Critique of Dean Ornish Op-ed

The following is a critique of the science employed by Dr. Dean Ornish, in his op-ed published in The New York Times on March 23, 2015

The Opinion Pages | OP-ED CONTRIBUTOR

The Myth of High-Protein Diets

Title is misleading and uninformed. The low-carb diet is not high-protein. It is high-fat. I’m not aware of anyone in the low-carb community advocating a high-protein diet.

By DEAN ORNISH MARCH 23, 2015

MANY people have been making the case that Americans have grown fat because they eat too much starch and sugar, and not enough meat, fat and eggs. Recently, the Dietary Guidelines Advisory Committee lifted recommendations that consumption of dietary cholesterol should be restricted, citing research that dietary cholesterol does not have a major effect on blood cholesterol levels. The predictable headlines followed: “Back to Eggs and Bacon?”

But, alas, bacon and egg yolks are not health foods.

This statement reflects a disregard for basic nutrition. Consider egg yolks, for example. With the exception of niacin and riboflavin, the yolk contains a higher proportion of the egg’s vitamins than the white, including vitamins B6 and B12, folic acid, pantothenic acid and thiamin. All of the egg’s vitamins A, D, E and K are in the yolk. Egg yolks are one of the few foods naturally containing vitamin D, choline and lutein. The yolk also contains more calcium, copper, iron, manganese, phosphorus, potassium, selenium and zinc than the white. Given that a number of these (vitamins A, D, E and potassium) are nutrients for which Americans experience shortfalls, egg yolks would certainly be considered a “health food.”

Pork, meanwhile, contains large amounts of iron, niacin, phosphorous, selenium, vitamin C, and vitamin B12 (the last of which is not available in plant foods). Of these, vitamin C and iron are “shortfall” nutrients. Pork, like all animal foods, also contains complete proteins with the full complement of essential amino acids, unlike vegetables, which contain only partial proteins. So pork, too, could easily be considered a health food.

Although people have been told for decades to eat less meat and fat, Americans actually consumed 67 percent more added fat,

“Added fat” refers almost exclusively to vegetable oils. By contrast, animal fats have declined by 17% since 1970. Total fat (in both absolute terms and as a % of calories) has declined as well.

39 percent more sugar, and 41 percent more meat in 2000 than they had in 1950

This number is driven by the huge increase in poultry (up 224%), not red meat (up only 6%). And why would Ornish choose to single out this statistic to cite from 1950, which is a date that has no relevance (i.e., it does not track with the obesity/diabetes epidemics, which didn’t begin in earnest until 1980, nor does it track with the heart disease epidemic, which began earlier). The food data in 1950 is also known to be less accurate. It ‘s possible that Ornish chose the 1950 date for maximum numeric effect. Had he simply been consistent in his date comparisons and stuck with 1970, he would have reported that total meat consumption increased by 10% (which reflects a 17% decline in red meat and 118% increase in poultry)

and 24.5 percent more calories than they had in 1970, according to the Agriculture Department. Not surprisingly, we are fatter and unhealthier.

The debate is not as simple as low-fat versus  low-carb. Research shows that animal protein may significantly increase the risk of premature mortality from all causes, among them cardiovascular disease, cancer and Type 2 diabetes.

The key word here is “may.” The finding on mortality, cardiovascular disease, cancer and diabetes all come from epidemiological studies, which establish associations, not causation.  The magnitude of the observed associations are marginal, by normal scientific standards, and could very well be due to confounding factors, such as the fact that meat-eaters (who, after all, are the sort of people who must have strenuously disregarded their doctors’ orders and are therefore less health conscious) tend to be fatter and smoke more.

One reality check is that consumption of red meat has dropped by 17% since 1970 (and beef by 22%), during which time the obesity and diabetes epidemics have sky-rocketed, so it’s hard to blame meat for these diseases.

Any and all lifestyle variables confound these studies, including many that are not measured (for example, the Nurses Health Study, which is the biggest epidemiological study in the US, cannot accurately measure sugar consumption—and therefore cannot control for it.).  Moreover, these studies rely on self-reporting of the diet, which has been demonstrated to be highly unreliable. And there are other problems with epidemiological findings, particularly with regard to red meat (see page 108-111 and 261-266 in The Big Fat Surprise, or this article in the New York Times by Gary Taubes). These fundamental structural problems in epidemiology are the reason that their findings have only a 0-20% chance of being right when tested in clinical trials, according to an analysis from Stanford University.

Heavy consumption of saturated fat and trans fats may double the risk of developing Alzheimer’s disease.

This is another epidemiological study, for which the same caveats apply. In this case, the findings might have been due entirely to trans-fat consumption, as the authors noted, or sugar consumption, which was not measured.

A study published last March found 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 — those who got 20 percent or more of their calories from animal protein.

