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How Should We Be Eating?

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How Should We Be Eating?

Health Care

How Should We Be Eating?

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IRA FLATOW, host:

This is TALK OF THE NATION/SCIENCE FRIDAY. I'm Ira Flatow.

Remember the Food Pyramid? Well, just recently the US government unveiled its latest incarnation, totally overhauled, updated and cyberized. You can actually create a custom version of it on the Internet. The makeover follows new eating guidelines issued earlier, all designed to make us healthier. Because, as you probably know, two-thirds of American adults are overweight, and one-third are obese.

This hour we're going to talk about the new guidelines and the new Food Pyramid. How are they different from their predecessors? How do they incorporate physical activity and exercise--something new in the guidelines? What's the role of vitamin and mineral supplements in a healthy diet and in disease prevention? And has the government gotten the message right this time around? Are we Americans just not getting this nutritional message? Are we ignoring it? Is there something wrong to begin with there? Maybe they're just asking us to do too much, because I'm looking now at the new pyramid, which asks us to eat 6 ounces every day of grains, 2 1/2 cups every day of vegetables, 2 cups every day of fruit, 3 cups of milk every day and 5 1/2 ounces of meat and beans every day. Could you follow that diet? Could you eat that much every day? Well, we'll talk about it. Maybe there's something wrong here that needs still to be fixed.

My guests today are in Portland, Oregon, participating in the 3rd International Conference on Diet and Optimum Health, organized by the Linus Pauling Institute at Oregon State University in Corvallis. And if you'd like to join our discussion, our number is 1 (800) 989-8255; 1 (800) 989-TALK.

Have you seen the new Food Pyramid? Have you seen the guidelines? What do you think of them? What do you think about staying fit and nutritious all at the same time?

And let me introduce my guests, who join me now from the studios of member station KOPB in Portland, Oregon. George Brooks is a professor of exercise physiology and metabolism at the University of California at Berkeley.

Welcome to the program.

Dr. GEORGE BROOKS (University of California, Berkeley): Thank you, Ira, and hello, NPR network.

FLATOW: Balz Frei is the director and endowed chair of the Linus Pauling Institute at Oregon State University in Corvallis.

Welcome to the program.

Dr. BALZ FREI (Linus Pauling Institute): It's a pleasure to be on the show.

FLATOW: You're welcome.

Janet King is the chair of the 2005 Dietary Guidelines Advisory Committee. She's a professor of nutrition and internal medicine at the University of California, Davis, and a professor of nutrition at the University of California, Berkeley, a senior scientist at the Children's Hospital Oakland Research Institute at Oakland, California.

Welcome to the program.

Dr. JANET KING (2005 Dietary Guidelines Advisory Committee): Thank you, Ira.

FLATOW: You'll forgive me if I don't go through all of that later on.

(Soundbite of laughter)

Dr. KING: That's quite all right.

FLATOW: OK. Meir Stampfer is a professor of nutrition and epidemiology and the chair of the department of epidemiology at Harvard School of Public Health in Boston.

Welcome to the program.

Dr. MEIR STAMPFER (Harvard School of Public Health): Thank you.

FLATOW: Janet, let me talk to you first. Let's talk about these latest dietary guidelines, the latest ones since 2000. What's new compared to the previous guidelines?

Dr. KING: Well, there are quite a few things that are different about the new 2005 dietary guidelines, but there are a couple things that I would really like to emphasize. The committee was very concerned about the large proportion of Americans who are either overweight or obese, so we put a lot more emphasis on maintaining healthy body weights this time around by balancing energy intake with energy expenditure. We're fortunate; we live in a country where we have a very ample food supply. But this means that we do have to exercise some restraint in the amount of food we eat and balance it with how active we are.

The second major difference with this set of dietary guidelines is that we came up with a food pattern that would help Americans not only reduce their risk of chronic disease, but also help them achieve their nutrient requirements. We did an evaluation of the quality of the diets consumed by Americans, and we were surprised to find out that adults in the United States have low intakes of vitamins A, vitamin C, vitamin E, calcium, magnesium, potassium and fiber, levels that are so low that it puts them at a risk of possibly having an inadequate amount in their diet. So we then looked to see what food groups would provide those particular nutrients that were low, and it turned out to be vegetables, fruits, whole grains and milk and milk products. We then also reviewed the literature to see what food groups were associated with reducing the risk of chronic disease and found that it was those same food groups: vegetables, fruits, whole grains and milk and milk products.

FLATOW: But haven't we been hearing that...

Dr. KING: But we put a lot of emphasis on that.

FLATOW: ...for years now, though?

Dr. KING: That is true. And what is the problem is that the literature shows--there's hundreds of papers that we reviewed that show that these food groups are the ones that reduce the risk of chronic disease and help us meet our nutrient requirements. But the intake of Americans of those food groups is far less than the amount that we predict are needed.

