compare and contrast dr ornish and dr atkins

Some people are able to handle more simple carbohydrates and/or more cholesterol and saturated fat in their diet than others. WebAtkins 40 is an easy low carb diet plan for those with less than 40 pounds to lose. The results of the trial, published in 1990, revealed that at least some effects of coronary atherosclerosis had been reversed in many patients. Brody J. 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. 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. 1999;99:1278-1285. Foster GD, Wyatt HR, Hill JO, et al. This site is using cookies under cookie policy . 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. 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. Thanks for reading Scientific American. Stevens A, Robinson DP, Turpin J, et al. Stout RW. HDL is important only to the extent that it affects atherosclerosis and myocardial perfusion, it is not a disease. Knowledge awaits. Intensive risk factor modification. 2007 Jul 11;298(2):178).This says something important about the quality of that research. 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. 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 case for a low-fat, highcarbohydrate diet. Create your free account or Sign in to continue. As Moyer indicates here, the 2014 meta-analysis showed higher mortality risks associated with both processed meat and unprocessed meats. Ornish told Reuters, There has been a bit of a backlash against not only just low-fat eating, but healthy living in general. Here's a blog in which I addressed this issue: As Attilio Maseri, MD, an internationally known and respected cardiologist, wrote: My colleagues and I conducted a demonstration project of 333 patients from four academic medical centers and four community hospitals. In educating patients in an evidenced-based practice, it may be helpful to summarize an optimal diet as one that is high in good carbohydrates (complex carbohydrates), good fats (n-3 fatty acids) (62), and good protein (plant based) and low in ones that are less healthful. Pereira MA, Jacobs DR Jr, Pins JJ, et al. 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. Cognitive effects of ketogenic weight-reducing diets. Energy density of foods affects energy intake across multiple levels of fat content in lean and obese women. We found that almost 80 percent were able to avoid surgery by making these comprehensive lifestyle changes. N Engl J Med. N Engl J Med. 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. You can eat fewer calories by consuming less food. Brown MS, Goldstein JL. 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. 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. Increased whole grain intake was associated with decreased risk of CHD in 75,521 women followed for 10 years (13). 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). And Im not aware of any studies showing that walking and stress management techniques alone can reverse heart disease. Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. 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. Geriatrics. 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. RAISING AND LOWERING HDLBENEFICIAL OR HARMFUL? Kern PA, Ong JM, Saffari B, Carty J. Nutrition is complex but there is little evidence our countrys worsening metabolic ills are the fault of protein or fat. 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. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) 1999;84:339-341A8. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. Let us know if you have suggestions to improve this article (requires login). 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. Ornish begins his piece with a misleading statistic. BACKGROUND: 1970;27:59-67. 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. 1998;339:12-20. 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. 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. Unfortunately, most studies of the Atkins diet and other highprotein diets measure only risk factors for CHD such as weight and lipids. Diet was assessed by validated food frequency questionnaires and updated every four years. 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. This is not true, as I wrote about years ago in my Newsweek column. 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. 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. Prev Cardiol. What is Kim MOST trying to strengthen? Theres also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. 2023 Scientific American, a Division of Springer Nature America, Inc. 4) Dr. 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. If anything, our attempts to eat less fat in recent decades have made things worse. Outcomes were assessed at months 0, 2, 6, and 12. The authors wrote: The beneficial effects of lower protein intake were not seen in those over 65. 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. Ornish D. Dr. Dean Ornishs Program for Reversing Heart Disease. To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. But they dont mask the truth; compared with individual studies, they get closer to it. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? Three recent studies suggested that an Atkins diet is superior to a low-fat diet with respect to short-term changes in weight, triglycerides, and HDL cholesterol (HDL-C) (18-20). Fleming R, Boyd LB. . An Atkins diet may increase postprandial lipemia and increase free fatty acids, which may have harmful effects on platelet aggregation and may promote ventricular arrhythmias (57,58). In simple terms, those with higher HDL-C levels have more garbage trucks (HDL) to get rid of the garbage (excessive fat and cholesterol). And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. Am J Clin Nutr. Am J Clin Nutr. JAMA. 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. Harrisons Advances in Cardiology. Southern Med J. 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). 1987;76:504-507. SUBSTITUTE SIMPLE WITH COMPLEX CARBOHYDRATES. Available at: http://www.americaonthemove.org/. 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. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95 percent CI) of total mortality for a one-serving-per-day increase was 1.13 (1.071.20) for unprocessed red meat and 1.20 (1.151.24) for processed red meat. A food or nutrient can be healthy without requiring that all other foods or nutrients be unhealthy. WebMean 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), Presented at the American Heart Association Scientific Sessions, Orlando, November 11, 2003. Pres. For 37 years he has been touting the benefits of very low-fat, high-carbohydrate, vegetarian diets for preventing and reversing heart disease. (1980) in internal medicine from Baylor College of Medicine in Houston. (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.). A critique of the diet guru's views on high-protein diets, followed by a response from Ornish and a reply from the author. 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). 1994;1:283-286. Copyright [c] 2004 by the American Dietetic Association. 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. The rivalry between Atkins and Ornish was related to food intake. 