<DOC>
[107th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:81866.wais]
DIET, PHYSICAL ACTIVITY, DIETARY SUPPLEMENTS, LIFESTYLE AND HEALTH
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
JULY 25, 2002
__________
Serial No. 107-109
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
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COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
STEVEN C. LaTOURETTE, Ohio ELIJAH E. CUMMINGS, Maryland
BOB BARR, Georgia DENNIS J. KUCINICH, Ohio
DAN MILLER, Florida ROD R. BLAGOJEVICH, Illinois
DOUG OSE, California DANNY K. DAVIS, Illinois
RON LEWIS, Kentucky JOHN F. TIERNEY, Massachusetts
JO ANN DAVIS, Virginia JIM TURNER, Texas
TODD RUSSELL PLATTS, Pennsylvania THOMAS H. ALLEN, Maine
DAVE WELDON, Florida JANICE D. SCHAKOWSKY, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
ADAM H. PUTNAM, Florida DIANE E. WATSON, California
C.L. ``BUTCH'' OTTER, Idaho STEPHEN F. LYNCH, Massachusetts
EDWARD L. SCHROCK, Virginia ------
JOHN J. DUNCAN, Jr., Tennessee BERNARD SANDERS, Vermont
JOHN SULLIVAN, Oklahoma (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on July 25, 2002.................................... 1
Statement of:
Coates, Paul M., Ph.D., Director, Office of Dietary
Supplements, National Institutes of Health; and William
Dietz, M.D., Director, Division of Nutrition and Physical
Activity, Centers for Disease Control and Prevention....... 127
Ladd, Diane, actress, film director, certified nutritional
consultant, Ojai, CA....................................... 32
Seckman, David, executive director and CEO, National
Nutritional Foods Association; George Bray, M.D., Boyd
professor, Pennington Biomedical Research Center, Louisiana
State University; Larry Kushi, associate director for
etiology and prevention research, division of research,
Kaiser Permanente; Pamela Peeke, M.D., assistant clinical
professor of medicine, University of Maryland School of
Medicine, adjunct senior scientist, National Institutes of
Health; Timothy S. Church, M.D., senior associate director,
medical and laboratory director, division of epidemiology
and clinical applications, the Cooper Institute; and David
Heber, M.D., director, division of clinical nutrition,
University of California at Los Angeles.................... 59
Letters, statements, etc., submitted for the record by:
Bray, George, M.D., Boyd professor, Pennington Biomedical
Research Center, Louisiana State University, prepared
statement of............................................... 72
Burton, Hon. Dan, a Representative in Congress from the State
of Indiana, prepared statement of.......................... 6
Church, Timothy S., M.D., senior associate director, medical
and laboratory director, division of epidemiology and
clinical applications, the Cooper Institute, prepared
statement of............................................... 105
Coates, Paul M., Ph.D., Director, Office of Dietary
Supplements, National Institutes of Health, prepared
statement of............................................... 130
Dietz, William, M.D., Director, Division of Nutrition and
Physical Activity, Centers for Disease Control and
Prevention, prepared statement of.......................... 141
Heber, David, M.D., director, division of clinical nutrition,
University of California at Los Angeles, prepared statement
of......................................................... 112
Kushi, Larry, associate director for etiology and prevention
research, division of research, Kaiser Permanente, prepared
statement of............................................... 84
Ladd, Diane, actress, film director, certified nutritional
consultant, Ojai, CA, prepared statement of................ 38
Maloney, Hon. Carolyn B., a Representative in Congress from
the State of New York, prepared statement of............... 63
Peeke, Pamela, M.D., assistant clinical professor of
medicine, University of Maryland School of Medicine,
adjunct senior scientist, National Institutes of Health,
prepared statement of...................................... 99
Schrock, Edward L., a Representative in Congress from the
State of Virginia, article entitled, ``The Million Pound
Challenge''................................................ 21
Seckman, David, executive director and CEO, National
Nutritional Foods Association, prepared statement of....... 63
Towns, Hon. Edolphus, a Representative in Congress from the
State of New York, prepared statement of................... 61
Waxman, Hon. Henry A., a Representative in Congress from the
State of California, prepared statement of................. 158
DIET, PHYSICAL ACTIVITY, DIETARY SUPPLEMENTS, LIFESTYLE AND HEALTH
----------
THURSDAY, JULY 25, 2002
House of Representatives,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 10:29 a.m., in
room 2154, Rayburn House Office Building, Hon. Dan Burton
(chairman of the committee) presiding.
Present: Representatives Burton, Morella, Schrock, Maloney,
Norton, Cummings, Kucinich, and Tierney.
Staff present: Kevin Binger, staff director; James C.
Wilson, chief counsel; David A. Kass, deputy chief counsel; S.
Elizabeth Clay, professional staff member; Blaine Rethmeier,
communications director; Allyson Blandford, staff assistant;
Robert A. Briggs, chief clerk; Joshua E. Gillespie, deputy
chief clerk; Robin Butler, office manager; Elizabeth Crane,
deputy communications director; Corinne Zaccagnini, systems
administrator; Sarah Despres, minority counsel; Ellen Rayner,
minority chief clerk; and Jean Gosa and Earley Green, minority
assistant clerks.
Mr. Burton. Good morning.
A quorum being present, the Committee on Government Reform
will come to order.
I ask unanimous consent that all Members' and witnesses'
written and opening statements be included in the record.
Without objection, so ordered.
I ask unanimous consent that all articles, exhibits and
extraneous or tabular material referred to be included in the
record, and without objection, so ordered.
Let me start by saying we will probably have Members
wandering in with their shirttails hanging out and their ties
not tied because we ran until 2:30 a.m. As a matter of fact, is
there anybody in the audience? I can't see yet. In any event,
this is going to be a very busy day. Members are trying to get
their offices all squared away so they can head for the August
recess and district work period. As a result, we will have
people coming in and out. We may be interrupted for several
votes on the floor. We will probably have votes coming in a
series of two, three or four. Representative Schrock and others
probably will take the chair from time to time because I will
have to go down and speak probably this afternoon on the
homeland security issue since our committee had primary
jurisdiction over that when we were marking up the bill.
For those of you who will be wondering why we are running
in and out and why we all look bloodshot eyed and tired, that
is why.
Health care oversight activities have been a high priority
for this committee during my tenure as chairman. I firmly
believe that as we enter the 21st century we have the
opportunity to change the landscape of health care and delivery
of services.
Health care costs are skyrocketing. The national health
expenditures are projected to reach $2.8 trillion in 2011. If
we don't turn things around by 2011, we will be spending 17
percent of the Gross Domestic Product on health care, almost $1
out of every $5. One would think that because we spend more of
our GDP on health care than any other country, that we would
have the best health status. This, however, is not the case.
In June 2000, the World Health Organization announced their
first ever analysis of the world's health systems. They
compared 191 countries and found that the United States ranked
37th out of 191. Obviously, dramatically increasing our
spending on health care is not the solution. I am attaching to
this statement a list of guiding principles for health care
renewal in the 21st century. These principles embody what we
have been working on for the last 4 years, as we have looked at
the role of complementary medicine in our health care system
and the importance of preserving our rights as Americans to
make our own health care choices.
One of the things we have noted is that doctors are taught
how to deal with problems after they occur and not before they
occur. That is why complementary and alternative medicine is a
necessary adjunct to make sure that we do something that will
prevent the onset of health care problems so that we can cut
the health care costs.
I am pleased that Ms. Diane Ladd is here with us today. Ms.
Ladd has been called 1 of the 10 leading actresses in the
world. Her film credits include ``Rambling Rose,'' ``Wild at
Heart,'' ``Alice Doesn't Live Here Any More,'' and ``Christmas
Vacation.'' Ms. Ladd has also appeared in numerous television
shows including ``Dr. Quinn, Medicine Woman'' with my friend,
Jane Seymour, and a show that everyone loves, ``Touched by An
Angel.'' One of her most recent television movies was ``Talking
to Heaven.'' Ms. Ladd, in addition to acting and directing, is
a certified nutritional consultant. She is here today to share
her personal insights on the role of nutrition in healing.
It may seem like common sense that diet and exercise can
improve our health. There is also an increasing body of
scientific evidence that supports this. Experts tell us that
about 85 percent of diseases and illnesses in this country
result from lifestyle decisions. Conversely, the adoption of
healthy lifestyle choices, including moderate physical
activity, a sensible diet and the appropriate use of dietary
supplements, can improve our health.
Unfortunately, the typical medical school student will
spend less time in classes learning about nutrition than we
will spend in our hearing today. My son-in-law is a doctor and
when I start talking to him about this stuff, he says let's
talk about golf. He is a real neat guy thought. If doctors have
no training in nutrition, much less dietary supplements, how
are they supposed to advise their patients?
One of our witnesses today is working to change that. Dr.
Pamela Peeke is a Pew Scholar in nutrition and metabolism and
an adjunct clinical professor at the University of Maryland.
She is also the author of the book, ``Fight Fat After Forty.''
Dr. Peeke devotes her energies to the education of medical
professionals in nutrition, lifestyle and fitness. She
presently is teaching and devising new medical curricula in
nutrition and metabolism.
As part of our investigation, we have learned that
naturopathic doctors who are trained at accredited naturopathic
universities receive the training in nutrition that M.D.'s
ought to receive. However, students may be discouraged from
applying to these schools because there is an inequality in the
loan programs at the Department of Education between M.D.s and
N.D.s. The Department of Education needs to eliminate this
discrepancy. The committee has been active in monitoring the
implementation of the Dietary Supplement Health and Education
Act of 1994. Previous hearings have focused primarily on the
Food and Drug Administration's lack of full implementation. To
date the American public has not been well served by the FDA in
this respect. It has been 8 years, and still, we do not have
good manufacturing practice guidelines published. There is
negligible review of imported products. We must have the full
implementation of DSHEA in order to assure the quality of
products on the market and that information is readily
available to consumers.
Yesterday, the National Academy of Sciences, under contract
with the FDA, published for comment a Proposed Framework for
Evaluating the Safety of Dietary Supplements. This is also an
important issue that the FDA needs to understand in order to
fully implement DSHEA. As we have learned previously, tracking
adverse events for dietary supplements does not provide valid
scientific data on which to develop policy.
Mr. David Seckman, the executive director and CEO of the
National Nutritional Foods Association is here representing the
manufacturers and retailers of dietary supplements. Mr. Seckman
is appropriate to speak to these issues today not just in his
role at the NNFA, but also because of his background as the
former vice president for regulatory affairs of the American
Health Care Association and former executive director of the
Illinois Health Care Association.
In addition to traditional use, there is a scientific basis
for the wise use of vitamins, minerals, and botanicals to
improve health. Through research, we are learning which
nutritional components are best obtained through diet and which
are absorbed from supplements.
We already know from traditional use and research that
drinking cranberry juice can help prevent certain infections.
We also know the use of acidophilus, when taking antibiotics
can help prevent the onset of yeast infections. Dr. Linus
Pauling told me over 30 years ago that taking vitamin C every
day would help prevent cancer. I am attaching a list of widely
accepted nutritional connections to improving health.
In a February 1999 hearing, Dr. Dean Ornish testified about
his research showing that heart disease could be reversed
through a comprehensive lifestyle improvement program that
includes a low-fat and plant-based diet, moderate physical
activity, stress management, and dietary supplements. This
approach has been shown to reverse heart disease, a feat that
drug and surgical approaches do not achieve. Currently the
Ornish program is being evaluated in a Medicare demonstration
program. Clinical trials are also under way evaluating the
benefit of the Ornish program for preventing a recurrence of
prostate cancer. The preliminary findings are promising.
In December, I introduced H.R. 3475, the Dietary Supplement
Tax Fairness Act of 2001. This bill amends the Internal Revenue
Code to treat amounts paid for foods for special dietary use,
dietary supplements, and medical foods as medical expenses for
purposes of the medical expense deduction. This bill has also
been introduced as S. 1330 in the Senate.
Last month the Journal of the American Medical Association
published research that recommended that all Americans take a
multivitamin every day. With improved and expanded research we
will learn more about how and when nutritional supplements will
improve health and play a role in the healing process. It is
also through research that we will learn more about safety,
toxicity, and contraindications.
On June 20th, in outlining his health and fitness
initiative, President Bush made the following remarks:
Better health is an individual responsibility, and it is an
important national goal. We are making great progress in
preventing, detecting and treating many chronic diseases. That
is good for America. We are living longer than any generation
in history. Yet we can still improve. When America and
Americans are healthier, our whole society benefits. If you are
interested in improving America, you can do so by taking care
of your own body. This year, heart disease will cost our
country at least $183 billion. If just 10 percent of adults
began walking regularly, we could save billions in dollars in
costs related to heart disease. Research suggests that we can
reduce cancer deaths in America by one-third simply by changing
our diets and getting more exercise. The evidence is clear, a
healthier America is a stronger America.
The President called for the adoption of four guideposts:
No. 1, be physically active every day; No. 2, develop good
eating habits; No. 3, take advantage of preventative
screenings; and No. 4, don't smoke, don't do drugs, and don't
drink excessively.
Dr. Timothy Church of the Cooper Research Institute will be
testifying about the important role that physical activity
plays in improving and maintaining health. The Cooper Research
Institute, founded by Dr. Kenneth Cooper, has long promoted
improved health through aerobic exercise.
Regular physical activity substantially reduces the risk of
dying from coronary heart disease, the Nation's leading cause
of death, and decreases the risk for colon cancer, which my
wife succumbed to just recently, diabetes, and high blood
pressure. It also helps to control weight; contributes to
healthy bones, muscles, and joints; reduces falls among the
elderly; helps to relieve the pain of arthritis; reduces
symptoms of anxiety and depression; and is associated with
fewer hospitalizations, physician visits, and medications.
Moreover, physical activity need not be strenuous to be
beneficial. People of all ages benefit from moderate physical
activity, such as 30 minutes of brisk walking five or more
times a week.
We have a lot of other people who will testify today and I
am pleased that we will hear from a variety of these people,
Dr. George Bray, Boyd professor of medicine, Louisiana State
University is a leading expert on obesity. Dr. Larry Kushi,
associate director for etiology and prevention research, Kaiser
Permanente, is an expert on macrobiotics and other plant-based
diets and their role in preventing diseases such as cancer. Dr.
David Heber, director, division of clinical nutrition,
University of California at Los Angeles is one of the country's
leading experts on the science of dietary supplements. I am
also pleased that we will receive testimony from Dr. Paul
Coates of the Office of Dietary Supplements at the National
Institutes of Health and Dr. William Dietz, the Director of the
Division of Nutrition and Physical Activity at the Centers for
Disease Control and Prevention.
Improving our health through diet and lifestyle is low cost
and effective, and will save the taxpayers a lot of money and
the individual citizen a lot of money. We need to find ways to
empower Americans to take charge of their lives and improve
their health, and reduce the incidence and tragedy of chronic
and life-threatening medical conditions.
The hearing record will remain open until August 8.
Other statements? Mr. Schrock.
[The prepared statement of Hon. Dan Burton follows:]
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Mr. Schrock. Thank you, Mr. Chairman.
Thank you for calling this meeting today to discuss what I
feel is a critical issue that is facing our Nation. It is no
secret that obesity is epidemic in the United States. According
to this committee's background documents, there are currently
over 45 million obese adults and about 8 million obese
children. These numbers, I can assure you, are on the rise.
The effects of obesity in our population and on our economy
is staggering. According to the Surgeon General, 300,000
Americans die prematurely each year due to their weight and
obesity which costs Americans $100 billion per year. According
to the RAND Corp., obesity contributes to higher cost increased
for health care services and medications than do either smoking
or drinking problems.
The July August 2002 edition of Men's Health Magazine, and
I appear on the cover. [Laughter.]
Mr. Burton. Something has happened to you. [Laughter.]
Mr. Schrock. There is a lot under this clothing, I can tell
you.
The magazine had a series of articles on this topic and
they have challenged American men to lose 1 million pounds
collectively. This is a great challenge that will help men feel
better, live longer and save them thousands of dollars over
their lifetimes. Overweight men, according to this article, are
50 percent more likely to develop heart disease, 70 percent
more likely to develop high blood pressure, 58 percent more
likely to have total cholesterol of 250 or greater, 16 percent
more likely to die from their first heart attack, 9 percent
more likely to have a stroke, and 250 percent more likely to
develop diabetes.
Overweight men spend 37 percent more a year at the
pharmacy, make 12 percent more visits per year to their primary
care doctor, spend 19 percent more days per year in the
hospital, and pay $4,200 more over their lifetimes for medical
care. Overweight men are 5 percent more likely to die of
prostate cancer, 35 percent more likely to develop kidney
cancer, 120 percent more likely to develop stomach cancer and
590 percent more likely to develop esophageal cancer. These
statistics are staggering and though they are particularly for
men, I am sure they could be translated to women as well.
The way I see it, the Federal Government should do all it
can to encourage healthier living. After all, an ounce of
prevention is worth a pound of cure. Last month, President Bush
outlined his health and fitness initiative. Congress should
take his lead and find ways to positively encourage our society
toward healthier living. Our panel of experts today will
provide us with valuable information that we should use to
improve Federal policies with regards to diet, physical
activity and dietary supplements. I look forward to their
testimony.
I can tell you firsthand how important health is. On July
15, 1975, I was diagnosed with an incurable cancer and given 6
months to live. In 90 days, I lost 142 pounds and lived in a
coma for 6 months and the doctors gave me absolutely no hope.
