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