I have been asked by several people to comment on the recent study from Tulane that wasfeatured prominently in The New York Times purporting to show that a low carb diet was not only more effective at losing weight than a “low fat” diet but also was better for your heart.
Here are my thoughts:
1. It’s not low carb vs. low fat. It’s both: an optimal diet is low in unhealthful carbs (both sugar and other refined carbohydrates) and low in fat (especially saturated fats and trans fats) as well as in red meat and processed foods.
Reduce your intake of “bad carbs” (sugar, white flour, refined carbs) and increase your intake of good carbs (fruits, vegetables, whole grains, legumes, soy products in their natural forms) — as well as reduce your intake of “bad fats” (including trans fats and saturated fats) and increase your intake of “good fats” (e.g., omega-3 fatty acids).
2. This study did not distinguish between the types of carbs and fats. Patients in the “low-fat” group of the study increased their consumption of “bad carbs” (sugar and refined carbohydrates) during the study.
3. The “low-fat diet” in this study was not very low in fat. Participants in the “low-fat” group decreased from 35% fat to 30% fat over the course of the study, hardly any change at all. In our studies, patients with heart disease who consume a diet like this become worse and worse over time. However, we found that patients who made bigger changes in diet and lifestyle (e.g., a 10% fat whole foods plant-based fat diet) could reverse their heart disease. They also showed a 40% average reduction in LDL-cholesterol (without drugs) which was not seen in the Tulane study, and they lost an average of 24 pounds in the first year.1
4. Perhaps most important, risk factors are not diseases; they are only important to the degree that they affect the underlying disease process. An article published in The New England Journal of Medicine showed what happens inside your arteries on different diets.2
Even though the changes in cholesterol and blood pressure were not that different between the low-fat and low-carb groups in the Tulane study, when you look at what’s happening inside their arteries, there is all the difference in the world.
On a low-carb diet, the arteries are significantly clogged (please see image C in the graphic below), on a typical American diet the arteries are partially clogged (please see image B below), whereas on a low-fat diet high in “good carbs” the arteries are not clogged—even though the traditional coronary heart disease risk factors such as LDL were not that different between groups (please see image A below). Unfortunately, the Tulane study did not measure what was happening in the arteries, it only measured changes in risk factors such as LDL.
The NEJM article goes on to say that these changes in coronary atherosclerosis were mediated primarily through what they term non-traditional risk factors, such as endothelial progenitor cells.
I am not aware of a single study published in a peer-reviewed journal showing that a low-carb diet such as the one described in the Tulane study has stopped or reversed the progression of coronary heart disease. Indeed, as this NEJM study shows, the arteries worsen on a low-carb diet.
However, our research as well as those of others have proven that a whole-foods, plant-based diet naturally low in fat and in refined carbs (plus walking, meditating, and social support) can reverse the progression of even severe heart disease.
Last March, an article was published in Cell Metabolism showing that it’s not just fat vs. carbs; those consuming the most animal protein had a 75% increase in overall premature mortality, a 400% increased risk of cancer deaths, and a 500% increase risk of diabetes.3
Also, studies from more than 37,000 men in the Harvard Health Professionals Follow-Up Study and more than 83,000 women from the Harvard Nurses Health Study showed that red meat consumption (part of most low-carb diets) increased premature mortality from all causes, from cancer, and from type 2 diabetes.4
So, it concerns me greatly that many people are getting the erroneous message that a low carb diet is better for your heart than a low-fat diet, when nothing could be further from the truth.
In more than 37 years of randomized trials and demonstration projects, my colleagues and I at the nonprofit Preventive Medicine Research Institute and the University of California, San Francisco School of Medicine have shown that when people with even severe coronary heart disease change to a whole-foods, plant-based diet low in fat and low in refined carbs, their heart disease begins to reverse.
In other words, blood flow to the heart improved by 300% (as measured by PET scans), and 99% of these patients stopped or reversed their heart disease. Coronary arteries become progressively less clogged, and there were 2.5 times fewer cardiac events when compared to the randomized control group (which was following a 30% fat AHA-type diet). These patients also showed a 40% reduction in LDL-cholesterol without any cholesterol-lowering drugs. And they lost an average of 24 pounds in the first year and kept half that weight off five years later.5
We also conducted a randomized, controlled clinical trial in collaboration with the Chairs of Urology at both Memorial Sloan-Kettering Cancer Center and UCSF showing that this diet (plus walking, meditating, and social support) could slow, stop, or reverse the progression of early-stage prostate cancer.6 I’m not aware of any study showing that a low-carb diet that includes red meat can do this.
