The Oprah Winfrey Show

Inside the Human Body

January 30, 2004

Brace yourself, we're going inside! See what your fat really
looks like, and start to live longer now. In a word: fascinating.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Dr. Mehmet Oz is one of the most respected surgeons in the

world, as well as host of Second Opinion on the Discovery Health
Channel.

Today, Dr. Oz brought a selection of real healthy and damaged

organs to demonstrate what goes on inside the human body. If
you overeat, smoke or drink too much, you may be surprised to
see what you're doing to your body.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

The healthy heart (left) is very supple, firm and poetic, according
to Dr. Oz.

The unhealthy heart (right) is larger and paler. The lighter spot
in the middle indicates that this person had a heart attack. That
scarred vessel was unable to bring blood to the heart, and the
damage can be seen on the inside.

Once an artery is closed, it doesn't heal, which is a devastating

problem, Dr. Oz says. While medicine has gotten better at curing
heart attacks, damage is still done after a heart attack, creating
an epidemic of heart failure.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Surprisingly, Dr. Oz says it's nearly impossible to find an aorta

without plaque. The healthy aorta (left) is such a rarity, it took
Dr. Oz a month to find one. Most people's aortas look more like
the unhealthy example (right).

The plaque that is created in the aorta is hard, like a rock, so it

literally causes hardening. While plaque is dangerous, the
possibility of a clot forming is even more worrisome. It is
possible to reverse some of the effects of plaque on the aorta,
but the best solution is prevention, says Dr. Oz.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

This should put your dieting into perspective—this container

holds five pounds of human body fat! Imagine carrying five or
ten of these on your back. That's what you're doing to your
body when you gain weight.

The reason we get fat, Dr. Oz explained, is because our

ancestors survived because they could store fat. In modern
society, with no problems of food shortage, we're taking in
more fat than we need to survive. By controlling your weight,
Dr. Oz says, you can add years to your life.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Dr. Oz took a cross-section of a healthy liver (left) and an

unhealthy liver (middle) to better demonstrate the differences.

The healthy liver is soft, smooth and supple. The unhealthy liver
contains little nodules, which is an example of cirrhosis, caused
by drinking too much alcohol. The liver serves to process all the
materials you bring into your body, which it can't do if it's
diseased.

The worst thing that can happen to your liver is cancer (right).
When your liver becomes damaged, and the body is continually
trying to repair itself, it can lead to cancer.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

If you're trying to quit smoking, this could be the day you go cold
turkey. The healthy lung (left) is generally pinkish and healthy,
with a bit of damage from living in an urban area. The unhealthy
lung (middle) comes from a smoker, and is riddled with dark tar
from cigarettes.

What's even more worrisome than tar, according to Dr. Oz, is

cancer. A cancerous lung (right) will have nodules of cancer cells
that grow and spread, invading into everything around them.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

In this cross-section of the spine (left), there's a bit of tissue

called the meniscus that acts as a shock absorber between the
pieces of the spine. If you're overweight, every time you take a
step, you take seven times that weight on your spine. If you
don't stay limber or lose weight, over time that piece of tissue
can get crushed down. In addition, according to Dr. Oz, you
recreate your bones every ten years. If you don't do some sort of
weight-bearing exercise, your bones will become fragile from
osteoporosis and break more easily.

The knee (right), also has the meniscus to protect your joint. In
an overweight person, it can get fractured and the bones begin
to wear. This can lead to knee pain, back pain, and a number of
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

If you fall into the Four F's (Fat, Female, near Forty and Fertile),
you're a likely candidate for gallstones. Gallstones are created in
the gallbladder, which stores materials including cholesterol and
bile, usually squeezed into our intestines to digest. When that
doesn't happen, the stones can get lodged in the gallbladder,
which is painful, especially under your ribcage on the right side.

To alleviate the problem, the gallbladder is often removed, which

Dr. Oz says is one of the most common operations performed by
doctors.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

According to the American Diabetes Association, more than 18

million people in the United States have diabetes. Dr. Oz says
that although diabetes can be managed, it's important to pay
the right kind of attention to the disease. "One of the problems
with diabetes is that you feel normal, so you don't take things
seriously," he says.

What diabetics can't see is how blood vessels can shrink,

causing harm to the kidneys. On the left is a normal kidney; on
the right, a damaged kidney. The good news is that Type 2
diabetes can be prevented through exercise and diet.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Using the term "egghead" to describe a genius isn't too far off
from reality. That's because the consistency of the human brain
is similar to the white part of eggs.

