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Tuesday, October 03, 2006

Ornish: HDL Cholesterol Is 'Garbage Trucks' For Fat, Cholesterol In The Body

(This is a continuation of my interview with Dr. Dean Ornish that began on Monday with Part 1 in a four-part series. Part 2 today features what Dr. Ornish thinks of the so-called "good" cholesterol HDL, his reaction to the infamous 8-year study released earlier this year showing the low-fat diet has no benefit on health, a closer look into why the low-fat diet monopolizes government and health recommendations in America, and how much fat he thinks a person should be eating.)

JIMMY MOORE: Since you mentioned cholesterol, share your thoughts about LDL "bad" cholesterol and the HDL "good" cholesterol. How important are these in your opinion regarding good cardiovascular health?

DEAN ORNISH: People get into simplistic ways of thinking about what the different sub-fractions of cholesterol mean that LDL is bad and HDL is good. It's more complicated than that. When I was a medical student in Framingham, Massachusetts when a lot of the risk factors were first determined.

People with HDL, for example, that is higher while on a high-fat, high-cholesterol diet have a lower risk of heart disease than those that are lower. But it's a very different prognostic significance when someone lowers their dietary fat and cholesterol and improves their dietary intake of whole foods.

Their HDL levels may actually go down a little, because you have to say what does HDL do, why does your body make HDL? HDL is like the garbage trucks of your body. So if you are eating a lot of garbage like most people in Framingham were doing that we studied--without trying to sound judgmental, if you're eating a very high-fat, high-cholesterol diet--those people who are making more garbage trucks to get rid of the excess fat and cholesterol (taking out the garbage, if you will).

It is very different, though, for people who aren't eating as much garbage and eating a very healthy diet. In a sense, your body goes, "Hey, there's not as much garbage, I don't to make as many garbage trucks." So, HDL levels actually came down to some degree in our studies, although not nearly as much as the LDL did.

But some people will say, "Oh gosh, if HDL comes down, that's bad." What they forget is that bad HDL is a risk factor for heart disease. One of the easiest ways to get your HDL to go up is to eat a stick of butter because if you are eating more fat and cholesterol (again, more garbage, if you will), if your body has the capacity genetically to increase the amount of garbage trucks, it will do so.

That's a far cry from saying that butter is good for your heart simply because it raises your HDL levels. So there's a lot of confusion around this. This came up often in my debates with Dr. Atkins. He would say, "Your diet is dangerous for people because HDL comes down" and I was going, "Excuse me, by every measure the heart disease is reversing and these studies are published in all the leading peer-reviewed journals."

We have yet to see a study showing that the Atkins diet can reverse the progression of heart disease, not just the risk factors.


JIMMY MOORE: Well, then, let's get into the 8-year study that came out in February showing that there was no benefit to eating a low-fat diet for disease prevention which is basically your life's work. Do you feel the low-fat diet recommendation by our government and health officials has now been damaged in any way as a result of this study?

DEAN ORNISH: I wrote a monthly column for both Newsweek magazine and Reader's Digest about the Women's Health Initiative in both of those.

JIMMY MOORE: I read them.

DEAN ORNISH: People can read for themselves what I wrote if they are interested, but they didn't really test the low-fat diet because the diet they used wasn't very low in fat and most people didn't follow it as well as they should have as they were trying to get them to do. Plus, the difference between the control group and the group being studied was negligible.

When they looked at the subgroup of people who actually made the bigger changes in diet, they found it did have an effect on the risk of both heart disease and breast cancer. So it was a very badly done study that unfortunately served to confuse many people about the realities of what it really showed.


JIMMY MOORE: Well, let's look at the low-fat diet recommendation some more. The United States government through the Food Pyramid does seem to push this pretty hard as the healthy way to eat. You've got doctors, insurance companies, medical-related entities, they all push the low-fat diet as the healthy way to eat. Do you feel the public is getting all the information that they need to make the best informed decisions about what to do about their weight and health?

DEAN ORNISH: I'm a scientist and I believe in the power of facts and information, so I always think people can stand to get more information. But, again, the diet I recommend--I've never said all fats are bad nor do I think you believe all carbs are bad either. There are good carbs and bad carbs and there are good fats and bad fats.

