DEAN ORNISH: SCIENCE BE DAMNED, SELF-INTEREST BE SERVED

As always, Dean Ornish and the media put aside science in favor of headlines and self-interest.  The following editorial was rejected by NEWSWEEK, TIME, the Journal of the American Medical Association and others.  However, Ornish was allowed exclusivity on the playing field.  And who pays the price yet again?  The American consumer and the millions suffering from obesity, diabetes and heart disease.  Dear reader: write to your local media, the national media, phone, email and demand that Dr. Vernon and other experts who follow the trail of science be given a voice.

More Science and Less Zealotry, Please.

The controversy over which diet is best for all has again made headlines with the publication of the Stanford University study in the Journal of the America Medical Association March 7, 2007. Since the results are favorable to the low-carbohydrate Atkins diet, the usual criticism can be expected to follow.

Predictably, Dean Ornish has launched a tirade in which he manipulates the study findings to find fault with the low-carb approach and to deflect criticism away from his ultra low-fat diet which did not perform well in the study. Unfortunately, this is an argument based on dogma and not on science. The science speaks for itself.

As scientists and clinicians, we believe that no one dietary approach is going to be ideal for everyone. There is no doubt that, for some, an ultra-low-fat approach may be appropriate. Unlike Dr. Ornish, we recognize that there is no one-size-fits-all approach to the enormously complex problem of obesity and related conditions. Unfortunately, other authoritative sources like the US dietary guidelines also recommend a single lowered fat high-carbohydrate diet approach and have been doing so over the decades that this epidemic has grown.

Gratuitous attacks on the Atkins diet that imply it involves abandonment of wholesome vegetables and fruit for “bacon and brie” are simply wrong. Even in the most restrictive phase it meets the recommended daily guidelines for vegetables and fruits. As one advances through the phases, low-glycemic fruits, more vegetables, legumes and even whole grains are introduced based on an individual’s metabolic tolerance for these foods. One survey found that people who follow the Atkins plan over the long term eat more vegetables than they did before. Another study found that rather than increase the intake of fat and protein to compensate when carbohydrates were reduced, people simply ate less.

The unfortunate reality of today is that too many Americans are eating potato chips and fries and drinking sugar-sweetened beverages. We support the idea that wholesome foods such as meat, fish, cheese and eggs along with vegetables and low glycemic fruits constitute a healthier diet than chips and fries and sodas.

While this study examined four popular dietary approaches, what is clear is that whatever approach one takes to healthy eating, success will depend on how well you can stick to it. In this case, and in many earlier studies, it is clear that the Atkins diet is the one most people can maintain. On the other hand, the extremely low-fat diet advocated by Dr. Ornish is very difficult to follow. In this study, the subjects who were supposed to reduce their fat intake to his recommended intake of 10% could not reach that target.

Another important aspect of this and earlier studies is the beneficial effect that reducing carbohydrates has on metabolic markers. In his criticism, Dr. Ornish states that the LDL-cholesterol level fell in response to his diet, but does not mention that none of the differences in LDL-C in this study were statistically significant. This is therefore not a scientifically valid criticism. On the other hand, it is widely recognized that elevating the HDL-C, the good cholesterol, is an important factor in reducing cardiovascular risk. In this study there was a highly significant 10% rise in HDL-C in the Atkins group but no such change among those who followed the very high-carbohydrate Ornish diet.

In the same vein, the Atkins group demonstrated a significant (both statistically and clinically) greater reduction in systolic and diastolic blood pressure than the other three diets. A difference in mean arterial pressure of 5 mm Hg is about the response we would expect to see with a first-line pharmaceutical in the clinical setting. Any objective observer would acknowledge this as a major beneficial effect of the Atkins diet.

Dr. Ornish suggests that the positive findings of research such as this that supports the Atkins diet will cause problems, and that “many people may go on a diet that harms them based on inaccurate information.” This is a wildly irresponsible statement, given the consistency with which a reduction in important metabolic and cardiovascular risks are achieved by lowering carbohydrate consumption. It is simply preposterous to suggest that an approach that leads to significant risk factor reduction is unhealthy.

The seriousness of the accelerating epidemic compels us to think outside the box to find new solutions where the status quo has failed. The only approach that will be successful is one that people can actually follow. This study adds to the mounting evidence that the Atkins diet is a healthy choice which should be supported as a viable way to lose weight and improve metabolic and cardiovascular risk factors.

The Real Atkins Lifestyle

Before there was research on the Atkins diet it was commonly criticized in the belief that it would elevate cholesterol, ruin one’s kidneys and bones and cause heart disease. None of this has been borne out by the research.

What is clear from this JAMA study, and others like it, is that cardiovascular risk factors actually improve when controlling carbs. The scientific studies of this approach have shown numerous times that a pattern of rising HDL-C and falling triglycerides is the hallmark of carb restriction and that this benefit occurs even in the absence of weight loss.

