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. New York: HarperCollins Publishers; 1996. J Clin Invest. Anitschkow N. Experimental arteriosclerosis in animals. An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). New York: McGraw Hill; 2002. DISTINGUISHING BETWEEN RISK FACTORS AND ACTUAL MEASURES OF DISEASE. People have a spectrum of choices. The decrease in the percentage of calories from fat during the period 1971 to 1991 is attributed to an increase in total calories consumed; absolute fat intake in grams actually increased. WebDr. Other studies have documented that an AHA/NCEP diet is not very effective in lowering LDL-C (21). Ornish D, Brown SE, Scherwitz LW, et al. SUBSTITUTE SIMPLE WITH COMPLEX CARBOHYDRATES. These are not theoretical discussions; they are real people who have shown substantial improvements in their health and well-beingnot just in risk factors but also in the underlying disease process. Eating a high glycemic index food along with mostly low glycemic index foods may reduce the overall glycemic load of the meal. Peyreigne C, Bouix D, Aissa Benhaddad A, et al. I believe the low-fat message promoted the obesity epidemic, says Lyn Steffen, a nutritional epidemiologist at the University of Minnesota School of Public Health. But even if the NHANES data are accurate, they show Americans are eating more fat than ever and even more refined carbohydrates than ever. Science. However, an Atkins diet was compared with a conventional 30% fat American Heart Association/National Cholesterol Education Program (AHA/NCEP) diet, which is not very low in fat and often high in simple carbohydrates (which increase triglycerides). They documented 23,926 deaths (including 5,910 CVD and 9,464 cancer deaths) during 2.96 million person-years of follow-up. As all dietetics professionals know, there is no mystery in how to lose weight: burn more calories and/or eat fewer calories. Resolving the coronary artery disease epidemic through plant-based nutrition. Clinical professor of medicine, University of California, San Francisco 1998;339:12-20. It found that individuals assigned to eat high-fat (41 percent calories from fat), Mediterranean-style diets for nearly five years were about 30 percent less likely to experience serious heart-related problems compared with individuals who were told to avoid fat. Credit: Nick Higgins. 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. The information on this website is intended to supplement, not replace, the advice of a trained health professional. Omissions? Am J Med. She completely misrepresents my recommendations: carbohydratesone of the nutrient groups Ornish says we should eat more ofincreased. Ive always recommended that people limit their consumption of sugar and other refined carbohydrates. The point here is not that Ornishs dieta low-fat, whole food, plant-based approachis necessarily bad. WebAtkins 40 is an easy low carb diet plan for those with less than 40 pounds to lose. My colleagues and I have been training and certifying teams of health care professionals at leading hospitals, clinics and health systems in this lifestyle program for reversing heart disease. The only peer-reviewed study that examined the underlying disease processes found that blood flow to the heart improved on a very low-fat, whole foods diet but worsened on an Atkins diet (35). But looking more closely at the report (pdf) he discussesas others already haveone finds that it, too, shows that in the decades from 1970 to 2000, when obesity and chronic disease rates skyrocketed, U.S. consumption of red meat and eggs dropped 12 percent. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Prev Cardiol. Sudden cardiac death of an adolescent during dieting. Encyclopaedia Britannica's editors oversee subject areas in which they have extensive knowledge, whether from years of experience gained by working on that content or via study for an advanced degree. Cardiovascular effects of n-3 fatty acids. Potential benefits and risks have not been tested adequately. Regulation of low-density lipoprotein receptors: Implications for pathogenesis and therapy of hypercholesterolemia and atherosclerosis. 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. Ornish told Reuters, There has been a bit of a backlash against not only just low-fat eating, but healthy living in general. I have no horse in this race. Buzzano notes that even high-fat dietsif they are high in the right fatscan be healthy and help you lose weight. Past studies also support the claim that low-carb diets are more effective than low-fat. All consumption estimates are imperfect, of course, including the U.S. Department of Agriculture (USDA) data he cites. RESULTS: 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. N Engl J Med. But they dont mask the truth; compared with individual studies, they get closer to it. Theres also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. 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. Fourth, the patients in our randomized controlled trial (JAMA. Westman EC, Yancy WS, Edman JS, et al. He received an M.D. Dietary cholesterol and saturated fats increase plasma LDL-C in part by down-regulating LDL receptors in the liver (28). And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. Dietschy JM, Brown MS. Effect of alterations of the specific activity of the intracellular acetyl CoA pool on apparent rates of hepatic cholesterogenesis. 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. Saunders; 1998. Weight loss at 12 months was the primary outcome. Am J Physiol. The other way people get too many calories is by consuming too many simple carbohydrates. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. OBJECTIVE: Dietary fat intake as risk factor for the development of diabetes: Multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD). Journal of the American Medical Association 104(2004):537. These surges may cause a reactive hypoglycemia, increasing hunger and a desire to eat more simple carbohydrates in a vicious cycle, sometimes called carbohydrate cravings. In addition, excessive insulin enhances the growth and proliferation of arterial smooth muscle cells, promoting atherosclerosis (9). 