Dr. Oz calls the brain a "spectacular" organ that can actually

shrink if you don't exercise it. What's the best way to do that?

"Daydream," says Dr. Oz. "You finally have an excuse!“

The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

There's a lot more to the tongue than you might think: when you
stick it out, you're actually seeing only part of it. The full tongue
muscle reaches back to include the Adam's apple.

Dr. Oz says that if the tip of your tongue is too red, it could mean
emotional or physical stress.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

The stomach is an amazing organ. When you eat, its muscular

walls stretch to hold up to three pints of food.

Unfortunately, stress can literally eat away at the body, says Dr.
Oz. That's a leading cause of painful stomach ulcers, shown here
at left. The black spots and discolored craters are signs of an
overworked stomach. To protect your own stomach from these
problems, try relaxing, stress-busting exercises like meditation.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Along with a lack of fiber and insufficient water, stress can cause
major problems for the colon. "When you eat food that isn't high
in fiber," explains Dr. Oz, "food gets caught in the crevices. Years
of abuse can create bigger problems.“

Foods high in fiber include oatmeal, blueberries, brown rice,

strawberries, carrots, beans, and peas.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

You might be surprised by how small the uterus is (left). The

fallopian tubes reach out to the ovaries, and the uterus—"a small
and elegant structure," says Dr. Oz—stretches to hold a fetus.

Humans are the only mammals without a bone in their penises

(right). This is because when men are sexually aroused, blood
flows into the penis to make it stiff. That's another reason that
men should exercise and eat well; doing so will keep the blood
flowing throughout the entire body.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Uterine fibroids are common, non-cancerous tumors of the

uterus. Although they are benign, they can be painful. The
fibroid shown here is almost the size of a grapefruit!

There is no known cause for uterine fibroids, and treatments

may range from hormonal therapy to hysterectomy.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

When it comes to figuring out if you're digesting things properly and eating healthy, Dr.
Mehmet Oz says that you should rely on your senses in the bathroom. For starters, have you
ever thought about the importance of what your bowel movement sounds like when it hits the
water? Listen up!

"You want to hear what the stool, the poop, sounds like when it hits the water. If it sounds like
a bombardier, you know, 'plop, plop, plop,' that's not right because it means you're
constipated. It means the food is too hard by the time it comes out. It should hit the water like
a diver from Acapulco hits the water [swoosh]."

The next thing Dr. Oz recommends is looking at your stool—c'mon, you've done it before! You
should look twice—look at the shape and then, the color.

"It should be an S shape and you want to make sure the color's normal because the color of
the poop tells you a lot about how you made it," Dr. Oz says. "You don't want [pieces]. Food is
a medicine for you. It helps you. [If the stool is in pieces] by the time you finished digesting
your food, you don't have enough of it left to poop out in the right way and probably it's hurt
the colon that has to process it. At the end of the day you can analyze your body really
effectively by looking at what comes out of your body.“
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Here's a pop quiz. What part of your body is most similar to your brain?
The surprising answer is your small bowel, where most digestion occurs.

"That's the saying, you know, you've got blank for blank," Dr. Oz jokes.
"But the thing about the small bowel is it has primitive messenger
chemicals that tell the bowel how to work. If your bowel's not happy,
those same chemicals influence your brain.“

In this bowel the green stuff is bile, material in the process of being
digested. Dr. Oz says it's important to listen to what your bowel tells you.

"A lot of times you don't pick up on the subtle clues," he says. "It will tell
you that you feel washed out or tired or a little bit of cramping. Or, you
know, if you wake up in the morning and just don't feel like yourself, you
probably had something allergic that you didn't clue into.“
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Susan (left), a busy, working mother of three children, says that

she struggles with constipation—sometimes only going to the
bathroom once every five days. She admits to not getting
enough water, instead opting for eight cans of diet soda a day.
She also says she likes to eat a lot of cookies and chips, but
doesn't get enough fruits and vegetables.

Maureen (right), a mother of four children, says that her health is

the last thing on her mind. She suffers from diarrhea,
hemorrhoids and constipation. "My hemorrhoids feel so bad that
it's like grapes hanging out of my rear," she says. "Sometimes
they hurt so bad, I can't get out of bed for two days." Maureen
admits to eating too much fast food, and not getting enough
fiber and water in her diet.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

"I mean, their bodies are screaming to them," Dr. Oz says of

Susan and Maureen's health. "'Help me. Help me.' Their big
colon is saying, 'I need something from you.' And they're not
processing it. … We are the best health educated society in the
history of mankind but we don't take information and use it to
motivate us to change our behavior.“

On top of suggesting to Susan and Maureen to change their

diets, Dr. Oz says that Susan and Maureen need to pass gas
more often and not be ashamed—we all need to! Dr. Oz says
that the average person passes gas 14 times a day—and less
than one percent of it actually smells. He says it's so important
that we start creating a "no embarrassment zone"—we need to
pass this much gas!
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Dr. Dean Ornish is the first doctor to prove that heart disease
can be reversed through diet and exercise. His low-fat, high-fiber
eating plan has helped millions of people, but he says another
key to good health is avoiding stress.

