Ornish begins his piece with a misleading statistic. His famous 1990 Lifestyle Heart trial involved a total of 48 patients with heart disease. A case report in a peer-reviewed journal described the fatal ventricular fibrillation arrest of a 16-year-old girl who had started a high-protein/low-carbohydrate diet 2 weeks earlier and presented profound hypokalemia and hypocalcemia during resuscitation attempts (54). As Moyer indicates here, the 2014 meta-analysis showed higher mortality risks associated with both processed meat and unprocessed meats. 1974;15:508-516. WebDean Ornish, in full Dean Michael Ornish, (born July 16, 1953, Dallas, Texas, U.S.), American physician and author whose approach to treating heart disease through radical 2023 Scientific American, a Division of Springer Nature America, Inc. 1972;56:359-364. 1996;46:325-341. For instance, he wrote that animal proteins have been associated with higher disease and mortality risks in observational studies. That only supports my thesis, because I recommend that people eat less harmful fats and fewer refined carbohydrates. The amount of dietary cholesterol and saturated fat in either a 30% fat diet or an Atkins diet may saturate and suppress the LDL receptor system, thereby leading to little fall in plasma LDL-C levels (29). Atkins R. The case for low carbs. Third, it is a common misconception that anything that raises HDL is beneficial and anything that lowers it is not. In contrast, the NHANES data is from surveying only a small sample of people nationwide, so its less reliable. The New York Times, May 27, 2003. This reduction in LDL-C is much greater than on an Atkins diet and is comparable with the effects of statin drugs. First, I cited several large-scale studies from many different investigators, all of which showed that a diet high in red meat increases the risk of premature death from virtually all causes, even when adjusting for confounding variables. Effect of 6-month adherence to a very low carbohydrate diet program. : How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (2019; written with his wife, Anne Ornish). There are no data showing that the physiologic reduction of HDL-C levels with a low-fat diet is detrimental, especially in that LDL-C usually decreases more than HDL-C (42). New York: Random House; 1990. What is missing in Moyers article is the clinical experience that comes from helping people change their diet and lifestyle. Could it be that our attempts to reduce fat have in fact been part of the problem? In summary, decreases in HDL-C due to a low-fat diet have a very different prognostic significance than someone who cannot raise HDL-C as much on a high-fat diet. WebWas Dr. Atkins Right? 2002;113:30-36. Judging the quality of a study by the number of patients is like judging the quality of a book by the number of pages. 1998;339:12-20. If you would like to visit their site, please use Ornish D, Pettengill E, Merritt-Worden T. Marked improvements in biomedical and psychosocial cardiac risk factors from a community-based lifestyle program. Whole foodssuch as whole grain products and fruits and veggiesare healthy, but I think that dairy products, fish and lean cuts of meat or poultry can also be part of a healthy diet, Steffen says. I would love to be able to tell you that these are health foods, but they are not. He says that dietary meta-analyses and systematic reviews involving humanssuch as the one I cited from 2010 that found no association between red meat consumption and heart disease or diabetescan be misleading because the noise obscures the ability to detect statistically significant differences. Meta-analyses and systematic reviews have their limitations, of course, and they must be conducted carefully. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Here's a blog in which I addressed this issue: As Attilio Maseri, MD, an internationally known and respected cardiologist, wrote: My colleagues and I conducted a demonstration project of 333 patients from four academic medical centers and four community hospitals. The diet limited fats to 10 percent of total caloric intake and cholesterol to only 5 mg a day, mainly through eliminating animal products and processed foods. which types of nerves carries stimuli away from the brain?, In planning his fitness goals, Alonso wants to make sure that he improves his fitness without pushing himself too hard too fast. Can lifestyle changes reverse coronary heart disease? She wrote about the reasons that autoimmune diseases overwhelmingly affect women in the September 2021 issue. He attended Rice University in Houston but dropped out after experiencing severe depression and mononucleosis. In a survey of food consumption data from the United States Department of Agricultures National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII), Individuals of all ages who consume a diet with fewer than 30% of calories from fat consistently have lower energy intakes. Again, meta-analyses of observational studies are certainly not perfect, but because they analyze all relevant data, they circumvent the problem of cherry-picking. He should know better. So even when we look at the data Ornish likes, we still dont see reason to blame Americas ill health on unprocessed red meat and saturated fats. Lancet. Upon changing from high to low intake of saturated fat and cholesterol, the mean HDL-C decreased 29%, whereas apo A-I levels fell 23%. 