FLATOW: George Brooks, you were on the Institute of Medicine panel that made recommendations in 2002 for our daily energy and nutritional needs. Are the guidelines consistent with that report?

Dr. BROOKS: Yeah, the guidelines are very consistent with the report, and I was really happy to see the way the guidelines were written. And I think Janet and her colleagues are to be congratulated. And the key thing about our report was to look at the whole field and to really change the paradigm. And I think this has--the paradigm in the past led to a lot of confusion. So we basically changed the paradigm to one based on energy expenditure. So we looked at the population and obtained the best data we could to find out what the energy expenditures were on Americans. And, of course, there's a range of energy expenditures.

And then we decided then to base our dietary recommendations on energy expenditures. So people who are basically sedentary then, of course, they need to adjust their diet by it. But then it becomes very difficult to get the micronutrients and other rich nutrients that we all need to live on. But if people have a more active lifestyle, then they can eat more and they can get the micronutrients they need, and then they can have--be more effective in their daily life. So we changed the paradigm from one based on eating this, eating this, to saying, `OK, what are you doing? OK, now we need to balance that out.'

FLATOW: Balz Frei, do the dietary guidelines include recommendations for vitamins and mineral supplements? People take these all the time. Are they there in the guidelines?

Dr. FREI: Yeah, they are in the guidelines, but to a very limited degree. As Dr. King mentioned, the premise of the dietary guidelines is the nutrient needs should be met primarily through consuming foods, and supplements should always be just supplements, not substitutes. But there are some special population groups that should make sure they get enough vitamin B12, for example, for the elderly people over the age of 50. They may not get enough vitamin B12 from their food, so there B12 supplements are recommended. Women of childbearing age who may become pregnant should be sure they get enough iron as well as enough folate, and that may come from a supplement. And then finally, older adults, people with dark skin and people exposed to insufficient UV light--sunlight, that is--should make sure they get enough vitamin D, and again, that may be from vitamin D fortified foods or from the supplements.

But other than that, the dietary guidelines really don't emphasize supplements. I personally think that a multivitamin-multimineral is a good idea for everybody just to make sure they do get the RDA or the recommended dietary allowance of each and every vitamin and mineral just sort of as a health insurance.

FLATOW: It's interesting also, there's a--if you go on the Web, you can sort of tailor-make the Food Pyramid to yourself, to what you should be eating.

Dr. FREI: That's right. And Dr. King may comment on that, but you really can tailor-make your pyramid, and there are actually 12 different pyramids depending on your age and sex and energy level.

Dr. KING: Yes, there's--as Balz said, there's 12 different patterns, starting at a thousand calories a day, going up to 3,200 calories a day. And you can find out what your caloric needs are by putting in your age and your weight and your height, and it'll predict what your energy needs are, and then you can choose a pattern that is close to that.

FLATOW: 1 (800) 989-8255 is our number.

What are the--is there a direct one-to-one relationship between the dietary guidelines and the Food Guide Pyramid, Janet?

Dr. KING: Well, in a way. There were three major messages for the consumers that we came up with when we were working on the dietary guidelines. Those three messages are to balance food intake with physical activity--in other words, balance calories in with calories out--also to eat a variety of foods each day, and to choose nutrient-rich foods within each of the various food groups. The goal was to cover those three messages in the new pyramid, but I'm afraid that the graphic may be a little bit too subtle for most of us to get those messages. The man...

FLATOW: You need a sledgehammer.

Dr. KING: Right. The man climbing up the side of the pyramid does suggest that we need to be physically active every day. And turning the pyramid over on its side and putting all of the different six food groups across the bottom was supposed to convey the message that we should choose foods from each one of those six food groups every single day.

And then the fact that the areas of the strips are wider at the bottom than they are at the top is to suggest that there are some foods at the bottom that we should eat more of vs. foods at the top. For example, in the milk group, a food that you might want to eat more of would be low-fat or non-fat milk, whereas you would want to limit your intake of ice cream, which would be at the top because of the higher amounts of saturated fat and sugar in ice cream.

So those were the key points that we hoped were going to come across in the pyramid, but as I said, I'm afraid it's just a little bit too subtle for even the best of us to get those messages.

FLATOW: Meir Stampfer, you were critical of the first pyramid. Are you a little happier with the second one?

Dr. STAMPFER: Well, I think that the new pyramid has two main advantages over the old one. First is the figure of the person climbing up the top, which suggests more physical activity. And the second advantage is that it's essentially incomprehensible, so that...

FLATOW: The old one or the new one?

(Soundbite of laughter)

Dr. STAMPFER: ...because really a lot of the dietary advice given through the pyramid, in contrast to the guidelines, is really not helpful. For example, they talk about customizing it according to age, sex and activity level, but there's nothing about body size. So a man 6'8" gets exactly the same dietary advice as a man who's 5'3".

FLATOW: All right. I'm going to stop you at that critique right there, and we'll pick up with that critique after this break, 'cause we have to take time for a break. We're going to come back and talk more about the food guideline recommendations and the Food Pyramid, take your calls, what you like, don't like about it, and finish with the critique and commentary. So stay with us; we'll be right back after this break.

