5 (Whereupon, a slide was shown.) 6 (Applause.) 7 DR. AYOOB: I can hear that. The bottom line is 8 that's the only way anybody is ever going to lose weight. 9 Okay. You cut calories. You have to burn more calories 10 than you eat. 11 There are also in addition to these diets lots and 12 lots of other studies and diets actually that have been 13 effective at producing weight loss. Ask a dieter. Their 14 bookshelves are probably loaded with them. I wonder how 15 many diet books they've bought after they bought the diet 16 books up here? I wonder sometimes. 17 Actually, I should say that, you know -- next 18 slide, please? Okay. Do you know what? It looks like 19 we're having technical problems. I can fill in for the 20 slides. Trust me. 21 Suppose I told you that I know of a diet that 22 would be absolutely guaranteed to get you to lose weight 23 fast. You can lose weight. You can lower your cholesterol. 24 You can sleep better. Most people say that they feel 25 better, and many have said that they have more energy. 63 1 Okay. I can also tell you it's guaranteed to work 2 on absolutely everybody, no matter what your medical 3 profile. It will work every time. It will be 100 percent 4 effective at getting you to lose weight. It's fasting. 5 Books have been written about it. 6 Do we have a slide now? Okay. Great. There we 7 go. We have our fasting slide. 8 (Whereupon, a slide was shown.) 9 DR. AYOOB: Anyway, fasting works. Books have 10 been written about it. It's not just in the 1960s that 11 books were written about it. You know, it's been written 12 about for a long, long time, hundreds of years. 13 There have been diets. Remember about ten years 14 ago there was the Beverly Hills diet? Whatever happened to 15 that? The one that was going to take us, I think to quote 16 the author, by taking us from hamburgers to hipbones and 17 cheesecake to cheekbones. Well, that went the way of the 18 wind, probably to chase Manhattan. Who knows. 19 Also back in the 1960s there was the drinking 20 man's diet. I'm surprised this one didn't catch on. Do you 21 all remember this one? Some of you aren't old enough. I 22 am. I was underage at the time. However, the point is that 23 that's the only way you're going to be able to lose weight 24 is to cut your calories. You can do it in lots of different 25 ways. 64 1 We shouldn't be judging these or any other diets 2 based on whether or not they can produce a weight loss 3 because they can all do that. The real issue here is 4 long-term weight management. 5 Now, I'm here as a representative of the American 6 Dietetic Association, but we don't endorse a diet. Okay. 7 We don't have a diet. I haven't written a book. Maybe 8 someday. I'm not a paid spokesperson. I'm a volunteer 9 spokesperson, so I'm really here in the best interest. 10 We don't endorse a diet because we look at the 11 scientific evidence and the research, and that tells us that 12 diets don't work. They work in the sense of you can get 13 somebody to lose weight, but do you want to stay on it 14 forever? Diet almost by itself, the word itself, suggests a 15 limitation. It suggests temporary, and controlling weight 16 is a lifelong issue that needs a permanent solution, not a 17 quick fix. 18 There is a slide to that effect, if we can get it. 19 If you can't don't worry about it. 20 (Whereupon, a slide was shown.) 21 DR. AYOOB: Diets are essentially a quick fix. 22 Managing weight is a long-term issue. It takes a lifetime 23 commitment, and it takes a long-term solution. 24 How am I doing on time? Okay. 25 The diets that we've seen here are chiefly about 65 1 avoidance and restriction of a group of foods. Consumer 2 surveys about attitudes tell us time and again that people 3 don't want to hear any more about what they can't eat. The 4 more foods you eliminate from the diet, the more likely 5 people are to feel deprived, and the greater the chance that 6 their diets are going to be deficient in the very nutrients 7 that can enhance their health. 8 Now, another problem with restricting or 9 eliminating whole groups of foods is the risk for the 10 probability of having an unbalanced diet. Now, a diet 11 that's desired for permanence should in and of itself be 12 balanced. If it's not, then the solution is then not to go 13 out and design and sell supplements that the consumer can 14 buy in order to correct the diet's deficiencies. The 15 solution is to get a better diet. You don't supplement a 16 bad diet. You correct a bad diet. 17 We've heard a lot of talk about the alleged big, 18 bad carbohydrate villain, and it's amazing to me that the 19 world has managed to survive for thousands of years, you 20 know, eating such things as beans, rice, potatoes and whole 21 wheat bread. 22 First of all, I want to say on the record that we 23 would have absolutely no problem with Americans consuming 24 less white sugar and white flour. No problem with that at 25 all. 66 1 Okay. I would like people to also consume a lot 2 more fruits, a lot more vegetables and lot more whole grains 3 ideal world, but at ADA we make recommendations based on 4 individual needs, and our recommendations have to be based 5 on sound science, and that's the total body of sound 6 science, not an occasional paper from 30 years ago, as was 7 quoted here today, that gives you the results that we want. 8 We modify our recommendations when research 9 justifies doing so because nutrition is a dynamic field. An 10 example of this is research recently that supports including 11 somewhat more fat into the diets of some heart patients with 12 high triglycerides. Okay. Fair game. But, the same 13 research cautions that the slightly higher fat intake should 14 come from monounsaturated fats, such as olive oil, peanut 15 products, etcetera, not from the saturated fat of pork 16 rinds. 17 What's missing from some of the patients here is 18 solid and sustained evidence. You may hear from Dr. Ornish 19 that he may be the exception because while his diet is, you 20 know, low enough in fat that some people have a problem with 21 palatability when the diet goes too low in fat. He does 22 have some good evidence as to the effectiveness in reducing 23 heart disease, and it's sustained. 24 Now, some of the other presentations here have 25 been offered to consumers as near panaceas without the solid 67 1 evidence first, and this is backwards, okay? It runs 2 contrary to good practice. The usual order is to get 3 evidence that can stand up to scientific scrutiny and then 4 present it to the public, not the other way around. 5 Consumers are entitled to that, and a responsible 6 health professional would consider this necessary. You 7 don't want to make your claims and then go later on and go 8 and try to get a study together that proves what you've been 9 saying for a long time. 10 Rather than focus on unbalanced or overly 11 restrictive diets that leave out many foods that people 12 enjoy, many basic foods, we need to focus on finding the 13 best ways to help people make long-term, positive dietary 14 change and lifestyle changes, and to do that we need to 15 study the people who have done exactly that. 16 The National Weight Control Registry has been very 17 helpful in that. It's out of the University of Pittsburgh, 18 and they study people for -- well, actually it documents 19 thousands of people who have lost at least 60 pounds and 20 kept it off, kept half of that off for at least five years. 21 That's a 30 pound weight loss over five years. 22 What they did was they had a solid commitment to a 23 low fat diet. They had a solid commitment to exercise, 24 which hasn't been mentioned here per se today. They also 25 included the high calorie foods they liked, but they did it 68 1 in moderation. Then they focused on a positive attitude and 2 a balanced lifestyle. 3 What was interesting is they all lost weight in 4 different ways. It didn't matter. It didn't matter at all 5 whether they did it in groups, individuals, you know, fad 6 diets, whatever. There were no quick fixes. 7 This isn't a simple thing. The food guide pyramid 8 is only a guide, you know, as was mentioned here before. 9 It's a guide. Individual needs certainly vary. It wasn't 10 meant to be something based on individual, specific needs, 11 but if you eat the minimum number of servings you'll get 12 1,300 calories a day about, and you'll lose weight. 13 You'll also have a balanced diet, and balance is 14 the key. I would like that to be the diet word of the new 15 millennium. Maybe balance. We've gone to all the extremes 16 now. Maybe somewhere in the middle between those two is 17 where we need to go. 18 A recent Gallup poll found that 86 percent of 19 dieters like the USDA food guide pyramid. They thought it 20 was a common, no nonsense approach to managing weight in the 21 long term, even though 40 percent of those people had at 22 some point tried a high protein/low carbohydrate diet. 23 Anyway, there's reason that balance has sound 24 scientific backing, as does the pyramid. Lots of it. A 25 mountain of it. Consumers are also advised about the 69 1 importance of physical activity. Do what you enjoy, but 2 make it a part of your life. Also remember to take this 3 slow. Slow and steady is what wins. Big changes are 4 temporary changes. Slow, steady changes are going to be 5 more likely to be permanent. We want this to be a 6 lifestyle, not just a temporary thing. 7 Thank you very much. 8 (Applause.) 9 MS. O'NEIL: Thank you, Dr. Ayoob. I think 10 lifestyle is certainly key, and that's something that we 11 hear more and more about because lifestyle indicates long 12 term. 13 I was investigating the Mediterranean diet in 14 traveling through Tuscany last year and gained ten pounds. 15 Had a great time. I don't think it was just the pasta. I 16 think I was just having a really good time. I came back and 17 got back to my usual lifestyle program. 18 Next week I'm going to Vietnam, so I'm sure I'll 19 probably lose ten pounds, but that might be a different 20 gastrointestinal mechanism. 21 (Laughter.) 22 MS. O'NEIL: Anyway, now it's time for what I call 23 the photographer check. If the photographers understand 24 what's going on at a press conference or an interview -- I 25 always turn to mine. I've been working with a guy named 70 1 Rick Blackburn at CNN for 15 years. 2 During the time when Nabisco introduced the 3 Snackwell cookies we were dispatched to cover that 4 phenomenon, and we had a box of them in the van. He was 5 eating. He said, "Oh, these are so good. These are really 6 good. These are so good." I said, "Rick, how many have you 7 eaten?" He said, "I've had 12. Am I thin yet?" 8 (Laughter.) 9 MS. O'NEIL: I think that was the problem with the 10 fat free foods, and Rick brought it home for me. 11 Now, our next speaker is Dr. Denise Bruner, and, 12 Denise, obviously with the title American Society of 13 Bariatric Physicians you're very involved in calorie balance 14 and weight control. Your time starts now. 15 DR. BRUNER: Thank you very much. 16 You know, do we all want to just get up and 17 stretch a little? We've been sitting. You know, just get 18 up. We need to stretch. Please, you know. We just do. 19 Does that count towards my time? I'm just 20 kidding. I'm just kidding. 21 I represent really a different view, a different 22 perspective, than the presenters you've heard today because 23 I'm a lady and, I'm proud to say, representing the American 24 Society of Bariatric Physicians. 25 As we start the millennium, you've heard over and 71 1 over again that obesity is the number one treatable health 2 epidemic in this country that's killing over 300,000 people 3 each and every year. The annual direct cost of obesity 4 exceeds $70 billion, as it is associated with a myriad of 5 co-morbid diseases, such as diabetes, hypertension, 6 cardiovascular disease, strokes and osteoarthritis. 7 I am representing this 50-year-old organization, 8 which you all may never have heard of, but I hope you know 9 now. This is a group that are physicians and scientists who 10 are dedicated to the treatment of this chronic disease, 11 obesity, and the associated health problems. 12 ASBP is the only medical society that provides 13 continuing medical education for practicing physicians in 14 areas of nutrition, psychology, exercise, physiology, 15 behavior modification and emergent treatment strategies. 16 ASBP's expertise continues to be utilized frequently as a 17 resource for state and federal agencies, along with regional 18 and national media, and that's why we're here today. 