2001;73:1010-1018. Bill Clinton is one of the more public examples of this, having lost and kept off more than 20 pounds since following the whole foods, plant-based diet I recommended for him five years ago (including salmon once a week). WebIn contrast to these studies, and most others, on the lack of influence of calcium intake on fracture risk, the authors of this study conclude calcium is the problem and this is based on findings in only 74 people with fractures following a vegan diet. A wide body of scientific evidence links the consumption of animal protein, saturated fat, and cholesterol with CVD, cancer, and other chronic illnesses (47-51). The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. Ornish also dismisses the randomized controlled trials I cited in large part because the subjects in these trials did not adhere to the diets and reduce their fat intake enough. The New York Times Sunday Magazine, July 7, 2002. An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). So when Ornish wrote in his oped that for reversing disease, a whole-foods, plant-based diet seems to be necessary, he is incorrect. Liu S, Stampfer MJ, Hu FB, et al. The fact that processed meat is even worse for you than unprocessed meats does not change the fact that the risk of premature death from all causes is higher in those eating red meat than those who do not. If you know or suspect that you have a health problem, consult a health professional. An Atkins diet may increase postprandial lipemia and increase free fatty acids, which may have harmful effects on platelet aggregation and may promote ventricular arrhythmias (57,58). The primary drive was volume not calories (7). Am J Physiol. WebComparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: a Randomized Trial The following information is available WHY PEOPLE LOSE WEIGHT ON LOW-CARBOHYDRATE/HIGH-FAT DIETS. Ornish D. A diet rich in partial truths. WebDr, Atkins vs. Dean Ornish and John McDougall - USDA Debate from 2000. 2003;103:867-872. This study was widely reported and caused many to say, See, another study showing that the Atkins diet is good for your heart. It sounds good, but it is not true. In other words, the diet I recommend causes weight loss, not weight gain. In: Cowdry EV, ed. Am J Cardiol. You used to find a lot more people interested in Intensive lifestyle changes for reversal of coronary heart disease Five-year follow-up of the Lifestyle Heart Trial. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) These studies need to be replicated, although similar findings were found by others (39,40). Omissions? N Engl J Med. Cardiovascular effects of n-3 fatty acids. The level of LDL-C is regulated by the LDL receptor, a cell surface glycoprotein that removes LDL from plasma by receptor-mediated endocytosis (27). But Ornish is conflating hot dogs and pepperoni with fresh, unprocessed meats, says Lydia Bazzano, professor of nutrition and epidemiology at Tulane University School of Public Health and Tropical Medicine, and theres a big difference between them. A 2010 systematic review and meta-analysis of 20 studies found consumption of processed meat was associated with an increased risk of diabetes and heart disease but eating unprocessed red meat was not. Also, as I wrote in my oped in The New York Times, my colleagues and I have conducted randomized controlled trials that these same diet and lifestyle changes reverse the progression of other common chronic diseases. To the degree that people reduce their overall intake of simple carbohydrates and excessive fat and increase their intake of whole foods such as complex carbohydrates, they are likely to lose weight and gain health. Articles from Britannica Encyclopedias for elementary and high school students. Gould KL, Ornish D, Scherwitz L, et al. Dietary cholesterol and the pathogenesis of atherosclerosis. WebIn this video, we are comparing the new Atkins Protein Chips to the Quest Protein Chips. Effect of 6-month adherence to a very low carbohydrate diet program. Even better would be to reduce the intake of simple carbohydrates and most fats, which results in losing even more weight while enhancing health rather than potentially harming it. Despite being told to eat less fat, he says, Americans have been doing the opposite: They have actually consumed 67 percent more added fat, 39 percent more sugar and 41 percent more meat in 2000 than they had in 1950 and 24.5 percent more calories than they had in 1970. Yes, Americans have been eating more fat, sugar and meat, but we have also been eating more vegetables and fruits (pdf)because we have been eating more of everything. Ornish told Reuters, There has been a bit of a backlash against not only just low-fat eating, but healthy living in general. Available at: http://www.americaonthemove.org/. New York: MacMillan; 1933:271-322. Dean Ornish, MD, is founder and president of the non-profit Preventive Medicine Research Institute and is Clinical Professor of Medicine at the University of California, San Francisco. Moyers article only adds to that confusion. Whole grain consumption improves insulin sensitivity in overweight and obese adults (15). The recent multicenter PREDIMED trial also supports the notion that fat can be good rather than bad. Therefore, diet-induced changes in HDL-C levels correlate with and may result from changes in apo A-I transport rate. But even if the NHANES data are accurate, they show Americans are eating more fat than ever and even more refined carbohydrates than ever. 