I'm Ira Flatow. This is TALK OF THE NATION/SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to TALK OF THE NATION/SCIENCE FRIDAY. I'm Ira Flatow.

We're talking this hour about new dietary guidelines and the Food Pyramid. My guests are Balz Frei of Oregon State University, Janet King at the University of California, Meir Stampfer, Harvard, and George Brooks, University of California, Berkeley. Our number, 1 (800) 989-8255.

And when I rudely interrupted Meir Stampfer, he was talking about some of the--How shall we say it?--the shortcomings of the new Food Pyramid. And one you were talking about that--makes no references to different body sizes.

Dr. STAMPFER: Right.

FLATOW: Yeah.

Dr. STAMPFER: Some people need to be losing weight and they should be advised to take in fewer calories than they're burning. But body size is a very important determinant of how many calories we should be consuming. But I think, beyond that, the new pyramid really represents a missed opportunity to inform the public of the major advances in the last couple decades in nutrition advice. We really now know quite a bit about how to eat to stay healthy, and I don't think it's adequately conveyed by the new pyramid.

FLATOW: Well, how could anything--and no matter what it looked or--you know, shape, size, color--convey the tremendous amount of conflicting and all kinds of information that is out there about food and nutrition? I mean, don't you--really, you could just make--you have to take hours to study it on your own vs. just looking at a Food Pyramid.

Dr. STAMPFER: Absolutely, and it's very complicated and people want simple messages. But there are a few simple messages that virtually all nutritionists do agree upon that aren't adequately emphasized. For example, first, limit refined carbohydrates. And we're told, `Eat this, eat that,' but we're not told enough, `Don't eat this and don't eat that.'

FLATOW: Don't eat the sugars, all that--the sugars and the colas and the...

Dr. STAMPFER: Don't eat sugars--sugared beverages.

FLATOW: High-fructose things.

Dr. STAMPFER: Reduce saturated fat. Increase fruits and vegetables. Increase whole-grain foods. Distinguish between types of fat, so that we should eliminate trans fat from our diet. Reduce saturated fat, but have adequate intakes of the essential fatty acids. I think you can boil it down to about six simple messages.

Dr. KING: If I could jump in at this point...

FLATOW: Yes, Dr. King. Go ahead.

Dr. KING: This issue about what not to eat was one of the most contentious things that we dealt with when we were working on the dietary guidelines. And we decided not to get specific about what not to eat, but instead to put more emphasis on what to eat, and therefore came up with the recommendations to emphasize fruits, vegetables, whole grains, dairy. And the reason for that is if people are very careful about choosing nutrient-rich food sources, and they should have a few calories left over for discretionary choices, the dessert they might want to have or the glass of wine they might want to have with dinner.

And we didn't feel that we should try to dictate in any way how they use those discretionary calories, but we wanted to convey the message that you probably won't have any discretionary calories if you don't choose your food sources carefully and choose nutrient-rich foods first, and be physically active. If you do that, you can have as many as 300, 150 to 300 discretionary calories a day. That's not a lot of discretionary calories if you're going to eat a lot of french fries or desserts or a couple glasses of wine. That'll be way over that amount of calories. But that was the conclusion that we came to.

FLATOW: 1 (800) 989-8255 is our number. Let's go to Barbara from Menlo Park, California. Hi, Barbara.

BARBARA (Caller): Oh, hi. Good afternoon. OK, I'm coming from a 30-year teaching career, from second grade through eighth grade, and over the years, the government has cut back on nutritional education in the schools, has grievously cut back on physical education funds that are available. And these are the two ways to reach people, because the cultures that people come from are so different and their eating habits are so different that the only way this very expensive program will work is if the teaching is begun in elementary school, nursery school, kindergarten, all the way through. And we can throw money at fancy pyramids, but it's not going to affect the people unless we start at an essentially more malleable level and make changes in the way children look at themselves and their world. So--but the money needs to be...

Dr. BROOKS: Yeah, Barbara, this is George Brooks. I couldn't agree with you more.

BARBARA: Oh, well, thank you.

Dr. BROOKS: There's a lot of information in the pyramid and the guidelines that went into it. It just needs to be explained, and it needs to be explained from childhood education on up. And if adults have a difficulty understanding the pyramid, then imagine what the kids face. So education is really the key thing in facilitating the conveyance of information not only in childhood, but then reinforcing it all the way through life is really important. It's important for older people, too.

BARBARA: Yes. Yes.

FLATOW: OK, Barbara, thanks for calling.

BARBARA: You're welcome. Bye.

FLATOW: Bye.

Why don't we have an exercise pyramid? You know, can...

Dr. KING: We talked about that actually a little bit.

FLATOW: Yeah.

Dr. KING: But I think that since the dietary guidelines try to integrate energy in with energy out, we felt that it was important to put both concepts together in one pyramid.