We also found that this diet and lifestyle changes changed gene expression in 501 genes in just three months, turning on protective genes, turning off genes that promote heart disease, prostate cancer, breast cancer, colon cancer, and others.7
Last summer, we published the first study showing that these diet and lifestyle changes may even lengthen telomeres, the ends of our chromosomes that control aging (in collaboration with Dr. Elizabeth Blackburn, who won the Nobel Prize in Medicine five years ago for discovering telomerase, the enzyme that repairs and lengthens telomeres).8
In all of these studies, the more closely people adhered to our dietary recommendations, the more improvement we measured—at any age.
It saddens me that these studies confuse people and may motivate many of them to start eating a diet high in red meat and “bad fats” that may be harmful to them.
1Ornish D et al. JAMA. 1998;280:2001-2007
2Smith S et al. A look at the low-carbohydrate diet. N Engl J Med. 2009;361:23, 2286-2288
3Levine ME et al. Cell Metabolism. 2014;19:407-417
4Ornish D. Holy cow! What’s good for you is good for our planet. Arch Intern Med. 2012;Apr 9;172(7):563-4
5Ornish D et al. JAMA. 1998;280:2001-2007 and Gould KL et al. JAMA. 1995;274:894-901
6Ornish D et al, Journal of Urology. 2005;174:1065-1070
7Ornish D et al. Proc Nat Acad Sci USA 2008; 105: 8369-8374
8Ornish D et al. Lancet Oncol. 2013 Oct;14(11):1112-20
Dean Ornish, MD is president and founder of the Preventive Medicine Research Institute in Sausalito, California, as well as Clinical Professor of Medicine at the University of California, San Francisco. He is the author of six books, all national bestsellers, including: Dr. Dean Ornish’s Program for Reversing Heart Disease; Eat More, Weigh Less; Love & Survival; and his most recent book, The Spectrum. VisitOrnishSpectrum.com for more from Dr. Ornish.
The Second Expert Report, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective, features eight general and two special Recommendations. These Recommendations are being kept current through the Continuous Update Project. The 10 Recommendations for Cancer Prevention are listed below.
Click on each Recommendation to find out more about it.
Be as lean as possible within the normal range of body weight.
Be physically active as part of everyday life.
Limit consumption of energy-dense foods. Avoid sugary drinks.
Eat mostly foods of plant origin.
Limit intake of red meat and avoid processed meat.
Limit alcoholic drinks.
Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes).
Aim to meet nutritional needs through diet alone.
Mothers to breastfeed; children to be breastfed.
Follow the recommendations for canc
I know I’ve already covered this before, but it continues to shock me that the meat industry can get away with something so forcefully and universally condemned by the public health community. What other industrial sector could get away with putting people at such risk? It speaks to the combined might of the livestock industry and the pharmaceutical industry in holding sway over our democratic process no matter what the human health consequences.
EDMONTON – Alberta’s chief medical officer says 100 people in the province have gotten ill from E. coli linked to raw pork products, including 19 people who have been hospitalized.
The Canadian Food Inspection Agency has ordered a recall of pork products from V and T Meat and Food in Calgary and Hiep Thanh Trading in Edmonton over concerns they may contain E. coli 0157:H7.
Dr. James Talbot said the two companies — one a grocery store and the other a meat processor that distributes to restaurants — have been shut down.
Late Friday, the CFIA reported that Vinh Fat Food Products of Edmonton had recalled its frozen pork spring rolls, pork buns and pork wontons due to possible E. coli contamination. A spokeswoman for the company said it was a voluntary recall.
“From July 15 to Sept. 4 in this province there have been 153 cases of E. coli. One hundred of them have been associated … to be part of this outbreak and linked to raw pork products,” he said Friday.
“Nineteen people have been hospitalized to date. There have been, fortunately, no deaths.”
Talbot said most people affected by this E. coli strain get diarrhea and are knocked off their feet, but others can suffer more serious problems such as kidney problems or kidney failure.
