THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 487.1 to 487.5

Week: 487.1 Guest: John McDougall, M.D. Topic: Low Fat Eating - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a five part series on weight loss and health through low fat eating with author and internist Dr. John McDougall whose latest book is the McDougall Program for Maximum Weight Loss.

NEMA: Dr. McDougall, for those who may not be familiar with your books, would you explain the basic principles of your eating program.

MCDOUGALL: I start out as an internist looking at people as basically healthy and that's a big step for a doctor because we're trained to look at people as genetic mishaps. What I consider the problem is not in the genes or heredity but I consider the problem in how people take care of themselves and the main misunderstanding here is how to fuel yourself. People in our society eat the richest diet known to humankind and it's a diet of meat and dairy and cakes and ice creams and the way I take care of people is I change the way they eat to a diet that is traditional for people. It's a diet based on starch like rice, corn, potatoes, pastas, breads with the addition of fruits and vegetables and they put their ice cream and cake back into their birthday and have it on just occasions instead of every day.

NEMA: Well, that's interesting because one of your ideas is the concept of the feast as it existed historically versus how it's employed in America which is a minimum of three times a day.

MCDOUGALL: Yeah. Minimum.

NEMA: Historically, you've written books on health through nutrition but this is the first book of yours that I'm familiar with that is targeted directly with the stated goal of weight reduction. What inspired this book?

MCDOUGALL: What inspired that book was a large advance and my publisher wanted a book on weight loss. I never wanted to write a book on weight loss but they said that this was important to round out what you've written so far so I got involved in it and it turned out to be one of the most exciting books that I ever researched and I think one of the most helpful for people who have weight problems because it really came down to an understanding of weight that I think anybody can grasp. The problem with being overweight in our society is again the wrong fuel and that wrong fuel is too dense in calories, in other words it's too concentrated for the volume in calories. The second thing about that fuel is it's full of fat and the fat you eat is the fat you wear. And the third thing is that the wrong fuel is deficient in carbohydrate and it's carbohydrate that shuts off the hunger drive and so we get satisfaction from carbohydrate when we eat just like we get satisfaction from oxygen when we breathe air and we get satisfaction from thirst when we consume water so people need to understand they've got to get that carbohydrate in to feel satisfied, otherwise they'll be a "compulsive overeater."

NEMA: Interesting. Is there such a thing as a dangerous rate of weight loss if the person is eating healthy food?

MCDOUGALL: No. There's not such a thing as dangerous weight loss and the reason is is because if you're eating healthy food - well I suppose you could if you ended up back in the old diet mentality and that is that you're going to eat healthy food but not enough of it - yes, that would defeat the purpose because not only would you be trying to learn to like new foods but at the same time, you'd be suffering with the misery of hunger like you are in so many other programs so that would be an unhealthy thing to do. But if you just let your appetite go, just believe your appetite is correct and your hunger drive will give you what you need in terms of nutrition if you answer it and you provide healthy foods for that hunger drive, it never makes a mistake just like nobody overbreathes air and nobody overdrinks water.

NEMA: Join me for part two on low fat eating with Dr. John McDougall.

Week: 487.2 Guest: John McDougall, M.D. Topic: Low Fat Eating - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a five part series on safe, healthy weight loss with author and internist Dr. John McDougall whose latest book is the McDougall Program for Maximum Weight Loss.

MCDOUGALL: Nobody overbreathes air and nobody overdrinks water. You're not going to overeat food if the food is what it is intended for the human being. The mistake is is people consume a diet that was never intended for people to eat - maybe a diet that would be fine for your cat or your dog but the human being cannot survive on it.

NEMA: How important is the time of the day when a food is eaten?

MCDOUGALL: The time of the day I think is of not much importance and I'd have to say that in terms of the fact that we live in a society where some people work graveyard shifts and other people work afternoons and it's just a society where you really can't base your life on when the sun shines. Likewise I don't think it's important the number of times people eat a day even though there are some advantages to eating more often. What we find is people who are nibblers and grazers, in other words they eat many meals during the day, small meals, end up losing more weight and they also lower their cholesterol more effectively than those people that we classify as gorgers, in other words people who eat one, two, three times a day. So frequent eating is an advantage. The hour that you eat I don't think makes a lot of difference.