19 We recognize that in our heterogenous, 20 multi-ethnic and multi-cultural society many factors 21 influence the development of obesity. In our fast-paced 22 lives, our quest for quick fixes has led people to seek out 23 simplistic answers or solutions for this complex disease, 24 hence the popularity of the fad diets. 25 Some of the more popular fad diets have identified 72 1 one nutrient as the offending agent, as we've heard today. 2 In the early 1970s and even a hundred years ago it was 3 carbohydrates. Then in the 1980s, fat intake was identified 4 as the obesity producer. Consequently, the food 5 manufacturers, with the government's blessing, starting 6 massive production of low fat and no fat foods. 7 Over the past 20 years, the overall U.S. fat 8 intake has declined from 40 percent to 34 percent of total 9 calories. However, the incidence of overweight and obesity 10 has risen astronomically from 26 percent to over 50 percent 11 of our adult population. Why? 12 Well, in part because in order to make these 13 reduced fat items palatable, people added more sugar to them 14 and really tended to eat them in unlimited quantities 15 because they figured they were going to ignore those 16 calories, but calories still count. 17 The average daily caloric consumption over this 18 time has increased by about 200 calories per day. In the 19 most recent past, carbohydrates again have been designated 20 as the obesity culprit, but as long as the intake of 21 calories exceeds the caloric requirement, the imbalance in 22 the system results in a net weight gain. 23 This principle goes back to the first law of 24 thermodynamics, which we learned in basic chemistry, so we 25 as bariatric physicians recognize that one nutrition 73 1 prescription for obesity treatment is not appropriate for 2 nor is it going to be successful in each and every patient. 3 In medicine, no chronic disease has one singular 4 cause, nor one unique treatment protocol. Does a physician 5 treat every stomach ache with a pill, even though this pain 6 may be due to cancer, an ulcer or a variety of other 7 diseases? 8 Is every person with hypertension treated with the 9 same medication? If that medication does not control the 10 hypertension, does the physician just say keep taking it; 11 your blood pressure will get better? 12 Would the same exercise program be recommended for 13 each and every patient? The answer is resoundingly no. 14 Therefore, why would I recommend the identical same diet 15 protocol for every patient? 16 In order to formulate a successful bariatric 17 program for a patient, it is mandatory that the physician 18 first evaluate the patient's medical, psychological, family, 19 nutritional and exercise history, along with the result of a 20 physical examination and laboratory evaluation. After all, 21 the word diet comes from the Greek word dieta, which means 22 way of living. 23 Collectively, ASBP physicians have treated 24 millions of patients, and many of these patients present 25 challenges as they have experienced failures in other 74 1 treatment programs. Our principles of obesity management 2 include identification and treatment of co-morbid diseases, 3 along with psycho-social problems, implementation of 4 lifestyle changes, including physical activities, and 5 customizing a nutritional plan based on inclusion of all 6 food groups. 7 Pharmacological intervention may be included for 8 specific patients as adjunctive therapy. The most effective 9 treatments are developed and adjusted based on the patient's 10 clinical responses and needs. Diets that are too 11 restrictive become impossible to sustain over the long haul, 12 and, furthermore, many of the restricted diets that you've 13 heard about are nutritionally imbalanced. 14 Focusing solely on the diet instead of a lifestyle 15 as a method for maintenance of weight reduction has led to 16 miserable failure in the past. The medical literature 17 documents for the maintenance or for really that the 18 maintenance of a five to ten percent weight loss 19 significantly improves obesity related co-morbidities. 20 Obesity treatment in the twenty-first century 21 should focus on prevention and not just intervention. 22 Obesity has a clear pattern of genetic inheritance that has 23 remained unchanged over the centuries, yet if we continue at 24 the current pace more than 70 percent of our total 25 population will be overweight or obese in the next 20 years. 75 1 The present incidence of obesity and overweight is 2 disproportionately higher in African-Americans, Hispanics, 3 children and adolescents. According to the national health 4 and nutritional education survey that was completed in 1994, 5 the prevalence of obesity or overweight combining males and 6 females in this category is approaching 67 percent and 25 7 percent. Why? 8 Well, to answer this question, all one has to do 9 is observe the following. An abundance of fast food stores 10 with their super sized bargains, lack of safe recreational 11 facilities, latchkey kids watching an average of 32 hours of 12 television per week, elimination of structured physical 13 activity and education classes in public schools, sedentary 14 jobs and lives, increased use of computers. 15 Despite the paucity of funding for obesity 16 research, scientists are currently investigating the role of 17 neurotransmitters such as serotonin and hormones such as 18 lepton in the development of pharmacologic agents for the 19 obesity treatment. 20 These new pharmacological interventions or genetic 21 interventions will have little value if we do not address 22 the social and cultural variables that we know are 23 significantly affecting the prevalence of twenty-first 24 century obesity. We will literally be fighting a losing 25 battle. 76 1 (Applause.) 2 MS. O'NEIL: Thank you. Of course, we look 3 forward to hearing more from our panelists during the panel 4 discussion, but, Denise, you were the first to mention diet 5 drugs and, of course, today we have quite an active 6 liposuction business going on around the country, and you 7 mentioned something very serious about the social variables 8 and community support. 9 I know in New Orleans, Sugar Busters!, there's a 10 lot of community support in the grocery stores and the 11 supermarkets. That can't hurt. That certainly can help, so 12 again the community support, too, is important for the long 13 term. We can get into that. 14 Our next presenter is Dr. John McDougall. Dr. 15 McDougall, your time starts now. 16 DR. MCDOUGALL: Hello? Great. Let's see. Can we 17 have the slide, please? 18 You know, just as we get the slides going, I 19 wanted to tell you I learned about good diet when I was a 20 plantation doctor in 1973 through 1976. I took care of 21 first, second, third and fourth generation Filipino, 22 Japanese, Chinese and Koreans. 23 My first generation patients, who lives on rice 24 and vegetables, were always trim. They never had heart 25 disease, rheumatoid arthritis, multiple sclerosis. They 77 1 were a very fit people, but as their descendants learned the 2 rich American diet, what happened to them? They got fatter 3 and sicker. 4 Can I have the first slide, please? 5 (Whereupon, a slide was shown.) 6 DR. MCDOUGALL: That's where my background is from 7 is learning it from a practical point of view from my 8 patients 23 years ago. Okay. The plantation was in Hawaii. 9 It was on the big island of Hawaii. It was a sugar 10 planation in a place called Honokaa, and it was a wonderful 11 experience. 12 The nice thing I learned as time went on was that 13 if you stopped doing the things to people that make them 14 sick, then they get healthy, and that's the kind of medicine 15 that I've been practicing for many years. Just like 16 somebody who stops smoking cigarettes. What happens? Their 17 cough, their wheezing goes away. 18 If you stop burdening people with the rich 19 American diet, what happens? We don't quite have the slide. 20 Tell me when. 21 (Whereupon, a slide was shown.) 22 DR. MCDOUGALL: Okay. My first question is why 23 are we debating? You know, I thought this was all settled. 24 The Surgeon General of the United States in 1988 issued a 25 report on diet and health in America, and he said five of 78 1 the ten leading causes of death are due to our diet, 2 including obesity, and he said very clearly in his 3 conclusions that it's due to the disproportionate 4 consumption of foods high in fats, often at the expense of 5 foods high in complex carbohydrates and fiber. So why are 6 we heading in this other direction? I don't understand. 7 You've heard that carbohydrates are bad for you, 8 and if that were the case when you looked to Japan you'd see 9 fat, sickly, lethargic people. When those Japanese people 10 moved to Washington, D.C., they'd get trimmer and healthier 11 as they decrease their rice intake. Is that what you see? 12 No. 13 I was at a restaurant recently, and to my left at 14 a table sat some first and second generation Japanese people 15 eating rice, looking trim, healthy and young. At the table 16 to my right sat some third and fourth generation Japanese 17 people. What happened? Did they change their genetics? 18 Uh-uh. They now eat less carbohydrate, less rice and more 19 protein, fat, dairy and meat. You can see this. You don't 20 have to be confused. Just look around. 21 What you see worldwide is that in countries where 22 people eat high carbohydrate diets -- Africa, the Middle 23 East, the Far East -- they are trim. They have low rates of 24 heart disease, breast cancer, colon cancer, prostate cancer. 25 When they move to the United States and western Europe and 79 1 they abandon their high carbohydrate diet, they get fat and 2 sick. 3 You know, the first case of rheumatoid arthritis 4 was described in Africa in 1957, and the first case of lupus 5 was described in Africa in 1960. Today in the United 6 States, the highest instance of lupus and rheumatoid 7 arthritis is among the African-American people. What 8 happened in 40 years? 9 Now, the high protein diet books are all the rage, 10 aren't they? For the last nine years, that's what it's 11 been, the most popular books. Well, there are some reasons 12 for it. It's easy to follow a high protein diet. You just 13 throw it in a hamburger bun, right? 14 They have done some good. They've made people 15 aware of the harmful effects of sugar in refined foods, and 16 that's very important. People have lost weight, sometimes 17 quickly, but rarely permanently. 18 All high protein diet books blame obesity on too 19 much insulin, as you've heard today. That's the culprit, 20 right? That's the evil hormone. Well, do they really? 21 Let's take a look at the research. 22 Suzanne Holt published in the American Journal of 23 Clinical Nutrition, 1997. She looks at some responses to 24 various foods. Brown pasta produces less insulin than beef, 25 white pasta less insulin than cheese, porridge less insulin 80 1 than fish. 2 Seventy-two people were studied. This is from the 3 Pritikin Institute. They put them on a three week intensive 4 diet and exercise program, 80 percent carbohydrate. They 5 were diabetics, insulin resistant people, normal people. 6 They cut their insulin levels in half. They also cut their 7 triglycerides nearly in half, too. 8 You say well, that's the exercise. Well, part of 9 it is, but we've known that low carbohydrate/high fat 10 feeding reduces insulin resistance. That's what the 11 scientific research says. It also says that carbohydrate 12 improves insulin sensitivity. Read the research. It's 13 clear, and it's consistent. 14 Obesity, as has been mentioned, is caused by too 15 many calories. We're not eating less fat in this country. 16 The research says we're eating about the same, but we're 17 eating a lot more sugar. We're eating more flours. We're 18 going to fast food industries more, snack foods, and we're 19 not exercising as much. 20 I will further point out in the time that the high 21 protein diets have ruled the last eight to nine years, we've 22 increased obesity from 12 to 18 percent. Something is 23 missing. 24 Now, the mechanism for short-term weight loss. 25 Dr. Atkins told you that the way his diet works is similar 81 1 to fasting. Well, nature has designed us so that if we 2 don't have food and we've starving to death, it doesn't hurt 3 so much to die, so we develop ketosis, which suppresses the 4 hunger drive, a natural mechanism. 5 Ketosis also occurs when we get severely ill, and 6 the reason is we're not supposed to be gathering and 7 preparing food. We're supposed to be recuperating, so the 8 natural mechanism that occurs when you get sick is the 9 mechanism utilized in ketogenic diets, and that's why I call 10 them the make yourself sick diets. 