He said the 100 cases have been linked either directly or indirectly to the companies. The results of more tests are expected Monday.
“We don’t require absolute proof before we go in and act to make sure that public safety is protected,” he said.
Talbot said Alberta Health Services and the CFIA continue to investigate to determine if more products need to be recalled.
The investigation has been complicated by two factors — E. coli bacteria problems are more likely associated with beef products than pork, and the outbreak has mainly affected people from the Asian community, which posed language challenges for investigators, Talbot said.
He said it is the largest E. coli outbreak in Alberta in 15 years, when 42 cases were reported in the province.
The CFIA has designated the recall a Class 1, or high hazard recall.
The agency warns food contaminated with this form of E. coli may not look or smelled spoiled, but could cause health problems and, in severe cases, possible kidney damage or death.
“Consumers, food service establishments, retailers, distributors and manufacturers in Alberta, should not consume, serve, use, or sell certain raw pork products sold by these two retailers/distributors because the raw pork products may be contaminated with E. coli 0157:H7,” the CFIA says in a release.
A list of the affected products can be found here:
The epidemic of cardiovascular disease is nonexistent in cultures which thrive
predominantly on whole foods, plant-based nutrition. Is it logical to assume that patients
with this disease would be willing to transition to plant-based nutrition and might this
transition halt or reverse the disease? The authors have experience beyond 25 years
demonstrating the success of plant-based nutrition in arresting and reversing
cardiovascular disease. Nevertheless, the medical community is still skeptical of
patients’ adherence and efficacy of this method. We, therefore, report three case
histories of carotid, coronary, and peripheral vascular disease. Each case demonstrates
disease progression and the failure of the standard cardiovascular approaches in
contrast to the prompt, powerful and enduring resolution of disease with whole foods,
plant-based nutrition. These outcomes constitute an additional mandate that patients
with cardiovascular disease be offered a plant-based option which is safe, inexpensive,
empowering, and has the potential to end the cardiovascular disease epidemic.
Recently, updated recommendations for the management of hypertension, or high blood pressure, were released by the expert panel appointed to the Eighth Joint National Committee (JNC 8).1
Two key recommendations that differ from the previous JNC 7 guidelines, released in 2003, were:
Americans aged 60 or older should only take blood pressure drugs if their blood pressure exceeds 150/90. The 2003 panel recommended drugs if blood pressure was higher than 140/90.
Diabetes and kidney patients younger than 60 should be prescribed drugs at the same point as everyone else that age, when their blood pressure exceeds 140/90. The prior treatment goal was 130/80.
Why the changes?
Clinical trials had not shown convincing evidence that the lower treatment goals produced more benefits than risks.
Although the blood pressure drugs in the trials pushed blood pressure lower, they often caused harm via adverse side effects, and they sometimes dropped blood pressure too much, which could also negatively impact patients’ overall well being.
Bottom Line: Driving blood pressure lower than 140/90 in people over 60 by using drugs, and down to 130/80 or less in younger people with diabetes and kidney problems, had not been proven to provide better health outcomes than the less ambitious guidelines released this week.
“The control of hypertension with drugs always comes at a price. The fact is, all drugs, including those to lower blood pressure, are themselves toxic, too often causing adverse side effects,” points out Dr. Jay Kenney, Nutrition Research Specialist at the Pritikin Longevity Center.
All over social media last week Americans themselves agreed. Many wrote about their own struggles with blood pressure medications (“The pills I was on made me feel like a big lump… I could barely exercise”) or that of family members (“My mother was turned into a zombie”). Many were searching for alternatives to high blood pressure medication.
“Controlling blood pressure – or cholesterol levels or blood sugar – with drugs is generally neither as safe nor as effective as doing so with a healthier diet and exercise,” asserts Dr. Kenney.
The value of lifestyle change was affirmed by the expert panel who created the new blood pressure guidelines. Led by Paul James, MD, of the University of Iowa and Suzanne Oparil, MD, of the University of Alabama, the panel stressed the need to implement healthy lifestyle interventions as the first line of treatment.
“For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized,” the scientists wrote. “These lifestyle treatments have the potential to improve blood pressure control and even reduce medication needs.”