During conversations the doctors had over me with my wife, they
were convinced I would be dead anytime soon but I knew I was
meant to be here to work on this issue. I think that is why I
am here today.
I worked out heavily, I weighed 240, I drank and smoked
more than I should have but that was my wake-up call. I no
longer do any of that and I am the biggest health advocate in
the world and I think when we come back in January I am going
to challenge my colleagues on both sides of the aisle to take
part in this million pound loss by challenging the Democrats to
lose 5,000 pounds and the Republicans to lose 5,000 pounds
because folks, some of the people I see walk into that chamber
need to do it because they are going to die young and that is
not a good thing. This is a very important issue and I wish
every Member was here to hear it.
I am looking forward to hearing Ms. Ladd. Thank you for
coming. I am delighted you are here and I am delighted the
others are here as well.
Thank you, Mr. Chairman.
[The article referred to follows:]
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Mr. Burton. Thank you, Mr. Schrock.
We do kid around a lot about some of these things, but it
is very, very serious and I think you have illuminated that
issue very well.
Now for our 29 year old colleague.
Mrs. Morella. Thank you, Mr. Chairman.
I didn't prepare any remarks but I am very interested in
this hearing. I thank you very much for scheduling it.
I must say I was moved by my colleague, Mr. Schrock's
comments and indeed, I would be very happy to help to partner
with him as he pursues that tremendous goal.
This is a hearing where we might sometimes find ourselves
in the situation where Robert Frost defined a poem. He said,
``In the end, it tells me something I didn't know I knew''
because some of the issues that will come up are really common
sense issues like diet, to find out how important diet is;
nutrition; the whole concept of supplements, how important are
they; and the whole issue of exercise; and I would add another
ingredient and that is attitude. I have always felt that
attitude is altitude, how you look at things. We have seen that
with you, Mr. Chairman, as well as with Mr. Schrock, in terms
of how you handle situations.
Indeed, mention was made of obesity and you mentioned, Mr.
Schrock, obesity in men in particular but we are going to have
somebody testify today, someone who is a constituent of mine,
Dr. Peeke who is going to be looking at the gender facet of
that. Whereas 31 percent of men are obese, 34 percent of women
are. Maybe in some way we can also look at gender nuances.
Above all, we can look at our role as policymakers and
think of the money we would be saving. We are pouring a lot of
money into the National Institutes of Health and I also note
that Paul Coates, the Director of Dietary Supplements at the
National Institutes of Health, is here. We know that some of
the research is being reflected in our knowledge as well as our
cures, including prevention of some of the major illnesses and
the money we have saved, and the impact on families. We tend to
forget sometimes that when you have these health crises, the
impact on families, on caregivers, on every member of the
family.
So I look forward to learning a great deal from the hearing
today. I want to thank all the witnesses. You have assembled a
very distinguished group of witnesses who will be able to share
their experiences and knowledge with us. Dr. Peeke is
accompanied by another constituent of mine, Irene Pollin. I am
pleased she is here and Dr. Coates from NIH.
I yield back time served so we can commence the hearing.
Thank you, Mr. Chairman.
Mr. Burton. Thank you, Mrs. Morella, and you do look very
young. You obviously take very good care of yourself.
Before we bring up Ms. Ladd, let me say that one of the
things Katie Couric expressed when she lost her husband to
colon cancer, and I lost my wife recently to colon cancer, and
one of the things I try to say at every meeting, not on the
subject at hand today, but anybody over 40 and surely over 50
should get a colonoscopy. My wife never was told that and
because of that, when she started having stomach problems, they
gave her stomach medicines and by the time we found out it was
colon cancer, it had metastasized into her liver and it was too
late. So I would say anybody over 40 if you haven't had it,
especially if you are over 50, remember what I am telling you.
It is something that can save your life.
I gave a speech at a Republican get together in northern
Indiana not long ago and I said this and the guy that was
putting on the program wrote me a letter last week and said he
had never even thought about that. He was a former State
senator and they found 10 polyps in his colon and my bringing
that to his attention probably saved his life because they
think a couple of those were cancerous.
So all I am saying to you is that this is not on this
subject but in addition to good health, good diet and good
exercise and all that, you need to do these other things that
are important as well.
With that, Ms. Ladd, you are a lovely lady. Would you
please come forward so I can swear you in?
[Witness sworn.]
Mr. Burton. I have admired your work as have my colleagues
for many years. I don't know how many movies you have appeared
in but it is well over 100. We are very happy to have you as we
have had other celebrities here and we are anxious to hear what
you have to say, so would you make your opening statement?
STATEMENT OF DIANE LADD, ACTRESS, FILM DIRECTOR, CERTIFIED
NUTRITIONAL CONSULTANT, OJAI, CA
Ms. Ladd. Mr. Chairman, Congressman Schrock, Congresswoman
Morella, it is my privilege and pleasure to be here today. I
not only talk to you as a fellow citizen and American, but as
an actress, a species that lives between chance and oblivion. I
am a resident of the State of California, previously a resident
of New York. I have also at times in my life because of my work
in the medical field been a resident of Texas and Florida but I
was raised in the beautiful magnolia State of Mississippi.
My name is Ladd. My real name was Lanier or Ladner. My
father sold medicine for poultry and livestock, wholesale and
retail throughout five States. As a child at his knee, I
witnessed my father encouraging human beings who did not have
proper nutrition to go beyond the norm, to reach the extra mile
to save their lives, the same with my great grandmother who was
a doctor who studied with the Cherokee Indians, the healing
arts and herbology.
As an actress, I am privileged to have represented my
country and be a three time Oscar nominee and to have been
honored with over 23 international awards and honors and sent
telegrams by my Government, by Washington, by Mr. Jack Valenti
representing my government.
My advocation is health. It is my love and it is a
professional hobby. I am here with you today to share with you
how important I feel vitamins and minerals are and how they can
be involved in miracles. I am here to testify to the art of
miracles and how they can be accomplished by making changes
mentally, physically and spiritually. It takes a triad and in
order to have a cure, one must know the cause.
As a young, young wife and mother, seems like eons ago, a
young bride, my husband, actor Bruce Dern and I, two struggling
actors, had a beautiful baby daughter 2 years old. Our child
died in a very tragic accident. Being an emotional actress, the
pain is always with me because memory is always in you as a
human being but the trick in life is to use the things that we
go through not only to better ourselves but to better our
fellow human beings. As Congressman Schrock said, maybe he is
supposed to be here today to fight for these issues. I feel the
same way.
After my daughter's death, my body screamed to replace that
child, for God to give me another child. Indeed in a little
over 8 weeks, I got pregnant again and I said, God taketh away,
God giveth back but it was not to be so simple. It turned out
it was a tubular pregnancy, a pregnancy in the fallopian tube.
I almost died, it almost took my life. My right tube was
completely removed and most of the left tube. They left me with
just a little piece of a tube, probably for female functions.
Five top doctors in our country told me that I, Diane Ladd,
would never, never, impossible, have another child, no way.
I went on my own search in 1962 and there were no health
stores, no health books except for Gaylord Houser's ``Mirror,
Mirror on the Wall.'' I took it to heart. I absorbed it. I
spent my days not looking for acting jobs, but being in
libraries, reading about the human body. What vitamins could
help my body, what foods could help my body, avocado, the oils,
bee pollens, the Vitamin B's, and so forth.
I flew to New York to a great semiscean pellor doctor who
really cared about his fellow human beings who informed me that
mud baths can prevent sterility. I went over massage,
chiropractory, the doctors thought I was nuts. They wouldn't
talk to me about it but I continued my search. Gentlemen, after
3\1/2\ years, I walked into the office of Dr. Charles
Ledagurber, one of the top gynecologists in our country, one of
the five doctors chosen by my government to go to China to do
research on their traditional modalic medicine which is our
alternative modalities in medicine.
I went in to Ledagurber, who had great empathy for me
because he too had lost a child in his life but he had four
other children, I had none. I had a smile and I said, Dr.
Ledagurber, I think I am pregnant, go make your test. He looked
at me with such a sad look and said, ``Oh, Diane, honey, you
cannot be pregnant. It is impossible. Go home and cry.'' I
said, ``Dr. Ledagurber, I have cried, now go make your test.''
He made the test and I was pregnant.
When my daughter, Laura Elizabeth Dern, was born, they took
her caesarian to prevent any possibility of complications.
While I was on that operating table, after they took my child
from my womb, I remained on the table for 4 solid hours while
they played in my gut and removed 16 major adhesions that had
been caused by tubular pregnancy. They removed them from my
body.
One of the other five doctors who said I could never have
another child showed up to see it for himself. I was passed out
on the table. They don't knock you out because the body bleeds
more when it is knocked out but if you pass out, it is a little
bit better. So I was passed out and they were in there doing
their work when my subconscious heard the other doctor say,
``My God, my God, it is impossible that this child got through
that body and that tube. This is a miracle.'' I scared him,
this blond head rose up off the table and I said, ``That is
right. It is a miracle and it is a hell of a lot of hard
work.''
My daughter, Laura Elizabeth Dern, would not be on this
planet today were it not for my own, individual vitamin and
mineral program that gave my body the ability to assimilate
those nutrients that I needed to rise above the negatives that
had been created. Our body is a miracle machine, if we can
follow our intuition. Or course actors have a seventh sense and
they gave the medical profession psychodrama. Actors have been
known to go into mental institutions and where doctors cannot
get a patient to speak, actors have gotten a patient to speak,
have opened them up to literally talk. As I said before, at one
time in history in Egypt art and science was one profession.
My second medical miracle came when my daughter, Laura
Dern, was 12\1/2\ years old. She was discovered to have
scoliosis, a disease which is a crippler and a killer. I took
her to a Dr. Jack Moshime, a very famous Beverly Hills
orthopedic surgeon. He has done a lot of great work in this
country. On x-ray, my daughter's spine was like an ``S,'' very
severe. I was pretty hysterical because having lost a child you
can imagine how protective I was of this child, my little
miracle. The fact that they hadn't discovered it before was
unbelievable to me but it appeared that when she was 5 years
old, she had been bitten by a black widow spider, and the
poison from that bite had thrown the alignment of her spine out
of balance so as she grew, the spine formed in a crooked
manner.
I asked Dr. Moshime how long have I got before I have to
put my child in that back brace you are telling me to put her
in from her hips to her neck, her whole teenage livelihood? He
said, I will give you 9 months, Diane, and you be back in here
and we are going to put that brace on her. You go do whatever
you think you are going to do and I will see you here in 9
months. In those 9 months, I took my daughter through several
things. One of them was a Dr. Viola Framman in San Diego who
today has the Osteopathic Promise for Children. Viola Framman
had lost a child when she was a young medical student and she
knew and testifies that she knew then and knows today that if
the doctors treating her child had gone the extra mile, that
her child would have lived. So she has devoted her whole
lifetime to humanity, especially to children, with the art of
cranial therapy. Her mentor was Dr. Magune who was one of
President Eisenhower's private physicians. He is the
grandfather of the art of cranial therapy. Dr. Magune taught
Viola, Dr. Magune sent me to Viola and she worked on my
daughter every 2 weeks and then every month for the next 9
months.
Through the art of adjustment, through cranial therapy,
pictures were taken where you could see her body changing
literally, photographs. I also took her to a chiropractor, I
also took her to a laying on of hands healing arts, Doug
Johnson, very famous all over the world. I also went on a
vitamin, mineral regimen. I also rubbed peanut oil which is a
healer on the bottom of her feet. I took the skin from potatoes
and tied them at night on her eyes with a rag because I know it
draws out poison from the body.
In 9 months, I went back in to Dr. Moshime. He takes one
look at Laura and says, oh, my God, she has grown 2 inches.
Diane, growth is a detriment. Scoliosis is a not only a
crippler, it is a killer. He was almost hysterical. I said, I
don't know, go take your x-rays and tell me what to do now.
I sat in his waiting room among 16 other patients, my
daughter and I, waiting for the verdict, the health verdict
when suddenly this doctor comes racing through that room,
waving his hands over his head, ``My God, it is a miracle.'' I
whispered, ``Yes, Doctor, it is a miracle and a hell of a lot
of hard work.'' On x-ray, in those 9 months, my daughter's
spine instead of being like this, still had a little bit of
problem, but ladies and gentlemen, it was like this, you could
hardly see the curve. Laura Dern did not have to wear that
prescribed brace for her whole teenage lifetime. Instead of
being able to share her great talent that God gave her and make
movies such as ``Mask'' and help influence our teenagers in the
world to fight for morality and the good in their own lives,
Laura would not have been able to do anything or fulfill her
destiny had I not fought and used alternative modalities.
Third was allergies. I had gotten those from emotionalism,
having gotten divorced and I had ragweed and pollens, dog hair
and the actor's disease is dust because of our travels and old
theaters. All of these, I had to get a staph shot once a month
for the different cities, floating staph in the air and once a
week, I had to get shots for the other allergies, and I had to
give away my dogs.
Virginia Capers, a Tony winning, beautiful black actress
came to me and said, ``Diane Ladd, I am tired of you suffering
like this, you take this book and make it your bible.'' It was
a book on juices. It was a book that taught me that when the
body gets uneasy, when the body gets too stressed, when it has
disease, it begins to develop disease and the more it needs the
vitamins and minerals, the body isn't capable of assimilating,
of withdrawing from the nutrients what it needs. It must have
supplementation.
I took the book and I supplemented my diet four times a day
with natural juices, mixtures of carrot juice, cucumber,
celery, spinach and very little parsley. Too much parsley is
not good and beet. I mixed these juices and supplemented my
diet four times a day and in 1 month all of my allergies were
totally gone and I have never had to have a shot. That was in
1976. So that was the third thing.
The late Rock Hudson was a friend of mine, I had done a
movie with him. They asked me to portray after his death his
mother in a TV show. I hated the script, I thought it was
completely a ripoff of this man's life. I took the script and
threw it I was so angry. Then I said, Diane, if you don't do
the movie, Hollywood is just going to do it and it is going to
be terrible. At least if you get in there, you can fight,
scream and try to make it better. Go do it and try to make it
better and honor this man. So I did.
I told the producers that I would do it for very little
money, minimum, if they would contribute $25,000 to research
for immune related diseases at the hospital of my choice. I
chose Scottsdale, AZ where Dr. Terry Friedman was doing his
work. He was one of the seven doctors who founded one of the
great organizations in our country, the American Holistic
Medical Association. These are AMA doctors who believe in the
oath they took and they believed when you say you are going to
make a human being well, you help them heal by using everything
God gave you to help that person balance their body.
Dr. Friedman worked with the money they gave him on cancer
victims and AIDS victims and one particular young man who came
from Texas had been given 3 months to live, he was dying from
AIDS. You could see this was a skeleton walking around. They
gave him chelation, they gave him mineral programming, they
gave him a diet of vitamins and minerals and as much proper
foods as they could. They did alternative modalities, massage,
manipulation, detoxification. Within 3 months, that man did not
look like the same man. That young boy walked out of that
hospital. Maybe he carried still some of the AIDS with him but
life is precious, none of us knows who will walk out of here
and be hit by a car. A minute is a minute to smell a rose. If
God can give it to us, we have the right to fight for it.
There have been many other experiences. I have since worked
with doctors, lectured all over the country. I am on the
scientific board of advisors for Congressman Berkeley Bodel's
organization here in Washington, the NFAM, the National
Foundation for Alternative Modalities and when time permits, I
work with doctors. I have a book I have written called,
``Spiraling through the School of Life,'' which is coming out
sharing all of the experiences I have had.
These experiences even included a sojourn to Central
America where I picked up a parasite and St. John's Hospital
didn't find it. Again, it was alternative modality doctor who
is also an AMA medical doctor who in 2 weeks changed my body.
In your packet today you have, which I asked for, approximately
20 letters from some of the top medical doctors in our country
today who each has testified to the importance of vitamins and
minerals. I as an actor testified that the actor's instrument
is his body and today the arts are in as much trouble as
medicine. There are those who would keep culture from shining
and helping people. Culture is the mental part of health and if
you don't believe me, go step in your Library of Congress. Take
a minute and see what it does for your whole body, how it
refurbishes your very soul. That is my primary way of healing
through the arts.
In a profession where there is 120,000 actors today, and
87,000 of them didn't work last year, they made less than a
poverty wage of $7,500, and in a world where 37,000 didn't
work, in a world where we are losing $150 billion this decade
to Canada alone which is $30 billion of your tax money, why
should we give that money away? That can build medical centers,
playgrounds. Why aren't we helping medicine and why aren't we
helping the arts so that we can make good films which will make
people feel better and be healthy?
I beg that the protection of vitamins and medicines, we
have the right to choose our own vitamins. Medicines are food.
Sure it can't be poisonous anymore than food should be
poisonous but we have the right to choose. Nobody should give
me a prescription for a vitamin or medicine. Don't they dare
start to play that game. I want the right to choose my food in
my country and the right to buy my own vitamins and medicines.
If my poor actors, 120,000 of them, 80,000 who are probably
getting pretty depressed and pretty ill by now, don't have the
right to buy a vitamin or a medicine, they are going to die. So
let us keep some of your artists alive, let us keep humanity
alive and by the way, just so you know, the cultural business
is affecting men and women across the country. They are going
belly up because of a lack of the right to do independent films
in this country. They have no money and we need to get on board
with France, Spain, Australia and everybody else and get some
work in this country for these people.
We also need to have the educational committees work with
Congressman Burton and you Congresspeople and let us get
vitamins and minerals in the school lunches for our kids. If
your own Surgeon General has said a proper diet can indeed
prevent cancer, then let us help to get them a proper diet
because when you go to dinner tonight, what is the proper diet?