Now, though, it's better to eat a low-fat diet because even the so-called "good" fats are 100 percent fat. All oils are 100% fat and all fats have 9 calories per gram. So they're very dense in calories. So one of the easiest ways to cut back on the amount of calories you consume is to eat less fat for the reasons that we talked about.

Even the so-called "good" fats like olive oil are 14 percent saturated fat, so a lot of people say "Oh, well it's good for me" and they pour it on their food, they dip their bread in it, and they end up eating a whole lot more calories that they could easily be avoiding and they end up eating more saturated fat than they could be avoiding if they weren't eating so much of it.

So I do think that people would be better off eating less fat, but not necessarily down to 10 percent unless they were trying to reverse heart disease or cancer or if they can't get their cholesterol levels to go down enough by making more moderate changes.


JIMMY MOORE: What's the most fat you think someone should be eating in their diet?

DEAN ORNISH: Remember, the diet that I recommend is not just a low-fat diet...

JIMMY MOORE: Right, you said that.

DEAN ORNISH: It's a diet that's low in fat that is high in fruits, vegetables, whole grains, legumes, soy products. It includes 3g of fish oil a day for almost everybody, it is low in the simple carbohydrates, and high in the "good" carbs. Time Magazine published an article called "The Atkins Ornish South Beach Zone Diet", have you seen that one?

JIMMY MOORE: I haven't seen that one. What's it about?

DEAN ORNISH: I just got so tired of the debates with Dr. Atkins and others. When you get right down to it, there's really more that we agree upon than we disagree upon. I think there's a growing convergence that most people will say trans fats are not good for you. Dr. Atkins and I agreed on that. Most people will say and Dr. Atkins and I agreed that too many simple carbs are not good for you and omega-3s are good for you. And fruits and vegetables, whole grains, legumes and soy products are good for you.

We can argue around the edges of where the differences are and there are some clear differences. But I think that there's also as I have always said simple carbs should be avoided and I've become more explicit about recommending that to people so we don't have the confusion.


Remember to check out Part 1 of my interview if you missed it and come back to read Part 3 and Part 4 later this week.

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6 Comments:

Blogger Newbirth said...

Ha! I was right.

Dr. Michael Eades answer this HDL/garbage truck thing in his blog:

Garbage Truck Rag

10/03/2006 11:34 PM  
Blogger Invisible Blogger said...

ah haaaa hhaaaaa.."garbage trucks" hahaa haaaa hoooo weeee...

"I'm a scientist" ahhh hahhhhaahahhahhhh aaaa wowsa! wowsa! yeah baby, sure ya are!

whew...

10/03/2006 11:47 PM  
Blogger Viking Dan said...

Dr. Eade's The Dean Ornish HDL-ain't-nothin-but-a-garbage-truck rag takes this apart wheel by wheel. ;)

10/04/2006 9:07 AM  
Blogger Rob said...

HAha...great comment IB!

"Fat makes you fat because fat is extra calories--fat has 9 calories per gram whereas protein and carbohydrates have only 4."

Okay "Mr. Scientist", explain the pathway?

{insert chirping cricket sound here}

10/04/2006 12:10 PM  
Blogger Newbirth said...

I beat you to it, Dan! Already posted the link to that article!

10/04/2006 8:21 PM  
Blogger Newbirth said...

Here's the pertinant part of the article for those too lazy to read the whole thing (please DO read it if you have the time).

"...(R)esearchers have suspected that there is much more to HDL than simply the cholesterol-scavenging aspects. And sure enough, there are.

HDL acts as an anti-inflammatory agent and an antioxidant. It binds harmful substances in the blood, stimulates endothelial cell movement, decreases multiple clotting functions, protects red blood cells, stimulates the synthesis of prostacyclin (an important substance involved in arterial relaxation), and increases the half life in the circulation of this prostacyclin. HDL reduces growth factor synthesis in the vascular smooth muscle cells, stimulates the production of nitric oxide, modulates endothelial function and is antithrombotic. All in all, HDL is something you want more of, Dean Ornish's talk of needing fewer garbage trucks notwithstanding."

10/04/2006 8:27 PM  

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