11 The other way that they work, the other kind of 12 diets as recommended by Dr. Sears and Sugar Busters!, is 13 diet that results in semi-starvation. They invoke 14 complicated roles and restrict foods, and, of course, you 15 can't stay on either one of these diets for very long 16 because you can't stay sick forever, and you can't be hungry 17 forever. 18 The mechanism for long-term weight loss on a high 19 carbohydrate diet is the stomach is filled with fewer 20 calories because this is a low calorie dense diet. Fats are 21 very calorie dense. Excess carbohydrates are not usually 22 converted to fat, contrary to what you've heard today. 23 Carbohydrate provides a high level of satiety, and fat has a 24 weak level of satisfaction of the appetite. 25 Let me talk about this in a little more detail. 82 1 (Whereupon, a slide was shown.) 2 DR. MCDOUGALL: Each of the stomachs contains 500 3 calories. The stomachs at the bottom filled with meat, 4 cheese and butter barely make a dent in filling the stomach, 5 whereas the stomachs full of rice, corn and potatoes fill or 6 overfill the stomach with the same 500 calories. When you 7 switch from a high meat, high fat diet to a high 8 carbohydrate diet, you decrease the calorie concentration by 9 one-fourth. In other words, for the same volume of food 10 you've got one-fourth as many calories. 11 The fat you eat is the fat you wear. The human 12 body does the most efficient thing possible with everything 13 that you give it, so you give it protein, which it utilizes 14 to build things. You give it carbohydrate, which it 15 utilizes to run the machinery, and you get it fat, which is 16 the metabolic dollar that is saved for when food is no 17 longer available, which never seems to happen. 18 Multiple studies and reviews have clearly shown 19 that the body does not convert carbohydrate into fat under 20 ordinary circumstances. It's called de novo lipogenesis. 21 And, according to this study in the American Journal of 22 Clinical Nutrition and multiple studies, dietary 23 carbohydrates do not appear to increase an individual's fat 24 content by de novo lipogenesis. It's too wasteful to do 25 that, but it effortlessly stores fat. 83 1 In fact, so effortlessly, you know, you could come 2 to somebody, you could stick a needle in their buttocks, 3 thigh or abdomen, suck the fat out, you could take it to the 4 lab, you can analyze, you can tell what they like to eat. 5 If they like cold water marine fish, it will be full of 6 Omega-3 fats. If they like margarines and shortenings, it 7 will be full of trans fats. The fat you eat is the fat you 8 wear. 9 As far as satisfaction of appetite, do you know 10 the potato, which has been maligned here today, is among the 11 most satisfying of all foods? It is seven times more 12 satisfying than croissants and twice as satisfying as cheese 13 and beef. Yes. 14 Fat has a very, very poor effect on satisfying the 15 appetite. This has again been shown in multiple studies. 16 Go to the National Library of Medicine. Read it. It's 17 clear and consistent. 18 The satiating effect of fat is weak, and a 19 carbohydrate rich breakfast may assist weight control 20 efforts by maintaining fullness. Yes. John Blondell tells 21 us that eating fat results in passive over consumption and a 22 disproportionate effect on satiety. 23 In my patients -- I run a clinic at St. Helena 24 Hospital where people eat as much as they want. They eat 25 three times a day. They get wonderful meals, and the 84 1 average weight loss for overweight men is 5.3 pounds in 11 2 days, and women is about four pounds in 11 days. 3 I just finished a one year study for Blue Cross/ 4 Blue Shield of Minnesota, and we found an eight percent 5 reduction of weight in patients at one year. That's a 16.5 6 pound weight loss. 7 The National Weight Control Register was 8 mentioned, a very important study. The important thing for 9 you to know is they studied 450 people, and those who were 10 able to keep 30 pounds off for more than a year consistently 11 ate a low fat diet, which is a low energy diet. In fact, 80 12 percent of them ate less than 30 percent fat, and 30 percent 13 of them ate less than 20 percent fat. There is where the 14 long-term results are. 15 We also get cholesterol changes that are 16 significant and important. We get a 29 point drop in 17 cholesterol in 11 days at the clinic. If you start with 18 high cholesterol, we get a 65 drop in cholesterol in 11 19 days. Our triglycerides also drop. There's an average of a 20 ten point drop in triglycerides. If you start with high 21 triglycerides, say over 600, they drop on an average of 311 22 points. 23 The diet I recommend is a starch based diet with 24 the addition of fruits and vegetables. It's a traditional 25 diet. It's what most people who have ever walked this 85 1 planet have consumed, a diet of rice for Asia, a diet of 2 pasta for southern Europe, a diet of breads for northern 3 Europe, a starch based diet with the addition of fruit and 4 vegetables. 5 Now, throughout history this is what most people 6 consumed, except on special days, on holidays, on festival 7 days. Then they celebrated. They danced in the street. 8 They took the day off work, and maybe they would roast a pig 9 and have a feast. 10 Now, most people could only do this on occasion, 11 but in every society there were some rich people. They had 12 so much fun at that party that they took that idea up the 13 hill and up to their castle, and they feasted three times a 14 day, seven days a week. Do you remember what this 15 aristocrats, kings and queens looked like? They looked like 16 Americans. That's what they looked like. 17 (Laughter.) 18 DR. MCDOUGALL: That's how I was raised. I 19 started out every morning with Easter. I went on to 20 Thanksgiving and Christmas for lunch and dinner. Every 21 night after dinner I had a birthday party, and that is the 22 problem. 23 (Laughter.) 24 DR. MCDOUGALL: We need to put rich foods back 25 into special occasions. If you're tired of look like a king 86 1 and queen, then what you need to do is eat a starch based 2 diet, as the humankind has for millions of years. 3 Thank you very much. 4 (Applause.) 5 MS. O'NEIL: So the pendulum is swinging on the 6 panel back towards obviously the carbohydrate corner. De 7 novo lipogenesis? Easy for you to say. 8 DR. MCDOUGALL: That's synthesis of fat from 9 carbohydrate. Thank you. 10 MS. O'NEIL: Okay. Thank you. Thank you very 11 much. 12 Okay. Now it's time for Dr. Dean Ornish, and I 13 know you've been feverishly tapping away notes in response 14 to everything that's been said. Your time begins now. 15 DR. ORNISH: Thank you. Thanks, Carolyn. Can you 16 all hear me okay? Okay. Can you hear me now? Thank you, 17 Carolyn. 18 Mr. Secretary, Madam Assistant Secretary, 19 distinguished panelists, I just want to say how grateful I 20 am to be here. Not a day goes by these days when I'm having 21 dinner, whether it's with the Secretary of Agriculture or 22 with whomever, and people ask me about the high protein 23 diets. They usually also comment on what I'm eating or 24 apologizing for what they're eating or something like that. 25 (Laughter.) 87 1 DR. ORNISH: I just feel sad that so many people 2 are getting information that's really based on half truths, 3 nutritional half truths. To me, the point of science is to 4 help people sort out conflicting things, and so this morning 5 I want to go through with you what I think the science is. 6 I think it's also interesting that to me at least 7 the order of presentation was from the most unhealthful to 8 the most healthful diets so far. 9 (Laughter.) 10 DR. ORNISH: Life is like that sometimes. But 11 having seen what a powerful difference changes in diet and 12 lifestyle can make, it makes we want to pull out what's left 13 of my hair when I see these claims that are being made and 14 so many people changing their diets in ways that I think are 15 hazardous to their health. 16 You know, telling people that pork rinds and 17 sausage is good for you is an appealing way to sell books, 18 but I think it's irresponsible, and I think it's dangerous 19 for people who follow those advice. I know that's strong 20 words, but I want to try to substantiate that. 21 Let's see here if I can do this. Does that work? 22 Great. So the idea is that high animal protein diets I 23 think are hazardous to your health, and in a way all of my 24 work and my colleagues' work at the non-profit Preventive 25 Medicine Research Institute is based on turning off the 88 1 faucet and treating the cause of the problem. You know, 2 sometimes you do have to mop up the floor, but we also need 3 to treat the cause. 4 (Whereupon, a slide was shown.) 5 DR. ORNISH: There's a lot of misinformation out 6 there. You know, 7-Up flushes out cholesterol. The cartoon 7 says, "I've got some good news. While your cholesterol has 8 remained the same, the research findings have changed." 9 (Laughter.) 10 DR. ORNISH: So people get confused, and it's 11 understandable, whether you're reading the New England 12 Journal of Medicine or coming to a debate like this morning 13 or reading the National Examiner. It's still the same 14 issue. But if you actually look at all of the data, what 15 you find is really not how conflicted, but how consistent it 16 is that a meat-based diet is not as healthful as a 17 plant-based diet, and here are just some of the reasons. 18 First of all, you only find cholesterol in meat, 19 which tends to be high in saturated fat, total fat and 20 oxidants, whereas a plant-based diet has no cholesterol, low 21 in saturated fat, low in oxidants, high in antioxidants, 22 high in fiber, which we will talk about more in some and 23 some of the panelists have already talked about, and there's 24 literally a thousand substances that Dr. McDougall alluded 25 to earlier that have anti-cancer, anti-heart disease and 89 1 even anti-aging properties. 2 Where do you find them? You find them in a 3 plant-based diet. Phytochemicals, bioflavonoids, 4 carotenoids, retinols, isoflavums, leucopoines, guanosine, 5 There's a whole alphabet soup of these and they're powerful, 6 so when you switch from a meat-based diet to a plant-based 7 diet, in short you get a double benefit. You stop eating 8 those foods that cause disease, and you also start eating 9 foods that are actually protective. 10 Now, we've heard that, you know, the Mediterranean 11 diet, the people in France and so on, are healthier than 12 they are here, and that's true, but health better doesn't 13 mean optimal. Optimal is an Asian diet, as Dr. McDougall 14 mentioned, people in Japan and Africa. Heart disease is as 15 rare there as malaria is here until they move here, and they 16 begin eating and living like we do. It's not just heart 17 disease. It's breast cancer in women, prostate cancer, 18 colon cancer. You find the same patterns there as well. 19 In fact, you can graph intake of dietary fat on 20 the X axis against the incidence of breast and prostate 21 cancer by country, and you find the same patterns. The 22 highest intake of saturated fat and cholesterol like in the 23 United States, in the U.K., the Scandinavian countries, are 24 the highest. The eastern European countries and the 25 Mediterranean diets are in the middle, and on the lowest end 90 1 of the spectrum are the Asian countries. 2 Now that's changing, and there's a globalization 3 of illness that's occurring as people begin to -- you know, 4 they see the United States as a superpower. They want to 5 live like us, and now they're starting to die like us, and 6 it's all avoidable and really unfortunate. I think we can 7 get a globalization of health instead of a globalization of 8 illness. 9 (Whereupon, a slide was shown.) 10 DR. ORNISH: You can look at a number of animal 11 studies. For example, in this one they actually injected 12 carcinogens into rats, and they found when they put them on 13 a typical American high protein diet, the higher the dose of 14 the carcinogen, the more cancer they got. That's what you'd 15 expect. 16 But look at the rats that were fed a low animal 17 protein diet. They didn't respond to the carcinogens in the 18 same way because there are protective elements in a 19 plant-based diet that help to prevent that. The cartoon 20 says, "My only consolation is that by eating us, they're 21 killing themselves." 22 (Laughter.) 