Sometimes food is like some of the people we know, pretty good
on the outside, not much going on inside. So when you go to get
your food tonight, I don't know what that food you eat has.
Just to protect yourself, please let us get our kids some
vitamins and minerals.
Thank you for allowing me to speak. Any questions, please.
[The prepared statement of Ms. Ladd follows:]
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Mr. Burton. Thank you, Ms. Ladd. You are very informative
in your statement but you are also very interesting and I found
it very entertaining as well.
You mentioned that your daughter, Laura Dern, wouldn't have
been born if you hadn't had proper diet and vitamins and
supplements. Are you aware of any research in our government
that is looking at those issues?
Ms. Ladd. I am aware of those letters from the doctors who
are AMA doctors. I was privileged in Arizona, unfortunately, to
be in a room with five top doctors from this country. A
hospital is a terrible place to get your karma. You had better
pray to God if you are ever in a hospital that you get a doctor
who believes in his work because the chips are down then. I was
in a hospital with doctors who believed in their work and they
called the Center for Disease Control in Atlanta, GA. Dr.
Friedman had them on the speaker and he begged them to please
come monitor the work they were doing. They didn't want any
work from them, they just wanted them to come and monitor it so
they could maybe get a grant or something to continue their
work for humanity sake. They asked them, please, in God's name,
come monitor what we are doing. They said, well, what are you
doing to save the lives? He said, chelation, which I personally
have seen do wonders; Vitamin C drips, and I have seen that do
wonders, miraculous wonders; vitamins, massage, and modalities
and herbology, and mental programming. The Centers for Disease
Control laughed in their face, roared with laughter and said,
we don't believe in anything holistic and they slammed the
phone down in these famous doctors' faces. I was there and
witnessed it.
There is an organization called AHHA. She sent me a letter
to thank me for coming to testify for you. She said she had
heard me speak once in Scottsdale, AZ about 15 years ago and
because of that she formed this organization to do research.
She has a lot of research. You have a letter from her. Dr.
Gladys McGary is one of the giants of the business and Dr. Bob
Anderson. These doctors are the ones I put my faith in, the
ones who working together to ask each other, tell me what you
learned, I will tell you what I have learned, I will help you,
you help me. We can't live alone, we are not isolated.
Mr. Burton. Other cultures have embraced nutrition. I think
China is a leading example of that. They have other methods of
healing which are not generally recognized here in the United
States. Here in America, it seems like we focus on after the
fact, after the disease has taken place and trying to come up
with the magic bullet. Can you tell us a bit about your
experience with some of the methods used in other countries,
the vitamins and supplements they use and how that might be
effective?
Ms. Ladd. When I mentioned my great grandmother, Prudence,
she was a young doctor, had trained herself. First, she was a
midwife and went to New Orleans with a horse and buggy and
stole all the books from the library so she could help her
patients. They didn't have any libraries in Mississippi at that
time. She came back and finally got a medical degree, delivered
over 3,000 babies. She was the kind of woman that once was
thrown in a blizzard off a horse, broke her leg, got back on
the horse and went and delivered a baby, then had her leg set.
There are records of her cures of typhoid fever and diphtheria
before the advent of the drugs that would cure those diseases.
She used the herbs the Cherokee Indians taught her.
I am also aware of an experience of my father when I was 5
years old. I was in Mobile, AL and there was an outbreak of
spinal meningitis. The neighbor's son had been taken to the
Mobile Infirmary and they even had beds in the halls. They told
this poor farm couple take your son home, he was 17 years old,
he will be dead by morning, there is nothing we can do. They
came over to my daddy begging him, and my daddy said I am a
doctor for chickens and cows and dogs. They said, oh, Mr. Ladd,
please, you have to help us, we have nobody to turn to.
I remember seeing my father's chin quiver and I saw those
tears in his eyes and I heard him mutter, you don't ever give
up on life while you are in life. He went out that door and
found a young country doctor who had just graduated from
Harvard and was in this place Chickasaw, AL. He brought him to
these people. This doctor rounded up the neighbors and the
neighbors held the boy's body, the legs and hands down because
in spinal meningitis the body will curl until the back will
snap. They held the boy down so the body wouldn't snap and he
worked on that boy all night. You could hear that boy screaming
all through the neighborhood.
He also brought in an old man about 84 years old, a country
doctor to advise him, tell me what to do, tell me what to use,
what can we do. I don't know what all he used but I know he
used alternative medicine just as fast as he could get his
hands on it. Alternative medicine is herbs, perfecting the
human body.
Yes, I believe in traditional medicine but today, we are
overmedicated and there are many, many side effects. If a woman
takes an antibiotic, she is going to get yeast unless she takes
acidophilus. Lots of time men will get it too in their gut, all
through their body. Like you said earlier, Shelley Winters'
daughter graduated from Harvard, she had 7 years there, she
only got 2 weeks nutrition. That is impossible. That doesn't
make any sense today. How can that make sense when the Surgeon
General says you need a proper diet? We must have nutritional
training for our doctors. This must be demanded from the
universities. We must protect the old and the young.
In answer to your question, I have seen with my own eyes
miracles. I have seen women come into the wellness clinic there
in Florida. I have seen them have breasts cutoff from cancer,
and there is cancer in their body and I have seen the
application of mental, physical and spiritual practices that
then you couldn't find cancer in the body. This is without
chemotherapy. I just lost another friend from chemotherapy. Two
or three of my friends had cancer and it returned years later
and took their lives.
My witness to these miracles of cancer tells me that we
don't have to be so arrogant to think that we know what we
don't know. Yes, I bless the people who have drugs that will
cure my body, I also want to know if it can hurt my body. You
had better warn me and tell me what else I do to get those
toxics it is creating out of my body.
One of my experiences, and I am so sorry, Congressman, that
you just lost your wife. Grief is an emotion that one cannot
pretend does not exist. On May 23, I lost my beautiful 89 year
old mother. She had a stroke 6 weeks earlier and I was in the
hospital with her day and night. I know that I am still full of
grief. I wake up and think, oh, I will make lamb tonight, it
will be good for mother. Mother is not here, she won't eat the
lamb, she is on the other side.
I know that in those 6 weeks, the little hospital I was at
the nurses cried and said, you and your daughter have helped
someone leave in death in a manner we have never seen before.
We wish that every human being could have this kind of
treatment and this kind of love as they were leaving. I know
the doctor said, my God, your mother is a strong woman. My
mother was a strong woman because of the vitamin/mineral regime
I gave her.
My mother fell and broke her pelvis. She got up and healed.
My mother fell and broke her arm. She got up and healed. My
mother fell and cracked her hip but she got up and healed and
she was looking forward to her 90th birthday, a beautiful party
which she didn't get, but I know how vitamins and minerals
helped her. I know many times the medicines they were giving
her were the wrong medicines and they caused great side
effects. We had to go back and talk to them and remove some of
these medicines.
I talked to my own Motion Picture Academy and they have
really been having a terrible time with some of the side
effects from some of our drugs. Again, I repeat, we bless the
people who got us the drugs but we really need to use all of
the knowledge and wisdom of the medical doctors who care about
their patients and believe in medicine alternative modalities.
Let us not throw out the baby with the bath water. Let us
embrace their wisdom and their experience, people like Berkley
Bodell who went fishing 1 day, a tick bit him and he got lyme
disease. He has set up this whole organization, NFAM.
My daughter did a picture one time where she played a blind
girl. I remember Barbara Streisand saying to Peter Bogdanovich,
where did you find a blind girl who could act? He said, that
isn't a blind girl, that is Diane Ladd and Bruce Dern's
daughter, she is an actress. She was 14 years old. Laura went
to the Blind Institute to study, to find out. She was a method
actress without even knowing it, to find out what do you need
to know, what are the experiences she doesn't know because none
of us knows what it is like when you are sick, none of us know
what it is like when that person loses somebody they love. We
forget what it is like to wear each other's shoes.
When my daughter went to the ball of the blind people, it
was her graduation from high school year. She went to the party
where the blind kids were having their party. She went into the
bathroom and there was a little girl who could see but she
couldn't hear and could hardly talk. It was just a little dark
room with a little ball up there with lights and when Laura
went back to dance, the child looked over her shoulder and
looked at Laura, isn't it good? She experienced the greatest
job whereas my daughter, who was at a private school, had a big
shindig for graduation, Laura said, mother, none of those kids
had as much joy as that child with the joy in her heart. Why is
that? I said, Laura, it is a sad thing that man has to go
through hell to get to heaven, that only when his body is
starving or dying does he realize his soul can starve too.
Like I said the arts have times when we are in great
depression. Then we had men like FDR. Let us not do that with
medicine, we will all be dead.
Mr. Burton. Thank you, Ms. Ladd. Mr. Kucinich.
Mr. Kucinich. I just wanted to say your story is quite
compelling. As someone who has a great deal of respect for
complementary and alternative medicine, I think it is important
that you have come before Congress to share your story and your
understanding because I think a lot of Americans can identify
with it.
Thank you for having the courage and the wisdom to pursue
the path you have. Thank you.
Ms. Ladd. You have just made my day. Thank you so much. It
is my privilege and pleasure to have been here.
Mr. Burton. Mr. Schrock.
Mr. Schrock. Thank you, Ms. Ladd. That was very
interesting.
This really is all about prevention. If we did more
prevention, then we wouldn't have to worry about the after
effects of not taking care of yourself. I told you earlier
years and years ago I used to think chiropractory was hocus
pocus. Believe me it is not. It is absolutely right on. I work
out heavily and I got to a chiropractor at least once a week
and when I am home, twice a week. It has made all the
difference in the world. My wife started going 5 years ago and
she had a curvature of the spine and it is now ram-rod
straight. It is absolutely amazing. I am a big fan of that.
Proper diet is right. Before I got sick, I would eat
anything the traffic could bear and I realize now that is just
not right. Diet will certainly prevent a lot of these problems.
A lot of the diet problems occur right in the schools. My wife
is a kindergarten teacher and you would see some of the junk
these kids eat and that is provided by the school system, we
are creating a generation of kids that will have all these
problems. That has to stop. When they sell McDonald's in high
schools, we are a junk food society. I like McDonald's like
everybody else, but when I eat it I may as well get a can of
Crisco and eat it. We have to stop that and that is what we are
doing to our kids.
We are overmedicated. When I was going through my
chemotherapy, they had me on more stuff and I was a different
person when they did that. My wife's kids in kindergarten are
on Ritalin, she has eight or nine kids on Ritalin in
kindergarten and that is a terrible, terrible thing.
I think what you are doing is wonderful and everybody
else's testimony will attribute to that, will agree with that
and we just have to make sure we get this message out. It is
very, very important because when you don't have your health,
you don't have anything.
I appreciate what you do. Thank you.
Mr. Burton. Mr. Tierney.
Mr. Tierney. I have no questions. I want to thank the
witness for her testimony.
Ms. Ladd. My privilege.
Mr. Burton. Mrs. Maloney, any questions?
Mrs. Maloney. First of all, I want to welcome you and thank
you for your many contributions to New York culture, the
Copacabana, our theater and some of the movies that you starred
in were filmed in our great city, so I appreciate very much
your professional career and also speaking out on what is a
very, very important subject and one that does not get enough
attention.
You mentioned three miracles in your own life and I often
hear miracles from others diagnosed with cancer, they are going
to die, they go on a special diet, they cure themselves, they
are fine now.
I would like to ask do you agree complementary and
alternative treatment need to be proven safe and effective
before patients decide not to take say traditional treatment
but to follow a holistic item? I agree with my friend,
Congressman Schrock, that we don't focus enough on prevention
in our medicine. We don't focus on any treatment except coming
up with a pill or a manufactured way to treat something. The
whole focus from the NIH is not a holistic one; even
environmental medicine or how the environment impacts us
ignores it. I just don't think there is that much focus on it.
What do you think we should be doing in government to advance
this?
Second, expand on the idea of where do you recommend
holistic or the traditional method?
Ms. Ladd. I recommend both. I recommend respect for the
medical profession so that the people get their sugar, their
TLC which we all need today, that it is worthwhile for their
lives. I see you Congresspeople getting up and running to that
bell, I pray for your adrenalin. It is hard to be a
Congressperson, it is hard to be a doctor, it is hard to be a
human being and in today's society, we are all in a mechanized
world. You would think the faster paced society and the
mechanized world would pull us closer together. Unfortunately,
it is not doing it. It is alienating us one from the other.
The high cost of living is accelerating greed in many areas
in medicine and in culture and we are not always getting the
quality of food, the quality of medicine, the quality of
culture that we need. I think we need to look at all these
issues. These issues have one goal, to make the world a more
balanced, humane and harmonious place to live, especially our
own country and for our kids.
I said quite often, and I mean this, if I win all the
Oscars in the world and leave the planet as a sewer for my
grandkids to roll around in, I haven't done a damned thing.
When it comes to medicine, there is a threefold healing
process. Many diseases are caused by free radicals and free
radicals are anger. I think we have to help each other not to
judge too harshly. We are all in a state of shock over being
judged. At the same time, we have to apply wisdom. That means
we have to have mental healing for people, physical healing for
people and spiritual. Spiritual means a lack of judgment.
Mental is culture.
I think many of the movies today are making people angrier.
I think people are alienated and that is why they are looking
at all these realism type TV shows to watch somebody eat bugs
on TV. I don't want my kid watching this. I don't think this is
a healthy thing. Where are the good shows where you could laugh
and cry and respect human beings and get angry? I am not
against even violence if violence teaches me something in a
film or a story, the same way a medical doctor examines the
waste from your body to try to heal your body but he doesn't
recommend that you go out in the middle of the street to get
rid of the waste.
I think we have already found safety methods. I think our
alternative modalities today have as many safety methods as
traditional medicine. I think traditional medicine in many
instances is a lot more detrimental and harmful than our
holistic methods. People are going after them. People are
getting smart in some areas.
Ms. Maloney. What can we do as a government to really
educate people about the importance of a healthy lifestyle,
good nutrition and alternative medicine?
Ms. Ladd. I think as a government you need to give some
support and grants to those qualified great physicians that
have proven themselves in an organization so powerful like the
AMA. This is not chopped liver. These are doctors who have
spent their whole lifetime. I am not saying there might not be
one bad apple in the barrel, but that is life, that is karma,
wherever you go, whatever you are dealing with.
By and large we need to promote the best. Promoting the
best gives a higher rate of involvement of understanding of
wisdom. It is like that at the Library of Congress. That is the
best. Just stand there and you will understand exactly what I
mean. If you can see the best, if you hear a great singer hit a
high note, if you hear that high note, something happens
literally in your body. When you read a great book, how many
are reading the great books today? When our children get the
best, if we can help our children have the understanding and
wisdom to select the best, they will have the brains to go
after the best in medicine, after the best in culture.
Anytime through our history and any civilization that
culture and medicine has been shot down because of greed and
selfishness, the civilization has gone to decay. This has been
proven. Right now, we have a tax in many areas on good medical
modalities that could help our human beings. I think the
government has to make sure that helpful aids to humanity,
healthful aids, is not stopped. If you go to a restaurant, you
get food. If you find out that somebody is selling you rotten
meat, they get closed down. If there is a complaint about
manufacturing vitamins, fine, if it is bad or rotten, close
them down but I don't think ever in a billion years should this
ever be put under pharmaceutical companies or prescriptions.
That would be tantamount to greed on the highest level and that
would be horrendous to those old people or poor people who can
afford a vitamin, they wouldn't be able to afford it. It would
be such a sin, nothing more than a mistake, to take something
and miss the mark.
Help people not miss the mark. Help them fight for the
best. You are all such intelligent people. My heart goes out to
you as much as it does to my actors to try to do culture in a
commercialized world, it is not easy to fight for truth and
fair play. May God help you fight for proper, medical and
proper alternative modalities. Insurance companies should cover
alternative modalities. Detoxification of a human being, you
get new cells every day. Everyday your body does 360 something
billion cells tomorrow morning. How is that possible that you
have that kind of machine?
If you are polluted in there when they do those billion
cells, they have to fight that pollution. Alternative medicine
isn't anything but good sense and detoxification and finding
food and massage and things that detoxify. That is all it is.
The poorest Indian of eons ago knew that in his heart and soul.
We know it in ours. We know it in our wisdom.
Health, wisdom. There is knowledge and there is wisdom.
Knowledge changes everyday. We find out tomorrow we should have
done this. Wisdom supersedes knowledge for all of us and there
are those people who would keep us from using our wisdom. Don't
ever let that happen to you. Please help me, don't ever let
that happen to me.
Go talk to the AMA people, get a Gladys McGary and a Bob
Anderson in here, get Christian Northrop who wrote those books,
get Cynthia Watson from Beverly Hills who is doing it all, get
Berkley Bedell in here. He has gone to 83 countries. You have
the best out there fighting. Encourage that kind of caring and
enthusiasm. If it is shot down, it may never come again in our
kids' lifetime. Don't let it die. Fight for the good. That is
all you can do is fight for the good and I beg of you to do
that.
Mr. Schrock [presiding]. Mrs. Morella.
Mrs. Morella. Thank you, Ms. Ladd. I am not going to ask
you any questions in the interest of time but we are very
honored that you are here and gave us such a moving
presentation of personal experiences.
I want to thank you for the nutrition that you provide
through your acting. I think the arts do provide a tremendous
amount of sustenance to life. I have a son who is an actor and
I would agree with what you said about an actor lives between
chance and oblivion, but it is so very necessary. I am pleased
this year that on the House side we have increased the amount
of money for the National Endowment for the Arts and
Humanities.