FLATOW: Well, you know, if you get enough exercise, it hardly matters what you eat. I mean, I don't mean, you know, eating doughnuts for lunch, things like that.

Dr. KING: No.

FLATOW: But...

Dr. BROOKS: Well, Ira, this is George. I'm the exercise physiologists. And there are a few exercise physiologists who believe that, but I do not, because we know so much more, as Meir said earlier, about healthy nutrition. So it's not true that you can exercise and then go out and eat french fries that contain trans fats in them and believe that you're immune from heart disease and other kinds of chronic diseases. That's not true.

So Janet's quite correct that exercise--it was remarkable that the exercise was integrated with the dietary recommendations, and it's, I think, really a breakthrough that the dietary recommendations consider energy expenditure. And as people call in and time goes on, we really need to talk a little bit about by what we mean physical exercise and what physical exercise is as distinguished from physical activity and how both are important to consider.

FLATOW: Is there any alcoholic intake on the pyramid?

Dr. KING: Alcoholic intake is not on the pyramid. It is in the guidelines, however. And in the guidelines, it says specifically to--if you choose to drink alcohol, do so in moderation. And two or less drinks a day for men and one or less drinks a day for women, and that would be like a five-ounce glass of wine or 12 ounces of beer.

Dr. FREI: Yeah, alcohol is really an interesting topic--this is Balz Frei--because there is quite a lot of evidence that alcohol does lower the risk of heart disease, and the evidence is really quite consistent across the board. But obviously as you go to higher alcohol intakes, you see all these adverse health effects. So making a public recommendation for alcohol is always a little tricky because you want to be in the right range and don't want to send the wrong message. But there are clear health benefits of moderate alcohol consumption.

FLATOW: Let's go to Josh from Oakland. Hi. Welcome to SCIENCE FRIDAY.

JOSH (Caller): Hi there. Thanks for having me on. You know, I work as a nutrition analyst here in the Bay area, and, I mean, the pyramid to me is great for the reasons that you've been discussing. I have to say I wish there was a little bit more of an eat-less message. In spite of what Janet King talked about, I think that the fact that there is no--what's in the discretionary calories group, for example, is kind of unfortunate. But the thing that strikes me most is that this--the behaviors and the patterns that the pyramid describes and the dietary guidelines describe just doesn't resemble, in any way, what the majority of Americans do, and doesn't resemble what our food system looks like and doesn't resemble what our opportunities for physical education look like.

FLATOW: Give me a few examples.

JOSH: Well, for example, if I go to the store--you walk into a grocery store, the first thing you see on the aisles are the Coke on one side, potato chips on the other; frozen pizza. Our stores are designed to guide us towards the least healthy options in them. And then the way that the most--least perishable, most highly processed foods also happen to be the most profitable ones to sell. And that just strikes me as a real problem and something that, you know, these guidelines and the pyramid are not going to address. I don't know--I might say that more, you know, USDA policy--bringing agricultural policy in line with nutritional policy is a good idea, but then people get nervous about government intervention and free markets and the food marketplace.

And I--you know, the--until the way that Americans interact with their food system and their exercise opportunities really changes in a significant way, I just don't see education messages doing anything, even if you can understand them, which--it's really difficult to understand these education messages. I think that the six or seven--even if we just had those six messages that the fellow talked about earlier, I think that still would be--I still don't think you'd see any change. What I think you need is environmental changes in addition to these educational messages. We know what people should be doing; it's obvious. This is a great food guidance system, I mean, regardless of what you think about the little problems. But what we need now are to help people make those changes, not just by telling them what to do, but by really physically assisting them in making those changes.

Dr. STAMPFER: I think, Josh, you make good points, and certainly, compared to what Americans are eating, the new pyramid and especially the new guidelines represent an enormous advance. But when you compare it to what it could be, what's optimal, it really falls short. And your other point about the government involvement--I think, you know, if you stand back and look at it, what other industry has a Cabinet-level secretary? There's a secretary of Agriculture; there's no secretary of any other industry group. So there's already a very close connection of government with agriculture.

Dr. FREI: And speaking of government, I think this brings up an interesting point in terms of how the government subsidizes farmers and what kinds of foods that the government actually supports. If you look at it, there's a lot of corn being produced in this country, which then is fed to cattle or is used as high-fructose corn syrup and put into sodas, whereas fruits and vegetables almost get no subsidies from the government. And so the USDA Food Guide Pyramid is one thing, but what the government does, on the other hand, in terms of supporting different commodities, is very different.

FLATOW: Why is...

Dr. KING: I would agree with...

FLATOW: I'm sorry. Go ahead, Dr. King.

Dr. KING: I was just going to say, I agree with the points that my colleagues have made about we need to change the environment in order for the guidelines to be better implemented by Americans. But I also think that it's extremely important to have a document such as the dietary guidelines that integrates all of the research that has been done that shows what we should be striving towards. If we don't have those goals in mind, it's very difficult to know what changes we need to make in the environment in order to achieve more healthy diets in the United States.

