The ‘Atkins’ Study (ahem, ahem) According To Ornish

I was all set to spend part of today pointing out the many flaws in the latest “Low-Carb Kills!” study, but Denise Minger beat me to it.  She wrote pretty much what I would’ve written, so I’ll let her do the talking on that subject.  I’ll save my comments for an article written by Dr. Dean Ornish, who of course jumped all over this lousy study as proof that we should all live on low-fat  vegetarian diets.

But first, in case you missed them, here are some of the headlines and lead paragraphs generated by media reporting on the study:

Low-carb, high meat diet has high risks

Comparing the health effects of two diets over more than two decades, researchers from Harvard School of Public Health and the University of Singapore found consumption of a low-carbohydrate, vegetable-based plan resulted in reduced rates of death from cardiovascular disease and cancer, and a lower rate of all-cause death overall, whereas animal-based low-carbohydrate diet were associated with a higher risk for overall mortality.

“You can have the initial Atkins-type of low-carb diet, which is loaded with sausages, bacon, steaks, and you can have healthy versions of the low-carb diet with more vegetable- or plant-based protein and fat,” said Dr Frank Hu, lead author of the study, published in the Annals of Internal Medicine.

Low carb diets might be deadly

A big concern about low carb diets is the source of fat and protein. Researchers say emphasis on fat and protein is associated with higher mortality from all causes of death in both men and women.

Vegetable-based low carb diets, on the other hand, are associated with lower mortality rates. Researchers say while the idea behind the diets are similar, the differences that affect mortality lie in specific fatty acids, protein, fiber and other vitamins.

Okay, you get the idea.  An Atkins-type diet loaded with meat will kill you.  Now here’s some of what Denise Minger — the same young blogger who recently shredded the China Study — had to say about the study:

Some of these “low carbers” were eating up to 60% of their diet as carbohydrates (first decile), which-last time I checked-is kind of not low-carb. Even the lowest low-carb eaters were still eating over 37% of their calories from carbohydrates. Whoever decided to call this study “low carbohydrate” is nuttier than a squirrel turd.

Folks in the Animal Group were more likely to smoke and had higher BMIs than adherents of the Vegetable Group. Along with influencing mortality outcomes, this suggests the Animal Food group, in the aggregate, may have been somewhat less health-conscious than the dieters lumped into the vegetable category. And that’s the type of thing that has repercussions for other diet and lifestyle choices that weren’t measured in the study.

The Vegetable Group was nowhere near plant-based: They derived almost 30% of their daily calories from animal sources (animal fat and animal protein), versus about 45% for the Animal Group. If we compare the middle (fifth) decile, the Vegetable Group was eating a greater percent of total calories from animal foods than the Animal Group was. D’oh!

For the Vegetable Group, cancer and cardiovascular mortality was lower in the tenth decile than the first decile, even though both deciles ate exactly the same amount of red meat and nearly the same amount of total animal foods. This suggests animal products aren’t the driving force behind differences in mortality rates.

Similarly, at the fifth decile, the Vegetable Group had a lower cardiovascular mortality hazard ratio than the Animal Group (0.99 versus 1.21), even though the Vegetable Group was eating a slightly greater proportion of animal foods (33.3% versus 29.9% of total energy for women; 32.9% versus 31% for men).

Bottom line: In this study, when you look closer at the data, differences in mortality appear to be unrelated to animal product consumption. Changes in cancer and cardiovascular risk ratios occur out of sync with changes in animal food intake.

I’ve read the full study, and it’s a joke.  In addition to what Ms. Minger wrote, the first thing I noticed is that the researchers used food questionnaires to determine who was on a (ahem, ahem) “low-carb” diet.  One group answered a total of 14 questionnaires between 1980 and 2002, and another group answered 10 questionnaires between 1986 and 2002.  From this, the researchers supposedly can make very specific conclusions about total intakes of animal protein and fats versus vegetable proteins and fats.

Then there’s old missing-data problem.  You can pretty much guess how they handled that:

A multiple imputation procedure was used with 20 rounds of imputation and included all covariates to account for missing dietary and covariate data. The analysis was repeated by using noncumulative updating of dietary information, in which we used the most recent diet data to predict mortality rate.

Same as in the recent low-fat vs. low-carb study:  they performed mathematical magic to fill in the missing data.  As Dr. Mike Eades like to say, if you torture the data long enough, it will tell you whatever you want to hear.  This data appears to have been water-boarded until it screamed “Yes! Yes! Animal foods are deadly!”

So naturally, Dean Ornish decided this is the kind of unimpeachable study that proves he’s been right all along, as he wrote in the Huffington post under the dramatic headline:

Atkins Diet Increases All-Cause Mortality

I’ve got to hand it to you, Dr. Ornish … most anti-fat hysterics manage to write at least a paragraph or two before they start misconstruing the facts.  But you told a whopper right there in the headline.  The Atkins Diet?  Say what?

As I noticed immediately and Ms. Minger pointed out as well, even if we grant that the researchers could accurately determine dietary intake from a dozen questionnaires mailed out over 20 years, these people weren’t on anything close to the Atkins diet.  At the high end, their diets were 60% carbohydrates.  At the lowest end, the diets were 37% carbohydrates. According to the study tables, the average calorie intake was right around 2000 calories per day (which sounds low to me, but we’ll roll with it). So let’s do the math:

(2000 * .37) / 4 = 185 carbohydrates per day … for the lowest carb group.

Could you please point out a page in any of the Atkins books where he recommends consuming 185 carbohydrates per day? The Atkins diet starts at 20 grams per day and gradually increases the carbs until weight-loss slows down — which for most of us is well under 100 grams per day. I rarely consume more than 50.  That makes my diet less than 10% carbohydrates.