Research also shows that rising HDL-C (good cholesterol) and falling triglycerides is correlated with larger LDL-C particles which are less likely to cause heart disease. Even the much touted statin drugs do not deliver this kind of improvement in LDL-C particle size. On the other hand, the research shows that eating a high-carb diet and cutting fat intake results in small dense LDL-C particles that are linked to an increased risk of heart disease.

Importance of Fat

There are other problems associated with extremely low fat diets, as well. Cutting fat intake can lead to deficiencies in fat soluble vitamins, depletion of essential fats such as EPA and DHA, and decreases in the absorption of nutrients. Studies also show that people with cholesterol levels that are too low become prone to depression, suicide and cancer and have higher overall death rates than those who have higher cholesterol levels.

When all is said and done, it behooves us to remember that the diet debate is not a horse race where there is only one winner. We know there is a great variability in metabolic and genetic factors that will determine what dietary approach is best for each individual person. Although, in this and many other studies the Atkins diet worked better for more people, it is also evident that other dietary approaches will work for some people as well. The most important thing we have learned from dietary research is that people need to find the approach that will deliver healthy outcomes for them individually. And, just as the proof of the pudding is in the eating, the proof of a diet's effectiveness is whether it can sustain those benefits over the long haul. Hopefully, the weight of the evidence will now allow the Atkins diet to be recognized and supported as a legitimate option for people who want to improve their health through better nutrition.

On a final note, Dr. Ornish’s repugnant attempt to undermine Dr. Atkins’ credibility by perpetuating the myth that he had heart disease is unconscionable. It is unbecoming of any honorable person to make ad hominem attacks on those who are departed. Enough is enough. Dr. Atkins died of a head injury. He is no longer with us, but the line of scientific inquiry that he started continues to vindicate his dietary approach. And no amount of unfounded criticism will alter the fact that this study, and the 60 others before it, clearly demonstrate that what Dr. Atkins had been telling us all along was right.

• Jacqueline A. Eberstein, R.N. Co-author, Atkins Diabetes Revolution, President, Controlled Carbohydrate Nutrition
• Stephen D. Phinney, M.D. Ph.D Emeritus Professor, Department of Medicine, UC Davis, Elk Grove, Cal
• Mary C. Vernon, M.D., CMD, Co-author, Atkins Diabetes Revolution, President, American Society of Bariatric Physicians
• Eric C. Westman, M.D. M.H.S, Associate Professor of Medicine, Duke University Medical Center
• Jay Wortman, M.D, Department of Health Care & Epidemiology, Faculty of Medicine, University of British Columbia

Comments

[Andre La Pierre]

Dear Dr. Vernon,

Thank you very much for such a wonderful article. A true masterpiece, and it is deeply saddening to realize that this article, the TRUTH, has not been published. I read your posts on your website on a regular basis, and I want you to know that I have the deepest respect and admiration for you and your work, your intelligence and experience, your courage, and your determinism to get the truth out there.

The scientific evidence is clear and overwhelming, and it's about time the media payed some attention! That's why I will write to (all of) them to give you airtime, or at least an opportunity to get this article published. In my not-so-humble opinion it's a crying shame that while untold millions upon millions of people worldwide are suffering and even dying from obesity and diabetes -not to mention the related slew of associated illnesses - and the truth on how to prevent and even cure these diseases is not even considered for publication!

I always have had rather limited respect for the media, but now they've really gone too far.

Anyway, dr. Vernon, enough about my frustrations. I wish you well in your courageous and brilliant career! If I can help, in any way, please don't hesitate to contact me anytime. It'll be my pleasure.

With respect and warm regards,

Andre

[Andre La Pierre]

Oh, and as for Dr Ornish: ignore the man. It's too much honor, really. He's increasingly irrelevant - nothing more than a noisy negativist: "don't bother me with the facts, my mind is made up" type of person. He clearly does his research by proclamation rather than by investigation. There are many of them. No matter how noisy they are, and how much free airtime they will be granted by our "impartial media": in the end the truth will prevail. I firmly believe that. I can't wait to see that day!

[Anssi Manninen]

As expected, Dean "Dont Confuse Me With the Facts" Ornish is still perpetuating pathetic myths and misconceptions regarding carbohydrate restriction, so "Ingore the man!" is the take-home message.

[Jimmy Moore]

While it is certainly expedient for US to simply "ignore the man," the fact is he is so heavily promoted by the media and health establishment that he gains credibility among a consuming public who has no idea Dr. Ornish is full of himself.

That's why I think we all need to continue speaking out against him at every opportunity that he tries to pull this kind of stunt against Dr. Atkins and his amazing life's work. I'll do my part, Dr. Vernon, to keep putting the TRUTH out there because it WILL prevail in the end.