I also note in you a personality trait that I think is part
of what you exude in terms of health and that is you have a
determination and an attitude which probably, as you said in
your opening statement, is a kind of linchpin, a kind of
spirituality. I commend you for that and I thank you very much.
Ms. Ladd. Thank you. It has been my privilege and pleasure
to be here today.
Mr. Schrock. Ms. Ladd, thank you very much for being here.
I was privileged to be the Navy's liaison to the motion picture
and television industry for 4 years. I probably should not
admit that but I was, so I understand exactly where you are
coming from.
Really, health is the most important thing we can deal
with. When you say we are under pressures up here, you can't
imagine sometimes and our health is impacted by that. So what
you are doing is absolutely magnificent and I am really going
to try to do my part up here because I know what good health is
and I know what good health is not. There is no comparison.
Ms. Ladd. I would like to respond to your comment about
health through the arts, helping people. It is true, it is a
proven fact that when you are watching actors, especially in a
theater or a great show on television, which is very rare, when
you cry it releases toxins and pains from your body and those
who make you laugh actually release gas from your body and it
is very good for your heart. Laughter is the most important
commodity to have.
As I said, science and art was once one and you can look up
my website, www.dianeladd.com and go to the bottom of the left
side where there is a group called ACT. It is an art and
cultural task force of 160 professional actors who are fighting
to try to create Stay Here Productions to help culture in our
country. Congressman McCarthy of Missouri, who got that motto
from Truman, ``The Buck Stops Here,'' has taken over my ball
and is going to run with it on behalf of art and culture to try
to do something. I hope you will all give her your support
while I am supporting medicine.
Mr. Schrock. Great. I think they say when you smile, you
burn so many calories. Smile all the time and you can be slim
and trim the rest of your life.
I thank you and Mr. Hunter for coming here today. We hope
you will come back again soon.
Ms. Ladd. Thank you.
Mr. Schrock. We are now ready for our second panel. Please
rise and we will swear you in.
[Witnesses sworn.]
Mr. Schrock. Before we hear our speakers, let me yield to
the ranking member, Mr. Kucinich.
Mr. Kucinich. I want to thank the gentleman and welcome the
witnesses. In particular, I want to welcome David Seckman.
Thank you and I appreciate the opportunity to work with you in
so many areas. And also, Dr. Larry Kushi. Dr. Kushi and I have
known each other, our families have known each other a long
time. His father and mother are the individuals most
responsible in the world for promoting macrobiotics. I have
learned much from both of them in following their writings and
I have to say Larry Kushi has continued on the brilliant path
of his parents in his own writings and his work. I just wanted
to be here for a moment particularly to welcome you and to
thank you and your family for your lifetime commitment to
macrobiotics and to alternative health, and to peace.
Thank you.
Mr. Schrock. Mr. Seckman is the executive director and CEO,
National Nutritional Foods Association of Newport Beach, CA. We
are happy to have you here today. You are recognized to give
your opening statement.
STATEMENTS OF DAVID SECKMAN, EXECUTIVE DIRECTOR AND CEO,
NATIONAL NUTRITIONAL FOODS ASSOCIATION; GEORGE BRAY, M.D., BOYD
PROFESSOR, PENNINGTON BIOMEDICAL RESEARCH CENTER, LOUISIANA
STATE UNIVERSITY; LARRY KUSHI, ASSOCIATE DIRECTOR FOR ETIOLOGY
AND PREVENTION RESEARCH, DIVISION OF RESEARCH, KAISER
PERMANENTE; PAMELA PEEKE, M.D., ASSISTANT CLINICAL PROFESSOR OF
MEDICINE, UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, ADJUNCT
SENIOR SCIENTIST, NATIONAL INSTITUTES OF HEALTH; TIMOTHY S.
CHURCH, M.D., SENIOR ASSOCIATE DIRECTOR, MEDICAL AND LABORATORY
DIRECTOR, DIVISION OF EPIDEMIOLOGY AND CLINICAL APPLICATIONS,
THE COOPER INSTITUTE; AND DAVID HEBER, M.D., DIRECTOR, DIVISION
OF CLINICAL NUTRITION, UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Mr. Seckman. Thank you for the opportunity to address the
committee with respect to the dietary supplement industry.
I am David Seckman, executive director and CEO of the
National Nutritional Foods Association. NFA was founded in 1936
and is the oldest and largest trade association in the natural
products industry. We represent the interests of more than
3,000 health food stores, thousands of manufacturer-suppliers
and distributors of health foods, dietary supplements and
related items.
The committee has asked that I address the economic
opportunity for improving health through diet, physical
activity and the use of dietary supplements. In addition, I
will also address the importance of natural foods and diet as a
tool for disease prevention and health maintenance.
First, let me say that I believe this hearing is occurring
at a very fitting time, both in terms of some of the critical
health issues we are facing today and emerging recent
scientific research. There are probably few Americans who have
not heard about our Nation's newest epidemic, obesity. Even our
President has carved time from his own pressing schedule to
personally address and champion physical activity and a healthy
diet in combating this problem. Hopefully President Bush's
involvement in this issue has served as a wake up call to all
Americans. That call can't come soon enough.
This year, the Centers for Disease Control estimated that
approximately 47 million Americans will suffer increased risk
of a whole host of serious illnesses, including heart disease
and cancer due to poor nutrition and physical inactivity. As if
this news weren't bad enough, the CDC also estimates that the
problem increases exponentially with age.
Having worked for many years in the long term care
industry, I have witnessed firsthand how declining health in
older Americans negatively impacts not only the patient but
family members and society as well. One of the most devastating
effects of a poor diet and inactivity is experienced by older
Americans. This group is by no means the only population
affected. The percentage of children and adolescents who are
overweight has more than doubled since the 1970's. Today over
13 percent of our children and 14 percent of our teenagers are
considered obese. These figures continue to rise each year,
paving the way for increased health problems in adulthood.
Between the ages of 40 and 60, 1 in 3 will feel the effects
of a lifestyle that favors fast food and inactivity. These are
prime earning years for many adults whose professional and
economic contributions to society will be severely or
completely curtailed.
It is estimated that treating obesity related health
problems in the United States exceeds $117 billion annually.
Diabetes alone, which has a direct connection to obesity,
accounts for more than $45 million each year.
The reason my organization was formed more than 65 years
ago was to support the growing number of consumers looking to
make healthier choices about the foods they eat. Much of what
the followers of this trend believed based on empirical
evidence and common sense has been borne out by science over
the years.
For instance, whole, unprocessed and fortified foods has
always been an important aspect of the natural or health food
industry. Processing can eliminate some or all of a product's
health qualities such as fiber and essential nutrients. Foods
such as these that have retained their health benefits can be
recognized by FDA authorized claims on the label such as fiber
from whole oats can reduce the risk of coronary heart disease.
It is important to keep in mind that whatever the health
claim, the FDA requires substantial scientific proof that it is
correct.
Since I am on the subject of vitamins and minerals, let me
make a transition into the more generic topic of dietary
supplements and their role in human health. The term dietary
supplement encompasses a wide range of products that include
essential nutrients, herbal remedies and what we call specialty
supplement products comprised of natural ingredients like
enzymes and amino acids.
When Congress unanimously passed the Dietary Self Help and
Education Act in 1994, it acknowledged there may be a conection
between dietary supplement use, reduced health care expenses,
and disease prevention. In fact, current research is bearing
out this very supposition.
For example, the American Medical Association recently
reversed its position on the value of taking a daily
multivitamin suggesting that every adult would benefit from a
daily multivitamin. This study is particularly important
because our research indicates that physicians often do not
discuss supplementation with their older patients.
Other landmark studies include two published relating to
the delay and lessening of symptoms of Alzheimer's disease by
patients who took the herb ginko, Vitamin C and E. Not only has
research demonstrated the health benefits of dietary
supplements in foods, it has also shown they can reduce health
care costs by billions of dollars.
For example, a major medical journal reported that
increased intakes of Vitamin E, folic acid and zinc could save
$20 billion annually in hospital costs by reducing heart
disease, birth defects and premature death. Alzheimer's disease
costs Americans $61 billion a year in lost productivity from
absenteeism of employees who care for family members and
businesses that share health and long term health care costs.
Even this modest reduction in symptoms and the delay of
onset of this disease can save billions of dollars. Clearly
dietary supplements as a whole, not just vitamins and minerals
are beginning to get the research they deserve.
Stimulating a good deal of this research is funding from
two groups under the National Institute of Health's umbrella,
the Office of Dietary Supplements and the National Center for
Complementary Alternative Medicine. Both play a vital role in
providing consumers with accurate and reliable information
about alternative treatments and therapies.
The recent questions raised about hormone replacement
therapy which could affect an estimated 42 million American
women underscores the need for more research and more
information about safe and effective alternatives. More
information about the qualities of dietary supplements is
critical and so is access to them. Bills like Chairman Burton's
Tax Fairness Act would allow taxpayers to deduct amounts paid
for foods for dietary supplement uses, dietary supplements or
medical foods as medical expenses.
We also agree with Chairman Burton that food stamp
recipients should be allowed to use their benefits to purchase
dietary supplements. Although this amendment which was added to
but ultimately removed from the most recent farm bill failed to
become law, we hope this issue will be pursued in future
legislation.
Without question, combining a nutritional diet and an
appropriate supplementation with physical activity not only
reduces the risk of contracting a host of ailments, it improves
quality of life for every age group. The body of research about
the health benefits of a nutrient rich diet is impressive but
needs to be expanded, particularly in the area of dietary
supplements.
While funding for research in this area has continued to
grow, further investigation of the role of dietary supplements
in maintaining optimum health is critical. Congressional
hearings such as this one make strong impressions on the minds
of Americans about the issues they cover. Often these issues
are negative and the focus is on what went wrong and how can it
be fixed.
I want to thank the chairman and members of the committee
for taking time today to examine what is right about
nutritional foods and dietary supplements.
[The prepared statement of Mr. Seckman follows:]
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Mr. Schrock. Thank you, Mr. Seckman.
As you can hear, we have a vote. It is one vote. I think we
will just recess for a few minutes. We will be back as quickly
as we can and will continue then.
[Recess.]
Mr. Schrock. I want to recognize Dr. George Bray, a Boyd
professor at the Pennington Biomedical Research Center at
Louisiana State University in Baton Rouge. We are delighted to
have you here and look forward to your opening statement.
Dr. Bray. Thank you for the opportunity to participate in
this hearing this morning. I won't read anything. I will make a
few comments about the relationship of obesity and its
treatment and the use of dietary supplements and over the
counter products in that regard.
My interest has been peaked in this area by a man named Mr.
Pennington who provided the money to LSU to build the
Pennington Biomedical Research Center which I directed for a
decade. Mr. Pennington was, he thinks, cured of his cancer very
much like your story for 25 years from taking a group of
vitamins. He believes it was B12, I am not sure which one it
was, but because of his belief in this area, when he was making
his donations, he provided $125 million to Louisiana State
University in 1980 to develop a nutrition research institute.
That is the basic work that our facility has been doing since
the completion of those buildings.
Obesity, my area of interest, is an epidemic and I wanted
to show you two figures. Dr. Dietz could do this but he said he
wasn't, so I will. This is the behavioral risk factor survey
data from 1989. I use it in color because it shows clearly the
prevalence of obesity, less than 10 percent in yellow, 10 to 15
in green and there are no red States on this map. Ten years
later, using the same survey techniques, you can see that only
a handful of States are not now in this high risk category. So
the epidemic as we all know, is a big and serious one.
It is also an expensive one with major risks. Data from a
paper in 1989 looking at attributable risk for physical
inactivity and obesity are causally related to diabetes, heart
disease, hypertension, gall bladder disease and osteoarthritis.
In those data, obesity can account for up to 70 percent of
diabetes, 40 to 50 percent of gall bladder disease,
hypertension and heart disease and 7 to 27 percent of cancers
and osteoarthritis. Physical inactivity on the other hand is of
the order of 5 to 20 percent. So obesity is a major epidemic
with major health risks and high cost associated with it.
I was pleased to have Ms. Ladd's testimony earlier. She
used at the end, the title of my testimony which is ``Don't
throw out the Baby with the Bathwater.'' Having a major
epidemic we need things to do to overcome it, to provide
American citizens with ways to deal with it when they are
afflicted with the problem. The broader those options, the more
likely we are to be effective.
When I was preparing for this testimony I went out to my
health food stores to see what sorts of over the counter
products there were and a number were available. I will have
some suggestions about ways that might improve the public's
ability to make decisions about using those supplements at the
end.
Two additional points. Small weight losses can be highly
beneficial in reducing the risk for the diseases I described
earlier. In a study of which we are a part that is funded by
the National Institutes of Health, called ``The Diabetes
Prevention Program,'' weight losses of 3 to 7 percent reduced
by 58 percent and 31 percent the risk of people who are at high
risk for diabetes from actually becoming diabetic.
If you translate that into a 3-year delay in the
complications of this disease, it saves billions of dollars by
reducing the risk for human dialysis, for renal failure, for
amputations, for blindness and other complications associated
with diabetes. So modest weight losses can be highly
beneficial.
The dietary supplements that are available, particularly
the ephedra-caffeine combinations have clear evidence from
clinical trials of up to 6 months suggesting that the weight
loss in the treating group is substantially larger than placebo
and in the range that would be associated with these reductions
in risk that were demonstrated in diabetes prevention programs.
If we could get small weight losses, we would have a major
improvement in the health of the American public and that would
be highly beneficial.
Let me read the three recommendations that came from my
survey and I will finish. I want to read these so they are
clear. First, provide clear and unambiguous labels on packages.
All packages should be labeled so that consumers can find out
what is in them. I found at least one that had no labeling
information on it at all. Labeling should be improved to help
consumers make choices. I found products with the same trade
name having very different labeling of internal ingredients
which can be confusing. It was confusing to me as a
professional and certainly could be to the public. Having
multiple packages with the same trade name but with different
combinations makes selection difficult.
Second, standard dosing and use good manufacturing
practices in preparing them, providing the public with
assurance that the amount of active ingredients in each package
is standardized by analytical testing and comparable from lot
to lot would provide them with assurance that they are getting
what they think they are purchasing.
Finally, encouraging research, providing financial
incentives for manufacturers that conduct research to establish
efficacy and safety of their products might be an important way
to get this research done. Premarketing research should be
particularly rewarded because knowing that the materials you
are taking are safe and effective before they are available has
real advantages to the public.
Thank you for the opportunity to testify and I would be
happy to answer questions.
[The prepared statement of Dr. Bray follows:]
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Mr. Schrock. Thank you very much.
We are happy today to have from California, Dr. Larry
Kushi, the associate director of etiology and prevention
research, division of research, Kaiser Permanente in Oakland,
CA. Thanks for coming all the way from the West Coast. We look
forward to your opening statement.
Dr. Kushi. Thank you for the opportunity to describe to you
some of the strong and consistent scientific evidence that
plant based eating patterns are perhaps the most helpful way of
eating.
I am honored to be invited and thank the committee for its
interest in how Americans can improve their health through diet
and lifestyle choices.
I have a degree in nutrition and training in epidemiology
from the Harvard School of Public Health. As mentioned, I now
work at Kaiser Permanente.
As Representative Kucinich mentioned, my parents are
credited with popularizing the macrobiotic way of life, the
macrobiotic diet which is a central part of macrobiotics, a
predominantly vegetarian diet emphasizing minimally processed
whole foods. Among other things, it may be the most popular
alternative comprehensive lifestyle approach to management of
cancer.
The central role that macrobiotics and my parents has
played as a catalyst for the natural foods industry and for
inspiring many people in the complementary and alternative
medicine field led the Smithsonian Institution to start a
collection of works related to their work. As you may recall,
my father actually testified before this committee in 1999.
Because of my personal and professional background, some
say I have a unique perspective on what I can say on this
topic. I am not sure how unique I am in that way but I will say
my comments today are uniquely my own and don't necessarily
reflect Kaiser Permanente's views or my parent's views.
As the committee members are aware, there is a tremendous
interest in diet and health in the United States. For example,
I will show you a couple of publications published 2 weeks ago,
one from the New York Times, ``What if fat doesn't make you
fat?'' and inside it says, ``What if it has all been a big fat
lie?'' The same week, Time Magazine published this cover story,
``Should you be a vegetarian?'' Clearly there seems to be a bit
of contradiction here. I am going to say the answer to both of
these questions is probably yes and there isn't really a
contradiction. There is a contradiction probably in the way
Gary Taubes talked about fat and the Atkins diet in the New
York Times article.
Let me make my views a little clearer. Basically, this
article ignored certain fundamental truths about diet and
health that can be gleaned from an epidemiologic perspective.
We know, for example, there are tremendous variations in cancer
and heart disease rates around the world. For example, with
breast cancer, in which I have done a fair amount of work,
there is a five to tenfold difference in breast cancer rates
comparing countries in Asia versus the United States.
We know despite NIH's emphasis on molecular biology and
genetics that most of these differences are not due to
fundamental differences in biology but rather to the lifestyle
choices we make, the foods we eat, the physical activity we
get, whether we smoke or not, the reproductive choices we make.
And we know this because people who come from low incidence
countries, such as Japan, and move to the United States, take
on the disease experience of people in the United States rather
than maintaining that in their home country.
Two areas of the world that attract considerable interest
regarding diet and disease relationships are the Mediterranean
area and East Asia because they have both good quality disease
registries as well as good documentation of eating habits.