23 DR. ORNISH: All right. So I recommend a whole 24 food, low fat, plant-based diet. You can actually lose even 25 more weight, lower your cholesterol even more than on the 91 1 high protein diets. You don't get the exaggerated insulin 2 response that we talked about earlier. There's strong 3 science not only from our work, but from many others, to 4 back it up. As I mentioned, it's low in the substances that 5 cause disease and high in the ones that are protective. 6 (Whereupon, a slide was shown.) 7 DR. ORNISH: The cartoon says, "I'm going order a 8 broiled, skinless chicken breast, but I want you to bring me 9 lasagna and garlic bread by mistake." 10 (Laughter.) 11 DR. ORNISH: Now, sometimes people say oh, yes, 12 but am I going to live longer, or is it just going to seem 13 longer if I eat a low fat diet if it's not palatable? The 14 answer is you can eat low fat foots that are delicious, and 15 you can eat high fat foods that are awful. It's really how 16 you make the food that's more important than whether it's 17 low fat or not. 18 Many people have switched from regular milk to 19 skim milk or low fat milk. At first the skim milk tastes 20 like water. After a couple weeks, it tastes fine. You go 21 out to dinner, and they feed you whole milk. It tastes like 22 cream. It's too greasy. 23 Of course, the cow didn't change, but your palate 24 adapts to fat, and if you move to -- in fact, one of the 25 reasons why I think it's often easier to make big changes 92 1 than small ones is that you begin not only to feel better, 2 but your palate begins to adapt, and you begin to prefer low 3 fat foods. 4 (Whereupon, a slide was shown.) 5 DR. ORNISH: It says, "I give smokers a discount 6 because there's not as much to tell." Here again, fear of 7 dying is not a good motivator. The joy of living is. 8 When you make big changes in your diet and 9 lifestyle all at once, most people feel so much better so 10 quickly it reframes the reason for changing diet and 11 lifestyle from fear of dying to joy of living. You feel 12 better. Your brain gets more blood flow, so you have more 13 -- you can think more clearly. 14 You've all experienced what it's like to eat a big 15 Thanksgiving high fat, high protein meal. You feel tired or 16 sluggish an hour or two later. It's not the pasta that 17 makes you sluggish. It's the fat. It clogs up your brain. 18 It clogs up the arteries in your heart, so even a single 19 meal -- the American Heart Association has shown even a 20 single meal high in fat and cholesterol makes your arteries 21 constrict and your blood clot faster. 22 Also, it can cause sexual dysfunction. Viagra was 23 the most popular drug of all time last year because it's a 24 big problem in this country. A number of studies have shown 25 that when you heat a high fat, high animal protein diet, 93 1 it's not just your heart that gets less blood flow, and when 2 you change your diet, it improves other areas as well. 3 (Laughter.) 4 DR. ORNISH: For many people, that's a whole lot 5 more meaningful than telling them they're going to live to 6 be 86 instead of 85. 7 (Laughter.) 8 DR. ORNISH: Now let me talk about the work that 9 my colleagues and I have done for the last 23 years to see 10 if heart disease could be reversed by changing diet and 11 lifestyle. What did we find? 12 (Whereupon, a slide was shown.) 13 DR. ORNISH: The first study I did back in 14 1977-1978 when I was a medical student at Baylor in Houston. 15 We took ten people, all of whom had bad heart disease, put 16 them in a hotel for a month and put them on this diet and 17 lifestyle program, and we found that their chest pain went 18 away in most cases. There was over a 91 percent reduction 19 in angina or chest pain. 20 They not only felt better. In most cases they 21 were better in ways we could actually measure. We weren't 22 talking about risk factors. We were talking about the 23 disease itself, and I'll come back to that point because 24 it's a really important one. 25 On the left you see a picture of a man's heart, 94 1 the different -- the more bright it is, the more blood flow 2 the heart is getting, so around 10:00 where it's dark you 3 see there's not any blood flow there. In the picture on the 4 right, just a month later, that area that wasn't getting 5 enough blood flow was more normal. 6 That was just ten patients, no control group, but 7 it got me interested in doing this. So I went back to 8 school and after finishing medical school did a second study 9 in 1980, and this is with Dr. McClanahan and other people 10 who are here tonight, and we found that using a randomized 11 control study, using a test that measured how well the heart 12 was pumping blood, it actually got better in the month in 13 the experimental group, got a little worse in the control 14 group. The differences were highly significant, and we 15 published that in the Journal of the AMA in January of 1983. 16 After finishing that I moved to Boston to do my 17 medical training, then moved to San Francisco when I 18 finished that, and we did a third study called the lifestyle 19 heart trial. We wanted to know, first of all, could people 20 do this in the real world; not just when you had them in a 21 hotel? What happened over a year? Then we got funding from 22 the NIH to extent it for four more years. 23 What happened to the blockages in the arteries? 24 We used these high-tech, state-of-the-art, twenty-first 25 century diagnostic technologies like quantitative 95 1 arteriography and cardiac PET scan to prove the power of 2 this very ancient and low tech and low cost diet and 3 lifestyle program. 4 Overall, we found that there was almost a 40 5 percent reduction in LDL cholesterol, not the three to five 6 percent reductions that you find on the high protein diets. 7 We found a 91 percent reduction in the frequency of chest 8 pain in the first month, and we found again that they got 9 better and better over time. 10 The control group was following a 30 percent fat 11 Step II diet. Their arteries got worse after one year and 12 even worse four years later, whereas the experimental group 13 got better and better. Not every patient got better. Not 14 every lesion got better, but overall the more people 15 changed, the better they got, and overall they got better 16 and better instead of worse and worse. 17 (Whereupon, a slide was shown.) 18 DR. ORNISH: This is an example of one man who at 19 the time was 73, had severe heart disease in all three of 20 his major coronary arteries, was told he needed to undergo 21 bypass surgery. I'm sure Dr. Bethea would have done a great 22 job if he had gone to him. 23 I want to make that clear. I'm not against bypass 24 surgery or angioplasty. They can be life saving, but even 25 then we have to treat the cause. We have to turn off the 96 1 faucet. 2 (Whereupon, a slide was shown.) 3 DR. ORNISH: Now, here's a picture from his 4 angiogram. On the left you can see where it's narrowed, and 5 on the right, a year later, it's less narrowed. Now, those 6 aren't huge changes, but even moderate changes in the 7 blockages can cause dramatic improvements in the blood flow. 8 On the PET scan, as you can see here on the bottom 9 left-hand, blue and black means no blood flow, and, on the 10 right, orange and white is maximum blood flow. Clinically 11 he literally could not walk across the street without 12 getting severe chest pain; by the end of the first month was 13 completely pain free, by the end of the year was climbing 14 more than 100 floors a day on a Stairmaster, and that's not 15 unusual. It's really part of why it's easier for people to 16 stay on a program like this because you make big changes, 17 but the improvements are correspondingly big. 18 The more people changed, the better they got, both 19 at one year and also four years later. I thought the 20 younger patients with milder disease would be more likely to 21 show reversal, but I was wrong. The oldest people did as 22 well as the younger ones. 23 (Whereupon, a slide was shown.) 24 DR. ORNISH: I got this as a holiday card two 25 years ago from two of the patients in one of our programs on 97 1 the east coast. These are two brothers. The younger 2 brother is 85, and the older one on the right is 96. They 3 wanted to show me how much more flexible they were. 4 (Whereupon, a slide was shown.) 5 DR. ORNISH: Then the following year they sent me 6 this one just to show me how much better they got. 7 (Laughter.) 8 DR. ORNISH: You just never know what's possible. 9 Barry Sears mentioned that Dr. Gould doesn't 10 believe in this diet. We have some minor differences, but, 11 by Dr. Gould's own analysis, 99 percent of the patients 12 stopped or reversed the progression of their heart disease, 13 so I don't think that's so shabby. 14 We also found that eight of eight patients who 15 were on the heart transplant list showed enough improvement 16 that they were able to get off of it, and again the 17 rejection fractions improved by echocardiography. Their 18 blood flow to the heart improved by PET scan, and their 19 myocardial viability -- in other words, how many of the 20 cells in the heart were actually functioning -- got better. 21 (Whereupon, a slide was shown.) 22 DR. ORNISH: You can see on the -- well, there's 23 really not time, but just the more red means better, so you 24 can see how much better these people have gotten. 25 Now, that's only eight patients and on a control 98 1 study. We were planning a randomized control study, but 2 it's indicative of how powerful. You know, on the one 3 extreme of the spectrum someone is waiting for a heart 4 transplant. They were able to avoid it. 5 (Whereupon, a slide was shown.) 6 DR. ORNISH: The cartoon says, "I can operate, or 7 you can go on a strict diet." He says, "Well, you better 8 operate because my insurance doesn't cover a strict diet." 9 We've been working with insurance companies. 10 Through our non-profit institute, we have training sites 11 around the country. Mutual of Omaha was the first to cover 12 it. There are 42 companies that are covering our program in 13 the sites that we've trained. 14 Hi-Mark, which is western Pennsylvania Blue Cross/ 15 Blue Shield, is both providing it, as well as covering it, 16 and not just in San Francisco, but in Omaha and DesMoines 17 and Columbia, South Carolina, where they told me gravy is a 18 beverage. This will be a big change in our diet. 19 We found that they were able to follow it. The 20 program was a year long, but we followed them for three 21 years, and we found that almost 80 percent of the people who 22 were told they needed a bypass or an angioplasty were safely 23 able to avoid it, and because of that the insurance 24 companies saved almost $30,000 per patient. We published 25 this in the American Journal of Cardiology a little over a 99 1 year ago. 2 Now, we also found that the LDL levels stayed 3 down. There wasn't a transient phenomenon. Again, the 4 program was only a year long, but we followed them for three 5 years, and the LDL stayed down during that whole time. 6 (Whereupon, a slide was shown.) 7 DR. ORNISH: Now, a number of the panelists have 8 made reference to the fact, and this is to me where it 9 becomes a dangerous half truth, that HDL levels may go down 10 on a diet like I recommend. Indeed, they do go down 11 initially, but look what happens over a longer period of 12 time. That's why it's important to do studies for more than 13 eight weeks or more than ten weeks, as most of these studies 14 that they were quoting, but to follow people for longer 15 period of time. 16 Conversely, the triglycerides in some patients do 17 go up a little, but again over a longer period of time they 18 also go down. 19 Now, this has particular implications for women. 20 Dr. Susan Blumenthal, the Assistant Surgeon General who is 21 here, had a conference a year and a half ago on women and 22 heart disease, and what came out of that is that, of course, 23 heart disease is by far the leading cause of death in women. 24 They're much less likely to get operated on. When they do, 25 they don't do as well, but, if anything, women seem to be 100 1 able to reverse heart disease even easier than men, so this 2 has particular implications and benefits for women. 3 We're doing a study in collaboration with Dr. 4 Peter Carroll at UCSF and Dr. Bill Fair at Sloane Kettering 5 to see whether prostate cancer might be affected through a 6 similar kind of intervention. See, I'm a scientist, and the 7 people I work with are scientists because science can help 8 us say okay, this sounds good in theory. What happens when 9 you actually do this in a randomized trial, which is the 10 most rigorous approach. 11 (Whereupon, a slide was shown.) 