2002;40:265-274. But his claims about the dangers of saturated fat and red meat go beyond the science and in some cases contradict it. Whereas simple carbohydrates tend to have a high glycemic index/glycemic load and may be harmful for reasons discussed earlier, complex carbohydrates usually have a low glycemic index/glycemic load and are beneficial. The mechanism of the effects on HDL-C levels of changing from a high- to low-fat diet differs substantially from the mechanism explaining the differences in HDL-C levels between individuals who are eating a high-fat diet. On August 12, 2010, after 16 years of review, the Centers for Medicare & Medicaid Services began providing Medicare coverage for my intensive lifestyle program for reversing heart disease under a new benefit category, intensive cardiac rehabilitation. Many insurance companies are also providing coverage. He received an M.D. They documented 23,926 deaths (including 5,910 CVD and 9,464 cancer deaths) during 2.96 million person-years of follow-up. But Ornish is conflating hot dogs and pepperoni with fresh, unprocessed meats, says Lydia Bazzano, professor of nutrition and epidemiology at Tulane University School of Public Health and Tropical Medicine, and theres a big difference between them. A 2010 systematic review and meta-analysis of 20 studies found consumption of processed meat was associated with an increased risk of diabetes and heart disease but eating unprocessed red meat was not. Whats more relevant to the discussion is this fact: During the time in which the prevalence of obesity in the U.S. nearly tripled, the percentage of calories Americans consumed from protein and fat actually dropped whereas the percentage of calories Americans ingested from carbohydratesone of the nutrient groups Ornish says we should eat more ofincreased. He began the Lifestyle Heart Trial, a controlled study of the effects of a low-fat diet and stress-management regime on a small group of heart disease patients, implementing a unique approach to treating heart disease that he developed in the late 1970s while he was still a student. In his lengthy reply to my article Dean Ornish says I distort his beliefs, cite questionable studies and dont have the clinical experience to assess nutritional evidence. They concluded, A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates. Another major research article studied 43,396 Swedish women over 15 years. Leaf A, Weber PC. Brown MS, Goldstein JL. Taubes G. What if its all been a big fat lie? As Dr Atkins wrote a few months before he died, At what point am I allowed to say, I told you so? (4). Nutrition is complex but there is little evidence our countrys worsening metabolic ills are the fault of protein or fat. All consumption estimates are imperfect, of course, including the U.S. Department of Agriculture (USDA) data he cites. On one side was Atkins, who had two strips of bacon and three eggs for breakfast. Am J Cardiol. Discover world-changing science. Recent studies also seem to provide some evidence that high-protein diets may have beneficial effects on cardiovascular disease (CVD) risk factors such as high-density lipoprotein (HDL) and triglycerides. Available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof . Some scientists think so. Second, if subjects in dietary clinical trialswho are attending dietician-led classes and being monitored regularlyare unable to reduce their fat intake to anywhere close to Ornishs recommendations, then how could his approach possibly be a sustainable solution for the entire country? In: Harrisons Principles of Internal Medicine (online), Braunwald E, ed. Dietary fat intake as risk factor for the development of diabetes: Multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD). Believing this, many people are throwing up their hands, exasperated, saying, These damn doctors cant make up their mindsto hell with them, Ill eat whatever I want, when there is actually an emerging consensus among scientists and physicians who do research in nutrition about what constitutes an optimal way of eating. . In practice, someone trying to lose weight may begin by moderately reducing their intake of simple carbohydrates and fat and moderately increasing their level of exercise. 1998;339:12-20. Cardiology. Ornish then moved to the Boston area for a clinical fellowship at Harvard Medical School and an internship and residency in internal medicine at Massachusetts General Hospital, which he completed in 1984. By planning to improv USDA data also show (pdf) that between 1970 and 2005 U.S. consumption of saturated fatrich butter and lard as well as hydrogenated shortening decreased 17 percent. Not exactly. Oliver MF, Yates PA. Diabetes mellitus, hypoglycemia, and other endocrine disorders. Brinton EA, Eisenberg S, Breslow JL. On one side was Atkins, who had two strips of bacon and three eggs for breakfast. Pres. Join the hundreds of thousands in my email community for the latest news, insight, and more, Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. I have presented these research findings on several occasions at the annual scientific meetings of the American Heart Association, American College of Cardiology, American Dietetic Association (now the Academy of Nutrition and Dietetics), the Institute of Medicine of the National Academies and many others. Prev Cardiol. Theres also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. Induction of ventricular arrhythmias by elevation of arterial free fatty acids in experimental myocardial infarction. Dietary cholesterol and saturated fats increase plasma LDL-C in part by down-regulating LDL receptors in the liver (28). 