THANK YOU and all of your fellow researchers and medical experts for what you are doing to combat the lies, too.

[BamaGal]

Dr Vernon---I applaud your and your colleges efforts. I am a nurse and I am confronted daily by the stupidity of some of the so called experts in the field of nutrition. Many times I have been asked by MDs to keep my diet advice to myself. That I am endangering the lives of my patients with the low carb nonsense---as they put it. It is increasingly difficult to remain quiet and watch my patients continue to suffer needlessly, so I will continue to answer questions when asked about my lifestyle. It was instilled in me long ago by an older nurse that the patient was my first responsibility.
The media is our biggest foe for the layperson---but for the life of me I don't see why some docs are so blind to all the research.

[michael jones]

Dr. Vernon i agree with your article.Health is the most important thing and there are general questions connected with it that we have to observe carefully.We should not let some people lie us.I support you.

[Ray Hooker]

With all due respect, I really believe there is more to this story. First there is science behind what Dr. Ornish saw in his study. I think anyone who dismisses this does it to their discredit. There was reversal of heart disease. If we are to learn, we need to start there.

Secondly even those in the "Ornish camp" are looking at variations that consider the importance of fats.

Finally I can tell you that we are not all equal. Best I can tell I am the poster child for the low fat approach. Friends of mine seem to fall in other camps. Can we not lobby for personalized medicine that acknowledges differences. VLFNV has worked incredibly well for some though not for all. Can we not have a better response that takes the high road?

Ray

[Ray Hooker]

With all due respect, I really believe there is more to this story. First there is science behind what Dr. Ornish saw in his study. I think anyone who dismisses this does it to their discredit. There was reversal of heart disease. If we are to learn, we need to start there.

Secondly even those in the "Ornish camp" are looking at variations that consider the importance of fats.

Finally I can tell you that we are not all equal. Best I can tell I am the poster child for the low fat approach. Friends of mine seem to fall in other camps. Can we not lobby for personalized medicine that acknowledges differences. VLFNV has worked incredibly well for some though not for all. Can we not have a better response that takes the high road?

Ray

[Larry]

Are you guys getting paid by the National Beef Council or something or are you just in denial?

[Paul]

I think you are wrong with the "studies also show that people with cholesterol levels that are too low become prone to depression, suicide" There are a number of studies, including a major Finish study that shows low levels of cholesterol are beneficial for mood and emotions. Also, our bodies produce all the cholesterol that we need, without getting it from our diets. The lower cholesterol levels found may be an indicator that people are not getting enough DHA and EPA in there diets and cholesterol is low because most people's sources of DHA and EPA would be animal, when there are plant sources that are available-algae, etc...

[Colon Cleanse Geek]

Knowing that Type II diabetes is increasing it is important that we all become educated and come to a healthy conclusion as to what is healthy eating. The average person is becoming so confused with such a glutton of info. it is hard for anyone to tell the difference in between healthy eating and a fad diet. Interesting post, thanks for sharing.

[Diet Eating Club]

Yes, the average person is becoming so confused with a glutton of info. But the average person can learn too: the more the better - but a right reading such a medicine books. This way bring the structure into the chaos.
Thanks for the post.

[Robert]

We know there is a great variability in metabolic and genetic factors that will determine what dietary approach is best for each individual person. Although, the Atkins diet has been shown to have worked for people, it is also evident that other dietary approaches work for other people. The proof of a diet's effectiveness is whether it can sustain those benefits in the long term.

The debate should not be restricted to diet alone. Lifestyle can also be a significant factor, particularly in type 2 diabetes.

While the proof of a diet's effectiveness is whether it can sustain those benefits in the long term, those benefits will be enhanced if they are coupled with appropriate life style changes.

People need to find the approach that will deliver healthy outcomes for them individually.

[Steve Thomas]

I reversed my heart disease with a vegetarian diet inspired by Dr. Ornish's research. It was such a rare event even here in health-conscious Boulder, Colorado that the medical person reading my nuclear heart image, taken four months after beginning an Ornish style diet, could only conclude that my heart had never had a blockage to begin with.

[Alive today]

I had a heart attack, I ate healthy, , no fried foods good cuts of meat exercised regularly. After the heart attack I did my own research and looked to the China Study, and another a book by Dr. Esselsteyn and another by Dr. Ornish. It has been proven over the decades as well as individual life times as in the China study. You can eat what you want but I am sure I will outlive many who are on the Adtkins diet. So eat your meats and fats and oils and time will tell what works and doesn't the results will be life and death

[roaminghermit]

after 3 heart attacks doing the veggie/ornish low fat etc., I'm doing the low carb with great success thank you no move going on 4 yrs now. So simple to take fish oil, even the hospitals are pushing the expensive prescription fish oil, which of course is no better than the regular heath food stuff.

[roaminghermit]

yes lets check in next year and see who's still here. Atkins with lots of low carb veggies....