FLATOW: Why is milk singled out at three cups of milk a day? The cynics among us would say, `Oh, there's the Department of Agriculture and the dairy lobby going for the milk.'

Dr. KING: Well, that's not true, Ira. But that is a question I've been asked more than any other question about this guideline. As I mentioned earlier, one of the criteria for setting the dietary guidelines was that they would provide a food pattern that would meet the recommended dietary allowances. One of the allowances that we had a very difficult time meeting was the recommendation for potassium. Dairy foods is one of the best sources of potassium in the American diet and--as well as fruits and vegetables. We increased the amount of fruits and vegetables in this set of guideline to nine to 13 servings a day, but we felt we couldn't increase them any more. So we added another cup of milk in order to meet the potassium recommendations.

FLATOW: Yeah. Now this sounds like the Total commercial. Have you ever seen that Total commercial...

Dr. KING: Yes.

FLATOW: ...you take the hundred bowls of Total for this amount of whatever. And I'm yelling at the screen saying, `Take a vitamin pill.' You don't need all those bowls.

Unidentified Guest: Yeah.

FLATOW: You know, one vitamin pill will take a hundred bowls of Total.

Dr. KING: Ira...

FLATOW: We're talking--let me just take a break and we'll get into that. We're taking about dietary nutrition guidelines and pyramid this hour on TALK OF THE NATION/SCIENCE FRIDAY from NPR News.

I think it's a valid criticism. Instead of adding another cup, say, `Take a vitamin,' or...

Unidentified Guest: Yeah.

FLATOW: ...take a multiple vitamin.

Unidentified Guest: Yeah, which one?

FLATOW: You don't have to say any company, you know?

Dr. FREI: Yeah, no, that's what I said at the outset. You know, a multivitamin just as a health insurance. This is Balz.

FLATOW: Yeah.

Dr. FREI: And then you don't have to worry so much about getting all your nutrients from the diet, and you know, with fat-soluable vitamins, for example, you have to eat it with fatty foods. Otherwise, you don't get it, and so you don't want to get that fatty food, and taking a supplement is just as good to get that particular nutrient, and so to get hung up on these micronutrients and try to get everybody to get their micronutrient needs covered from the diet to me doesn't make a whole lot of sense.

Dr. STAMPFER: The dairy--emphasis on dairy I thought was the single biggest deficiency of the current guidelines. Adults don't need to drink any milk, let alone three cups a day, and if you look around the world, there are hundreds of millions of people who have no milk at all in their diet; they do fine. When you look at fracture rates around the world, it's--the countries that have high milk intakes that have high fractures. The overemphasis of milk is really unsustainable when you look at the human health data.

FLATOW: What about the recommendations for exercise? Aren't they--they've been almost doubled? George Brooks, aren't they--the recommendations for daily exercise has gone from--What?--30 minutes to 60 minutes?

Dr. BROOKS: Well, you know, the way it's been presented that people get that impression. I can understand that fully. But the 30-minute recommendation was from the 1996 surgeon general's report, which was remarkable. And it documented very nicely, and this has been substantiated after, that there's a certain amount of physical activity we really need to help us, you know, from the tip of our toes to the top of our head, and the surgeon general's report also said that beyond the 30 minutes, then more and more intense activity is better. So the 60 minutes comes in from the macronutrient report that I was part of. We tried to figure out, really, how much the more was. And for most people, the more was another 30 minutes, but it should be really clear that we're not talking about 60 minutes on the treadmill at high speed or 60 minutes of playing some vigorous sport. We're just talking about the equivalent of walking briskly for 60 minutes in daily activities of all sorts combined.

FLATOW: So if you took two minutes to walk up and down the steps, but you did that 30 times a day, that would be 60 minutes.

Dr. BROOKS: Yeah, if you live in a building--if you work in a building and you take the stairs and then you walk to the corner...

FLATOW: Right.

Dr. BROOKS: ...to mail your letters instead of driving and you ride your bike, like Meir does, then this all adds up. And so, you know, there are at least two aspects of the activity. One is a calorie expenditure, and that's important in terms of balancing, and that allows people to eat more. You know, I have friends who are--were on the macronutrient report and they were women and they were not large people, and they said, `You know, if I don't exercise I can't get my micronutrients 'cause I just can't eat enough,' so that's one thing about activity--it raises expenditure. And the other thing about it is that, of course, it builds bones, it builds muscle, it helps the brain work in a variety of ways, so there's something about the activity itself that it really engenders a fitness for daily life.

FLATOW: 1 (800) 989-8255. Let's go to Anna in Mt. Clemmens, Michigan. Where's Mt. Clemmens, Anna?

ANNA (Caller): Mt. Clemmens is northeast of Detroit, right off of Lake St. Clair.

