compare and contrast dr ornish and dr atkins

The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. 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 impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency. 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. I feel passionately about doing this work because it helps transform peoples lives for the better. N Engl J Med. Ornish begins his piece with a misleading statistic. As I wrote about in my oped, according to the U.S. Department of Agriculture (pdf), every decade since 1950 Americans actually have been eating more fat, more sweeteners, more meat and more calories. Im not cherry-picking data; Im looking at the preponderance of evidence from many studies by leading investigators such as those at Harvard School of Public Health. 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. Hu JF, Zhao XH, Parpia B. Dietary intakes and urinary excretion of calcium and acids: A cross-sectional study of women in China. Although we always need more research, there is enough science now to guide us. 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). Thus, by eating less fat, you reduce calories by reducing energy density without having to reduce volume. These studies have been conducted with well-respected collaborators, published in the leading peer-reviewed journals, and presented at the most credible scientific meetings. 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 what about the claims Ornish makes about the success of his own dietdo they hold up to scrutiny? Although Dr Atkins and I agreed on the diagnosisthat many Americans eat too many simple carbohydrateswe disagreed about the prescription. Atkins R, Ornish D. Cardiology Crossfire. American College of Cardiology 50th Annual Scientific Sessions, Orlando, FL, March 20, 2001. 2003;348:2057. (In contrast, the recommendations of the American Heart Association allowed up to 30 percent of total calories from fat and 300 mg of cholesterol daily.) HDL returns cholesterol to the liver for metabolism, a pathway known as reverse cholesterol transport. Circulation. Could it be that our attempts to reduce fat have in fact been part of the problem? Clin Hemorheol Microcirc. You can eat fewer calories by consuming less food. If anything, our attempts to eat less fat in recent decades have made things worse. To understand better the mechanism of this phenomenon, Breslow and colleagues studied the turnover of HDL apolipoproteins (apo) A-I and A-II in 13 subjects on two contrasting metabolic diets. Mean apo A-II levels did not change. ", The recent multicenter PREDIMED trial also supports the notion that fat can be good rather than bad. (All groups consumed about the same amount of protein.) Its not just 48 patients. Unfortunately, most studies of the Atkins diet and other highprotein diets measure only risk factors for CHD such as weight and lipids. Am J Cardiol. And although Ornish is right that I lack clinical experience, when analyzing evidence, distance can be useful. Esselstyn CB Jr. Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). 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. 2002;75:848-855. N Engl J Med. 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. 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 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.. 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. 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. Presented at the American Heart Association Scientific Sessions, Orlando, November 11, 2003. 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. Although this was shown in animals, it is likely true in humans as well. Discover world-changing science. Prev Cardiol. Ornish eventually received a bachelors degree in humanities (1975) from the University of Texas at Austin, graduating first in his class. Taubes G. What if its all been a big fat lie? Diet, obesity, and cardiovascular risk. 2000;51:817-826. All three diets reduced blood pressure, total and low-density lipoprotein cholesterol levels, and estimated coronary heart disease risk. In March 1998 he partnered with ConAgra Foods to release a line of vegetarian foods. Accessed March 5, 2004. 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 title is confusing and potentially harmful to many readers. In contrast, there was a statistically significant reduction in LDL-cholesterol in the Ornish group but not in the Atkins group after one year. 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 fact that not all studies have shown this risk does not mean that it is not true. Dietary cholesterol and saturated fats increase plasma LDL-C in part by down-regulating LDL receptors in the liver (28). 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). Body weight is inversely associated with dietary fiber and carbohydrates and positively associated with protein intake (11). The authors wrote: The beneficial effects of lower protein intake were not seen in those over 65. On August 12, 2010, after 16 years of review, the Centers for Medicare & Medicaid Services began providing Medicare coverage for my intensive lifestyle program for reversing heart disease under a new benefit category, intensive cardiac rehabilitation. Many insurance companies are also providing coverage. Am J Clin Nutr. In addition to promoting weight loss, Atkins claimed that this diet may help people prevent heart disease, diabetes, and possibly other chronic illnesses. 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. Effect of 6-month adherence to a very low carbohydrate diet program. 1974;15:508-516. 1999;18:207-212. 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. The arterial damage was caused by animal-protein induced elevations in free fatty acids and insulin levels and decreased production of endothelial progenitor cells (which help keep arteries clean). There has been a recent resurgence of interest in low-carbohydrate/high-fat diets such as the Atkins diet (1-3). Ornish D. Dr. Dean Ornishs Program for Reversing Heart Disease. The Atkins Diet plan and the Dean Ornish diet are both established and popular diet plans. the following link: 1999;282:1539-1546. 1961;16:407-415. Plus, discouraging the intake of entire macronutrient groups can backfire. 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), Increased whole grain intake was associated with decreased risk of CHD in 75,521 women followed for 10 years (13). Dean Ornish, MD The case for a low-fat, highcarbohydrate diet. Medicare followed suit in 2006. The other way people get too many calories is by consuming too many simple carbohydrates. You may lose weight and start to attract people to you, but, when they get too close, it may be counterproductive. 