UNITED STATES
DEPARTMENT OF AGRICULTURE

Pages: 1 through 292
Place: Washington, DC
Date: March 8, 1999

HERITAGE REPORTING CORPORATION
Official Reporters
1220 L Street N.W., Suite 600
Washington, DC
(202) 628-4888

The meeting in the above-entitled matter commenced, pursuant to notice, at 9:10 a.m.

APPEARANCES:

Year 2000 Dietary Guidelines Advisory Committee:

CUTBERTO GARZA, M.D., Ph.D.
Vice Provost and Professor
Cornell University
Associate Director, Food and Nutrition Programme
United Nations University


RICHARD J. DECKELBAUM, M.D.
Director, Institute of Human Nutrition
Columbia University College of Physicians and
Surgeons

JOHANNA T. DWYER, D.Sc., R.D.
Director, Frances Stern Nutrition Center
New England Medical Center
Professor of Medicine (Nutrition) and
Community Health
Tufts University School of Nutrition


Year 2000 Dietary Guidelines Advisory Committee:

SCOTT M. GRUNDY, M.D., Ph.D.
Chair, Department of Clinical Nutrition
Director, Center for Human Nutrition
University of Texas Southwestern Medical Center
at Dallas

RACHEL K. JOHNSON, Ph.D., R.D.
Associate Professor
Department of Nutritional Sciences
University of Vermont

SHIRIKI K. KUMANYIKA, Ph.D., M.P.H., R.D.
Head and Professor, Department of Human Nutrition
and Dietetics
Professor of Epidemiology
University of Illinois at Chicago

ALICE H. LICHTENSTEIN, D.Sc.
Scientist I, USDA Human Nutrition
Research Center on Aging
Association Professor, School of Nutrition
Tufts University

SUZANNE P. MURPHY, Ph.D., R.D.
Researcher, Cancer Research Center of Hawaii
University of Hawaii

MEIR J. STAMPFER, M.D., Dr.P.H.
Professor of Epidemiology and Nutrition
Harvard School of Public Health
Associate Professor of Medicine
Harvard Medical School

ROLAND L. WEINSIER, M.D., Dr.P.H.
Chair and Professor, Departments of Nutrition
Sciences and Medicine
School of Medicine
University of Alabama-Birmingham

Co-Executive Secretaries:

SHANTHY BOWMAN, Ph.D. (USDA/ARS)
(301) 734-5640

CAROLE DAVIS, M.S., R.D. (USDA/CNPP)
(202) 418-2312

KATHRYN MCMURRY, M.S. (HHS/OPHS)
(202) 401-0751

LINDA MEYERS, Ph.D. (HHS/OPHS)
(202) 205-4872


Also Present:

JOAN LYON
CAROL SUITOR
EILEEN KENNEDY
ETTA SALTOS

I N D E X

P R O C E E D I N G S

CHAIRMAN GARZA: Good morning. I am Bert Garza. I have the privilege of chairing this group, and I want to take the opportunity to thank each of you for coming this morning. We have a full three days ahead of us and certainly appreciate the interest that your presence represents.

I want to also publicly thank the committee members who have been hard at work in getting ready for this meeting. There have been several comments about this being one of the hardest working committees in the history of the dietary guidelines, so that is a real testament to each of you because in fact certainly the other previous committees have worked very diligently as well.

Before moving on to hearing from those of you that have registered to testify this morning, and that is somehow too stringent a term; at least to comment and share your views with us, I think it is important for me to review with you the rules and procedures we are going to be following.

There is an electronic timer that you have by the microphone. The green light will go on as you speak. The yellow light will come on two and a half minutes into your presentation, and then at the red light there will be a gong, and then the floor will open from underneath.

(Laughter.)

CHAIRMAN GARZA: So I would advise that you step off that platform quickly. The consequences, I am told, are not pleasant. Shanthy has provided for the opening platform.

Through all of this, we have as a committee five broad objectives in mind for the next three days. The first is to hear from you and to have an opportunity to evaluate the information that will be presented from your oral and/or written presentations.

We also will be hearing from a number of invited guests today and tomorrow, and so the committee will be looking very carefully at the information that they bring us.

It also gives us an opportunity to update for each of the working groups that have been involved with various of the guidelines, since our last meeting, an opportunity to update the entire committee on the review of their work. It gives us an opportunity to assure the committee the opportunity to review various options that are under consideration that are based on information that has been reviewed by each of the working groups to date.

Thus, I want to stress that we are still in the information gathering stage of our deliberations. We still have at least two more meetings, possibly even three, but I do not think that three will be necessary. Nonetheless, we have at least two more before we reach any final recommendations.

Lastly, we would like by the end of the three days to reach a consensus regarding the format of our report to the Secretary and to begin the development of outlines that address each of the report's sections.

All of this process and achieving these aims and in the presentations we are about to hear, I would like to ask each of you to concentrate or focus your attention primarily on information that has been obtained since 1995.

To the extent that we need additional information from previous studies to help interpret that context, that is great, but our primary goal is to evaluate information that has come up since 1995, not necessarily to second-guess the scientific judgments that have gone before us.

Certainly if there is data that would cause us to relook at some of those judgments we ought to, but our principal focus should be assessing data that has been developed since the last guidelines were formulated.

With that very brief introduction, I would like to ask any of the committee members if they would like to add anything before we turn to the first organization that will be presenting?

If not, then let's begin. Again just to refresh everybody's mind in case the horror of it caused you to forget, you have three minutes. The orange light comes out at two and a half, and then the red light comes on at three.

Our first presenter is Ms. Kathryn Carroll. I would ask that you please state your name clearly, the organization that you are representing, because those individuals that are transcribing need to make that part of the record.

MS. CARROLL: Sure. Can you hear me? I am Kathy Carroll with the American Dietetic Association.

The American Dietetic Association commends USDA, HHS and the Dietary Guidelines Advisory Committee for their work on the Year 2000 Dietary Guidelines for Americans. We recognize the difficulty of adhering to the science while providing understandable and applicable messages in an increasingly complex and confusing environment.

We urge the committee to continue to base the guidelines on sound scientific evidence. We stand ready to assist in translating that science from the textbook to the table. Our written comments provide additional detail to augment these verbal ones.

ADA feels strongly that variety should remain the cornerstone of the guidelines. Because a variety of foods are needed for health, it is vital that the total diet be emphasized. We urge the committee to state that all the guidelines are important. One does not take precedence.

The guidelines should reinforce the importance of grain, vegetable and fruit consumption, but not to the exclusion of other nutrients and foods, such as non-fat and low-fat foods within the dairy and meat/meat alternative groups.

ADA feels strongly that optimal nutrition and physical activity can promote health and reduce chronic disease. Physical activity goes hand in hand with sound nutrition, and the guidelines should continue to reflect this interrelationship.

Advice on serving sizes should be strengthened and reinforced throughout. The guidelines should encourage achievement and maintenance of a healthy weight through expanded information on serving sizes and portion control in a variety of settings, including restaurants.

ADA feels strongly that eating well is more than nutrient selection. The importance of pleasure and emotional satisfaction should be acknowledged throughout as well.

ADA concurs with the 1995 guideline on alcohol, which includes a balance of positive and negative effects of drinking. We urge the committee to explore the risks and benefits of moderate alcohol consumption among those at higher risk for certain diseases.

ADA supports the language in the 1995 guidelines on supplements and recognizes some subpopulations may require supplementation to meet certain nutrient needs. Research continues to show that most Americans can lead healthy lives by eating a variety of foods and being physically active.

In addition, the current legislative and regulatory environment governing dietary supplements lacks sufficient controls. A separate guideline, regardless of the message, could prove very confusing to consumers and potentially unsafe if misunderstood and misapplied.

Given the scope of consumer concern about food safety, ADA urges the committee to consider adding food safety messages in an informative, but not alarming, way. In light of the need to keep the number of guidelines manageable, we do not support a separate food safety guideline, however.

ADA is ready to assist in developing scientifically based and consumer focused guidelines. We look forward to working with government agencies and other organizations such as the Dietary Guidelines Alliance inputting the dietary guidelines into practice.

CHAIRMAN GARZA: Thank you.

Ms. Margo Wootan?

MS. LEIBMAN: I am Bonnie Leibman from Center for Science in the Public Interest.

The sugar guideline needs more strengthening than any other because the advice is weak, and intakes of sugar, added sugars, are going through the roof. Added sugars now comprise 16 percent of the average American's calories and 20 percent of the average teenager's calories.

The guideline should make a clear distinction between foods rich in added sugars versus fruits and low-fat dairy products which are rich in naturally occurring sugars, but are associated with a lower risk of disease.

In contrast, foods rich in added sugars displace healthy foods as illustrated by the steep rise in soft drink consumption and steady fall in milk consumption. Analyses of USDA's 1987-88 data indicate that adults age 25 to 50 who consume the most added sugars are less likely to get the RDA for iron, zinc, calcium, vitamins E, B6, B12, thiamine, riboflavin and niacin than those who consumer lower, moderate amounts of added sugars.

The high sugar consumers would probably also have fared worse for folate, Vitamin A and Vitamin C if that analysis had not lumped fruit sugars in with added sugars and if the analysis had used current sugar intakes, which are higher than they were in the 1980s.

Foods rich in added sugars also contribute to the nation's epidemic of obesity because they are typically calorie dense. Furthermore, recent studies suggest that people may not compensate for the calories in liquid foods like soft drinks as well as for the calories in solid foods.

An analysis of NHANES III found that overweight boys and girls consume a greater percentage of their calories from soft drinks than normal weight children. For years, the sugar industry has argued that high sugar consumers are skinnier, but that relationship is probably confounded by age.

Foods rich in added sugars also contribute to heart disease because they raise triglycerides more than other carbohydrates, at least in the growing fraction of the population that is insulin resistant.

The guidelines should tell the public how much added sugar is moderate. Like the food guide pyramid, it should urge people to "limit added sugars to six teaspoons a day if you eat about 1,600 calories, 12 teaspoons at 2,200 calories, or 18 teaspoons at 2,800 calories."

The sodium guidelines should elaborate on the evidence that salt raises blood pressure, especially the evidence from clinical trials. The guidelines should also point out that one out of two Americans age 60 or older has high blood pressure, and millions more have higher than optimal blood pressure, which raises the risk of heart disease and stroke.

The guidelines should also urge people to look for foods labeled healthy, like Healthy Choice and Campbell's Healthy Request soups. FDA allows healthy foods to contain no more than 480 milligrams per serving. That regulation has single-handedly given consumers an alternative to high salt soups, processed meats, frozen dinner and other foods. The success of these brands show that if it has to, the food industry can cut sodium levels and maintain taste.

We suggest changing the title of the fat guideline to choose a diet low in fats, especially saturated fat, transfat and cholesterol. The text should explain which foods contain transfat and also explain that ground beef is a major source of saturated fat in the average American's diet, and ground beef labeled 80 percent or 85 percent lean is still high in saturated fat.

Finally, the guidelines should address the extremely high levels of salt, sugar and sodium in restaurant foods. The tips in each guideline --

CHAIRMAN GARZA: I am afraid I have to interrupt.

MS. LEIBMAN: Okay. Well, anyway.

