Research and Development Service, J.A. Haley Veterans Hospital

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Presentation transcript:

Research and Development Service, J.A. Haley Veterans Hospital Myths and Misinformation About Saturated Fat and Cholesterol: How Bad Science and Big Business Created the Obesity Epidemic David Diamond, Ph.D. Departments of Psychology, Molecular Pharmacology and Physiology, University of South Florida and Research and Development Service, J.A. Haley Veterans Hospital

Bad News: Abnormal Blood Lipids Triglycerides (mg/dl) Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

Bad News: Abnormal Blood Lipids Total/HDL Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

The Solution: Diet Changes and Exercise Total/HDL Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

Diet Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Vegetables, Fruit, Nuts, Cereal, Potatoes Total/HDL Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

Diet Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Vegetables, Fruit, Nuts, Cereal, Potatoes Total/HDL X Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

Diet Skinless Chicken, Low Fat Foods (Cheese, Yogurt), Olive Oil, Bread, Vegetables, Fruit, Nuts, Cereal, Potatoes Total/HDL X Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

! Really Scary News Triglycerides (mg/dl) Heart Disease Risk Years Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

! Really Scary News Total/HDL Heart Disease Risk Years Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Years

Obesity and Heart Disease in My Future Body Weight (lb) ! Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 weight in 1980 Years

Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

Myths and Misinformation: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease

Myths and Misinformation: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease Myth #2: - Cholesterol clogs arteries and causes heart disease - You will live longer if you take medication to lower your cholesterol

Myths and Misinformation: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease Myth #2: - Cholesterol clogs arteries and causes heart disease - You will live longer if you take medication to lower your cholesterol Misinformation: Food and Drug Company-Supported Research and the government have provided incorrect recommendations on ideal sources of food for optimal health – we have been misled

Obesity Arthritis Heart Disease Metabolic Syndrome Alzheimer’s Disease Hypertension Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Diabetes Stroke Cancer

Historical Perspective on Diet, Obesity and Health (1864 - Present) 5’5” >200 lbs Obesity-related health problems William Banting (1797 – 1878)

Historical Perspective on Diet, Obesity and Health (1864 - Present) 5’5” >200 lbs Obesity-related health problems His doctor (Dr. William Harvey) prescribed a low carbohydrate diet: Unlimited consumption of meat No potatoes, bread or sugar William Banting (1797 – 1878)

Historical Perspective on Diet, Obesity and Health (1864 - Present) 5’5” >200 lbs Obesity-related health problems His doctor (Dr. William Harvey) prescribed a low carbohydrate diet: Unlimited consumption of meat No potatoes, bread or sugar The Banting diet was a great success Banting lost 46 lbs, enjoyed great health, and lived into his 80’s. (no clogged arteries!) William Banting (1797 – 1878)

An obese person … may be given a diet of meat, excluding bread and potatoes, and the patient will reduce to his normal weight. As soon as the patient returns to his diet of bread and potatoes, he straightaway begins to increase in weight. 1892

= 1972 1864

Eat Meat (fat): Lose weight But is it a healthy diet? Does eating red meat, full fat cheese, butter and eggs increase serum cholesterol? Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

HDL (good cholesterol) Total Cholesterol Triglycerides LDL (bad cholesterol) Ratio Total/HDL Blood Glucose

Low Carb Diet (unlimited red meat): Lose Weight and Lower Cholesterol! Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

Low Carb Diet (unlimited red meat): Lose Weight and Lower Cholesterol! Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 If a low carb diet reduces serum cholesterol, will a high carb diet (sugar) increase serum cholesterol?

Triglycerides (mg/dl) Cholesterol (mg/dl) Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Cholesterol (mg/dl) Normal Diet No Sugar + Sugar No Sugar Weeks

Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, My Diet (2007 – Present) Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, Dark Chocolate, Nuts and Vegetables (Broccoli) Small Quantities of Fruit, Bread, Potatoes and Sugar Triglycerides (mg/dl) Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Low Carb Diet Years

Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, My Diet (2007 – Present) Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, Dark Chocolate, Nuts and Vegetables (Broccoli) Small Quantities of Fruit, Bread, Potatoes and Sugar Triglycerides (mg/dl) 70% Fat 20% Protein 10% Carbs Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Low Carb Diet Years

Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, My Diet (2007 – Present) Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, Dark Chocolate, Nuts and Vegetables (Broccoli) Small Quantities of Fruit, Bread, Potatoes and Sugar Total/HDL 70% Fat 20% Protein 10% Carbs Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 Heart Disease Risk Low Carb Diet Years

Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, My Diet (2007 – Present) Eggs, Butter, Beef, Chicken (with the skin), Full Fat Cheese, Coconut, Dark Chocolate, Nuts and Vegetables (Broccoli) Small Quantities of Fruit, Bread, Potatoes and Sugar Body Weight (lb) 70% Fat 20% Protein 10% Carbs Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2 weight in 1980 Low Carb Diet Years

Our Current State of Confusion

Consequences of the Fat Phobia

Excess Consumption of Carbs Carbohydrates Fats Protein 1970 1980 1990 2000

Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

Simple Message to the Obese: Stop the Vilification of the Atkins Diet It’s ok to eat meat, lose weight! Eat Less Carbs: Less Potatoes, Bread and Anything Sweet Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

Myths and Misinformation: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease

X Myths and Misinformation: Myth #1: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease

How Did Food Recommendations Go Awry?