It’s somewhat embarrassing that Ornish would cite this study. The finding above is an association calculated in a highly flawed manner, as analyzed in thorough detail by Zoe Harcombe here. Moreover, the paper was written by an owner and three employees of a plant-based diet company named L-Nutra, which very likely biased the outcome.

Low-carb, high-animal-protein diets promote heart disease via mechanisms other than just their effects on cholesterol levels. Arterial blockages may be 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).

This is a mouse study (and even stranger, the mice in question were genetically-altered in such a way as to make their relevance to human disease effectively impossible to determine). As one reads through the rest of Ornish’s claims, keep in mind this question: why does he need to cite mouse studies or tiny, preliminary trials on humans? Given that animal foods containing saturated fats have been dietary culprit #1 since 1961 (when the American Heart Association issued the nation’s very first national guidelines telling people to cut back on animal foods to fight heart disease), don’t we have better evidence on this important hypothesis after all these years? Of course we do: there are large, controlled clinical trials on many thousands of people lasting many years. These are, in fact, the biggest nutritional trials ever undertaken, but the results doesn’t support Ornish’s case, so he doesn’t cite them. He cites mouse studies instead.

Egg yolks and red meat appear to significantly increase the risk of coronary heart disease and cancer due to increased production of trimethylamine N-oxide, or TMAO, a metabolite of meat and egg yolks linked to the clogging of arteries. (Egg whites have neither cholesterol nor TMAO.)

Actually, nearly all fish and shellfish yield far higher amounts of TMAO than do meat or egg yolks, and the science on TMAO is still extremely preliminary (The data Ornish cites includes observational data and mice studies.)

Animal protein increases IGF-1, an insulin-like growth hormone, and chronic inflammation, an underlying factor in many chronic diseases.

This is another mouse study. In fact, it’s the same one cited above, conducted by an owner and three employees of the plant-based diet company.

Also, red meat is high in Neu5Gc, a tumor-forming sugar that is linked to chronic inflammation and an increased risk of cancer.

This is an in vitro (test-tube) and therefore very preliminary study that only speculates about its hypothesis. Its obscure idea has not been confirmed by other studies.

A plant-based diet may prolong life by blocking the mTOR protein, which is linked to aging.

No citation is given for this statement.

When fat calories were carefully controlled, patients lost 67 percent more body fat than when carbohydrates were controlled.

This is an unpublished study on 19 men, lasting only 6-7 days, on an experimental diet so low in fat (7-8%) that is has virtually no comparison in human history. Again, one must ask: why is Ornish citing such obscure, speculative and even unpublished data for his argument? After so many years of studying the low-fat diet, don’t we have better data? Yes we do. There have been many tests of the low-fat diet on tens of thousands of people, but their findings do not support the hypothesis that this diet helps people lose a significant amount of weight. In head-to-head diet trials, the low-fat diet nearly always performs the worst.

An optimal diet for preventing disease is a whole-foods, plant-based diet that is naturally low in animal protein, harmful fats and refined carbohydrates. What that means in practice is little or no red meat; mostly vegetables, fruits, whole grains, legumes and soy products in their natural forms; very few simple and refined carbohydrates such as sugar and white flour; and sufficient “good fats” such as fish oil or flax oil, seeds and nuts. A healthful diet should be low in “bad fats,” meaning trans fats, saturated fats and hydrogenated fats. Finally, we need more quality and less quantity.

No studies are cited for these assertions. In fact, the recent 2015 Dietary Guidelines for America Committee (DGAC) report found only “limited” (second-lowest grade) evidence that the vegetarian “diet pattern” led to better health and only “moderate” evidence that consuming more fruits and vegetables improved health. (This is based on epidemiological data; the DGAC report cites no clinical trials on the vegetarian diet or the “fruits and vegetables” category).

Moreover, his assertions about “good” and “bad” fats reflect conventional misunderstandings about fats. It now appears that saturated fats are not, after all, “bad,” in that they cannot be said to cause heart disease. This was the finding of two recent major meta-analyses that re-evaluated all the data on saturated fats (and there are other such analyses by less prominent scientists as well). These meta-analyses are here, here, and here.

The “good fats” that Ornish cites refer to are vegetable oils. However, these are by definition highly processed foods and are extremely unstable, leading to harmful oxidation and inflammation unless hydrogenated (See end of Chapter 9 in The Big Fat Surprise). Vegetable oils as a comestible were introduced in the early 1900s and previously have no record of consumption by humans.

My colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco, have conducted clinical research proving the many benefits of a whole-foods, plant-based diet on reversing chronic diseases, not just on reducing risk factors such as cholesterol. Our interventions also included stress management techniques, moderate exercise like walking and social support.

We showed in randomized, controlled trials that these diet and lifestyle changes can reverse the progression of even severe coronary heart disease.