CHAIRMAN GARZA: Sorry.

MS. LEIBMAN: That last sentence you can read. Thank you.

CHAIRMAN GARZA: That is much kinder than the platform opening beneath your feet.

MS. LEIBMAN: Okay. Thanks.

CHAIRMAN GARZA: Council for Responsible Nutrition?

MS. DICKINSON: This is a contest to see who can talk the fastest.

I am Annette Dickinson with the Council for Responsible Nutrition. CRN is a trade association of dietary supplement manufacturers whose members manufacture a large fraction of the dietary supplement products available to you in supermarkets, drugstores, discount department stores, health food stores, direct sales and mail order.

In 1998, we submitted extensive comments urging the Dietary Guidelines Committee to recognize nutritional supplements as an important tool in assuring desirable intakes of key nutrients. We provided copies of our publication, Optimal Nutrition for Good Health, Benefits of Nutritional Supplements.

Today we want to remind the committee of the importance of fairly recognizing the contribution of supplements and draw your attention to two new developments in this area. One is the formation of a national campaign on folic acid. The other is the recent development of a new food guide pyramid for seniors which features a pennant on top to flag the importance of supplementation of some specific nutrients.

The National Campaign on Folic Acid, under the leadership of the March of Dimes and the CDC, is launching a major campaign to make all women of childbearing age aware of the importance of folic acid in preventing neural tube birth defects. But, as we all know, awareness is only one part of the puzzle. The key is to change behavior.

Another goal of the National Campaign on Folic Acid is to create an environment in which taking a multivitamin with folic acid everyday becomes the community norm, along with improving dietary folate intake and using foods fortified with folic acid.

We have provided copies of the draft advertising copy and the brochure being developed by the National Campaign on Folic Acid, and we urge you to include language in the guidelines which are consistent with these messages.

The second development we wish to highlight briefly is the publication this month in the Journal of Nutrition of a new food guide pyramid for seniors developed by researchers at Tufts.

The guide is a departure from other pyramids in that it sits on a base of water, eight glasses a day recommended for everyone, but especially seniors, emphasizes whole grains over refined grains, focuses on richly colored vegetables rather than pale vegetables, and is topped by a pennant flagging the importance of several nutritional supplements for seniors, specifically calcium, Vitamin D and Vitamin B12.

We urge this committee to consider these advances as you think about dietary guidelines for the year 2000. As emphasized by both of these developments, nutritional supplements are achieving a level of acceptance which should make it easier for this Dietary Guidelines Committee to move forward with language in the year 2000 revision which specifically acknowledges supplements as an important source of nutrients which are difficult to obtain from diet alone.

Thank you.

CHAIRMAN GARZA: Thank you.

The Dietary Guidelines Alliance?

MS. SOWA: Good morning. I am Jeanne Sowa, Group Director of Consumer and Marketing Services for the American Dietetic Association, but today I am here on behalf of the Dietary Guidelines Alliance to provide a consumer communications perspective to your deliberations.

Four years ago, 17 organizations from the food industry, the health community and the Federal Government joined forces to promote the Dietary Guidelines for Americans. The result is the Dietary Guidelines Alliance, a public/private partnership with the mission of supporting the guidelines by helping consumers incorporate them and making them actionable in their everyday lives.

We applaud the Advisory Committee's dedication to continue to base the guidelines on sound science and consensus. Many in this room agree that consumers are still confused about how to use the guidelines. Repeatedly we hear appeals to communicate the guidelines in meaningful and motivating ways.

Our experience working with the 1995 guidelines and conducting consumer research show that consumers need nutrition messages that are simple and practical. There is a large gap between what consumers say and what they do about eating and physical activity.

Consumers want more healthful lifestyles, but real or perceived obstacles of time, confusion, fear of giving up foods get in their way. We've also learned that consumers do not want to hear nutrition speak. They want empowering, useful messages and tips that resonate with their core values.

Based on this research, the Alliance launched a broad scale campaign for consumers called It's All About You. The campaign was designed for consumers by consumers, and they shaped the core messages, these being -- be realistic, be adventurous, be flexible, be sensible and be active. These messages are designed to motivate positive change.

For the past two years, the American Dietetic Association has made these messages the cornerstone of our National Nutrition Month campaigns, and soon we will see the messages and the food guide pyramid on the $2 food stamp coupon book. We are completely a nutrition education tool kit that includes a unique owner's manual for the body. Again, consumer research is shaping and evaluating the kit.

I wish to leave you with these thoughts as you review the Dietary Guidelines for Americans. First, the Alliance pledges to continue its support of the dietary guidelines, and, secondly, we urge the Advisory Committee and all of us in the nutrition and health communities to listen to what consumers are telling us. They say give us positive, simple and consistent dietary messages that we can understand and use throughout our lives.

Thank you for your interest.

CHAIRMAN GARZA: Thank you.

Geiger & Associates?

MS. GEIGER: Good morning. It is a pleasure to be here. I am Constance Geiger, president of Geiger & Associates, a food labeling, health communications and government affairs consulting firm, and assistant research professor, Division of Foods and Nutrition, University of Utah.

I appreciate the opportunity to be here today to share the results of the Dietary Guidelines for Americans focus group study, which was funded by the International Life Sciences Institute's Human Nutrition Institute and upon which comments and advice was given to me by both USDA and the Department of Health and Human Services.

This research was a follow-up to the questions from the 1995 dietary guidelines, which I was asked to address at that time. One, what would be the effect of a two-tiered information approach on consumer attitudes and comprehension, and, two, how would consumers react to fewer dietary guidelines?

There was concern about consumer perception at that time. Therefore, this research examined consumers' reactions to and understanding of the bulleted headlines of the dietary guidelines as a whole and then each individual guideline. And then we also looked at consumers' reactions to potential changes in the guidelines and alternative wording for some of those, and, thirdly, consumers' reactions to three different formats for the dietary guidelines. The committee has a full copy of the report, which is being prepared for publication.

In terms of some of the selected results, consumers are confused by several of the guidelines' messages. First, the message to maintain or improve your weight does not make sense to them.

Second, to some focus group respondents the term balance with respect to high-fat foods conveys permission to balance high-fat foods with other high-fat foods instead of balancing -- that was quite of interest to us. Instead of balancing low-fat foods with high-fat foods.

Consumers are also frustrated because they think dietary advice should be restrictive, but they do not believe the advice is realistic or achievable, and they do not appear to understand how to apply the dietary guidelines to an eating pattern. Respondents are also receptive to changes in the guidelines as long as they are supported by research, so you can make changes.

The respondents reacted to three different formats for the guidelines based on the deliberations of the previous Dietary Guidelines Committee. Again, I was asked to address those in 1996.

Most respondents do not care for the current format; that is the list of the seven statements -- you have those formats in the handout I just passed around -- because it provides too much information. It cannot be read quickly and does not hold their interest.

The two-tiered format is considered easier to read. People like the grouping by importance. The final format is the most preferred. Short, and easy to follow are most important. It contains the most important information. Almost all of the guidelines could be better communicated to the public, and the format of the guidelines could be changed to make them more useful to consumers.

Thank you for considering our comments today.

CHAIRMAN GARZA: Thank you.

International Food Information Council?

MS. BORRA: Good morning. I am Susan Borra from International Food Information Council. We are a nonprofit organization based here in Washington, and our mission is to communicate science-based food safety and nutrition information. Our programs are supported by the broad based food and beverage industry.

We do support the Dietary Guidelines for Americans, but when we look at government data, that data shows us that only one percent of Americans are eating according to food guide pyramid recommendations. Therefore, that tells us that we all must work together to make the science-based recommendations much more useable for consumers so that they can improve their diets and ultimately their health.

At IFIC, we conduct both quantitative and qualitative research, consumer research, in order to assist in understanding their concerns and behaviors regarding food nutrition and food safety. Last August, IFIC conducted consumer focus groups with adult women about dietary guidance messages. We were especially interested in their perceptions about dietary fats. We discovered the following.

While we knew consumers would tell us if they were confused, which they did, we were amazed at the extreme guilt, worry and fear evoked about their diets and those of their families. Guilt about eating habits results from feelings that they are not doing what is expected of them or what is right. Worry and fear emerge from thinking about the effects of not eating a healthy diet. Other feelings include helplessness, anger, deprivation and frustration. That is what they told us.

Next we shared the dietary guidelines' message, choose a diet low in fat, saturated fat and cholesterol. Consumers interpreted this message as no fat, no taste, no enjoyment and not attainable. Most felt this meant a diet with as little fat as possible, which was an unrealistic prospect for them.

Now, by simply substituting the word moderate, as in choose a diet moderate in fat, saturated fat and cholesterol, this promoted common sense and responsible choice. These consumers believed that a moderate-fat diet was motivational and doable, while a low-fat diet was not achievable.

By encouraging a moderate rather than a low-fat diet, we may be more effective in building consumer confidence that they can indeed achieve a healthful diet. Moderation works with consumers.

Similarly, consumer research on sugars found that adults believe that a healthy diet can include sugar- containing foods in moderation, a concept that reflects current dietary advice.

Looking toward the future, consumers want information about how foods can promote optimal health. The committee really has an opportunity to help Americans understand functional foods, foods that promote health benefits beyond basic nutrition. This will provide consumers with additional choices to meet dietary goals.

The committee is also considering including food safety in the guidelines. Our research shows that consumers want diet and health messages that incorporate safe food handling. With escalating interest in food safety fundamentals, along with nutrition, the committee can provide leadership to empower consumers to handle food properly via the guidelines and other nutrition education vehicles.

I thank you for the opportunity this morning.

CHAIRMAN GARZA: Thank you.

Klugman?

(No response.)

CHAIRMAN GARZA: National Food Processors Association?

MS. APPLEBAUM: Good morning. I am Rhona Applebaum with the National Food Processors Association. NFPA is the principal scientific and technical trade association representing the food-processing industry.

As a scientific trade association, NFPA strongly supports the need for scientifically based dietary guidelines designed to promote the health and well-being of Americans. The dietary guidelines must be based on the best current science, and I underscore current science. If not, they run the risk of being nothing more than folktales.

These guidelines are too important to the health of our nation to be based on anything less than the best current science available, and we applaud the Chair in his direction to the committee to focus on information 1995 and on.

In addition to the guidelines being science-based, NFPA considers it essential that the guidelines be easily understood, easily managed and motivational. Until consumers understand the advice, are convinced of the benefits the guidelines can deliver and incorporate them into their daily lives, the guidelines will continue to be ineffective. Consequently, it is imperative the guidelines trigger action by consumers.

The question before us is how can the guidelines evolve from mere recommendations to motivational tools? NFPA recommends strongly that the committee request the government agencies to review the literature for any research that enumerates criteria needed to produce behavioral change in consumers.

This information, if it exists, should be combined with findings from the work of the Dietary Guidelines Alliance, as well as others, in order to prompt behavioral changes in consumers. In the absence of such research, we strongly urge it be undertaken as soon as possible.

In addition, the guidelines in their current form do not adequately provide Americans with a priority listing of targeted recommendations to serve as a foundation for a healthful diet and lifestyle. The laundry list of recommendations is simply too unwieldy, too difficult for consumers to manage as part of their busy and hectic lives.