1998;82:18T-21T. DISTINGUISHING BETWEEN RISK FACTORS AND ACTUAL MEASURES OF DISEASE. 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. Knight EL, Stampfer MJ, Hankinson SE, et al. 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). Dr Atkins advocated substituting simple carbohydrates with high-fat, high-animal protein foods such as bacon, sausage, butter, steak, pork rinds, and brie. In: Seman FJ, ed. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Effect of 6-month adherence to a very low carbohydrate diet program. If anything, our attempts to eat less fat in recent decades have made things worse. Cognitive effects of ketogenic weight-reducing diets. 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. (This study was funded by the Atkins Center for Complementary Medicine.) Yet as I read this article, I cant help but to find amusement in Intensive risk factor modification. 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. Knowledge awaits. For someone trying to reverse heart disease, for example, the diet needs to be rather strict to accomplish this. Dansinger ML, Gleason JL, Griffith JL, Li W, Selker HP, Schaefer EJ. Melinda Wenner Moyer, a contributing editor at Scientific American, is author of How to Raise Kids Who Arent Assholes: Science-Based Strategies for Better Parentingfrom Tots to Teens (G. P. Putnams Sons, 2021). Theres also another issue to consider: Although Ornish emphasizes that his diet is low in fat and animal protein, it also eliminates refined carbohydrates. 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. Thus, we need to move beyond simplistic notions that anything that raises HDL-C is beneficial and anything that lowers HDL-C is harmful. Brody J. However, HDL increased more on the other diets, so the differences in the Framingham risk score were due primarily to changes in HDL. 1998;318:549-557. 2003;26:302-307. 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. Founder and president, Preventive Medicine Research Institute At Pennsylvania State University, researchers found that healthy women instinctively ate about 3 lb of food a day, whether high or low in calories. Robert Atkins debates Dean Ornish and John McDougall on whether a low-carb, high-protein diet is 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. They documented 23,926 deaths (including 5,910 CVD and 9,464 cancer deaths) during 2.96 million person-years of follow-up. 1999;70:412-419. WebDr. 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). In contrast, within each diet, the HDL-C and apo A-I levels were inversely correlated with apo A-I FCR both on the high-and low-fat diets but not with apo A-I transport rate (44). If they stop eating bagels, they may also stop eating the cream cheese. Am J Med. 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. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. These studies need to be replicated, although similar findings were found by others (39,40). I have no horse in this race. In: Harrisons Principles of Internal Medicine (online), Braunwald E, ed. Its hardly surprising that quitting smoking, exercising, reducing stress and dietingwhen done togetherimproves heart health. If they stop eating pasta, they are often avoiding sauces that are high in oil or cream (olive oil is 100% fat and only 1 tablespoon has 14 g fat). Moyers article only adds to that confusion. Create your free account or Sign in to continue. The fractional catabolic rate (FCR) of apo A-I increased 11%, whereas its absolute transport rate decreased 14%. The Atkins diet caused the most coronary artery blockages whereas a diet low in fat and high in unrefined carbohydrates caused the least amount of blockages. Pounds lost on Atkins diet may quickly return. Science. Harrisons Advances in Cardiology. HDL is important only to the extent that it affects atherosclerosis and myocardial perfusion, it is not a disease. Question 9 options: her bones and muscles her heart and lungs her flexibility her physical However, an Atkins diet was compared with a conventional 30% fat American Heart Association/National Cholesterol Education Program (AHA/NCEP) diet, which is not very low in fat and often high in simple carbohydrates (which increase triglycerides). 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. History tells us its not going to be spinach. The effects of weight loss on the activity and expression of adipose-tissue lipoprotein lipase in very obese humans. The results of the trial, published in 1990, revealed that at least some effects of coronary atherosclerosis had been reversed in many patients. On one side was Atkins, who had two strips of bacon and three eggs for breakfast. 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. New York: HarperCollins Publishers; 1996. 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. Sudden cardiac death of an adolescent during dieting. The primary drive was volume not calories (7). Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial Michael L. In a survey of food consumption data from the United States Department of Agricultures National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII), Individuals of all ages who consume a diet with fewer than 30% of calories from fat consistently have lower energy intakes. Total cholesterol decreased much more on the Ornish diet than on any of the other diets. You can specify conditions of storing and accessing cookies in your browser, Compare and contrast Dr. ornish and Dr Atkins, which virus is responsible for chickenpox?. I am not against all forms of animal protein. 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. The other problem with Ornishs antiprotein stance is that he lumps all animal proteins together. Urinary excretions of calcium and acids are correlated positively with intakes of animal and nondairy animal protein but are correlated negatively with plant-protein intake (53). Insulin accelerates the conversion of calories into triglycerides, which may contribute to hypertriglyceridemia. Explain the scientific basis of each author's position. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. OBJECTIVE: Compared to the reduced carbohydrate diet, the reduced fat diet led to a roughly 67 percent greater body fat loss. So theres little evidence to suggest that we need to avoid protein and fat. His dietary regimen was mostly an inverted version of the USDA pyramid that was high in fat and low in carbohydrates. Weight loss was 1 lb/week on the 10% fat diet and 0.6 lb/week on the Atkins diet. This site is not affiliated with, sponsored by, or related in any way to Omissions? 