There is tremendous variation in the amount of fat in these
diets. The traditional Japanese diet has about 10 percent of
calories from fat whereas the traditional Mediterranean diets
can range up to 40 percent of calories from fat. So the overall
question, does fat make you fat, or does fat intake make a
difference in overall health, perhaps is not the appropriate
focus of what public health policy should have been.
For comparison, in the United States our average fat intake
is about 34 percent of calories and many of our recommendations
have said we should be consuming 30 percent of calories from
fat. This focus on fat may have been misguided public health
policy.
Despite fat intake differences there are tremendous
commonalities between the Mediterranean and East Asian dietary
patterns. There is an emphasis on plant foods in terms of what
people have eaten traditionally, and there is minimal use of
animal food. There is a substantial literature on this topic. I
have provided some copies of a few articles that I wrote on
this topic to the committee.
I served as a member of the American Cancer Society's
committees to develop dietary guidelines for the prevention of
cancer in 1996 and again in 2001. In both cases, the committee,
not just my view, but all committee members, agreed there was
substantial evidence that the prevention of cancer can be
helped through the adoption of plant based diets, deemphasizing
meat and emphasizing whole grains, fruits and vegetables.
There have been a couple of good, randomized trials of
plant based diets demonstrating they really are effective in
promoting health and preventing cardiovascular disease. The
Ornish trial mentioned by Congressman Burton in his
introduction is one example, using a very low fat diet. The
Lyon Diet Heart Study is another example, using a Mediterranean
type diet with about 30 percent of calories. So you have two
different studies, using different dietary patterns with
emphasis on plant foods but differing in fat intake, that
demonstrates that these types of dietary patterns can really
help in promoting health.
As I mentioned, my parents have been leaders in
macrobiotics. The macrobiotic diet is also characterized by an
emphasis on whole, minimally processed foods. I also provided a
copy of a paper to the committee we recently published last
year about macrobiotics and cancer. Among the things in that
paper was a picture of a pyramid which is sort of a takeoff of
the USDA food guide pyramid. Unlike the USDA food guide
pyramid, the macrobiotic pyramid my father drafted and promoted
emphasizes plant foods and doesn't suggest that eating red meat
on a regular basis is compatible with good health.
We also received funding from the NIH Office of Alternative
Medicine to compile and document a series of cases of
individuals who had used macrobiotics for cancer and appeared
to benefit from this use. While the amount of funding was
extremely small, we are still in the process of completing the
best case series. I should mention some of my colleagues at the
University of South Carolina are helping with that as well as
the Kushi Institute, an organization my parents founded.
In that context, this past February 25, we presented six of
these cases to the NIH Cancer Advisory Panel on Complementary
and Alternative Medicine. While we are still waiting for the
final report from the meeting, it did conclude that the cases
we presented provided compelling rationale for further funding
and research into macrobiotics and cancer care. I believe these
cases we presented were quite remarkable, including a case of
lung cancer which I detail in my written testimony, as well as
several other cases of cancer.
In the meantime, the NIH has funded a couple of randomized
trials of plant based diets on the recurrence of breast cancer.
There is substantial literature growing related to diet and
cancer treatment and breast cancer which I reviewed in this
book, ``Breast Cancer: Beyond Convention.'' I wrote one of the
chapters, and it is edited by others.
Basically, I would like to emphasize that current
scientific evidence really does point toward plant based whole
food diets for the prevention and treatment of major chronic
diseases, including heart disease and cancer. The macrobiotic
diet that I am familiar with for personal reasons is one
example of such a diet.
I thank the committee members for this opportunity.
[The prepared statement of Dr. Kushi follows:]
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Mr. Schrock. We are glad to welcome Dr. Peeke here today.
You have heard her mentioned a few times. Dr. Peeke is the
assistant clinical professor of medicine, University of
Maryland School of Medicine, and also an adjunct senior
scientist, National Institutes of Health. We are delighted to
have you here and look forward to your testimony.
Dr. Peeke. It is an absolute delight to be here. I also
wish to acknowledge my distinguished guest, Irene Pollin, who
is the founder and executive director of a new national program
called Sister to Sister which will acknowledge heart disease in
women for education screening purposes.
You read an advertisement about nutrition or dietary
supplements and what does it always end with? Before doing any
of this, please consult your physician, the one person who
knows less than you do. The ultimate nightmare for any
physician in America today is during the 8 minutes allocated
for a patient visit, a patient comes in with what we now refer
to as the Internet printout under the armpit sign which means
they have scanned the Internet, they have many questions, most
of which we can't answer because they have to do with a topic,
nutrition, that is now not taught actively or a required topic
in the majority of medical schools in this country.
I am a bit of a mutation because after 11 years of critical
care and trauma as an intensivist, I went back into academia as
a Pugh scholar at the University of California at Davis where I
had to, with a couple of colleagues, spend a couple of years
learning nutrition and metabolism which is tough stuff, it is
biochemistry. Then I came to the National Institutes of Health
after that. What I found was that across America as I began to
look at the medical curriculum in nutrition, there was none. As
I teach at the University of Maryland, what I find is that the
classes are standing room only, they are still voluntary not
required and that interestingly who attends these classes are
also the attendings, residents, interns and not just the
medical students. There is an avid interest in this, if not
just for our survival sake when our patients come in and ask
these questions and we have so little information.
So I speak first to the salient point of a gap and the gap
in the knowledge on the part of the medical professionals
nationally, clearly anything that you can do to be able to help
us with that would help all of us and the consumer in the end.
I will now speak to another gap, a gap that I had addressed
in my testimony. What I was really trying to drive home was the
issue of a brand new way of looking at this issue of obesity,
nutritional deficiency, and that is looking at a new field of
intellectual as well as academic concern. We now call it gender
specific medicine after the work done by my colleague, Marianne
Magado at Columbia University and others and clearly being put
forth by the National Institutes of Health and the Office of
Women's Research and Dr. Vivian Penn's excellent work as well
as that of the HHS Division.
Here we are looking at a very interesting question. When
you look at obesity, look at the unfitness of Americans, is
there something that is gender specific about that per se? We
have never really looked at that in a significant way until in
2001 we published the findings of a milestone report by the
Institute of Medicine, a Committee on Understanding the Biology
of Sex and Gender Differences. It asked a provocative question,
does sex matter? The answer? Yes.
We found that scientists were able to turn their attention
to issues of everything from behavior and perception to
lifestyle, the metabolism of drugs, to physical activity. Women
and men do things differently, both of which need to be
honored. It is no longer just about women's health and men's
health. It is about gender specific medicine, one learning from
the other's strengths and vulnerabilities.
What have we learned? During the endocrinological
milestones of a woman's life which involve the onset of
menstruation, pregnancy and her periomenopause, interesting
things take place. What we have found in recent monographs is
that during that time everything from depression to diabetes to
asthma, epilepsy, migraine, are all worsened especially when a
woman is unfit. We have been looking at this closer in the pre-
menstrual period and now we are looking in the periomenstrual.
What does this mean? This means that during this period of
time when a woman is trying desperately to maintain a healthy
lifestyle, it is rather difficult. These are physiologic and
biologic interferences that need to be honored. Interestingly,
the herbal industry has been looking at this very closely,
certainly with the current evidence-based medicine that has
been generated, looking at black cohosh, for instance, but
there is a paucity of data in this certainly with the new
evidence that has emerged over the last couple of weeks with
regard to hormonal replacement therapy and there issues
thereof, we now turn our attention to again a woman's fitness,
mind and body, during these endocrinological milestones and
during the menopause.
We look at specific foods, for instance, phytoestrogens
which were just mentioned. These are plant estrogens. Are they
better for a woman, are they helpful? Absolutely. There is no
question about that. We look at all kinds of new products like
energy bars, this one in particular. What does it say? Soy,
heart healthy. We never really looked at this before. Is this
something that might be able to augment a woman's wellness
during this time? Absolutely. No question.
We look at issues of obesity and fitness. One of the things
we have never really looked at in a significant way before was
the whole issue of diversity, ethnic diversity. Thirty-four
percent of women, as Congresswoman Morella noted, are obese 31
percent of men. Among women there are important racial
differences. Blacks, 48.6 percent, Mexican-American, 47.2
percent and these women are much heavier than the Caucasian
women, 33 percent, there are real differences among these
ethnic groups with regard to the kind of incidence of disease,
for instance, diabetes.
For men, interestingly, White and Black men have almost
identical numbers of incidence of obesity, 31.6 percent and
31.2 percent and yet 39.2 percent of Mexican-American men are
overweight.
Have we spent enough time looking at this, not just in
terms of gender differences but also in terms of ethnic
diversity, absolutely not. We need much more information with
regard to this.
Let us look at the psychological issues. You tell a man or
you tell a woman, go ahead and get fit. Here is the template
and you are going to hear excellent templates, everything from
vegetarianism to physical fitness. What happens when a man and
woman pursue this? What are the differences, the obstacles?
Interestingly, it is the mind in a lot of this. For
instance, in a man's mind, he could be 105 percent of ideal
body weight and still look in the mirror and see himself as
thin and fit. Over 43 percent of women who are absolutely of
normal weight and quite fit see themselves as overweight and go
out of their way to torment themselves with more what I refer
to as science fair projects or every diet fad that comes down
the block, interfering with one of the most important things we
need to look at, new avenues of science, not just weight, not
about weight, it is about fitness, about body composition,
about body fat.
If you look at a woman's body as she begins to evolve
through her periomenopausal years after the age of 40, you will
find there is a transformation. One of my female patients once
told me, I am 45 years old, all of my life I have looked like
an hour glass and I have looked at my body today and suddenly
it is changed, I am not an hour glass anymore, I look more like
a shot glass. In saying so, she noticed she was filling in. Was
this more than just an aesthetic eyesore? Absolutely more. Why?
Because she was adding weight to one of the most pieces of her
body and that was the intra-abdominal area. We never knew this
before.
By placing too much weight there, depositing there through
a lack of physical activity in addition to abnormal eating
patterns, clearly she is increasing her morbidity and mortality
risk for everything from heart disease to diabetes to cancer.
You do not have to be overweight significantly or even obese
for this to happen. It is no longer just what you weigh, it is
where you weigh it.
If you look at the current guidelines of the American Heart
Association from this week, they are now asking that waist size
now be looked at very closely as one of the greatest predictors
and criterion for looking at disease morbidity and mortality,
certainly for heart disease than just standing on a scale and
looking at that specific number. Women are greatly affected by
this. Women are more greatly affected by diabetes.
Going back to the mind for another moment, if you look at
the mind, you look at the mind of a woman who needs to go out
and take care of herself, what do you see? The No. 1 stressor
of a woman, globally, is caregiving. Frankly, women will
caregive anything that comes within 20 feet of them and usually
defer anything in their own self-care to be able to accomplish
this goal which is usually lethal for them because they never
get to their self care.
Men are much smarter. They compartmentalize, they are
highly focused, they are able to achieve that goal. Women's
caregiving gets in the way. Clearly as they go through each
decade of life, we just caregive different groups of people. So
this must be understood.
Where are the easy to access parks for women to be able to
walk with their strollers? How can we make it easier for women
who have to caregive sick ones to be able to get that physical
activity, to be able to access that healthy food vegetarian or
otherwise? Are we making that possible?
Finally, in science itself, if you look at everything from
a hormone called leptin and its concentrations in women, women
have higher concentrations as they get more obese. Leptin is
supposed to be able to regulate their appetite and ability to
maintain more healthy body fat. What happens here? There is a
difference.
Look at some of the findings of the Institute of Medicine's
report which are really quite astounding. Cigarette for
cigarette, if a woman smokes exactly the same number of
cigarettes as a man, she has 50 to 72 percent greater risk of
lung cancer. We metabolize things like nicotine very
differently. We do not do heart attacks the same as men do. We
don't clutch the chest and drop to the floor. We have
epigastric distress, perhaps a little stomach aid as mentioned
before might be able to help. It doesn't. Usually these women
will come in now sicker because they didn't know they had heart
disease all along.
What are we doing to be able to educate women nationally
about this phenomenon? Most women don't know that. They are
more terrified of breast cancer than heart disease, yet the No.
1 killer of women is heart disease.
In putting together programs and services nationally, I
think now we are going to have to look at the issue of gender
and also racial diversity as we have never done before to be
effective and to be meaningful.
Thank you.
[The prepared statement of Dr. Peeke follows:]
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Mr. Schrock. Dr. Church, welcome. Dr. Church is a senior
associate director, medical and laboratory director, division
of epidemiology and clinical applications, the Cooper Institute
in Dallas. We are glad you are here today and look forward to
your testimony.
Dr. Church. I have some slides.
First, it is an honor and privilege to be here and be a
part of such an esteemed panel.
The Cooper Institute was founded in 1970 by Dr. Cooper, as
a non-profit research institution. Its original mission was to
examine the role of exercise in the maintenance of health and
function. Since that time, our mission has broadened
considerably. To date there has been over 650 published works
to come out of the Cooper Institute and the works have
influenced major national policy initiatives from NIH, the
American Heart Association, and the Centers for Disease Control
and Prevention.
We are probably most famous for the Aerobics Center
Longitudinal Data base, a data base consisting of over 70,000
Cooper Clinic patients, some of whom have been followed up to
30 years. This data base is so unique because of the fact that
nearly every one of these individuals had a fitness test. They
got on a treadmill and went to exhaustion. That is the max
treadmill fitness test. No other data base in the world is
greater than 10,000 which has max treadmill fitness test.
This is representative of some of the work that has come
out of our group over the year. This slide shows CVD death
rates across levels of fitness. On the left we have women and
on the right we have men. You can see with increasing levels of
fitness, you have dramatic dropoffs in CVD death rates. Often
this is attributed to obesity. Individuals who are higher fit
have lower rates of obesity.
We can see in this the left set of bars is lean, the middle
set of bars is normal weight and the right set of bars is
overweight. The pink bars are unfit, the yellow bars are fit
and you can see at every single weight, there is a great
benefit to being fit as compared to unfit. Even in obese
individuals there is a tremendous advantage for risk of
mortality for being fit compared to unfit.
We have a number of ongoing studies. We have an outstanding
study going on now examining the role of exercise in the
treatment of depression. We have an army looking at the role of
exercise in weight loss and long term weight maintenance. We
have a very exciting NIH funded study going now looking at
different doses of exercise and risk factor reduction of post
menopausal women.
I was specifically asked to spend some time commenting on
the Cooper clinical trial which has just completed, so a lot of
this data is literally right out of the computer. The trial
ended last week. This was a placebo controlled, double blinded
study consisting of over 200 participants with a 6-month trial
period. Placebo controlled means that half of the study
participants received a placebo and they didn't know they were.
The other half received a vitamin and they didn't know they
were receiving the vitamin. They don't know what they are
getting, we don't know what they are getting. It is not until
the end of the study when we break the code that we find out
who got what. It is very important. This was a privately funded
study and it cost approximately $300,000.
The primary outcomes of the study were homocystine, an
amino acid found in the blood and a known risk factor for
Alzheimer's disease and cardiovascular disease. Another primary
outcome was oxidized LDL, a particularly bad type of
cholesterol. The last primary outcome which was added during
the course of the study was C reactive protein. C reactive
protein is an inflammatory marker found in the blood. It has a
risk factor for diabetes and cardiovascular disease.
I want you to look at the highlighted number at the top and
the bottom of the screen. This shows how difficult it is to run
these studies. We phone screened nearly 1,300 people at this
time to complete 176. It takes quite a bit of work to run one
of these studies.
These are the characteristics. You can see we have an even
distribution of men and women, average age is 50 years, and BMI
was 26.
You are always going to be looking at the vitamin group on
the left two bars and on the right two bars, it is always going
to be the control group. In this instance, we are looking at
change in Vitamin C and change in betacarotene. This is change
in the blood. As you can see there was a 60 percent increase in
Vitamin C and a 60 percent increase in the betacarotene in the
group that received the vitamin with no changes in the control
group.
Same type of slide. There was a 100 percent increase in
Vitamin E and a 50 percent increase in folic acid in the blood
of the individuals who received the vitamins compared to the
controls.
There was a 273 percent increase in Vitamin B6 and a 55
percent increase in Vitamin B12. Why is this important? This
shows if you take a multivitamin, it gets into our blood, not
just simply going out the way it came in.
Looking at our outcomes, there was a substantial decrease
in homocystine in the vitamin group, nearly a 17 percent
decrease. This is particularly interesting when you realize
that folic acid is currently being supplemented in many of the
grains we eat today.
Both these slides show the same thing, just measured
differently. The individuals taking the multivitamin, there was
a significant decrease in LDL oxidation meaning there was less
of this bad cholesterol.
This is particularly provocative showing that a
multivitamin lowers C reactive protein. This has never been
examined before. We hope to submit this next week. C reactive
protein is receiving a lot of attention because of its strong
associated risk with diabetes and cardiovascular disease.
This is an important point. We saw no change in plasma
glucose and it is important because in our pilot data, we saw a
very large drop in plasma glucose in individuals who took a
multivitamin but that was simply pilot data. These things need
to be tested. When we rigorously tested it we saw no change in
plasma glucose. It is important that these things be tested at
the right study protocols.
In our findings we found that serum vitamin levels
increased greatly with a multivitamin use. Individuals who took
multivitamins had a decrease in homocystine, LDL oxidation and
C reactive protein.
Thank you for this opportunity.
[The prepared statement of Dr. Church follows:]
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Mr. Schrock. Thank you very much.