Although Ornish routinely says that he performed multiple “trials,” in fact, he performed only one well-controlled clinical trial looking at heart-disease endpoints. That trial had data on only 41 men. That same trial was also published here and here, which are additional links provided by the NYT in Ornish’s op-ed. These multiple publications give the impression that there were separate trials, but in fact they are all different aspects of that one trial. For the blood-flow finding from that trial, Ornish had data on only 35 men.

Although Ornish makes the case that even small sample sizes can have meaningful results, this kind of argument can only be applied to interventions with clear, obvious results, such as a vaccine that cures 100% of a people in a small sample. For studies looking at chronic diseases, which evolve slowly over many years, if not decades, and exhibit dramatic variations across populations, far larger sample sizes are needed to justify generalizations.

Moreover, due to the Ornish program’s multiple interventions, it’s impossible to know whether his results were due to the diet or the yoga, or exercise, or social supports, or dietary supplements or any other aspect. Perhaps the diet made the difference, but one could never know. 

Also, he compares his diet only to the standard American low-fat diet, which pretty much everyone agrees is a failed diet. In nearly all clinical trials, every diet looks better than a low-fat diet.

And crucially, despite several attempts, Ornish’s findings have never been successfully replicated, which is a basic hallmark of good science.

(Ornish did perform an earlier trial in the early 1980s, in which he took 23 men to a remote retreat in Marin county, California, to provide a very intense version of his intervention. Yet he did not have any comparable treatment for the controls–they were left to their own devices back in S.F.–so the experiment was effectively uncontrolled. Also, it lasted only 24 days.)

Episodes of chest pain decreased by 91 percent after only a few weeks. After five years there were 2.5 times fewer cardiac events. Blood flow to the heart improved by over 300 percent.

This is the trial cited above, with data on only 35 men. The “300%” refers to the relative change. Drug companies also report changes this way to maximize the appearance of impressive results. The absolute change in the arterial widening that Ornish found was only 3 percentage points. Moreover, arterial widening itself has been found not to predict heart attack risk with any accuracy. Rather than the build-up of plaque, it is a certain type of unstable, break-away plaque that is now thought to clog arteries and cause heart attacks.

Also, one should note that although there were fewer cardiac events in the diet-and-exercise group, the ultimate endpoint, death, did not favor the Ornish group: two people died in his diet-and-exercise group (out of 22 total) vs. only one of the controls.

Other physicians, including Dr. Kim A. Williams, the president of the American College of Cardiology, are also finding that these diet and lifestyle changes can reduce the need for a lifetime of medications and transform people’s lives. These changes may also slow, stop or even reverse the progression of early- stage prostate cancer, judging from results in a randomized controlled trial.

This trial was on 93 men for 1 year. It shows very modest improvements in PSA for the experimental group. When Ornish retested the same group of patients for his 2013 paper on this study, he did not see nearly such dramatic results.

These changes may also alter your genes, turning on genes that keep you healthy, and turning off genes that promote disease.

Again, the key word here is “may.” This is a speculative pilot study on only 30 men for 3 months. As a pilot study, the data can be used to generate a hypothesis, not as proof for one.  And again, one needs to ask why Ornish is relying on such unconventional, marginal outcome measures when there are a host of normal outcome measures, such as LDL, HDL, etc. A possible answer to this question is that Ornish’s diet does not look especially good by these outcomes: HDL-C (the “good” kind) reliably falls on his diet.

They may even lengthen telomeres, the ends of our chromosomes that control aging.

This is a follow-up publication from earlier studies with data on only 10 men showing modest increases in telomere length. It’s not clear if Ornish’s findings are real or due to measurement error. Moreover, the biological significance of telomore length is considered to be speculative.

Note that all of Ornish’s studies are exclusively on men.

The more people adhered to these recommendations (including reducing the amount of fat and cholesterol they consumed), the more improvement we measured — at any age. But for reversing disease, a whole-foods, plant-based diet seems to be necessary.

Adherers always look better in any study. This is called the “healthy adherer” effect and is due to the fact that people who adhere tend to be the kind of people who have many other behaviors that make them healthier. This effect is independent of the intervention (e.g., it also occurs with placebo interventions).

In addition, what’s good for you is good for our planet. Livestock production causes more disruption of the climate than all forms of transportation combined. And because it takes as much as 10 times more grain to produce the same amount of calories through livestock as through direct grain consumption, eating a plant- based diet could free up resources for the hungry.

This argument is part of the growing idea that environmental, ethical and health concerns can all be wrapped up into one “Do Good, Be Good, Feel Good” food “movement.” However, they are all separate scientific questions, and it’s a vital matter, for each of them and for the public health, that they be studied and evaluated separately.

What you gain is so much more than what you give up.

Dean Ornish is a clinical professor of medicine at the University of California, San Francisco and the founder of the Preventive Medicine Research Institute.