12 DR. ORNISH: Well, Dr. Fair, who was chief of 13 urology at Sloane Kettering, did a study, and he injected 14 prostate tumor cells into rats, actually into mice, and they 15 grew very quickly on a typical American diet. 16 You can see on the blue line those mice that were 17 kept on a 40 percent fat typical American diet. The tumors 18 just kept getting bigger and bigger, but when they got the 19 fat intake down around ten or 11 percent or below, the 20 tumors stopped growing, or they even shrank in some of the 21 mice. 22 So what we're taking is men who have, and this, by 23 the way, is not something that I want reported in the media 24 because we're still in the middle of the study, but I 25 thought it was important to show here just to show how 101 1 important these things are. 2 I know, but we're in the middle of a study, so 3 it's not really ready for prime time, you might say, but 4 we're taking men who have biopsy proven prostate cancer who 5 have elected not to be treated conventionally. Half of them 6 go on our program. Half of them don't. Overall, the PSA 7 levels are going up in the control group. They're going 8 down in the experimental group. PSA is a marker of prostate 9 cancer, considered the best available. 10 We found the same pattern; that the more closely 11 they followed the diet and lifestyle program, the lower 12 their PSAs went. In order for the PSAs to start going down 13 instead of up, they had to make big changes, just like to 14 reverse heart disease you have to make big changes. 15 Now, I have a reversal diet and a prevention diet. 16 You know, the old saying about an ounce of prevention is 17 true. You don't have to make changes this big to prevent 18 disease, but once you have it the reason why we're able to 19 show you can reverse heart disease is that we went further 20 than most people did along the lines of what Dr. McDougall 21 recommends and others. 22 We have one patient, as an example, who not only 23 his PSA went down, but his MRI and his spectroscopy seems to 24 show that his tumor activity is improving. 25 (Whereupon, a slide was shown.) 102 1 DR. ORNISH: Now let's talk about weight because 2 clearly that's a big issue here. This is one way to lose 3 weight. It's very effective. What's wrong with this 4 picture? I don't know if you can see, but she's sitting on 5 a chair while standing on a scale. 6 The problem with most approaches to weight loss is 7 that they all work in the short run, and virtually none of 8 them work in the long run. In fact, the government, the NIH 9 Nutrition Coordinating Committee, about seven years ago 10 found that within a year, two-thirds of the people who lost 11 weight gained it all back. Within five years, 97 percent 12 gained it all back, so it's no big deal to get people to 13 lose weight in the short run. 14 That's why I saw show me, as Barry Sears would 15 say. Show me the data. Show me the long-term data that 16 these approaches can help people lose weight and keep it 17 off. 18 Now, the half truth here, the big lie that gets 19 repeated over and over again in all of these books, is that 20 carbohydrates are bad. Carbohydrates are bad because they 21 get absorbed easily. They make your blood sugar go up. 22 Your pancreas makes insulin to bring it back down, and the 23 insulin has other effects that aren't so good, which, you 24 know, in some cases can accelerate the conversion of 25 calories into fat if you get enough carbohydrate, can 103 1 stimulate HMG CoA reductase and make your liver make your 2 cholesterol. 3 That's all true, but then the goal then is not to 4 say, and that's what makes it so dangerous is that it's a 5 half true. The goal is not then to say okay, so go eat pork 6 rinds and pork chops because it won't provoke an insulin 7 response. Insulin is only one of many factors that affect 8 your health. It's not the key to everything. It's just one 9 factor. 10 The goal is to go from eating simple carbohydrates 11 to complex carbohydrates. As Dr. Bethea very clearly 12 showed, when you refine carbohydrates when you go from whole 13 wheat flour to white flour or brown rice to white rice, you 14 remove the fiber and the bran that slow their absorption so 15 they get absorbed quickly, but fruits and vegetables and 16 grains and beans and soy products are rich in fiber, which 17 slows the absorption. 18 You don't get that rapid rise. You don't provoke 19 an insulin response, and so you don't have to go away from 20 carbohydrates, but you want to eat a diet that's 21 predominantly whole foods and, as Dr. Bethea said, avoid 22 sugar, white flour, white rice, moderate alcohol and so on. 23 Again, from the American Journal of Clinical 24 Nutrition, as Dr. McDougall mentioned, it's not just the 25 glucose response. It's also the insulin response that 104 1 they're all talking about. Now, it turns out that beef 2 protein is as potent as glucose in stimulating insulin 3 production, so it doesn't make sense to eat a high animal 4 protein diet even from within the own frame of reference 5 that people are talking about. 6 Now, calories do count, but, as Dr. McDougall 7 mentioned, fat has over twice as many calories as protein 8 and carbohydrate, so if you go from a 40 percent fat to a 9 ten percent fat diet, even if you eat the same amount of 10 food, you're getting a third fewer calories. 11 Most weight loss diets don't work because they're 12 based on counting calories, restricting portion sizes. 13 Sooner or later people get tired of feeling hungry and 14 deprived. They get off the diet. They gain the weight 15 back, and then they blame themselves because they didn't 16 have enough willpower discipline when they were just going 17 about it in the wrong way. 18 If you change the type of food, if you eat 19 predominantly whole foods low in fat, you don't have to 20 reduce the amount of food. You can eat whenever you're 21 hungry. You can eat until you're full, and you can lose 22 weight safely and simply and easily without hunger and 23 without deprivation. 24 (Whereupon, a slide was shown.) 25 DR. ORNISH: Now, here's a patient who read Eat 105 1 More, Weigh Less and came to my office about two months ago, 2 and he lost 190 pounds from reading the book, and so it's 3 not just minor weight losses that you can get. We did find 4 the average person in our heart disease study lost 25 pounds 5 in the first year. They kept off half that weight five 6 years later. 7 I forget to mention earlier that we've very 8 grateful to the Health Care Financing Administration because 9 they've recently agreed to begin a demonstration project to 10 see whether we can show that we can avoid bypasses and 11 angioplasties in people in the medicare in the various sites 12 that we've trained. 13 Anyway, this is this man's before picture, and 14 this is his after picture. He's the one on the right. 15 (Laughter.) 16 DR. ORNISH: It's an example that people actually 17 really can lose a lot of weight on a diet like I recommend. 18 Now, the problem with high animal protein diets is 19 that even if you can lose weight, you're mortgaging your 20 health in the process. They're high in the disease causing 21 substances and low in the disease preventing substances. So 22 why do some people lose weight? Everybody has known someone 23 who has lost weight on an Atkins type diet, and the reason 24 is that people eat so many simple carbohydrates in this 25 country. You know, a study two months ago showed that a 106 1 third of the vegetables eaten in the United States are 2 either French fries or potato chips. 3 Consumption of sugar, white flour and processed 4 foods have significantly increased in the past 20 years, 5 along with obesity. Again, you can eat a lot of meat 6 instead of the simple carbohydrates to lower your insulin 7 response, but even then it may not lower it was much as 8 people think, and people are mortgaging their health in the 9 process. 10 Also, because you can eat a ridiculous amount of 11 calories, as Dr. Bethea indicated, by eating a lot of sugar, 12 it doesn't fill you up. You can only eat so many fruits and 13 vegetables. You get full before you get too many calories. 14 Now, the study that Dr. Atkins made reference to 15 that Dr. Westman did at Duke, which he was kind enough to 16 share with me, showed some pretty adverse side effects by 17 his own study. Constipation, bad breath, headache, hair 18 loss are not unusual when you go on a diet like this. If 19 you've been around someone on an Atkins kind of diet, it's 20 not a fun thing necessarily because how does your body 21 excrete toxic substances? Through your breath, through your 22 perspiration and through your bowels, and so all three of 23 them don't do well on a high protein diet for that reason 24 because it's toxic. It's not good for you. 25 Going into a ketonic state is not a healthful way 107 1 to eat. It may make you so sick that you don't feel like 2 eating, but that's not the most healthful way to lose 3 weight. 4 (Whereupon, a slide was shown.) 5 DR. ORNISH: I do agree with Dr. Atkins and others 6 that some supplements are beneficial, particularly things 7 like antioxidants, fish oil and so on. These are all on our 8 website at ornish.com if you don't have time to copy these 9 down now. It's the easiest way to restrict calories by 10 eating foods that are less dense in calories, which can also 11 help reduce tumors in many studies. 12 Now, HDL does go down on a diet initially that's 13 like the one I recommend, but it's a confusion. Again, it's 14 another half truth or half lie, if you will. Your body 15 makes HDL to get rid of excessive fat and cholesterol. If 16 you're eating a lot of fat and cholesterol, like most 17 Americans do, and your body can't make much HDL to get rid 18 of it, you're at higher risk than someone who can make more 19 of it. 20 If you reduce your intake of fat and cholesterol 21 to the levels that we're talking about, it's like your body 22 goes well, there's not as much garbage. I don't need as 23 many garbage men. Your body may make less HDL initially, 24 but that's not a mark of something bad. It means that 25 you're doing something good. 108 1 (Whereupon, a slide was shown.) 2 DR. ORNISH: This was a study where Jan Bresler at 3 Rockefeller University said again, it's inappropriate to 4 include that diet induced decreases in HDL are the same as 5 people who can't make much HDL when they're eating the 6 typical American diet. 7 There are no data. This is from the New England 8 Journal of Medicine. There are no data showing that 9 reducing HDL in a low fat diet is detrimental, and it does 10 not give you the same risk. They are only risk factors at 11 best. Even if you accept that HDL goes down, these are risk 12 factors. 13 They're not diseases. The disease is heart 14 disease. When we actually measure the disease, people get 15 better and better over time, as we've found, and we found a 16 two and a half times reduction in cardiac events in people 17 who went through our program, contrary to what Dr. Sears 18 mentioned. 19 When we measured the actual severity of heart 20 disease, the patients showed continued improvement, even 21 those patients who initially their HDL went down or their 22 triglycerides went up. Again, if you look at populations 23 that have low rates of heart disease like Asia, they have 24 low HDLs, but they also have low incidents of heart disease. 25 You can lose weight in lots of ways that aren't 109 1 very healthy. You can take chemotherapy or get cancer or 2 AIDS or be an alcoholic and lose weight, but losing weight 3 per se is not necessarily the only thing we need to keep in 4 mind. 5 (Whereupon, a slide was shown.) 6 DR. ORNISH: I think I'm out of time, so I'm going 7 to just go through the last slide here, which is that I 8 think we also need to take into account that there are 9 environmental consequences of eating a lot of meat. This is 10 from Time magazine two months ago. 11 To produce a pound of beef requires 7,000 pounds 12 of water, and there's increasing evidence that the 13 deforestation, the global warning last week, that is 14 occurring even more frequently than it did, these things are 15 all interrelated, and it's not just weight loss that we need 16 to be concerned about. 17 MS. O'NEIL: Thank you very much, Dr. Ornish. 18 Thank you very much. 19 (Applause.) 20 MS. O'NEIL: We are now entering the panel 21 discussion zone. Would you like to stand up again and 22 stretch a little bit? Look, you're getting a standing 23 ovation already. 24 A new study, something new on the plate, to 25 support your diet. Why don't we start with that? 110 1 Pass your questions towards the front. That would 2 be great. 