In locations such as Asia, where a low-fat diet has been the norm, HDL-C levels are low, yet the incidence of CVD is among the lowest in the world (43). As I wrote: I agree that replacing fat with sugar is not healthful, as Ive written about for decades. Journal of the American Medical Association 104(2004):537. 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. OBJECTIVE: The information on this website is intended to supplement, not replace, the advice of a trained health professional. We found that almost 80 percent were able to avoid surgery by making these comprehensive lifestyle changes. Continue reading with a Scientific American subscription. I would love to be able to tell you that these are health foods, but they are not. Insulin may also raise the secretion of lipoprotein lipase, increasing the uptake of fat into cells, leading to weight gain (10). You can lose weight without feeling hungry or deprived. (1980) in internal medicine from Baylor College of Medicine in Houston. That only supports my thesis, because I recommend that people eat less harmful fats and fewer refined carbohydrates. 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 And although Ornish is right that I lack clinical experience, when analyzing evidence, distance can be useful. Pounds lost on Atkins diet may quickly return. Am J Clin Nutr. Editor's Note: Our April 22 article elicited a lengthy response from Dean Ornish, which we publish here, along with a rebuttal from Melinda Wenner Moyer. Foster GD, Wyatt HR, Hill JO, et al. Please refer to the appropriate style manual or other sources if you have any questions. 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. But his claims about the dangers of saturated fat and red meat go beyond the science and in some cases contradict it. 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. Below is my letter to the editor of The New England Journal of Medicine that they published about this study: Protein, too, doesnt look so evil when one considers the 2010 trial published in The New England Journal of Medicine that found individuals who had recently lost weight were more likely to keep it off if they ate more protein, along with the 2005 OmniHeart trial that reported individuals who substituted either protein or monounsaturated fat for some of their carbohydrates reduced their cardiovascular risk factors compared with individuals who did not. 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. CLAIMS THAT AN ATKINS DIET IS BETTER THAN A LOW-FAT DIET. After 1 year, there was a 52% decrease in LDL-C on the 10% fat diet compared with a 6% increase in LDL-C on the Atkins diet (33). Accessed March 5, 2004. 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. Intensive risk factor modification. They write new content and verify and edit content received from contributors. Ornish D. Dr. Dean Ornishs Program for Reversing Heart Disease. 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. Ornish believed that the stress-management aspect of his program, designed to combat social isolation as well as daily pressures, was as essential to his patients recovery as diet and physical activity. Risk assessment tool for estimating 10-year risk of developing hard CHD (myocardial infarction and coronary death). Whole-grain consumption and risk of coronary heart disease: results from the Nurses Health Study. An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). Fourth, the patients in our randomized controlled trial (JAMA. The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. A food or nutrient can be healthy without requiring that all other foods or nutrients be unhealthy. Dr. David Perlmutter is on the cutting edge of innovative medicine that looks at all lifestyle influences on health and illness. 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. 1999;277:F813-F819. Clinical Trials in Cardiovascular Disease. 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. 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 Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? Am J Physiol. Wing RR, Vazquez JA, Ryan CM. Connor WE. But the research he cites to back up his oped claims is tenuous at best. Another meta-analysis of 21 studies found no association between saturated fat intake and heart disease. It concluded that low-carbohydrate/high-protein diets are associated with increased risk of cardiovascular diseases.. This argument raises two interesting points: First, it contradicts Ornishs claim that hes not really against fat, just certain types of fat. These studies have been conducted with well-respected collaborators, published in the leading peer-reviewed journals, and presented at the most credible scientific meetings. 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. 2000;19(suppl 3):326S-330S. Part of the problem in this and other studies that compare weight loss in low-fat versus low-carb diets (which is the wrong question anyway, because its the type of fats and carbs) is that adherence to different diets is often suboptimal, so its hard to make meaningful comparisons. You can hear some of their stories here. 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. N Engl J Med. Am J Cardiol. 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. 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! Oliver MF, Yates PA. And Im not aware of any studies showing that walking and stress management techniques alone can reverse heart disease. Both are written by doctors and have many successful followers but Zeman FJ, Hansen RJ. For 37 years he has been touting the benefits of very low-fat, high-carbohydrate, vegetarian diets for preventing and reversing heart disease. As Dr Atkins wrote a few months before he died, At what point am I allowed to say, I told you so? (4). 