Dean Ornish also licenses his program and runs a fee-based service to train health professionals to administer his program through a partnership with the for-profit Healthways Corporation.

For more on Dean Ornish’s science, see: http://www.ketotic.org/2015/05/ornish-diet-worsens-heart-disease-risk.html

A word on the New York Times:

Although the Times usually publishes several Letters to the Editor in response to op-eds, in Ornish’s case, they published only one, from an animal rights activist who was highly supportive of Ornish, from an animal ethics perspective. There were no letters addressing any of the substantive issues about nutrition science (The letter I submitted selected from some of the points, above.)

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About the Author
Nina Teicholz

Nina Teicholz

Nina Teicholz is an investigative journalist and author of the International (and New York Times) bestseller, The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet (Simon & Schuster). Named a *Best Book* of 2014 by the Wall Street Journal, The Economist, Forbes, Mother Jones, and Library Journal, The Big Fat Surprise has upended the conventional wisdom on dietary fat and challenged the very core of our nutrition policy.  Before taking a deep dive into researching nutrition science for nearly a decade, Teicholz was a reporter for National Public Radio and also contributed to many publications, including the Wall Street Journal, New York Times, Washington Post, The New Yorker, and The Economist. She attended Yale and Stanford where she studied biology and majored in American Studies. She has a master’s degree from Oxford University and served as associate director of the Center for Globalization and Sustainable Development at Columbia University. She lives in New York city.

Comments 77

  1. amie

    A question from one of your greatest admirers here in the UK:
    This report appeared in the Times of London, from which I copy extracts, because of paywall. I am baffled by the assertion, which I heard repeated in radio interviews, that RCTs are not appropriate for this area of study. What are they suggesting is the best evidence and why? Can you figure out their arguments, Nina? (And they refer to “one study” when it was in fact a meta-analysis!)

    “Many diets sold to the public have no scientific basis and can be summed up as “nutribabble”, according to experts.

    Branded diets such as the high-protein, high-fat, low-carbohydrate Atkins Diet, or the“Paleo” trend, which avoids foods a caveman would not have recognised, do not instil good long-term eating habits, they argue.

    Mike Knapton, associate medical director at the British Heart Foundation, said: “Branded diets that promise shortcut ways to lose weight or improve health are sometimes supported by individual pieces of research but rarely by the overall body of available evidence on which guidelines are based. …
    A study last week suggested that guidelines to cut saturated fat to reduce rates of heart disease should not have been introduced because of the lack of gold-standard scientific evidence.

    Much of the scientific community said that the study was based on a flawed premise, and that “randomised controlled trials” were unsuitable when it came to dietary advice. They urged people not to change their diets based on one study. ”
    http://www.thetimes.co.uk/tto/health/news/article4355043.ece

  2. amie

    I thought you might be interested in this post I put on my FB wall last year:
    Anecdotal confirmation on my visit to Corfu last week, of Nina Teicholz’ revelation that the secret of Cretan and Corfu longevity is NOT their consumption of olive oil from time immemorial. Our guide was a formidable woman of late years who had been delivering a lengthy paen to the olive tree and its oil in the history of the region. So it was with trepidation that I asked whether it was true as Teicholz writes, that until less than 100 years ago, it was reserved for anointing, coating athletes, and medicinal purposes, and not the “dominant item of the diet going back at least 4,000 years”, as Ancel Keys claimed. To my surprise, she agreed with alacrity. “Of course! My mother and her mother always used lard for cooking! Olive oil was for athletes and rubbing on aches and pains, along with camomile”. When she resumed her narrative to the coach, her story had modified somewhat: “What did we know about olive trees until the Venetians conquered us and ordered us to plant them.” Exactly as Teicholz points out, that a Greek archaeologist found that its production expanded only in the mid 17C, as directed by Venetian rulers- for the making of soap.
    The reason for this glorification is colourfully depicted in Teicholz book, and succinctly encapsulated in our guide’s repeated message to the coachful of tourists. “In Corfu, we have only two things: our olive trees, and.. You.”
    That’s not to say olive oil is not one of the good alternatives to seed oils, but the story we are told is as authentic as the origins of the ploughman’s lunch, and because of its distortion by Keys of the health lessons he draws from his Crete study, a more pernicious one.

    1. Anonymous

      This is fantastic! Thank you for relaying this story. I still cannot quite believe this about olive oil. It’s so deeply ingrained in us to think otherwise!

      1. George Henderson

        Olives and olive oil appear in the bible, yet are nowhere mentioned there as foods; anointing and ceremonial lamps are the uses mentioned. Leviticus pays attention to what fats should be eaten (proscribing tallow) but overlooks olive oil, neither is this mentioned as a food in Maimonides’ brilliant explanation of Leviticus in his 11th century Guide for the Perplexed.
        This doesn’t mean it was not consumed, hungry people will eat anything, but probably indicates a minor role. By the Fifteenth century Christopher Columbus listed the olive as one of the four most important plants to man (wheat, aloes, and wine grapes were the other three) but as the list includes a food, a medicine, and a recreational drug the exact use of the olive thus intended is debatable.