Dr. Ornish, whenever yet another clinical study demonstrates that people on low-carb diets experience greater improvements in cardiovascular markers than people on low-fat diets, you immediately say the results are illegitimate because the low-fat dieters didn’t restrict their fats as much as you recommend.  Okay, fair enough:  if they get 20% of their calories from fat, it’s not really the Ornish diet.

But when people in an observational (not clinical) study consume 185 carbs per day — at least three times what most Atkins dieters consume — that somehow becomes the Atkins Diet. Very consistent of you.

However, all-cause mortality rates as well as cardiovascular mortality rates were decreased in those eating a plant-based diet low in animal protein and low in refined carbohydrates. Although this plant-based diet was called an “Eco-Atkins” diet, it’s essentially the same diet that I have been recommending and studying for more than 30 years.

No, Dr. Ornish, you recommend a very low-fat (10% of calories) vegetarian diet.  As Ms. Minger pointed out (and as the study data clearly shows), people in the group labeled “plant-based low-carb” were getting 20% to 30% of their calories from animal products.  They consumed more than twice as much animal protein as vegetable protein, more animal fat than vegetable fat, and got nearly 30% of their overall calories from fat — and yet, according to the study, they experienced lower-than-average mortality rates.  So if you believe this study is accurate, it doesn’t support the diet you recommend at all.

In many debates with Dr. Atkins before he died, I always made the point that it’s important to look at actual measures of disease, including mortality, not just risk factors such as HDL cholesterol. This is the first study that examined mortality rates in those consuming an Atkins diet, and it confirms what I’ve been saying all along: an Atkins diet is not healthful and may shorten your lifespan.

I can see why you’re pooh-poohing cardiovascular markers these days, since the Atkins diet keeps winning that battle in clinical research.  (Although let’s be honest:  you spent a lot of years bragging how your diet lowers LDL.)  And I agree that what matters is longevity and health, not an impressive lipid panel.

But once again, this study has zip to do with the Atkins diet.  These folks were consuming between 185 and 300 grams of carbohydrates per day.  So “the first study that examined mortality rates in those consuming an Atkins diet” did no such thing.

And of course, it’s nothing more than an observational study based on food questionnaires and a fair amount of “imputed” data.  It’s not a controlled study, so the results don’t tell us anything conclusive.  If animal fats and proteins caused cardiovascular disease, we’d see those results repeated consistently around the world.  But we don’t … that’s why there’s a French Paradox, a Spanish Paradox, a Swiss Paradox, an Indian Paradox, etc.

Your body makes HDL to remove excessive cholesterol from your body. Eating a stick of butter will raise HDL, but butter is not good for your heart. Pfizer discontinued a study of its drug, torcetrapib, which raised HDL but actually increased risk of heart attacks.

So let me get this straight … excess cholesterol causes heart disease, HDL removes cholesterol from your body, but foods that raise your HDL aren’t good for you.  And we know this because a drug that artificially raised HDL produced a higher heart-attack rate.  Makes sense.  But I noticed you conveniently failed to mention that the Pfizer drug also dramatically lowered LDL.  So using Ornish logic here, a diet that lowers my LDL isn’t good for me.  That means I should avoid the Ornish diet.

Or here’s another possibility:  artificially raising or lowering any type of cholesterol with drugs is pointless and possibly harmful.  It’s not the same as improving lipid profiles through a better diet, because the high HDL is just a biomarker for good cardiovascular health, not health itself.  Since you’re such a fan of observational studies, you can’t ignore the observation that HDL is strongly associated with a reduced risk of heart disease.  The Atkins diet (the real Atkins diet, that is) raises HDL.  It’s a diet, not a drug.

And if butter isn’t good for the heart, I guess that explains the screamingly high rate of heart disease in France, where they consume four times as much butter as Americans.  No, wait … didn’t I just mention something called the French Paradox?  Well, it’s probably because of all those other good health habits practiced by the French, such as higher rates of drinking, smoking, and visiting your mistress for an hour or two before going home for dinner.

By the way, Dr. Ornish, if you’ve done the research, you’re aware of the many intervention studies that attempted to lower rates of heart disease through low-fat diets, but failed miserably.  You claim you succeeded (of course, you also had your subjects give up sugar and flour, quit smoking, exercise, and take stress-reduction classes).  Perhaps so.  But if the results aren’t consistent and repeatable, they’re not scientifically valid.  As Karl Popper would say, if your theory is that all swans are white, it doesn’t matter how many white swans you show me; as soon as I point out some black swans, your theory is invalid.

Conversely, a whole foods plant-based diet that’s also low in refined carbohydrates may reverse coronary heart disease and beneficially affect the progression of prostate cancer and even improve gene expression despite reductions in HDL.

A whole-foods diet of any kind that’s low in refined carbohydrates will prevent disease.  Make it a balanced whole-foods diet instead of a vegetarian whole-foods diet, and you can keep your HDL high, too.

Finally, what’s good for you is also good for our planet. Livestock consumption causes more global warming than all forms of transportation combined. It takes 10 times more energy to produce animal-based protein than plant-based protein.

I’m not at all surprised you’ve swallowed the vegan nonsense about how meat production causes global warming and uses 10 times the energy to produce.  The figures about how much energy is required to raise cattle are, as Lierre Keith pointed out, based on the notion that cattle are supposed to eat grains. They’re not. Cattle are supposed to eat grass.

I’ll bet you’re also blissfully unaware of how much fossil-fuel fertilizer is required to grow an acre of soybeans.  Not your fault, really:  the United Nations, which originally made the absurd statement about cattle being responsible for global warming (based on nothing resembling actual evidence), managed to ignore that one as well. In fact, a recent book written by a former editor of The Ecogolist concludes that vegetable oils leave a larger “carbon footprint” than animal fats.  If we really want to save the planet by changing our food preferences, the answer is to raise our animals in pastures and stop farming grains.

