As all dietetics professionals know, there is no mystery in how to lose weight: burn more calories and/or eat fewer calories. (All groups consumed about the same amount of protein.) WebIn this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more Peyreigne C, Bouix D, Aissa Benhaddad A, et al. Regression of coronary atheromatosis in rhesus monkeys. Although this was shown in animals, it is likely true in humans as well. Am J Cardiol. 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. Updates? New York: Macmillan Publishing Co; 1991:409-410. And Im not aware of any studies showing that walking and stress management techniques alone can reverse heart disease. The case for a low-fat, highcarbohydrate diet. 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 fruitsbecause we have been eating more of everything. How might a mans reproductive health concerns change at different periods of his life? If you know or suspect that you have a health problem, consult a health professional. Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. Accessed March 5, 2004. DESIGN, SETTING, AND PARTICIPANTS: Telling people what they want to believe is part of the reason that the Atkins diet has become so popular. 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. Zeman FJ, Hansen RJ. 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. 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. He is recognized internationally as a leader in the field of nutritional influences in neurological disorders. Get a Britannica Premium subscription and gain access to exclusive content. Founder and president, Preventive Medicine Research Institute JAMA. Ornish D. A diet rich in partial truths. 1999;99:1278-1285. The Atkins Diet plan and the Dean Ornish diet are both established and popular diet plans. However, CHD patients who followed a 10% fat, whole foods diet demonstrated significant regression of coronary atherosclerosis after 1 year as measured by quantitative coronary arteriography (37) and even more regression after 5 years (the amount of exercise was not significantly different between groups, but the experimental group was also practicing yoga and meditation) (32). Ornish studied the effects of a similar regimen on prostate cancer patients and in 2008 concluded that adherence to the lifestyle changes recommended by the program slowed progression of the cancer. Am J Clin Nutr. Pres. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. 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. 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 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). 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. Accessed March 5, 2004. Second, another big fat lie that has been repeated so often its becoming a meme is that there is not enough good science to inform us about an optimal way of eating. Resolving the coronary artery disease epidemic through plant-based nutrition. 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. The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. 2002;40:265-274. MAIN OUTCOME MEASURES: Both eating plans recommend avoiding saturated fat from animal proteins and full-fat dairy. For instance, he wrote that animal proteins have been associated with higher disease and mortality risks in observational studies. Over time, in some people, insulin surges may lead to insulin resistance, causing further weight gain. Intensive risk factor modification. 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. 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. The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. This site is not affiliated with, sponsored by, or related in any way to Pereira MA, Jacobs DR Jr, Pins JJ, et al. In a study from Harvard School of Public Health they prospectively observed 37,698 men from the Health Professionals Follow-Up Study (19862008) and 83,644 women from the Nurses' Health Study (19802008) who were free of cardiovascular disease (CVD) and cancer at baseline. The concept of a dietary spectrum empowers people with information and freedom of choice rather than the feeling of constraint or restriction. The participants all had trouble adhering to their regimens, but all lost about the same statistically significant amounts of weight, and when compared head to head, the Atkins dieters saw greater improvements in blood pressure and HDL cholesterol than the Ornish dieters did. If anything, our attempts to eat less fat in recent decades have made things worse. Could it be that our attempts to reduce fat have in fact been part of the problem? In contrast, within each diet, the HDL-C and apo A-I levels were inversely correlated with apo A-I FCR both on the high-and low-fat diets but not with apo A-I transport rate (44). Ornish D. Dietary treatment of hyperlipidemia. On one side was Atkins, who had two strips of bacon and three eggs for breakfast. Body weight is inversely associated with dietary fiber and carbohydrates and positively associated with protein intake (11). If anything, our attempts to eat less fat in recent decades have made things worse. As evidence for these causal claims, he cites a handful of observational studies. But even if the NHANES data are accurate, they show Americans are eating more fat than ever and even more refined carbohydrates than ever. New York: Random House; 1990. Insulin may also raise the secretion of lipoprotein lipase, increasing the uptake of fat into cells, leading to weight gain (10). HDL-C decreased 9% from 40.0 to 36.3 mg/dL after 1 year, yet these patients showed clear improvement in coronary atherosclerosis, myocardial perfusion, and cardiac events. Circ Res. 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 Cardiol. High-protein diets may cause loss of calcium and decreased levels of urinary citrate, leading to osteoporosis and kidney stones (52). To some, the fact that an Atkins diet does not significantly raise LDL-C is surprising given the amount of saturated fat and cholesterol in the diet. In addition to giving up smoking and fatty foods, the test subjects did yoga, meditated, and participated in a support group. Others expressed skepticism because his experimental methods did not attempt to account for the ways in which each component of his program affected the results. 