Presented at the American Heart Association Scientific Sessions, Orlando, November 11, 2003. Most Americans consume a diet high in saturated fat and cholesterol, so those who are able to increase HDL-C in response to this diet are at lower risk than those who cannot, since they will be more efficient at metabolizing excessive dietary fat and cholesterol. As Moyer indicates here, the 2014 meta-analysis showed higher mortality risks associated with both processed meat and unprocessed meats. Connor WE, Connor SL. Third, it is a common misconception that anything that raises HDL is beneficial and anything that lowers it is not. 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. 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. 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 fact that not all studies have shown this risk does not mean that it is not true. DISTINGUISHING BETWEEN RISK FACTORS AND ACTUAL MEASURES OF DISEASE. However, reducing dietary fat and cholesterol may cause a decrease in HDL-C because there is less need for it. 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 authors also reported that among those without type 2 diabetes at baseline, those in the high animal protein group had a 73-fold increased risk of developing diabetes during the study. The fractional catabolic rate (FCR) of apo A-I increased 11%, whereas its absolute transport rate decreased 14%. Its almost certainly healthier than the highly processed, refined-carbohydrate-rich diet most Americans consume today. When Moyer accuses me of having inadequate scientific evidence to support my statements, I must respectfully and strongly disagree. The goal is to lose weight in ways that enhance health rather than in ways that may harm it. 1990;336:129-133. Stevens A, Robinson DP, Turpin J, et al. J Am Diet Assoc. Esselstyn CB Jr. Southern Med J. 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). The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans. 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 other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. Am J Clin Nutr. The concept of a dietary spectrum empowers people with information and freedom of choice rather than the feeling of constraint or restriction. 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. The Atkins diet has four phases: Phase 1: Induction A person consumes less than 20 grams (g) of carbs each day. INTERVENTION: But even if the NHANES data are accurate, they show Americans are eating more fat than ever and even more refined carbohydrates than ever. This is especially incongruous when, as mentioned earlier, the only study to examine blood flow on the Atkins diet found that it actually worsened (35). Bill Clinton from 1993 to 2000 and served on the White House Commission on Complementary and Alternative Medicine Policy in 200102. (All groups consumed about the same amount of protein.). Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. Knight EL, Stampfer MJ, Hankinson SE, et al. It was terribly misleading when this abstract made it appear as though the Atkins diet is better for your heart. Although this was shown in animals, it is likely true in humans as well. Ornish goes to argue that protein and saturated fat increase the risk of mortality and chronic disease. Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD. 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. Get a Britannica Premium subscription and gain access to exclusive content. The American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and Cancer Prevention. High total protein intake, particularly high intake of nondairy animal protein, may accelerate renal function decline (60). Regression of coronary atheromatosis in rhesus monkeys. Ive never said that protein is evil. In my oped, I clearly stated that its better to consume plant-based proteins than animal-based proteins, especially red meat. Let us know if you have suggestions to improve this article (requires login). Credit: Nick Higgins. 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. 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). Lancet. If anything, our attempts to eat less fat in recent decades have made things worse. 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. 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. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? N Engl J Med. 1999;99:1278-1285. The USDA tracks changes in consumption of the entire food supply. . The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. Thats in part because when we cut out fat, we began eating foods that were worse for us. 1968;2:702-703. 1998;280:2001-2007. Not exactly. Am J Clin Nutr. 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. Fiber also slows the absorption of food, thereby preventing blood glucose from rising too rapidly and reducing insulin surges. 1999;282:1539-1546. What is the comparison and contrast of dr.Atkins and dr. Ornish See answer Advertisement ingramjazmine9 Answer: The two doctors had much in common: Am J Physiol. 2002;113:30-36. This reduction in LDL-C is much greater than on an Atkins diet and is comparable with the effects of statin drugs. 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. Am J Med. N Engl J Med. Discover world-changing science. Ornish was a physician consultant to U.S. Pres. 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. Corrections? Accessed March 5, 2004. This does not confer the same risk of atherosclerosis as in Americans with low HDL levels who are consuming a high-fat diet (41). Ornish D, Hart J. Second, as I made clear in the oped as well as in my books and journal articles, the diet I recommend is low in refined carbohydrates and high in good carbs such as fruits, vegetables, whole grains, legumes and soy products in their natural, unrefined forms (which tend to have low glycemic loads). 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). 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. Despite being told to eat less fat, he says, Americans have been doing the opposite: They have actually consumed 67 percent more added fat, 39 percent more sugar and 41 percent more meat in 2000 than they had in 1950 and 24.5 percent more calories than they had in 1970. Yes, Americans have been eating more fat, sugar and meat, but we have also been eating more vegetables and fruits (pdf)because we have been eating more of everything. 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. As you approach your weight loss goals, you start to History tells us its not going to be spinach. 2002;75:848-855. These studies need to be replicated, although similar findings were found by others (39,40). But fact that the participants were making all of these lifestyle changes means that we cannot make any inferences about the effect of the diet alone. However, HDL increased more on the other diets, so the differences in the Framingham risk score were due primarily to changes in HDL. 