But thanks for making it clear to us where you’re really coming from, Dr. Ornish:  you believe eating meat is wrong.  Just admit it.  This isn’t about science for you; it’s about your version of morality.  That’s why you’re able to ignore every bit of clinical evidence that doesn’t support your beliefs, then embrace one lousy observational study as if it were handed down on stone tablets from on high.

Now if you’ll excuse me, my steak is nearly done.


50 thoughts on “The ‘Atkins’ Study (ahem, ahem) According To Ornish

  1. Dave, RN

    And what’s unfortunate is that the gullible public will take it as gospel. I’ve told the story here befoe aboutmy vegan friend and his heart attack. ‘Nuff said as far as I’m concerned.

    On the other hand, that just means more animal products for me. Now where did I put that bucket of tallow…

    Oh, and keep up the good work. One of the best blogs on the ‘net.

    Thank you. I hope your vegan friend recovers well.

  2. Lori

    Jenny Ruehl at the Diabetes Update blog recently posted that she was part of a long-term food study. She said, “[The food questionnaire results] bore no relationship at all to what I had eaten either in terms of calories or the percentages of my diet represented by protein, carbs, or fat.” She notes other serious flaws with the questionnaires here:

    Based on that alone, it sounds like everyone doing nutritional studies based on those questionnaires needs to go back to the drawing board.

    The more I learn about plant-based foods, the more iffy they sound. And between busting up sod, planting, irrigating, fertilizing, harvesting, leaching the anti-nutrients out of beans and grains, and then processing them into something edible, or letting the buffalo roam as they’ve done for millennia and harvesting some, using buffalo sounds like the more sensible way to get your protein.

    Those food questionnaires can really stupid. I had to fill one out years ago when the company that employed me was running a health survey. No way I could fill it out to accurately represent my diet, and I wasn’t even low-carb at the time.

  3. k_the_c

    Why did you divide by four in the carb calculation?

    Four calories per gram of carbohydrate. So 100 calories from carbs = 25 carbs.

  4. Richard Tamesis, M.D.

    Ornish is increasingly sounding like one of those sidewalk preachers standing on a corner with a bullhorn asking people to believe in his message in order to find salvation.

    The clinical studies aren’t working out in his favor, so yeah, he’s going a little nutty.

  5. Felix

    Wow. Now that’s a joke of a study. Yikes! And Ornish should read the studies he comments on. It would help with not losing all his credibility.

    Unfortunately, he and Dr. Oz seem to be worshipped by media reporters. You’ll notice few traditional media outlets questioned the validity of this study. They just reported it exactly as the researchers hoped.

  6. Markus

    The whole problem is perfectly summed up by your last paragraph.

    Taubes once mentioned that, while interviewing a nutrition researcher, the researcher said that Taubes shouldn’t be talking about animal products beiing good for you (or something like that) because meat eating causes all these problems in the world. So sadly Taubes had to point out the the researcher that it is all about the science and then, based on the science you can make decisions.

    Taubes was told before he wrote the book that the field of nutrition research was full of bad science conducted by bad scientists. I guess he received confirmation in that interview.

  7. Markus

    Also people like Ornish show their true colours when they say that, because of negative environmental effects (assuming the are for real) of the current food production system we should stop eating meat.

    If they really cared they would say: “Ok what can we do to make things better, what are the options” The only option might be to stop eating meat, but it could also be a industrialised version of the old farming system with the manure of the live stock used as fertilizer, efficiently converting unedible (for humans) plant calories to not only meat by to milk, eggs etc.

    But instead the just jump to where they wanted to be from the beginning: STOP EATING MEAT!!!. And so they are quite happy about the whole disastrous soy/wheat monocultures as long as no cow has ther manure stolen.

    Bingo. They don’t form their beliefs from the evidence; they pick and choose evidence based on their existing beliefs.

  8. Cynthia

    Another smokin’ post Tom. I think we should demand that “researchers” who do such a lousy job of scientific research should have to pay back the grant money and salaries they clearly defrauded the public of. And I’m not kidding. They should be accountable for their use of public monies as much as anyone receiving money ostensibly to be used for the public good, and not allowed to just pad their CVs with more bogus papers.

    I agree, but the lousy research is being supported by a government that agrees with the conclusions of the lousy research.

  9. Karin

    Hi Tom. Great post. I’m sorry to be pedantic, but you really should put the units (grams) on the 185 carbohydrates. I saw at least three instances of that in your post without the units. Sorry, it got drilled into my head in college (science, engineering classes). Now it’s become an annoying little pet peeve of mine. I’m sure most people who eat a low carb diet will know what you mean since we’re used to thinking of carbohydrates in terms of grams, but it may be confusing to someone less familiar with low carb dieting.

    You’re exactly right. My college physics professor, when presented with an answer such as “128.5” would write “128.5 golf balls? Picnic tables? Pencils?”

  10. mrfreddy

    Did you catch Joel Furhman’s blog post on this study? Fairly predictable, of course:

    And don’t miss his smug dismissal of his critics in the comments section, it’s gobsmackingly unbelievable!

    Guys like him and TC Campbell and Ornish have quite a racket going, they don’t need to respond to actual science or penetrating analysis of their anti-meat stance, just do a little hand waving and put out some sciencey sounding mumbo jumbo, and the adoring meat fearing hoards soak it up.

    These folks will never be persuaded otherwise.

    Ornish, Fuhrman and Campbell believe meat-eating is wrong, and that belief gives them the capability of ignoring all contrary evidece — one of the traits Eric Hoffer described in his book The True Believer. They pretend they believe in science, and they’re able to attract other True Believers who also pretend they believe in science. But since they don’t adhere to the most basic scientific principle — results must be consistent and repeatable to be valid — it’s not about science at all for them. It’s about the “meat is murder” belief.

  11. CPM

    Chris Masterjohn has an interesting post up concerning this study. One of the interesting points was that apparently someone did a study to see how accurate the questionaires were.

    BTW, great blog. Your blog is quickly becoming one of my favorites.

