Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. 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). What is the comparison and contrast of dr.Atkins and dr. Ornish See answer Advertisement ingramjazmine9 Answer: The two doctors had much in common: Omissions? 1993;328:1213-1219. 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. Presented at the American Heart Association Annual Scientific Sessions, Orlando, FL, 2003. 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 Diet, obesity, and cardiovascular risk. There are so many other factors. 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. Bell EA, Rolls BJ. Clin Hemorheol Microcirc. 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? Available at: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof . 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. Am J Cardiol. (This lack of association is notable because this analysis probably overestimates risks associated with red meat consumption; all but two of the studies it assessed lumped processed meats into the red meat category.) 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 2003;348:2074-2081. Compared to the reduced carbohydrate diet, the reduced fat diet led to a roughly 67 percent greater body fat loss. Brinton EA, Eisenberg S, Breslow JL. Ludwig DS, Pereira MA, Kroenke CH, et al. The fact is, individuals on his diet are supposed to consume (pdf) no more than 10 percent of calories from fat, and thats very, very low compared to the average Americans adults intake of 33 percent of calories from fat. American Dietetic Association. Discover world-changing science. 1999;84:339-341A8. JAMA. Circulation. These include a whole foods, plant-based diet low in refined carbohydrates, moderate exercise, stress management techniques and social support. Science. 2001;4:171-177. Diet was assessed by validated food frequency questionnaires and updated every four years. Ornish D. Dietary treatment of hyperlipidemia. Second, there was no statistically significant difference in either systolic blood pressure or diastolic blood pressure after one year in comparing the groups. 2003;348:2057. 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). David Perlmutter, MD, FACN is a board-certified neurologist, Fellow of the American College of Nutrition, and five-time New York Times bestselling author. In other words, when you change the type of food, you dont have to be as concerned about the amount of food. 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. When you eat less fat, you consume fewer calories without having to eat less food, thereby increasing satiety without adding calories. Ornish D, Hart J. In: Harrisons Principles of Internal Medicine (online), Braunwald E, ed. First, shes again perpetuating the myth that when we cut out fat, we began eating foods that were worse for us. As the USDA data show, were eating more fat, not less. Am J Physiol. I would love to be able to tell you that these are health foods, but they are not. 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. 1995;274:894-901. Reductions in total cholesterol, LDL-C, triglycerides, and total-to-HDL cholesterol ratios were significant only in patients who were following either a 10% fat diet or a 15% fat, calorie-controlled diet. Accessed March 5, 2004. The American Cancer Society 1996 Advisory Committee on Diet, Nutrition, and Cancer Prevention. In other words, the diet I recommend causes weight loss, not weight gain. Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. WebDr. 1961;16:407-415. 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). Was Dr. Atkins Right? Dr. Atkins believed that cutting off carbohydrates and sugar will also do the same. 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). Twenty-eight were assigned to his low-fat, plant-based diet and 20 were given usual cardiac care. Fung TT, Hu FB, Pereira MA, et al. HDL is important only to the extent that it affects atherosclerosis and myocardial perfusion, it is not a disease. J Am Diet Assoc. Effect of 6-month adherence to a very low carbohydrate diet program. Fleming R, Boyd LB. 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). You can lose weight without feeling hungry or deprived. Ornish begins his piece with a misleading statistic. Editor's Note: Our April 22 article elicited a lengthy response from Dean Ornish, which we publish here, along with a rebuttal from Melinda Wenner Moyer. Upon changing from high to low intake of saturated fat and cholesterol, the mean HDL-C decreased 29%, whereas apo A-I levels fell 23%. 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. The concept of a dietary spectrum empowers people with information and freedom of choice rather than the feeling of constraint or restriction. The other way people get too many calories is by consuming too many simple carbohydrates. And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. Diabetes mellitus, hypoglycemia, and other endocrine disorders. How might a mans reproductive health concerns change at different periods of his life? 4) Dr. 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. 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). Some people are able to handle more simple carbohydrates and/or more cholesterol and saturated fat in their diet than others. Pres. J Clin Invest. 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. Explore our digital archive back to 1845, including articles by more than 150 Nobel Prize winners. In: Cowdry EV, ed. Please refer to the appropriate style manual or other sources if you have any questions. A receptor-mediate pathway for cholesterol homeostasis. A food or nutrient can be healthy without requiring that all other foods or nutrients be unhealthy. Even better would be to reduce the intake of simple carbohydrates and most fats, which results in losing even more weight while enhancing health rather than potentially harming it. Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. The fact that not all studies have shown this risk does not mean that it is not true. Geriatrics. Ornish believed that the stress-management aspect of his program, designed to combat social isolation as well as daily pressures, was as essential to his patients recovery as diet and physical activity. 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. But the real issue is what happens to actual measures of heart disease, not just risk factors, which I will describe further on. 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. 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. 1970;27:59-67. 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. 1988;81:300-309. Clinical Nutrition and Dietetics. Telephone: (415) 332-2525 x222. On one side was Atkins, who had two strips of bacon and three eggs for breakfast. Lancet. The abstract clearly states, Respondents aged 5065 reporting high protein intake had a 75 percent increase in overall mortality and a fourfold increase in cancer death risk during the following 18 years. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. First, in this study, JAMA published a retraction of one of the main conclusions of this study by led by Christopher Gardner, which initially claimed that people lost more weight on the Atkins diet than on the diet I recommend, which turned out to be false (JAMA. Brody J. 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. Over and over, Ive seen patients with coronary heart disease so severe that they cant walk across the street or work or play with their kids or make love or do much of anything without getting severe chest pain become pain-free after only a few weeks of making these diet and lifestyle changes. 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. 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 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. What is Kim MOST trying to strengthen? The purpose of this article is to find common ground among seemingly contradictory information about different diets, present an evidence-based rationale for optimal nutrition, and describe many of the half-truths and distortions of the Atkins diet and other similar diets. Thus, by eating less fat, you reduce calories by reducing energy density without having to reduce volume. HDL returns cholesterol to the liver for metabolism, a pathway known as reverse cholesterol transport. All three diets reduced blood pressure, total and low-density lipoprotein cholesterol levels, and estimated coronary heart disease risk. For example, the thenAmerican Dietetic Association published a position paper on plant-based diets in which they wrote, It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases.. The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. Sample sizes ranged from 1,730 men and 2,003 women in NHANES 1999 to 2000 to 6,630 men and 7,537 women in NHANES III. That only supports my thesis, because I recommend that people eat less harmful fats and fewer refined carbohydrates. : How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (2019; written with his wife, Anne Ornish). 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. By planning to improv Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. Unfortunately, most studies of the Atkins diet and other highprotein diets measure only risk factors for CHD such as weight and lipids. History tells us its not going to be spinach. 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). Create your free account or Sign in to continue. In another study, 70% of patients on an Atkins diet for 6 months were constipated, 65% had halitosis, 54% reported headaches, and 10% had hair loss (59). Risk assessment tool for estimating 10-year risk of developing hard CHD (myocardial infarction and coronary death). 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). In contrast, someone who increases the amount of fat and cholesterol in their diet (eg, an Atkins diet) may increase their HDL-C because their body is trying to get rid of the extra garbage (fat and cholesterol) by increasing the number of available garbage trucks (HDL). But his claims about the dangers of saturated fat and red meat go beyond the science and in some cases contradict it. WHAT IS THE EVIDENCE THAT COMPLEX CARBOHYDRATES ARE BENEFICIAL? The fact that processed meat is even worse for you than unprocessed meats does not change the fact that the risk of premature death from all causes is higher in those eating red meat than those who do not. Ornish goes to argue that protein and saturated fat increase the risk of mortality and chronic disease. 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. Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Thus, we need to move beyond simplistic notions that anything that raises HDL-C is beneficial and anything that lowers HDL-C is harmful. MAIN OUTCOME MEASURES: 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. A frequently overlooked "waste product" of metabolism, uric acid actually threatens our health. He should know better. An Atkins diet often shows a greater reduction in triglycerides by comparison. 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. Stevens A, Robinson DP, Turpin J, et al. This argument raises two interesting points: First, it contradicts Ornishs claim that hes not really against fat, just certain types of fat. 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. 