To facilitate acceptance and internalization of these recommendations by consumers, NFPA urges the committee to employ a two-tiered approach to presenting the dietary guidelines. The first tier, the foundation, would include those guidelines judged most important. The second tier will include those less critical.

In our view, the first tier would consist of three guidelines, those being -- eat a variety of foods, engage in physical activity to maintain or improve weight, and choose a diet with plenty of grain products, fruits and vegetables. These three guidelines set the foundation for consumers who can then advance to the second tier of guidelines.

Time constraints permit me to focus on only one other guideline, the guideline on salt and sodium. In brief, NFPA believes this should be removed. Current science does not support a policy of universal sodium restriction for healthy, normotensive Americans to prevent hypertension and reduce the risk of cardiovascular disease.

In conclusion, NFPA believes the dietary guidelines provide important public health messages to consumers. We believe they should be scientifically based, easily understood, easily managed and trigger behavioral change.

To sum up, they should be short, sweet -- yes, we also have issues with the guideline on sugar, but that is commentary for another day -- and, most important, motivational action items.

Thank you for this opportunity to address these important issues. We will provide more substantial input on these issues in our written comments. Thank you.

CHAIRMAN GARZA: Thank you.

The Nebraska Association of Family and Consumer Sciences?

(No response.)

CHAIRMAN GARZA: Physicians Committee for Responsible Medicine?

(No response.)

CHAIRMAN GARZA: Society for Nutrition Education?

MS. PENNINGTON: Good morning. My name is Jean Pennington. I am president of the Society for Nutrition Education. The Society is pleased to address the Dietary Guidelines Advisory Committee, and we are proud to have three SNE members among you.

The mission of SNE is to promote healthy, sustainable food choices. The vision is healthy people and healthy communities. We provide forums for nutrition educators to exchange and share innovative ideas, disseminate research findings and advocate for public policy concerning nutrition education programs and food service programs.

SNE members are a diverse group, holding positions in academia, government and private industry in the U.S. and other countries. We translate the science of nutrition into practical messages and communicate those messages to target audiences, including students, patients, clients, parents, families, other educators, and policymakers.

Our members are effective in encouraging behavior change so that nutrition messages become incorporated into healthier lifestyles. Because of the diverse views of SNE members, we will not make comments on individual guidelines, but wish to make general comments regarding the communication of nutrition messages to the public.

First, we recognize that the dietary guidelines must be based on sound science and understand that science evolves and changes. We urge the committee to be willing to adapt the guidelines' messages to match the evolving science and to have the message tested on audiences diverse in age, ethnic group and educational level to determine if the intended meanings are correctly interpreted.

Second, we encourage the committee to review not only nutrition science research, but nutrition education research, such as the papers published in the Journal of Nutrition Education, to have a better understanding of how population groups understand and interpret nutrition information.

Third, we know well that imparting information is not sufficient to change patterns or behavior related to eating or physical activity. We request that the committee design the guidelines for people at varying stages of readiness to make behavior change and to address the environmental as well as the personal supports for behavior change.

Fourth, we ask that you look at the nutrition education tools that have been developed and tested by nutrition educators to determine what works and identify potential barriers to behavior change. Lastly, we ask that you focus on messages that are active, practical and positive.

SNE members rely on the dietary guidelines as a primary educational tool to convey nutrition information to the public. We offer two items for your use. One, we have prepared a list of papers published in the Journal of Nutrition Education and other journals over the past five years that relate to message interpretation, behavioral modification and educational tools.

Secondly, we have a list to obtain quick response from our members. We would be pleased to put any questions or requests that the committee might have and provide timely responses from a wide range of nutrition educators.

We thank you for considering our comments and wish you well in your deliberations.

CHAIRMAN GARZA: Thank you.

Dairy Management, Inc., the National Dairy Council?

MS. CRAIG: Good morning. My name is Suzanne Craig. I am a registered dietician responsible for nutrition and health promotion for the National Dairy Council.

Since its founding in 1915 by the nation's dairy farmers, the National Dairy Council has funded nutrition education and nutrition research projects and provided health professionals with nutrition information based on sound sciences. References for all my remarks are found in the written version of our comments.

Ladies and gentlemen, our nation is in a calcium crisis. As many as seven out of ten pre-teen and teen girls and six out of ten preteen and teen boys in the United States are not drinking their milk. As many as nine out of ten adult women in their childbearing years are not getting enough calcium.

Many of us have experienced teenagers growing seemingly overnight. Children put on 15 percent of their adult height during their teen years. That could be nine to ten inches. What is not so visible is that 45 percent of their bone density mass is forming as well. Bone density formation continues until about 35, provided there is adequate calcium in the diet.

Recognizing the critical need for calcium during the growth years, a National Institutes of Health expert panel a few years ago recommended that calcium consumption be increased. The National Academy of Sciences increased their recommendations for calcium two years ago.

Calcium is also essential in disease prevention. Osteoporosis is a painful and crippling disease that affects 25,000,000 Americans, and it is not just a woman's disease. We are finding that one out of five men will also get osteoporosis.

Higher intakes of milk and other dairy foods during childhood are linked with greater bone density and a reduced risk of hip fractures and osteoporosis in later years, and recent research is also showing that milk and calcium helps in reducing hypertension. It has been found that a diet rich in low-fat dairy foods and fruits and vegetables may be an alternative to drug therapy for some people with hypertension.

Other research indicates dairy foods may prevent colon cancer, kidney stones and lead intoxication. Milk and other dairy foods are rich sources of calcium, along with other essential nutrients, including vitamin D essential for nutrition for calcium absorption.

Use of supplements to meet calcium needs is a pharmacological rather than a natural dietary approach. Many calcium supplements do not contain vitamin D. Diets with adequate amounts of dairy foods also provide significant amounts of riboflavin, complete protein, zinc, potassium, vitamin A, magnesium and vitamin B6. Milk and dairy foods are readily available in all communities.

On behalf of the National Dairy Council, thank you for this opportunity to provide comments today.

CHAIRMAN GARZA: Thank you.

The Egg Nutrition Center?

MR. MCNAMARA: Good morning. I am Donald McNamara, the Executive Director of the Egg Nutrition Center. I thank the committee for the opportunity to address the role of dietary cholesterol and heart disease risk.

Clinical studies show that dietary cholesterol really has only a small effect on plasma cholesterol levels in most people. In 166 cholesterol feeding trials in 3,498 subjects, the average plasma cholesterol response was a 2.3 milligram per deciliter change in plasma cholesterol for 100 milligram change in dietary cholesterol. This response is shown to be independent of dietary fat type and amount and of the patient's baseline plasma cholesterol level.

However, we recognize there are individuals who are sensitive to dietary cholesterol. It is estimated that 15 to 25 percent of the population has the inability to compensate for a dietary cholesterol challenge. That would indicate that 100 milligrams per day of dietary cholesterol changes plasma cholesterol by four milligrams per deciliter in that 20 percent of the population who is sensitive, but only 1.5 milligrams per deciliter in the 80 percent of the population who is insensitive.

It has been suggested that dietary cholesterol contributes to heart disease risk independent of its effects on plasma cholesterol. Recent reports from the seven country studies, the Framingham heart trial, Mr. Fidd and the Lipid Research Clinic's prevalence trial, all support no significant relationship between dietary cholesterol and plasma cholesterol levels or heart disease incidents.

Analysis of the nurses' health study, the health professionals' follow-up study, the alpha-tocopherol, beta- carotene cancer study also report no significant relationship between dietary cholesterol and cardiovascular incidence. There is no consistent evidence supporting an independent effect of dietary cholesterol.

The question is whether dietary cholesterol restrictions are needed for the general population since half the population has cholesterol levels below 200, and 75 percent of those with cholesterol levels above 200 are insensitive to dietary cholesterol.

While dietary cholesterol does have a statistically significant effect on blood cholesterol levels, the epidemiologic data indicate that this has little biological importance. This is the conclusion drawn in 17 of 27 dietary guidelines from other industrialized countries, which do not include dietary cholesterol restrictions.

An emphasis on dietary cholesterol diverts attention away from effective dietary changes, while limiting the contribution of low-fat, high-cholesterol products such as eggs to the nutrient value of the diet.

With regard to eggs, international data of cardiovascular mortality and per capita egg consumption indicate a significant, but negative, relationship. NHANES III shows that eggs provide more nutrition than calories with high-quality protein and 22 different vitamins and minerals.

Exclusion of eggs from the diets from growing children, the elderly and low-income families can negatively impact the nutrition well-being of these subgroups. I believe the evidence shows that undue restrictions of dietary cholesterol, and indirectly eggs, have little benefit and potential concerns.

Thank you.

CHAIRMAN GARZA: Thank you.

National Cattlemen's Beef Association?

MS. YOUNG: Good morning. My name is Mary Young. On behalf of the National Cattlemen's Beef Association, it is a privilege to participate in today's discussion. I will highlight the nutrient contributions of red meats to the diet of today's consumers.

Red meats are one of nature's most nutrient dense foods. A three-ounce serving of beef contributes less than 10 percent of calories to a 2,000 calorie diet. Yet it supplies more than 10 percent of the RDAs for protein, iron, zinc, niacin, vitamins B6 and B12, and does so in a highly absorbable form.

Of red meat's nutrient contributions, iron often is most trumpeted, perhaps because iron deficiency is the most common nutritional deficiency in the United States, affecting 7.8 adolescent girls and women of childbearing age and 700,000 children who are one to two years old.

In a CDC report on preventing iron deficiency, scientists wrote, "In children, iron deficiency causes developmental delays and behavioral disturbances, and in pregnant women it increases the risk for pre-term deliveries and delivering low birth weight babies."

Hemiron, found only in the meat group, is two to three times more absorbable that non-hemiron found in plant- based foods, and hemiron in cooked red meat can be as high as 70 percent, while white meat is less than 25 percent.

Deficiencies in zinc are equally prevalent. According to USDA's 1995 CSFII, only 26.7 percent of Americans are meeting the dietary requirement for zinc. Deficiencies can delay cognitive and physical development and decrease immunity, among other things. Since nearly half of the most highly available zinc in the food supply comes from the meat group, it is not surprising that studies have linked deficiencies to meatless diets.

Red meats also are a significant source of vitamin B12, contributing 62 percent of this nutrient to the food supply, while plant sources, including soy, contribute very little physiologically active B12, and B12 deficiencies can be extremely serious.

The Bogalusa heart study shows red meats enhance diet quality. The percentage of individuals meeting at least two-thirds of the RDA for key nutrients was greatest among those in the upper quartile of meat consumption.

There is a perception that Americans over-consume meat. However, few people actually meet minimum needs. Data from CSFII reports that on average, Americans eat 2.6 ounces or red meat daily. It is often what is missing from the diet that has long-term health implications.

The meat industry agrees Americans need to consume more whole grains, fruits and vegetables, but not at the expense of foods like red meat that provide key nutrients deficient in American's diet.

It is also important to note that red meat contributes functional components such as selenium and conjugated linoleic acid to the diet. According to the Journal of the American Dietetic Association, beef is the number one source of protein, B12 and zinc in the diet.

In conclusion, in a very small package, red meat plays a major role in meeting the nutrient needs of Americans, which demonstrates the essential nature of including red meat in a varied diet.