NEMA: There are more and more low or no-fat food substitutes every day showing up on supermarket shelves - no-fat mayonnaise, cookies, cream cheese - how good or bad is this trend and are the chemicals in these foods more dangerous than the fat that they're trying to avoid in the first place?

MCDOUGALL: Low fat doesn't tell you what's in there. It's just like a product telling you that it's no cholesterol. It could be solid oil such as olive oil. You have to read the entire ingredient package and what you find is they come in several categories as far as problems go. There are low-fat cookies and cakes that take out the fat but then they add loads of sugar and refined flour and lots of chemicals. Then there are low-fat meat products that take out the fat and they just increase the animal protein which gives you problems of kidney stones and also osteoporosis and the dairy products do something similar. They take the fat out and just leave you with dairy protein which really - it puts quite a burden on the kidneys and the liver and also removes a lot of calcium from the system so these products may have an advantage in one area but they cut your throat in another area.

NEMA: There have been thousands, literally thousands or more of different diets based on many different concepts or models of the human body according to the people who devise them and some have been very successful, at least they have been successful in losing weight, long term was a different story but some have been downright dangerous and I would like you to touch on that because this to me is a real health issue, particularly something that there's less of now, these high protein diets, but there are still other diets that are touching on that. What was that about, why did it work when it did work and why did it inevitably fail?

MCDOUGALL: High protein diets work by changing the body's metabolism. What they do is when you deprive the body of carbohydrate which is the fuel the body prefers to burn, if it goes to a secondary fuel which is fat and that is the fat in your body that it burns and also the fat in any foods that you eat and a byproduct of that fat metabolism are ketones and ketones have the ability to suppress the appetite.

NEMA: Join me for part three on low fat eating with Dr. John McDougall.

Week: 487.3 Guest: John McDougall, M.D. Topic: Low Fat Eating - Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a five part series with author and internist Dr. John McDougall whose latest book is the McDougall Program for Maximum Weight Loss. I asked Dr. McDougall about high protein, ketone-producing diets.

MCDOUGALL: As a result of the ketones being produced and floating around in the blood, your appetite is suppressed so you eat less, you burn fat and you lose weight. The problem with these kinds of diets is the foods that they ask you to eat are the very foods the Cancer Society and the Heart Association tell you will cause you cancer and heart disease. This is meat, dairy products and of course the diet lacks very much in carbohydrates such as potatoes and rice so it's a basically unhealthy diet. This kind of diet will also contribute to osteoporosis and kidney stones because it's very high in animal protein. The real down side to this kind of diet for anybody who's serious about losing weight is you can only stay in this state of ketosis for a limited amount of time and then you eventually go back to eating and then you regain all your lost weight. Now there's a modern version of this high protein, low carbohydrate diet and these are the diets that you find in little packages and also cans and these are the liquid protein diets and they give you instant ketosis or as I'd like to say "instant sickness." Now these diets likewise you can only stay on for a limited amount of time, then you get off of them and you regain all your lost weight.

NEMA: One thing I think I see more of an emphasis on in your most recent book - talk about exercise and its importance to your program. Now I know your fundamental issue in the past has been to reduce intake of fat and to the point that you even very wisely advise that a person should be very careful about taking up an exercise program until they've adjusted their diet but talk about the importance of exercise to your program.