Dr. Heber, welcome. Dr. Heber is the director of the
division of clinical nutrition at the University of California
at Los Angeles. We are glad to have you and look forward to
your testimony.
Dr. Heber. Health has no party line identification. I want
to thank Congressman Burton for his leadership role and the
many conversations I have had with Beth Clay over the last few
months.
I want to confine my comments to a very few brief areas.
In the late 1970's, the State of California passed a law
providing funding for a professor of nutrition at each of the
University of California Medical School campuses. I was the
first appointee at UCLA in 1983. Since 1985, we have had one of
two National Cancer Institute funded Centers for Nutrition and
Cancer Prevention. There are only two in the country and the
other is Sloan Kettering and the American Health Foundation.
Those green boxes in the middle represent core laboratories
of that Clinical Nutrition Research Unit. When I go back to
California tomorrow, I will have my laboratory meeting with
four assistant professors, two associate professors and seven
research fellows, conducting research not only on nutrition and
cancer prevention but also the box below the pink box is one of
four nutrition obesity training programs in the United States
funded by the NIDDK. This money was made specifically available
in response to the earmarking by Congress of obesity as a
national issue.
The top box represents an additional three core
laboratories which we competed for in 1999 through the Office
of Dietary Supplement Research represented today by Dr. Paul
Coates whose testimony you will hear later. I wanted to
indicate that UCLA as far as I know is the only university that
has all three of these coordinated within a center for human
nutrition in a dedicated facility.
The U.S. Government passed a law in 1977 called the Farm
Bill, Public Law 95-113, which granted the USDA the
responsibility for dietary advice as opposed to what was at
that time called DHEW, now called DHHS. Many viewed this as a
conflict of interest since the USDA is also dedicated to
increasing food consumption, while it is clear that the over-
consumption of some foods may be contributing to the health
problems of obesity.
Many scientists in the community, including those who work
in the health nutrition information service, such as Dr. Marian
Nestle, have recently raised the issue of whether we ought to
revisit and remodel the USDA pyramid which developed in 1992.
This pyramid you see before you shows how Americans are eating.
They are eating refined carbohydrates off the bottom of the
pyramid and they are eating sweets, fats and oils at the top of
the pyramid which appears to be almost toppling off.
The issue here with pyramids is that we recommended in 1997
that fruits and vegetables be placed at the bottom of the
pyramid with whole grains above that. Dr. Alice Lichenstein at
Tufts University and others, Dr. Walter Willet and others have
asked that we revisit the pyramid. The USDA has held to the
view we should have dietary guidelines. The difference between
a dietary guideline and a pyramid is a pyramid creates a
hierarchy of foods according to their health value whereas a
dietary guideline allows you to talk in the abstract about fat,
carbohydrate or protein. We know when we had fat free foods in
the 1980's, there was a 30 percent increase in obesity as
sugars were put into foods.
We are having a lot of argument now which Dr. Kushi
indicated and I think the answer is to go to a plant based
diet. Man evolved on a plant based diet. If we look at this
apple that has a red skin, there are 25,000 phytochemicals in
that skin. If I take the Vitamin C from this apple and put it
in with colon cancer cells, it will not inhibit their growth as
well as if I take an extract of this whole apple. We have taken
extracts of whole fruits and vegetables in our research and
shown significant effects on cancer inhibition.
This is a simple picture of visualizing your plate. I think
we can get advice to the American people through pyramids and
also through looking at your dinner plate and making it
colorful, two-thirds full of fruits and vegetables, berries for
dessert and a nice dark green salad which is full of folic acid
as mentioned in the last talk, and Dr. Kushi also mentioned.
These are not impossible changes. I wanted to get that across
to the committee, very simple things we can educate the public
to do.
I wanted to indicate the botanical dietary supplements did
not come from another planet. They are actually from our fruit
and vegetable and traditional food sources. Chinese red yeast
rice was classified by the USDA in 1920 as a food product. It
was declassified as a dietary supplement in 2001 following the
FDA's pursuit of a Federal Appeals Court decision in April 2001
declaring it an unapproved drug. The reason for this was that
there is a part of the DSHEA legislation which says if a
botanical dietary supplement contains something previously
approved as a drug, it may not be classified as a dietary
supplement.
This shows you nine chemicals and they look like little
chicken wires up there. One of them is classified as a drug but
the other eight all have activities in lowering cholesterol.
This is one of the nine called monocolin K, made by the red
yeast when it sits on top of the rice and the rice stimulates
the yeast to make this family of nine compounds. One of these
was selected and classified as a drug because it was purified
and crystallized. The key difference between a dietary
supplement and a drug is dietary supplements are combinations
of multiple compounds whereas a drug is a single purified and
crystallized compound.
We did the first trial of Chinese red yeast rice and
published it in February 1999. In that trial, we showed that
approximately 6 mg of monacolin K or lovastatin, the drug, when
included in a matrix of an herb would actually lower
cholesterol as effectively as 20 mg of mevacor. The yeast
material cost $10 to $20 per month in your local drug store.
This represents a potential significant cost savings, not just
to the American public, but to the Federal Government through
the Medicare and Medicaid programs who have to pay for
expensive prescription drugs when these types of herbal
products would do a similar job.
Over 57 million Americans today have high cholesterol. Only
13 million take expensive prescription lowering drugs. The
affordability of botanical supplements could help save money as
well as improve the public health. Both drugs and botanical
supplements have a role to play in promoting health. It is not
one versus the other but the DSHEA law should be fully
implemented and not selectively implemented. As I will point
out in the next example, while FDA selectively implemented this
provision I spoke about, they have not implemented the one you
pointed out this morning, the issuance of good manufacturing
practices which is almost 10 years overdue.
PC-SPES is a mixture of eight Chinese herbs, has a 50
percent response rate in advanced prostate cancer. We have
recently done research to show this has a response in colon
cancer and leukemias and lymphomas as well. Some of that work
is going to be very shortly published. I have with me the July
15 issue of Cancer Research, one of our most prestigious
journals in the United States in cancer research. There is an
article in there by Dr. Peter Nelson at the University of
Washington funded through CAP Cure, the Association for the
Cure of Prostate Cancer where Mr. Michael Milken has raised
almost $200 million for prostate cancer research.
This slide is fairly scientific but if you look at the line
of identity in the upper two lines, that is comparing PC-SPES
to itself and you get a 45 degree angle. If you look at it for
a comparison for diethylstilbesterol which was said to be
contaminated, you see there is no specific response comparing
it. So it is totally different than diethylstilbestrol.
This slide shows a gene profile. The genes in red are the
ones that are up regulated and that is taken from this article.
The green genes are the ones that are down regulated. The PC-
SPES is a mixture of eight well known Chinese herbs and
specifically down regulates the androgen receptors,
specifically down regulates tubulin genes and other genes
involved in the carcinogenesis process.
Today using 21st century science, gene chips where we can
monitor 80,000 genes from the prostate cancer cell, we see that
the actions of PC-SPES which is prostate cancer has actions far
beyond what can be explained by any of the putative
contaminants which caused it to be removed from the market.
The California version of the FDA found warfarin
contamination in PC-SPES and it was voluntarily withdrawn from
the market so thousands of patients were deprived of this
treatment. This is something that could have been avoided with
good manufacturing practices. We are currently mobilizing
research at UCLA to reactivate the science foundation for PC-
SPES after it is appropriately manufactured with good
manufacturing practices.
One of the problems here is that the FDA has not issued
good manufacturing practices. The burden has been left to the
industry in hard fiscal times to have to pay for these quality
controls on their own rather than have this done as a
government function which is how it should be done.
I would urge you to have full implementation of the DSHEA
legislation by asking FDA not only to fully implement the good
manufacturing practices to help us with that aspect but I would
also ask you to increase support efforts to increase fruit and
vegetable intake in the American diet because 93 percent of
Americans say they want to change their diet, 78 percent want
to increase fruit and vegetable intake, only 4.5 percent of the
USDA budget is currently being spent on fruit and vegetable
intake promotion. Secretary Veneman is supportive of this, so
we have the public and USDA both supportive. I think you could
provide a very good catalytic action in moving this ahead.
We do have an IND pending before FDA to research the basic
metabolism of Chinese red yeast rice. I would say to bring this
public health benefit to the public, we do need to continue to
have pressure for full implementation of DSHEA so that when we
get nutrition breakthroughs as we have in the last 20 years,
they are fully benefiting the American public by coordinating
the activities of USDA, NIH, CDC, FDA and the Federal Trade
Commission which has a role in clearing up the labeling
problems that Professor Bray has noted.
Thank you for your time and your dedication. I look forward
to working with you in the future.
[The prepared statement of Dr. Heber follows:]
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Mr. Schrock. Thank you very much.
Your testimony has been fascinating and I appreciate
everything you have said.
Mr. Seckman, you are right, our President is kind of taking
a lead in this. His workout routine every morning is an
inspiration to a lot of people and hopefully will get people on
board. We do need to speak out up here and make sure that we
are taking a lead in that. Some of us will certainly do that.
You talk about obese kids who eat chips and cokes all day
long. It is no wonder we have that problem.
As a consumer decides what dietary supplements to use, not
just the brand but specific substances like Vitamin C, ginseng,
Vitamin E and others because you walk into these health food
stores and there is this sea of things there and you think,
what do I need and it is very, very difficult. The people
behind the counter certainly don't know how to respond to you.
Mr. Seckman. That is an excellent question.
The local retailer is probably one of the best experts to
direct you to certain areas. The NNFA has produced over the
years and puts on our Web sites information for consumers
written in language that consumers can understand about certain
types of ingredients and products. We encourage them to go
there. It is very difficult to go out to the mass market and
have discussions with people in such and such a store but go to
the local health food store where these people spend a vast
majority of their lives, this is what they believe in, what
they do. Talk to the retailers of those facilities about the
different products and they can help guide you. Also look on
the Internet at our Web site, www.nfa.org and get other
information that is directed to consumers.
Mr. Schrock. Dr. Bray, you were talking about some of the
health foods. In this magazine I held up earlier, there is one
product that I have thought about using. It is called
hydroxycut. I don't even know if you are familiar with that.
Dr. Bray. I am.
Mr. Schrock. I have been advised by some not to use it
because they say it makes you depressed and has other sorts of
side effects. How does one know because on many of these
bottles, you don't see that stuff and how much weight can one
expect to lose from using some of these products?
Dr. Bray. Let me take the second question first. Almost all
of the data we have people will lose no matter what they do,
sort of surgical approaches, less than 10 percent of where they
started. The message I also delivered was that 3 to 7 percent
is associated with reductions in risks for diabetes for people
at high risk. So even small weight losses of 5 percent or less
can be beneficial to people who are at risk for problems.
The issue of how you make selections is a very difficult
one. It is where the educational forces from consumers unions,
from Prevention Magazine, from the television, newspaper and
magazine issues really come into play. I think we have to do
the best we can to make sure the science writers are as well
educated as possible in the broad issues and that they write it
in a way in which it is informative.
The article that Dr. Kushi referred to a few moments ago in
the New York Times has probably generated more letters and e-
mails to them than any other thing they have had in a great
while suggesting people read it, but there is controversy in
this issue. This is a place where the press is particularly
important where groups like yours are important but where it is
difficult. Going in as I did on Saturday with my professional
background but with nothing more than that, I found it a real
challenge.
I think one area where improvement could be made would be
in the labeling strategy that we use. Putting large numbers of
things on a package can be more confusing than helpful. I think
that our regulatory agencies could work to improve the labeling
information that consumers have so that when they go in after
reading the New York Times or Prevention Magazine, they can
identify what they want in an easily readable and intelligent
fashion.
Mr. Schrock. It seems every publication you read that each
one tells you something different and that adds to the
confusion when you try to decide what to take.
Dr. Bray. The problem is some of the scientific articles
shift back and forth. Sometimes fiber is good, sometimes it is
not so good. That confuses even those of us who work in the
field.
Mr. Schrock. If you will excuse me, we do have a vote. I
assure you I will run over there, and run back here. We should
be back in just a few minutes.
[Recess.]
Mr. Schrock. Thank you for waiting.
Dr. Kushi, thank you and your parents for what you do. You
provide wonderful things for society and I really appreciate
that a lot.
Fat in the diet, boy is that a big issue. The males had a
screening in the Capitol not long ago and my communications
director had his done and I had mine done. He had 11 percent
body fat and mine was 15 and I was furious because he is
younger than I am but I just don't understand. My doctor says
for you, that is perfect, so I am trying to figure out what is
the right amount of fat, what is not and is it OK for the
average American to include plant products that contain fat
such as avocadoes, nuts and olives because sometimes you hear
there is too much in the nuts. From a personal standpoint, I
would like to get your spin on that.
Dr. Kushi. As far as fat in the diet, generally, one of the
points I tried to make is that it is really the type of fat not
the amount that is probably more important, although certainly
the amount also plays some role. Plant-based products that have
fat intake, for example, nuts, can be part of a healthful diet
and probably should be.
We actually published a study that demonstrated that people
who eat nuts on a regular basis have approximately 30 to 40
percent decreased risk of developing heart disease. So it is
consumption of that type of plant-based quality, relatively
high oleic acid, linoleic acid type fat.
Mr. Schrock. That is good because I thought if I liked it,
it was not good for me.
Dr. Kushi. I think the recommendations from the Heart
Association will be changing partly as a result of these types
of observations.
Mr. Schrock. Dr. Peeke, you made a lot of comments I want
to comment on. You said nobody is teaching health anymore. When
I was a kid, as I recall, we had a health class. It was Mr.
Ridenhauer who was my health teacher. I don't think they have
that sort of thing anymore but I remember it and I remember
some of the things he taught me. I think that has carried me
through to where I am right now. It seems like with budget
cutbacks in school and such, they have gotten rid of that and I
think that is a bad thing. I guess it is incumbent on us to try
to do something about that. I certainly agree that is a
problem.
You are the recognized expert in understanding the
relationship between stress and weight gain and those of us who
work here in Washington can certainly relate to that. How do
you explain that, stress and the weight gain? In my case, when
I am stressed, I don't eat but most people do and I wonder in
the environment we have here how that impacts us?
Dr. Peeke. We go back to the issue of men and women again.
As it turns out, a number of studies have now been done over
the last 2 years that have shown that it is women who are the
primary stress overeaters, that it is men who tend to lean to
alcohol in response to stress.
Your proclivity to undereating or overeating really depends
on one, your genetic base upon which you usually deal with
stress which is about 30 percent and also it depends on the
level of stress. If you have a true tragedy, if you have
something that is of monumental portions, it doesn't matter
what the event was in your mind, by definition stress
undereating tends to take place.
When we look at what happened with September 11th in town,
as a Washingtonian, we studied this rather closely and what we
found in both New York and Washington almost uniformly across
the board, people were stress undereating for that first week,
they were not stress overeating because of the incredible
tragedy and the level of pain that was ensuing.
What was fascinating was there a rebound eating phenomenon
that took place within the month. Once again, it was women who
were the stress overeaters primarily and the men who
interestingly coped with the stress much better. They tend to
compartmentalize as I mentioned before, stay focused and just
realize things would go on.
Women are womenators, women are ponderers and we have new
research that has just been published by the proceedings of the
National Academy of Sciences and others over the last 2 weeks
that has shown there are real changes in the brain that you can
actually follow using something called a MRI, a scan of your
head which has been noted in at least two different university
studies in the last month. Again, you see that gender
difference.
The stress issue, very straightforward. We all have stress
hormone and when stress hormone is utilized appropriately for
your typical fight and flight, if I was running up those stairs
and trying to not be late for the next meeting, that is normal.
I am going to have a bit more functional elevation of that
stress hormone, cortisol.
The problem ensues--something studied by my mentor, Dr.
George Krusos at the National Institutes of Health in our lab--
it was found when you have chronic levels of stress, and you
have chronic elevations of stress hormone for long periods of
time, this is abnormal and unhealthy and it leads to a number
of different ramifications, everything from depressed immune
function, retarded growth, dysfunctional reproduction, and
through the use of new technology in molecular biology and work
of others, we have found that you can actually stimulate
increased amounts of fat deposition in the worst place in the
human body which is deep under your abdominal muscle wall. So
if you get too much of that, that lovely little apple look or
in a guy it is that big waist look, that fat is basically toxic
to the human body. It is highly associated with what we now
call the metabolic syndrome associated with an increased risk
in incidence of heart disease, high blood pressure, blood
clotting problems, diabetes and cancer.
If you look specifically at waist to hip ratios, rather
than body mass index in women, the Iowa Women's Study, that is
a greater predictor for morbidity, mortality than just scale
weight alone. So you see we have come quite far.
Mr. Schrock. Obviously this guy has no stress is that what
you are saying?
Dr. Peeke. No, he has other things going on.
Mr. Schrock. Dr. Church, in some of the examples you gave,
you had the two test groups and you said there was no change in
the plasma glucose. My guess is that is what you were looking
for and you didn't find it in those two groups. Why would that
be because obviously one was better than the other?
Dr. Church. It wasn't something I was looking for, it was
something somebody told me to look for. I didn't believe the
pilot data to start with. I thought it was just a sample size
issue. Once again, that is why it is so important to always
have placebo control, appropriately powered, double blinded
studies to see if there really is an effect or not.
I think that glucose phenomenon we saw is an interesting
issue because that is often what you see in those magazines you
are holding. They will look at 10, 15 or 20 people and use a
study that is a horrible study design and meant to show the
results they are looking for. It is not a properly run study.
If we were not who we are and don't do things the way we do, we
could have made the claim that our research shows our vitamin
lowers glucose but in fact now that we have done the
appropriate research, it doesn't.
