THE DIET DEBATE

March 2, 2000
		Susan Dentzer reports on a debate over the hottest new diets. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

Are you a healthy weight? The NewsHour's Health Spotlight. More NewsHour health coverage.   USDA Center for Nutrition Policy and Promotion Risks of obesity from the NIDDK Center for Science in the Public Interest Shape Up America	SUSAN DENTZER: The subject was breakfast. DR. ROBERT ATKINS: Starts with a three-egg omelet, avocado and cheese and tomato, and two strips of bacon and so on. SUSAN DENTZER: Talk of less savory matters follows. DR. DEAN ORNISH: Constipation, bad breath, hair loss are not unusual when you go on a diet like this. SUSAN DENTZER: And then the big business of slimming down. DR. KEITH-THOMAS AYOOB: You market this, I say this is not for the public good. This is marketed. SUSAN DENTZER: Amid record levels of obesity, and sales of diet books, Agriculture Secretary Dan Glickman brought together best-selling authors and unaligned nutritionists for a Washington-style food fight. After all, Glickman pointed out, the USDA oversees everything from development of the government's food pyramid to the nation's school lunch program. DAN GLICKMAN: I thought this was an appropriate place for us to have a discussion of not only the diets, but of the whole issue of diet and nutrition, and try to give some, not only balance, but some clarity to the American people as to, you know, what they ought to do and what isn't necessarily appropriate.
	Food for thought
	SUSAN DENTZER: And while the three-hour exchange hardly settled the issues, it did give Americans eager to control their weight plenty of food for thought. First to make the case for his diet was Dr. Robert Atkins, who has for three decades pushed a program that is a gourmand's dream. DR. ROBERT ATKINS: Much of the success of the low-carbohydrate diet is that it is extremely effective for people with large appetites who enjoy eating. SUSAN DENTZER: Atkins argued that obesity is due to a specific metabolic defect that afflicts many people: Excessively high levels of the hormone insulin. Normally, insulin converts sugar circulating in the blood to a form of starch that can be stored to meet the body's future energy needs. But in people with too much insulin who also eat excessive amounts of carbohydrates, the insulin converts the sugar instead into the very components of bodily fat. He says the solution is to consume as little as 40 grams of carbohydrates per day-- about the equivalent of a quarter of a bran muffin. Then the dieter will not only lose weight eating substantial amounts of foods like red meats, eggs and cheeses; He'll also gain what Atkins calls a phenomenal metabolic advantage. DR. ROBERT ATKINS: You can take in more calories than you can on other diets and still lose weight. You can go to restaurants, order from the best of the main courses. It will correct diabetes, hypertension, most of the risk factors of heart disease, gastritis, esophageal reflux disorder, headaches, and a variety of other problems. SUSAN DENTZER: Next to make his case was Dr. William Sears, author of "Enter the Zone," his term for reaching a metabolic state where the body works at peak efficiency. Like Atkins, he warned against focusing on calories, and agreed that excess levels of insulin are a dieter's public enemy number one. But his prescription was far different from Atkins'. Instead of cutting carbohydrates to the bone, he recommended eating about twice as much in carbohydrates as proteins. DR. WILLIAM SEARS: You take your plate at each meal, divide it into three sectors. On one third of that plate you put some low-fat protein no bigger and no thicker than the palm of your hand. The other two-thirds of the plate, you fill it full of fruits and vegetables till 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. SUSAN DENTZER: Next came California Dr. John McDougall, author of "The McDougall Diet Program." Most bullish of all the panelists on the subject of carbohydrates, he argued that a diet rich in them actually had a long history of keeping people slim. DR. JOHN McDOUGALL: It's what most people who have ever walked this planet have consumed: A diet of rice for Asia, a diet of pasta for Southern Europe, a diet of breads for Northern Europe, a starch-based diet with the addition of fruits and vegetables.
	Heart healthy?
	SUSAN DENTZER: Up last was well-known California doctor and diet expert Dean Ornish. In sharp contrast to the Atkins diet, his calls for only 10% of calories to be consumed as fat, mainly by limiting intake of oils and of animal products like meat and cheese. Not only will this result in weight loss, he said, but studies he has published show that it can actually reverse heart disease. DR. DEAN ORNISH: If you actually look at all of the data, what you'll find is really not how conflicted but how consistent it is, that a meat-based diet is not as healthful as a plant-based diet. And here are just some of the reasons: First of all, you only find cholesterol in meat, which tends to be high in saturated fat, total fat and oxidants. SUSAN DENTZER: Ornish said a diet like Dr. Atkins'-- heavy on fat and protein, has well-known deleterious effects. DR. DEAN ORNISH: Even a single meal high in fat and cholesterol makes your arteries constrict and your blood clot faster, and also it can use sexual dysfunction. Viagra was the most popular drug of all time last year because it's a big problem in this country. A number of studies have shown that when we eat a high-fat, high-animal protein diet, it's not just your heart that gets less blood flow. SUSAN DENTZER: Ornish complained that Atkins vastly overstated the role of insulin in producing body fat, and he challenged Atkins' claim that his diet, too, had valuable long-term health benefits. DR. DEAN ORNISH: I would love to see some data from Dr. Atkins showing that he can actually get reversal of heart disease, measuring the underlying disease process. DR. ROBERT ATKINS: We're working on it. DR. DEAN ORNISH: Well, good. DR. ROBERT ATKINS: We're not as good a fund- raiser as you are. We have to dig into our own pockets. DR. DEAN ORNISH: Oh, please. DR. ROBERT ATKINS: That's the problem. SUSAN DENTZER: That was too much for one of the two independent diet experts on the panel, pediatric nutritionist Dr. Keith-Thomas Ayoob of Albert Einstein Medical College in New York. DR. KEITH-THOMAS AYOOB: This diet has been out there for 30 years. DR. ROBERT ATKINS: And I haven't been able to fund a study. DR. KEITH-THOMAS AYOOB: Excuse me, 10 million books in print and you can't fund the study? DR. ROBERT ATKINS: Now I can, and I will be the first doctor to dig into his own pocket to do a study, and it will be me, but it's the first time I had to-- DR. KEITH-THOMAS AYOOB: 10 million books. You market the vitamins, you sell the vitamins to correct the nutritional deficiencies. DR. ROBERT ATKINS: That's true --
	Moderate portions, less sugar
	SUSAN DENTZER: So what, if anything, did participants in the great diet debate agree on? Louisiana heart surgeon Morrison Bethea, co-author of the book "Sugar Busters," ventured a try. DR. MORRISON BETHEA: We all agree that the United States, this country is eating too much refined sugar and too much processed grain. SUSAN DENTZER: In other words, cut out the cookies and white bread. Beyond that, what was the best advice for dieters? DR. MORRISON BETHEA: Moderate portions. We give an example in our book about the dinner plate. Your meat and vegetables should fit neatly on the bottom of the plate. It should not be on the sides, it shouldn't be stacked, and it shouldn't fall over the sides. And when you fill it up correctly once, don't go back and fill it up twice. SUSAN DENTZER: That advice hit home with Secretary Glickman. DAN GLICKMAN: That was perhaps the most useful thing for me, personally. My problem is generally with the quantity of food that I eat. SUSAN DENTZER: But beyond agreement on that simple advice, Glickman said it would probably be up to the government to fund long-term studies of the diets' effectiveness, to sort out all the conflicting claims.