FLATOW: All right. I've got to ask you to stay on the line 'cause we're going to take a break. We'll come right back for your question, OK? Stay with us. We'll be right back talking about nutrition, health and fitness, the guidelines and your questions. And as I say, we'll be right back. Stay with us.

I'm Ira Flatow. This is TALK OF THE NATION/SCIENCE FRIDAY from NPR News.

(Announcements)

FLATOW: You're listening to TALK OF THE NATION/SCIENCE FRIDAY. I am Ira Flatow.

We're talking this hour about new dietary guidelines and the food pyramid with my guests who are all in Portland, Oregon, participating in the 3rd International Conference on Diet and Optimum Health. That was organized by the Linus Pauling Institute at Oregon State University in Corvallis. Janet King, Meir Stampfer, George Brooks and Balz Frei, and on the line--I rudely interrupted Anna from Mt. Clemmens, Michigan.

I'm sorry, Anna. You've got a question for us?

ANNA: I have a comment actually, and thanks for taking my call. And I want to say I think it's a very important topic and I'm glad to hear it was on the radio. I was driving along and I had an idea. Somebody mentioned the problem with having so many things that we shouldn't eat, right?

FLATOW: Right.

ANNA: So I was thinking why don't we have a reverse food pyramid that sort of goes down, and it could be like Dante's version of hell.

(Soundbite of laughter)

FLATOW: So you start out at level one at the top and go down.

ANNA: Yeah. Yeah, we could put sort of like trans fats way at the bottom and soda somewhere in the middle.

FLATOW: And it gets redder and redder as it gets toward the bottom.

ANNA: What do you think?

FLATOW: I like that.

Dr. FREI: Yeah, reflecting what we actually eat in the United States. I think it's a great idea.

ANNA: I think maybe we should have a committee or some kind of conference about it.

FLATOW: Wow.

Dr. KING: I like that. I think that'd be a lot of fun.

FLATOW: Let's get her on the committee.

ANNA: I think it's wonderful. I'll be on the committee.

FLATOW: All right, Anna. Send us a version, you know? Send it to SCIENCE FRIDAY.

ANNA: OK.

FLATOW: We'll put it on our Web site.

ANNA: I'll draw it up and I'll mail it to you.

FLATOW: OK. Thanks a lot, Anna. Bye-bye.

ANNA: Bye-bye.

FLATOW: Yeah, people respond to a lot of negative things, so why not have a negative food pyramid there, and then get a little more with an edge on it.

Dr. FREI: Well, I think that's not the advice we need, but that's what the US population's already eating, so it's not going to be difficult to come up with that pyramid.

Dr. STAMPFER: You know, we need to listen to our clientele. If Anna's idea--you know, we laughed about it. Well, it might be appealing to some of us and maybe we need to listen better to the public...

FLATOW: Yeah. Yes.

Dr. STAMPFER: ...say, `Well, how do you interpret this and how do we change it so you understand better, and how do we change it so you'll act on it?'

FLATOW: There was a study out a few weeks ago that talked about how the statistics for being--for obesity in the country were severely overblown. Remember that study?

Dr. STAMPFER: Yeah.

FLATOW: Do you think that has damaged the idea that--do people now use that to sort of rationalize? `Hey, I'm not that overweight anymore. Look, they've been lying to us all these years.'

Dr. STAMPFER: Yeah, people have taken that study--and it's quite unfortunate because there's some really serious flaws in that study that led to the wrong conclusion. The studies of obesity and mortality are difficult because typically when you get sick you lose weight, and people who are sick are much likelier to die within a short time frame, and studies like that don't take into account the long time lag that it takes for obesity to shorten your life. The typical scenario might be let's say a 40-year-old who's overweight, gets diabetes, hypertension, gets a heart attack in their 50s, starts getting congestive heart failure because of the heart attack, can't breathe as well, can't eat as well, loses weight, dies 10 years later because of the obesity in the middle years. That new study didn't take that into account, and I think it's really too bad because obesity is an enormous health problem, and it's getting worse as this big bulk of bulky people pass through our population.

FLATOW: And remember we did a story on a few weeks ago about how kids with Type II diabetes are going to start showing up more in emergency rooms and doctors and clinics and places and coming up with whole different demands on the health system we never thought that would be made.

Let me just--that was just a comment. Let me move on to Balz. Let me ask you about high-dose vitamin supplements. You work at the Linus Pauling Institute, and we all know that Linus Pauling was famous for taking and recommending megadoses of vitamin C...

Dr. FREI: Right.

FLATOW: ...to prevent disease and especially the common cold. We've heard vitamin E...

Dr. FREI: Yeah.

FLATOW: ...about antioxidants and that has not panned out so well. These megadoses are not working out so well, are they?