MCDOUGALL: Exercise will give you the fitness that you really deserve in terms of looking really great. It also contributes to cardiovascular health, you know, of course you have muscle tone that everybody admires. The problem with exercise and not dieting is that it makes it very very difficult for people to lose weight. If you look up the calorie content of a juicy cheeseburger, you find about 400 calories and then you figure out that you only burn about 100 calories in an hour of walking. You say to yourself well, it hardly makes any sense and I had that experience myself just recently. I went to Europe and exercised. I mean, I walked four or five, six hours a day going around seeing all the sights and yet I gained five pounds, not because I ate meat or dairy. I was able to stay away from those but I just couldn't stay away from the oil, particularly the olive oil. So even though you exercise heavily, if you don't get the diet right it makes it very very difficult to maintain a trim weight or attain a trim weight and very difficult to stay in the health that you're trying to get, in other words, solve problems such as diabetes, heart disease, high blood pressure and so on. You really have to get the oils out of the diet.

NEMA: Well, you just touched on something very important. A real dilemma for many people is eating out without getting too much fat. How do you go about organizing a trip to a restaurant?

MCDOUGALL: In my town it's very easy. In Sonoma County, we have over 90 restaurants that serve McDougall-style food and I say that not because I want you all to come to Sonoma County. It's because you can do the same thing in your town. You pick places that cook similar to what you're looking for. In other words, you'd go to an Indian restaurant which is noted for its vegetarian foods and you'd say I'd like to have an Indian dish made without oil, meat and dairy products and they would have no difficulty at all understanding what you mean and also complying.

NEMA: Join me for part four on low fat eating with Dr. John McDougall.

Week: 487.4 Guest: John McDougall, M.D. Topic: Low Fat Eating - Part Four Host: Richard Roeder Producer: Ed Graham

NEMA: This is part four in a five part series on low fat eating and your health. My guest is author and internist Dr. John McDougall whose latest book is the McDougall Program for Maximum Weight Loss. I asked Dr. McDougall how to find low fat foods when you go out to eat.

MCDOUGALL: Go to a Chinese restaurant. Tell them you'd like to have a "monk's dish." You would like your vegetables cooked in a ginger sauce and of course you have it over white rice because that's usually all they have. Go to an Italian restaurant and tell them you'd like to have a marinara sauce but could they please make it without margarine or without olive oil in it and the angel hair pasta is oil and cholesterol free. You can go to Subway Sandwiches or other sandwich shops and have them make you a vegetable sandwich. Just tell them to leave the mayonnaise off. Burger King will even feed you a vegetarian Whopper. With a little bit of creativeness that's not too unhealthy, you have tomatoes and lettuce and onions between the buns that they serve and so you do it almost any place in the country. I'd have no trouble at all. Pick salad bars. Bring your own salad dressing. That would help of course because most of the salad dresssings are high fat so I don't find it difficult to eat out.

NEMA: Do you continue to view salt as a serious dietary offender as in general it's been viewed in heart disease?

MCDOUGALL: Salt and sugar are two basic tastes on the tip of the tongue and so I have to believe the human being is a natural seeker of these two substances. Once upon a time, salt was a rare commodity and it was important for us to seek it because it provided the minerals for the body. And of course, once upon a time sweetness was corn, rice, potatoes, fruits and maybe a little bit of honey. Industry has discovered that we desire these substances greatly and so they put tremendous amounts of sugar, about 150 pounds a year, in our food and there's a salt shaker on every table and packaged foods are just loaded with salt so that we'll desire them and buy them. Yes, you can get into trouble with salt and sugar but as far as a list of culprits for most people, it's real low on the list of damaging substances. Most people can tolerate a little bit of salt and a little bit of sugar and the way we use it, people rarely get into problems. We tell folks that what they ought to do is they ought to add the salt or sugar to the surface of the food where the tongue tastes it with great pleasure but it adds very little of the substance to the food itself. Now by doing this, you might start out with a meal plan like ours that has 300 milligrams of sodium. You add 1/2 teaspoon of salt which is around 1200 milligrams of sodium. Now you're up to 1500 milligrams. Well, if you have a massive heart attack and you end up in the coronary care unit, their low sodium diet is 2000 milligrams of sodium which is 500 more than our diet with a 1/2 teaspoon of salt added to the surface. So you can manipulate the salt so that you get tremendous amounts of taste with very little burden to the body and actually no harm for a healthy person.