    Brilliant post by Chris. As someone who once was required to fill out a food questionnaire, I don’t trust their accuracy at all. You try answering “how many hamburgers did you eat in the last month” accurately when you’re 25 and single and eat half your meals outside the home.

  12. john

    Okay, so these people (Fuhrman also wrote on this study) must simply be stupid (as opposed to dishonest) since they follow their own advice, right? Ignoring all the interventions that exist just make you look like a preaching moron to anyone who can think for him/herself. When all the evidence that supports a diet are observational studies showing weak associations, that diet should not be popular.

    Fuhrman and Ornish both push diets that remove sugar, white flour, processed food, etc., as well as animal foods. Then when people following those diets show improved health, they offer that as proof that animal foods are bad for us. If you swallow that logic, I fear for you. If I convince a smoker to give up cigarettes and olives and his health improves, that’s not proof that olives are bad for you.

    Since there have been plenty of remarkably healthy native peoples around the world who ate both animal and plant foods, but no sugar, white flour or processed foods, the real problem is almost certainly with sugar, white flour and processed foods. Fuhrman and Ornish toss animal fats into the same cell and declare it guilty because they think eating meat is wrong, not because there’s any real evidence to support their belief.

  13. Chris B

    I’m no lawyer, but Ornish’s article seems to border on malpractice. He’s clearly misinterpreting the study’s data (as is the study’s author) as well as misrepresenting the “Atkins” diet. It’s unfortunate that he has such a high profile pulpit from which to spew his nonsense. I like to think that he has the public’s best interest in mind, but the more I learn the more I suspect he’s just protecting his reputation at the sake of public health. Shame on him.

    I think having preached low-fat vegetarianism for 30 years, he’s now incapable of changing his mind. His head would explode if he ever admitted animal fats aren’t bad for us.

  14. Becky

    The kind of logic that brings us to eat “healthy” vegetarian diets never ceases to amaze me. Grains = natural = good. Weren’t we all told as kids that not everything that grows is safe to eat? [See: mushrooms, tobacco, hemlock]. Stroll down anecdote lane.

    I once had a 2-hour long discussion with my then seven-year-old daughter on the issue of grains. It began as an explanation of why we buy grass-fed beef instead of beef from the store. Unprompted, she asked, “So, if stuff like corn makes cows fat and sick, won’t it make us fat and sick, too?”

    A bit later we got to animals that were designed to eat seeds, like birds. The second inevitable question: “If we have to grind it up and cook it to eat it, should we really be eating it? Or have people always had stuff to grind it up?”

    Smart girl, mine. Maybe, some day, these researchers will also understand the obvious logic that is kicking them in the face, and we can stop hearing about how we evolved canines to rip into really dangerous raspberries…

    Smart girl indeed, and she’s well on her way to being a healthy adult.

  15. PhilM

    Owing to widespread CHD in my family, I started taking an active role in managing my risks. My first total cholesterol readings were 210 and I was so surprised at that number. I was a vegetarian and ate no cholesterol in my diet and yet it was not low! I happened across Ornish’s books and followed his regimen. Jettisoned all eggs, butter, coconut and whole milk from my diet. Ate lots and lots of carbs. I thought I was doing good but twenty years later, I have ended up with impaired glucose handling. I am not saying, that is the result of my diet but my trigs were so high on it.

    An unfortunate event in my life caused me to reevaluate my diet and exercise habits. I read GCBC and saw Fathead too! After much research, I have convinced myself that eating fat and eggs and whole milk is not just okay but even necessary. I now eat fish at least five times a week and eat eggs everyday. My trigs are in 50s and my lipid panel looks great (although, I don’t put much stock in them anymore).

    Whenever I come across Ornish’s diet, I am reminded of my stupidity in buying his theory. I was so taken by his message that his diet stops and even reverses heart disease! Snake oil at is slickest, I say! It doesn’t take a PhD in biochemistry to realize that, despite all the adherence to FDA’s eating guidelines, americans still suffer from more CHD than anybody else and it’s only increasing. The pseudo science that has shadowed solid research is behind this tragedy of widespread poor health. And the continued drumming of low-fat or vegetarianism and such other activism is not helping.

    Sorry for the long rant, but had to say it. I hold this Ornish guy in great contempt and wonder if he really believes any of the nonsense he advocates or if it is just a matter of marketing himself to humanity. I am so glad that there are people who ask some tough questions of all this nonsense and someday, we will all wise up.

    Ranting allowed. After wasting years trying to get in better shape on low-fat and vegetarian diets, I still rant about the bad advice.

  16. Alex

    HDL removes cholesterol from the body? As I understand it, HDL carries cholesterol back to the liver to be recycled. And, to the best of my knowledge, the liver is still actually part of the body. But, hey, I’m not a doctor, so what do I know?

    Yup, cholesterol is recycled.

  17. Paul451

    “Your body makes HDL to remove excessive cholesterol from your body.”
    True enough.
    “Eating a stick of butter will raise HDL,…”
    “…but butter is not good for your heart.”
    An UNPROVEN assertion based on studies with insufficient firepower to establish causality and where other confounding variables – such as refined carbohydrate consumption – were NOT isolated. This is an ASSUMPTION that, essentially, stands on the ‘results’ of BAD SCIENCE. It is NOT a fact.

    “Pfizer discontinued a study of its drug, torcetrapib, which raised HDL but actually increased risk of heart attacks.”
    True and, yes, manipulating a lab test result isnt a measure of much of anything. OTOH, we’re starting to sound more like a character from a certain famous George Orwell novel when we start asserting that a plant-based diet -like the one Dr. Ornishg promotes – will improve your health when it LOWERS your HDL and shifts your LDL particle size from large and fluffy to small and dense, thus TRIPLING your risk for heart disease. That would be doubleplusungood, Dr. Ornish.