1997;337:562-563. In one of these studies, low-density lipoprotein cholesterol (LDL-C) increased from 118 to 121 mg/dL on an AHA/NCEP low-fat diet and increased from 114 to 118 mg/dL on a high-protein/low-carbohydrate diet (19). 1972;56:359-364. Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Other large observational studies have found that diets high in fat and protein are not associated with disease and may even protect against it. 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 Create your free account or Sign in to continue. Spady DK, Dietschy JM. The authors wrote: The beneficial effects of lower protein intake were not seen in those over 65. The abstract did not mention that people lost the most weight on the Ornish diet, it was the only one to significantly lower LDL-C, and it was the only one to significantly lower insulin (even though one of the main premises of the Atkins and Zone diets is their purported effect on insulin). On one side was Atkins, who had two strips of bacon and three eggs for breakfast. These are rich in fiber, which enhances satiety without adding significant calories. Insulin stimulates 3-hydroxy-3-meth-ylglutaryl coenzyme A reductase (which statin drugs inhibit), increasing lipid production, which may help to explain why high-protein diets do not always exacerbate hypercholesterolemia (26). Im not cherry-picking data; Im looking at the preponderance of evidence from many studies by leading investigators such as those at Harvard School of Public Health. 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? Chanmugam P, Guthrie JF, Cecilio S, Morton JF, Basiotis PP, Anand R. Did fat intake in the United States really decline between 1989-1991 and 1994-1996? 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. How might a mans reproductive health concerns change at different periods of his life? Thus, neither an Atkins diet nor a 30% fat diet is very effective in lowering LDL-C or in maintaining long-term weight loss (25). They write new content and verify and edit content received from contributors. Taubes G. The soft science of dietary fat. 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. Twenty-eight were assigned to his low-fat, plant-based diet and 20 were given usual cardiac care. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. Total cholesterol decreased much more on the Ornish diet than on any of the other diets. 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. Outcomes were assessed at months 0, 2, 6, and 12. It is all about energy balance. J Lipid Res. Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. Connor WE, Connor SL. The primary drive was volume not calories (7). 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. Bell EA, Rolls BJ. Atkins BACKGROUND: 1970;27:59-67. To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. 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. As stated earlier, a low-fat, whole foods diet has been proven to reverse heart disease using actual measures of coronary atherosclerosis and myocardial perfusion, whereas none of the other three diets has been shown to do so. Pereira MA, Jacobs DR Jr, Pins JJ, et al. I feel passionately about doing this work because it helps transform peoples lives for the better. A critique of the diet guru's views on high-protein diets, followed by a response from Ornish and a reply from the author. Functional foods: Position of the American Dietetic Association. Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study. But the research he cites to back up his oped claims is tenuous at best. Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Ninety-nine percent of experimental group patients were also able to stop or reverse the progression of CHD as measured by cardiac positron emission tomography (PET) scans (38). Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. JAMA. Meat has virtually no dietary fiber. 2002;40:265-274. He is recognized internationally as a leader in the field of nutritional influences in neurological disorders. Hunninghake DB, Stein EA, Dujovne CA, et al. Arteriosclerosis. 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. 1998) showed an average reduction of 24 pounds in the first year. (This study was funded by the Atkins Center for Complementary Medicine.) These associations were either abolished or attenuated if the proteins were plant derived.. Dean 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 diet modification and exercise generated significant debate in the medical community and attracted a popular following. 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. Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD. Explain the scientific basis of each author's position. Brown MS, Goldstein JL. Reductions in total cholesterol, LDL-C, triglycerides, and total-to-HDL cholesterol ratios were significant only in patients who were following either a 10% fat diet or a 15% fat, calorie-controlled diet. This optimal diet is based predominantly on fruits, vegetables, grains, and legumes in their natural, unrefined forms. The March 2014 study in Cell Metabolism did distinguish between animal protein and plant-based proteins. Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. In addition to giving up smoking and fatty foods, the test subjects did yoga, meditated, and participated in a support group. The Atkins diet has four phases: Phase 1: Induction A person consumes less than 20 grams (g) of carbs each day. The decrease in HDL-C and apo A-I levels correlated with the decrease in apo A-I transport rate but not with the increase in apo A-I FCR. 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. In: Cowdry EV, ed. 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. Kern PA, Ong JM, Saffari B, Carty J. Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: The Iowa womens health study. 