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. Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: The Iowa womens health study. J Cardiovasc Risk. 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). Ornishs diet would probably be an improvement on the current American dietif people could actually follow it long-term. In my numerous debates with Dr Atkins, we agreed that many Americans eat excessive amounts of processed foods high in simple carbohydrates, including sugar, high-fructose corn syrup, white flour, white rice, and alcohol. It's the type of protein, fat and carbohydrates that matters. The point is, its possible to cherry-pick observational studies to support almost any nutritional argument. If they stop eating desserts, they consume less fat as well as less sugar. 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. The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. Thanks for reading Scientific American. Only patients following the Atkins diet showed a worsening of each CVD risk factor (LDL-C, triglycerides, total cholesterol, HDL-C, total-to-HDL cholesterol ratio, homocysteine, Lp(a), and fibrinogen), despite achieving statistically significant weight loss. Peyreigne C, Bouix D, Aissa Benhaddad A, et al. A diet high in whole grains was associated with a reduced risk of type 2 diabetes in 42,898 men followed for 12 years. Bill Clinton from 1993 to 2000 and served on the White House Commission on Complementary and Alternative Medicine Policy in 200102. 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. People have a spectrum of choices. The level of LDL-C is regulated by the LDL receptor, a cell surface glycoprotein that removes LDL from plasma by receptor-mediated endocytosis (27). The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans. J Am Diet Assoc. Fung TT, Hu FB, Pereira MA, et al. 1993;58:398-406. 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. Journal of the American Medical Association 104(2004):537. I am not against all forms of animal protein. 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. Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. 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). On one side was Atkins, who had two strips of bacon and three eggs for breakfast. Available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof . 2003;348:2057. This reduction in LDL-C is much greater than on an Atkins diet and is comparable with the effects of statin drugs. At Pennsylvania State University, researchers found that healthy women instinctively ate about 3 lb of food a day, whether high or low in calories. They should not be used to make claims about cause and effect; doing so is considered by nutrition scientists to be inappropriate and misleading. The reason: People who eat a lot of animal protein often make other lifestyle choices that increase their disease risk, and although researchers try to make statistical adjustments to control for these confounding variables, as theyre called, its a very imperfect science. 2002;75:848-855. 1999;277:F813-F819. And although Ornish is right that I lack clinical experience, when analyzing evidence, distance can be useful. Atkins R, Ornish D. Cardiology Crossfire. American College of Cardiology 50th Annual Scientific Sessions, Orlando, FL, March 20, 2001. 2002;113:30-36. Westman EC, Yancy WS, Edman JS. Its not just 48 patients. Dean Ornish, MD Chanmugam P, Guthrie JF, Cecilio S, Morton JF, Basiotis PP, Anand R. Did fat intake in the United States really decline between 1989-1991 and 1994-1996? Taubes G. What if its all been a big fat lie? 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. WHY PEOPLE LOSE WEIGHT ON LOW-CARBOHYDRATE/HIGH-FAT DIETS. These studies have been conducted with well-respected collaborators, published in the leading peer-reviewed journals, and presented at the most credible scientific meetings. 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). 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). A more healthful and evidence-based choice is to substitute simple carbohydrates with complex (unrefined) carbohydrates including whole foods such as fruits, vegetables, legumes (including soy products), and whole grains (such as brown rice and whole wheat flour). Third, it is a common misconception that anything that raises HDL is beneficial and anything that lowers it is not. 2003;138:460-467. Only total cholesterol and HDL changed in this study, so these were the only factors in determining the risk score. 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. 1997;337:562-563. Indicate whether you agree with one or both researchers or have a different One-year effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in decreasing body weight and heart disease risk. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. 2001;73:1010-1018. He is recognized internationally as a leader in the field of nutritional influences in neurological disorders. Science. These associations were either abolished or attenuated if the proteins were plant derived.. Cambridge, MA: Harvard University Press; 1980. This argument raises two interesting points: First, it contradicts Ornishs claim that hes not really against fat, just certain types of fat. In other words, the diet I recommend causes weight loss, not weight gain. When you eat less fat, you consume fewer calories without having to eat less food, thereby increasing satiety without adding calories. A receptor-mediate pathway for cholesterol homeostasis. Cardiology. Insulin may also raise the secretion of lipoprotein lipase, increasing the uptake of fat into cells, leading to weight gain (10). For the past 37 years my colleagues and I at the nonprofit Preventive Medicine Research Institute, in collaboration with leading scientists and medical institutions, have published a series of randomized controlled trials and demonstration projects showing that comprehensive lifestyle changes may slow, stop and often reverse the progression of many chronic diseases. Her article begins with a gross distortion of what I believe. In doing large-scale studies in which people complete dietary surveys, there is often so much noiseespecially in combining data in meta-analysesthat a type 2 error often occurs (that is, the noise obscures the ability to detect statistically significant differences). Zeman FJ, Hansen RJ. Telephone: (415) 332-2525 x222. Total fat and animal fat intake were higher and carbohydrate intake was lower in those with recently diagnosed diabetes or previously undiagnosed diabetes in the multinational, multicenter study of the Mediterranean Group for the Study of Diabetes (17). Atkins R. The case for low carbs. HDL returns cholesterol to the liver for metabolism, a pathway known as reverse cholesterol transport. 1972;56:359-364. 2002;95:1047-1049. Your body excretes toxic substances through your bowels, breath, and perspiration, so this is not surprising. His famous 1990 Lifestyle Heart trial involved a total of 48 patients with heart disease. CONCLUSIONS: 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). CA Cancer J Clin. 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. 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.
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