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. 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. Thanks for reading Scientific American. According to the lead author, "Calorie for calorie, reducing dietary fat results in more body fat loss than reducing dietary carbohydrate when men and women with obesity have their food intake strictly controlled. BACKGROUND: Cambridge, MA: Harvard University Press; 1980. In: Hennekens C, Manson J, eds. It may be worth noting that my most recent book, The Spectrum, featured a piece of salmon on the cover. 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). Guidelines on diet, nutrition, and cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. 1993;328:1213-1219. So theres little evidence to suggest that we need to avoid protein and fat. Mean apo A-II levels did not change. If we start fearing protein, too, what will we fill our plates with instead? : How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (2019; written with his wife, Anne Ornish). 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. Am J Clin Nutr. Many dietitians and other health professionals as well as people in the general public are often confused by the fact that many people are able to lose weight on these diets. Functional foods: Position of the American Dietetic Association. 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). This optimal diet is based predominantly on fruits, vegetables, grains, and legumes in their natural, unrefined forms. Foster GD, Wyatt HR, Hill JO, et al. Also, as I wrote in my oped in The New York Times, my colleagues and I have conducted randomized controlled trials that these same diet and lifestyle changes reverse the progression of other common chronic diseases. As I wrote: I agree that replacing fat with sugar is not healthful, as Ive written about for decades. Also, in a randomized controlled trial, ketogenic diets such as the Atkins impaired cognitive performance in higher order mental processing after only 1 week (61). An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). Geriatrics. Hemorheologic effects of a short-term ketogenic diet. 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. 1999;18:207-212. Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. 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? Also, C-reactive protein and creatinine clearance were significantly lowered only on the Ornish and Weight Watchers diets. Diet, obesity, and cardiovascular risk. Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P less than .05). Dietary fat intake as risk factor for the development of diabetes: Multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (MGSD). CLAIMS THAT AN ATKINS DIET IS BETTER THAN A LOW-FAT DIET. The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. 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. The Atkins Diet plan and the Dean Ornish diet are both established and popular diet plans. 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. 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). 1999;21:147-153. 2007 Jul 11;298(2):178).This says something important about the quality of that research. Total cholesterol decreased much more on the Ornish diet than on any of the other diets. Fourth, the Gardner study did not really test very much of anything, other than its hard for many people to change their dietsany dietfrom just reading a book. 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. Atkins Nutritionals, Inc. Harrisons Advances in Cardiology. 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. Both eating plans recommend avoiding saturated fat from animal proteins and full-fat dairy. Am J Clin Nutr. N Engl J Med. If his diet worksand again, we dont know for sure that it doesis that because it reduces protein or fat or refined carbohydrates? Other high-protein diets such as the Zone and the South Beach diets are somewhat better but still emphasize consumption of meat, eggs, and butter. Founder and president, Preventive Medicine Research Institute Your body excretes toxic substances through your bowels, breath, and perspiration, so this is not surprising. Taubes G. The soft science of dietary fat. 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. 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). 1998;339:12-20. Dietary cholesterol and saturated fats increase plasma LDL-C in part by down-regulating LDL receptors in the liver (28). 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. Judging the quality of a study by the number of patients is like judging the quality of a book by the number of pages. 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. 2000;51:817-826. The title is confusing and potentially harmful to many readers. 2003;348:2057. Increased whole grain intake was associated with decreased risk of CHD in 75,521 women followed for 10 years (13). 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. 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. Fung TT, Hu FB, Pereira MA, et al. New York: HarperCollins Publishers; 1996. 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. (1980) in internal medicine from Baylor College of Medicine in Houston. WHY PEOPLE LOSE WEIGHT ON LOW-CARBOHYDRATE/HIGH-FAT DIETS. Leaf A, Weber PC. Fleming RM. A diet high in whole grains was associated with a reduced risk of type 2 diabetes in 42,898 men followed for 12 years. Accessed March 5, 2004. CONCLUSIONS: 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. 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 Ornish represented the other viewpoint with his fruits, veggies, and sharp criticisms of Atkins. 2002;95:1047-1049. The Framingham risk score is calculated from age, sex, total cholesterol, HDL, smoking, and systolic blood pressure (46). Believing this, many people are throwing up their hands, exasperated, saying, These damn doctors cant make up their mindsto hell with them, Ill eat whatever I want, when there is actually an emerging consensus among scientists and physicians who do research in nutrition about what constitutes an optimal way of eating. 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. Therefore, diet-induced changes in HDL-C levels correlate with and may result from changes in apo A-I transport rate. In contrast, there was a statistically significant reduction in LDL-cholesterol in the Ornish group but not in the Atkins group after one year. Its not just 48 patients. OBJECTIVE: Clin Hemorheol Microcirc. 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. But the research he cites to back up his oped claims is tenuous at best. Potential benefits and risks have not been tested adequately. 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.
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