  18. Anon.

    I just read this on CNN and I couldn’t believe it:
    Based on what I’ve learned about food from Taubes, you and many others, is this as full of crapola as i think it is?
    a quote:
    “The reality is we don’t really know the impact of different types of sugars on infants. It is not likely as big a concern with regards to obesity because infants are not in a metabolic state to be impacted by things such as too much sugar or the glycemic index of foods since they are using every calorie for growth, unlike adults who use excess calories for fat
    OK, WTF??” aren’t there massive differences between how the body handles fructose/glucose and lactose??

    We may not know much about the metabolic state of infants, but we know insulin resistance can be passed from mother to baby to a certain extent, so I can’t believe filling baby formula with corn syrup (fructose) is ever a good idea.

  19. obee

    In defense of Dr. Ornish, he probably didn’t write the headline.

    That could be. But the article itself still calls the diet an Atkins diet.

  20. Ben_P

    Tom, corn syrup is actually mostly glucose, since it’s basically broken down starch. Corn syrup then goes through another industrial process to give us high fructose corn syrup. So “corn syrup solids” is basically powdered glucose.

    “Corn syrup is a food syrup, which is made from the starch of maize and composed mainly of glucose. Corn syrup is used in foods to soften texture, add volume, prevent crystallization of sugar, and enhance flavor. Corn syrup is distinct from high-fructose corn syrup, created when corn syrup undergoes enzymatic processing that produces a sweeter compound containing higher levels of fructose.”

    I’d be more worried about the stuff that is known to be bad, like lead or mercury, possibly lurking in powdered formula or worried about the stuff that isn’t in it, like maybe not enough Vitamin K2 or something.

    Thanks for the clarification.

  21. Dana

    Re: that one comment about babies and sugar. One of the reasons gestational diabetes is dangerous is that the excess blood sugar circulating through both mother and baby causes the baby to grow excessively large, which complicates childbirth and increases the chances of both infant and maternal mortality. This is connected with the fact that one of the risk factors for type 2 diabetes in a woman is that she’s ever borne an infant that weighed nine pounds or more at birth. It is possible for a pregnant woman’s blood sugar to be deranged many, many years before she finally tips over into diabetes. That was my problem; both my babies were over nine pounds at birth, and during my second pregnancy, they gave me multiple GTTs because my first one came back inconclusive, possibly high-normal. I haven’t been diagnosed with diabetes yet and my A1C is normal these days, but I cut way back on my overall carb intake, too.

    So, YES, I would think excess sugar consumption would hurt a baby. If they’re responding to it in utero, they’ll respond to it after birth too. Now, mind you, human milk is high in lactose, and lactose converts pretty easily to glucose. There is *some* use for sugar in a baby’s diet; if there weren’t, we’d have died out long ago. But anything over the normal amount of sugar in a baby’s diet is going to be detrimental to the baby’s health. And high-fructose corn syrup is worlds away from the lactose found in mother’s milk. I’m shocked, actually, that formula makers DON’T just sweeten with lactose. It’s already used pharmaceutically; for instance, it’s what is used to make homeopathic tablets. So it even survives in powder form. They’re just being cheap f?!ks, if you ask me. And at the expense of children’s health.

    That talk about children using sugar for (non-adipose) growth is pure B.S. What part of the body gets bigger if it gets more sugar? Sugar can only be used for energy. No part of it augments any (non-adipose) cell or tissue. For that, you want protein. There would be no obese children if sugar only went to non-adipose growth. There are obese infants, too–they’re just not as obvious, since babies already have visible fat stores. Babies born to diabetic mothers are one example of this–the greater size is from fat, not from greater length or muscle mass.

    Bottom line, moms-to-be: Breastfeed. And eat healthy while you’re doing it. Preferably not according to Ornish’s definition of “healthy.” If you have trouble getting started, I recommend or the Boob Nazis community at The latter in particular was very helpful to me, even if one has to grow a thicker skin to survive it for long.

    Awesome work by Denise Minger. Between this and her debunking of the China Study, she is officially my hero.

    She’s a brilliant young blogger, and I hope we hear from her for many years.

  22. Carol Bardelli

    I write a regular column for a major website and they allow us writers to write our own titles, so I’d bet a paycheck Ornish hand picked that title.

    Back in the early 1990s, when I still believed the low fat crap I’d been spoon fed in college nutrition classes, I tried Ornish’s diet. He had a line of packaged frozen dinners and they ended up in my Canned Foods outlet at a buck a piece. Thinking “cheap, healthy, and tasty” I stocked up and kept eating them for about six month. (They were spicy and I’m a chilihead.) First, I lost no weight. Second, my cholesterol went down to 170 – we know that’s bad from Sally Fallon and Mary Enig. Third, my HDL was too low for my doctor’s liking. I forget the ratio or numbers. I switched to low carb (Atkins actually) about 1993 or so. My numbers are good now. And I lost weight and feel better. It’s just observational, but I think Ornish is full of it.

    Here’s how to live on the Ornish diet: put food in your mouth. If it tastes good, spit it out.

  23. Richard Tamesis, M.D.

    “The reality is we don’t really know the impact of different types of sugars on infants. It is not likely as big a concern with regards to obesity because infants are not in a metabolic state to be impacted by things such as too much sugar or the glycemic index of foods since they are using every calorie for growth, unlike adults who use excess calories for fat.”

    Sometimes I wonder if people making these statements even took a basic course in biochemistry and physiology; and if they did, they must have flunked or barely passed it before forgetting it entirely in a sugar-induced haze.

  24. Laurie

    Not to get off topic, and not to spark a fetal rights thread (like trying to control what pregnant women are allowed to eat), but maternal gestational diabetes can adversely affect the developing fetal pancreas and set the kid up for future adult health issues- how’s that for additional guilt induction mothering?.
    “Lifetime consequences of abnormal fetal pancreatic development
    K Holemans, L Aerts, and F A Van Assche”
    Ornish and his ilk should indeed be charged with malpractice. They can affect future generations with their dietary swill recommendations!