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    2. matina Chronopoulou

      Reading the above story I would like to share what I have witnessed in the area of Greece which I come from and also the long life of my great grand parents, grand parents my father plus the villagers in the province of Laconia in the village of Kremasti.

      My great grandmother died at 114 years old she was a mid-wife back in the 1920’s and in the middle of the night riding on a mule going to another village to help a women give birth and the mule stumbled she fell off hit her head and this is how Maroula passed on. Visiting the village cemetery, I read on the tomb stones, the villagers die of old age – ranging from 84 to 107.

      Long life in not uncommon in many areas in Greece. What I see is that the people in these remote villages eat fresh food grown seasonally in their area, the fresh air in the countryside, the sun exposure at the hight altitude, working in their small farms and gardens and socializing with their neighbors, taking their siesta and their meals are small.

      My father is 92 and still going strong! The breakfast my great grandmother was having as described by my father
      was a small glass of home made wine a few drops of olive oil since at that time olive oil was scarse a pinch of sea salt and a small piece of barley crust. The village is around 900 meters high and mostly the diet consists of vegetables, some fruit in season, wild greens collected in the winter time, dried and a small amount of these wild greens are used every day all year
      round in the main meal.

      Feta cheese and yogurt is eaten in small amounts produced by the shepherds in the area a few eggs from their own chickens and on weekends and holidays as a condiment chicken lamb and goat meat, fish is not used except in certain holidays and is brought in from the city. Yes olive oil is more plentiful nowdays and used for cooking but no vegetable oils.

      The tradition in the area and other areas of Greece has been to raise a family pig and just before Christmas they slaughtered the pigs, salted their meat and smoked it with wood and aromatic plants in the fireplace or in their courtyards. Next they boiled the salted meat in pots with wine, oranges and spices. They preserved it throughout the year in large clay pots in olive oil, to pass the long winter and used in small amounts in omelets, legumes, in pasta dishes with “trahana” or “hylopites” (traditional Greek pasta).

      Pigs were used in barren places in Greece the companion of every household. They fed them well all year with leftovers, bran, “tyrogalo” sour milk and the skin of fruit and around Christmas it was slaughtered in a festive atmosphere. From that day on, they started the processing of its meat (“syglino”, sausages, “glina” (fat) etc) that would feed the family for a year.

      They are not afraid to use fat in their meals. They eat dairy with all the fat, yogurt with all the fat and from the stories I hear
      visiting the villagers they ate more fat in the old days than what they are eating now and they attribute their long life to their diet then and now.

      I have moved back to Greece living the simple life and loving every minute of it. Olives and olive oil is used in our traditional
      diet, but life is more than food.

      I have followed the work of Dr. Ornish for years. Everyone needs to be respected for their effort to help others when they have lost their health. Improving one’s diet with fresh foods in season, less refined carbohydrates, good fats, preparation of food is important to keep the goodness and healing properties of the food alive so that healing will take place in our bodies. we need to learn more from traditional diets, and Greece is a great place to live and experience this in the life of real people. I would like to share this video about the olive tree and its fruit.

      The Olive Tree Will Always Be Here…

      https://vimeo.com/112261027

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  4. Elviira

    Thank you, Nina! I really appreciate your time to dig deeper into this. It always makes me wonder how Dr. Ornish is so appreciated even with his vague statements.

    1. WereBear

      Dean Ornish got a great deal of positive publicity with that one study, at a time people were primed to believe such an approach should work. It confirmed what they had been told to believe.

      I don’t think much of his science, but I’ll admit he’s good at networking, knows a lot of prominent people, and fits right into the righteous vegan/PETA/virtuous eating crowd that is zealous about avoidance of animal foods, despite not having much evidence to their assertions.

      Back in the day, I knew lots of people who started an Ornish program… and very few who stuck with it. Ironically, I think this helped him stay on top. People would not blame his program. They would blame themselves for not sticking with it.

    2. Brooks Butler

      100% All Meat Diet:

      Nina Teicholz would eat Dr. Dean Ornish alive in any one on one debate! It will never happen anywhere at anytime.

      1. Stephen

        Nina Teicholz did debate with John Mackey, a prominent vegan and CEO of Whole Foods Market. I think Dean Ornish was in the audience. The debate took place in March 2015 and it’s on YouTube https://www.youtube.com/watch?v=CjDMTCG0bk8

        Although the debate seems to have been properly conducted, the editing of the film looks biased in some respects and I was sceptical about the vote at the end. Teicholz’s slides can’t be seen whilst Mackey’s are prominently displayed in an attempt to bolster his case. Mackey didn’t do the vegetarian/ vegan side any favours. At times he was petulant, personal and lacking in evidence. What ‘evidence’ he could produce was largely association studies and these are close to worthless. I think four out of five conclusions from association studies later turn out to be wrong.

