But its not true. This does not confer the same risk of atherosclerosis as in Americans with low HDL levels who are consuming a high-fat diet (41). 2023 Scientific American, a Division of Springer Nature America, Inc. Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. 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. As I wrote: I agree that replacing fat with sugar is not healthful, as Ive written about for decades. Arteriosclerosis. 2002;113:30-36. Atkins Is Better Than Ornish, Stanford Study Says. When you eat less fat, you consume fewer calories without having to eat less food, thereby increasing satiety without adding calories. 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. As for Ornishs contention that the risk of premature death from all causes is higher in those eating red meat than those who do not, I disagree, because the 2014 meta-analysis of 13 studies that I discussed did not find this to be true. Am J Physiol. 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. 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). Liu S, Stampfer MJ, Hu FB, et al. Thus, by eating less fat, you reduce calories by reducing energy density without having to reduce volume. He attended Rice University in Houston but dropped out after experiencing severe depression and mononucleosis. J Cardiovasc Risk. Thanks for reading Scientific American. 1998;82:18T-21T. 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. 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. It was terribly misleading when this abstract made it appear as though the Atkins diet is better for your heart. Dietary fat intake as risk factor for the development of diabetes: Multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD). : How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (2019; written with his wife, Anne Ornish). Ornish D. The case for low fat. This reduction in LDL-C is much greater than on an Atkins diet and is comparable with the effects of statin drugs. Her article begins with a gross distortion of what I believe. 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! They lost 24 pounds during the first year and kept off more than half of that weight 5 years later and had 2.5 times fewer cardiac events than the control group. 2002;95:1047-1049. 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). 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). CLAIMS THAT AN ATKINS DIET IS BETTER THAN A LOW-FAT DIET. 2000;19(suppl 3):326S-330S. 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 A receptor-mediate pathway for cholesterol homeostasis. 1968;2:702-703. 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. Judging the quality of a study by the number of patients is like judging the quality of a book by the number of pages. These include a whole foods, plant-based diet low in refined carbohydrates, moderate exercise, stress management techniques and social support. The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. Science. Articles from Britannica Encyclopedias for elementary and high school students. A food or nutrient can be healthy without requiring that all other foods or nutrients be unhealthy. Ornish D, Brown SE, Scherwitz LW, et al. 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). 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). But replacing animal protein with well-balanced plant proteins is beneficial, and this is in the mainstream of what most scientists who do nutrition research believe. This site is using cookies under cookie policy . A diet high in whole grains was associated with a reduced risk of type 2 diabetes in 42,898 men followed for 12 years. 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. 2001;4:171-177. 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. The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. It's the type of protein, fat and carbohydrates that matters. Dietary cholesterol and the pathogenesis of atherosclerosis. 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. 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. Thanopoulou AC, Karamanos BG, Angelico FV, et al. Brody J. 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. 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. Its not just 48 patients. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Hemorheologic effects of a short-term ketogenic diet. Induction of ventricular arrhythmias by elevation of arterial free fatty acids in experimental myocardial infarction. Based on his experience caring for patients, Atkins thought that the things that were relegated to the narrow point of the food pyramidmeat, eggs, cream, and cheesewere the healthiest. 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). 1999;282:1539-1546. 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. Insulin accelerates the conversion of calories into triglycerides, which may contribute to hypertriglyceridemia. 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. But his claims about the dangers of saturated fat and red meat go beyond the science and in some cases contradict it. (This study was funded by the Atkins Center for Complementary Medicine.) An easier way to consume fewer calories is to eat less fat because fat (whether saturated, monosaturated, or unsaturated) has 9 kcal/g, whereas protein and carbohydrates have only 4 kcal/g. A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates. There was a direct correlation between the intake of dietary cholesterol and fat and changes in coronary atherosclerosis. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. In rural China, for example, the average LDL is less than 95 mg/dL. 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. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Its almost certainly healthier than the highly processed, refined-carbohydrate-rich diet most Americans consume today. 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). 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. 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). 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. His famous 1990 Lifestyle Heart trial involved a total of 48 patients with heart disease. Again, we dont know because his studies have not been designed in a way that can tell us anything about the effect of his diet alone. 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. The case for a low-fat, highcarbohydrate diet. 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. Diabetes Care. (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.). 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. 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. Atkins R, Ornish D. Cardiology Crossfire. American College of Cardiology 50th Annual Scientific Sessions, Orlando, FL, March 20, 2001. Pres. Weight loss at 12 months was the primary outcome. Diet, obesity, and cardiovascular risk. Am J Med. Founder and president, Preventive Medicine Research Institute WebWas Dr. Atkins Right? (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) Bushinsky DA, Chabala JM, Gavrilov KL, Levi-Setti R. Effects of in vivo metabolic acidosis on midcortical bone ion composition. Kennedy ET, Bowman SA, Powell R. Dietary-fat intake in the U.S. population. WebDr. 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). For 37 years he has been touting the benefits of very low-fat, high-carbohydrate, vegetarian diets for preventing and reversing heart disease. 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. 1994;1:283-286. MAIN OUTCOME MEASURES: Unfortunately, most studies of the Atkins diet and other highprotein diets measure only risk factors for CHD such as weight and lipids. Second, there was no statistically significant difference in either systolic blood pressure or diastolic blood pressure after one year in comparing the groups. This case report is not proof, but it is worrisome, especially in that these disorders of electrolytes and free fatty acids that increase the risk of sudden cardiac death may be seen in high-protein diets. I am not against all forms of animal protein. 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. J Am Coll Nutr. J Clin Invest. Although we always need more research, there is enough science now to guide us. Accessed March 5, 2004. Although this was shown in animals, it is likely true in humans as well. 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. 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. 2003;26:302-307. Both eating plans recommend avoiding saturated fat from animal proteins and full-fat dairy. Diet was assessed by validated food frequency questionnaires and updated every four years. Time magazine, August 26, 2002. But heres the thing: The patients who followed his diet also quit smoking, started exercising and attended stress management training. Kern PA, Ong JM, Saffari B, Carty J. Goldstein JL, Brown MS. Cholesterol and cardiovascular disease. 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 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. Third, it is a common misconception that anything that raises HDL is beneficial and anything that lowers it is not. Could it be that our attempts to reduce fat have in fact been part of the problem? Total cholesterol decreased much more on the Ornish diet than on any of the other diets. Indeed, the USDA explicitly states that most of our increase in consumption of added fats has been due to the growing use of vegetable oils and related products. 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). 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. N Engl J Med. Ornishs diet would probably be an improvement on the current American dietif people could actually follow it long-term. Risk assessment tool for estimating 10-year risk of developing hard CHD (myocardial infarction and coronary death). This optimal diet is based predominantly on fruits, vegetables, grains, and legumes in their natural, unrefined forms. 2002;113:30-36. So when Ornish wrote in his oped that for reversing disease, a whole-foods, plant-based diet seems to be necessary, he is incorrect. N Engl J Med. 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). 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). N Engl J Med. Eat more meat, butter and eggs, theyre good for you (prominently pictured on the cover of their books), all those experts have been wrong. This has been repeated so often in the echo chamber of modern media that its become a meme. 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. 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. 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). 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. RESULTS: Ann Intern Med. 1974;15:508-516. You used to find a lot more people interested in The other way people get too many calories is by consuming too many simple carbohydrates. Ornish D. Dietary treatment of hyperlipidemia. One-year effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in decreasing body weight and heart disease risk. Ornish eventually received a bachelors degree in humanities (1975) from the University of Texas at Austin, graduating first in his class. 