Ornish: Burden Of Proof On Low-Carb Advocates To Show Supporting Studies

(This is a continuation of my interview with Dr. Dean Ornish with Part 1 and Part 2 in a four-part series already published this week. Part 3 today highlights the surprising comments Dr. Ornish has about the low-fat and fat-free food industry, the volume of scientific evidence that is coming out in favor of the low-carb lifestyle, what he thinks of "moderation" and a "balanced" diet, and how he thinks people can transform their lives for the better.)

JIMMY MOORE: What about all these low-fat and fat-free food products that dominate the food market, but are loaded with tons of excess sugar and refined carbs that you loathe so much? Do you support these products?

DEAN ORNISH: People are going out and eating the Snackwell cookies and the fat-free desserts and cakes that may be very low in fat, but very high in sugar--I've never recommended that which is why I've been more explicit in clarifying that.

At the same time, a lot of the Atkins people have become convinced that eating butter and pork rinds with their bacon and sausage is a particularly healthy way to eat and it's not. I mean the fruits and vegetables and whole grains are now being recommended by many of the Atkins advocates as well.

There's so many things to fight about in this country, I think it's really more important that we can try to find the areas that we do agree on so that it doesn't look like people can't make up their minds about anything because that just leaves the American public totally confused. Let's take the good science to try sort out where we don't agree and see what the evidence shows.

JIMMY MOORE: Well, I agree with that, Dr. Ornish, and I think where my concern and a lot of people who support low-carb are concerned is that there is a volume of science coming out in favor of the low-carb nutritional approach. I just did an interview with Dr. Jeff Volek from the University of Connecticut and he states that saturated fat is really becoming a non-issue when you lower the carbohydrate consumption. He's going to release the details of that study in 2007. What do you say to that?

DEAN ORNISH: What is he measuring?

JIMMY MOORE: Like I said, this is a very preliminary study. He's looking at the saturated fat and its effect on heart disease and how when you lower carbohydrates in combination with the saturated fat that it lessens that risk for heart disease.

DEAN ORNISH: Well is he measuring heart disease or is he measuring risk for heart disease? See that's the key distinction that I want to keep coming back to. In our studies, we've actually measured heart disease and we've found a direct correlation between the amount of saturated fat people eat and the amount of change in their coronary arteries. We're not just looking at risk factors, we're looking at the actual disease.

Now if you've found a study where he looked at the actual disease and this is what we found, I'd love to see it.

JIMMY MOORE: I think you're gonna see a lot of that kind of science come out in the next few years...

DEAN ORNISH: You know, if that's what it says then I'll be the first to change my mind, but at this time there's a wide body of evidence from animal studies and randomized controlled trials in humans not only from our work but from others that show if you actually look at underlying disease, this is what happens.

The only study that I'm aware of that actually looked at what happens to heart disease when people go on the Atkins diet was done by Dr. Richard Fleming from Omaha, Nebraska who looked at blood flow of people who went on the Atkins diet and he claimed that the blood flow actually worsened. The study was not a randomized trial and wasn't particularly well done, but it's the only data that we have that shows what happens to actual disease when people go on a low-carb diet.

The burden of proof when you are saying something that is counterintuitive as we did when we started 30 years ago when I started discussing that heart disease was reversible. The burden of proof was on us to show that it really could be and over the past 30 years we've produced some really hard studies to show it is true and we did it.

To me, I'm a scientist and I'm open to any new information that comes from well-designed studies. But the burden of proof to me before making those claims by low-carb advocates is to say, "Yeah, we've done the studies and here's the studies that show that the actual heart disease gets better" and not just looking at HDL levels or triglycerides.

JIMMY MOORE: I sincerely hope that we do see that in the next few years and that certainly we can come to a consensus on that. Let's shift gears a little bit and talk about the idea of "healthy living" as it relates to "moderation" and "balance" and maintaining control of what you eat, how much you exercise. Tell me what you think a "balanced" diet is and share how you would implement "moderation" into your life. How does that give you back control of your health?

DEAN ORNISH: Again, it's about a spectrum of choices, so you have to decide where on the spectrum you need to be. You can categorize foods from the least healthful to the most healthful. If you are trying to reverse heart disease or cancer, then you need to spend most of your time on the healthy end of the spectrum. For some that may sound extreme or not moderate at all. But my approach is not to say what needs to be, but what's true.

The data shows that if you are trying to reverse disease, that's what it takes. If you're simply trying to stay healthy and prevent disease, then you have a much broader spectrum of choices. I love chocolate, for example. So if I eat chocolate I try to get the best quality, highest fat chocolate that I can find. But I'll just have a little bit of it.

Moderation is not only what we eat, but also how we eat. If you eat with awareness and eat while you're paying attention, then it can become a form of meditation. You can eat small amounts of really rich foods and enjoy them without having a negative impact on your health as opposed to what often happens in our society where people eat while watching TV or talking with someone or reading a newspaper and you look down at the plate that's empty and you eat a whole meal and didn't even taste it. You get all of the calories and none of the pleasure.

JIMMY MOORE: Are there any foods that people shouldn't eat at all?

DEAN ORNISH: We need to get away from the idea of good foods and bad foods and more into area that some foods are more healthful than others. The whole language of behavioral change is that we tend to have this moralistic quality that we're eating bad foods, I cheated on my diet, I'm eating bad foods, so I must be a bad person. This only creates eating disorders that become self-fulfilling in a negative way or the fascist quality of manipulating people into changing their diet and lifestyle.

My attitude is to say, "Look, food is just food." Clearly some foods are more healthful for you than others, but that doesn't mean you should never indulge yourself. It just means being aware and if you're trying to reverse disease then you don't want to indulge very often. But if you're not, then you can indulge yourself one day and try to eat healthier the next day. Then it gets away from the idea of being on a diet or off a diet. Instead, this is just a way of eating and living that I can sustain because it's moving me generally in a healthier direction.

JIMMY MOORE: So basically a lifestyle change.

DEAN ORNISH: My work is not so much about lifestyle change, it's about transformation because we're all going to die it's just a question of when. To me the more important question is not in how long we live, but also how well we live. And so what we try to do in our work is try to help people use the experience or illness or suffering as a catalyst or a doorway to transforming their lives that go beyond just unclogging their arteries or bringing their blood pressure and cholesterol down.

While those are desirable goals, the real ailment of our culture isn't just heart disease or obesity, it's depression. More prescriptions are written for antidepressants than any other drugs right now. In our work, we're not just focused on behaviors like what you eat, what you're doing and whether you're smoking, we also focus on the deeper issue that underlies those behaviors.

My study patients tell me these poor behaviors are very adaptive because they help us get through the day. For many people just getting through the day is more important than worrying about living a few months longer or even a few years longer. So our program is much more comprehensive.

It tends to get reduced to the low-fat diet, but frankly diet to me is not nearly as interesting to as these other issues because they really deal with the profoundly human questions of values, meaning and rediscovering inner sources of peace and joy and well-being. It's helping people understand that ancient spiritual values of altruism, compassion, love and respect have a real health basis as well as providing a sense of meaning to people as they go through their daily lives.

It's much more than just a low-fat diet.

Don't forget to go back and read Part 1 and Part 2 of this interview and come back tomorrow to read the fourth and final segment of my interview with Dr. Dean Ornish.