The great nutrition debate part 3

[Guest guest]

Our next panelist is Dr. Barry Sears, entering the

ring now. Dr. Sears, your time begins now.

DR. SEARS: Thank you. Presently we have an

epidemic spreading across our land that threatens to destroy

our entire health care system. Currently, 55 percent of all

American adults are overweight. Obesity has increased by 50

percent in the last seven years, and more than 300,000

Americans die each year due to excess body fat.

The question is what has caused this epidemic?

We've been told for the last 20 years that dietary fat is

the villain, and the question is we have basically pulled

dietary fat out of our diet, as shown in the first slide,

which I hope basically is up there.

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(Whereupon, a slide was shown.)

DR. SEARS: It's there? Unfortunately, it's not

down here.

As you can see from that slide is that over the

last several decades we have reduced the amount of fat in

our diet as a percent of calories, but this leads to what I

call the American paradox. That is, we are reducing the

amount of fat in our diet, yet we are becoming the fattest

people on the face of the earth, and this trend is

accelerating.

Three of our most renown nutritional researchers

looked at this very carefully, reviewed all the long-term

studies and wrote a report published two years ago in the

New England Journal of Medicine. In this report they came

to two conclusions. The first was replacement of fat by

carbohydrate has not been shown to reduce the risk of

coronary heart disease. They also came to the conclusion

that beneficial effects of high carbohydrate diets on the

risk of cancer or body weight have also not been

substantiated.

In essence, they are quoting that great scientist,

Jerry Maguire, saying show me the data because they're

saying there is no data that very low fat, high carbohydrate

diets have significant health benefits when viewed from a

scientific perspective.

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Now, if dietary fat is not the villain, what is

the cause of our epidemic of obesity in our land? The

answer is it's not excess dietary fat. It's excess levels

of the hormone insulin. Dr. Atkins would agree with me, and

even Dr. Ornish would agree with me indirectly from a quote

that he had published in JAMA stating that, " Insulin also

accelerates conversion of calories into triglycerides,

stimulates cholesterol synthesis and may enhance the

proliferation of arterial smooth muscle cells. "

What we have to do to understand this epidemic is

now view food from a new perspective. View food no longer

as a source of calories, which it is, but really view food

as a drug. This is shown on the next slide.

(Whereupon, a slide was shown.)

DR. SEARS: Now we have to view this from the

standpoint of not only a powerful drug, but probably the

most powerful drug anyone will ever encounter, because we

have to look at food now from what will be the hormonal

effects on the diet.

Each time you eat, whatever you eat is composed of

macronutrients. What are macronutrients? Carbohydrate,

protein and fat. The power of nutrition in the twenty-first

century is looking at what the appropriate combination of

those macronutrients are to give the most ideal hormonal

response.

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My background, as Carolyn has pointed out, is I'm

not a nutritionist. My background is development of

intravenous drug delivery systems for cancer patients where

you try to keep drugs in therapeutic zones. I began to

apply that philosophy to food some 20 years ago to treat

food as if it were a drug to maintain a therapeutic zone; in

essence primarily for hormone insulin, keeping it within a

zone, not too high, but not too low.

Now, from the standpoint we are not all

genetically the same when it comes to how we handle

carbohydrates -- is that slide up there? I'm guessing.

(Whereupon, a slide was shown.)

DR. SEARS: This is work done at Stanford Medical

School nearly 13 years ago taking normal weight individuals

who had no disease and giving them the same load of sugar.

You can see on the left-hand side of the slide their sugar

levels went up, and they came down. Nothing remarkable

about that.

But on the right-hand side of the slide, a very

different picture emerges. There was about one-quarter of

the population whose insulin levels never went up very high,

and they came back to baseline very quickly. These are the

genetic lucky ones because they can eat a high carbohydrate

diet and never have the ill effects of excess insulin

production.

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However, the other 75 percent of the American

population will not be so genetically lucky. As they

consume more and more carbohydrates, they will create more

and more insulin, and it's excess insulin that makes you fat

and keeps you fat.

How can you tell which of those two groups you

fall into? A very simple test. Have a big bowl of pasta at

noon and see how you feel at 3:00. If you can barely keep

your eyes open and you're falling asleep and you're hungry,

then you know you fall into that category of the 75 percent

of Americans who genetically have a predisposition to make

lots of insulin.

But, having a predisposition to make insulin is

different than hyperinsulinemia where your insulin levels

are chronically elevated. This is shown on the next slide.

(Whereupon, a slide was shown.)