    Weston A. Price also believed the mother’s diet during pregnancy can have profound effects on the baby’s development.

  25. Laurie

    When I was pregnant 24 years ago, I gave up drinking coffee. And of course I drank NO alcohol. Nobody ever told me to give up bread, potatoes or any other carb. I had a blood test to make sure I was already immune to Rubella. I had tests for anemia and a few other knows, all negative. But here’s the thing, during labor I had a grand mal seizure- eclampsia (toxemia of pregnancy) with respiratory arrest. My daughter is fine (just graduated from college Magna) and although eclampsia is very rare, I suspect it is a DOC and a kind of auto-immune problem that is exacerbated by the SAD. Ornish’s diet makes all this even worse IMHO because all you eat on his diet is starch and whole grains. I’m glad I wasn’t on Ornish, though I did hear of him soon after my daughter was born, because we’d both have been dead and my husband might have perished from watching her being born.

  26. Pierce

    I like to give people the benefit of the doubt, and assume if possible their hearts are in the right place, but it’s difficult in this case. Either the “researchers,” and low fat gurus here are extremely bad scientists, and thus their advice is irrelevant, or they have no problem blatantly lying to people, and thus their advice is irrelevant. I really don’t see a middle ground here.

    Strange as it sounds, I think many researchers believe it’s okay to stretch the truth in order to present the truth. Ancel Keys, for example, really and truly believed fat in the diet caused heart disease. So he threw out the data that didn’t fit because he didn’t want “anamolies” to obscure a “truth” he believed everyone needed to know.

    That definitely makes people like him bad scientists, of course, but that’s my guess as to how they think.

  27. Franklin Mason

    Folks like Ornish seem to have so very much invested in their anti-fat, anti-meat view. I really don’t get it. Why does it matter so much to them? Why can’t they allow themselves to go where the evidence leads? There’s a deeply ingrained world-view here; it has depths that I can’t quite grasp. Perhaps it’s anti-nature in some way, or anti-human. It appears obvious to me that life requires death, that all forms of life feed upon others. Why should we be any different? It appears obvious to me as well that we’re made to run off animal fat with a bit of fruit and vegetable derived carbohydrate. That’s what allowed us to climb down out of the trees, grow big brains, and become the dominant predator everywhere in the world. Ornish and others like him seem to want to make us into something we’re not, and I don’t know why.

    It’s a moral thing. They believe it’s possible to eat without other creatures dying.

  28. T

    This study used statistics from studies following 85,168 women and 44,548 men for a minimum of at least 20 years. The researchers came to the following conclusion “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.”

    The study does not merely show the damaging effects of animal based foods, but also the protective effects of plant based foods. The results from this study certainly do not suggest that “animal products aren’t the driving force behind differences in mortality rates”, as it was clear that the participants in the highest deciles of animal-based diet and lowest deciles of the plant-based diet had the highest overall mortality. When comparing groups that consumed similar amounts of animal foods, it was the group consuming the most plant foods which had the lowest mortality. Ms. Minger is only able to make these statements (about animal products not causing increased mortality due to the fact that groups that consumed a similar of animal products had significantly different rates of mortality) because she believes that plant foods do not provide a significant amount of protection. In a prospective study of over half a million people, the researchers came to the following conclusion: “Red and processed meat intakes were associated with modest increases in total mortality, cancer mortality, and cardiovascular disease mortality”

    Ms. Minger made a good point that the people in the animal-based low carbohydrate group were fatter, however she failed to mention that both the men and women in the 10th decile of the animal low-carbohydrate group had the lowest calorie intake out of all groups, yet both men and women in this group were on a average fatter than the participants in all other groups. In a study with over 370,000 participants, the researchers concluded that “Our results suggest that a decrease in meat consumption may improve weight management.”, as total meat consumption was positively associated with weight gain in both men and women even after adjusting for energy intake.
    Ms. Minger also failed to mention that the plant based group consumed more alcohol.

    This study may not have shown the effect of a truly low carbohydrate diet, nor did it show the effect of a truly plant-based diet. However what is did show was that an increased consumption of animal food intake together with a decreased in consumption of plant food was strongly correlated with an increase in mortality. Many other studies have found similar results:

    If you really want to believe researchers can accurately determine diet from a dozen food questionnaires over 20 years, be my guest. But I filled out one of those questionnaires some years ago, and it was a joke. No way to make it reflect my actual dietary intake. Take one sometime and see for yourself.

    The researchers accepted questionnaires as valid if, according to their analysis, the answers would indicate a caloric intake of 500-4500 calories per day. If you know people who live on 500 calories per day for 20 years, let us know. If you can find a page in any Atkins book where he recommends 185-300 carb per day, let us know. If you can explain why the Swiss and the French consume far more animal fat than Americans, have higher cholesterol, but far lower rates of heart disease, let us know. Not consistent, not repeatable, not scientifically valid.

    In the meantime, just yell out “number 35!”

  29. T

    Dean Ornish, M.D., proved that not only that heart disease need not exist, but that it is also reversible. Both Tom Naughton and Denise Minger have absolute zero proof that a whole foods diet of “any kind” can reverse heart disease. In the mid-eighties when Dr Ornish first carried out his heart studies, refined carbohydrates were not adequately restricted yet patients were still reversing their heart disease. It was not until years later when Dr Ornish became as strict about refined foods as he is now. No study has shown that you can reverse heart disease by increasing both LDL and HDL cholesterol simultaneously; however Dr. Ornish proved it is possible to reverse heart disease even when HDL decreased and triglycerides increased in patients who experienced a decrease in total and LDL cholesterol.
    Dr. Ornish is also aware that many studies on low fat diets fail to lower rates of heart disease as these studies are not whole food plant based ones. The results in Dr. Ornish’s studies have been repeated before, including the study carried out by Caldwell B. Esselstyn, M.D. which put patients on a diet similar to the Ornish Diet and reversed severe heart disease, which was is backed up with angiogram evidence.