2001;4:171-177. Sample sizes ranged from 1,730 men and 2,003 women in NHANES 1999 to 2000 to 6,630 men and 7,537 women in NHANES III. 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 After one year those following his diet were more likely to see a regression in their atherosclerosis. Ornish D, Pettengill E, Merritt-Worden T. Marked improvements in biomedical and psychosocial cardiac risk factors from a community-based lifestyle program. The goal is to lose weight in ways that enhance health rather than in ways that may harm it. However, HDL increased more on the other diets, so the differences in the Framingham risk score were due primarily to changes in HDL. The concept of a dietary spectrum empowers people with information and freedom of choice rather than the feeling of constraint or restriction. Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China Study. N Engl J Med. 1995;19:811-816. Some people are able to handle more simple carbohydrates and/or more cholesterol and saturated fat in their diet than others. This is why I use the USDA data (which tracks consumption of the entire food supply, not just a tiny sample). Accessed March 5, 2004. 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. The New York Times Sunday Magazine, July 7, 2002. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) There are so many other factors. David Perlmutter, MD, FACN is a board-certified neurologist, Fellow of the American College of Nutrition, and five-time New York Times bestselling author. Second, there was no statistically significant difference in either systolic blood pressure or diastolic blood pressure after one year in comparing the groups. INTERVENTION: 1999;84:339-341A8. For instance, he wrote that animal proteins have been associated with higher disease and mortality risks in observational studies. The corresponding HRs (95 percent CIs) were 1.18 (1.131.23) and 1.21 (1.131.31) for CVD mortality and 1.10 (1.061.14) and 1.16 (1.091.23) for cancer mortality. In our randomized controlled Lifestyle Heart Trial, HDL cholesterol did not increase but patients showed regression of coronary atherosclerosis after one year, even more improvement after five years, and a 300 percent improvement in myocardial perfusion (blood flow to the heart) as measured by cardiac PET scans. WHAT EVIDENCE SUPPORTS THAT HIGH-PROTEIN DIETS MAY BE HARMFUL? There was a direct correlation between the intake of dietary cholesterol and fat and changes in coronary atherosclerosis. N Engl J Med. All three diets reduced blood pressure, total and low-density lipoprotein cholesterol levels, and estimated coronary heart disease risk. This is some-what akin to the story of Dr Johnsons dog walking on its hind legs: it does not do it very well, but it is amazing that it can do it at all. Bazzano and her associates concluded that going on a low-carb diet is better than a low-fat one for those wishing to lose weight. Kennedy ET, Bowman SA, Powell R. Dietary-fat intake in the U.S. population. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) First, in this study, JAMA published a retraction of one of the main conclusions of this study by led by Christopher Gardner, which initially claimed that people lost more weight on the Atkins diet than on the diet I recommend, which turned out to be false (JAMA. If ones looks at the right data, he says, its clear that our countrys metabolic ills can be blamed on our increasing consumption of red meat and bad fatsboth of which, he says, are proved to be unhealthy. This article was most recently revised and updated by, https://www.britannica.com/biography/Dean-Ornish, American Entertainment International Speakers Bureau - Biography of Dean Ornish, Ornish, Dean - Student Encyclopedia (Ages 11 and up). Also, C-reactive protein and creatinine clearance were significantly lowered only on the Ornish and Weight Watchers diets. Pres. Risk assessment tool for estimating 10-year risk of developing hard CHD (myocardial infarction and coronary death). Several studies that used serial coronary arteriography to assess CHD patients who were consuming a conventional 30% fat diet revealed that the majority showed progression (worsening) of coronary atherosclerosis (22,36). Available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof . JAMA. Induction of ventricular arrhythmias by elevation of arterial free fatty acids in experimental myocardial infarction. Interaction of dietary cholesterol and triglycerides in the regulation of hepatic low-density lipoprotein transport in the hamster. This becomes a way of eating rather than a diet with rigid eat this and dont eat that guidelines. The Ornish and Zone books suggest some stimulus-control strategies but on the whole do not emphasize behavior modification, whereas both the Atkins and LEARN Armstrong ML, Warner ED, Connor WE. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. At Pennsylvania State University, researchers found that healthy women instinctively ate about 3 lb of food a day, whether high or low in calories. In other words, when you have less garbage, you need fewer garbage trucks to remove it, so a reduction in HDL on a low-fat diet is not harmful. These foods are low in cholesterol, saturated fat, oxidants, and other disease-promoting substancesa double benefit (12). Fiber from whole grains, but not refined grains, was inversely associated with all-cause mortality in 11,040 postmenopausal women followed for 11 years (16). In contrast, an Atkins diet is high in disease-promoting substances and low in protective onesa double whammy. 2nd ed. 2003;26:302-307. For example, an important article, published in The New England Journal of Medicine, reviewed data showing that high-protein, low-carbohydrate diets promote coronary artery disease independent of their effects on traditional risk factors such as blood pressure and cholesterol levels. Brinton EA, Eisenberg S, Breslow JL. (In contrast, the recommendations of the American Heart Association allowed up to 30 percent of total calories from fat and 300 mg of cholesterol daily.)

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