DR. SEARS: Because many of our major disease

states, coronary heart disease, the number one killer of

males and females in America, are related to

hyperinsulinemia, as is Type II diabetes. That's the

definition of a Type II diabetes. Somebody who's

hyperinsulinemic. Likewise, hyperlipidemia, hypertension,

polycystic ovary syndrome, the primary cause of infertility

in women, and obesity are all caused by excess insulin.

Now, this is why we're concerned about obesity in

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our landscape. If it was simply a cosmetic problem, no one

would care, but the fact is a greater number of deaths -- as

I said earlier, over 300,000 a year -- can be attributed to

excess body fat because of the effect of excess insulin on

cardiovascular disease and Type II diabetes.

Let me show you some data that supports my

contention that excess insulin is one of our primary

predictors. This was published in the New England Journal

of Medicine some four years ago, taking patients who had no

trace of heart disease and following them for a five year

period and then asking what in the blood predicted who would

or would not develop heart disease.

It was not high cholesterol. It was not high

blood pressure. It was slight elevations of insulin, which

could predict with frightening certainty, as you can see by

that P factor there, who would and who would not develop

heart disease.

Another study has demonstrated, a prospective

study looking at individuals who had no trace of heart

disease and following them for a five year period and again

asking what blood parameters were most predictive of heart

disease. It turns out by far and away the most predictive

was increased levels of fasting insulin. This is followed

by increased levels of triglycerides and even increased

levels of LDL cholesterol, the so-called bad cholesterol,

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were not nearly as predictive.

If you don't measure insulin levels, are there any

other blood parameters that can be markers of insulin? It

turns out the ratio of triglycerides to HDL cholesterol is a

very good surrogate marker for insulin. As insulin levels

increase, triglyceride levels increase. As insulin levels

increase, HDL levels decrease.

This is the work that Dr. Atkins had talked about

from Harvard Medical School looking at people who had

survived heart attacks and matched them with individuals who

had not. We can see a dramatic increase in the likelihood

of a heart attack the higher the ratio of triglycerides to

HDL cholesterol.

If you have high cholesterol, you are twice as

likely to get a heart attack. We have made a national war

against cholesterol. If you smoke, you are four times more

likely to get a heart attack. We have made a national war

against smoking.

But according to Harvard Medical School, if you

have high levels of triglyceride to HDL, which is really a

surrogate marker for insulin, so we can say if you have high

levels of insulin you are 16 times more likely to get a

heart attack, yet we hear nothing about the war on reducing

hyperinsulinemia, and until that war is fought successfully

we'll continue to become fatter and more likely to develop

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heart disease.

If you do have hyperinsulinemia, how do you treat

it? Well, there is one drug that does exist. That drug is

called food, but you have to treat food with the same

respect you would treat any prescription drug, and part of

our trouble, why we have debates like these, we don't have

good definitions. We have to have a definition of what

diets are, and that's why we talk about putting a

mathematical prescription behind the zone diet.

We could call a high carbohydrate diet is any diet

that has more than double the amount of grams of

carbohydrate relative to the grams of protein. We can call

a high protein diet any diet that has more grams of protein

compared to grams of carbohydrate.

Between those two extremes lies the zone where

looking at balancing protein and carbohydrate, no different

than you're balancing a carburetor of a car because if you

have high levels of carbohydrate in your diet and you're

genetically predisposed to develop high levels of insulin,

that will lead to fat accumulation and increased likelihood

of cardiovascular disease.

On the other hand, if you're following a high

carbohydrate diet -- excuse me; a high protein diet -- you

will increase the production of the hormone glucagon, and

that will lead to ketosis, so we could call the zone diet is

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that diet that stands just beyond ketosis and before you

reach hyperinsulinemia, but better to put it on a mathematic

format and now look at the literature, the scientific

literature, that supports that concept that controlling the

ratio of protein to carbohydrate will lower insulin and will

decrease heart disease.

The first of these studies actually appeared last

year from Harvard Medical School. They took adolescent,

overweight boys who were already hyperinsulinemic, and they

gave them meals of equal number of calories. The only

difference was the ratio of protein to carbohydrate. When

they consumed the high carbohydrate meal, their insulin

levels for the next four hours were highly elevated. When

they consumed the zone meal, their insulin levels had been

increased by nearly 50 percent, and again with a high degree

of statistical significance.

My work has primarily focused on Type II diabetics

because, as I said earlier, they're characterized by high

levels of insulin. Is the slide up there? Yes, it is.

(Whereupon, a slide was shown.)

DR. SEARS: This is one study we did for an HMO in

Texas taking their elderly Type II diabetic patients and

putting them on a zone diet for a six week period of time.