    Dr. Ornish was trying to say that your body produces more HDL to accommodate for the increase in LDL cholesterol when consuming large amounts of saturated fat. His studies demonstrate that a high HDL is not necessary in order to maintain good cardiovascular health when a low LDL cholesterol can be maintained. Certainly a low HDL level in most western populations is a cause for concern due to a high average LDL cholesterol, however this is not a major concern for people in nations with a low average serum and LDL cholesterol.

    The majority French, Spanish and Swiss die of heart disease, strokes and cancer. The French DO have screamingly high rates of heart disease, it is just that many other nations have insanely high rates of heart disease. The French do not have 1/17th the mortality rate of heart disease compared to the U.S. like that traditionally seen in rural Chinese men, nor 1/20th the mortality rate of breast cancer compared to the U.S. like that traditionally seen in Vietnam or Laos, nor do they suffer from only 1/47th the rate of broken hips compared to the U.S. like that traditionally seen in Papua Nugini. Below are some studies that tackle the French Paradox. Among some of the reasons, the researchers talked about the “time lag hypothesis” in regards to the fact the French have been increasing saturated fat consumption in recent decades, and in regards to French doctors certifying many heart related deaths as “poorly specified causes”, and also in regards to the greater amount of medical intervention compared to other nations:

    Ornish proved (according to Ornish) that if you have people give up smoking, start exercising, undergo stress management, give up sugar and other refined carbohydrates, and oh by the way give up meat too, you can reverse heart disease. To leap from there to “meat causes heart disease” isn’t valid. If meat caused heart disease, we would see high rates of heart disease among all meat-eating populations, but we don’t. Not consistent, not repeatable, not scientifically valid.

    More “let’s explain it away” nonsense about the French Paradox from the the Lipid Hypothesis True Believers. The papers you’re quoting are taking the absurd position that 40 years of higher saturated fat consumption in France aren’t enough to produce a rise in heart disease. If that’s true, you can stop pestering me now about your beloved low-fat, plant-based diet. I’m already in my 50s. If it’s consumption of animal fat early in life that causes heart disease, I can’t change that now. If it takes 40 years for the effects to show up, I’ll be in my 90s.

    The heart-disease death rate in France is 1/4 the rate in Britain. If you believe it’s because French doctors are lousy at ascribing deaths due to heart disease, that means you believe they miss 75% of them. A frenchman should slap you for the insult.

  30. Pierce

    “That definitely makes people like him bad scientists, of course, but that’s my guess as to how they think.”

    If it’s deliberate, then IMO they aren’t scientists at all. Anyone who puts evidence secondary to any other consideration is not performing science. And what does peer review actually involve? Do they just make sure the statistical methods etc don’t contain any mathematical errors, or do they actually see if the study makes sense and comes to true and rational conclusions? This kind of research makes me question whether its pointless to ever believe a peer reviewed article without independently investigating.

  31. Karen

    Back when Ornish’s book “Eat More Weigh Less” was everywhere, I bought a discounted copy at Costco. Tried to adhere to his cockamamie diet, but all I did was gain pounds and shiver from the cold. Endless brown rice, no fats or even olive oil, not so much as a sesame seed. The only way you were permitted to “season” the boiled veg and starch was with nasty infusions of apple juice concentrate and spices. Gross. Plus, all that cabbage, whole grains and lashings of fructose made for epic intestinal gas. I tossed the book and diet because his only reasoning for why no fats or oils were allowed was essentially “because I say so.” The man is a zealot, not a scientist. I switched to low carb years ago, and am effortlessly skinny at 48.

    Zealot is the perfect description.

  32. Richard Tamesis, M.D.

    “Why can’t they allow themselves to go where the evidence leads?”

    That’s why it’s a good thing that they are not police detectives or criminal investigators. Otherwise, no crime would ever get solved if they were in charge.

  33. brendan

    Good point. To use unreliable questionnaires in the study is just plain dumb.

    @T : What is consistent in the scientific litterature is the fact that refined carbs and sugar are bad for us. Not meat or fat. In the US, for the past half a century, the consumption of animal’s fat has dropped but the rate of obesity and heart disease has increased.

  34. Bob Kaplan

    Great post, sir!

    I posted the following comment at HuffPo (awaiting approval) and thought I would share it here as well:

    I created a blog post critiquing the study in question: (Another study from the Annals raises important questions)

    You should also read (before you take what Ornish and Katz wrote at face value:

    Denise Minger: (Are Low-Carb Meat Eaters in Trouble?):

    “Whoever decided to call this study “low carbohydrate” is nuttier than a squirrel turd.”

    Tom Naughton: (The ‘Atkins’ Study according to Ornish):

    “I’ve got to hand it to you, Dr. Ornish … most anti-fat hysterics manage to write at least a paragraph or two before they start misconstruing the facts. But you told a whopper right there in the headline. The Atkins Diet? Say what?”

    Chris Masterjohn: (Lying about Burger intake Prevents Disease…):

    “If we pretend [the steps to the scientific method] is a map and pay close attention to the arrows, we can see why the approach of this study is a bit like trying to travel from California to Virginia by going west. You’re going to get pretty wet.”

    Fred Hahn: (“Medium and High Carbohydrate Diets and All-Cause Mortality”)

    “We, as lay people, rely on physicians, scientists and experts that can accurately read and assess scientific papers for the betterment of our health and well being. At the very least we assume that they can and will without bias.”

  35. Crusader

    It’s probably not a good idea to load up on sausages and hot dogs due to all the fillers and preservatives. Better to eat steak, chicken, pork & turkey in as whole a form as possible most of the time. Oh and add in organ meats!

  36. KD

    From poster Chris B:

    “I’m no lawyer, but Ornish’s article seems to border on malpractice. He’s clearly misinterpreting the study’s data (as is the study’s author) as well as misrepresenting the “Atkins” diet.”