        Mackey regularly resorted to stating that although the evidence is lacking he knows he’s healthy and he has lots of other healthy vegan friends. That’s enough. The world is full of people who are convinced about one thing or another, but that’s not a basis for policy or changing our diet. Teicholz challenged Mackey about children being brought up as vegans when there was no evidence of its safety and some against. Again Mackey knew lots of healthy vegan children and that’s all he needs. If these children have problems in 10, 20 or 30 thirty years, presumably it’s a price worth paying. Teicholz raised the connection of a low fat diet to mental ill health and suicide, but Mackey didn’t answer this point, which I thought was real pity. The evidence in this area is fascinating and important. Zoe Harcombe provided a link to this interesting item https://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones

        In contrast to Mackey, and despite some provocation, Teicholz remained calm, professional and her presentation was full of evidence. The problem is that zealots like Mackey aren’t interested in the mass of evidence that contradicts them because their veganism is a moral position and nothing can be allowed to challenge it. They despair that their beliefs aren’t widely held, so they seek to convince on health grounds and that requires them to twist and torture the evidence.

        Vegetarians seem to be the last defenders of Ancel Keys and his discredited heart-diet hypothesis. Without it, there will be little or no health argument for vegetarianism and this worries them.

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  6. Bryan

    Wow. Thank you Nina.
    When Margaret Wente’s column about BFS ran last month, the Globe and Mail ran one letter to the editor. It was from a Professor at University of Ottawa, whose name escapes me at the moment. At any rate, she proudly displayed in her signature line that she held the Merck Chair in such and such. (Gee. No possible biases there.)

    The good Professor’s opening salvo was as predictable as it was pathetic. “The author of this book is not even a scientist, she is a journalist!” she burbled.

    Exactly! It took an accountant to bring down Al Capone, it may very well take a journalist to bring down organized medicine.

    Keep up the fight.

  7. Onlooker from Troy

    Brilliant analysis, Nina. Best critique of this latest grasping at straws by Ornish.

    Thanks so much for this important work, as somebody has to reply to these misinformation pieces that come out in the mainstream or else the conventional wisdom just continues to be reinforced, to the detriment of the ignorant (and misled) masses. Too bad the NYT didn’t have the integrity to publish your critique.

  8. David Stewart

    Let’s use one of Teicholz’s favorite sources.

    http://www.ers.usda.gov/media/210681/eib33_1_.pdf

    She says, in a Scientific American comment: “People are not eating more of everything: red meat is down by 17% since 1970. Eggs are down by 17% also. Butter is down. Most of the increased calories have come from more carbohydrates. For references on shifting American food consumption since 1970, see this report, which is pretty much the only place you can find this info (otherwise buried by the USDA).”

    Using the data in the report, which is per capita availability and not per capita consumption data, but is nevertheless what Teicholz references and calls “eating,” she says “red meat is down by 17% since 1970.” What about total meat (red, poultry, seafood)? Well, that’s not down, though you might think that, from what Teicholz says here. Meat availability was up 22.23 pounds per capita from 1970 to 2005, which was an increase of meat availability of 12.8%. Dairy availability–milk and cheese products–increased by 36 pounds, a 6% increase. Between them, dairy and meat were up by 58 pounds.

    Teicholz wants to blame sugar. Well, as she says, sugar was up. How much? By 22 pounds, which was a 19% increase. So the increase in sugar availability was just 38% that of meat and dairy combined. Note that the increase in availability of sugar and meat was the same 22 pounds; it was a larger increase in the amount of sugar because less sugar is consumed than meat, and far less sugar than meat and cheese.

    In 2005, the total per capita availability for meat and dairy together (including eggs) was 832 pounds. This compares to 142 pounds of sugar. For comparison, in 1970, those numbers were 119.1 for sugar and 781 pounds for meat, dairy, and eggs. Animal foods increased 51 pounds, compared to an increase in sugar of 22 pounds. (Availability of sugary dairy–ice cream and the like–actually fell in the period.)

    At the same time, availability of added fats and oils increased by 32 pounds, which was a 63% increase.

    So in the period of Teicholz’s choosing, using her source (which she insinuates was being hidden–“buried”), the increase in fatty animal foods and added fats was 83 pounds, while sugar increased by 22 pounds.

    True, by weight sugar is 3.66 times as caloric as chicken, and about 1.5 times as caloric as cheese, and half as caloric as oil. Using availability data as a proxy for consumption (Teicholz called it “eating”), the increase in meat calories was larger than the increase in sugar calories by a modest amount, the increase in dairy was 58% greater calorically than the increase in sugar, and the increase in oils and added fat was 118% greater calorically than the increase in sugar.