Deaths from Cardiovascular Disease Lloyd-Jones et al, 2010. Circulation

Deaths from Cardiovascular Disease Lloyd-Jones et al, 2010. Circulation

‘There is a remarkable relationship between death rate from heart disease and the proportion of fat calories in the national diet” Keys (1953). Journal of the Mount Sinai Hospital New York

He selected data from 6 countries to create the linear relationship. - Ancel Keys cheated - He selected data from 6 countries to create the linear relationship. Data were actually available from a total of 22 countries! Keys (1953). Journal of the Mount Sinai Hospital New York

Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

No Significant Relation Between Fat Consumption and Heart Disease Mortality (r2=0.1, p > 0.05) Significant Relation Between Sugar Consumption and Heart Disease Mortality (r2=0.41, p < 0.05)

“Coronary Heart Disease – Doing the Wrong Things” “A generation of citizens has grown up since the Diet/Heart Hypothesis was launched as official dogma. They have been misled by the greatest scientific deception of our times: the notion that consumption of animal fat causes heart disease.” “Coronary Heart Disease – Doing the Wrong Things” Nutrition Today (July, 1985) George Mann, Sc.D., M.D. Professor, Nutritional Biochemist, Vanderbilt University Associate Director of the Framingham Study

 Intake of total fat was not significantly associated with coronary events (heart attacks) or mortality Intake of saturated fat (animal fat) was not significantly associated with coronary events or mortality Fatal heart disease was not reduced by low-fat diets or by replacing saturated (animal) fats with polyunsaturated (vegetable) fats

Chair, Department of Nutrition Harvard School of Public Health Walter Willett, M.D. Chair, Department of Nutrition Harvard School of Public Health “data on nearly 300,000 individuals … clearly contradict the low-fat-is-good-health message … the exclusive focus on adverse effects of fat may have contributed to the obesity epidemic.”

Ancel Keys – Created the Artificial Link Between Fat and CHD Became Editor of Circulation on the cover of Time Magazine, January, 1961 Pos – 1.87/1.75 Size 75/75% = 4.96/6.88 crop: 3/2

In 1977, a Senate Committee led by George McGovern released its "Dietary Goals for the United States." Without any evidence to support their conclusions, the committee identified fat as the culprit causing obesity.

The President of the US National Academy of Sciences, Dr. Philip Handler, an expert on metabolism, referred to McGovern’s “Dietary Goals” as “nonsense”.

Steak for Dinner, Angioplasty for Dessert? The Myth That Cholesterol Clogs Arteries

The Cholesterol Controversy, 1973 by Edward Pinckney, M.D. “Thanks solely to “Madison Avenue” promotion by commercial food producers and the American Heart Association, a great many people imagine that if they lower their blood cholesterol … they will prevent heart disease... Few people realize that there has never been a proven, scientific relationship between lowering blood cholesterol levels and preventing heart disease” The Cholesterol Controversy, 1973 by Edward Pinckney, M.D. Editor of Journal of the American Medical Association

A hypothesis out-of-date: The diet-heart idea “An almost endless number of observations and experiments have effectively falsified the hypothesis that dietary cholesterol and fats, and a high cholesterol play a role in the causation of atherosclerosis and cardiovascular disease. The hypothesis is maintained because allegedly supportive, but insignificant findings, are inflated and most contradictory results are ignored.” A hypothesis out-of-date: The diet-heart idea by Uffe Ravnskov, M.D., Ph.D. Journal of Clinical Epidemiology, 55:1057-1063, 2002

24% reduction in heart disease-related deaths! - of 480,000 men, screened the top 5% in cholesterol level (290 mg/dl) to be in the study followed for 7.4 years, treated with cholestyramine or placebo 24% reduction in heart disease-related deaths!

24% reduction in heart disease-related deaths! - of 480,000 men, screened the top 5% in cholesterol level (290 mg/dl) to be in the study followed for 7.4 years, treated with cholestyramine or placebo 24% reduction in heart disease-related deaths!

