Dean Ornish just published another self righteous Op-Ed, which is essentially word for word from his previous Op-Ed in the New York Times in 2012, touting the benefits of an ultra low-fat, high carbohydrate diet. So instead of writing a new response, here it the one we wrote back then that went viral. In fact, if you google "Ornish response," it is the first thing that pops up. 

Enjoy.

"In 35 years of medical research, conducted at the nonprofit Preventive Medicine Research Institute, which I founded, we have seen that patients who ate mostly plant-based meals, with dishes like black bean vegetarian chili and whole wheat penne pasta with roasted vegetables, achieved reversal of even severe coronary artery disease."

This claim - which is ubiquitous in the medical literature - is based on one study on 35 people, deemed the "landmark heart disease-reversal trial" by US News and World Report. 20 of the 35 people were randomized to receive the intervention which included consuming a low-fat vegetarian diet for at least a year. The diet consisted of fruits, vegetables, grains, legumes, and soybean products without caloric restriction. No animal products were allowed except egg whites and one cup per day of non-fat milk or yoghurt; 10% of calories as fat, 15-20% protein, and 70-75% carbs. Cholesterol intake was limited to 5 mg/day. Subjects were also asked to practice stress management techniques at least 1 hour per day, exercise for at least 3 hours per week, and quit smoking if they were smokers. They also attended group meetings two times per week. The control group was given no guidance besides to continue following their own physician's advice. 

After one and five years, the experimental group had less cardiac events, and a decrease in the size of the plaques in their coronary arteries. 

This is perhaps one the most referenced studies in support of the protective effects of a low-fat diet, cited over 930 times (previous publication cited over 1500) according to Google Scholar, which is unfortunate due to the tremendous amount of confounding interventions. Along with an extremely low fat diet, the experimental group ate more fruits and vegetables, lost 23.9 pounds (control lost no weight), performed relaxation techniques 1 hour each day, exercised at least 3 hours a week, and had group counseling. The control group had none of this. The experimental group contained only 20 subjects (all male), and the control group had 15 (12 men and 3 women). 

The small sample size resulted in an uneven distribution of risk factors between groups. At baseline, the mean age of the control group participants was 4 years higher, mean total cholesterol 8% higher and mean LDL 10% higher than those in the experimental group. Mean BMI was three points higher in the experimental group. 

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Dr. Ornish goes on to say that "in a randomized controlled trial, patients on this lifestyle program lost an average of 24 pounds after one year and maintained a 12-pound weight loss after five years. The more closely the patients followed this program, the more improvement we measured in each category — at any age."

This is a true statement, and a misleading use of the exact same clinical trial cited above twice, to likely add credibility to the argument. While they are two separate links, the linked "reversal of even severe disease" from above and this controlled trial cite the identical article on 35 people: Here and Here.

"Calories do count — fat is much denser in calories, so when you eat less fat, you consume fewer calories, without consuming less food. Also, it’s easy to eat too many calories from sugar and other refined carbs because they are so low in fiber that you can consume large amounts without getting full." 

This argument is made over and over, reducing the complexities of the hormonal control and appetite regulation of the human body to simple arithmetic. The satiating nature of eating high fat, high protein diets cannot be over stated, and will have a much greater effect on subsequent eating behaviors than consciously ignoring our most basic physiological drive to eat when we are hungry, simply because we have reached our daily limit of fat calories mandated by the Ornish diet. 

The satisfying, filling nature which lay the foundations for a Paleo or Atkins diet has been shown in clinical trials, and supported by literally thousands of people who have registered on the Ancestral Weight Loss Registry, from over 35 countries around the world. Based on the first 1,100 people to register, 95% report rarely or never feeling hungry between meals and 88% reported feeling less hungry than on a low-calorie diet (if they had tried it in the past). If you do not believe these stats, then you can read the hundreds of stories from the people themselves:

"After a lifetime of being overweight... through childhood, the teen years, my twenties, thirties, and forties,... finally, at the age of 55, I experienced a "normal" appetite on a low carb diet. For all of those decades I "overate" because I was hungry...It certainly is NOT a problem of weak willpower."