Mr. Schrock. We talk about obesity in kids and my wife
teaches kindergarten and you cannot believe how many are so
badly out of shape, you would think they were 30 year olds. How
do we turn that around? PE programs? They try to teach some of
that and feed the kids correctly in school but you have to be
able to turn that around or these kids are going to be health
nightmares all their lives.
Dr. Church. I think PE is a great place to start. Look at
Louisiana, a State that has gotten rid of PE and when I lived
there, they were starting to get rid of recess. The studies
show that kids who are not active in school will not be active
when they go home. PE and laws that mandate PE is a great place
to start.
Mr. Schrock. I agree.
Dr. Heber, your book is great. I am going to read this,
``What color is your diet?'' Explain why that is important.
Dr. Heber. Humans and a few primates are the only ones who
have red-green color discrimination. Dogs, cats and other
animals are red-green color blind. It is believed we evolved
that to be able to select our food supply. These colors are not
random. They represent specific families of chemicals that have
been implicated in disease prevention.
The red group would be tomato juice, tomatoes, tomato
sauce, tomato soup and pink watermelon and pink grapefruit all
have lycopene. The green-yellow group would be spinach, kale
and avocado which have lutein in them. We were the ones at UCLA
that showed that avocado is the richest source of lutein among
fruits. These are concentrated in the back of the retina where
they help prevent age related macular degeneration, the primary
preventable cause of blindness in people over 65.
The orange group is alpha and betacarotene, it is a cancer
preventive and also contributes to night vision. Around the
world most people get their Vitamin A from plant products. Here
in the United States, we get it from Vitamin A and D fortified
milk and from meat products. There may be biological
differences of getting it in that way versus getting it from
the fruits and vegetables.
Garlic, onion and chives have Allyl sulfides in them which
were used as antibiotics before World War II and these also
inhibit cancer growth.
The red-purple group are raspberries, blueberries and
strawberries. If you feed blueberries to mice as they age, they
don't go through a maze as quickly but if you put blueberries
in their feed and change it from that brown, beige color to a
purple color, they do better in performance tests.
There is the green group which is broccoli, brussels
sprouts, bok choy and cabbage that has isothiocanates which
goes to your liver and stimulates enzymes to help you fight off
pesticides and carcinogens in the environment.
The yellow-orange group is citrus, pineapple, banana.
Citrus fruits have preventive substances on their surface. If
you squeeze an orange peel, a little bit of fluid comes out
that has liminoids in it and these have also been shown to be
cancer preventive. The oranges and lemons develop this to fight
off fungi that would land on their surface and by an accident
of nature, these substances are cancer preventive in humans.
These and many other compounds are being studied by the
National Cancer Institute for Cancer Prevention and seven
servings a day of these different colors not only give you the
diversity but there is 475 calories there, a lot of fiber and
it is easier to diet when you fill up. Barbara Rolls wrote a
book on that called ``Volumetrics.''
Nutrition authorities disagree a lot but we all agree that
more fruits and vegetables are healthy. That is my push with
this book. We are going to meet with grocers to see if we can
get increased emphasis on produce sales throughout the country.
The National Cancer Institute has an Office of Five a Day for
Better Health that we initiated in California that is working
on this in partnership with us.
Mr. Schrock. All of what you said is in here?
Dr. Heber. Absolutely.
Mr. Schrock. I had a boss a few years ago who used to eat
garlic all the time. He looked great, smelled like the dickens
but he said it was a very healthy thing for him. I understand
that now.
Dr. Heber. There is a lot of science on that and on green
tea and other things.
Mr. Schrock. I thank you all. You have been wonderful. We
have learned a lot and I hope we can continue this discussion.
This Member wants to get involved in this subject and if there
is anything I can do to help you on Capital Hill, I want to be
the person to do that. I probably have a better feel for good
health than most Members. I want to be a part of that to make
sure nobody else has to go through what I went through. If
there is anything I can do to help you all, that is what I am
here for.
Again, thank you for being here.
We have Dr. Coates and Dr. Dietz next. We have to do the
obligatory swearing.
[Witnesses sworn.]
Mr. Schrock. Let the record reflect the witnesses responded
in the affirmative. Thank you for being here.
Our first speaker is Dr. Paul Coates, Director, Office of
Dietary Supplements, National Institutes of Health. We are
delighted to have you here. Our second speaker is Dr. William
Dietz, Director, Division of Nutrition and Physical Activity,
Centers for Disease Control and Prevention.
STATEMENTS OF PAUL M. COATES, Ph.D., DIRECTOR, OFFICE OF
DIETARY SUPPLEMENTS, NATIONAL INSTITUTES OF HEALTH; AND WILLIAM
DIETZ, M.D., DIRECTOR, DIVISION OF NUTRITION AND PHYSICAL
ACTIVITY, CENTERS FOR DISEASE CONTROL AND PREVENTION
Dr. Coates. I appreciate the opportunity to discuss with
you the activities of the Office of Dietary Supplements and to
highlight the directions we have taken in developing good
science in the field of dietary supplements.
At the end of my testimony, I will also provide some
comments about issues related to diet and chronic diseases as
requested by the committee.
Dietary supplements are widely used by American consumers
often in combination with other lifestyle measures such as diet
and physical activity for their potential benefits in health
promotion and disease prevention. This potential has been
realized when some supplement ingredients have been put to a
true scientific test. I have provided examples of these in my
written testimony. I will give one example here, folic acid in
the prevention of neural tube defects.
The positive effects of other ingredients, while promising
and subjected to early scientific testing, have yet to be fully
proven. Some of these are under active investigation in studies
funded by the National Institutes of Health such as a study of
Gingko biloba to prevent decline in cognitive function in older
individuals.
I want to remind folks that the Office of Dietary
Supplements was authorized by DSHEA in 1994 and its mission is
to identify and foster research on the health benefits and the
risks of supplements based on the merit of the underlying
scientific evidence.
To meet this goal, ODS uses a number of mechanisms. A major
one is that we fund a network of multidisciplinary botanical
research centers around the country. These centers at the
University of Illinois, Chicago; UCLA; University of Arizona;
and Purdue University are jointly funded with the National
Center for Complementary and Alternative Medicine or NCCAM with
additional support coming from other components of the NIH.
The National Institute of Environmental Health Sciences
supports the activities of a related center at the University
of Missouri. I am pleased to announce that as of yesterday, we
added a new center at Iowa State University funded in
collaboration with the NIEHS.
Examples of other ongoing activities of the ODS are
research training and career development, an important
component in establishing new careers in the area of dietary
supplement research. We also cofund grants and conferences with
other NIH institutes and among our educational activities, we
create fact sheets for consumers.
The budget for ODS has grown substantially from
approximately $3.5 million in 1999 to $17 million this year.
This has permitted us to expand our research agenda into new
and important areas including evidence-based reviews of dietary
supplement efficacy and safety, development of improved tools
to evaluate dietary supplement use in the population, a
research agenda focused on ephedra and analytical science tools
relevant to botanical ingredients.
We have worked with partners in both the public and the
private sectors to meet these goals. In my view, these
collaborations within and outside the NIH demonstrate the
strength of forging partnerships and in my opinion have been
crucial to the advancement of science in this area of dietary
supplements.
You asked me to comment on our efforts related to ephedra.
ODS and NCCAM recently funded an evidence report on the
efficacy and safety of ephedra containing dietary supplements
for weight loss and athletic performance. Our specific goal in
sponsoring this report was to help us with the appropriate next
research steps on this topic, a mandate called for in recent
congressional report language supporting the ODS budget.
This evidence report, still in draft form and under review
by content experts, was developed by the RAND Southern
California Evidence Based Practice Center, one of a network of
such centers supported by the Agency for Health Care Research
and Quality, a sister agency in HHS.
This report systematically and objective assesses and
analyzes the world's literature relevant to this topic, both
published and unpublished. The final version of this report is
expected to be released later this year but in the meantime,
ODS has already begun to develop research initiatives for
ephedra including the development and validation of analytical
methods and standard reference materials and the evaluation of
potential ephedra toxicity using animal models.
In the last part of my testimony, I wanted to comment
briefly on some issues related to the role of dietary and
lifestyle interventions that may be involved in the prevention
of or contribution to chronic disease. While this is somewhat
outside the purview of the Office of Dietary Supplements, here
are some comments I was able to gather from my colleagues at
the National Institutes of Health. More details are given in my
written testimony.
The Dietary Guidelines for Americans, issued by the
Departments of Agriculture and Health and Human Services in
2000, recommend a diet low in saturated fat and cholesterol and
moderate in total fat as part of an overall healthy eating
pattern. This healthy eating pattern needs to consist of a
variety of foods including grains, fruits and vegetables. The
Guidelines also point to the critical importance of maintaining
a healthy weight and a physically active lifestyle.
Balancing dietary intake with energy expenditure is
crucial, given concerns about the rising epidemic of obesity
and the increase in sedentary lifestyles in the United States.
A large body of evidence, alluded to more than once in previous
testimony, indicates that avoiding overweight, obesity, and
adult weight gain is linked with reduced risk of several
cancers as well as heart disease, hypertension, and Type II
diabetes.
Finally, I wanted to comment that the Departments of Health
and Human Services and Agriculture have contracted with the
Institute of Medicine to prepare a report on dietary reference
intakes of macronutrients, specifically carbohydrates,
proteins, and fats. This report, due to be released within the
next several weeks, is expected to contain recommendations
regarding adequate levels of intake, levels that may exert
positive health benefits, as well as levels that may be
associated with adverse health outcomes.
I thank you again for inviting me and I would be happy to
answer questions.
[The prepared statement of Dr. Coates follows:]
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Mr. Schrock. Last but certainly not least is Dr. William
Dietz, the Director, Division of Nutrition and Physical
Activity, Centers for Disease Control and Prevention. We are
delighted to have you here and would love to hear your
testimony as well.
Dr. Dietz. It is a pleasure to be here and I am grateful
for the opportunity to address the risks of obesity and the
scientific basis for diet and physical activity.
You are already very familiar with the topic which I was
invited to address, the burden and the costs of this disease.
With your permission, I would like to abbreviate my comments
and focus on a few points which I think deserve greater
emphasis.
You mentioned already the prevalence of obesity has
increased substantially but the increases have been even
greater in children and adolescents than they have been in
adults. Between 1980 and 1994, the prevalence of obesity in
children doubled and in adolescents it tripled. Over that same
time period it only increased by about 50 percent in adults.
Second, you mentioned the burden of disease attributable to
obesity. I think diabetes which has been mentioned is a very
pertinent example. This used to be a disease which was limited
to adults and now we are seeing it in children and adolescents
for the first time and in some communities, Type II diabetes
accounts for almost half of all new cases of diabetes. This is
in effect a new disease and there has been a recent report
which suggests the morbidity associated with Type II diabetes
in adolescents is worse than we previously have seen and is
associated with early death, early blindness, early kidney
failure.
The other point I think is worth emphasizing is the
contribution of childhood onset obesity which you have been
very concerned about and I think appropriately so. We know from
some data we published that over 60 percent of overweight 5 to
10 year olds already have one additional complication of
obesity like elevated blood pressure, elevated lipid levels or
elevated insulin levels and 25 percent of those 5 to 10 year
old children have two or more. This is a disaster waiting to
happen.
We published data last month showing that hospitalization
rates for obesity and its associated diagnoses in children
tripled over a 20 year period. The costs from obesity in
childhood also tripled.
To me the gravest concern is that although childhood onset
obesity only contributes about 25 percent of adult obesity,
children who are overweight in early childhood tend to be the
heaviest of adults. The mean BMI for a child who is overweight
before 8 years of age is over 40 which means that as an adult
they are 100 pounds or more overweight and therefore, more
susceptible to the complications of adult disease.
You are very familiar with the deaths and disabilities
attributable to this, so I won't emphasize that except to say
that State Medicaid costs already account for 20 percent of the
average State's budget and the epidemic of obesity and its
associated illnesses are going to drive those costs further. So
in an era of shrinking State budgets and increased Medicaid
costs, we are going to be confronting a very serious financial
crisis.
Paul mentioned the collaboration of NIH with other groups
and we have been pleased to assist the Office of Dietary
Supplements with a survey of non-prescription weight loss
products by adults in five States. According to our data, 7
percent of adults reported they used an over the counter weight
loss product in the past 2 years and 2 percent reported the use
of phenylproponolimine and 1 percent the use of an ephedra
product. I think this reflects the high level of concern on the
part of the population about the need for effective weight
control strategies and emphasizes the need to provide the
public with very effective and safe weight loss strategies.
However, the rapidity with which obesity has increased can
only be explained by substantial changes in the environment
that have served to modify calorie intake and energy
expenditure. Effective control of this epidemic will require
more information about the opportunities and barriers to
physical activity and good nutrition and most importantly, the
development of effective interventions.
The size of the population that we are attempting to reach,
25 percent of the adult population, 15 percent of the pediatric
population, indicate that we can't rely on individual behavior
changes alone, that those must be augmented with broader,
coordinated policy and environmental changes across multiple
sectors that affect large numbers of people.
We have made efforts to develop effective prevention and
treatment strategies through our State obesity programs, the
State coordinated school health programs, the youth media
campaign, partnerships with other organizations and applied
research agenda to develop and refine new approaches.
We believe there are four strategies which can be
implemented today to address the epidemic of obesity and its
associated chronic diseases. These include physical activity,
which includes physical education programs in schools,
increased fruit and vegetable intake, control of TV time
watched by children and breast feeding for all infants. There
is recent data which suggests that breast fed infants have a
lower risk of the subsequent development of obesity.
In summary, as you pointed out, obesity in the United
States is epidemic. The diseases caused by obesity are already
increasing and are already contributing to increased health
care costs. Our programs have begun to address the problem of
obesity but are small and just beginning. Nonetheless,
comprehensive nutrition and physical activity programs to
prevent and treat obesity appear the most logical course for us
to address this widespread problem.
Thank you very much for the opportunity to talk with you
about it.
[The prepared statement of Dr. Dietz follows:]
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Mr. Schrock. Thank you very much. Fascinating.
Dr. Coates, first of all, thank you for what you do at NIH.
I think this Federal Government is finally realizing we need to
do more there and I know the budget increased last year. We
need to continue doing that because what you do there has such
an impact on every other segment of society that we need to
continue funding that.
I am not going to ask you for name brands but everybody is
on a weight loss program. What is the best kind of weight loss
program? My wife, who is gorgeous anyhow, is now 32 pounds
lighter because she has lost 32 pounds on her way to 35 on
Weight Watchers. It really does the trick but is that a
permanent solution or what? How do people get it off and keep
it off?
Dr. Coates. I can make a couple of brief comments and
perhaps Dr. Dietz would be able to expand on it.
Thank you for your comments about the NIH. I wish I could
take credit for the broad swath of advances made there but I am
very pleased to be a part of an organization that has this kind
of reputation. It is a very exciting place to work, I assure
you.
In terms of weight loss programs, I think it was alluded to
a little earlier that a great many weight loss programs can
work in the early phases. The trick is to be able to sustain
the weight management and if necessary the continued weight
loss, whether it is possible to continue to take off weight.
There are a lot of programs out there. There are some that
have been well designed, well tested. Sometimes you cannot
distinguish between the ones that have been well designed and
tested from the ones that might not have.
I think it is fair to say that consumers are in a position
where they have to make choices among a great many things. It
is not always easy to do that.
Do you have any further wisdom on that?
Dr. Dietz. I completely agree there are a lot of approaches
to taking off weight but the key is sustaining those losses.
There is an interesting weight loss registry that exists in
Pittsburgh, a national registry, that consists of people who
have lost 60 pounds and kept it off for a year.
There are four strategies that appear to be successful in
maintaining weight loss. The first is eating breakfast; the
second is monitoring weight at least on a weekly basis; third
is a reduced fat diet; and fourth is physical activity, about a
hour of moderate physical activity daily. Those strategies
appear to be uniform across the people who have lost
substantial amounts of weight and sustained it.
Mr. Schrock. I am not so sure my wife would be happy about
me talking about that but those are the four things she has
done and it really does work.
Dr. Coates, as I get closer to being a senior citizen, it
is said that they often absorb less nutrition from their food
and you kind of wonder why it wouldn't be important for seniors
to do more supplemental food type things. Every time I am in
one of those food supplement stores, I am the oldest guy there.
They are usually young ladies trying to keep thin and guys who
want to bulk up, and the young but not senior citizens.
Wouldn't that be a good thing for them?
Dr. Coates. I agree with you on that. Indeed, one of the
items I referred in my written testimony was that
supplementation with Vitamin B12 is an effective strategy,
particularly among the elderly because of the decreased ability
to absorb B12 from food. I think we are really just beginning
to understand some of those issues. B12 is a signal example.
Our colleagues in the National Institute on Aging and we
are sponsoring a conference on this issue about dietary
supplement use in the elderly to be held at the NIH early next
year. In part, this was driven by the good sense at the NIH
that this was an area that needed developing, but you probably
also remember that Senator Breaux from Louisiana held a hearing
last year I believe on September 10 on the issue of dietary
supplement use in the elderly. So there is clearly a lot of
concern and enthusiasm at the same time for the potential for
dietary supplement use in the elderly. We just don't understand
enough of the need there.
Mr. Schrock. Isn't a lot of it genetics? My dad will be 89
in a couple of weeks and honestly I go out to California and I
come back exhausted just trying to keep up with him and others
half his age look like they are twice his age.