2002;113:30-36. We documented significant improvements in the hearts function after only 24 days compared with a randomized control group. As I wrote: I agree that replacing fat with sugar is not healthful, as Ive written about for decades. Our editors will review what youve submitted and determine whether to revise the article. 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. A person is likely to lose more weight by reducing intake of both simple carbohydrates and fat than from simple carbohydrates alone. Yet as I read this article, I cant help but to find amusement in Ornish D, Brown SE, Scherwitz LW, et al. 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. 2023 Scientific American, a Division of Springer Nature America, Inc. Am J Clin Nutr. J Cardiovasc Risk. Liu S, Stampfer MJ, Hu FB, et al. These are rich in fiber, which enhances satiety without adding significant calories. It is all about energy balance. Bushinsky DA, Chabala JM, Gavrilov KL, Levi-Setti R. Effects of in vivo metabolic acidosis on midcortical bone ion composition. 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. Knowledge awaits. Only one person in the experimental group of the Lifestyle Heart Trial was smoking at baseline, so its unlikely that made a significant difference. 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. An AHA/NCEP 30% fat diet reduces LDL-C by only about 5% to 7% in most patients (22-24). Some colleagues claimed that the admonitions of his program were entirely unrealistic and that patients not under supervision would in all likelihood return to their previous, unhealthy habits. The title is confusing and potentially harmful to many readers. 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. Regression of coronary atheromatosis in rhesus monkeys. Brown MS, Goldstein JL. (Also: the heavy protein consumers in the study were consuming nearly 30 percent more protein than the average American does.) For those simply trying to lose weight or lower their risk factors moderately, less extensive changes may be required. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Bill Clinton is one of the more public examples of this, having lost and kept off more than 20 pounds since following the whole foods, plant-based diet I recommended for him five years ago (including salmon once a week). 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. RESULTS: N Engl J Med. Prev Cardiol. Ornish eventually received a bachelors degree in humanities (1975) from the University of Texas at Austin, graduating first in his class. 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 This was clearly stated in my New York Times oped: Moyer wrote: Nutrition is complex but there is little evidence our countrys worsening metabolic ills are the fault of protein or fat. Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. WebWas Dr. Atkins Right? In: Seman FJ, ed. New York: Random House; 1990. After one year those following his diet were more likely to see a regression in their atherosclerosis. Am J Kidney Dis. Its almost certainly healthier than the highly processed, refined-carbohydrate-rich diet most Americans consume today. Increased whole grain intake was associated with decreased risk of CHD in 75,521 women followed for 10 years (13). If you would like to visit their site, please use Ornish D. Concise Review: Intensive lifestyle changes in the management of coronary heart disease. In August 1993 the insurance company Mutual of Omaha announced that it would reimburse policyholders for the cost of participation in Ornishs program, marking the first time a major insurer had agreed to cover an alternative treatment for heart disease. Weight loss at 12 months was the primary outcome. 1999;21:147-153. Both eating plans recommend avoiding saturated fat from animal proteins and full-fat dairy. The advantage of small changes is that the barriers to change are low, but the benefits are also modest. 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. 1974;15:508-516. 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). They documented 23,926 deaths (including 5,910 CVD and 9,464 cancer deaths) during 2.96 million person-years of follow-up. Your body excretes toxic substances through your bowels, breath, and perspiration, so this is not surprising. The percentage of calories from fat has decreased, but the amount of fat consumed has increased (6). 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). There has been a recent resurgence of interest in low-carbohydrate/high-fat diets such as the Atkins diet (1-3). Fleming RM. Dietary cholesterol and the pathogenesis of atherosclerosis. 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. Harrisons Advances in Cardiology. Question 12 options: his core , muscle memory, his progression , specificity training, Kim is conditioning. Atkins Is Better Than Ornish, Stanford Study Says. OBJECTIVE: Ornish moved to San Francisco in July 1984 after accepting a teaching position at the University of California School of Medicine. It's the type of protein, fat and carbohydrates that matters. 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. 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. 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. Whole grain consumption improves insulin sensitivity in overweight and obese adults (15). Boston: W.B. WHY PEOPLE LOSE WEIGHT ON LOW-CARBOHYDRATE/HIGH-FAT DIETS. Its hard to move the science forward when there are so many stakeholders who say this is the right diet and no other one could possibly be right, Bazzano says. New York: MacMillan; 1933:271-322.
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