3 DR. ATKINS: Just very simply, -- 4 MS. O'NEIL: Just towards the sides. Pass them 5 towards the sides. They'll be collected. 6 DR. ATKINS: -- we have been concerned over the 7 fact that nobody has done a study, so when Dr. Westman 8 called us and volunteered to do a study, we were very, very 9 cooperative and said we'll give all the help we can. 10 He first published the first results I think last 11 week, and he can tell a little bit about the early returns. 12 I'd like to have that started so we can go on. 13 MS. O'NEIL: We won't have time to do a complete 14 presentation on that study, but that's why I said if you 15 wanted to -- 16 DR. ATKINS: I know that. 17 MS. O'NEIL: -- summarize that? 18 DR. ATKINS: Well, let him do it because he's the 19 one that knows. 20 MS. O'NEIL: Thank you very much. Thank you. 21 Just briefly. One minute. 22 DR. WESTMAN: Can I have the slides, please? 23 AUDIENCE MEMBER: Can we have your name, please? 24 DR. ATKINS: Dr. Eric Westman. Go ahead. Tell 25 your name. 111 1 DR. WESTMAN: My name is Dr. Eric Westman. I saw 2 many patients doing this diet, the Atkins diet, in my 3 practice. 4 AUDIENCE MEMBER: Where are you from? 5 DR. WESTMAN: I'm from the Durham VA Medical 6 Center in Durham, North Carolina, and it's my pleasure to 7 tell you some early results of the study that's going on. 8 This is a four month result interim analysis. 9 Are the slides up yet? Okay. Thank you. 10 (Whereupon, a slide was shown.) 11 DR. WESTMAN: These are unpublished, published in 12 abstract form. 13 The next slide, please? 14 (Whereupon, a slide was shown.) 15 DR. WESTMAN: I'm going to hustle through these 16 slides. 17 Next slide, please? 18 (Whereupon, a slide was shown.) 19 DR. WESTMAN: Our research question was what is 20 the effect of a very low carbohydrate program on body 21 weight, serum chemistries and serum lipids over a 16 week 22 period. 23 This was a single arm, prospective clinical trial. 24 The subjects were overweight, otherwise healthy, motivated 25 community volunteers, and the setting was an outpatient 112 1 research clinic. Like setting a new drug, we first wanted 2 to assess the effects of this program in a healthy 3 population. 4 Intervention consisted of dietary recommendation. 5 We consulted the Atkins Center for their recommendation for 6 nutritional supplements. We recommended exercise and 7 followed them in group meetings. The diet recommendation 8 was to consume fewer than 20 grams of carbohydrate per day. 9 The outcome measures included body weight and body 10 mass index measured at each visit, and we found, after four 11 months, that the program consisting of the nutritional 12 supplements, the Atkins diet and exercise resulted in a 13 weight loss of 22 pounds after four months. 14 The diet composition was a carbohydrate intake of 15 six grams per day. Excuse me. Six percent per day. That's 16 22 grams per day, so they followed the diet fairly closely 17 as we recommended. The percent change in body weight after 18 four months was 11 percent in their percent change of body 19 weight. 20 You saw a slide earlier that showed the adverse 21 effects of the diet, which were constipation and halitosis 22 for the main side effects. We did find a significant 23 increase in BUN and a significant decrease in bicarbonate. 24 Most interestingly, we did find a reduction in total 25 cholesterol. We did find an increase in HDL cholesterol of 113 1 nine percent and a reduction in triglycerides of 2 approximately 40 percent. There was no significant change 3 in LDL over the four month period. 4 There was individual variability such that not 5 everyone's total cholesterol improved. Seventy-six percent 6 of patients had an improvement in their cholesterol, but 23 7 percent did not. I've heard people say the cholesterol goes 8 up on this diet. The cholesterol goes down on this diet. 9 In reality, both are right. 10 There were no clinically serious adverse effects 11 in this four month trial, a sample of 41 subjects who were 12 healthy. Even though this is the largest study to date, the 13 sample of 41 healthy volunteers may not apply to our other 14 populations so we're encouraged by these results, but 15 cautiously optimistic. 16 There was no control group in this trial. We 17 recommend a randomized control trial to give higher 18 confidence in these results. We enrolled only healthy 19 subjects, so the effects we saw may not apply to subjects 20 with medical conditions. Closer monitoring for metabolic 21 changes and side effects may be necessary in patients with 22 medical conditions. 23 While this is the longest study of this dietary 24 approach, the four month duration and follow up limits its 25 long-term generalizability, but we were able to conclude in 114 1 an uncontrolled trial a very low carbohydrate diet program 2 was efficacious for short-term weight loss and motivated 3 healthy, mildly overweight individuals, leading to an 4 average weight loss of 22 pounds over four months. The 5 amount of weight loss correlated with the amount of urinary 6 ketones that were talked about today. 7 Due to the limited number of subjects in clinical 8 trials, we believe it is too preliminary to make a 9 definitive statement about safety at this time. Further 10 research is needed with more sensitive monitoring to 11 determine possible immediate adverse effects and long-term 12 effects of this dietary program. 13 Thank you very much. 14 MS. O'NEIL: Thank you. Thank you very much. 15 (Applause.) 16 MS. O'NEIL: Thank you for sharing that. 17 DR. ORNISH: Can we comment on that? 18 MS. O'NEIL: Yes. This is a panel discussion. Of 19 course, we can comment on anything. Go ahead, Dr. Ornish. 20 DR. ORNISH: Well, first of all, the last time I 21 debated Dr. Atkins I chided him for not publishing any 22 research anywhere, so I think this is a good start. It's 23 not a particularly good study, but it's a good start. I'm 24 just glad to see that he's doing research. 25 In that there's no control group, we don't know 115 1 what these patients were eating when they started. I mean, 2 they could have been eating a diet even higher in fat when 3 they started. There's no baseline data at all. 4 There was no change in the LDL, and the only 5 published study that was done of an Atkins diet was done in 6 1980 by John Larosa in the Journal of the American Dietetic 7 Association, and they found that the LDL did go up and the 8 cholesterol levels did go up, and so I think that while I 9 applaud the beginning of doing research, I think that we 10 need to evaluate research based on the standards of good 11 science. 12 MS. O'NEIL: Okay. Thank you very much. 13 I'm going to go to -- certainly. Go ahead. 14 DR. BETHEA: I wanted to make one comment. All of 15 the panelists have said that, you know, we want to give the 16 best information available. I think there are two points 17 that need to be made. 18 Dr. Ornish's presentation was superb, and I 19 applaud what he's doing, but I want everyone to realize that 20 atherosclerotic coronary disease or vascular disease or 21 hardening of the arteries, whatever term you want to apply 22 to it, is an aging process. 23 While Ponce de Leon failed to find the fountain of 24 youth, we can't reverse aging. What Dr. Ornish and I think 25 all of us are trying to do is slow down the process, but 116 1 don't go home thinking that if you do this or this you can 2 prevent coronary artery disease. If you live long enough, 3 you will get it. 4 The second misconception. The comment was made 5 that calories produce fat. Calories don't produce fat. A 6 calorie is a unit of heat. Fat produces fat, protein 7 produces fat, and carbohydrates produce fat. The key is 8 moderation. Don't eat so much of them that you become fat. 9 Thank you. 10 MS. O'NEIL: I think what's emerging here, too, is 11 I think when people listen to all of your comments, very 12 intelligent, obviously well thought, and it's interesting. 13 Again, the man on the street might say well, if they're all 14 so smart and they all know so much about nutrition, why do 15 they not agree? 16 I think that is the question that emerges in my 17 mind. Maybe, Denise, that might be a good question for you. 18 I'm sure your patients come to you with that question. I 19 read all these things from smart people, and they don't 20 agree. 21 DR. BRUNER: Well, it really is true. One of the 22 things that I wanted to point out is that there is certainly 23 that diversity of opinion. What we need to understand is 24 most of the people are consuming too many units of unhealthy 25 foods, and what we need to do is really modify the 117 1 consumption. 2 We certainly endorse a high complex carbohydrate 3 ingestion, moderating the proteins and fat, but what we all 4 lose sight of is with the study, Dr. Ornish, in your study 5 of reversal of coronary artery disease people were 6 physically active on a regular basis. They had five, six 7 hours a week of physical activity. 8 DR. ORNISH: Three hours of walking. 9 DR. BRUNER: Okay. In the lifestyle heart study? 10 DR. ORNISH: They were asked to walk for an hour 11 three times a week. 12 MS. O'NEIL: How about a show of hands? How many 13 people on this panel believe that exercise is an important 14 component? 15 (Whereupon, a show of hands.) 16 MS. O'NEIL: Wow. 17 DR. ORNISH: We all agree. 18 MS. O'NEIL: We've got a point of agreement. 19 DR. BRUNER: Yes. Absolutely. But what I wanted 20 to stress is that without putting together multiple things, 21 we've all heard people diet. They do diet. They do lose 22 weight. I can put them on a Twinkie diet. When it's 23 restricted enough they will lose weight, but the question is 24 to what cost metabolically? What things are you doing to 25 people when you're putting them on very stringent diets? 118 1 You know, a skinny person can have a heart attack 2 and can diet, but what are we doing in the long run? 3 Through what we're doing, are we improving their health 4 parameters in general, not just their weight? We need to 5 look at that other global issue. 6 DR. ORNISH: Yes, and I want to just say I agree 7 with everything that you said. I applaud, Dr. Bethea, your 8 helping people become more aware of the importance of 9 limiting the intake of simple sugars, but I do strongly 10 disagree with your statement that heart disease is an 11 inevitable fact of aging. 12 It's an inevitable fact of aging when people eat a 13 diet like people in this country have eaten, but in other 14 cultures heart disease is quite rare, even when people get 15 older, so I think we can give people a more healthful 16 message that there actually is a lot they can do, and if you 17 can stop or reverse heart disease then you can probably 18 prevent it. It's not such a leap of faith. 19 MS. O'NEIL: Let me ask the protein folks. One 20 thing I think, Dr. Sears, is very important. Can you 21 explain how your diet is specifically different from Atkins? 22 DR. SEARS: Well, as I tried to point out in the 23 presentation, the diet is based on two words most Americans 24 hate to hear, balance and moderation. 25 When you're eating ten to 15 servings of fruits 119 1 and vegetables per day, I don't think anybody could disagree 2 with that. If you're never eating any more than three to 3 four ounces of low fat protein at a meal, I don't think 4 anyone can disagree with that. If you're adding small 5 amounts of heart healthy monounsaturated fat to your diet, I 6 don't think anyone could disagree with that. 7 What we have is from the standpoint we have again 8 a misconception here. We have to basically, as I said 9 earlier, get back and look at the epidemic of obesity from a 10 different perspective, treat it as a disease and find the 11 most appropriate blood parameter that predicts it, and that 12 is excess insulin. If you're following Dr. Ornish's diet 13 and your insulin levels are under control, keep following 14 it. If you're follow Dr. Atkins' diet and your insulin 15 levels are under control, keep following it on a lifetime 16 basis. 17 But, if both of those extremes are not working for 18 you, then begin to moderate your diet and eat the things 19 that we are genetically designed to eat. We're designed to 20 eat fruits and vegetables. We are not designed to eat 21 grains. They did not exist on the face of the early 10,000 22 years ago. 23 MS. O'NEIL: Thank you for that. 24 You know, Dr. Atkins, following up on let's say 25 the severe, which you're usually put in that category, would 120 1 you have a patient that would come to you, because I think 2 about the importance today about treating the individual and 3 everybody's individual lifestyles, food preferences. Have 4 you had people come to you and you'd say to them I don't 5 think this is for you? 6 DR. ATKINS: Fifty percent of my patients I don't 7 think it's for them because 50 percent of my patients don't 8 have a weight problem. 