"When you manage stress better, when you exercise, when you
eat better, your quality of life improves," he says. He suggests
meditation as a way to reduce stress, adding that patients who
meditate show improved medical tests.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Meditation with Dean Ornish, M.D.

"Meditation can help us experience our own inner wisdom and peace," says Dr.
Dean Ornish. Along with eating the right food and getting enough exercise, he
recommends meditation as a powerful way to stay healthy. "Meditation is part of
all cultures and religions," Ornish adds. "It's powerful because when you focus
your awareness, you gain power. Your mind quiets down, and you experience
inner sense of well-being.“

How to Meditate
• Find a quiet, calm place and set aside a few minutes for yourself. "Ten to 15
minutes is ideal, but meditating for even a minute has great benefits," says
Ornish. "Consistency is more important than length."
• You can meditate silently, but many people use a focusing word that begins
with an "oh" or "ah" sound and ends with an M or N sound—like amen, om, or
shalom.
• Close your eyes and take deep, slow breaths.
• Allow yourself to feel more centered and relaxed.
• Breathe in through your nose and exhale slowly.
• Keeping your eyes closed, repeat your word and emphasize the humming
sound at the end
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Reversing and Preventing Heart Disease

For over 20 years, Dr. Dean Ornish has been making headlines as the first doctor to prove that heart disease
can be reversed by a change of lifestyle. "You have to treat the cause. If you treat the cause, your body can
quickly begin to heal," Dr. Ornish says.

The choices you make in your life are a much more powerful determinant in your survival than I or any doctor
can provide you" Dr. Dean Ornish. Today, he shows us how to prevent and reverse heart disease, plus, gain
more energy and lose weight!*

It's estimated that one out of every two women will die of heart disease. Find out how to fight off potential or
current heart problems with Dr. Ornish's life-saving tips.
• The plan involves a low-fat, high-fiber diet that puts food into three categories: foods to
choose most often, foods to eat in moderation, and foods to choose least often.
• Don't count calories. Instead, keep track of fat and sugar, which cause problems for
the heart.
• Choose a diet high in fruits, vegetables, beans and whole grains not high in animal proteins.

• Try to replace white foods such as sugar, white rice and white flour with whole grains like
brown rice and whole-wheat flour.
• Try to use hydrogenated and partially hydrogenated oils less often. They preserve food but
could add to your cholesterol levels.
• Take three grams a day of fish oil. Rich in omega-3 fatty acids, it can reduce
sudden cardiac death by 50–80 percent. It can also reduce incidences of breast
cancer and prostate cancer. Conversely, women (but not men) may try flax seed oil.
• Everybody should know his or her cholesterol level. The goal should be to get the total
cholesterol number under 150, and the LDL (or the "bad" cholesterol) under 95.
• Smoking contributes to a much greater risk of heart disease. If you smoke and take
birth control pills, you quadruple your risk.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Cholesterol Check-In

Dr. Dean Ornish believes that your body has a remarkable capacity to
begin healing itself, especially from heart disease. It can happen much
more quickly than many people realize if you address the underlying
causes. One of these causes is cholesterol, which can be brought under
control.
First, get your cholesterol checked by a doctor. Dr. Ornish says that it's
an easy, affordable test that everyone should have. After you have your
numbers, set one of these numbers as your goal:
Total cholesterol of less than 150 mg/dl —or—LDL cholesterol (bad
cholesterol) less than 95 mg/dl —or—Ratio of total cholesterol divided by
HDL(good cholesterol) equal to 4 or less.
Most Americans have levels above these numbers. If your numbers are
too high, and you don't have heart disease, you can begin to move
toward better health. Make moderate reductions in dietary fat and
cholesterol; for example, if you're eating six eggs a day, reduce that
number to three. Make choices that you can follow; the key is
moderation.
Have your blood levels checked again in four to eight weeks, and if
you've reached your goal, stay with your new eating patterns. If your
cholesterol is still too high, progressively reduce the amount of fat and
cholesterol in your diet until you achieve your goal.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Not going "number two" enough? New health guidelines suggest we