Dr. FREI: No, they are not. You know, with respect to vitamin C, there's really not much evidence that it prevents the common cold. There's some evidence that once you have the first symptoms of a common cold and you take a gram or more, it does shorten the duration and the severity of the cold. But by and large, it doesn't prevent it. The same with vitamin E. Yes, you're right. There are a number of clinical trials that have been performed on vitamin E and heart disease risk and those came out largely negative, some even suggesting some adverse effects, although that has not been confirmed in other studies. But there are still more studies out there. For example, just a recent one on vitamin E and upper respiratory tract infection, including the common cold, vitamin E at 200 international units a day showed a protective effect in elderly people. There is a big ongoing study on vitamin E and prostate cancer together with selenium; that's the select trial. So there still are many ongoing studies out there to address this issue of whether vitamin E and vitamin C can help prevent chronic disease.

FLATOW: Yeah. Yeah.

Dr. FREI: But you're right. At this point, there is no conclusive evidence.

FLATOW: I think, though, that the hot new pill now is probably the omega-3 and the fish oil pills, as cutting down on heart disease by reducing inflammation in the arteries.

Dr. FREI: Right, and there's also evidence for cancer. Maybe Meir can address that point.

FLATOW: Meir?

Dr. STAMPFER: Well, the--yeah, for the omega-3s, there's actually good evidence in particular for reducing sudden death among people with heart disease, and this has been shown in an actual randomized experiment in humans, and it probably doesn't work through inflammation, but most likely it works by making it more difficult for the heart to start fibrillating instead of beating, which when you die of a heart attack, the heart instead of beating regularly just flutters and it--so it can't pump blood to the brain and then the person dies. Fish oil maintains the capability of the heart to beat even if it's damaged, so I think there's really good evidence for the omega-3s for sudden death reduction.

FLATOW: 1 (800) 989-8255. And looking at the pyramids, the recommendations for the sizes--it's interesting that things are measured in cups or ounces because we all know that portion control is out of control these days.

Dr. KING: Right.

FLATOW: I mean, you didn't--it's interesting--no one said one portion of this, two portions of that 'cause we would have--you would have been...

Dr. KING: Right.

FLATOW: ...dead in the water on that.

Dr. KING: Yes, that was a major change this time around with the guidelines. Portion distortion is totally out of hand, and we felt that we had to go to household measures. I don't know if that has solved the problem, because at times it's confusing to know just what is an ounce of cereal, so...

FLATOW: It's not too much, an ounce.

Dr. KING: ...or an ounce of meat. No, it isn't.

FLATOW: Yeah.

Dr. KING: But it's a step in the right direction.

FLATOW: And for example, in the grains I find interesting, because you say for a 2,000-calorie diet eat six ounces every day. That would be--I'm doubling what it says for the regular--one ounce is about one slice of bread, so you're talking two slices of bread, two cups of breakfast cereal or a cup of cooked rice, cereal or pasta.

Dr. KING: You know what I would emphasize in the grains area...

FLATOW: Yeah.

Dr. KING: ...would be to have three ounces of whole grains a day. I don't think it's so important to have six ounces of grains total. What's really important from a point of view of nutrition and health is to have three ounces of whole grains a day.

FLATOW: Right. I agree--that I--I'm with you on the whole grains. Let's go to T.J. in Salem, Oregon. Hi, T.J.

T.J. (Caller): Hi, Ira. Thank you for taking my call. I was real pleased that you took up the subject. The political element--political elephant in the front room on the nutrition issue and especially hot here in Oregon is the pop and candy vendors who make quite a bit of money promoting pop and candy to the kids. I understand that the kids consume on average 54 gallons of pop a year, and parents can't seem to get through to the school boards. I've been trying to get through to our Legislature to try to talk some sense to the people. We can't raise healthy children if the schools are going to push pop and candy. I wonder if your guests could deal with that issue some.

FLATOW: Well...

Dr. KING: Well, in California we have been dealing with that, and now in California, one cannot have sodas or vending machines in the elementary or middle schools. They still exist in the high schools, however, and there's a bill in the Assembly now to take them out of the high schools as well. My concern is that taking the machines out of the schools doesn't necessarily change behavior because there are often places nearby the schools where these same food items can be purchased or they can be brought from home. So we clearly have to get the message across that these foods should be limited in the diet and replaced with healthier choices.

FLATOW: Do school lunch programs abide by these new pyramids?

Dr. KING: They--yes. They will need to abide by the new pyramid and the new dietary guidelines, and this is under discussion right now as to how to change the school lunch program so they can come into compliance with the new guidelines.

Dr. BROOKS: Ira...

FLATOW: Yeah.

Dr. BROOKS: ...this is George here.

FLATOW: Yes.

Dr. BROOKS: Earlier some other callers talked about the absence of leadership in this area at the national level, and this is absolutely true, and it goes down to the local level. So many schools are dependent on the money that they get from the sale of sodas and candies and snacks that exist in the hallways and their budgets are so tight in many school districts that it's--to take them out could cause a real problem with financing the school district, so there's a real moral dilemma and a financial dilemma to deal with this. And I know my wife works with the Seattle public schools and she works with sports medicine and the athletic programs are really dependent on the sale of sodas and so on.