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. 1999;21:147-153. A critique of the diet guru's views on high-protein diets, followed by a response from Ornish and a reply from the author. 1990;85:144-151. But Ornishs arguments against protein and fat are weak, simplistic and, in a way, irrelevant. 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). The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. The New York Times Sunday Magazine, July 7, 2002. We found that almost 80 percent were able to avoid surgery by making these comprehensive lifestyle changes. It was terribly misleading when this abstract made it appear as though the Atkins diet is better for your heart. The Framingham risk score is calculated from age, sex, total cholesterol, HDL, smoking, and systolic blood pressure (46). High total protein intake, particularly high intake of nondairy animal protein, may accelerate renal function decline (60). The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. Dansinger ML, Gleason JL, Griffith JL, Li W, Selker HP, Schaefer EJ. Westman EC, Yancy WS, Edman JS, et al. Insulin-stimulated lipogenesis in arterial tissue in relation to diabetes and atheroma. He received an M.D. An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). DISTINGUISHING BETWEEN RISK FACTORS AND ACTUAL MEASURES OF DISEASE. In addition, patients on an Atkins diet are counseled to take n-3 fatty acids in the form of fish oil (something else we agreed on), which is known to reduce triglycerides significantly. New York: McGraw Hill; 2002. Analyses of all pairwise differences by the Tukey standardized range test (<.05) indicate that the Atkins diet group was significantly different than all other diet groups at 2 and 6 months and that the Atkins diet group was significantly different than the Zone diet group at 12 months. 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). In rural China, for example, the average LDL is less than 95 mg/dL. Your body excretes toxic substances through your bowels, breath, and perspiration, so this is not surprising. Bell EA, Rolls BJ. Flavors include Nacho Cheese and Ranch. Dietschy JM, Brown MS. Effect of alterations of the specific activity of the intracellular acetyl CoA pool on apparent rates of hepatic cholesterogenesis. Geriatrics. 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. 75 percent increase in premature deaths from all causes, rated the Ornish Diet as the number-one diet for heart health, a recent National Institutes of Health study, In a study from Harvard School of Public Health, reverse the progression of early-stage prostate cancer, Four Laws That Could Stem the Rising Threat of Mass Shootings, Long-Haul COVID Cases Could Spike after Latest Wave. Cambridge, MA: Harvard University Press; 1980. 2000;51:817-826. 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. WebWas Dr. Atkins Right? Cardiovascular effects of n-3 fatty acids. Atkins 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). It's the type of protein, fat and carbohydrates that matters. Fiber also slows the absorption of food, thereby preventing blood glucose from rising too rapidly and reducing insulin surges. 4) Dr. Atkins R, Ornish D. Cardiology Crossfire. American College of Cardiology 50th Annual Scientific Sessions, Orlando, FL, March 20, 2001. 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. Knight EL, Stampfer MJ, Hankinson SE, et al. For someone trying to reverse heart disease, for example, the diet needs to be rather strict to accomplish this. 1998;280:2001-2007. 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). The Lifestyle Heart Trial. If they stop eating pasta, they are often avoiding sauces that are high in oil or cream (olive oil is 100% fat and only 1 tablespoon has 14 g fat). The arterial damage was caused by animal-protein induced elevations in free fatty acids and insulin levels and decreased production of endothelial progenitor cells (which help keep arteries clean). Ornish D. Dr. Dean Ornishs Program for Reversing Heart Disease. I wrote: For example, in the OmniHeart trial she cited, the group that was asked to consume 10 percent more protein emphasized plant proteins, not animal protein. What is missing in Moyers article is the clinical experience that comes from helping people change their diet and lifestyle. 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. Another meta-analysis of 21 studies found no association between saturated fat intake and heart disease. The fractional catabolic rate (FCR) of apo A-I increased 11%, whereas its absolute transport rate decreased 14%. In simple terms, those with higher HDL-C levels have more garbage trucks (HDL) to get rid of the garbage (excessive fat and cholesterol). Am J Clin Nutr. 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. J Am Diet Assoc. 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. 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). 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. 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. The authors wrote: The beneficial effects of lower protein intake were not seen in those over 65. In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Dietary fat intake as risk factor for the development of diabetes: Multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD). Prev Cardiol. 