should drink about eight glasses of water a day, about 64 ounces,
and get 25 grams of fiber to stay regular and healthy. World-
renowned heart surgeon Dr. Mehmet Oz says that if we can work on
our fiber and water intake, our digestive systems could dramatically
improve.
"High fiber comes in vegetable form: artichokes, lima beans,
soybeans," he says. "You can get fruits that have lots of fiber like
grapefruit, blackberries and raspberries."
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Another fantastic source of fiber is whole grains. Dr. Oz says that eating whole
grains isn't just the latest craze—they offer multiple benefits to your health.
You may have already heard about the health benefits of whole wheat bread
and oatmeal, but now doctors say other whole grains like spelt, bulgar and
quinoa can reduce cholesterol and high blood pressure and even help prevent
heart disease, cancer, and diabetes. They say that whole grains help flush fat
and cholesterol out of your system and provide powerful antioxidants that help
you stay healthier, look younger and live longer. The USDA just recently
recommended eating at least three servings a day.
One of Oprah's favorite whole grain choices is steel cut oatmeal for its crunchy
texture. Dr. Oz says steel cut oatmeal and other whole grain foods are high in
fiber—great for digestion.
"[Steel cut oatmeal] doesn't have a lot of calories, and it drags the food [you
eat] along so it can't become like putty—until it gets to the very end," Dr. Oz
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Foods rich in magnesium like beets, raisins, dates and soybeans are
important because they get your bowels moving! The more natural,
the better, says Dr. Oz.
"The easy part of this message is all of these foods come out of the
ground looking the way they look when you eat them," he says.
"That's the only thing you have to remember. 'Does it look the way it
looked when it came out of the ground when I eat it? There are no
white bread plants!"
Dr. Oz recommends magnesium supplements when necessary.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Dr. Oz says you can reduce your chances of getting cancer by up to

50 percent by doing three simple things. The first is eating foods rich
in folate. If you don't take it as a supplement, you can find folate in
orange juice, spinach and other leafy green vegetables.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Another cancer-fighting agent is vitamin D. Non-fat milk, orange juice

or supplements are great sources.
"And you get vitamin D from the sun," Dr. Oz says. "So especially if
you live in northern latitudes, you're not getting enough vitamin D
unless you take supplements."
Dr. Oz says that since African-Americans have a darker skin color,
they should probably be taking supplements in order to insure proper
vitamin D intake.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

If there's a magic pill for anything, Dr. Oz says it's the third cancer-
fighting agent on his list—two baby aspirin daily.
"It's cheap and easy to take aspirin," Dr Oz says. "Aspirin has many,
many helping elements. It helps your skin, it helps about anything
you can imagine. It has some potential risks if people have sensitive
stomachs. But for cancer, you've got to be on it."
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Being aware of what our bodies are telling us and how to deal with
those challenges is what Dr. Oz says is most important. As well as
being good for the heart, foods with tomato-based products can help
alert our systems to what might be wrong, Dr. Oz says. Tomato sauce
is part of so many foods it's just a matter of incorporating it into our
diets more often. Dr. Oz says tomatoes contain lycopene which has
been shown to fight cancer. But you can't just put a few slices in your
salad to reap the effect. The tomato needs to be cooked in order to
provide the most nutrients.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Many people will stand up and cheer for this next Dr. Oz tidbit—
coffee is actually good for you, in reasonable amounts.
Coffee actually has been shown to reduce liver cancer and to be
effective with (or with symptoms of) Alzheimer's and Parkinson's
diseases," Dr. Oz says. "So there are a bunch of different places
where coffee can play a role. The reason it got a bad name is
because it does have side effects, for example, migraine headaches
and heart palpitations. But if you're not having them, coffee is
reasonable."
Did we mention, it's good for those bowel movements, too? Dr. Oz
suggests 24 ounces of coffee a day is a rational amount.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

Dr. Oz is on the New York Presbyterian Hospital team that operated on President Clinton
during his recent quadruple bypass operation. While in office, President Clinton
underwent daily health screenings, but the tests never showed he was on the verge of a
major heart attack. The President had experienced tightness in his chest after exercising
that would eventually go away. He finally decided to consult doctors after experiencing
tightness in his chest unrelated to exercise—a decision that saved his life.
"I'm much more careful about what I eat and I have resumed a vigorous exercise
program," President Clinton says. "I'm convinced that if it hadn't been for the fact that I
was in pretty good shape, I might not have survived it."
Dr. Oz says that the president had done the right thing in listening to his body and
pushing to cure what seemed wrong. But President Clinton had stopped taking his
medications after he had seen a drop in his cholesterol.
"Fifty percent of Americans don't take their medications the way they need to," Dr. Oz
says. "And he's the President of the United States. He's as well tested as you can be. And
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