FLATOW: Yeah.

Dr. BROOKS: So this is a real moral dilemma to give these unhealthful foods and make them readily available to kids, and then to take them away and then have major curricular events in the school disappear.

FLATOW: You already cut out the music and the arts programs and the other extra curricular stuff, and the science clubs and--well, let's not go on in that direction. Then taking out the vending machines would just make you cut out some more of those things, is what you're saying. Yeah.

Dr. BROOKS: Well, that's what I'm saying, and what I'm saying is that we need real leadership in this realm, and we're all--the four of us are here at the Pauling Institute meeting because we see the need for this kind of thing. But just explaining--there are parts of 500 people at the meeting and the level of sophistication of what's being discussed is really incredible, and so--but there are more than 500 people that need to understand how nutrition and physical activity affect health and well-being, not just immediately but over the long term.

FLATOW: If we could only make the health and well-being of our children a national security issue we could get some attention.

Dr. BROOKS: Well, I think it is. I think it is.

Dr. FREI: It should be.

FLATOW: Yeah. Well, I don't hear you yelling loud enough.

(Soundbite of laughter)

FLATOW: 1 (800)...

Dr. FREI: Well, but there's an incredible...

FLATOW: Go ahead.

Dr. FREI: ...potential in really improving public health and getting health-care costs under control through diet and lifestyle. I mean, if we are talking about getting out of this health-care crisis in the United States, you have to talk prevention. Now prevention is the name of the game and that is all related to diet and lifestyle.

FLATOW: We're talking about diet and lifestyle this hour on TALK OF THE NATION/SCIENCE FRIDAY from NPR News. I'm Ira Flatow, and we'll continue our discussion.

You'd have to say that the last food pyramid was not a terrible success, I guess is an oxymoron or a contradiction in terms. What makes you think this one's going to work better?

Dr. KING: I don't know that this one will work better I guess is the answer to that. I think by keeping the shape of a pyramid we are consistent with using that shape as a message that is associated with a healthy diet. But helping us decide how is it telling what is a healthy diet is really not that clear I think from the graphic that has been put together. I've looked at similar graphics developed in other countries, and I must admit I think they've done a better job. Some of them use plates and they divide the plate up into four parts or three parts, and they put different types of food in each section of the plate to convey to individuals what they should be selecting to eat to get a well-balanced meal. So I think we still need to work at the pyramid and see if we can refine it to make it more useful.

FLATOW: Do we know where it shows up in public life? Where you get to see it?

Dr. KING: Well, it's not...

FLATOW: Is it in everybody's school class? Is it in the pediatrician's office or does it not...

Dr. STAMPFER: Well, mostly in advertising, especially the old--well, we'll see what happens with the new pyramid, but the old pyramid, the place you'd see it the most is to sell grain products because we're told in the old pyramid Americans should eat six to 11 portions of grain every day, like carbohydrate deficiency was our number-one health problem. You know, so I think industry is using it to sell their products.

FLATOW: So you could put the old...

Dr. FREI: The only...

FLATOW: Go ahead.

Dr. FREI: The only way to really find out what's on the pyramid is to go to the Web site, MyPyramid.gov and dig into that Web site to find out what the advice is all about. You have to have a computer and Internet access to do that, obviously.

Dr. KING: You know...

FLATOW: So the government's not giving out posters for classrooms and things like that?

Dr. KING: Yes, they are. They're giving out posters for classrooms and flyers to use as teaching aids in the classroom, but they've just begun that process and I think that there are plans to develop the educational tools even more, to particular show how to use the pyramid to modify the food choices for different cultural influences on the diet, so it's a work in progress.

FLATOW: And it'll be around for at least another year or two.

Dr. KING: Who knows?

FLATOW: Who knows? OK. I'm going to thank--I'm thanking you all for being around for our program today. Meir Stampfer, professor of nutrition and epidemiology and chair of the Department of Epidemiology at Harvard School of Public Health in Boston; George Brooks, professor of exercise physiology and metabolism at the University of California-Berkeley; Balz Frei, director and endowed chair of the Linus Pauling Institute at Oregon State University in Corvallis; Janet King, chair of the 2005 Dietary Guidelines Advisory Committee and professor of nutrition at the University of California-Davis and other UC places.

Thank you all for taking time to be with us today.

Dr. STAMPFER: Thank you, Ira.

(Guests speak at same time)

FLATOW: You're welcome.

(Credits)

FLATOW: If you missed where to see the food pyramid, you go to our Web site at SCIENCE FRIDAY; we've got a link to it up there. And you can be sure to copy down that address. Also, we're making teaching materials out of SCIENCE FRIDAY, and you can get the copies of those by clicking on our Web site at the teachers button there. And also podcasting--you can now download a podcast each week and also listen to it on RealAudio or take it and play it later on your audible.com player.

Have a great weekend. We'll see you next week. I'm Ira Flatow in New York.

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