"I was amazed how quickly my body adjusted to the new way of eating. In previous attempts to lose weight I had gone on low-fat, calorie-restricted diets that are based on 'mainstream' advice for weight loss. I would always be hungry and feel fatigued, and could never resist 'cheating' on my diets. On the low-carb diet, I rarely get hungry between meals and never feel fatigued. I weigh myself once a week. By the end of the first full month on the diet, I had lost twenty pounds."

"I ate an extremely low calorie diet for perhaps two years. I didn't follow any particular plan, I just avoided empty calories and counted calories carefully, limiting myself to about 1000 calories per day. I didn't eat an obsessively low-fat diet and I ate a lot of carbs I thought were healthy - rice, whole grain bread, potatoes. I was hungry all the time; I obsessed about food to the point that I planned every meal for several days in advance. I felt cold much of the time, especially at night. In addition, I fasted many weekends. Doing this, I was able to get down to a 34 inch waist."

"I've literally been on a diet all my life.  Lost weight through calorie deprivation and also following the ill-advised low fat/high carb recommended by conventional wisdom and the U.S. government.  I was always hungry with low energy.  Eating that way was completely unsustainable for me."

"I was always hungry and thinking about food.  Now on a low carb diet I eat without worrying about counting calories. It makes life easier."

Read literally hundreds more such quotes here, all of which are variations on a similar theme: Sudden lack of hunger on a diet high in meats, fats, and vegetables.

Dr. Ornish goes on to say:

"But never underestimate the power of telling people what they want to hear — like cheeseburgers and bacon are good for you. People are drawn to Atkins-type diets in part because, as the study showed, they produce a higher metabolic rate. But a low-carb diet increases metabolic rate because it’s stressful to your body. Just because something increases your metabolic rate doesn’t mean it’s good for you."

The cited study is the recent clinical trial done in a metabolic ward, in which the researchers explain: "Among overweight and obese young adults compared with pre-weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in Resting Energy Expenditure (REE) and Total Energy Expenditure (TEE) that were greatest with the low-fat diet, intermediate with the low-glycemic index diet, and least with the very low-carbohydrate diet." In other words, the fewer carbohydrates in the diet, the higher the resting and overall expenditure, which was exciting news for the proponents of the Alternative hypothesis. 

Dr. Ornish criticizes these results, explaining that "patients on an Atkins diet in this study showed more than double the level of CRP (C-reactive protein), which is a measure of chronic inflammation and also significantly higher levels of cortisol, a key stress hormone. Both of these increase the risk of heart disease and other chronic diseases."

As Dr. Peter Attia explains so eloquently on his blog, this is simply untrue. "Each group experienced a significant decline in both PAI-1 and CRP, and there was no significant difference between the groups for either marker. However, the trend was (barely) significant, favoring the low carbohydrate group for PAI-1 and favoring the low GI group for CRP. Sorry low fat, you didn't win either." As you can see in the graphs below, each group showed a reduction in CRP levels, just the Atkins group had a slightly smaller decrease than the other groups.

When Good Calories, Bad Calories (GCBC) was published in 2007, it rocked the public health world with a medical-textbook-non-fiction-thriller mashup that made an incredibly powerful argument for the idea that a low fat diet doesn't make you thin or prevent heart disease. I, like many other people interested in health and nutrition, went through the proverbial stages of denial to acceptance to praise..."This is bullsh&%....This research must be cherry picked....This isn't bad....It is incredibly thorough....Great literature cited....Damn, maybe he is onto something?"

I was a senior in college at the time I came across this book. Reading it was shocking. The message was unapoligetically brash and the literature cited was laughably enormous, with the makings of an outrageous David vs Goliath themed hollywood blockbuster. The protagonist, a cocky journalist touting the annoyingly commercial, made-for-late-night-informercial line: "everything you know about nutrition is WRONG." 