What you can see from the slide is several key

factors. One, insulin levels dropped by some 23 percent.

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Notice the ratio of triglyceride to HDL cholesterol dropped

by almost the equivalent amount. That's why I say that high

levels of insulin and high levels of triglycerides to HDL

are surrogate markers. Notice they also lost body fat

because the only way you can lose excess body fat is to

lower insulin. There's nothing magical about this. You

have to lower insulin.

Now, the key of science is not whether I do an

experiment. It's whether can somebody else do the same

experiment someplace else in the world and get the same

results. Those results were actually replicated in

Australia two years ago when Australian investigators took

both hyperinsulinemic overweight individuals and

hyperinsulinemic Type II diabetics and put them on a zone

diet, and within three days their levels of insulin had

dropped dramatically.

Another study published last year looking at

long-term effects taking overweight individuals and put them

on diets of equal number of calories. The only difference

was the ratio of protein to carbohydrate. Those on the high

carbohydrate diet lost less fat, actually almost one-half

less fat, than those on the zone diet.

Finally, the long-term aspects. We have data gain

from Harvard Medical School stating that on a high

carbohydrate diet you're more likely to get a heart attack

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than on a zone diet. You're 26 percent less likely.

Now, we say it's too hard to follow this program.

All you need is your hand because all the rules we need is

saying you never, ever eat any more low fat protein in a

meal than you put on the palm of your hand. That is three

to four ounces. Every nutritionist in America agrees with

that.

Now, you take your plate at each meal, divide it

into three sectors. On one-third of that plate you put some

low fat protein not bigger and no thicker than the palm of

your hand. The other two-thirds of the plate you fill it

full of fruits of vegetables until it's overflowing. You

add a dash of heart healthy monounsaturated fat, and now you

have a zone meal to keep insulin controlled for the next

four to six hours.

If we put this into a food pyramid, we get the

zone food pyramid. Notice the base of this you're eating

lots of fruits and vegetables. How many? Ten to 15

servings a day followed by low fat protein, followed by

small amounts of heart healthy monounsaturated fat and using

grains and rices in moderation.

We compare this to the USDA food pyramid. We see

two different pyramids. One is almost guaranteed to

increase insulin levels because of the high reliance on high

density carbohydrates such as grains and starches.

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What about high protein diets? The zone has been

accused of that, but, as you can see from this picture,

there is really no relation between a high protein diet and

a zone diet because in a zone diet you're eating more

carbohydrates than protein, and the fat you are eating is

heart healthy monounsaturated fat, as opposed to heart

unhealthy saturated fat.

Millions of people have lost weight on high

protein diets. Unfortunately, the same millions have gained

them back. The question is why? I think there are reasons.

The longer you stay in ketosis, you turn yourselves into fat

magnets, and you accumulate body fat more readily. The more

saturated fat you eat, you tend to basically make yourselves

more resistant to insulin. Finally, the longer you stay in

ketosis, you begin to oxidize lipoproteins, so these are

long-term consequences which begin to explain why high

protein diets fail.

Now, Dr. Ornish will tell you later today that his

diet has cured heart disease, reversed it. Let's say what

are the facts? This is the data he presented in 1995. Yes,

his patients lost weight, but look. Their HDL levels went

down dramatically. Their triglyceride levels increased, and

he has said already earlier and been quoted that that is due

to basically high levels of insulin, increased

triglycerides, and the ratio of triglycerides to HDL

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increased. According to Harvard Medical School, that's not

good.

The lead author of that study was actually K.

Lance Gould, one of the leading cardiologists in our

country, saying frequently triglyceride levels and HDL

cholesterol levels decrease for individuals on a vegetarian

high carbohydrate diet since low HDL cholesterol,

particularly with high triglycerides, incurs a substantial

risk of coronary events.

I do not recommend a high carbohydrate diet, and

the reason why? Because two years later the data came out

that those who followed the Ornish diet had twice the number

of fatal heart attacks. Perhaps when Dr. Ornish speaks

today he can explain how can he reverse heart attack and

double the number of fatal heart attacks.

(Whereupon, a slide was shown.)

DR. SEARS: Just one last slide. We want to take

this whole debate out of the area of politics and make it a

medical statement. The blood will tell you. Your blood

will tell you whether you're naughty or nice. You want to

keep your blood levels of insulin under ten microunits per

ml. If they're more than 15, change your diet. If you

don't have insulin levels, it's the ratio of triglycerides

to the HDL. Keep that under two.

If your numbers are in the right zone, I don't

care if you're eating Pop Tarts. Keep eating the Pop Tarts.

They're working for you.