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. 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. The reduction in HDL-C that may occur on a low-fat diet is another example of a half-truth that is confusing to many people. Some colleagues claimed that the admonitions of his program were entirely unrealistic and that patients not under supervision would in all likelihood return to their previous, unhealthy habits. And the 10 percent reduction in carbohydrate in the higher protein diet and the higher unsaturated fat diet was achieved by replacing some fruits with vegetables, reducing sweets and using smaller portions of refined grain products. Dean Ornish, MD Yet as I read this article, I cant help but to find amusement in Urinary excretions of calcium and acids are correlated positively with intakes of animal and nondairy animal protein but are correlated negatively with plant-protein intake (53). You may lose weight and start to attract people to you, but, when they get too close, it may be counterproductive. Int J Obes Relat Metab Disord. 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. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial, Journal of the American Medical Association. HDL-C is predictive of relative heart disease risk only in populations in which everyone is eating a similar high-fat diet, such as the Framingham population. The fact that not all studies have shown this risk does not mean that it is not true. Ornish D. Concise Review: Intensive lifestyle changes in the management of coronary heart disease. The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. 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). The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. 2007 Jul 11;298(2):178).This says something important about the quality of that research. JAMA. (An adult who consumes two tablespoons of olive oil in, say, a portion of salad dressing has already exceeded getting 10 percent of his days calories from fat if hes eating 2,000 calories daily.). These include JAMA The Journal of the American Medical Association, The Lancet, Proceedings of the National Academy of Sciences, The Lancet Oncology, The New England Journal of Medicine, The American Journal of Cardiology and others. The data suggest that reducing fat intake is one effective strategy for also reducing total energy consumption Given the increasing rates of obesity in the United States at an earlier age, dietary-fat reduction may be an effective part of an overall strategy to balance energy consumption with energy needs (8). WebAtkins 40 is an easy low carb diet plan for those with less than 40 pounds to lose. In contrast, the NHANES data is from surveying only a small sample of people nationwide, so its less reliable. 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. 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. 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. The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans. Total cholesterol decreased much more on the Ornish diet than on any of the other diets. 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). Can lifestyle changes reverse coronary heart disease? 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.. In a larger study of almost 3,000 patients who went through my lifestyle program in 24 hospitals and clinics, BMI (body mass index) decreased by 6.6 percent. Ornishs diet would probably be an improvement on the current American dietif people could actually follow it long-term. CA Cancer J Clin. Brody J. Clin Hemorheol Microcirc. This site is using cookies under cookie policy . (All groups consumed about the same amount of protein.). These associations were either abolished or attenuated if the proteins were plant derived.. The USDA tracks changes in consumption of the entire food supply. That conclusion contrasted with standard medical treatment of heart disease, which typically relied upon cholesterol-lowering medications and the use of invasive and potentially risky procedures, such as coronary artery bypass surgery and angioplasty. The American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and Cancer Prevention. This is not true, as I wrote about years ago in my Newsweek column. In contrast, control group patients following a 30% fat diet showed more progression of atherosclerosis after 5 years than after 1 year. Diabetes Care. Fung TT, Hu FB, Pereira MA, et al. 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. These patients were eligible for revascularization and chose to make these comprehensive lifestyle changes instead. When Moyer accuses me of having inadequate scientific evidence to support my statements, I must respectfully and strongly disagree. 1990;322:1053-1059. Atkins Nutritionals, Inc. 2nd ed. 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. A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates. After one year those following his diet were more likely to see a regression in their atherosclerosis. J Clin Invest. Thus, we need to move beyond simplistic notions that anything that raises HDL-C is beneficial and anything that lowers HDL-C is harmful. In assessing the health effects of different diets its important to measure the disease process itself, not just risk factors such as blood pressure and cholesterol levels. 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. When people dutifully cut down on fat in the 1980s and 1990s, they replaced much of it with high-sugar and high-calorie processed foods (think: Snackwells). Ketone bodies formed on a high-protein diet undergo urinary excretion with a cation to maintain electrical neutrality, resulting in the loss of cations such as calcium, magnesium, and potassium (55,56). 