But the message was sexy for someone like me. And it made sense.....Using physiology to explain why we lose or gain weight, not simply arithmetic of calories in and out. I was used to journalists writing a nice summary of one new study in the New York Times, a tiny little leaf on the gigantic redwood of dietary research. Along comes Taubes's 447 page tome on the history of medical and dietary research as it relates to human health. I was intrigued. I sent him a cold email as a wide-eyed graduate student looking for some advice, and he graciously replied. Years later, we are still good friends.

Now, 13 years after What if it's all been a big fat lie? appeared in the NY Times for the first time, people are following suit. Now we see articles like these, which are essentially word for word from 
various chapters of GCBC:

The Government's Bad Dietary Advice - NY Times
Ending the war on fat (PDF) - Time magazine
Butter is back - NY Times
Don't fear the fat: Experts question the saturated fat guidelines - NPR

Now, in what seems like a dream come true for the readers of this blog, the dietary guidelines is listening.

The panel also dropped a longstanding recommendation that Americans restrict their intake of dietary cholesterol from foods like eggs and shrimp, which we have known doesn't affect blood cholesterol levels since the 1950s. “For many years, the cholesterol recommendation has been carried forward, but the data just doesn’t support it,” said Alice H. Lichtenstein, the vice chairwoman of the advisory panel and a professor of nutrition science and policy at Tufts University.

(Youtube video link)

Now, thanks to Gary's decade of perseverance, we have the Nutrition Science Initiative, co-founded with Dr. Peter Attia, powered by massive funding to run the most rigorous trials we have ever seen in the field of dietary research. 

I look forward to the hollywood ending of this future film.

I was born in Romanian, and I grew up as a skinny child/teenager. So skinny in fact, that my parents would literally pay me money to eat. I also remember having to take multi-vitamin supplements and B vitamin shots in the hope that they would stimulate my appetite and make me gain weight. Looking back, I do not believe that I was too skinny. I ate when I was hungry, and until I felt full. My childhood diet consisted of copious amounts of fries and white bread. Despite such a high-carb diet, I remained skinny until the age of 18. I am 5’2”, and I pretty much stayed at 100 pounds no matter what I ate up until that point.

At 18, two things changed. I started eating out more, and I started taking the birth control pill. I might never fully understand the biochemical changes that occurred (or why) in my body after that point, but I slowly began gaining weight. By the age of 21, I was already at 112 pounds. I didn’t feel like I ate a lot, but I could tell something was different because I seemed unable to shed those extra pounds. My first experience with a low carb diet occurred in 2004. I did Atkins’ induction for 2 weeks and lost about 6 pounds. I was stoked, but also still very tempted by starchy foods.

At that point in time, I really did not understand why a restricted carbohydrate diet allowed weight loss, and I couldn’t conceive giving up fries and bread, so I went back to my old eating habits. I promptly gained the lost pounds back, and in 2005, I weighed between 114-116 pounds. After that, I experienced a lot of changes in my personal life and I totally lost myself in carb-rich comfort foods. It was also a matter of money. My income was below poverty level, working in north Florida with animals as a kennel technician; packets of noodles/noodle soups were just so quick, convenient and affordable for me back then. My job was physically very demanding. I had to deal with rambunctious dogs of all sizes as I walked and groomed them, and I also did a lot of cleaning/scrubbing/mopping. I wasn’t losing an ounce, no matter how little I ate.

By 2008, I believe I was already in the mid 140’s. After that, it’s all a blur to me. I remember weighing myself on the dog scale at work, at the beginning of 2009. I was shocked to see that I was now about 155 pounds. I continued to eat pasta until I found myself at 180 pounds, later that same year (2009). I believe the summer of 2009 is when I came across a video called “Adiposity 101, Why we get fat”, by Gary Taubes. As I watched him build his argument I felt so betrayed by life and every well-meaning person that had ever tried to help me, yet only made me feel worse about myself in the process (telling me I had to eat less and exercise more). It was all there, black on white… Women become insulin resistant with age, poverty and obesity form the marriage from hell, and last but not least, carbohydrates and fructose in particular wreck havoc on our bodies. I felt more enlightened, but still nowhere near motivated enough to change the only way of eating I’d known all my life.