2001;73:1010-1018. For those simply trying to lose weight or lower their risk factors moderately, less extensive changes may be required. That year Ornish also founded the nonprofit Preventive Medicine Research Institute (PMRI) in nearby Sausalito. These types of studieswhich might report that people who eat a lot of animal protein tend to develop higher rates of diseaseonly look at association, not causation, explains Christopher Gardner, a nutrition scientist at the Stanford Prevention Research Center. In contrast, an Atkins diet is high in disease-promoting substances and low in protective onesa double whammy. Ornish begins his piece with a misleading statistic. And categorizing entire nutrient groups as good or bad is facile. Ludwig DS, Pereira MA, Kroenke CH, et al. 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 I feel passionately about doing this work because it helps transform peoples lives for the better. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Copyright [c] 2004 by the American Dietetic Association. Connor WE. 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. 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. 1987;76:504-507. The Atkins Diet plan and the Dean Ornish diet are both established and popular diet plans. Am J Clin Nutr. But they dont mask the truth; compared with individual studies, they get closer to it. 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. When Moyer accuses me of having inadequate scientific evidence to support my statements, I must respectfully and strongly disagree. Insulin-stimulated lipogenesis in arterial tissue in relation to diabetes and atheroma. 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. 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). Was Dr. Atkins Right? We documented significant improvements in the hearts function after only 24 days compared with a randomized control group. 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. They documented 23,926 deaths (including 5,910 CVD and 9,464 cancer deaths) during 2.96 million person-years of follow-up. Losing weight is important, but the history of medicine is replete with examples of weight-loss approaches that were harmful to health (eg, amphetamines, fen-phen). 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. There are so many other factors. Dr. David Perlmutter is on the cutting edge of innovative medicine that looks at all lifestyle influences on health and illness. Ornish D. Everyday Cooking with Dr. Dean Ornish. You can hear some of their stories here. The March 2014 study in Cell Metabolism did distinguish between animal protein and plant-based proteins. 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. The goal is to lose weight in ways that enhance health rather than in ways that may harm it. RAISING AND LOWERING HDLBENEFICIAL OR HARMFUL? 1997;337:562-563. Bonow RO, Eckel RH. Bell EA, Rolls BJ. For someone trying to reverse heart disease, for example, the diet needs to be rather strict to accomplish this. These patients were eligible for revascularization and chose to make these comprehensive lifestyle changes instead. The American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and Cancer Prevention. Let us know if you have suggestions to improve this article (requires login). 2002;5:110-118. Gould KL, Ornish D, Scherwitz L, et al. The point is, its possible to cherry-pick observational studies to support almost any nutritional argument. Ornish D, Scherwitz LW, Billings JH, et al. Ornish D. Concise Review: Intensive lifestyle changes in the management of coronary heart disease. Your body excretes toxic substances through your bowels, breath, and perspiration, so this is not surprising. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? 1998;318:549-557. For instance, he wrote that animal proteins have been associated with higher disease and mortality risks in observational studies. Am J Kidney Dis. Although Dr Atkins and I agreed on the diagnosisthat many Americans eat too many simple carbohydrateswe disagreed about the prescription. Atkins Plus, discouraging the intake of entire macronutrient groups can backfire. Hunninghake DB, Stein EA, Dujovne CA, 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. All evidence is to the contrary. Twenty-eight were assigned to his low-fat, plant-based diet and 20 were given usual cardiac care. 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. High-protein diets may cause loss of calcium and decreased levels of urinary citrate, leading to osteoporosis and kidney stones (52). JAMA. Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. Angiology. In addition to promoting weight loss, Atkins claimed that this diet may help people prevent heart disease, diabetes, and possibly other chronic illnesses. A randomized trial of a low-carbohydrate diet for obesity. 1961;16:407-415. WHAT EVIDENCE SUPPORTS THAT HIGH-PROTEIN DIETS MAY BE HARMFUL? That is why you can lose weight on any diet that restricts portion sizes, but it is hard to keep it off because you may feel hungry and deprived. You can burn more calories by exercising. Omissions? The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans.
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