Dr. Coates. You can argue if it were that genetic that you
would be the same but I think there are differences among
people. There is an unknown proportion of this sort of thing
that is under genetic control and it is probably true for all
of these issues. Maybe there are some common themes that run
through them. I don't actually know that is true but we would
be always looking for those interactions between genes and the
environment, where in this case the environment would be
nutrition or dietary supplements.
Mr. Schrock. Dr. Dietz, you made a comment that was
interesting. All of a sudden we are really concerned about the
increase in childhood diabetes. Why? When I was a kid, I don't
remember it at all. Now, it is a big deal. We have friends who
have kids that have it. I never heard about that when I was
growing up.
Dr. Dietz. It is driven by obesity, 80 to 90 percent of the
Type II diabetes in children and adolescents is attributable
directly to obesity. There is a strong family history in those
kids that it is the obesity which brings it on.
Mr. Schrock. I never would have thought that.
What role is the CDC playing in the President's new
initiative on physical fitness? Are you integrally involved?
Dr. Dietz. Yes, we very much are. We helped write the
document that came out and in my division there is a Physical
Activity and Health Branch which in the last administration
helped put together the President's report on physical fitness
or I think it was entitled, ``Physical Activity in Youth.''
We are part of the co-lead with the President's Council on
Physical Fitness and Sports for drafting the Healthy People
2010 Guidelines and are actively pursuing revisions in the
recommendations around physical activity. For example, our
questions and surveillance only ask about leisuretime physical
activity and neglecting the potential for physical activity at
work. So we are involved both in terms of assessing the
problem, developing recommendations and implementing those both
within communities and within States.
Mr. Schrock. It is not a bad thing to see the President in
a workout environment, working with weights and things. I think
that sends a strong message.
Dr. Dietz. Yes. He is a wonderful model. In some respects
though I think what the President is doing may have exactly the
opposite effect because I think a lot of people see the
President running and doing 7 minute miles which is
extraordinary and just dismiss it, they say I can't do that.
The message we try to send is you don't have to be a marathoner
to have an improvement in your health as a result of physical
fitness.
Mr. Schrock. That is right. Schools, can they have an
impact on this and how?
Dr. Dietz. Absolutely. We recently published a chapter for
a document known as the Guide to Community Preventive Services
which is an evidence based document much the same type of
analysis that physicians rely on when they prescribe a specific
drug for a specific problem. One of the recommendations in that
chapter was the importance of physical education as a
documented way to increase physical activity in children and
adolescents.
In an era when parents are increasingly concerned about
safety and neighborhoods are increasingly less safe for
children and adolescents, schools represent one of the last
safe places for children to be physically active, not only
within school but one of the programs we are working on which
is turning out to be quite popular in communities is the Kids
Walk to School Program. When I was young, I walked to school
regularly. In fact, 80 to 90 percent of adults today walked
regularly to school. Today, less than one-third of children
walk to school. In part, that is because they lack safe routes
and in part, it is because communities lack sidewalks and part
is the absence of neighborhood schools.
Walking to school is one of the ways that children could
build physical activity routinely into their day because they
have to get to school. If they have a safe route to walk to
school, that is a ready made opportunity for physical activity.
Mr. Schrock. I walked to school. I would grouse about it
and my dad would say, when I was your age I used to walk 5
miles uphill to get to school and 5 miles uphill to get home
and I bought that for a long time but that is true. That is one
thing my wife does, she walks several miles every day and she
wears a thing on her hip and that is an incentive to see how
high she can get that thing.
Faith based initiatives and issues have kind of taken hold
in the last few years. I am wondering if there is a role for
those kinds of organizations in promoting physical fitness in
communities and if there are funds available for that sort of
thing?
Dr. Dietz. It is a very important opportunity and churches
have played a major role and there are well documented studies.
For example, in North Carolina church based initiatives can
change fruit and vegetable consumption and change physical
activity levels. I think with appropriate funding that is an
important opportunity.
Mr. Schrock. Let me recognize the real chairman, Chairman
Burton.
Mr. Burton. I want to apologize for not being here. As I
said earlier, this is the last day, today and tomorrow, of the
session before the break and we have been working on homeland
security. We have been down there fighting over that and what
kind of amendments are going to be and so forth. I have a
couple of amendments for the floor tomorrow, so I apologize for
not being here.
One of the things that concerns me about the first panel,
Ms. Ladd, she mentioned the Food and Drug Administration about
some alternative and complementary therapies that were used
involving supplements and she said they literally laughed at
them and said, we don't buy that supplement theory and that
sort of thing, words to that effect.
Do you find there is a mindset in any of our agencies, FDA,
HHS, or CDC, that would indicate that complementary and
alternative therapies and dietary supplements are not worth a
darned?
Dr. Dietz. That is certainly not true at the CDC. She
mentioned the CDC as the place she called and was greeted with
guffaws and laughter. I was embarrassed to hear that, first,
because I think that certainly is not the way my division
treats callers and second, because it is the agency I work for
and I am quite proud of it.
We think there is a very important role for dietary
supplements and weight loss supplements. As I mentioned
earlier, we have been pleased to assist the NIH in transferring
funds to South Carolina to explore the frequency of usage of
these products.
Mr. Burton. Have any of the agencies, including CDC, had
any extensive studies on how supplements affect different
diseases? Have there been any double blind studies you know of
that would say large amounts of Vitamin C reduce the risk of
heart attack or cancer or stroke or any of those things? Have
there been double blind studies you know of that deal with
that?
Dr. Coates. On behalf of the NIH--because it is generally
more likely that those kind of clinical trial studies would
emerge from the National Institutes of Health--while I didn't
go into any detail in my oral testimony, I did provide some
examples in my written testimony of ongoing and some finished
studies that have looked at these sorts of things where people
are randomized to a treatment group and to a placebo group and
the questions asked are how effective is it, how safe is it?
So examples of ongoing trials using NIH funds are on Gingko
biloba for the prevention of cognitive decline in older
individuals, Echinacea to look at the possibility of prevention
of colds in children, either prevention or the severity of
colds. So there are a number of these studies. We think this is
the right way to do this kind of evaluation so that we can send
good messages to consumers about issues related to efficacy.
Mr. Burton. Have you done any studies on any of the
approaches to medicine that are age old like in China where you
use acupuncture and other things? Are they doing studies on
that?
Dr. Coates. I won't speak for my colleagues in NCCAM or the
other Institutes, but I do know because we have some areas of
common interest with NCCAM that they are actively pursuing
these kinds of things, addressing frontier kinds of medicine or
age-old traditional medical approaches and trying to evaluate
them in the context in which they are being used in the United
States, which in some instances is quite different from the
traditional ones.
Mr. Burton. We have had a number of hearings on the health
care industry and our government agencies, as well as
supplements and alternative therapies and that sort of thing.
One feels sometimes that the pharmaceutical industry has a
tremendous amount of influence because of the grants they help
with and other things they do in conjunction with our health
agencies.
Do you ever feel like sometimes our health agencies are in
some way being manipulated or controlled by the pharmaceutical
industry?
Dr. Coates. I don't have an opinion on that. I don't
observe it as part of my regular work. I don't know.
Mr. Burton. But you do know that sometimes people come from
the pharmaceutical industry and come into government work and
work in the various health agencies and vice versa, people that
work in the health agencies will leave and go to work for the
pharmaceutical companies with very lucrative jobs.
Dr. Coates. I certainly have seen people moving back and
forth, yes.
Mr. Burton. And that would have some influence I think on
some people?
Dr. Coates. It might, I don't have an opinion on that.
Mr. Burton. OK. You are being very political.
There was a letter published in the Journal of American
Medical Association last week from Dr. Wayne Jonas about a St.
John's Wort study. Are you familiar with that letter?
Dr. Coates. I saw the letter, yes, I did.
Mr. Burton. What did you think of that?
Dr. Coates. It is a very reasoned approach. There are
issues about trial design that always come up. I think he
alluded in his letter to the fact that the recent funded St.
John's Wort study in the population that was studied did not
demonstrate any effectiveness of either St. John's Wort or the
active drug in reducing the impact of depression in this
population.
Part of his comment was that the placebo effect is
increasingly a complexity of depression oriented trials. I
don't know how much weight that has but it was certainly
something that others commented on.
Mr. Burton. Was that study flawed, do you think?
Dr. Coates. Studies, if they don't come up with the answer
that a person wants, that person could think it is flawed. If
they don't come up with an answer at all, you do begin to
question whether there was something about the design or the
followup that may have complicated the interpretation of those
results. At this point, I can't say.
Mr. Burton. The staff says they studied major depression
when St. John's Wort was never supposed to have been used for
that, only mild and minor depression. Can you explain why they
did that? I think right on the bottle it says it is not for
major depression and yet they did include that in the study.
Dr. Coates. The study population was called major
depression of moderate severity. These are terms that I am not
aware everybody can agree on. As an example, this is my
understanding, I am somewhat peripheral to this argument, but
in some European studies of St. John's Wort, the criteria that
were used to enter patients into studies were similar to or
maybe not very dissimilar from the criteria used to enter
patients to this recently completed St. John's Wort study.
That the populations might be called something different
could be a function of how we define depressive disorders in
the United States as opposed to their definition somewhere
else. I am not trying to take the fifth on this, I am trying to
help to understand why there might be some differences.
I think it is true that this population had some measures
of depression that would be considered more severe than people
would have been interested in seeing. Just as an aside, we in
the Office of Dietary Supplements along with NCCAM and the
National Institute of Mental Health are mounting a follow-on
study in a population that will be defined in a somewhat
different way but will carry the diagnosis of minor depression.
It is a tricky diagnosis to make and I think that may have also
contributed some to the final results.
Mr. Burton. You know what the DSHEA law is?
Mr. Coates. Yes.
Mr. Burton. What do you think about that?
Dr. Coates. The law was passed in 1994, enacting among
other things the Office of Dietary Supplements. It asked for us
to provide a scientific basis, scientific support to better
inform the American people about the benefits and the risks of
dietary supplements, to give people the best information
possible. That is my interpretation of DSHEA. It is how it
affects me directly and my office.
Mr. Burton. Do you think that the people at our health
agencies, HHS and CDC and FDA, feel Congress overstepped its
bounds in passing the DSHEA law?
Dr. Coates. I can't speak for others.
Mr. Burton. How about you?
Dr. Coates. I think this is a law that presented a very
worthy opportunity and in 1994, it was an excellent piece of
legislation to try to deal with an emerging area of use in the
population. I think--this is a personal opinion for which
nobody else should take blame or credit--that it is not a bad
idea periodically to reexamine where we are with a piece of
legislation. I am not a legislator so I can say that.
Mr. Burton. What do you think about today, 8 years later?
Dr. Coates. I think we have demonstrated that there is
plenty of room for the use of dietary supplements in a host of
different conditions. I also think that people in some sectors
have used it as an opportunity to be able to market in an area
that was beyond what was intended by DSHEA. If DSHEA was
intended to provide products that people could use for health
promotion, then it is perhaps a stretch to market products for
disease treatment.
Mr. Burton. Such as obesity, like ephedra?
Dr. Coates. That is a tricky one, sir.
Mr. Burton. The reason I bring up ephedra is because the
ephedra issue, we have had some discussions with people in our
health agencies and a lot of companies have used synthetic
ephedra and it has caused severe problems. Non-synthetic
ephedra when used in proper doses as shown on the bottle and
the inserts has minimal side effects.
There was a study done by Harvard and Columbia Universities
which I believe has been published now in the International
Journal of Obesity and they tried to get it published in some
others but they ran into some problems. That study which we
have looked at pretty thoroughly showed it wasn't a big
problem.
I know that our health agencies are doing another study on
that right now. You are managing that study now?
Dr. Coates. The Office of Dietary Supplements and the
National Center for Complementary and Alternative Medicine
sponsored the development of an evidence report by the RAND
Corp. They do that under contract to AHRQ.
Mr. Burton. That is going on right now.
Dr. Coates. That is going on now.
Mr. Burton. Do you think the study that was done and
published that came out of Columbia and Harvard was flawed? Why
are we seeing another study being done? I am just curious.
Dr. Coates. This was one of the very first randomized,
clinical control trials of an ephedra-containing and caffeine-
containing product used for weight management or weight loss,
one of the very first randomized placebo-controlled trials. So
it is significant that it was.
As is true of most studies like this, it was done in a
population of very-well defined and characterized subjects in
whom potential risk factors for the development of some side
effects were excluded. That is a good thing. You don't wish to
embark on a clinical trial for weight loss where you put
subjects at increased risk. So what I would say is, on the
basis of that study, the results are promising but the results
of that trial relate to a population so described, monitored
carefully over 6 months. Over 6 months they experienced weight
loss that was comparable to weight loss that could have been
obtained through other pharmacologic means. That is
encouraging. It was also encouraging that there were no
evidence safety problems.
I have to keep reminding myself that in the context of a
randomized control trial, your job is to do the very best you
can to monitor and prevent potential side effects in a
population like that. Therefore, I think we have to limit our
enthusiasm. I limit my enthusiasm for the results of the study
to a similarly described population and would need to have more
information in order to be certain that people who are using
this in the context of weight loss in their communities, walk
into a store and buy it, they are not being monitored by a
physician.
Remember this randomized control trial was done under the
control of a number of physicians. It is a somewhat different
circumstance. We should be encouraged but I also maintain some
caution.
Mr. Burton. Individuals buy aspirin and all kinds of
products and if they don't read the label, and I have been
guilty of that from time to time, taking more things than I
should have or less and finding out they didn't work. I am
talking about pharmacological products.
Dr. Coates. I agree with you.
Mr. Burton. So we can't control everything a human being
does. They have to be responsible themselves and if there is a
dietary supplement or a prescription drug, they have to read
what they are supposed to do or else they put themselves at
risk. That study, as you said, didn't appear to be flawed and
we hope when the results of the study you are doing come out,
it isn't skewed in such a way that it is designed to change the
outcome specifically because they want to see us move toward
pharmacological products instead of natural products like
natural ephedra.
Dr. Coates. I will make one reminder, sir. We commissioned
that report because we wanted to determine what the next
research steps needed to be in terms of ephedra.
Mr. Burton. Not to discredit the other report?
Dr. Coates. Not at all. In fact, the Boozer study to which
you referred and published in the International Journal of
Obesity is one of the studies being systematically reviewed in
the report that is being developed by the RAND Corp.
To clarify one thing, this is not a brand new clinical
study, this is a meta-analysis of existing studies that relate
to ephedra efficacy and safety.
Mr. Burton. Let me end by saying I hope the health agencies
continue to look at alternative and complementary therapies as
well as dietary supplements as a help to people to help cut
down the overall cost of medical care and the cost to the
government for medical care.
I hope there is not an attempt to circumvent or change the
DSHEA law. If there is need to change the law, people like you
who have expertise I hope will come to the U.S. Congress and
talk to laymen like me who have been interested in the subject
for a long time and explain why there is a need to change that
so we can try to work together to get that done in a way that
is very responsible.
We have an awful lot of jobs and people who make their
living in the private sector through the supplement industry. I
believe the supplement industry has helped a great deal as far
as health is concerned. So I hope we have a good working
relationship and that if there is need for change, it is done
in the proper way and not with our health agencies trying to
circumvent what Congress decided.
Dr. Coates. I would be pleased to talk with you in more
detail about that at your request. We have also found that the
dietary supplement industry has been a valuable partner in
trying to move forward research activities, that they have not
interfered with our activities, they try to be effective
partners with us in some aspects of those things where they
really do have expertise.
Mr. Burton. Beth just told me that we have not yet fully
implemented or health agencies have not yet fully implemented
the DSHEA law and until that is done, we probably wouldn't be
of a mind to change it anyhow but once it is completely
implemented, if there is flaws, we will try to get those
corrected.
Mr. Schrock. Thank you, Mr. Chairman.
Thank you for your testimony and the discussion. It has
been very helpful. I think this whole day has been helpful
because this is an issue that should be important to every
single Member of Congress, every single staff member because it
impacts so much of what we do up here.
Mr. Burton. I don't know if you were here earlier. My wife
died of metastatic colon cancer on May 10. One of the things I
hope our health agencies will do has nothing to do with the
present subject, is to illuminate the need for people above 40
or 50 to have colonoscopies and other preventative measures to
prevent death or severe health problems.
Had my wife's doctor told her to get a colonoscopy, she
would be here today. I am convinced of that. They didn't. When
she started having some minor symptoms, they just gave her
pills. I am not so sure the medical profession, all of them,
are aware of how important things like colonoscopies are. So if
our health agencies could send out a circular when you do a
mailing or whatever you do to inform the AMA or doctors, tell
them how important some of these preventive measures are, it
would be appreciated by not only me but I am sure thousands
across the country that might be saved because of that.
You guys can do a lot in addition to making sure we get the
right prescriptions and the right drugs to make sure people are
informed about how important preventive measures like
colonoscopy are.
Mr. Schrock. I agree with that. I wish we could somehow
legislate people to get physicals every year. I hate to say it,
but the male is worse than anybody else. We need to make sure
we do that. You heard his story. Mine was caught early. I am
blessed it was but so many times it gets so far down the pike,
there is nothing you can do about it.
Thank you very much for your testimony. Thank you for being
here.
This hearing is now adjourned.
[Whereupon, at 3:09 p.m., the committee was adjourned, to
reconvene at the call of the Chair.]
[The prepared statements of Hon. Henry A. Waxman, Hon.
Edolphus Towns, and Hon. Carolyn B. Maloney, and additional
information submitted for the hearing record follow:]
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