During a brief period when I felt ready to change my life, I dropped from 180 to 170 pounds, by reducing the amount of food I ate, and not eating in the evening (November 2009). I remained at 170 pounds until Fall 2010. My “before” picture was taken at the end of August 2010 (170lbs). In October 2010, I met someone who made me feel joy for the first time in many years. I suppose I consider this the only “cheating” element of my “diet”, because I doubt I would’ve found the initial required motivation to lose weight otherwise. Wanting to be with this person gave me all the motivation I needed to finally put Gary Taubes’ knowledge to work. My new friend did not like me fat, and made no secret of it, and I turn took no offense to his preference, because I didn’t like myself fat either. I missed my “old” body that I felt so comfortable in.

By December 16, 2010, I had dropped to about 152 pounds. In March 2011, I was at 145 pounds. May 2011, 130 pounds. I spent the rest of 2011 going from 130 pounds to about 117-120 pounds (December 2011 was the first time I saw 117). Although ideally I would like to reach 100 pounds again, I have remained at 120 until the present day (September 2012). All this weight loss was achieved without doing any exercise whatsoever. I quit my physically demanding jobs in March 2010, and went back to school to get an undergraduate degree in Biology. I am at a point now where I do sometimes indulge in fries and bread products, but the weight gain is instantaneous. They are "gateway foods" for me so I end up falling off the low carb wagon for weeks sometimes if I allow myself to go there once. It is the reason why I’ve spent the last year oscillating between 117 and 123 pounds. I can’t blame anyone but myself for not being at 100 pounds already. By cutting the grains out of my diet, I realized that I am in fact allergic to them. I don’t get a rash or IBS, but their digestion is certainly not pleasant to me. They bloat me, and I generally feel “nasty”/heavy for lack of a better word as soon as they hit my stomach. 

As part of a school project analyzing blood glucose curves, I discovered that mine is abnormal, and even though I am now much healthier by blood work results (lipid profile) than I was at 21 (almost 31 now), this insulin resistance is my biggest hardship right now. It requires a lot of will-power to see results, and I’m not exactly good in that department; this should be motivating to many out there who are certainly a lot more determined than me. If I can do it, a lot more people out there should be able to as well (as long as they can afford a healthy diet – sad but true). Perhaps it is time for me to start exercising if that indeed improves insulin sensitivity. Perhaps that is the next part of my journey towards better health. 

As I started to lose weight, there was a shift in my motivation. I started losing weight for/because of someone else, but after I reached 150 pounds, the weight loss became about myself, and about being good to myself. I feel like I owe my life and health to Gary Taubes, and I am forever grateful that he took the time to expose all that data and research about obesity that most everyone else in the scientific community is hiding under the rug or simply refusing the acknowledge. The second influential person that was part of my weight loss was Wayne Dyer. He said one thing that always resonated in my mind… Something along the lines: “When you truly love yourself and you ‘are’ health, you are unable to make decisions that will cause harm to yourself”. These decisions can range from drinking a regular soda drink, to smoking a cigarette, or eating bread in my case. I now understand (thanks to Adiposity 101) that no matter how “whole-grain”, organic and clean grains are, there is no way around the metabolic reaction they cause upon ingestion. Same goes for any other high-starch containing vegetable or sugar filled drinks. They cause me harm, therefore I must avoid them in order to feel good. When I go to the grocery store and see delicious bread and processed frozen/breaded foods, I hear that statement about “being health” loud and clear in my head, and I feel absolutely no temptation to buy said foods anymore. I generally succumb to temptation when I go out to eat, that is what gets me. :(