The American Heart Association and American College of Cardiology have not yet reviewed the new recommendations. But the AHA expressed concerns that the panel’s conclusions to relax the thresholds at which medications are prescribed might mean that more people would have inadequately controlled blood pressure, which could lead to more heart attacks, strokes, and other cardiovascular events.
Yes, it’s a Catch 22. People don’t take medications because they often cause nasty side effects. But what they’re left with – if they don’t change their lifestyle – is blood pressure readings that are scary.
The risk of death from cardiovascular events begins to rise as blood pressure increases above the optimal range of 110 to 115/70 to 75. It roughly doubles for each 20/10 increase in blood pressure.2
Calculates Dr. Kenney: “The risk of dying from a cardiovascular event for someone with a blood pressure of 150/90 is about four times greater than it is for someone the same age who is maintaining a blood pressure of 110/70 with a healthy lifestyle like the Pritikin Program.
Can you cure high blood pressure? Get Answers To Hypertension Questions
Get better results. Discover Alternatives To High Blood Pressure Medication
“Smoking a pack of cigarettes a day increases the risk of dying from a cardiovascular event by about 2.3 times. So yes, having a blood pressure of 150/90, whether it’s medically controlled or not, is likely more dangerous for promoting cardiovascular events than smoking a pack of cigarettes every day.”
So here’s where we come to the dilemma that the expert committee of the new blood pressure guidelines had to wrestle with: How high must blood pressure be before the benefits of drugs are more likely to outweigh the harm?
“The sad fact is that the risk of having or dying from a cardiovascular event like a heart attack or stroke must increase about 4-fold before the benefits of reducing high blood pressure with drugs has been shown to reduce cardiovascular disease and total mortality,” says Dr. Kenney.
Optimal blood pressure achieved by healthy diet and exercise, not drugs, is likely no more than 110 to 115/70 to 75. It’s at this level, research has found, that people have the lowest risk of strokes, heart attacks, heart failure, and dying.
What they’re doing is living a lifestyle that naturally helps maintain blood pressure at healthier lower levels throughout life – a lifestyle that involves daily physical activity and a diet rich in whole unprocessed foods that are naturally low in salt, sugar, and fat.
The Pritikin Program of diet and exercise mimics this lifestyle, and studies on people taking hypertension drugs who came to the Pritikin Longevity Center have confirmed its benefits. Within two to three weeks, the Pritikin Program often eliminated or dramatically reduced the need for blood pressure medications.3
Simple Meal Plan For Blood Pressure
Get healthy. Get thin. Take good care of your blood pressure. And get out of the kitchen in no time. Meal Plan for Lowering Blood Pressure
So if lifestyle changes like the Pritikin Program are so effective for blood pressure control, and devoid of the risks caused by drugs, why do most doctors prescribe drugs?
“Probably because it’s quicker than detailing how to eat and exercise to better control blood pressure, and it’s certainly easier to take a few pills than make changes to your diet and lifestyle,” surmises Dr. Kenney.
“But these drugs, while they lower blood pressure to less dangerous levels, often cause negative side effects. That’s why experts are left trying to figure out how high a patient’s blood pressure must be before the benefits are more likely to outweigh the harms.”
It’s good that the expert panel’s recommendations for the new blood pressure guidelines recognize the problems and impotence of pharmacological treatments for hypertension, particularly among older patients and those with diabetes and kidney problems.
It’s also good that the panel states that diet and lifestyle changes should be a priority.
“It would be much better if medical organizations admitted that drugs are not nearly as safe or as effective as healthy lifestyles like the Pritikin Diet and Exercise Program for dealing with not only hypertension but many other metabolic issues like high blood sugar, insulin resistance, atherosclerosis, obesity, and chronic inflammation,” notes Dr. Kenney.
“What we need more than anything else is medical and governmental leadership that recognizes that the best way to deal with our epidemic health problems isn’t with drugs or surgery. The real solution to diet- and inactivity-promoted ills is in fact a healthy lifestyle that prevents these problems from ever happening in the first place.”