NEMA: There are so many different sets of numbers around today that are related to cholesterol, proper weight for a person of certain height, how often do you find yourself agreeing with the accepted standards and how often do you find yourself disagreeing with them?

MCDOUGALL: Things are changing more and more in the direction that I recommend in terms of what good health parameters are. When I was younger and just started my medical practice, normal cholesterol in our society was based on a bell-shaped curve and that meant you could have a cholesterol between 150 and 350 still be considered normal. That normal is determined based on a sick population of people where half the people die prematurely of heart attacks and strokes.

NEMA: Join me for part five on low fat eating with Dr. John McDougall. Week: 487.5 Guest: John McDougall, M.D. Topic: Low Fat Eating - Part Five Host: Richard Roeder Producer: Ed Graham

NEMA: This is part five in a five part series on low fat eating with author and internist Dr. John McDougall who has a new book called the McDougall Program for Maximum Weight Loss and a low cost series of tapes on low fat eating. Dr. McDougall and his parrot spoke to me from the Sonoma Valley in California.

NEMA: You've written quite a lot about the effect of dietary fat on women and one woman's health issue that comes to mind is menopause and the diet. Does diet affect menopause and what foods could make menopause less uncomfortable?

MCDOUGALL: In our society, menopause is a disease. Women get sick. They get depression. They get hot flashes. They feel terrible. It's interesting - in other societies and here I'm talking about third world countries or rural societies that have not been developed where they still live on primarily starch-based diets, when a woman goes through a change in life, she stops her menstrual period but she doesn't get sick. She doesn't get hot flashes. She doesn't get depressed. What I'm talking about in particular here is one society that's been studied and that's the Japanese. The Japanese woman has virtually no trouble with menopause. It's just not considered a health issue. Now initially they thought this was due to the stoic nature of the Japanese woman but when they studied it carefully, they found it really wasn't a social issue. It had to do with the fact that she lived on a diet that was high in vegetable foods. In vegetable foods, you find a substance or a group of substances known as phyto-estrogens. These are plant estrogens and these estrogens, they stimulate a woman's cells, estrogen-receptive sites of a woman's cells and give her a bit of estrogen stimulation which actually keeps her younger and actually prevents the menopause.

NEMA: You have written that heart medications are not necessarily a positive thing because they are treating a symptom instead of the underlying problem. First I'd like you to talk about that and do you not acknowledge however there are some people walking around at least alive today because they are on this medication?

MCDOUGALL: Heart medications can be of benefit to people, particularly when you're dealing with heart irregularities. The problem comes from medications that just deal with symptoms. Let's take two categories. One is medications that relieve chest pain. That's all they do is relieve the chest pain. They take away a warning sign and that sign to the patient is that their heart is in big trouble and that they ought to be responding to this particular symptom of pain and do something about their diet and exercise. The other is high blood pressure medication. High blood pressure medication lowers the pressure and gives people a false sense of confidence that everything's okay. That high blood pressure is an indication that the blood vessel system is in big trouble and they ought to respond with a healthy diet and exercise program.

NEMA: Scientists seem to think that they've found the mechanism in the body that causes some people to get fat and others not and the way the direction in medicine seems to be going on this issue is about some pills. It's looking very much like they're going to be a few pills that you can take if you don't want to be fat anymore. Obviously the opportunity for abuse here is amazing because the only issue is not just not getting fat on your gut, is it?

MCDOUGALL: No. As a matter of fact, if they had a pill today that would cause fat people to become thin and keep thin people trim, it would only address one issue and that's their appearance which, by the way, is very important. People care most about how they look but it wouldn't do anything as far as heart disease, breast cancer, colon cancer, prostate cancer, diabetes, and so it would really fall short of what people could get if they'd consumed the big pill and the big pill is the one to five pounds of food that's on their plate. If that was correct and they went out and got a little bit of exercise, they could have the advantage of good looks as well as good health.