Thank you.

CHAIRMAN GARZA: Thank you.

National Pork Producers Council?

MR. HENTGES: Eric Hentges, National Pork Producers Council.

Fat, saturated fat and cholesterol are integral components of all meat and meat products. Nature put them there. Currently, 25 percent of total caloric intake comes from the discretionary fat at the pyramid tip. Meat and poultry fat contribute 9 percent of the total caloric intake.

It is common, even in scientific circles, to hear saturated fats are animal fats. However, the predominant fatty acid class in meat is monounsaturated, accounting for half of the fatty acid composition. Furthermore, one-third of meat's saturated fatty acid content is stearic acid. This is important because stearic acid does not elevate serum cholesterol.

The December 1994 supplement of the American Journal of Clinical Nutrition on stearic acid documents the lack of effect stearic acid has on serum LDL cholesterol concentration. The review also suggests a lack of effect of stearic acid upon thrombosis and coagulation factors. Despite this evidence, for regulatory purposes stearic acid is still classified with saturated fatty acids known to elevate serum cholesterol.

The meat industry has supported numerous research projects since the mid 1980s that look at meat's inclusion in an NCEP step one diet. Most recently, abstracts from the latest studies have been published in the Journal of the American College of Nutrition, October 1995, American Journal of Clinical Nutrition, July, 1997, and Circulation, October, 1998.

Like the many studies before them, these recent studies document that a step one diet plan containing lean beef and pork in servings consistent with the food guide pyramid can be effective in lowering serum lipids. Current research also is discovering that meats, not just plant foods, contain functional properties.

I am referring to conjugated linoleic acid or CLA, a natural derivative of the fatty acid, linoleic acid. Initial interest in CLA was in CLA's anticarcinogenic effects. In animal studies, as little as .1 percent CLA in the diet was sufficient to cause significant reduction in mammary tumors. Recent interests have turned to CLA's influence on body fat accretion. Studies with mice, rats, chicks and pigs have shown decrease in body fat accretion and increase in lean muscle.

Finally, with feeding, breeding and fabrication, the industry has reduced the amount of fat in the fresh meat case by 31 percent for pork and 27 percent for beef. Currently, 24 percent of lunchmeat purchases are low-fat products. These changes resulted in complete overhauls of USDA's nutrient database for these products.

In conclusion, these data do not support any substantial change to the fat intake guideline, significant changes to the content or quantification of the guideline. The recommendations --

CHAIRMAN GARZA: I am afraid I have to interrupt.

MR. HENTGES: -- are not scientifically justified. Thank you.

CHAIRMAN GARZA: Physicians Committee for Responsible Medicine?

DR. BARNARD: Good morning. Please review our letters of support from the Congressional Black Caucus, former Surgeons General Joycelyn Elders and C. Everett Coop, Martin Luther King, III, Jesse Jackson, Jr., --

CHAIRMAN GARZA: Please identify yourself.

DR. BARNARD: I am sorry. I am Dr. Neal Barnard, as listed in the program.

-- Mohammed Ali, Alice Walker, leading physicians and many minority health organizations.

Since 1916, federal food guides have promoted dairy products, but in the 1960s and 1970s research established that most members of racial minorities are unable to digest the milk sugar, lactose.

Lactose intolerance occurs in more than 50 percent of Hispanic Americans, 70 percent of African Americans and Native Americans, and 95 percent of Asian Americans, but in only about 15 percent of Caucasians. African Americans are not only much more likely than whites to have lactose intolerance. When it occurs, they are much more likely than affected whites to have pain, diarrhea and bloating.

Dairy industry research studies suggest that spacing out dairy products during the day and consuming them with other foods can reduce the problem, but what they avoid pointing out is that many people still have serious symptoms.

Nearly half of their research participants have dropped out, presumably due to symptoms, and their research has largely excluded African Americans. Indeed, African Americans have also been excluded from nearly every calcium and milk study due to better bone density and lower rates of osteoporosis.

Milk consumption is in fact poor protection against osteoporosis. In the Harvard nurses' health study of 78,000 women followed prospectively for 12 years, those who got the most calcium from dairy products had slightly, but significantly, more fractures compared to those who drank little or no milk, even after adjustments for weight, menopausal status, smoking and alcohol use.

A 1995 study of 10,000 elderly women reached similar results, as have other studies. Studies suggesting any benefit of milk have often been confounded by vitamin D supplemented to milk.

Dairy products should be considered optional and in no way superior to other calcium sources, such as green, leafy vegetables, beans and other legumes or fortified fruit juices for those who may choose them.

Our second key point is that diet related diseases take a disproportionate toll among minorities, despite the fact that nutrient intakes are similar. Diabetes prevalence is high among minorities. Prostate cancer is especially common among African Americans, yet the current guidelines promote the very meat and dairy diets that increase the risk of these problems in the first place.

Stronger dietary guidelines are essential. For example, ischemic heart disease rates are high among middle- aged African Americans and Hispanic women. Diets adhering to the guidelines clearly foster heart disease progression, while vegetarian diets promote disease reversal. Hypertension also takes a disproportionate toll, yet African Americans who switch to a vegetarian diet cut their risk in half.

Those who may wish to reduce their risk of disease by increasing their use of vegetables, fruits, whole grains and legumes or by reducing or eliminating the use of meats, dairy products and fatty foods should be encouraged to do so by the federal dietary guidelines. The guidelines have unintentionally --

CHAIRMAN GARZA: I have to interrupt.

DR. BARNARD: Thank you very much.

CHAIRMAN GARZA: Thank you.

Before moving on to the next speaker, I have a brief question to staff. Have we had anyone register that wants to make a presentation, Shanthy, to the committee that was not pre-registered? I am trying to look at time and see how we are going to be.

DR. BOWMAN: I don't think there's any one else.

CHAIRMAN GARZA: No one that you are aware of?

DR. DWYER: Dr. Garza, I had been contacted from Dr. William Grant earlier, who is not listed here.

CHAIRMAN GARZA: So we only have one then. Okay.

Looking at how we have been using time, I am going to stop just for a few minutes to ask the committee if they have any questions of anyone that has spoken previously?

I will be taking questions after every five presenters because I think we are going to have the flexibility in time.

Johanna?

DR. DWYER: I had a question for Donna Leibman.

CHAIRMAN GARZA: She just left.

DR. DWYER: The question was simply if corn syrup is what has gone up, then why talk about teaspoons because that is not how we eat or drink corn syrup?

CHAIRMAN GARZA: Okay. Are there any other questions?

Shanthy? Shiriki?

DR. KUMANYIKA: The presentation from the consumer research of the Alliance, I want to clarify whether the responses of consumers are to the pyramid or to the guidelines themselves because I think there is confusion about how to interpret some of the things on the pyramid, but that's not actually our domain so I would just ask people to clarify that whenever it is appropriate.

FEMALE VOICE: Yes. The clarification is what is on the guidelines.

DR. KUMANYIKA: On the guidelines? Okay.

FEMALE VOICE: Yes.

DR. KUMANYIKA: Thank you.

CHAIRMAN GARZA: Dr. Lichtenstein?

DR. LICHTENSTEIN: With respect to the comments from the Council for Responsible Nutrition, I would like to point out that written in the text for that pyramid that was recommended for older individuals with the flag on the top for supplements, that was clearly stated as optional and that one needs to consider various conditions that are more prevalent in the elderly like achlorhydria and the impact on B12 absorption, so it was not recommended for everyone.

CHAIRMAN GARZA: Any other comments or questions?

If not, everyone understood Dr. Shiriki's comment about distinguishing between the pyramids and the guidelines. It is the purview of this committee to make recommendations to both departments related to the guidelines, but in fact we do not formulate the pyramid.

The pyramid is based on the guidelines, but it is totally in the purview of the Federal Government. They do not rely on us theoretically at least on advice for the construction of the pyramid itself. It is the teaching tool for the guidelines.

I think I have that correct. I will turn to both agencies to make sure.

DR. KENNEDY: Do you want a response on that?

CHAIRMAN GARZA: Yes. I think that needs to be clarified.

DR. KENNEDY: I always present it as there are three parts to how the pyramid is developed. Number one, Dr. Garza is absolutely right. It is the most recent Dietary Guidelines for Americans.

Secondly, it is also the nutrient needs, and, thirdly, it is looking at current consumption patterns, trying to deviate in the least possible way in meeting nutrient needs in dietary guidelines.

I bring that out because as we talk in global forum, I mean clearly there are an infinite number of combination of foods that could be used to meet both our dietary guidelines and nutrient needs, but it is anchored to the current consumption patterns of Americans.

CHAIRMAN GARZA: Thank you.

We will move on. USDA Human Nutrition Center for Aging at Tufts University?

MR. BLUMBERG: Good morning. I am Jeffrey Blumberg, a professor in the School of Nutrition, Science and Policy and a researcher at the John Meiere USDA Human Nutrition Research Center on Aging at Tufts University.

In addition, since last year I have served as a member of the Scientific Advisory Board of the Egg Nutrition Center, a resource for scientifically accurate information on egg nutrition supported by a cooperative agreement between the American Egg Board and the United Egg Producers.

Among older Americans, there is an increased risk of malnutrition and evidence of subclinical deficiencies with a direct impact on physiologic function. Critical risk factors of malnutrition among older adults are their declining need for energy due to a reduction in the amount of lean body mass and a more sedentary lifestyle.

Decreasing energy intake with advancing age has important implications for the diet in terms of protein and micronutrients. There is a substantial gap between nutrient consumption common among older adults and the recommended intakes from diets associated with health promotion and the prevention of chronic disease.

New dietary guidelines sensitive to the needs of the elderly should emphasize the value of high-quality nutrient dense foods. Eggs are a nutrient dense food. A single egg can provide 10 percent of the requirement for protein and serve as a rich source of several vitamins, for example, providing 15 percent of the riboflavin, 8 percent of the vitamin B12 and 6 percent of the vitamin D and folate required by older adults, all in about 70 calories.

Eggs are also a good source of bio-available lutein and zeaxanthin, two carotenoids associated in recent research with a lower risk for age-related macular degeneration.

Eggs also present a number of features which make them a sound part of a balanced diet for most older adults. They are lower in cost than most other animal protein foods and so can be served occasionally as an alternative to meat, poultry or fish to keep a food budget affordable.

The single serving packaging of eggs makes them convenient to store and prepare, especially for older people who live alone. Eggs are also easy to chew so that older adults with dental problems and/or dysphasia will experience less problems eating them than meat or poultry. Importantly, eggs are perceived by many older adults as a welcome part of a traditional American diet and thus not a food choice where compliance with recommendations is difficult.

Eggs are a significant source of dietary cholesterol, and the impact of egg consumption must be considered by those with levels of serum cholesterol which place them at risk for heart disease. However, it is important to recognize that people who eat eggs are consuming a complex food, one that has high-quality protein, various mono and polyunsaturated fatty acids, micronutrients and carotenoids.

Specifically restricting only one food, that is eggs, in the Dietary Guidelines for Americans would discourage people from any consumption despite their value as a nutrient dense food.