    Sugar is the culprit? No. Not by any evidence Teicholz references. What Teicholz does with evidence is more like mauling, through her partial selection, selective and misleading citation, and complete disregard of contrary conclusions even in studies she cites.

    1. JD Mumma

      David Stewart – Thank you for taking on Nina Teicholz “investigative reporter” claims about food consumption patterns and your summary “Sugar is the culprit? No. Not by any evidence Teicholz references. What Teicholz does with evidence is more like mauling, through her partial selection, selective and misleading citation, and complete disregard of contrary conclusions even in studies she cites.”

      Seems like a clear case of Cherry Picking (http://en.wikipedia.org/wiki/Cherry_picking_%28fallacy%29) to confirm a bias (http://en.wikipedia.org/wiki/Confirmation_bias)!

    2. George Henderson

      Ignoring the facts that are inconvenient to you – the only meats that have increased are the supposed “healthy” and “slimming” ones, most of the fat now eaten is vegetable fat, and sugar, whether it has increased or not is now eaten in the context of more carbohydrate than ever before.
      It would be cherry picking to overlook these exceptions to the Ornish mantra, that red meat and animal fat are what makes America sick.

  9. Pingback: Nina Teicholz kritik mot Dean Ornishs artikel

  10. Douglas Finlayson MD

    Food is my passion and faithful unquestioning friend and restaurants are temples in which I confess my love for meat and wine. I am pleased by the science that feeds my mind in sync with my culinary passions. It is strange but predictable that we squabble about food science like children fighting over cookies.
    Nina Teicholz exposes Ornish for the food politician he is. It is delicious irony that her studying of the studies reveals more than the studies themselves. Evidence based medicine is an illusion when we are hungry and willing to lie for a tasty donut. Science has grown fat from feeding its sponsored ideas to us.

    1. Rick Hannigan

      If you’re an MD, don’t you think this fixation on micronutrients by Americans is completely misguided? Look around and see how many cases of lutein or B-12 deficiency you see. Then look at the people with cancer, heart attacks and strokes.

  11. Professor Göran Sjöberg

    As a long time researcher in the natural science of metallurgy, at Chalmers University in Gothenburg Sweden, I was unknowingly also believing that nutritional ‘science’ also belonged to the same realm of natural sciences as metallurgy until I for personal health reasons got interested in the question about nutrition about six years ago. What actually turned my world upside down was when I put my teeth into Gary Taubes “Good Calories & Bad Calories” which was a book to my taste – serious – no quack as with this Ornish guy!

    When I initially read about your book I was at first very reluctant to get a copy since I thought it might be ‘just’ a book that conveyed the same message as Gary Taubes but in a ‘less serious’ way. Well, after now having read your book thoroughly I must apologise for my misconception. In fact I think it brings both depth and perspective to the whole issue and especially to the story of the Mediterranean diet – great reading!

    In fact, I am rather involved in supporting the LCHF (Low Carb High Fat) grass-root movement in Sweden, not least by supporting one of our pioneers, Dr. Annika Dahlqvist, on her blog by writing chronicles related to different LCHF issues. One of those chronicles is partly an eulogy to your book.

    http://annikadahlqvist.com/2015/02/25/leve-det-mattade-fettet/

    You might be interested how a Swedish professor of metallurgy may praise your book and if your Swedish, as I suspect, is not on top you might still grasp what is said in my chronicle by pushing the translator button to the right reading ÖVERSÄTT – should work!

    By the way I got to your blog by a link on the latest thread at Dahlqvist blog.

  12. massimo palladino

    Dear Nina,
    thank you for your incredible work , but what about David Stewart (APRIL 23, 2015 AT 1:17 AM) ‘s critique?

    Hello from Italy

    1. Micki

      There is a component in all this that is missing: the nutrient/hormone vitamin K2.

      Much new information has come in about this topic, and how it translates into ‘optimal human diet’ is one that is evolving.

      In rodents who are made to model what is thought to be atherosclerosis via warfarin, a vitamin K antagonist, subsequently giving them supplemental vitamin K2 moves their inappropriate calcium depositions in arteries (plaque), yet this is still unstudied in humans.
      Humans with inappropriate calcium deposition in arteries (atherosclerosis) are sometimes scored as to cardiovascular risk via the Agatston score. This score is the single best independent predictor of an event. Much better than others like CRP, LDL-C, HDL-C, etc.

      Current thinking about calcium in arteries varies with some claiming that dense calcium is ‘stable’ whereas less dense calcium deposits are ‘less stable.’ Calcium is a component of plaque, but we have emphasized the lipids in plaque more than Ca. There is much research in the area of plaque behaviors, but few are looking at how vitamin K2 affects this.