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 other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. A paper was presented from Tufts University titled One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in Decreasing Body Weight and Heart Disease Risk. The researchers concluded All diets resulted in significant weight loss from baseline and all but the Ornish diet resulted in significant reductions in the Framingham risk score (45). Lets check the facts: Headline: Why Almost Everything Dean Ornish Says about Nutrition Is Wrong, Subhead: When it comes to good eating habits, protein and fat are not your dietary enemies. Fleming RM. Thus, we need to move beyond simplistic notions that anything that raises HDL-C is beneficial and anything that lowers HDL-C is harmful. Other nonscientist, nonphysician writers have also been saying that Americans have been told to eat less fatWere eating less fat, were fatter than ever, so weve been given bad advice. 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. Anitschkow N. Experimental arteriosclerosis in animals. WebNo two doctors represent opposite sides of THE DIET WAR spectrum better than Dr.s Atkins and Ornish. The processing and lack of fiber may cause these foods to have a high glycemic index and often a high glycemic load; they are absorbed quickly, causing blood glucose levels to spike, which causes insulin surges. History tells us its not going to be spinach. N Engl J Med. Melinda Wenner Moyer, a contributing editor at Scientific American, is author of How to Raise Kids Who Arent Assholes: Science-Based Strategies for Better Parentingfrom Tots to Teens (G. P. Putnams Sons, 2021). (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.). J Cardiovasc Risk. Ornish D. Concise Review: Intensive lifestyle changes in the management of coronary heart disease. I'm not aware of a single study showing that a diet high in red meat can reverse the progression of coronary heart disease. Connor WE, Connor SL. Ornish begins his piece with a misleading statistic. He attended Rice University in Houston but dropped out after experiencing severe depression and mononucleosis. The diet I recommend is low in refined carbohydrates and low in harmful fats (including trans fats, hydrogenated fats and some saturated fats) and low in animal protein (particularly red meat) but includes beneficial fats (including omega-3 fatty acids), good carbs (including fruits, vegetables, whole grains, legumes and soy in their natural, unrefined forms) and good proteins (predominantly plant-based). You can burn more calories by exercising. Last month, an oped in The New York Times argued that high-protein and high-fat diets are to blame for Americas ever-growing waistline and incidence of chronic disease. The people in the control group were told to do none of these things. 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. Gould KL, Ornish D, Scherwitz L, et al. 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. American Dietetic Association. 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). Am J Med. As Dr Atkins wrote a few months before he died, At what point am I allowed to say, I told you so? (4). Brown MS, Goldstein JL. One-year effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in decreasing body weight and heart disease risk. Ornish then cites a barrage of individual studies to back his claim that red meat and saturated fats are dangerous, including one that has not even been published in the peer-reviewed literature. CLAIMS THAT AN ATKINS DIET IS BETTER THAN A LOW-FAT DIET. Am J Kidney Dis. 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 A frequently overlooked "waste product" of metabolism, uric acid actually threatens our health. 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 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. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. They write new content and verify and edit content received from contributors. Create your free account or Sign in to continue. 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. One reason that people often lose weight when they reduce their intake of carbohydrates is that they are usually reducing their intake of fats as well. An example of the half-truth of saying that anything that raises HDL-C is beneficial whereas anything that lowers it is harmful came at the November 11, 2003 annual scientific session of the American Heart Association. Presented at the American Heart Association Scientific Sessions, Orlando, November 11, 2003. 1998) showed an average reduction of 24 pounds in the first year. Mean apo A-II levels did not change. Fung TT, Hu FB, Pereira MA, et al. 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. 1988;81:300-309. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) Leaf A, Weber PC. Theres also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: The Iowa womens health study. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Although this study was limited by not having a randomized control group, the burden of proof is on the advocates of high-protein diets to show otherwise, especially given the large amount of data from other epidemiological studies, animal research, and randomized controlled trials linking the intake of a diet high in animal fat and protein with the incidence of CHD. 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). 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). 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. When people go on a high-protein diet, they may lose weight and lower triglycerides if, like most Americans, they had been eating a diet high in simple carbohydrates. The two doctors had much in common: they both made millions from their best-selling books; Atkins graced the cover of Time while Ornish, Newsweek. Third, shes confusing the USDA data (which I cited in my oped) and the National Health and Nutrition Examination Survey (NHANES) data (which looked at the percentage of calories). Other large observational studies have found that diets high in fat and protein are not associated with disease and may even protect against it. The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans. Corrections? 1998;318:549-557. 1995;19:811-816. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? 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).
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