The reputation of eggs as a significant factor for heart disease for all Americans is not founded in scientific fact, and recommendations that they be avoided by everyone are misguided. Eggs can readily be incorporated into a healthful diet and help increase the nutrient density of the diet.

Thank you.

CHAIRMAN GARZA: Thank you.

American Obesity Association?

MR. DOWNEY: Good morning. I am Morgan Downey, and I am the Executive Director of the American Obesity Association. It is a pleasure to be here today and hopefully help you with your work.

The American Obesity Association was founded in 1995 to advocate for the interests of persons suffering with obesity. By today's date, we have nearly 22 percent of the adult American population is obese. Over half is overweight and incurs the risk of obesity. Twelve to 14 percent of children suffer with obesity.

I appear before you today much like Mark Twain might have observed that everybody talks about obesity, but nobody does anything about it. That is certainly the case in Washington.

Obesity is second only to tobacco as the leading cause of preventable deaths in the United States, and it is responsible for over 300,000 to 500,000 preventable deaths each year.

It is also a major contributor to nearly 30 chronic diseases. Those include osteoarthritis of the knee and hip, rheumatoid arthritis, birth defects, breast cancer, cancer of the esophagus and gastric cardia, colorectal cancer, endometrial cancer, renal cell cancer, cardiovascular disease, carpal tunnel syndrome, chronic venous insufficiency, daytime sleepiness, end stage renal disease, gallbladder disease, gout, heat disorders, hypertension, impaired immune response, etc., down to Type II diabetes.

The full complement and description of the current medical literature is in your materials of statements we have provided.

We have several recommendations. One, we believe the dietary guidelines should recognize that obesity is the overwhelming dietary influence on major chronic disease. Two, the dietary guidelines should prioritize their recommendations to Americans to correct what we see as a false equality among all recommendations.

We also believe that the literature would support our belief that obesity is the major contributor to chronic disease in America and thus should receive major attention in a prioritization of the guidelines.

We believe that the section on weight should be retitled Achieve a Healthy Weight. The current title, Balance the Foods You Eat With Physical Activity, Maintain or Improve Your Weight, is unclear, awkward, and I believe does not directly affect the primary issue for some 22 percent of Americans, which is that they need to lose weight.

Finally, we believe that the dietary guidelines should be identified as being for adult Americans, and a separate dietary guideline should be established for children.

We believe that the recommendations should include a body mass index chart, not the current height and weight chart in the guidelines. That would be preferable, but not entirely adequate. We would recommend proceeding further to develop a profile based on a further consideration of the effects of weight.

Thank you.

CHAIRMAN GARZA: Thank you.

Georgetown University Center for Food and Nutrition Policy?

MS. STOREY: Good morning. My name is Maureen Storey. I am a faculty fellow with the Georgetown University Center for Food and Nutrition Policy.

The key point I would like to make before this committee is also provided in written testimony submitted to you by me and several of my colleagues, namely Drs. Robin Wu and Richard Forshi. I would also like to acknowledge my graduate student, Alexis Weaver, without whom we would not have these data.

Over the last several months, a great deal of media attention has been turned to the issues of obesity among children and carbohydrates as a chief villain in keeping our children and adults from having a healthier body weight. While this is a great media story, our data suggest that that is exactly what it is, a story, a fairy tale.

To get to the point, we recently examined the association between several dietary components and other variables on the body mass index of children ages six to 11 years. In our study, we used the Continuing Survey of Food Intakes by Individuals, CSFII, and performed bivariate and multivariate regression analyses to determine the association between children's BMI and these independent variables. There were 1,230 records from the children in the study.

These independent variables may also be categorized as those that are not modifiable and those that are modifiable. The nonmodifiable variables included gender, age and race. The modifiable independent variables included total energy intake, total fat, carbohydrate and protein intake, added sugars intake, servings of milk and television hours watched.

The bivariate regression analysis showed that children's BMI was not correlated with total energy intake, total carbohydrate intake or added sugars intake. We found a very small, but significant, correlation between children's BMI and total fat intake and hours of TV watched. However, only .4 percent of the variation in the children's BMI was predicted by total fat intake, and only 1.4 percent of the variation in BMI was attributable to TV hours watched.

The multivariate regression analysis showed that combining seven variables, including three dietary components, total energy, total fat and added sugars, with age, race, gender and TV hours explained only 6 percent of the variation in children's BMI.

In the multivariate model, BMI was positively correlated with age. This is no surprise. African American children had higher BMIs than other children. BMI increased by two-tenths of a BMI unit as TV hours watched increased.

To conclude, these data show that no single dietary component, including total energy, total carbohydrate and added sugars intake, contributes to increased BMI among children.

Based on our study, the Georgetown University Center recommends that the language regarding the importance of physical activity be strengthened.

CHAIRMAN GARZA: I apologize. I have to interrupt.

MS. STOREY: Thank you.

CHAIRMAN GARZA: National Coalition for Promoting Physical Activity?

MR. DAVIS: Good morning. I am Mike Davis, Executive Vice-President of the American Alliance for Health, Physical Education, Recreation and Dance, which represents over 60,000 educators.

I am pleased to be here today to represent the interests of the National Coalition for Promoting Physical Activity. NCPPA combines the force of more than 154 organizations in our efforts to inspire Americans to lead physically active lifestyles that enhance their health and quality of life.

Eight leading national organizations serve on NCPPA's board of directors, including my organization, the American College of Sports Medicine, the American Cancer Society and the American Heart Association. Together we are dedicated to addressing the need to increase the physical activity of all Americans in response to the 1996 Surgeon General's report on physical activity and health.

As the committee members know, this landmark report of the Surgeon General was issued since the last review of the U.S. dietary guidelines. We applaud the 1995 advisory committee for recognizing the importance of physical activity and weight maintenance and for including a guideline addressing the need to balance the food we eat with physical activity.

We look forward to the current committee's review and strengthening of these physical activity recommendations in light of the Surgeon General's report, the National Institutes of Health consensus development conference on physical activity and health, and the National Institutes of Health clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults.

We encourage the committee to craft recommendations that more strongly convey the role of physical activity in preventing obesity, assisting in weight maintenance and reducing chronic disease risk.

We know physical inactivity to be a major national public health problem. The Surgeon General's report established that nearly half of Americans 12 to 21 years of age are not vigorously active on a regular basis. More than 60 percent of American adults are not regularly physically active, and 25 percent are sedentary. Yet, as the Surgeon General also points out, physical activity reduces the risk of premature mortality, mortality in general and of coronary heart disease, hypertension, colon cancer and diabetes in particular.

Therefore, the Surgeon General recommends that all Americans include a moderate amount of physical activity on most, if not all, days of the week. The NIH consensus development conference reinforced these findings.

We encourage the Dietary Guidelines Advisory Committee to consider including this recommendation in the revised guidelines. Clearly, when an estimated 97,000,000 adults --

CHAIRMAN GARZA: Excuse me. I apologize. I have to interrupt.

MR. DAVIS: Thank you.

CHAIRMAN GARZA: Rutgers University, The Nutraceuticals Institute?

MR. LACHANCE: Thank you. I am Paul LaChance, professor of Food Science and Nutrition at Rutgers. I happen to be the Executive Director of the Nutraceuticals Institute also.

I have a couple of points I just want to get across which are I think important, and that is that I think that we need to reduce the number of dietary guidelines down to probably five or do a two-tier thing.

I am suggesting daily nutrient dense foods, particularly fruits, vegetables, legumes, seeds and nuts, along with basic cereal grain products. Look for fortified foods, especially if dieting, skipping meals or experiencing changing nutrient requirements.

Control body weight through proper selection of foods and daily activity, minimally walking briskly two miles a day. I think we should push details. Choose desserts and snack foods that are moderate in saturated fat, sugars or salt, and, if you drink alcohol, do so in moderation.

One of the reasons I am hoping that would come out and emerge out of this is that when the pyramid is evolved that the new base would be fruits, vegetables, legumes, nuts, because that is where all the phytochemicals are. That is where all the immunological data is telling us that we have a lot to gain from.

I mean, we are talking about hundreds of studies showing decreased heart disease, decreased cancer if people consume fruits and vegetables, legumes and cereal grains, so I think we should put the emphasis there because that is where the data is.

The other point I would like to point out to you is that obesity correlates almost perfectly with the amount of dollars spent eating away from home. The USDA has just recently released some data showing that there is a 6 percent increase in percent calories from fat looking at what they do at home relative to what they do when they eat out.

When we eat out, our value system is we want value for our dollar. When we are at home, we may have a healthy guideline kind of idea in our head, but we disinhibit our inhibition, if you will, with that concept.

Another point that I think I would like to keep reinforcing in the document is in addition to food fortified, that vitamin supplements serve and provide an advantage in thwarting morbidity and mortality of chronic disease. I have always been an advocate of that, so I am not changing my tune. I really think that that is important to do.

In the long run, I think what we are talking about is what C. Everett Coop has pointed out with his colleagues, that as much as 70 percent of disease and associated cost can be modified by dietary means. I think we ought to start moving down that road as soon as we can with very direct approaches. Be daring.

Thank you.

CHAIRMAN GARZA: Thank you.

Are there any questions or comments from the group to any of the last five speakers?

DR. GRUNDY: I have one --

CHAIRMAN GARZA: Dr. Grundy?

DR. GRUNDY: -- question of the last speaker.

You said there have been hundreds of studies showing the benefit or epidemiologic association with fruits and vegetables. Could you provide us with that list of those studies? Do you have those references?

MR. LACHANCE: I have those references. They are available. A couple of different books have tabulated them. We can send that to you.

DR. GRUNDY: What would you say is the single best study to prove that of the hundreds?

MR. LACHANCE: The single best would be a difficult thing to point to. There are so many of these devoted to overseas, multicountry studies. There are several country studies. There are regional prospective studies.

You know, every type of study is giving us this positive stuff. I mean, there are a few exceptions. Obviously we are talking about, you know, 130 positive and maybe ten or 20 more that do not show anything, but I still think that is a very powerful direction in terms of the delivery of it says fruits and vegetables.

I think it is phytochemicals and micronutrients myself, but we do not have the data to support that since we translated it by tunnel vision back to vitamin A or, you know, some nutrient that we were aware of at the time.

CHAIRMAN GARZA: Okay. Any other comments or questions from the group?

All right. The American Bakers Association?

MR. LINEBACK: I am David Lineback presenting testimony on behalf of the American Bakers Association, which is a national trade association representing the wholesale baking industry.

I encourage you to look at the written comments because we will not have time to develop many of those this morning. Based upon data, it has been recognized in our recommendations on dietary guidelines that the foods consumers need in the greatest number, the grain foods, should be the base of a healthy diet.

However, the USDA's healthy eating index for 1994 to 1996 indicated Americans are barely eating the recommended number of servings of grains, averaging a little over six servings per day. Recommendations to consume six to 11 servings from the grains group is well supported. Data used in developing the guidelines emphasizes the contribution grain foods have to total nutrient intake.

Grain products such as enriched white breads and rolls are nutritionally fundamental. They are recognized as sources of B vitamins and other antioxidant nutrients, folate, potassium, calcium, iron, protein and magnesium.