1999;70:412-419. Weight loss at 12 months was the primary outcome. Second, as I made clear in the oped as well as in my books and journal articles, the diet I recommend is low in refined carbohydrates and high in good carbs such as fruits, vegetables, whole grains, legumes and soy products in their natural, unrefined forms (which tend to have low glycemic loads). They write new content and verify and edit content received from contributors. Indicate whether you agree with one or both researchers or have a different In addition to giving up smoking and fatty foods, the test subjects did yoga, meditated, and participated in a support group. Resolving the coronary artery disease epidemic through plant-based nutrition. To understand better the mechanism of this phenomenon, Breslow and colleagues studied the turnover of HDL apolipoproteins (apo) A-I and A-II in 13 subjects on two contrasting metabolic diets. I feel passionately about doing this work because it helps transform peoples lives for the better. Create your free account or Sign in to continue. Yet as I read this article, I cant help but to find amusement in 1995;19:811-816. 1999;18:207-212. The results of the trial, published in 1990, revealed that at least some effects of coronary atherosclerosis had been reversed in many patients. J Am Diet Assoc. A 2014 meta-analysis similarly reported much higher mortality risks associated with processed meat compared with red meat consumption and found no problems associated with white meat. Am J Clin Nutr. Second, there was no statistically significant difference in either systolic blood pressure or diastolic blood pressure after one year in comparing the groups. For example, the thenAmerican Dietetic Association published a position paper on plant-based diets in which they wrote, It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases.. Although we always need more research, there is enough science now to guide us. As you approach your weight loss goals, you start to Ornish was raised in Dallas by his father, a dentist, and his mother, a childrens book author and filmmaker. Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD. These studies have been conducted with well-respected collaborators, published in the leading peer-reviewed journals, and presented at the most credible scientific meetings. You can specify conditions of storing and accessing cookies in your browser, Compare and contrast Dr. ornish and Dr Atkins, which virus is responsible for chickenpox?. But fact that the participants were making all of these lifestyle changes means that we cannot make any inferences about the effect of the diet alone. Randomized controlled clinical trials, although certainly not perfect, are better tools for chipping away at causality, and they suggest that protein and fat dont deserve to be demonized. And although Ornish is right that I lack clinical experience, when analyzing evidence, distance can be useful. A randomized trial of a low-carbohydrate diet for obesity. Interaction of dietary cholesterol and triglycerides in the regulation of hepatic low-density lipoprotein transport in the hamster. And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. Over and over, Ive seen patients with coronary heart disease so severe that they cant walk across the street or work or play with their kids or make love or do much of anything without getting severe chest pain become pain-free after only a few weeks of making these diet and lifestyle changes. Am J Clin Nutr. Whole foodssuch as whole grain products and fruits and veggiesare healthy, but I think that dairy products, fish and lean cuts of meat or poultry can also be part of a healthy diet, Steffen says. N Engl J Med. Westman EC, Yancy WS, Edman JS, et al. Dean Ornish, MD In contrast, differences in HDL-C levels between people on a given diet correlate with and may result from differences in apo A-I FCR. Ornish first takes issue with the data I cite on food consumption patterns from the National Health and Nutrition Examination Survey (NHANES). However, reducing dietary fat and cholesterol may cause a decrease in HDL-C because there is less need for it. Dr. Atkins' Diet Revolution, first published in 1972 Dr. Robert C. Atkins, cardiologist Achieve a "metabolic advantage" with a four-phase diet low in carbohydrates What is Kim MOST trying to strengthen? Clinical Nutrition and Dietetics. Dr Atkins advocated substituting simple carbohydrates with high-fat, high-animal protein foods such as bacon, sausage, butter, steak, pork rinds, and brie. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Total fat and animal fat intake were higher and carbohydrate intake was lower in those with recently diagnosed diabetes or previously undiagnosed diabetes in the multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (17). The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. The Atkins diet caused the most coronary artery blockages whereas a diet low in fat and high in unrefined carbohydrates caused the least amount of blockages. New York: HarperCollins Publishers; 1996. Clinical Trials in Cardiovascular Disease. Please refer to the appropriate style manual or other sources if you have any questions. Dietschy JM, Brown MS. Effect of alterations of the specific activity of the intracellular acetyl CoA pool on apparent rates of hepatic cholesterogenesis. We found that almost 80 percent were able to avoid surgery by making these comprehensive lifestyle changes. History tells us its not going to be spinach. In another study, 100 people were randomly assigned to one of four diets for 1 year: an Atkins diet; a 30% fat diet; a 15% fat, calorie-controlled diet; or a 10% fat, whole foods diet with an emphasis on complex carbohydrates. J Lipid Res. A receptor-mediate pathway for cholesterol homeostasis. Accessed March 5, 2004. Presented at the American Heart Association Scientific Sessions, Orlando, November 11, 2003. Robert Atkins debates Dean Ornish and John McDougall on whether a low-carb, high-protein diet is It's the type of protein, fat and carbohydrates that matters. Stevens A, Robinson DP, Turpin J, et al. Hu JF, Zhao XH, Parpia B. Dietary intakes and urinary excretion of calcium and acids: A cross-sectional study of women in China. Its hard to move the science forward when there are so many stakeholders who say this is the right diet and no other one could possibly be right, Bazzano says. N Engl J Med. J Am Coll Nutr. Was Dr. Atkins Right? And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. A related study by this group looked at 85,168 women and 44,548 men without heart disease, cancer or diabetes from the Nurses Health Study and the Health Professionals Follow-Up Study. Ornish moved to San Francisco in July 1984 after accepting a teaching position at the University of California School of Medicine. Am J Kidney Dis. Journal of the American Medical Association 104(2004):537. Earlier this year a panel of experts from U.S. News & World Report rated the Ornish Diet as the number-one diet for heart health for the fifth year in a row (that is, all five years they have been doing rankings). The March 2014 study that Ornish cites as finding a 75 percent increase in premature deaths from all causes and a 400 percent increase in deaths from cancer and type 2 diabetes among heavy consumers of animal protein under the age of 65, also did not distinguish between types of animal protein. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Armstrong ML, Warner ED, Connor WE. They should not be used to make claims about cause and effect; doing so is considered by nutrition scientists to be inappropriate and misleading. The reason: People who eat a lot of animal protein often make other lifestyle choices that increase their disease risk, and although researchers try to make statistical adjustments to control for these confounding variables, as theyre called, its a very imperfect science. Ornish wrote several popular books, including Stress, Diet, and Your Heart (1982), Dr. Dean Ornishs Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery (1990), The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health (2007), and Undo It! These associations were either abolished or attenuated if the proteins were plant derived.. 1994;1:283-286. You can lose weight without feeling hungry or deprived. Its possible that quitting smoking, exercising and stress management, without the dieting, would have had the same effectbut we dont know; its also possible that his diet alone would not reverse heart disease symptoms. 1997;337:562-563. Zeman FJ, Hansen RJ. Since the U.S. population last year was 322 million people, this represents only 0.000044% of the population, and different people are surveyed each year. Eating a high glycemic index food along with mostly low glycemic index foods may reduce the overall glycemic load of the meal. David Perlmutter, MD, FACN is a board-certified neurologist, Fellow of the American College of Nutrition, and five-time New York Times bestselling author. First, shes again perpetuating the myth that when we cut out fat, we began eating foods that were worse for us. As the USDA data show, were eating more fat, not less. New York: McGraw Hill; 2002. Anitschkow N. Experimental arteriosclerosis in animals. J Clin Invest. I have no horse in this race. The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. I dont usually respond to ad hominem attacks, but when I read Melinda Wenner Moyers article Why Almost Everything Dean Ornish Says about Nutrition Is Wrong, I felt a need to set the record straight. Mean apo A-II levels did not change. HDL is important only to the extent that it affects atherosclerosis and myocardial perfusion, it is not a disease. Atkins R, Ornish D. Cardiology Crossfire. American College of Cardiology 50th Annual Scientific Sessions, Orlando, FL, March 20, 2001. In a 2007 clinical trial led by Gardner researchers randomly assigned 311 individuals to four groups: One group was assigned the high-fat, high-protein and low-carbohydrate Atkins diet; the second was assigned Ornishs very low-fat vegetarian diet, which requires consuming fewer than 10 percent of calories from fat; the third was assigned the Zone diet, which aims for a 40/30/30 percent distribution of carbohydrate, protein and fat; and the fourth was assigned the high-carbohydrate, lowsaturated fat LEARN (for: lifestyle, exercise, attitudes, relationships, nutrition) diet. Atkins To address this issue, a recent National Institutes of Health study that I cited in my oped put people in a metabolic ward where they could actually control what people were eating and then measured the effects. Fung TT, Hu FB, Pereira MA, et al. Dansinger ML, Gleason JL, Griffith JL, Li W, Selker HP, Schaefer EJ. Westman EC, Yancy WS, Edman JS.