So what can you eat to make your heart healthy and happy? Foods
rich in omega-3 fatty acids are the best, says Dr. Oz. Salmon, walnuts
and hazelnuts are great sources. Keep nuts in your refrigerator so
they don't oxidize. Garlic and onions are also heart-healthy.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

Food Solutions

You've heard it before, and we'll say it again—yay, red wine! So why
is red wine healthier than white?
"Red wine has a chemical in it called rezveritrol, which is a very
strong antioxidant that's also been shown to be heart-healthy," Dr.
Oz says. "Red wine has the material from the skins of the grapes [the
rezveritrol]. The white wine has that skin stripped away. So if you're
going to drink wine and you're going to take the hit on calories, drink
red wine."
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

Dr. Michael Roizen, co-author of YOU: The Owner's Manual with Dr.
Mehmet Oz is renowned worldwide for his revolutionary anti-aging
research.
Dr. Roizen says the keys to looking younger and staying healthy are
found in certain foods you should eat every day, and other foods you
should eat several times a week.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

"You want to eat a handful of nuts every day," Dr. Roizen says. "Walnuts and
almonds are excellent. And you want to eat five handfuls of fruits and
vegetables every day. Then you want some whole grains and some whole
grain cereal."
"Don't make the mistake of 'whole wheat' being 'whole grain,'" Oprah says.
"There is a difference. It should say whole grain."
Dr. Roizen cautions against eating foods like corn too often, because the body
absorbs sugar differently. He says it is important to eat some fat, like nuts,
before eating sugars. "Having the walnuts or almonds a little bit before you
have [sugar] slows your stomach from emptying," Dr. Roizen advises. "One,
you feel full and you don't eat as much. And, two, because sugar's absorbed
after the stomach, in the intestine, you keep your blood sugar level more
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

In recent years, there has been conflicting information about fish. On

the one hand, fish is consistently regarded as a terrific source of low-
fat protein. On the other hand, there are serious concerns about
mercury and other environmental impurities, and their effects on
children, pregnant women and the elderly.

Dr. Roizen says you just have to remember a few great fish—tilapia,
salmon, flounder, cod and mahi-mahi. "Those are the fish that have
none of the toxic chemicals, none of the PCBs, and very low content
of mercury." According to Dr. Roizen, you should eat a serving of
these fish three times a week.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

Dr. Roizen beams when he talks about one particular food: tomatoes. "They
decrease cancer and they decrease arterial aging, heart disease, stroke,
memory loss, impotence, wrinkling of the skin," he says. "In fact, Dr. Oz and I
think a small town should be named after aspirin: it's that important. But a
whole country should be named after tomatoes!"

So should they be raw or cooked? "It takes 165 raw tomatoes to equal 10
tablespoons of tomato sauce," Dr. Roizen says. "So it's much easier to have
tomato sauce.“

Dr. Roizen adds that it doesn't matter what kind of tomato sauce you have,
"as long as it's cooked, and you eat it with a little olive oil and a little healthy
fat because it's much better absorbed with it."
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

Dr. Roizen says that it is important to drink eight glasses of fluid

every day. "It helps move the poop and gives you better hydration. It
actually cuts down on wrinkles, too, because you hydrate your skin
when you take it internally.“

On top of this, you should have the glass of red wine, which is good
for your heart, and milk or a milk substitute with vitamin D and
calcium. If you prefer not to have the milk, you can get vitamin D and
calcium in fortified orange juice or in vitamins.
The Oprah Winfrey Show - Inside the Human Body
January 30, 2004

What You Should Eat Daily

"There are two vitamins that really are as good as tomatoes and
should have a country named after them," Dr. Roizen says. "They are
folate, which decreases arterial aging, decreases blood pressure and
decreases cancer rate. [It will say] either folate or folic, they're the
same, and you want 800 micrograms a day. And vitamin D: you want
400 international units a day. Those two together decrease cancer
rates substantially."

Dr. Roizen also says that calcium and magnesium are crucial vitamin
supplements. Even in a daily multivitamin, there is not enough
calcium. Most women can only absorb 600 milligrams at a time,
though you need 1,200 milligrams everyday. Therefore, it is