In addition, enriched grain products such as breads, rolls, bagels and crackers, including whole grain crackers or daily staples that contain fortification, are emphasized by dieticians and nutritionists as a healthy, low-calorie, low-fat sources of essential vitamins, nutrients and dietary fiber.

Recent studies have indicated that bread products provide an important component of fiber in the diet of many Americans, and, of course, other grain bases add to that. Some recent studies indicate that yeast bread is the single largest contributor, about 14 percent, of fiber in the diets of children ages two to 18. The folic acid found in enriched grain products protects against neural tube birth defects, as we know. It may help protect against some heart disease and certain cancers.

Data has indicated that fortification of grain products, such as breads, cereals and flour, will enable nearly 50 percent -- some will say as high as 70 percent -- of women ages 11 to 50 years old to ingest a minimum of 400 micrograms of folic acid per day.

Grain products since World War II have been responsible for most of the increases in key nutrients, such as thiamine, riboflavin, iron and niacin in the diet, and, after dairy products, grain-based foods are the second best source of calcium in the diet.

Unfortunately, there are many who would like to recommend against the consumption of enriched grain products. This would be unfortunate. It sends a mixed message to consumers and adds to the confusion about good nutrition. Research data indicate that the grain-based foods play major roles in our diet, and there is no evidence that there is any negative aspects to the consumption of such products.

On behalf of the American Bakers Association, I would like to point out for all of us who work in the field that the grain-based foods offer consumers a wide range of convenient, affordable and enjoyable food products which we eat.

Therefore, I encourage the committee to maintain the current dietary recommendation of six to 11 servings of bread and other grain-based foods per day as a foundation of a healthy diet. I think we can realize that grain-based foods play a major role.

Thank you.

CHAIRMAN GARZA: Chilean Fresh Fruit Association?

MR. GRANGER: Thank you for the opportunity to give testimony. I am Curtis Granger, Executive

Vice-President, Chilean Fresh Fruit Association. I oversee the strategic marketing of all imported fruit to the United States from Chile.

Chile has been providing the United States with fresh fruit for more than 30 years. Chile is the primary winter source of fresh table grapes, peaches, plums, nectarines, pears, raspberries, apricots and cherries. It is North America's largest summer provider of kiwi fruit, as well as a major supplier of apples, blueberries and blackberries.

In reference to the dietary guidelines for fruit consumption, my purpose here today is twofold. First, to present some of the research showing that the overall fruit consumption is low and seasonally lower in winter. Secondly, this research will highlight the need to strengthen the dietary guidelines, focusing on effective communication messages to educate the public and achieve the current pyramid recommendations.

The first research as shown here is the healthy eating index. It is a summary measurement of how well Americans conform to the dietary guidelines. It is the real scorecard on food consumption measured against the dietary guideline recommendations.

Of the ten diet components measured in the healthy eating index, the lowest score is fruit at 3.9 out of ten points. Eighty-three percent of Americans are not meeting the USDA's recommended of two to four servings per day. Fruit consumption annually is at one and a half servings, half the recommendation.

Chile conducted the further analysis of the latest CSFII 1994-1996 data to determine fruit intake by age, sex group, and by season of the year. For females, each group is broken down into recommended servings, annual average and by quarter.

The chart shows no single age group meeting the minimum fruit recommendation in any season of the year. In fact, fruit consumption is lowest in the winter months. The male fruit consumption shows the same results. There is not a single age group meeting the recommendation, children included, in any season.

These findings present an opportunity to strengthen the dietary guidelines for the year 2000. The 1995 committee challenged future committees to be more effective in communicating current scientific thought and to insure that dietary guidelines respond to current consumption issues.

The current guidelines should be updated to address the current problems found in consumption data. The guidelines should inform Americans of the healthy eating index. Knowing the score is the first step in implementing changes in the diet.

In conclusion, we urge the committee to include the healthy eating index in the year 2000 guidelines. This scorecard should be used in conjunction with recommendations as a performance measure. It will serve as an effective communication measure to educate the public and to achieve behavior modification.

Finally, in response to the extreme lack of fruit consumption, the dietary guidelines should urge Americans to double -- and I repeat, double -- their current fruit consumption.

Thank you for your time and consideration.

CHAIRMAN GARZA: Thank you.

Dole Food Company?

MS. DISOGRA: Good morning. My name is Lorelei DiSogra, and I am Director of Nutrition and Health for Dole Food Company. For the last 20 years, I have been professionally involved in the area of nutrition and cancer prevention and one of the principals in creating the Five a Day for Better Health Program.

Dole Food Company is one of the founding members of the national Five a Day for Better Health Program, and we are committed to developing effective technology-based nutrition education programs to encourage children to eat five to nine servings of fruits and vegetables a day. Our educational programs are used in more than 50 percent of all elementary schools in the United States today.

Today, I am here to recommend a stronger and more prominent guideline on fruits and vegetables, a guideline that emphasizes the overwhelming scientific evidence that eating five to nine servings of fruits and vegetables a day improves health and reduces the risk of chronic diseases.

Dr. Elizabeth Pivonka, who will speak to you very shortly, will provide the overwhelming scientific research in this area.

We just completed an analysis of the 1997 MRCA survey of children's eating habits. What children ages six to 12 eat is appalling and clearly not conducive to good health in this country.

This chart illustrates children's eating patterns compared to the USDA food guide pyramid. Children are only eating 2.4 servings of fruits and vegetables a day, less than half of the five that are recommended. These results are consistent with USDA's 1996 CSFII data if remove the french fries and potato chips from the USDA data from the vegetable category.

Allow me to share some alarming statistics from this recent survey with you. At breakfast, less than half of all children drink 100 percent fruit juice. At lunch, children are twice as likely to eat french fries than any other vegetable.

Children hardly eat any nutrient dense, dark green leafy or yellow/orange vegetables. Potatoes are one-third of all vegetables consumed by children at dinner. Children seldom eat fruit for dessert, and they eat very few fruit and vegetable snacks.

You will also notice from this chart that children's diets are exploding with fat and sugar. For the health of all Americans, both children and adults, fruits and vegetables should be at least one-third of the total food eaten on a daily basis.

I am recommending that the Dietary Guidelines Committee first position fruits and vegetables as the foundation of a healthy diet by creating a separate guideline for fruits and vegetables. Please separate us from grains. This guideline should be prominent and emphasize the unique nutrient contribution that only fruits and vegetables make to a healthy diet.

Second, emphasize that Americans make fruits and vegetables, in addition to other plant-based foods, the center of their plate. Some foods, such as fruits and vegetables, are in fact more healthy than others. This must be communicated clearly. Guidelines recommending variety, balance and moderation are just not specific enough anymore and do not communicate anything to the American public.

Third, recommend that all federal food and nutrition policies --

CHAIRMAN GARZA: I apologize for having to interrupt. You are out of time.

MS. DISOGRA: Thank you very much.

CHAIRMAN GARZA: Thank you.

Farm Animal Reform Movement?

MR. HERSHAFT: Good morning. My name is Alex Hershaft, and I am the president of FARM, a national public interest organization promoting plant-based eating.

According to the latest figures from the Centers for Disease Control and Prevention, 2,314,690 Americans died in 1996. Nearly 60 percent, or approximately 1,376,000, of these deaths were attributed to diseases linked conclusively to consumption of meat and other animal products. Not one death in America has been linked to consumption of grains, vegetables and fruits.

The current edition of Dietary Guidelines for Americans devotes four pages to touting a diet with plenty of grain products, vegetables and fruits, and seven pages to a diet low in fat, saturated fat and cholesterol, yet the document fails to recommend the vegan diet, which abides zealously by these recommendations. In fact, it cautions vegan consumers to get proper amounts of iron, zinc, calcium and vitamins B and D.

Ladies and gentlemen, let me ask you. How many vegans die each year in America from shortages of these nutrients, and where are the warnings in the guidelines to consumers of meat and other animal products about proper amounts of saturated fat, cholesterol, hormones, nitrites, dioxin, benzopyrene, benzaldehyde, methylcholanthrene, E. coli, salmonella, campylobacter, listeria, clostridium and staphylococcus?

My personal guess is that the current guidelines are guided less by science than by the politics of fear instigated by the swift retribution visited by the meat industry on the U.S. Senate Select Committee on Nutrition and Human Needs in 1977. The committee's guidelines call for Americans there to recommend reduced meat consumption.

This distinguished committee has an opportunity to redeem this sorry record. As we enter the new millennium, Dietary Guidelines for Americans 2000 should reflect the science rather than the politics of nutrition. The guidelines should recommend a gradual, but steadfast, transition to a vegan diet with no qualifications, no apologies.

Thank you.

CHAIRMAN GARZA: Thank you.

Great American Meatout 1999?

MR. PRYOR: Good morning. My name is David Pryor. I am the National Director of America's largest annual grassroots diet education campaign, the Great American Meatout, now in its fifteenth year.

Culminating on the first day of spring, the Great American Meatout campaign brings together thousands of caring people across this nation to stage over 2,000 educational events focused on helping friends and neighbors quit the meat habit for at least one day and explore a more wholesome and less violent plant-based diet.

Meatout draws massive support from consumer, environment and animal protection advocates, as well as health providers, meatless food manufacturers and educators. They believe the consumer is entitled to a one-day respite from the relentless barrage of meat industry propaganda in schools, in the media and in the streets.

While it is estimated that only five or six percent of the population is currently vegetarian, growth estimates for new vegetarians are in the 100,000 per month range. This trend is particularly prevalent among teens. The acceptance and growth of demand for vegetarian products among mainstream public can probably best be reflected in the 50 to 150 percent growth rates of manufacturers who produce these products.

A major strategy for this year's Great American Meatout campaign is to encourage mainstream supermarket chains to step up their introduction of nonanimal-based product selections in all appropriate areas of the store. That includes a greater selection of meat alternatives,

nondairy/nonegg-based pastas, breads, cereals, baking supplies, etc., and nonanimal ingredient personal and health care products.

Reports from our coordinators in the field suggest that American consumers are confused about nutritional advice. It is time for the health communities and the government to stop kowtowing to economic/political interests of the meat industry and start speaking in one clear, unambiguous voice.

We ask this committee to strengthen its commitment to get Americans off the meat habit and on a more wholesome plant-based diet.

Thank you.

CHAIRMAN GARZA: Are there any questions or comments related to any of the five previous speakers? Dr. Lichtenstein?

DR. LICHTENSTEIN: This is for the gentleman from the Chilean Fresh Fruit Association.

Is it safe to assume the data that you gave to us was limited to fresh fruit consumption and not to all fruit consumption?

FEMALE VOICE: No. It is all fruit consumption as was listed in the pyramid grouping for fruit.

DR. LICHTENSTEIN: So that is canned, frozen, dried?

CHAIRMAN GARZA: All fruit?

FEMALE VOICE: All types.

DR. LICHTENSTEIN: Thank you.

CHAIRMAN GARZA: Dr. Dwyer?

DR. DWYER: On that same analysis, do those differences by season reflect price?

FEMALE VOICE: Price? No, it didn't reflect price.

DR. DWYER: I am just wondering if --

FEMALE VOICE: No.

DR. DWYER: -- the reasoning was --

FEMALE VOICE: It is year-around availability of fruit.

DR. DWYER: Thank you.