9 MS. O'NEIL: Okay. Of the people who do have a 10 weight problem. 11 DR. ATKINS: Well, that rarely happens. If the 12 weight problem is serious, then I'm going to work on 13 restricting carbohydrates. They may have some other 14 problems. 15 I never put any two people on the same diet 16 because we do food allergy testing so we know right from the 17 very beginning which foods certain people have to avoid, and 18 that's not the same in other people, and then they come in 19 with a different problem. 20 I don't want people to think that most people come 21 to me with a weight problem. Only about ten percent of the 22 people come to me. It's because I am a cardiologist. Most 23 of the time they come to me because they were told the same 24 thing that David Letterman heard. You've got to have a 25 bypass; only these people weren't intimidated enough to get 121 1 it right away. They came to see me, and 85 percent of those 2 people didn't need a bypass after they went on our program. 3 This is why I sort of resent the idea that people 4 are saying my diet is not heart healthy. If it were not 5 heart healthy, we wouldn't be reversing heart disease and 6 getting these people who were having chest pain on a little 7 bit of exertion out there running and jogging a few months 8 later. 9 MS. O'NEIL: This brings me to Dr. Ornish to 10 follow up on that. Dr. Ornish, would you then, and this is 11 a question from someone in the audience. Tiny handwriting, 12 by the way. 13 With your focus being on disease prevention diet 14 and reversal diet, would you at any time recommend a high 15 protein diet for severely obese individuals? I mean high 16 protein fasting. 17 DR. ORNISH: First of all, let me say that I would 18 love to see some data from Dr. Atkins showing that he can 19 actually get reversal of heart disease, measuring the 20 underlying disease process. 21 DR. ATKINS: We're working on it. 22 DR. ORNISH: Well good. I'd love to see it. 23 DR. ATKINS: We're not as good a fundraiser as you 24 are. We have to dig into our own pockets. That's the 25 problem. 122 1 DR. ORNISH: Carolyn, could I address that issue? 2 MS. O'NEIL: Yes. 3 DR. ORNISH: I think with the number of books 4 you've sold, you could probably fund your own studies, 5 but -- 6 (Applause.) 7 MS. O'NEIL: These are the different numbers. 8 DR. ORNISH: I recommend a -- most people, 9 unfortunately, when they think about the diet I recommend 10 think about the reversal diet, and it is a strict diet, and 11 I'd love to be able to tell people that more moderate 12 changes can reverse heart disease, but they don't. 13 Every study that's been done where they looked at 14 arteriography has found that a 30 percent fat diet the 15 majority of people continue to get worse, but there is a 16 genetic variability in how efficiently your body can handle 17 fat and cholesterol. It's a bell curve. In fact, the Nobel 18 prize in 1975 went to Brown and Goldstein, who discovered 19 the LDL receptors. 20 On one end of the spectrum are the 95-year-old men 21 or women, and you say what do you eat? They say I have 12 22 eggs for breakfast and a steak for lunch, and you kind of go 23 well, maybe a diet isn't that important. Look what they're 24 eating. But, they're so efficient at getting rid of fat and 25 cholesterol it almost doesn't matter what they eat. Those 123 1 people who weren't so efficient at getting rid of it never 2 made it to 95, so you have a selective group. 3 So what I tell people is that if your cholesterol 4 level is below 150 consistently or your ratio of total to 5 HDL is below four, then either you're not eating much fat 6 and cholesterol or your body is very good at getting rid of 7 it. Either way, your risk of disease is so low. Whatever 8 you're doing is probably fine. 9 MS. O'NEIL: Thank you. 10 DR. ORNISH: Most people don't fall into that 11 category, and they can begin by making more moderate changes 12 until they get to that point. 13 MS. O'NEIL: Okay. Which reminds me when I went 14 to a mechanic and they said I think your microtuner is 15 maladjusted. I didn't know what it meant. 16 Sometimes the explanations are long, they're 17 complicated, but they're very important obviously in 18 educating, especially when most of the American public has 19 no baseline of nutrition knowledge. 20 You wanted to make a comment, Dr. Ayoob? 21 DR. AYOOB: Just because it was brought out about 22 Dr. Atkins' claim to reverse heart disease, and he said he's 23 working on the data, but he's been making this claim for a 24 long time, and that's what I -- 25 DR. ATKINS: No, I haven't. 124 1 DR. AYOOB: Excuse me. 2 DR. ATKINS: I haven't been -- 3 DR. AYOOB: Excuse me. 4 DR. ATKINS: -- making that claim. 5 DR. AYOOB: You just did, and you don't have the 6 evidence -- 7 DR. ATKINS: Before. 8 DR. AYOOB: -- to back it up. Now, this diet has 9 been out there for 30 years or close to 30 years. 10 DR. ATKINS: And I haven't been able to fund the 11 study. 12 DR. AYOOB: Excuse me. Excuse me. Ten million 13 books in print, and you can't fund the study? 14 (Applause.) 15 DR. ATKINS: Now I can, and I will be the first 16 doctor to dig into his own pocket to do a study, and it will 17 be me, but it was the first time I had any money left. 18 DR. AYOOB: Ten million books. You market the 19 vitamins. You sell the vitamins -- 20 DR. ATKINS: Now. 21 DR. AYOOB: -- to correct the nutritional 22 deficiencies. 23 DR. ATKINS: That's true. That's why I'm doing 24 the study now. 25 DR. AYOOB: You market them. I keep saying -- 125 1 DR. ATKINS: That's why I couldn't do it before. 2 DR. AYOOB: You market this. I say this is not 3 for the public good. This is marketed. This is a money 4 making proposition. 5 MS. O'NEIL: Yes. Also, I think what happens with 6 tests and research and studies, which is what we've all been 7 talking about. I even wonder, too, what the level playing 8 field is in presenting information. 9 We have found. We have shown. Certainly all of 10 us in the press want to know where those statements come 11 from, what they're based on, and is there in fact a level 12 playing field when people go and give their presentations? 13 Dr. McDougall, you haven't said anything. Also, 14 we'll bring you in. In terms of presenting, you know, 15 everybody can throw up, you know, their Journal of the 16 American this, that and the other thing. Does it matter how 17 many you have piled up there to make your diet the best? 18 DR. MCDOUGALL: This is why I gave an example that 19 no one can deny, and that is you look around the world. 20 What do you see? If I asked you to design a diet and I gave 21 you the world and the populations of people, design a diet 22 where people would be thin for a lifetime, what populations 23 would you pick? China, Korea, Japan, African countries. 24 It's obvious. They live on starch based diets 25 with the addition of fruits and vegetables, and rich foods 126 1 are kept to a minimum. When these people move to the United 2 States or change their diet in their own land, they 3 consistently get fat, heart disease, rheumatoid arthritis, 4 diabetes and on and on. This is a no brainer. 5 DR. SEARS: Can I speak on that also for one 6 second? 7 MS. O'NEIL: Yes, quickly. 8 DR. SEARS: Yes. 9 MS. O'NEIL: Remember, this is not a long period 10 of time. 11 DR. SEARS: What we're looking at is saying there 12 are so few long-term intervention studies. There are only 13 two to my knowledge. One is Dr. Ornish's lifestyle trial. 14 He did not address the point I brought out of how to explain 15 why he had twice the number of fatal heart attacks -- not 16 cardiovascular or hospitalizations, but fatal heart 17 attacks -- in comparison to another recently published 18 long-term intervention trial, the Leone diet heart study, 19 that had four times as much fat, but on that arm, those 20 following that diet eating more fruits and vegetables and 21 eating more Omega-3 fatty acids -- 22 DR. ORNISH: Well, let me respond to that. 23 DR. SEARS: -- in a very controlled diet, they had 24 70 percent fewer fatal heart attacks. 25 DR. ORNISH: We're talking about -- 127 1 MS. O'NEIL: Keep it brief, Dr. Ornish, if you 2 can. 3 DR. ORNISH: Sure. We were talking about one 4 versus two deaths, and in both deaths Nova actually did a 5 one-hour documentary where they followed one of the people 6 who died, and he died while greatly exceeding the exercise 7 recommendations. 8 He was on a rowing machine competing against a 9 video game of other rowers, got his heart rate up way past 10 what we told him to and died while on the rowing machine. 11 You know, what can you do? It wasn't following the program. 12 The other person who died had gotten off the 13 program completely, was eating the kind of diet that Dr. 14 Atkins and Dr. Sears might recommend and died while on that, 15 so we have to report all of the data, including the people 16 who didn't follow it. 17 DR. SEARS: But, Dr. Ornish, you had down here in 18 your paper in JAMA, you had both people in the experimental 19 program who were dying. 20 DR. ORNISH: Well, of course they're in the 21 experimental program because if they were in the control 22 group we wouldn't be asking them to follow the program. 23 That's by definition. 24 MS. O'NEIL: Dr. Bethea? 25 DR. BETHEA: Still on the cardiovascular disease, 128 1 keep in perspective that the greatest risk factor to any of 2 us is heredity, and in the Asian countries it's true that 3 there's a little lower incidence of cardiovascular disease, 4 but remember this country has the greatest medical 5 capability of the world, and a lot of the other countries in 6 Asia do not have the diagnostic capabilities that we have, 7 so we really don't know. 8 I have been a consultant to the Jakarta Heart 9 Institute, and I can tell you now we're finding that the 10 incidence of coronary artery disease in Indonesia is just as 11 high and maybe higher than in the country of the United 12 States. 13 MS. O'NEIL: I think I'm going to go to a 14 question, please, from the participants here to the panel. 15 Here we go. 16 When will it become common medical practice to 17 measure serum insulin levels in people who are at risk for 18 development of high insulin level related diseases and 19 perhaps say they have a risk that should be addressed in 20 nutrition counseling? I mean, is that part of the plan 21 maybe, Dr. Bruner? 22 DR. BRUNER: Well, I will say this. Currently 23 that's what we do in our practice, and many of the 24 bariatricians do do that because the whole issue of science 25 and discovery and documentation is constantly evolving. 129 1 By the way, I must say that in my random and 2 routine measurements of serum insulin levels in people, 3 contrary to what was said, not every obese person has a high 4 serum insulin level nor a high two hour post prandial 5 insulin level. 6 MS. O'NEIL: There are a number of questions about 7 children. Who would like to address that? Dr. Atkins, for 8 instance, would you put a child on this diet? 9 DR. ATKINS: An overweight child should be on this 10 diet -- 11 MS. O'NEIL: Okay. 12 DR. ATKINS: -- because this is going to really 13 keep them away from attention deficit disorder and all the 14 other problems which are associated with unstable blood 15 sugar. 16 It also prevents the craving of sweets, which is 17 the one thing which makes it impossible to get a child thin 18 as he grows up. Once they become a sugar addict, you have a 19 real problem. 20 MS. O'NEIL: I don't think anyone on the panel is 21 disagreeing that too much refined sugar -- I mean, again, is 22 this common ground that we seem to be sharing that 23 perhaps -- 24 DR. ATKINS: Yes. I think we can all agree on 25 that. 130 1 DR. BRUNER: Yes. 2 MS. O'NEIL: -- too much refined sugar, too much 3 refined carbohydrates is a health problem, but it's just in 4 the -- 5 DR. ATKINS: Well -- 6 MS. O'NEIL: So where's the difference? Let me 7 ask you this. Why does it matter that there is diet 8 disagreement between you? Why would you care that Ornish 9 doesn't agree with you, and why would you care that he 10 doesn't agree with you? 11 DR. ORNISH: Well, I do care that a lot of people 12 are believing what Dr. Atkins is saying and making choices 13 that I think are harmful to them. 14 To go back to your earlier question, I think that 15 the way that people can help to reconcile different points 16 of view is to say what is the science? Are these published 17 in peer reviewed journals? The whole point of science is to 18 help people resolve conflicting claims by saying what is the 19 evidence? What is the experimental design? 