Key guidelines of the Pritikin Program for preventing and controlling hypertension include:
Providing at least 5 servings of vegetables and 4 servings of fruits daily, which help ensure that you eat plenty of foods that are full of stomach-filling volume yet are low in calories, enhancing your weight-loss efforts. Losing excess weight is one of the most effective ways to lower blood pressure in the short term. Eating plenty of nutrient-rich fruits and vegetables also means you’ll be eating rich sources of potassium, magnesium, and calcium. Many studies have found that foods rich in these minerals help blunt some of the toxic effects of sodium.
Cutting back on calorie-dense foods loaded with fat, sugar, and/or refined grains to enhance weight-loss efforts.
Limiting the consumption of sodium to a healthy level – less than 1,500 mg daily for people under 50 years, less than 1,300 mg daily for those 50 to 69 years, and no more than 1,200 mg daily for people 70 years and older.
Discouraging excess alcohol drinking (which has been shown to increase hypertension when consumed in excess of 3 drinks daily).
Getting an adequate intake of calcium, omega-3 fatty acids, and vitamin D by consuming moderate amounts of nonfat dairy milk or soymilk, fish, and a little sunshine.
Scientific Benefits of Beets
- Improve athletic performance. Pre-exercise consumption of nitrate rich beetroot juice (200gm) improved and enhanced running performance inthis study. In another study, six days of 140ml of concentrated beetroot juice (loaded with nitrates) reduced pulmonary oxygen usage (VO₂) during cycling and improved performance in professional cyclists. And yet another study showed enhancement of muscle contraction after consumption of beetroot juice.
- Decrease oxidative stress. Beets contain a new class of antioxidants called Betalains, which decrease oxidative stress and aid in detoxification. Regular consumption of 300ML daily of red beet in this study showed decrease in oxidative stress markers and may prevent chronic degenerative diseases. Red Betalain pigment are not very heat stable so best if eaten raw or juiced. If you choose to cook your beets, steam them for less than 15minutes or roast them for less than 45minutes.
- Increase nitric oxide. Beets contain nitrates which are a precursor of nitric oxide. Nitric oxide helps our blood vessels dilate appropriately, improving vascular function in conditions such as heart disease, high blood pressure, and erectile dysfunction. In this study, overweight men who drank beet juice had increases in nitric oxide levels after consumption.
- Prevent Cancer. Betalains, the antioxidant in beets, has been shown to have anti-cancer effects! This study showed the antioxidant from beets caused death of leukemia cells. Andanother study suggested beet juice consumption may prevent lung and skin cancers.
- Improve detoxification. Regular consumption of beets which contain betaine and polyphenols in this study enhanced the liver’s ability to product glutathione and superoxide dismutase, both key factors in daily detoxification. Because of their powerful ability to enhance detoxification this study showed a protective benefit against toxic chemicals, like carcinogens.
Don’t forget the greens!
The leafy greens attached to the beet roots are delicious and can be prepared like spinach. They are incredibly rich in vitamins and minerals as well as beta-carotene and lutein/zeaxanthin.
Tips for storing and preparing
To clean, rinse gently under cool water and avoid tearing the skin which helps keep the health-promoting pigments inside.
Cut beets into quarters leaving 1-2 inches of root and a small bit of stem.
I like to throw them raw into green juices or smoothies for most nutritional benefit. However, if you cook them, I recommend lightly steaming or baking on low heat to maximize nutritional benefit. Steam for no more than 10-15min or until you can easily insert tip of fork into beet.
- Grate raw beets into salads or as garnish on main dish
- Marinate steamed beets with olive oil or ghee, sea salt and fresh basil and thyme
- Sauté beet greens like you would spinach or swiss chard or mix them all together for a fresh take on salad
Recipe from the Institute for Functional Medicine:
2 cups finely shredded cabbage 2 cups boiling water
½ cup chopped onion 2 Tbsp olive oil
2 tsp caraway seed 1 tsp honey, if desired
3 Tbsp lemon juice Salt and pepper to taste
1 pound cooked small beets, peeled, chopped (save the cooking water)
1 quart chicken or vegetable stock (gluten-free)
Cook the cabbage for ten minutes in boiling, salted water. Cook the onion in the oil for a few minutes, without browning. Drain the beets, saving the cooking liquid, and finely chop. Add the chicken or vegetable stock to the onions. Upon boiling, add the cabbage and its cooking liquid back in. Add the beets, one cup of beet cooking liquid, caraway seeds, honey, and salt and pepper. Simmer for ten minutes, skimming carefully. Remove the soup from the heat. Add lemon juice and heat just to the boiling point. Serve with dill weed garnish. Eat soup hot or cold.