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 attended Rice University in Houston but dropped out after experiencing severe depression and mononucleosis. 1987;76:504-507. When you eat less fat, you consume fewer calories without having to eat less food, thereby increasing satiety without adding calories. Guidelines on diet, nutrition, and cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. Available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof . Science. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. This was clearly stated in my New York Times oped: Moyer wrote: Nutrition is complex but there is little evidence our countrys worsening metabolic ills are the fault of protein or fat. Insulin accelerates the conversion of calories into triglycerides, which may contribute to hypertriglyceridemia. 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. 1986;232:34. Paradoxically, it may sometimes be easier for people to make more comprehensive changes in diet and lifestyle because they experience the benefits so quickly and to a much greater degree (25,64). Harrisons Advances in Cardiology. Copyright [c] 2004 by the American Dietetic Association. WebIn this article, an example of translation of the English term learning outcome into the Lithuanian system of educational terms is used to discuss semantic peculiarities of translating professional terms. In simple terms, those with higher HDL-C levels have more garbage trucks (HDL) to get rid of the garbage (excessive fat and cholesterol). All consumption estimates are imperfect, of course, including the U.S. Department of Agriculture (USDA) data he cites. Effect of 6-month adherence to a very low carbohydrate diet program. 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. Campbell TC, Parpia B, Chen J. In other words, when you change the type of food, you dont have to be as concerned about the amount of food. 1997;337:562-563. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). As Moyer indicates here, the 2014 meta-analysis showed higher mortality risks associated with both processed meat and unprocessed meats. How might a mans reproductive health concerns change at different periods of his life? 2002;40:265-274. 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). On one side was Atkins, who had two strips of bacon and three eggs for breakfast. www.atkins.com, All Content Copyright 2014-2019 AtkinsFacts.org, Center for Science in the Public Interest, Low Carb Diets: Potential Short and Long-term Health Implications, Northwestern University School of Medicine, Physicians Comittee for Responsible Medicine, Sudden Cardiac Death of an Adolescent During [Atkins] Dieting, United States Department of Agriculture 1/2, United States Department of Agriculture 2/2, http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof. You can burn more calories by exercising. If they stop eating bagels, they may also stop eating the cream cheese. People have a spectrum of choices. Am J Med. If moderate changes are not sufficient to achieve the desired goals, then the patient can be encouraged to make more intensive ones. Corrections? Atkins R. The case for low carbs. If you know or suspect that you have a health problem, consult a health professional. An Atkins diet often shows a greater reduction in triglycerides by comparison. The fact is, individuals on his diet are supposed to consume (pdf) no more than 10 percent of calories from fat, and thats very, very low compared to the average Americans adults intake of 33 percent of calories from fat. 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. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. 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 wrote: In any event, I wasnt wrong about this; in my oped I was clear that these benefits were seen in those under age 65. 1998) showed an average reduction of 24 pounds in the first year. 2023 Scientific American, a Division of Springer Nature America, Inc. Thus, dietary fat is not responsible for obesity. In fact, per capita consumption of fat has risen by 10 Ib/year since 1975, whereas per capita consumption of simple carbohydrates has increased even more, by 20 Ib/year (5). Ornish D. The case for low fat. 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. In addition to promoting weight loss, Atkins claimed that this diet may help people prevent heart disease, diabetes, and possibly other chronic illnesses. A critique of the diet guru's views on high-protein diets, followed by a response from Ornish and a reply from the author. 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. Accessed March 5, 2004. Taubes G. The soft science of dietary fat. Brown MS, Goldstein JL. In March 1998 he partnered with ConAgra Foods to release a line of vegetarian foods. It is all about energy balance. However, even in those with reduced numbers of LDL receptors who are not very efficient in metabolizing dietary saturated fat and cholesterol, decreasing the intake of these to a greater degree has a much bigger impact. WebDean Ornish and Dr. T. Colin Campbell have conducted research and published books that suggest a "Whole Food Plant-Based" (WFPB) diet is best for achieving optimal health. In our debates, Dr Atkins often claimed that his diet can reverse coronary heart disease (CHD) but never published any peer-reviewed data to support this assertion, nor has anyone else, including advocates of similar diets such as the Zone and the South Beach diets (34). Keys A. 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). The primary drive was volume not calories (7). Ornish eventually received a bachelors degree in humanities (1975) from the University of Texas at Austin, graduating first in his class.
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