4) Dr. But heres the thing: The patients who followed his diet also quit smoking, started exercising and attended stress management training. 1996;46:325-341. The people in the control group were told to do none of these things. The relative risk of developing type 2 diabetes was 58% lower when comparing the highest with the lowest quintile of whole grain intake (14). 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. Lancet. These surges may cause a reactive hypoglycemia, increasing hunger and a desire to eat more simple carbohydrates in a vicious cycle, sometimes called carbohydrate cravings. In addition, excessive insulin enhances the growth and proliferation of arterial smooth muscle cells, promoting atherosclerosis (9). If moderate changes are not sufficient to achieve the desired goals, then the patient can be encouraged to make more intensive ones. A critique of the diet guru's views on high-protein diets, followed by a response from Ornish and a reply from the author. 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). 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. The effect of high-protein diets on coronary blood flow. Journal of the American Medical Association 104(2004):537. 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. In contrast, the NHANES data is from surveying only a small sample of people nationwide, so its less reliable. 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. Copyright [c] 2004 by the American Dietetic Association. MAIN OUTCOME MEASURES: 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. Fleming RM. 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. And it is worth noting that among people in the study over 65, heavy consumption of animal protein actually protected against cancer and mortality. 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. Reddy ST, Wang CY, Sakhaee K, et al. Credit: Nick Higgins. Part of the problem in this and other studies that compare weight loss in low-fat versus low-carb diets (which is the wrong question anyway, because its the type of fats and carbs) is that adherence to different diets is often suboptimal, so its hard to make meaningful comparisons. 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. Pereira MA, Jacobs DR Jr, Pins JJ, et al. Am J Kidney Dis. He received an M.D. It is all about energy balance. But Ornishs arguments against protein and fat are weak, simplistic and, in a way, irrelevant. Southern Med J. Buzzano notes that even high-fat dietsif they are high in the right fatscan be healthy and help you lose weight. Past studies also support the claim that low-carb diets are more effective than low-fat. 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). 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. Bonow RO, Eckel RH. Time magazine, August 26, 2002. As Dr Atkins wrote a few months before he died, At what point am I allowed to say, I told you so? (4). 1990;322:1053-1059. Whole grain consumption improves insulin sensitivity in overweight and obese adults (15). Atkins R. The case for low carbs. 2002;113:30-36. 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. 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. Induction of ventricular arrhythmias by elevation of arterial free fatty acids in experimental myocardial infarction. One-year effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in decreasing body weight and heart disease risk. Adherence in his study to each of the diets was only 20 to 30 percent after one year, so its hard to make any conclusions at all. 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. All evidence is to the contrary. Hunninghake DB, Stein EA, Dujovne CA, et al. 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). To address this issue, a recent National Institutes of Health study that I cited in my oped put people in a metabolic ward where they could actually control what people were eating and then measured the effects. As you approach your weight loss goals, you start to 2nd ed. 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). In: Cowdry EV, ed. Ornish moved to San Francisco in July 1984 after accepting a teaching position at the University of California School of Medicine. 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? Ornish first takes issue with the data I cite on food consumption patterns from the National Health and Nutrition Examination Survey (NHANES). Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: The Iowa womens health study. In: Hennekens C, Manson J, eds. 2000;19(suppl 3):326S-330S. 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. N Engl J Med. Intensive lifestyle changes for reversal of coronary heart disease Five-year follow-up of the Lifestyle Heart Trial. These are not theoretical discussions; they are real people who have shown substantial improvements in their health and well-beingnot just in risk factors but also in the underlying disease process. Peyreigne C, Bouix D, Aissa Benhaddad A, et al. Am J Clin Nutr. Gould KL, Ornish D, Scherwitz L, et al. 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). The author, Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute, is no newcomer to these nutrition debates. Fourth, the patients in our randomized controlled trial (JAMA. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial, Journal of the American Medical Association. Not exactly. CONCLUSIONS: 2003;348:2074-2081. For those simply trying to lose weight or lower their risk factors moderately, less extensive changes may be required. Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. Risk assessment tool for estimating 10-year risk of developing hard CHD (myocardial infarction and coronary death). Eating a high glycemic index food along with mostly low glycemic index foods may reduce the overall glycemic load of the meal. Another meta-analysis of 21 studies found no association between saturated fat intake and heart disease. RAISING AND LOWERING HDLBENEFICIAL OR HARMFUL? 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. As I mentioned above, we found significant improvements in virtually all risk factors in almost 3,000 patients who went through my lifestyle program in 24 hospitals and clinics in West Virginia, Nebraska, and Pennsylvania. As evidence for these causal claims, he cites a handful of observational studies.

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