98% (Placebo) vs 98.4% (Treated) Survived Start: 480,000 men 98% (Placebo) vs 98.4% (Treated) Survived

Start: 480,000 men 0.4% becomes 24%

96.3% (Placebo) vs 96.4% (Treated) Survived Start: 480,000 men 0.4% becomes 24% 96.3% (Placebo) vs 96.4% (Treated) Survived

Start: 480,000 men The $120 Million Study That Produced a Non-Significant Treatment Difference of 3 People! = 0.1%

The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant Effect on Mortality

The Drug Trial Failed Miserably – Lowering Cholesterol Had no Significant Effect on Mortality The Lead Investigators Declared Victory – Predicting Heart Disease Would Be Eradicated With Drugs

Professor, Nutritional Biochemist, Vanderbilt University “No sensible person can avoid the conclusion that the NCEP is an expensive fraud perpetuated by avaricious business enterprises and dishonest scientists.” George Mann, Sc.D., M.D. Professor, Nutritional Biochemist, Vanderbilt University

The Missing Conflict of Interest Statement

ATP III Update 2004: Financial Disclosure Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline. Dr. Grundy Dr. Cleeman has no financial relationships to disclose. Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol- Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite. Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering- Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis. Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol- Myers Squibb, Merck, and Pfizer. Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer. Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS- Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca. Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson. Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant. Dr. Grundy … honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb and AstraZeneca; … research grants from Merck, Abbott and Glaxo Smith Kline.

ATP III Update 2004: Financial Disclosure Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline. Dr. Grundy Dr. Cleeman has no financial relationships to disclose. Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol- Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite. Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering- Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis. Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol- Myers Squibb, Merck, and Pfizer. Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer. Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS- Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca. Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson. Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant. Dr. Grundy … honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb and AstraZeneca; … research grants from Merck, Abbott and Glaxo Smith Kline. $150,000/drug company x 10 = $1,500,000/year!

ATP III Update 2004: Financial Disclosure Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline. Dr. Grundy Dr. Cleeman has no financial relationships to disclose. Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol- Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite. Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering- Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis. Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol- Myers Squibb, Merck, and Pfizer. Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer. Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS- Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca. Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson. Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant. Dr. Grundy … honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb and AstraZeneca; … research grants from Merck, Abbott and Glaxo Smith Kline. $150,000/drug company x 10 = $1,500,000/year! Dr. Bairey Merz … honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer and Merck; she has received grants from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca and Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson ...

* These guidelines were developed by people with a financial conflict of interest.

Are they wrong?

A Different Opinion From Scientists Unsupported by the Statin Industry

*These guidelines were developed by people with a financial conflict of interest. **These guidelines have been disputed by scientists without a conflict of interest.

Isn’t there a benefit from statins in the reduction of cardiac events?

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Adverse Side Effects of Statins: Erectile Dysfunction, Type 2 Diabetes, Rhabdomyolysis, Acute Renal Failure, Cancer and Liver Dysfunction

Final 2 Issues: What Caused the Increase in Deaths from Cardiovascular Disease in the 20th Century? How is Cholesterol Involved in Heart Disease? Villain or Misunderstood Hero?

Does Butter or Saturated Fat Consumption Parallel the Increase in Heart Disease-Related Death? Lloyd-Jones et al, 2010. Circulation

Deaths from Cardiovascular Disease No Relation of Butter Consumption to Heart Disease Deaths from Cardiovascular Disease

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What Causes Coronary Heart Disease? Cross Section of a Damaged Artery sugar

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Thickening of the Artery Wall Following Repeated Injury and Repair

Myths and Misinformation: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease

X Myths and Misinformation: Myth #1: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease

X Myths and Misinformation: Myth #1: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease Myth #2: - Cholesterol clogs arteries and causes heart disease - You will live longer if you take medication to lower your cholesterol

X X Myths and Misinformation: Myth #1: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease X Myth #2: - Cholesterol clogs arteries and causes heart disease - You will live longer if you take medication to lower your cholesterol

X X Myths and Misinformation: Myth #1: Consumption of food high in saturated fat and cholesterol (beef, butter) makes people fat and causes heart disease X Myth #2: - Cholesterol clogs arteries and causes heart disease - You will live longer if you take medication to lower your cholesterol Misinformation: We have been misled

The Bittersweet End Of Humans as Hunters

My Mentors Anthony Colpo Gary Taubes Barry Groves Paul Rosch, M.D. Jeff Volek, Ph.D. Rodney Hayward, M.D. Walter Willett, M.D. Joel Kauffman, Ph.D. John Abramson, M.D. Walter Willett, M.D., Ph.D. Robert C. Atkins, M.D. Uffe Ravnskoff, M.D., Ph.D. Germain Brisson, Ph.D. James H. Salisbury, M.D. Emmet Densmore, M.D. C. De Lacy Evans Marcia Angell, M.D. Jean Anthelme Brillat-Savarin John Abramson, M.D. George Mann, ScD., M.D. James H. Salisbury, M.D. Duane Graveline, M.D. Kilmer McCully, M.D. Nancy Appleton, Ph.D. Bruce Fife, C.N., N.D. Jay S. Cohen, M.D. William Rothstein, Ph.D. Edward H. Ahrens, M.D. Michael F. Oliver, M.D. Edward R. Pinckney, M.D. and Cathey Pinckney Sally Fallon and Mary G. Enig, Ph.D.

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