CHAIRMAN GARZA: Dr. Murphy? I looked everywhere but to my right and to my left.

DR. MURPHY: I would like to ask Dr. DiSogra about the one-third of the children's diets from fruits and vegetables. Do you mean by calories or by grams? How are you calculating that?

MS. DISOGRA: Well, we just did something. We looked at the pyramid, and if you take away the top, which is the fats and oils used sparingly, and you just look at the number of servings, so assuming kids, okay, so we took the low ends of the servings, six servings of grains, five servings of fruits and vegetables, two or three dairy, two or three meat.

You get a total of 15 servings of healthy foods you are supposed to eat everyday. One-third, five out of 15, is fruits and vegetables. That is how. Very simple.

DR. MURPHY: So it is servings?

MS. DISOGRA: Servings.

DR. MURPHY: Thank you.

MS. DISOGRA: The pyramid is supposed to represent a healthy diet, is it not?

DR. MURPHY: Right.

CHAIRMAN GARZA: Are there any other questions or comments?

I am going to ask is it Ms. Finalli?

MS. FINALLI: Finalli.

CHAIRMAN GARZA: We are going to take a break now, and we will reconvene -- you have a generous Chair -- in 20 minutes instead of the 15 that we were allotted.

I hope this does not represent the triumph of optimism over experience once again, but let's try and reconvene at 11:00 a.m.

(Whereupon, a short recess was taken.)

CHAIRMAN GARZA: We had a light exchange with Dr. Grundy. He led a minimutiny at the break. He said we were promised 30 minutes. What did you do with our other ten? I said all right. I must have misread the agenda. I just got back and realized I was tricked.

(Laughter)

CHAIRMAN GARZA: He is from Texas, and I am from Texas, so between two Texans it is all right. We will just mark this one down for our next exchange.

DR. DECKELBAUM: Lunch is four hours.

(Laughter)

CHAIRMAN GARZA: See what happens when you set a bad example for a New Yorker?

DR. DECKELBAUM: I am from French Quebec.

CHAIRMAN GARZA: Well, to a Texan it's up north.

All right. Let's continue then with that to the Humane Society of the United States.

MS. FINALLI: Hello. I am Mary Finalli, senior researcher in the Farm Animals and Sustainable Agriculture Section of the Humane Society of the United States.

Americans eat far too much fat, saturated fat, cholesterol and protein, the majority of which, and in the case of cholesterol all of which, come from animal products in the form of meat, including poultry and fish, dairy products and eggs.

These substances are closely associated with the leading causes of death and disease in the United States, including heart disease, cancer and stroke. Additionally, animal products are the primary sources of acute foodborne disease and death from bacterial contamination.

The medical dollar cost of meat consumption alone is conservatively estimated to be as much as $60 billion annually in direct health care costs and hundreds of billions of dollars in indirect costs such as lost work time.

We are glad that vegetarian and vegan diets were acknowledged as being diets suitable to good health in the last revision of the federal dietary guidelines. However, if the government is sincere in its intent to provide sound and current dietary guidance to consumers, it needs to more than acknowledge the suitability of vegetarian and vegan diets. It needs to advocate their adoption.

For example, according to the Food and Drug Administration, 25 grams of soy protein a day may reduce the risk of heart disease. Twenty percent of the American population is said to have elevated cholesterol levels. Over 50,000,000 people in the U.S. could benefit from increased soy consumption. This is an excellent example of the positive and meaningful guidance the federal dietary guidelines should include.

According to the American Dietetic Association's position on vegetarian diets, scientific data suggests positive relationships between a vegetarian diet and reduced risk for several chronic degenerative diseases and conditions, including obesity, coronary artery disease, hypertension, diabetes mellitus and some types of cancer.

Studies indicate that vegetarians often have lower morbidity and mortality rates from several chronic degenerative diseases than do nonvegetarians. Vegetarian diets have been successful in arresting coronary artery disease, and vegetarians tend to have a lower instance of hypertension than nonvegetarians.

Type II diabetes mellitus is much less likely to be a cause of death in vegetarians, and the incidence of lung and colorectal cancer is lower in vegetarians. A vegetarian diet may be useful in the prevention and treatment of renal disease, and breast cancer rates are lower in populations that consume plant-based diets.

The American Dietetic Association states that vegan diets are appropriate for all stages of life, including during pregnancy and lactation. They satisfy nutritional needs of infants, children and adolescents and promote normal growth. Vegetarian diets can also meet the needs of competitive athletes.

The American public should be advised to reduce their dietary consumption of animal products. The federal dietary guidelines can help accomplish this by stating more effectively the hazards of animal products and by revising its position on vegetarian and vegan diets from that of mere acknowledgement of their suitability to promotion of their healthful advantages.

Thank you very much.

CHAIRMAN GARZA: Thank you.

National Pasta Association?

MS. MCMAHON: Good morning. I am Kathy McMahon with Edelman Public Relations, and I would like to thank the committee for the opportunity to testify this morning on behalf of my client, the National Pasta Association.

The NPA is the trade organization for the U.S. pasta industry composed of manufacturing, industry supplier and allied industry representatives. It is involved in a number of activities that serve to promote the use and benefits of American-made dry pasta providing leadership in the development of public policy, collecting data and information on pasta production and disseminating information concerning the value, nutrition and quality of pasta.

At this time we would like to share our perspective on the grain foods and carbohydrate issues raised at the open meeting of the committee last September. Our comments stress the importance of placing evolving sound science into practical context.

We hope that you will carefully scrutinize the totality of the body of evidence and consider the implications that changes in the dietary guidelines might bring to messages that are targeted to an already confused consumer.

Our comments fall under two categories, the current consumer environment and the state of misinformation on the role carbohydrates and grain foods play in healthful eating and the limited body of evidence that is driving this consumer misinformation.

When we look at the current state of the consumer environment, we hope that you will keep in mind consumers' knowledge and attitudes to provide the appropriate context especially in this area. According to the 1997 Wheat Foods Council survey, while 75 percent of consumers agree that complex carbohydrates are good for you, another 45 percent also agree high protein/high carbohydrates diets can help them lose weight.

In the 1997 American pasta report, close to 50 percent of those who hear about high-protein diets have changed their behavior, and really only 10 percent polled knew the current recommendations for what they should be consuming for grain foods.

Consumers are swayed by books like The Zone Diet Sugarbusters. These popular diet books have captured headlines for overextending the limited research base and taking the science too far. We are concerned that the discussion here and the outcomes from the committee could inadvertently fuel the fire where the science has become pseudoscience in the lay press.

Under a limited body of evidence, dietary recommendations to keep dietary guidelines of carbohydrate at 55 percent of total calories have been revisited and not changed by the most recent report of the joint FAO/WHO committee.

As a specific example, we would like the committee to take a serious look at the science behind the glycemic index as a rating for carbohydrate foods. It appears that a carbohydrate like pasta is predominantly resistant starch and does not act like other grain foods.

What does this mean? Is it possible that although it is refined it acts like a grain food? We ask the committee to consider these kinds of things in considering what the implications are going to be for guidelines for consumers.

Thank you.

CHAIRMAN GARZA: Thank you.

People for the Ethical Treatment of Animals?

MS. PARK: Good morning. My name is LeeAnn Park. I am with People for the Ethical Treatment of Animals.

There is no credible doubt any more that vegetarianism is the healthiest dietary choice. America's top three killers, heart disease, cancer and stroke, have been conclusively linked to meat consumption, as have a variety of other illnesses, including diabetes, osteoporosis and obesity.

Sadly, it is the children who are paying the biggest price for our nation's addiction to chicken nuggets and high-fat hamburgers. For their sake, we urge the committee to strongly recommend vegetarianism in the new dietary guidelines.

Almost any five year old can master the basics of good nutrition. Eat a variety of fresh fruits and vegetables, beans and whole grains. Unfortunately, the government has not done nearly enough to educate consumers about the health benefits of a plant-based diet.

In the current dietary guidelines, which promote the consumption of meat, dairy products and eggs, foods known to be high in saturated fat and cholesterol and which contain absolutely no fiber, undermine the healthful vegetarian message altogether.

Unfortunately, companies like McDonalds and Oscar Mayer, the Joe Camels of the food industry, have no qualms about selling our children down the river by promoting their artery-clogging animal products. The average American child is bombarded by 10,000 food commercials every year. These ads are not promoting apples or broccoli, but rather a nutritionist's worst nightmare -- fast food, sugary cereals, soft drinks and candy.

By the time they are two years old, kids know who Ronald McDonald is, and more of them can recognize the golden arches than the Christian cross. It is little wonder then that 41 percent of schoolchildren in America have elevated blood cholesterol levels or that in the last three decades the number of children who are overweight has more than doubled.

In fact, one-quarter of American kids are clinically obese, weighing 20 percent or more than their ideal body weight. These extra pounds put children at risk for diseases typically associated with adults, everything from heart disease to Type II diabetes and arthritis.

According to research cited by Dr. Neal Barnard, author of Food for Life, vegetarians are on average 10 percent leaner than the typical meat eater. Studies published in the Journal of the American Dietetic Association have shown that the main sources of fat in children's diets are meat and dairy products. All that unhealthy food leaves little room for healthful fare like fruits and vegetables.

A National Cancer Institute study found that 30 percent of children eat less than one serving of vegetables a day and that 50 percent eat less than one serving of fruit. Of course, most children would never eat meat in the first place if adults did not concoct myths about where animal foods come from.

In a Rocky Mountain News article, one nine-year-old boy told a reporter, "I thought meat was made out of something else. I didn't know about the cow." That is hardly surprising. Ronald McDonald tells kids that hamburgers grow in hamburger patches.

Other companies also hide from children the horrific suffering and abuse animals endure on today's factory farms. Oscar Mayer, for example, sends its colorful Weinermobile car across the country to convince kids that eating pigs is fun and that singing about ham and sausages can make you rich and famous. Were children to see where hotdogs really come from, they would be deeply traumatized and never touch meat.

CHAIRMAN GARZA: I am sorry.

MS. PARK: Thank you.

CHAIRMAN GARZA: Produce Marketing Association?

MR. SILBERMAN: Good morning, Mr. Chairman, members of the committee. My name is Bryan Silberman, and I am the president of the Produce Marketing Association. I would like to thank you very much for the opportunity to be here this morning.

PMA is the largest worldwide, not-for-profit trade association representing more than 2,000 organizations that market fresh fruits and vegetables from seed to supermarket. I am delighted to have some of those members with me today.

Also having been present at the birth of the national Five a Day for Better Health program, I have a personal interest in seeing an ongoing improvement in the diet of American consumers.

PMA agrees with the advice on fruit and vegetable consumption that has been part of previous versions of the dietary guidelines. Now we believe we have to look to your leadership for even stronger counsel about the health benefits of fruits and vegetables in the Year 2000 Dietary Guidelines for Americans.

Our interest in this issue is very strong because we believe fruits and vegetables should be the mainstay of the American diet. We know from scientific studies and the recommendations of many credible health authorities that you will hear about more later that greater consumption of fruits and vegetables does help consumers reduce the risk of many diseases, such as cancer, heart disease, diabetes, obesity and more.