      None of the folks mentioned – not Ornish, not Atkins, not Cordain, not Teicholz, not anyone – have pursued the role of vitamin K2 in atherosclerosis, but there is some very interesting data showing how important K2 is in plaque and this disease and in the vascular system.

      Vitamin K2 is mostly found in animal products – MK-4 is in animal fats and we also endogenously make it in tissues throughout our body, with the highest amounts of MK-4 in brain, pancreas, kidneys, but it is also found in other tissues – and we have avoided these dietary sources due to ‘expert’ dietary advice.
      Long chain vitamin k2 is found in fermented foods, is also made by our gut bacteria but little is absorbed from them (they make it for their energy), and it is also in organ meats like liver. These foods, too, are now mostly gone.

      Those Blue Zones? They eat K2.
      K2 can be missed when Okinawans eat natto (fermented soybeans), or Sardinians eat Pecorrino (fermented sheep milk), or liver is eaten (southern France…not a Blue Zone, but lots of centenarians) so instead of asking ‘animal based or plant based??’ we should ask if a diet is nutritionally replete. And we should especially ask if there is some vitamin K2 in a diet. Ornish diet will definitely miss K2 unless fermented plants (soybeans, cabbage, fruits, etc) are included, which is unlikely.

      Vitamin K2 is essential to activate vitamin K-dependent proteins found throughout the body. Other nutrients are also involved in the pathways of vitamin K actions, so it is not ONLY vitamin K2, but K2 is definitely fouled up by us. We have fouled up the processes of activation of these proteins and synthesis of MK-4 via some drugs (statins and bisphosphonates), via hydrogenated high vitamin K1 oils (soy and canola – when hydrogenated they make an aberrant form of vitamin K called dihydrophylloquinone, which cannot make MK-4 and cannot activate vitamin K-dependent proteins) as well as dietary loss of K2.

      In a perfect one-two punch we dysregulated calcium, impaired glucose metabolism (search vitamin K2 diabetes and be amazed), got fat and sick and blamed all the wrong things.

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  14. Nina Teicholz

    My point was that red meat consumption was down. If you lump together poultry, seafood and meat, those might be up, but our official dietary guidelines do not target poultry and seafood as bad. They only target red meat, so that is the relevant point.
    Similarly, our official guidelines say that veggie oils are good and animal fats are bad, but the increases have all been in vegetable oils.
    Nowhere do I blame sugar as the sole culprit for disease. That is an argument that others are making, but not me.

  15. Stephen

    Dear Nina, I’m grateful for your outstanding and crucially important work. Outsiders are often the people who look in and see how the ‘experts’ have taken leave of their senses.

    Are you aware of the Ted Talk by Wendy Pogozelski on YouTube. She’s a professor of Biochemistry and a Type 1 diabetic. She was successfully managing her condition with a low carb diet until she was forced to see the dietician. I think the talk’s significant because I don’t see how anyone with any sense or judgment can dismiss a professor of Biochemistry who’s clearly knows her stuff.

    I’ve also attached an excellent summary about diet and diabetes co-authored by Professor Pogozelski.

    https://www.youtube.com/watch?v=WIebxoTx408

    http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext

  16. Jeff Dornoff

    Nina,

    Good reply to this article. I just finished reading The Big Fat Surprise. Although it was meticulous and a little dry at times ;-), I enjoyed it and have personally experienced much of what you discussed. In fact, between reading your book and studying the Paleo diet, I have significantly altered my diet. More fat, more meat, more nuts, much less starch, sugar, and processed food……have lost about 6-7 lbs and originally at 156/157 lbs and 5’9″, I wasn’t exactly overweight. More importantly, more energy and just feel better. Yes, I exercise about 5x/week, but I actually exercise less now than I did in college/early married years, but weigh less and am in better shape.

    I am a chemical engineer by training so certainly no stranger to tests, data, theories, statistics, etc., but your book and subsequent blog posts have given me reason to pause. I’ve taken statins for nearly 25 years, my parents both died of cancer many years ago even though both had off the charts cholesterol (>300 mg/dL) and yet only my father had a mild heart attack in his early 40s. With this diet change, I will be curious to see how my blood work looks in terms of HDL, LDL, etc.. Most importantly, your book and subsequent work provide an important lesson in researching things on your own and really digging into something when it doesn’t match your own personal experience.

    Thanks,

    Jeff

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  18. Laura B

    You definitely poke a lot of holes in Ornish’s op-ed, but you haven’t disproven his claims, just pointed out that the science is imperfect. (as you know, nutrition studies are inherently difficult.)

    I agree with the comment above, can you show us data (flawed or otherwise) where someone has prevented and reversed heart disease with a high fat/meat diet? Caldwell Esselstyn, MD has shown this in his many published studies and his book, Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure.

    But, maybe you would (or have?) discredited his findings as well, by pointing out that he also had relatively small numbers?

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