    I’m no lawyer either, but if I were part of the Atkins company (even though I don’t particularly care for many of their practices nowadays, but that’s another story) I would certainly look into suing for libel. The diet breakdown, however ineffectively gathered, is not Atkins and to say it is while accusing it of also causing higher mortality doesn’t seem like a good idea to do, legally speaking.

  37. lwhiteside

    I’m almost finished reading “My Life in France” by Julia Child. One observation in particular stuck with me. She had a conversation with a restaraunt owner in France who talked about his town’s large meals, a large portion of which was meat. The man was very lean. I’ve also heard the stuff about raising cows contributing to global warming but have never really reserached it. Now, I’m curious! What’s really screwed up is our factory style of food in general (from grains, to oil, to animals). I can’t help but think that we just need more localized production and less vegetarians brainlessly brandishing their form of morality.

  38. Jojo Bizarro

    Funny thing I gotta mention about meat production. The Hi-Carb Crowd denounce meat as the reason for the loss of the rain forests in South America, but people are cutting down those rain forests for agriculture, not pasture. Last time I checked, agriculture was for growing plant-derived foods, not meat.

    Monocrop farming is what’s screwing up the planet.

  39. Blanche

    The trend is to think that a low fat diet is good for the heart. Since, we are so healthy in America this must be the way to eat. The logic is really good, if someone can improve on a diet it shows the diet is good. However, when you take people away from the Halloween candy, the pre-packaged food, and the overeating you will find most diets will improve health.

    I think it is scary that we need such intervention. The typical American diet isn’t a paleo diet of grass fed beef. It is one of ” so-called chopped beef between two “buns” with a side or fries. If we turn back time we would see what people shoud be eating. When people shed pounds they improve their health.

    Nourishment doesn’t come from processed protein or processed carbs. Common sense would say you have it right on this blog.

  40. John

    US News ranks the Ornish Diet as the #1 diet for your heart, and also said it’s the ONLY diet that has been proven to not just stop heart disease, but to reverse it.

    Uh, no … Dr. William Davis has also reversed heart disease. The Ornish “diet” includes instructions to stop smoking, stop drinking, take stress-management classes, etc. But it’s that meatless diet that does the wonders. Riiiiight.

  41. NoRemorse

    “Atkins Diet Increases All Cause Mortality”

    Don’t expect Ornish or any low-fat advocate (and that is what he is, no matter how he might try to reinvent himself), to ever back off their low-fat advocacy and embrace the growing body of science that runs counter to their theories. To do so would be to acknowledge their contribution to the unhealthiest American population – ever.

    Their insistence of a high percentage of calories from carbs and a low percentage of calories from fat has produced declining life expectancy rates for the first time ever. Obesity is rampant and type II diabetes isbecoming an epidemic crippling an already vulnerable US health care system – both entirely preventable by moving from low fat to low carb.

    Ancel Keys, the godfather of all these low-fat advocates was wrong – how wrong in terms of actual increased mortality will be something folks will get to argue about for years to come.

    They don’t have arguments any more, the science has never been on their side, all they have left are the false beliefs that, having followed them, have ruined our health.

    They aren’t going to admit they were wrong – how can they?

  42. Richard Lodvenko

    I haven’t seem such a large number of deluded people on an online forum since going on a conspiracy theory website last year.

    There are numerous studies linking high red meat intake to all sorts of negative health outcomes (CHD, cancer) and all cause mortality. Have you seen any regarding vegetarians? The british study even showed a decrease in certain cancers. Look up the Adventist studies.

    Get out of your bubble for a second. Dean Ornish did show that his diet reversed heart disease in multiple studies. And no, cutting smoking wasn’t a part of what he did. That didn’t even include smokers. It was stress management + diet. And no, stress management wasn’t the main determinant of positive results. Look for the studies done on stress management after CHD and you’ll see how small the gains were. And there were control groups who went on the American Heart Foundation diet + physicians advise. So it wasn’t Dean Ornish Diet vs junk food diet. It was Dean Ornish diet vs healthy less refined food diet (+ surgery in one study).

    And while you’re at it, could you give me a link showing the low carb diets links to health outcomes? not clinical markers which is all you have but actual results. Let me guess, you don’t have any.

    So what do we have here. Evidence based medicine vs non evidence based delusion. Let out of you evolutionary mind frame and think with rationality without bias.

    1. Tom Naughton Post author

      You people crack me up. You think Ornish considers all the evidence? You think you do? That’s hilarious. But I want to thank you for inspiring me to update my post titled “To The Vegetarian Evangelists.” I just posted that one.

      What do you mean by “actual results” vs. markers? You want me to to dig up all the studies that followed low-carb dieters for 20 years? There aren’t any. But since Orish cites markers all the time (including markers in mice!), I suggest you issue the same challenge to him.

      Ornish didn’t reverse heart disease in “multiple studies.” He conducted one small study that demonstrated a very slight reversal in the narrowing of arteries. (You are free to cite the “multiple” studies.) Smoking cessation was absolutely, positively part of the program. The intervention is described in Ornish’s paper as:

      Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psycho-social support) for 5 years.

      The published study states that only one person in the intervention group of 20 people smoked, but quit. The study doesn’t mention (at least not that I can find) how many people in the control group smoked, which is a bit suspicious.

      Stress management was definitely part of the program — several sessions per week, according to the study document. You have no way of knowing whether or not stress management was the “main determinant” of the outcome. You also have no way of knowing whether the extra exercise was the main determinant. That’s the problem with a multi-factorial intervention: there’s no way to isolate the effects of any one factor.

      In Ornish’s other studies, he demonstrated improvements in markers — blood pressure, LDL, etc. That’s not a reversal of heart disease. It’s a change in markers — but you’ve already made it clear you don’t care about changes in markers.


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