There are four simple requests I have for you today. First, we seek your unequivocal endorsement that for healthy consumers, including children, eating whole foods is the best way to get the nutrients needed to maintain health. Popping pills is no substitute for a proper diet.

Secondly, we ask you to strengthen your dietary guidance by increasing the prominence of fruit and vegetables. Eating five servings of fruit and vegetables a day is a laudable but only a minimal start. We ask that you strengthen or preferably separate the advice about increasing fruit and vegetable consumption from that currently linked with grains.

Making fruits and vegetables the food of choice can help consumers implement most of the guidelines you present. Therefore, our third request is that in each guideline, where appropriate, you specifically mention how fruit and vegetables can help consumers achieve that specific objective.

Fourth, we ask your support in making your guidelines the rule for government feeding programs. The benefits of such action will continue to be felt for generations as children learn to make good food choices, and the less fortunate among us gain greater access to fresh produce. Why should our government's feeding programs not follow our government's dietary advice?

Ladies and gentlemen of the committee, the scientific evidence is in. The time for action is now. Simply put, it is time to move fruit and vegetables from the side of the plate to the center.

We applaud your efforts. We thank you for this opportunity. Thank you.

CHAIRMAN GARZA: Thank you.

Produce for Better Health Foundation?

MS. PIVONKA: Good morning. My name is Elizabeth Pivonka, and I am the president of the Produce for Better Health Foundation, a national nonprofit organization devoted to increasing the consumptions of fruits, vegetables, fresh, canned, frozen, dried and 100 percent juice among Americans for their better health. We work in partnership with the National Cancer Institute on the Five a Day program.

As a starting point, regarding the guideline that states choose a diet with plenty of grain products, vegetables and fruits, we ask you to consider a new guideline for just fruits and vegetables. Americans are much better at including more grains in their diets than fruits and vegetables.

Grouping grains, fruits and vegetables almost makes them sound interchangeable, and we know that they are not. By separating fruits and vegetables, we can emphasize their importance in and of themselves. However, in addition to a separate guideline for fruits and vegetables, we ask that the committee consider placing fruits and vegetables and other plant-based foods at the core of the dietary guidelines. We are not alone in this request.

I would like to present to you, the Advisory Committee, this petition. This petition is signed by hundreds of researchers and health organizations across the country, including the American Cancer Society, the American Diabetes Association, the Boys and Girls Clubs of American, the American Institute for Cancer Research, AARP, the American Public Health Association, the Center for Science in the Public Interest, Shape up America, schools of medicine, cancer research centers, state and local departments of health and many others.

It reads, "An overwhelming body of evidence strongly supports increased consumption of fruits and vegetables to reduce the risk of chronic diseases, including, but not limited to, many types of cancer, heart disease and stroke.

"The Year 2000 Dietary Guidelines will determine the direction of nutrition education for the next century. As such, the revised guidelines should reflect the established and ever increasing research behind the key role that fruits and vegetables play in the diet.

"We, the undersigned, strongly urge the Year 2000 Dietary Guidelines Advisory Committee to position fruits and vegetables, in addition to other plant-based foods, as the core of America's diet and facilitate educating Americans to make fruits and vegetables the center of their plate."

A copy of the petition with all supporting signatures is attached to our written comments, along with a summary document outlining the latest research that has accumulated on fruits and vegetables and their importance in the reduced risk of disease. That document is in your folder, and I encourage you to take a look at that. It is literature searched through the month of January of this year.

Placing fruits and vegetables at the core of the guidelines can help the public understand how easily other elements of the guidelines can fall into place. With this in mind, the Foundation has additional requests which are outlined in our written comments.

I would also like to say that as nutrition communicators, we have done a great job with the message, "All foods can fit." Unfortunately, we have not adequately communicated the more important fact that some foods are clearly more healthful than others. The new guidelines should refine the variety message to emphasize the most healthful, nutrient dense foods.

We believe the new guidelines will greatly help improve the health status of Americans in the next century if, and only if, they reflect the science-based evidence of the health value of nutrient rich foods like fruits and vegetables in a clear, dramatic form.

Thank you.

CHAIRMAN GARZA: Thank you.

Are there any questions or comments the group might have for any of the five speakers?

Okay. Let's move on then to United Poultry Concerns, Inc.

MS. DAVIS: My name is Karen Davis. I am delighted to be here today. My name is Karen Davis again, United Poultry Concerns president, and I am here to offer the following comments in regard to the proposed revised guidelines, Dietary Guidelines for Americans.

The revised guidelines should recommend a plant- based, nonanimal-based vegan or vegetarian diet. The guidelines should promote the positive health benefits of a vegan diet.

The conservative annual cost estimate of human illness caused by the seven best known, most prevalent

foodborne pathogens is anywhere between $5 billion and $10 billion or more per year. The USDA Economic Research Service has in its own studies identified meat and poultry as the primary sources of these pathogens and has said that they are in fact the result of consumption of meat, poultry, seafood, dairy products and eggs.

Regarding antibiotics, which have not really been brought out here today, but should be, a University of Maryland study that was reported by the British journal, Lancet, and summarized in The New York Times on February 26 of this year, states that bacteria are resistant to the most powerful antibiotics used to treat infections in people and that they have been found in chicken feed, raising concerns about the threat to human health from the overuse of antibiotics in humans and in animal agriculture.

Ironically, the overuse of antibiotics such as fluroquinolones in humans is in large part an effort to treat food poisoning, such as campylobacteriosis and salmonellosis and E. coli infections derived from the consumption of animal products, including poultry, beef, dairy, and eggs.

The overuse of antibiotics in animal agriculture is an effort to compensate for the overcrowding, filth and overstressed immune response imposed on animals who are forced to live in systems that are making them sick.

The use of antibiotics as growth promoters in these animals predisposes these animals to metabolic diseases that in turn require the use of more antibiotics, and a vegan diet would eliminate this pathogenic recycling of disease organisms and overuse of antibiotics to cope with them, unsuccessfully I should add.

The revised Dietary Guidelines for Americans should promote a vegan diet. A vegan diet will reduce human illness and human health care costs. It will eliminate the animal waste management problem that we are faced with. It will eliminate the unwholesome and unethical confinement of animals, itself a major cause of diseases in humans and

nonhumans, including both wild and domestic animals.

It will encourage the manufacture and development of nutritional plant-based foods and promote human culinary and food processing creativity, as well as human health. This is an opportunity for us.

I should say in conclusion that anybody who really would visit an egg factory or a poultry house and saw the absolutely filth --

CHAIRMAN GARZA: I apologize. You are --

MS. DAVIS: -- that these animals live in, would not even consider these things as a healthy diet.

Thank you.

CHAIRMAN GARZA: Thank you.

The next group is the Vegetarian Nutrition Dietetic Practice Group of the American Dietetic Association.

MS. REESER: Good morning. My name is Cyndi Reeser, and I am the past Chair of the Vegetarian Nutrition Dietetic Practice Group of the American Dietetic Association, hereafter referred to as the VNDPG.

The VNDPG views the fifth edition of the U.S. Dietary Guidelines for Americans as a unique and historic opportunity to strengthen our national commitment to promote health and prevent disease. The dietary guidelines can and must reach for higher outcomes than have been achieved in the past.

Government surveys indicate that the prevalence of overweight has increased for nearly all age, ethnic and gender groups since 1980. This may be explained in part by the exceedingly large portions served in restaurants.

We also know that fat and saturated fat intake both declined only one percent from 1989 to 1996. Only 33 percent of the population over two currently meets goals for fat intake, and only 36 percent of the same population meets the goal of five or more servings of fruits and vegetables per day. Vegetarian eating patterns tend to be lower in caloric density and fat and higher in fruits and vegetables and fiber.

The VNDPG are just a committee to revise and strengthen dietary guidelines so as to make it an even more effective and powerful tool for health promotion in the hands of the consumer. We make the following recommendations:

Strengthen guidelines for achievement and maintenance of healthy weight by clarifying and expanding information on serving sizes of foods and portion control, especially for restaurant and take-home meals.

Update and expand information on the well-documented protective benefits of a vegetarian diet, including phytochemicals and antioxidants. The VNDPG stands ready to assist the committee by providing this documentation from the scientific research as needed.

Provide information on alternative sources of calcium for those who avoid consumption of dairy products. Provide information on plant sources of protein for those who avoid consumption of animal foods. Finally, expand emphasis on ethnic and cultural diversity in the food supply.

Thank you for the opportunity to testify today.

CHAIRMAN GARZA: Thank you.

The Vegetarian Society of the District of Columbia?

MR. BALCOMBE: Members of the panel, thank you for the opportunity to comment. I did bring a helper today.

My name is Jonathan Balcombe. I am a biologist with a Ph.D. in Animal Behavior. I have been a vegetarian for 20 years and practically vegan for the past ten. I come representing the Vegetarian Society of the District of Columbia, a fast-growing group whose members have doubled to about 800 members in the last few years.

I am also accompanied by my four-year-old daughter whose hand I just stepped on -- my apologies, Emily -- who has been a vegetarian and practically vegan since her birth.

I would like to comment briefly on two relevant issues, both from the perspective of a parent. I apologize that I may be flogging a dead carrot, because several of these issues have been brought up with the past few speakers.

First as a general comment, I urge you to recommend that the dietary guidelines under your purview go beyond the current acknowledgement that vegetarian diet is adequate to meet the nutritional needs of Americans. These guidelines ought to strenuously urge Americans to replace meat-derived protein in their diets with plant-based protein.

Not only does a vegetarian diet provide more than adequate nutrition, it provides numerous benefits to the traditional meat-based diet most Americans consume today. Vegetarians are markedly less likely to suffer from heart disease, cancer, and stroke than their meat-eating counterparts. Vegetarians are also much less prone to obesity, as you have already heard, and tend to live years longer.

It is also worth mentioning from an economic standpoint that the above diseases of affluence not only take a huge toll on American lives, but a huge economic toll as well due to the cost of treatment, which amounts to tens of billions of dollars annually.

Second, I wish to comment briefly on the national school lunch program. The national school lunch program is generous in principle, but unhealthy in practice. A 1993 survey by the USDA found that national school lunch program meals averaged 38 percent of calories from fat. This is eight percentage points higher than the government's maximum recommended dietary daily intake of fat, which, in the view of many medical experts, is already much higher than it ought to be.

A 1991 analysis found that 90 percent of the foods the USDA bought from industry for the national school lunch program were butter, cheese, whole milk, beef, pork, and eggs. All of these foods are loaded with fat, cholesterol and sodium.

Being a middle-class child, my daughter will probably not likely need to resort to the national school lunch program for the support that it provides, but, for the sake of those who do, please recommend an overhaul of the national school lunch program to emphasize plant-based protein in the place of the high-fat/low-fiber fare that currently dominates it.

Emily, do you want to make a comment? No.

Thank you for the opportunity to comment.

CHAIRMAN GARZA: Thank you.

The Wheat Foods Council?

MS. SLAVIN: Hi. My name is Joanne Slavin. I am a professor at the University of Minnesota, but here I am speaking on behalf of the Wheat Foods Council, which is a nonprofit organization formed in 1972 to help increase public awareness of grains, complex carbohydrates and fiber as essential components of a healthful diet. The Council is supported voluntarily by wheat producers, millers, bakers and related industries.