While many people believe that eating fish is necessary to get omega-3 fatty acids and maintain heart and brain health, there is absolutely nothing healthful about fish.
Recent research has even debunked the age-old myth that Eskimos, who ate diets heavy in fish, had a lower risk for heart disease. Fortunately, there are plenty of plant-based sources of omega-3s.
So what do we know about omega-3s?
Omega-3 fatty acids are necessary nutrients that cannot be synthesized by the body, so we need to get them from our food. Since omega-3s do help with cell function, a deficiency in omega-3 fatty acids can result in negative health consequences such as liver and kidney abnormalities, decreased immune function, or dry skin.
While some studies show that omega-3s might help with aging or brain health, omega-3s from fish or other animal products come with some unwanted side effects.
Fish contains toxic contaminants, and all animal products contain cholesterol and saturated fat—and have no fiber, an essential nutrient for digestion, cancer prevention, and weight loss. In my piece for the Huffington Post, I summarize some of the researchdebunking the health halo of fish oil supplements. Fast food companies have also jumped in on the popularity of fish during Lent, but don’t take the bait—fish is not a health food.
Even if omega-3s are not the fountain of youth, plant sources of omega-3s are full of fiber and rich in other nutrients. Edamame and walnuts contain omega-3s and also contain protein. Winter squash is packed with omega-3s and is also a great source of vitamin A and vitamin C.
Flaxseeds are easy to incorporate into baked goods, smoothies, and a whole variety of recipes. Research has even shown that women who follow vegan diets have higher levels of omega-3 fatty acids in their blood than those who consume diets rich in fish, meat, and dairy.
Friends or family have questions about omega-3s? Just share the infographic below!
When we eat red meat, its carnitine interacts with our gut bacteria, forming trimethylamine, which is then metabolized by the liver into TMAO. And it appears that TMAO is not our friend.1,2
TMAO promotes the formation of cholesterol plaques in our blood vessels, which make them less healthy and may lead to heart attack, stroke, and death. TMAO reduces our body’s ability to excrete cholesterol.1,2 And, if that is not bad enough, TMAO may be linked to death from prostate cancer.3
The good news is that people who eat an exclusively plant-based diet appear to form little TMAO. In fact, when researchers fed steak to a vegan, virtually no TMAO was made.2 Why is that? Vegans, it seems, do not select for the specific gut bacteria that lead to the formation of TMAO, whereas meat eaters do. Hence, it’s as if plants create a coat of armor in our stomachs, protecting us when they are not even there.
So if we’re protected by plants, is it okay for us to eat steak for just a few days? Are we protected from TMAO? It appears that we may not be. The trillions of bacteria in our gut change very quickly. In fact, they may meaningfully shift even within one to two days!4 So aside from the many other deleterious effects of meat, even one day of steak could cut a chink in the natural armor afforded us by eating plants.
Notably, red meat is not the only source of TMAO. Choline, which is found in chicken, fish, dairy ― and even plants ― is another. Choline is structurally similar to the carnitine in red meat, and with the help of the same gut bacteria, also forms TMAO. Accordingly, when investigators fed omnivores an egg, they made TMAO.1
Although we have no dietary need for carnitine, we do require dietary choline. So how can we get the choline we require without the unwanted company of toxic TMAO? The answer appears to be in the armor. Eating a plant-based diet selects for gut bacteria that do not lead to the formation of TMAO.2 So even though we are eating choline in plants, our stomach’s plant-derived protection is in place, practically freeing us from concern about TMAO.
Science’s understanding of the interaction of our diet and gut bacteria and their influence on our health is at an early stage. However, evidence is mounting that a plant-based diet may be beneficial for this interaction in many ways. Yet another reason to go (or stay) plant based!
1 N Engl J Med 2013; 368:1575-1584 April 25, 2013 DOI: 10.1056/NEJMoa1109400
2 Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7
3 Am J Clin Nutr. 2012 Oct;96(4):855-63. Epub 2012 Sep 5
4 Nature 505, 559–563 (23 January 2014) doi:10.1038/nature12820