20 Now, I'm not aware of any studies that Dr. Atkins 21 or Dr. Sears have published in any peer reviewed journal 22 about anything ever. You know, that's important. 23 Now, we also found that we had a two and a half 24 times reduction in cardiac events, and the reason why a 25 control group is important is so you know what would have 131 1 happened anyway. 2 MS. O'NEIL: Why do you care that Dr. Ornish 3 doesn't agree with you, or do you? 4 DR. ATKINS: Well, I really care because I care 5 about the people who are suffering because of all of the 6 misinformation they've heard about obesity and its 7 consequences. These people are being told something which 8 is quite different from the experience that we have in 9 treating people. 10 The experience that we have is one of consistent 11 improvements in health and in cardiac symptoms, as well as 12 cardiac risk factors, and we see major improvements in 13 diabetes. We see people who come to us taking insulin, yet 14 80 percent of them, if they're Type II diabetics taking 15 insulin, get off their insulin. 16 MS. O'NEIL: Well, let me respond, too, to 17 something of the criticism about the body odor and the bad 18 breath and all these things that go with, because I know you 19 want to respond to that. 20 DR. ATKINS: Well, there's nothing to respond. 21 That's just -- 22 MS. O'NEIL: Also, this anecdote. Can I just 23 repeat this anecdote because I have, of course, interviewed 24 people on the diet who perhaps weren't too thrilled with it, 25 and they would say, you know, I was on the Atkins diet. I 132 1 was on a high protein diet. I was cranky. I was miserable. 2 I lost a lot of weight. I look great, but nobody wanted to 3 talk to me. 4 (Laughter.) 5 MALE VOICE: So what's the point? 6 DR. ATKINS: Well, I think that's minor. The 7 number of people who actually present that as a complaint to 8 me is so rare. 9 It really doesn't happen, and it's quite possible 10 that these people are not taking vitamins or something 11 because the people in my office simply don't have that 12 problem, and if they did it would be so minor compared to 13 the major problems that they're confronted with. They're 14 confronted with a need to have a bypass. They're confronted 15 with -- 16 MS. O'NEIL: Okay. Well, you didn't really answer 17 the question, but -- 18 DR. ATKINS: -- diabetes. They're on six or seven 19 high blood pressure medicines and other medications, and we 20 get them off their medications. 21 This is serious stuff. Whether the sweet smell of 22 ketones is considered bad breath or just sweet breath is a 23 matter of opinion. 24 MS. O'NEIL: Smells like money. 25 Dr. McDougall? 133 1 DR. MCDOUGALL: Yes. I want you to know that I'm 2 concerned about the recommendations for high protein diets 3 because the foods that are emphasized are the very foods the 4 Heart Association has condemned as causing heart disease, 5 the Cancer Society has condemned as causing cancer and the 6 Surgeon General has condemned for being the leading cause of 7 death and disability in this country. I'm concerned. 8 DR. ATKINS: I am concerned about the American -- 9 MS. O'NEIL: Dr. Bethea? 10 DR. ATKINS: -- Heart Association's 11 recommendations of Fruit Loops and Pop Tarts having their 12 seal of approval. If that's their recommendation, I'm 13 certainly happy that they're not in my camp. I wouldn't 14 want them there. 15 (Applause.) 16 MS. O'NEIL: We'll check on that. 17 DR. BETHEA: Carolyn, I think if we can give the 18 audience and the press something to take away that we all 19 agree on that would be a start, and I think we all agree 20 that the United States, this country, is eating too much 21 refined sugar and too much processed grain. If you can take 22 that away, I think most everyone here will agree with that. 23 MALE VOICE: I agree with that. 24 MS. O'NEIL: How do you eat carbohydrates then? 25 You're saying eat the ones that are less processed? 134 1 DR. BETHEA: I'm saying -- 2 MS. O'NEIL: Somebody is saying don't eat carrots. 3 DR. BETHEA: I'm saying eat the ones that are the 4 higher fiber. Eat the ones that are -- in the grains, eat 5 the whole grains, not the processed and enriched grains. 6 We at Sugar Busters! are not against 7 carbohydrates. We need carbohydrates. We can't live 8 without them. We're not restrictive. We're selective. You 9 can make a better choice, and that's what we want each of 10 you to do. 11 MS. O'NEIL: One more comment. 12 DR. AYOOB: Also, we've heard a lot today about 13 insulin and insulin resistance, etcetera, and how it goes 14 down on all of the diets. Do you know what? It does, 15 because when you lose weight your insulin resistance goes 16 down. Okay. That's the bottom line. Any diet. Lose 17 weight. The insulin resistance comes better under control. 18 Insulin resistance is not due to a diet. It is 19 not due to the carbohydrate. It is not due to the protein 20 or the fat. It is due to obesity. Reduce weight. Insulin 21 becomes less of a problem. That wasn't really cleared up. 22 MS. O'NEIL: I'd like to just wrap up my comments 23 before I bring Secretary Glickman back up, and that is this. 24 One thing I think that's very important, and I'm sure 25 everyone here with their signature diets and representing 135 1 their viewpoints would agree that enjoying what we eat is 2 certainly foremost today. 3 I mean, personally I couldn't eat a cheese 4 omelette every morning, you know, and that kind of a thing. 5 Do you know what I'm saying? The varied diet. The 6 enjoyment. 7 You may say people love your diet. You say people 8 love, you know, your restrictive diet, Dr. Ornish. The 9 Sugar Buster! people are loving, the American Dietetic 10 Association with the dieticians. People say yes, you can 11 enjoy it. 12 Let's not forget the individual approach. What 13 works for somebody might not work for somebody else, and 14 certainly sound science is the backbone, but then it goes to 15 the pleasures of eating. Let's not forget that. 16 Ladies and gentlemen, let's bring up Secretary Dan 17 Glickman. 18 (Applause.) 19 MR. GLICKMAN: Carolyn did a great job. Let's 20 give her a hand for what a fine job she did. 21 (Applause.) 22 MR. GLICKMAN: I want to thank each member of our 23 panel. Again, the purpose of this was to provide additional 24 information. 25 I do recall last year I went to a dinner, and I 136 1 happened to be the speaker of the dinner. The master of 2 ceremonies was Cokie Roberts of ABC. Of course, as you 3 know, we're the food agency, the food safety agency, and all 4 she says is watch what Glickman eats. Whatever he eats, you 5 should eat. I've never written a book on anything, and I 6 want you to know that I got that recommendation from her. 7 Let me just make a couple of points. I'm reminded 8 I think it was H.L. Menken who once said for every 9 complicated problem there is a simple and a wrong solution, 10 and I think that these are complicated problems here, and 11 the science changes. 12 I saw the one cartoon Dr. Ornish did that said 13 wait until the results change. The fact is that there is a 14 lot of evolution of the science in these basic areas, and we 15 have to be cognizant of that. 16 I think it was Dr. Bethea. That's how we 17 pronounce your name, right? 18 DR. BETHEA: Yes. 19 MR. GLICKMAN: You made the comment about the 20 costs of health care, which are monumental, and how much of 21 these cost are related to lifestyle and the old expression 22 you are what you eat. 23 Food and food intake is probably the biggest 24 single contribution of most Americans as to their lifestyle 25 and then what it will affect in terms of their health, and 137 1 there's no question that billions of that health care cost 2 you talked about are related to improper diet and lack of 3 exercise, which was agreed to here. 4 There was some commonality here, which I think was 5 important. We didn't get any unanimity, and I was glad to 6 see the comments on children because you see a lot of these 7 diets are geared towards middle aged, heavy set people like 8 me, but the fact is that we have a special obligation to 9 deal with the formative years of life to provide the kinds 10 of standards and patterns so that kids will take them with 11 them and perhaps change their families as well, which kids 12 can do. 13 What is USDA and the Department of Health and 14 Human Services and the government's role? One is to help to 15 provide some clarity and information. We do provide the 16 dietary guidelines, which we're working on right now, the 17 revised guidelines, along with Secretary Shalala and the 18 Department of Health and Human Services. 19 We have, of course, the pyramid here, which we've 20 seen both the original and variations thereof, and I think 21 that's useful because imitation is the best form of 22 flattery, and we continue to work on those things as well. 23 I also think, given our role in the science 24 process, that I think we do have an obligation to 25 investigate the science as it relates to all of the claims 138 1 here because the fact is each person here who's been 2 involved in this issue obviously has a perspective, is an 3 advocate and has I'm not saying an ax to grind, but 4 certainly has a perspective and an advocacy role. 5 We in the government can provide, particularly 6 with our nutrition labs, with NIH, with all of the health 7 related facilities, we ought to be able to help calibrate 8 some of this science without being an advocate and see that 9 there is some rigorous review of some of the claims that are 10 being made here. 11 I'm not sure exactly how to do it. I know that 12 there are some people in the science community who resist 13 doing anything like this. They want to see the science done 14 on the most basic level, but the fact is millions and 15 millions of people want to lose weight, read your books, 16 hear what you're saying, and they do look for something or 17 somebody to give them some degree of perspective, or 18 calibration and sometimes truth as to the claims that are 19 being made. 20 I don't know whether we can totally do that, but 21 we have a lot of very, very bright people who work both 22 directly through various institutions of government, as well 23 as through private institutions, that have relationships 24 with this as well. 25 I just want to close by thanking everybody. I 139 1 think this is very important for us as Americans who want 2 greater information about how we can live longer and 3 healthier lives. It also is very important for the 4 producers of food. 5 I have to make my final point here. Food does not 6 just come from a grocery store. People work very hard to 7 grow and raise their food, and safe food and healthy food 8 sells, so what you eat and those who work very hard to 9 produce the food have a lot in common, and I think that's 10 the tie that makes our department so useful in dealing with 11 these issues. 12 Again, I want to thank the panel for your 13 excellent presentations. I thank you for being here, and 14 everybody eat well and eat healthy. 15 Thank you all very much. 16 (Applause.) 17 (Whereupon, at 1:05 p.m. the symposium was 18 concluded.) 19 // 20 // 21 // 22 // 23 // 24 // 25 // 140 1 CERTIFICATE OF REPORTER, TRANSCRIBER AND PROOFREADER 2 Symposium On The Great Nutrition Debate 3 Name of Hearing or Event 4 N/A 5 Docket No. 6 Washington, D.C. 7 Place of Hearing 8 February 24, 2000 9 Date of Hearing 10 We, the undersigned, do hereby certify that the 11 foregoing pages, numbers 1 through 139 , inclusive, 12 constitute the true, accurate and complete transcript 13 prepared from the tapes and notes prepared and reported by 14 Jan M. Jablonsky, who was in attendance at the above 15 identified hearing, in accordance with the applicable 16 provisions of the current USDA contract, and have verified 17 the accuracy of the transcript (1) by preparing the 18 typewritten transcript from the reporting or recording 19 accomplished at the hearing and (2) by comparing the final 20 proofed typewritten transcript against the recording tapes 21 and/or notes accomplished at the hearing. 22 2-24-00 23 Date Karen Stryker 24 Name and Signature of Transcriber 25 Heritage Reporting Corporation 26 3-06-00 27 Date Lorenzo Jones 28 Name and Signature of Proofreader 29 Heritage Reporting Corporation 30 2-24-00 31 Date Jan M. Jablonsky 32 Name and Signature of Reporter 33 Heritage Reporting Corporation